Age estimation using dental periapical radiographic parameters. A review and comparative study of clinically based and regression models with the Operation Desert Storm victims.

A brief discussion of teeth and aging is followed by a review of the first four studies by our group at Temple University. In the present study, periapical, postmortem radiographs taken with the bisecting-angle technique from U.S. armed forces personnel killed during Operation Desert Storm were analyzed for age estimation. A total of 74 sets of dental radiographs (52 complete and 22 incomplete) with documented age of the individual at the time of death recorded were examined by investigators (D.R.M. and J.V.E.), who were blind to age range and specific ages of the victims. Comparisons were made between the same clinically based and multiple regression models used in a previous study of age estimation from private dental practice patients in which the long-cone radiographic technique had been used. Age estimation for both models was based on the same radiographic parameters used in that previous study (13 for the clinical model and eight for the regression model). Results showed that, in contrast to that previous study, the clinical model was superior to the regression model. Mean difference between estimated and actual age was +/- 4.4 years (clinical) and +/- 6.3 years (regression). Median difference between estimated and actual age was +/- 2.0 years (clinical) and +/- 6.0 years (regression). Mode difference between estimated and actual age was +/- 2.0 years (clinical) and +/- 6 and 7 years (regression). The results from the present study show that the clinical and regression models developed from full-mouth series of periapical radiographs taken of living patients by the long-cone radiographic technique can be used with decedents' radiographs taken with the bisecting-angle technique.

A radiographic study of aging changes of the dental pulp and dentin in normal teeth.

One aspect of a previous retrospective radiographic study was an examination of diameter and length changes of root canals at various ages. It was found that root canal shrinkage increased with advancing age. In the present follow-up study, a larger population (500 subjects) was used and only mandibular anterior teeth were evaluated. Root canal shrinkage was calculated vertically and horizontally. Measurements taken were tooth length, coronal length, apical length, root canal length, cervical width, midroot width, and apical width. Six age groups were examined: 17 through 29; 30 through 39; 40 through 49; 50 through 59; 60 through 69; and 70 through 79. Root canals showed statistically significantly more shrinkage with advancing age; there were significant changes among all groups. These findings could prove useful in anthropology and forensics and as an aging biomarker.

A review of aging of dental components and a retrospective radiographic study of aging of the dental pulp and dentin in normal teeth.

A review of aging of dental components is followed by a clinical radiographic study. Patients received radiographs at 5-year intervals with a 10-year minimum followup. Data obtained were age, gender, tooth, and systemic diseases. Measurements taken were tooth length, coronal length, apical length, cervical width, midroot width, and apical width. Root canal shrinkage was calculated vertically, horizontally, and as a combination (vertical and horizontal). Results showed statistically significantly more shrinkage in men, the elderly, and people with calcification-related diseases. Shrinkage increased with advancing age. With further studies, radiographically determined root canal measurements could prove useful in anthropology, forensics, and as a biomarker of aging.

A clarification on endodontic flare-ups.

In an article on endodontic flare-ups by Robert J. Matusow, our research and publications are discussed. Since we found what we consider to be distortions and misinterpretations of our work, it was decided to clarify the apparent discrepancies found in Matusow's article.

Comparison of prophylactic and on-demand diflunisal for pain management of patients having one-visit endodontic therapy.

To determine whether the posttreatment prophylactic use of diflunisal (Dolobid 500) would be more effective than the on-demand use of diflunisal in reducing endodontic posttreatment pain, the current open-label, randomized study was undertaken. After one-visit nonsurgical endodontic therapy, 100 patients with asymptomatic teeth having either vital-inflamed pulp, pulpal necrosis, or pulpal necrosis with periapical radiolucent lesion were randomly given either prophylactic diflunisal (two tablets immediately at the conclusion of the visit, then four tablets to be taken in the schedule of one every 8 to 12 hours for pain if needed) or on-demand diflunisal (same dosage schedule; pills to be taken only if needed). The outcome showed that compared to the on-demand usage, the posttreatment prophylactic administration of diflunisal resulted in a statistically significant reduction in the number of episodes of endodontic posttreatment pain that required analgesic intervention. It appears from the results of this study that the posttreatment prophylactic use of diflunisal is significantly more effective than the on-demand usage of diflunisal in reducing endodontic posttreatment pain for one-visit endodontic therapy with all types of originally asymptomatic endodontic conditions. Further studies are necessary to determine whether pretreatment prophylactic deflunisal would be more effective, and also the effectiveness of prophylactic diflunisal in reducing posttreatment pain in presenting symptomatic cases and for cases treated in multiple visits.

A comparison of erythromycin and cefadroxil in the prevention of flare-ups from asymptomatic teeth with pulpal necrosis and associated periapical pathosis.

In a previous study by our group with patients having asymptomatic teeth with pulpal necrosis and an associated periapical radiolucent lesion (PN/PL), it was shown that prophylactic administration of penicillin V or erythromycin (high-dose, 1-day regimen) resulted in a low incidence of flare-up (mean = 2.2%) and a low incidence of swelling and pain not associated with flare-up. No hypersensitivity responses occurred, and gastrointestinal side effects were found primarily with the erythromycins. To ascertain whether a single-dose administration of a long-acting 1-gm tablet of the cephalosporin antibiotic cefadroxil would result in a similar outcome, the present study was undertaken with 200 patients having quiescent PN/PL. The patients were randomly given either cefadroxil or erythromycin (base or stearate). Evaluations of flare-up were done 1 day, 1 week, and 2 months after endodontic treatment. A 2.0% flare-up incidence was found, with no statistically significant differences for cefadroxil (1.0%), stearate (2.0%), or base (4.0%). No hypersensitivity responses occurred. Gastrointestinal side effects were found primarily with the erythromycins (19.0%). The results showed that a 1-gm, single-dose regimen of cefadroxil was as effective as erythromycin and penicillin in preventing flare-ups and serious sequelae. A comparative analysis of the data from our first study (no peritreatment antibiotics) and the pooled data from our last three investigations (including the current trial) showed that peritreatment antibiotic coverage significantly reduced flare-ups and serious sequelae after endodontic treatment of asymptomatic PN/PL (p less than 0.001).

Apical violation in periapical "area" cases. Blasphemy or therapy?

This article investigates the age-old controversial question: With a periapical "area" case, should instrumentation be short of, to, or beyond the radiographic apex?

Comparison of diflunisal and an aspirin-codeine combination in the management of patients having one-visit endodontic therapy.

One hundred seventy-nine patients with asymptomatic or mildly symptomatic endodontic disease had single-visit therapy and were given either diflunisal (n = 94) or aspirin with codeine (n = 85) to control posttreatment pain. In this open-label, randomized study, diflunisal was judged superior to the aspirin-codeine combination in all major categories evaluated. Of patients receiving diflunisal, 93.6% needed the medication for only one day. In contrast, 77.7% of patients receiving aspirin with codeine needed the medication for only one day. Almost 64% of patients receiving diflunisal needed only one dose, while 32.9% of patients using aspirin with codeine needed only one dose. Four or more doses were required by 5.3% of patients receiving diflunisal and by 23.5% of patients receiving the aspirin-codeine combination. In patients receiving diflunisal, 20.2% experienced side effects. In contrast, 29.4% of patients receiving aspirin with codeine reported side effects. Thirty-five percent of patients receiving diflunisal rated the analgesic as excellent; 5.3% rated it as fair or poor. In contrast, 12.9% of patients receiving aspirin with codeine rated the analgesic combination as excellent; another 12.9% rated it as fair or poor. Diflunisal was found to be generally effective and well-tolerated, and superior to aspirin with codeine in the management of pain from endodontic treatment.

A radiographic evaluation of the periapical status of teeth treated by the gutta-percha-eucapercha endodontic method: a one-year follow-up study of 458 root canals. Part III.

In Part I which appeared two issues previously, the authors discussed the variations in treatment methods of nonsurgical endodontic therapy and in the determination of success and failure. They then reported on the materials and methods used and the radiographic criteria for success and failure in their clinical study of 458 root canals treated by the gutta-percha-eucapercha method. In Part II which appeared in the last issue, the one-year follow-up results were presented. Some of these results differ from previous investigations. For example, better success was found in (1) necrotic cases with areas of pathosis than in necrotic cases without "areas and in (2) overfilled cases than in underfilled cases. In Part III the authors discuss the possible reasons for these and other findings and give some implications for clinical practice.