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An apical lesion is caused by bacteria invading the tooth apex through caries. Periodontal disease is caused by plaque accumulation. Peri-endo combined lesions include both diseases and significantly affect dental prognosis. The lack of clear symptoms in the early stages of onset makes diagnosis challenging, and delayed treatment can lead to the spread of symptoms. Early infection detection is crucial for preventing complications. PAs used as the database were provided by Chang Gung Memorial Medical Center, Taoyuan, Taiwan, with permission from the Institutional Review Board (IRB): 02002030B0. The tooth apex image enhancement method is a new technology in PA detection. This image enhancement method is used with convolutional neural networks (CNN) to classify apical lesions, peri-endo combined lesions, and asymptomatic cases, and to compare with You Only Look Once-v8-Oriented Bounding Box (YOLOv8-OBB) disease detection results. The contributions lie in the utilization of database augmentation and adaptive histogram equalization on individual tooth images, achieving the highest comprehensive validation accuracy of 95.23% with the ConvNextv2 model. Furthermore, the CNN outperformed YOLOv8 in identifying apical lesions, achieving an F1-Score of 92.45%. For the classification of peri-endo combined lesions, CNN attained the highest F1-Score of 96.49%, whereas YOLOv8 scored 88.49%. [ABSTRACT FROM AUTHOR]

Objective: The proposed study aims to compare the effectiveness of conventional endodontic treatment (ET) with that of ET associated with antimicrobial photodynamic therapy (aPDT) in patients with apical lesion. Methods: Controlled, double-blind, randomized clinical trial (RCT); superiority study with three parallel arms. Randomization will be conducted in exchange blocks of six, with allocation 1:1:1. The control group will receive conventional ET, while experimental group 1 (EG1) will receive conventional ET + aPDT with laser at 660 nm, fluence of 600 J/cm2; EG2 will receive conventional ET + aPDT with laser at 660 nm, fluence of 1200 J/cm2. The primary outcome will be canal disinfection before treatment, measured by analysis of colony formation (CFU/mL) and the success rate measured after 6 months on the clinical and radiographic evaluations. The mean and standard deviation will be calculated for continuous outcomes, and the CFU/mL mean between groups will be evaluated by ANOVA test. The Chi-squared test will be calculated for binary outcomes. A logistic regression analysis will be performed to assess differences in the success rate between groups, adjusted for the covariates. The Stata 18 software will be used, with a significance threshold of 5%. Conclusions: Few RCTs have evaluated the effectiveness of aPDT in root canal disinfection in patients with permanent dentition presenting apical lesion. New RCTs with larger numbers of participants are needed to support using aPDT as an adjuvant to conventional ET in root canal disinfection for routine use in clinical practice. The trial was registered prospectively in ClinicalTrials.gov (NCT05916859). [ABSTRACT FROM AUTHOR]

Apical lesions of endodontic origin can be classified as either granulomas or cysts. In rare cases, respiratory epithelium can proliferate and encapsulate a lesion, forming a cyst. Moreover, the innervation of apical lesions has only been previously reported in animal models of apical periodontitis. This report demonstrates an unusual case in which tooth #15 was initially treated with nonsurgical root canal therapy. Still, the patient remained in moderate to severe pain for several days following the procedure. Next, an intentional replantation was performed in which a periapical cyst was curetted from the alveolus. The patient experienced immediate pain relief following the procedure. Histological analysis revealed that the periapical cyst was lined entirely with respiratory epithelium, and immunohistochemical analysis showed it to be densely innervated. In addition, these nerve fibers expressed the LPS receptor, TLR4. This is the first demonstration of the innervation pattern of a periapical cyst. Further studies are warranted to evaluate innervation in apical lesions and its correlation with pre- and intra-operative symptoms and their participation in the pathogenesis of apical periodontitis. [ABSTRACT FROM AUTHOR]

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Purpose: To retrospectively investigate whether apical lesion, alveolar bone loss, probing pocket depth, or local infectious symptoms were associated with the onset of medication-related osteonecrosis of the jaw (MRONJ) in patients treated with high-dose antiresorptive agents who did not undergo tooth extraction. Methods: The study included 92 patients receiving high-dose antiresorptive agent therapy who had teeth with apical lesion ≧ 3 mm, alveolar bone loss ≧ 1/2, probing pocket depth ≧ 4 mm, or local infection symptoms such as swelling, pain, and pus discharge, but did not undergo tooth extraction. Univariate and multivariate Cox regression analyses were performed to determine the relationship between each variable and MRONJ onset. Results: MRONJ developed in 15 of 92 patients (35 of 404 teeth) from 74 to 1883 days (median, 383 days) after the first visit. Multiple Cox regression analysis revealed that a lower number of teeth, diabetes, increased leukocyte count, administration of antiresorptive agents for 180 days or more, local infection symptoms, apical lesion ≧ 3 mm, and probing pocket depth ≧ 4 mm were significantly correlated with the development of MRONJ. Conclusion: It is recommended that teeth with apical lesion ≧ 3 mm, probing pocket depth ≧ 4 mm, or local infection symptoms are extracted before or as early as possible after beginning of medication in cancer patients receiving high-dose antiresorptive agent therapy to prevent the development of MRONJ. [ABSTRACT FROM AUTHOR]

While autologous platelet concentrates (APCs) have gained traction as promising regenerative materials in recent years, their impact on wound healing and tissue regeneration in periapical hard tissue defects remains controversial. Endodontic microsurgery (EMS) has embraced the potential of platelet concentrates, particularly L-PRF (Leucocyte-Platelet-Rich Fibrin) and PRP (Platelet-Rich Plasma), as regenerative tools. These concentrates, rich in growth factors and other bioactive molecules, are thought to enhance healing and treatment outcomes for various endodontic conditions. However, their effectiveness remains a subject of investigation. Despite encouraging 3-D cone beam computed tomography (CBCT) based evidence for PRP's effectiveness in complex lesions and apico-marginal defects, inconsistencies in its performance across preparation and application protocols raise questions about its superiority over existing options. More research is crucial to understand its full potential as a reliable regenerative tool in endodontics. L-PRF and its derivatives are particularly effective in treating apical-marginal defects. It enhances clinical attachment levels and reduces probing pocket depths, likely due to its slow and coordinated release of various growth factors. L-PRF has been shown to also improve patients' quality of life by reducing postoperative swelling and pain. However, more research is needed to standardize its preparation methods and confirm its long-term benefits. This paper aims to provide a comprehensive review of the current knowledge and recent advances in endodontic surgery and the use of platelet concentrates, focusing on their roles in managing periapical lesions and endo-perio lesions., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Tobacco smoking presents a health hazard that negatively affects oral health. The possible link between tobacco smoking and periapical pathosis has been a subject of long debate. However, recent systematic reviews and meta-analyses have indicated that tobacco smokers had an increased prevalence of pulpal and periapical disease. The purpose of this study was to assess the prevalence of periapical pathosis in smokers versus nonsmokers and to examine the differences between males and females and between African American and Caucasian patient populations. Method: Integrated data of hospital patients were used. Data included the corresponding diagnosis code for periapical abscess (PA). History of smoking, including current and past smoking, was retrieved by searching the appropriate query in the database. The relative risk of smoking and its association with gender and race were calculated and analyzed statistically; p < 0.05 was considered statistically significant. Results: Out of 953,741 patients examined, 6,283 were diagnosed with periapical abscesses. The relative risk for the presence of periapical abscesses in African Americans was 3.37 whereas the relative risk in Caucasians was 0.75. The difference was statistically significant for both African Americans and Caucasians (p < 0.0001). The relative risk for the presence of periapical abscesses in the smokers' groups was 4.14. The relative risk was significantly higher in female smokers than in male smokers (p < 0.0001). The relative risk for the presence of periapical abscesses in African Americans who smoked was 7.13 compared to the relative risk of 2.36 in African Americans who didn't smoke. The relative risk for the presence of periapical abscesses in Caucasians who smoked was 3.63 compared to the relative risk of 0.68 in Caucasians who didn't smoke. The differences were statistically significant (p < 0.0001). The relative risk for the presence of periapical abscesses was higher in African Americans than in Caucasians in both smoking and nonsmoking groups. Conclusions: Under the conditions of this study, it appears that a strong correlation exists between tobacco smoking and the presence of periapical pathosis. Gender and race may play a role in the prevalence of such lesions. Practical implications: Smoking cessation and prevention protocols should be adopted and recommended to patients. [ABSTRACT FROM AUTHOR]

Large apical lesions at the anterior teeth have a fairly high frequency. These require a treatment approach that ensures full biological healing and functional restoration of the tooth or teeth involved. A cystic apical lesion, which can not be cured by non-surgical endodontic treatment, will be treated with surgical intervention with retrograde filling, literature recommending the use of MTA as a retrograde filling material. This article presents a clinical case for the surgical management of a cystic lesion using MTA as a retrograde material. Surgical endodontics is a reliable treatment method for managing such cases that do not respond to conventional root canal treatment.

The aim of the study was to present views on the correlation between apical periodontitis (AP) and the risk of cardiovascular diseases (CVD) based on a review of the available literature. A review of PubMed for papers from the years 2011-2020 was conducted. Searched phrases included: apical periodontitis cardio-vascular diseases, apical periodontitis endothelial dysfunction, apical periodontitis myocardial infarction endodontic lesion CVD. Based on the literature review, it is suspected that there is a positive correlation between AP and the risk of CVD. Further studies are required to examine the prognostic impact of the treatment of AP on CVD. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this systematic review was to examine if, in adult patients, the absence or presence of smoking influenced the prevalence of periapical periodontitis (PP). Materials and methods: Databases were searched, and original research manuscripts up to June 2019 were identified by two reviewers. The Newcastle-Ottawa Scale (NOS) was used for risk of bias. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. A meta-analysis was performed using RevMan 5 software. Risk ratio (RR) was used for the cohort studies, and odds ratio (OR) was used for the case-control studies with 95% confidence interval (CI). Results: All the studies had many covariates and confounding variables. Three longitudinal cohort articles discussed radiographic findings as they related to the prevalence of PP in root-filled teeth. The RR of smoking and the prevalence of PP was 2.11 (95% CI 0.88–5.05, p = 0.09). Nine case-control studies focused on the prevalence of PP and smoking. There was a positive association between smoking and the prevalence of PP with an OR of 2.78 and a 95% confidence interval of 2.23–3.48, with p value < 0.05. The quality of the studies was fair per NOS, and the certainty of the literature assessment was moderate per GRADE. Conclusions: The current best available evidence suggests that smoking was associated with the prevalence of PP but more studies are needed to report this association in the longitudinal cohort studies. Clinical relevance: Smoking has a positive association with the prevalence of PP. [ABSTRACT FROM AUTHOR]

Apical lesions, the general term for chronic infectious diseases, are very common dental diseases in modern life, and are caused by various factors. The current prevailing endodontic treatment makes use of X-ray photography taken from patients where the lesion area is marked manually, which is therefore time consuming. Additionally, for some images the significant details might not be recognizable due to the different shooting angles or doses. To make the diagnosis process shorter and efficient, repetitive tasks should be performed automatically to allow the dentists to focus more on the technical and medical diagnosis, such as treatment, tooth cleaning, or medical communication. To realize the automatic diagnosis, this article proposes and establishes a lesion area analysis model based on convolutional neural networks (CNN). For establishing a standardized database for clinical application, the Institutional Review Board (IRB) with application number 202002030B0 has been approved with the database established by dentists who provided the practical clinical data. In this study, the image data is preprocessed by a Gaussian high-pass filter. Then, an iterative thresholding is applied to slice the X-ray image into several individual tooth sample images. The collection of individual tooth images that comprises the image database are used as input into the CNN migration learning model for training. Seventy percent (70%) of the image database is used for training and validating the model while the remaining 30% is used for testing and estimating the accuracy of the model. The practical diagnosis accuracy of the proposed CNN model is 92.5%. The proposed model successfully facilitated the automatic diagnosis of the apical lesion.

Radicular cysts are inflammatory jaw cysts that form in the apices of infected and necrotic pulp teeth. They are usually asymptomatic and tend to grow slowly. However, depending on the progressive size of the lesion and its relation to neighboring tissues, it may cause mobility, root resorption and displacement. In addition, a limited number of studies have been reported in which paresthesia occurs as a result of local pressure caused by periapical pathology and various mandibular intraosseous lesions on nerve tissue. In this study, treatment process of the paresthesia of inferior alveolar nerve caused by radicular cyst which is remained asymptomatic for a long time in the left posterior mandible is presented in a 33 year-old male patient and it is evaluated in the light of current literature. [ABSTRACT FROM AUTHOR]

Large apical lesions at the anterior teeth have a fairly high frequency. These require a treatment approach that ensures full biological healing and functional restoration of the tooth or teeth involved. A cystic apical lesion, which can not be cured by non-surgical endodontic treatment, will be treated with surgical intervention with retrograde filling, literature recommending the use of MTA as a retrograde filling material. This article presents a clinical case for the surgical management of a cystic lesion using MTA as a retrograde material. Surgical endodontics is a reliable treatment method for managing such cases that do not respond to conventional root canal treatment. [ABSTRACT FROM AUTHOR]

Oxidative stress is involved in the pathogenesis of a variety of inflammatory disorders. Apical periodontitis (AP) usually results in the formation of an osteolytic apical lesion (AL) caused by the immune response to endodontic infection. Reactive oxygen species (ROS) produced by phagocytic cells in response to bacterial challenge represent an important host defense mechanism, but disturbed redox balance results in tissue injury. This mini review focuses on the role of oxidative stress in the local and associated systemic events in chronic apical periodontitis. During endodontic infection, ligation of Toll-like receptors (TLRs) on phagocytes' surface triggers activation, phagocytosis, synthesis of ROS, activation of humoral and cellular responses, and production of inflammatory mediators, such as, cytokines and matrix metalloproteinases (MMPs). The increment in ROS perturbs the normal redox balance and shifts cells into a state of oxidative stress. ROS induce molecular damage and disturbed redox signaling, that result in the loss of bone homeostasis, increased pro-inflammatory mediators, and MMP overexpression and activation, leading to apical tissue breakdown. On the other hand, oxidative stress has been strongly involved in the pathogenesis of atherosclerosis, where a chronic inflammatory process develops in the arterial wall. Chronic AP is associated with an increased risk of cardiovascular diseases (CVD) and especially atherogenesis. The potential mechanisms linking these diseases are also discussed.

Oxidative stress is involved in the pathogenesis of a variety of inflammatory disorders. Apical periodontitis (AP) usually results in the formation of an osteolytic apical lesion (AL) caused by the immune response to endodontic infection. Reactive oxygen species (ROS) produced by phagocytic cells in response to bacterial challenge represent an important host defense mechanism, but disturbed redox balance results in tissue injury. This mini review focuses on the role of oxidative stress in the local and associated systemic events in chronic apical periodontitis. During endodontic infection, ligation of Toll-like receptors (TLRs) on phagocytes' surface triggers activation, phagocytosis, synthesis of ROS, activation of humoral and cellular responses, and production of inflammatory mediators, such as, cytokines and matrix metalloproteinases (MMPs). The increment in ROS perturbs the normal redox balance and shifts cells into a state of oxidative stress. ROS induce molecular damage and disturbed redox signaling, that result in the loss of bone homeostasis, increased pro-inflammatory mediators, and MMP overexpression and activation, leading to apical tissue breakdown. On the other hand, oxidative stress has been strongly involved in the pathogenesis of atherosclerosis, where a chronic inflammatory process develops in the arterial wall. Chronic AP is associated with an increased risk of cardiovascular diseases (CVD) and especially atherogenesis. The potential mechanisms linking these diseases are also discussed. [ABSTRACT FROM AUTHOR]

INTRODUÇÃO: A lesão apical ventricular é típica da cardiopatia chagásica e sua presença representa risco de fenômenos tromboembólicos. O objetivo deste trabalho é avaliar a frequência de LA à necropsia de portadores de cardiopatia chagásica crônica. MÉTODOS: Análise retrospectiva de necropsias de chagásicos maiores que 17 anos. Efetuada análise estatística comparativa das variáveis clínicas e dos achados necroscópicos entre o grupo A (com lesão apical) e o grupo B (ausência de lesão apical). RESULTADOS: Estudados 51 casos: 25 no grupo A (idade média de 53 anos, 64% do sexo masculino)e 26 no B.. A LA localizava-se no ventrículo esquerdo em 80% casos. No grupo B, a média de idade foi de 56 anos e 46,1% eram do sexo masculino. A forma clínica prevalente nos dois grupos foi a miopática, mas arritmia cardíaca também esteve presente em ambos (57,9% no grupo A e 32,1% no B). Foi constatada a presença de trombos em 60% dos casos do grupo A (53,3% localizados na LA ) e 30,7% no B; CONCLUSÕES: Houve predomínio da forma miopática nos casos com LA, com média de peso cardíaco maior em relação ao B. Em ambos os grupos observamos relação diretamente proporcional entre maior peso cardíaco e presença de tromboses. Houve predomínio do número de tromboses no grupo A, mais de 50% eram localizadas na lesão, cujo diferencial clínico principal consistiu na presença maior de arritmias. A miopatia (com aumento de peso acima de 500g) foi primordial para aparecimento de tromboses.INTRODUCTION: The presence of an apical ventricular lesion increases the risk of intracardiac thrombosis and thromboembolic phenomena. The study evaluated the incidence of apical lesions and intracardiac thrombosis in Chagas' heart disease patients at autopsy. METHODS: A retrospective review of autopsies of Chagas' heart disease patients was conducted. Statistical analysis included comparison of clinical variables and autopsy findings between two groups: group A (apical lesions) and group B (no apical lesions). RESULTS: A total of 51 cases of Chagas' disease patients were studied: 25 in group A (mean age 53 years-old; 64% male) and 26 in group B. Apical lesions were verified in the left ventricle in 80% of cases. The prevalent clinical subtype in both groups was myopathic, but significant cardiac arrhythmia was present in 57.9% of patients in group A, while 76.9% in group B did not present arrhythmias. Mean heart weight was 500.9g in group A and 408.4g in group B. The presence of thrombosis occurred in 60% of group A with 8 (53.3%) thrombi occurring in the apical lesion. CONCLUSIONS: The myopathic subtype was the most common clinical form in group A and the mean heart weight was statistically higher in this group. Clear prevalence of thrombosis was verified in group A, with 50% located in the apical lesion, whose main differential factor was a greater incidence of arrhythmias. Myopathy (heart weight above 500g) was primordial for the presence of thrombosis in both groups.

Introduction Mucosal fenestration at the root apex may compromise the treatment results of periradicular surgery from exposing the surgical wound to the oral environment. The purpose of this study was to evaluate the long-term outcomes of periapical lesions with mucosal fenestrations treated by guided tissue regeneration (GTR) combined with the management of soft tissue defects. Methods Five patients with mucosal fenestration and large periapical lesions were treated by endodontic surgeries and periodontal regenerative procedures during 1999 to 2006. The barrier membranes and osseous grafts were placed over the periapical defects after root end resection and retrograde filling. The mucosal openings in all cases were sutured, whereas a connective tissue graft was placed before repositioning the flap in 2 cases. Results The cases involving connective tissue grafting showed complete soft tissue coverage, whereas 2 of the 3 cases involving primary closure of fenestrations still had a small soft tissue opening that was further managed by placement of a connective tissue graft beneath in 1 case and direct suturing in the other case. After at least 6 years (72–160 months) of follow-up, all cases showed complete soft tissue and radiographic healing. Conclusions Connective tissue grafting in combination with GTR therapy facilitated fenestration closure and ensured long-term success in the treatment of a large periapical bony defect with mucosal fenestration. [ABSTRACT FROM AUTHOR]

Objective: We aimed to assess the diagnostic accuracy of different cone beam CTs (CBCTs) and the influence of field of view (FOV) in diagnosing simulated periapical lesions. Methods: 6 formalin-fixed lateral mandibular specimens from pigs were used for creating 20 standardized periapical bone defects. 18 roots were selected for the control group. Three CBCT devices [Accuitomo 3D® (Morita, Kyoto, Japan), NewTom 3G (Quantitative Radiology, Verona, Italy) and Scanora® (Soredex, Tuusula, Finland)] and three FOVs (NewTom 3G® FOV 6, 9 and 12 inches) were used to scan the mandible. Five observers assessed the images, using a five-point probability scale for the presence of lesions. Specificity, sensitivity and areas under the receiver operating characteristic (ROC) curves were calculated. Results: Sensitivity ranged from 72% to 80%. Specificity ranged from 60% to 77%. A difference in scoring between Scanora and the other two devices existed only in the control group. ROC analysis for different FOVs showed a decreased sensitivity with an increasing FOV, but this difference was not significant. Conclusion: In the control group, there was a difference between the CBCT devices regarding their specificity. FOV size did not show any difference in diagnostic performance. In cases in which conventional radiographic methods in combination with clinical evaluation are not sufficient, CBCT may be the method of choice to assess periapical pathology. CBCT examinations should be complementary to a clinical examination and FOV adaptation can be utilized to keep the dose to the patient as low as possible. Dentomaxillofacial Radiology (2012) 41, 548-552. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Clinical research regarding the clinical and histopathologic characteristics of cemental tear is limited in the endodontic literature. The objective of this study was to evaluate the morphology, apicocoronal location, and the histologic characteristics of cemental tear. Methods: The material was collected during 1987–2009 and consisted of 54 teeth that were presented with cemental tears by histologic examination. To investigate the atypical prospects among the groups of each variable, a series of the Poisson χ2 goodness-of-fit tests were conducted to test for a fit of a discrete, uniform distribution. Results: Cemental tear occurred mainly in incisors (74.1%), proximal root surfaces (79.6%), male patients (74.1%), and patients older than 60 years (72.3%). They were noted often in the middle third of root (45.3%), but 41.5% of cemental tears were noted over the apical region. The morphology of cemental tear was either small/thin piece-shaped (77.4% cases) involving 1 root surface or U-shaped (22.6%) involving >1 root surface. The size of cemental tear had an average length of 3.8 mm, width of 2.2 mm, and thickness of 0.9 mm. The separations of cemental tears occurred at cementodentinal junction (77.6%) relative to cementum (22.4%). The adhered soft tissue was either granulation tissue (92.3%) or cyst (7.7%). Conclusions: Cemental tear mainly occurs in incisors of male and older persons. It is also popularly noted in the apical region mimicking an endodontic lesion and some with cystic change. Clinically, endodontists should know this disease entity, make accurate early diagnosis, and totally remove the cemental tear during apical surgery to improve the prognosis. [Copyright &y& Elsevier]

Abstract: Introduction: The purpose of the present study was to evaluate the thickness and the anatomic characteristics of the Schneiderian membrane and cortical bone using limited cone beam computed tomography (CBCT) scannning in patients referred for planning of apical surgery of maxillary molars. Methods: This controlled study included 2 cohorts of patients (n = 50 for each group). For patients in group 1 (with apical pathology), 3 measurements in millimeters were performed using coronal and sagittal CBCT slices: the dimension of the apical lesion in the axis of the root, the width of the cortical bone in the axis of the root, and the thickness of the Schneiderian membrane perpendicular to the underlying cortical bone. For the analysis of CBCT scans of group 2 (without apical pathologies), 2 measurements were performed using coronal and sagittal CBCT slices: the width of the cortical bone in the axis of the root and the thickness of the Schneiderian membrane perpendicular to the underlying cortical bone. Results: For group 1, the periapical lesions evaluated measured between 0.27 and 7.41 mm in diameter, the apical bone separating the apical lesions from the maxillary sinus ranged from 0.13 to 7.83 mm, and the dimensions of the Schneiderian membrane ranged from 0.25 to 13.98 mm. The apical bone was generally thicker in patients with periapical lesions. Regarding the dimensions of the Schneiderian membrane, the values were statistically significantly higher for the patients in group 1 compared with group 2. Conclusions: The study showed that the Schneiderian membrane in the vicinity of roots with apical lesions tends to be significantly thicker when compared with the roots of teeth without apical pathoses. [Copyright &y& Elsevier]

Abstract: Introduction: The purpose of the present study was to evaluate the detectability and dimensions of periapical lesions, the relationship of the mandibular canal to the roots of the respective teeth, and the dimension of the buccal bone by using limited cone-beam computed tomography (CBCT) in comparison to conventional periapical (PA) radiographs for evaluation of mandibular molars before apical surgery. Methods: The study comprised 38 molars with 75 roots. The type of PA lesion as diagnosed on PA radiographs was compared with the type of lesion seen on sagittal and coronal CBCT sections. The distances of the apices of the first mandibular molars and basal border of the PA lesion to the coronal lining of the mandibular canal were assessed with PA radiographs and corresponding sagittal and coronal CBCT images. Furthermore, coronal CBCT images were used to measure the distance from the apices to the buccal bone surface and the corresponding width of the cortical bone plate. Results: Of 58 detected PA lesions, 15 (25.9%) lesions diagnosed with sagittal CBCT slices were missed with PA radiography. The distance between the apices and the upper border of the mandibular canal was only measurable in 24 of 68 radiographs (35.3%) by using PA images. The cortical bone wall had a mean thickness of 1.7 mm, whereas the total buccal bone wall (cortical and spongious) measured 5.3 mm on average. Conclusions: The present study highlights the advantages of using limited CBCT for treatment planning in mandibular molars before apical surgery. [ABSTRACT FROM AUTHOR]

Abstract: This study compared periapical (PA) radiography and cone-beam tomography (CBT) for preoperative diagnosis in posterior maxillary teeth of consecutive patients referred for possible apical surgery. Images were concurrently analyzed by an oral radiologist and an endodontist to reach consensus in interpretation of the radiographic findings. The final material included 37 premolars and 37 molars with a total of 156 roots. CBT showed significantly more lesions (34%, p < 0.001) than PA radiography. Detecting lesions with PA radiography alone was most difficult in second molars or in roots in close proximity to the maxillary sinus floor. Additional findings were seen significantly more frequently in CBT compared with PA radiography including expansion of lesions into the maxillary sinus (p < 0.001), sinus membrane thickening (p < 0.001), and missed canals (p < 0.05). The present study highlights the advantages of using CBT for preoperative treatment planning in maxillary posterior teeth with apical pathology. [Copyright &y& Elsevier]

Apical lesions, the general term for chronic infectious diseases, are very common dental diseases in modern life, and are caused by various factors. The current prevailing endodontic treatment makes use of X-ray photography taken from patients where the lesion area is marked manually, which is therefore time consuming. Additionally, for some images the significant details might not be recognizable due to the different shooting angles or doses. To make the diagnosis process shorter and efficient, repetitive tasks should be performed automatically to allow the dentists to focus more on the technical and medical diagnosis, such as treatment, tooth cleaning, or medical communication. To realize the automatic diagnosis, this article proposes and establishes a lesion area analysis model based on convolutional neural networks (CNN). For establishing a standardized database for clinical application, the Institutional Review Board (IRB) with application number 202002030B0 has been approved with the database established by dentists who provided the practical clinical data. In this study, the image data is preprocessed by a Gaussian high-pass filter. Then, an iterative thresholding is applied to slice the X-ray image into several individual tooth sample images. The collection of individual tooth images that comprises the image database are used as input into the CNN migration learning model for training. Seventy percent (70%) of the image database is used for training and validating the model while the remaining 30% is used for testing and estimating the accuracy of the model. The practical diagnosis accuracy of the proposed CNN model is 92.5%. The proposed model successfully facilitated the automatic diagnosis of the apical lesion. [ABSTRACT FROM AUTHOR]

The association between smoking and periapical periodontitis: a systematic review. Aminoshariae A, Kulild J, Gutmann J. Clin Oral Investig 2020;24(2):533-545. https://doi.org/10.1007/s00784-019-03094-6. None. The authors declared no conflict of interest. Systematic review with meta-analysis. [ABSTRACT FROM AUTHOR]

Aim: Cone beam computed tomography (CBCT) is the most refined and affordable method available today for the examination of an incoming patient for different dental pathologies. The aim of this paper is to evaluate the significance of some factors influencing the prevalence of apical periodontitis., Materials and Methods: An ortopantomography (OPT) and CBCT scan of the dental arches were examined for each of the selected 45 patients. The presence of apical periodontitis (AP) was compared for CBCT and OPT examination. Sensitivity, specificity, predictive values, and accuracy were calculated for CBCT, using OPT as a reference. The impact of protective/risk factors on the development of AP was examined., Results: CBCT showed higher sensitivity (250%), predictive values (111%), accuracy (111%), and specificity (101%) than OPT. It was found to have higher sensitivity in all the dentition areas, especially where empty anatomical spaces or more radiotransparent structures have a strict relationship with the tooth apex and periapical structures like upper front area, premolar areas, and, especially, in the upper molar area. The prevalence of AP increased from 16 to 17% in the case of insufficient conservative restoration or 25% in the case of microleakage, 35-42% in the case of prosthetic restoration, 56-67% for posts, and 60 and 85%, respectively, for inadequate endodontic treatment and missed canals., Conclusion: CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between the apex and important anatomical structures exists. Different risk factors with different relevance are identified., Clinical Significance: As CBCT-examined results show, coronal restorations are moderate-risk factors, while insufficient endodontic treatments and posts are high-risk factors for the development of AP.

Objective: The purpose of this study was to evaluate the effect of periapical lesion size on the degree of mucosal thickening of maxillary sinus and thickness of apical bone using cone-beam computed tomography., Materials and Methods: In Group 1 (teeth with apical lesions), diameter of apical lesion, width of apical bone, thickness of Schneiderian membrane; for Group 2 (teeth without apical lesions), width of apical bone in long axis of root and thickness of Schneiderian membrane were measured on coronal and sagittal images., Results: Mann-Whitney U-test revealed no significant difference between two groups regarding mucosal thickening and apical bone measurements (P > 0.05). Wilcoxon signed-rank test showed no significant difference between the measurements in sagittal and coronal slices (P > 0.05)., Conclusion: Results of the present study showed that Schneiderian membrane near the maxillary premolars and molars with apical lesions is not significantly thicker compared to teeth without apical lesions., Competing Interests: There are no conflicts of interest