Imaging diagnosis of external root resorption in replanted permanent teeth.

The present study aimed to evaluate the performance of cone beam computed tomography (CBCT) and digital periapical radiographs (PR) in diagnosing external root resorption (ERR) in human permanent teeth replanted after traumatic avulsion. The samples comprised 39 permanent maxillary incisors replanted after traumatic avulsion. Digital PR and CBCT images were taken from each tooth and independently examined by 2 calibrated examiners to assess the ERR activity regarding type and extension. The degrees of agreement between both imaging examinations were determined by the mean global agreement index using SPSS software. The two imaging examinations diverged greatly in the diagnosis of the type of ERR since CBCT identified more cases as inflammatory ERR and PR as replacement ERR. A discordance level of 69.2% was observed between the two methods in the diagnosis of the type of ERR when CBCT for mesial and distal (MD) surfaces was considered and 61.5% when CBCT for mesial, distal, buccal and lingual (MD/BL) was considered. Likewise, CBCT and PR differed regarding the ERR index. PR examinations classified most cases as moderate or severe (69.2%), while CBCT examinations classified more cases as mild either in the MD surfaces analysis (41.4%) or in the analysis of the MD-BL surfaces (51.3%). In conclusion, the present results highlight a discrepancy between CBCT and digital PR performance in the diagnosis of different types and extent of ERR in replanted teeth.

Imaging diagnosis of external root resorption in replanted permanent teeth

Abstract The present study aimed to evaluate the performance of cone beam computed tomography (CBCT) and digital periapical radiographs (PR) in diagnosing external root resorption (ERR) in human permanent teeth replanted after traumatic avulsion. The samples comprised 39 permanent maxillary incisors replanted after traumatic avulsion. Digital PR and CBCT images were taken from each tooth and independently examined by 2 calibrated examiners to assess the ERR activity regarding type and extension. The degrees of agreement between both imaging examinations were determined by the mean global agreement index using SPSS software. The two imaging examinations diverged greatly in the diagnosis of the type of ERR since CBCT identified more cases as inflammatory ERR and PR as replacement ERR. A discordance level of 69.2% was observed between the two methods in the diagnosis of the type of ERR when CBCT for mesial and distal (MD) surfaces was considered and 61.5% when CBCT for mesial, distal, buccal and lingual (MD/BL) was considered. Likewise, CBCT and PR differed regarding the ERR index. PR examinations classified most cases as moderate or severe (69.2%), while CBCT examinations classified more cases as mild either in the MD surfaces analysis (41.4%) or in the analysis of the MD-BL surfaces (51.3%). In conclusion, the present results highlight a discrepancy between CBCT and digital PR performance in the diagnosis of different types and extent of ERR in replanted teeth.

Tomografia computadorizada de feixe cônico no diagnóstico de reabsorção radicular externa em dentes permanentes reimplantados: uma investigação em vivo / Reabsorção externa radicular associada ao traumatismo dentário: comparação entre radiografia periapical e tomografia computadorizada cone beam - uma investigação in vivo / Cone beam computed tomography in the diagnosis of external root resorption in replanted permanent teeth: an in vivo investigation

As reabsorções radiculares externas progressivas inflamatórias (RREI) e por substituição (RRES) representam a sequela mais frequente em dentes permanentes reimplantados ou que sofreram luxações intrusivas. O exame clínico, incluindo os sinais e sintomas e ainda os exames complementares, em destaque os exames radiográficos são fatores determinantes para o diagnóstico. A radiografia periapical (RP) é o exame complementar de escolha para o acompanhamento em casos de RRE, no entanto, as imagens bidimensionais apresentam sobreposições de estruturas anatômicas. Para suprir as limitações apresentadas pelas radiografias convencionais as imagens multiplanares vêm sendo amplamente utilizadas, destacando-se a tomografia computadorizada de feixe cônico. O objetivo do presente estudo foi fazer uma avaliação do desempenho de exames de imagem da TCFC e de radiografias periapicais para diagnóstico dos diferentes tipos de RRE pós-traumáticas, em diferentes estágios. A amostra foi composta por 29 pacientes, com 39 incisivos superiores reimplantados após avulsão. Radiografias periapicais e TCFC realizadas no mesmo dia foram examinadas de forma independente por 2 avaliadores, a fim de identificar a presença, o tipo e a extensão da reabsorção radicular nos dois exames. As reabsorções leves e as inflamatórias foram mais frequentemente identificadas pela TCFC enquanto as reabsorções moderadas a severas e por substituição nas radiografias periapicais. Pode-se concluir que apenas uma técnica radiográfica não é suficiente para o diagnóstico de todos os tipos e gravidade de RRE, sendo assim a TCFC é importante para complementar o exame periapical, principalmente em estágios iniciais.

The progressive external inflammatory root resorptions (IERR) and substitution (RERR) represent the most frequent sequelae in permanent teeth replanted or that suffered intrusive dislocations. The clinical examination, including the signs and symptoms and the complementary exams, highlighting the radiographic examinations are determining factors for the diagnosis. Periapical radiography (PR) is the complementary exam of choice for follow-up in RRE cases, however, two-dimensional images show overlaps of anatomical structures. In order to overcome the limitations presented by conventional radiographs, multiplanar images have been widely used, particularly concomitant computed tomography. The objective of the present study was to make a evaluation of the performance of CBCT and periapical radiographs for the diagnosis of different types of posttraumatic RRE at different stages. The sample consisted of 29 patients, with 39 superior incisors reimplanted after avulsion. Periapical radiographs and CBCT performed on the same day were independently examined by 2 evaluators in order to identify the presence, type and extent of root resorption in both examinations. Mild and inflammatory resorptions were more frequently identified by CBCT while moderate to severe resorptions and by replacement in periapical radiographs. It can be concluded that only one radiographic technique is not sufficient for the diagnosis of all types and severity of RER, so CBCT is important to complement periapical examination, especially in the early stages.