Accuracy of Conventional Periapical Radiography in Diagnosing Furcation Repair after Perforation Treatment.

INTRODUCTION: Periapical radiography (PR) is a diagnostic tool to be used by professionals in clinical practice. The method presents limitations, and doubts still exist about its value to evaluate furcation perforation and the reparative process of hard or soft tissues after treatment. Thus, the aim of this study was to evaluate the accuracy of PR as a diagnostic method to detect both resorption of the furcation area after induced experimental perforation and repair after perforation treatment using histopathological findings as a gold standard. METHODS: Thirty teeth of beagle dogs with furcation perforation were filled with Biodentine (Septodont, Saint-Maur-des-Fossés, France), ProRoot White mineral trioxide aggregate (Dentsply Tulsa Dental Specialties, Tulsa, OK), or gutta-percha and examined using PR and histology. Sensitivity, specificity, predictive values, and accuracy were calculated. RESULTS: PR detected repair and reabsorption of furcation perforation in 55% and 48% of the teeth, respectively. Histologic analysis showed furcation perforation in 66% and 21% of the teeth, respectively. Sensitivity and specificity of PR for the detection of repair were 0.84 and 1, respectively, whereas for resorption detection, the values were 0.43 and 0.65, respectively. Diagnostic accuracy for PR was 0.89 and 0.72 for repair and resorption of furcation perforation, respectively. PR showed more accurate diagnostic (true positives + true negatives/total) in repair detection compared with resorption of furcation perforation. CONCLUSIONS: We conclude that PR is not adequate in detecting resorption progress after the treatment of furcation perforation, and we encourage the use of digital imaging when suspicious of a possible unsuccessful result after furcation perforation treatment.

Correlation between the Periapical Index and Lesion Volume in Cone-beam Computed Tomography Images.

INTRODUCTION: The study aimed to correlate the Periapical Index (PAI), obtained by way of periapical radiographs, with the volume of chronic periapical lesion, obtained through cone-beam computed tomography (CBCT), in the permanent teeth. METHODS AND MATERIALS: Radiographs and CBCT images were selected from 35 single-rooted permanent teeth, with fully formed apices, with a diagnosis of pulp necrosis and chronic apical periodontitis that was radiographically visible. Two independent raters evaluated the radiographs on two separate occasions and classified the periapical lesions in accordance with Ørstavik's PAI. The periapical lesion volume was calculated in the CBCT images. The correlation between the PAI and the lesion volume was calculated using Spearman's correlation test. RESULTS: There was a positive, moderate correlation between the PAI and the volume (rs=0.596; P<0.001) where rs2 is equal to 0.355, showing that only 35% of the PAI variation was dependent upon the variation in periapical lesion volume. CONCLUSION: The radiographic evaluation of the periapical lesion does not reflect the lesion's volumetric characteristics as the volume had a moderate effect on the choice of PAI score.

Oral aspects in celiac disease children: clinical and dental enamel chemical evaluation.

OBJECTIVE: The aim of this study was to evaluate the oral manifestations of celiac disease (CD), the chemical composition of dental enamel, and the occurrence of CD in children with dental enamel defects (DEDs). STUDY DESIGN: In the study, 52 children with CD and 52 controls were examined for DEDs, recurrent aphthous stomatitis (RAS), dental caries experience, and salivary parameters. In addition, 10 exfoliated primary enamel molars from each group were analyzed by energy dispersive x-ray spectroscopy and Fourier transform infrared spectroscopy. Fifty children with DEDs were submitted to CD diagnosis. RESULTS: Among the children with CD, a higher prevalence of DEDs (P = .00001) and RAS (P = .0052), lower caries experience (P = .0024), and reduction of salivary flow (P = .0060) were observed. Dental enamel from the children with CD demonstrated a lower calcium-to-phosphorus ratio (P = .0136), but no difference in the carbonate-to-phosphate ratio (P = .5862) was observed. In the multivariate analysis, CD was a protective factor for caries (OR = 0.74) and a risk factor for RAS (OR3.23). CONCLUSIONS: The children with CD presented with more RAS, DEDs, reduction of salivary flow, and chemical alterations in the enamel.

Cellular and molecular tissue response to triple antibiotic intracanal dressing.

INTRODUCTION: The aim of this study was to characterize the response of mouse subcutaneous tissue to triple antibiotic paste (TAP) using conventional light microscopy and real-time PCR (qRT-PCR). METHODS: Polyethylene tubes containing TAP or calcium hydroxide (CH) (ie, the control group) were implanted in mouse subcutaneous tissue. Animals that received empty tubes or no tubes were used as additional controls. After periods of 7, 21, and 63 days postimplantation, the specimens were removed and subjected to histologic processing. The number of inflammatory cells and vessels, vessel areas, vascular density, and relative percentage of collagen were evaluated. Gene expression of proinflammatory (interleukin-1 beta, tumor necrosis factor alpha, and interleukin 17) and anti-inflammatory (transforming growth factor beta) cytokines and angiogenic factors (vascular endothelial growth factor and hypoxia-inducible factor-1 alpha) was quantified by 7 and 21 days postimplantation. Results were analyzed using the Student t test, analysis of variance, and the Tukey test (α = 0.05). RESULTS: TAP induced an exuberant inflammatory and angiogenic response, with higher numbers of inflammatory cells, higher vascular area and density, and lower relative percentage of collagen compared with CH. In general, the expression of genes involved in inflammation and angiogenesis was higher in the TAP group compared with animals that received CH or empty tubes. CONCLUSIONS: The response of mouse subcutaneous tissue to TAP was characterized by exuberant and persistent inflammatory and angiogenic responses with no repair and high gene expression of biomarkers associated with inflammation and angiogenesis.

Response of mice connective tissue to intracanal dressings containing chlorhexidine.

Substances containing chlorhexidine (CHX) have been studied as intracanal medicaments. The aim of the present study was to characterize the response of mouse subcutaneous connective tissue to CHX-containing medications by conventional optical microscopy. The tissue response was evaluated by implanting polyethylene tubes containing one of the substances evaluated: Calen paste + 0.5% CHX, Calen + 2% CHX, 2% CHX gel, and Calen paste (control). After experimental periods of 7, 21, and 63 days, the implants (n = 10) were removed along with the subcutaneous connective tissue. Tissue samples were subjected to histological processing, and sections were stained with hematoxylin and eosin. Qualitative and quantitative analyses of the number of inflammatory cells, blood vessels, and vascularized areas were performed. Results were analyzed by ANOVA and Tukey tests with the significance level set at 5%. We concluded that Calen + 0.5% CHX led to reparative tissue response in contrast with Calen + 2% CHX and 2% CHX gel, which induced persistent inflammatory response, pointing to the aggressive nature of this mixture. When Calen + 2% CHX and 2% CHX gel were compared, the latter induced more intense inflammatory response.

Outcome of root canal treatment in dogs determined by periapical radiography and cone-beam computed tomography scans.

The purpose of this study was to compare the favorable outcome of root canal treatment determined by periapical radiographs (PRs) and cone beam computed tomography (CBCT) scans. Ninety-six roots of dogs' teeth were used to form four groups (n= 24). In group 1, root canal treatments were performed in healthy teeth. Root canals in groups 2 through 4 were infected until apical periodontitis (AP) was radiographically confirmed. Roots with AP were treated by one-visit therapy in group 2, by two-visit therapy in group 3, and left untreated in group 4. The radiolucent area in the PRs and the volume of CBCT-scanned periapical lesions were measured before and 6 months after the treatment. In groups 1, 2, and 3, a favorable outcome (lesions absent or reduced) was shown in 57 (79%) roots using PRs but only in 25 (35%) roots using CBCT scans (p = 0.0001). Unfavorable outcomes occurred more frequently after one-visit therapy than two-visit therapy when determined by CBCT scans (p = 0.023).

Root canal adhesive filling in dogs' teeth with or without coronal restoration: a histopathological evaluation.

The purpose of this study was to evaluate in vivo the response of the periradicular tissues after endodontic treatment and root filling with Epiphany/Resilon (Penntron Clinical Technologies, LLC, Wallingford, CT) or gutta percha and new Sealapex (SybronEndo, Glendora, CA) in dogs' teeth with or without coronal restoration. Teeth without coronal restorations were used to assess the influence of continuous exposure to the oral environment on the periradicular tissues. Sixty root canals with vital pulps in three dogs were instrumented and obturated in a single session and randomly assigned to one of four groups as follows. group 1: root canal filling with Epiphany/Resilon with coronal restoration, group 2: root canal filling with Sealapex sealer and gutta percha with restoration, group 3: root canal filling with Epiphany/Resilon without restoration, and group 4: root canal filling with Sealapex sealer and gutta percha without coronal restoration. After 90 days, the animals were euthanized, and the maxillas and mandibles were removed and submitted for histologic processing. Longitudinal sections were obtained and stained with hematoxylin and eosin, Mallory's trichrome, and Brown and Brenn stains and examined under light microscopy. There were significant differences found between the four groups (p < 0.05). The results showed that roots canals filled with Epiphany/Resilon, with coronal restoration, had significantly less periradicular inflammation than roots canals filled with gutta percha and Sealapex, with coronal restoration (p = 0.021). No significant difference was observed in the intensity of inflammation between roots canals filled with Epiphany/Resilon with no restoration and roots filled with gutta percha and Sealapex with restoration (p = 0.269). Roots canals filled with gutta percha and Sealapex sealer without coronal restoration showed the greatest degree of periradicular inflammation.