OBJECTIVE: The purpose of the present study was the radiographic evaluation of endodontically treated teeth presenting periapical radiolucency and unintentional overfilling with gutta-percha or sealer on treatment outcome and persistence of the extruded materials.
METHODS: After assessment using periapical index (PAI), 202 roots filled with gutta-percha and zinc oxide-eugenol sealer (Roth 811, Roth International), exhibiting unintentional overfilling and periapical radiolucency were selected. All cases had at least 1 year of follow-up. Type of extruded material, periapical status, and removal/persistence of the extruded material were evaluated by two independent observers. Data were statistically analyzed using logistic and linear regression analysis.
RESULTS: Tooth location (P .001), follow-up period (P .001), and type of extruded material (P = .004) significantly influenced treatment outcomes. Specifically, posterior roots exhibited better outcomes compared to anterior, and cases with overfilling of sealer showed superior healing potential compared to those with gutta-percha overfilling. Additionally, longer recall periods were associated with improved treatment success. The type of extruded material (P .001) and follow-up period (P .001) significantly affected the presence of extruded material in the follow-up radiograph. The persistence of extruded material was greater when gutta-percha was extruded, and extruded materials were less detected when the follow-up period was longer.
CONCLUSIONS: Teeth with periapical radiolucency and unintentional overfilling require longer follow-up intervals for effective monitoring of healing. Treatment outcome was associated with the type of extruded materials used in the present study. The persistence of those materials in the periapex did not affect healing.

The canalis sinuosus is an anatomical variation whereby the infraorbital canal sometimes generates a small, lateral branch (canal) close to its midpoint, to allow the passage of the anterior superior alveolar neurovascular bundle in the anterior maxilla. This article focuses on an incidental finding of this variant, in a 74-year-old Trinidadian female of Afro-Caribbean descent with an endodontic presenting complaint. The canalis sinuosus shadow on conventional radiography resulted in uncertainty as to the offending tooth until a 3-dimensional scan was undertaken in this region. This report will discuss the implications of the presence of this canal from radiologic, endodontic, and surgical perspectives.

Interpretation of the state of healing of chronic apical periodontitis or apical curettage with apicoectomy in radiological images is based on the analysis of changes in the appearance of the periapical area and in the bone structure adjacent to the site of inflammation or surgical intervention, which are projected onto normal bone structures. However, distortion of structures or the superposition of anatomical images should be considered when interpreting radiographs. We compared conventional studies of evaluation of the periapical area following treatment, together with 2D images, with the periapical index and the criteria of evaluation in both successful and unsuccessful cases of endodontic surgical treatment. Some studies have reported that the radiographic appearance of the tooth crown and root may facilitate interpretation of the periapical area. In addition, cone-beam computed tomography can show the relationship between injured and repairing tissue using buccal and lingual tables to measure the periphery in transverse reconstruction. Indeed, complex biological events and mechanisms can occur during the healing process of periapical and root tissues. Knowledge of the diversity of tissues is essential to identify the dynamics of the signs of regeneration or the presence of healing due to repair. Hence, the aim of this article was to identify the criteria used to interpret periapical healing in two-dimensional or three-dimensional images and their relationship with diagnosis and treatment according to the literature currently available.

UNASSIGNED: Vital partial pulpotomy (PP) or cervical pulpotomy (CP) in carious pulp-exposed permanent teeth preserves tooth vitality, promotes pulp healing, decreases treatment costs, and shortens treatment duration, which is a significant factor in treating noncooperative children. The aim of this retrospective study was to compare clinical and radiographic outcomes of partial and CP in vital carious-exposed permanent teeth.
UNASSIGNED: All vital permanent teeth with carious pulp exposure, treated by pulpotomy using mineral trioxide aggregate (MTA) during 2017-2019, by two operators in one dental center, were included in the study. Around 118 permanent teeth in 97 children and adolescents (mean age 10.9 years) were evaluated 6-57 months postoperatively.
UNASSIGNED: The total success rates of CP and PP were 82.5 and 80.8%, respectively (p = nonsignificant). The only factor that significantly affected the success rate was the presence of preoperative periapical pathology. Teeth without such pathology showed an 87.3% success rate compared to 74.1 and 58.3% in teeth with preoperative enlarged periodontal ligament (PDL) or with periapical radiolucency, respectively (p = 0.0301). Demographic variables, maturation state of the tooth, type of tooth (incisor, premolar, molar), postoperative variables, such as the presence of radiographic dentinal bridge, partial or full obliteration of the pulp during the follow-up period, and the integrity of the final restoration during the recall examinations did not affect the success rate of the treatment.
UNASSIGNED: Partial and CP in vital permanent teeth with carious pulp exposure in children and adolescents might be a reliable alternative to full root canal treatment (RCT).
UNASSIGNED: Yoshpe M, Kaufman AY, Lin S, et al. Clinical and Radiographic Outcomes of Mineral Trioxide Aggregate Pulpotomies in Vital Permanent Teeth with Carious Pulp Exposure: A Pioneering Retrospective Study. Int J Clin Pediatr Dent 2023;16(4):555-559.

This study aimed to evaluate periapical radiolucency of endodontically treated teeth before and after orthodontic treatment using cone-beam computed tomography (CBCT).
Patients who underwent orthodontic treatment at Wonkwang University Daejeon Dental Hospital between January 2009 and June 2022 were included based on the following criteria: root canal treatment, and availability of CBCT images taken before and after orthodontic treatment with an interval of > 1 year between both scans. Patients with primary teeth or orthodontic tooth extractions were excluded. The size of the periapical radiolucency (SPR) of the endodontically treated tooth was evaluated using CBCT. Pre-orthodontic treatment CBCT images and the latest post-orthodontic treatment CBCT images were analyzed. The selected teeth were further categorized based on the orthodontic duration, CBCT interval, the patient sex and age, the tooth type and position (maxilla or mandible), and quality of root canal obturation. Statistical analyses were performed to evaluate changes in SPR using the paired t-test and multiple regression analysis.
In total, 115 teeth (37 anterior teeth, 22 premolars and 56 molars) from 61 patients (age, 14-54 years) were included, with 39 teeth from male patients and 76 teeth from female patients. The age was ranged between 14 and 54 years old, and mean age was 25.87 years old. The mean CBCT interval and orthodontic treatment period were 43.32 months and 36.84 months, respectively. Seventy-five teeth showed good obturation quality, 80 were not used as anchors during orthodontic treatment, and 71 were maxillary. The SPR size increased after orthodontic treatment for 56 teeth and decreased for 59 cases. The average change in SPR was -0.102 mm and the difference was not significant. Significant decrease of SPR were observed between female patients (p = 0.036) and maxillary teeth (p = 0.040).
Orthodontic treatment had no significant impact on the changes in the SPR in endodontically treated teeth in most categories. However, there was a significant difference among females and the maxillary teeth. In both categories, the size of radiolucency decreased significantly.

Cross-sectional studies assess a population\'s health state and the prevalence of diseases or treatments. Few systematic reviews regarding the prevalence of periapical radiolucency (PARL) and nonsurgical root canal treatment (NSRCT) were conducted in the last decade. The goal of this study was to collect and review all updated and available cross-sectional studies that focus on the prevalence of both PARL and NSRCT in adult populations. It involves a systematic literature review of cross-sectional studies on the prevalence of PARL and NSRCT published from 1987 to 2022 in PubMed, Google Scholar, Web of Science, and Scopus with specific keywords used in the search process. A total of 52 articles were included in this systematic review. The majority of the included articles were from different populations. The overall prevalence of teeth with PARL was 43,522 (6.40%), while the prevalence of NSRCT teeth was 52,149 (7.67%). On the other hand, the overall prevalence of PARL in teeth that have received endodontic treatment and teeth that have not received endodontic treatment were 22,110 (3.25%) and 21,412 (3.15%), respectively. A meta-analysis was not performed due to underreporting of publication bias and the high degree of heterogeneity between studies. The overall risk of bias assessment revealed a low risk of bias in 25 (48%) of the included studies. The prevalence of NSRCT was higher at 7.67%, followed by PARL at approximately 6.40%. However, future studies are recommended to investigate the prevalence of both PARL and NSRCT in different patient populations.

This study aimed to determine the prevalence and quality of endodontic treatment, by radiographically assessing the periapical periodontitis and endodontic treatment status in patients with cardiovascular disease (CVD) and cardiovascular risk (CVR) factors. Patients who visited the Out Patient Department of Institute of Dental Sciences and Department of Cardiology, Institute of Medical Sciences and SUM Hospital, Siksha \'O\' Anusandhan University, Bhubaneswar, from August 2021 to February 2022, for a check-up or dental problem were considered as participants in this study. After obtaining informed consent, the participants were enrolled on the Oral Infections and Vascular Disease Epidemiology Study (INVEST) IDS, BHUBANESWAR. After testing negative for COVID-19, patients\' demographic details, such as age and gender were recorded, followed by a panoramic radiographic examination (OPG). A total sample of 408 patients were divided into three groups: Group 1/control (without any cardiovascular manifestation) consisting of 102 samples, group 2 of 222 CVR patients, and group 3 of 84 CVD cases. The CVR and CVD groups had a preponderance of elderly age groups between 60 to 70 years, with a significantly higher proportion of males. Co-morbidities such as diabetes mellitus, hypertension, and dyslipidemia were significantly associated with the CVR and CVD groups. From OPG interpretation, it was observed that the periapical radiolucency was greater in the CVR and CVD groups than in the control group (p = 0.009). The prevalence of endodontically treated teeth was higher in CVR and CVD than in the control group (p = 0.028). A high prevalence of dental caries, about 70%, was reported in all three groups (p = 0.356). The presence of dental restoration among all the groups was low (p = 0.079). The proportion of periodontal bone loss in the control group was significantly lower than CVR and CVD (p = 0.000). There was a strong association between periapical radiolucency, endodontically treated teeth, and periodontal bone loss in CVR and CVD patients. Notably, the associations reported herein do not reflect a cause-effect relationship; however, individuals with endodontic pathologies may accumulate additional risk factors predisposing them to hypertension or other CVDs. The results emphasize that eliminating local infections may decrease the systemic infection burden.

BACKGROUND: The advent of Cone Beam Computed Tomography (CBCT) in endodontics has enhanced the diagnosis of periapical radiolucencies and the assessment of endodontically treated teeth.
OBJECTIVE: The purpose of this study was to assess the prevalence of periapical radiolucencies in a Bulgarian subpopulation and the quality of previous endodontic treatment using CBCT scans.
METHODS: This study included 2795 roots from 160 Large FOV CBCT which were evaluated by two independent examiners using two scoring systems: CBCT-PAI and PESS.
RESULTS: The inter-examiner agreement spanned from strong to almost perfect (0.892 and 0.983). The prevalence of periapical lesions according to the two scoring systems was 23.1% and 12.9 %, respectively. The prevalence of endodontically treated teeth was high (34.1%). Sixty-five percent of them presented with signs of periapical radiolucencies, while only 1.4% of all non-treated roots had a periapical lesion. A significant association between periapical disease, poor quality of the root canal filling and inadequate coronal seal was found (p<0.001).
CONCLUSIONS: The prevalence of periapical disease in endodontically-treated teeth in the Bulgarian subpopulation was high. Poor qual-ity of the root canal filling and inadequate coronal seal were assessed as prognostic determinants of treatment failure. CBCT techniques can augment conventional diagnostic techniques in the field of endodontics.

BACKGROUND: Accurate radiographic interpretation is of the utmost importance in the diagnosis and treatment of patients. Previous studies have indicated subjectivity in the radiographic interpretation of periapical tissues irrespective of using conventional radiography, digital radiography, or cone-beam computed tomographic (CBCT) imaging. No studies to date have evaluated the reliability of the interpretation of periapical tissues based on the size of periapical radiolucency (PAR). The purpose of this study was to assess the interobserver and intraobserver reliability of CBCT interpretation by observers from different specialties and different levels of experience when identifying PARs of various sizes.
METHODS: Limited field of view CBCT scans were selected such that a variety of PARs with various sizes were included. Six observers with different levels of experience and fields of specialty evaluated periradicular tissues of 28 roots on the CBCT scans at 3 separate sittings each a month apart.
RESULTS: The overall Fleiss kappa coefficient for interobserver reliability and intraobserver reliability was 0.88 and 0.85; the larger the PAR, the more reliable the radiographic interpretation. Increased experience level improved the intraobserver reliability.
CONCLUSIONS: CBCT imaging appears to be a reliable method for the interpretation of PAR. The larger the PAR is the more reliable the radiographic interpretation.

Extranodal non-Hodgkin lymphoma (NHL) in the oral region can present similarly to diseases of odontogenic origin. The objective of this report was to describe a rare case of maxillary and mandibular NHL that presented similarly to and concurrently with lesions of odontogenic origin.A unique case of extranodal NHL, which presented at the apices of maxillary and mandibular teeth in conjunction with lesions of odontogenic origin in a 68-year-old white man, is described. The patient sought care because of a lesion in the right maxillary paranasal region that caused him paresthesia. Radiographically, periapical radiolucencies were present along teeth #5-8, #23 and 24, and #30 and 31. Biopsies of the right maxillary and anterior mandibular lesions were completed and led to a diagnosis of NHL at the apices of teeth #5-8 extending to the hard palate and granulation tissue at the apices of teeth #23 and 24. Two years later, the patient returned because of pressure and sensitivity associated with teeth #30 and 31. Vestibular swelling was noted clinically, and a multilocular periapical radiolucency was present radiographically. Via endodontic therapy and a positron emission tomographic scan, the lesion associated with teeth #30 and 31 was determined to be of both odontogenic and nonodontogenic origin because it possessed both a sinus tract associated with tooth #30 and NHL. Lesions of odontogenic and nonodontogenic origin possess diagnostic and treatment challenges because they may present similarly and/or concurrently. Thoughtful and conservative management of odontogenic lesions with associated NHL is imperative. Interprofessional collaboration and communication among providers must be thorough and clear to properly coordinate care and prevent delays in diagnosis and treatment when these entities occur together.