Through-and-through cystic lesion: spontaneous healing after needle aspiration and conventional root-canal therapy / Tunnelierende zystische Läsion: Spontanheilung nach Aspiration und Wurzelkanalbehandlung

Inflammation-related pathologies such as apical periodontitis or radicular cysts are frequent lesions of the jawbones. Typically, a radiolucency is present that is not always distinguishable from other pathologies. A surgical approach would allow for tissue harvesting with further histopathologic processing. However, in the present case report of a cystic and large tunnelling lesion in the anterior maxilla, a conservative treatment with diagnostic needle aspiration and subsequent root-canal therapy was chosen. The long-term follow-up (eight years) including cone-beam computed tomography demonstrates a complete healing of the former bone defect with reestablishment of the vestibular and palatal cortices as well as absence of pain and other clinical symptoms.

[Cone beam computed tomography in endodontics: a review for daily clinical practice]. / Die digitale Volumentomographie in der Endodontologie. Eine Übersicht für den Praxisalltag.

Since the introduction of cone beam computed tomography (CBCT), this 3-dimensional diagnostic imaging technique has been established in a growing number of fields in dental medicine. It has become an important tool for both diagnosis and treatment planning, and is also able to support endodontic treatments. However, the higher effective dose of ionizing radiation compared to conventional 2-dimensional radiographs is not justifiable in every case. CBCT allows for a more precise diagnosis of periapical lesions, root fractures as well as external and internal resorptions. Concerning the utility of CBCT in treatment planning decisions, the gain of information through 3-dimensional imaging for any of these pathologies has to be evaluated carefully on an individual basis. Moreover, radioopaque materials such as root canal filling and posts often create artefacts, which may compromise diagnosis. The aim of this review is to summarize the possibilities and limits of CBCT imaging in endodontology as well as introduce guidelines for daily clinical practice. Furthermore, the article presents possible therapeutic advantages of preexisting CBCT scans for root canal treatments.

Endodontic working length measurement with preexisting cone-beam computed tomography scanning: a prospective, controlled clinical study.

INTRODUCTION: The determination of root canal length is a significant outcome predictor for endodontic treatments. The aim of this prospective, controlled clinical study was to analyze endodontic working length measurements in preexisting cone-beam computed tomography (CBCT) scans and to compare them with clinical root canal length determination by using an electronic apex locator (EAL). METHODS: All included patients had received a CBCT scan independent of the present study and needed root canal treatment of at least 1 anterior tooth visible in the field of view. Clinically, the root canal length was measured with an EAL by an endodontist. This measurement was compared with the root canal length as measured on vestibulo-oral and mesiodistal CBCT sections by an examiner not involved in the endodontic treatment. The CBCT measurements were repeated once for analysis of intrarater reliability. RESULTS: Forty anterior teeth in 30 patients (13 women and 17 men; average age, 44 years; range, 18-80 years) were included in this investigation. The Pearson correlation coefficient (r) comparing the root canal length measurements by using CBCT and EAL was 0.97. In addition, high intrarater reliability for the CBCT measurements was found (r = 0.99). CONCLUSIONS: This prospective, controlled clinical study showed that limited CBCT scans can be used for endodontic working length measurements. Future studies are needed to evaluate whether preexisting CBCT scans could replace initial periapical radiographs and working length periapical radiographs.

Precision of endodontic working length measurements: a pilot investigation comparing cone-beam computed tomography scanning with standard measurement techniques.

INTRODUCTION: The objective of this pilot investigation was to evaluate the utility and precision of already existing limited cone-beam computed tomography (CBCT) scans in measuring the endodontic working length, and to compare it with standard clinical procedures. METHODS: Three patients referred to the department received limited CBCT scans for diagnostics and preoperative treatment planning of cystic jawbone pathologies. Part of the therapy consisted of root canal treatments before surgical enucleation of the lesion. For the determination of the working length, the root canal length was measured with an electronic apex locator (EAL) by the endodontist. This measurement was compared with the root canal length as measured on the respective CBCT scans by an examiner not involved in the endodontic treatment. The interrater agreement between the two examiners was analyzed to determine the feasibility of this technique. RESULTS: In the three included patients, 9 teeth with a total of 10 root canals were treated. For these canals, a strong correlation was found between the endodontic working length as measured in the CBCT images and the EAL measurements (Pearson correlation coefficient ranging from 0.904 to 0.968). CONCLUSIONS: Based on the present findings, an already existing CBCT scan of teeth to be endodontically treated can be useful to determine the endodontic working length in combination with clinical measurements such as the EAL. Future prospective studies should evaluate if and when intraoral radiography for measuring the length of root canals can be avoided when CBCT images are available.