- Email: [email protected]
Cone beam computed tomography in endodontics
Mean MMSE score was 23.1 and showed links to age, education, depressive symptoms, perceived masticatory disability, and functional quality of the dentures. Adjusting for significant risk factors (age, years of education, and depression), perceived masticatory disability was related to cognitive status. About 6% of the variation in MMSE score was attributable to masticatory disability. Discussion.—The results indicate that the quality of dentures may influence cognitive status among elderly persons. The mechanism that may explain this relationship is likely the masticatory pathway.
Clinical Significance.—Cognitive impairment is a major public health issue that carries
a substantial risk of morbidity for elderly persons. Cognitive status may be influenced by functional denture quality. Further study is needed to determine if the masticatory pathway is the mechanism by which cognition and mastication are linked.
Cerutti-Kopplin D, Emami E, Hilgert JB, et al: Cognitive status of edentate elders wearing complete denture: Does quality of denture matter? J Dent 43:1071-1075, 2015 Reprints available from D Cerutti-Kopplin, Dept of Preventive and Social Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; e-mail: [email protected]
Imaging Cone beam computed tomography in endodontics Background.—Root canal treatment is undertaken to provide an optimal biological environment for tissue healing, prevent periodontitis or facilitate apical periodontitis healing, and retain the involved tooth’s function. Periapical status is an essential determination before a proper treatment plan and prognosis can be formed. The gold standard for the determination of apical periodontitis is biopsy and histological examination, but this is an invasive process and is not used routinely in clinical practice. Dentists rely on clinical and radiographic assessments, so imaging is an essential part of diagnosing and managing these teeth. Intra-oral periapical radiographs (PRs), whether conventional or digital, are the standard used in endodontics, but provide only a two-dimensional image of a three-dimensional situation. Cone beam computed tomography (CBCT) offers the advantage of allowing the clinician to assess image sections in all planes. However, there is an increased dose of radiation to the patient compared with PR exposure. The diagnostic efficacy of CBCT used for periapical lesions was investigated. Methods.—The MEDLINE database was searched between 2000 and July 2013 for studies assessing the potential of CBCT imaging in diagnosing and planning treatment for periapical lesions. The search yielded 25 publications that met the inclusion criteria. Results.—None of the studies investigated the therapeutic efficacy, patient outcome efficacy, or societal efficacy of CBCT. One focused on the diagnostic thinking efficacy and all the others delved into the diagnostic accuracy of CBCT.
48
Dental Abstracts
Twelve used a gold standard, with 8 using direct observations and 4 using histological evaluation. The 8 using direct observation showed that CBCT had higher accuracy than two-dimensional images. Two human studies using histological analysis found CBCTwas not a reliable method for differentiating between periapical granulomas and periapical cysts. One animal study using histologic findings showed CBCT had higher sensitivity than PR, but the two were equal in identifying healthy teeth. A study using CBCT-based evaluation and one using clinical symptoms as their gold standard were classified as having no gold standard. Thirteen studies had no gold standard. These all reported the proportion of detected periapical lesions, finding that more were detected by CBCT than by PR, with proportions found using CBCT varying widely. One study investigated the addition of CBCT use for treatment planning. Treatment choice did not differ between cases with and without CBCT information available to the clinician. CBCT was found to detect more periapical lesions than panoramic radiography (PAN) in a single study. Discussion.—The current literature indicates that although CBCT tends to be more accurate than PR when used to detect periapical lesions, no evidence supports the standard use of CBCT for all cases. For now, the efficacy of CBCT has only been analyzed at a low-diagnostic-efficacy level.
Clinical Significance.—The use of CBCT has not yet been proved to provide a benefit to the patient. In most cases, the treatment plan was not altered when CBCT data were available for analysis compared to the use of PR data alone. Prognosis may or may not be altered, but further studies are needed to determine that. None of the studies addressed the effect exposure to an increased dose of radiation will have compared to the benefits derived from CBCT use. Basically, the jury is still out.
Kruse C, Spin-Neto R, Wenzel A, et al: Cone beam computed tomography and periapical lesions: A systematic review analysing studies on diagnostic efficacy by a hierarachical model. Int Endod J 48:815828, 2015 Reprints available from C Kruse, Oral Radiology – Dept of Dentistry – Aarhus Univ, Vennelyst Blvd 9 – 8000 Aarhus, Denmark; e-mail: [email protected]
Implants Failure related to endodontic treatment Background.—Dental implants have become reliable alternatives to replace teeth, although many failures occur during initial healing, the first year of loading, and implant maintenance and retention. Typically these failures are characterized by specific clinical and radiographic signs and generally fall into the categories of infection- or trauma-induced types. Apical peri-implantitis may be provoked by remaining scar tissue or granulomatous tissue at the recipient site. The risk factors potentially related to the development of peri-implantitis were investigated. Methods.—Eight hundred implants were evaluated, with 580 in women and 220 in men. Patient age ranged from 28 to 81 years. Five hundred patients attended a university clinic and 300 were seen at private clinics. This observational retrospective descriptive study sought to identify the possible effects of lesions of pulpal or periapical origin on implant success. Most of the implants were 10, 12, or 15 mm long, with 11.4% having other lengths. Diameter measurements were 3.3, 3.8, or 4.3 mm, with 10.9% having other diameters. The most frequent cause of dental extraction was the presence of periodontal disease, followed by endodontic failure and trauma. Results.—One fourth of the sample had endodontic failure in the implant site and/or adjacent to implant placement previously. Peri-implantitis was found in 50.41% of the university patients and 23.38% of the private clinic patients. The incidence of peri-implantitis was higher for those treated in the university setting than for those in private clinics, although the difference was not statistically significant. Peri-implantitis was present in 31.5% of the implants having had previous endodontic treatment. Only 2.84% of the peri-implantitis was found in areas with no previous
root canal treatment. Therefore a link was shown between endodontic failure and peri-implantitis. The upper jaw was involved with peri-implantitis more often than the lower jaw, with a high prevalence of disease in the premolar area. Mandibular bone that is spongy and thick, surrounded by a thick layer of dense cortical bone, is considered ideal for placement of a dental implant. Discussion.—Placing implants in infected or previously infected sites increases the risk of developing apical periimplantitis or peri-implantitis, so this approach is not recommended. The tooth or area should be treated before the implant is placed if at all possible. In addition, the bone health of the tissues of the implant site should be carefully evaluated clinically and radiographically.
Clinical Significance.—Developing inflammation and infection around implants may be the result of bacteria remaining after endodontic treatment. This situation can cause late failure of implants and trigger the development of apical peri-implantitis.
pez-Martinez F, Morena GG, Olivares-Ponce P, et al: Implants failLo ures related to endodontic treatment. An observational retrospective study. Clin Oral Impl Res 26:992-995, 2015 Reprints available from JL Calvo-Guirado, Dept of General Dentistry, Faculty of Medicine and Dentistry, Hosp Morales Meseguer, Univ of Murcia Call e Marques de los Velez S/N, 30007 Murcia, Spain; fax: þ34 968 368 353; e-mail: [email protected]
Volume 61
Issue 1
2016
49
Clinical Significance.—Cognitive impairment is a major public health issue that carries
a substantial risk of morbidity for elderly persons. Cognitive status may be influenced by functional denture quality. Further study is needed to determine if the masticatory pathway is the mechanism by which cognition and mastication are linked.
Cerutti-Kopplin D, Emami E, Hilgert JB, et al: Cognitive status of edentate elders wearing complete denture: Does quality of denture matter? J Dent 43:1071-1075, 2015 Reprints available from D Cerutti-Kopplin, Dept of Preventive and Social Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; e-mail: [email protected]
Imaging Cone beam computed tomography in endodontics Background.—Root canal treatment is undertaken to provide an optimal biological environment for tissue healing, prevent periodontitis or facilitate apical periodontitis healing, and retain the involved tooth’s function. Periapical status is an essential determination before a proper treatment plan and prognosis can be formed. The gold standard for the determination of apical periodontitis is biopsy and histological examination, but this is an invasive process and is not used routinely in clinical practice. Dentists rely on clinical and radiographic assessments, so imaging is an essential part of diagnosing and managing these teeth. Intra-oral periapical radiographs (PRs), whether conventional or digital, are the standard used in endodontics, but provide only a two-dimensional image of a three-dimensional situation. Cone beam computed tomography (CBCT) offers the advantage of allowing the clinician to assess image sections in all planes. However, there is an increased dose of radiation to the patient compared with PR exposure. The diagnostic efficacy of CBCT used for periapical lesions was investigated. Methods.—The MEDLINE database was searched between 2000 and July 2013 for studies assessing the potential of CBCT imaging in diagnosing and planning treatment for periapical lesions. The search yielded 25 publications that met the inclusion criteria. Results.—None of the studies investigated the therapeutic efficacy, patient outcome efficacy, or societal efficacy of CBCT. One focused on the diagnostic thinking efficacy and all the others delved into the diagnostic accuracy of CBCT.
48
Dental Abstracts
Twelve used a gold standard, with 8 using direct observations and 4 using histological evaluation. The 8 using direct observation showed that CBCT had higher accuracy than two-dimensional images. Two human studies using histological analysis found CBCTwas not a reliable method for differentiating between periapical granulomas and periapical cysts. One animal study using histologic findings showed CBCT had higher sensitivity than PR, but the two were equal in identifying healthy teeth. A study using CBCT-based evaluation and one using clinical symptoms as their gold standard were classified as having no gold standard. Thirteen studies had no gold standard. These all reported the proportion of detected periapical lesions, finding that more were detected by CBCT than by PR, with proportions found using CBCT varying widely. One study investigated the addition of CBCT use for treatment planning. Treatment choice did not differ between cases with and without CBCT information available to the clinician. CBCT was found to detect more periapical lesions than panoramic radiography (PAN) in a single study. Discussion.—The current literature indicates that although CBCT tends to be more accurate than PR when used to detect periapical lesions, no evidence supports the standard use of CBCT for all cases. For now, the efficacy of CBCT has only been analyzed at a low-diagnostic-efficacy level.
Clinical Significance.—The use of CBCT has not yet been proved to provide a benefit to the patient. In most cases, the treatment plan was not altered when CBCT data were available for analysis compared to the use of PR data alone. Prognosis may or may not be altered, but further studies are needed to determine that. None of the studies addressed the effect exposure to an increased dose of radiation will have compared to the benefits derived from CBCT use. Basically, the jury is still out.
Kruse C, Spin-Neto R, Wenzel A, et al: Cone beam computed tomography and periapical lesions: A systematic review analysing studies on diagnostic efficacy by a hierarachical model. Int Endod J 48:815828, 2015 Reprints available from C Kruse, Oral Radiology – Dept of Dentistry – Aarhus Univ, Vennelyst Blvd 9 – 8000 Aarhus, Denmark; e-mail: [email protected]
Implants Failure related to endodontic treatment Background.—Dental implants have become reliable alternatives to replace teeth, although many failures occur during initial healing, the first year of loading, and implant maintenance and retention. Typically these failures are characterized by specific clinical and radiographic signs and generally fall into the categories of infection- or trauma-induced types. Apical peri-implantitis may be provoked by remaining scar tissue or granulomatous tissue at the recipient site. The risk factors potentially related to the development of peri-implantitis were investigated. Methods.—Eight hundred implants were evaluated, with 580 in women and 220 in men. Patient age ranged from 28 to 81 years. Five hundred patients attended a university clinic and 300 were seen at private clinics. This observational retrospective descriptive study sought to identify the possible effects of lesions of pulpal or periapical origin on implant success. Most of the implants were 10, 12, or 15 mm long, with 11.4% having other lengths. Diameter measurements were 3.3, 3.8, or 4.3 mm, with 10.9% having other diameters. The most frequent cause of dental extraction was the presence of periodontal disease, followed by endodontic failure and trauma. Results.—One fourth of the sample had endodontic failure in the implant site and/or adjacent to implant placement previously. Peri-implantitis was found in 50.41% of the university patients and 23.38% of the private clinic patients. The incidence of peri-implantitis was higher for those treated in the university setting than for those in private clinics, although the difference was not statistically significant. Peri-implantitis was present in 31.5% of the implants having had previous endodontic treatment. Only 2.84% of the peri-implantitis was found in areas with no previous
root canal treatment. Therefore a link was shown between endodontic failure and peri-implantitis. The upper jaw was involved with peri-implantitis more often than the lower jaw, with a high prevalence of disease in the premolar area. Mandibular bone that is spongy and thick, surrounded by a thick layer of dense cortical bone, is considered ideal for placement of a dental implant. Discussion.—Placing implants in infected or previously infected sites increases the risk of developing apical periimplantitis or peri-implantitis, so this approach is not recommended. The tooth or area should be treated before the implant is placed if at all possible. In addition, the bone health of the tissues of the implant site should be carefully evaluated clinically and radiographically.
Clinical Significance.—Developing inflammation and infection around implants may be the result of bacteria remaining after endodontic treatment. This situation can cause late failure of implants and trigger the development of apical peri-implantitis.
pez-Martinez F, Morena GG, Olivares-Ponce P, et al: Implants failLo ures related to endodontic treatment. An observational retrospective study. Clin Oral Impl Res 26:992-995, 2015 Reprints available from JL Calvo-Guirado, Dept of General Dentistry, Faculty of Medicine and Dentistry, Hosp Morales Meseguer, Univ of Murcia Call e Marques de los Velez S/N, 30007 Murcia, Spain; fax: þ34 968 368 353; e-mail: [email protected]
Volume 61
Issue 1
2016
49