Influence of root width and dentin wall thickness evaluated by endoscopy upon the outcome of periapical surgery. A cohort study.

BACKGROUND: An analysis was made of the correlation between root width, the thickness of the remaining dentinal wall as determined by endoscopy, and the outcome of periapical surgery. MATERIAL AND METHODS: A retrospective cohort study was carried out involving patients subjected to periapical surgery between 2017 and 2019 at the University of Valencia (Valencia, Spain). One year after surgery, cone-beam computed tomography (CBCT) was used to evaluate healing against the preoperative volumes. The maximum root width was measured on the postoperative CBCT scan at the apical section of the treated root. This measurement was transferred to the intraoperative endoscopic image, where the minimum root width, peripheral dentin thickness, and minimum dentin thickness were recorded. Root measurements, and the position (maxillary or mandibular) and type of tooth (roots of incisors, canines, premolars or molars) were further correlated to periapical surgery outcome. RESULTS: A total of 51 patients, comprising 52 teeth and 62 roots, were included in the study. The mean measurements were: maximum root width (4.13±0.84 mm), minimum root width (2.46±0.72 mm), peripheral dentin thickness (0.77±0.2 mm) and minimum dentin thickness (0.4±0.2 mm). The success rate was 82.2%. Premolar roots showed a greater minimum dentin thickness (0.58±0.25 mm) (p<0.003) than incisor roots. No significant association was found between the different measurements and the healing rate at one year, though the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly. The position and type of tooth did not influence healing outcome. CONCLUSIONS: The root width and thickness of the remaining dentin wall did not significantly influence healing. However, the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly.

Endoscopic findings in periapical surgery. A cross-sectional study of 206 roots.

BACKGROUND: A study is made of the findings of high-magnification rigid endoscopy at the root end surface following apicoectomy of teeth subjected to periapical surgery. MATERIAL AND METHODS: A cross-sectional study was made of patients subjected to periapical surgery at the Unit of Oral Surgery and Implantology (University of Valencia, Valencia, Spain) between 2011 and 2019. Following apicoectomy, the root end surfaces were inspected, with the evaluation of untreated canals, isthmuses, craze lines, crack lines, opaque dentin and gaps. Likewise, an analysis was made of the association between patient age and the tooth type and restoration and the presence of craze lines, cracks, opaque dentin and gaps. RESULTS: The final sample consisted of 168 patients subjected to periapical surgery, with 177 operated teeth and 206 roots. Untreated canals were observed in 14 roots (6.8%). Isthmuses were identified in 74 roots (35.9%), particularly in the mesial root of the lower first molar (94.1%). In turn, craze lines were identified in 8.3% of the roots, cracks in 3.9%, and gaps in 53.4%. The prevalence of opaque dentin was 78.3%, with a greater presence in posterior teeth (90.3% in premolars and 86.2% in molars) than in anterior teeth (50.6%) (p<0.001). Patient age and tooth restoration showed no correlation to the studied parameters. CONCLUSIONS: Craze lines and crack lines were observed in less than 10% of the roots, though opaque dentin was identified in 73% of the roots, particularly in posterior teeth, and gaps were found in over half of the canals.

Is periapical surgery follow-up with only two-dimensional radiographs reliable? A retrospective cohort type sensitivity study.

BACKGROUND: Two-dimensional (2D) radiographic techniques are commonly used for assessing lesion prognosis after endodontic surgery. The present retrospective cohort study analyzes the sensitivity and ability of different radiographic techniques in obtaining area and volume measurements of periapical lesions. MATERIAL AND METHODS: Preoperative and follow-up (6-48 months) periapical and panoramic radiographs (index test) and cone-beam computed tomography (CBCT) images (reference standard) were selected from an endodontic microsurgery database. Sensitivity was analyzed independently by two examiners. The areas of the 2D radiographic images and CBCT volumes were studied using Itk-Snap software and Romexis viewer. RESULTS: The sample comprised 105 patients and 105 teeth, with a mean follow-up of 21 months (range 6-48). Preoperatively, CBCT detected all the periapical areas, periapical radiography detected 67, and panoramic radiography detected 60. Postoperatively, of the 52 cases in which CBCT detected remains of the periapical area, periapical radiography detected 22, and panoramic radiography detected 17. The measurements of the areas obtained by the 2D methods, and the volumes obtained by CBCT, had to be transformed into linear measures for comparison purposes. The measurements were found to be significantly different in both the preoperative and the follow-up images. CONCLUSIONS:  Periapical radiography showed greater sensitivity than panoramic radiography, both preoperatively and at follow-up. The lesions measured with CBCT were larger, with significant differences than as evidenced by the periapical and panoramic radiographs.

Estudio comparativo de la fiabilidad y reproducibilidad de los tamaños MEDIODISTA LES y las medidas de la arcada dentaria, entre la tomografía Computarizada de haz cónico (CBCT ) y un método digital / No disponible

Introducción: La introducción de herramientas diagnósticas como Tomografía Computarizada de Haz Cónico (CBCT) y su aplicación clínica a la imagen dentofacial en 3D, es una de las materias más interesantes y más novedosas actualmente en Ortodoncia permitiendo obtener imágenes tridimensionales de los dientes y por lo tanto, realizar mediciones sobre las mismas. Objetivos: Valorar la fiabilidad y reproducibilidad de los tamaños mesiodistales y las medidas de la arcada dentaría, entre un Método Tridimensional (CBCT) y un Método Digital. Material y método: La muestra estaba compuesta de 50 pacientes a los que se les realizó un CBCT como parte de su diagnóstico ortodóncico. El CBCT utilizado fue el Dental Picasso (..) (AU)

Introduction: The introduction of diagnostic tools such as Cone Beam Computed Tomography (CBCT) and its clinical application to dentofacial 3D image, is one of the most interesting materials and latest in Orthodontics currently possible to obtain three-dimensional images of the teeth and therefore measurements on them. Objectives: To assess the reliability and reproducibility of tooth size and dental arch measurements between a Three Dimensional Method (CBCT) and a digital one. Material and Methods: The sample consisted of 50 patients who underwent a CBCT as part of orthodontic diagnosis. The CBCT used was Picasso Master 3D ®. The images were sent in DICOM format to secure the company’s Web In Vivo Dental (Anatomage, San Jose, California) to obtain three-dimensional images of the models. To make comparative studies were made of plaster study models these (..) (AU)