Introduction: Periapical lesions of teeth are typically evaluated using periapical X-rays (PA) or cone-beam computer tomography (CBCT); however, ultrasound imaging (US) can also be used to detect bone defects. A comparative analysis is necessary to establish the diagnostic accuracy of US for the detection of periapical lesions in comparison with PA and CBCT. Objectives: This study aimed to evaluate and compare the measurement precision of US against PA and CBCT in detecting periapical lesions. Methods: This study included 43 maxillary and mandibular teeth with periapical lesions. All teeth were examined clinically, radiographically, and ultrasonographically. Observers evaluated and measured the periapical lesions on CBCT, PA, and US images. Results: The comparison of lesion size showed that it differs significantly between the different methods of examination. A statistically significant difference was found between CBCT and US (mean difference = 0.99 mm, 95% CI [0.43–1.55]), as well as between CBCT and PA (mean difference = 0.61 mm, 95% CI [0.17–1.05]). No difference was found between the US and PA methods (p = 0.193). Conclusion: US cannot replace PA radiography in detecting pathologies but it can accurately measure and characterize periapical lesions with minimal radiation exposure. CBCT is the most precise and radiation-intensive method so it should only be used for complex cases.

Background: Apical surgery can address periapical pathologies when conventional endodontic treatments fail. Advanced platelet-rich fibrin (A-PRF) has emerged as a regenerative material with the potential to enhance healing in periapical surgery. In this study, we evaluated the effect of A-PRF on periapical lesion healing using cone beam computed tomography (CBCT). Methods: A randomized controlled trial at Rīga Stradiņš University Institute of Stomatology included 43 participants (15 males, 28 females; mean age: 44 years) with periradicular lesions. Participants were divided into experimental and control groups. Baseline and follow-up CBCT imaging assessed lesion volumes at 6 and 12 months post-surgery. Results: Mean lesion volumes significantly decreased from 431.4 mm³ at baseline to 102.8 mm³ at 6 months and 49.2 mm³ at 12 months (p < 0.001). A-PRF did not significantly reduce the lesion sizes compared to the controls (p = 0.043), but was associated with reduced inflammation and enhanced soft tissue healing. Key confounders included gender and baseline lesion volume, with males exhibiting smaller lesion sizes postoperatively. Conclusions: The results suggest that A-PRF may not offer a significant advantage in terms of reducing defect size or improving radiographic resolution.

Background: Oral dirofilariasis is a rare parasitic infection that can mimic common dental pathologies. This report presents a unique case where dirofilariasis was mistaken for an acute apical abscess, highlighting diagnostic challenges and the importance of interdisciplinary collaboration. Case presentation: A 47-year-old male presented with a persistent, painless swelling in the maxillary anterior region (tooth 11). Initial history and radiographic examinations suggested an acute apical abscess following inadequate root canal treatment. However, during surgical exploration, a live nematode was discovered in the periapical lesion. The parasite was extracted, and histopathological analysis confirmed Dirofilaria spp. The patient underwent endodontic retreatment and achieved full recovery. Conclusions: This case underscores the need for clinicians to consider parasitic infections in atypical presentations of periapical pathology. Advanced imaging, thorough surgical assessment, and histopathological confirmation are essential in distinguishing rare infections from common dental diseases.