Periapical abscess of the maxillary teeth and its fistulizations: Multi-detector CT study

Abstract

Aim: The aim of this study was to assess the role of MDCT and the dedicated dental software in assessment of the periapical abscesses of the maxillary teeth and in detection of abnormal fistula as well as post intervention complications.
Materials and methods: This study was conducted on 20 patients with periapical abscess of the maxillary teeth. MDCT machines were used in examination of all patients. Workstation was used for manipulation of data. Dedicated dental software was used in the evaluation of all diseased teeth.
Results: Fourteen patients had their abscesses involving the maxillary molar and premolar teeth, six of them showed associated oro-antral fistula (42.8%). Four patients had their abscesses surrounding the apices of the incisors, two of them showed associated oro-nasal fistula (50%). None of the patients with periapical abscesses surrounding the roots of the canine teeth (n=2) showed abnormal fistulization. Nine cases (45%) showed missing crowns and retained roots due to previous trials of extractions. Two cases (10%) of fracture of the maxillary alveolar process complicating trials of previous extraction were also encountered.
Conclusion: The MDCT with its outstanding image quality of the bony structures supported by its 3-D and VR capabilities can detect the periapical dental abscess in a 3-D fashion, accurately define its location, size and extent and is excellent in evaluation of possible fistula. As compared to panorama X-ray, MDCT was more accurate in diagnosis of abnormal fistula and associated fracture of the alveolar process of the maxillary bone.

KEYWORDS Periapical abscess; MDCT; Oro-antral fistula; Oro-nasal fistula