Resolution of maxillary sinus mucositis after endodontic treatment of maxillary teeth with apical periodontitis: a cone-beam computed tomography pilot study

Introduction

Apical periodontitis (AP) is an inflammatory response that can affect the maxillary sinus. This study characterized maxillary sinus mucositis adjacent to teeth with AP and assessed its resolution after endodontic treatment.

Methods

Thirty maxillary sinuses in subjects (n = 29) who had AP associated with maxillary posterior teeth were imaged with cone-beam computed tomography (CBCT). When mucositis was detected, its resolution was assessed with CBCT scanning 3 months after treatment, and periapical healing was assessed using the periapical index (PAI) after 6 months.

Results

Excluding 5 sinuses obscured by sinusitis, mucositis was detected in 14 of 25 sinuses (56%). Nonsignificant inverse association was observed between the mucosal lining thickness and the distance from the sinus to root apices with AP. Four noncompliant subjects were discontinued. Three months after treatment, mucositis was fully resolved in 3 of 10 subjects (30%), partially resolved in 3 of 10 subjects (30%), unchanged in 3 of 10 subjects (30%), and worsened in 1 subject (10%). Six months after treatment, 6 of 10 subjects (60%) had reduced PAI scores classified as healed or healing. The subject with expanded mucositis at 3 months was not healing at 6 months.

Conclusions

Within the limited sample of this pilot study, CBCT imaging revealed a lower-than-expected prevalence of mucositis adjacent to teeth with AP. Fully resolved mucositis was not common 3 months after endodontic treatment, suggesting that in specific cases it might linger beyond 3 months after the elimination of the endodontic infection. Because of the low statistical power, the association between the resolution of mucositis and periapical healing could not be explored.     

CBCT在牙根尖周炎源性上颌窦黏膜炎根管治疗疗效评价中的应用

目的　通过CBCT检查患根尖周炎的上颌后牙,探讨牙根尖周源性上颌窦黏膜炎的特点及根管治疗后黏膜及骨质的改变。方法: 对25例患上颌后牙根尖周炎患者上颌窦进行CBCT扫描重建,确诊为黏膜炎后,根管治疗3个月后CBCT扫描明确黏膜炎消退程度,6个月后扫描通过根尖周指数评估根尖骨质愈合情况。结果: 剔除2例上颌窦炎,14例上颌窦表现为黏膜炎（61％),根管治疗3个月后,黏膜炎完全消退5例（35.7％）;部分消退6例（42.9％）;3例无明显改变（21.4％）。6个月后,3颗牙齿愈合（21.4％）,4颗牙齿好转（28.6％）,7颗牙齿未愈合（50％）。结论:上颌后牙根尖周炎易引发上颌窦黏膜炎,根管治疗是该疾病有效的治疗方法,CBCT影像能精确反映根管治疗前后上颌窦黏膜炎消退及骨质愈合情况,具有重要的临床参考价值。     

Influence of Length of Root Canal Obturation on Apical Periodontitis Detected by Periapical Radiography and Cone Beam Computed Tomography

IntroductionThe verification of the best length of root canal instrumentation and obturation still is controversial theme in endodontics. The purpose of this study was to determine the influence of length of root canal obturation on apical periodontitis (AP) detected by periapical radiography and cone beam computed tomography (CBCT).MethodsA total of 503 root canal obturations were evaluated by using periapical radiography and CBCT. Distances from the radiographic apex to the tip of filling material were measured and classified as close to 2 mm, 1 mm short or beyond apex, and at the apex. Obturations at the apex were associated with AP. Odds ratio, confidence intervals, and χ² test were used for statistical analyses.ResultsPeriapical radiographs showed that root canal obturations were 1–2 mm short of the apex in 88%, 89.3%, and 95% of the anterior teeth, premolars, and molars, respectively. CBCT images showed obturations had the same length in 70%, 73.7%, and 79% of anterior teeth, premolars, and molars, respectively. The frequency of AP was significantly greater in molars than in the other tooth groups, regardless of diagnostic method. AP was detected more frequently when CBCT was used.ConclusionsAP was detected at all lengths of root canal obturation. The analyses of diagnostic methods showed that AP was detected more frequently when CBCT was used.     

应用锥形束CT和根尖片评估工作长度对根管治疗疗效的影响

目的： 应用锥形束CT（cone-beam computed tomography, CBCT）和根尖片研究工作长度对根管治疗疗效的影响。方法：利用CBCT和根尖片评估503个做过根管充填的牙根管。依据影像学上的根尖孔点和充填材料末端的距离将其分为4组,分别是：①大于1 mm、小于2 mm;②小于1 mm;③超出根尖孔;④恰到根尖孔。采用SPSS13.0软件包对数据进行χ²检验。结果：在前牙、前磨牙和磨牙的根管治疗中,根管充填距离根尖孔1~2 mm,根尖片显示分别占88%、89.3%和95%;CBCT显示的结果则分别是70%、73.7%和79%。无论哪一种诊断方法,磨牙出现根尖周炎的概率均显著高于其他牙。结论：各种工作长度的根管充填都能检测到根尖周炎,应用CBCT进行检查,能更好地评估根管治疗疗效。     

Anatomical relationship of maxillary posterior teeth with the sinus floor and buccal cortex

This study aimed to evaluate the possibility of root fenestration or oroantral communication by evaluating the distance from root apex to the sinus floor and buccal cortex in maxillary posterior teeth using cone‐beam computed tomography (CBCT) images. The study included 2182 roots of the maxillary posterior teeth from 219 patients after reviewing CBCT images of 462 patients according to the location of roots by two endodontists. The distances from each root apex to the maxillary sinus floor and buccal and palatal cortices were evaluated according to sex and age, and the mean values were compared by one‐way analysis of variance and Mann–Whitney U‐test. The distance between root apex and maxillary sinus floor was the greatest in maxillary first premolars and shortest in the mesio‐buccal roots of maxillary second molars. The distances from root apex to the buccal and palatal cortical bones were significantly greater in male patients than those in female patients (P < 0·05). The palatal roots of maxillary first molars exhibited the highest incidence as well as the greatest mean length (1·96 mm) of protrusion into the maxillary sinus. The distance from root apex to the sinus floor was found to increase with age, except in case of maxillary second premolars. Understanding the relationship of maxillary posterior teeth with the sinus floor and buccal cortex could provide clinicians valuable information to help reduce iatrogenic damage.     

Cone beam computed tomographic analysis of maxillary premolars and molars to detect the relationship between periapical and marginal bone loss and mucosal thickness of maxillary sinus

Background

This study assessed the relationship between mucosal thickness (MT) of the maxillary sinus and periodontal bone loss (PBL) and periapical condition of related teeth. We also aimed to identify the association between root apices and the inferior wall of the maxillary sinus using Cone beam computed tomography (CBCT).

Material and Methods

In this study, CBCT images of 205 patients with 410 maxillary sinuses were examined, retrospectively. A total of 582 maxillary molars and 587 premolars were observed. The relationship of each root with maxillary sinus and apical lesions of these roots were classified, PBL was examined and the situations of adjacent teeth were estimated. The effect of these conditions on sinus mucosal thickness (MT) was evaluated.

Results

There was a significant correlation between MT of maxillary sinus and both PBL and age (r = 0.52, p=0.000 and r = 0.111, p= 0.002, respectively). The frequency of MT increased as the severity of apical lesion enlarged. A positive correlation was found between MT and degree of PBL and periapical lesions. To reveal the association between MT and pulpoperiapical condition bivariate correlation was done and a significant relationship between the pulpoperiapical condition and MT was found (r = 0.17, p=0.000).

Conclusions

This retrospective study showed that MT of the maxillary sinus was common among patients with PBL and MT was significantly associated with PBL and apical lesions. The relationship of maxillary sinus to adjacent teeth had also positive correlation with MT. CBCT imaging enabled better evaluation of maxillary sinus, posterior teeth and surrounding structures compared to other imaging tools. Key words:Maxillary sinus mucosal thickness, apical periodontitis, periodontal bone loss, CBCT.     

Cone-beam computed tomographic evidence of the association between periodontal bone loss and mucosal thickening of the maxillary sinus

Background: The aim of the present study is to determine the relationship between dental findings and mucosal abnormalities of the maxillary sinus among dental patients, using cone‐beam computed tomography (CBCT). Methods: Two hundred fifty CBCT scans of dental patients were studied. Dental findings of the upper posterior teeth, including periodontal bone loss, periapical lesions, and root canal fillings, were assessed. The presence of mucosal thickening and mucosal cysts of the maxillary sinus was recorded. Logistic regression analysis was used to determine the influence of periodontal bone loss, periapical lesions, and root canal fillings on these sinus mucosal abnormalities. Results: Mucosal thickening was present in 42% of patients and in 29.2% of sinuses studied. Mucosal cysts were observed in 16.4% of patients and in 10% of sinuses studied. Both abnormalities were present more frequently among males than females. Severe periodontal bone loss was significantly associated with mucosal thickening (odds ratio: 3.02, P <0.001), whereas periapical lesions and root canal fillings were not. There was no association between dental findings and mucosal cysts. Conclusions: Severe periodontal bone loss was significantly associated with mucosal thickening of the maxillary sinus. Sinuses with severe periodontal bone loss were three times more likely to have mucosal thickening. Mucosal cysts were not associated with any dental findings.     

锥形束CT对后牙根尖周炎骨病损的评价作用

目的:以锥形束CT(cone-beam computed tomography,CBCT)为标准,评价X线片在诊断后牙根尖周炎骨病损中的作用。方法:收集门诊同时拍摄X线片和CBCT图像的病例80例,共106颗后牙,包括前磨牙和磨牙各53颗,其中健康牙58颗,临床诊断为慢性牙髓炎11颗,诊断为慢性根尖周炎34颗(含8颗根管治疗后的患牙),根管治疗后表现正常的牙3颗。由2名有经验的医师对CBCT图像及X线片进行判读,确定根尖周指数(periapical index,PAI)分级。采用SPSS13.0软件包对所得数据进行χ2检验。结果:分别对106颗疑似患牙的CBCT图像与X线片进行判读,根尖周炎的检出率分别为59.4%和39.6%,差异有显著性(χ2=8.32,P<0.01)。X线片为二维影像,其结构重叠产生伪影,使病变范围界限不清,而CBCT三维图像则对病损范围有明确的显示,有利于疾病的诊断与治疗。另外,X线片不能表现CBCT显示的骨皮质破坏情况。结论:CBCT图像诊断根尖周炎比X线片更有临床价值,可展现X线片无法显示的细节,对疾病的破坏范围和相关结构毗邻显示更清楚,从而准确划分根尖周炎的分级,为临床正确诊断以及科学制定治疗计划提供有效的依据。     

上颌窦黏膜增厚的锥形束CT影像分析

目的 运用锥形束CT (CBCT)研究牙源性因素对上颌窦黏膜增厚的影响,同时,通过对上颌窦黏膜增厚的随访,研究口腔治疗的作用。方法 回顾性分析2017年8—12月四川大学华西口腔医院就诊的患者,通过CBCT图像筛选出上颌窦最大黏膜厚度>2 mm的患者,评估上颌窦底及上颌窦黏膜增厚与患牙的关系,同时,记录患牙及其治疗的情况,观察随访前后上颌窦黏膜增厚的变化。结果 黏膜厚度与炎症距窦底的距离呈极弱负相关（P<0.05,r=-0.154）,而根尖距窦底的距离与黏膜厚度无直接相关性（P>0.05）。在治疗组中,窦底破坏组的黏膜厚度变化较窦底连续组大,黏膜厚度变化与根尖距窦底的距离呈弱负相关（P<0.01,r=-0.382）,黏膜厚度变化与炎症距窦底的距离呈中等程度负相关（P<0.001,r=-0.524）。结论 上颌窦炎的严重程度可能更大程度上取决于根尖周炎症边缘距窦底的远近而与单纯的根尖位置没有明显的关系。但从治疗效果来讲,炎症病变离上颌窦越近,上颌窦底越易被破坏,上颌窦炎受牙源性因素影响越大,口腔治疗的效果也越好。     

青少年埋伏阻生牙CBCT三维定位辅助诊断的临床研究

目的:使用CBCT三维定位分析54颗青少年上颌埋伏阻生牙,为正畸诊疗设计提供精准依据。方法:采用CBCT技术重建54颗青少年上颌埋伏阻生牙,应用CS 3D Imaging软件分析阻生牙位置、牙根情况及与邻牙关系进行测量分析并评价。结果:上颌埋伏阻生牙主要以垂直阻生为主,埋伏高度以牙冠位于邻牙根1/2至根尖占到66.7%;根尖位置以偏于10 mm以内居多;牙骨性粘连占1.9%。最终对54颗埋伏阻生牙牵引45颗,拔除9颗。结论:CBCT可精准三维定位埋伏阻生牙,为正畸临床治疗提供重要依据。     

上颌窦对上颌后牙显微根尖手术的影响

显微根尖手术是临床上保存牙髓根尖周病患牙的有效手段之一,也是治疗其疑难病例的必备技术。但由于位置靠后操作空间狭小、根尖与上颌窦毗邻,导致在上颌后牙区进行根尖外科手术仍存在一定挑战。本文就上颌窦与上颌后牙解剖关系、对显微根尖手术影响以及辅助技术如:3D打印手术导板、超声骨刀等在上颌后牙区手术中的应用进行总结。文献复习结果表明,上颌后牙根尖与上颌窦空间关系通常分3类:根尖突进上颌窦底;根尖与上颌窦底相接触;根尖和上颌窦底之间有间隙或空间。术前CBCT检查后结合患牙根尖周和上颌窦状态以及根尖病损到上颌窦距离评估手术难度,术中应用导板、内窥镜、超声骨刀等以使手术更加安全可靠和精准微创,但后者在临床上的普及仍需进一步推广。目前尚缺乏高质量的上颌后牙区现代显微根尖手术长期疗效的临床研究。     

锥形束CT研究上颌磨牙根尖与上颌窦底壁的解剖关系

目的采用锥形束CT,观测上颌磨牙根尖与上颌窦底壁的解剖关系,并进行分类,为治疗方案的制定和操作风险评估提供解剖学依据。方法从宿迁口腔医院影像科数据库中筛选出60位成年人,120侧上颌磨牙区锥形束CT影像,对其进行重建,测量磨牙根尖与上颌窦底壁的距离,并按照Shahbazian M分类法进行分析。结果上颌第一磨牙远中颊侧根距离上颌窦底壁的距离最小。分类中出现最多的为Ⅰ型(41.67%),最易引起上颌窦炎的Ⅳ型约占总数的19.85%,且上颌第一磨牙的远颊侧根出现Ⅳ型最多(29.17%)。结论上颌磨牙根尖与上颌窦底壁的关系个体差异较大。因此临床上,涉及该区域的治疗,需个性化的制定治疗方案,增加治疗的成功率且减少医源性问题。     

Associations between Periapical Health of Maxillary Molars and Mucosal Thickening of Maxillary Sinuses in Cone-beam Computed Tomographic Images: A Retrospective Study

IntroductionThis retrospective study aimed to assess the radiologic characteristics of the possible associations between mucosal thickening of the maxillary sinuses (MSs) and periodontal and anatomic conditions of healthy and diseased maxillary teeth.MethodsThe periapical health of the maxillary molars in cone-beam computed tomographic (CBCT) images from 50 patients (mean age = 40.60±14.59 years) was evaluated using the CBCT–periapical index. Anatomic associations between maxillary molars and the inferior wall of the MSs and periodontal bone loss and its relation to MS pathology were assessed. The possible effects of these conditions on mucosal thickening of MSs were analyzed. Kruskal-Wallis, Mann-Whitney U, chi-square, and logistic regression (for relative risk) tests were used for statistical analysis.Results: CBCT-periapical index 4 was the most frequently encountered apical periodontitis (AP) lesion. The risk for pathologic changes in the MSs was significantly higher in the presence of AP (P < .001). This risk was 62.364 times greater than that in areas of MSs adjacent to healthy teeth of the same patient (95% confidence interval, 7.968–488.14). Thicker MS mucosae were detected when the molar roots with AP were closer to the MSs (P < .004). No statistically significant difference was found between periodontal status and MS pathology.ConclusionsThe findings of this study showed that MSs were affected by the endodontic health of adjacent molar teeth. Dental and medical practitioners should take into consideration the possible odontogenic causes while examining pathologic changes in the MS.     

Radiographic evaluation of the anatomical relationship of maxillary sinus floor with maxillary posterior teeth apices in the population of Al-Qassim,Saudi Arabia,using cone beam computed tomography

Background & objectiveIn current clinical dental practice radiographic imaging plays a major role in exploring the relationship between the maxillary sinus floor (MSF) and maxillary posterior teeth root apices, especially when there is an involvement of pathology in the periapical area that may lead to infectious, inflammatory or traumatic changes in the maxillary sinus (MS). It is also essential for exact implant placement, and therapeutic and surgical plans. The prevalence of different forms of anatomic relationship of the MSF to posterior root apices from one population to another is large. Hence the current research was conceived to evaluate the horizontal and vertical relationship forms of posterior root apices to the MSF in the Al-Qassim population of Saudi Arabia using Cone Beam Computed Tomography (CBCT).Materials and methodsTo conduct the study, a total of 200 patients' data (100 male and 100 female) were taken from the archives. The linear distances of the root apices to the MSF were measured for maxillary posterior teeth. On cross-sectional CBCT images, the Kwak et al. criteria were used to assess the horizontal and vertical relationships between the root apices of maxillary posterior teeth and the MSF.ResultsThe mean distance between the apices of the maxillary second premolar ranged from 4.63 mm to 6.49 mm. The mean value of the distance between the apices of the posterior teeth and the MSF had a range of 0.68 ± 0.39 mm on the disto-buccal root (DBR) of the maxillary right second molar to 3.93 ± 1.26 mm on the palatal root (PR) of the maxillary left first molar. A similar result was observed in the maxillary second molar DBR in the male group (0.68 ± 1.17 mm) and the female group (0.69 ± 1.17 mm). The most frequently observed vertical relations were type 2 and type 2H horizontal relations.ConclusionThis study concludes that maxillary molar roots show greater proximity with the MSF when compared with premolars, and that the type 2 vertical and type 2H horizontal distribution suggests that the anatomy of each tooth and the maxillary sinus floor should be evaluated by CBCT prior to treatment planning.     

210例根管治疗失败病例的根尖X线片和锥形束CT的影像学分析

[摘要]目的：比较根尖X线片（periapical radiograph, PR）与锥形束CT（cone-beam computed tomography, CBCT）在诊断根管治疗（root canal treatment, RCT）失败病例时的差异。方法：回顾性分析RCT失败患牙的影像学资料,比较PR与CBCT诊断RCT失败病例的病因和病情时的差异。结果：共分析210颗RCT失败患牙的PR和CBCT资料,根管欠填和遗漏根管是导致RCT失败的主要原因。CBCT能更准确的判断根管充填质量和根折类型,CBCT对遗漏根管的检出率比PR高14.8%,对根折的检出率比PR高5.7%。结论：CBCT对RCT失败病例的病因和病情分析优于PR,能为根管再治疗的方案制定提供更有意义的参考。     

Maxillary molar root protrusion into the maxillary sinus: a comparison of cone beam computed tomography and panoramic findings

This study aimed to examine the prevalence of molar roots protruding into the maxillary sinus and to determine the panoramic radiographic signs as correlated with cone beam computed tomography (CBCT). CBCT images of 354 roots were assessed and classified into three types, according to the relationship between the root and maxillary sinus. The prevalence of root protrusion into the maxillary sinus was calculated then the panoramic images assessed. After excluding some unidentified roots on the panoramic images, 200 were investigated for panoramic signs, including (i) projection of the root apex into the sinus cavity, (ii) interruption of the maxillary sinus floor’s cortex, (iii) absence of periodontal ligament space, (iv) darkening of the involved root region, and (v) upward curving of the sinus floor. The respective correlation between the panoramic signs and CBCT types was assessed. Forty-six percent of roots showed protrusion into the sinus with the palatal root of the first molar having the greatest prevalence (33/200 roots). The panoramic signs ‘projection of the root apex in the sinus cavity’ and ‘darkening of the involved root apical region’ both strongly indicated root protrusion into the maxillary sinus (P < 0.05).     

Frequency and distribution of root filled teeth and apical periodontitis in a Greek population

AIM: To investigate the prevalence of root filled teeth and apical periodontitis (AP) in a Greek population. METHODOLOGY: A random sample of 320 patients who required full mouth periapical radiographic examination as a part of diagnostic and planning procedures were included. The age of the patients ranged from 16 to 77 years. A total of 7664 teeth were assessed and the frequency of root filled teeth and periapical status was recorded. Two observers evaluated the radiographs under standardized conditions. AP was defined as distinct periapical radiolucency or widening of the periodontal ligament space exceeding two times the normal width. Statistical evaluation of differences in proportions between groups was performed using random effects logistic regression models. RESULTS: The periapical status of 286 (3.7%) teeth was impossible to evaluate because of radiographic faults; these teeth were excluded from further analysis. A total of 1040 (13.6%) teeth had radiographic signs of AP and 680 (9.2%) teeth had been root filled. Of the root filled teeth, 408 (60.0%) had AP. There was no difference in the number of root filled teeth between males and females; the prevalence of root filled teeth increased with age. Significantly more molars (13.1%) and premolars (11.9%) than anterior teeth (5.8%) had been root filled (P < 0.001). The prevalence of AP was significantly higher (P < 0.001) in molars (23.9%) and premolars (14.0%) than anterior teeth (9.4%). CONCLUSIONS: The prevalence of AP and the frequency of root filled teeth with AP in this Greek population were higher than those found in many other European countries. The frequency of root filled teeth was comparable with findings in other epidemiological studies.     

A cone-beam computed tomography study of root canal morphology of maxillary and mandibular premolars in a Turkish population

Aim. The aim of this study was to evaluate the root canal number and configuration of maxillary and mandibular premolar teeth by gender, intervals for decades, tooth position and unilateral or bilateral occurrence in a Turkish population using Cone Beam Computed Tomography(CBCT) scanning. Methodology. CBCT images of 5496 maxillary and mandibular premolars from 849 patients were evaluated. The following was evaluated in all the images: numbers of roots and root canals, the morphology of the root canal configuration according to the Vertucci classification, male–female differences in the tooth position and male–female differences in unilateral or bilateral occurrence. The reliability data were analyzed with a chi-square test. Results. The most prevalent root canal frequency was the two canals (86.2%) and type IV (76.9%) configuration for maxillary first premolar, one canal (59.7%) and type I (54.5%) canal configuration for second premolar. The incidence of one canal was higher in females and the occurrence of two or three canals was more common in males. The incidence of one canal was higher on the left side of maxillary premolars and the incidence of two canals was higher on the right side. Most mandibular first (93.5%) and second (98.5%) premolars had one canal. In general, females had one root canal of the mandibular premolar, whereas males had two or three canals. The type I configuration was most common and the incidence was higher on the right side. There were some differences found in the frequency distribution of the number of root canals and configuration of maxillary and mandibular premolar teeth according to intervals for decades. Conclusion. CBCT scanning provides comprehensive information about the root canal morphology of maxillary and mandibular premolar teeth. These data may help clinicians in root canal treatment of premolar teeth.     

The Effect of the Anatomic Variables on the Success Rate of Anesthesia in Maxillary Molars with Irreversible Pulpitis

IntroductionObtaining anesthesia of teeth with irreversible pulpitis is 1 of the most challenging issues in endodontic practice. The aim of this study was to evaluate the effect of anatomic variables on the success rate of anesthesia in maxillary molars with irreversible pulpitis.MethodsPatients who had maxillary molars with irreversible pulpitis and who had already had a cone-beam computed tomographic (CBCT) scan performed were included in this study. After infiltration injection of an anesthetic solution, the success rate of anesthesia was recorded by asking the patients to rate their pain during access cavity preparation and root canal instrumentation as well as their need for a supplementary injection during the treatment. The distance of the palatal root to the buccal cortical plate was calculated using the Romexis Viewer (Planmeca, Helsinki, Finland) measuring tools in both the axial and coronal views. Data were analyzed by chi-square and t tests as well as receiver operating characteristic curve analysis.ResultsForty-seven maxillary first and second molar teeth were eligible to be included in this study. The overall success rate of anesthesia was 63.80%. The palatal roots that had their apex located more than 12.34 mm from the buccal cortical plate in the axial view, and 12.46 mm in the coronal view had a higher chance of anesthesia failure compared with the teeth with smaller distances. The presence of the maxillary sinus between the cortical plate and roots had no significant impact on the efficacy of anesthesia (P > .05).ConclusionsThe potential of anesthesia failure during the treatment of irreversible pulpitis in maxillary molars with a divergent palatal root is significantly higher than in teeth with shorter distances from the palatal root apex to the buccal cortical plate. If a patient already had a CBCT scan done for other reasons or the CBCT is available in his or her records, a dental practitioner can use it to predict anesthesia success for maxillary molars with irreversible pulpitis.     

Association between Endodontically Treated Maxillary and Mandibular Molars with Fused Roots and Periapical Lesions: A Cone-beam Computed Tomography Cross-sectional Study

IntroductionFused root variations of the root canal system increase the complexity of the inner root canal system anatomy. The aim of the present study was to determine, in in vivo conditions, the proportion of periapical lesions in association with endodontically treated maxillary and mandibular molars with fused roots presenting previous root canal treatment by assessing preexisting data via cone-beam computed tomographic volumes.MethodsA total of 1160 CBCT scans with an overall sample of 20,836 teeth were screened. A global count of 3701 maxillary molars and mandibular second molars were included in the study. The Cohen kappa test and interclass correlation coefficient tested the intra- and interrater reliability, respectively. The percentage of periapical lesions associated with molars with or without root fusion was determined. Proportions were expressed with 95% confidence intervals (CIs). The z test for proportions was used to analyze differences between subgroups, and an odds ratio was calculated in order to understand the association between periapical lesions and root configuration.ResultsFused molars presented a prevalence of periapical lesions in endodontically treated teeth of 74.0% (95% CI, 65.2%–82.8%), whereas nonfused molars had a proportion of periapical lesions in root canal–treated teeth of 69.5% (95% CI, 65.2%–73.8%; P > .05). Endodontically treated molars with fused roots presented with 1.3 higher odds of being associated with periapical lesions than endodontically treated molars with nonfused roots.ConclusionsA tendency of a higher proportion of periapical lesions was found in the fused rooted molars with a history of root canal treatment when compared with nonfused teeth; however, no statistically significant difference was noted.