The Correlation Between Morphologic Characteristics of Condyle and Glenoid Fossa with Different Sagittal Patterns of Jaw Assessed by Cone-Beam Computed Tomography

Objective:This study aimed to determine the relationship between the morphologic characteristics of condyle and glenoid fossa in different sagittal skeletal patterns using cone-beam computed tomography.Methods:In this cross-sectional study, the lateral cephalometric and cone-beam computed tomography images of 90 patients were evaluated. The patients were categorized into three equal groups of sagittal skeletal patterns, according to the ANB angle. The greatest anteroposterior and mediolateral diameters of the mandibular condyles, as well as the angle between the long axis of the mandibular condyles and the midsagittal plane, were measured on the axial view of cone-beam computed tomography images. The anterior joint space, superior joint space, posterior joint space, articular eminence inclination, depth of the glenoid fossa, and width of the glenoid fossa were also measured on the central sagittal slices. One-way analysis of variance (ANOVA), Tukey’s post hoc test and chi-square test were performed.Results:Patients with the skeletal Class III had a significantly higher articular eminence inclination, while Class II patients had a lower articular eminence inclination (P = .001). In Class III patients, the depth of the glenoid fossa was greater, and the width of the glenoid fossa was smaller than in the other groups (P < .01). The anterior and posterior joint space did not show any significant differences between the 3 groups.Conclusion:There were significant differences in some morphological characteristics of the condyle and glenoid fossa in patients with different sagittal skeletal patterns; therefore, this relationship should be considered in the treatment of these patients

The Accuracy of Four Impression-making Techniques in Angulated Implants Based on Vertical Gap

Statement of the Problem: Precision of the impression taken from implant positions significantly determines accurate fit of implant-supported prostheses. An imprecise impression may produce prosthesis misfit. Purpose: This study aimed to evaluate the accuracy of four impression-making techniques for angulated implants by stereomicroscope through measuring the vertical marginal gaps between the cemented metal framework and the implant analog. Materials and Method: A definitive cast with two 15° mesially angulated implants served as the standard reference for making all the impressions and later for accuracy evaluation. Four groups of five samples were evaluated: (1) closed-tray snap-fit transfer, (2) open-tray nonsplinted impression coping, (3) metal splinted impression coping, and (4) fabricated acrylic resin transfer cap. A gold-palladium framework was fabricated over the angulated implant abutments, the fit of which was used as reference. The gaps between the metal framework and the implant analogs were measured in sample groups. Corresponding means for each technique and the definitive cast were compared by using ANOVA and post hoc tests. Results: The mean marginal gap was 38.16±0µm in definitive cast, 89±19.74µm in group 1, 78.66±20.63µm in group 2, 54.16±24.29µm in group 3, and 55.83±18.30µm in group 4. ANOVA revealed significant differences between the definitive cast and groups 1 and 2, but not with groups 3 and 4 (p< 0.05). Conclusion: Vertical gap measurements showed that metal splinted impression coping and fabricated acrylic resin transfer cap techniques produced quite more accurate impressions than closed-tray snap-fit transfer and open-tray nonsplinted impression coping techniques do. The fabricated acrylic resin transfer cap technique seems to be a reliable impression-making method

Precisión de las radiografías digitales bitewing con y sin aplicación de desplazamiento horizontal del tubo en el diagnóstico del exceso de cemento residual alrededor de los implantes dentales: Un estudio in vitro.

Purpose: This study was designed to evaluate the diagnostic value of digital Bitewing (BW) radiographs with and without horizontal tube shift in detecting Residual excess cement (REC) on the proximal and non-proximal surfaces of implant restorations. Material and Methods: Eight mandibular models were fabricated with two implants placed on each side in the premolar and first molar positions. Excess cement was applied to either proximal or non-proximal surfaces of the restorations intentionally during the process of crown cementation. BW radiographs with and without applying horizontal tube shift were acquired. Three maxillofacial radiologists were asked to determine the presence and location of REC in the radiographs. Sensitivity and specificity of the radiographic technique were assessed according to the restoration surface that contained REC. Results: Sensitivity of BW radiographs was 100% for the detection of REC on the proximal surfaces and 41-18, 80% on the non-proximal surfaces. Specificity of the technique was 85.71%-100% for the proximal surfaces and 75-94. 12% for the non-proximal areas. Specificity of the radiographic method was generally greater than its sensitivity for the non-proximal surfaces while in the proximal areas, the two variables had quite similar values. Conclusion: Digital BW radiography is generally more useful for detection of REC on the proximal surfaces. Higher specificity of this technique for the bucco-lingual surfaces suggests more reliability of the negative diagnoses in the non-proximal areas.Objetivo: Evaluar el valor diagnóstico de las radiografías digitales bitewing (BW), con y sin desplazamiento horizontal del tubo, para detectar el exceso de cemento residual (ECR) en las superficies proximales y no proximales de las restauraciones con implantes. Material y Métodos: Se fabricaron ocho modelos mandibulares con dos implantes colocados a cada lado en las posiciones premolar y primer molar. El exceso de cemento se aplicó intencionalmente en las superficies proximales o no proximales de las restauraciones durante el proceso de cementación de la corona. Se adquirieron radiografías BW con y sin aplicación de desplazamiento horizontal del tubo. Se pidió a tres radiólogos maxilofaciales que determinaran la presencia y ubicación de ECR en las radiografías. La sensibilidad y la especificidad de la técnica radiográfica se evaluaron según la superficie de restauración que contenía ECR. Resultados: La sensibilidad de las radiografías de BW fue del 100% para la detección de ECR en las superficies proximales y del 41,18-80% en las superficies no proximales. La especificidad de la técnica fue 85-71, 100% para las superficies proximales y 75-94, 12% para las áreas no proximales. La especificidad del método radiográfico fue generalmente mayor que su sensibilidad para las superficies no proximales, mientras que en las áreas proximales, las dos variables tuvieron valores bastante similares. Conclusión: La radiografía digital BW es generalmente más útil para la detección de ECR en las superficies proximales. La mayor especificidad de esta técnica para las superficies buco-linguales sugiere una mayor confiabilidad de los diagnósticos negativos en las áreas no proximales

The Efficacy of Metal Artifact Reduction Mode in Cone-Beam Computed Tomography Images on Diagnostic Accuracy of Root Fractures in Teeth with Intracanal Posts

Introduction: The purpose of this study was to evaluate the efficacy of cone-beam computed tomography CBCT in the diagnosis of RF in the presence of an intracanal posts with and without applying “metal artifact reduction” (MAR) mode. Methods and Materials: This in vitro study included 60 single-canal endodontically treated premolars. Post spaces were created in all roots. RFs were simulated in 30 of the 60 teeth. Dentatus posts were cemented in 15 of 30 roots with and without RFs. Teeth were arranged randomly in 6 artificial dental arches. Images were taken using a Vatech CBCT machine with and without MAR (MAR and WMAR, respectively). A radiologist and an endodontist evaluated the CBCT images for the presence of RFs. Sensitivity, Specificity, positive and negative predictive values were determined for each mode. MC Nemar’s and Kappa tests were used for data analysis. Results: The percentage of correct diagnosis using the WMAR mode in both the post space and pin groups in the presence of root fracture was 46.6%; with MAR, it increased to 86.6% and 66.6%, respectively. There was no significant difference between two modes in post space (P=0.503) and metal pin groups (0.549). The overall sensitivity of VRF diagnosis in WMAR mode was 46.67%; in MAR mode, sensitivity was 76.67%. The specificity of WMAR and MAR modes were 60% and 53.33%. The levels of agreement between two modes and real findings were less than 0.45. Conclusions: There were no significant differences between the efficacies of imaging modes. The sensitivity of the MAR mode for diagnosis of VRF in both the pin and post space groups was higher than the WMAR mode. The specificity of MAR in comparison with WMAR was less or equal in dental groups. The agreement between CBCT and real findings was poor.Keywords: Artifact; Cone-Beam Computed Tomography; Diagnosis; Tooth Fracture; Vertical Root Fractur

Cone-Beam Computed Tomographic Assessment of Bone Thickness in the Mandibular Anterior Region for Application of Orthodontic Mini-Screws

Objective: To determine the proper zones for placement of orthodontic mini-screws, based on cone-beam computed tomography (CBCT) measurements in the anterior mandibular region.Methods: The current cross-sectional study was performed on CBCT images of 77 individuals in the age range of 18-60 years. Axial slices at the levels of 2, 5, and 8 mm from the cementoenamel junction (CEJ) of the mandibular anterior teeth were selected. Interdental distances were measured in the mesiodistal direction, parallel to the midline of the mandibular arch. Areas with more suitable width were investigated for measuring the minimum interdental space. On the reconstructed cross-sectional images, labiolingual thickness of the bone was measured at the levels of 2, 5, 8, and 11 mm from the CEJ. The Kruskal–Wallis test, Mann–Whitney test with Bonferroni correction, Welch test, and Tukey’s multiple analogy test were used to analyze the data.Results: Mesiodistal and labiolingual distances between the roots in every measured region had the highest values at the levels of 8 and 11 mm from the CEJ. The highest measured values were related to the interdental region between the lateral incisor and canine teeth on both sides of the arch. There were no statistically significant differences between these values (P < .001).Conclusion: The lateral incisor–canine areas at the level of 8 mm from the CEJ are introduced as the optimal sites for placement of orthodontic mini-screws. In addition, the results recommend the application of mini-screws with 1.3-1.7 mm diameter and 5-7 mm length

Eosinophilic Granuloma of the Skull Base: Patient with Unique Clinical Moreover, Radiographic Presentation

This case report presents an eight-year-old girl having periauricular swelling and severe pain during mouth opening on the right-side temporomandibular joint (TMJ). CBCT showed extensive destruction of the base of the skull and the roof of the glenoid fossa on the right side. The findings based on CT and MRI images with and without contrast are discussed herein. This report highlights a skull base eosinophilic granuloma that mimics TMJ disorder and the importance of proper evaluation of CBCT images to make an early diagnosis

Prevalence and patterns of palatine and adenoid tonsilloliths in cone-beam computed tomography images of an Iranian population

Background: Tonsilloliths are calcified concretions that develop in tonsillar crypts. They are usually small and asymptomatic, so they are found accidentally during routine dental radiogrphy procedure. Large tonsilloliths can occur with clinical signs and symptoms. The purpose of this study was to evaluate the prevalence and patterns of palatine and adenoid tonsilloliths in cone-beam computed tomography (CBCT) images. Materials and Methods: In this cross-sectional study, 0.5-mm axial and coronal slices of 134 CBCT images were evaluated to determine the presence of palatine and adenoid calcifications. Their patterns such as being unilateral or bilateral as well as single or multiple and their largest linear sizes were reported. Results: Fifty-four (40.3%) patients with palatine tonsilloliths and 17 (12.7%) with adenoid calcifications were found. Thirty (55.6%) palatine tonsilloliths were unilateral, 19 (35.2%) were detected in the left tonsils. Approximately, 54 cases of 78 palatine calcifications were multiple. Seventeen patients had adenoid calcifications that 41.1% of them were unilateral. Fourteen adenoid calcifications were single. The mean ages of patients with palatine tonsilloliths and adenoid calcifications were 45.59 years and 46.53 years, respectively. The range of linear measurements of palatine tonsil calcifications was 0.9–4.2 mm (2.47-mm mean size) while adenoid calcifications ranged from 0.5 to 2.2 mm (0.95-mm mean size). The level of statistical significant difference was <0.05. Conclusion: Gender did not affect total prevalence, the pattern of tonsilar calcifications and their linear sizes. The prevalence of tonsilloliths increased with aging, but this variable did not have an effect on their linear size

Effect of Topacal C-5 on enamel adjacent to orthodontic brackets. An in vitro study

Enamel demineralisation leading to ‘white spots’ can occur during orthodontic treatment. Casein phosphopeptides may reduce demineralisation during orthodontic treatment

Evaluation of the nasopalatine canal with cone-beam computed tomography in an Iranian population

Background: Implant placement plays a vital role in oral rehabilitation following loss of the incisors. Thus, having knowledge of anatomical variations of adjacent neurovascular structures especially the nasopalatine canal (NPC) is essential. Due to the lack of basic information in Iran about the morphology of this canal and the probability of its variety in different populations, this study was designed on an Iranian population. Materials and Methods: In this descriptive study, we selected cone-beam computed tomography images of 198 patients comprising of 98 males and 100 females in two dental groups (edentulous or dentate). The shape of the nasopalatine foramen and the form of the canal in axial views were assessed. Then, the canal height and its diameter at the palatal, middle and nasal levels in cross-sectional images were measured. The available bone in the buccal and palatal sides of the canal was assessed. Data analysis was carried out using a Chi-square test and an independent t-test (P ≤ 0.05). Results: The majority of the samples (81.8%) presented a single foramen. Cylindrical shape (57.6%) was the most frequently detected canal form. The mean of the estimated canal height was 12.84 ± 2.88 mm. The canal diameter at the palatal level between the sexes and dental groups showed statistically significant differences. Conclusion: In our investigated population, the NPC form was mainly cylindrical with a single opening foramen. The mean of the canal height was higher than that found in other populations. Furthermore, the canal diameter in the edentulous group was greater than that observed in the other group

Accuracy of Cone-beam Computed Tomography in Comparing with Clearing and Staining Method in Evaluating the Root Canal Morphology: An In Vitro Study

Introduction: In order to successfully perform root canal treatment, thorough knowledge of the root canal anatomy is essential. Cone-beam computed tomography (CBCT) has the ability to improve our understanding of the root canal system. The goal of the present study was to compare the accuracy of CBCT in revealing the number and form of the root canals of different maxillary and mandibular teeth with clearing and staining method. Methods and Materials: CBCT images were taken from 80 extracted human teeth fixed in agar arch models. The number and configuration of the root canals of each tooth were determined by the two observers. Then the teeth were cleared and stained. Two endodontists evaluated the number and forms of the root canals. The accuracy of CBCT was determined and compared with clearing and staining by Fisher’s exact test. The agreement of two methods in detection of the number and form of the root canals were evaluated by Kappa test, P≤0.05. Results: CBCT accurately detected the number of root canals in 129 (92.1%) of 140 roots and the form of the canals in 119 (85%) of the roots. There was no significant difference between the accuracy of CBCT in the detection of the number (P=0.13) and forms (P=0.4) of root canals of maxillary and mandibular teeth. The agreement between CBCT, and tooth clearing and staining in detection of the number of root canals was excellent in the maxilla (kappa=0.88±0.05) and good in the mandible (kappa=0.720±0.097). The agreement between the two methods in demonstration of the form of root canals was good in both maxillary (kappa=0.73±0.07) and mandibular (kappa=0.67±0.09) teeth. Conclusion: CBCT provides accurate information about root canal morphology. Application of this technique could result in more successful endodontic treatments.Keywords: Anatomy; Cone-beam Computed Tomography; Root Canal