New Endodontic Technologies

Comparison of Periapical Radiographs and CBCT Imaging in Endodontic Practice

Case 1

A 52 year old male patient presented with soreness to palpation, percussion and acute sinusitis secondary to necrosis of the pulp, maxillary right cuspid. The patient's past medical history was non-contributory to the present illness.

The pre-operative periapical radiograph (a) demonstrates a corticated unilocular periradicular osteitis associated with the maxillary right cuspid. In the focused field high-resolution CBCT images of the same case, the lesion's invasion of the maxillary antrum (b, sagittal) and associated periradicular mucositis [(c, axial), green arrow] are appreciated. A post-operative periapical radiograph (d) shows the completed endodontic treatment.

 

a: Kodak 6100 per-operative periapical radiograph

b: CBCT sagittal view

c: CBCT axial view

d: Kodak 6100 post-operative periapical radiograph

 

Case 2

A 55 year old male patient presented for evaluation of three lower anterior teeth with asymptomatic extraradicular invasive cervical resorption noted on routine radiographic examination.. He denied any history of trauma, orthodontics or bleaching; his past medical history was non-contributory to the present illness. The mandibular right central, left central and left lateral incisors were non-responsive to pulp tests and were non-mobile. Periodontal findings were within normal limits except pocket depths of 4 and 5 mm were present on the lingual of the mandibular right central and left lateral incisors, respectively.

The pre-operative periapical radiograph (a) demonstrates large resorptive lesions affecting the mandibular right central, left central and left lateral incisors. Focused field high-resolution CBCT provided 3D visualization of the portals of entry [(b, axial), yellow and green arrows], and the extent of the lesions relationship to the osseous crest [(c, d, and e) serial sagittal].

 

a:  Kodak 6100 pre-operative periapical radiograph

 

Case 3

A 63 year old male was referred by an endodontic  colleague for imaging of the mandibular left second bicuspid. He related a history of prior endodontic treatment 10 years earlier. The tooth was slightly sensitive to percussion and bite stick, and probed 10 mm on the direct buccal. Other findings were within normal limits and the medical history was non-contributory to his illness.

A periapical radiograph was exposed (a), revealing a condensing osteitis at the apical terminus and a widened periodontal membrane on the mesial. A focused field high-resolution (CBCT) was exposed, revealing a vertical area of low density along the mesial aspect of the root consistent with a vertical fracture [(b, sagittal), green arrow] and periradicular periodontitis at the buccal aspect with disruption of the cortical bone and vertical fracture [(c, axial), yellow arrow].

 

a: Kodak 6100 pre-operative periapical radiograph

b: CBCT sagittal view

c: CBCT axial view

 

Case 4

A 58 year old male was referred for possible endodontic treatment of the mandibular right first molar after neglecting his dentition for 5 years. He related a history of "fracturing his tooth while eating." There were no symptoms reported, and his dentist had placed him on a regimen of penicillin VK for four days prior to my evaluation. The mesial cusps were fractured, extensive caries was present and the amalgam restoration was dislodged. There was slight sensitivity to percussion and bite stick, the tooth was non-responsive to cold and had localized, non-probing  inflammation at the buccal furcation. Other findings were within normal limits and the medical history was non-contributory to his illness.

A periapical radiograph was exposed (a) and the dislodged amalgam, caries and slight thickening of the periodontal membrane at the mesial root apex was noted. A focused field high-resolutionCBCT was exposed, revealing an area of low-density at the furcation [(b, sagittal view), yellow arrows] and periradicular periodontitis associated with the mesial and distal roots [(b, sagittal view), green arrow].

 

a: Kodak 6100 pre-operative periapical radiograph

b: CBCT sagittal view

 

Case 5

A 42 year old female was referred for possible endodontic treatment of the maxillary left first molar. The patient presented with mild swelling and soreness to palpation at the area of the mesio-buccal root; the tooth had been treated more than 5 years previously and was occasionally symptomatic since the completion of endodontic treatment. Other findings were within normal limits and the medical history was non-contributory to her illness.

A periapical radiograph was exposed (a) and an inadequately obturated root canal was noted, along with a periradicular periodontitis associated with the mesial root. A focused field high-resolution CBCT image was exposed, and revealed a periradicular periodontitis at the mesio-buccal root and its associated periradicular mucositis [(b, sagittal), green arrow and yellow arrows, respectively]. The previously untreated mesio-accessory canal [(c, axial), green arrow] was also noted.

 

 

 

 

 

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