The effects of different metal posts, cements, and exposure parameters on cone-beam computed tomography artifacts

Purpose@#This study assessed the intensity of artifacts produced by 2 metal posts, 2 cements, and different exposure parameters using 2 cone-beam computed tomography (CBCT) units. @*Materials and Methods@#The sample was composed of 20 single-rooted premolars, divided into 4 groups: Ni-Cr/ zinc phosphate, Ni-Cr/resin cement, Ag-Pd/zinc phosphate, and Ag-Pd/resin cement. Samples were scanned before and after post insertion and cementation using a CS9000 3D scanner with 4 exposure parameters (85/90 kV and 6.3/10 mA) and an i-CAT scanner with 120 kV and 5 mA. The presence of artifacts was assessed subjectively by 2 observers and objectively by a trained observer using ImageJ software. The Mann-Whitney, Wilcoxon, weighted kappa, and chi-square tests were used to assess data at a 95% confidence level (α<0.05). @*Results@#In the subjective analyses, AgPd presented more hypodense and hyperdense lines than NiCr (P<0.05), and more hypodense halos were found using i-CAT (P<0.05) than using CS9000 3D. More hypodense halos, hypodense lines, and hyperdense lines were observed at 10 mA than at 6.3 mA (P<0.05). More hypodense halos were observed at 85 kV than at 90 kV (P<0.05). CS9000 3D presented more hypodense and hyperdense lines than i-CAT (P<0.05). In the objective analyses, AgPd presented higher percentages of hyperdense and hypodense artifacts than NiCr (P<0.05). Zinc phosphate cement presented higher hyperdense artifact percentages on CS9000 3D scans (P<0.05). CS9000 3D presented higher artifact percentages than i-CAT (P<0.05). @*Conclusion@#High-atomic-number alloys, higher tube current, and lower tube voltage may increase the artifacts present in CBCT images. (Imaging Sci Dent 2023; 53: 127-35)

Positioning errors of dental implants and their associations with adjacent structures and anatomical variations: A CBCT-based study

Purpose@#The objective of the present study was to evaluate the prevalence of dental implants positioning errors and their associations with adjacent structures and anatomical variations by means of cone-beam computed tomography (CBCT). @*Materials and Methods@#CBCT images of 207 patients (584 dental implants) were evaluated by 2 oral radiologists. The distance between the implant and the adjacent teeth/implants was measured and classified as adequate (≥1.5 mm and ≥3 mm, respectively) or inadequate. The presence of thread exposure, cortical perforation, implant dehiscence, implant penetration into adjacent structures, and anatomical variations was also recorded. The incisor canal diameter and the depth of the concavity of the submandibular fossa were measured in order to evaluate their correlations with the frequency of implant penetration in these structures. Descriptive analyses, the Fisher exact test, and Spearman correlation analysis were performed (α= 0.05). @*Results@#The overall prevalence of positioning errors was 82.9%. The most common error was the inadequate distance between the implant and the adjacent teeth/implants. The presence of anatomical variations did not significantly influence the overall prevalence of errors (P>0.05). There was a positive correlation between the diameter of the incisor canal and the frequency of implant penetration in this structure (r= 0.232, P<0.05). @*Conclusion@#There was a high prevalence of dental implant positioning errors, and positioning errors were not associated with the presence of anatomical variations. Professionals should be aware of the space available for implant placement during the preoperative planning stage.

Assessment of the anterior loop of the mandibular canal: A study using cone-beam computed tomography

PURPOSE: Sufficient area in the interforaminal region is required for dental implant placement, and the anterior loop of the mandibular canal is located within the limits of this area. The aim of this study was to evaluate the prevalence and extent of the anterior loop in a Brazilian sample population using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT images from 250 patients (500 hemimandibles) obtained for various clinical indications were randomly selected and evaluated to determine the presence and length of the anterior loop. The length of the anterior loop was then compared based on gender, age, and the side of the mandible. The data were analyzed using the Pearson chi-square test and linear regression analysis. RESULTS: An anterior loop was identified in 41.6% of the cases, and its length ranged from 0.25 mm to 4.00 mm (mean, 1.1±0.8 mm). The loop had a greater mean length and was significantly more prevalent in males (p=0.014). No significant differences were found between the right and left sides regarding length (p=0.696) or prevalence (p=0.650). CONCLUSION: In this study, a high prevalence of the anterior loop of the mandibular canal was found, and although its length varied greatly, in most cases it was less than 1 mm long. Although this is a prevalent anatomical variation, safety limits for the placement of implants in this region cannot be established before an accurate evaluation using imaging techniques in order to identify and preserve the neurovascular bundles.

The chronology of second molar development in Brazilians and its application to forensic age estimation

PURPOSE: This study investigated the possible correlation between the mineralization of the second molars and the chronological age of a sample population of the state of Paraiba, Brazil. MATERIALS AND METHODS: One thousand eight hundred fifty-four digitized panoramic images using a scanner of a private dental radiology service were obtained in six months. Of these, 457 were selected from patients aged 4.6 to 16 years who met certain criteria. The images were assessed twice by a radiologist with 5 years experience. A minimum interval of 30 days between the evaluations of the same patient was established. To analyze the relationship between chronological age, calcification level proposed by Demirjian et al in 1973, gender, and tooth, a multiple linear regression model was adjusted, taking age as the response variable (p<0.05). RESULTS: The gender and calcification level were significantly correlated with the age of the patients (p<0.05). There was a significant difference between the average age of the patients' upper teeth compared to the lower ones in both genders (p<0.05). The dental development occurred earlier in female individuals than in male ones, and there was no significant difference between the right and left second permanent molars. CONCLUSION: It was observed that ethnic variables are related to certain parameters of age and sex identification in the Brazilian population, providing important information for forensic evaluations.