Tiempo empleado para estimar edad dental en niños peruanos comparando el método de Demirjian y el cuadro integral del enfoque de Demirjian: un estudio piloto / Time spent to estimate dental age in peruvian children comparing the demirjian method and the comprehensive chart based on demirjian method: a pilot study

El objetivo de este estudio fue comparar el tiempo empleado al estimar la edad dental (ED) entre el método propuesto por Demirjian et al. y el cuadro integral del enfoque de Demirjian (DAEcc) utilizando radiografías panorámicas digitales de individuos peruanos de 5 a 13 años residentes en Lima. Se realizó un estudio no experimental, comparativo, transversal y retrospectivo. Se utilizaron 100 radiografías panorámicas digitales que presentaban siete dientes permanentes mandibulares izquierdos. Una odontóloga forense capacitada y calibrada determinó el tiempo utilizado en evaluar la maduración dental y la estimación de ED con dos métodos (Demirjian y DAEcc). La unidad de medida utilizada fue los minutos (min.). No hubo diferencias en el tiempo de evaluación del estadio de maduración dental entre ambos métodos (p<0,05). El tiempo para estimar ED fue estadísticamente inferior con DAEcc (2,09 min) que con Demirjian (4,19 min). La diferencia del tiempo total de evaluación resultó estadísticamente significativa entre ambos métodos (Δ2,1 min.; 2,05-2,11; p=0,000). La aplicación del DAEcc redujo en 50 % el tiempo empleado en estimar ED en comparación con los cuadros propuestos por Demirjian. Aunque la odontología forense se centra en el estudio de la eficacia de estimación de la edad, es necesario abordar también su uso práctico.

SUMMARY: The objective of this study was to compare the time used to estimate dental age (DA) between the method proposed by Demirjian et al., and the comprehensive chart for dental age estimation (DAEcc) using digital panoramic radiographs of Peruvian individuals aged 5 to 13 years residing in Lima. A non- experimental, comparative, cross-sectional and retrospective study was carried out. 100 digital panoramic radiographs showing seven mandibular left permanent teeth were used. A trained and calibrated forensic odontologist determined the time used to assess tooth maturation and DA estimation with two methods (Demirjian and DAEcc). The unit of measurement used was minutes (min.). There were no differences in the evaluation time of the dental maturation stage between both methods (p<0.05). The time spent to estimate DA was statistically less with DAEcc (2.09 min) than with Demirjian (4.19 min). The difference in total evaluation time was statistically significant between both methods (Δ2.1 min; 2.05-2.11; p=0.000).The application of DAEcc reduced by 50 % the time spent estimating DA compared to the method proposed by Demirjian. Although forensic odontology focuses on the study of the effectiveness of age estimation, its practical use needs to be addressed as well.

Panoramic radiography and cone-beam computed tomography to measure distances between root apexes and anatomical structures / Radiografía panorámica y tomografía computarizada de haz cónico para medir distancias entre ápices radiculares y estructuras anatómicas

Aim: To compare the accuracy of the panoramic radiography with cone-beam computed tomography (CBCT) scans in measuring the distances between root apexes and the adjacent anatomical structures including the maxillary sinus and the mandibular canal. Material and Methods: A total of 200 CBCT scans (100 maxillary and 100 mandibular) from patients who also had corresponding panoramic radiography were selected. Linear measurements (in mm) presenting centralized image were made between the apexes of the maxillary teeth and the inferior wall of the maxillary sinus, and between the apexes of the mandibular teeth and the superior border of the mandibular canal by using specific software for panoramic radiography and the measurements on the coronal sections in CBCT scans. Data were submitted to inferential statistical analysis and Student's t-test for comparison between measurements. Results: CBCT scans were significantly more accurate than panoramic radiography to measure the distances between the apexes of the maxillary teeth and the inferior wall of the maxillary sinus (p<0.05) and between the apexes of the mandibular teeth and the superior border of the mandibular canal or mental foramen (p<0.05). Conclusion: CBCT scans present more accurate measurements than panoramic radiography.

Objetivo: Comparar la precisión de la radiografía panorámica con las exploraciones de la tomografía computarizada dental de haz en cónico (CBCT) para medir las distancias entre los vértices radiculares y las estructuras anatómicas adyacentes, incluidos el seno maxilar y el canal mandibular. Material y Métodos: Se seleccionaron un total de 200 tomografías CBCT (100 maxilares y 100 mandibulares) de pacientes que además tenían la correspondiente radiografía panorámica. Se realizaron mediciones lineales (en mm) que presentaban imagen centralizada entre los ápices de los dientes maxilares y la pared inferior del seno maxilar, y entre los ápices de los dientes mandibulares y el borde superior del canal mandibular mediante software específico para radiografía panorámica. y las mediciones en las secciones coronales en escaneos CBCT. Los datos se sometieron a análisis estadístico inferencial y prueba t de Student para comparación entre mediciones. Resultados: Las exploraciones CBCT fueron significativamente más precisas que la radiografía panorámica para medir las distancias entre los ápices de los dientes maxilares y la pared inferior del seno maxilar (p<0,05) y entre los ápices de los dientes mandibulares y el borde superior de los dientes mandibulares. canal o agujero mentoniano (p<0.05). Conclusión: Las exploraciones CBCT presentan mediciones más precisas que la radiografía panorámica.

Tooth and pulp chamber automatic segmentation with artificial intelligence network and morphometry method in cone-beam CT / Segmentación automática de cámaras dentales y pulpares con red de inteligencia artificial y método de morfometría en TC de haz cónico

SUMMARY: This study aims to extract teeth and alveolar bone structures in CBCT images automatically, which is a key step in CBCT image analysis in the field of stomatology. In this study, semantic segmentation was used for automatic segmentation. Five marked classes of CBCT images were input for U-net neural network training. Tooth hard tissue (including enamel, dentin, and cementum), dental pulp cavity, cortical bone, cancellous bone, and other tissues were marked manually in each class. The output data were from different regions of interest. The network configuration and training parameters were optimized and adjusted according to the prediction effect. This method can be used to segment teeth and peripheral bone structures using CBCT. The time of the automatic segmentation process for each CBCT was less than 13 min. The Dice of the evaluation reference image was 98 %. The U-net model combined with the watershed method can effectively segment the teeth, pulp cavity, and cortical bone in CBCT images. It can provide morphological information for clinical treatment.

RESUMEN: El objetivo del presente estudio fue extraer estructuras dentarias y óseas alveolares desde imágenes CBCT automáticamente, lo cual es un paso clave en el análisis de imágenes CBCT en el campo de la estomatología. En este estudio, se utilizó la segmentación de tipo emántica para la segmentación automática. Se ingresaron cinco clases de imágenes CBCT marcadas, para el entrenamiento de la red neuronal U-net. El tejido duro del diente (incluidos esmalte, dentina y cemento), la cavidad de la pulpa dentaria, hueso cortical, hueso esponjoso y otros tejidos se marcaron manualmente en cada clase. Los datos se obtuvieron de diferentes regiones de interés. La configuración de la red y los parámetros de entrenamiento se optimizaron y ajustaron de acuerdo con un análisis predictivo. Este método se puede utilizar para segmentar dientes y estructuras óseas periféricas mediante CBCT. El tiempo del proceso de segmentación automática para cada CBCT fue menor a 13 min. El "Dice" de evaluación de la imagen de referencia fue de 98 %. El modelo U-net combinado con el método "watershed"puede segmentar eficazmente los dientes, la cavidad pulpar y el hueso cortical en imágenes CBCT. Puede proporcionar información morfológica para el tratamiento clínico.

Concordancia en la evaluación de tratamientos de endodoncia preclínica: un estudio en diferentes unidades académicas / Agreement in the evaluation of preclinical endodontic treatments: a study at different academic units

Objetivo: El objetivo del presente estudio fue analizar el grado de concordancia entre alumnos y docentes de dife- rentes unidades académicas en la evaluación radiográfica de tratamientos endodónticos realizados en dientes humanos "ex vivo". Materiales y métodos: Un docente y un alumno de grado pertenecientes a siete unidades académicas, dos cáte- dras de Endodoncia de Argentina y una de México, Ecuador, España, Chile y Portugal evaluaron radiográficamente 357 tratamientos endodónticos realizados "ex vivo" por estu- diantes de grado. De acuerdo con su criterio individual, de- terminaron si cada uno de esos tratamientos podía ser con- siderado como correcto o incorrecto. El coeficiente Kappa fue utilizado para el análisis estadístico. Resultados: El valor de Kappa fue entre 0,04 y 0,30 considerado como indicador de escasa concordancia y varió según la unidad académica en la que se habían registrado los datos. Conclusión: El nivel de concordancia en la categoriza- ción del resultado de la evaluación radiográfica de tratamien- tos endodónticos varía entre alumnos de grado y docentes de las distintas unidades académicas (AU)

Aim: To analyse the degree of agreement between stu- dents and teachers at different academic units regarding the radiographic evaluation of endodontic treatments performed on human teeth "ex vivo". Materials and methods: One teacher and one student from seven Academic units, two Departments of Endodontics in Argentina and one each in Mexico, Ecuador, Spain, Chile and Portugal conducted a radiographic evaluation of 357 endodontic treatments performed by undergraduate students. According to their individual criteria, they determined wheth- er the treatments were adequate or inadequate. Kappa coeffi- cient was used for statistical analysis. Results: The Kappa value was between 0.04 and 0.30, considered as an indicator of poor agreement, and varied ac- cording to the academic institution where the data had been recorded. Conclusion: The level of agreement in classifying the re- sults of the radiographic evaluation of endodontic treatments varies between undergraduate students and teachers at the different academic units (AU)

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.

Research on a segmentation and evaluation method combining tooth morphology features / Investigación sobre un método de segmentación y evaluación que combina características morfológicas dentales

SUMMARY: To explore a new semi-automatic method to segment the teeth from the three-dimensional volume data which acquired from cone beam computed tomography (CBCT) scanner. Scanned dental cast models are used to evaluate the segmentation accuracy. The CBCT data are loaded to ORS software. Based on gray value, a semi-automatic method was used to segment teeth and then the segmented teeth were saved in STL format data. Smooth the mesh data in the Geomagic Studio software. The upper and lower dental cast models were scanned by a white light scanner and the data was saved in STL format too. After registering the model data to teeth data, the deviation between them was analyzed in the Geomagic Qualify. All teeth could be obtained, the method is simple to use and applied in orthodontic biomechanics. The entire process took less than 30 minutes. The actual measured Root Mean Square (RMS) value is 0.39 mm, less than 0.4 mm. This method can segment teeth from the jaw quickly and reliably with a little user intervention. The method has important significance for dental orthodontics, virtual jaw surgery simulation and other stomatology applications.

RESUMEN: El objetivo de este estudio fue explorar un nuevo método semiautomático para segmentar los dientes a partir de datos de volumen tridimensional adquiridos mediante escáner de tomografía computarizada de haz cónico (CBCT). Los modelos escaneados de moldes dentales se utilizan para evaluar la precisión de la segmentación. Para los datos CBCT se utilizó el software ORS, y basado en el valor gris, se usó un método semiautomático para segmentar los dientes los que posteriormente se guardaron en datos de formato STL. Los datos se ingresaron en el software Geomagic Studio. Los modelo dentales superior e inferior se escanearon con un escáner de luz blanca y la información también se guardó en formato STL. Después del registro y comparación de los datos del modelo y los datos de los dientes, la desviación entre estos se analizó en el programa Geomagic Qualify. Usando este método fue posible obtener de forma fácil todos los dientes y además aplicar en la biomecánica de ortodoncia. El proceso completo demoró menos de 30 minutos. El valor real medido de la raíz cuadrada media fue de 0,39 mm, menos de 0,4 mm. Este método puede segmentar los dientes mandibulares de forma rápida y confiable, con una mínima intervención del usuario. El método tiene una importancia crítica para la ortodoncia, simulaciones virtuales de las cirugías de la mandíbula y otras aplicaciones en estomatología.

Micro-computed tomographic analysis of apical foramen enlargement of mature teeth: a cadaveric study / Análisis mediante micro-CT del ensanchamiento del foramen apical de dientes maduros: un estudio cadavérico

Revitalization procedures have been extensively studied during the last decade and offers several advantages over root canal treatment, such as the recovery of the natural immune system. Mature teeth have a small apical foramen diameter (AFD), which could impair the ingrowth of tissue into the root canal. We analysed three methods for apical foramen enlargement by instrumentation in in situ human teeth and evaluated the damage over hard tissues produced by the techniques. Tooth length (TL), defined as the length from the most coronal part of the crown to the point at which the file abandons the root canal, was calculated. Forty-four in situ teeth were randomized: Group I: instrumentation 0.5 mm coronal to TL; Group II: at TL level; Group III: 0.5 mm beyond TL. Teeth were instrumented up to K-file #80. The mandibles were scanned in a micro-CT device before and after treatment. Group I: Only 20 % of teeth presented an enlarged AFD, with augmentation of 0.09 mm. No damage to hard tissues was observed. Group II: 71.4 % of the teeth presented an enlarged AFD with augmentation of 0.42 mm. 35.7 % presented damage to periapical tissues. Group III: 86.7 % presented an enlarged AFD with augmentation of 0.43 mm. 46.7 % presented damage to periapical tissues. All groups presented similar prevalence of teeth with dentine thickness less than 1mm. All mandibular incisors presented areas of thickness less than 1mm. Instrumentation 0.5 mm beyond TL is the most effective technique.

La revitalización de dientes necróticos ha sido ampliamente estudiada durante la última década y ofrece varias ventajas sobre la endodoncia convencional, tal como la recuperación del sistema inmunitario natural del diente. Los dientes maduros tienen un diámetro de foramen apical (FA) pequeño, lo que podría afectar el crecimiento de tejido en el conducto. Se evaluaron tres métodos para la ampliación del foramen apical en dientes humanos in situ y se evaluó el daño sobre los tejidos duros producidos por las técnicas. Mediante radiografía periapical se calculó la longitud del diente (TL), definida como la longitud desde la parte más coronal de la corona hasta el punto en que la lima abandonó el conducto radicular. En el estudio fueron aleatorizados 44 dientes in situ: Grupo I: instrumentación 0,5 mm coronal a TL; Grupo II: a nivel TL; Grupo III: 0,5 mm más allá de TL. Los dientes fueron instrumentados hasta la lima K #80. Las mandíbulas se escanearon en un dispositivo de microCT antes y después del tratamiento. Grupo I: solo el 20 % de los dientes presentaron un diámetro de FA ensanchado, con un aumento de 0,09 mm. No se observó daño a los tejidos duros. Grupo II: el 71,4 % de los dientes presentaban un FA ensanchado con un aumento de 0,42 mm. El 35,7 % presentó daño a los tejidos periapicales. Grupo III: el 86,7 % presentó un FA ensanchado con un aumento de 0,43 mm. El 46,7 % presentó daño a los tejidos periapicales. Todos los grupos presentaron una prevalencia similar de dientes con un espesor de dentina inferior a 1mm. Todos los incisivos mandibulares presentaban áreas de grosor inferior a 1mm. La instrumentación 0,5 mm más allá de TL es la técnica más efectiva, aunque se debe tener especial consideración en aspectos como el debilitamiento de la estructura dentaria.

Estimación de edad mediante la relación área pulpa/diente en caninos mandibulares: estudio en una muestra chilena utilizando el Método de Cameriere / Dental age estimation by pulp/tooth ratio in mandibular canines: study in a Chilean sample by Camerierer's Method

La estimación de edad compone un aspecto importante en investigaciones forenses. Diferentes métodos se han descrito en odontología forense basadas en la correlación entre la edad y estructuras dentales. Cameriere et al. proponen un método cuantitativo para estimación de edad en adultos, a partir de la evaluación de la relación del área pulpa/diente, en base a la aposición de dentina secundaria. El objetivo del estudio fue desarrollar modelos de regresión para la estimación de edad dental mediante la relación área pulpa/diente en caninos inferiores en una muestra Chilena. Se analizaron 212 radiografías periapicales digitales (RPD) (86 hombres y 126 mujeres) de caninos mandibulares mediante el programa Image J para establecer el área de la pulpa y el diente. Se registraron los datos de sexo y edad de las RPD seleccionadas en forma ciega. Fueron desarrollados modelos de regresión lineal simples para la estimación de edad. El coeficiente de determinación para R33 fue 27,8 % y de 29,6 % para R44, con un error absoluto medio de 11,02 años y 10,37 años respectivamente. El análisis de ANOVA no mostró diferencias estadísticamente significativas para las relaciones área pulpa/diente de caninos según sexo (p> 0,05). Según los resultados obtenidos, la metodología propuesta por Cameriere et al. es fiable para estimar la edad dental mediante la relación área pulpa/diente en adultos. Sin embargo, en los modelos de regresión desarrollados para la población Chilena, se puede afirmar que el ajuste indicado por los coeficientes de determinación muestran incerteza entre las variables área pulpa/diente y edad cronológica en caninos inferiores, por lo tanto se sugiere considerar otros métodos adicionales para estimar edad en esta población.

Age estimation is an important aspect In forensic investigations. Different methods in forensic odontology based on the correlation between age estimation in adults, from the analysis of the pulp/tooth area, based on the apposition of secondary dentine. The aim of the study was to develop regression models for the dental age estimation by the relation pulp/tooth area, in lower canines in a Chilean sample, using digital peri-apical radiographs (DPR) applying Cameriere's method. We analyzed 212 DPR (86 males and 126 females) mandibular canines through Image J program to measure the pulp/tooth area. Age and sex information was obtained of the DPR's blindly selected. We developed simple linear regression models for age estimation. The coefficient of determination to R33 was R2 age and dental structures have been described. Cameriere et al. proposed a quantitative method for 27.8 % and R2 29.6 % to R44, with a mean absolute error of 11.02 years, to R33 and 10.37 years to R44. ANOVA analysis showed no statistically significant differences for the pulp/tooth relation area of canines according to sex (p> 0.05). According to the results, the Cameriere's et al., method is reliable for dental age estimation according to pulp/tooth ratio in adults. However, in the regression models developed for Chilean population, it can be stated that the adjustment indicated by the coefficients of determination, show uncertainty between the pulp / tooth area and chronological age in lower canines, therefore it is suggested to use additional estimation methods for age in this population.

Forensic Individual Identification Based on the New Coding Method of Oral Pano-ramic Tomography / 法医学杂志

Objective To discuss a new coding method for individual identification based on oral panoramic tomography, analyze the diversity of different coding modules in nonhomologous images and the consistency and the matching rate of the coding indexes of different coding modules in homologous images, and evaluate the application value of the different modules and the new coding method in individual identification. Methods The oral panoramic tomography images of 1 000 patients with permanent teeth were collected retrospectively. Each patient had two images taken at different times （called the Early database and the Late database according to the chronological order）. Each image was coded according to the designed coding method. A computer program was designed to compare the diversity of different modules, and calculate the diversity and consistency of different coding modules as well as the matching rate of the coding indexes. Results The diversity of the 4 modules that reflected teeth characteristics was much higher than that of other modules in the same database. The highest diversity was noticed in the module of right mandibular teeth in samples of both databases. The coding consistencies of the 4 modules were all above 50%. Besides, 90.2% of the matching rates of indexes of homologous images were over 80%. Conclusion The 4 modules have higher application value in individual identification, especially the right mandibular teeth. The coding method has a certain value in forensic individual identification.

CBCT assessment of bone thickness in maxillary and mandibular teeth: an anatomic study

Abstract The site of the sinus tract depends on the rate of resistance against abscess exudate drainage, bone morphology, and distance from the root apex to the outer cortical bone. Objective To assess apical bone thickness in buccal and palatal/lingual aspects of maxillary and mandibular teeth, using a high-resolution cone-beam computed tomography (CBCT) system. Methodology In total, 422 CBCT examinations were included in the study, resulting in a sample of 1400 teeth. The scans were acquired by PreXion 3D, with a high-resolution protocol. The bone thickness was taken as the distance between the center of the apical foramen and the buccal and lingual/palatal cortical bone. The quantitative variables were expressed as mean values±standard deviation. The independent samples were analyzed using the t-test or the Mann-Whitney test (p<0.05). Results The lowest mean value of bone thickness was observed in the buccal cortical bone of the upper canines (1.49 mm±0.86) and in the upper central incisors (1.59 mm±0.67). In premolar teeth, the lowest values were found in the buccal cortical bone of upper first premolars (1.13 mm±0.68). In the posterior teeth, the lowest values were found in the buccal cortical bone of upper first molars (1.98 mm±1.33). In the lower second molar region, the buccal cortical bone (8.36 mm±1.84) was thicker than the lingual cortical bone (2.95 mm±1.16) (p<0.05). Conclusions The lowest mean values of bone thickness are in the buccal cortical bone of the maxillary teeth. In the mandible, bone thickness is thinner in the buccal bone around the anterior and premolar teeth, and in the lingual aspect of mandibular molars. All these anatomic characteristics could make the occurrence of the sinus tract more susceptible in these specific regions of the maxillary and mandibular alveolar bone.

In-depth morphological evaluation of tooth anatomic lengths with root canal configurations using cone beam computed tomography in North American population

Abstract Objective This study aimed to assess the association between tooth size and root canal morphology by using CBCT analysis. Methodology In this retrospective study, tooth anatomic lengths (crown and root lengths, buccolingual and mesiodistal dimensions) of 384 patients were assessed and correlated with Vertucci's root canal morphology classification. Data was analyzed for gender-related differences using the independent sample t-test, ANOVA, and the Pearson's correlation for a possible relation between anatomic lengths and canal morphology. Results The maxillary first and second premolars showed a greater predilection for Type IV and II variants, respectively, while the mandibular first premolar showed a greater predilection for Type II canal system. The root canal system of the mandibular second premolar showed maximal diversity (47% Type I, 30% Type II, and 20% Type III). The dimensions were greater in men regardless of tooth type. The most significant relation (p<0.05) between the anatomic size and canal morphology was observed in the maxillary first premolars, followed by the mandibular canines (buccolingual dimension) and the lower second premolars (crown length). Negative correlations existed between the crown length and the patient's age for the anterior teeth and mandibular second premolar (r=−0.2, p<0.01). Conclusions The most common canal formation for anterior teeth was the Type I. The anatomic lengths had the strongest influence on the canal configuration of the maxillary first premolar, with Type IV being the most common root canal system. The mandibular second premolars showed maximal diversity in the canal classification terms and had a significant correlation with their crown lengths. Clinical Relevance The complex relationship between the canal morphology and anatomic tooth sizes need meticulous awareness and recognition during endodontic procedures, in conjunction with the demographic variabilities.

Importância da radiografia intra-oral em tratamentos periodontais de cães e gatos: relato de três casos / The importance of intra-oral radiographs in periodontal treatments of dogs and cats: three cases reports

A radiografia intra-oral é um método de diagnóstico por imagem essencial em pacientes submetidos a tratamento odontológico de qualquer natureza, especialmente em casos de doença peridontal. Permite a avaliação de estruturas ósseas e dentárias, elucidando múltiplos diagnósticos que não são firmados clinicamente. Inclui-se no estudo radiográfico a análise da integridade da lâmina dura, do ligamento periodontal, de afecções dentárias como abscessos periapicais, cistos, alterações de desenvolvimento coronário e radicular, agenesias, dentes inclusos ou supranumerários, raízes fraturadas remanescentes na região subgengival, reabsorções dentárias ou ósseas (associadas à doença periodontal ou neoplasias) e estruturas internas do dente (diâmetro da câmara pulpar e canal radicular). O presente artigo visa, portanto, mostrar através da apresentação de casos clínicos, a relevância do exame radiográfico para a correta abordagem diagnóstica e terapêutica de afecções subclínicas, mesmo em pacientes sem sinais de dor ou supostamente portadores de apenas gengivite. Foram relatados um caso de hipoplasia radicular, um de cisto de origem dentária e outro de reabsorção dentária, todos diagnosticados após a realização da documentação radiográfica intra-oral.

The intra-oral radiography is an essential diagnosis imaging method, in patients submitted to dental treatment of any nature, especially cases of periodontal diseases. It allows the evaluation of structural bone and dental diseases, elucidating multiple diagnoses, which are not clinically proven. The radiographic study includes the analysis of the periodontal ligament and lamina dura integrity, dental anomalies such as periapical abscesses, cysts, coronary and root development failures, agenesis, unerupted or supernumerary teeth, fractured roots remaining in the subgingival area, tooth or bone resorption, (associated with neoplasia or periodontal disease) and Internal tooth structures such as diameter of pulp chamber and root canal. The present article aims to show, through clinical case reports, the relevance of the radiographic examination towards the correct diagnosis and therapeutic approach of subclinical infections, even in patients without signs of pain or supposedly gingivitis bearers. Amongst the reported cases, there is a root hipoplasia, a dental origin cyst and a tooth resorption, all diagnosed after intra-oral radiographic completion.

Correlación entre la edad cronológica y dental con los estadios de maduración vertebral en pacientes de 5 a 15 años / Correlation between the chronological and dental age with the vertebral maturation stages in patients from 5 to 15 years old

El uso de un método rápido y efectivo para la estimación de la maduración esquelética de los pacientes pediátricos es fundamental para la aplicación oportuna de tratamientos ortopédicos/ortodónticos. En Odontología Pediátrica, la toma de una radiografía panorámica, como método diagnóstico de rutina, puede servir para estimar con precisión el estadio de maduración en estos pacientes, mediante el cálculo de la edad dental. El objetivo del presente trabajo fue determinar la correlación entre las edades cronológica y dental con los estadios de maduración esquelética de las vértebras cervicales, a través del método estadístico no paramétrico con Rho de Spearman. Se utilizó un diseño observacional, transversal y analítico. La muestra consistió en 516 expedientes de pacientes entre los 5 y 15 años de edad, sistémicamente sanos, con radiografías panorámica y lateral de cráneo, tomadas en la misma fecha. Se determinó la edad cronológica de cada paciente según su historia clínica. Se realizó el cálculo de la edad dental de cada paciente con el método de Demirjian, y se determinó el estadio de maduración de vértebras cervicales con el método de Lamparski. Se determinó una correlación de 72 % entre la edad cronológica y la maduración ósea vertebral; una correlación del 66 % entre la edad dental y la maduración ósea, y una correlación del 86 % entre la edad cronológica y la dental. De acuerdo con estos resultados, tanto la edad cronológica y dental presentan una alta correlación con la edad de maduración vertebral. Se concluye así que la edad dental y cronológica son indicadores apropiados para estimar el estadio de maduración esquelética de los pacientes pediátricos.

The use of fast and effective methods for estimating the skeletal maturity for pediatric patients, is fundamental for the opportune application of orthopedic/orthodontic treatments. In pediatric dentistry, the panoramic radiography as a routine diagnostic method, can be used to estimate the stage of maturation in these patients, through the calculation of dental age. The aim of the present study is to determine the correlation between the chronological and dental ages, with the cervical vertebrae stages of skeletal maturity, through the non-parametric Spearman statistical method. An observational, transversal, and analytical design was employed. The sample consisted of 516 records from patients between 5 and 15 years of age, systemically healthy, with panoramic and lateral skull radiographs taken on the same date. The chronological age of each patient was determined according to the clinical history. Dental age of each patient was calculated with the Demirjian approach, and the stage of maturation of cervical vertebrae was determined by means of the Lamparski method. The results showed a correlation of 72 % between chronological age and bone maturation, a correlation of 66 % between dental age and bone maturation, and a correlation of 86 % between chronological and dental age. It is concluded that both chronological and dental age exhibit a high correlation with the correspondent stage of vertebral maturity. Thus, dental and chronological age are appropriate indicators to estimate, with high precision the stage of skeletal maturation in pediatric patients.

Lesión quística en un premolar superior relacionada con un molar primario pulpotomizado / Lesão cística num pré-molar superior relacionada com um molar decíduo pulpotomizado / Cystic lesion on an upper premolar related to pulpotomized primary molar

La pulpotomía es un tratamiento endodóncico frecuentemente realizado en niños. A pesar de que se trata de un procedimiento seguro, se han reportado efectos secundarios. Caso clínico: Un niño de 10 años de edad llegó para revisión dental. Los resultados de los rayos X mostraron una lesión radiolúcida por encima del segundo molar primario superior izquierdo, relacionada con el diente permanente. La extracción de los primeros y segundos molares primarios se realizó bajo anestesia local. La lesión quística se eliminó quirúrgicamente, y el análisis histopatológico mostró un quiste dentígero inflamatorio. Una cavidad casomarsupialización fue creada para permitir la erupción de los premolares. Después de un año de seguimiento, el hueso se había regenerado totalmente y los premolares habían erupcionado completamente. Conclusión: Este caso resalta la necesidad de una supervisión regular de los dientes pulpotomizados, incluso si están asintomáticos, además de la fase de erupción de los dientes permanentes y primarios. La marsupialización del quiste dentígero permitió el tratamiento eficaz y la preservación del premolar involucrado.

A pulpotomia é um tratamento endodôntico frequentemente realizado em crianças. Ainda que seja um procedimento seguro, efeitos colaterais foram reportados. Relato de caso: Um menino de 10 anos veio para um check-up dentário. Os resultados da radiografia mostraram uma lesão radiolúcida acima do segundo molar superior esquerdo, relacionada com o dente permanente. A extração dos primeiros e segundos molares decíduos foi realizada sob anestesia local. A lesão cística foi removida cirurgicamente e a análise histopatológica revelou um cisto dentígero inflamado. Uma cavidade marsupialização foi criada para permitir a erupção dos pré-molares. Depois de um ano de acompanhamento, o osso encontrava-se completamente regenerado e os pré-molares tinham erupcionado completamente. Conclusão: Este relato de caso destaca a necessidade de uma supervisão regular dos dentes pulpotomizados, mesmo se estes são assintomáticos, tal como acontece na fase de erupção dos dentes permanentes e decíduos. A marsupialização do cisto dentígero proporcionou um tratamento eficaz e permitiu a preservação do pré-molar envolvido.

Pulpotomy is a frequent endodontic treatment performed in children. Even though it is a safe procedure, side effects have been reported. Case Report: A 10-year-old boy came for a dental checkup. X-ray findings showed a radiolucent lesion above the maxillary second deciduous left molar, related to the permanent tooth. Extraction of the first and second deciduous molars was realized under local anesthesia. The cystic lesion was removed surgically, and histo-pathological analysis showed an inflammatory dentigerous cyst. A marsupialization cavity was created to allow eruption of the premolars. After a one-year follow-up, the bone had completely regenerated, and premolars had completely erupted. Conclusion: This case report highlights the need for regular supervision of pulp treated teeth, even if they are asymptomatic, as well as eruption phase of permanent and deciduous teeth. Marsupialization of the dentigerous cyst provided effective treatment and allowed preservation of the involved premolar.

Mandibular radiomorphometric assessment of bone mineral density in survivors of pediatric hematopoietic stem-cell transplantation

OBJECTIVE: Hematopoietic stem-cell transplantation (HSCT) childhood survivors of hematologic malignancies are prone to develop late osteopenia and osteoporosis. The purpose of this retrospective study was to quantitatively and qualitatively assess bone mineral density (BMD) in HSCT childhood survivors and to compare the effectiveness of both qualitative and quantitative assessment methods. METHODS: DESIGN BMD assessment using panoramic radiographs of childhood HSCT survivors aged 3.69-18.88 years using two radiomorphometric indexes. Case-control double-blinded comparison of panoramic radiographic images from childhood HSCT survivors and age- and sex-matched healthy controls. Quantitative assessment was performed by measuring the cortical bone width bilaterally at the mental foramen level. Qualitative assessment was performed using the mandibular cortical index bilaterally on all panoramic images. RESULTS: Radiographs were taken 6.59-83.95 months after bone marrow transplantation [median±SD=25.92±24.9 months]. Fifty-two panoramic radiographic images were analyzed: 21 from HSCT survivors and 31 from healthy controls aged 3.69-25.1 years [mean±SD=11.89±5.28 years]. The mandibular cortical bone width was 17% smaller in childhood HSCT survivors than in healthy controls (case group: 2.420, control group: 3.307; p=0.00617). Qualitative analysis revealed an increased frequency of severe mandibular cortical erosion in childhood HSCT survivors, although no significant difference was observed (case group: 1.540, control group: 1.490; p=0.32). The interobserver agreement was 85% (Kappa index). CONCLUSIONS: HSCT childhood survivors exhibit quantitative and qualitative mandibular bone impairments. Further studies are needed to establish an association between mandibular cortical bone impairment and osteoporosis.

Age estimation by pulp/tooth area ratio in anterior teeth using cone-beam computed tomography: comparison of four teeth

Abstract Objectives Age estimation is one of the most important factors in forensic medicine. Measuring secondary dentin deposition using cone-beam computed tomography images is an easy and noninvasive method. The aim of this study was to evaluate cone-beam computed tomography images as a reliable method to estimate chronological age by pulp/teeth ratio in anterior teeth in Iranian population. Methodology A total of 649 CBCT images from 377 Iranian patients aged between 20 and 69 years were evaluated. Pulp/teeth ratio (PTR) in maxillary and mandibular canine and central incisor teeth was measured in the axial and sagittal sections using OnDemand 3D Dental software. The Pearson correlation coefficient was determined to evaluate the correlation between the variables. Linear regression analysis, as well as age estimation formula, was used for each tooth separately. Results The regression analyses indicated that maxillary central incisors were more reliable for age estimation (R2=0.586 and standard error of estimate=7.045) compared with the other anterior teeth studied. Maxillary canine teeth had the lowest predictive power (R2=0.392 and standard error of estimate=8.387). Also, comparison of the axial and sagittal sections showed that the axial sections had a higher predictive power. (R2=0.48 for axial plans and R2=0.328 for sagittal plans) Conclusion The use of cone-beam computed tomography in age estimation by pulp/teeth ratio of anterior teeth is useful and a reliable method for age estimation in Iranian population.

Concordancia entre la Edad Cronológica y Edad Dental Según el Método de Demirjian en Pacientes Mexicanos / Concordance Between Chronological Age and Dental Age by the Demirjian Method in Mexican Patients

RESUMEN: En la práctica forense un dato de gran importancia es la edad cronológica de los pacientes, este puede obtenerse de múltiples formas, algunas son complejas, costosas y tardadas, el cálculo de la edad dental (ED) por vía radiográfica es sencillo y de bajo costo, ha mostrado ser concordante con la edad cronológica (EC), presentando variaciones por sexo y raza. El objetivo de este estudio es establecer la concordancia de la ED y la EC en población mexicana. Este es un estudio transversal, observacional en el que un residente estandarizado evaluó 88 Ortopantomografías (44 femeninos y 44 masculinos) de manera cegada respecto a la EC, del archivo de la clínica de Ortodoncia de la Facultad de Odontología de la Universidad Autónoma de Sinaloa, con edades desde los 3 a los 16 años. Existe una diferencia en meses de 3,36 entre los valores ED y EC en el total de la población (p=0,384) con una concordancia de 94 % entre los valores. Al analizarlos por sexo los masculinos muestran una diferencia de 5,16 (P=0,785) con una concordancia de 96 % y los femeninos de 7,32 (P=0,095) con una concordancia de 92 %. La ED según Demirjian es un método confiable para estimar la EC en esta población.

ABSTRACT: In forensic practice knowledge of chronological age (CA) is an important factor, and it can be estimated by several methods. Some are complex, expensive and time consuming. Dental Age (DA) estimation by radiographic methods is easy and inexpensive, it has shown to be consistent with chronological age (CA), with variations according to sex and race. The objective of this study was to estimate the concordance between DA and CA in Mexicans. This is a cross sectional, observational study, in which a standardized dental resident reviewed 88 Orthopantomographies (44 female, 44 male), blinded to CA, of the Orthodontics School Files of the Universidad Autónoma de Sinaloa, the population was 3 to 16 years of age. The main difference in months between DA and CA was 3.36 (p=0.384) and 94 % of concordance, the analysis by sex for males showed a main difference of 5.16 (P=0.785) and 96 % concordance; for females it showed 7.32 (P=0.095) and concordance of 92 %. In conclusion the DA according to Demirjian is a reliable method to estimate CA in these patients.

The implications of different lateral wall thicknesses on surgical access to the maxillary sinus

Abstract: The objective of this study was to measure the topographic thickness of the lateral wall of the maxillary sinus in selected Asian populations. Measurements were made on the lateral walls of maxillary sinuses recorded using CBCT in a convenient sample of patients attending an Asian teaching hospital. The points of measurement were the intersections between the axes along the apices of the canine, first premolar, and second premolar and along the mesiobuccal and distobuccal apices of the first and second molars and horizontal planes 10 mm, 20 mm, 30 mm and 40 mm beneath the orbital floor. The CBCT images of 109 patients were reviewed. The mean age of the patients was 33.0 (SD 14.8) years. Almost three quarters (71.8%) of the patients were male. The mean bone thickness decreased beginning at the 10-mm level and continuing to 40 mm below the orbital floor. Few canine regions showed encroachment of the maxillary sinus. The thickness of the buccal wall gradually increased from the canine region (where sinus encroachment of the canine region was present) to the first molar region, after which it decreased to the thickness observed at the canine region. The buccal wall of the maxillary sinus became thicker anteroposteriorly, except in the region of the second molar, and thinner superoinferiorly. These changes will affect the approach used to osteotomize the lateral sinus wall for oral surgery and for the sinus lift procedure.

External cervical resorption: diagnostic and treatment tips

ABSTRACT External cervical resorption is caused, almost exclusively, by dental trauma - especially those characterized by concussion - and is a dental disease to be diagnosed and treated accurately by endodontists. However, the vast majority of the cases is initially diagnosed by an orthodontist, due to the imaging possibilities in standardized documentations. Among the causes of external cervical resorption, it is common to mistakenly attribute it to orthodontic treatment, traumatic occlusion or even to chronic inflammatory periodontal disease. External cervical resorption is associated to dental trauma in several situations mentioned in this paper. In old cases, and eventually still nowadays, it may have been induced by internal tooth bleaching, which is increasingly less frequent in endodontically treated teeth. There are some tips to be followed and some care that must be taken during the diagnosis and treatment of external cervical resorption clinical cases. The present study lists foundations that will allow the professional to perform safely and accurately in each specific case. Some of these tips and care measures are of orthodontic nature.

RESUMO A reabsorção cervical externa é provocada, quase exclusivamente, pelo traumatismo dentário, especialmente os do tipo concussão. Ela constitui uma doença dentária a ser diagnosticada e tratada com precisão pelo endodontista, mas a grande maioria dos casos é inicialmente diagnosticada pelo ortodontista, em função das oportunidades imagiológicas nas documentações padronizadas. Entre as causas da reabsorção cervical externa, é comum atribuí-la equivocamente ao tratamento ortodôntico, à oclusão traumática ou, ainda, à doença periodontal inflamatória crônica. A reabsorção cervical externa está associada ao traumatismo dentário em várias situações mencionadas neste trabalho. Em casos mais antigos - e ainda hoje, eventualmente -, pode ter sido induzida pelo clareamento dentário interno, cada vez menos realizado em dentes endodonticamente tratados. Algumas dicas e cuidados devem ser tomados no diagnóstico e no tratamento dos casos clínicos de reabsorção cervical externa. No presente trabalho, são listados fundamentos para que o clínico possa atuar com segurança e precisão em cada caso, especificamente. Nessas dicas e cuidados, encontram-se alguns de natureza ortodôntica.

Dentoalveolar mandibular changes with self-ligating versus conventional bracket systems: A CBCT and dental cast study

OBJECTIVE: The aim of the present study was to compare dentoalveolar changes in mandibular arch, regarding transversal measures and buccal bone thickness, in patients undergoing the initial phase of orthodontic treatment with self-ligating or conventional bracket systems. METHODS: A sample of 25 patients requiring orthodontic treatment was assessed based on the bracket type. Group 1 comprised 13 patients bonded with 0.022-in self-ligating brackets (SLB). Group 2 included 12 patients bonded with 0.022-in conventional brackets (CLB). Cone-beam computed tomography (CBCT) scans and a 3D program (Dolphin) assessed changes in transversal width of buccal bone (TWBB) and buccal bone thickness (BBT) before (T1) and 7 months after treatment onset (T2). Measurements on dental casts were performed using a digital caliper. Differences between and within groups were analyzed by Student's t-test; Pearson correlation coefficient was also calculated. RESULTS: Significant mandibular expansion was observed for both groups; however, no significant differences were found between groups. There was significant decrease in mandibular buccal bone thickness and transversal width of buccal bone in both groups. There was no significant correlation between buccal bone thickness and dental arch expansion. CONCLUSIONS: There were no significant differences between self-ligating brackets and conventional brackets systems regarding mandibular arch expansion and changes in buccal bone thickness or transversal width of buccal bone. .

OBJETIVO: o objetivo do presente estudo foi comparar as alterações dentoalveolares transversais e a espessura óssea da arcada inferior em pacientes submetidos ao tratamento ortodôntico utilizando sistemas de braquetes autoligáveis ou convencionais. MÉTODOS: uma amostra de 25 pacientes requerendo tratamento ortodôntico foi recrutada com base no tipo de braquete. No Grupo 1, 13 pacientes foram tratados com braquetes autoligáveis (SLB, slot 0,022"); o Grupo 2 incluiu 12 pacientes, nos quais foram colados braquetes convencionais (CLB, slot 0,022"). Utilizou-se tomografia computadorizada de feixe cônico e um programa 3D (Dolphin) para avaliar as alterações pré-tratamento (T1) e 7 meses após o início desse (T2). As medições em modelos de gesso foram realizadas com o auxílio de um paquímetro digital. As diferenças intergrupos, bem como intragrupo, foram analisadas por meio de teste t de Student. Além disso, o coeficiente de correlação de Pearson foi utilizado. RESULTADOS: alterações dentoalveolares significativas foram observadas em ambos os grupos. Entretanto, não houve diferenças significativas entre os grupos. Houve uma diminuição da espessura óssea na região posterior e das medidas transversais em ambos os grupos. Não houve uma correlação significativa entre a espessura óssea posterior e a expansão da arcada dentária, em nenhum dos dois sistemas de braquetes utilizados. CONCLUSÕES: comparando-se o uso dos aparelhos autoligáveis e convencionais, concluiu-se que não houve diferenças dentoalveolares significativas quanto à expansão da arcada inferior e quanto à espessura óssea posterior. .