• Imaging Science in Dentistry
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• 제47권1호
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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.

• 대한치과의사협회지
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• 제58권10호
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• pp.604-614
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• 2020

Objective: The purpose of this study was to analyze the Cone-beam computed tomograghy(CBCT) scan of endodontically treated maxillary first molars and investigate how second mesiobuccal (MB2) canal is treated, how the prognosis of mesiobuccal (MB) root is different compared to other roots and the prognosis factor on apical periodontitis. Methods: Subjects were endodontically treated maxillary first molars whose were collected from CBCT scans taken from January 2018 until December 2019. A total of 525 maxillary first molars were analyzed by an endodontist to determine the presence of the MB2 canal, the quality of the root canal filling, and the presence of apical periodontitis. The chi square test and Fisher's exact test was used to examine the relationship between each variable. Results: MB2 canals were found in 46.3%, of which 76.5% were not treated. The more main canal of mesiobuccal root (MB1 canal) was well filled, the more significantly MB2 canal was well filled (p<0.001). The apical periodontitis of MB root was not related to the filling quality of MB1 canal (p=0.370) and was related to the filling quality of MB2 canal (p=0.004). The apical periodontitis of MB root was related to the quality of canal filling of MB2 canal and the apical periodontitis of DB and P root. Conclusions: It was found that the majority of MB2 canals were not treated. The apical periodontitis of MB root was analyzed to be related to the quality of canal filling of MB2 canal. The apical lesion of the MB root was not correlated with the treatment of the MB1 canal, but it was significantly related to the quality of filling of MB2 canal.

• Infection and chemotherapy
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• 제50권4호
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• pp.340-345
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• 2018

Frequent isolation of Enterococcus faecalis from root canal treated teeth with apical periodontitis, has proposed the role of this organism in endodontic treatment failures. Different factors have been suggested in the pathogenicity of this organism. In this study, 22 E. faecalis isolates from canals of root-filled teeth were identified, and phenotypic and genotypic characteristics were investigated. No resistance to vancomycin and gentamicin was noted, and most isolates (91%) were susceptible to ampicillin. Biofilm formation was detected in 73% of the isolates and may be considered as the most important virulence factor involved in the pathogenesis of these isolates.

• Journal of Periodontal and Implant Science
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• 제29권1호
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• pp.95-102
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• 1999

The purpose of this study was to observe histopathologically the influence of advanced periodontitis on pulp tissue, and to conclude the correlation between the results with clinical manifestations. The samples were teeth with over 7mm pocket depth and over 50% radiographic bone loss. These were diagnosed to have very poor prognosis and thus planned to be extracted. Those with any of following conditions were excluded from the samples, loss of vitality, periapical pathology, restoration or prosthesis, dental caries, and attrition or abrasion. It was because these conditions could affect pulp without any correlation with periodontal disease. For the experiment, 17 teeth from 11 patients were selected. Average age of patient was 47. Each tooth was examined for following categoris; pocket depth, gingival recession, electric pulp test, mobility, percussion test, sensitivity test. The extracted teeth were fixed buffered neutral formalin solution. It was decalcified using 4% nitric acid. Sliced histological samples observed using light microscope, for pulp status, and severeity of inflammation. 4 samples were excluded due to histologic sample discrepency. Thus 13 samples were subject to observation. 4 showed normal conditions. Focal reversable pulpitis was shown in 5 samples. Chronic pulpitis was observed 1 sample. Pulpal abscess was observed in 3 samples.

• Restorative Dentistry and Endodontics
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• 제49권2호
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• pp.16.1-16.10
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• 2024

Objectives: This cross-sectional study evaluated the prevalence of apical periodontitis (AP) and the technical quality of root canal fillings in an adult Kuwaiti subpopulation using cone-beam computed tomography (CBCT) images. Materials and Methods: Two experienced examiners analyzed 250 CBCT images obtained from Kuwaiti patients aged 15-65 years who attended government dental specialist clinics between January 2019 and September 2020. The assessment followed the radiographic scoring criteria proposed by De Moor for periapical status and the technical quality of root canal filling. Chi-square and Fisher's exact tests were used for statistical analysis, with significance level set at p < 0.05. Results: Among the 2,762 examined teeth, 191 (6.91%) exhibited radiographic signs of AP, and 176 (6.37%) had undergone root canal filling. AP prevalence in root canal-treated teeth was 32.38%, with a significant difference between males and females. Most of the endodontically treated teeth exhibited adequate root canal filling (71.5%). Conclusions: The study demonstrated a comparable prevalence of AP and satisfactory execution of root canal treatment compared to similar studies in different countries.

• 대한치과보존학회:학술대회논문집
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• 대한치과보존학회 2001년도 추계학술대회(제116회) 및 13회 Workshop 제3회 한ㆍ일 치과보존학회 공동학술대회 초록집
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• pp.564.1-564
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• 2001

Porphyromon as endodontalis, a gram-negative anaerobic rod, is an important pathogenic organism in periapical lesionis with acute symptoms, such as pain, swelling, and suppuration in endodontic patient. Like P. gingivalis, a major pathogen of adult periodontitis, P. endodontalis is asaccharolytic and forms black-pigmented colonies on enriched blood agar plates. However, the pathogenic factors and the pathological potential of this microbe have been poorly characterized.(omitted)

• Journal of Periodontal and Implant Science
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• 제45권6호
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• pp.216-222
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• 2015

Purpose: After extraction, the alveolar bone tends to undergo atrophy in three-dimensions. The amount of alveolar bone loss in the horizontal dimension has been reported to be greater than the amount of bone loss in the vertical dimension, and is most pronounced in the buccal aspect. The aim of this study was to monitor the predictive alveolar bone level following the extraction of anterior teeth seriously involved with advanced chronic periodontitis. Methods: This study included 25 patients with advanced chronic periodontitis, whose maxillary anterior teeth had been extracted due to extensive attachment loss more than one year before the study. Periapical radiographs were analyzed to assess the vertical level of alveolar bone surrounding the edentulous area. An imaginary line connecting the mesial and the distal ends of the alveolar crest facing the adjacent tooth was arbitrarily created. Several representative coordinates were established in the horizontal direction, and the vertical distance from the imaginary line to the alveolar crest was measured at each coordinate for each patient using image analysis software. Regression functions predicting the vertical level of the alveolar bone in the maxillary anterior edentulous area were identified for each patient. Results: The regression functions demonstrated a tendency to converge to parabolic shapes. The predicted maximum distance between the imaginary line and the alveolar bone calculated using the regression function was $1.43{\pm}0.65mm$. No significant differences were found between the expected and actual maximum distances. Likewise, the predicted and actual maximum horizontal distances did not show any significant differences. The distance from the alveolar bone crest to the imaginary lines was not influenced by the mesio-distal spans of the edentulous area. Conclusions: After extraction, the vertical level of the alveolar ridge increased to become closer to the reference line connecting the mesial and distal alveolar crests.

• Imaging Science in Dentistry
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• 제31권1호
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• pp.35-42
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• 2001

Purpose: To evaluate the usefulness of fractal analysis for diagnosis of periodontitis. Materials and Methods : Each 30 cases of periapical films of male mandibular molar were selected in normal group and patient group which had complete furcation involvement. They were digitized at 300 dpi, 256 gray levels and saved with gif format. Rectangular ROIs (10×20 pixel) were selected at furcation, interdental crest, and interdental middle 1/3 area. Fractal dimensions were calculated three times at each area by mass radius method and were determined using a mean of three measurements. We compared fractal dimensions at furcation and interdental crest area of normal group with those of patient group. And then we compared ratio of fractal dimensions at furcation area, interdental crest area to interdental middle 1/3 area. Results: Fractal dimension at interdental crest area of normal group was 1.979±0.018 and that of patient group 1.971±0.012 (p>0.05). Fractal dimension at furcation area of normal group was 1.986±0.024 and that of patient group 1.974±0.015 (p<0.05). The ratio of fractal dimension at interdental crest area to interdental middle 1/3 of normal group was 1.003±0.015 and that of patient group 0.993±0.018 (p<0.05). The ratio of fractal dimension at furcation area to interdental middle 1/3 of normal group was 1.006±0.018 and that of patient group 0.994±0.018 (p<0.05). Conclusion : The ratio of fractal dimension at interdental crest and furcation area to interdental middle 1/3 area showed a statistically significant difference between normal and patient group. In conclusion, it is thought that fractal analysis might be useful for the diagnosis of periodontitis.

• Restorative Dentistry and Endodontics
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• 제47권3호
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• pp.27.1-27.14
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• 2022

Objectives: This systematic review and meta-analysis aimed to assess the association of cigarette smoking with the prevalence of post-endodontic apical periodontitis in humans. Materials and Methods: We searched through PubMed/Medline, Web of Science, and Scopus from inception to December 2020. Risk of bias was performed by using the Newcastle-Ottawa Scale for cross-sectional, cohort, and case-control studies. We performed the statistical analysis in Review Manager 5.3 (RevMan 5.3). Results: 6 studies met the inclusion criteria for qualitative and quantitative synthesis. Statistical analysis of these studies suggests that there were no differences in the prevalence of post endodontic apical periodontitis (AP) when comparing non-smokers vs smoker subjects regarding patients (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.31-1.49; I2 = 58%) and teeth (OR, 1.71; 95% CI, 0.99-2.93; I2 = 72%). Conclusions: Our findings suggest that there was no association between cigarette smoking and post-endodontic apical periodontitis, as we did not find statistical differences in the prevalence of post-endodontic AP when comparing non-smokers vs smoker subjects. Therefore, smoking should not be considered a risk factor associated with endodontic failure.

• Restorative Dentistry and Endodontics
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• 제48권2호
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• pp.17.1-17.8
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• 2023

The present report describes the endodontic treatment of an Oehlers type II dens invaginatus in a maxillary lateral incisor with 5 root canals, an extremely rare condition. Apical periodontitis and related symptoms were noted. Cone-beam computed tomography was used to aid the diagnosis, reveal tooth morphology, and assist in canal location. The pulp chamber was carefully accessed, and the root canals were explored under magnification. All root canals were prepared with an R25 Reciproc Blue system and sodium hypochlorite (NaOCl) irrigation. After initial preparation, a self-adjusting file (SAF) with NaOCl and ethylenediaminetetraacetic acid was used to complement the disinfection. Additionally, calcium hydroxide medication was applied. Vertical compaction was used to fill the canals with a calcium silicate-based endodontic sealer and gutta-percha. After 12 months, the patient exhibited healing of the periapical region, absence of symptoms, and normal dental function. In conclusion, this nonsurgical treatment protocol was successful in promoting the cure of apical periodontitis. Both complementary disinfection with an SAF and use of calcium hydroxide medication should be considered when choosing the best treatment approach for dens invaginatus with very complex anatomy.