Background:Differential diagnosis of periapical cysts and granulomas is required as their treatment modalities are different.Aim:The aim of this study was to evaluate the efficacy of cone beam computed tomography (CBCT) in the differential diagnosis of periapical cysts from granulomas.Settings and Design:A single-centered observational study was carried out in the Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, using CBCT and dental operating microscope.Methods:Forty-five lesions were analyzed using CBCT scans. One evaluator analyzed each CBCT scan for the presence of the following six characteristic radiological features: cyst like-location, shape, periphery, internal structure, effect on the surrounding structures, and cortical plate perforation. Another independent evaluator analyzed the CBCT scans. This process was repeated after 6 months, and inter- and intrarater reliability of CBCT diagnoses was evaluated. Periapical surgeries were performed and tissue samples were obtained for histopathological analysis. To evaluate the efficacy, CBCT diagnoses were compared with histopathological diagnoses, and six receiver operating characteristic (ROC) curve analyses were conducted.Statistical Analysis Used:ROC curve, Cronbach's alpha (α) test, and Cohen Kappa (κ) test were used for statistical analysis.Results:Both inter- and intrarater reliability were excellent (α = 0.94, κ = 0.75 and 0.77, respectively). ROC curve with regard to ≥4 positive findings revealed the highest area under curve (0.66).Conclusion:CBCT is moderately accurate in the differential diagnosis of periapical cysts and granulomas.

Background:Numerous researches have been done on the permanent maxillary first molars for the presence of an extra canal, especially the mesiobuccal roots for the presence of MB2 canals. Cone beam computed tomography (CBCT) has been used recently in the detection of these canals. However, literature discussing the efficacy and reliability of CBCT in the detection of these canals is scanty.Aims:This study aims to evaluate the efficacy of CBCT as a preoperative diagnostic aid in locating the second mesiobuccal canal in maxillary first molars.Methods:Selected sixty extracted maxillary first molars were placed in the skull base, and CBCT scans were done for evaluating the presence of MB2 canals in the mesiobuccal root. Sectioning of the roots at 3, 5, and 7 mm from the tip was performed and further examined under the microscope for the presence of the MB2 canals. Evaluations were done by two evaluators independently. Results of evaluations were statistically analyzed. Statistical analysis used were standard normal deviation (Z value), interrater reliability (Chronbach's alpha-), P value and receiver operating curve(ROC).Results and Conclusions:Detection rates of MB2 using both the methods did not show any significant difference (P > 0.05). CBCT was found to be a reliable tool for the detection of MB2 canal in maxillary first molar teeth when compared to gold standard sectioning technique.

Context:Where nonsurgical endodontic intervention is not possible, or it will not solve the problem, surgical endodontic treatment must be considered. A major cause of surgical endodontic failures is an inadequate apical seal, so the use of the suitable substance as root-end filling material that prevents egress of potential contaminants into periapical tissue is very critical.Aims:The aim of the present ex-vivo study was to compare and evaluate the three root-end filling materials of mineral trioxide aggregate (MTA) family (white MTA [WMTA], grey MTA [GMTA] and Portland cement [PC]) for their marginal adaptation at the root-end dentinal wall using scanning electron microscopy (SEM).Materials and Methods:Sixty human single-rooted teeth were decoronated, instrumented, and obturated with Gutta-percha. After the root-end resection and apical cavity preparation, the teeth were randomly divided into three-experimental groups (each containing 20 teeth) and each group was filled with their respective experimental materials. After longitudinal sectioning of root, SEM examination was done to determine the overall gap between retrograde materials and cavity walls in terms of length and width of the gap (maximum) at the interface. Descriptive statistical analysis was performed to calculate the means with corresponding standard errors, median and ranges along with an analysis of variance and Tukey's test.Results:The least overall gap was observed in GMTA followed by PC and WMTA. While after statistically analyzing the various data obtained from different groups, there was no significant difference among these three groups in terms of marginal adaptation.Conclusion:GMTA showed the best overall adaptation to root dentinal wall compared to PC and WMTA. Being biocompatible and cheaper, the PC may be an alternative but not a substitute for MTA.

The procedure of regeneration has shown promising results in the treatment of nonvital teeth with immature apices. However, the tissue being regenerated can only be confirmed through histological examination. This report describes an immature nonvital 12 with apical pathology which was treated via revascularization using 3% NaOCl and 17% ethylenediaminetetraacetic acid as irrigants; Ca(OH)2 as intracanal medicament and platelet-rich fibrin (PRF) as scaffold. On follow-up at 6 and 12 months, healing of periapical lesion, dentinal thickening, and apical closure with a canal exit forming distally were evident. The tooth, however, got fractured and was subsequently extracted at 12 months and sent for histopathological examination. It was revealed that a collagenous matrix for forming hard tissue similar to acellular cementum with a diffuse area of calcification could be seen in pulp space being attached with root canal dentin walls, suggesting that PRF may yield favorable outcomes in regenerative endodontic procedures.

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