Detection of bone defects using CBCT exam in an Italian population

Background. The aim of this study was to evaluate the in vivo incidence and the location of fenestrations in a young Italian population by using CBCT. Materials and Methods. Fifty patients who had previously performed CBCT for planning third molar extraction or orthodontic therapy were selected for the study. No previous dental treatment had been performed on these patients. Overall, 1,395 teeth were evaluated. Root fenestrations were identified according to the definition of Davies and the American Association of Endodontists. Data was collected and statistically analyzed. Results. Fenestrations were observed in 159 teeth out of 1,395 (11% of teeth). In the lower jaw, we found 68 fenestrations (5%) and 91 in the maxilla (6,5%). Incisors were the teeth with the highest incidence of fenestrations. Conclusion.The relative common finding (11%)of fenestration supports the need for CBCT exams before any surgical/implant treatment to avoid complications related to the initial presence of fenestrations. CBCT was found to be an effective and convenient tool for diagnosing fenestration

Usefulness of Cone Beam Computed Tomography for the Diagnosis and Treatment of Oral and Maxillofacial Pathology

Three-dimensional (3D) evaluation of oral and maxillofacial pathology, in comparison with two-dimensional (2D) radiological studies, offers many advantages that can assist in the diagnostic and in the preoperative evaluation of certain lesions and conditions of the jaws, reducing the risk of intraoperative and postoperative complications. The introduction of cone beam computed tomography (CBCT) represents an important technological advance in the context of oral and maxillofacial radiology as it permits the acquisition of high-quality 3D images and dynamic navigation over an area of interest in real time, with a short scan time and lower dose of radiation than conventional computed tomography (CT). The initial indications for CBCT have been extended by the progressive addition of new ones such as evaluation of the extent of osteonecrotic lesions of the jaw due to bisphosphonates, preoperative staging of oral cancer, and planning reconstructive surgery. As a consequence, this radiological technique represents an interesting complement to conventional radiology in those clinical situations in which 3D imaging can facilitate diagnosis and/or treatment

Root Morphology and Canal Configuration of First and Second Maxillary Molars in a Selected Iranian Population: A Cone-Beam Computed Tomography Evaluation

Introduction: The aim of this investigation was to evaluate root canal morphology of maxillary first and second molars and also to assess the prevalence and morphology of the second mesiobuccal canal (MB2) in these teeth, using cone-beam computed tomography (CBCT). Methods and Materials: In this cross-sectional study, the total of 470 CBCT images from the archive of Radiology Department of Isfahan University of Medical Sciences (IUMS), Iran, was evaluated and 295 images were selected. The number of roots, and canal configuration were determined based on Vertucci’s classification system. The data was analyzed using SPSS 20, and P-values less than 0.05 were considered significant. Results: A total of 295 images from 295 patients (165 females and 130 males), including 389 maxillary first (197 right and 192 left) and 460 maxillary second (235 right and 225 left) molars were evaluated. The prevalence of MB2 canals were 70.2% and 43.4% in the maxillary first and second molars, respectively. The most common type of Vertucci’s classification was type II (53.1%), followed by type I. Conclusion: The second mesiobuccal canal was present in almost two thirds of first and less than half of second molars. The morphology and canal configuration of a maxillary molar can almost predict the morphology of contralateral molar. However, it does not relate to the ipsilateral molar.Keywords: Cone-Beam Computed Tomography; Maxillary Molar; Mesiobuccal Canal; Root Canal Configuratio

Tomographic late evaluation of xenogeneic bone grafts in sockets of impacted third molars

It is necessary to preserve height and thickness of the alveolar bone to facilitate rehabilitation with osteointegratable implants or simply to maintain bone integrity after extraction. Biomaterials associated with resorbable or non-resorbable membranes, when placed in the region of the socket, may contribute to avoid this unwanted reabsorption. Objective: The objective of this study was to evaluate the distance of the crest of alveolar ridge to the cementoenamel junction (CEJ) of the lower second molars and the bone density of the third molar socket filled with Gen-Tech®, 5 years after an exodontia using cone beam computed tomography (CBCT) to visualize the central region of the sockets, without overlapping of the buccal and lingual cortical bones. Material and Methods: A total of 12 individuals from an initial group of 39 patients submitted to extraction of the unruptured lower third molars and grafting of an association of inorganic bovine bone matrix, organic bovine bone matrix, collagen and bone morphogenetic proteins (BMP) (Gen-Tech®) on one side and the contralateral sockets filled only by clot, returned to control after 5 years, and were submitted to CBCT. The distance from the crest of alveolar bone to the CEJ and the bone density (BD) were measured using the i-CAT Vision Software. Results: The results showed that the distance from the crest of alveolar bone to the CEJ in the control group was similar to that observed before the exodontia; in the experimental group, this distance was smaller. Considering the BD measurement, a significantly higher density was observed in the experimental group (p<0.05). Conclusion: Part of the biomaterial was not absorbed and allowed the stability of the evaluated parameters after 5 years, being able to be used as a bone substitute in the socket

Association Between Maxillary Sinus Pathologies And Healthy Teeth

The proximity of the roots to the maxillary sinus can create a variety of risks. Objective: To evaluate the relationship between the roots of healthy teeth and the maxillary sinus, as well as the occurrence of sinus pathologies. Methods: Three radiologists analyzed 109 cone beam computed tomography (CBCT) images. The Kappa test was used to assess the intra- and inter-rater agreement. The chi-squared test and prevalence ratio were used to test the hypothesis that roots of healthy teeth in the maxillary sinus favored the occurrence of sinus pathologies (p = 0.01). Results: Intra- and inter-rater agreement ranged from good to excellent. The chi-squared test demonstrated a statistically significant difference (p= 0.006) between the tooth roots in diseased maxillary sinuses (6.09%) and those in normal sinuses (3.43%). The prevalence ratio test showed a statistically significant higher prevalence of tooth roots in diseased sinuses than in normal sinuses (p < 0.0001). Roots in the maxillary sinus were 1.82 times more associated with diseased sinuses. Conclusion: Dental roots in the maxillary sinus are almost twice as likely to be associated with diseased sinuses than normal sinuses. Healthy teeth whose roots are inside the maxillary sinus may induce an inflammatory response in the sinus membrane. It is suspected that dental procedures may exacerbate the condition. (C) 2015 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda. All rights reserved.821333

Evaluation of mandibular third molars through cone beam computed tomography : influence of acquisition parameters

Orientador: Deborah Queiroz de Freitas FrançaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A tomografia computadorizada de feixe cônico (TCFC) pode ser indicada quando há suspeita de proximidade entre o terceiro molar inferior e o canal da mandíbula e quando maiores informações acerca das estruturas da região são necessárias. A qualidade da imagem tomográfica pode ser influenciada por fatores de aquisição, como o tamanho do FOV (field of view) e do voxel e o número de imagens base. O objetivo nesse estudo foi avaliar a influência dos parâmetros de aquisição na obtenção de exames de TCFC na avaliação do terceiro molar inferior e sua relação com o canal da mandíbula. Foram utilizadas 8 mandíbulas humanas secas com 13 terceiros molares inferiores. Esses foram submetidos ao exame de TCFC no aparelho Picasso Trio®. Os parâmetros energéticos foram fixados em 80 kVp e 3,5 mA e os tamanhos do FOV (12 x 8,5 cm e 5 x 5 cm) e do voxel (0,2 e 0,3 mm) e o número de imagens base (375 e 600) variados. Dois examinadores juntos, por meio do programa CS 3D Imaging®, avaliaram as imagens em relação à posição do dente, número e curvatura das raízes, posição dessas em relação ao canal da mandíbula e presença ou não de contato direto entre o dente e o canal. Quando não havia contato entre as raízes e o canal da mandíbula, foi obtida a distância entre eles. Após 30 dias, 30% da amostra foi reavaliada. Também foi realizada a dosimetria dos exames adquiridos com os protocolos estudados. Para isso, foi utilizado um phantom antropomórfico com 7 dosímetros termoluminescentes (LiF 100) posicionados na região de cristalinos, glândulas parótidas, submadibulares e tireóide. Os dados foram analisados utilizando os testes de McNemar e t de Student para comparar as respostas obtidas nas avaliações e ANOVA para comparar as doses de radiação obtidas com os diferentes protocolos. O teste Kappa ponderado e o Índice de Correlação Intraclasse (ICC) foram realizados para verificar a concordância intraexaminador. As análises adotaram um nível de significância de 5%. Os diferentes protocolos utilizados não influenciaram nas avaliações realizadas, exceto o voxel para a presença ou não de contato entre o dente e o canal da mandíbula (p=0,021). Na ausência do contato direto, a média da distância entre o dente e o canal foi de 1,94mm. A concordância intraexaminador foi de substancial a excelente (0,65 a 1,00) e o ICC indicou replicabilidade excelente para a distância entre o dente e o canal (0,87) e para as doses de radiação (0,92). A dose de radiação foi maior para os FOVs maiores e para o maior número de imagens base. Foi possível concluir que a análise do terceiro molar inferior e sua relação com o canal da mandíbula não é influenciada pelos fatores FOV e número de imagens base. Desta forma, protocolos de baixa dose devem ser utilizados (FOV e número de imagens base menores). O uso de voxel menor favoreceu a avaliação do contato entre o dente e o canal da mandíbula, devendo ser preferidoAbstract: Cone Beam Computed Tomography (CBCT) may be indicated when there is a suspect of proximity between the mandibular third molar and the mandibular canal and when more information about the structures of the region is needed. The quality of the tomographic image can be influenced by acquisition factors such as the FOV (field of view) and voxel sizes and the number of base images. The aim of this study was to evaluate the influence of the acquisition parameters used in CBCT exams for assessment of mandibular third molar and its relationship with the mandibular canal. Eight dried human mandibles with 13 mandibular third molars were used. These were submitted to CBCT exams in Picasso Trio®. The energy parameters were fixed in 80 kVp and 3.5 mA and the FOV size (12 x 8.5 cm and 5 x 5 cm), the voxel (0.2 and 0.3 mm) and the number of basis images (375 and 600) were varied. Two examiners, together, evaluated the images using CS 3D Imaging® program. They evaluated the images according to the tooth position, number and curvature of roots, the position of the roots in relation to the mandibular canal and the presence or not of direct contact between the tooth and the mandibular canal. When there was no contact between the tooth and the mandibular canal, the distance between them was obtained. After 30 days, 30% of the sample was reassessed by the examiners. Also, the dosimetry of the studied protocols was performed. For this, was used an anthropomorphic phantom with 7 thermoluminescent dosimeters (LiF 100) positioned in the crystalline region, parotid glands, submandibular gands and thyroid. The data were analyzed using McNemar and Student¿s t tests to compare the answers obtained in evaluations and multifactor variance analysis (ANOVA) to compare the absorbed doses obtained in each protocol. For intra-examiner agreement analysis, weighted Kappa test and the Intraclass Correlation Coefficient (ICC) was performed. A significance level of 5% was considered for all statistical tests. The different protocols used did not influence in the assessments, except voxel for the presence or not of the contact between the tooth and the mandibular canal (p = 0.021). When the direct contact was absence, the average of the distance between the tooth and the canal was of 1.94mm. The intra-examiner agreement was substantial to excellent (0.65 to 1.00) and ICC showed an excellent replicability for the distance between the mandibular canal and the roots (0.87) and for the radiation doses (0.92). The radiation dose was higher for larger FOVs and for the greater number of base images. It was concluded that the analysis of the third molar and its relationship with the mandibular canal is not influenced by the acquisition factors, FOV and the number of base images. Thus, low dose protocols should be used (lower FOV and number of base images). The use of lower voxel favored the assessment of contact between the tooth and the mandibular canal and it should be preferredMestradoRadiologia OdontologicaMestra em Radiologia Odontológic

A proposed method for evaluation of morphological changes in the condyle and glenoid fossa by cone beam computed tomography

The difficulty with three-dimensional analyses remains with the myriad of data that is possible to derive from a volume. The goal of this study is to report 3D changes in the temporomandibular joint in a reliable and quantifiable way. The approach included plotting specific referents on the mandibular condyle and tracking them in magnitude (mm) and direction (°) on a reference plane after superimposing the cone beams three-dimensionally on the inferior alveolar nerve canal and the lower contour of the third molar tooth germ. Two sets of measurements were compared for reliability and each measurement showed varied correlation. Linear measurements tended to be more reliable than component and angular measurements. Angular measurements were generally the least reliable. The varied reliability results are likely due to the difficulty in superimposing limited field of view (FOV) cone beam radiographs because of inadequate structures that are able to be superimposed

Inferior alveolar nerve trajectory, mental foramen location and incidence of mental nerve anterior loop

Background: Injury of the inferior alveolar nerve (IAN) is a serious intraoperative complication that may occur during routine surgical procedures, such as dental implant placement or extraction of impacted teeth. Thus, the purpose of this study was to analyze the trajectory of the mandibular canal (MC), the location of the mental foramen (MF) and the presence and extension of an anterior loop of the mental nerve (AL). Study Design: In this cross-sectional study, a total of 348 CBCTs were analyzed. Distances from MC to the surface of the basal, medial and lateral cortical of the mandible were measured at the level of the second molar, first molar and second premolar. Location of the MF relative to the apices of the premolars, as well as incidence and anterior extent of the AL were also determined. Results: Significant and clinically relevant correlations were found between the position of the MC in women, which was located more caudal (r=-0.219, p=0.007; r=-0.276, p<0.001; right and left, respectively) and lateral (r=-0.274, p=0.001; r=-0.285, p<0.001; right and left, respectively), particularly at the level of the premolars. Additionally, the presence (r=-0.181, p=0.001; r=-0.163, p=0.002; right and left, respectively) and anterior extension (r=-0.180, p=0.009; r=-0.285, p=0.05; right and left, respectively) of the AL was found to be inversely correlated with the age of the patient. Conclusions: This analysis of a Caucasian population has found that the older the patient, the lower the incidence of the loop and the shorter its anterior extension. Key words:Cone-beam computed tomography, mandibular nerve, mental foramen

Contribution of dental private practitioners to publications on anatomical variations using cone beam computed tomography

Objective: To investigate the participation of citizens-dental private practitioner in scientific articles about anatomical variations on dentomaxillofacial CBCT. Our null hypothesis was that private practice practitioners are not involved in publications on anatomical variations using cone beam computed tomography. Material and methods: This study was performed from home without access to our university library. Only PubMed database was used to perform our study. We found 384 articles published among 1830 articles corresponding to our&nbsp;inclusion/exclusion criteria. For each selected article we searched for affiliation of all of the authors (university, private dental practice, students, other). We applied a co-creation approach to involve colleagues from private practice in analyzing results of this study. Results: A large majority of authors have university affiliation (96.5%). Only 3% of authors come from private practice. Most of articles belong to the group of 7 emergent economies (E7), and from Asia. 47.9% of 96 journals published only one article on anatomical variations discovered on CBCT. The higher number of articles (18.75%) were published by journals related to endodontics. The 84% of articles were dispersed among a vast span of general and specific dental, and maxillofacial journals. The 68.4% of articles on variations in CBCT were available in closed&nbsp;access and 31.6% of articles were available in open access. Only 6.7% of articles were published in open access without author publication charges (APC). The 31.6% of authors with university affiliation choose open access for their article. 7.8% of authors from private practice were involved in publishing in closed access journals and 2.34% in open access journals. Only 3 articles (0.78%) were published by authors affiliated to private practice without involvement of university authors. 2.6% of articles involved students as co-authors. Authors with other affiliation were involved only in one closed access publication. For the step of co-creation none of 183 private practitioners, and 3/33 (9%) university-affiliated members of Nemesis Facebook group actively participated in analyzing the results of this study. Conclusions: the null hypothesis was accepted: dentists from private practice are exceptionally involved in publications on anatomical variations using CBCT in dentomaxillofacial area.Objective: To investigate the participation of citizens-dental private practitioner in scientific articles about anatomical variations on dentomaxillofacial CBCT. Our null hypothesis was that private practice practitioners are not involved in publications on anatomical variations using cone beam computed tomography. Material and methods: This study was performed from home without access to our university library. Only PubMed database was used to perform our study. We found 384 articles published among 1830 articles corresponding to our&nbsp;inclusion/exclusion criteria. For each selected article we searched for affiliation of all of the authors (university, private dental practice, students, other). We applied a co-creation approach to involve colleagues from private practice in analyzing results of this study. Results: A large majority of authors have university affiliation (96.5%). Only 3% of authors come from private practice. Most of articles belong to the group of 7 emergent economies (E7), and from Asia. 47.9% of 96 journals published only one article on anatomical variations discovered on CBCT. The higher number of articles (18.75%) were published by journals related to endodontics. The 84% of articles were dispersed among a vast span of general and specific dental, and maxillofacial journals. The 68.4% of articles on variations in CBCT were available in closed&nbsp;access and 31.6% of articles were available in open access. Only 6.7% of articles were published in open access without author publication charges (APC). The 31.6% of authors with university affiliation choose open access for their article. 7.8% of authors from private practice were involved in publishing in closed access journals and 2.34% in open access journals. Only 3 articles (0.78%) were published by authors affiliated to private practice without involvement of university authors. 2.6% of articles involved students as co-authors. Authors with other affiliation were involved only in one closed access publication. For the step of co-creation none of 183 private practitioners, and 3/33 (9%) university-affiliated members of Nemesis Facebook group actively participated in analyzing the results of this study. Conclusions: the null hypothesis was accepted: dentists from private practice are exceptionally involved in publications on anatomical variations using CBCT in dentomaxillofacial area