Guided Endodontic Access in a Calcified Central Incisor: A Conservative Alternative for Endodontic Therapy

Guided endodontic access is a promising method to treat teeth with pulp calcification. This report aimed to describe a case of root canal treatment performed through guided endodontic access in a calcified anterior tooth with apical periodontitis. A 23-year-old female with a history of trauma 10 years ago in the anterior maxilla was referred to the dental office.  Her chief complaint was discolouration of the left central incisor crown. The tooth was sensitive to percussion and responded negatively to pulp sensitivity tests. The periapical radiography showed pulp calcification and periapical radiolucency. Cone-beam computed tomography (CBCT) was obtained to allow a more detailed view of the pulp canal and the periapical area. An intraoral scan was performed and the standard tessellation language (STL) archive was combined with digital imaging and communications on medicine (DICOM) images from CBCT in the Implant Viewer software. Subsequently, a 3D model was designed and printed to guide the endodontic access in position and appropriate angulation for dental instrumentation. The mold was positioned on the patient's tooth and the root canal treatment was performed. After two years, complete healing of periapical tissues was observed. This method facilitates the drill targeting during access, reducing the risk of deviations and perforations

Major salivary glands magnetic resonance imaging

Objetivos: Fornecer informações básicas sobre as modalidades de ressonância magnética (RM), enfatizando o método da imagem ponderada em difusão, bem como apontar sua aplicabilidade para diagnosticar doenças das glândulas salivares maiores. Métodos: O método Prisma foi usado durante a extração e avaliação dos dados. As buscas foram feitas no banco de dados MEDLINE (PubMed) considerando o período de 2010 a novembro de 2017 e estudos que contivessem informações básicas sobre as modalidades de RM, bem como seu uso para diagnosticar doenças das glândulas salivares. A extração de dados incluiu informações sobre a aplicação das modalidades de RM, especialmente dos métodos de coeficiente de difusão aparente e da imagem ponderada em difusão, para diagnosticar doenças das glândulas salivares maiores. Resultados: A busca encontrou 58 publicações no MEDLINE (PubMed). A triagem inicial das publicações foi realizada usando os resumos e palavras-chave. Após a aplicação dos critérios de exclusão, um total de 9 estudos foi identificado como elegível para ser avaliado. Os estudos apontaram dois tipos principais de modalidades de RM: o coeficiente de difusão aparente e a imagem ponderada em difusão. A maioria dos estudos sugere que a RM pode ser uma útil ferramenta de diagnóstico para as glândulas salivares maiores. Conclusão: Modalidades de RM são vantajosas ferramentas para avaliações dos tecidos das glândulas salivares. São necessários mais estudos envolvendo um maior número de pacientes estudados para demonstrar a eficácia dos métodos e modalidades de abordagem distinta.Objectives: To provide basic information on the magnetic resonance imaging modalities, emphasizing the diffusion-weighted imaging technique, as well as to clarify its applicability to diagnose major salivary gland disorders. Methods: The PRISMA statement was used during data assessment and extraction. The MEDLINE (PubMed) database was searched for the period from 2010 to November 2017, for studies providing basic information on the MRI modalities as well its applicability to diagnose salivary gland disorders. Data extraction included information regarding: application of MRI modalities especially ADC and DWI to diagnose major salivary gland disorders. Results: The search yielded 58 publications in MEDLINE (PubMed). The initial screening of the publications was performed using abstracts and keywords. After application of exclusion criteria, we identified a total of 9 studies as eligible to be discussed. Studies revealed two main types of MRI modalities: ADC and DWI. Most of the studies suggest that MRI can be useful as a diagnostic tool for major salivary glands. Conclusion: MRI modalities are advantageous tools for salivary gland tissue evaluations. To demonstrate the accuracy of the distinct approach methods and modalities, more studies involving a larger number of patients studied are necessary

Influence of Apical Patency on the Adaptation of the Master Filling Cone: A Cone-beam Computed Tomography Assessment

Introduction: This study aimed to evaluate if the apical patency can influence the adaptation of the master cone of gutta-percha, quantifying the volume of voids and areas at the last 2 mm of the working length (WL). Materials and Methods: Sixty distobuccal canals of extracted upper molars were divided into 3 groups (n=20) based on the patency length (A: passed 1 mm beyond the apical foramen (AF), B: at the AF and C: 1 mm short of the AF) with the Easy ProDesign Logic 25/0.01 file. Each group was subdivided into 2 subgroups (n=10) based on the WL established to prepare the root canal (1: 1 mm short of the AF or 2: at the AF) with the Easy ProDesign Logic 25/0.05 file. After the scan, void volumes were calculated from the last 2 mm of the WL and void areas at 0 mm, 1 mm and 2 mm of the last of WL, as well as the relation between the tip and taper of the master cone with the amount of void volume and areas. To investigate statistically significant differences, we used the Kruskal-Wallis statistical test. Results: There were more voids in volume when patency was achieved 1 mm beyond the AF and the root canal preparation was conducted at 1mm short of the AF (A1 group). Furthermore, the same group showed more voids areas, mainly on the last millimeter of WL. Conclusion: Achieving apical patency at 1 mm beyond the AF followed by instrumentation 1 mm short of the AF created more voids between the master gutta-percha cone and the root canal wall, especially on the last millimeter of WL

Effect of a metal artifact reduction algorithm on dehiscence and fenestration detection around zirconia implants with cone beam computed tomography

Objective. To assess the efficacy of the metal artifact reduction algorithm (MARA) of the Cranex 3D cone beam computed tomography (CBCT) device in the detection of peri-implant dehiscence and fenestration around zirconia implants. Study Design. In total, 60 implants were placed in bovine ribs. Dehiscence and fenestration defects were created around the implants, after which 60 CBCT images were obtained with and 60 without activation of MARA. Three radiologists examined the images for the presence of defects. The area under the curve (AUC) from receiver operating characteristic analysis, sensitivity, and specificity were calculated to assess the ability to discriminate the presence vs absence of bone defects. One-way analysis of variance was employed to analyze outcome measures. The significance level was established at 5% (a = 0.05). Results. AUC values indicated excellent discrimination of dehiscence on images with MARA activation and an excellent to outstanding range of discrimination with MARA deactivation. For fenestration, MARA activation and deactivation both led to outstanding discrimination. Sensitivity and specificity values revealed that activation of MARA was helpful in distinguishing the presence vs. absence of dehiscence, while both MARA conditions were helpful for fenestration. However, there were no statistically significant differences between MARA activation and deactivation for any outcome measure (P >.05). Conclusion. CBCT is suitable for detecting peri-implant defects, but MARA application does not significantly affect peri-implant dehiscence and fenestration detection. (Oral Surg Oral Med Oral Pathol Oral Radiol 2024;138:316-323

Hausdorff Distance evaluation of orthodontic accessories' streaking artifacts in 3D model superimposition

The aim of this study was to determine whether image artifacts caused by orthodontic metal accessories interfere with the accuracy of 3D CBCT model superimposition. A human dry skull was subjected three times to a CBCT scan: at first without orthodontic brackets (T1), then with stainless steel brackets bonded without (T2) and with orthodontic arch wires (T3) inserted into the brackets' slots. The registration of image surfaces and the superimposition of 3D models were performed. Within-subject surface distances between T1-T2, T1-T3 and T2-T3 were computed and calculated for comparison among the three data sets. The minimum and maximum Hausdorff Distance units (HDu) computed between the corresponding data points of the T1 and T2 CBCT 3D surface images were 0.000000 and 0.049280 HDu, respectively, and the mean distance was 0.002497 HDu. The minimum and maximum Hausdorff Distances between T1 and T3 were 0.000000 and 0.047440 HDu, respectively, with a mean distance of 0.002585 HDu. In the comparison between T2 and T3, the minimum, maximum and mean Hausdorff Distances were 0.000000, 0.025616 and 0.000347 HDu, respectively. In the current study, the image artifacts caused by metal orthodontic accessories did not compromise the accuracy of the 3D model superimposition. Color-coded maps of overlaid structures complemented the computed Hausdorff Distances and demonstrated a precise fusion between the data sets

Evaluation of mandibular condyles in children with unilateral posterior crossbite

The relationship of mandibular condyle dimensions and its association with unilateral posterior crossbite (UPXB) has been suggested in the literature. The purpose of this prospective study was to evaluate mandibular condyles on the left and right sides and between crossed and non-crossed sides in the sagittal and coronal planes, using cone-beam computed tomography (CBCT). Twenty CBCT images of 40 temporo mandibular joints (TMJs) in individuals in mixed dentition phase, which included 9 males (mean 7.9 years) and 11 females (mean 8.2 years), with unilateral posterior crossbite without premature contacts and functional mandibular shifts and with transverse maxillary deficiency. The criteria for sample exclusion included the presence of painful symptoms, facial trauma history, systemic diseases such as juvenile rheumatoid arthritis, mouth opening limitation (< 40 mm), congenital or genetic anomalies, and skeletal asymmetries that may result in TMJ disorders. Dimensional measurements of the condyles between the right and left sides and crossed and non-crossed sides in sagittal and coronal view were made. There was no significant difference between the measurements of the crossed and non-crossed sides in both sagittal and coronal view. These findings suggest that the presence of unilateral posterior crossbite in children with UPXB did not result in changes between the mandibular condyles in the right and left sides or between the crossed and non-crossed sides in the coronal or sagittal plane

Correlations between tomographic findings related to degenerative changes, condylar excursions and position, and pain symptomatology in temporomandibular disorders

Aim: This study analyzed possible correlations between tomographic findings related to degenerative changes and condylar excursions and position with pain symptomatology in temporomandibular disorders (TMD). Materials and Methods: Sixty patients (40 women and 20 men; mean age: 37.9 years) with a diagnosis of TMD, according to the Diagnostic Criteria for Temporomandibular Disorders, were evaluated. The data of their tomographic examinations were retrieved in relation to their degenerative changes, estimations of condylar excursion, and condylar position. Associations between the variables were analyzed using the chi-square test (P ≤ 0.050). Results: There was a predominance of myopain (M) (35% left side), which was followed by arthralgia plus disc displacement (ADD) (23% left side) and latter myopain plus arthralgia and disc displacement (MADD) (18% left side). Regarding the degenerative changes, there was the predominance of flattening (100%), which was followed by sclerosis (85%). The estimation of condylar excursion was more frequent in the hyperexcursion form, followed by the normoexcursion form, and the hypoexcursion form, all on both sides. The position of the condyle was predominantly posterior and less frequently anterior, and there were few cases in the equidistant position. Considering the sides independently, hyperexcursion and MADD were correlated to the left side. For the total sample, condylar hyperexcursion and ADD, and also sclerosis and MADD, were correlated. There was no correlation between condylar position and symptomatology. Conclusion: There was a correlation between hyperexcursion and symptomatology, especially articular, few correlations between degenerative changes and symptomatology, and no correlation between condylar position and symptomatology

Análise anátomo-radiográfica da persistência do Forame de Huschke Anatomic and radiograph study of the persistence of Foramen of Huschke

OBJETIVO: o objetivo neste trabalho é avaliar e localizar o Forame de Huschke. FORMA DE ESTUDO: anatômico. MATERIAL E MÉTODO: utilizando materiais de contraste como a Guta percha e o sulfato de bário, através de técnicas radiográficas extrabucais, como a panorâmica, submentovértex e a tomografia linear lateral corrigida para a Articulação Têmporo-mandibular, em quatro crânios, onde foi verificada clinicamente a presença do Forame de Huschke. RESULTADO: Os resultados obtidos mostraram que o Forame de Huschke pôde ser observado em crânios secos após a sua evidenciação por meio de material de contraste nestas técnicas radiográficas.<br>AIM: the aim of this study is to assess and locate the Foramen of Huschke. STUDY DESIGN: anatomical. MATERIAL AND METHOD: using contrast material like gutta-percha and barium sulfate, through extraoral radiographs, such as panoramic, submental vertex and corrected saggital linear Temporal Mandibular Joint tomograms in four skulls where we clinically checked the existence of foramen of Huschke. RESULTS: The results proved that the foramen of Huschke can be observed in skulls submitted to contrast using radiographic techniques

How Should the Articular Disk Position Be Analyzed?

Purpose: To compare 2 methods used to determine the disk position based on sagittal magnetic resonance images. Patients and Methods: A cross-sectional study of patients with the signs and symptoms of temporomandibular disorders was conducted. The patients' ages and gender distributions were collected. The disk position diagnosis from the clinical examination was considered the primary outcome. Three observers evaluated the presence of anterior displacement on magnetic resonance images according to 2 criteria: method 1 (12-o'clock position) and method 2 (location of the intermediate zone). To assess the intraobserver variability of the 2 methods, the examiners evaluated the same magnetic resonance images at the beginning of the study (time 1) and 40 days later (time 2). The intraobserver agreement was assessed using the observed agreement and the kappa statistic. McNemar's test was used to assess the differences between each method and the clinical examination findings (P &lt; .05). The accuracy, sensitivity, specificity, and positive and negative predictive values were calculated by comparing the diagnosis from each method with that from the clinical examination (considered the reference standard). Results: The final sample was composed of 20 subjects with a mean age of 33.0 +/- 33.7 years; 3 were men (15%) and 17 were women (85%). A statistically significant difference between the 2 methods was found. Method 1 yielded a greater percentage of anterior displaced disks (52.5%). The agreement between the clinical diagnosis and method 1 was lower (70.0%) than that between the clinical diagnosis and method 2 (87.5%). No statistically significant difference was found between the clinical diagnosis and method 2. Conclusion: The disk position should be judged according to the intermediate zone criterion. (C) 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70:1534-1539, 201