VOLUME 18, NO. 4 PERIODONTIC ENDODONTIC SOLUTIONS C O N E B E A M T O M O G R A P H Y KEN SEROTA / MARK NICOLUCCIEvaluation of Odontogenic Maxillary Sinusitis Using cbCT; Three Case Reports Ten to twelve percent of all cases of maxillary sinusitis derive from odontogenic origin. The purpose of this study was to report the use of cone-beam computed tomography (CBCT) scanning in elucidating dental pathology as an etiology of maxillary si- nusitis. Methods: Intraoral periapical radiographs and CBCT scanning were performed in the evaluation of three patients presenting with pain, sinus congestion, or respiratory complaints. In the first case, extractions of impacted third molar and adjacent non- restorable tooth were performed. In the second two cases, endodontic therapy was done. Radiologic follow-up with CBCT scanning or medical computed tomography scanning was performed 6 to 12 months after dental procedures were performed. Results: All three patients presented with severe sinusitis that resolved after appropriate dental treatment. The first patient also showed marked improvement of chronic bronchitis after completion of dental treatment. In all patients, complete or near total resolution of sinusitis, including eradication of mucous retention cyst, was confirmed by post-treatment CBCT or computed to- mography scanning. Conclusions: These cases show the utility of CBCT scanning in evaluating patients presenting with concurrent sinus and den- tal complaints. In these three patients, maxillary sinusitis of odontogenic origin responded well to the eradication of dental etiol- ogy. (Cymerman, JJ, Cymerman, DH, O’Dwyer RS. J Endod 2011;37:1465–1469) (A) The preoperative periapical radiograph shows previous root canal treatment on teeth #1.7 and 1.54. (B) The postoperative periapical radio- graph shows completion of endodontic retreatment on tooth #1.7. (C) The preoperative CBCT sagittal view of the buccal roots of the second mo- lar shows thickening of the sinus membrane. (D) The preoperative CBCT sagittal view of the palatal root of the second molar reveals the extent of dome-shaped radiopacity superior to tooth #1.7. E) The preoperative CBCT coronal view of tooth #1.7 shows thickening of the sinus membrane. (F) The 12-month follow-up CBCT sagittal view of the buccal roots of the second molar shows the mucous retention cyst resolved. (G) The 12- month follow-up CBCT sagittal view of the palatal root of tooth #1.7 shows resolved mucous retention cyst and mild thickening of the mucous membrane of the maxillary sinus. (H) The 12-month follow-up CBCT coronal view of tooth #1.7 also shows the resolved mucous retention cyst and mild thickening of the sinus membrane.
CONE BEAM TOMOGRAPHY Page 2BASIC RESEARCH—TECHNOLOGY Detection of Horizontal Root Fracture with Small-volume Small- Cone-Beam Computed Tomography in the Presence and Cone- Absence of Intracanal Metallic Post Introduction: The aim of the present study was to test the accuracy of small-volume cone-beam com- puted tomography (CBCT) scanning in the detection of horizontal root fractures and to assess the influ- ence of a metallic post. Methods: Forty teeth were divided into four groups based on the presence of metallic posts and horizon- tal root fracture. The teeth were examined by small-volume CBCT scanning at 0.2-mm voxel resolution. Three observers analyzed the samples for the presence of a horizontal root fracture. Sensitivity and specificity were calculated. Results: High values for accuracy (73%–88%) were obtained in the groups without a metallic post, and statistically significant differences were found when the group with a metallic post has been observed (55%–70%). Intraobserver agreement also showed statistically significant differences in the groups with a metallic post. Conclusions: Small-volume CBCT scanning showed high accuracy in detecting horizontal root fracture without a metallic post. However, the presence of a metallic post significantly reduced the specificity and sensitivity of this examination. (Costa FF, et al. J Endod 2011;37:1456–1459) Circumferential CBCT images: (A) a sample with a horizontal root fracture (arrow) and a metallic post, (B) a sample without a horizontal root fracture with a radiolucent image caused by a metallic artifact (arrow), and (C) a sample with a horizontal root fracture (arrow) without a metallic post.
VOLUME 18, NO. 4 Page 3MAP-READING STRATEGY TO DIAGNOSE ROOT PERFORATIONSNEAR METALLIC INTRACANAL POSTS BY USING CONE BEAMCOMPUTED TOMOGRAPHYIntroduction: To determine the diagnostic hypothesis on the basis of periapical radiography (PR) is a great challenge for radiolo-gists and endodontists. Visualization of three-dimensional structures, available with cone beam computed tomography (CBCT),favors precise definition of the problemand treatment planning. However, metallic artifact effect of intracanal posts might also in-duce untrue images. The aim of this article is to suggest a map-reading strategy to diagnose root perforations near metallic intra-canal posts (ICPs) by using CBCT.Methods and Results: The incapacity to locate correctly the position of root perforation might lead to clinical failures. One strategyto minimize metallic artifact in root perforation associated with ICP is to obtain sequential axial slices of each root, with an imagenavigation protocol from coronal to apical (or from apical to coronal), with axial slices of 0.2 mm/0.2 mm. This map reading pro-vides valuable information showing dynamic visu-alization toward the point of communication be-tween the root canals and the periodontal space,associated with radiolucent areas, suggesting rootperforation.Conclusions: The accurate management of CBCTimages might reveal abnormality that is unable tobe detected in conventional PR. A map-readingapproach reduces problems related to detection ofroot perforations near metallic artifacts. The finaldiagnosis should always be made in conjunctionwith the clinical findings. (Bueno MR, Estrela C ,etal. J Endod 2011;37:85–90) (A) Radiographic imaging of tooth #2.5 showed root canal filling 1 mm short from root apex, associ- ated with ICP and AP. In sagittal views it identified ICP in palatal and buccal root canals, presence of lat- eral radiolucency near to the tip of post in palatal root, and presence of metallic artifact. In axial view root perforation can be observed. (B) (Tooth #2.5). Navigation in axial slices of 0.2 mm/0.2 mm involving the coronal to apical direction (and also in apical to coronal direction) provided information regarding better localization, suggesting root perforation associated with lateral radiolucency.
Kenneth S. Serota, DDS, MMScE NDO DO NT I CPE R I O DO NT I CS O LUT I O NS Mark Nicolucci, BSc, DDS, MS, FRCD(C) 4310 Sherwoodtowne Blvd., Suite 300Primary Business Address Mississauga, ON L4Z 4C4Your Address Line 2 905.270.3357Your Address Line 3 1.877.642.3636Your Address Line 4 www.endosolns.com www.facebook.com/endosolns