Rubens Spin-Neto

Impact of cone beam computed tomography on periapical assessment and treatment plan five to eleven years after surgical endodontic retreatment

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AIM: To evaluate how additional information from Cone Beam CT (CBCT) impactson periapical assessment and treatment planning based on clinical examination and periapical radiographs (PR) in cases followed-up five to eleven years after surgical endodontic retreatment (SER).

METHODOLOGY: Patients receiving SER during 2004-2010 were re-invited for follow-up examination including clinical examination, PR, and CBCT. In total 108 patients (119 teeth) were re-invited, 74 patients (83 teeth) accepted to participate. Three observers initially assessed PR according to the four-scaled, increasing disease severity criteria by Rud et al. (1972) and Molven et al. (1987): "Radiographic assessment A". By including clinical information "Treatment plan A" was made: 1) no treatment, 2) further observation, 3) SER re-operation (SER-R), or 4) extraction. Hereafter the CBCT volume was assessed and the information incorporated for "Radiographic assessment B" followed by "Treatment plan B". Agreement between radiographic assessments and between treatment plans was recorded and assessed statistically by Stuart-Maxwell-test for marginal homogeneity.

RESULTS: Nine teeth had been extracted, thus, the final analysis included 74 teeth (66 patients). The radiographic assessment was changed as a result of the CBCT evaluation in 38 cases (51.4%), of which 35 (47.3%) were to a higher Rud & Molven score, p<0.001. Treatment plan was changed for 18 teeth (24.3%). For 14 teeth (18.9%) the change was from no treatment or further observation to a more invasive treatment plan (SER-R or extraction), p=0.005.

CONCLUSION: The use of CBCT for long-term follow-up after SER may lead to more cases diagnosed with persisting or recurrent apical periodontitis and hence often to the recommendation of a more invasive treatment modality. This article is protected by copyright. All rights reserved.

TidsskriftInternational Endodontic Journal
Sider (fra-til)729-737
Antal sider9
StatusUdgivet - 18 jan. 2018

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