The study of bone healing after endodontic microsurgery using cone beam computed tomography: A retrospective cohort study.

Background: The main aims of this study were to evaluate mean volume reduction, radiographic healing rate and healing outcome two years after endodontic microsurgery. The effects of certain preoperative clinical factors upon preoperative volume, volumetric changes and healing outcome were also studied. Material and Methods: A clinical database was searched for patients who had undergone endodontic microsurgery and with the availability of a cone beam computed tomography (CBCT) scan preoperatively and after a control period. Volumetric analysis of the periapical area was made to assess volumetric reduction. The modified Penn 3D criteria were applied. The relationship between preoperative volume, volumetric reduction and healing outcome and certain preoperative factors was also studied. Results: Fifty-seven cases were evaluated. Initially, the bone cavities had a median volume of 163.2 mm3, and this volume decreased by 147.7 mm3 after treatment, with a radiographic healing rate of 6.2 mm3 per month. After applying the modified Penn 3D Criteria, 53 cases were classified as successful healing (93%). Regarding the influence of the different preoperative factors, patient age and sex, dental arch and cortical bone significantly influenced preoperative volume, while only the dental arch exerted a significant influence upon volumetric changes and preoperative symptoms on healing outcome. Conclusions: The CBCT data evidenced a significant volume reduction of 79.1%, with a monthly volume reduction rate of 6.2 mm3. The success rate obtained was 93%. Patient age and sex, dental arch and cortical bone influenced preoperative volume, tooth type had an impact upon the volumetric changes, and the preoperative symptoms influenced healing outcome. Key words:Cone beam computed tomography, endodontic microsurgery, healing, lesion volume, prognostic factors.

Is periapical surgery follow-up with only two-dimensional radiographs reliable? A retrospective cohort type sensitivity study / ¿El seguimiento de la cirugía periapical se realiza únicamente con radiografías bidimensionales confiable? Un estudio retrospectivo de sensibilidad de tipo cohorte

Background: Two-dimensional (2D) radiographic techniques are commonly used for assessing lesion prognosisafter endodontic surgery. The present retrospective cohort study analyzes the sensitivity and ability of differentradiographic techniques in obtaining area and volume measurements of periapical lesions.Material and Methods: Preoperative and follow-up (6-48 months) periapical and panoramic radiographs (indextest) and cone-beam computed tomography (CBCT) images (reference standard) were selected from an endodonticmicrosurgery database. Sensitivity was analyzed independently by two examiners. The areas of the 2D radio-graphic images and CBCT volumes were studied using Itk-Snap software and Romexis viewer.Results: The sample comprised 105 patients and 105 teeth, with a mean follow-up of 21 months (range 6-48). Preop-eratively, CBCT detected all the periapical areas, periapical radiography detected 67, and panoramic radiographydetected 60. Postoperatively, of the 52 cases in which CBCT detected remains of the periapical area, periapical ra-diography detected 22, and panoramic radiography detected 17. The measurements of the areas obtained by the 2Dmethods, and the volumes obtained by CBCT, had to be transformed into linear measures for comparison purpos-es. The measurements were found to be significantly different in both the preoperative and the follow-up images. Conclusions: Periapical radiography showed greater sensitivity than panoramic radiography, both preoperatively andat follow-up. The lesions measured with CBCT were larger, with significant differences than as evidenced by theperiapical and panoramic radiographs.(AU)

Comparison of the diagnostic efficacy of 2D radiography and cone beam computed tomography in persistent apical periodontal disease: A PRISMA-DTA systematic review and meta-analysis.

OBJECTIVE: The objective of this study was to answer the question: Do conventional radiographs (periapical/panoramic) afford better diagnostic outcomes than cone beam computed tomography (CBCT) as a complement for clinical diagnosis of apical lesions with persistent apical periodontitis or disease after root canal treatment? STUDY DESIGN: Five electronic databases were searched and provided information to enable construction of a table to determine primary diagnostic measures and secondary parameters. The evidence was appraised with the Quality Assessment of Diagnostic Accuracy Studies tool and GRADEpro software. RESULTS: Twenty-seven articles (9903 diagnostic images) were included. The pooled sensitivity, specificity, area under the receiver operating characteristic curve (AUCROC), positive predictive value, negative predictive value, negative likelihood ratio, and accuracy were 0.58, 1, 0.77, 1, 0.68, 0.45, and 0.79, respectively. CONCLUSIONS: Moderate certainty evidence suggested that conventional radiographs showed poor sensitivity and excellent specificity but good diagnostic performance in terms of AUCROC and accuracy. Sensitivity, AUCROC, and negative likelihood ratio values could be reduced if the time elapsed to diagnosis after root canal treatment exceeded 5 years. The use of CBCT with a reduced field of view or a 2D radiographic technique should be weighed considering patient-specific and indication-oriented criteria as taking precedence over the therapeutic goal.

Comparison of diagnostic accuracy between periapical and panoramic radiographs and cone beam computed tomography in measuring the periapical area of teeth scheduled for periapical surgery. A cross-sectional study.

BACKGROUND: The aim of the study was compare the sensitivity and measurements obtained from teeth with apical lesions scheduled for periapical surgery using three different diagnostic methods: periapical radiography (Gendex Expert DC), panoramic radiography (Planmeca® Promax 3D Classic) and cone beam computed tomography (CBCT) (Planmeca® Promax 3D Classic). MATERIAL AND METHODS: This cross-sectional study involved 35 patients (45 teeth) scheduled for periapical surgery in which periapical radiographs, panoramic radiographs and CBCT scans had been obtained. The images were used to analyze the maximum vertical and horizontal dimension and the resulting areas of the periapical lesions based on the three diagnostic methods. RESULTS: The two-dimensional techniques (periapical radiography and panoramic radiography) yielded a sensitivity of 82% versus 100% in the case of CBCT. The mean vertical dimension of the apical areas was 5.48 mm with periapical radiography and 5.04 mm with panoramic radiography - the difference with respect to CBCT being statistically significant (6.36 mm for the coronal sections). There were no significant differences among the three techniques in terms of horizontal dimension (p>0.05) or lesion area. CONCLUSIONS: The sensitivity of periapical radiolucencies detected using CBCT was significantly greater than with the two-dimensional imaging techniques. Significant differences between the latter and CBCT were only observed in the case of the vertical measurements. Key words:Periapical lesion, apicoectomy, CBCT, periapical radiography, panoramic radiography.