Three-dimensional image contribution for evaluation of operative procedural errors in endodontic therapy and dental implants

Braz Dent J (2012) 23(2): 127-134 Operative procedural errors ISSN 0103-6440 127 Three-Dimensional Image Contribution for Evaluation of Operative Procedural Errors in Endodontic Therapy and Dental Implants Julio Almeida SILVA Ana Helena Gonçalves de ALENCAR Sicknan Soares da ROCHA Lawrence Gonzaga LOPES Carlos ESTRELA Dental School, UFG - Federal University of Goiás, Goiânia, GO, Brazil Acceptable therapeutic protocol in dentistry depends on the outcomes obtained with follow up. Operative procedural errors (OPE) may occur and they represent risk factors able to compromise a tooth or a dental implant. The aim of this study was to detect the OPE in endodontically treated teeth and dental implants, using cone beam computed tomography (CBCT). Eight hundred and sixteen CBCT exams were performed between January 2009 and October 2010, and only those which presented endodontically treated teeth and/ or dental implants were selected. The sample was as follows: 195 CBCT exams (n=200 teeth and 200 dental implants), 72 male, 123 female, with mean age of 51 years. In endodontically treated teeth, OPE included underfilling, overfilling, and root perforation; OPE in dental implants were thread exposures, contact with anatomical structures, and contact with adjacent teeth. Kolmogorov-Smirnov test was used for statistical analysis, with significance level set at α=0.05. Underfilling, overfilling, and root perforations were detected in 33.5%, 8% and 4.5% of the teeth, respectively. Dental implants with thread exposures, contact with important anatomical structures and contact with adjacent teeth were seen in 37.5%, 13% and 6.5% of the cases, respectively. OPE were detected in endodontically treated teeth and dental implants, and underfilling and thread exposures were the most frequent occurrences, respectively. Key Words: endodontic failure, dental implant failure, cone beam computed tomography, diagnostic imaging. INTRODUCTION The periapical tissue health and the maintenance of the tooth in the oral cavity are the main goal of endodontic therapy. Another alternative to replace the compromised tooth is dental implant-based restoration (1). However, both Endodontics and Implantology are challenging considering the technical difficulties, professional ability and scientific knowledge in both areas. Clinical radiographic criteria of therapeutic success have been considered important to establish a clinical decision in both specialties. In endodontically treated teeth the success includes absence of pain and swelling; absence of drainage and fistula; tooth in function, with normal physiology; disappearance of periapical bone rarefaction (2). The clinical condition after rehabilitation treatment with dental implants might be determined with an implant quality scales. Success (optimum health) is considered when the patient does not report pain or tenderness upon function, absence of mobility, radiographic bone loss initial surgery less than 2 mm, and no exudate history. Satisfactory survival includes no pain upon function, absence of mobility, radiographic bone loss between 2-4 mm, and no exudate history. In situations of compromised survival there may be sensitivity on function, absence of mobility, radiographic bone loss greater than 4 mm (less than half of implant body), probing depth greater than 7 mm and no exudate history, and there may be exudates history. Clinical or absolute failure is characterized by pain on function, mobility, radiographic bone loss greater than half the length of implant, uncontrolled exudate, and no longer Correspondence: Prof. Dr. Carlos Estrela, Departamento de Ciências Estomatológicas, Universidade Federal de Goiás, Praça Universitária S/N, Setor Universitário, 74605-220 Goiânia, GO, Brasil. Tel: +55-62-3016-2121. e-mail: Braz Dent J 23(2) 2012 J.A. Silva et al. 128 in the mouth (3). The assessment of dental treatment by computed tomography represents an expressive advance of information in health studies and contributes in planning, diagnosis, therapeutic process and prognosis of several diseases. The continuous advance of technology enabled the development of cone beam computed tomography (CBCT) (4,5), which had shown numerous perspectives for applications in different research areas and clinical dentistry (4-9). Imaging resources routinely had been used before, during and after dental management. Conventional radiographic images provide a twodimensional rendition of a three-dimensional structure, which may result in interpretation errors. Periapical lesions of endodontic origin may be present but not visible on conventional 2D radiographs (2,6,7). Diagnostic accuracy is critical for treatment success. The correct management of CBCT images might reveal abnormality that is unable to be detected in periapical radiography and may favor more predictable planning and treatment. A possibility of map-reading approach with CBCT images reduces problems related to difficult evaluation conditions which require special care during diagnosis (8). CBCT scans provide detailed high-resolution images of oral structures and permit early detection of alterations in maxillofacial structures. This technology allows the determination of linear distances and volume of anatomic structures, pre-surgical planning of maxillofacial lesions, root length and marginal bone level during orthodontic treatment, reconstruction techniques, bone level changes following regenerative periodontal therapy, periodontal defect, periapical lesions, and root resorptions (6-9). Operative procedural errors (OPE) are caused by several factors inherent to patient and/or professional, and their consequences may influence on prognosis. Alencar et al. (10) assessed OPE (fractured instruments, perforations and apical transportation) created by rotary NiTi instruments during root canal preparation by using CBCT, and observed that this imaging method offered more resources for diagnosis. Endodontic therapy or placement of a dental implant requires planning, knowledge and an accurate operative ability. OPE characterize disability, nonobservance of therapeutic protocol and low level of knowledge involving endodontic and dental implant principles. Deficient attendance may be responsible for severe consequences and sequels, which impairs the prognosis, and may be responsible for serious judicial questions. The dilemma of replacing a biological structure by biocompatible material requires care, information about criteria and rates of success in endodontically treated teeth and dental implants. Thus, viewing the lack of studies comparing the outcome between endodontic therapy with dental implants and the limitations in its longitudinal interpretations showed the need of researches using a more accurate tool. The potential of CBCT as diagnosis imaging method justifies this investigation. The aim of this cross-sectional study was to detect OPE in endodontically treated teeth and dental implants, using CBC (...truncated)