Effect of radiation dose on the prevalence of apical periodontitis--a dosimetric analysis.

OBJECTIVES: The objective of this study is to analyse the effect of the radiation dose of oral radiotherapy for cancer on the presence of apical periodontitis in patients without dental pre-screening or specific preventive measures. MATERIALS AND METHODS: All selected patients had been diagnosed with cancer in the head and neck region and presented in the dental clinic post radiotherapy with side effects (mainly radiation caries). The panoramic radiographs of these patients were examined for several parameters, including tooth decay and apical periodontitis. The total radiation dose per tooth was determined. RESULTS: A total of 36 patient files were included, which accounted for 628 teeth to be scored. Tooth decay was present in 88.2% of teeth. Radiographic signs of apical periodontitis were found in 9.1% of the teeth. Teeth with apical periodontitis had significantly more caries present. The radiation dose was significantly higher for teeth with apical periodontitis (37.2 vs. 24.9 Gy). Binary logistic regression found the radiation dose to be the only explanatory variable in the presence of apical periodontitis. CONCLUSIONS: This study found that in zones with higher radiation dose, inflammation of the jawbone due to bacterial infection of the root canal is more likely to develop. This is probably due to bone changes post radiotherapy. CLINICAL RELEVANCE: An increase of this prevalance of apical periodontitis in irradiated bone found in this study needs to be taken into account in the dental evaluation before the start of radiotherapy.

Two-year clinical performance of glass ionomer and resin composite restorations in xerostomic head- and neck-irradiated cancer patients.

The aim of this study was to evaluate the clinical performance of adhesive filling materials in class V cavities in xerostomic head- and neck-irradiated cancer patients, in terms of marginal adaptation, anatomical form and recurrent caries. We selected 35 high-caries-risk, post-radiation, xerostomic adults with ≥3 cervical carious lesions in the same arch. Every patient received a KetacFil (KF), PhotacFil (PF) and Herculite XRV (HX) restoration. Patients were instructed to use a neutral 1% sodium fluoride gel in custom trays, on a daily basis. After 6, 12, 18 and 24 months, the restorations were examined for material loss, marginal integrity and recurrent caries. Fluoride compliance was determined at each recall appointment and recorded as the percentage of recommended use during that interval [compliance of ≤50% = NFUs, >50% = FUs]. Only 30 patients were available for recall at 6 months, with 28 patients at 12 and 18 months, and 27 patients at 24 months. In the NFU group, differences in recurrent caries were found between KF and HX at all observation times (p < 0.05). Differences (p < 0.05) in adaptation and/or anatomical form were found between KF and PF in NFUs after 18 and 24 months. In FUs, significant differences were observed between KF and PF, and KF and HX after 6 and 12 months, between KF and HX, PF and HX after 18 and 24 months. In summary, glass ionomers (especially the conventionally setting formulation) provide clinical caries inhibition but erode easily, while composite resin provides greater structural integrity.

Terminal restriction fragment length polymorphism analysis of the microflora in necrotic teeth of patients irradiated in the head and neck region.

This study evaluated the microflora in root canals of necrotic teeth after radiotherapy of the head and neck region. The microbial composition of samples taken from necrotic root canals in patients treated with irradiation of the head and neck (group A, n = 13) and in healthy controls (group B, n = 11) was analyzed by terminal restriction fragment-length polymorphism (T-RFLP) analysis. A total of 50 different terminal restriction fragment lengths (T-RFs) (each representing one or more bacterial species) were detected in the T-RFLP profiles, 44 in group A and 28 in group B. A mean of 13.2 T-RFs per sample were detected in group A and 6.6 T-RFs were present per sample for group B (p < 0.05). Twenty-two different T-RFs (mainly subspecies of Lactobacillus spp., Capnocytophaga spp., and Actinomyces spp.) found in group A were not found in group B. In conclusion, the diversity of root canal microflora increases significantly after head-neck radiotherapy.

Surgical root restoration after external inflammatory root resorption: A case report.

External inflammatory root resorption after a jaw fracture is rare. This report describes a case of extensive external root resorption in the middle third of the root of a mandibular right canine after a mandibular fracture involving the tooth socket. Because of delayed treatment and damage to the root caused by a surgical screw, root canal treatment was performed followed by surgical intervention. The resorptive defect was debrided and part of the root was rebuilt with conventionally setting restorative glass ionomer cement. Postoperative follow-up revealed complete healing.