Search Results (10)

Left ventricular (LV) apical obliteration represents a convergent imaging phenotype arising from diverse cardiac conditions, including thrombotic, hypertrophic, infiltrative, congenital, and neoplastic diseases. These conditions, despite sharing overlapping morphological features, require profoundly different management strategies. In this context, an accurate characterization of the LV apex is a cornerstone point, and can be performed through various techniques. Advances in multimodality imaging have substantially improved diagnostic precision, allowing clinicians to differentiate true obliteration from mimicking conditions such as hypertrabeculation, apical hypertrophy, or subendocardial fibrosis. This review provides a comprehensive overview of the anatomical variability of the LV apex and its implications for imaging interpretation. We appraise the role of echocardiography, including contrast-enhanced and speckle-tracking studies—alongside cardiac magnetic resonance (CMR), computed tomography (CT), and selective nuclear imaging in the evaluation of apical pathology. For each principal cause of apical obliteration—LV thrombus, apical hypertrophic cardiomyopathy, left ventricular non-compaction, endomyocardial fibrosis, cardiac amyloidosis, and intracardiac tumors—we outline key diagnostic clues, imaging red flags, and distinguishing tissue characteristics. Special emphasis is given to the incremental value of CMR for tissue characterization, thrombus detection, and fibrosis mapping, as well as to the interpretative challenges posed by apical foreshortening, near-field artefacts, and suboptimal acoustic windows. A practical, stepwise imaging framework is proposed to guide clinicians through the differential diagnosis of apical obliteration using an integrated multimodality approach. Future directions include the incorporation of 4D flow, advanced mapping techniques, and artificial intelligence-powered analysis to refine apical phenotyping and identify early disease signatures. Recognizing the full spectrum of apical pathology and its imaging manifestations is essential to prevent misdiagnosis, enable timely therapeutic decisions, and improve risk stratification. Full article

Purpose: Gradenigo syndrome is a rare complication of acute otitis media (AOM) in children, characterized by suppurative otitis media, unilateral facial pain, and ipsilateral abducens nerve palsy. This review summarizes pediatric data on the presentation, diagnostics, treatment, and outcomes. Methods: A literature research was conducted using the terms “Gradenigo syndrome,” “petrous apicitis,” and “complications otitis media.” Pediatric cases were analyzed for demographics, symptoms, diagnostic findings, therapeutic strategies, and clinical outcomes. Results: Sixty-three articles described 65 patients (mean age: 8.0 years). The classic triad occurred in 22% of cases; 74% showed incomplete presentations. Imaging revealed petrous apex inflammation (84%) and petrous bone tip obliteration (49%). Antibiotics were administered in 88% of cases, most commonly third-generation cephalosporins. Surgery was performed in 72%, mainly myringotomy, tympanostomy tube insertion, and mastoidectomy; no direct petrous apex approaches were reported. Pathogens were identified in 41% of cases, most commonly Fusobacterium necrophorum. Clinical improvement occurred in 98%, with 75% achieving a complete resolution; complications were reported in 29%, including one fatality (2%). Conclusions: Given its variable presentation, comprehensive diagnostic imaging is essential for the diagnosis of Gradenigo syndrome. Early broad-spectrum antibiotic therapy is essential. Surgical intervention is required in severe cases. Long-term targeted antibiotic therapy may help prevent recurrence. Full article

(1) Background: Pulp canal obliteration (PCO) is a common condition characterized by an abnormal dentinal apposition within the canal wall, which often rises as a consequence of dental trauma. In recent years, “guided endodontics” has offered a reliable and safer procedure for endodontic access in case of PCO. The present case report aims to introduce a new endodontic guided system with a sleeveless, open-frame titanium guide designed to reduce costs compared to traditional templates. (2) Methods: The patient is a 19-year-old female who was referred to a private clinic to treat a calcified and symptomatic tooth (3.3) with apical periodontitis. Following the first unsuccessful treatment attempt using the operating microscope, a three-dimensional cone beam computed tomography (CBCT) examination and an optical impression were performed in agreement with the patient. The Digital Imaging and Communications in Medicine (DICOM) and Standard Tessellation Language (STL) files were sent to the lab for the template packaging, and the patient was scheduled for a second appointment. The endodontic guide was accurately positioned, and shaping and filling were concluded with success. The canal was sealed with the single-cone technique and bioceramic sealer. (3) Results: The patient reported no significant post-operative symptoms. Notably, the treatment achieved total symptom resolution, as evidenced by radiographic assessments conducted 3 and 24 months post-treatment, confirming the procedure’s success. (4) Conclusions: This innovative sleeveless, open-frame static titanium guide presents a promising advancement in guided endodontics for PCO treatment. The advantages include preserving healthy dental tissue, reduced chairside operating time, and cost savings compared to conventional templates. This approach holds promise for enhancing the quality and efficiency of endodontic procedures in cases of PCO. While the static guide holds promise, larger prospective studies are necessary to validate its efficacy, safety, and broader applicability in routine endodontic procedures. Full article

Root canal treatment of carnassial teeth in dogs is a common endodontic technique which aims to re-establish or maintain the health of the periapical tissues. In total, 43 dogs were used in this study. Root canal morphology was evaluated in 86 superior fourth premolars and 86 inferior first molars. Apical delta was present in 247 roots, while obliteration of the root canal was found in 11 roots. The most common type of apical delta of the roots of superior fourth premolars was type II, with up to 10 apical ramifications, while type IIIA, with 10–20 apical ramifications, was most commonly present in the roots of inferior first molars. Considering that knowledge of the morphology of root canals is essential for a successful endodontic procedure, the aim of this study was to analyze and compare the morphology of root canals in the carnassial teeth of German shepherds and mixed-breed dogs. Apical resection for the purpose of endodontic therapy of the superior fourth premolar and the inferior first molar is indicated at a length of 4 to 6 mm from the anatomical tip of the roots, which would completely remove the apical delta of these two teeth. Full article

This study aimed to evaluate the precision of the guided endodontic technique applied to calcified canals in anterior teeth in relation to demographic and dental variables. The present observational study was conducted during the period 2020–2021. The patients were consecutive referrals at the Department of Endodontics and Conservative Dentistry of the University Hospital of Siena. The guided endodontics protocol was applied using 0.75 mm diameter burs for the lower teeth and 0.90 mm for the upper teeth. The inclusion criteria were as follows: (i) teeth with pulp canal obliteration (PCO) associated with a periapical lesion (periapical index (PAI) ≥ 2); (ii) teeth with PCO that require the placement of a root canal post for the execution of a prosthetic treatment; (iii) teeth in which surgical treatment was not justified. Socio-demographic characteristics of the patients were recorded and related to the drill path accuracy through the guide in the calcified endodontic canal, evaluated through a radiographic analysis, and classified as optimal (in the center of the root canal) and acceptable (deviated peripherally/tangentially). A logistic regression model was built to predict the factors that influence the poor precision of the technique. Seventeen patients (mean age 48 years) with eighteen calcified single-rooted teeth were enrolled. All teeth were associated with periapical lesions with PAI scores from 2 to 5 (mean PAI: 3.055). From the model, it is evident that the presence of a calcification affecting the apical area of the root increases the probability of being off-center with the bur by about 15 times. In addition, a previous attempt at endodontic treatment and the position in the lower arch increases the probability of non-centrality of the drill, although in a non-statistically significant way. In any of the analyzed cases, the guided endodontic technique applied to PCO did not determine the presence of iatrogenic errors, such as perforations. However, the apical localization of the obliteration increases the probability of being off-center with the drill during the instrumentation phase by about 15 times. Full article

Pulp canal obliteration (PCO) is a significant complication in endodontics that can occur due to various factors. Cone beam computed tomography (CBCT) is a useful diagnostic tool for identifying root canal anatomy and variations, and guided endodontics is emerging as an alternative treatment solution for teeth with partially or entirely obliterated pulpal canals. However, the accuracy of CBCT-guided 3D-printed guides on different materials and layer thicknesses is not well understood. Therefore, this study aimed to evaluate the accuracy of guides prepared using CBCT images on 3D-printed teeth with stereolithography (SLA) using three different materials and two different layer thicknesses. This study found that 3D-printed guides were accurate and reliable for accessing 3D-manufactured obliterated teeth and reaching the apical area. No significant differences in distance or angle measurements were found when different guide materials were used, suggesting that materials can be selected based on availability and cost. These findings contribute to the knowledge base regarding the effectiveness of 3D printing technology in guided endodontics and can help to identify the most suitable materials and techniques for this application. Full article

(1) Introduction: Deciduous traumatic dental injuries pose a serious global health concern. Root fractures show an incidence rate of approximately 2%; however, the literature is limited regarding the appropriate treatment and prognosis of affected teeth. This retrospective study aims to analyze the long-term outcomes of orthodontic splinting using brackets compared with composite resin-only splinting in two homogeneous samples affected by root fractures. The study also examines the onset and patterns of root resorption. (2) Methods: The first group included 25 patients with 27 deciduous upper incisors affected by root fracture; Group 2 consisted of 35 patients with 38 root fractures of maxillary deciduous teeth. The categorical data for both groups were analyzed using the chi-squared homogeneity test. Age groups were compared using the Mann–Whitney U test; p < 0.005 was considered statistically significant. (3) Results: In both groups, the male gender predominated similarly. In Group 1, early decidual loss occurred in 16% of cases, whereas in Group 2 it occurred in 51% of cases. Pulp canal obliteration was observed in 68% of deciduous teeth in Group 1, compared with 30% in Group 2. No complications affecting permanent teeth were noted in Group 1; in Group 2, 29% developed enamel dysplasia and 26% experienced delayed eruption, with statistically significant differences in these proportions. Apical fragment resorption was observed in 92% of cases in Group 1 and 30% in Group 2. (4) Conclusions: The treatment of deciduous tooth root fractures using orthodontic splints can yield significant benefits, such as reduction of early tooth loss. Furthermore, the study confirms that early resorption of the distal fragment of fractured roots is a common physiological phenomenon in primary teeth and typically occurs within a year following trauma. Full article

In recent years, the application of Guided Endodontics has gained interest for non-surgical endodontic treatment and retreatment. The newest research focuses on the accuracy of Dynamic Navigation (DN). This article systematically reviewed existing data on the accuracy of non-surgical endodontic treatment procedures that were completed using DN. Following the PRISMA criteria, an electronic database search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library. Studies comparing the accuracy of non-surgical endodontic treatment using DN and the conventional freehand technique were eligible. The literature search resulted in 176 preliminary records. After the selection process six studies were included. The risk of bias was evaluated using the modified Cochrane Collaboration Risk of Bias 2.0 tool. Five studies examined the aid of DN for planning and executing endodontic access cavities, and one for fiber post removal. In two studies, endodontic access cavities were performed in teeth with pulp canal obliteration. The main outcomes that were measured in the included studies were preparation time, global coronal entry point and apical endpoint deviations, angular deviation, tooth substance loss, qualitative precision, number of unsuccessful attempts or procedural mishaps. The risk of bias was rated from low to raising some concerns. Overall, DN showed increased accuracy compared to the freehanded technique and could be especially helpful in treating highly difficult endodontic cases. Clinical studies are needed to confirm the published in vitro data. Full article

One of the most important diagnostic challenges in clinical practice is the distinction between pulmonary hypertension (PH) due to primitive pulmonary arterial hypertension (PAH) and PH due to left heart diseases. Both conditions share some common characteristics and pathophysiological pathways, making the two processes similar in several aspects. Their diagnostic differentiation is based on hemodynamic data on right heart catheterization, cardiac structural modifications, and therapeutic response. More specifically, PH secondary to heart failure with preserved ejection fraction (HFpEF) shares features with type 1 PH (PAH), especially when the combined pre- and post-capillary form (CpcPH) takes place in advanced stages of the disease. Right ventricular (RV) dysfunction is a common consequence related to worse prognosis and lower survival. This condition has recently been identified with a new classification based on clinical signs and progression markers. The role and prevalence of PH and RV dysfunction in HFpEF remain poorly identified, with wide variability in the literature reported from the largest clinical trials. Different parenchymal and vascular alterations affect the two diseases. Capillaries and arteriole vasoconstriction, vascular obliteration, and pulmonary blood fluid redistribution from the basal to the apical district are typical manifestations of type 1 PH. Conversely, PH related to HFpEF is primarily due to an increase of venules/capillaries parietal fibrosis, extracellular matrix deposition, and myocyte hypertrophy with a secondary “arteriolarization” of the vessels. Since the development of structural changes and the therapeutic target substantially differ, a better understanding of pathobiological processes underneath PH-HFpEF, and the identification of potential maladaptive RV mechanisms with an appropriate diagnostic tool, become mandatory in order to distinguish and manage these two similar forms of pulmonary hypertension. Full article

The aim of this study was to investigate and compare, radiographically and clinically, the impacts of calcium-silicate based-cement (CSBC), nano-hydroxyapatite and platelet-rich fibrin (PRF) as pulpotomy agents in permanent immature molars with incomplete root development. Sixty-three participants (63 permanent immature molars) were included in this study. The patients were randomly divided into three equal groups. Fast setting MTA (MM-MTA), nano-hydroxyapatite and platelet-rich fibrin were used as pulpotomy agents. The teeth were evaluated clinically and radiographically after 6 and 12 months by two blinded examiners. Apical closure and pulp canal obliteration percentages were recorded. The in vitro reaction of the tested materials after a 7-day immersion period of the different materials in phosphate-buffered solution was analyzed using scanning electron microscopy to associate the in vitro mineralization with in vivo pulp canal obliteration percentages. Data were analyzed using Chi-square and ANOVA tests (α = 0.05). No significant difference was found between the three tested groups in terms of clinical and radiographic success (p > 0.05). All cases demonstrated evidence of root growth, including complete apical closure or continued apical closure. At 12 months, complete apical closure was found among the MM-MTA group (50%), nano-hydroxyapatite group (55%) and platelet-rich fibrin group (60%) (p > 0.05). After 12 months, pulp canal obliteration was more observed in the MM-MTA and nano-hydroxyapatite groups than in the PRF group (p < 0.05). MM-MTA (auto-mixed), NHA (hand-mixed) and PRF (autologous) could be used as pulpotomy agents since they exhibit comparable high clinical and radiographic success rates. However, the fact that the groups managed with MM-MTA and NHA have a higher tendency to canal obliteration might indicate that PRF should be considered the first choice material as pulpotomy agent, as it would make retreatment considerably easier. Full article