STEP BY STEP DESCRIPTION OF THE TOOTH IN PERIODONTITIS BASED ON RADIOGRAPHIC DIAGNOSTIC DATA

ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 1107 STEP BY STEP DESCRIPTION OF THE TOOTH IN PERIODONTITIS BASED ON RADIOGRAPHIC DIAGNOSTIC DATA Khabilov Nigman Lukmanovich Tashkent State Medical University https://orcid.org/0000-0002-1404-507X e-mail: [email protected] Annotation X-rays are a common tool in dental practice and are widely used in the diagnosis of periodontitis. This is documented in treatment protocols. CT scans have been used for this purpose sporadically to date. It has been noted that the use of a step-by-step protocol for describing pathology based on radiological diagnostic data ensures adequate treatment tactics in the future. However, a step-bystep diagnostic protocol for describing a tooth with periodontitis based on radiological diagnostic data is not provided. This determines the relevance of this work. Keywords: radiological diagnosis, periodontitis, apical constriction, tooth root assessment. Research objective. To present a working version of the proposed and tested protocol for step-bystep description of teeth in periodontitis based on radiographic data and to explain why it is necessary. Materials and methods. The methodology for conducting a step-by-step description of the tooth based on radiological diagnostic data in periodontitis, proposed and tested at the departments of orthopedic dentistry, as well as radiological diagnostics and radiation therapy at the M. Gorky Donetsk National Medical University. Results. The tested protocol for step-by-step description of periodontitis based on radiological diagnosis data provides the following algorithm: assessment of the tooth and mouth cavity; identification of anomalies in the pulp cavity; determination of the number of roots; characterization of the number of root canals as well as other manifestations of pathology in them; apical characterization of the canal: curvature of the tooth roots and canals and their shape: morphological form of apical periodontitis; canal filling; detection of perforations: assessment of the success of the treatment. Conclusions. The presented protocol for a step-by-step description of dental examination for periodontitis based on radiographic data is an effective method for multifactorial assessment of dental status. Radiographic methods of dental examination are a justified step in providing dental care to patients. They play a special role in endodontic practice. X-rays are a routine part of dental practice in cases of periodontitis. This is recorded in treatment protocols. It is the most widely used method of additional examination, while CT scans are used sporadically at the examination stage. The analysis of studies to obtain data for assessing dental status in this pathology is carried out directly by dentists. At the same time, in practical healthcare, for some reason, the protocol for providing medical care does not require a description and its registration in the medical history (card). ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 1108 Standard radiographic methods for examining periodontitis have been used for quite some time and have proven their usefulness in examination, but a number of authors believe that they only provide approximate information about the pathological process (dental status). Computed tomography (CT) allows for the diagnosis during the patient's lifetime and invasive assessment of the destructive process in the periodontium and the structural features of the “tooth-periodontium” complex. To diagnose pathological changes, a clear understanding and knowledge of radiographic anatomy is necessary, and according to CBCT data, it has its own characteristics. We have not identified an algorithm for the diagnostic analysis of a number of dental diseases based on the results of radiographic diagnostics for these methods. Therefore, a step-by-step diagnostic protocol for describing a tooth with periodontitis based on radiographic and CT examination data has not been developed either, which determines the relevance of this work. Research objective. To present a working version of the proposed and tested protocol for a step-bystep description of a tooth with periodontitis based on radiographic diagnostic data and to explain why it is necessary. Materials and methods. The research materials are interdepartmental research on the topic: “Longterm results of endodontic treatment of chronic periodontitis, causes of adverse outcomes, and ways to solve them.” The protocol description methodology was proposed and tested at the Department of Prosthetic Dentistry of the M. Gorky Donetsk National Medical University. It should be noted that the literature describes multiple atypical and diverse terms that are used to describe the same morphological variants of tooth structure. Alternatively, the same names are used to designate two different anatomical variations. Terms that have become popular over time due to their simplicity are often erroneous and inaccurate. Such terms cannot anatomically determine the location of the canals and have no analogues in scientific terminology. No consensus has been reached to date. A complete list of anatomical structures, taking into account the above, which should be taken into account when conducting an analysis, is included in the proposed protocol according to the available information in the protocols for the provision of dental care in the treatment of periodontitis [9] and ICD-10 (ICD-C). 1. Assessment of the connection between the tooth cavity and the mouth 1.1 Presence of a connection (no, yes) 1.2 Localization of the connection (distal, medial, central, oral, buccal, combined). Why it is important: determines the tactics for opening the pulp chamber and the extent of odontopreparation. In addition, the absence of communication with the pulp chamber allows for certain rational endodontic treatment techniques. 2. Identification of anomalies in the pulp cavity (crown part). 2.1 Denticles. Why it is important: their location can complicate surgical access for endodontic treatment, which determines the tactics of tooth preparation. 3. Determining the number of roots. 3.1 Teeth with possible (encountered) variability in their number. ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 1109 3.1.1. First premolar in the upper jaw. More often than not, there is only one, but it may have two canals with a different number of constrictions in the apex. 3.1.2 Molars of the upper jaw - occur with two (connected buccal) and one root. In the latter case, the molar has only one canal. Anthropologists attribute such teeth to the Mongoloid race. 3.1.3. Third molars (wisdom teeth) - various options are possible. 3.2 Presence of an extra root. 3.2.1 More common in molars, especially in the upper jaw. Why it is important: the number of roots mainly determines the number of main canals. 4. Characteristics of the number of root canals in a tooth or a specific root. 4.1. Number of canals. 4.1.1. Corresponds to anatomical indicators: one root, one canal. 4.1.2. Well-known variants of two canals in one root - for example, the medial root of the first and second molars of the lower jaw and the first premolar of the upper jaw with one root. 4.1.3 Atypical number. It should be noted that the presence of lateral canals may be associated with periapical pathology. Recent (latest) studies show that additional canals are common but play a minor role in perirradicular pathology. Why it is important: the number of root canals determines the number of endodontic treatments performed, i.e., the scope of endodontics. An undetected (unidentified) and, as a result, untreated canal will lead to undesirable consequences that will negate the quality of treatment of others. For high-quality endodontic treatment of a tooth, it is essential to detect all canals. This is ensured by CT examination. 4.2 Internal resorption. The pathology is considered from the perspective of ICD-C. It is diagnosed on the basis of X-ray examination. Why it is important: specific tactics are required, not only for endodontic treatment. The treatment plan is largely determined by the class – ICD-C. 5. Assessment of the tooth root. 5.1 External resorption is considered in terms of ICD-C. 1 It is more common in cases of pulp necrosis and apical bone resorption, which can lead to loss of taper in the structure. Unfortunately, it is only detected in 20% of cases during radiological diagnosis. Why it is important: it is considered the main factor determining the advisability of endodontic treatment. 6. Apical characteristics of the canal. 6.1 Location. Traditionally, the apical endpoint of the canal is set at a distance of 1 mm from the apical radiograph. However, another researcher found that in 92% of the teeth examined, the apical constriction was 0.5-1 mm from the apex. The results of this study showed deviations of the openings from the apex in 76% of roots under microscopy and 57% under radiography; the average distance was 1 mm. A subsequent study found that none of the openings coincided with the long axis of the root, and the distance varied from 0.2 to 3.8 mm. Why it is important – determines the endodontic treatment plan and the prognosis for its effectiveness. ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 1110 7. CURVATURE OF THE TOOTH ROOTS AND CANALS AND THEIR SHAPE. 7.1 Type: S-shaped root canal (root) S-shaped root canal (root) Abnormal canal (root) structure Why it is important (indicated in cases requiring the use of special endodontic instruments). 7.2 Shape of the roots of the lateral teeth (molars): - funnel-shaped; - cylindrical; - conical; - barrel-shaped. Why it is necessary: this shape determines the choice of endodontic instruments for high-quality treatment, especially in the area of barrel-shaped roots, although it has certain features for other shapes as well. 8. Morphological shape of the apical periodontium. 8.1 Fibrous. 8.2 Granulating. 8.3 Granulomatous. 8.4 Ankylosis. 8.5 Hypercementosis. Why it is important: details the diagnosis form. This determines certain features of the treatment plan. 9. CANAL FILLING. Characteristics of endodontic treatment—the quality of filling (sealing) is considered. 9.1 - necrotic decay, putrid masses; 9.2 - the level and quality of root canal obturation, especially in its apical part, determines the prognosis of treatment, root filling materials: (filling performed). • Meets requirements; • Incomplete filling; • Overfilling; • Insufficient density of the filling material; • Voids in the canal; • Presence of posts and fragments of endodontic instruments. 9.3 - stage of endodontic treatment. • Previously started treatment; • Periapical periodontitis at the stage of treatment; • Previously treated. Insufficient filling material in the apical third of the canal (underfilling). This is a common mistake that too often goes unnoticed. Overfilling or removal of filling material beyond the apical openings. However, removal of filling material beyond the apical opening does not guarantee three-dimensional filling of the canal. Filling material may extend beyond the root canal without providing a sealed isolation of the apical opening. ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 1111 Insufficient density of the filling material in the apical part of the canal is indicated by low radiographic density of the filling material in the apical part of the canal on the X-ray. Blurred canal contours, pores, and voids in the filling material are observed, as well as poor adhesion to the canal walls. The problem becomes more apparent when using root sealants with minimal radiopacity. 10. Perforation: we consider it necessary to highlight and detail in a separate class the characteristics (according to assessment) of endodontic root perforations, due to the prevalence of this type of pathology in healthcare. 10.1 Presence of perforation. 10.2 By location: • ostial - in the area of the root canal opening; • mid-root - in the middle third of the root; • apical - in the apical third of the root; • apical - at the tip of the root. This significantly determines the tactics for choosing a root sealant and, to a large extent, the assessment of the status. 11. Problems with assessing recovery, success, and failure. According to the guidelines of the European Society of Endodontology (ESE), regular monitoring is necessary for 4 years. The first check-up is after one year. ESE criteria based on the results of radiographic examination. 11.1. Complete recovery. Ro: definition of a continuous periodontal gap of normal width (i.e., Ro signs of bone regeneration). 11.2. 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