de Paula-Silva Francisco Wanderley Garcia, Santamaria Milton, Leonardo Mário Roberto, Consolaro Alberto, da Silva Léa Assed Bezerra
Department of Pediatric Clinics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Nov;108(5):796-805. doi: 10.1016/j.tripleo.2009.06.016. Epub 2009 Sep 5.
To evaluate the periapical repair after root canal treatment in the teeth of dogs using CT and conventional radiography and to compare these findings with the gold standard microscopic evaluation.
The animals were divided into three groups according to endodontic treatment performed: Group 1, single-visit endodontic treatment in teeth without apical periodontitis; Group 2, single-visit endodontic treatment in teeth with apical periodontitis; and Group 3, endodontic treatment in teeth with apical periodontitis using calcium hydroxide as a root canal dressing. Group 4 consisted of teeth with apical periodontitis not submitted to root canal treatment and Group 5 consisted of healthy teeth without periapical disease. Radiographic, tomographic, and microscopic evaluations were performed by blind examiners. At 180 days experimental time, CT and radiographic measurements of periapical disease were compared with the gold standard microscopic measurement using intraclass correlation coefficient. Intergroup comparisons considering different methods of periapical lesions measurement or different clinical protocols of root canal treatment were performed by Kruskal Wallis test followed by Dunn. Integrity of lamina dura, presence of radiolucent areas, and presence of root resorption were analyzed by Fisher's exact test.
There was discontinuity of the lamina dura and CPD in all teeth from Groups 2, 3, and 4 evaluated by tomography and radiography 45 days after CPD induction. Radiographically, 180 days after root canal treatment, there was no periapical lesion in teeth from Groups 1 and 3, different from groups 2 and 4 (p < .05). The highest reduction in the CPD size was observed on Group 3 (p < .05). According to the tomographic results, there was decrease of the size of the CPD on Group 3 but not on Groups 2 or 4. However, in all groups the periapical lesions presented larger mesio-distal extension if compared with radiography, both 45 days after CPD induction and 180 days after root canal treatment. At 180 days, CT measurements were closely related to microscopic results (ICC = 0.95) differently from radiographic evaluation (ICC = 0.86).
CT Scan evaluation of periapical repair following root canal treatment provided similar information than that obtained by microscopic analysis, whereas radiographic evaluation underestimated the size do periapical lesion.
使用CT和传统X线摄影评估犬牙根管治疗后的根尖周修复情况，并将这些结果与金标准显微镜评估结果进行比较。
根据牙髓治疗方法将动物分为三组：第1组，对无根尖周炎的牙齿进行一次性根管治疗；第2组，对有根尖周炎的牙齿进行一次性根管治疗；第3组，对有根尖周炎的牙齿使用氢氧化钙作为根管敷料进行根管治疗。第4组由未接受根管治疗的根尖周炎牙齿组成，第5组由无根尖周疾病的健康牙齿组成。由盲法检查者进行影像学、断层扫描和显微镜评估。在实验时间180天时，使用组内相关系数将根尖周疾病的CT和影像学测量结果与金标准显微镜测量结果进行比较。通过Kruskal Wallis检验和Dunn检验进行组间比较，考虑根尖周病变测量的不同方法或根管治疗的不同临床方案。通过Fisher精确检验分析硬骨板的完整性、透射区的存在以及牙根吸收的存在。
在诱导CPD 45天后，通过断层扫描和X线摄影评估，第2、3和4组所有牙齿的硬骨板和CPD均有连续性中断。在根管治疗180天后，影像学检查显示，第1组和第3组牙齿无根尖周病变，与第2组和第4组不同（p < 0.05）。第3组CPD大小的减少最为明显（p < 0.05）。根据断层扫描结果，第3组CPD大小减小，而第2组和第4组未减小。然而，在CPD诱导45天后和根管治疗180天后，与X线摄影相比，所有组的根尖周病变在近远中方向上的延伸均更大。在180天时，CT测量结果与显微镜结果密切相关（ICC = 0.95），与影像学评估不同（ICC = 0.86）。
根管治疗后根尖周修复的CT扫描评估提供的信息与显微镜分析获得的信息相似，而影像学评估低估了根尖周病变的大小。
