Automatic Classification System for Periapical Lesions in Cone-Beam Computed Tomography.

Imaging examinations are of remarkable importance for diagnostic support in Dentistry. Imaging techniques allow analysis of dental and maxillofacial tissues (e.g., bone, dentine, and enamel) that are inaccessible through clinical examination, which aids in the diagnosis of diseases as well as treatment planning. The analysis of imaging exams is not trivial; so, it is usually performed by oral and maxillofacial radiologists. The increasing demand for imaging examinations motivates the development of an automatic classification system for diagnostic support, as proposed in this paper, in which we aim to classify teeth as healthy or with endodontic lesion. The classification system was developed based on a Siamese Network combined with the use of convolutional neural networks with transfer learning for VGG-16 and DenseNet-121 networks. For this purpose, a database with 1000 sagittal and coronal sections of cone-beam CT scans was used. The results in terms of accuracy, recall, precision, specificity, and F1-score show that the proposed system has a satisfactory classification performance. The innovative automatic classification system led to an accuracy of about 70%. The work is pioneer since, to the authors knowledge, no other previous work has used a Siamese Network for the purpose of classifying teeth as healthy or with endodontic lesion, based on cone-beam computed tomography images.

Impact of Periodontal Attachment Loss on the Outcome of Endodontic Microsurgery: A Systematic Review and Meta-Analysis.

Background and Objectives: Endodontic microsurgery (EMS) aims to eradicate the sources of infection once the apical root resection removes most of the infected anatomical structures and repairs potential procedural errors in the apical region. An endodontic-periodontal lesion yields a pathological communication between the pulp and the periodontium. The purpose of this systematic review and meta-analysis is to evaluate the impact of periodontal attachment loss on the outcome of teeth submitted to EMS. Materials and Methods: PRISMA guidelines were followed. An electronic search was performed in EBSCOhost, Embase and PubMed databases with the following search key: ("endodontic microsurgery" AND "outcome"). No filters were used concerning the year of publication or language. Only randomized clinical trials, prospective and retrospective clinical studies in humans, with a minimum one-year follow-up, defined clinical and radiographic outcome criteria and estimable success rate for endodontic-periodontal lesion were included. Statistical analysis was performed using OpenMeta[Analyst] software. Results: Of a total of 113 articles, 34 were selected for full-text reading after duplicates deletion and title and abstract analysis. Thirteen and six studies were included in the systematic review and meta-analysis, respectively. A total of 2775 pooled teeth were submitted to EMS, of which 492 teeth and 4 roots had periodontal involvement. According to the qualitative analysis, success rates of the endodontic-periodontal group ranged from 67.6% to 88.2%. Meta-analysis revealed that the absence of periodontal attachment loss was predictive of a higher likelihood of success with an odds ratio of 3.14. Conclusions: Periodontal attachment loss presents a risk factor for EMS outcome. Although endodontic-periodontal lesions were associated with lower success rates considering a 1 to 10 years follow-up period, long-term successful prognosis following EMS has been reported, therefore presenting a fully valid and viable therapeutic option for the management of this type of lesions.

Lesions Misdiagnosed as Endodontic Pathosis: A Narrative Review.

In daily practice, clinicians come across certain radiographic abnormalities which may or may not be asymptomatic. This abstract discusses radiographic abnormalities encountered by clinicians in daily practice, some of which resemble endodontic lesions. Prompt attention is crucial as these lesions can be benign or malignant. The article emphasizes the importance of differential diagnosis for accurate identification of periapical pathosis.

Successful Management of a Rare Distant Endodontic Lesion: A Case Report.

The current case report aims to document a rare presentation of a distant odontogenic lesion of a 35-year-old male patient with mild clinical discomfort in the mandibular right first molar; exploring the diagnostic and therapeutic intricacies of an uncommon distant endodontic pathosis ultimately resolved through meticulous nonsurgical retreatment. Despite a normal oral examination, diagnostic radiography revealed a suboptimal root canal treatment and apical lesions surrounding mesial- and distal-root apices; including a distinct radiolucency beneath the apex of the second mandibular molar discovered through panoramic radiography, and confirmed via cone-beam computed tomography. In addition, the computed tomography disclosed a previously unreported and unusually large endodontic lesion that extended toward the mandibular canal; highlighting a necessity for the continued exploration of a unique endodontic presentation. A nonsurgical endodontic retreatment led to a remarkable reduction in the radiolucent lesions within one year; emphasizing the significance of comprehensive diagnostic approaches and individualized treatments.

Surgical treatment of endo-periodontal lesion - а case report.

The interrelationship between periodontium and pulp makes the treatment of combined endo-periodontal lesions (EPL) more challenging. It involves successful elimination of both periodontal and endodontic lesion. The current case report represents the efficacy of regenerative potential of enamel matrix derivates (Emdogain®) in endo-periodontal lesion after successful endodontic treatment. A 39-year-old woman presented with EPL on a left first mandibular molar. After the initial 3 months of healing, the clinical examination showed that the furcation involvement still prevailed. A decision was made to use a regenerative procedure using Emdogain®. Fourteen months after the procedure, full periodontal regeneration can be seen on the X-ray. The results demonstrated the synergetic effect of the endodontic and periodontal therapy that changed the prognosis for the tooth.

Treatment of a Hopeless Tooth with Combined Endodontic-periodontal Lesion Using Guided Tissue Regeneration: A Case Report with One Year Follow-up.

Endodontic-periodontal lesions have always been a challenge for treatment due to the reduced success rate in comparison to endodontic or periodontal lesions alone. This case report describes surgical/endodontic management of supra-erupted non-vital maxillary incisor with primary periodontal and secondary endodontic lesions with mobility grade III and severe horizontal and vertical loss of attachment apparatus in a 55 years old woman with aggressive periodontitis. The successful results at one-year follow-up revealed that with an appropriate case selection strategy, proper regeneration method and soft tissue enhancement, severe combined endo-perio lesions may treat.

Is odontogenic keratocyst an endodontic enigma? A rare case report of management of odontogenic keratocyst in anterior mandible.

Odontogenic keratocyst (OKC), a rare, locally aggressive developmental cyst, is found incidentally on dental radiographs, most commonly in the posterior mandible. When it occurs in the periapical region in association with nonresponding teeth to pulp sensibility tests, it is often misdiagnosed as other endodontic lesions such as radicular cyst, lateral periodontal cyst and dentigerous cyst. This case report describes the rare occurrence of OKC in the anterior mandibular region managed successfully with endodontic treatment and re-interventional surgery in a conservative approach. This case report also emphasizes on the importance of histopathological examination of the surgically excised tissue specimens as the clinical, radiographic and histopathological correlations are essential for successful treatment.

Atypically grown large periradicular cyst affecting adjacent teeth and leading to confounding diagnosis of non-endodontic pathology.

This article reports a case of a large osteolytic lesion in the mandible, mostly associated with the apices of the premolars, and suspected as having a non-endodontic origin because the 2 premolars responded positively to the cold sensibility test. The distal border of the lesion reached the mesial root of the first molar, which also had a small lesion in its distal aspect. Cone-beam computed tomography revealed that the large lesion communicated with the small molar lesion. Because the large lesion was suspected as having a non-endodontic origin, surgery was scheduled for enucleation and biopsy. The molar was root canal-retreated, and the 2 premolars treated. Histologic analysis of the premolar pulps showed vitality but advanced degenerative changes. The lesion was histologically diagnosed as an inflammatory periradicular cyst, which originated in the first molar and had an atypical growth to the premolar area. Follow-up revealed that the affected area healed uneventfully.

Apical periodontitis induces changes on oxidative stress parameters and increases Na+/K+-ATPase activity in adult rats.

OBJECTIVES: Endodontic infection can cause systemic alterations. The involvement of oxidative stress (OS) and transmembrane enzymes compose the pathogenesis of various systemic diseases. However, the relation among apical periodontitis (AP), OS parameters, and Na+/K+-ATPase (NKA) pump was not reported in the literature. This study evaluated the AP influence on OS parameters and NKA activity in adult rats. METHODS: Adult male Wistar rats (sixteen weeks old) were randomly assigned to two experimental groups: control (CT group; n = 8) and AP (AP group; n = 9), which was induced in the first right mandibular molar tooth. After 21 days of AP induction, mandibles were dissected for radiographic analysis. In addition, the heart, liver, pancreas, and kidney were collected for analysis of endogenous OS parameters and NKA activity. Data were analyzed by Student's T-test. Values of p < 0.05 were considered statistically significant. RESULTS: AP presence increased reactive species (RS) generation only in the heart, while the other analyzed organs did not have this parameter modified. Heart and pancreas had a decreased endogenous antioxidant system (catalase activity and vitamin C levels), liver and kidney had an increased one. AP increased NKA activity in the heart, liver, and pancreas, but not in the kidney. CONCLUSION: The modulation of both endogenous antioxidant defense system and NKA activity in vital organs suggested that alterations in the antioxidant status and cellular electrochemical gradient may be involved in the AP pathophysiology.

The Use of Antimicrobial Photodynamic Therapy to Maintain a Hopeless Tooth With a PeriodonticEndodontic Lesion: A Case Report.

Background: In spite of some advances in periodontal generative methods, it is impossible to stop progressive Loss of supporting alveolar bone in some end-stage periodontitis. The aim of this study is to report a kind of treatment modality which was seemed to be successes full in maintaining teeth. In this case-report, a hopeless tooth was saved by combined non-surgical periodontalendodontal treatment and antimicrobial photodynamic therapy (aPDT). Case Report: A 58-year-old male presented with a chief complaint of pain and mobility of tooth number 38. Clinical examinations revealed a periodontic-endodontic lesion with clinical attachment loss exceeding 10 mm and grade III mobility. To preserve the tooth, we operated nonsurgical periodontal treatment including scaling and root planning (SRP) plus root canal therapy (RCT) combined with intra-root canal non-aPDT laser decontamination. Then we applied laser pocket therapy with and without aPDT. Following 6 months of the aPDT treatment, the mobility and pocket depth of the tooth improved from grade III to I and from 10 to 3 millimeters respectively. Conclusion: aPDT is a novel adjunctive therapy that can be used for various conditions with microbial etiology. This case report demonstrated that aPDT might be effective in the treatment of periodontic-endodontic lesions in a hopeless tooth.

Successful management of a tooth with endodontic-periodontal lesion: A case report.

BACKGROUND: Endodontic-periodontal lesion is a commonly encountered dental condition. However, the prognosis of the condition varies from good to poor. Some cases are associated with a poor prognosis that requires tooth extraction. This report presents a case of an endodontic-periodontal lesion in a tooth that was successfully treated by root canal treatment. CASE SUMMARY: A 51-year-old female patient with no medical history complained about persistent pain and discomfort in her left mandibular first molar. Clinical examination showed the left mandibular first molar with poor restoration. It was also associated with underlying necrotic pulp and periodontal involvement. Radiographic examination revealed visible bone defects in the apical and periodontal areas. Based on the findings, the patient was diagnosed with a primary endodontic lesion. A root canal treatment for the endodontic lesion was performed. The patient received a coronal all-ceramic endocrown restoration. A follow-up was arranged to check the prognosis. At the 3 mo follow-up, the clinical and radiography evaluations showed complete disappearance of signs and symptoms and an increase in the radiopacity of the root area. CONCLUSION: Despite the poor prognosis associated with many endodontic lesions, this case report highlights that a good prognosis is still possible for an endodontic lesion with apical and periodontal bone loss. In this case, it was achieved via successful root canal treatment without the need for periodontal or surgical intervention.

Dynamics of Bone Loss in Cases with Acute or Chronic Apical Abscess.

INTRODUCTION: Acute and chronic apical abscesses are 2 dramatic ways that periradicular tissues may react to pulpal infection and necrosis. Although both of these clinical states are the response to pulpal infection, their clinical manifestations are significantly different. It is not clear why the body responds to root canal infection in one way or another. The objective of this study was to evaluate the size and pattern of bone loss in patients with acute apical abscess (AAA) and chronic apical abscess (CAA) using cone-beam computed tomographic images. METHODS: Twenty-three cone-beam computed tomographic images of cases with AAA and 25 cases with CAA were selected and evaluated. The presence and location of fenestration and the volume and pattern of the periradicular lesions were recorded and compared between the 2 groups using the Fisher exact and Mann-Whitney U tests. RESULTS: One hundred percent of cases with CAA had cortical fenestration, but only 47% of cases with AAA had cortical fenestration (P < .05). The median volume of the lesions was 233 mm3 in the CAA group and 109 mm3 in the AAA group (P > .05). CAA cases, in comparison with the AAA group, had a relatively larger cortical disruptions. CONCLUSIONS: Cortical fenestration is fundamental for the development of CAA. However, periradicular lesions without evident cortical fenestration can still cause AAA and fascial space involvement.

Intentional Replantation with a 2-segment Restoration Method to Treat Severe Palatogingival Grooves in the Maxillary Lateral Incisor: A Report of 3 Cases.

The palatogingival groove is a developmental anomaly that typically starts near the cingulum of the maxillary incisors and extends along the roots at varying lengths and depths. Severe grooves that extend to the root apex often lead to complex combined periodontal-endodontic lesions. There are various therapeutic options available for these cases; however, the prognosis is unfavorable. Here, we report the successful surgical treatment of 3 cases of maxillary lateral incisors with severe palatogingival grooves using intentional replantation with a 2-segment restoration method. The teeth were gently extracted, resulting in minimal damage to the periodontal ligament. Under a dental operating microscope, 3 mm of the root end was resected. The palatogingival groove was removed, and root-end preparation was performed with a #700 fissure bur. The groove cavity was connected with root-end cavity to form a class II cavity. The cavity was then filled using a 2-segment restoration method (ie, dividing the cavity into 2 parts by the cementoenamel junction, the coronal portion was filled with a flowable composite while the radicular portion, including the root-end cavity, was filled with bioceramics). The tooth was then replanted into its alveolar bone and splinted with a flexible splint for 7 days. The sinus tract was closed at the 1-week postoperative visit. During subsequent recalls, the teeth showed almost complete periapical healing. In summary, intentional replantation with a 2-segment restoration method is a viable treatment modality for single-rooted teeth with a severe palatogingival groove that extends to the root apex.

[Time lapse between endodontic and periodontal treatments of combined periodontal-endodontic lesion: a systematic review].

OBJECTIVE: This study aims to evaluate the time lapse between the endodontic and periodontal treatments of the combined periodontal-endodontic lesion to guide the clinical treatment. METHODS: A systemic literature search was performed in articles published from 1980 to March 2017 using the electronic databases, including PubMed, EMbase, Cochrane, Web of Science, CNKI, CBM, and Wanfang Databases. RESULTS: After screening, two randomized controlled trials, two prospective case series studies, and eight case reports were ultimately included. All clinical studies and case reports were treated with root canal therapy and periodontal nonsurgical or periodontal surgical treatment, with root canal therapy as the initial treatment step. Changes in the periodontal probing depth and attachment loss were reported in all clinical studies and case reports. CONCLUSIONS: An observational period between the endodontic and periodontal nonsurgical treatments may not be required. However, given that the quality of several included studies was limited, and the number of randomized controlled trials was small, a large number of randomized controlled trials are needed to verify this result.

The Impact of Endodontic Infections on the Pathogenesis of Cardiovascular Disease(s): A Systematic Review with Meta-analysis Using GRADE.

INTRODUCTION: The purpose of this systematic review was to determine whether endodontic infections had an impact on the pathogenesis of systemic disease. METHODS: Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies, gray literature of all relevant articles, and textbooks were manually searched. There was no disagreement between the 2 reviewers. RESULTS: Four articles met the inclusion criteria with a high risk of bias. Three articles were analyzed for quantitative synthesis. All these articles were regarding cardiovascular disease (CVD). There was low-certainty evidence that a lesion of endodontic origin can contribute to systemic disease, 95% confidence interval, risk ratio 1.2 (0.79-1.83). Owing to high heterogeneity among the studies, sub-group analysis was undertaken. The results reported more consistent outcome with risk ratio 0.95 (0.75-1.21) and low certainty. Therefore, the authors have limited confidence in the effect estimate, which indicates that the true effect may be substantially different from the estimate of the effect. CONCLUSIONS: Whether the presence of a lesion of endodontic origin may or may not have some impact on cardiovascular disease, the level of evidence is low, and our confidence in the assessment is low. This systematic review raised questions in the designs and analysis of the data, and further well-conducted longitudinal research would be required to make this causality claim.

Collaborative Management of Combined Periodontal-endodontic Lesions with a Palatogingival Groove: A Case Series.

INTRODUCTION: This article reports 3 representative cases of interdisciplinary management of a palatogingival groove in maxillary lateral incisors. The development, pathology, and effectiveness of management approaches in cases involving a combined periodontal-endodontic lesion with a palatogingival groove are discussed. METHODS: We describe 3 patients with a noncontributory medical history presenting with a chief complaint related to a maxillary incisor and diagnosed with a combined periodontal-endodontic lesion with a palatogingival groove at Seoul National University Dental Hospital, Seoul, Korea. RESULTS: Palatogingival grooves were mostly associated with deep periodontal pockets connected to a periapical lesion. Optional collaborative treatments were performed according to the condition as follows: case 1, root canal treatment (RCT), open flap debridement, odontoplasty, and guided tissue regeneration; case 2, RCT, apicoectomy, open flap debridement, and odontoplasty; and case 3, RCT, crown restoration, root planning, and odontoplasty. After clinical examination and radiographic assessments, the periapical lesion and periodontal deep pocket were successfully resolved with periodontal-endodontic collaborative treatment involving both periodontal surgical procedures (cases 1 and 2) and a nonsurgical procedure (case 3). CONCLUSIONS: Within the limitations of this study, these case reports show that accurate diagnosis of developmental anomalies and elimination of inflammatory irritants are key factors for favorable long-term outcomes.

Use of an amniotic membrane as a novel barrier in a tooth with a questionable prognosis.

The chief goal of combination therapy using guided tissue regeneration along with bone grafts is to optimally and predictably regenerate the periodontal attachment apparatus. The evolution of regenerative therapy along with careful patient selection and treatment planning can have positive results even in cases which are not ideal. The present case report describes a tooth with a questionable prognosis treated successively by endodontic then periodontal therapy using an amniotic membrane along with a bone graft to treat an intrabony defect. The follow-up, 12 months later showed a resolution of the interradicular lesion and a radiographic bone fill.

Management of palato radicular groove in a maxillary lateral incisor.

This study is to report the rare localization of a radicular groove on the palatal aspect of the maxillary lateral incisor and to discuss the pathology and management of the concomitant endo-periodontal defect. Unilateral palato-radicular groove was located on the Maxillary right lateral incisor of an 18-year-old female patient. The groove was associated with deep local periodontal pocket resulting in pulp necrosis and the formation of a large periapical lesion. A collaborative management was carried out using a combination of endodontic therapy, surgical enucleation, odontoplasty, and periodontal regenerative procedure resulting the successful healing of the periapical lesion.

Management of failed periodontal surgical intervention for a furcal lesion with a nonsurgical endodontic approach.

As long as the prognosis of teeth remains a matter of concern, the endodontic-periodontal relationship will be considered a challenge for the clinician. Many etiologic factors, including bacteria, fungi, and viruses, plus other contributing factors, such as trauma, root resorptions/perforations, and dental malformations, play a role in the co-occurrence of endodontic and periodontal lesions. Whatever the cause, a correct diagnosis on which to base the treatment plan is the key to successful maintenance of the tooth. This article reports the successful endodontic management of a furcation lesion in a mandibular molar that was nonresponsive to a previous periodontal surgical graft. The case had presented a diagnostic challenge for the clinicians, and this article reviews the key points that can lead to a correct diagnosis and treatment planning.