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. 2013:2013:564392.
doi: 10.1155/2013/564392. Epub 2013 May 22.

Cone beam computed tomography evaluation of the diagnosis, treatment planning, and long-term followup of large periapical lesions treated by endodontic surgery: two case reports

Vijay Shekhar  1 , K Shashikala
Affiliations

Cone beam computed tomography evaluation of the diagnosis, treatment planning, and long-term followup of large periapical lesions treated by endodontic surgery: two case reports

Vijay Shekhar et al. Case Rep Dent. 2013.

Abstract

The aim of this case report is to present two cases where cone beam computed tomography (CBCT) was used for the diagnosis, treatment planning, and followup of large periapical lesions in relation to maxillary anterior teeth treated by endodontic surgery. Periapical disease may be detected sooner using CBCT, and their true size, extent, nature, and position can be assessed. It allows clinician to select the most relevant views of the area of interest resulting in improved detection of periapical lesions. CBCT scan may provide a better, more accurate, and faster method to differentially diagnose a solid (granuloma) from a fluid-filled lesion or cavity (cyst). In the present case report, endodontic treatment was performed for both the cases followed by endodontic surgery. Biopsy was done to establish the confirmatory histopathological diagnosis of the periapical lesions. Long-term assessment of the periapical healing following surgery was done in all the three dimensions using CBCT and was found to be more accurate than IOPA radiography. It was concluded that CBCT was a useful modality in making the diagnosis and treatment plan and assessing the outcome of endodontic surgery for large periapical lesions.

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Figures

Figure 1
Figure 1
Preoperative photo showing presence of sinus tract with respect to 12 and 13.
Figure 2
Figure 2
Pre-operative photo showing swelling of the palatal soft tissue.
Figure 3
Figure 3
Pre-operative IOPA radiograph showing well-defined large periapical lesion.
Figure 4
Figure 4
Pre-operative CBCT image in coronal plane showing presence of a large periapical lesion.
Figure 5
Figure 5
Pre-operative CBCT image in sagittal plane.
Figure 6
Figure 6
Pre-operative CBCT image in axial plane showing disruption of buccal and palatal cortex.
Figure 7
Figure 7
Reconstructed 3D CBCT image.
Figure 8
Figure 8
Postobturation IOPA radiograph.
Figure 9
Figure 9
Surgical incision on palatal aspect.
Figure 10
Figure 10
Flap reflection.
Figure 11
Figure 11
Flap retraction and exposure of bony defect.
Figure 12
Figure 12
Suturing.
Figure 13
Figure 13
Lesional tissue stored in formalin for histopathological examination.
Figure 14
Figure 14
Splinting of mobile teeth using composite.
Figure 15
Figure 15
Tooth preparation.
Figure 16
Figure 16
Temporization with acrylic crowns.
Figure 17
Figure 17
PFM crown cementation on 11, 12, 13, and 21.
Figure 18
Figure 18
Histopathology report: periapical granuloma.
Figure 19
Figure 19
1-month followup IOPA radiograph.
Figure 20
Figure 20
6-month followup IOPA radiograph.
Figure 21
Figure 21
12-month followup IOPA radiograph.
Figure 22
Figure 22
18-month followup IOPA radiograph.
Figure 23
Figure 23
24-month followup IOPA radiograph.
Figure 24
Figure 24
1-year followup CBCT image in coronal plane.
Figure 25
Figure 25
1-year followup CBCT image in sagittal plane.
Figure 26
Figure 26
1-year followup CBCT image in axial plane showing establishment of buccal and palatal cortical plates.
Figure 27
Figure 27
Pre-operative photo showing fractured and discolored 11 and displaced 12.
Figure 28
Figure 28
Pre-operative IOPA radiograph showing well-defined large periapical lesion.
Figure 29
Figure 29
Pre-operative CBCT image in coronal plane.
Figure 30
Figure 30
Pre-operative CBCT image in sagittal plane.
Figure 31
Figure 31
Pre-operative CBCT image in axial plane.
Figure 32
Figure 32
Reconstructed 3D CBCT image.
Figure 33
Figure 33
Postobturation IOPA radiograph.
Figure 34
Figure 34
Surgical incision.
Figure 35
Figure 35
Flap retraction and exposure of the cyst.
Figure 36
Figure 36
Apicoectomy.
Figure 37
Figure 37
Suturing.
Figure 38
Figure 38
Lesional tissue stored in formalin.
Figure 39
Figure 39
Tooth preparation.
Figure 40
Figure 40
Temporisation.
Figure 41
Figure 41
PFM crown cementation.
Figure 42
Figure 42
Histopathology report: radicular cyst.
Figure 43
Figure 43
1-month followup IOPA radiograph.
Figure 44
Figure 44
6-month followup IOPA radiograph.
Figure 45
Figure 45
12-month follow-up IOPA radiograph.
Figure 46
Figure 46
18-month followup IOPA radiograph.
Figure 47
Figure 47
24-month followup IOPA radiograph.
Figure 48
Figure 48
1-year followup CBCT image in coronal plane.
Figure 49
Figure 49
1-year followup CBCT image in sagittal plane.
Figure 50
Figure 50
1-year followup CBCT image in axial plane showing establishment of the buccal and lingual cortical plates.
See this image and copyright information in PMC

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