Detecting chronic apical periodontitis for improved endodontic success

Abstract

Endodontic treatments are frequently carried out in daily clinical practice. The presence or absence of a periapical radiolucency, assessed using intraoral radiographs, is one of the criteria used to determine endodontic success. When such a lesion is present around the apex of a tooth, the condition is known as chronic apical periodontitis. While this is common around root treated teeth, it can also be associated with otherwise healthy teeth. In both instances, it represents an inflammatory response to bacteria or irritants in the periapical space, and results in bone loss and areas of reduced density, which can then form apical granulomas or cysts. The literature has shown that periapical lesions can go undetected, due to the two-dimensional limitations of periapical radiographs. These “hidden” lesions can compromise the longevity of the tooth. Considering that apical periodontitis can be far more accurately detected and diagnosed on cone beam computed tomography, it has been recommended by several authors that endodontic treatment outcomes ideally should be evaluated using this imaging modality, whenever possible.