Iranian Endodontic Journal

Vol. 16 No. 3 (2021)

Two and Three-dimensional Parameters in Cone-beam Computed Tomography Monitoring of Apical Periodontitis in Traumatized Teeth: Case Report and Long-term Follow-up

Iranian Endodontic Journal, Vol. 16 No. 3 (2021), 1 July 2021 , Page 193-197
https://doi.org/10.22037/iej.v16i3.33811

Abstract

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)2. 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.

Keywords:
  • Apical Periodontitis; Cone-beam Computed Tomography; Computer-generated 3D Imaging; Volume Computed Tomography

How to Cite

1.
Soares de Toubes KM, Tonelli SQ, Felipe Magalhães Girelli C, Murad Villoria E, de Oliveira Buzatti Carneiro L, Ferreira Silveira F. Two and Three-dimensional Parameters in Cone-beam Computed Tomography Monitoring of Apical Periodontitis in Traumatized Teeth: Case Report and Long-term Follow-up. Iran Endod J [Internet]. 2021 Jul. 1 [cited 2025 Apr. 28];16(3):193-7. Available from: https://journals.sbmu.ac.ir/iej/article/view/33811

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