Bonfanti Elisa, Maddalone Marcello, Pellegatta Alberto, Citterio Claudio Luigi, Baldoni Marco
School of Dental Medicine, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy.
School of Dental Medicine, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy, Phone: +39 3924655950, e-mail:
J Contemp Dent Pract. 2019 Jun 1;20(6):664-669.
Cone beam computed tomography (CBCT) is the most refined and affordable method available today for the examination of an incoming patient for different dental pathologies. The aim of this paper is to evaluate the significance of some factors influencing the prevalence of apical periodontitis.
An ortopantomography (OPT) and CBCT scan of the dental arches were examined for each of the selected 45 patients. The presence of apical periodontitis (AP) was compared for CBCT and OPT examination. Sensitivity, specificity, predictive values, and accuracy were calculated for CBCT, using OPT as a reference. The impact of protective/risk factors on the development of AP was examined.
CBCT showed higher sensitivity (250%), predictive values (111%), accuracy (111%), and specificity (101%) than OPT. It was found to have higher sensitivity in all the dentition areas, especially where empty anatomical spaces or more radiotransparent structures have a strict relationship with the tooth apex and periapical structures like upper front area, premolar areas, and, especially, in the upper molar area. The prevalence of AP increased from 16 to 17% in the case of insufficient conservative restoration or 25% in the case of microleakage, 35-42% in the case of prosthetic restoration, 56-67% for posts, and 60 and 85%, respectively, for inadequate endodontic treatment and missed canals.
CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between the apex and important anatomical structures exists. Different risk factors with different relevance are identified.
As CBCT-examined results show, coronal restorations are moderate-risk factors, while insufficient endodontic treatments and posts are high-risk factors for the development of AP.
锥形束计算机断层扫描（CBCT）是目前用于检查患者各种牙病的最精确且经济实惠的方法。本文旨在评估影响根尖周炎患病率的一些因素的重要性。
对45例选定患者的每例进行牙弓的曲面体层摄影（OPT）和CBCT扫描。比较CBCT和OPT检查中根尖周炎（AP）的存在情况。以OPT为参考，计算CBCT的敏感性、特异性、预测值和准确性。研究保护/风险因素对AP发生发展的影响。
CBCT显示出比OPT更高的敏感性（250%）、预测值（111%）、准确性（111%）和特异性（101%）。发现在所有牙列区域CBCT都具有更高的敏感性，特别是在一些解剖学空隙或更透射线的结构与牙根尖和根尖周结构（如上颌前部区域、前磨牙区域，尤其是上颌磨牙区域）有密切关系的地方。在保守修复不足的情况下，AP的患病率从16%增加到17%；在微渗漏的情况下为25%；在修复体修复的情况下为35 - 42%；桩修复的情况下为56 - 67%；根管治疗不充分和遗漏根管的情况下分别为60%和85%。
当根尖与重要解剖结构存在密切关系时，CBCT在磨牙区域评估和根管治疗计划中起决定性作用。确定了具有不同相关性的不同风险因素。
正如CBCT检查结果所示，冠修复是中度风险因素，而根管治疗不充分和桩修复是AP发生发展的高风险因素。
