Soares de Toubes Kênia, Tonelli Stéphanie Quadros, Magalhães Girelli Caroline Felipe, Villoria Eduardo Murad, de Oliveira Buzatti Carneiro Leonardo, Silveira Frank Ferreira
Department of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Department of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil.
Iran Endod J. 2021 Summer;16(3):198-204. doi: 10.22037/iej.v16i3.33811.
Assessment of apical periodontitis (AP) is a challenging task. This case report highlights the CBCT diagnosis and monitoring of periapical radiolucency (PR) using ITK-SNAP software 3.8v in a complex clinical scenario of three traumatized anterior teeth. An 11-year-old male patient complained of recurrent swelling and pain in the maxillary incisor region (teeth #11 and #21). His parents reported a history of traumatic injury affecting these teeth two years back. Digital periapical radiographic (DPR) and cone-beam computed tomography (CBCT) were requested. PR was identified on teeth #11, #21, and # 22. In tooth #22, besides a PR, an area suggesting internal root resorption or oblique root fracture was observed. The teeth were shaped and dressing with calcium hydroxide Ca(OH). MTA repair was delivered to the apical portion of the canals (approximately 3 mm). The remainder of the canal was filled with thermoplastic gutta-percha and Endosequence sealer. After one year, the patient returned complaining of pain in tooth #11. Radiographically, the PR of tooth #11 did not reduce. A CBCT was taken, showing a reduction of radiolucency. The patient was clinical and radiographically re-evaluated for 6 months, and he remained asymptomatic. After three years of follow-up, the patient suffered a new trauma on teeth #11 and #21. As tooth #11 presents mobility and biting pain, a new CBCT was requested due to the risk of a possible root fracture. So, the PR was synchronously monitored with linear measurements and volumetric analysis using ITK-SNAP software 3.8v. In this case, the volumetric evaluation was essential to identify the PR's correct dimensions, reducing image interpretation's subjectivity. At 48-month follow-up, the patient was symptoms free and radiographically showed a reduction in the PR's size, compatible with osseous healing.
根尖周炎（AP）的评估是一项具有挑战性的任务。本病例报告强调了在三颗外伤前牙的复杂临床情况下，使用ITK-SNAP软件3.8v对根尖周透射区（PR）进行CBCT诊断和监测。一名11岁男性患者主诉上颌切牙区（11号和21号牙）反复肿胀和疼痛。他的父母报告称，两年前这些牙齿曾受过外伤。遂要求进行数字化根尖片（DPR）和锥形束计算机断层扫描（CBCT）检查。在11号、21号和22号牙上发现了PR。在22号牙上，除了PR外，还观察到一个提示内部牙根吸收或斜行牙根骨折的区域。对这些牙齿进行了塑形并用氢氧化钙Ca(OH)进行了换药。将MTA修复材料放置到根管根尖部分（约3 mm）。根管其余部分用热塑性牙胶和Endosequence封闭剂充填。一年后，患者复诊主诉11号牙疼痛。影像学检查显示，11号牙的PR没有减小。拍摄了CBCT，显示透射区减小。对患者进行了6个月的临床和影像学复查，他仍无症状。随访三年后，患者的11号和21号牙再次受伤。由于11号牙出现松动和咬合痛，鉴于可能存在牙根骨折的风险，要求再次拍摄CBCT。因此，使用ITK-SNAP软件3.8v通过线性测量和体积分析对PR进行同步监测。在本病例中，体积评估对于确定PR的正确尺寸至关重要，减少了图像解读的主观性。在48个月的随访中，患者无症状，影像学检查显示PR大小减小，与骨质愈合相符。
