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- Pigg, Maria, et al.
(författare)
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A comparative analysis of MRI, CBCT and conventional radiography in patients with atypical odontalgia and symptomatic apical periodontitis : preliminary results
- 2006
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Ingår i: Swedish Dental Journal. - 0347-9994. ; 30:4, s. 173-174
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Aim: Atypical odontalgia(AO) is a chronic pain condition located in the teeth and jaws. It has been suggested, that AO is best regarded as a neuropathic pain condition, but knowledge regarding the etiology, diagnostics, and management of AO is not yet satisfactory. This pilot study evaluates the clinical usefulness of more recently developed imaging methods for intraoral pain conditions. The aim is to compare the diagnostic findings using magnetic resonance imaging(MRI) and cone beam computed tomography(CBCT) with the findings from conventional radiography in patients with atypical odontalgia(AO) and symptomatic apical periodontitis(SAP). Material and methods: 12 patients (9 F, 3 M) mean age 50,25 years, range 36 - 63 years participated in the study. The patients were referred to the Orofacial Pain Unit or the Department of Endodontics, Faculty of Odontology, Malmö University. Inclusion criteria for AO were chronic pain (>6 months) located in a region where a tooth had been endodontically or surgically treated, pain with no pathological cause detectable in clinical or radiological examinations. For SAP, the inclusion criteria were recurrent pain from a tooth diagnosed with apical periodontitis in a clinical and radiographic examination. Ten of the patients in the study were diagnosed with AO and two with SAP. The patients were clinically assessed with a qualitative somatosensory examination, a dental examination, an examination of the masticatory system(RDC/TMD), and panoramic and intraoral radiographs. A questionnaire was used to gather information about pain characteristics, psychosocial status(SCL-90), and quality of life. Besides these measures, each patient underwent a CBCT(3D-Accuitomo, J Morita Co) examination and a MRI(Siemens Sonata Vision 1.5 T) examination with and without contrast enhancement. Contrast was enhanced by injections of Magnevist (469 mg/ml, Schering Nordiska). Bone destruction, sclerosis, and signs of inflammation were the main parameters studied. Results: In the preliminary results, average pain intensity was 6.3 on a numerical rating scale(NRS) and average pain duration was 3,6 years. 83% exhibited somatosensory abnormalities. Bone destruction not visible in the intraoral and panoramic radiographs was detected with CBCT in 40% (4/10) of the patients diagnosed with AO, and signs of inflammation were detected in the MRIs of 20% (2/10) of the patients diagnosed with AO. Conclusion: Preliminary findings indicate that CBCT and MRI can provide additional information to conventional radiography in the diagnosis of intraoral orofacial pain. Further studies with larger sample sizes of AO and SAP patients are necessary to determine the clinical relevance of these findings.
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| 3. |
- Pigg, Maria, et al.
(författare)
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Diagnostic yield of conventional radiographic and cone-beem computed tomographic images in patients with atypical odontalgia
- 2011
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Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 12:44, s. 1092-1101
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Tidskriftsartikel (refereegranskat)abstract
- Abstract AIM: To investigate whether the additional diagnostic yield of a cone-beam computed tomography (CBCT) examination over conventional radiographs in patients primarily suspected of having atypical odontalgia (AO) improves differentiation between AO and symptomatic apical periodontitis (SAP) in patients with severe chronic intraoral pain. METHODOLOGY: In this clinical study, 25 patients (mean age 54 ± 11 years, range 34-72) participated; 20 were diagnosed with AO and 5 with SAP. All patients were recruited from the clinics of the Faculty of Odontology, Malmö University. AO inclusion criteria were chronic pain (>6 months) in a region where a tooth had been endodontically or surgically treated, with no pathological cause detectable in clinical or radiologic examinations. SAP inclusion criteria were recurrent pain from a tooth diagnosed with apical periodontitis in clinical and radiographic examinations. Assessments comprised a self-report questionnaire on pain characteristics, a comprehensive clinical examination and a radiographic examination including panoramic and intraoral radiographs and CBCT images. The main outcome measure was periapical bone destruction. RESULTS: Sixty per cent of patients with AO had no periapical bone destructions detectable with any radiographic method. Overall, CBCT rendered 17% more periapical bone destructions than conventional radiography. Average pain intensity in patients with AO was 5.6 (± 1.8) on a 0-10 numerical rating scale, and average pain duration was 4.3 (± 5.2) years. CONCLUSION: Cone-beam computed tomography improves identification of patients without periapical bone destruction, which may facilitate differentiation between AO and SAP.
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| 4. |
- Havsed, Kristian, et al.
(författare)
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Multivariable prediction models of caries increment : a systematic review and critical appraisal.
- 2023
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Ingår i: Systematic Reviews. - : BioMed Central (BMC). - 2046-4053. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Multivariable prediction models are used in oral health care to identify individuals with an increased likelihood of caries increment. The outcomes of the models should help to manage individualized interventions and to determine the periodicity of service. The objective was to review and critically appraise studies of multivariable prediction models of caries increment.METHODS: Longitudinal studies that developed or validated prediction models of caries and expressed caries increment as a function of at least three predictors were included. PubMed, Cochrane Library, and Web of Science supplemented with reference lists of included studies were searched. Two reviewers independently extracted data using CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) and assessed risk of bias and concern regarding applicability using PROBAST (Prediction model Risk Of Bias ASessment Tool). Predictors were analysed and model performance was recalculated as estimated positive (LR +) and negative likelihood ratios (LR -) based on sensitivity and specificity presented in the studies included.RESULTS: Among the 765 reports identified, 21 studies providing 66 prediction models fulfilled the inclusion criteria. Over 150 candidate predictors were considered, and 31 predictors remained in studies of final developmental models: caries experience, mutans streptococci in saliva, fluoride supplements, and visible dental plaque being the most common predictors. Predictive performances varied, providing LR + and LR - ranges of 0.78-10.3 and 0.0-1.1, respectively. Only four models of coronal caries and one root caries model scored LR + values of at least 5. All studies were assessed as having high risk of bias, generally due to insufficient number of outcomes in relation to candidate predictors and considerable uncertainty regarding predictor thresholds and measurements. Concern regarding applicability was low overall.CONCLUSIONS: The review calls attention to several methodological deficiencies and the significant heterogeneity observed across the studies ruled out meta-analyses. Flawed or distorted study estimates lead to uncertainty about the prediction, which limits the models' usefulness in clinical decision-making. The modest performance of most models implies that alternative predictors should be considered, such as bacteria with acid tolerant properties.TRIAL REGISTRATION: PROSPERO CRD#152,467 April 28, 2020.
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| 5. |
- Pigg, Maria, et al.
(författare)
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A comparative analysis of magnetic resonance imaging and radiographic examinations of patients with atypical odontalgia
- 2014
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Ingår i: Journal of oral & facial pain and headache. - : Quintessence. - 2333-0384 .- 2333-0376. ; 28:3, s. 233-242
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To examine (1) the occurrence of magnetic resonance imaging (MRI) signal changes in the painful regions of patients with atypical odontalgia (AO) and (2) the correlation of such findings to periapical bone defects detected with a comprehensive radiographic examination including cone beam computed tomography (CBCT). METHODS: A total of 20 patients (mean age 52 years, range 34 to 65) diagnosed with AO participated. Mean pain intensity (± standard deviation) was 5.6 ± 1.8 on a 0-10 numerical rating scale, and mean pain duration was 4.3 ± 5.2 years. The inclusion criterion was chronic pain (> 6 months) located in a region with no clear pathologic cause identified clinically or in periapical radiographs. In addition to a clinical examination and a self-report questionnaire, the assessments included radiographic examinations (panoramic, periapical, and CBCT images), and an MRI examination. Changes in MRI signal in the painful region were recorded. Spearman's rank correlation between radiographic and MRI findings was calculated. RESULTS: Eight of the patients (40%) had MRI signal changes in the pain region. The correlation to radiographic periapical radiolucencies was 0.526 (P = .003). Of the eight teeth displaying changes in MRI signal, six showed periapical radiolucency in the radiographs. CONCLUSION: MRI examination revealed no changes in the painful region in a majority of patients with AO, suggesting that inflammation was not present. MRI findings were significantly correlated to radiographic findings
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