Computed tomography (CT) in the selection of treatment for root-filled maxillary molars with apical periodontitis

Almeida, F. J. Mota de; Huumonen, Sisko; Molander, Anders; Öhman, Anders; Kvist, Thomas

doi:10.1259/dmfr.20150391

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…This led experts in four out of five cases to decide for a treatment to eradicate the OIF, mainly through a surgical approach. This is in agreement with previous studies in endodontics and orthodontics showing that CBCT could lead to a more invasive treatment ( 17 - 20 ). The only case for which experts recommended therapeutic abstention was Case 3: incomplete endodontic treatment without apical periodontitis.…”

Section: Discussionsupporting

confidence: 93%

Impact of cone-beam computed tomography for the identification and management of an oral portal of entry in patients with infective endocarditis. A Delphi study

Cloître¹,

Hascoët²,

Iung³

et al. 2022

Med Oral

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Background Infective endocarditis (IE) is a rare and life-threatening disease. Cutaneous portal of entry (POE) is predominant for IE, but an oral POE is the second most frequent source. Thus looking for and treating an oral POE in IE patients is of critical importance in order to reduce the risk of IE relapse or recurrence. The objectives of this study were: 1) To reach a consensus on decision-making following the detection of an oral POE on cone-beam computed tomography (CBCT) while they were not identified using the current recommended approach in IE patients (oral examination and orthopantomogram: OPT). 2) To determine whether this consensus differs when regarding the microbiology of IE. Material and Methods Twenty oral or maxillofacial surgeons participated to this Delphi study. The questionnaire was based on five radiological cases (OPT and matching CBCT) with two scenarios according to the objectives of detecting oral POE in an IE patient (curative in case of oral causative microorganism, and preventive if not) and different therapeutic approaches (surgical or conservative treatment, no treatment) for each of them. Consensus was defined as an agreement rate of ≥75%. Results The response rate was≥85%. After four rounds, consensus was achieved for all proposals. CBCT changed the decision-making of experts in four cases. In one case, the decision was influenced by the IE microbiology toward a more radical approach in case of oral causative microorganism. Conclusions In IE patients, CBCT changed markedly the decision-making of experts by eradicating more oral POE than when using OPT. This could reduce the risk of IE relapse and recurrence. Key words: Cone beam computed tomography, orthopantomogram, clinical decision-making, oral infectious foci, infective endocarditis, Delphi study.

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Section: Discussionsupporting

confidence: 93%

Impact of cone-beam computed tomography for the identification and management of an oral portal of entry in patients with infective endocarditis. A Delphi study

Cloître¹,

Hascoët²,

Iung³

et al. 2022

Med Oral

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“…It was found that 33 (40%) of the root filled teeth with signs of post-treatment disease at first examination had been retreated or extracted, while the remaining 49 teeth had received no radiographically detectable treatment. Similar observations continue to be published and the overall conclusion is that there is no consensus about how to deal with post-treatment disease (Çiçek et al, 2016;Kirkevang et al, 2014;Mota de Almeida et al, 2016;Taha et al, 2019).…”

Section: How Decisions About Post-treatment Disease Are Madementioning

confidence: 77%

“…Since several studies have demonstrated large inter‐ and intraindividual variation in interpretation of the periapical area in radiographs (Petersson et al, 2012) it has been hypothesized that variation in retreatment decisions might be regarded as a function of diagnostic variation. However, neither studies among general practitioners (Reit & Gröndahl, 1987) nor specialists (Mota de Almeida et al, 2016) have given support to this idea.…”

Section: How Decisions About Post‐treatment Disease Are Madementioning

confidence: 99%

Clinical decision making of post‐treatment disease

Kvist

Hofmann

2022

Int Endodontic J

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Root-filled teeth presenting with signs of post-treatment disease is a common finding in virtually every dental practice. There is both empirical and experimental evidence that, as long as the condition is asymptomatic, it is often left untreated. Professional judgements and decision making in endodontics as in any medical discipline are based on qualified estimations of the probability and the value of relevant outcomes.In this paper we describe various aspects of clinical decision making in general, from a descriptive as well as a normative point of view, but with a particular focus on the condition of the root-filled tooth with post-treatment disease. We review how attention to various types of uncertainties are relevant for the decision-making process. Additionally, we discuss the nature of value judgements and different concepts of health and disease which are important for understanding the complexity of the clinical decision-making process. We also refer to a set of principal rules that can guide the clinician's decision making in every-day practice in front of a case with endodontic post-treatment disease. Finally, we provide some aspects on the sometime cumbersome decision whether to go for a non-surgical or surgical method, whenever a decision on retreatment has been made.

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“…Imagens tomográficas têm qualidade superior quando comparadas às radiografias periapicais e panorâmicas na detecção de lesões periapicais [5,6,20]. Para alguns autores, a TCFC gera aumento da exposição de radiação quando comparada aos exames radiográficos, além de ser mais dispendiosa, devendo ser evitada ou usada, quando possível, de forma pontual [16,17,20], entretanto a dose de radiação gerada pela tomografia com campo de visão pequeno é próxima à dose de radiação de uma radiografia panorâmica. De acordo com a alta prevalência de canais MV2 não tratados e a variabilidade anatômica dos primeiros molares superiores, a TCFC poderia ser sugerida como padrão ouro para o diagnóstico [19,20].…”

Section: Discussionunclassified

Alta prevalência de quartos canais não tratados e forames independentes em primeiros molares superiores e associação com lesões periapicais: um estudo transversal

Paulo¹,

Barriviera²,

Barriviera³

et al. 2021

RSBO

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O conhecimento sobre a ocorrência do segundo canal mesiovestibular (MV2) em dentes já tratados é insuficiente, e variações anatômicas do forame apical representam um grande desafio para o endodontista, o que pode estar associado a altas taxas de falha clínica. Objetivo: Este estudo objetivou determinar a prevalência de quartos canais tratados e forames apicais independentes em primeiros molares superiores permanentes com tratamento endodôntico e sua associação com lesões periapicais, usando tomografia computadorizada de feixe cônico (TCFC) em campo de visão pequeno. Material e métodos: O total de 1.100 primeiros molares superiores permanentes com tratamento endodôntico de diferentes pacientes da cidade de Brasília (DF, Brasil) foi analisado em imagens de TCFC por dois examinadores calibrados e especialistas em imaginologia. A presença do canal MV2 foi registrada e classificada nas variáveis categóricas com ou sem tratamento, com ou sem forame apical independente e com ou sem lesão periapical, e suas frequências foram analisadas pelo teste do χ2 (p < 0,05) e razão de chances. Resultados: Houve proporção discrepante de canais MV2 tratados e não tratados (razão de 1:6,5) e MV2 com forame independente presente e ausente (razão de 1,4:1). A associação entre lesões periapicais com quartos canais não tratados e forame apical independente foi significativamente forte e positiva. Conclusão: Este estudo demonstrou a alta prevalência de canal MV2 sem tratamento e forame apical independente em primeiros molares superiores permanentes com tratamento endodôntico e sua associação com lesões periapicais em análise por TCFC. Esses achados apontam para a necessidade de se reforçar procedimentos de diagnóstico e tratamento em endodontia.

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Computed tomography (CT) in the selection of treatment for root-filled maxillary molars with apical periodontitis

Cited by 9 publications

References 24 publications

Impact of cone-beam computed tomography for the identification and management of an oral portal of entry in patients with infective endocarditis. A Delphi study

Impact of cone-beam computed tomography for the identification and management of an oral portal of entry in patients with infective endocarditis. A Delphi study

Clinical decision making of post‐treatment disease

Alta prevalência de quartos canais não tratados e forames independentes em primeiros molares superiores e associação com lesões periapicais: um estudo transversal

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