Evaluation of the relationship between periapical lesions/sclerotic bone and general bone density as a possible gauge of general health among 80-year-olds

OBJECTIVES: To evaluate the incidence among 80-year-olds of periapical lesions as detected on panoramic radiographs and to determine the relationship between sclerotic bone around the periapical lesions to heel bone density, body height, and hand-grip strength. STUDY DESIGN: Six hundred fifty-nine panoramic radiographs (262 males, 397 females), obtained from 80-year-old residents of Fukuoka Prefecture, Japan, were used for evaluation of periapical lesions. These findings were correlated with physical examination results to determine the relationship to general health. RESULTS: Of 659 panoramic radiographs, 31 (5%) were noted to have periapical lesions. Average size of the 31 periapical lesions was 6.1 +/- 2.2 mm. Of the 31 periapical lesions, 21 (68%) were accompanied by linear or diffuse types of sclerotic bone. Of the 21 sclerotic bones, 10 (48%) were of a linear type of sclerotic bone and 11 (52%) of a diffuse type of sclerotic bone. Of the 11 diffuse types of sclerotic bone, 10 (91%) were in the mandible and 1 (9%) in the maxilla. Periapical lesions in the mandible were more frequently accompanied by a diffuse type of sclerotic bone than those in the maxilla (P < .01). The hand-grip strength of those having periapical lesions, accompanied by a diffuse type of sclerotic bone, was stronger than those having no periapical lesions (P < .01) and those accompanied by a linear type of sclerotic bone (P < .03). However, there was no relationship between presence of sclerotic bone and heel bone density or body height. CONCLUSIONS: Periapical lesions accompanied by a diffuse type of sclerotic bone were more frequently seen in the mandible of 80-year-olds. To evaluate the clinical significance of sclerotic bone around periapical lesions in 80-year-olds, further study to evaluate the significance of endodontic treatment needs to be done.     

Subtraction radiography of interradicular bone lesions.

Subtraction and conventional radiography were evaluated for their diagnostic potential to assess interradicular bone lesions in the mandibular premolar region. Both conventional radiographs and subtraction images were interpreted by 10 observers. The receiver-operating characteristic (ROC) technique was used to compare the two techniques. The diagnostic validity was higher for the subtraction technique, both for lesions confined to cancellous bone and for lesions including the cortical bone, than for the conventional technique. For bone defects confined to cancellous bone the diagnostic accuracy was lower than those reported from periapical bone lesions irrespective of whether subtraction or conventional radiography was used. We conclude that subtraction radiography improves the detectability of bone lesions, shallow ones in particular. Lesions in the interradicular bone are more difficult to detect than those in the periapical bone.     

Periradicular Lesions in Cancellous Bone Can Be Detected Radiographically

IntroductionThe purpose of this study was to evaluate whether naturally occurring periradicular lesions confined to cancellous bone can be detected on periapical digital radiography and whether the size of the lesion had any effect on lesion detection.MethodsOne hundred twenty-nine roots were chosen based on cone-beam computed tomographic imaging and categorized as having no lesion, a lesion confined to cancellous bone, a lesion that encroaches on junctional corticocancellous trabeculae, or a lesion with cortical involvement. The largest buccolingual dimension of the lesions was measured on cone-beam computed tomographic imaging. Two observers separately viewed the corresponding periapical radiographs in their original version as well as in the edge-enhanced setting on MiPACS (LEAD Technologies Inc, Charlotte, NC). Observers were asked to evaluate and interpret the periapical radiographs as having a lesion present, absent, or “unsure.” Evaluations of images were conducted at 2 times 1 week apart. Data were analyzed, and the level of significance was set at P = .05.ResultsLesion size, not the degree of cortical involvement, significantly affected the observers’ ability to accurately detect lesions. As the size of the lesion increased, the probability of correctly identifying a lesion increased (P = .0008). Lesions were correctly identified 97.6%, 94.1%, 91.6%, and 89.3% of the time, respectively, when in cortical bone, at the junction of corticocancellous bone, in cancellous bone, and when no lesion was present. Observers were “unsure” whether a lesion was present or absent 10.7% of the time. Only lesions in cortical bone significantly increased observers’ certainty in making a diagnosis.ConclusionsThis study concluded that lesions confined to cancellous bone can be detected radiographically at a high rate. Lesion size was positively correlated with correct lesion identification, whereas the degree of cortical involvement had no significant effect. This suggests that lesion size may be a better predictor for correct lesion identification than lesion location.     

Subtraction radiography for the diagnosis of periapical bone lesions

Abstract Subtraction and conventional radiography were evaluated for the diagnostic potential to assess periapical bone lesions. The periapical region of dry human mandibles was radio-graphically examined, subjectively evaluated and measured by ¹²⁵I absorptiometry before and after the creation of bone defects. Both conventional radiographs and subtraction images made from the conventional radiographs after digitization were interpreted by 10 dentists. Receiver operating characteristic (ROC) analysis technique was used to compare the two techniques. There was a higher diagnostic accuracy using subtraction technique. For a lesion depth corresponding to < 2 mm of compact bone, there was a clear difference between the techniques, but for deeper lesions the conventional technique gained force. The subtraction technique was significantly superior for lesions confined to cancellous bone. The statistical difference in the diagnostic utility of subtraction compared with conventional technique was found to be less for lesions of the cortical bone. Therefore, the conclusion is that subtraction radiography improves the detection of small lesions in the periapical bone area.     

The radiopaque lesion: A diagnostic consideration

Abstract This study attempts to designate that some periapical and periodontal radiopacities can be caused by inflamed or necrotic pulps and periodontitis. An hypothesis is offered to explain the formation of a periapical sclerotic lesion. The increase in periapical bone density can often mask an occult granulomatous lesion and it can be obscured by inadvertently superimposing tori over apical radiolucencies. The increased reactive periapical sclerosis is not necessarily clue to an osteitis. This is especially true of dense trabecular bone patterns that are noted in cases of occlusal stress and in periodontitis. It is questionable whether the use of the terms condensing osteitis or sclerosing osteitis is appropriate. Endodontic or periodontic therapy in cases associated with increased bone density produce a normalization of the bone trabeculae. The lesions that do not respond to the specific treatment may be due to anatomic landmarks, increase in functional stimuli producing excessive bone production, local and systemic disorders. Diagnostic features of the radiopaque lesion are discussed.     

Digital subtraction radiography for detecting cortical and cancellous bone changes in the periapical region

Previous studies have found that bony lesions cannot be visualized on conventional radiographs unless there is cortical plate involvement. The aim of this project was to compare the sensitivity of digital subtraction to conventional radiography for detecting periapical changes in cortical and cancellous bone. Using a long source-to-object X-ray technique and E-speed film, serial radiographs of a dry skull mandible were obtained. Two bone lesions per radiograph were simulated using #1 to 8 round burs. Conventional and digitally subtracted images were evaluated for lesion presence by a board of reviewers. The results demonstrated greater sensitivity scores for digitally subtracted images in identifying cortical and cancellous bone changes. The lower limit of detection was less for digitally subtracted images in cortical and cancellous bone as well.     

Detection of the apical lesion and the mandibular canal in conventional radiography and computed tomography

OBJECTIVE: The purpose of this study was to compare the information gathered from dental radiography and high resolution computed tomography (CT) scans with regard to the detection of the endodontic lesion and its relation to the important neighboring anatomic structures such as the mandibular canal. STUDY DESIGN: Fifty patients with a persistent apical lesion referred for endodontic surgery were selected. The teeth involved were 6 mandibular premolars and 44 mandibular molars. Eighty roots were evaluated. For each case 1 CT scan and 1 periapical radiograph were taken. The apical lesion and the mandibular canal were evaluated for possible identification in CT scan or radiograph. The presence of the lesion was correlated to the findings during the surgical procedure. The CT scans of the involved roots were further evaluated with regard to the bone thickness and differentiation between cancellous and cortical bone. The position of the lesion/root within the mandible was studied in all dimensions. RESULTS: All 78 lesions diagnosed during surgery were also visible with the CT scan. In contrast, only 61 of the lesions were noted by conventional radiographs. The mandibular canal could be identified in 31 cases in dental radiographs, whereas in the oblique cuts of the corresponding CT scans the mandibular canal was detected in all patients. The amount of cortical and cancellous bone and the bone thickness as well as the three-dimensional extent of the lesion could only be adequately interpreted in CT scans. CONCLUSIONS: The use of CT provides additional, beneficial information not available from dental radiographs for treatment planning in apical surgery of mandibular premolars and molars. When the mandibular canal cannot be detected in dental radiographs or is in close proximity to the lesion or root apex, CT should be considered before endodontic surgery. The presence, extent, and location of the lesion and its relation to the mandibular canal can be predictably evaluated in a CT scan of the area.     

Fibrous dysplasia of jaw and facial bones:A combined analysis of clinic,radiologic and histopathologic diagnosis of 117 cases]

A clinical-radiologic-histopathologic review of 106 cases of fibrous dysplasia involving the jaws is presented. Ninety eight patients onset in the first and second decades.Fifteen cases were polyostotic and the remaining cases were were monstotic.Radiologicaly,the lesions showed and extending growth pattern,poor definite border and slight pattern,poor definite border and slight involvement of teeth.The radiographic features were classified into four types:ground grass (52.0%),sclerotic(8.0%),cystic-like(8.0%) and mixed type (32.0%).Histologically the lesions were characterized by a cellular fibrous stroma that contain varying amounts of mineralized substance,represented by woven bone(63.0%),lamellar bone(30.0%) and cementum-like structure(7.0%).The final definitive diagnosis requires the combined evaluation of clinic,radiologic and histopathologic findings.     

Extraradicular infection: a methodological study

Whether bacteria live or die in periapical lesions of endodontic origin is debated. Sampling of periapical bacteria is difficult due to possible contamination from the indigenous microflora. The aim of this study was to examine whether bacteria were present in periapical lesions of asymptomatic teeth before sampling or were transferred there during sampling. Thirty patients with root-filled teeth and periapical radiolucencies were divided into two groups, each containing 15 patients. In Group 1, a marginal incision was made to explore the periapical lesion. In Group 2, a submarginal incision was made. Before incision, the gingiva and mucosa were washed with 0.2% chlorhexidine gluconate. Bacterial samples were taken from the mucosa before reflecting the flap, and from the alveolar bone and the periapical lesion immediately after. All samples were cultured anaerobically on all-purpose and selective media. In Group 1, 12 of the 15 patients (80%) yielded bacteria from their mucosal samples despite the chlorhexidine wash. Bacterial growth was observed in all samples (100%) from the alveolar bone while the periapical lesions gave bacterial growth in 11 of 15 cases (73%). In Group 2, bacteria were cultured from the mucosa in 11 of 15 (73%) patients. Three samples (20%) from the alveolar bone and 10 from the periapical lesions (67%) gave positive growth. The predominant cultivable bacteria were anaerobic. Phenotypic profiling, performed with the data-based API bioMérieux system, indicated that the sampling technique used prevented mucosal bacteria from reaching the exposed bone and the periapical lesions. Profiling also indicated that following marginal incision, bacteria from the periodontal pocket might have reached the underlying tissues by surgeon-released bacteremia or direct translocation. Most organisms detected in the periapical lesions were clearly different from the bacteria present at neighboring sites and appeared to have been there before sampling.     

Use of micro‐computed tomography for the assessment of periapical lesions in small rodents: a systematic review

This systematic review aimed to evaluate the literature on the acquisition‐, reconstruction‐ and analysis parameters of micro‐computed tomography (micro‐CT) for the assessment of periapical lesions in rats and mice, and to illustrate the effect of variation in these parameters. The PubMed database was searched from 2000 to January 2015 (English‐language publications) for reports on the use of micro‐CT to evaluate periapical lesions in rats and mice. QUADAS criteria were used to rate the quality of the studies. To illustrate the effect of variations in acquisition‐, reconstruction‐, and analysis parameters on images of periapical lesions, micro‐CT examination of two hemi‐mandibles of mice, with periapical lesions around the first molar was undertaken. Twenty‐one studies were identified, which analysed periapical lesions in rats or mice using micro‐CT. According to the QUADAS, no study was classified as high‐, seven were classified as moderate‐, and 14 as low quality. The effect of variation in parameters was that voxel size may interfere with image sharpness, reconstruction may interfere with image sharpness and contrast, and inadequate plane orientation may alter the size of the periapical lesion. Nonpersonalized ROIs resulted in areas that were not part of the periapical lesion. Changing the limits of the threshold for bone‐tissue visualization increased lesion size. There is no defined protocol for acquiring and analysing micro‐CT images of periapical lesions in rats and mice. Furthermore, acquisition‐, reconstruction‐ and analysis parameters are not adequately explained, which may compromise the scientific impact of the studies.     

Extraradicular infection: a methodological study

Abstract – Whether bacteria live or die in periapical lesions of endodontic origin is debated. Sampling of periapical bacteria is difficult due to possible contamination from the indigenous microflora. The aim of this study was to examine whether bacteria were present in periapical lesions of asymptomatic teeth before sampling or were transferred there during sampling. Thirty patients with root‐filled teeth and periapical radiolucencies were divided into two groups, each containing 15 patients. In Group 1, a marginal incision was made to explore the periapical lesion. In Group 2, a submarginal incision was made. Before incision, the gingiva and mucosa were washed with 0.2% chlorhexidine gluconate. Bacterial samples were taken from the mucosa before reflecting the flap, and from the alveolar bone and the periapical lesion immediately after. All samples were cultured anaerobically on all‐purpose and selective media. In Group 1, 12 of the 15 patients (80%) yielded bacteria from their mucosal samples despite the chlorhexidine wash. Bacterial growth was observed in all samples (100%) from the alveolar bone while the periapical lesions gave bacterial growth in 11 of 15 cases (73%). In Group 2, bacteria were cultured from the mucosa in 11 of 15 (73%) patients. Three samples (20%) from the alveolar bone and 10 from the periapical lesions (67%) gave positive growth. The predominant cultivable bacteria were anaerobic. Phenotypic profiling, performed with the data‐based API bioMérieux system, indicated that the sampling technique used prevented mucosal bacteria from reaching the exposed bone and the periapical lesions. Profiling also indicated that following marginal incision, bacteria from the periodontal pocket might have reached the underlying tissues by surgeon‐released bacteremia or direct translocation. Most organisms detected in the periapical lesions were clearly different from the bacteria present at neighboring sites and appeared to have been there before sampling.     

Detectability of artificial periapical lesions using direct digital and conventional radiography

The ability of different radiographic techniques to detect the presence of artificially created periapical lesions in mandibles of human cadavers was investigated. Conventional radiography was compared with direct digital imaging using the Digora system. Artificial lesions were created around the roots of molars in three stages: removal of lamina dura only, extension to cancellous bone, and involvement of cortical plate. Radiographs and digital images (gray scale, color, and reverse image) were obtained preoperatively and after each stage of bone removal. Images were scored on a 5-point scale by eight observers. For all image types, lesions were readily detectable after removal of lamina dura only, with increasing detectability associated with further bone removal (especially cortical plate involvement). Radiographs and gray-scale digital images were comparable at all stages, whereas color and reverse images were associated with a greater spread of diagnostic scores. Digital imaging did not enhance detectability of lesions.     

实验性根尖周病变的X线及组织学研究

本实验将三只实验狗的全部牙髓暴露于口腔环境内诱导根尖周病变的发生，术后第５，１４，１８周分别处死动物，Ｘ线片显示各组动物根尖周均有不同程度的密度减低影像，观察时间最长的动物其密度减低范围较前两组增大，且部分根尖周密度减低区周围存在密度增高的Ｘ线阻射带，组织学检查，１５７个牙根右的８６个根尖周出现不同程度的炎症或有肉芽肿形成，１３个根管内有活髓残留，其根尖周均无炎症，认为根尖周病主煌发生出现在牙髓感     

Echographic evaluation of bone lesions of endodontic origin: report of two cases in the same patient

We report on two periapical lesions of endodontic origin detected in the maxillary bone of the same patient, whose echographic examination was used to address a tentative differential diagnosis between a granuloma and a cystic lesion. The patient on whom two periapical lesions were diagnosed with clinical and conventional radiographic findings and scheduled for endodontic surgery, was also examined using echography and color power doppler at the site of the lesions. The lesions were echographically described in each case according to a scheme from a previous work. A tentative differential diagnosis between a cystic lesion and a granuloma was made. One lesion was described as a cyst, the other as a granuloma. After surgical excision, the lesions were examined under light microscopy. In both cases the two echographic diagnoses were confirmed by the histopathologic examination.     

The potential applications of cone beam computed tomography in the management of endodontic problems

AIM: To provide core information on cone beam computed tomography (CBCT) technology and its potential applications in endodontic practice. SUMMARY: CBCT has been specifically designed to produce undistorted three-dimensional information of the maxillofacial skeleton as well as three-dimensional images of the teeth and their surrounding tissues. This is usually achieved with a substantially lower effective dose compared with conventional medical computed tomography (CT). Periapical disease may be detected sooner using CBCT compared with periapical views, and the true size, extent, nature and position of periapical and resorptive lesions can be assessed. Root fractures, root canal anatomy and the true nature of the alveolar bone topography around teeth may be assessed. CBCT scans are desirable to assess posterior teeth prior to periapical surgery, as the thickness of the cortical and cancellous bone can be accurately determined as can the inclination of roots in relation to the surrounding jaw. The relationship of anatomical structures such as the maxillary sinus and inferior dental nerve to the root apices may also be clearly visualized. KEY LEARNING POINTS: CBCT has a low effective dose in the same order of magnitude as conventional dental radiographs. CBCT has numerous potential applications in the management of endodontic problems.     

Asymptomatic radiopaque lesions of the jaws: a radiographic study using cone-beam computed tomography

Panoramic radiography and cone-beam computed tomography (CT) were used to analyze asymptomatic radiopaque lesions in the jaw bones and determine the diagnostic relevance of the lesions based on their relationships to teeth and site of origin. One hundred radiopaque lesions detected between 1998 and 2002 were examined by both panoramic radiography and cone-beam CT. On the basis of panoramic radiographs, the region was classified as periapical, body, or edentulous, and the site was classified as molar or premolar. Follow-up data from medical records were available for only 36 of these cases. The study protocol for simultaneous use of cone-beam CT was approved by the ethics review board of our institution. A large majority of radiopaque lesions were observed in premolar and molar sites of the mandible; 60% of lesions were periapical, 24% were in the body, and 16% were in the edentulous region. An interesting type of radiopaque lesion, which we named a pearl shell structure (PSS), was observed on cone-beam CT in 34 of the 100 lesions. The PSS is a distinctive structure, and this finding on cone-beam CT likely represents the start of bone formation before bone sclerosis.     

锥形束CT对牙根外吸收早期诊断价值的探讨

目的:探讨锥形束CT(cone beam CT,CBCT)在牙根外吸收早期诊断中的临床应用价值。方法:对50例牙根外吸收的患者应用CBCT和数字化根尖片检查,对患牙在牙槽骨中的近远中向、颊舌向病损情况进行对比分析。由3名影像学专家采用双盲法对不同方法产生的图像质量进行评价,采用5阶法行ROC曲线解析。结果:50例应用CBCT检查得到的图像可准确显示近远中向、颊舌向的牙根外吸收情况;而数字化根尖片只可显示近远中情况,不能准确判断牙根外吸收颊舌向情况。CBCT图像的ROC曲线解析参数(Az=0.90),大于数字化根尖片的解析参数(Az=0.69)。结论:CBCT有利于牙根外吸收的早期诊断。     

Trepanation and curettage treatment for acute implant periapical lesions

Six dental implants in six patients with periapical lesions were inserted and underwent trepanation and thorough curettage. During surgery, the lesion area was irrigated with copious natural saline and chlorhexidine and the bone defects were treated with tetracycline paste. The six implants were stable and asymptomatic postoperatively. The implants were loaded after 3 months. Radiologically, the radiolucency in the apical part disappeared gradually. These prostheses have functioned satisfactorily with no further complication during the follow-up period. For cases in which small lesions initially appear soon after implant placement, trepanation and curettage of the periapical lesion without resection of the apical part of the implant or bone substitute material and/or autogenous bone grafting is an effective management option. A rapid and exact diagnosis is important for treating implant periapical lesions.     

A comparison of phosphor-plate digital images with conventional radiographs for the perceived clarity of fine endodontic files and periapical lesions

OBJECTIVE: We sought to compare digital images with radiographs for the perceived clarity of small endodontic file tips at 2 different working lengths, as well as for the visualization of periapical bone lesions. STUDY DESIGN: Standardized conventional radiographic and phosphor-plate digital images were taken of 20 extracted permanent mandibular molars with 06 K-files placed in the distal root canal either 2 mm short or flush with the apical foramen. Similar images were obtained from mandibles with teeth that demonstrated large (n = 10) or small (n = 10) periapical lesions. Four evaluators ranked the clarity of the digital image with that of the radiograph. Results were analyzed by using the 2-sided sign test, ordinal logistic regression, and the kappa test. RESULTS: The perceived clarity of an endodontic file tip, at any position, and of a small or large periapical lesion was significantly (P < .01) less on all digital images compared with conventional films. CONCLUSION: Evaluator ratings indicated that the perceived clarity of fine endodontic files and periapical lesions was significantly less with phosphor-plate digital images than with conventional radiographs.