根尖周病中锥形束CT与根尖片识别病损差异的研究进展

随着影像学技术的进步,锥形束CT（CBCT）作为口腔临床检查的一种辅助手段,已经广泛应用于口腔医学的各个领域。它具有分辨率高、辐射量低、成像迅速、三维重建、失真小、对硬组织成像好等诸多优点。传统的根尖片是以二维图像的形式显示三维物体及其周围结构,仅显示重叠的近远中向骨质破坏,不能显示颊舌向骨质破坏。CBCT作为一种三维成像技术,可以从矢状位、冠状位和轴位显示组织的三维结构,克服了根尖片二维图像重叠、变形等缺陷。CBCT的三维成像技术较传统根尖片具有独特优势,与根尖片相比,CBCT在观察骨质结构和根尖骨质破坏方面具有更高的灵敏度。本文就CBCT与根尖片在根尖病损识别中的差异研究进展作一综述。     

锥形束CT与根尖片在慢性牙周炎诊断中的应用比较

目的:研究CBCT在慢性牙周炎诊断中的价值。方法:通过拍摄20例慢性牙周炎患者的后牙区CBCT及根尖片,并对其进行临床牙周探针检查,比较纳入的276颗牙唇(颊)、舌(腭)、近中、远中牙槽骨缺损情况。结果:CBCT与临床探诊检查后牙区各位点牙槽骨缺损情况未见明显差异,而CBCT、临床探诊、根尖片检查后牙区近远中牙槽骨缺损可见明显差异(P＜0.05),其中根尖片所测结果小于CBCT及临床探诊,均有统计学意义(P＜0.05)。结论:在慢性牙周炎的诊断中CBCT检测较根尖片更加准确。     

根尖显微手术预后的影响因素

随着口腔显微镜和超声倒预备器械以及生物相容性良好的倒充填材料的广泛应用,根尖手术取得了较大的成功率.通过对根尖显微手术预后影响因素进行研究,可为临床上病例选择及制定正确的治疗方案提供参考依据.本文就患者、牙体、手术相关三个方面对根尖显微手术预后影响因素作一综述.     

根尖切除长度和冠根比对显微根尖手术治疗根尖囊肿效果的影响研究

目的 研究根尖切除长度和冠根比对显微根尖手术治疗根尖囊肿效果的影响,为临床治疗提供指导意见。方法 选择2018年1月至2021年6月于浙江大学医学院附属口腔医院口腔颌面外科行显微根尖手术治疗根尖囊肿的116例患者临床和影像学资料行回顾性分析,共计患牙164颗。根据患者的手术术式分为2组,分别为根切组43例（75颗患牙）和倒充填组73例（89颗患牙）。基于2组患者术前和术后12个月的锥形束CT影像,测量和计算牙体相关指标[解剖牙根长度（ARL）、临床牙根长度（CRL）、囊肿累及牙根长度（RLC）、截根长度（RRL）、RRL与RLC之比（RRL/RLC）、解剖冠根比（ACR）、临床冠根比（CCR）、解剖冠根比相对变化百分比（RACR）、临床冠根比相对变化百分比（RCCR）]。比较2组不同疗效（治愈、治疗有效、治疗无效）患牙牙体相关指标测量结果差异。结果 根切组治愈患牙13颗、治疗有效患牙40颗、治疗无效患牙22颗,不同疗效患牙术后12个月的ARL、CRL、ACR、CCR,以及RRL/RLC、RACR、RCCR总的比较,差异均有统计学意义（均P <0.05）。其中,术后12个月治愈患牙...     

锥形束CT与根尖片对实验性根尖周炎根管治疗结果的评估

目的：???观察一次法根管治疗的短期临床疗效,并比较锥形束CT（CBCT）与根尖片在根管治疗结果评估中的差异。方法??选择4只比格犬的24颗上颌前磨牙（56个根管）为研究对象,所有牙齿形成实验性根尖周炎后,随机分为2组,一组采用一次法根管治疗,另一组采用两次法根管治疗,术后6个月应用CBCT和根尖片评估根管治疗疗效。结果 CBCT显示：一次法根管治疗成功率为28.57%,二次法根管治疗成功率为53.57%,两组间的成功率差异无统计学意义（P=0.057）。根尖片显示：一次法根管治疗成功率为67.86%,二次法成功率为78.57%,两组间差别无统计学意义（P=0.365）。CBCT显示的根管治疗总成功率为41.07%,根尖片显示的总成功率为73.21%, CBCT与根尖片在根管治疗后疗效评估中的差异有统计学意义（P=0.001）。结论??在针对实验性根尖周炎的治疗中,一次法根管治疗的近期治愈率与两次法根管治疗的近期治愈率相比较,其差异无统计学意义;然而,CBCT与根尖片的检查结果,在根管治疗后的疗效评估上,存在着一定差异。由此可见,CBCT这种三维检查手段相较于根尖片的二维影像来说,在根管治疗后对疾病的诊断评估中的准确性以及灵敏度更高。     

显微根尖手术的全周期管理

显微根尖手术是实现疑难根尖周病患牙保存的有效手段.本文提出显微根尖手术的全周期管理理念,针对患者的全身情况和患牙的局部特点制定全面的检查、治疗和复查方案,以达到预期手术疗效,有效保留天然牙.全周期管理包括术前通过对患者的全身评估和口腔术区评估,针对患牙情况选择合适方法进行显微根尖手术;术中应用激光技术、骨窗技术、动静态...     

锥形束CT用于诊断复杂根尖周病价值研究

目的    评价锥形束CT（CBCT）检查对根尖周病复杂病例的诊断价值 。方法    于2013 年5月至2014年5月从沈阳市铁西区牙病防治所门诊随机选取以不明原因牙痛为主诉的患者40例（患牙40颗）,拍摄患牙X线根尖片（常规正位和远中10°平行投照）并进行CBCT检查,采用根尖周指数（PAI）评价根尖周病损状况,比较两种方法对根尖周病复杂病例诊断及病因判断的差异。结果    X线根尖片与CBCT检查在判断患牙有无根尖周病损上一致性差;两种方法对患牙PAI 分级判断的一致性亦差;CBCT检查能够更好地明确牙痛原因。结论    CBCT 检查有助于诊断临床上不明病因的根尖周病复杂病例。     

锥形束CT在根尖周病诊断中的临床价值研究

目的对比研究锥形束CT和根尖片对根尖周病的诊断价值。方法分别对35位患者,总共41颗诊断为根尖周病的患牙用锥形束CT和根尖片进行扫描,阅片后作出判断。结果通过锥形束CT发现有37颗牙存在根尖阴影,而根尖片仅发现27颗牙存在根尖阴影。结论锥形束CT比根尖片诊断根尖周病的准确度高,临床上锥形束CT可以辅助诊断疑难病例。     

锥形束CT与数字化根尖片对根充效果的评价

目的比较锥形束CT(CBCT)与根尖片对根管充填后效果的评价,进一步探讨CBCT在根管治疗中的优势及应用价值。方法选取经临床诊断需要进行根管治疗的100颗患牙(221例根管),根管充填后同步拍摄根尖片与CBCT,术后分别由2位经验丰富的临床医生从根管充填的有效长度与严密程度两方面进行读片,运用卡方检验比较2种方法是否在评价结果上存在差异性。结果总计充填根管214例,充填遗漏7例,在根管充填长度、严密程度及满意程度评价方面,分别约有34.58%、30.48%和37.58%的根管在数字化根尖片与CBCT的评价结果上未能达成一致意见,经过统计学检验,数字化根尖片与CBCT在上述三方面的评价均有高度显著性差异(P<0.01)。结论 CBCT较根尖片在根管治疗术的长度及严密程度评价方面更为灵敏及准确,在复杂或疑难的根管治疗术中拥有很高的临床应用价值。     

Periapical Radiography versus Cone Beam Computed Tomography in Endodontic Disease Detection: A Free-response,Factorial Study

AimTo assess and compare reader performance in interpreting digital periapical (PA) radiography and cone beam computed tomography (CBCT) in endodontic disease detection, using a free-response, factorial model.Materials and MethodsA reader performance study of 2 image test sets was undertaken using a factorial, free-response design, accounting for the independent variables: case type, case severity, reader type, and imaging modality. Twenty-two readers interpreted 60 PA and 60 CBCT images divided into 5 categories: diseased–subtle, diseased–moderate, diseased–obvious, nondiseased–subtle, and nondiseased–obvious. Lesion localization fraction, specificity, false positive (FP) marks, and the weighted alternative free-response receiver operating characteristic figure of merit were calculated.ResultsCBCT had greater specificity than PA in the obvious nondiseased cases (P = .01) and no significant difference in the subtle nondiseased category. Weighted alternative free-response receiver operating characteristic values were higher for PA than CBCT in the subtle diseased (P = .02) and moderate diseased (P = .01) groups with no significant difference between in the obvious diseased groups. CBCT had higher mean FPs than PA (P < .05) in subtle diseased cases. Mean lesion localization fraction in the moderate diseased group was higher in PA than CBCT (P = .003). No relationships were found between clinical experience and all diagnostic performance measures, except for in the obvious diseased CBCT group, where increasing experience was associated mean FP marks (P = .04).ConclusionsReader performance in the detection of endodontic disease is better with PA radiography than CBCT. Clinical experience does not impact upon the accuracy of interpretation of both PA radiography and CBCT.     

锥形束CT与根尖牙片诊断牙根折裂的对比分析

目的:对比分析锥形束CT与根尖牙片在根折诊断中的诊断价值。方法:选取经临床拔牙或外科探查证实的35 例(37个患牙)根折裂患者,均作CBCT和根尖牙片检查,对比分析图像。结果:37个患牙中,CBCT在检出根折35个,根尖牙片检出折裂线16个。结论:CBCT检知牙根折裂的准确率明显高于根尖牙片,能清晰显示根折位置及类型,对临床制定根折治疗方案有重要应用价值。     

Comparison of Endodontic Diagnosis and Treatment Planning Decisions Using Cone-beam Volumetric Tomography Versus Periapical Radiography

Introduction

Accurate and confident treatment planning is an essential part of endodontic practice. Periapical radiographs have been used to aid in the diagnosis of pathology and to help establish an appropriate treatment strategy. Recently, a new imaging modality, cone-beam volumetric tomographic (CBVT) imaging, has been shown to be a useful tool in a number of endodontic applications. The aim of this study was to compare the relative value of preoperative periapical radiographs and CBVT scanning in the decision-making process in endodontic treatment planning.

Methods

Thirty endodontic cases completed in a private endodontic practice were randomly selected to be included in this study. Each case was required to have a preoperative digital periapical radiograph and a CBVT scan. Three board-certified endodontists reviewed the 30 preoperative periapical radiographs. Two weeks later, the CBVT volumes were reviewed in random order by the same evaluators. The evaluators were asked to select a preliminary diagnosis and treatment plan based solely on their interpretation of the periapical and CBVT images. Diagnosis and treatment planning choices were then compared to determine if there was a change from the periapical radiograph to the CBVT scan.

Results

A difference in treatment plan between the 2 imaging modalities was recorded in 19 of 30 cases (63.3%, P = .001), 17 of 30 cases (56.6%, P = .012), and 20 of 30 cases (66.7%, P = .008) for examiners 1, 2, and 3, respectively.

Conclusions

Under the conditions of this study, preoperative CBVT imaging provides additional information when compared with preoperative periapical radiographs, which may lead to treatment plan modifications in approximately 62% of the cases.     

Periapical Microsurgery: An In Vivo Evaluation of Endodontic Root-End Filling Materials

The purpose of this study was to assess the healing of periapical tissues using three different materials (IRM [L.D. Caulk Inc, Dentsply International Inc, Milford, DE], Geristore [Den-Mat, Santa Maria, CA], and MTA [ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK]) after endodontic microsurgery in an animal model. Using beagle dogs as a study model, 48 bicuspids were accessed, instrumented, and intentionally infected. The surgical procedures were performed after 30 days following the radiographic confirmation of periapical radiolucencies. The root canals were still infected and had no disinfection procedure carried out. The root ends were resected, retrograde preparations were completed, and the experimental materials were placed under surgical operating microscopy. After a period of 6 months, digital radiographic images of the periradicular areas were taken. The samples were prepared for histologic evaluation. Although Geristore showed no radiographic difference when compared with the other groups, it showed the least favorable healing in the histologic evaluation. Our histologic and radiographic results showed no statistical difference between MTA and IRM.     

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.     

Long-term Success and Survival of Endodontic Microsurgery

IntroductionHealed rates of endodontic microsurgery (EMS) may decrease over time, but research on the long-term outcomes is scarce. The aims of this retrospective cohort study were to evaluate the 5- to 9-year healed and survival rates of EMS, to identify associations between prognostic factors and healing status, and to compare the short-term (1- to 2-year) with long-term (5- to 9-year) outcomes.MethodsOne hundred fifty-one eligible patients (166 teeth) who underwent EMS in 2007–2010 were invited for a follow-up examination. Eighty-three patients (94 teeth) participated in the study. Survival status and reasons for extraction of all teeth were determined, and survival rates were calculated by Kaplan-Meier analyses. Outcomes were determined on the basis of clinical and radiographic findings and associated with potential prognostic variables via multivariate Cox regression analyses.ResultsThirty-two teeth were extracted: 6 because of endodontic failure, 20 for unrelated reasons, and 6 for unknown reasons. Outcomes were categorized as healed and not healed. Multivariate analysis revealed that adjusted hazard ratio for failure was 5.95 times higher (95% confidence interval, 1.54–22.91) for teeth treated with intermediate restorative material than with mineral trioxide aggregate and 3.38 times higher (95% confidence interval, 1.05–10.9) for teeth with no known history of nonsurgical retreatment. Teeth classified as healed in the 1- to 2-year review mostly remained healed at 5- to 9-year review (45/48 teeth); those with uncertain healing had varied outcomes at long-term review.ConclusionsEMS results in high long-term healed (78.3%, 72/92 teeth) and survival (95.2%) rates. Root-end filling material and nonsurgical retreatment before EMS may influence the long-term outcome.     

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。     

Comparison of Clinical Outcomes of Endodontic Microsurgery: 1 Year versus Long-term Follow-up

Introduction

The purpose of this study was to examine and compare the clinical outcome of endodontic microsurgery after 1 year of follow-up and over a period of 4 years.

Methods

The database of the Department of Conservative Dentistry, Yonsei University, Seoul, South Korea, was searched for patients who had undergone endodontic microsurgery and had been evaluated 1 year after surgery and over a period of 4 years. Two examiners independently evaluated the postoperative radiographs taken 1 year after surgery and over a period of 4 years using Rud's criteria. To analyze and compare the success rate based on the observation period, the McNemar test was performed with a significance level of 0.05.

Results

The study included 115 cases. Using Rud's criteria, the overall success rate of cases with 4 or more years of follow-up was 87.8% compared with 91.3% at 1 year of follow-up. There was no significant difference between the follow-up periods (P = .344).

Conclusions

There was no significant difference in the clinical outcome after endodontic microsurgery when comparing 1-year follow-up periods with longer follow-up periods.