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CBCT examination was introduce in endodontics in 1993. Compared to retrodentoalveolar radiography, the radiation dose received during CBCT in endo- dontics when the narrowest FOV is used is 2-3 times higher. Method: Our aim was to correlate clinical signs with the images obtained originally using digital retrodentoalveolar radiography in the cases of varied canal morphologies, followed by CBCT examinations in order to establish a correct diagnosis and perform an adequate treatment that is in accordance with the existing anatomy. The CBCT examination was carried out according to the ALARA principle, only in those cases in which the retrodentoalveolar radiograph was not enough in order to establish a clear diagnosis. Results: In the cases with intraoperatory difficulties such as a complex root canal system manifested in anatomical variations, radicular perforations, broken instruments inside the canal, it is prudent to take into consideration the CBCT examination, due to its high diagnostic value compared to the high radiation dose. Conclusions: The benefits for diagnosis and for choosing the most adequate therapy option by analysing CBCT sections far outweigh the fact that the patient is exposed to a higher radiation dose. [ABSTRACT FROM AUTHOR]

Dental pulp represents a specialized connective tissue enclosed by dentin and enamel, the most highly mineralized tissues of the body. Consequently, the direct examination as well as pathological evaluation of dental pulp is difficult. Within this anatomical context, our study aimed to evaluate the correlation between dental pulp lesions and clinical diagnosis. Pulpectomies were performed for 54 patients with acute and chronic irreversible pulpitides and for 5 patients (control group) with orthodontic extractions. The morphological features were semiquantitatively assessed by specific score values. The clinical and morphological correspondence was noted for 35 cases (68.62%), whereas inconsistency was recorded for 16 cases (31.38%). The results of the statistical analysis revealed the correlations between clinically and pathologically diagnosed acute/chronic pulpitides. No significant differences were established between the score values for inflammatory infiltrate intensity, collagen depositions, calcifications and necrosis, and acute, respectively chronic pulpitides. We also obtained significant differences between acute pulpitides and inflammatory infiltrate and calcifications and between chronic pulpitides and inflammatory infiltrate, collagen deposition, and calcifications. On the basis of the predominant pathological aspects, namely, acute and chronic pulpitis, we consider that the classification schemes can be simplified by adequately reducing the number of clinical entities. [ABSTRACT FROM AUTHOR]

Several clinical cases outline the difficulties of root canal treatment, due to the morphological changes of the endodontic space in elderly patients. The changes in the shape of pulp chamber and root canal make the treatment more difficult. It is also shown that the pulp chamber diminishes, due to reparative dentin. Calcification of the pulp space makes more difficult the access to the cavity. The obliterated canals lead to a challenging negotiation of the root canals. To avoid errors in the appreciation of the general health condition of the patient, the specialists should have an accurate preoperative radiograph or cone beam computing tomography (CBCT), use magnification (dental operative microscope), safe-ended burs, consider carefully any morphological changes, and apply the most proper techniques. [ABSTRACT FROM AUTHOR]

The present study aimed at assesssing - by clinical, histological and radiological investigations - the influence of some external factors on the pulp-dentin complex, and at providing a causal interpretation of the structural changes observed. Materials and methods. Clinical and radiological exams were performed on 65 old patients with ages between 60-75, and also on 40 young patients with ages between 20-35, presenting different dental-periodontal pathologies. The pulp-dentin complex was submitted to a morphopathological examination, to highlight the structural changes observed at microscopic level. Fragments of dental pulp were imersed in a 4% formaldehyde solution with phosphate buffer 0.1 M., pH 7.2, for 12-14 hours, at a temperature of 4°C, and 3-5 µm thick slices were prepared. The slices were coloured with hematoxylin-eosine (HE), by the trichromic technique - Masson. Photographies were taken with a Zeiss microscope, with Kodak 200 ASA. Results. Significant differences were observed, between the two groups of patients, as to the external factors that produce structural changes on pulp-dentin organ. In the group of young patients dental caries and coronal fillings prevailed, while the group of old patients was mostly associated with atrition and chronic marginal periodontitis. Out of the 40 young patients, 30 presented chronic dental caries (75%), while, among the 65 old patients, only 24 presented dental caries (36.9%). The percentages of coronary fillings between the two study groups were close, which could be considered as one of the causes producing changes in the pulp-dentin organ, following aggresive preparation of cavities, the action of materials used for the protection of pulp-dentin complex or of the materials used for coronry fillings. Conclusions. Dental pulp has a remarkable ability to counteract the action of harmful factors, producing a mineral barrier and stimulating the reparatory processes. Changes in the endodontic space can be produced in both experimental groups, but more intensely and more frequently in the old patients. The endodontic space is modified, both physiologically and pathologically, including deposition of secondary or tertiary dentin (reactionary or reparative dentin), as well as pulp reactions, such as: inflammation, fibrosis, calcium degeneration or vacuolisis. At cell level, microsocopic images showed a decrease of the odontoblasts number and sizes, as well as a reduced fibroblasts/fibrocytes ratios. These changes are associated with progressive vascular and nervous changes, that can be considered both theis cause and effect. These pathological transformations are related with a more difficult preparation of the endodontic space and can be considered as having a major role in the failure of endodontic therapy. [ABSTRACT FROM AUTHOR]

Objective: Periapical granulomas, chronic periapical osteitis produced particularly by the bacterial continuous agression from the endodontic space, can develop accordingly, or they can transform in epithelial or cystic granulomas, their diagnosis being more difficult to determine at these stages. This study aimed to emphasize a few aspects that can conduce to an easier diagnosis establishment. Materials and method: 78 patients with periapical chronic periodontitis have been evaluated in order to assess their evolution to epithelial or cystic granulomas. These cases were monitorised during the endodontic treatment and, were necessary, endodontic surgery was performed and samples for the histopathologic exam were drawn, in order to make an accurate diagnose. Results: From the 78 cases of teeth with chronic periapical periodontitis, 18 required surgical approach: 4 curettages, 5 apicectomies, 9 extractions, from which 7 were labeled as cystic granulomas, after the microscope examination. Conclusions: Untill the comming out of an accurate diagnosis method for these lesions, the practitioner must consider all possible data from the anamnesis to the clinic and radiographic exam, the only relyable method to establish a correct diagnosis being the histopathologic exam. [ABSTRACT FROM AUTHOR]