Endodontic management of a rare case of the geminated maxillary second molar tooth using CBCT

This report illustrates a rare case of a geminated maxillary right second molar tooth using CBCT in a 23‐year‐old man with severe pain. Nonsurgical endodontic treatment was performed, which gave rise to an asymptomatic tooth at the 12‐month follow‐up.     

Multifunctional anatomical prototypes (MAPs): Treatment of excessive gingival display due to altered passive eruption

Objective

To describe a strategy using digital technologies for improving the diagnosis, treatment planning, and surgical execution of patients with excessive gingival display (EGD) due to altered passive eruption (APE).

Clinical Considerations

An important component for successful patient's management is to fulfill their esthetic expectations whilst delivering predictable and long-term therapeutic outcomes. To achieve this goal in patients with excessive gingival display due to altered passive eruption, it is essential to perform an accurate diagnosis and to communicate to the patient the expected customized results using digital technologies. Computer-aided designed and manufactured multifunctional anatomical prototypes (MAPs) may contribute to these purposes. Additionally, they can guide the surgical crown lengthening procedure or serve as a reference during the surgical guide fabrication providing information of the required anatomical landmarks.

Conclusions

This novel strategy protocol for diagnosis, communication, and treatment management of patients with excessive gingival display follows functional and biological principles within the frame of a digital workflow, which improves the diagnostic capabilities, enhances communication, and guides the surgical treatment as shown in the 12 months follow-up of the reported case.

Clinical Significance

Developing a virtual patient by combining multiple digital data sets including cone-beam computed tomography (CBCT), intra-oral scans and digital photography, supports the clinician and the patient to achieve a comprehensive diagnosis and to better communicate the expected results to the patient. Furthermore, this digital treatment exercise based on anatomical and biological principles will facilitate the surgical precision and the achievement of successful outcomes, thus fulfilling the patient needs and expectations.     

锥形束CT辅助诊断根尖囊肿累及范围的临床应用研究

目的：分析锥形束CT（CBCT）辅助诊断慢性根尖囊肿累及范围的临床应用效果。方法：选取2013年4月－2014年4月诊断为慢性根尖囊肿的CBCT三维重建影像资料42例，观察X线根尖片及CBCT三维重建影像资料，综合评价CBCT在辅助诊断慢性根尖囊肿累及范围中的应用效果。结果：CBCT诊断慢性根尖囊肿累及范围的能力显著优于X线根尖片，42例均能通过CBCT准确诊断囊肿累及患牙，并于根管治疗后根尖囊肿如期愈合。结论：CBCT能够辅助诊断慢性根尖囊肿的累及范围，并指导临床医生判断受累患牙。     

Management of internal root resorption in the maxillary central incisor with fractured root using Biodentine

Biodentine is desirable to successfully manage internal root resorption, and the MTA apical plug backfilled with thermoplasticized gutta‐percha is suggested for the tooth with external apical root resorption.     

Prevalence of pulp canal obliteration and periapical pathology in human anterior teeth: A three-dimensional analysis based on CBCT scans

This study aimed to determine the prevalence of pulp canal obliteration (PCO) and its association with periapical pathology (Hypodense areas) in cone-beam computed tomography (CBCT) scans of anterior teeth. A total of 2161 CBCT scans from patients 18 years or older taken between 2000 and 2020 were selected. Patient-, tooth- and scan-related data were registered. Two calibrated evaluators recorded the number of teeth with PCO ≥4 mm in the cervical third of the roots and the presence or absence of periapical hypodensities (PH). The length of the root canal that was calcified was also determined. Logistic regression analysis was used to determine whether any of the recorded factors influenced the presence of PCO and the presence of periapical pathology in teeth presenting with PCO. The only factor significantly related to the presence of PCO was patient age. The prevalence of PH in teeth exhibiting PCO was 10%.     

Incidental Findings in Small Field of View Cone-beam Computed Tomography Scans,Part 2: Interpretation with Aid of a Checklist

IntroductionCone-beam computed tomography (CBCT) scans are routinely used by endodontic residents and faculty at Tufts University School of Dental Medicine for diagnostic purposes but are not routinely read for pathologic findings by a radiologist. In a 2017 study by Oser et al (part 1), endodontic residents and a radiologist interpreted CBCT scans taken for endodontic diagnostic purposes, and their findings were compared. The results demonstrated that a radiologist is significantly more likely to report incidental findings in small field of view (FOV) scans. A limitation of this study was that the radiologist used a checklist of common findings to review the scans. The purpose of this study was to examine whether the use of a checklist would improve the sensitivity of the endodontic residents’ reporting of incidental findings in small FOV CBCT scans.MethodsThe 203 small FOV CBCT scans used in part 1 were obtained and reviewed by endodontic residents in a systematic fashion. Radiographic findings were reported using a blank checklist. The results were compared with those previously reported.ResultsThe radiologist reported abnormalities in 176 of the 203 subjects (87%), and the residents reported abnormalities in 184 of the 203 subjects (91%). There was an increase in false positive findings when the residents were using a checklist.ConclusionsThe use of a checklist improved the sensitivity but decreased the specificity of the reporting of incidental findings in small FOV CBCT scans by endodontic residents.