جستجوی مقالات مرتبط با کلیدواژه « periapical re » در نشریات گروه « پزشکی »

Untreated canals represent the primary cause of treatment failure in molars and the second leading cause in other dental groups. This study determined the prevalence of untreated canals and their relationship with periapical periodontitis using cone -beam computed tomography (CBCT) images.

385 CBCT images with at least one treated canal were selected from the oral and maxillofacial radiology center. The number of roots and canals, presence, and size of periapical pathology, and presence of untreated canals were recorded. The study used descriptive statistics and Chi -square, Fisher's exact, and odds ratio tests to analyze data.

Of the 2053 teeth examined, 14.9% had at least one untreated canal. Untreated canals in teeth increase the chance of having a periapical lesion, raising the prevalence by 11 times. Of these, 91.8% had both untreated canals and periapical lesions. This was more than teeth without untreated canals (35.8%). Most untreated canals were in maxillary molars (65.3%), and mandibular molars (12.54%). There was a statistically significant relationship (P<0.001) between the number of roots, canals, expansion, destruction, and jaw type with the prevalence of untreated canals. The maxillary first molar (68.66%) and second mesiobuccal (MB2 ) canal (63.27%) had the highest percentages of untreated canals.

The MB2 had the highest prevalence of untreated canals. The presence of untreated canals significantly increased the risk of expansion and/or destruction. Therefore, identifying these conditions can also be useful in diagnosing untreated canals .Dentists should assess the anatomy of the tooth and the structure of the root canal to minimize the possibility of an untreated canal. CBCT can assist in this process.

Apical periodontitis (AP) is a common inflammatory condition predominantly caused by the response of the immune system to microbial invasion within the root canal system. Contrary to conventional perception, AP may occur in vital teeth with inflamed pulp; adding complexity to diagnosis and treatment. AP, due to its frequent lack of symptoms and reliance on radiographic evaluation for detection, often presents diagnostic challenges. In addition, AP pathogenesis involves complex interactions between microbialvirulence and host immune response at the cellular and molecular levels. Comprehensive diagnostic procedures, including patient history, clinical examination, and radiographic evaluation, are essential for early detection and necessary intervention, with the recognition of clinical signs and symptoms underscoring the importance of regular dental evaluations. The current review primarily discusses the radiographic and clinical features of AP in vital and non-vital teeth; introducing a new taxonomic classification to improve diagnostic precision and treatment outcomes. Moreover, it proposes different treatment categories/options for the management of AP, based on pulp status as well as clinical and radiographic findings; emphasizing vital pulp therapy and root canal treatment for vital and non-vital teeth with AP, respectively. Furthermore, the global and regional epidemiology of AP is presented, along with its association with systemic health conditions; e.g., cardiovascular diseases, diabetes mellitus, and adverse pregnancy outcomes. Moreover, future research directions are advocated to improve the efficacy and predictability of diagnosis and treatments; paving the path for clinicians in early detection, accurate diagnosis, and effective management of AP to enhance oral health outcomes

Foraminal Enlargement (FE) is a cleaning performed in the apical-most region of the tooth, in order to optimize root disinfection. This systematic review evaluated the influence of FE during root canal treatment on bacterial reduction and repair of the periapical lesion.

Searches in PubMed/MEDLINE, Scopus, Cochrane Library, Web of Science, Embase, Scielo, Lilacs and OpenGrey were performed until January-2024. Ex vivoand in vivostudies evaluating the effects of FE in the bacterial reduction and repair of the periapical lesion were included, respectively, followed by risk of bias assessment (modified version of Joanna Briggs Institute’s for ex vivostudies and Systematic Review Centre for Laboratory animal Experimentation’s risk of bias tools for in vivostudies). The meta-analysis was not feasible and a qualitative summary for each outcome was provided.

Of 950 studies, 2 in vivostudies were eligible, using animal models with infected teeth. Of these two, periapical repair was evaluated with hematoxylin-eosin stain, and FE improved periapical healing. Regarding ex vivo studies, 3 were eligible, using extracted human teeth. The inoculations in ex vivomodels were performed with Enterococcus (E.) faecalis, and FE reduced E. faecalis in the ex vivomodels.

Foraminal enlargementseems to increase bacterial reduction within the root canal, and provide major periapical tissue repair on the histological analysisin animal studies. However, caution is necessary when translating these results to the clinical environment.

Statement of the Problem: 

Periapical cyst and granuloma are inflammatory endodontic lesions. Periapical granuloma usually heals spontaneously after endodontic treatment; however, periapical cyst mostly needs to be removed via surgical approaches. Although some clinicians believe that microscopic examination of periapical lesions is unnecessary, it is proved that some of them has non-endodontic nature that need critical consideration.

The purpose of this study was to assess the disagreement between clinico-radiographic and microscopic diagnosis of periapical cysts and granulomas in a major center of oral pathology service in Iran.

In this retrospective, descriptive cross-sectional study, the archives of the oral and maxillofacial pathology department of Shahid Beheshti University of Medical Sciences served as the source of the material during an 18-year-period for this retrospective, descriptive cross-sectional study. The reports of all patients whose initial clinical diagnosis was a periapical cyst/granuloma were extracted.

 In the present study, 474 cases were diagnosed with a periapical cyst/granuloma clinico-radiographically, of which 61 cases (12.86%) received a microscopic diagnosis of a non-endodontic pathology. The most frequent lesion was odontogenic keratocyst (n= 12, 19.67%) followed by infected odontogenic cyst (n= 12, 19.67%). About 21.31% of diagnoses were non-cystic lesions and 4.9% were malignancies. The most odontogenic tumors that were diagnosed as periapical cyst/granuloma in clinico-radiography were the ameloblastoma variants (n= 4, 6.55%).

 A wide variety of microscopic diagnoses, including aggressive lesions such as ameloblastoma, as well as other malignant lesions was noted in this study. These misdiagnoses can lead to an inappropriate treatment plan. It is important to microscopically examine all lesions removed from the jaw.

Periapical radiolucency occurs due to root canal infections. In this respect, effective root canal treatment and appropriate coronal restoration can aid in preventing these lesions. Thus, the present study aimed to assess the periapical status in posterior root canal-treated teeth by cone-beam computed tomography (CBCT) in the Iranian population.

The CBCT images of 210 patients (475 endodontically treated molars and premolars) referred to the Hamadan Dental School (from 2020 to 2022) were evaluated in this observational study. The images were obtained by a NewTom 3G CBCT device (NewTom, Verona, Italy) with an FOV of 6×6 inches at 110 kVp and varying milliampers and exposure times according to the patient’s age and body size. They were observed by two maxillofacial radiologists who recorded the periapical status, coronal seal, and endodontic treatment quality of root canal-treated teeth. The Chi-square test was used for data analysis (P≤0.05). Finally, the periapical lesion was determined, along with its association with gender, type of tooth, endodontic treatment quality, and appropriate restoration.

The results revealed no significant association between periapical radiolucency and gender. The prevalence of periapical lesions was higher in males aged 25–50 years, but no significant correlation was found in this regard. There was no significant relationship between tooth type and the presence of periapical lesions, while it had the highest prevalence in maxillary molars. Endodontic treatment quality and coronal restoration showed significant correlations with the presence of periapical radiolucency.

There was no significant association between the presence of periapical radiolucency and gender and age. The prevalence of periapical lesions was higher in males. Cases with poor endodontic treatment and poor restoration demonstrated the highest prevalence of periapical lesions.

An untreated root canal in an endodontically treated tooth can lead to periapical lesions which can ultimately result in necrosis and inflammation of the pulp or destruction of periodontal tissues. This study was conducted to determine the prevalence of periapical radiolucency in endodontically treated teeth with untreated canals identified by CBCT.

In this analytical cross-sectional observational study, a total of 326 maxillary and mandibular premolars and molars with 775 root canals with previous root canal treatment obtained from CBCT images from the archives of the Radiology Center of the Faculty of Dentistry of Azad University of Isfahan (Khorasgan) were examined. , The study recorded the number of teeth and roots, presence/absence of periapical lesions, and untreated canals. Data were analyzed using chi-square and Fisher's exact tests.(α=0.05)

A total of 38 cases (4.9%) showed untreated canals, with the second mesiobuccal canal being the most common type (57.9%) and the maxillary first molar having the highest number of untreated canals (52.6%). In 125 canals (16.1%), apical periodontitis lesions were detected. There was a significant difference between the frequency of untreated canals in the endodontically treated maxillary premolars and molars, mandibular premolars, and molars (p<0.05). Similarly, there was a significant difference in the frequency of apical periodontitis between endodontically treated maxillary premolars and molars, and mandibular premolars and molars (p<0.001).

Apical periodontitis is more common in the second mesiobuccal canal of maxillary first molars that have not undergone successful root canal treatment.

The presented study aimed to characterise periapical disease in teeth with primary non-surgical root canal treatment in persistent or emergent categories and their risk association.

A retrospective observational study that evaluated permanent teeth with primary non-surgical root canal treatment, was conducted clinically and radiographically for over one year. The following variables were analysed: gender, age, type and location of tooth, previous diagnosis, treatment conditions, and type of coronalrestoration. The supplementary variables included the perspectives of the treatment outcome, such as Remains normal, Improvement, and Failure. Statistical analysis was performed using a univariate analysis that estimated the average and proportion for each factor according to the result of the primary non-surgical root canal treatment. The multiple correspondence analysis identified the hierarchy between active variables and their association with the results.

A total of 232 teeth in 155 participants were analysed. A χ2 value, (P=0.023) showed that the emergent disease is associated with patients around the age of 50. The multiple correspondence analysis identified a tendency of grouping between the emergent disease and the short filling category, followed by symptomatic pulpitis as a previous diagnosis. The persistent disease was associated with errors and overfillings. An inadequate root filling and taper density adversely impacted the treatment outcome.

The length of obturation influenced the presence of failure. Short fillings were associated with emerging periapical disease. Errors and overfillings contributed to the persistent disease in the populations studied.

Introduction How to save more bone for the teeth of patients with chronic periapical periodontitis with intact or small defects of the labiobuccal cortical plate in the periapical surgeries is a problem that many dentists are concerned about. The Hypothesis: We came up with a new strategy for periapical surgery by designing a modified osteotomy and fenestration method, which we named the “guiding groove” method. There are two ways to achieve this, one is to perform guided groove positioning under CBCT dynamic navigation, and the other is to design a guide plate that marks the position and direction of the guided groove based on CBCT data before surgery. Evaluation of the Hypothesis: The existence of the “guiding groove” locks in the angle and direction of the ultrasonic root end preparation and retrofilling apparatus, which not only minimizes the deviation of the root canal but also preserves more cortical plate on the labial and buccal sides of the teeth and thus improves the efficiency of treatment. This hypothesis has certain limitations. Firstly, the technical sensitivity of the operation is high, and proficiency in CBCT dynamic navigation technology is required. The accuracy requirements for navigation equipment are also relatively high. It will also increase the patient’s exposure to X-rays. For the guide plate designed before surgery that has already marked the position of the guide groove, it can only accurately avoid the deviation of the operating instrument in the proximal and distal directions, and it is difficult to avoid the deviation of the instrument in the buccal and lingual directions.

Management of a skin dimpling due to a chronic periapical lesion may pose challenges. This case report presents a multidisciplinary approach to resolving a persistent cutaneous scar of endodontic origin and also offers a flowchart for the management of similar cases.

Case report: 

A 34-year-old female referred to the Endodontics Department of Mashhad Dental School at Mashhad University of Medical Sciences, complained of a skin dimpling on her face with a history of pus discharge. Diagnostic workup and radiographic examination revealed that the right mandibular first molar had a failing root canal treatment and a defective restoration. The respective tooth underwent endodontic retreatment. Due to palpation of a cord-like tract at the apical region of the tooth, surgical removal of the mentioned structure was planned using a mucoperiosteal flap. After flap elevation, the cord was cut at the base of attachment to the bone, which resulted in immediate correction of facial contour. Finally, the tooth was permanently restored. At the 6-month follow-up visit, the periapical lesion was healing, and the face had a normal contour.

Considering the significance of surgical intervention in cases with a cord-like sinus tract and consequent skin dimpling, a flowchart for a step-by-step decision-making process is offered to better restore the normal facial contour.

</span> Periapical surgery is a reliable method for treating teeth with periapical lesions for which conventional root canal treatment methods are not effective. The aim of this study is to investigate the results of periapical surgical treatment after a follow-up period of one to five years and the factors related to the success rate of the treatment.</span></span></span>
</span> In this cross-sectional study, complete clinical and radiographic examinations were performed on 128 patients who underwent periapical surgery in the endodontics department of Mashhad Dental School. The success of the treatment was evaluated based on radiographic and clinical criteria for three groups: recovered, recovering and non-recovering. The patients were examined in terms of the relationship between the success rate of periapical surgery and the variables of age, gender, type of tooth, type of jaw, presence of post, type of coronal restoration and the presence of preoperative symptoms.</span></span></span>
</span> From a total of 128 patients, 64 patients including 35 women and 29 men were studied. The results showed that the number of successful treatments is higher in women and in anterior teeth, although their difference was not statistically significant. In the age range of 11 to 30 years, all treatments were successful, with a treatment success rate of 89% in the recovered and recovering groups. In addition, there was no statistically significant difference in the success rate of periapical surgery in terms of factors such as the type of jaw, the presence or absence of a post, the presence of symptoms before treatment, and the type of tooth restoration.</span></span></span>
</span></span> The results of this study showed that periapical surgery can be considered as an effective treatment method for patients. In addition, factors such as age, gender, type of jaw, presence or absence of post, presence of symptoms before treatment and type of tooth restoration do not have a significant effect on the treatment result.</span></span></span></div>

The aim of this study was to evaluate the histopathological findings of oral lesions in patients referred to the pathology department of Kosar Hospital of Semnan city (Iran) in 2012-2018.

This population-based cross-sectional study was concocted on the histopathological findings of oral lesions 137 patients referred to the pathology department of Kosar Hospital of Semnan city (Iran) in 2012-2018. The sampling method was census. The data collection tool was a check including demographics and dentistry (type of dental lesion, location of the lesion, malignancy of lesions, origin of dental lesions, side of the lesion conflict, jaw involved, anterior-posterior position and type of biopsy). SPSS24 was used for data analysis and a significance level of less than 0.05 was considered.

The most common type and the most common location of oral lesions were periapical cyst (16.7%) and periapical (28.3%); respectively. The most common sources of oral lesions were related to inflammation and connective tissue with 27.5 and 26.8%, respectively. Mandible (47.8%) was the most common involved jaw and 5.1% of reported lesions were malignant. In addition, the prevalence of periapical cyst (78.3 vs. 21.7%) and pyogenic granuloma (82.4 vs. 17.6%) were significantly higher in women than men (P-Value=0.035).The highest rates of periapical cyst (43.5%)and pyogenic granuloma (58.5%) were observed in the age group ≤30 and 31-40 years; respectively(P-Value=0.013).

This study suggests that the female patients and over 40 years should be more careful to check for periapical cyst. However, more detailed studies with higher sample sizes are recommended.

Various mechanisms suggest that periodontal pathogens and inflammatory processes contribute to systemic pathogenic processes such as atherosclerosis. This study investigated the possibility of a correlation between the presence of incidentally found calcifications along the course of the internal carotid artery (ICA) and tooth loss and periodontal status.

A retrospective CBCT analysis was performed on 110 patients. CBCT scans obtained as a part of the dental examinations were analyzed for missing teeth and evidence of any calcification along the ICA course. The mean age, gender, and the total number of missing teeth for all scans revealing calcifications were evaluated. 

The study sample consisted of 110 scans, with the cohort’s mean age (SD) of 50.01 (±11.6) and gender distribution of 53.4% females and 43.6% males. A total of 17% of the scans exhibited the presence of calcification. A comparison of missing teeth between the two groups revealed that the group with calcification exhibited more missing teeth, which was statistically significant with a p-value of 0.01. Comparison of the apical lesions between the two groups revealed that apical lesion was higher in the group with calcification and was statistically significant with a p-value of 0.011.

The greater the number of missing teeth, the higher the chances of calcifications being detected along the course of the ICA.

Cholesterol crystals and foamy macrophages can delay the healing of inflammatory periapical lesions. The purpose of this study was to evaluate the relationship between age and the presence of focal aggregations of cholesterol crystals and foamy macrophages in these lesions.

In this descriptive-analytic study, 770 samples of inflammatory periapical lesions including 335 periapical granulomas, 329 radicular cysts, and 106 residual periapical cysts were evaluated histopathologically in order to find at least two focal aggregations of cholesterol crystals and foamy macrophages in two age groups of young (20-35 years old) and elderly (over 50 years old) adults. Finally, the data were entered into SPSS version 23.0 and analyzed using chi-square and Fisher’s exact tests.

In the present study, 74.3% of the samples lacked at least two focal aggregations of foamy macrophages, and 84% of the samples lacked at least two focal aggregations of cholesterol crystals. The frequency of focal aggregations of cholesterol crystals was not significantly different between the two age groups (P=0.14). However, the frequency of foamy macrophages was significantly higher in the age group of young adults than in elderly adults (P=0.002).

According to the obtained results, it does not appear that the healing rate of periapical lesions in young and elderly adults has necessarily significant difference; and whereas, it is lower in the elderly adults than in young adults, probabely relates to factors other than the accumulation of cholesterol crystals or foamy macrophages.

Radiography is one of the techniques used to evaluate the quality of obturation. This study compared the quality of root canal obturation and periapical tissue using periapical and panoramic radiographs and cone-beam computed tomography (CBCT). This descriptive cross-sectional study was conducted on 138 teeth of patients referring to Tabriz Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran. The patients were in the 15-72 age range and had undergone CBCT, panoramic, and periapical x-ray examinations of their endodontically treated teeth. The patients’ periapical, panoramic, and CBCT radiographs were retrieved from the faculty archives and studied. All the images and results were studied by an endodontist and a radiologist separately. The results showed a significant difference between panoramic radiography and CBCT in identifying samples without voids. Panoramic radiographs showed the most samples without voids, and the CBCT method showed the least samples without voids (23.7% vs. 2.2%). The highest agreement in identifying the lesions was obtained between the panoramic and periapical methods. The CBCT technique showed the highest frequency (97.3%, P=0.003) of bone thickness changes in samples with lesions. Based on the results, a significant difference in the quality of root canal obturation was observed between periapical and panoramic radiographs with CBCT; however, no significant difference was observed between periapical and panoramic radiographs.