The impact of different dental restorations on detection of proximal caries by cone beam computed tomography.

OBJECTIVES: To evaluate the effects of different types of restorations on observer ability to detect proximal caries in CBCT images. MATERIALS AND METHODS: Forty human premolars and molars with artificial proximal caries were placed proximal and distal to 5 molars having different restorations (amalgam, composite, resin-modified glass ionomer cement (RMGIC) fillings, zirconia, and lithium disilicate crowns) and a non-restored molar. CBCT scans were obtained using i-CAT® Next Generation. Images were rated twice by 2 observers. The exact depth of artificial caries was histologically established. Sensitivity, specificity, and area under the receiver operating characteristic curve (Az) values were calculated. RESULTS: Caries detection in teeth surfaces mesial and distal to amalgam showed compromised specificity and accuracy. Moreover, caries detection in teeth surfaces mesial to zirconia crown showed low sensitivity, specificity, and accuracy. Capability of CBCT in detection of proximal caries in teeth adjacent to composite, RMGIC, and lithium disilicate was comparable to those adjacent to non-restored molar. CONCLUSIONS: CBCT scans performed for tasks other than caries detection should be assessed for proximal caries in absence of any restorations as well as in presence of composite, RMGIC fillings, and lithium disilicate crowns. However, CBCT should not be used for proximal caries detection in teeth adjacent to amalgam and teeth surfaces mesial to zirconia crowns. CLINICAL SIGNIFICANCE: It is important to investigate the influence of artifacts produced by various restorations on CBCT-based caries detection to optimize CBCT benefits, caries diagnosis and avoid unnecessary treatment of sound surfaces.

Tooth Agenesis in Patients with Complete Bilateral Cleft Lip and Palate.

AIM: The aim of this study was to compare the number of teeth in the premaxilla (cleft area) and to assess the presence of tooth agenesis with the ultimate goal of finding whether differences existed in the two suggested subtypes of nonsyndromic bilateral cleft lip and palate (BCLP) patients. SETTINGS AND DESIGN: A retrospective comparative study was conducted, where cone- beam computed tomography (CBCT) images of 22 BCLP patients (10 males and 12 females, with age range 8 to 14, mean age 9.6 years) obtained from archive of Cleft Clinic, affiliated to the Oral and Maxillofacial Surgery department, Ain-Shams University, Cairo, Egypt were assessed. SUBJECTS AND METHODS: CBCT images were divided into two subtypes: Group (P) - this represents BCLP characterized by well-developed (P) prominent premaxilla and SNA >80 ± 2 and Group (R) - this represents BCLP characterized by ill-developed (R) rudimentary premaxilla and SNA <80 ± 2. The number of teeth in the premaxilla was evaluated, and the presence of agenesis in the premaxilla and posterior segments was documented. STATISTICAL ANALYSIS USED: Unpaired-Student's t-test was used to compare the number of teeth among the two groups and to test significance at P < 0.05. Intraobserver agreement was assessed using alpha (Cronbach) reliability analysis. A descriptive analysis using percentages was performed to characterize tooth agenesis. RESULTS: A significant difference was found in the number of teeth in the premaxilla among Group R and Group P. Maxillary lateral incisor showed the highest percentage of agenesis in the two groups followed by the maxillary second premolar. CONCLUSIONS: The number of teeth might be useful in differentiating different subtypes of nonsyndromic BCLP.