O condicionamento de tecido peri-implantar na reabilitação estética de próteses unitárias sobre implantes: relato de caso clínico / Peri-implant tissue conditioning in the esthetic rehabilitation of unitary prostheses on implants: Clinical case report / Acondicionamiento del tejido periimplantario en la rehabilitación estética de prótesis unitarias sobre implantes: Informe de caso clínico

Introdução:A reabilitação protética implantosuportada de espaços edêntulos na região do sorriso é um desafio para o cirurgião-dentista. Para obtenção da estética em próteses unitárias sobre implante é necessário considerar aspectos como o correto posicionamento do implante e sua harmonia com os tecidos moles e duros. Objetivo:relatar o resultado estético e funcional de um tratamento com auxílio de coroa provisória associada ao condicionamento gengival na reabilitação final com coroa unitária implantossuportada. Relato de caso clínico: Paciente MJFA, 36 anos, sexo feminino, compareceu à clínica de Prótese Dentária do Departamento de Odontologia/UFRN queixando-se de trauma dentário com perda do elemento dentário 15 e necessidade de "ficar com sorriso mais bonito". Após instalação de implante com conexão cônica e período de osseointegração, foi realizada a confecção da coroa provisória sobre implante e iniciada sessões de condicionamento gengival por meio de acréscimos com resina acrílica, utilizando a técnica de pressão gradual sob a margem gengival. Observou-se uma melhora no tecido periimplantar e um perfil de emergência adequado. O caso possui proservação de 3 anos. Conclusões:a realização de condicionamento gengival previamente a prótese final é uma etapa importante para alcançar umareabilitação com característicasestéticas e funcionais semelhantes à de dentes naturais (AU).

Introduction:Implant-supported prosthetic rehabilitation of edentulous spaces in the smile areais a challenge for dental surgeons. To achieve pleasing esthetics in single implant prostheses it is necessary to consider aspects such as the correct positioning of the implant and its harmony with the soft and hard tissues.Objective:to report the esthetic and functional results of a treatment with the aid of a provisional crown associated with gingival conditioning in the final rehabilitation with a single implant-supported crown.Clinical case report:Patient MJFA, 36 years old, female, attended the Prosthodonticsclinic of the Department of Dentistry/UFRN complaining of dental trauma with loss of tooth 15 and the need to "havea more beautiful smile". Afterinstalling an implant with a conical connection and a period of osseointegration, a temporary crown was made on the implant and gingival conditioning sessions were initiatedby means of acrylic resin augmentations, using the gradual pressure technique under the gingival margin. An improvement in the peri-implant tissue and an adequate emergenceprofile were observed. The case has a 3-year follow-up period.Conclusions:performing gingival conditioning prior to the final prosthesis is an important step in achieving rehabilitation with esthetic and functional characteristics similar to those of natural teeth (AU).

Introducción: La rehabilitación protésica implantosoportada de espacios edéntulos en el áreade la sonrisa es un desafío para el cirujano dentista. Para conseguir una buena estética en las prótesis unitarias sobre implanteses necesario tener en cuentaaspectos como el posicionamiento correctodel implante y su armonía con los tejidos blandos y duros.Objetivo: informar losresultadosestéticosy funcionalesde un tratamiento con ayuda de coronas provisionales asociado al acondicionamiento gingival en la rehabilitación final con corona única implantosoportada.Relato de caso clínico: Lapaciente MJFA, 36 años, sexo femenino, se dirigióa la clínica de Prostodonciadel Departamento de Odontología/UFRN quejándose de un traumatismodental con pérdida del diente 15 y de la necesidad de "tener una sonrisa más bonita". Después de la colocación de un implante con conexión cónica y de un período de osteointegración, se realizó una corona provisional sobre el implante y se iniciaron sesiones de acondicionamiento gingival con aumentos de resina acrílica, utilizando la técnica de presión gradual bajo el margen gingival. Se observó una mejora del tejido periimplantario y un perfil de emergencia adecuado. El caso tiene un seguimiento de 3 años. Conclusiones: el acondicionamiento gingival previo a la prótesis definitiva es una etapaimportante para conseguiruna rehabilitación con características estéticas y funcionales similares a las de los dientes naturales (AU).

Oral Healthcare Services Delivered During COVID-19 Lockdown: A Report from Eastern Mediterranean Region

ABSTRACT Objective: To describe oral healthcare services administered during the lockdown in the Eastern Mediterranean region and to investigate the role of socio-professional characteristics of dental practitioners or their self-reported COVID-19 infection. Material and Methods: A questionnaire was distributed to dental practitioners in all healthcare sectors in Jordan, Egypt, and Saudi Arabia. Results: There was a total of 335 participants, with the majority being females (N=225, 67.2%) and general practitioners (N=202, 60.3%). Cellulitis was the most common emergency encountered (N=108). The most common urgent procedures were for pulpitis, abscesses, and pericoronitis (N=191, 130, and 95, respectively). Country-specific significant associations were pulpitis in Egypt and Jordan, broken symptomatic teeth in Jordan, and biopsy in Egypt (p<0.05). The Ministry of Health was significantly associated with the management of dental infections, avulsion, and orthodontic emergencies, while university hospitals were significantly associated with advanced restorative procedures (p<0.05). Male practitioners performed significantly more procedures, particularly surgical emergencies (p<0.05). Conclusion: Dental infections were the most common complaints among dental patients during lockdown. Countryand sector-specific dental procedures are detected. Male gender seems to play a determinant role in performing a higher number of procedures, particularly for surgical emergencies (AU).

Assessment of root canal anatomy of maxillary and mandibular canine teeth: a cone-beam computed tomography study / Evaluación de la anatomía del canal radicular de caninos maxilares y mandibulares: un estudio de tomografía computarizada de haz cónico

Abstract To investigate the root canal anatomy of permanent maxillary and mandibular canines in a Turkish subpopulation using cone beam computed tomography (CBCT). Retrospective CBCT data of 300 patients admitted to our clinic between 2016 and 2018 were screened and evaluated. A total of 235 patients, 100 males and 135 females, aged 14-76 years (mean age 37.27±13.40) were included in this study. A total of 191 (44,8%) maxillary canine teeth and 235 (55,2%) mandibular canine teeth were examined. The number of roots and root canal morphology according to Vertucci's classification, the presence of accessory canals, and the position of the apical foramen of the root were analyzed. The effect of gender and age on the incidence of root canal morphology was also investigated. The majority of the teeth had a Type I canal configuration in both maxillary canines (100%) and mandibular canines (92,8%). In the mandibular canines the other canal patterns found were Type III (6,8%), and Type II (0,4%). Apical foramen was centrally positioned in the majority of the teeth, 70,2% and 66,8% in maxillary and mandibular canines, respectively. The occurrence of two roots in mandibular canines was 3,8% and the root canal separation was found 53,8% and 46,2% in the middle and cervical third of the root, respectively. No significant statistical difference was observed effect of gender and age on the incidence of the root canal morphology and the position of the apical foramen. Due to the diverse morphology and the potential presence of a second canal for canine teeth among the Turkish subpopulation, dentists should perform endodontic treatments with greater care. CBCT is an accurate tool for the morphological assessment of the root canals.

Resumen Investigar la anatomía del conducto radicular de los caninos maxilares y mandibulares permanentes en una subpoblación turca utilizando la tomografía computarizada de haz cónico (CBCT). Se examinaron y evaluaron los datos CBCT retrospectivos de 300 pacientes ingresados en nuestra clínica entre 2016 y 2018. Un total de 235 pacientes, 100 hombres y 135 mujeres, de entre 14 y 76 años (edad media de 37,27±13,40) fueron incluidos en este estudio. Se examinaron un total de 191 (44,8%) dientes caninos maxilares y 235 (55,2%) dientes caninos mandibulares. Se analizó el número de raíces y la morfología del conducto radicular según la clasificación de Vertucci, la presencia de conductos accesorios y la posición del foramen apical de la raíz. También se investigó el efecto del sexo y la edad en la incidencia de la morfología del conducto radicular. La mayoría de los dientes tenían una configuración de conductos de tipo I tanto en los caninos maxilares (100%) como en los caninos mandibulares (92,8%). En los caninos mandibulares los otros patrones de conductos encontrados fueron el Tipo III (6,8%) y el Tipo II (0,4%). El foramen apical estaba situado en posición central en la mayoría de los dientes, 70,2% y 66,8% en los caninos maxilares y mandibulares, respectivamente. La ocurrencia de dos raíces en los caninos mandibulares es del 3,8% y la separación del conducto radicular se encontró en el tercio medio y cervical de la raíz en el 53,8% y el 46,2%, respectivamente. No se observó ninguna diferencia estadística significativa en el efecto del sexo y la edad sobre la incidencia de la morfología del conducto radicular y la posición del foramen apical. Debido a la diversa morfología y a la posible presencia de un segundo conducto en los dientes caninos entre la subpoblación turca, los odontólogos deberían realizar los tratamientos endodónticos con mayor cuidado. La CBCT es una herramienta precisa para la evaluación morfológica de los conductos radiculares.

Correlação entre os estágios de maturação da sutura palatina mediana e das vértebras cervicais / Correlation between the maturation stages of the median palatal suture and cervical vertebrae

Introdução: Atualmente, a avaliação da maturação da sutura palatina mediana (MSPM) em pacientes que precisam ser submetidos à expansão rápida da maxila é realizada por meio de tomografias computadorizadas de feixe cônico (TCFC). No entanto, doses adicionais de radiação são induzidas ao paciente para a aquisição desse exame. Objetivo: Correlacionar os estágios de MSPM com os estágios de maturação das vértebras cervicais (MVC). Material e métodos: Um total de 268 TCFC da região da cabeça e do pescoço de indivíduos de ambos os sexos e com idades variando entre 5 e 76 anos foram analisadas de forma cega por uma única examinadora. O estágio de MSPM foi avaliado por meio da observação da maxila no corte axial e foi classificado como A, B, C, D ou E. Por outro lado, o estágio de MVC foi avaliado por meio do corte sagital das vértebras cervicais e foi classificado como CS1, CS2, CS3, CS4, CS5 ou CS6. A concordância intraexaminador foi avaliada por meio do Coeficiente Kappa. O teste de Correlação de Spearman foi utilizado para avaliar a correlação entre os estágios de MSPM e os estágios de MVC. Resultados: Uma correlação positiva forte foi encontrada entre os estágios de MSPM e MVC. Os estágios A e B mostraram correlação com os estágios CS1, CS2 e CS3. Diferentemente, o estágio C se correlacionou com maior frequência com os estágios CS4 e CS5. Por fim, os estágios D e E, se mostraram mais frequentes em indivíduos nos estágios CS5 e CS6 de forma similar. Conclusão: A predição da MSPM por meio da MVC em telerradiografias laterais pode ser uma alternativa viável à avaliação sutural na TCFC em pacientes nos estágios CS1, CS2 e CS3. A partir do estágio CS4, uma TCFC é recomendável para avaliar com maior segurança o estágio de MSPM e definir a melhor modalidade de expansão (AU).

Introduction: Currently, the assessment of maturation of the midpalatal suture (MPSM) in patients who need to undergo rapid maxillary expansion is performed using cone-beam computed tomography (CBCT). However, additional doses of radiation are induced to the patient for the acquisition of this exam. Objective: To correlate the stages of MPSM with the stages of maturation of the cervical vertebrae (CVM). Material and methods: A total of 268 CBCT of the head and neck of individuals of both sexes and aged between 5 and 76 years were analyzed blindly by a single examiner. The MPSM stage was assessed by observing the maxilla in the axial view and was classified as A, B, C, D or E. On the other hand, the CVM stage was assessed in the sagittal view of the cervical vertebrae and was classified as CS1, CS2, CS3, CS4, CS5 or CS6. Intraexaminer agreement was analyzed using the Kappa coefficient. Spearman's Correlation test was used to assess the correlation between MPSM and CVM stages Results: A strong positive correlation was found between MPSM and CVM stages. Stages A and B showed correlation with stages CS1, CS2 and CS3. Differently, stage C correlated more frequently with stages CS4 and CS5. Finally, stages D and E were more frequent in individuals in stages CS5 and CS6, similarly. Conclusion: The prediction of MPSM by assessing CVM in lateral cephalograms seems to be a viable alternative to the sutural evaluation in CBCT in patients in stages CS1, CS2 and CS3. From the CS4 stage onwards, a CBCT is recommended to assess the MPSM stage and define the most adequate expansion modality for patients (AU).

In Vivo Detection of External Apical Root Resorption Induced by Apical Periodontitis Using Periapical Radiography and Cone-Beam Computed Tomography

Abstract Objective: To compare the accuracy of periapical radiography (PR) and cone-beam computed tomography (CBCT) for the detection of external apical root resorption (EARR) due to root canal contamination. Material and Methods: Dog's teeth with experimentally induced root resorption due to root canal contamination underwent or not root canal treatment (n=62). True positives (TP), false positives (FP), true negatives (TN), and false negatives (FN) in PR and CBCT diagnoses were determined using histopathologic findings as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (TP + TN) in the diagnosis of EARR were calculated. Data were compared using chi-squared test (α=0.05). Results: EARR was detected in 35% of roots by PR, in 47% by CBCT, and in 50% of the roots by microscopy (p=0.03 PR versus microscopy; p=0.67 CBCT versus microscopy). Overall, CBCT produced more accurate diagnoses than PR (p=0.008). PR and CBCT allowed the identification of large resorption in 100% of the cases and showed the same accuracy. However, for small resorptions, PR showed an accuracy of 0.83, whereas CBCT showed an accuracy of 0.96 (p=0.003). Conclusion: Cone-beam computed tomography showed higher accuracy in detecting external apical root resorption of endodontic origin.

Prevalencia y distribución de cálculos pulpares en un grupo de adultos peruanos: un estudio mediante tomografías de haz cónico / Prevalence and Distribution of Pulp Stones in a Group of Peruvian Adults: a Cone Beam Computed Tomography Study

Resumen: El objetivo de este estudio fue evaluar la prevalencia y distribución de cálculos pulpares en un grupo de adultos peruanos mediante tomografía de haz cónico (CBCT). Materiales y métodos: Se analizaron 67 tomografías de haz cónico seleccionadas aleatoriamente de un centro tomográfico en Lima, Perú. Fueron evaluadas 1263 imágenes de piezas dentarias mediante el tomógrafo Point 3D Combi 500 S. El análisis de las imágenes se realizó con el software Real Scan y todas las piezas dentarias fueron evaluadas en las vistas sagital, axial y coronal. Todas las medidas fueron sometidas a prueba de chi cuadrado. (p<0.05). Resultados: De un total de 67 pacientes, un 83,58% presentaron calcificaciones y de 1263 piezas dentarias, un 30.8% a través de la CBCT. La prevalencia de calcificaciones fue mayor en el sexo femenino que masculino. Los molares maxilares y mandibulares fueron los grupos de dientes con mayor frecuencia de cálculos pulpares. Se encontró significancia entre los cálculos pulpares y el género, rango de edad, tipo y estado de pieza dentaria. Conclusiones: La primera molar maxilar tuvo mayor prevalencia de calcificaciones pulpares que la mandibular. La presencia de caries aumentó la posibilidad de aparición de estas calcificaciones, específicamente en maxilar. La CBCT podría ser una herramienta sensible para detectar cálculos pulpares. El conocimiento de la distribución de cálculos pulpares puede ayudar a los dentistas en el tratamiento clínico de endodoncia.

Abstract: The aim of this study was to evaluate the prevalence and distribution of pulp stones in a group of Peruvian adults using cone beam tomography (CBCT). Materials and methods: 60 randomly selected CBCT from a tomographic center in Lima, Peru were analyzed. A total of 1263 images of teeth using the Point 3D Combi 500 S tomograph were evaluated. Images analysis was performed with Real Scan software and all teeth were evaluated in sagittal, axial and coronal views. All measurements were subjected to a chi square test. (p<0.05). Results: Of the 1263 teeth, 30.8% presented pulp calcifications through the CBCT. The prevalence of calcifications was higher in women than in men. The maxillary and mandibular molars were the groups of teeth with the highest frequency of pulp stones. There was significance between the pulp stones and the gender, age range, type and state of the tooth. Conclusions: The maxillary first molars had a higher prevalence of pulp calcifications than the mandibular ones. The presence of caries increased the possibility of the appearance of these calcifications, specifically in the maxillary teeth. CBCT could be a sensitive tool to detect pulp stones. Knowledge of the distribution of pulp stones can help dentists in the clinical treatment of endodontics.

Accuracy of cone-beam CT in detecting vertical root fractures in teeth with post-endodontic restorations: an in vitro study

The aim of this study was to evaluate the accuracy of cone-beam CT (CBCT) for the detection of artificially created vertical root fractures (VRF) in extracted teeth restored with metallic (MP) and fiberglass (FGP) posts. After root canal obturation, 60 extracted human premolars were scanned by using the highest-resolution settings of a CBCT unit. Theprepared roots were randomly divided into three groups: group C (control group): non-restored and non-endodontically treated teeth (n = 20); group MP (n = 20); group FGP (n = 20). In all groups, 10 teeth were artificially fractured. Two external and independent observers blindly recorded the presence or absence of VRF. Sensitivity, specificity, accuracy, intra-and interobserver agreement were calculated. Kappa value for inter-and intraobserver agreement was 0.82 and 0.84 respectively, demonstrating goodagreement. The highest values for sensitivity (0.80 -0.90), specificity (1.00) and accuracy (0.90 -0.95) were found in the control group. The teeth with FGP restoration presented the lowest sensitivity (0.30 -0.50) and accuracy (0.60 -0.65) values. Both examiners had a good performance in the diagnosis of fractures in teeth with MP, with accuracy ranging between 0.85 -0.90. The presence of MP did not influence accuracy; however, the presence of FGP reduced the diagnostic capacity of CBCT.

Relationship of Angulation of Maxillary Impacted Canines with Maxillary Lateral Incisor Root Resorption

ABSTRACT Objective: To assess the relationship of ɑ and ß angles of maxillary impacted canines with maxillary lateral incisor root resorption. Material and Methods: For this, 40 patients (between 11 and 45 years) with impacted maxillary canines presenting to a private orthodontic clinic were evaluated.20% of the cases were male and 80% were female. The ɑ and ß angles were measured on panoramic radiographs to determine the angulation of impacted canine. CBCT scans had been taken by ProMax 3D CBCT system were used to examine lateral root reorption. The relationship between the size of ɑ and ß angles of impacted maxillary canines and root resorption in the adjacent maxillary lateral incisor was analyzed using SPSS version 22. Results: The mean size of ɑ and ß angles had no significant correlation with the presence/absence, location, or severity of root resorption in the adjacent lateral incisor or the buccolingual position of impacted canine. The ɑ and ß angles in impacted maxillary canines cannot be used to determine the incidence or severity of root resorption in the adjacent lateral incisor. Conclusion: No significant association between ɑ and ß angles and incidence or severity of root resorption in the adjacent lateral incisor was found.

Dentin Thickness of Pulp Chamber Floor in Primary Molars: Evaluation by Cone-Beam Computed Tomography

ABSTRACT Objective: Use cone-beam computed tomography (CBCT) images to evaluate the dentin thickness of the pulp chamber floor in primary molars. Material and Methods: Cross-sectional study, conducted with CBCT images of teeth of children. Primary molars with preserved pulp chamber floor were included. The dentin thickness of the pulp chamber floor in the primary molars was measured linearly in CBCT cross-sections. Data were descriptively analyzed and the Mann-Whitney test was applied (p<0.05). Results: 27 CBCT exams and 123 primary molars of children aged 4 to 13 years were analyzed; the majority was female (52.0%). In maxillary molars, the median dentin thickness was 1.50 (0.6-2.2) mm in the first and 1.65 (0.6-2.3) mm in the second (p=0.049) molars. In mandibular molars, the median was 1.20 (0.3-1.7) mm in the first and 1.60 (1.0-2.2) mm in the second (p<0.001) molars. Children aged 4 to 8 years showed less dentin thickness (p<0.001). Conclusion: The median dentin thickness of the pulp chamber floor in primary molars was 1.50 mm, ranging from 0.3 to 2.3 mm. Less dentin thickness was associated with younger children, teeth in the mandibular arch, and first molars.

Tooth Coronal Index: A Novel Tool For Age Estimation on Cone-Beam Computed Tomography

ABSTRACT Objective: To evaluate dental age assessment reliability through Tooth Coronal Index (TCI) method. Material and Methods: The cone-beam computed tomography (CBCT) scans of 160 individuals aged between 20-70 years were analyzed in the present study. The height of the crown, i.e., coronal height, and the height of the coronal pulp cavity, i.e., coronal pulp cavity height, of mandibular second premolars and first molars were calculated and then TCI was measured. The actual age of a subject was compared with TCI of tooth and the acquired data were subjected to Pearson's correlation and unpaired t-tests. Results: Negative correlation was observed between the real age and TCI of mandibular first molar (r = -0.094, p=0.382) and second premolar (r = -0.176, p=0.0961. Statistically significant difference was observed between actual age and TCI for mandibular second premolar and first molar (p<0.001). Conclusion: Tooth coronal index has the potential to estimate age of an individual on CBCT scans. It is simple, cost-effective than histological methods and can be applied to both living and unknown dead.

Accuracy of Cone Beam Computed Tomography in the Assessment of Mandibular Molar Furcation Defects

Abstract Objective: To evaluate the accuracy of cone-beam computed tomography (CBCT) in the assessment of mandibular molar furcation defects. Material and Methods: Thirty patients with furcation defects were selected, oral hygiene instructions, scaling, and root planing with ultrasonic devices and hand instruments and occlusal adjustments were performed. Pre-surgical clinical measurements were carried out at the buccal aspect of the selected mandibular molars. The horizontal furcation measurements were measured with a Nabers Probe starting at the furcation entrance to the greatest horizontal depth. The degree of furcation involvement was graded from 0 to III. Bone loss in the horizontal and vertical direction and the width of the furcation entrance were measured on CBCT and after reflecting the full-thickness flap and debridement of the defects. The data were analyzed using t-test and Pearson's correlation coefficient. Results: The width of furcation entrance in clinical method was 3.27 ± 0.77, while in CBCT method was 3.35 ± 0.71, clinically the vertical bone loss was 3.61±1.09, while in CBCT was 3.57 ± 1.15, horizontal bone loss in clinical method was 5.08 ± 2.21, while in CBCT was 5.11 ± 2.23. No significant difference between the two methods was noted, and a high correlation between the two methods was observed. With regards to the agreement between the two methods of assessment, the width of furcation entrance revealed a difference between the two methods by 0.08 ± 0.21, while vertical bone loss showed difference between the two methods by -0.04 ± 0.19, the horizontal bone loss showed a mean difference between the two methods by 0.03 ± 0.21. Conclusion: CBCT provided high accuracy for the furcation involvement detection and anatomy of surrounding periodontal tissues.

The Using Virtual Computer-Assisted Planning in Orthognathic Surgery: A Systematic Review and Meta-Analysis

Abstract Objective: To use virtual computer-assisted planning in orthognathic surgeries through meta-analysis and systematic review. Material and Methods: This search took place between 2010 and 2019. The databases searched in this domain included MEDLINE, PubMed, Cochrane Library, Embase, ISI, and Google scholar. Accordingly, the abstracts of the articles were initially reviewed and the ones that had the most coordination with the study objectives were selected. Then, the full texts of the articles were examined; and finally, five studies were selected. In addition to reviewing the related literature, the results were extracted and entered into the meta-analyzer Stata V.14 to summarize the final results. Results: The sample size in this study was at a range from 6 to 28 patients and a total number of 85 patients had participated in the given investigations. As well, CT and CBCT were selected as imaging methods. Clinical imaging and analysis were also employed in computer-assisted planning in all five studies. Subsequently, surgical planning was performed and the virtual splint was designed while the planning time was 225 minutes and 145 minutes in two studies. Conclusion: The present results supported computer-assisted planning and the quality of scientific evidence.

Efficacy of the Tent-Pole Technique in Horizontal Ridge Augmentation

Abstract Objective: To evaluate the efficacy of the technique for ridge augmentation prior to implant placement. Material and Methods: Six patients with nine sites presenting an initial ridge width of smaller than 4 mm were included in this study. The tent-pole technique (combination of osteosynthesis screws measuring 1.5 mm in diameter, ABBM, and resorbable collagen membrane) was applied at defect sites. After eight months of healing time, implants were placed in the treated sites. The primary outcomes (radiographic initial ridge width, re-entry ridge width, ridge width gain) were measured by cone-beam computed tomography in reference buccopalatal cross-sections and the secondary outcomes (clinical parameters) were recorded by a digital caliper at the first and second stages. Results: After grafting, the radiographic ridge width increased by 3.02 ± 1.11 mm (1.57-4.75 mm) at 2 mm below the crest and 3.32 ± 1.70 mm (0.23-5.66 mm) at 6 mm below the crest significantly (p< 0.05). For clinical results, the mean horizontal dimension gain was 3.21 ± 1.04 mm (1.83-4.57 mm), while the mean reduction in dimension was 0.38 ± 0.33 mm. These results were statistically significant (p<0.05). Uneventful healing and no infections or membrane exposure were recorded at all sites during the study process. Three of nine (33.33%) defect sites required additional bone grafting. Conclusion: The tent-pole technique is an effective method for increasing the horizontal ridge dimension, minimizing postoperative complications, and facilitating subsequent implant placement.

Comparative Measurement of Tooth Length: Actual vs. Orthopantomography and CBCT-Based Measurements

Objective: To compare the reliability of cone beam computed tomography (CBCT) in assessing the tooth length in comparison to orthopantomography (OPG). Material and Methods: Forty patients scheduled for extraction as result of caries or periodontal involvements were randomly selected. Panoramic radiographs and CBCT images were obtained and subsequently patients were subjected for extraction. Teeth with poor prognosis were extracted and stored in 10% formalin. Radiographic teeth measurements were carried out on OPG and CBCT images using a software and the actual tooth length (A-L) measurements were carried out with a digital vernier caliper. The data collected were statistically analyzed for paired "t" test significance of differences and Pearson's correlation at 5% level of confidence. Results: There was significant difference comparing all three actual tooth length (A-L) and CBCT- and OPG-measured tooth lengths. A significant positive correlation was observed among all the measurements. Conclusion: CBCT images exhibited accuracy over panoramic images even though the measurements are still significantly different from actual anatomical tooth lengths.

Evaluation of Incidental Findings on Cone Beam Computed Tomography

Objective: To assess the prevalence of incidental findings in relation to the side of a patient's face, location, and age group on cone beam computed tomography. Material and Methods: 175 CBCT examinations were performed on patients aged between 12 and 77 years, consisting of recordings of the anatomical location and findings following each examination. For standardization of tomographic evaluations, acquired images were analyzed by two previously trained expert radiologists. After positional adjustment of the multi-dimensional images on the monitor screen, examination of each scan was conducted simultaneously on the coronal, axial, and sagittal planes. Fisher's exact tests and Chi-square tests were used to compare the frequencies of incidental findings using a significance level of 0.05. Results: The most frequent incidental finding was maxillary sinus mucosal thickening, which occurred on the right and left side in 46.3% and 46.9% of the patients, respectively. The second most frequent incidental finding was flattening of the mandibular condyle, occurring on the right and left side in 29.7% and 24% of the patients, respectively. No significant difference was observed among the individual age groups. The number of incidental findings per patient varied from 0 to 5 on the right side and left side and from 0 to 12 in total. The Kendall correlation coefficient for the number of incidental findings between the sides was 0.25 (p<0.0001), indicating a weak but significant and positive association between the sides in relation to the number of incidental findings. The mean total number of incidental findings was 4.07. Conclusion: The prevalence of the individual incidental findings and the total number of findings were not statistically different. However, some alterations were more likely to be observed bilaterally.

Evaluation of Alveolar Bone on Dental Implant Treatment using Cone Beam Computed Tomography

Objective: To observe the outcomes of dental implant treatment based on the evaluation of bone conditions using Cone Beam Computed Tomography (CBCT). Material and Methods: A total of 31 dental implants were collected for the present study. Subsequently, mesial and distal bone losses were examined, while buccal and lingual bone thickness were measured at 7 levels. Evaluation and interpretation of CBCT results was performed by 3 independent examiners. Results: The average of mesial bone loss was 1.08 mm and 1.36 mm on distal bone. Every dental implant had lingual/palatal bone on level 1 to 3, only 1 (6.5%) didn't have bone on level 4, 3 implants (9.7%) had no bone at level 5 and 6, and 22 implants (74.2%) had no bone at level 7/implant platform. There were 8 implants (25.8%) didn't have buccal bone at level 7, only 1 implant (3.2%) didn't have buccal bone at level 2,4,5 and 6, and there were 2 implants (6.5%) had no buccal bone on level 3. Dehiscence / fenestration can be seen on 90% of the implant subjects. Conclusion: These bone loss condition could be consequence of several factors such as infection, diagnosis, treatment plan, and operator's surgery skills. The implants that placed without CBCT could lead to operator miscalculation on bone condition, therefore in moderate to advanced cases, the use of CBCT should be mandatory for treatment plan.

Evaluation of the Relationship Between Morphology, Volume, and Density of the Mandible and Dentofacial Vertical Dimension Using Cone Beam Computed Tomography

Abstract Objective: To evaluate the relationship between mandibular shape, mandibular bone density, cortical bone thickness, and condylar volume and facial height using a cone-beam computed tomography (CBCT). Material and Methods: Fifteen female patients (16-25 years old) were included in this study. The following measurements were performed on CBCT radiographs; inter-canine and inter-molar width of the mandible at three vertical points (alveolar crest, apex and basal bone), mandibular cortical bone thickness in disto molar and canine sections, bone density of the mandibular body and condylar volume. Afterward, subjects were divided into short face, normal and long face groups according to the Frankfort-mandibular plane angle (FMA) measured on lateral cephalograms obtained from CBCTs. Data were analyzed using Pearson correlation, one-way ANOVA, and post-hoc analysis Results: The inter-canine width of the mandible at the apical point in long face subjects was greater than in the other groups. Likewise, the cortical bone thickness was significantly higher in long face patients compared to the short face and normal subjects. There was no statistically significant difference in mandibular density or condylar volume between patients with various vertical heights (p>0.1) Conclusion: Vertical growth pattern is correlated with mandibular morphology to some extent.

Simulation of Stress Distribution on the Upper First Molar and Alveolar Bone with the Transpalatal Arch and Upper Second Molar Using Finite Element Analysis

Abstract Objective: To evaluate the differences in the stress distribution on the upper first molar with and without transpalatal arch and a second molar when a 150 g force is applied during canine distalization using finite element analysis. Material and Methods: We constructed several models with data obtained by scanning human skulls using cone beam computed tomography. A robust three-dimensional maxillary model was then constructed by assembling the previously completed robust models of the maxilla and second molar with and without transpalatal arch, and canine distalization was simulated using a 150 g force. The data consisted of color spectrum figures representing the stress distribution Results: For the upper first molar and its alveolar bone, there was a statistically significant difference in the stress distribution between the upper first molar with transpalatal arch, the upper first molar without transpalatal arch, and the upper first molar with transpalatal arch and a second molar as reinforcement Conclusion: Stress distribution on the first molar and alveolar bone, indicated by the maximum and minimum principal stress, as well as the pressure von Mises, exhibited a similar pattern. The highest amount of stress was observed in the model of the first molar without transpalatal arch, followed by the model of the first molar with transpalatal arch and, finally, the model of the first molar with transpalatal arch and a second molar.

Evaluation of Peri-Implant Bone Reduction Levels from Superimposition Perspective: Pilot Study among Ukrainian Implantology Practice

Objective: To evaluate the possibility and efficiency of using adapted peri-implant bone evaluation method based on the principle of graphical superimposition and compare it to the possibilities of using sagittal sections of CBCT results to register the dynamics of peri-implant bone changes during the first year of implant functioning. Material and Methods: 108 pairs of DICOM data sets were selected and pre-anonymized and coded in Planmeca Romexis® Viewer software. Each pair of datasets consisted of a CBCT file, obtained immediately after the installation of a dental implant, and one year after its operation. The first method of peri-implant bone changes evaluation was carried out by analyzing the sagittal sections of the CBCT data from the mesial and distal sides of the implant. The second method was followed by original algorithm, which included specific steps of superimposition of graphical images. Results: Superimposition method helped to establish volumetric parameter of circular bone reduction around dental implants after 1 year of their functioning. Such average values for the maxillary distal implants were 3.547 mm3, maxillary frontal implants ­ 3.118 mm3, mandibular distal implants ­ 2.614 mm3, mandibular frontal implants ­ 2.456 mm 3. Correlation values between averages of vertical bone loss parameters and volumetric bone loss parameters riches r=0.954. Among all patients the highest peri-implant bone reduction rates were observed in the distal and frontal areas of the maxilla, even though statistical difference among such parameters of implants installed at the areas of mandible and maxilla was not significant (p > 0.05). Such observation was established during the analysis of results obtained both by digital sagittal cross section from CBCT results and by superimposition method. Conclusion: Using the superimposition principle allows us to evaluate the individual indicator of volumetric bone loss at the peri-implant region. The possibility of taking into account the parameters of bone tissue volume reduction, instead of just geometrical parameter of bone height, allows to individualize the parameters of bone loss among patients of different prosthetic rehabilitation group.

Comparison of Digital Diagnostic Value and Cone Beam Computed Tomography (CBCT) in Determining Vertical Root Fracture in Single- Root Teeth

Objective: To compare the accuracy of digital radiography and CBCT for the diagnosis of vertical root fractures in single root teeth. Material and Methods: For this descriptive-analytic study, 50 non-fractured, single-root teeth were selected. The teeth were randomly divided into a control and an experimental group (25 teeth in each group). The teeth in the control group did not have vertical root fractures. In the test group, after preparing the access cavity, the root canal was cleared and loosened up to No. 80 file, then a vertical root fracture was created by one of the K-Reamers Nos. 90- 130.The images were prepared by CBCT radiography in axial and cross-sectional slices and in digital radiography with PSP sensors at mesial, distal, and parallel angles. The Chi-square test was used to express the correlation of variables. Results: In the diagnosis of vertical root fractures, the sensitivity of CBCT in the axial section was 32% and in the cross-sectional slice it was 20%, whereas the specificity in both the sections was 100%. The sensitivity of the digital radiography in detecting vertical root fractures for parallel, mesial, and distal angles was 38%, 16%, and 24%, respectively. Conclusion: According to this study, the sensitivity, specificity, and accuracy of digital radiography and CBCT were not significantly different.