Comparison of findings of radiographic and fractal dimension analyses on panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw.

OBJECTIVES: The aim of this study was to compare the panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw (MRONJ) for differences in radiographic findings and fractal dimension (FD). STUDY DESIGN: Data were collected from the medical records of 66 patients confirmed as having MRONJ. Panoramic radiographs of 66 patients (group I; without bone exposure; and group II; with bone exposure) were evaluated for the following signs; osteolysis, cortical erosion, focal and diffuse sclerosis, sequestrum, lamina dura thickening, enhancement of the inferior alveolar canal (IAC), persistent alveolar socket, pathologic fractures, and enhancement of the external oblique ridge. FD values were also compared between groups. RESULTS: The signs of focal and diffuse sclerosis, sequestrum, and enhancement of the IAC were observed significantly more often in group II than group I (P < .05). The mean FD values were 1.42 ± 0.11 in group I and 1.44 ± 0.18 in group II and were significantly different only in 1 region but not significantly different overall. CONCLUSIONS: Radiographic alterations of bone structures appeared more frequently in patients with advanced stages of MRONJ. No significant difference was detected in the FD values among the tested regions except the cancellous bone above the mandibular canal on the distal side of the mental foramen.

Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study.

OBJECTIVE: This study was performed to evaluate the trabecular pattern of patients with cancer taking bisphosphonates on panoramic images using fractal dimension (FD) analysis by comparison with healthy subjects and to assess whether any difference exists between regions. METHODS: FD analysis was conducted using ImageJ 1.3 software (National Institutes of Health, Bethesda, MD, USA) with the box-counting method on panoramic radiographs of 33 patients taking bisphosphonates (13 males and 20 females) and 33 healthy sex- and age-matched individuals. RESULTS: FD values were higher (1.39 ± 0.14) in the study group than control group (1.38 ± 0.07) (p ≤ 0.05). No difference was detected in the FD values among the tested regions. The mean FD values in the control and study groups were as follows: region 1, 1.49 and 1.41 (p = 0.54); region 2, 1.36 and 1.37 (p = 0.84); region 3, 1.35 and 1.42 (p = 0.11); and region 4, 1.39 and 1.39 (p = 0.90), respectively. Female patients showed significantly lower values above the mandibular canal on the distal side of the second premolar and anterior to the mental foramen than did male patients (p ≤ 0.05). Age was unrelated to the FD in the study group (p ≥ 0.05). CONCLUSIONS: The FD values of the patients with cancer taking bisphosphonates were higher than those of the controls. FD analysis showed the potential for examining bone structure in panoramic radiographs. Studies with a larger sample size are necessary to confirm these results.

Evaluation of Anatomical and Volumetric Characteristics of the Nasopalatine Canal in Anterior Dentate and Edentulous Individuals: A CBCT Study.

OBJECTIVE: To examine the nasopalatine canal (NPC) anatomical and volumetric measurements in anterior edentulous (AE) and anterior dentate (AD) individuals and to compare these findings according to sex, age, shape, and severity of resorption in the premaxilla. METHODS: Two hundred cone beam computed tomography images were divided into 2 groups: AE and AD. The diameter, the length of the NPC and the width, the length of the buccal bone anterior to the NPC were measured and recorded. Linear and volumetric measurement results were evaluated in terms of age, sex, dental status, shape, and severity of resorption. RESULTS: No significant differences were observed between the AE and AD groups in terms of the NPC volume (P = 0.289). In the AE group, the spindle shape had the highest volume, and in the same group, with aging, the volume significantly increased (P = 0.00). The mean NPC volume was found to be statistically significantly larger in males than females (P = 0.02). A statistically significant relation was observed between NPC volume and resorption status. CONCLUSION: Severe bone resorption due to sustained edentation complicated implant surgery because of the increase in incisive and nasal foramen diameters and decrease in buccal residual bone dimensions. The NPC volume was found fewer in edentulous patients, and by the resorption, the volume was decreased.

Evaluation of the Characteristics and Association Between Schneiderian Membrane Thickness and Nasal Septum Deviation.

OBJECTIVE: Nasal septum deviation (NSD) is an anomaly that disturbs normal mucus drainage in sinuses, leading to recurrent sinusitis. Sinusitis, infections, and mucosal irritations are the potential causes of Schneiderian membrane thickening (SMT). The aim of this study was to evaluate the characteristics and association between NSD and SMT along with factors such as age, gender, and tooth groups using cone-beam computed tomography (CBCT) imaging. METHODS: The maxillary sinus and nasal cavity of 249 patients (136 females and 113 males) were examined retrospectively using CBCT. The statistical analysis was performed to determine the association between SMT, NSD, gender, and age. RESULTS: No statistically significant relation was detected between NSD and SMT. The NSD was found in 50.6% of patients without gender predilection. Age was not associated with the presence of NSD. The mean thickness of the membrane was least in the third molar region and highest in the first molar region. The average SMT was found to be higher in males for all the examined tooth areas (P ≤ 0.05). CONCLUSION: A retrospective evaluation of CBCT images emphasized the concept that NSD was not a factor that affected the thickening of maxillary sinus mucosa. The CBCT imaging could be used for evaluating the maxillary sinuses and nasal septum.

Evaluation of root canal sealer filling quality using a single-cone technique in oval shaped canals: An In vitro Micro-CT study.

The aim of this study was to evaluate and compare the presence of voids in oval root canals filled with different root canal sealers (EndoSequence BC Sealer, Smartpaste bio, ActiV GP) and to compare those with root canals filled with AH Plus sealer using micro-CT. In total, 40 freshly extracted human single-root maxillary premolars were used. Specimens instrumented with the EndoSequence NiTi rotary instrument were assigned randomly into four groups. In each group, root canals were filled with single-cone gutta-percha and one of the tested sealers. Each specimen was then scanned using micro-CT at a voxel resolution of 13.47 µm. Proportions of sections with voids in cross-sectional images and void volumes for each sealer were calculated in the apical, middle, and coronal thirds. Differences according to root canal sealers were evaluated statistically using the Kruskal-Wallis test and the Mann-Whitney U-test at a significance level of 5%. The analysis showed a decrease in void formation in the apical third, with a significant difference between the apical and coronal thirds among bioceramic sealers, ActiV GP, and AH Plus (p < 0.05) but no significant difference between the apical and middle thirds or between the middle and coronal thirds was found for the sealers tested (p > 0.05). All root canal sealers tested resulted in voids. The bioceramic sealers (EndoSequence BC Sealer, Smartpaste bio) produced similar voids which had the fewest in the apical third of root canals among the sealers tested which can be related due to root canal anatomy variations.

Survival rate of short, locking taper implants with a plateau design: a 5-year retrospective study.

BACKGROUND: Short implants have become popular in the reconstruction of jaws, especially in cases with limited bone height. Shorter implants, those with locking tapers and plateau root shapes, tend to have longer survival times. We retrospectively investigated the cumulative survival rates of Bicon short implants (<8 mm) according to patient variables over a 5-year period. MATERIALS AND METHODS: This study included 111 consecutively treated patients with 371 implants supporting fixed or removable prosthetics. Data were evaluated to acquire cumulative survival rates according to gender, age, tobacco use, surgical procedure, bone quality, and restoration type. Statistics were performed using chi-square, Mann-Whitney, and Kruskal Wallis H tests. RESULTS: The survival rate was 97.3% with, on average, 22.8 months of follow-up. Patients older than 60 years had higher failure rate than the other age groups (P < 0.05). Placed region, age, and bone quality had adverse effects on survival rate in the <8 mm implant group with statistically significant difference (P < 0.05). CONCLUSIONS: Approximately 23-month follow-up data indicate that short implants with locking tapers and plateau-type roots have comparable survival rates as other types of dental implants. However, due to limitations of study, these issues remain to be further investigated in future randomized controlled clinical trials.

Comparative evaluation of shaping ability of two nickel-titanium rotary systems using cone beam computed tomography.

BACKGROUND: We evaluated and compared the effects of different NiTi rotary systems--ProTaper Next and New One Shape--on the volume of dentin removed, canal transportation, and canal curvature in extracted human teeth using CBCT scanning with different voxel sizes. METHODS: Fifty extracted human maxillary first molars with mesiobuccal canal curvature (25-35°) were used. Specimens were instrumented with the ProTaper Next or New One Shape. Pre- and post-instrumentation scans were performed to compare transportation at the levels of 2, 5, and 8 mm and volumes with two different voxel sizes (0.125-and 0.100-mm(3)) using 3D CBCT images. This study evaluated and compare the volume of dentin removed, canal transportation, and canal curvature. Differences according to instrumentation and voxel sizes were assessed using the Mann-Whitney U-test and the Wilcoxon signed-rank test. RESULTS: Significant differences were found between apical and coronal levels for both systems (p < 0.05) in canal transportation. In comparing the systems, similar values were found at each level, without significant difference (p > 0.05) in terms of canal curvature and volume. Voxel sizes did not affect the measurements on canal volume, curvature or transportation; no significant difference was found between the 0.100- and 0.125-mm(3) voxel sizes (p > 0.05). CONCLUSIONS: Both instrumentation systems produced similar canal transportation and volume changes. The two voxel resolutions also showed similar results, however a 0.125-mm(3) voxel size can be recommend for a flat panel CBCT scanner with lower exposure dose.

Assessment of endodontically treated teeth by using different radiographic methods: an ex vivo comparison between CBCT and other radiographic techniques.

PURPOSE: To compare different radiographic methods for assessing endodontically treated teeth. MATERIALS AND METHODS: Root canal treatments were applied in 120 extracted mandibular teeth, which were divided into four groups: (1) ideal root canal treatment (60 teeth), (2) insufficient lateral condensation (20 teeth), (3) root canals filled short of the apex (20 teeth), (4) overfilled root canal treatment (20 teeth). The teeth were imaged using intraoral film, panoramic film, digital intraoral systems (CCD and PSP), CCD obtained with portable X-ray source, digital panoramic, and CBCT images obtained at 0.3 mm(3) and 0.2 mm(3) voxel size. Images were evaluated separately by three observers, twice. Kappa coefficients were calculated. The percentage of correct readings obtained from each modality was calculated and compared using a t-test (p<0.05). RESULTS: The intra-observer kappa for each observer ranged between 0.327 and 0.849. The inter-observer kappa for each observer for both readings ranged between 0.312 and 0.749. For the ideal root canal treatment group, CBCT with 0.2 mm(3) voxel images revealed the best results. For insufficient lateral condensation, the best readings were found with periapical film followed by CCD and PSP. The assessment of teeth with root canals filled short of the apex showed the highest percentage of correct readings by CBCT and CCD. For the overfilled canal treatment group, PSP images and conventional periapical film radiographs had the best scores. CONCLUSION: CBCT was found to be successful in the assessment of teeth with ideal root canal treatment and teeth with canals filled short of the apex.