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PubMed1976

Apical curettage as a treatment of acute periapical inflammation.

In 16 incisors, one canine, and one premolar with an acute periapical infection which had perforated the cortical bone, an apical curettage was carried out. During the treatment and the following 5 days, the patients were protected with antibiotic therapy. The curettage was performed through a slightly arched incision, convex toward the gingival margin. At the same sitting, a guttapercha root filling was made in the conventional way. Irrespective of operation, which involved a somewhat larger than normal incision, no spread from local to general infection was found in any of the cases. The patients were free from pain and other symptoms of infection after one treatment. In the radiographic examinations carried out from 6 to 12 months and 3 years later, it was found that 50% of curetted roots showed complete healing, 33% were uncertain and 17% were unsatisfactory. Bone formation was most rapid during the first postoperative year, after which it decreased. The bone formation was also most rapid in larger lesions but decreased, even in these, when it advanced to the vicinity of the root.

Acute Disease↗
PubMed1979

Periapical surgery.

A retrospective study of 572 teeth treated with periapical surgery was undertaken in order to evaluate the influence of preoperative, operative and postoperative factors in the healing process as well as the operation method used. It was also the aim to assess whether the histophatological diagnosis of biopsies taken at the operation could be correlated to healing. Statistical analyses by the AID method and conventional cross-classification methods were performed. Factors of importance were found to be the extent of the destrucion, the operation method used, the bone surrounding the destruction, the quality of the orthograde root filling, the age of the patient, and the marginal bone buccally. The operation method was of importance in large destructions where root fillings were considered as not having properly sealed the canals, and when treating inflamed cysts. The histopathological diagnosis could not be ascribed any definite prognostic value.

Adolescent↗
PubMed1982

Intraalveolar transplantation. (I). The use of autologous bone transplants in the periapical region.

Intraalveolar transplantation of teeth with unfavourable cervical root fractures were performed in 15 patients. The roots were surgically extruded on an average 4.5 mm, and autologous bone transplants were placed above the apical part to support the root. Temporary endodontic therapy was carried out before the transplantation in 10 patients and 3 weeks after transplantation in 2 patients. 3 of the teeth had old root fillings. Postoperative controls were made weekly during the first month, after 3 months, 6 months, 1 and 2 years. The roots had become stable in most cases after 3 weeks. The mobility grade was dependent on the extent of extrusion. Radiographic controls showed formation of a normal periodontal space around the roots after 3 months, but also minor root resorption in the most apical part in 10 of the cases. The resorption was, however, not progressive in nature and was limited to the apical part. Remodelling of the marginal bone contour around the transplanted roots was evident in 11 patients. Periapical destructions were found in 3 patients at the 2-year control. Crown therapy was carried out with due attention to the special prosthetic problems associated with preparation of small remaining root fragments with unfavourable crown/root ratio.

Adolescent↗
PubMed1999

Surgically assisted rapid palatal expansion: orthodontic preparation for clinical success.

Close root proximity between the maxillary central incisors presents a problem in the surgical management of a maxillary palatal expansion. During the surgical fracture of this interdental area, the possibility exists for a separation to occur between the root surface and the bone. If this does occur, it is paramount that the gingival attachment remain intact. Asymmetric separation places more stress on the mesial gingival attachment because of the anatomy of the gingival fiber apparatus. Gingival detachment results in epithelial downgrowth in an apical direction, which in turn prevents bone apposition in a coronal direction. The resulting osseous defect is difficult to treat with an osseous graft procedure, as there are few if any intrabony walls. Treatment planning should include analysis of a recent periapical radiograph of the incisor roots to determine the need for orthodontic root separation before surgery. A postsurgical periapical radiograph should be taken to determine where the interdental separation has occurred. The expansion schedule should be adjusted depending on the symmetry of the separation and the health of the gingival attachment.

Adult↗
PubMed2003

A retrospective radiographic study of root-end surgery with amalgam and intermediate restorative material.

OBJECTIVE: We sought to compare amalgam with intermediate restorative material in terms of their effectiveness as root-end filling materials during root-end surgeries. STUDY DESIGN: A root-end operation was performed on 228 patients with 262 endodontically treated teeth with periapical lesions. Of these teeth, 122 from 101 patients were available for follow-up. Radiographs were taken immediately postoperatively and again at a mean of 11.25 months (range, 6-45 months) postoperatively. The radiographs were digitized, and the diameter of the periapical lesion was measured by means of a computerized system. The mesiodistal distance at the cementoenamel junction served as an internal standard. Radiographic findings were classified into 1 of 3 groups: complete healing, incomplete healing, or unsatisfactory (no) healing. RESULTS: Complete healing was observed in 44.3% of the teeth, incomplete healing in 21.3%, and unsatisfactory healing in 34.4%. No statistical significance was found for amalgam versus intermediate restorative material, but teeth that underwent additional operations had a significantly worse success rate than those that underwent only first-time operations. No correlation was found between the subjective prognosis by the surgeons and the long-term outcome. CONCLUSION: As root-end filling materials, amalgam and intermediate restorative material had the same clinical effectiveness. The classic root-end operation is unpredictable. Reoperations should be reconsidered and avoided if possible.

Adolescent↗
PubMed2003

Perceived quality of radiographic images after rapid processing of D- and F-speed direct-exposure intraoral x-ray films.

OBJECTIVE: We sought to compare the densitometric properties and perceived image quality of InSight (F-speed) and Ultra-Speed (D-speed) film radiographs processed with rapid chemistry. The effects of density, contrast, and film speed on perceived image quality were also studied. STUDY DESIGN: Images were made of a human cadaver phantom with exposures to achieve background densities approximating 1.5, 2.0, and 3.0. Films were processed in a radiographic darkroom by using Insta-Neg and Insta-Fix rapid chemistry as the manufacturer had recommended. Five endodontic residents independently analyzed images of varying density, speed, and contrast that were presented in a randomized manner. They were required to evaluate the perceived image quality of 5 specifically designated areas on the film, using a labeled photograph as a guide. These areas included root canal obturation, periodontal ligament space, dentinoenamel junction, and crestal bone height. In addition, they were also asked to assess the overall perceived image quality. Statistical analysis consisted of ordinal regression and 2-factor analysis of variance. RESULTS: No statistically significant differences were proved between F- and D-speed radiographs within the same density group. Higher density and higher contrast resulted in a statistically significant positive impact (P <.01) on the ranking for all 5 subjective determinations. Observers preferred the films exposed to a background density of 3.0 over those of a lower density (P <.01). CONCLUSIONS: InSight (F-speed film) can be used with rapid chemistry to ensure less radiation exposure to patients than is necessary with D-speed film. The observers participating in this study preferred radiographs from the 3.0 background density group to those from the 2.0 and 1.5 density groups.

Absorptiometry, Photon↗
PubMed2004

A prospective study on transplantation of third molars with complete root formation.

OBJECTIVE: The study objective was to evaluate the prognosis for autotransplantation of third molar teeth with fully developed roots followed by endodontic treatment on the basis of a time-table analysis. STUDY DESIGN: A total of 50 third molars with completely developed roots were autotransplanted to replace a lost first or second molar in the same number of admitted patients. Root canal treatment was started 3 to 4 weeks later. Clinical and radiographic checkup of the transplanted and root-filled third molars was done annually according to a predesigned record form. Descriptive statistics including a life table and statistical analysis were performed. RESULTS: The cumulative survival rate during 4 years' follow-up was 81.4%. In all, 7 transplants were lost during the follow-up time, 4 of them due to marginal periodontal pathosis and the other 3 due to root resorption. None of the root resorptions was observed before the second postoperative year. The radiographic periapical status was considered normal in 96% of the transplants at the latest follow-up visit. CONCLUSIONS: Autotransplantation of mature third molar teeth is a reasonable treatment alternative to conventional prosthetic rehabilitation or implant treatment in cases of partial edentualism from both a therapeutic and an economic point of view.

Adult↗
PubMed1995

Periapical neural changes after pulpectomy.

Pulpectomy and pulpal necrosis result in severance of the nerves that supply the pulp as well as loss of their target organ. Inflammatory changes commonly extend into the periapical region to involve those nerves. The neural response to pulpal loss combined with periapical inflammation is a derangement of the periodontal plexus normally located in the center of the periodontal space around the apical third of the root; the result is the formation of a disorganized group of sprouting and branching axons that have some features in common with neuromas. The inflammatory and neural responses continue for at least a year even when pulpectomy is followed by canal debridement and obturation. Then the responses are reduced but not eliminated by steroids. Root canal therapy with techniques that do not leave residual inflammation still results in increased periapical innervation; the increase seems to be an organized addition to the normal periradicular plexus.

Animals↗
PubMed1995

Radiographic evaluation of implant-obscured bone. Comparison of digitally subtracted tomographic and periapical techniques.

This study evaluated the diagnostic accuracy of digitized and substracted periapical and tomographic film images in the assessment of facial and lingual bone loss at implant-obscured sites. An edentulous dried human mandible was prepared with implants in the incisor, premolar, and molar regions. Successive bur sizes from quarter round to no. 6 were used to create circumferential infrabony periodontal defects in the alveolar crest adjacent to the implants. Periapical radiographs were made with the use of custom stents. Linear tomograms imaged sites in a cross-sectional orientation. An equal number of radiographs with and without lesions were digitized and subtracted from baseline images. Radiographic anatomy on the mesial and distal aspects of each implant was electronically masked before the evaluation by a series of eight observers. Receiver operating characteristics analysis and analysis of variance were used to evaluate accuracy of interpretation of the presence or absence of crestal defects. Observer accuracy in detecting facial or lingual bone defects was significantly greater with subtracted tomographic images than with substracted periapical images (p < 0.001).

Alveolar Bone Loss↗
PubMed1997

Digitizing of radiographs with a roller-type CCD scanner.

OBJECTIVES: Roller-type scanners can be used to digitize radiographs. This study evaluated the physical performance of a roller-type scanner with regard to dynamic range, scan reproducibility, and homogeneity. METHODS: A VXR-12 (Vidar System Corp., Herndon, Va.) roller-type scanner with imaging editing software Paint Shop Pro (JASC Inc., Minnetonka, Minn.) was used to digitize a step tablet image on Kodak T-MAT G films (Kodak, Rochester, N.Y.). The step tablet image was scanned at various locations and with different scanning settings. The pixel values of the resulting image were analyzed. The step tablet image was also scanned by a Wellhofer WD 102 Filmdensitometer (Wellhofer Dosimetrie, Schwarzenbruck, Germany) to measure the optical densities of the steps on the film for comparison. RESULTS: With the use of the default scanning settings the digitized images had pixel values distributed in a similar dynamic range to that of the film densitometer. This scanner produced consistent images with different scanning positions, different orientation of the images, and different power states of the scanner. CONCLUSIONS: This roller-type scanner has a similar dynamic range to that of the film densitometer. The operating condition of the scanner is stable, and the resulting image is not significantly affected by the scanning positions. This type of scanner should be suitable for digitizing dental x-ray films, although the limiting scanning resolution might not be sufficient for some diagnostic purposes.

Absorptiometry, Photon↗
PubMed2004

Patient characteristics associated with receipt of dental radiographic procedures during a 48-month population-based study of dentate adults.

OBJECTIVE: The objective was to test hypotheses that patient characteristics are associated with receipt of specific types of radiographic procedures. STUDY DESIGN: The Florida Dental Care Study was a prospective cohort study of dentate adults. RESULTS: From 19% to 59% of participants received a full-mouth series, panoramic, bitewing, or periapical radiograph(s), depending on procedure type. Receipt varied with reason(s) for dental visit(s), baseline clinical condition, race, approach to care (problem-oriented or regular dental attender), and socioeconomic status. CONCLUSION: These findings underscore the distinction between what dentists hypothetically would prescribe, compared to what is actually received, receipt that results from the interaction between dentist recommendations and what patients will accept and pay for. Blacks and lower-income persons received dental radiograph types that were consistent with less comprehensive dental treatment, even with entry into the dental care system, reason(s) for incident dental visit(s), baseline clinical status, and regular versus problem-oriented attendance taken into account.

Adult↗
PubMed2000

Radiographic detection and assessment of the periodontal endosseous defects.

AIMS: The aim of the present study was to investigate the potential of conventional radiography in detecting and accurately imaging periodontal endosseous (or osseous) defects when compared to surgical measurements. A further objective of the study was the selection of the most successful radiographic method for the assessment of endosseous defects. METHOD: Surgical measurements, during periodontal flap surgery, and radiographic measurements, from periapical and panoramic radiographs, were obtained from 5,072 proximal surfaces of 100 patients presenting with periodontitis. RESULTS: Statistical evaluation of the surgical and radiographic measurements revealed the following. (1) The ability of the radiographs to detect periodontal osseous defects was relatively low. (2) For periapical radiography, it depended, in descending order, on the depth and buccolingual width of the defect, the number of osseous walls and the jaw location. For panoramic radiography, it depended only on buccolingual width. (3) Osseous defects of small depth and/or small buccolingual width were the most difficult to detect radiographically. (4) Periapical radiography was more successful than panoramic in detecting osseous defects, and more accurate in assessing the defect dimensions (depth, mesiodistal width). (5) The difference in the defect detection ability between the 2 radiographic methods, the accuracy of the radiographic defect dimensions assessment as well as the degree of agreement between periapical and panoramic assessment depended on defect location and dimensions. CONCLUSIONS: Periapical radiography is superior to panoramic in detecting and accurately imaging periodontal osseous destruction.

Adolescent↗