The effect of maxilla impacted canine positions on root resorption of adjacent teeth using cone-beam computed tomography imaging

Objective@#To determine the effect of the impacted position of the maxillary canine on the root resorption of the adjacent incisor using Cone-beam Computed Tomography (CBCT) imaging. @*Methods@#This was an analytic quantitative study. The research sample determined CBCT images of treatment patients at the Orthodontic Specialist Policlinic in Dental Hospital of Airlangga University over a three-year period and secondary data taken from Pramita Laboratory. CBCT photos that met the inclusion criteria, including mesially impacted canine or close to central or lateral incisors with completely formed anatomy were then analyzed. Multiple linear regression was used to determine x-axis, y-axis, z-axis position of the impacted canine on the severity of root resorption of the adjacent incisor, and the effect of impacted canines on all axes simultaneously on the severity of root resorption of the adjacent incisors. @*Results@#The position of the impacted canine in the x-axis and z-axis planes had a significant influence on the root resorption of the adjacent incisor. Meanwhile, impacted canine from the y-axis plane showed non-significant influence on the root resorption. @*Conclusion@#The position of the impacted canine when viewed in all planes of the tooth axis has a significant effect on the severity of root resorption of the adjacent incisor

Corrección del artefacto producido en imágenes tomográficas en equipos odontológicos / Correction of the artifact produced in tomographic images in dental equipment

Objetivo: disminuir el efecto de artefacto que generan objetos de alta densidad mediante la utilización de filtros de distintos materiales y espesores, ubicados en lugares estratégicos del tomógrafo. Material y métodos: se utilizaron filtros de aluminio y de cobre ubicados en lugares estratégicos en el equipo tomográfico. Se realizaron cortes oblicuos en piezas dentarias con restauraciones metálicas y en implantes; se midió la extensión del artefacto en ancho y alto en cada adquisición tomográfica. Resultados: se hallaron diferencias significativas respecto a la disminución de la dispersión de acuerdo con cada filtro con respecto a la no utilización de estos elementos. Conclusión: la utilización de filtros logró disminuir el efecto de artefacto en estructuras de alta densidad, obteniendo una mejor calidad de imagen para el diagnóstico, permitiendo que el software pueda reconstruir una imagen real (AU)

Objective: to diminish the artifact effect generated by high density objects by using filters of different materials and thickness, located in strategic places of the tomograph. Material and methods: aluminum and copper filters located in strategic places in the tomographic equipment were used. Oblique cuts were made on dental pieces with metal restorations and implants; the extension of the artifact in width and height was measured in each tomographic acquisition. Results: significant differences were found regarding the decrease of the dispersion according to each filter with respect to the non-use of these elements. Conclusion: the use of filters achieves to diminish the artifact effect in structures of high density, obtaining a better image quality for the diagnosis, allowing the software to reconstruct a real image (AU)

Mucormycosis- A Case Report

Mucormycosis, an aggressive and opportunistic fungal infection caused by Rhizopus sp., Mucor, and Lichtheimia, poses a significant challenge in the post-COVID era. Previously considered a rare occurrence, mucormycosis has witnessed a surge in cases, particularly affecting the nose, paranasal sinuses, and cerebral tissue. These fungal pathogens exhibit a destructive behaviour, eroding small blood vessels and leading to thrombosis, ischemia, and tissue necrosis. Patients with compromised systemic health, such as diabetes mellitus, leukemia, and immunosuppressive therapy, are particularly susceptible to this infection due to impaired immunity. The various clinical manifestations of mucormycosis are categorized into rhinocerebral, pulmonary, cutaneous, gastrointestinal, and disseminated forms. Within the rhinocerebral form, subdivisions based on the affected tissues further refine the classification like rhino-orbital, rhino-sino-orbital, rhino- orbito-cerebral. Fungal culture remains a cornerstone for identifying the causative organism, while magnetic resonance imaging is the gold standard for radiological evaluation, offering detailed imaging of the affected regions. Computed tomography scans also play a crucial role in the diagnostic pathway. With dental practitioners encountering an increasing number of mucormycosis cases, Cone Beam Computed Tomography has emerged as a valuable diagnostic tool. Recent advancements have led to the development of diagnostic criteria based on CBCT findings, aiding in the accurate and timely diagnosis of mucormycosis. We report a case of mucormycosis affecting maxilla highlighting the importance of CBCT in addition to conventional diagnostic methods thereby improving its management and clinical outcome.

Maxillary Molar Root Canal Morphology Using Cone-Beam Computed Tomography: An Epidemiological Study from Shandong Province, China / Morfología del Conducto Radicular del Molar Maxilar Mediante Tomografía Computarizada de Haz Cónico: Un Estudio Epidemiológico de la Provincia de Shandong, China

SUMMARY: The objective of this study was to evaluate the maxillary molar root canal morphology in individuals from the Shandong province, China, using cone-beam computed tomography (CBCT) and classify it based on Ahmed et al. (2017) classification system to obtain a reference for clinical diagnosis and treatment. From December 2020 to June 2021, we screened CBCT data of 1,619 patients at the Jinan Stomatological Hospital who had been indicated for CBCT because of various oral abnormalities. The root and root canal morphologies of all teeth were statistically analyzed, and the root canal morphology was classified based on Ahmed et al. (2017) classification system. In the maxillary molars, three roots were the most common, accounting for 99.24 % and 74.61 % of all maxillary first and second molars, respectively. Two roots were the second most common, accounting for 0.66 % and 17.29 % of all maxillary first and second molars, respectively. Root morphology variation, e.g., fusion or furcation defect, was present in 22 (0.76 %) maxillary first molars and 765 (25.39 %) maxillary second molars, with the most common being mesiobuccal and distobuccal root fusion. Detection rates of a second mesiobuccal canal (MB2) in the maxillary first and second molars were 48.5 % and 26.5 %, respectively. Among age groups, the frequency of MB2 was the highest in the 15-24-year-old group and lowest in the 55-64-year-old group. Bilateral MB2 root canals were present in 64.8 % and 48.4 % of the maxillary first and second molars, respectively. Men and women accounted for 60.6 % and 67.8 % of the maxillary first molars, respectively, and 51.7 % and 45.6 % of the maxillary second molars, respectively. According to Ahmed et al. (2017) classification of root canal morphology, 18 and 22 root canal configurations were found in 1,453 right maxillary first molars and 1,444 left maxillary first molars, respectively. The right maxillary first molars showed three two-rooted, 14 three-rooted, and one four-rooted type. The left maxillary first molars showed two one-rooted, six two-rooted, and 14 three-rooted types. According to Ahmed et al. (2017) classification of root canal morphology, 43 and 45 root canal configurations were found in 1,507 right maxillary second molars and 1,506 left maxillary second molars, respectively. The right maxillary second molars showed 17 one-rooted, 16 two- rooted, eight three-rooted, and two four-rooted types. The left maxillary second molars showed 19 one-rooted, 13 two-rooted, 12 three- rooted, and one four-rooted type. This study showed that the maxillary molar root canal morphology is diverse in the Shandong province. Ahmed et al. (2017) classification system provides a clear description of the root canal morphology. CBCT can be used to study complex root and root canal morphologies.

El objetivo de este estudio fue evaluar la morfología del conducto radicular del molar superior en individuos de la provincia de Shandong, China, utilizando tomografía computarizada de haz cónico (CBCT) y clasificarla con base en el sistema de clasificación de Ahmed et al. (2017) para obtener una referencia para diagnóstico clínico y tratamiento. Desde diciembre de 2020 hasta junio de 2021, analizamos los datos de CBCT de 1619 pacientes en el Hospital Estomatológico de Jinan a quienes se les indicó CBCT debido a diversas anomalías orales. Las morfologías de la raíz y del conducto radicular de todos los dientes se analizaron estadísticamente, y la morfología del conducto radicular se clasificó según el sistema de clasificación de Ahmed et al. (2017). En los molares superiores, tres raíces fueron las más comunes, representando el 99,24 % y el 74,61 % de todos los primeros y segundos molares superiores, respectivamente. Dos raíces fueron las segundas más comunes, representando el 0,66 % y el 17,29 % de todos los primeros y segundos molares superiores, respectivamente. La variación de la morfología de la raíz, por ejemplo, fusión o defecto de furcación, estuvo presente en 22 (0,76 %) primeros molares superiores y 765 (25,39 %) segundos molares superiores, siendo la fusión radicular mesiovestibular y distovestibular la más común. Las tasas de detección de un segundo canal mesiovestibular (MB2) en los primeros y segundos molares superiores fueron del 48,5 % y 26,5 %, respectivamente. Entre los grupos de edad, la frecuencia de MB2 fue más alta en el grupo de 15 a 24 años y más baja en el grupo de 55 a 64 años. Los conductos radiculares MB2 bilaterales estaban presentes en el 64,8 % y el 48,4 % de los primeros y segundos molares superiores, respectivamente. En los hombres y en las mujeres representaron el 60,6 % y el 67,8 % de los primeros molares superiores, respectivamente, y el 51,7 % y el 45,6 % de los segundos molares superiores, respec- tivamente. Según la clasificación de la morfología del conducto radicular de Ahmed et al. (2017) se encontraron configuraciones de conducto radicular 18 y 22 en 1453 primeros molares superiores derechos y 1444 primeros molares superiores izquierdos, respectivamente. Los primeros molares superiores derechos mostraron tres tipos de dos raíces, 14 de tres raíces y uno de cuatro raíces. Los primeros molares superiores izquierdos mostraron dos tipos de una raíz, seis de dos raíces y 14 de tres raíces. Según la clasificación de la morfología del conducto radicular de Ahmed et al. (2017) se encontraron configuraciones de conducto radicular 43 y 45 en 1507 segundos molares superiores derechos y 1506 segundos molares superiores izquierdos, respectivamente. Los segundos molares superiores derechos mostraron 17 tipos de una raíz, 16 de dos raíces, ocho de tres raíces y dos de cuatro raíces. Los segundos molares superiores izquierdos mostraron 19 de una raíz, 13 de dos raíces, 12 de tres raíces y uno de cuatro raíces. Este estudio mostró que la morfología del conducto radicular del molar superior es diversa en la provincia de Shandong. El sistema de clasificación de Ahmed y colaboradores proporciona una descripción clara de la morfología del conducto radicular. CBCT se puede utilizar para estudiar morfologías complejas de raíces y conductos radiculares.

Manejo de quiste odontogénico glandular con rehabilitación implantológica guiada. Reporte de un caso / Management of glandular odontogenic cyst with guided implantologic rehabilitation. Case report

Resumen Objetivo: Describir el manejo de un caso de quiste odontogénico glandular, con tratamiento conservador, terapias adyuvantes y rehabilitación implantoasistida a los 7 años de seguimiento. Caso clínico: Se presenta un caso clínico de un paciente masculino con una lesión mandibular con diagnóstico de quiste odontogénico glandular. El tratamiento que se realizó fue una enucleación con tratamiento de superficie con solución de Carnoy y ostectomía periférica. Se realizó seguimiento clínico y radiográfico durante 7 años verificando ausencia de recidiva, momento en cual se realizó mediante planificación virtual la colocación de implantes con guías quirúrgicas de precisión para rehabilitación implanto asistida.

Abstract Aim: To describe the management of a case with a glandular odontogenic cyst, treated with a conservative treatment, adyuvant therapy and guided implantologic rehabilitation at 7 years of follow up. Clinical case: A case report of a male patient with a mandibular lesion with a diagnose of glandular odontogenic cyst is presented. The treatment that was performed was an enucleation with surface treatment with Carnoy's solution and peripheral ostectomy. Clinical and radiographic follow up was carried out for 7 years, verifying the absence of recurrence. At that time, it was done placement of implants with virtual planning and precision surgical guides for implant-assisted rehabilitation.

Comparison of panoramic radiography and cone-beam computed tomography images for detecting external root resorption of mandibular second molar associated with third molar impaction / 口腔医学

Objective@# To compare the diagnostic performance between panoramic radiography(PR)and cone beam computed tomography(CBCT)in the assessment of external root resorption(ERR)of mandibular second molars associated with impacted third molars. @*Methods@# A total number of 832 patients with 1 074 mesially and horizontally impacted mandibular third molars treated at our institution from January 2019 to December 2020 were retrospectively analyzed. Presence of ERR on the adjacent second molar was investigated with PR and CBCT. Factors affecting the diagnostic accuracy of PR were determined. @*Results@# The overall incidence of ERR in second molars was 33.15%(356/1 074)as detected by CBCT images. The accuracy of PR was 66.39%. Multivariate Logistic regression analyses further revealed that middle and Class Ⅲ impaction, crown contact or overlap with the root of adjacent tooth were risk factors for inaccurate diagnosis of PR(P<0.05). @*Conclusion@#The accuracy of detection on ERR of mandibular second molar associated with impacted third molar using panoramic radiography is lower. CBCT is recommended for this clinical scenario.

Research progress on anterior alveolar bone changes after orthodontic treatment involving extractions / 口腔疾病防治

@#It has been traditionally believed that a 1:1 cortical bone remodeling/tooth movement ratio has been preserved during orthodontic treatment for tooth movement, with the alveolar bone on the tension side growing and the alveolar bone on the pressure side resorbing to maintain the balance of the alveolar bone. However, recent studies have shown that alveolar bone loss has been found in patients who have undergone orthodontic treatment, suggesting that the alveolar bone does not change as the teeth change over time. Whether the morphology of the alveolar bone will change when the anterior teeth are moved has been the clinical focus. The changes of anterior alveolar bone in patients who have undergone tooth extraction after orthodontic treatment were summerized by literature review in this paper. The results of the review showed that the alveolar bone at the lingual/palatal root-cervical site of the anterior root is more prone to bone loss after extensive movement of the anterior teeth. With the development of imaging technology, CBCT is now more commonly used for analysis instead of two-dimensional images for measurement, as its results are more accurate. However, there are few multifactorial studies in which CBCT has been used to assess the morphological changes in the alveolar bone. The focus of future research is to compare the long-term changes in the anterior alveolar bone of patients of different ages based on three-dimensional imaging, and to study the correlation between different skeletal features, tooth movement patterns and alveolar bone remodeling.

Impact of low intensity pulsed ultrasound on volumetric root resorption of maxillary incisors in patients treated with clear aligner therapy: A retrospective study

ABSTRACT Objective: The aim of this study was to evaluate the volumetric root resorption in maxillary incisors following clear aligner therapy (CAT) with low-intensity pulsed ultrasound (LIPUS), and compare the results to CAT alone. Material and Methods: This retrospective study evaluated pretreatment (T0) and post-treatment (T1) cone-beam computed tomography imaging of 42 adult patients. Twenty-one patients (14 females, 7 males, mean age= 38.1±12.96 years) were treated using CAT with LIPUS device, whereas the other twenty-one matching controls patients (15 females, 6 males, mean age= 35.6±11.7 years) were treated using CAT alone. Images were analyzed and a segmentation protocol was applied on the maxillary incisors. Each segmented tooth volume was exported as a surface mesh in the Visualization Toolkit (VTK) file format. The VTK files for all maxillary incisors were coded and corresponding teeth volumes from T0 and T1 were superimposed. Clipping the crown of each tooth was done, then measurements of root volumes and differences between groups were performed. Changes in root volumes were assessed (p<0.05). Results: Root loss was evident in all teeth in both groups, but was significantly increased in all maxillary incisors of the control group (p<0.001) and in upper left central incisor of LIPUS group (p=0.009). When both groups were compared, there was statistically significant minimal volumetric root loss in LIPUS group (3.50-7.32 mm3), when compared to control group (11.48-12.95 mm3) (p<0.05). Conclusion: LIPUS group showed less volumetric root resorption compared to control group during the studied treatment time using clear aligners.

RESUMO Objetivo: O objetivo deste estudo foi avaliar volumetricamente a reabsorção radicular em incisivos superiores após tratamento com alinhadores transparentes (CAT) com e sem uso adjuvante de ultrassom de baixa intensidade (LIPUS). Material e Métodos: Esse estudo retrospectivo avaliou imagens de tomografia computadorizada de feixe cônico pré-tratamento (T0) e pós-tratamento (T1) de 42 pacientes adultos: 21 pacientes (14 mulheres, 7 homens, idade média= 38,1±12,96 anos) foram tratados com CAT e LIPUS, enquanto os outros 21 pacientes controles correspondentes (15 mulheres, 6 homens, idade média= 35,6±11,7 anos) foram tratados apenas com CAT. As imagens foram analisadas e foi aplicado um protocolo de segmentação dos incisivos superiores. Os volumes de cada dente segmentado foram exportados como malhas de superfície, em arquivos no formato Visualization Toolkit (VTK). Os arquivos VTK de todos os incisivos superiores foram codificados e foram sobrepostos os volumes dos dentes correspondentes a T0 e T1. Foi realizada a clipagem da coroa de cada dente e, em seguida, foram realizadas medições dos volumes radiculares e comparadas as diferenças entre os grupos, avaliando-se as alterações nos volumes de raízes (p<0,05). Resultados: A perda radicular foi evidente em todos os dentes em ambos os grupos, mas foi significativamente maior em todos os incisivos superiores do grupo controle (p<0,001) e no incisivo central superior esquerdo do grupo LIPUS (p=0,009). Quando ambos os grupos foram comparados, houve perda volumétrica mínima estatisticamente significativa no grupo LIPUS (3,50-7,32 mm3), em comparação ao grupo controle (11,48-12,95 mm3) (p<0,05). Conclusão: O grupo LIPUS apresentou menor volume de reabsorção radicular, em comparação ao grupo controle, durante o tempo de tratamento estudado usando alinhadores transparentes.

Alignment efficiency and three-dimensional assessment of root resorption after alignment with conventional and copper-nickel-titanium archwires: A randomized controlled trial

ABSTRACT Objective: To compare alignment efficiency and root resorption between nickel-titanium (NiTi) and copper-nickel-titanium (CuNiTi) archwires after complete alignment in mandibular anterior region. Methods: In this two-arm parallel single-blind randomized controlled trial, forty-four patients with Class I malocclusion with mandibular anterior crowding were recruited form orthodontic clinic of All India Institute of Medical Sciences (Jodhpur, India). Patients were randomly allocated into NiTi and CuNiTi groups, with a 1:1 allocation. Alignment was performed using 0.014-in, 0.016-in, 0.018-in, 0.019x0.025-in archwire sequence in the respective groups, which terminated in 0.019 x 0.025-in stainless-steel working archwire. The primary outcome was alignment efficiency, measured on study models from baseline (T0) to the first, second, third, fourth and fifth-month (T5). Secondary outcome was root resorption, measured from CBCT scans taken at T0 and T5. Mixed-factorial ANOVA was used to compare Little's Irregularity Index (LII). For assessing the proportion of patients with complete alignment at the end of each month, Kaplan-Meier survival curve was built and time to treatment completion was compared between groups using log rank test. Paired t-test was used to assess external apical root resorption (EARR) within groups, whereas independent t-test was used to evaluate LII and EARR between the groups. Results: Twenty-two patients were recruited in each group. One patient was lost to follow-up in the CuNiTi group. No statistically significant differences were observed in alignment efficiency between the groups (p>0.05). Intergroup comparison revealed that the changes in root measurement in three-dimensions were not statistically significant (p>0.05), except for mandibular right central incisor, which showed increased resorption at root apex in NiTi group (p<0.01). Conclusion: The two alignment archwires showed similar rate of alignment at all time points. Root resorption measurement did not differ between the NiTi and CuNiTi groups, except for the mandibular right central incisor, which showed more resorption in NiTi group.

RESUMO Objetivo: Comparar os fios de níquel-titânio (NiTi) e de cobre-níquel-titânio (CuNiTi) quanto à eficiência do alinhamento e quantidade de reabsorção radicular, após alinhamento completo dos dentes da região anterior inferior. Métodos: Neste estudo clínico randomizado, cego, paralelo, de dois braços, quarenta e quatro pacientes com má oclusão Classe I e apinhamento anterior inferior foram recrutados na clínica ortodôntica do All India Institute of Medical Sciences (Jodhpur, India). Os pacientes foram alocados aleatoriamente nos grupos NiTi e CuNiTi, na proporção de 1:1. O alinhamento foi realizado usando a sequência de fios 0,014", 0,016", 0,018" e 0,019" x 0,025" nos respectivos grupos, finalizando com o arco de trabalho 0,019" x 0,025" de aço inoxidável. O desfecho primário foi a eficiência do alinhamento, medida nos modelos de estudo nos tempos inicial (T0) e após um, dois, três, quatro e cinco meses (T5). O desfecho secundário foi a reabsorção radicular, medida a partir de tomografias computadorizadas realizadas em T0 e T5. ANOVA fatorial mista foi utilizada para comparar o Índice de Irregularidade de Little (IIL). Para avaliar a proporção de pacientes com alinhamento completo ao fim de cada mês, foi construída uma curva de sobrevida pelo método de Kaplan-Meier, e o tempo até o fim do tratamento foi comparado entre os grupos por meio do teste log-rank. Um teste t pareado foi utilizado para avaliar a reabsorção radicular apical externa (RRAE) dentro dos grupos, enquanto um teste t independente foi utilizado para avaliar o IIL e a RRAE entre os grupos. Resultados: Vinte e dois pacientes foram recrutados em cada grupo. Um paciente perdeu o acompanhamento no grupo CuNiTi. Não foram observadas diferenças estatisticamente significativas entre os grupos quanto à eficiência do alinhamento (p>0,05). A comparação intergrupos revelou que as alterações na RRAE medida em três dimensões não foram estatisticamente significativas (p>0,05), exceto para o incisivo central inferior direito, que apresentou aumento da RRAE no grupo NiTi (p<0,01). Conclusão: Os dois tipos de fios de alinhamento apresentaram taxa de alinhamento semelhante em todos os momentos. A medida da reabsorção radicular não diferiu entre o grupo NiTi e CuNiTi, exceto para o incisivo central inferior direito, que apresentou maior reabsorção no grupo NiTi.

Tomografía computarizada de haz cónico como auxiliar para el tratamiento de incisivo superior con anatomía inusual: reporte de un caso

El fracaso en el tratamiento de conductos puede conducir a la pérdida del órgano dental, distintos factores han sido reportados como causantes del fracaso en la terapia endodóntica, dentro de estos factores los conductos omitidos tienen un influencia mayor debido a que permiten una colonización y multiplicación de las bacterias dentro del conducto radicular. Variaciones anatómicas anormales pueden aumentar las posibilidades de fracaso debido a la imposibilidad de diagnosticar de manera correcta, es en estos casos que la tomografía computarizada de haz cónico ha demostrado ser de gran ayuda para interpretarlas.

O fracasso no tratamento de canais radiculares pode levar à perda do órgão dental. Vários fatores têm sido relatados como causas de fracasso na terapia endodôntica. Dentre esses fatores, os canais omitidos têm uma influência maior, pois permitem a colonização e multiplicação de bactérias dentro do canal radicular. Variações anatômicas anormais podem aumentar as chances de fracasso devido à dificuldade de diagnóstico preciso. Em tais casos, a tomografia computadorizada de feixe cônico demonstrou ser de grande auxílio para a interpretação.

The failure in root canal treatment can lead to the loss of the dental organ. Various factors have been reported as causes of failure in endodontic therapy. Among these factors, omitted canals have a greater influence, as they allow colonization and multiplication of bacteria within the root canal. Abnormal anatomical variations can increase the chances of failure due to the inability to diagnose accurately. In these cases, cone-beam computed tomography has proven to be of great assistance in their interpretation.

3D reconstruction of lower anterior teeth from CBCT images: automatic segmentation with manual refinements

ABSTRACT Objective: To develop a well-detailed and reproducible tooth segmentation method, when quantifying tooth volumetric measurements is needed. Material and Methods: This was an in vitro study in which lower incisors and canines of five patients were 3D reconstructed by means of an automatic segmentation with manual refinements process. All the images were obtained using a 0.3-mm voxel size CBCT imaging. The software utilized was the ITK-SNAP®. The primary outcomes were the intra-rater and inter-rater reliabilities and the respective measurement errors. Results: The intra-rater reliability was excellent, with a mean measurement error of 4.16%. The inter-rater reliability was good, with a mean measurement error of 7.11%. Accuracy assessment was not possible, as the assessed teeth were not extracted. Conclusions: Although the described method is reliable, tooth volumetric error measurements may become significant, depending on the assessed situation.

RESUMO Objetivo: Desenvolver um método de segmentação dentária bem detalhado e reprodutível, para quando for necessário quantificar as medidas volumétricas dos dentes. Material e Métodos: Esse foi um estudo in vitro no qual incisivos inferiores e caninos de cinco pacientes foram reconstruídos em 3D por meio de um processo de segmentação automática com refinamentos manuais. Todas as imagens de TCFC foram obtidas usando tamanho de voxel de 0,3 mm. O software utilizado foi o ITK-SNAP®. Os resultados primários foram as confiabilidades intra-avaliadores e interavaliadores e os respectivos erros de medição. Resultados: A confiabilidade intra-avaliador foi excelente, com erro médio de medição de 4,16%. A confiabilidade interavaliadores foi boa, com erro médio de medição de 7,11%. A avaliação da precisão não foi possível, pois os dentes avaliados não foram extraídos. Conclusões: Embora o método descrito seja confiável, os erros nas medições volumétricas dos dentes podem se tornar significativos, dependendo da situação avaliada.

A radiation free alternative to CBCT volumetric rendering for soft tissue evaluation / Um método alternativo à TCFC sem radiação ionizante para a avaliação de tecidos moles da face

Objective: The aim of the present study is to evaluate whether a "radiation free" method using 3D facial scan can replace Cone Beam Computed Tomography (CBCT) volumetric rendering of soft tissue of the patient to assess maxillofacial surgery outcomes and compare the reference points and angular measurements of patient facial soft tissue. Material and Methods: Facial soft tissue scan of the patient's face, before and after orthognathic surgery and a CBCT of the skull for volumetric rendering of soft tissues were carried out. The 3D acquisitions were processed using Planmeca ProMax 3D ProFace® software (Planmeca USA, Inc.; Roselle, Illinois, USA). The participant were positioned in a natural position during the skull scannering. Three sagittal angular measurements were performed (Tr-NA, Tr-N-Pg, Ss-N-Pg) and two verticals (Go-N-Me, Tr-Or-Pg) on facial soft tissue scan and on the patient's 3D soft tissue CBCT volumetric rendering. Results: A certain correspondence has been demonstrated between the measurements obtained on the Proface and those on the CBCT. Conclusion: A radiation free method was to be considered an important diagnostic tool that works in conditions of not subjecting the patient to harmful ionizing radiation and it was therefore particularly suitable for growing subjects. The soft tissue analysis based on the realistic facial scan has shown sufficient reliability and reproducibility even if further studies are needed to confirm the research result.(AU)

Objetivo:Avaliar se um método "livre de radiação" usando escaneamento facial 3D pode substituir a renderização volumétrica da tomografia computadorizada de feixe cônico (TCFC) dos tecidos moles do paciente para analisar os resultados da cirurgia maxilofacial e comparar os pontos de referência e medições angulares afim de avaliar a correspondência entre as duas metodologias. Material e Métodos: Foi realizado o escaneamento dos tecidos moles faciais do paciente, antes e depois da cirurgia ortognática e uma tomografia computadorizada de feixe cônico do crânio para renderização volumétrica dos tecidos moles. As aquisições 3D foram processadas usando o software Planmeca ProMax 3D ProFace® (Planmeca USA, Inc.; Roselle, Illinois, USA). O participante foi posicionado em posição natural durante o escaneamento do crânio. Três medições angulares sagitais foram realizadas (Tr-NA, Tr-N-Pg, Ss-N-Pg) e duas verticais (Go-N-Me, Tr-Or-Pg) nas imagens de scaneamento e nas imagens do tecido mole facial da reconstrução tridimensional da TCFC. Resultados: Uma certa correspondência foi demonstrada entre as medidas obtidas no Proface® e aquelas na TCFC. Conclusão: Um método livre de radiação deve ser considerado uma importante ferramenta de diagnóstico que funciona em condições de não submeter o paciente a radiação ionizante nociva e, portanto, é particularmente adequado para indivíduos em crescimento. A análise de tecidos moles com base na varredura facial realista mostrou confiabilidade e reprodutibilidade, porém mais estudos são necessários para confirmar o resultado da pesquisa. (AU)

Radiological measurement and analysis of trans-inferior alveolar nerve implantation / 口腔医学

Objective@#To measure the position of the mandibular nerve canal at the mandibular second molar by CBCT image data, analyze the theoretical implantation range of trans-alveolar implantation, and provide a theoretical solution to insufficiency of posterior mandibular bone volume in clinical practice. @*Methods@#Eighty patients with missing mandibular second molars whose vertical bone height of the edentulous area was less than 9 mm were selected for CBCT image measurement, and the distances from the mandibular nerve canal to the buccal cortex, lingual cortex, and alveolar crest were measured to simulate trans-inferior alveolar nerve implantation. The angular range of the buccolingual inclination of the implant was also measured.@*Results@#The distances from the mandibular nerve canal to the buccal cortex, lingual cortex and alveolar crest at the mandibular second molar were(6.913±1.222)mm, (2.859±0.891)mm and (7.991±0.783)mm, respectively. The distance from the mandibular nerve canal to the buccal cortex was significantly greater than that to the lingual cortex. And, 75% of the patients could be implanted by the inferior alveolar nerve. The minimum angle of buccolingual inclination of the simulated implant was 19.360°±7.086°, and the maximum angle was 39.462°±6.924°. @*Conclusion@#The mandibular nerve canal at the mandibular second molar is inclined toward the lingual side, which ensures sufficient buccal bone volume. Most patients with severe mandibular atrophy can still adopt implants of conventional length by trans-inferior alveolar nerve implantation to keep a safe distance from the nerve canal.

Estudio de la morfología de los conductos radiculares de los primeros premolares superiores en tomografía computarizada de haz cónico / Study of the morphology of root canals of the first upper premolars in cone beam computed tomography

Objetivo: analizar, mediante tomografía computarizada de haz cónico (TC o CBCT [Cone Beam Computed Tomograph]) la frecuencia del tipo de morfología interna de los conductos radi- culares según la clasificación de Vertucci y el número de raíces de los primeros premolares superiores. Material y métodos: en una población argentina de 50 pacientes, 30 de sexo femenino y 20 masculino, que concurrieron a la Cátedra de Diagnóstico por Imá- genes de la Facultad de Odontología de la Universidad de Buenos Aires, se evaluaron 100 primeros premolares superiores con CBCT. Se estudiaron las variables: número de raíces, tipo de morfología interna, edad, sexo y lado. Fueron seleccionadas las tomografías de maxilar superior que incluyeron ambos primeros premolares en salud dental, periodontal y con ápice cerrado. Se realizó una adquisición volumétrica 100 × 90 mm y tamaño de vóxel de 150 µm. Se realizó la exploración de las imágenes en el plano axial de los tercios apical, medio y cervical de las piezas 1.4 y 2.4. Se utilizó un corte axial, observando en él, el tercio apical, medio y cervical de las piezas 1.4 y 2.4. Cada premolar fue analizado con 30 cortes transversales. Se utilizó la clasificación de Vertucci para agrupar las distintas variables anatómicas de los conductos radiculares de los primeros premolares superiores, la cual consta de VIII tipolo- gías. Resultados: el tipo más representativo entre los 100 primeros premolares superiores, dentro de la clasificación de Vertucci, fue el tipo IV (dos conductos separados desde la cámara al ápice). La coincidencia de tipos entre los lados derecho (78%; IC 95%: 65 a 87%) e izquierdo (70%; IC 95%: 56 a 81%) fue significativa. La distribución según el número de raíces en el lado derecho (χ 2 = 2.88) e izquierdo (χ2 = 0.72) no presentó una heterogeneidad significativa. La coincidencia del número de raíces entre los lados derecho e izquierdo fue significativa. Conclusión: se comprobó el tipo de morfología interna más frecuente, el número de raíces y su variabilidad de acuerdo al lado, sexo, y edad; lo cual es de una relevante importancia para realizar una correcta instrumentación y obturación del sistema de conductos radiculares (AU)

Objective: to analyze, using cone beam computed tomography (CBCT), the frequency of the type of internal morphology of the root canals according to the Vertucci classification and the number of roots of the first upper premolars. Material and methods: 100 first upper premolars were evaluated with CBCT, which corresponded to 30 female and 20 male patients in the Chair of Diagnostic Imaging of the Faculty of Dentistry, University of Buenos Aires. Variables were studied: number of roots, type of internal morphology, age, sex and side. The tomography of the upper jaw with both first premolars in dental, periodontal and closed apex health, a 100 × 90 mm volumetric acquisition and a voxel size of 150 µm were selected. An axial cut was used, observing the apical, middle and cervical third of pieces 1.4 and 2.4. Each premolar was analyzed with 30 paraxial cuts. The Vertucci classification was used to group the different anatomical variables of the root canals of the first upper premolars which consists of VIII typologies. Results: the most representative type among the top 100 upper premolars within the Vertucci classification was type IV (two separate ducts from the chamber to the apex). The type coincidence between the right (78%; 95% CI: 65 to 87%) and left (70%; 95% CI: 56 to 81%) los primeros premolares superiores, la cual consta de VIII tipolo gías. Resultados: el tipo más representativo entre los 100 primeros premolares superiores, dentro de la clasificación de Vertucci, fue el tipo IV (dos conductos separados desde la cámara al ápice). La coincidencia de tipos entre los lados derecho (78%; IC 95%: 65 a 87%) e izquierdo (70%; IC 95%: 56 a 81%) fue significativa. La distribución según el número de raíces en el lado derecho (χ 2 = 2.88) e izquierdo (χ2 = 0.72) no presentó una heterogeneidad significativa. La coincidencia del número de raíces entre los lados derecho e izquierdo fue significativa. Conclusión: se comprobó el tipo de morfología interna más frecuente, el número de raíces y su variabilidad de acuerdo al lado, sexo, y edad; lo cual es de una relevante importancia para realizar una correcta instrumentación y obturación del sistema de conductos radiculares (AU))

Cone beam computed tomography with oral contrast for accurate diagnosis and surgical planning of pharyngeal leakage and fistula: a case series

Abstract Objective: Pharyngocutaneous fistula is one of the severe complications related to head and neck surgeries. Detecting the accurate three-dimensional location of both the fistula and leakage is essential for surgical treatment. Videofluoroscopy is usually used for locating these; however, its imaging is two-dimensional. We evaluated pharyngeal leakage and fistulae using Cone Beam Computed Tomography (CBCT), known for its three-dimensional high spatial resolution imaging, taken in a sitting position, with oral contrast (contrast CBCT). Methods: Pharyngeal leakage and fistulae were evaluated in a total of 31 subjects by sequentially performing videofluoroscopy and contrast CBCT. The detection accuracy of videofluoroscopy and contrast CBCT for leakage and fistula, as well as the ability to determine the extent and depth for surgical planning, were investigated and compared. Results: Videofluoroscopy and contrast CBCT showed suspicious leakage and/or fistula in six and three of the 31 subjects, respectively. Surgical findings revealed the presence of leakage and/or fistula in three of the 31 subjects. The positive predictive values of videofluoroscopy and contrast CBCT were 50% (3/6) and 100% (3/3), respectively. Contrast CBCT provided more precise images, showing the extent and depth of leakage and fistula in three-dimensions. Conclusion: The present study's results indicate the usefulness of contrast CBCT in terms of accurate diagnosis of leakage and fistula, due to its three-dimensional imaging being performed with the patient in a sitting position. Level of evidence: 4.

Endodoncia guiada estática, una opción para obliteración del canal pulpar: serie de casos / Static guided endodontics, an option for pulpal canal obliteration: a case series

En la práctica endodóntica, la etapa del acceso al canal radicular es fundamental para el éxito de las siguientes etapas del tratamiento. En casos de canales pulpares obliterados o calcificados (PCO), lograr encontrar la entrada a estos es un reto en la endodoncia convencional dado el alto riesgo de sufrir un accidente intraoperatorio. Actualmente, existen los tratamientos de endodoncia guiada o accesos guiados digitalmente, una alternativa innovadora y con múltiples beneficios para el abordaje de este tipo de dientes. El objetivo de este reporte de casos fue describir el protocolo de cuatro casos de accesos guiados estáticos para endodoncia en canales obliterados, indicando las ventajas y consideraciones del tratamiento. Se presenta un reporte de casos de cuatro pacientes atendidos entre julio 2021 y junio 2022, que requerían tratamientos endodónticos en dientes anteriores con canales pulpares obliterados. Para la realización de estos procedimientos se requirió una Tomografía Computarizada de Haz Cónico (CBCT) y el escaneo intraoral de la zona a tratar, para poder a través de la ayuda de un software, planificar virtualmente la dirección y longitud de acceso al conducto radicular. Posteriormente, se realizó la impresión en 3D de la guía estática, la cual dirige la entrada de la fresa que se utiliza para encontrar el acceso al canal radicular. En los cuatro casos clínicos en que se realizó la planificación virtual e impresión de la guía de acceso, fue posible encontrar el canal radicular en una sesión, pudiendo realizar el tratamiento endodóntico de manera exitosa y conservadora. En conclusión, la endodoncia guiada estática permite realizar los tratamientos endodónticos en PCO de manera segura, a pesar de la alta complejidad que presentaban.

SUMMARY: In endodontics, the access to the root canal is essential for the treatment success. Pulp canal obliteration (PCO) is a challenge for conventional endodontic treatments with a high risk of fracture of endodontic instruments.Currently, guided endodontic treatments, or digitally guided accesses, are novel alternatives with multiple benefits for the treatment of PCO. The objective of this case report is to describe the protocol for static guided access in PCO, indicating the advantages and considerations of the treatment. A case report of four patients treated between July 2021 and June 2022 is presented. These patients required endodontic treatments in anterior teeth with PCO. In order to virtually plan the direction and length of the access, using a software, we used a cone Beam Computed Tomography (CBCT) and an intraoral scan. Then, a 3D printing of the static guide was made, which directs the entry of the drill. With this method, it was possible to find the root canal in one session and perform the endodontic treatment successfully and conservatively. In conclusion, although static guided endodontics requires planification, it allows a safe endodontic treatment in patients with PCO.

CBCT Evaluation of Unilateral Accessory Mental Foramina: Under Reported Anatomic Variant in Children

ABSTRACT: The following manuscript presents two paediatric cases with incidental finding of unilateral accessory mental foramina. Both the cases illustrate CBCT evaluation of a unilateral accessory foramina on the left side of the mandible, one of which, is a 12-year-old baby girl with pre-diagnosed medical history of precocious puberty and oral findings of supernumerary teeth and the other is an 8-year-old boy with oral bifurcation cyst. The not so frequent presence of additional foramina and canals in the mandible are frequently undervalued in clinical procedures and to our knowledge has not yet been reported in paediatric cases in the literature so far. In these case reports, authors attempt to document a rare and first of its type ever reported anatomic variant of mandible in paediatric patients in the whole literature.

RESUMEN: El manuscrito presenta dos casos pediátricos con hallazgo incidental de forámenes mentonianos accesorios unilaterales. Ambos casos se refieren a la evaluación CBCT de un foramen accesorio unilateral en el lado izquierdo de la mandíbula, uno de los cuales era una niña de 12 años con antecedentes medicos prediagnosticados de pubertad precoz y hallazgos orales de dientes supernumerarios y el otro un niño de 8 años con quiste de bifurcación bucal. La presencia no tan frecuente de forámenes y canales adicionales en la mandíbula se subestima con frecuencia en los procedimientos clínicos y, hasta donde sabemos, aún no se ha informado en casos pediátricos en la literatura hasta el momento. En esta serie de casos, los autores intentan documentar una variante anatómica rara y primera de su tipo de la mandíbula en pacientes pediátricos en toda la literatura.

Anatomical and morphological findings of the root canal of maxillary premolars and their prevalence: CBCT study in a Mexican population / Hallazgos anatómicos y morfológicos del conducto radicular de premolares maxilares y su prevalencia: estudio CBCT en una población mexicana

SUMMARY: An essential prerequisite to perform any dental procedure is a clear understanding and knowledge of dental anatomy and its possible variations. The root canal system is characterized for a complex morphology, which varies among populations, individuals in the same population and even in the same person. The aim of this study was to evaluate by CBCT the morphology, number, curvature, and length of roots of first and second maxillary premolars in a Mexican population. In this stud 1700 maxillary premolars were evaluated by CBCT scans of patients; the axial, sagittal and coronal sections were analyzed following the longitudinal axis of each tooth. As a result 51.60 % of the maxillary first premolars had a single root, 31.03 % had two roots, 16.29 % had root fusion, and 1.07 % had three roots. 22.3 % of the maxillary first premolars showed mesial curvature, 41.9 % had a distal curvature, and 35.7 % did not show any curvature; and the most prevalent configuration in maxillary first premolars was Type V. 88.9 % of the maxillary second premolars had a single root, 3.9 % had two roots, 6.9 % had root fusion, and 0.11 % had three roots; 37.59 % of the maxillary second premolars showed a mesial curvature and 62.40 % showed a distal curvature; and the most prevalent configuration in maxillary second premolars was Type I. The anatomy of the root canal system is extremely complex and has many anatomical configurations, these clinical situations must be considered previous to performing any endodontic treatment.

RESUMEN: Un requisito esencial previo a la realización de cualquier procedimiento dental es una clara comprensión y conocimiento de la anatomía dental y sus posibles variaciones. El sistema de canales radiculares se caracteriza por una morfología compleja, que varía entre poblaciones, individuos en una misma población e incluso en una misma persona. El objetivo de este estudio fue evaluar mediante CBCT la morfología, número, curvatura y longitud de raíces de primeros y segundos premolares maxilares en una población mexicana. En este estudio se evaluaron 1700 premolares maxilares mediante escaneos CBCT de pacientes; se analizaron los cortes axial, sagital y coronal siguiendo el eje longitudinal de cada diente. El 51,60 % de los primeros premolares maxilares tenían una sola raíz, el 31,03 % tenían dos raíces, el 16,29 % tenían fusión de raíces y el 1,07 % tenían tres raíces. El 22,3 % de los primeros premolares maxilares presentaban curvatura mesial, el 41,9 % presentaban curvatura distal y el 35,7 % no presentaban curvatura alguna; y la configuración más prevalente en primeros premolares maxilares fue el Tipo V. El 88,9 % de los segundos premolares maxilares tenían una sola raíz, el 3,9 % dos raíces, el 6,9 % fusión de raíces y el 0,11 % tres raíces; El 37,59 % de los segundos premolares maxilares presentaban curvatura mesial y el 62,40 % curvatura distal y la configuración más prevalente en segundos premolares maxilares fue el Tipo I. La anatomía del sistema de canales radiculares es extremadamente compleja y tiene muchas configuraciones anatómicas, estas situaciones clínicas deben ser consideradas antes de realizar cualquier tratamiento de endodoncia.

An In Vitro Study to Assess the Root Canal Morphology of Human Primary Molars Using Computerised Tomography

Background: A virtuous consideration of root canal morphology is required. Complications all through and after endodontic therapy are frequently caused by variances in the anatomy of root canals in primary teeth. The goal of present study was to determine the number and shape of root canals in primary incisors and molars, as well as the pertinency of cone beam computerised tomography (CBCT) in doing so.Material & Methods:On a total of 60 primary molars and incisors with complete root length, CBCT was used to assess the number of roots, number of canals, width of root canal at cementoenamel junction and middle-third, length and angulations of roots. The information was statistically analysed. Results:The CBCT revealed that 13 percent of mandibular incisors had bifurcation of the root canal in the middle third, while 20% of mandibular molars had two canals in the distal root. The distobuccal root canal diameter of maxillary molars and the mesiolingual canal diameter of mandibular molars were determined to be the smallest.Conclusions:Cone beam computed tomography (CBCT) is a comparatively new and effective technology that can be used in conjunction with conventional radiography to examine variations in root canal morphology in primary teeth.

Root Canal Morphology of Primary Molars – A Cone Beam Computed Tomography (CBCT) Study

Objectives: To evaluate the root and canal morphology of primary maxillary and mandibular molars in an Indian population using cone?beam computed tomography (CBCT). Methods: A retrospective cross?sectional study was performed, where CBCT scans of children less than 10 years of age taken for valid diagnostic purposes previously were considered and images were analyzed. The number of roots, root canals, and variations in morphology were recorded. Left–right symmetry was also noted. Results: A total of 433 deciduous maxillary and mandibular primary molars were studied. It was observed that two separate roots with three separate canals were common in primary mandibular first molars, whereas two separate roots with two canals in each root were common in mandibular second primary molars. In primary maxillary molars, three separate roots with one canal each were the most common. Maxillary first molars (17.21%) and 17.35% second molars had fused distobuccal and palatal roots. It was observed that primary maxillary molars showed more left–right symmetry (86.7% in first molars and 82.7% in second molars) compared to primary mandibular molars (54.05% in first molars and 68% in second molars). Conclusions: It was concluded that in both primary maxillary first and second molars, three separate roots, a mesiobuccal root, a distobuccal root, and a palatal root with one canal in each root, were the most common. Two separate roots with three separate canals were the most common in primary mandibular first molars, whereas two separate roots with two canals each in both roots were more common in mandibular second primary molars.