The detection and management of root resorption lesions using intraoral radiography and cone beam computed tomography - an in vivo investigation

Endodontic management of internal replacement resorption of two maxillary central incisors with the aid of cone-beam computed tomography as the diagnostic tool: a case report and review of literature

BACKGROUND

Internal root resorption is an infrequent resorption of dentin and stands among one of the endodontic challenges which comprises two types: internal replacement and inflammatory resorption. Regardless of the location, root resorption does not regress and continues to cause discomfort or sometimes tooth loss if left untreated. Internal replacement resorption is rarer compared with the other type of internal resorption. Regarding the scarcity of internal replacement resorption, the present article reports a case of endodontic management of internal replacement resorption by using NeoPutty mineral trioxide aggregate and cone-beam computed tomography to illustrate and clarify characteristics, diagnosis, possible etiologies, and treatment modalities for internal replacement resorption.

CASE PRESENTATION

A 55-year-old Iranian man was referred for a sinus tract. Periapical radiographs revealed a periradicular lesion and cone-beam computed tomography showed the internal replacement resorption of teeth nos. 8 and 9. The root canal was explored using ultrasonic tips under magnification. Irrigation was done using 2.5% sodium hypochlorite with ultrasonic irrigation. Calcium hydroxide was placed in the root canal for 2 weeks as an intracanal medicament. At the next appointment, after calcium hydroxide removal, the root canal was dried and obturated using NeoPutty mineral trioxide aggregate. At the 2 year follow-up, the teeth were unresponsive to percussion test.

CONCLUSION

Traumatic injuries may lead to internal replacement resorption, which has a progressive nature and urges instant endodontic management. Mineral trioxide aggregate seems to be a promising material for internal replacement resorption. Besides, cone-beam computed tomography and dental operative microscopes can improve the outcome of endodontic therapy in certain challenging cases.

The influence of endodontic treatment quality on periapical lesions' architecture in cone-beam computed tomography

This study assessed the influence of root canal treatment quality on the architecture of periapical lesions. A total of 121 lesions were involved in this research. Two researchers analysed the surface of the lesions, diameters in three planes, volume and sphericity. The quality of root canal treatment was assessed with PESS index. Non-parametric statistical tests: Mann-Whitney and Spearman rank correlation coefficient were used in this research. Connected lesions of multirooted teeth spread in the coronal plane revealed a positive correlation with coronal seal and root canal filling homogenicity, however their spread in the sagittal plane showed a positive correlation only with root canal filling homogenicity. The quality of root canal treatment has an influence on the periapical lesions' architecture.

Interdisciplinary Approach to Managing Complex Traumatic Dental Injuries in the Young Permanent Dentition

Traumatic dental injuries (TDIs) are a frequent challenge in pediatric dentistry, requiring a coordinated interdisciplinary approach for successful management. These injuries can affect various dental tissues and pose significant diagnostic and therapeutic challenges, particularly in young patients with developing dentition. This review aims to explore the complexities of managing TDIs in young permanent dentition, focusing on the role of orthodontics, endodontics, and other specialties in providing comprehensive care. We highlight the importance of interdisciplinary collaboration in achieving optimal functional and aesthetic outcomes, emphasizing the need for updated diagnostic tools and treatment protocols tailored to the growing child. Specific recommendations are provided for clinicians on integrating orthodontic and endodontic management in trauma cases, focusing on minimizing complications and ensuring long-term prognosis.

Potential predisposing features of external cervical resorption: An observational study

AIM

To assess the occurrence of external cervical resorption (ECR) in relation to patient characteristics and potential predisposing factors.

METHODOLOGY

In total, 215 ECR lesions (194 patients) referred to the Endodontic postgraduate Unit at King's College London or Specialist Endodontic practice (London, UK) between September 2017 and January 2022. The clinical records were readily accessible for evaluation. At the time of initial presentation, patients diagnosed with ECR were interviewed regarding potential predisposing factors using a checklist based on existing literature of reported predisposing factors. Absolute and relative frequencies for all variables were computed. Inferential analysis was carried out to determine if there was any potential association between the type and location of tooth in the jaw as well as sex, age of the patient and potential predisposing factors.

RESULTS

No identifiable predisposing factor were detected in 22.3% (48/215 teeth) of the cases, 57.7% (124/215 teeth) had a sole, identifiable predisposing factor and 20% (43/215 teeth) had combined (several) factors. The most common (sole or combined) potential predisposing factors were previous/existing history of orthodontic treatment (25.6%, 55/215 teeth), dental trauma injury (DTI) (20.9%, 45/215 teeth), domestic cat ownership (15.8%, 34/215 teeth) and parafunctional habits (10.2%, 22/215 teeth). The highest occurrence of sole predisposing factors was recorded for males (62%, 75/121 teeth), all other ethnic groups combined (non-white) patients (58.5%, 24/41 teeth), incisor teeth (64.4%, 56/87 teeth) and maxillary teeth (62.4%, 68/109 teeth). While the highest occurrence of combined predisposing factors was found in females (22.3%, 21/94 teeth), white patients (20.1%, 35/174 teeth), premolars (29%, 9/31 teeth) and mandibular teeth (21.7%, 23/106 teeth). There were significant associations between tooth type and trauma (p < .001), cat ownership (p = .003) and parafunctional habits (p = .017). The association between trauma (p < .001), cat ownership (p = .002) and jaw location were found to be significant. Concerning parafunctional habits, female patients had significantly (p = .015) more ECR occurrence than male patients.

CONCLUSION

Most cases had 1 (sole) identified predisposing factor; orthodontic treatment, dental trauma history and (previous) cat ownership were the most identified factors. The information may be helpful in diagnosing early stage ECR.

Poly-Ether-Ether-Ketone versus dead-soft coaxial bonded retainers: a randomized clinical trial. Part 2: periodontal health and microbial biofilm assessment

BACKGROUND

Retainers have the potential to detrimentally impact periodontal health and contribute to tooth decay.

OBJECTIVES

To investigate periodontal health and bacterial biofilm related to Poly-Ether-Ether-Ketone (PEEK) fixed retainers as compared to Dead-soft coaxial fixed retainer (DSC).

TRIAL DESIGN

A two-arm parallel groups single-centre randomized clinical trial.

METHODS

The trial included patients whose orthodontic treatment was completed and required retainers. Participants were randomly assigned into two retainer groups: PEEK retainers, prepared by computer-aided design and manufacturing into 0.8 mm wire form, and DSC retainers. The objectives included assessing periodontal health through plaque accumulation index (PI), bleeding on probing (BOP), periodontal pocket depth (PPD), gingival index (GI), calculus index (CI), and alveolar bone height (ABH) assessment. Biofilm assessment involved bacteriological screening of aerobic, facultative anaerobic, mutans streptococci, and lactobacilli. The periodontal indices and microbiological screening as well as were assessed at the debonding stage (T0), 1-month (T1), 3-month (T3), and 6-month (T6) after the commencement of the trial, except for the ABH, which was recorded using periapical radiograph at T0 and T6.

BLINDING

Single blinding of participants in addition to the bacteriological specialist.

RESULTS

Initially, the trial enrolled 46 participants, aged between 12 and 28 years, and were randomly assigned to two groups, with 23 participants in each group. Subsequently, one participant withdrew from the trial, resulting in a total of 45 participants whose data were analysed. Assessment of the periodontal indices, excluding the CI (P = .480), revealed statistically but not clinically significant differences between groups after 6-month of retention (P = .016 of PI, P = .020 of BOP, P = .05 of PPD, and P = .01 of GI). There was slight plaque accumulation, normal PPD (approximately 1 mm), healthy to mild gingivitis with a GI of less than 1 and BOP was around 10%. Concerning the ABH, there was a noticeable reduction in its score after 6 months, particularly in the PEEK group, although the difference was not statistically significant (P = .102). Furthermore, the bacteriological viable count did not show any significant difference between the groups during the recall visits.

HARMS

There have been no reported negative consequences.

LIMITATIONS

Blinding the assessor of periodontal indices was not feasible due to the nature of the intervention. The trial follow-up duration was limited.

CONCLUSIONS

Both the PEEK and DSC retainers have comparable impacts on periodontal health and bacterial accumulation and composition during the retention period.

TRIAL REGISTRATION

NCT05557136.

Panoramic evaluation of external root resorption in mandibular molars during orthodontic treatment: a comparison between root-filled and vital teeth treated with fixed appliances or clear aligners

BACKGROUND

This investigation compared the extent of external apical root resorption (EARR) in root-filled teeth (RFT) and their contralateral vital pulp teeth (VPT) counterparts during orthodontic treatment (OT) with clear aligner (CA) treatment or fixed appliance (FA) treatment.

METHODS

Sixty-six patients with similar baseline American Board of Orthodontics (ABO) discrepancy index scores were divided into two groups: 37 patients (21 females, 16 males; mean age 17.45 ± 2.67 years) in the FA group, and 29 patients (18 females, 11 males; mean age 18.33 ± 1.96 years) in the CA group. Digital panoramic radiographs captured pre- and post-OT were used to measure tooth lengths and root surface measurements in mandibular molars. EARR in both RFT and contralateral VPT was evaluated pre- and post-OT. Statistical analysis employed paired t-tests, independent t-tests, and analysis of covariance (ANCOVA) (p < .05).

RESULTS

All teeth exhibited varying degrees of EARR following OT. FA treatment resulted in significantly longer treatment duration (p < .05) and greater EARR compared to CA treatment (p < .05). Moreover, statistically significant differences in EARR were observed within both groups between RFT and VPT (p < .05).

CONCLUSIONS

Comparison of pre- and post-OT radiographs revealed different degrees of EARR in all teeth. CA treatment resulted in less frequent and less severe EARR compared to FA treatment. RFT demonstrated greater resistance to EARR than VPT in both treatment groups.

Exceptional bone remodeling over composite restoration in the management of external root resorption: A case report

A 65-year-old Caucasian male was referred to an endodontic specialist practice in a private clinic in December 2019 for the management of an asymptomatic, radiolucent lesion located at the cervical level of the distal root of his right lower first molar, noticed during a routine periapical radiograph. After an accurate evaluation with cone-beam computed tomography (CBCT), the subgingival lesion was diagnosed as a supracrestal external cervical resorption (ECR), with a circumferential spread ⩽90°, confined to dentine without pulp involvement. The lesion was treated with the following sequence: (1) a full flap accessed the ECR, (2) the granulomatous tissue was removed from the root area, (3) the cavity was refreshed and filled with a well-refined and polished resin composite, (4) the flap was sutured at the cemento-enamel junction. A mandibular CBCT scan was performed before treatment, right after treatment, and 3 years postoperatively. Compared to the 3-year posttreatment CBCT scan, the immediate posttreatment one, revealed the absence of bone loss and an unexpected coronal bone remodeling with new bone formation over the treated lesion.

External Cervical Resorption Detected by Cone Beam Computed Tomography on an Immature, Unerupted Maxillary Second Premolar

Root resorption is a commonly recognized risk of orthodontic treatment and can range from minimal changes at the apex to aggressive and extensive erosion of tooth structure. The following report is aimed at presenting a rare case of idiopathic aggressive preeruptive root resorption in a maxillary second premolar of a young child prior to orthodontic force. During phase I orthodontic treatment, the maxillary premolar required surgical exposure with a bracket and chain to assist in its eruption. Before the exposure, a cone beam computed tomography (CBCT) was captured to aid in localizing the premolar and its relationship to vital structures. In addition to identifying relevant anatomy, the image also revealed an incidental finding of extensive external cervical root resorption. The risks, benefits, prognosis, and alternatives of continuing with surgical exposure of the affected premolar were presented to the guardian. The informed and consented decision was made to continue with the exposure and subsequent orthodontic treatment to align the tooth in the arch. Upon eruption to the occlusal plane, the tooth was amenable to endodontic pulp vitality testing, Endo Ice, and a follow-up CBCT. It was determined that there was advanced aggressive progression of the resorptive process. The Patel Classification 3Cd/Class 4 Heithersay ECR diagnosis and a poor prognosis ultimately resulted in the extraction of the tooth. Management of this case highlights a number of important clinical features including the rarity of advanced preeruptive idiopathic external cervical root resorption, a multidisciplinary approach (orthodontic, endodontic, and surgical) to diagnose and manage the ECR, and the importance of prescribing and acquisition of appropriate imaging to aid in the early diagnosis of the entity. This case report will add to the body of knowledge of a rare incidence of advanced ECR on a young patient with a nontraumatized, unerupted maxillary second premolar.

Accuracy of three diagnostic tests to detect tooth resorption in unowned unsocialised cats in Denmark

OBJECTIVES

To estimate the relative diagnostic sensitivity and specificity of oral clinical examination, full-mouth dental radiography, and cone-beam CT for the detection of tooth resorption in cats, and to estimate the prevalence of tooth resorption in unowned, unsocialised cats in Denmark.

MATERIALS AND METHODS

Cadavers of 144 adult cats underwent an oral examination, full-mouth dental radiography, and cone-beam CT. Sensitivity and specificity of the three tests, along with the true prevalence, overall and stratified by sex and tooth location, were estimated using latent class methods.

RESULTS

We found cone-beam CT to be the superior image modality, with a sensitivity of 99.5% and a specificity of 99.8%. Dental radiography had a sensitivity of 78.9% and a specificity of 100%, and oral clinical examination had a sensitivity of only 36.0% and specificity of 99.9%. We estimated the prevalence of tooth resorption among unowned unsocialised cats in Denmark to be 40% of adult individuals, and 6.1% of teeth.

CLINICAL SIGNIFICANCE

When dealing with tooth resorption, cone-beam CT can help the operator to find and treat affected teeth that could otherwise go undiagnosed. The prevalence of tooth resorption among unowned, unsocialised cats in Denmark does not appear to differ from other populations of cats.

Volumetric Analysis and Healing Ratio: Refining Prognostic Assessment in Maxillofacial Cysts Using Cone-Beam Computed Tomography

Introduction

Volumetric analysis with imaging techniques provides clinicians with the capability to visualize the spatial extent of the lesions. CBCT offers images with minimal radiation, facilitating a detailed assessment of cystic dimension's relationships. This crucial information helps in formulating appropriate strategies, including excision, enucleation, or nonsurgical approaches. The "Healing ratio" emerges as a valuable technique for prognostic evaluation.

Materials and Methods

This retrospective study focused on outpatient cases with, clinic-radiologically diagnosed cases of odontogenic keratocyst or radicular cysts. Preoperative CBCT was utilized for volumetric analysis through MIMIC Software. Subsequent analyses were performed at 24 and 48 weeks postoperatively. The healing ratio was calculated for further correlation.

Results

A total of 21 cases were included in the study, with a mean age of 36.67 years with predominance of males (72.6%, n = 16). Healing ratio estimation revealed minimal or no association with age, gender, and location on point-biserial analysis. Noteworthy implications were observed concerning total cyst volume and the specific diagnosis of the cyst. Results suggested more favorable healing outcomes in smaller cysts and those diagnosed as radicular cysts.

Discussion

Proficiency in deciphering three-dimensional CBCT images accurately demands specialized training. The crux of our study lies in the application of volumetric analysis, particularly the "Healing Ratio," as a robust means of evaluating prognoses in management. The Healing Ratio, derived from three-dimensional imaging techniques, offers a comprehensive insight into the spatial dynamics of cystic lesions. Our findings underscore its significance as the optimal technique for prognostic assessment in the context of cyst management.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-024-02168-7.

Management of rarely seen internal tunnelling root resorption associated with a maxillary permanent incisor

This case presents clinical techniques and materials that may be applied in the management of internal tunnelling root resorption, a rare condition which has little published literature.A 25-year-old woman was referred to a specialist centre by her general dental practitioner following an incidental finding of a radiographic radiolucency, suggestive of root resorption associated with tooth 21. A provisional diagnosis of external cervical resorption was made, and following cone beam computed tomography (CBCT), a definitive diagnosis of internal tunnelling root resorption given. Non-surgical endodontic treatment was completed using continuous wave compaction with a calcium-silicate based sealer. No further intervention has been required.A summary of the histology, aetiology, prevalence, diagnosis, management and prognosis of internal tunnelling root resorption is provided. The benefits of CBCT for diagnosing and managing internal tunnelling resorption defects and using continuous wave compaction with a calcium-silicate based sealer, compared to cold obturation techniques, are discussed.

Diagnostic Accuracy of Cone Beam Computed Tomography and Periapical Radiography for Detecting Apical Root Resorption in Retention Phase of Orthodontic Patients: A Cross-Sectional Study

Objectives: This clinical study aimed to evaluate and compare the diagnostic accuracy of intraoral periapical radiography (PR) and cone beam computed tomography (CBCT) in detecting external apical root resorption (EARR) in orthodontic patients during the retention phase. Methods: The research involved 41 Caucasian patients who had undergone comprehensive orthodontic treatment, with a total of 328 teeth analyzed. The Kappa values for inter- and intra-examiner agreement were high for both PR and CBCT, indicating a robust level of agreement among examiners. The study used a four-point scale for classifying EARR. Results: This study showed comparable accuracy, sensitivity, and specificity between PR and CBCT when using the most stringent criterion of "Definitely present". The data suggested that CBCT outperformed PR when using a less stringent criterion ("Definitely present" or "Probably present"), particularly for maxillary incisors. However, overall diagnostic performance, as measured by the area under the ROC curve, showed only a slight advantage for CBCT over PR. Areas under the ROC curve range between 0.85 and 0.90 for PR and between 0.89 and 0.92 for CBCT. According to DeLong's test, there is no evidence to conclude that the area under the ROC curve is different for PR and CBCT. Conclusions: Both PR and CBCT are accurate diagnostic tools for identifying EARR, with PR being deemed more suitable for routine clinical use due to its cost-effectiveness and lower radiation exposure. The findings emphasize the importance of considering the risk-benefit ratio when deciding on imaging modalities for monitoring EARR in orthodontic patients.

Applying the American Association of Endodontists and American Academy of Oral and Maxillofacial Radiology guidelines for cone-beam computed tomography prescription: Impact on endodontic clinical decisions

BACKGROUND

The American Association of Endodontists (AAE) and the American Academy of Oral and Maxillofacial Radiology (AAOMR) developed guidelines for the prescription of cone-beam computed tomographic (CBCT) imaging. The impact of appropriately prescribed CBCT imaging on endodontic diagnosis and treatment (Tx) decisions was examined.

METHODS

The clinical databases at the School of Dentistry at the University of California, Los Angeles, Los Angeles, California, were queried to identify patients referred for CBCT imaging from the postgraduate endodontic clinic over a consecutive 36-month period. Primary and secondary indications for CBCT imaging were recorded. Pre-CBCT uncertainty in diagnosis, Tx of the teeth in question, and post-CBCT changes to the diagnosis and Tx plan were recorded.

RESULTS

CBCT imaging was prescribed for 12% of patients. A total of 442 scans were prescribed to evaluate 526 teeth. Molars accounted for 51% of teeth examined. Overall, CBCT effected a change in periapical diagnosis (21%) and in the Tx plan (69%). The 5 most frequent primary indications for CBCT imaging were, in order, AAE-AAOMR recommendations 7, 9, 2, 12, and 6. The impact of these recommendations on Tx decisions varied from 48% through 93%.

CONCLUSIONS

This study validates the use of the AAE-AAOMR guidelines for prescribing CBCT imaging for endodontic evaluations. CBCT imaging contributed predominantly to Tx decisions rather than diagnostic determinations.

PRACTICAL IMPLICATIONS

This study validates AAE-AAOMR case selection guidelines for CBCT imaging and shows a positive impact of prescription imaging on endodontic decision making.

Clinical and radiographic features of external cervical resorption - An observational study

AIM

To determine the prevalence of symptoms, clinical signs and radiographic presentation of external cervical resorption (ECR).

METHODOLOGY

This study involved 215 ECR lesions in 194 patients referred to the Endodontic postgraduate Unit at King's College London or Specialist Endodontic practice (London, UK). The clinical and radiographic findings (periapical [PA] and cone beam computed tomography [CBCT]) were readily accessible for evaluation. A checklist was used for data collection. Inferential analysis was carried out to determine if there was any potential association between type and location of tooth in the jaw as well as sex, age of the patient and ECR presentation and radiographic feature.

RESULTS

Eighty-eight patients (94 teeth) were female and 106 patients were male (121 teeth), the mean age (±SD) was 41.5 (±17.7) years. Fifteen patients (7.7%) had more than one ECR lesion. The most affected teeth were maxillary central incisors (21.4% [46 teeth]) and mandibular first molars (10.2% [22 teeth]). ECR was most commonly detected as an incidental radiographic finding in 58.1% [125 teeth] of the cases. ECR presented with symptoms of pulpal/periapical disease in 23.3% [n = 50] and clinical signs (e.g. pink spot, cavitation) in 16.7% [36 teeth] of the cases. Clinical signs such as cavitation (14%), pink spot (5.1%) and discolouration (2.8%) were uncommon, but their incidence increased up to 24.7% when combined with other clinical findings. ECR was detected in the resorptive and reparative phases in 70.2% and 29.8% of the cases respectively.

CONCLUSION

ECR appears to be quiescent in nature, the majority being asymptomatic and diagnosed incidentally from PA or CBCT. When assessed with the Patel classification, most lesions were minimal to moderate in relation to their height (1 or 2) and circumferential spread (A or B). However, the majority of ECRs were in (close) proximity to the pulp. Symptoms and clinical signs were associated with (probable) pulp involvement rather than the height and circumferential spread of the lesion. Clinical signs were more frequently associated when ECR affected multiple surfaces.

Does maxillary sinus proximity affect molar root resorption during distalization using Invisalign? a CBCT study

BACKGROUND

This study aimed to assess the correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption during molar distalization using clear aligner therapy (CAT).

MATERIALS AND METHODS

Thirty-eight cone beam computed tomography scans (CBCTs) obtained pre- (T0) and post-treatment (T1) from 19 adult patients (36.68 ± 13.50 years), who underwent maxillary molar distalization using Invisalign® aligners (Align Technology, Inc., San José, CA, USA) with a minimum of 2 mm distalization, were evaluated in this study At least 22 h of aligner wear per day was a main inclusion criterion. Sinus proximity and changes in root lengths were measured for 61 molars (183 roots). Spearman coefficient analysis was used for assessing correlation between sinus proximity and root resorption. The level of significance was set at p ≤ 0.05. The reproducibility of measurements was assessed by intraclass correlation coefficient (ICC).

RESULTS

Spearman coefficient revealed no significant correlation between sinus proximity and molar root resorption for mesiobuccal, distobuccal or palatal roots (p = 0.558, p = 0.334, p = 0.931, respectively).

CONCLUSION

There was no correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption.

A Survey on Cone-beam Computed Tomography Usage Among Endodontists in the United States

INTRODUCTION

The aim of the study was to investigate the accessibility and frequency of cone-beam computed tomography (CBCT) usage and to assess the economic and logistical factors involved with its usage among active American Association of Endodontists (AAE) members, utilizing a web-based survey.

METHODS

A survey of 19 questions was sent to 3,071 AAE members addressing participant access to, along with financial and logistical aspects of CBCT imaging. Descriptive analysis was performed and Fisher exact test utilized to test associations between groups (P < .05).

RESULTS

The overall response rate was 14.7% (n = 544). Ninety-five percent of respondents (n = 486) had an in-office CBCT unit, with those graduating after the year 2000 statistically more likely to have one (P < .05). Utilization of CBCT imaging for every case was reported by 40% of providers. Eighty-nine percent reported taking the scan at the consultation visit and 20% included this charge with the consultation fee. For those who charged for the scan separately, 85% charged more than $100. Providers who paid off their unit did so within 1-2 years (41%), 3-4 years (36%), 4-5 years (12%), and 5+ years (11%). Limited field of view was utilized by 95% of respondents. Fifty-eight percent reported interpreting the scans themselves, 38% send only if pathology is expected, and 3% always send their scans to a radiologist.

CONCLUSIONS

In conclusion, accessibility and utilization of CBCT imaging among United States endodontists has increased and acquisition of this equipment has not made a long lasting financial burden on providers.

Emerging Paradigms in Internal Root Resorption Management: Harnessing the Power of Bioceramics

Internal root resorption is a pathological activity involving dentin deterioration within the root canal walls. Numerous variables, including traumatic injury, infection, and orthodontic therapy, can trigger this process. Traditional materials such as mineral trioxide aggregate (MTA) have been utilized to treat internal root resorption but have limitations such as tooth discoloration and handling challenges. Bioceramic materials, such as Bio-C Repair, have emerged as possible MTA substitutes. This case study outlines the effective management of idiopathic extensive perforating internal root resorption using a non-surgical laser-assisted approach and the application of Bio-C Repair as an obturation material. The treatment resulted in the resolution of symptoms and the restoration of periapical tissues. Bioceramics, with their unique composition and favorable biological properties, offer the potential for effective tissue repair and provide alternatives to traditional materials in the treatment of internal resorption. The utilization of bioceramics, including Bio-C Repair, holds promise for achieving successful outcomes and preserving natural dentition.

Reprint of: Prevalence and Characteristics of Root Resorption Identified in Cone-Beam Computed Tomography Scans

INTRODUCTION

Root resorption is a destructive process that compromises tooth structure and can result in tooth loss. Often it remains asymptomatic and is an incidental finding on radiographic examinations. The purpose of this study was to determine prevalence and characteristics of root resorption in patients referred for cone-beam computed tomography (CBCT) imaging for a variety of indications.

METHODS

The study included CBCT scans of 1086 consecutive patients referred for CBCT imaging over an 18-month period. A total of 1148 scans were acquired. Data were abstracted from radiology reports, and prevalence estimates of resorption were computed for the aggregate sample and also across specific indications.

RESULTS

Resorption was identified in 171 patients (15.7%, 95% CI: 13.6%-17.9%) and in 249 teeth with a prevalence range of 2.6%-92.3% across specific indications. An 18.7% of the patients had 2 resorption sites whereas 8.8% had 3 or more resorption sites. The majority of affected teeth were anteriors (43.8%), followed by molars (40.6%) and premolars (14.5%). The most prevalent resorption types were external (29.3%), cervical (22.5%), infection-induced apical resorption (13.7%), internal (9.6%), and impacted tooth induced (8.8%). The majority of teeth with resorption did not have prior endodontic treatment (73.9%) and had radiographically normal periapex (69.5%). Of 249 teeth with resorption, 31% presented as incidental finding. The prevalence of incidental findings of resorption increased with age, P < .05, and was significantly lower for anterior teeth (20.2%) as compared to premolars (41.7%) and molars (36.6%), (P < .05).

CONCLUSION

The high proportion of incidental findings of resorption detected by CBCT suggests that resorption is not recognized/detected by conventional radiography and therefore remains underdiagnosed.

Is use of CBCT without proper training justified in paediatric dental traumatology? An exploratory study

BACKGROUND

Proper skills in radiographic diagnosis are essential for optimal management of dental trauma.

AIM

To assess diagnostic accuracy obtained by paediatric dentists using Cone Beam Computed Tomography (CBCT) without specific training and to compare this with their performance using intraoral radiographs.

METHODS

Intraoral and CBCT images of 89 teeth, spread over twenty dental trauma cases were presented in random order to nine paediatric dentists. Diagnostic findings were compared with those of a benchmark reference. Sensitivity and specificity were calculated and compared using paired t-tests.

RESULTS

Overall, observers' diagnostic performance was rather poor with significantly higher sensitivity when using 2D images (P = 0.017). Performance differed considerably according to the type of pathology. Using either imaging modality, sensitivity for diagnosing apical pathology and root fractures was high while the opposite was seen for inflammatory root resorption, root cracks and subluxations. Statistically significant differences between imaging modalities were seen for root fractures (P = 0.013) and apical pathology (P = 0.001), in favor of 3D, and for crown fractures (P = 0.009) in favor of 2D.

CONCLUSION

Overall poor performance of paediatric dentists indicates that additional training in radiographic diagnosis is required. In order to justify the use of CBCT to increase diagnostic performance, proper training of the paediatric dentist is mandatory.

Does endodontics influence radiological detection of external root resorption? an in vitro study

BACKGROUND

External root resorption (ERR) has a multifactorial etiology and is difficult to diagnose, which means that is continues to be of research interest. This work mainly aims to determine whether external root resorption can be differentially detected in root-filled versus non-endodontically treated teeth using digital periapical radiography (DPR) and cone-beam computed tomography (CBCT).

METHODS

The Checklist for Reporting In-vitro Studies (CRIS) guidelines were followed throughout this study. This experiment highlights the preparation and generation of standardized synthetic teeth measured on three-dimensional records converted into Digital Imaging and Communication on Medicine (DICOM) file format. Twelve replicate maxillary incisors were randomized into two groups: (G1) six non-endodontically treated, and (G2) six endodontically treated teeth. In both groups, actual tooth lengths of all specimens were measured and compared with measurements obtained using DPR and CBCT. Simulated ERR lesions [0.12, 0.18, 0.20 mm × 0.5 mm depth in the mesial, distal and palatal apical regions] were created progressively, radiographic images were recorded, and 24 DPRs and 96 CBCTs were obtained in total. Eight blinded, previously calibrated researchers made a total of 1920 measurements (using Horos Software). Data were analyzed using the Shapiro-Wilk, ANOVA, Kruskal-Wallis and Wilcoxon rank post-hoc tests [Bonferroni correction in multiple comparison tests (p < 0.05)].

RESULTS

ICC values for intra- and inter-examiner agreement were appropriate. DPR overestimated ERR detection compared to the actual and CBCT measurements [Mean diff = 0.765 and 0.768, respectively]. CBCT diagnosis of ERR lesions in specimens without root canal treatment was significantly more accurate than DPR diagnoses on both non-endodontically and endodontically-treated specimens [p = 0.044; p = 0.037, respectively]. There was an 18.5% reduction in sensitivity in all DPR diagnoses made on endodontic teeth versus those made on non-endodontically treated teeth. For the smallest ERR lesions, this sensitivity was even more marked, with 27.8 and 25% less sensitivity, respectively.

CONCLUSIONS

The results of this study highlight that both CBCT and DPR are good diagnostic methods for ERR. Nevertheless, root canal filling material influences diagnostic capability in ERR. The clinical significance was that the presence of intracanal material reduces the detection and diagnosis of ERR by DPR in teeth with root canal treatment.

External Cervical Resorption: Relationships Between Classification, Treatment, and One-Year Outcome with Evaluation of the Heithersay and Patel Classification Systems

INTRO

The purpose of this study was to identify possible associations between classification, treatment, and one-year outcome of external cervical resorption (ECR) lesions using the Heithersay and Patel systems. Performance of the Patel 3-dimensional classification system was also evaluated.

METHODS

A chart review identified 142 cases of ECR over a twelve-year period. Information regarding demographics, predisposing factors, lesion classification, treatment, and outcomes were collected and analyzed. Inter- and intra-observer reliability analyses were conducted for both classification systems.

RESULTS

There were 72 cases with at least one year of follow up. 70% of these cases survived. Treatment recommendations were correlated with both Heithersay and Patel classification. There were no correlations found between one-year outcome and either classification or treatment done. The weighted reliability analysis showed substantial agreement in both classification systems for both inter- and intra-observer agreement. There was a significant association between the two systems, however the Heithersay system tended to underestimate the apical extent of the lesion.

CONCLUSIONS

Periodic review of ECR lesions presents as a viable treatment option, at least for one year after diagnosis. The Patel 3-D classification system is at least as effective as the Heithersay system and should be used in future ECR prognosis studies. Further long-term outcome assessments are still needed.

Prevalence and Characteristics of Root Resorption Identified in Cone-Beam Computed Tomography Scans

INTRODUCTION

Root resorption is a destructive process that compromises tooth structure and can result in tooth loss. Often it remains asymptomatic and is an incidental finding on radiographic examinations. The purpose of this study was to determine prevalence and characteristics of root resorption in patients referred for cone-beam computed tomography (CBCT) imaging for a variety of indications.

METHODS

The study included CBCT scans of 1086 consecutive patients referred for CBCT imaging over an 18-month period. A total of 1148 scans were acquired. Data were abstracted from radiology reports, and prevalence estimates of resorption were computed for the aggregate sample and also across specific indications.

RESULTS

Resorption was identified in 171 patients (15.7%, 95% CI: 13.6%-17.9%) and in 249 teeth with a prevalence range of 2.6%-92.3% across specific indications. An 18.7% of the patients had 2 resorption sites whereas 8.8% had 3 or more resorption sites. The majority of affected teeth were anteriors (43.8%), followed by molars (40.6%) and premolars (14.5%). The most prevalent resorption types were external (29.3%), cervical (22.5%), infection-induced apical resorption (13.7%), internal (9.6%), and impacted tooth induced (8.8%). The majority of teeth with resorption did not have prior endodontic treatment (73.9%) and had radiographically normal periapex (69.5%). Of 249 teeth with resorption, 31% presented as incidental finding. The prevalence of incidental findings of resorption increased with age, P < .05, and was significantly lower for anterior teeth (20.2%) as compared to premolars (41.7%) and molars (36.6%), (P < .05).

CONCLUSION

The high proportion of incidental findings of resorption detected by CBCT suggests that resorption is not recognized/detected by conventional radiography and therefore remains underdiagnosed.

Early detection of external cervical resorption in posterior teeth: a radiographic, cross-sectional study of an adolescent population

OBJECTIVES

To establish the prevalence and severity of external cervical resorption (ECR) in posterior teeth observed in bitewing (BW) radiographs in an epidemiological study of a 17-year-old patient population from community dentistry. Furthermore, to assess the potential predisposing factors for ECR.

METHODS

Posterior BWs from 5596 patients (2717 females, 2879 males; mean age 17.8 years) were assessed by three observers in order to detect ECR (using Heithersay's classification system, severity classes 1-4). When ECR was suspected, cone beam CT (CBCT) was offered to verify diagnosis. Prevalence was estimated based on ECR suspected in BWs and finally in CBCT. Possible predisposing factors (orthodontic treatment, trauma, and periodontal disease) were recorded and assessed for association with ECR.

RESULTS

In 41 patients, ECR was suspected in BWs (suspected prevalence 0.73%). 32 patients accepted CBCT examination, of which eight were verified to have ECR (final prevalence 0.18%). In 24 patients, other disease entities and abnormal tooth morphology, that had mimicked ECR in BWs, excluded ECR in CBCT. ECR severity ranged from class 1-3 in BW and 2-4 in CBCT. All but one case had not been diagnosed by the patient's community dentist. No statistically significant association between predisposing factors and ECR was identified.

CONCLUSIONS

ECR had low prevalence in this adolescent population, as observed in both BWs and CBCT. Still, early detection of ECR is important for treatment prognosis, and attention should be paid to this disease entity when assessing BWs obtained for other diagnostic purposes. CBCT may subsequently aid in verifying the disease.

Influence of cone beam computed tomography on endodontic treatment planning: A systematic review

OBJECTIVES

The aim of this systematic review was to evaluate how treatment plans changed when cone beam computed tomography (CBCT) imaging was used in endodontic treatment decision-making.

DATA

Studies examining changes in clinicians' treatment plans with and without the use of CBCT were included. Risk of bias assessment was completed using a modification of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.

SOURCES

A systematic search was performed in PubMed, Embase, Scopus, Cochrane databases from inception to 14 September 2021.

STUDY SELECTION

The initial search identified 3379 titles and abstracts; 20 articles fulfilled inclusion and exclusion criteria for full text review. An additional three articles were identified through citation searching. Sixteen studies met inclusion and exclusion criteria for data extraction and analysis. Fifteen studies reported changes in treatment plan with CBCT imaging. Five studies reported changes in 45 - 66.7% of the cases but did not mention specific treatment options. Of the 11 remaining studies, 10 studies reported changes in 24.3 - 56% of cases and changes in treatment options, while one study reported no significant change in treatment plan after CBCT imaging was introduced. With CBCT imaging, clinicians were more likely to prescribe further intervention that included endodontic treatment and extractions.

CONCLUSION

Although the current evidence was heterogeneous, it was clear that CBCT offered more information than periapical radiography. This influenced endodontic treatment decision-making and in more complex cases, led to further intervention including non-surgical and surgical endodontic treatment and extractions.

CLINICAL SIGNIFICANCE

Additional information from CBCT imaging influenced endodontic treatment decision-making in the following situations: high difficulty cases, diagnosis of symptomatic teeth after failed root canal treatment, evaluation of periapical healing, pre-surgical treatment planning, and management of traumatised immature teeth and external cervical resorption.

Present status and future directions: Root resorption

Root resorption is the loss of dental hard tissue because of odontoclastic action. In permanent teeth, it is undesirable and pathological in nature. Root resorption may occur on the inner aspect of the root canal (internal root resorption) or on the outer aspect of the root (external root resorption). Regardless of its location, root resorption is irreversible, and may result in discomfort for the patient, requires management and/or, in some cases, results in the premature loss of the affected tooth. Root resorption is often challenging to accurately diagnose and manage. The aim of this narrative review is to present the relevant literature on the aetiology, pathogenesis, diagnosis and management, as well as discuss the future directions of diagnosis and management of root resorption.

Diagnostic Accuracy of Periapical Radiography in Detection and Measurement of the External Root Resorption in Primary Molars: A Single-Blind Prospective Clinical Study

Introduction

Identifying the external root resorption plays an important role in treatment planning for deciduous teeth. Although proper accuracy of digital radiography in the diagnosis of external root resorption has been established in permanent dentition, it cannot be at all generalized to the primary root being superimposed by the succeeding permanent teeth. Interestingly, no study has assessed this in primary teeth yet. Thus, this study was undertaken for the first time.

Methods

This was a single-blind prospective clinical diagnostic study performed on 501 observations (observed by 3 observers) pertaining to 167 roots of 45 maxillary/mandibular primary molars (in 6–8-year-old patients) which were indicated for extraction and did have succeeding permanent teeth. Digital parallel periapical radiographs were taken before dental extraction using a PSP sensor. Radiographs were printed and examined by two pediatric dentists. After the extraction, the extent of resorption was directly measured, twice, by third and fourth observers blinded to radiographic estimates. Radiographic errors and absolute errors (mm) were calculated. Various parameters were analyzed statistically.

Results

Of the roots, 56.3% were really resorbed with (mean = 5.01 ± 2.10 mm). First/second observers failed to identify 19.6% and 38.3% of roots, respectively. Average errors were −0.77 ± 2.31 and 0.14 ± 2.19 mm in girls and boys, respectively (P=0.043, t-test). The factors “side, jaw, tooth type, and root type” did not affect errors (P > 0.05). Average absolute errors were 1.79 ± 1.47  mm (significantly above zero, P < 0.0005). No evaluated factor affected it (P > 0.1). Actual lesion sizes correlated with errors (Pearson R = 0.682, P < 0.0005) but not with absolute errors (P=0.464).

Conclusion

Although many deciduous roots might be missed, digital radiography might still provide rather a good accuracy in diagnosis and measurement of external root resorption up to about 1.8 mm absolute error. Observers might overestimate resorption sizes in girls and in cases with actual lesions smaller than 3 mm. Size of the lesion can influence the direction of error (shortening/elongation), but not its directionless magnitude.

Sub-clinical Cervical Root Resorption: A Case Report

External cervical resorption (ECR) is a dynamic pathological process characterized by its cervical position on the root and arises below the epithelial attachment and the coronal part of the bone. This report will highlight a case of ECR in an asymptomatic patient. A radiolucent area was noted during a routine dental follow-up examination on the bitewings at the mesial surface of the upper right second premolar. Persistently, the radiolucency had multiple radiographic views indicating a true form of a lesion that could be diagnosed as external cervical resorption. The patient did not report any complaints since dental treatment was completed in 2016. After a series of radiographs and conducting further diagnostic measures, a diagnosis of ECR was confirmed. The best treatment of choice for this case was extraction and restoring the missing tooth with an implant-supported crown. The size and the extent of such a defect could affect the strategy for implant placement. This paper aimed to report that ECR can be asymptomatic for a long time with advanced cervical root resorption in some cases.

Tooth root resorption: A review

Tooth root resorption is multifactorial, leading to progressive destruction and eventual loss of tooth root dentin and cement. There are internal and external types of root resorption, each having its variety. The etiology and pathogenesis of tooth root resorption are poorly understood, and the most significant etiological factors are trauma, pulpal infection, tooth bleaching, and orthodontic treatment. Tooth root resorption is primarily asymptomatic; thus, it is revealed accidentally by radiographic examination. Progressive clinical manifestations are pain, tooth discoloration, tooth mobility, and other conditions. Awareness of the causes and risk factors allowing tooth root resorption, and regular radiographic examination, in case of necessity, make it possible to reveal resorption at an early stage and to prevent its further development. Thus, the aim of this study is to present etiopathogenesis, a clinical course, and diagnostic peculiarities of internal and external types of tooth root resorption, enabling practicing dentists to timely diagnose root resorption and take appropriate measures to avoid further complications. Within the limitation of this review, even though the etiopathogenesis of tooth root resorption is yet not fully understood, it is suggested that the etiological factors fall into two groups (endogenic and exogenic) to enhance further understanding of the possible causes and mechanisms of root resorption and allow practitioners to monitor high-risk patients and make timely diagnoses. Moreover, radiographic examination and CBCT are indispensable for the diagnosis of root resorption.

A Case Report on an Insurmountable Endodontic Problem: Internal Resorption

Endodontists have a major problem when dealing with perforating internal resorption, which is an uncommon condition in permanent teeth. Success in treating a resorbed root can only be achieved if the root is properly diagnosed, removed, and treated. Cone-beam computed tomography was used to locate the resorptive lesion and assess its severity (CBCT). A maxillary canine with significant root perforation owing to internal resorption was successfully surgically treated in this case report.

Impact of cone beam CT on diagnosis of external cervical resorption: the severity of resorption assessed in periapical radiographs and cone beam CT. A prospective clinical study

OBJECTIVES

To compare the severity of external cervical resorption (ECR) observed in periapical (PA) images and cone beam CT (CBCT) using the Heithersay classification system and pulp involvement; and to assess inter- and intraobserver reproducibility for three observers.

METHODS

CBCT examination was performed in 245 teeth (in 190 patients, mean age 40 years, range 12-82) with ECR diagnosed in PA images. Three observers scored the severity of ECR using the Heithersay classification system (severity class 1-4) and pulp involvement (yes/no) in both PA images and CBCT. Percentage concordance and κ-statistics described observer variation in PA images and CBCT for both inter- and intraobserver reproducibility.

RESULTS

For all three observers, the ECR score was the same in the two modalities in more than half of cases (average 59%; obs1: 54%, obs2: 63%, obs3: 61%). However, in 38% (obs1: 44%, obs2: 33%, obs3: 36%) of the cases, the observers scored more severe ECR in CBCT than in PA images (p < 0.001). The ECR score changed to a less severe score in CBCT only in 3% (obs1: 1%, obs2: 4%, obs3: 4%). For pulp involvement, 14% (obs1: 7%, obs2: 20%, obs3: 15%) of the cases changed from "no" in PA images to "yes" in CBCT. In general, κ values were higher for CBCT than for PA images for both the Heithersay classification score and pulp involvement.

CONCLUSIONS

ECR was generally scored as more severe in CBCT than PA images using the Heithersay classification and also more cases had pulp involvement in CBCT.

Diagnosis Efficacy of Cone-Beam Computed Tomography in Endodontics—A Systematic Review of High-Level-Evidence Studies

Introduction: The integration of clinical inspection and diagnostic imaging forms the basis for endodontic diagnosis, decision making, treatment planning, and outcome assessments. In recent years, CBCT imaging has become a common diagnostic tool in endodontics. CBCT should only be used to ensure that the benefits to the patient exceed the risks. As such, our aim in this study was to evaluate the high level diagnostic efficacy studies and their risk of bias. Methods: A systematic search of the literature was conducted to identify studies evaluating the use of CBCT imaging in endodontics. The following databases were searched: Medline (PubMed), Scopus, and Cochrane Central. The identified studies were subjected to rigorous inclusion criteria. Studies considered as having a high efficacy level were then subjected to a risk of bias assessment using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Results: Initially, 1568 articles were identified for possible inclusion in the review. Following title and abstract assessment, duplicate removal, and a full-text evaluation, 22 studies were included. Of those studies, 2 had a low risk of bias and 20 had a high risk of bias. Six studies investigated non-surgical treatment, eight investigated surgical treatment, two investigated both non-surgical and surgical treatment, and six studies investigated diagnostic thinking or decision making. Conclusion: The evidence for the influence of CBCT on decision making and treatment outcomes in endodontics is predominantly based on studies with a high risk of bias.

Estimation of Surface Radiation Dosage to Thyroid Gland and Lower Abdomen While Using Intraoral Periapical Radiography: A Phantom Study

Background and objective

Every dose of radiation has the potential to cause biological harm. Quantitative assessment of radiation doses to radiosensitive organs can aid dental professionals in taking the appropriate protective measures against radiation. This data may also be used among the general public to alleviate fears of radiation exposure in dental radiography. This study aimed to estimate the surface radiation dose at the level of the thyroid and lower abdomen during intraoral periapical radiography (IOPAR).

Materials and methods

A total of 80 calcium sulfate (CaSO₄) discs were utilized in this cross-sectional in vitro study to estimate the surface radiation dose at the level of thyroid and lower abdomen on a phantom model while using an IOPAR. After exposure, the discs were submitted to the Radiation Laboratory's "Personnel Monitoring Service" to measure the surface radiation dose. Mean and standard deviations were calculated using descriptive statistics for continuous variables. The Mann-Whitney U test was used to compare bi-variate samples of independent groups. All statistical analyses were performed using SPSS Statistics version 21.0 (IBM, Armonk, NY).

Results

The results showed a statistically significant difference in radiation exposure between the maxillary anterior and mandibular anterior regions when the thermoluminescent dosimeter (TLD) was placed in the lower abdomen (p=0.000). When the maxillary and mandibular posterior regions were compared, there was a statistically significant difference in radiation exposure when the TLD was placed in the lower abdomen (p=0.000).

Conclusion

When the cone was positioned in the maxillary region, there was an increase in surface radiation dosage to the lower abdomen and thyroid.

Root resorption associated with maxillary buccal segment intrusion using variable force magnitudes

OBJECTIVES

To compare the root resorption resulting from miniscrew-supported maxillary posterior dentoalveolar intrusion using two different force magnitudes.

MATERIALS AND METHODS

Adult patients with skeletal open bite, indicated for maxillary posterior dentoalveolar intrusion, were recruited and randomly assigned to the comparison or intervention groups. The comparison group involved applying 200 g of intrusive force per segment, which measured 20 g per root, while this force was 400 g per segment in the intervention group, measuring 40 g per root.

RESULTS

Twenty participants were included in the final analysis after 2 patients dropped out, 1 in each group, to end up with 10 subjects (200 roots) per group. There was statistically significant root resorption of 0.84 ± 0.96 mm and 0.93 ± 1.00 mm in the comparison and the intervention groups, respectively. However, there was no statistically significant difference between the groups.

CONCLUSIONS

Root resorption inevitably took place in association with orthodontic intrusion. However, increasing the magnitude of the intrusive force did not increase the amount of root resorption, either statistically or clinically.

Examination of Irrigant Flow on a Tooth With Internal Root Resorption by Using a Computational Fluid Dynamics Model

Objective:

This study investigated the flow of an endodontic irrigant in a single-rooted tooth with internal root resorption (IRR).

Methods:

A simulation of a prepared central incisor with internal root resorption was created and irrigation with a 30-G needle was performed. The fluid pattern of the irrigant was evaluated using a Computational Fluid Dynamics model. In addition, the effects of the needle-insertion depth in the root canal and the size of root resorption on the fluid flow and the wall shear stress (WSS) values were assessed. The IRR was placed immediately below the canal orifice.

Results:

Inadequate irrigant washout was observed inside the resorption cavity when the needle was positioned 1 mm from the working length while placing the needle slightly above the resorption cavity resulted in significant irrigant circulation inside the resorption cavity. Moreover, when the needle was placed slightly above the defect, the calculated WSS values in the resorption cavity walls were significantly higher (approximately 20 times higher in every case). In cases where the needle was placed 1 mm from the working length, the average and maximum WWS values were between 3 Pa and 51 Pa, while in cases where the needle was placed coronal to the IRR, the values were between 55 Pa and 528 Pa. The radius of the resorption cavity did not affect the irrigant flow patterns.

Conclusion:

During the endodontic treatment of cases with internal root resorption, complementary irrigations with the needle tip placed slightly above the resorption cavity should be followed to better debride the root canal.

Survey based assessment of diagnosis through periapical radiograph and CBCT and treatment of root resorption with Brazilian and American dentists and endodontists

Background

This study assesses and compares the knowledge level of endodontists (ENDs) and general dental practitioners (GPs) from Brazil and United States of America (USA) in the diagnosis and treatment of internal and external inflammatory root resorptions through periapical radiographic (PA) and cone beam computed tomography (CBCT) examinations.

Material and Methods

A cross-sectional online questionnaire-based survey was presented to the volunteers containing questions regarding personal and professional profile, as well as three clinical cases of internal and external inflammatory root resorption. A series of multiple-choice questions about the diagnosis and treatment options were surveyed. The data collected was analysed by the Chi-square test with Yates correction with a significance level of 5 %.

Results

Most answers were considered adequate when all three questions about the diagnosis and all two questions relating to the treatment were answered accurately. A total of 374 dentists answered the survey (n: 229 from Brazil vs. 145 from USA) being 41% END and 59% GP. END presented higher level of knowledge than GP regarding to diagnosis and treatment of inflammatory root resorptions both in Brazil and USA (p<0.05); USA presented higher level of adequate responses than Brazil (p<0.05).

Conclusions

END achieved a level of knowledge of the diagnosis and treatment of root resorption superior to the GP. Comparing the results obtained in both countries, it was observed that the USA had a higher correct response rate than Brazil. Key words:Internal root resorption, external root resorption, management, diagnosis, treatment.

External cervical resorption: Radiological diagnosis and literature (Review)

External cervical resorption (ECR) is a relatively unknown and insidious pathology characterized by the loss of hard dental tissues such as: Enamel, cementum and dentine due to clastic function. It begins as a localized resorptive process that initiates on the area of the root beneath the epithelial attachment and the coronal part of the alveolar process, involving vital and non-vital tissues. Despite the fact that there are several potential predisposing factors related to ECR, its aetiology still remains poorly understood and more research is needed to establish the cause-and-effect relationship of all the etiological factors. Improved radiographic detection using cone-beam computed tomography (CBCT) is required in order to correctly classify and assess this entity. This provides a three-dimensional insight into the lesion, regarding the location, the size, the depth and the circumferential spread of the ECR defect. It also allows establishment of the most efficacious treatment plan and management. The purpose of this literature review is to cover the relevant literature concerning the etiology, pathogenesis, clinical and radiological presentation and management of ECRs (based on the CBCT findings).

Management of internal inflammatory root resorption using injectable platelet-rich fibrin revascularization technique: a clinical study with cone-beam computed tomography evaluation

OBJECTIVES

The current study evaluated clinically and radiographically the management of internal inflammatory root resorption (IIRR) in permanent anterior teeth with or without periapical lesions using injectable platelet-rich fibrin (i-PRF) regenerative approach.

METHODS

Ten systemically healthy patients, with thirteen anterior mature teeth diagnosed with IIRR were selected for the study. At the first visit, the tooth was anesthetized, access cavity opened, root canals were mechanically prepared then medicated with calcium hydroxide and temporarily sealed. After 2-4 weeks, regenerative endodontic procedures were performed by preparing and applying i-PRF inside the canal, then a freshly prepared PRF membrane was placed over it. White mineral trioxide aggregate was placed over the PRF matrix, and the tooth was restored with a glass ionomer cement base and resin composite restoration. The patients were recalled for clinical and radiographic evaluation and follow-up every 3 months for 12 months. Cone-beam computed tomography (CBCT) imaging was performed preoperatively and after 12 months.

RESULTS

Clinical evaluation results showed resolution of signs and symptoms through the follow-up period in all of the cases. Both CBCT imaging readings of IIRR lesions and periapical lesions revealed a volumetric significant difference (p = 0.00) between the preoperative and the 12-month follow-up period.

CONCLUSIONS

Usage of i-PRF could arrest and allow for healing of IIRR in permanent mature teeth and allow for periapical healing with successful clinical results.

CLINICAL RELEVANCE

i-PRF revascularization technique proved to be a successful REP in the treatment of the IIRR, reducing the number of appointments and increasing patient compliance.

Comparative analysis of the accuracy of periapical radiography and cone-beam computed tomography for diagnosing complex endodontic pathoses using a gold standard reference - A prospective clinical study

AIM

To compare the diagnostic accuracy of periapical radiography (PR) and cone-beam computed tomography (CBCT) for detecting pathoses of endodontic origin using the gold standard of direct surgical visualization.

METHODOLOGY

Seventy-four patients (112 teeth) underwent radiographic examination by periapical radiography and CBCT. The presence of periapical lesions, root perforations and their locations, root fractures, different types of external root resorptive defects, apicomarginal bone defects, through and through bone defects, buccal bone status and proximity of root apices and lesions to vital anatomical structures were assessed. These same parameters were assessed intraoperatively by direct surgical visualization which served as the gold standard reference for the radiographic assessments. Sensitivity, specificity, positive predictive values, negative predictive values were determined for comparison of diagnostic accuracy between two modalities.

RESULTS

There were no significant differences between the two imaging modalities for root resorptive defects and root fractures. However, CBCT accurately detected periapical lesions, root perforations, apicomarginal bone defects and through and through bone defects. The overall accuracy of CBCT varied from 91% to 96% in detecting dehiscence and fenestration of buccal cortical plates.

CONCLUSION

Overall, CBCT had a higher diagnostic accuracy in complex endodontic pathoses compared to PR. Nevertheless, CBCT failed to diagnose apicomarginal bone defects in 33% teeth. In evaluating the status of buccal cortical plate from CBCT images, observers could detect absence of bone better than its presence. Thus, limited FOV CBCT should be considered for selective cases where periapical radiography has diagnostic ambiguity.

External cervical resorption detected via cone-beam computed tomography in a patient with myelin oligodendrocyte glycoprotein antibody-associated disease: A case report

External cervical resorption may occur in patients with MOG antibody-associated disease, which is clearly detected on cone-beam computed tomography. Therefore, dental screening is essential for these patients before initiating bisphosphonate therapy. Larger sample sizes are crucial to determine any possible association between external cervical resorption and MOG antibody-associated disease.

External root resorption in root-filled and vital teeth after extraction and non-extraction orthodontic treatments: a split-mouth retrospective study

OBJECTIVE

This study aimed to compare the amounts of external root resorption (ERR) during different modalities of orthodontic treatment (OT) in root-filled teeth (RFT) and their contralateral teeth with vital pulp (VPT) in the same patient.

MATERIAL AND METHODS

The study sample consisted of 69 patients in two groups: 35 patients in the non-extraction group (18 female, 17 male; 18.16 ± 3.79 years), and 34 patients in the extraction group (19 female, 15 male; 17.72 ± 2.78 years). Digital panoramic radiographs of each patient taken before and after OT were used to measure the tooth length and root surface area. The amounts of ERR in RFT and contralateral VPT were evaluated pre- and post-OT in mandibular molars. The data were statistically analyzed with the paired t-test, independent t-test, and analysis of covariance (ANCOVA) (p < .05).

RESULTS

A statistically significant difference was observed in both the orthodontic treatment groups when RFT and VPT were compared in terms of ERR (p < .05). A significant difference was observed between RFT and VPT in extraction treatments when the reduction in the root area between the two sides in the groups was compared (p < .05).

CONCLUSIONS

RFT are more resistant to ERR than VPT. The ERR in RFT may not be a significant matter for the planning of OT.

A Review of External Cervical Resorption

External cervical resorption (ECR) is a relatively uncommon yet aggressive form of dental hard tissue destruction. It is initiated at the cervical aspect of the root surface and extends apicocoronally and circumferentially inside the dentin. Despite the large number of case reports and clinical studies that have investigated ECR, its etiology remains unclear. Recent advancements in clinical assessment measures, such as the use of cone-beam computed tomographic imaging, have provided additional insights into the nature of this lesion. This has facilitated the continued development and improvement of treatment methods for this condition. In this article, we provide an overview of the latest research pertaining to the etiology, histopathology, predisposing factors, diagnosis, classification, and treatment of ECR. Furthermore, we provide a summary of the different classification schemes for ECR and highlight the relevant therapeutic principles.

Diagnosis and Management of Traumatic Dental Injuries Using Intraoral Radiography and Cone-beam Computed Tomography: An In Vivo Investigation

INTRODUCTION

The aim of this study was to compare periapical radiographs (PRs) and upper standard occlusal (USO) radiographs with cone-beam computed tomographic (CBCT) imaging on clinicians' confidence in the diagnosis and management of traumatic dental injuries (TDIs).

METHODS

This study included 35 maxillary anterior teeth from 25 patients with at least 1 PR (parallax view) and a CBCT scan. Fourteen patients also had a USO radiograph. Ten examiners selected a diagnosis and treatment plan, which were compared with a reference standard. Sensitivity, specificity, positive and negative predictor values, and receiver operating characteristic analysis were used to determine the diagnostic accuracy.

RESULTS

CBCT imaging exhibited significantly higher sensitivity than both conventional radiographic techniques combined (PRs and PRs + USO radiographs) for all diagnoses (TDI: 99% vs 84%, lateral luxation: 80% vs 34%, extrusions: 92% vs 42%, and cortical plate fracture: 58% vs 1%) other than horizontal root fractures in which the results were close to statistical significance (88% vs 69%). CBCT imaging was significantly more accurate for all diagnoses (TDI: 91% vs 70%, lateral luxations: 83% vs 61%, extrusive luxations: 92% vs 68%, alveolar cortical plate fractures: 78% vs 48%, and horizontal root fractures: 93% vs 82%). Examiners had the most confidence with CBCT imaging and the least confidence in diagnosing using PRs + USO radiographs than with PRs alone. Agreement with management plans was significantly better using CBCT imaging compared with PRs and PRs + USO radiographs.

CONCLUSIONS

CBCT imaging improved the clinical diagnosis of TDIs. The addition of USO radiographs to PRs did not improve the diagnosis of TDIs in this investigation. CBCT imaging improved confidence in the diagnosis of TDI cases and treatment planning compared with conventional radiography.

Effects of different wavelengths of low-level laser therapy on orthodontically induced inflammatory root resorption in rats investigated with micro-computerized tomography

INTRODUCTION

The objective of this research was to investigate the effects of different wavelengths low-level laser therapies on orthodontically induced inflammatory root resorption (OIIRR) during orthodontic tooth movement in rats by micro-computerized tomography.

METHODS

Forty Wistar albino rats were divided into 5 groups: control group (A), 405-nm laser group (B), 532-nm laser group (C), 650-nm laser group (D), and 940-nm laser group (E). The left side of group A was used as a positive control (A-PC), and the right side of group A was used as a negative control (A-NC) group. In all groups, the maxillary left first molars were moved mesially by 50 g of force for 14 days. The lasers were performed for 9 minutes on the maxillary left first molar tooth. At the end of the experimental period, OIIRR measurements were performed at the mesial and the distal sides along the mesial root of the maxillary first molars.

RESULTS

The root resorption volume was significantly lower in group A-NC than in groups A-PC, B, and D. The percentage of root resorption was significantly lower in group A-NC than in all other groups. The root resorption volume and the percentage of root resorption in groups C, D, and E were significantly lower than group A-PC. The depth and the width of the lacuna and even the number of mesial lacunae were similar between groups. The distal and the total lacunae were significantly lower in group A-NC than in all other groups except group C.

CONCLUSIONS

The 532-nm, 650-nm, and 940-nm lasers significantly reduced the volume of OIIRR. In addition, the 532-nm laser reduced the number of lacunae both distally and totally than all the other groups.

Comparison of Cone-beam Computed Tomography and Periapical Radiography to Determine the Proximity of Periapical Lesions to Anatomical Structures in Premaxillary Area prior to Surgical Endodontics: A Clinical Study

Aim

In the anterior maxillary region when periapical (PA) surgery is contemplated, knowledge of relation between root apices and lesion, spatial relationship of tooth root to adjacent anatomical structures is essential. The aim of this study was to compare cone-beam computed tomography (CBCT) and PA radiography to determine the proximity of PA lesions to anatomical structures in the premaxillary area for decision-making before apical surgery.

Materials and methods

Twenty subjects were selected. Three endodontists viewed PA radiographs and CBCT images. These observers (1) determined proximity of lesion to anatomical structures and (2) made decisions on treatment based on each imaging modality. Chi-square test was used to check the relationship between the treatment plans given by PA radiographs and CBCT images. Reliability of the observations was evaluated using intraclass correlation (ICC).

Results

Significant difference was noted in the treatment plan selected by the observers using the two modalities (p < 0.05).

Conclusion

After the lesions were observed with CBCT, there was an increase in the number of teeth involved with the lesion. A change in the observer's treatment plan was recorded after viewing the CBCT scans.

How to cite this article

Sheth K, Kapoor S, Daveshwar S, et al. Comparison of Cone-beam Computed Tomography and Periapical Radiography to Determine the Proximity of Periapical Lesions to Anatomical Structures in Premaxillary Area prior to Surgical Endodontics: A Clinical Study. Int J Clin Pediatr Dent 2020;13(4):322-326.

Reparative Endodontic Treatment of a Perforating Internal Inflammatory Root Resorption: A Case Report

The aim of this case report was to present a reparative treatment approach of an extensive internal inflammatory resorption with a lateral perforation and apical and lateral inflammatory lesions. Only the necrotic coronal part of the pulp was removed, and the vital pulp tissue within the resorption cavity and the apical part of the root canal was left uninstrumented. Bleeding was induced, and the blood clot was covered with mineral trioxide aggregate. Hard tissue repair and healing of the apical lesion could be observed in the 3-year recall.