The detection of periapical pathosis using digital periapical radiography and cone beam computed tomography - part 2: a 1-year post-treatment follow-up.

Part 2 of this clinical study aims to compare the radiographic change in periapical status of individual roots determined using digital periapical radiographs versus cone beam computed tomography (CBCT) 1year after primary root canal treatment and to determine the radiological outcome of treatment for each tooth. Periapical radiographs and CBCT scans of 123 teeth in 99 patients assessed 1year after completion of primary root canal treatment by a single operator were compared with their respective pre-treatment (diagnostic) periapical radiographs and CBCT scans. The presence or absence as well as the increase or decrease in size of existing periapical radiolucency was assessed by a consensus panel consisting of two calibrated examiners. The panel viewed the images under standardized conditions. Paired comparison of the outcome diagnosis of individual roots and teeth was performed using generalized McNemar's or Stuart-Maxwell test of symmetry analysis. The 'healed' rate (absence of periapical radiolucency) for all roots combined was 92.7% using periapical radiographs and 73.9% for CBCT (P<0.001). This rate increased to 97.2% and 89.4%, respectively, when the 'healing' group (reduced size of periapical radiolucency) was included (P<0.001). A statistically significant difference in outcome diagnosis of single roots was observed between DPA and CBCT in single-rooted teeth and the buccal or mesio-buccal roots of multi-rooted teeth (P<0.05). Analysis by tooth revealed that the 'healed' rate (absence of periapical radiolucency) was 87% using periapical radiographs and 62.5% using CBCT (P<0.001). This increased to 95.1% and 84.7%, respectively, when the 'healing' group (reduced size of periapical radiolucency) was included (P<0.002). Outcome diagnosis of teeth showed a statistically significant difference between systems (P<0.001). Reconstructed CBCT images revealed more failures (17.6%) in teeth with no pre-operative periapical radiolucencies compared with periapical radiographs (1.3%) (P=0.031). In teeth with existing pre-operative periapical radiolucencies, reconstructed CBCT images also showed more failures (13.9%) compared with periapical radiographs (10.4%). Diagnosis using CBCT revealed a lower healed and healing rate for primary root canal treatment than periapical radiographs, particularly in roots of molars. There was a 14 times increase in failure rate when teeth with no pre-operative periapical radiolucencies were assessed with CBCT compared with periapical radiographs at 1year.

Patel S ，Wilson R ，Dawood A ，Foschi F ，Mannocci F ... -  《-》

The detection of periapical pathosis using periapical radiography and cone beam computed tomography - part 1: pre-operative status.

Part 1 of this 2 part study aims to compare the prevalence of periapical lesions on individual roots viewed with intraoral (periapical) radiographs and cone-beam computed tomography (CBCT) of teeth treatment planned for endodontic treatment. Diagnostic periapical radiographs and CBCT scans were taken of 151 teeth in 132 patients diagnosed with primary endodontic disease. The presence or absence of periapical lesions was assessed by a consensus panel consisting of two calibrated examiners, a consensus agreement was reached if there was any disagreement. The panel viewed the images under standardised conditions. Part 2 will compare the radiographic outcome 1 year after completion of primary root canal treatment. Two hundred and seventy-three paired roots were assessed with both radiological systems, periapical lesions were present in 55 (20%) and absent in 218 (80%) roots assessed with periapical radiographs. When the same 273 sets of roots were assessed with CBCT, lesions were present in 130 (48%) and absent in 143 (52%) roots. Seventy-five additional roots were detected with CBCT. The limitations of periapical radiographs which may hinder the detection of periapical lesions are overcome with CBCT. This results in firstly, more roots being assessed, and secondly, more periapical lesions being detected with CBCT.

Patel S ，Wilson R ，Dawood A ，Mannocci F ... -  《-》

Radiographic healing after a root canal treatment performed in single-rooted teeth with and without ultrasonic activation of the irrigant: a randomized controlled trial.

The aim of this study was to compare the outcome of a root canal treatment with and without additional ultrasonic activation of the irrigant. Single-rooted teeth with radiographic evidence of periapical bone loss were randomly assigned to 2 treatment groups. In both groups syringe irrigation was performed, and in one group the irrigant was also activated by ultrasound. Ten to 19 months after treatment, the teeth were examined by using periapical radiography (PA) and cone-beam computed tomography (CBCT). Area and volume of the periapical lesions were measured, and the outcome was presented in 4 categories: absence, reduction or enlargement of the radiolucency, or uncertain. Lesions were classified as reduced or enlarged when the change in size of the radiolucency was 20% or more. The recall rate was 82%, and 84 teeth were analyzed. CBCT detected significantly more post-treatment lesions than PA (P = .038), but the percentages of absence and reduction of the radiolucency together revealed by CBCT and PA were similar (P = .383). The CBCT results showed that absence of the radiolucency was observed in 16 of 84 teeth (19%) and reduction of the radiolucency in 61 of 84 teeth (72.6%), but there was no significant difference between the results of the 2 groups (P = .470). Absence and reduction of the radiolucency together were observed in the ultrasonic group in 39 of 41 teeth (95.1%) and in the syringe group in 38 of 43 teeth (88.4%). Root canal treatments with and without additional ultrasonic activation of the irrigant contributed equally to periapical healing.

Liang YH ，Jiang LM ，Jiang L ，Chen XB ，Liu YY ，Tian FC ，Bao XD ，Gao XJ ，Versluis M ，Wu MK ，van der Sluis L ... -  《-》

The detection of periapical pathoses using digital periapical radiography and cone beam computed tomography in endodontically retreated teeth - part 2: a 1 year post-treatment follow-up.

Part 2 of this prospective clinical study aimed to compare the 1-year outcome of root canal retreatments, when individual roots and teeth were assessed by periapical radiographs and cone beam computed tomography (CBCT). Subjects participating in this study had been referred for management of an endodontic problem associated with one or more root filled teeth. Root canal retreatment was performed by Specialists or postgraduate students under the direct supervision of Specialist endodontic staff. A total of 98 teeth (84 patients) were reassessed clinically and radiographically 1 year after completion of root canal retreatment. The postoperative periapical radiographs and CBCT scans were compared with their respective pre-treatment (diagnostic) periapical radiographs and CBCT scans. The increase or decrease in size of existing periapical radiolucencies and development of new radiolucencies were assessed by a consensus panel consisting of two calibrated examiners. They also determined an appropriate management plan for each case based on the radiographical findings. Comparison of the outcome diagnosis of individual roots and teeth and case management, when assessed by periapical radiographs and CBCT scans, was performed using chi-squared and McNemar's tests. An overall favourable result of 93% success for teeth (96% roots) was recorded when the assessment was undertaken by periapicals compared with 77% success for teeth (87% roots) when assessed by CBCT. A significant difference in outcome diagnosis of single paired roots (P < 0.0001) and teeth (P = 0.0001) was observed when comparing periapicals to CBCT for the cohort of teeth as a whole. When comparing the future management plan on the basis of radiographic information alone, there was a significant difference between periapicals and CBCT-based management (P = 0.01). Diagnosis using CBCT revealed a significantly lower number of favourable outcomes than periapicals in root canal retreatment. This significantly affected the future management of cases attending for a review.

Davies A ，Patel S ，Foschi F ，Andiappan M ，Mitchell PJ ，Mannocci F ... -  《-》

Impact of three radiographic methods in the outcome of nonsurgical endodontic treatment: a five-year follow-up.

The periapical film radiograph (PFR) and digital periapical radiograph (DPR) techniques have some limitations in the visualization of small periapical lesions (PLs) when compared with cone-beam computed tomography (CBCT). However, the evidence supporting their effectiveness is very limited. This retrospective longitudinal cohort study evaluated the outcome of endodontic treatments measured/monitored by PFR, DPR, and CBCT during a 5-year follow-up and also determined the prognostic factors that influenced treatment success. A total of 132 teeth (208 roots) with vital pulps received endodontic treatment. The periapical indexes with scores ≥2 for PFR and DPR and ≥1 for CBCT indicated the presence of PLs. Prognostic factors were determined by bivariate and multivariate analyses. Statistical significance was defined at a P level <.05. CBCT detected a higher number of PLs (18.7%, n = 39 roots), followed by DPR (7.7%, n = 16 roots) and PFR (5.7%, n = 12 roots). Likewise, CBCT was more sensitive than PFR and DPR in detecting deficiencies in extension and density of the root canal filling (P ≤ .001). Of the 17 prognostic factors evaluated, 4 were significantly associated with poor outcome to the treatment (P < .05): root canal curvature, disinfection of gutta-percha, presence of missed canals, and the quality of definitive coronal restoration. The success outcome of endodontic treatment after 5 years in teeth with vital pulps varied with each radiographic method: 94.3%/PFR, 92.3%/DPR, and 81.3%/CBCT.

Fernández R ，Cadavid D ，Zapata SM ，Alvarez LG ，Restrepo FA ... -  《-》