Sample records for apicoectomy
-
Mandibular incisor apicoectomy in a Canadian Beaver.
Steenkamp, Gerhard; Venter, Leon; Crossley, David; Buss, Peter
2009-01-01
A 52-month-old Canadian beaver was presented for treatment of lip trauma resulting from overgrowth of the right mandibular incisor tooth following earlier loss of the right maxillary incisor tooth. Extraction of the affected tooth was considered, but rejected due to the length of the embedded portion of rodent mandibular incisor teeth. The lip injury was managed by crown reduction (odontoplasty) of the overgrowing incisor tooth pending a more permanent treatment plan. A 2-cm apicoectomy of the right mandibular incisor tooth was performed to arrest growth of the tooth when the beaver was 82-months-old. The remainder of the tooth continued to erupt and was completely expelled during a 9-month period with one additional odontoplasty being required. The beaver continued to feed normally with just the left maxillary and mandibular incisor teeth until its death at 118-months, with odontoplasty performed twice on the remaining incisor teeth during the 30-months following exfoliation.
-
Gutmann, James L
2013-01-01
In 1921, Dr. Thomas R Hinman of Atlanta, Georgia read a paper before the First district Dental Society in New York City that dealt with the management of infected teeth. Adherents of the theories of focal infection and elective localization advocated the extraction of teeth with necrotic pulps and particularly those with periapical lesions. In his presentation, Dr. Hinman overlooked the procedures of root amputation or apicoectomy (terms that were was synonymous at that time), stating that the technique had been abandoned as a failure by oral surgeons. Dr. Hinman later claimed that he had been misunderstood, and that what he really meant was that apicoectomy is only rarely successful. Out of this incident there appeared a lengthy symposium, with contributions from across the United States. While this debate ensued, the techniques of this procedure were being applied and evaluated in the European sector, with a number of treatises expounding on their versatility, acceptability, and applicability far beyond what was being addressed in the United States. This paper will focus on some of the unique historical perspectives from all parties, and clarify these perspectives relative to contemporary philosophies and rationales.
-
Stefopoulos, Spyridon; Tzanetakis, Giorgos N; Kontakiotis, Evangelos G
2012-01-01
Root-end resected teeth with persistent apical periodontitis are usually retreated surgically or a combination of non-surgical and surgical retreatment is employed. However, patients are sometimes unwilling to be subjected to a second surgical procedure. The apical barrier technique that is used for apical closure of immature teeth with necrotic pulps may be an alternative to non-surgically retreat a failed apicoectomy. Mineral trioxide aggregate (MTA) has become the material of choice in such cases because of its excellent biocompatibility, sealing ability and osseoinductive properties. This case report describes the non-surgical retreatment of a failed apicoectomy with no attempt at retrofilling of a maxillary central incisor. White MTA was used to induce apical closure of the wide resected apical area. Four-year follow-up examination revealed an asymptomatic, fully functional tooth with a satisfactory healing of the apical lesion. White MTA apical barrier may constitute a reliable and efficient technique to non-surgically retreat teeth with failed root-end resection. The predictability of such a treatment is of great benefit for the patient who is unwilling to be submitted to a second surgical procedure.
-
International Nuclear Information System (INIS)
Oliveira, Rodrigo Guerra de
2001-01-01
One of the objectives of endodontic treatment is to resolve pathological periapical processes caused by microbial contamination of the dental pulp. Correct execution of the necessary chemical preparation prior to surgery generally results in positive outcomes. However, a percentage of cases do not respond favorably and therefore require retreatment, a conservative therapeutic option. There are meanwhile a number of treatment failures which do not respond to these conservative measures and must therefore be subjected to paraendodontic surgical procedures. One of the principal problems of this therapeutic conduct is linked to the surface permeability of the dentin after apicoectomy and the lack of adequate marginal adaptation between the retrofilling material and the cavity walls. This permits the percolation of microorganisms and their metabolic by products from the system of root canals to the periapical region, thereby compromising the necessary tissue repair. The present work proposes the evaluation of the surface and marginal permeability of cut dentin after apicoectomy and treatment with Er:YAG and Nd:YAG lasers with fiber optics and then retrofilled with intermediate restorative material (IRM). A total of 24 single rooted teeth whose canals were endodontically treated were divided into 3 experimental groups: group I, whose apices were sectioned with an Er:YAG laser and the resulting cavity and the cut dental surface were irradiated with this laser via a 50/10 type fiber; in group II the apicoectomy was conducted with an Er:YAG laser and the resulting cavity and the cut surface were irradiated with a Nd:YAG laser; in group III, the samples were apicoectomized and the cavities were treated with a high speed bur (control group). Analysis of the infiltration of the dye methylene blue throughout the cut dental surface and the reconstruction demonstrated that the samples in the irradiated groups presented lower indices of infiltration than the control group. The
-
Directory of Open Access Journals (Sweden)
Víctor Gómez-Carrillo
2011-06-01
Full Text Available Diversos refinamientos de la técnica quirúrgica de apicectomía han propiciado que su tasa de éxito haya aumentado de modo considerable. Se revisa la bibliografía científica para determinar cuáles de estos procedimientos son superiores. Se realiza un protocolo que aúna racionalmente esas técnicas, con lo que así se optimiza el resultado final de la intervención.Diverse refinements of the apicoectomy surgical technique have considerably increased the success rate of the procedure. The scientific literature was reviewed to identify the most relevant procedures for the final outcome of surgery. A protocol was prepared to facilitate the rational selection of technique, thus optimizing the surgical outcome.
-
Energy Technology Data Exchange (ETDEWEB)
Oliveira, Rodrigo Guerra de
2001-07-01
One of the objectives of endodontic treatment is to resolve pathological periapical processes caused by microbial contamination of the dental pulp. Correct execution of the necessary chemical preparation prior to surgery generally results in positive outcomes. However, a percentage of cases do not respond favorably and therefore require retreatment, a conservative therapeutic option. There are meanwhile a number of treatment failures which do not respond to these conservative measures and must therefore be subjected to paraendodontic surgical procedures. One of the principal problems of this therapeutic conduct is linked to the surface permeability of the dentin after apicoectomy and the lack of adequate marginal adaptation between the retrofilling material and the cavity walls. This permits the percolation of microorganisms and their metabolic by products from the system of root canals to the periapical region, thereby compromising the necessary tissue repair. The present work proposes the evaluation of the surface and marginal permeability of cut dentin after apicoectomy and treatment with Er:YAG and Nd:YAG lasers with fiber optics and then retrofilled with intermediate restorative material (IRM). A total of 24 single rooted teeth whose canals were endodontically treated were divided into 3 experimental groups: group I, whose apices were sectioned with an Er:YAG laser and the resulting cavity and the cut dental surface were irradiated with this laser via a 50/10 type fiber; in group II the apicoectomy was conducted with an Er:YAG laser and the resulting cavity and the cut surface were irradiated with a Nd:YAG laser; in group III, the samples were apicoectomized and the cavities were treated with a high speed bur (control group). Analysis of the infiltration of the dye methylene blue throughout the cut dental surface and the reconstruction demonstrated that the samples in the irradiated groups presented lower indices of infiltration than the control group. The
-
[Sequence orthodontic treatment of impacted dilacerated maxillary central incisors].
Zheng, Yi; Pang, Xuannai; Nan, Lan; Mo, Shuixue
2012-06-01
To explore an effective orthodontic method for treating impacted dilacerated maxillary central incisors. 12 impacted teeth of 11 cases were chosen. The position of the impacted teeth and the relations with neighbour tissues were assessed by X-ray images, oral examination and plaster model, etc. The impacted teeth were induced to erupt with the closed-eruption technique and fixed orthodontic appliances, root canal therapy, apicoectomy and prosthetic treatment. 12 impacted teeth were moved into arches, and the occlusal relationship was normal. There were no root resorption or conglutination in those impacted teeth. The labial impacted teeth of nine cases had bigger labial crown torsion. The root apexes of four impacted teeth were palpable under mucosa of the labial sulcus and operated by root canal therapy and apicoectomy. One of them received prosthetic treatment. Others (five cases) hadn't accepted root canal therapy, and were observed temporarily. The effects of two palatal impacted teeth was stable. It was a good method to expand indication with sequence orthodontic treatment. The impacted dilacerated maxillary central incisors could be aligned with good esthetical and functional effect.
-
[Nonsurgical retreatment of lateral radiopacity after surgical treatment].
Arias de Luxan, A
1990-01-01
A case report is presented of an upper central incisor with incomplete endodontic procedure evidencing a radiolucent image that was treated by apicoectomy and retroamalgam. A year later the periapical lesion had healed completely but a new lateral radiolucency is observed. A reentry of the canal is performed eliminating the old obturating material, biomechanical preparation and obturation with sealer and thermo gutta-percha. The lesion was cured in nine months.
-
Use of Multiple Operatories in Dental Care Delivery.
1982-02-01
Treatment 1.8 36 03400 Periapical Treatment 03410 Apicoectomy 3.3 03420 Retrograde Filling 0.9 03470 Surgical Fenestration 1.0 03480 Pneumatization 1.6 03900...07442 Excision, Malignant Tumor 5.3 07452 Removal of Odontogenic Cyst or Tumor 2.5 07462 Removal of Non-Odontogenic Cyst or Tumor 1.2 07465...Removal of Non-Odontogenic Cyst or Tumor 300.00 07465 Destruction of lesions 200.00 07470 Removal of Exostoses 200.00 07480 Partial Resection, Maxilla or
-
The solutions to your problems in endodontic retreatment and microsurgery
Directory of Open Access Journals (Sweden)
Leslie Ang
2016-06-01
How to find the 4th canal in the upper Second molars in 60% of your patients, How to find the 4th canal in the upper First molars in 90% of your patients, How to retreat canals root filled with metal posts, fiber posts, gutta percha, hard canal cement & thermafils, How to remove fractured posts and posts cemented with resin cements. Understand why and how to perform Endodontic Surgery: How to treat large periapical lesions microsurgically, How to use the latest Ultrasonic technology under the Surgical Operating Microscope in all forms of microsurgery, Learn about the modern concepts in transplants, apicoectomies and intentional replantations.
-
Prevalence of periapical lesions in endodontic treatment teeth
Directory of Open Access Journals (Sweden)
Juliana Machado Barroso
2013-01-01
Full Text Available The aim of this study was to determine the prevalence of of persistent periapical lesions after conventional endodontic therapy. The persistent periapical lesions were removed paraendodontic surgery, followed by apicoectomy. The root ends were retroprepared with ultrasound and retrofilling with MTA. The specimens were stored in formaldehyde 10%, making a total of 107 samples. The lesions were referred to the Department of Pathology, FOB-USP for microscopic analysis using the technique of serial sections. The present results showed periapical cyst (48, granuloma (43, Crohn's abscess (2, apical fibrosis (3 and others (11. . Among the lesions analyzed in this study it can be observed a higher incidence of apical periodontal cyst, followed by apical granuloma and other pathologies.
-
PREVALENCE OF PERIAPICAL LESIONS IN ENDODONTIC TREATMENT TEETH
Directory of Open Access Journals (Sweden)
Francisco Carlos Ribeiro
2013-04-01
Full Text Available The aim of this study was to determine the prevalence of of persistent periapical lesions after conventional endodontic therapy. The persistent periapical lesions were removed paraendodontic surgery, followed by apicoectomy. The root ends were retroprepared with ultrasound and retrofilling with MTA. The specimens were stored in formaldehyde 10%, making a total of 107 samples. The lesions were referred to the Department of Pathology, FOB-USP for microscopic analysis using the technique of serial sections. The present results showed periapical cyst (48, granuloma (43, Crohn's abscess (2, apical fibrosis (3 and others (11. . Among the lesions analyzed in this study it can be observed a higher incidence of apical periodontal cyst, followed by apical granuloma and other pathologies.
-
Progression of periapical cystic lesion after incomplete endodontic treatment
Directory of Open Access Journals (Sweden)
Jong-Ki Huh
2016-05-01
Full Text Available We report a case of large radicular cyst progression related to endodontic origin to emphasize proper intervention and follow-up for endodontic pathosis. A 25 yr old man presented with an endodontically treated molar with radiolucency. He denied any intervention because of a lack of discomfort. Five years later, the patient returned. The previous periapical lesion had drastically enlarged and involved two adjacent teeth. Cystic lesion removal and apicoectomy were performed on the tooth. Histopathological analysis revealed that the lesion was an inflammatory radicular cyst. The patient did not report any discomfort except for moderate swelling 3 days after the surgical procedure. Although the patient had been asymptomatic, close follow-ups are critical to determine if any periapical lesions persist after root canal treatment.
-
Brito-Junior, Manoel; Faria-e-Silva, Andre Luis; Quintino, Alex Carvalho; Moreira-Junior, Gil; Geber, Mauro; Camilo, Carla Cristina; Soares, Janir Alves
2012-01-01
Absence of periapical healing after orthograde retreatment using an apical plug with mineral trioxide aggregate (MTA) can require surgical intervention. A patient with a root-filled maxillary central incisor with chronic apical periodontitis and sinus tract was referred for endodontic retreatment. Excessive apical enlargement was verified, indicating an MTA apical plug placement; however, an unintentional extrusion of MTA occurred during this step. The root canal was filled with gutta-percha and sealer, and periodic recalls were scheduled. The sinus tract was observed after six months and the lesion remained unaltered, although the extruded MTA had resorbed; therefore, an apicoectomy and retrograde root-end filling with MTA were performed. Absence of sinus tract, normal clinical aspect, and complete repair of the lesion were observed at the two-year follow-up.
-
Huh, Jong-Ki; Shin, Su-Jung
2013-08-01
This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.
-
Laser-assisted oral surgery in general practice
McCauley, Mark C.
1995-04-01
This presentation will demonstrate and discuss any surgical applications of the Argon dental laser. This presentation will also increase the awareness and basic understanding of the physical principals of the Argon laser. The wavelength of the Argon laser is specifically absorbed by red pigments such a hemoglobin which is abundant in oral soft tissue. The result is a sharp clean incision with minimal thermal damage to adjacent healthy tissue. Preprosthetic procedures such as full arch vestibuloplasty, labial and lingual frenectomy, and epulis fissuratum removal will be demonstrated. Other soft tissue management procedures such as minor periodontal pocket elimination surgery (gingivectomy), removal of hyperplastic granulation tissue from around poorly maintained implants, and the removal of granulation and/or cystic tissue from the apex of teeth undergoing endodontic (apicoec-tomy) surgery will also be demonstrated and discussed. Provided basic oral surgery protocol is followed, surgical procedures utilizing the Argon laser can be accomplished with minimal bleeding, minimal trauma and with minimal post-operative discomfort.
-
Esthetic periodontal surgery for impacted dilacerated maxillary central incisors.
Wei, Yu-Ju; Lin, Yi-Chun; Kaung, Shou-Shin; Yang, Shue-Fen; Lee, Shyh-Yuan; Lai, Yu-Lin
2012-10-01
Clinicians do not frequently see impacted dilacerated maxillary incisors in their patients. When they do, there are several diagnostic and management challenges for correcting root dilacerations. An unfavorable esthetic outcome might occur as a result of soft-tissue complications during surgical eruption procedures. We present 2 patients with an impacted and dilacerated maxillary central incisor. Computed tomography scans with 3-dimensional reformation were used to accurately assess the positions of the dilacerated teeth, the degree of dilaceration, and the stage of root formation. The therapy primarily involved 2-stage crown exposure surgery combined with orthodontic traction. An apicoectomy was performed on 1 dilacerated tooth; the other exhibited pulp vitality. This article highlights the periodontal surgical strategies for the esthetic management of inverted crowns. Through periodontal plastic surgery and interdisciplinary cooperation, the impacted dilacerated central incisors were properly aligned, and successful esthetic results were achieved. Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.
-
Lasers in endodontics: an overview
Frentzen, Matthias; Braun, Andreas; Koort, Hans J.
2002-06-01
The interest in endodontic use of dental laser systems is increasing. Developing laser technology and a better understanding of laser effects widened the spectrum of possible endodontic indications. Various laser systems including excimer-, argon+-, diode-, Nd:YAG-, Er:YAG- and CO2-lasers are used in pulp diagnosis, treatment of hypersensitivity, pulp capping, sterilization of root canals, root canal shaping and obturation or apicoectomy. With the development of new delivery systems - thin and flexible fibers - for many different wavelengths laser applications in endodontics may increase. Since laser devices are still relatively costly, access to them is limited. Most of the clinical applications are laser assisted procedures such as the removing of pulp remnants and debris or disinfection of infected root canals. The essential question is whether a laser can provide improved treatment over conventional care. To perform laser therapy in endodontics today different laser types with adopted wavelengths and pulse widths are needed, each specific to a particular application. Looking into the future we will need endodontic laser equipment providing optimal laser parameters for different treatment modalities. Nevertheless, the quantity of research reports from the last decade promises a genuine future for lasers in endodontics.
-
Alsalleeh, Fahd; Keippel, Jeffery; Adams, Lyde; Bavitz, Bruce
2014-09-01
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-known complication caused by amino-bisphosphonate therapy. We document one case of BRONJ associated with oral administration of methotrexate, a known immunosuppressive drug used to treat rheumatoid arthritis. A 66-year-old woman was referred for evaluation and endodontic surgery of recently re-treated tooth 13. Tooth 14 was extracted 3 months prior, and the extraction site had not completely healed. Her medical history revealed rheumatoid arthritis and osteoporosis. She had been taking Fosamax (alendronate) 70 mg daily. Because of adequate root canal therapy of tooth 13, endodontic surgery was performed. Five months after apicoectomy, her symptoms had not changed. Tooth 13 was extracted, and the socket healed without complications. The socket of extracted tooth 14 was also healing. At the 3-month recall visit, bone exposure and purulent discharge at the site of extracted tooth 14 were noted. The patient had recently received methotrexate. The methotrexate was discontinued, and she was given course of amoxicillin. At the 18-month follow-up, the healing progressed, and the wound was closed. A medication that suppresses the immune system such as methotrexate may complicate the management of BRONJ. Once a diagnosis of BRONJ is made, a closely monitored conservative approach is recommended. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
-
Laser scanning dental probe for endodontic root canal treatment
Blank, Molly A. B.; Friedrich, Michal; Hamilton, Jeffrey D.; Lee, Peggy; Berg, Joel; Seibel, Eric J.
2011-03-01
Complications that arise during endodontic procedures pose serious threats to the long-term integrity and health of the tooth. Potential complexities of root canals include residual pulpal tissue, cracks, mesial-buccal 2 and accessory canals. In the case of a failed root canal, a successful apicoectomy can be jeopardized by isthmuses, accessory canals, and root microfracture. Confirming diagnosis using a small imaging probe would allow proper treatment and prevent retreatment of endodontic procedures. An ultrathin and flexible laser scanning endoscope of 1.2 to 1.6mm outer diameter was used in vitro to image extracted teeth with varied root configurations. Teeth were opened using a conventional bur and high speed drill. Imaging within the opened access cavity clarified the location of the roots where canal filing would initiate. Although radiographs are commonly used to determine the root canal size, position, and shape, the limited 2D image perspective leaves ambiguity that could be clarified if used in conjunction with a direct visual imaging tool. Direct visualization may avoid difficulties in locating the root canal and reduce the number of radiographs needed. A transillumination imaging device with the separated illumination and light collection functions rendered cracks visible in the prepared teeth that were otherwise indiscernible using reflected visible light. Our work demonstrates that a small diameter endoscope with high spatial resolution may significantly increase the efficiency and success of endodontic procedures.
-
Radicular Cyst With Actinomycotic Infection in an Upper Anterior Tooth
Directory of Open Access Journals (Sweden)
Shuei-Kuen Tseng
2009-10-01
Full Text Available Actinomycosis is an infection caused by filamentous, branching, Gram-positive anaerobic bacteria. It rarely infects the jawbone. This case report describes a patient with a left maxillary central incisor with an apical lesion and actinomycotic infection. A 23-year-old male patient underwent conventional root canal treatment of tooth 21, in a local dental clinic for about 1 year. However, percussion pain and a sinus tract that originated from tooth 21 were still present after treatment. Nonsurgical root canal treatment of tooth 21 was performed again but failed to relieve the symptoms. Therefore, apicoectomy and retrograde filling of the apical root canal with mineral trioxide aggregate were carried out. Periradicular bony defect was grafted by biocompatible material, and postoperative antibiotics (250 mg amoxicillin were given three times daily for 5 days. Pathological examination of the removed periapical tissue showed a radicular cyst with actinomycosis. At the 9-month postoperative recall, the sinus tract had disappeared and radiographic examination showed healing of the apical lesion. Periradicular actinomycosis is one important reason for failure of nonsurgical endodontic treatment. Clinically, if the tooth shows a recurrent sinus tract and poor response to conventional root canal treatment combined with antibiotic control, apical actinomycotic infection should be highly suspected, and an alternative endodontic surgical approach is needed for successful treatment.
-
Götz, Carolin; Reinhart, Edeltraud; Wolff, Klaus-Dietrich; Kolk, Andreas
2015-11-01
Intraoral soft tissue infections (OSTI) are a common problem in dentistry and oral surgery. These abscesses are mostly exacerbated dental infections (OIDC), and some emerge as postoperative infections (POI) after tooth extraction (OITR) or apicoectomy (OIRR). The main aim of this study was to compare OIDC with POI, especially looking at the bacteria involved. An additional question was, therefore, if different antibiotic treatments should be used with OSTI of differing aetiologies. The impact of third molars on OSTI was evaluated and also the rates of POI after removal of third molars were specified. Patient data was collected from the patients' medical records and the results were statistically evaluated with SPSS (SPSS version 21.0; SPSS, IBM; Chicago, IL, USA). The inclusion criterion was the outpatient treatment of a patient with an exacerbated oral infection; the exclusion criteria were an early stage of infiltration without abscess formation; and a need for inpatient treatment. Periapical exacerbated infections, especially in the molar region were the commonest cause of OIDC. In the OITR group, mandibular tooth removal was the commonest factor (p=0.016). Remarkably, retained lower wisdom teeth led to significant number of cases in the OITR group (p=0.022). In our study we could not define differences between the causal bacteria found in patients with OIDC and POI. Due to resistance rates we conclude that amoxicillin combined with clavulanic acid seems to be the antibiotic standard for exacerbated intraoral infections independent of their aetiology. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
-
Pitcher, Brandon; Alaqla, Ali; Noujeim, Marcel; Wealleans, James A; Kotsakis, Georgios; Chrepa, Vanessa
2017-03-01
Cone-beam computed tomographic (CBCT) analysis allows for 3-dimensional assessment of periradicular lesions and may facilitate preoperative periapical cyst screening. The purpose of this study was to develop and assess the predictive validity of a cyst screening method based on CBCT volumetric analysis alone or combined with designated radiologic criteria. Three independent examiners evaluated 118 presurgical CBCT scans from cases that underwent apicoectomies and had an accompanying gold standard histopathological diagnosis of either a cyst or granuloma. Lesion volume, density, and specific radiologic characteristics were assessed using specialized software. Logistic regression models with histopathological diagnosis as the dependent variable were constructed for cyst prediction, and receiver operating characteristic curves were used to assess the predictive validity of the models. A conditional inference binary decision tree based on a recursive partitioning algorithm was constructed to facilitate preoperative screening. Interobserver agreement was excellent for volume and density, but it varied from poor to good for the radiologic criteria. Volume and root displacement were strong predictors for cyst screening in all analyses. The binary decision tree classifier determined that if the volume of the lesion was >247 mm 3 , there was 80% probability of a cyst. If volume was cyst probability was 60% (78% accuracy). The good accuracy and high specificity of the decision tree classifier renders it a useful preoperative cyst screening tool that can aid in clinical decision making but not a substitute for definitive histopathological diagnosis after biopsy. Confirmatory studies are required to validate the present findings. Published by Elsevier Inc.
-
Guo, Jing; Simon, James H; Sedghizadeh, Parish; Soliman, Osman N; Chapman, Travis; Enciso, Reyes
2013-12-01
The purpose of this study was to evaluate the reliability and accuracy of cone-beam computed tomographic (CBCT) imaging against the histopathologic diagnosis for the differential diagnosis of periapical cysts (cavitated lesions) from (solid) granulomas. Thirty-six periapical lesions were imaged using CBCT scans. Apicoectomy surgeries were conducted for histopathological examination. Evaluator 1 examined each CBCT scan for the presence of 6 radiologic characteristics of a cyst (ie, location, periphery, shape, internal structure, effects on surrounding structure, and perforation of the cortical plate). Not every cyst showed all radiologic features (eg, not all cysts perforate the cortical plate). For the purpose of finding the minimum number of diagnostic criteria present in a scan to diagnose a lesion as a cyst, we conducted 6 receiver operating characteristic curve analyses comparing CBCT diagnoses with the histopathologic diagnosis. Two other independent evaluators examined the CBCT lesions. Statistical tests were conducted to examine the accuracy, inter-rater reliability, and intrarater reliability of CBCT images. Findings showed that a score of ≥4 positive findings was the optimal scoring system. The accuracies of differential diagnoses of 3 evaluators were moderate (area under the curve = 0.76, 0.70, and 0.69 for evaluators 1, 2, and 3, respectively). The inter-rater agreement of the 3 evaluators was excellent (α = 0.87). The intrarater agreement was good to excellent (κ = 0.71, 0.76, and 0.77). CBCT images can provide a moderately accurate diagnosis between cysts and granulomas. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
-
[A retrospective study of 180 cases of apical microsurgery].
Wang, Hanguo; Li, Dan; Tian, Yu; Yu, Qing
2014-07-01
To evaluate the outcome and the potential prognostic factors of apical microsurgery. The teeth with persistent periapical diseases were treated by microsurgery using micro instruments, ultrasonic retrotips and mineral trioxide aggregate (MTA) under dental operate microscope. The procedure includes incision and flap retraction, osteotomy, apicoectomy, retro- preparation and retro- filling of root canal. Patients were recalled at 1, 3, 6, and 12- month intervals. The outcome was evaluated by clinical and radiographic examinations, and the potential prognostic factors were analyzed. One hundred and eighty cases (240 teeth), including 132 upper anterior teeth, 22 lower anterior teeth, 31 upper premolars, 18 lower premolars, 19 upper molars and 18 lower molars, were treated by microsurgery between July 2010 and December 2012. A total of 152 cases (207 teeth) were recalled. The application of the apical microsurgery included failure of previous endodontic treatment, periapical lesion with post, periapical cyst, calcified canals, separated instruments, overfilling, open apex, root facture, failure of previous apical surgery, apical fenestration, and special root canal system. The success rate was 90.8% (188/207). Age, sex, tooth position, type of periapical radiolucency, fistula and clinical application type appeared to have a negative effect on the outcome. Endo-perio lesion was a significant factor. Eighteen cases (19 teeth) failed mainly because of periodontally involved lesion and vertical root fracture. Apical microsurgery, which combines the magnification and illumination provided by the microscope with the proper use of micro instruments, can treat the teeth with persistent periapical diseases precisely and less traumatically with high success rate. Case selection and standardized operations play a key role for success.
-
Britain, Steven K; Arx, Thomas von; Schenk, Robert K; Buser, Daniel; Nummikoski, Pirkka; Cochran, David L
2005-03-01
Chronic periodontic-endodontic lesions are not uncommon in clinical practice and their regenerative capacity has long been questioned. However, there are no published studies investigating the application of guided tissue regeneration techniques in combination with endodontic surgery using an induced perio-endo defect model. This study evaluated the clinical, radiographic, and histologic outcomes of three surgical procedures used to treat induced perio-endo lesions. Pulpal necrosis was induced in foxhounds along with surgical removal of radicular buccal bone. After 4 weeks, chronic lesions were clinically and radiographically assessed. Treatment surgery consisted of apicoectomy, root canal instrumentation, and retrofilling with mineral trioxide aggregate. Teeth were then assigned to one of the following treatment groups: open flap debridement only (OFD), OFD with bioabsorbable porcine-derived collagen membrane (BG), or OFD with BG and anorganic bovine bone matrix (BO/BG). Clinical parameters and standardized radiographs were assessed at defect creation; treatment surgery; and at 1, 2, 4, and 6 months. Animals were sacrificed at 6 months and specimens prepared for histometric analysis. Clinical and radiographic conditions improved during the study period. Mean epithelial attachment was similar between all groups. Mean connective tissue attachment for groups OFD, BG, and BO/BG was 3.79 mm, 2.63 mm, and 1.75 mm, respectively, and mean radicular bone height was 2.16 mm, 3.24 mm, and 3.45 mm, respectively. Statistically significant increases in the amount of new cementum were observed in groups BG and BO/BG when compared with OFD (P periodontal ligament, and significant increases in the amount of new cementum when compared to open flap debridement in a canine model.
-
Differentiation of periapical granulomas and cysts by using dental MRI: a pilot study.
Juerchott, Alexander; Pfefferle, Thorsten; Flechtenmacher, Christa; Mente, Johannes; Bendszus, Martin; Heiland, Sabine; Hilgenfeld, Tim
2018-05-17
The purpose of this pilot study was to evaluate whether periapical granulomas can be differentiated from periapical cysts in vivo by using dental magnetic resonance imaging (MRI). Prior to apicoectomy, 11 patients with radiographically confirmed periapical lesions underwent dental MRI, including fat-saturated T2-weighted (T2wFS) images, non-contrast-enhanced T1-weighted images with and without fat saturation (T1w/T1wFS), and contrast-enhanced fat-saturated T1-weighted (T1wFS+C) images. Two independent observers performed structured image analysis of MRI datasets twice. A total of 15 diagnostic MRI criteria were evaluated, and histopathological results (6 granulomas and 5 cysts) were compared with MRI characteristics. Statistical analysis was performed using intraclass correlation coefficient (ICC), Cohen's kappa (κ), Mann-Whitney U-test and Fisher's exact test. Lesion identification and consecutive structured image analysis was possible on T2wFS and T1wFS+C MRI images. A high reproducibility was shown for MRI measurements of the maximum lesion diameter (intraobserver ICC = 0.996/0.998; interobserver ICC = 0.997), for the "peripheral rim" thickness (intraobserver ICC = 0.988/0.984; interobserver ICC = 0.970), and for all non-quantitative MRI criteria (intraobserver-κ = 0.990/0.995; interobserver-κ = 0.988). In accordance with histopathological results, six MRI criteria allowed for a clear differentiation between cysts and granulomas: (1) outer margin of lesion, (2) texture of "peripheral rim" in T1wFS+C, (3) texture of "lesion center" in T2wFS, (4) surrounding tissue involvement in T2wFS, (5) surrounding tissue involvement in T1wFS+C and (6) maximum "peripheral rim" thickness (all: P periapical cysts and granulomas in vivo. Thus, MRI may substantially improve treatment strategies and help to avoid unnecessary surgery in apical periodontitis.
-
Zamparini, Fausto; Siboni, Francesco; Prati, Carlo; Taddei, Paola; Gandolfi, Maria Giovanna
2018-05-08
periodontal tissue regeneration. As premixed materials, their application in endodontics may result easier in several complex endodontic situations (apicoectomy, root perforation, presence of wide/wet apices).