RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE. KARNATAKA.

ANNEXURE-II

PROFORMA FOR THE REGISTRATION OF SUBJECTS FOR DISSERTATION.

1. / NAME OF THE CANDIDATE AND ADDRESS ( IN BLOCK LETTERS) / DR. ROSAMMA GEORGE,
DEPT. OF CONSERVATIVE DENTISTRY AND ENDODONTICS,
SRI HASANAMBA DENTAL COLLEGE AND HOSPITAL.
2. / NAME OF THE INSTITUTION / SRI HASANAMBA DENTAL COLLEGE AND HOSPITAL,
VIDYANAGAR,
HASSAN-573201,
KARNATAKA.
3. / COURSE OF STUDY AND SUBJECT / MASTER OF DENTAL SURGERY IN CONSERVATIVE DENTISTRY AND ENDODONTICS.
4. / DATE OF ADMISSION TO COURSE / 31st MAY 2012.
5. / TITLE OF THE TOPIC / AN IN-VIVO COMPARATIVE EVALUATION OF CONVENTIONAL RADIOGRAPHY, RADIOVISIOGRAPHY, ULTRASONOGRAPHY AND HISTOPATHOLOGY IN DETERMINING THE PERIAPICAL LESIONS OF ENDODONTIC ORIGIN.
6 / BRIEF RESUME OF THE INTENDED WORK
6.1 Need for the study
Periapical lesions of endodontic origin are greatly due to bacterial infection of the pulpal tissue. Periapical lesions have received wide spread attention over a period of time both as primary lesion and persistent endodontic lesion.
Radiograph plays a vital role in diagnosis, treatment, prognosis and follow up of endodontic treatment.1 Recent advancement in radiography such as radiovisiography has gained popularity because of significant reduction in radiation exposure and allows image enhancement.2,3
Echography is a real time ultra sound imaging technique that is of great use in numerous diagnostic fields of medicine. Using colour power Doppler ultrasound it is possible to evaluate and determine the presence and direction of blood flow within the echographic image of the lesion. It gives accurate idea about the nature, content and size of the lesion.4,5 Histopathologic analysis helps to attain a confirmatory diagnosis of the particular lesion.6,7
Thus the purpose of this study is to evaluate the efficacy of conventional radiography, radiovisiograhy, ultrasonogrphy and histopathology in determining the periapical lesion of endodontic origin.
6.2 Review of Literature
A study Conducted by using roentgenographic and direct observation of experimental lesions made in mandibles from human cadavers. It was evident from these experiments that the lesions in cortical bone can be detected roentgenographically only if there is perforation in the bone cortex. But lesions in the cancellous bone cannot be detected roentgenographically. Extensive diseases of the bone may be present even when there is no evidence of it on roentgenograms.1
An in-vivo study was conducted by comparing clinical roentgenographic and histopathologic evaluation of periapical lesions showed that the roentgenography is important in determining the presence of an area of rarefaction, structure involved and the extent of the destructive process, but an accurate diagnosis of periapical pathosis can only be determined by microscopic evaluation.6
An in-vivo study on 11 patients diagnosed with periapical lesions were examined using ultra sound imaging and color power Doppler concluded that real- time ultra sound imaging can be used for the study of endodontic lesions. It is also possible to determine the histological nature of lesion. Color power Doppler provided the evidence of its vascularization.4
A study of periapical lesions correlating the presence of a radio opaque lamina with histological findings showed that the differential diagnosis of periapical lesions cannot be made based on the radiological appearance, but requires histological examination of serial sections.7
An in-vivo comparative study using radiovisiography and ultrasound real time imaging in the differential diagnosis of periapical lesions of endodontic origin showed that there was definite correlation between the echo structure and nature of lesion. Thus both of the techniques can be used in the endodontic field for the study of periapical lesions.2
An in-vivo study to evaluated the efficacy of ultrasonography with color Doppler and power Doppler application confirmed that ultrasonography with color Doppler and Power Doppler is superior to conventional radiopgraphy for diagnosing the nature of periapical lesions.5
6.3 AIM AND OBJECTIVE
Aim: An In-vivo comparative evaluation of conventional radiography, radiovisiography, ultrasonography and histopathology in determining the periapical lesions of endodontic origin.
Objectives:
1.  To evaluate the efficacy of conventional radiography.
2.  To evaluate the efficacy of radiovisiography.
3.  To evaluate the efficacy of ultrasonography.
4.  Comparative Evaluation of above methods with histopatholgy.
7 / MATERIALS AND METHODS
7.1 SOURCE OF DATA:
20 patients aged between 15 to 45 years having periapical lesions, reporting to Department of Conservative and Endodontics at Sri Hasanamba Dental College, Hassan will be selected for the treatment.
I Inclusion criteria
1.  Both male and female are included
2.  Age Group 15 to 45 years
3.  Patients diagnosed with periapical lesions of endodontic origin.
4.  Persistent periapical lesion after endodontic treatment
5.  Patients who are not willing for endodontic treatment and opted for extraction.
6.  Patients with periapical lesions undergoing conventional endodontic treatment with apical surgery
II Exclusion criteria
1.  Lesions which do not appear radiographically to represent periapical inflammatory disease.
2.  Patients with systemic conditions associated with bony pathology such as hyperparathyroidism, paget disease, multiple myeloma, diabetic mellitus, hypertension.
3.  Patients with bleeding disorder.
4.  Medically compromised patients.
7.2 METHODS
Patients with periapical lesion of endodontic origin were diagnosed based on clinical signs, symptoms and endodontic diagnostic procedures will be selected. Ethical clearance will be taken from the ethical committee and thorough charting of medical and dental history will be done. A written informed consent will be taken from each patient and are subjected to conventional radiographic analysis. Once the lesion is confirmed in radiograph, the dimensions of the lesion will be measured in a superior-inferior and mesio-distal direction in a millimeter scale using caliper and ruler.
Patients will then be subjected to radiovisiography and findings will be recorded in a superio-inferior and mesio-distal direction. Next area of diagnostic interest in the mouth is to be selected for the echography. The ultrasonic sensor covered with a layer of echographic gel is placed extra orally corresponding to the apical area of the tooth of interest. The sensor will be moved slightly in order to obtain adequate number of transverse and longitudinal scans to define the defect. All the lesions are measured in anterio-posterior, superio-inferior and mesio-distal dimensional planes and recorded. Color Doppler will be applied to detect the blood flow, size and content of the lesion. A tentative differential diagnosis between a cystic lesion and granuloma will be analyzed.
Surgical excision of periapical lesion will be done and specimens are subjected for histological examination and definitive diagnosis is made based on the following features.
The results are analysed by the following principles
Methods / Cyst / Granuloma
Conventional Radiography / A well circumscribed round or oval radiolucent lesion with sclerotic border measuring more than 1cm in diameter / A well circumscribed radiolucent lesion with or without sclerotic border measuring less than 1cm in diameter
Radiovisiography, / A well circumscribed round or oval radiolucent lesion with or without sclerotic border measuring more than 1 cm in diameter 5 / A well circumscribed radiolucent lesion with or without sclerotic border measuring less than 1cm in diameter,5
Ultrasonography / A hypoechoic, well defined, fluid filled lesion surrounded by reinforced bony walls and no internal color flow pattern on Doppler.5 / A hyperechoic/echogenic (frankly copersculated) an/or hypoechoic, poorly defined lesion showing rich internal color flow pattern on Doppler.5
Histopathology / Presence of a cystic cavity with stratified squamous epithelium with underlying connective tissue showing loosely arranged collagen fibers with mild to moderate inflammatory cell infiltrate and cholesterol crystals.8 / Connective tissue with wide spread areas of polymorphonuclear cells, lymphocytes, monocytes and newly formed blood vessels.8
STATISTICAL ANALYSIS
Data obtained will be analysed by variance (ANOVA) Test followed by Chi-square test.
7.3 Does the study require any investigations to be conducted on patients or other humans or animals? If so, please describe briefly.
Yes, specimens obtained from periapical lesion which are freshly collected in sterile air tight vials containing 10% formalin. These vials are then transported to the laboratory. The surgical specimens are processed for routine histological examination.
7.4 Has ethical clearance been obtained from your institution in case of 7.3.
Yes, ethical clearance certificate is enclosed.
8 / LIST OF REFERENCES:
1.  I. B. Bender, Samuel Seltezer.: Roentgenographic and Direct Observations of Experimental Lesions in Bone, Journal of American Dental Association 1961; 87: 708-16.
2.  Shipa H. Bandi and Subhash T. S.: Radiovisiograghy and Ultra sound real time imaging in differential diagnosis of periapical lesions of endodontic origin – A comparative in-vivo study, Endodontology 2010; 2: 29-34.
3.  John E. et al.: Radiovisiography in the Detection of Periapical lesions, Journal of Endodontics. 2000; 26: 32-35.
4.  E. Cotti, G. Campisi, R. Ambu and C. Dettori.: Ultrasound real time imaging in the differential diagnosis of periapical lesions, International Endodontic Journal 2003; 36: 556-563.
5.  Sumit Goel. et al.: Ultrasonography with color Doppler and Power Doppler in the diagnosis of periapical lesions, Indian Journal of Radiology and Imaging. 2011; 21: 279-283.
6.  William et al.: A clinical Roentgenographic and Histopathologic Evaluation of Periapical Lessions, Oral Surgery, Oral Medicine and Oral pathology.1964; 17: 467-472
7.  Domenico Ricucci, Francesco Mannocci and Thomas R Pitt Ford.: A Sudy of periapical lesions correlating the presence of a radiopaque lamina with histological findings, Oral Surgery, Oral Medicine, Oral pathology, Oral Radiology, Endodontics. 2006; 101: 389-94.
8.  M. Gundappa, SY Ng and EJ Whaites.: Comparison of ultra sound, digital and conventional radiography in differentiating periapical lesions, Dentomaxillofacial Radiology. 2006; 35: 326-333.
9 / SIGNATURE OF THE CANDIDATE / Dr. ROSAMMA GEORGE
10 / REMARKS OF THE GUIDE
11 / NAME & DESIGNATION OF
(IN BLOCK LETTERS)
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT
11.6 SIGNATURE /

Dr. SAHADEV C. K. M.D.S

PROFESSOR, DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS, SRI HASANAMBA DENTAL COLLEGE AND HOSPITAL, HASSAN – 573201.

Dr. M. J. BHARATH M.D.S

PROFESSOR AND HEAD, DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS, SRI HASANAMBA DENTAL COLLEGE AND HOSPITAL, HASSAN – 573201
12 /
REMARKS OF THE CHAIRMAN
& THE PRINCIPAL
12.1 SIGNATURE
/

Dr. S. RAVINDRA M.D.S.

PRINCIPAL,

SRI HASANAMBA DENTAL COLLEGE AND HOSPITAL, HASSAN – 573201.

ETHICAL APPROVAL CERTIFICATE

This is to Certify that Dr. ROSAMMA GEORGE Post Graduate Student, Department of Conservative Dentistry and Endodontics, her study titled “An In-Vivo comparative evaluation of radiography, radiovisiogrphy ultrasonography and histopathology in determining the periapical lesions of endodontic origin” has been certified in the Ethical Committee meeting held on 21 November 2012.

Convener.