• The Journal of the Korean dental association
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• v.50 no.7
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• pp.420-430
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• 2012

Purpose: The purpose of this study was to measure the absorbed dose and to calculate the effective dose for full-mouth periapical radiography using the portable dental x-ray machine and panoramic radiography Material and Method: Thermoluminescent chips were placed at 25sites throughout the layers of the head and neck of a tissue-equivalent human skull phantom. The man phantom was exposed with the portable dental x-ray machine and panoramic unit. During full-mouth periapical radiography the exposure setting was 60 kVp, 2 mA and 0.15 ~ 0.25 seconds, while during panoramic radiography the selected exposure setting was 72 kVp, 8 mA and 18 seconds. Absorbed dose measurements were obtained and equivalent doses to individual organs were summed using ICRP 103 to calculate of effective dose. Result: In the full-mouth periapical radiography, the highest absorbed dose was recorded at the mandible body follow with submandibular glands and cheek. Using panoramic unit, the highest absorbed dose was parotid glands and the following was back of neck and submandibular glands. The effective dose in full-mouth periapical radiography using portable dental x-ray machine was 46 ${\mu}Sv$. In panoramic radiography, the effective dose was 38 ${\mu}pSv$. Conclusion: It was recommended to panoramic radiography for general check in the head and neck area because that the effect dose in the panoramic radiography was lower than the dose in the full-mouth periapical radiography using portable dental x-ray machine.

• The Journal of the Korean dental association
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• v.54 no.5
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• pp.365-373
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• 2016

Purpose: Cemental tear is a specific type of root surface fracture characterized by a complete separation of a cemental fragment along the cementodentinal junction or a partial split within the cementum along an incremental line. It is suggested to be a factor for periodontal or periapical tissue destruction. The aim of this study is to present a diagnosis and treatment of cemental tear associated with periapical lesion with root canal treatment and regenerative periodontal surgery. Treatments: A 60-year-old male who had a history of sports trauma on the mandibular right central incisor about 10 years ago presented with apical cemental tear. Clinical examination showed a slightly dark yellowish discoloration and sinus tract that was located on the apical labial mucosa. The mobility and percussion were also assessed on the diseased tooth and recorded as $Miller^{\circ}{\phi}s$ Class II and tenderness to percussion. The probing depth was within the normal limit (<3 mm). Radiographic examination revealed a radiolucent lesion at the apical area and extended to distal aspect of the tooth along the fragment of cemental tear. After root canal treatment, periapical surgery was performed. The bony defect was exposed and then the detached root fragment was removed. Apical root resection and retrograde filling with Mineral Trioxide Aggregate (MTA) were accomplished and the bony defect was filled with deproteinized bovine bone mineral (DBBM) and covered with biodegradable collagen membrane. Results: After 9-month follow-up, healing of the mandibular right central incisor was uneventful and no swelling, purulence or pain was revealed in the associated area. Probing pocket depth was favorably stable, and the tooth mobility was decreased to the Miller's Class I. Conclusions: Apical cemental tear associated periapical lesion could be successfully treated with removal of the detached cementum in combination with apical surgery and GTR procedure.

• Imaging Science in Dentistry
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• v.47 no.1
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• pp.25-31
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• 2017

Purpose: The aim of this study was to compare the diagnostic accuracy of previously trained endodontists in the detection of artificially created periapical lesions using cone-beam computed tomography (CBCT) and digital periapical radiography (DPR). Materials and Methods: An ex vivo model using dry skulls was used, in which simulated apical lesions were created and then progressively enlarged using #1/2, #2, #4, and #6 round burs. A total of 11 teeth were included in the study, and 110 images were obtained with CBCT and with an intraoral digital periapical radiographic sensor (Instrumentarium dental, Tuusula, Finland) initially and after each bur was used. Specificity and sensitivity were calculated. All images were evaluated by 10 previously trained, certified endodontists. Agreement was calculated using the kappa coefficient. The accuracy of each method in detecting apical lesions was calculated using the chisquare test. Results: The kappa coefficient between examiners showed low agreement (range, 0.17-0.64). No statistical difference was found between CBCT and DPR in teeth without apical lesions (P=.15). The accuracy for CBCT was significantly higher than for DPR in all corresponding simulated lesions(P<.001). The correct diagnostic rate for CBCT ranged between 56.9% and 73.6%. The greatest difference between CBCT and DPR was seen in the maxillary teeth (CBCT, 71.4%; DPR, 28.6%; P<.01) and multi-rooted teeth (CBCT, 83.3%; DPR, 33.3%; P<.01). Conclusion: CBCT allowed higher accuracy than DPR in detecting simulated lesions for all simulated lesions tested. Endodontists need to be properly trained in interpreting CBCT scans to achieve higher diagnostic accuracy.

• Imaging Science in Dentistry
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• v.44 no.2
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• pp.115-119
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• 2014

Purpose: The aim of this in vitro study was to determine the sensitivity and specificity of cone-beam computed tomography (CBCT) and digital periapical radiography in the detection of mesial root perforations of mandibular molars. Materials and Methods: In this in vitro study, 48 mandibular molars were divided into 4 groups. First, the mesial canals of all the 48 teeth were endodontically prepared. In 2 groups (24 teeth each), the roots were axially perforated in the mesiolingual canal 1-3 mm below the furcation region, penetrating the root surface ("root perforation"). Then, in one of these 2 groups, the mesial canals were filled with gutta-percha and AH26 sealer. Mesial canals in one of the other 2 groups without perforation (control groups) were filled with the same materials. The CBCT and periapical radiographs with 3 different angulations were evaluated by 2 oral and maxillofacial radiologists. The specificity and sensitivity of the two methods were calculated, and P<0.05 was considered significant. Results: The sensitivity and specificity of CBCT scans in the detection of obturated root canal perforations were 79% and 96%, respectively, and in the case of three-angled periapical radiographs, they were 92% and 100%, respectively. In non-obturated root canals, the sensitivity and specificity of CBCT scans in perforation detection were 92% and 100%, respectively, and for three-angled periapical radiographs, they were 50% and 96%, respectively. Conclusion: For perforation detection in filled-root canals, periapical radiography with three different horizontal angulations would be trustworthy, but it is recommended that CBCT be used for perforation detection before obturating root canals.

• Imaging Science in Dentistry
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• v.34 no.4
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• pp.185-190
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• 2004

Purpose: To compare the diagnostic accuracy for the detection of root fractures in CMOS-based digital periapical images with conventional film-based periapical images. Materials and Methods: Sixty extracted single-root human teeth with closed apices were prepared endodontically and divided into two groups; artificially induced vertical root fracture group and control group. All radiographs were obtained using the paralleling technique. The radiographs were examined by 4 observers three times within a 4 week interval. Receiver operating characteristic (ROC) analysis was carried out using data obtained from four observers. Intra- and inter-examiner agreements were computed using kappa analysis. Results: The area under the ROC curve (Az) was used as an indicator of the diagnostic accuracy of the imaging system. Az values were as follows: direct-digital images; 0.93, film-based images; 0.92, and inverted digital images; 0.91. There was no significant difference between imaging modalities (P<0.05). The kappa value of inter-observer agreement was 0.42 (range: 0.28-0.60) and intra-observer agreement was 0.57 (range: 0.44-0.75). Conclusion : There is no statistical difference in diagnostic accuracy for the detection of vertical root fractures between digital periapical images and conventional periapical images. The results indicate that the CMOS sensor is a good image detector for the evaluation of vertical root fractures.

• Imaging Science in Dentistry
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• v.37 no.3
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• pp.149-156
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• 2007

Purpose: The purpose of this study was to measure the absorbed dose and to calculate the effective dose for periapical radiography done by portable intraoral x-ray machines. Materials and Methods: 14 full mouth, upper posterior and lower posterior periapical radiographs were taken by wall-type 1 and portable type 3 intraoral x-ray machines. Thermoluminescent dosemeters were placed at 23 sites at the layers of the tissue-equivalent ART woman phantom for dosimetry. Average tissue absorbed dose and radiation weighted dose were calculated for each major anatomical site. Effective dose was calculated using 2005 ICRP tissue weighted factors. Results: On 14 full mouth periapical radiographs, the effective dose for wall-type x-ray machine was 30 Sv; for portable x-ray machines were 30 Sv, 22 Sv, 36 Sv. On upper posterior radiograph, the effective dose for wall-type x-ray machine was 4 Sv; for portable x-ray machines doses were 4 Sv, 3 Sv, 5 Sv. On lower posterior radiograph, the effective dose for wall type x-ray machine was 5 Sv; for portable x-ray machines doses were 4 Sv, 4 Sv, 5 Sv. Conclusion: Effective doses for periapical radiographs performed by portable intraoral x-ray machines were similar to doses for periapical radiographs taken by wall type intraoral x-ray machines.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.28 no.2
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• pp.435-459
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• 1998

In order to achieve a successful endodontic treatment, root canals must be obturated three-dimensionally without causing any damage to apical tissues. Accurate length determination of the root canal is critical in this case. For this reason, I've used the conventional periapical radiography, Digora/sup (R)/(digital imaging system) and Root ZX/sup (R)/(the frequency dependent type apex locator) to measure the length of the canal and compare it with the true length obtained by cutting the tooth in half and measuring the length between the occlusal surface and the apical foramen. From the information obtained by these measurements, I was able to evaluate the accuracy and clinical usefulness of each systems. whether the thickness of files used in endodontic therapy has any effect on the measuring systems was also evaluated in an effort to simplify the treatment planning phase of endodontic treatment. 29 canals of 29 sound premolars were measured with #15, #20, #25 files by 3 different dentists each using the periapical radiography. Digora/sup (R)/ and Root ZX/sup (R)/. The measurements were then compared with the true length. The results were as follows: 1. In comparing mean discrepancies between measurements obtained by using periapical radiography(mean error: -0.449±0.444 mm), Digora/sup (R)/(mean error: -0.417±0.415 mm) and Root ZX/sup (R)/(mean error: 0.123±0.458 mm) with true length. periapical radiography and Digora/sup (R)/ system had statistically significant differences(p<0.05) in most cases while Root ZX/sup (R)/ showed none(p>0.05). 2. By subtracting values obtained by using periapical radiography, Digora/sup (R)/ and Root ZX/sup (R)/ from the true length and making a distribution table of their absolute values. the following analysis was possible. In the case of periapical film. 140 out of 261<53.6％) were clinically acceptable satisfying the margin of error of less than 0.5 mm. 151 out of 261 (53,6％) were acceptable in the Digora/sup (R)/ system while Root ZX/sup (R)/ had 197 out of 261(75.5％) within the limits of 0.5mm margin of error. 3. In determining whether the thickness of files has any effect on measuring methoths, no statistically significant differences were found(p>0.05). 4. In comparing data obtained from these methods in order to evaluate the difference among measuring methods, there was no statistically significant difference between periapical radiography and Digora/sup (R)/ system(p>0.05), but there was statistically significant difference between Root ZX/sup (R)/ and periapical radiography(p<0.05). Also there was statistically significant difference between Root ZX/sup (R)/ and Digora/sup (R)/ system(p<0.05). In conclusion, Root ZX/sup (R)/ was more accurate when compared with the Digora/sup (R)/ system and periapical radiography and seems to be more effective clinically in determining root canal length. But Root ZX/sup (R)/ has its limits in determining root morphology and number of roots and its accuracy becomes questionable when apical foramen is open due to unknown reasons. Therefore the combined use of Root ZX/sup (R)/ and the periapical radiography are mandatory. Digora/sup (R)/ system seems to be more effective when periapical radiographs are needed in a short period of time because of its short processing time and less exposure.

• Restorative Dentistry and Endodontics
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• v.35 no.1
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• pp.24-29
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• 2010

The purpose of this study was to find out the relationship of radiographic lesion size, gender, age of patients and radiographic character to the diagnosis of periapical cyst and granuloma. The data was collected from 187 periapical lesions of 167 patients who undergone apical surgery at Department of Conservative Dentistry, Seoul National University Dental Hospital from 2003 to 2005. The lesion were surgically removed and send for biopsy to the Oral Pathology Laboratory. From the initial radiograph, lesion size was calculated using $PiViewSTAR^{(R)}$ (INFINITT, Korea) program. The obtained data were statistically evaluated using SPSS (p<0.05). The result were as followings: 1. From 187 biopsy samples, the incidence of periapical cyst was 28.34% and granuloma was 65.24%. 2. There was a significant correlation between periapical cyst and the size of radiographic lesion (p<0.01). 3. There were no significant correlations between age, gender, location of lesion and the final diagnosis (p>0.05). 4. There was a significant correlation between the non-demarcation of the lesion and the incidence of periapical granuloma (p<0.01).

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.24 no.2
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• pp.279-290
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• 1994

The purpose of this study was to compare the diagnostic accuracy of periapical radiographs and their digitized images for the detection of simulated interproximal carious lesions. A total of 240 interproximal surfaces was used in this study. The case sample was composed of 80 anterior teeth, 80 bicuspids and 80 molars which were prepared in order to distribute the surfaces from carious free to those containing simulated carious lesions of varying depths (0.5㎜, 0.8㎜, and 1.2㎜). The periapical radiographs were taken by paralleling technique and film used was Kodak Ektaspeed(E group). All radiographs were evaluated by five dentist to recognize the true status of simulated carious lesion. They were asked to give a score of 0, 1, 2, or 3. Digitized images were obtained using a commercial video processor(FOTOVIX Ⅱ- XS). And the computer system was 486 DX PC with PC Vision and frame grabber. The 17' display monitor had a resolution of 1280×1024 pixels(0.26㎜ dot pitch). But the one frame of the intraoral radiograph has a resolution of 700×480 pixels and each pixel has a grey level value of 256. All the radiographs and digital images were viewed under uniform subdued lighting in the same reading room. After a week the second interpretation was performed in the same condition. The detection of lesions on the monitor was compared with the finding of simulated interproximal carious lesions on the film images. The results were as follows: 1. When the scoring criteria was dichotomous ; lesion present and not present 1) The overall sensitivity, specificity and diagnostic accuracy of periapical radiographs and their digital images showed no statistically significant difference. 2) The sensitivity and specificity according to the region of teeth and the grade of lesions showed no statistically significant difference between periapical radiographs and their digital images. 2. When estimate the grade of lesions ; score 0, 1, 2, 3 1) The overall diagnostic accuracy was 53.3% on the intraoral films and 52.9% on digital images. There was no significant difference. 2) The diagnostic accuracy according to the region of teeth showed no statistically significant difference between periapical radiographs and their digital images. 3. The degree of agreement and reliability 1) Using gamma value to show the degree of agreement, there was similarity between periapical films and digital images. 2) The reliability of each twice interpretation of periapical films and digital images showed no statistically significant difference. In all cases P value was greater than 0.05, showing that both techniques can be used to detect the incipient and moderate interproximal carious lesions with similar accuracy.

• Restorative Dentistry and Endodontics
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• v.13 no.2
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• pp.283-294
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• 1988

The purpose of this study was to investigate the characteristic features of the cells and tissues of the chronic periapical lesions using light microscope and electron microscope. Fifteen dental periapical lesions were obtained from the patients undergoing periapical surgery. Each specimen was divided into two parts along the tooth axis. One part was routinely processed for histopathologic examinations. 12 periapical lesions were diagnosed as granuloma and 3 periapical specimens as periapical cyst. The other part was fixed in 2.5% glutaraldehyde in 0.1M sodium cacodylate buffer at pH 7.4 and 1% osmic acid in same buffer. They were embedded in Epon 812. The semithin sections were used for the orientation of the lesions and the ultrathin sections were stained conventionally and examined with AEI Corynth 500 electron microscope. The results were as follows. 1. PMN and macrophages, which were dominant cell type, were scattered in small or large numbers throughout the central destructive area of granuloma. In the granulomatous area, plasma cells and lymphoytes were found in significant number and a lot of new capillary formation were revealed. Clefts caused by cholesterol were often seen in the connective tissue. Occasionally foam cells became collected in groups and epithelial proliferation were present. 2. In both granuloma and cyst, some plasma cells contained narrow cisternae of granular endoplasmic reticulum of which was tightly packed with electron dense materials, and other cells exhibited dilated profiles of granular endoplasmic reticulum. 3. In the area where plasma cells and lymphocytes were collected in groups, lymphocytes with well developed nucleolus and profuse cytoplasm were found and differentiating plasma cells were also present. 4. In the epithelial strands of the granulomatous area, epithelial cells contained enlarged endoplasmic reticulum, tonofilaments and ribosoms. Toward the intercellular space epithelial cells protruded a few microvilli. In the intercellular space, exudate-like electron dense materials, most of which was attached to the plasma membrane, appeared. 5. Some foam cells filled with numerous lipid droplets and others had lipid droplets and crystal-like structures. 6. Cyst epithelium consisted of bright cells and dark cells. The former had bright cytoplasm and small amounts of ribosoms, and the latter dark cytoplasm, many ribosoms, mitochondria and elongated microvilli. 7. Epithelial cells near the cyst lumen protruded a lot of long microvilli toward intercellular space and cyst lumen.