Correlation of the Initial Bone Height to the Middle Facial Height and the Maxillary Sinus Volume: A Retrospective Study

This study aims to measure and establish a correlation between the initial bone height (IBH) at the dentate posterior maxillary sextants to the middle facial height (MFH) and the maxillary sinus volume (SV). Thirty CBCTs split evenly between males and females were retrospectively selected and processed to measure the SV and the IBH from the first premolar to the second molar. A clinical measurement was performed on each patient to evaluate the MFH. A significant positive correlation was found between MFH and SV. No significant correlation was found between the IBH of the first premolar and the SV or MFH on both sides. The results showed a significant negative correlation between the IBH of the other teeth examined and the SV on both sides. A significant negative correlation was found between the MFH and the IBH of the second premolar, first molar, and second molar of each side. It can be concluded that the maxillary SV increases with the MFH, and the IBH decreases when the SV and the MFH increase except for the first premolar. The clinical relevance of this study lies in the capability of the general practitioner to estimate the IBH in the posterior dentate maxilla by measuring the MFH. Patients with a risk of having a low IBH can be advised, in the case of an extracted tooth, to consider ridge preservation techniques or implant therapy as soon as possible to avoid future complex surgical interventions

A Novel 3D Evaluation of the Correlation Between the Condylar Position and Angle Classification in a Lebanese Population: A Pilot Study

Résumé Introduction : L’articulation temporo-mandibulaire (ATM) est l’une des articulations les plus complexes. Sa morphologie varie selon les individus, et même entre les côtés gauche et droit. Plusieurs études ont démontré une relation significative entre certaines caractéristiques occlusales et la morphologie articulaire. La tomodensitométrie à faisceau conique (CBCT) est actuellement la modalité la plus largement adoptée pour l’examen de l’ATM. Objectif : Cette étude vise à comparer, dans une cohorte Libanaise, l’espace interarticulaire avec les différentes classes d’Angle en utilisant le CBCT. Méthodologie : Une analyse rétrospective a été menée sur des images CBCT réalisées à l’Université Saint Joseph de Beyrouth sur une période de 1 an, entre 2021 et 2022. Quatre valeurs de clairance ont été sélectionnées, représentant la distance minimale entre l’os temporal et le condyle mandibulaire qui définit l’espace interarticulaire : 0,5 mm, 1 mm, 1,5 mm et 2 mm. Pour chaque valeur choisie, nous avons recherché la présence ou non d’une surface visible. Cette surface correspond à la zone du condyle ayant une distance du condyle à l’os temporal inférieure ou égale à la valeur choisie. Résultats : Vingt-neuf patients âgés de 12 à 60 ans ont été inclus ; 12 (41 %) étaient des hommes et 17 (59 %) des femmes. Les 48 images CBCT (23 du côté droit et 25 du côté gauche) ont été réparties en trois groupes selon la classification d’Angle : classe I (n = 14), classe II (n = 29) et classe III (n = 5). Pour une distance de [0 mm ;0,5 mm ;1mm et 1,5mm] correspondent des surfaces de valeurs nulles. Pour un intervalle compris entre [1,5 – 2mm] correspond une surface de 18,8 mm2 pour les sujets de classe I, 16,6 mm2 pour les sujets de classe II, et 30,5 mm2 pour les sujets de classe III. Les résultats n’ont pas montré de corrélation statistiquement significative entre l’espace interarticulaire et les différentes classes d’Angle. Conclusion : L’évaluation tridimensionnelle de la position condylienne par CBCT a montré qu’il n’existe pas de corrélation entre les espaces interarticulaires et les différentes classes d’Angle. Mots clés : position condylienne ; classification d’Angle ; occlusion ; CBCT ; tomodensitométrie. Abstract Introduction: The temporomandibular joint (TMJ) is one of the most complex joints. Its morphology varies between individuals, and even between the left and right sides. Several studies have found a significant relation between certain occlusal features and joint morphology. Cone-beam computed tomography (CBCT) imaging is currently the most widely adopted modality for the examination of the TMJ. Objective: This study aimed to compare the joint space in a Lebanese cohort with different Angle classification using CBCT. Methodology: We retrospectively analyzed CBCT images performed at the Saint Joseph University of Beirut in Lebanon, over a period of 1 year, between 2021 and 2022. Four clearance values were selected, representing the minimum distance between the temporal bone and the mandibular condyle that defines the joint space: 0.5 mm, 1 mm, 1.5 mm, and 2 mm. For each value chosen, we looked for the presence or not of a visible surface. This surface corresponds to the area of the condyle with a distance from the condyle to the temporal bone less than or equal to the chosen value. Results: Twenty-nine patients aged between 12 and 60 years old were included; 12 (41%) were males and 17 (59%) females. We classified 48 CBCT images (23 on the right side and 25 on the left side) into three groups according to Angle’s classification: class I (n=14), class II (n=29), and class III (n=5). For a distance of [0-1.5 mm] corresponded a surface of 0 mm2. For the interval between [1.5-2 mm] corresponded a surface of 18,8 mm2 for class I subjects, 16,6 mm2 for class II, and 30,5 mm2 for class III. The results showed no statistically significant differences between the articular spaces and the different types of occlusion. Conclusion: The three-dimensional evaluation of the condylar position by CBCT showed that there are no significant differences between the joint spaces and the different types of occlusion according to Angle’s classification. Keywords: condylar position; Angle classification; occlusion; CBCT

Comparing clinical and radiographic periodontal parameters to software generated CBCT measurements

The aim of this study was to compare direct surgical measurements to data extracted from periapical radiographs and CBCT by means of software (coPeriodontix™ and Blue Sky Plan®) in order to assess the accuracy delivered by these 2 software. Ten patients were included in the study, and the number of teeth selected for measurements ranged from one to 10 per patient. All CBCT scans and X-rays were acquired within a maximum period of 1 month prior to surgery. Clinical linear measurements were performed at 6 sites for each tooth. Furcation defects were recorded according to the Hamp classification.Differences between data acquired from these 3 modalities were analyzed. Linear measurements showed statistically significant difference, where CBCT showed the least bone loss, periapical radiographs showed more bone loss, while direct surgical measurements showed the most bone loss. The Blue Sky Plan® that measured the furcation involvement accurately depicted the true furcation defect

Root and Root Canal Morphology of Premolars in a Sample of the Lebanese Population: Clinical Considerations

ABSTRACT Objectives: The aim of this study was to investigate the anatomy of the maxillary and mandibular premolars among a sample of the Lebanese population and to explore their incidence by sex and the symmetry between the left and right sides. Materials and Methods: This retrospective analysis of 250 cone-beam computed tomography (CBCT) scans consisted of 960 maxillary and 972 mandibular premolars. Roots, canals, and morphology types were recorded. Vertucci’s classification was used to categorize the canal morphologies. Fisher’s exact and chi-square tests (P≤.05) were applied. Results: The majority of maxillary first premolars had two roots (85.3%) with two canals (91.3%). Most of the maxillary second premolars showed one root (79.8%). Two-root canals (53.55%) were more common than one canal (44.2%). The three-root, three-canal morphology was rarely spotted in the maxillary first (0.4%) and second premolars (2.3%). The one-root (99.2%) and one-canal (84.5%) morphologies were most frequently located in the mandibular first and second premolars (100%, 88.6%), and two canals being less common (15.5%, 11.4%) correct same as before. The total prevalence of premolars with a complex root canal morphology was 62.4%, found in types II, III, and V to VIII. Men had significantly more roots and root canals in their maxillary first premolars than women (P≤.05). No significant differences were observed between the contralateral premolars (P\u3e.05). Conclusions: Premolars displayed wide variations in root and root canal morphology and symmetry between the contralateral premolars. Keywords: cone-beam computed tomography (CBCT), mandibular premolars, maxillary premolars, root canal anatomy, root canal configuration, sex distribution, symmetry. Objectif Cette étude vise à examiner le nombre de racines, les canaux radiculaires et la morphologie des canaux des prémolaires maxillaires et mandibulaires, au sein d’une population libanaise. Matériels et méthodes 250 images CBCT de 960 prémolaires maxillaires et 972 prémolaires mandibulaires ont été analysées rétrospectivement. Les tests de Fisher Exact et du Chi-Carré (P \u3c 0,05) ont été appliqués pour évaluer le nombre de racines et de canaux radiculaires, la fréquence et la symétrie entre les côtés gauche et droit, ainsi que l’incidence au sein du sexe. La classification de Vertucci a été utilisée pour classer les morphologies des canaux. Résultats Les premières prémolaires maxillaires étaient principalement caractérisées par deux racines (1 racine : 14,4%, 2 racines: 85,3% et 3 racines: 0,4%), avec deux canaux (91,3%). Une racine a été observée dans de nombreuses deuxièmes prémolaires maxillaires (79,8 %). Cependant, deux canaux radiculaires (53,55 %) étaient plus fréquents qu’un canal (44,2 %). Trois racines et trois canaux ont rarement été repérés dans les premières (0,4 %, 0,4 %) et les deuxièmes prémolaires maxillaires (2,3 %, 2,3 %). Une racine avec un canal était localisée respectivement le plus fréquemment dans la première (99,2 %, 84,5 %) et la deuxième prémolaire mandibulaire (100 %, 88,6 %), bien que deux canaux soient moins fréquents (15,5 %, 11,4 %). Des prémolaires avec une anatomie complexe du canal radiculaire ont été trouvées avec une prévalence de 16,2% allant du type II, III et de V à VIII. Les résultats ont également montré des différences entre les sexes : les hommes avaient remarquablement plus de racines et de canaux radiculaires dans leurs premières prémolaires maxillaires que les femmes (P \u3c 0,05). Aucune différence statistique n’a été observée entre les paires prémolaires controlatérales (P ³ .5). Conclusion Au sein de cette sous-population libanaise, les prémolaires maxillaires et mandibulaires présentaient de grandes variations dans la morphologie des racines et des canaux radiculaires, et une symétrie entre les paires controlatérales. Ces résultats susciteraient un intérêt clinique pour les praticiens et les chercheurs. Mots-clés : CBCT, prémolaires mandibulaires, prémolaires maxillaires, anatomie canalaire, configuration canalaire, symétrie, sexe

Computer-assisted analysis of bone volume for sinus augmentation procedure

The objectives of this study were to determine the volume of bone required prior to a sinus graft using two different methods, to compare it to the actual volume used during surgery and to evaluate a segmentation technique in quantifying the volume of a xenograft on the post-operative cone beam computed tomography (CBCT) slices. CBCT data from 11 CBCT scans for 11 patients (6 males, 5 females) requiring 13 lateral augmentation procedures were imported to Simplant Pro 15® (Materialise, Leuven, Belgium) in DICOM format. Residual ridge height (RRH) was measured for each implant site as well as mucosal thickness (MT). MT was classified by grades (1 to 4). Simulation of implant placement for each site was realized and the graft volume was pre-operatively calculated by a semi-automatic segmentation (SAS) technique and another automatic Simplant sinus graft (SSG) technique. All patients underwent a lateral sinus augmentation surgery 3 to 12 weeks after the initial CBCT scan. The volume of the bovine bone grafting material (BBM) particles was quantified during the surgery (Vr) for all patients and on immediate post-operative CBCT scans (CBCT-V) for 7 patients. With a mean augmentation of 9.45 ± 1.72 mm, the calculated volumes were 2.243 ± 0.962 mm3 and 2032 ± 0.843 mm3 for the SAS and SSG methods, respectively. Percent variation between Vr and SAS volume was significant (22.4%) and non-significant (4.5%) between Vr and SSG volume. In cases with MT grade 1 & 2, no difference was found between Vr and SAS volume. No difference was found between Vr (1.918 ± 1.118 mm3) and CBCT-V (1.979 ± 1.108). In conclusion, the results showed that the use of the Simplant® software was effective in determining the required graft volume for the surgery, the volume measurements with the SSG were more accurate than the SAS and the quantification of BBM particles on CBCT data sets was reliable and accurate with the segmentation technique used

Cyst volume changes measured with a 3D reconstruction after decompression of a mandibular dentigerous cyst with an impacted third molar

The aim of this article is to describe a large mandibular cyst treated with decompression followed by surgical enucleation. Furthermore, we described the utility of cyst volume measurements by using a 3D reconstruction on Cone Beam Computed Tomography (CBCT). The dentigerous cyst is the most common cyst type of epithelial origin, arising from remnants of odontogenic epithelium, asymptomatic and associated with the crown of an unerupted or partially or completely impacted tooth. However, after a long duration and extension of the cyst volume it may provoke significant bone resorption, cortical expansion, tooth displacement and the vitality of neighboring teeth may be affected. The regular treatment of this lesion is enucleation and extraction of the involved tooth. Marsupialization and decompression are proposed when the volume of the cyst is well developed to release the cystic pressure and allow the bone cavity to progressively decrease in volume with the gradual apposition of bone. This report presents a large dentigerous cyst related to impacted mandibular third molar of a 21-year-old male patient. The cyst was treated successfully by decompression and later by surgical enucleation with surgical extraction of the related molar. In conclusion, the combination of decompression and surgical approach showed on the three-dimensional CBCT investigation a significant correlation between the treatment and volume reduction of the cyst. The clinical case described allows us to observe bone formation after decompression and surgical enucleation was performed with less risk on vital anatomic elements

Evaluation of Two Shaping Systems and Two Ultrasonic Irrigation Devices in Removing Root Canal Filling Material from Mesial Roots of Mandibular Molars: A Micro CT Study

We assessed the efficiency of two shaping file systems and two passive ultrasonic irrigation (PUI) devices for removing filling material during retreatment. The mesial canals from 44 extracted mandibular molars were prepared and obturated. The teeth were randomly divided into two groups, and then one group was retreated with Reciproc R25 (VDW, Munich, Germany) (n = 44) and the other group was retreated with 2Shape (TS, Micro Mega, Besançon, France) (n = 44). A micro-computed tomography (CT) scan was taken before and after the retreatment to assess the volume of the filling material remnants. The teeth were then randomly divided into four groups to test two different PUI devices: Irrisafe (Satelec Acteon Group, Merignac, France) and Endo Ultra (Vista Dental Products, Racine, WI, USA). The teeth in Group A were retreated with 2Shape to test the Endo Ultra (n = 22) device, the teeth in Group B were retreated with 2Shape in order to test the Irrisafe (n = 22) device, the teeth in Group C were retreated with Reciproc to test the Endo Ultra (n = 22) device, and Group D was retreated with Reciproc to test the Irrisafe (n = 22) device. A third micro-CT scan was taken after the retreatment to test the PUIs. The percentage of Gutta-Percha (GP) and sealer removed was 94.75% for TS2 (p < 0.001) and 89.3% for R25 (p < 0.001). The PUI significantly enhanced the removal of the filling material by 0.76% for Group A (p < 0.001), 1.47% for Group B (p < 0.001), 2.61% for Group C (p < 0.001), and by 1.66% for Group D (p < 0.001). 2Shape was more effective at removing the GP and sealer during retreatment (p = 0.018). The supplementary approach with PUI significantly improved filling material removal, with no statistical difference between the four groups (p = 0.106)

Physicochemical and Antibacterial Properties of Conventional and Two Premixed Root Canal Filling Materials in Primary Teeth

International audienceIn this study, some physicochemical and antibacterial properties of three root canal filling materials for primary teeth, Calplus "CP" (Prevest DenPro, Lewes, DE, USA), Bio-C Pulpecto "Bio-CP" (Angelus, Basil, Londrina, Paraná, Brazil), and Zinc Oxide and Eugenol "ZOE" (Prevest DenPro, Lewes, DE, USA) were compared. For each material, the pH, solubility, contact angle, and crystalline microstructure under SEM were evaluated. Their antibacterial activity against Enterococcus faecalis was determined through direct tests. The Kruskal-Wallis test was used to analyze the results using a one-way analysis of variance on ranks. All the materials had an alkaline pH at 3, 24, and 72 h, with CalPlus having the highest (p < 0.05). Bio-CP was more soluble during the evaluation period (24 h) than ZOE and CalPlus (p < 0.05). Bio-CP and ZOE demonstrated the creation of crystallite structures on their surfaces after immersion in PBS at 37 • C, whereas CalPlus showed none. The lowest contact angle was observed for Bio-CP (53 ± 1.5 •); contact angles of (86 ± 4 •) and (96 ± 1 •), respectively, were observed after 10 s of the deposition of the water drop for CalPlus and ZOE. In conclusion, according to this study, there is still a need to develop new filling materials for primary teeth. ZOE, CalPlus and Bio-CP demonstrated different physicochemical and antibacterial properties, but none of the materials had optimal properties and could be considered the most suitable filling material for primary teeth pulpectomy. Bioceramics in their current state are not an alternative. The physicochemical and antibacterial properties still need improvement to fit the intricate anatomy of primary teeth

It Could Be Worse But It Should Be Better: COVID-19 and The Lebanese Radiology Departments Preparedness.

An unprecedented sanitary challenge is threatening human beings due to COVID-19 pandemic. There is no light at the end of the tunnel concerning treatment and worries from a possible second wave start to arise even before the end of the first one. We conducted a multicenter study to reassess the different aspects of radiology departments’ preparedness in Lebanon stating the points of strength and more importantly depicting the points of weakness. Lessons were then extracted to be more prepared for possible future similar circumstances

The Contribution of Various In Vitro Methodologies to Comprehending the Filling Ability of Root Canal Pastes in Primary Teeth

A void-free obturation during root canal treatment on primary teeth is currently very difficult to attain. In this study, the pulpectomy filling abilities of Bio-C Pulpecto (Angelus, Basil, Londrina, Paraná, Brazil) and of zinc oxide eugenol, or "ZOE" (DenPro, Prevest, New York, NY, USA), were compared using several in vitro techniques. Therefore, 30 primary anterior teeth were used in the present in vitro study. Analysis of variance (ANOVA), including a multiple comparison procedure (Holm-Sidak method, Dunn's Method, or Tukey test), was used. On micro-CT, Bio-C Pulpecto exhibited higher void percentages than did ZOE (10.3 ± 3.8%, and 3.5 ± 1.3%), respectively (p < 0.05). With digital microscopy, higher total void percentages were found in the BC (13.2 ± 26.7%) group compared to the ZOE (2.7 ± 2.8%) group (p < 0.05). With the CLSM, mean tubular penetration depths were higher for Bio-C Pulpecto than for ZOE in all canal thirds (p < 0.05). SEM images demonstrated no tags into dentinal tubules in either group throughout the three thirds. Moreover, higher statistically significant flowability was found for Bio-C (2.657 ± 0.06 mm) compared to ZOE (1.8 ± 0.13 mm) (p < 0.05). The findings of this study indicate that neither ZOE nor Bio-C Pulpecto appears to meet the criteria for an ideal root canal filling paste for primary teeth. This study laid the groundwork for future research by determining how micro-CT, digital microscopy, SEM, and CLSM contribute to our understanding of the filling process of primary teeth. More thorough research on the mechanism of root canal obturation on primary teeth is required to achieve a long-term successful root canal therapy in young children