Diş Hekimliği Fakültesi / Faculty of Dentistry

Fusion is a developmental anomaly of dental hard tissues. Since dental fusion is characterized by irregular coronal morphology and a complex endodontic anatomy, endodontic therapy of such teeth may present a serious clinical challenge. Cone-beam computed tomography (CBCT) is a useful tool for the management of complex endodontic problems and dental anomalies. In the case presented here, a CBCT scan revealed morphological details as well as the severity of periapical infection that had not been visualized with conventional imaging techniques. The results obtained with detailed imaging led to a change in the treatment plan.

Introduction: Changes in periapical lesion dimensions along with mucosal thickening after endodontic treatment have not been studied yet. Therefo1e, the objectives of this study were (1) to obtain linear and volumetric measurements of lesion dimensions in maxillary first molars with periapical pathology and (2) to measure maxillary sinus mucosal thickening in the vicinity of periapical lesions before and 1 year after endodontic treatment by using cone-beam computed tomography (CBCT). Methods: Twenty-one maxillary first molar teeth of 21 patients (14 female and 7 male) with periapical lesion that had local mucosal thickening in the vicinity of the periapical lesion were endodontically treated. A total of 21 maxillary first molar roots (8 mesiobuccal roots, 6 distobuccal roots, and 7 palatal roots), each one from different patients, was included. Pretreatment and 1-year post-treatment CBCT images of each tooth were obtained by using Kodak CS 9300 3D CBCT unit. Width, height, surface area, and volume measurements of periapical lesions and mucosal thickening of the maxillary sinus mucosa in the vicinity of the periapical lesion were measured before and 1 year after endodontic treatment. General linear model (analysis of variance) was used for the comparisons between measurements, and significance was set at P <.05. Regression analysis was also used to test the correlation between different measurements. Results: We found statistically significant differences between mean pretreatment and mean post-treatment measurements conducted by using CBCT images (width, P =.002; height, P <.001; maximum mucosal thickening, P <.001; medium mucosal thickening, P <.001; minimum mucosal thickening, P <.001; surface area, P =.032; and volume, P =.034). Considering gender, age, and root type variables, no significant differences were found for all the measurements conducted (P >.05). There were 36%, 41%, 53%, 54%, 53%, 73%, and 75% mean reductions in lesion width, lesion height, maximum sinus mucosal thickness, medium sinus mucosal thickness, minimum sinus mucosal thickness, lesion surface area, and lesion volume, respectively, before and 1 year after endodontic treatment. Regression analysis of pretreatment lesion volume versus percentage of post-treatment lesion volume change revealed a low regression coefficient (R2 = 16.7%, P >.05), showing a weak linear relationship. Conclusions: CBCT assessment of changes in periapical lesion and mucosal thickening dimensions may reveal useful information regarding endodontic treatment success.

Diş Hekimliği Fakültesi / Faculty of Dentistry

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