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Revista Cientifica Odontologica... 2021Interpretation of the state of healing of chronic apical periodontitis or apical curettage with apicoectomy in radiological images is based on the analysis of changes in... (Review)
Review
Interpretation of the state of healing of chronic apical periodontitis or apical curettage with apicoectomy in radiological images is based on the analysis of changes in the appearance of the periapical area and in the bone structure adjacent to the site of inflammation or surgical intervention, which are projected onto normal bone structures. However, distortion of structures or the superposition of anatomical images should be considered when interpreting radiographs. We compared conventional studies of evaluation of the periapical area following treatment, together with 2D images, with the periapical index and the criteria of evaluation in both successful and unsuccessful cases of endodontic surgical treatment. Some studies have reported that the radiographic appearance of the tooth crown and root may facilitate interpretation of the periapical area. In addition, cone-beam computed tomography can show the relationship between injured and repairing tissue using buccal and lingual tables to measure the periphery in transverse reconstruction. Indeed, complex biological events and mechanisms can occur during the healing process of periapical and root tissues. Knowledge of the diversity of tissues is essential to identify the dynamics of the signs of regeneration or the presence of healing due to repair. Hence, the aim of this article was to identify the criteria used to interpret periapical healing in two-dimensional or three-dimensional images and their relationship with diagnosis and treatment according to the literature currently available.
PubMed: 38463730
DOI: 10.21142/2523-2754-0904-2021-087 -
Clinical Case Reports Jan 2022At times, an infected tooth that may be deemed unrestorable may be salvaged by atraumatic removal, an in-hand apicoectomy and retrograde seal, then replantation. This...
At times, an infected tooth that may be deemed unrestorable may be salvaged by atraumatic removal, an in-hand apicoectomy and retrograde seal, then replantation. This patient was referred to this author for an extraction and implant treatment of the maxillary left second premolar. After a discussion, the patient preferred to salvage the tooth if possible. The tooth was successfully atraumatically removed, and an in-hand apicoectomy and retrograde amalgam seal was placed. The tooth was immediately replaced into its socket and was stable. The occlusal surface was flattened to prevent and off axial loading. A bis-acryl brace was applied to the facial and lingual aspect to prevent an overload while the tooth was healing. The patient was admonished to maintain a soft diet. After 3 weeks, the braces were removed, and the tooth was found to be stable. After 8 weeks, the tooth was asymptomatic, and the patient was able to revert to her normal diet without pain. While extraction, placing an apical seal and replantation of teeth is not a new modality; nonetheless, clinicians may need to be reminded of this procedure to increase the number of options presented to patients.
PubMed: 35106162
DOI: 10.1002/ccr3.5278 -
Indian Journal of Dental Research :... 2023Apicoectomy conceptualizes surgically maintaining a tooth with an endodontic lesion that cannot be resolved by conventional endodontic (re-) treatment. To achieve this,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Apicoectomy conceptualizes surgically maintaining a tooth with an endodontic lesion that cannot be resolved by conventional endodontic (re-) treatment. To achieve this, continuous improvement in surgical techniques, materials and instruments is being done to enhance the outcome of periapical endodontic surgeries. The purpose of this study was to compare, radiographically, the healing kinetics of platelet-rich fibrin (PRF) and mineralized freeze-dried bone allograft (FDBA) in patients undergoing apicoectomy.
MATERIALS AND METHODS
Nineteen patients (aged 18-40 years) were included in the study and randomly assigned to groups A or B, where they received PRF or FDBA, respectively. Following apicoectomy, PRF gel and FDBA graft were prepared and placed in the osseous defect followed by placement of PRF membrane for graft stabilization and flap closure. Radiographic follow-up was done at the 1, 3, 6 and 12 months for evaluation of healing using Molven's criteria. Statistical analysis was done with Pearson's and McNemar's Chi-square tests.
RESULTS
A highly significant difference (P = 0.002) in radiographic healing was observed at 6 months. Complete healing was observed in 50% of cases in Group A whereas in Group B, none of the cases presented with complete radiographic healing. However, at the end of 12 months, complete radiographic healing was observed in both groups.
CONCLUSION
Our data suggest that PRF accelerates bone healing as compared to FDBA and is both time and cost-efficient.
Topics: Humans; Allografts; Apicoectomy; Platelet-Rich Fibrin; Wound Healing
PubMed: 37417055
DOI: 10.4103/ijdr.ijdr_810_22 -
Medicina (Kaunas, Lithuania) Sep 2021: Endodontic microsurgery (EMS) aims to eradicate the sources of infection once the apical root resection removes most of the infected anatomical structures and repairs... (Meta-Analysis)
Meta-Analysis Review
: Endodontic microsurgery (EMS) aims to eradicate the sources of infection once the apical root resection removes most of the infected anatomical structures and repairs potential procedural errors in the apical region. An endodontic-periodontal lesion yields a pathological communication between the pulp and the periodontium. The purpose of this systematic review and meta-analysis is to evaluate the impact of periodontal attachment loss on the outcome of teeth submitted to EMS. : PRISMA guidelines were followed. An electronic search was performed in EBSCOhost, Embase and PubMed databases with the following search key: ("endodontic microsurgery" AND "outcome"). No filters were used concerning the year of publication or language. Only randomized clinical trials, prospective and retrospective clinical studies in humans, with a minimum one-year follow-up, defined clinical and radiographic outcome criteria and estimable success rate for endodontic-periodontal lesion were included. Statistical analysis was performed using OpenMeta[Analyst] software. : Of a total of 113 articles, 34 were selected for full-text reading after duplicates deletion and title and abstract analysis. Thirteen and six studies were included in the systematic review and meta-analysis, respectively. A total of 2775 pooled teeth were submitted to EMS, of which 492 teeth and 4 roots had periodontal involvement. According to the qualitative analysis, success rates of the endodontic-periodontal group ranged from 67.6% to 88.2%. Meta-analysis revealed that the absence of periodontal attachment loss was predictive of a higher likelihood of success with an odds ratio of 3.14. : Periodontal attachment loss presents a risk factor for EMS outcome. Although endodontic-periodontal lesions were associated with lower success rates considering a 1 to 10 years follow-up period, long-term successful prognosis following EMS has been reported, therefore presenting a fully valid and viable therapeutic option for the management of this type of lesions.
Topics: Humans; Microsurgery; Periodontal Attachment Loss; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 34577845
DOI: 10.3390/medicina57090922 -
Journal of Indian Society of... 2021Access to apical root canal system is gained after flap elevation using various incision techniques. Soft-tissue healing after periradicular surgery may include gingival... (Review)
Review
BACKGROUND
Access to apical root canal system is gained after flap elevation using various incision techniques. Soft-tissue healing after periradicular surgery may include gingival recession, papilla recession, changes in probing depth, and clinical attachment loss.
OBJECTIVE
The objective of this study was to compare the effect of full sulcular flap design versus papilla-sparing flap design on the periodontal parameters in periradicular surgeries.
MATERIALS AND METHODS
It was a systematic review and meta-analysis. Electronic and manual searches were conducted in multiple databases including PubMed, Dental and Oral Sciences, Cochrane, and CINAHL Plus until May 2019. Initial search yielded 2575 studies with 5 articles meeting the inclusion criteria. The primary outcomes assessed were gingival recession and change in the papilla height. The secondary outcomes evaluated were probing depth, clinical attachment loss, postoperative pain, bleeding, and discomfort. Random-effects model was employed for computation of effect size, and forest plots were made.
RESULTS
Out of the five articles that satisfied the inclusion criteria, three were randomized control trials and two were nonrandom trials. No significant differences were found in the gingival recession ( = 0.79), papilla height ( = 0.55), gingival bleeding, and plaque indices. Statistically significant differences in probing depth ( = 0.006) and clinical attachment loss ( = 0.0004) were observed for the two flap designs in probing depth ( = 0.006) and clinical attachment loss ( = 0.0004).
CONCLUSIONS
The present systematic review and meta-analysis showed that probing depth and attachment loss are affected by the choice of flap design. On the other hand, gingival recession and papilla height are not influenced by the type of incision. However, finding of the present review may change if more studies on this topic will be included in the future. Therefore, more clinical trials with long-term follow-ups are needed.
PubMed: 34158683
DOI: 10.4103/jisp.jisp_290_20 -
Journal of Oral Biology and... 2013Bisphosphonates are group of drugs that inhibit bone resorption and are used to treat a range of pathologies including Paget's disease, osteoporosis, multiple myeloma... (Review)
Review
Bisphosphonates are group of drugs that inhibit bone resorption and are used to treat a range of pathologies including Paget's disease, osteoporosis, multiple myeloma and metastasis associated with breast or prostate cancer. The most common complication in patients on bisphosphonate therapy is osteonecrosis of jaw (ONJ) which can occur after any surgical dental procedure and the risk for the development of osteonecrosis of jaw is higher in patients receiving intravenous bisphosphonate therapy than in patients receiving oral bisphosphonate therapy. Typical presentation is in the form of non-extraction socket, presence of exposed bone, gingival swelling or purulent discharge, when local debridement and antibiotics are ineffective. At present, there is no effective treatment for bisphosphonate induced osteonecrosis, so prevention is extremely important. Maximum precautions should be taken in patients who are at the risk of development of ONJ especially when any dental surgical procedure like extractions, retrograde apicoectomies, periodontal surgery and implant placement is contemplated. Dentists and oral or maxillofacial surgeon must keep up to date with the latest approaches or guidelines to prevention and the risk factors, particularly when treating patients who are on bisphosphonates, or who will be taking bisphosphonates.
PubMed: 25737876
DOI: 10.1016/j.jobcr.2012.11.001 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Oct 2018To establish an apicoectomy guide template design and manufacturing method, based on multi-source data fusion, computer aided design (CAD) and fused deposition modeling...
OBJECTIVE
To establish an apicoectomy guide template design and manufacturing method, based on multi-source data fusion, computer aided design (CAD) and fused deposition modeling (FDM). The feasibility of the guide template was preliminary evaluated by the in vitro model experiment.
METHODS
An extracted upper anterior tooth, after root canal treatment, was optical scanned, after which the extracted upper anterior tooth was poured in an apicoectomy plaster model. Cone-beam computed tomography (CBCT) scanning of the apicoectomy plaster model was performed, after which optical scanning of the plaster model for apical resection surgery was carried out. All of the relevant CBCT and optical scanning data of the extracted upper anterior tooth and the apicoectomy plaster model were introduced into the Geomagic Studio 2012 software. The multi-source data fusion technology was used to virtually simulate the three-dimensional positional relationship of the extracted tooth, the dentition, the alveolar bone and the gingival, based on which, the three-dimensional design of the apicoectomy guide template was completed in the Geomagic Studio 2012 software. With the technology of fused deposition modeling, the apical resection surgical guide template was three-dimensionally printed with the material of polylactic acid (PLA). Under the guidance of the surgical guide template, the root apical resection was performed on the plaster model. After the apicoectomy, the extracted upper anterior tooth was taken off from the apicoectomy plaster model and then was given the optical scanning. The apical resection length and angle were calculated by the function of distance measurement and angle measurement, and the results were compared with the preset values.
RESULTS
The length of the apical resection was 2.88 mm along the direction of the long axis of the tooth, which was 0.12 mm lower than the preset 3 mm. The included angle between the apical resection plane and the long axis of the tooth was 77.9°, 12.1° lower than the preset 90°.
CONCLUSION
This study successfully established a digital design and production method of apicoectomy guide template by combing the multi-source data fusion, CAD and FDM technology. The design route and the production method are feasible. The study will provide a technology and methodology reference for the development of domestic special software for the digital design of apicoectomy guide template.
Topics: Apicoectomy; Computer-Aided Design; Cone-Beam Computed Tomography; Printing, Three-Dimensional; Software
PubMed: 30337756
DOI: No ID Found -
Journal of Dental Sciences Apr 2022Sphingosine-1-phosphate (S1P) is a lipid mediator that exerts its physiological functions in vivo through receptors. In the bone, S1P induces osteoblast...
BACKGROUND/PURPOSE
Sphingosine-1-phosphate (S1P) is a lipid mediator that exerts its physiological functions in vivo through receptors. In the bone, S1P induces osteoblast differentiation. Here, we investigated the effects of S1P receptor agonists on the expression of osteoblast differentiation markers locally in the bone. Then, a rat apicoectomy and alveolar bone defect model was established to extend S1P applications to endodontics, and the effect of local administration of S1P receptor agonist on postoperative bone formation was examined.
MATERIALS AND METHODS
Sphingosine-1-phosphate receptor (S1PR) 1/S1PR3 agonists, S1PR2 agonists, and their signal-related agents were intraperitoneally administered to mice. Using the mRNA collected from the tibial bone, the expression of osteoblast differentiation markers was evaluated by real-time reverse-transcriptase quantitative polymerase chain reaction. An apicoectomy and alveolar bone defect model was established on the mesial root of the rat mandibular first molar. Bone formation parameters were measured by micro-computed tomography analysis 3 weeks after the procedure.
RESULTS
Intraperitoneal administration of S1PR2 agonist significantly increased the mRNA expression of osteoblast differentiation markers, including alkaline phosphatase (, osteopontin (, bone sialoprotein (), and osteocalcin, in the local tibial bone of mice. The S1PR2/Rho-associated coiled-coil forming kinase (ROCK) signaling was thought to be involved in the upregulated mRNA expression of , , and . In the rat apical defects, bone formation parameters significantly increased following local administration of S1PR2 agonist.
CONCLUSION
In the rat apicoectomy and alveolar bone defect model, therapeutic agents targeting S1PR2 agonist are effective against osteogenesis.
PubMed: 35756763
DOI: 10.1016/j.jds.2021.10.004 -
Journal of Clinical Medicine Jul 2023Diagnosis is a key aspect in endodontic treatment, in a decade where invasive interventions are misapprehended as social tendency instead of medical necessity. All... (Review)
Review
Diagnosis is a key aspect in endodontic treatment, in a decade where invasive interventions are misapprehended as social tendency instead of medical necessity. All diagnostic facets should be considered before intending the operative phase. Intraoral endodontic radiology-based diagnosis has been shown to be limited. Periapical X-ray is the most used endodontic imaging, yet it does not provide high accuracy. Traditionally, dentists have been trained to diagnose a cyst by certain aspects (size, shape and appearance); hence, an assumption that teeth are affected by "periapical cyst" were subjected to unnecessary extraction or apicoectomy. The aim of this systematic review is to critically appraise the publications that relate the histological diagnosis of a periapical lesion (considered the gold standard) to intraoral X-ray investigation. Ovid Medline, PubMed, ScienceDirect, Mendeley and Scopus were searched for English-language studies comparing periapical diagnosis obtained by using two techniques (histopathology and X-ray). Sixteen articles were included for the final analysis (qualitative and quantitative evaluation) out of which only two supported the statement that periapical diagnosis can be coherently assessed through periapical imaging. Although there is not enough evidence to deliver a definitive conclusion, there are many publications that refute the diagnosis of a cyst via periapical X-ray.
PubMed: 37510762
DOI: 10.3390/jcm12144647 -
In Vivo (Athens, Greece) 2021S100A4 expression is associated with the pathology of chronic inflammatory diseases. In this study, we investigated the role of S100A4 and four inflammatory mediators...
BACKGROUND/AIM
S100A4 expression is associated with the pathology of chronic inflammatory diseases. In this study, we investigated the role of S100A4 and four inflammatory mediators (IL-1β, IκB, IL-10, and TNF-α) in human periapical granulomas (PGs).
MATERIALS AND METHODS
S100A4 expression in PGs obtained by apicoectomy was examined by immunohistochemistry. Further, the expression of S100A4 and four inflammatory mediators was compared between PGs and healthy gingival tissues (HGTs) using real-time PCR.
RESULTS
In the PGs, S100A4 was found to be expressed in endothelial cells and fibroblasts. Furthermore, real-time PCR revealed that the expression of S100A4 and IL-1β in PGs was significantly higher than that in HGTs. Although a correlation between the expression of S100A4 and IκB or IL-10 was not detected, a positive correlation between the expression of S100A4 and IL-1β or TNF-α was observed.
CONCLUSION
The expression of S100A4 correlates with the pathogenesis of PGs.
Topics: Endothelial Cells; Gingiva; Humans; Inflammation Mediators; Periapical Granuloma; S100 Calcium-Binding Protein A4; Tumor Necrosis Factor-alpha
PubMed: 34182485
DOI: 10.21873/invivo.12479