DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20213188

Use of the cone-beam computed tomography-endodontic radiolucency index for determination of lesion extension in periapical periodontitis

Sanaa Shafshak, Faiz Alsubaie, Faisal Alzamil, Linah Alzughaibi, Meshal Alhaqbani, Rama Al Yamany, Saeed Basalem

Abstract


Background: Periapical periodontitis is caused by extension of necrotic pulp tissue into the periodontal ligament area. cone-beam computed tomography (CBCT) facilitates better diagnosis for periapical periodontitis, especially in the absence of clinical symptoms. This study aims to use cone-beam computed tomography-endodontic radiolucency index (CBCT-ERI) to determine the extension of periapical periodontitis in post-graduate clinics of Riyadh Elm university (REU) and to record the extension of periapical periodontitis in the coronal direction along the root surface and evaluate the degree of cortical bone involvement associated with periapical radiolucency.

Methods: CBCT images for patients treated at the endodontic clinics of REU were selected for this retrospective observational study. Images were examined after inter-examiner calibrations under the same magnification, slice thickness, and resolution and the measurements were analyzed statistically.

Results: The first permanent molars were the most frequently affected by periapical periodontitis, followed by the second molars. The majority of lesions were graded with a score of 6 in length and width according to CBCT-ERI.

Conclusions: The use of CBCT-ERI revealed extensive involvement of periodontal tissues around the apices of the roots of the examined teeth. Coronal extension of periapical periodontitis was observed along the root surface. The axial view accurately detected cortical bone involvement, including thinning of the cortical bone, which was the most common manifestation (11.76%). Apical radiolucency was observed most commonly in the first molars.


Keywords


CBCT, Apical periodontitis, Periapical index, Endodontic radiolucency index, Endodontics

Full Text:

PDF

References


Lia RC, Garcia JM, Sousa-Neto MD, Saquy PC, Marins RH, Zucollotto WG. Clinical, radiographic and histological evaluation of chronic periapical inflammatory lesions. J Appl Oral Sci. 2004;12(2):117-20.

Huumonen S, Ørstavik D. Radiological aspects of apical periodontitis. Endodontic Topics. 2002;1(1):3-25.

Persoon IF, Özok AR. Definitions and epidemiology of endodontic infections. Curr oral health rep. 2017;4(4):278-85.

Brynolf I. A histological and roentgenological study of the periapical region of human upper incisors. Almqvist and Wiksell. 1967;11.

Reit C, GrÖNdahl HG. Application of statistical decision theory to radiographic diagnosis of endodontically treated teeth. Eur J Oral Sci. 1983;91(3):213-8.

Ridao‐Sacie C, Segura‐Egea JJ, Fernández‐Palacín A, Bullón‐Fernández P, Ríos‐Santos JV. Radiological assessment of periapical status using the periapical index: comparison of periapical radiography and digital panoramic radiography. Int endodontic j. 2007;40(6):433-40.

Croitoru IC, CrăiŢoiu Ş, Petcu CM. Clinical, imagistic and histopathological study of chronic apical periodontitis. Romanian journal of morphology and embryology Revue roumaine de morphologie et embryologie. 2016;57(2):719-28.

Mota de Almeida FJ, Knutsson K, Flygare L. The impact of cone beam computed tomography on the choice of endodontic diagnosis. Int Endodontic J. 2015;48(6):564-72.

Laux M, Abbott PV, Pajarola G, Nair PNR. Apical inflammatory root resorption: a correlative radiographic and histological assessment. Int endodontic j. 2000;33(6):483-93.

Pinsky HM, Dyda S, Pinsky RW, Misch KA, Sarment DP. Accuracy of three-dimensional measurements using cone-beam CT. Dentomaxillofacial Radiol. 2006;35(6):410-6.

Torabinejad M, Rice DD, Maktabi O, Oyoyo U, Abramovitch K. Prevalence and size of periapical radiolucencies using cone-beam computed tomography in teeth without apparent intraoral radiographic lesions: a new periapical index with a clinical recommendation. J endodontics. 2018;44(3):389-94.

Estrela C, Bueno MR, Azevedo BC, Azevedo JR, Pécora JD. A new periapical index based on cone beam computed tomography. J endodontics. 2008;34(11):1325-31.

Wu MK, Shemesh H, Wesselink PR. Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment. Int endodontic j. 2009;42(8):656-66.

Bjørndal L, Kirkevang L-L, Whitworth J. Textbook of endodontology. John Wiley and Sons. 2018.

Riggio MP, Aga H, Murray CA. Identification of bacteria associated with spreading odontogenic infections by 16S rRNA gene sequencing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(5):610-17.

Khan SQ, Khabeer A, Al Harbi F. Frequency of root canal treatment among patients attending a teaching dental hospital in Dammam, Saudi Arabia. Saudi J Med Med Sci. 2017;5(2):145.

Lofthag-Hansen S, Huumonen S, Gröndahl K, Gröndahl H-G. Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2007;103(1):114-9.

Vengerfeldt V, Mändar R, Nguyen MS, Saukas S, Saag M. Apical periodontitis in southern Estonian population: prevalence and associations with quality of root canal fillings and coronal restorations. BMC oral health. 2017;17(1):147.

Yoshioka T, Kikuchi I, Adorno CG, Suda H. Periapical bone defects of root filled teeth with persistent lesions evaluated by cone‐beam computed tomography. Int Endodontic J. 2011;44(3):245-52.