Cone-Beam Computed Tomographic Analysis of Shaping Ability of XP-endo Shaper and ProTaper Next in Large Root Canals.

INTRODUCTION: The aim of this study was to evaluate and compare the shaping abilities of the XPS (XP-endo Shaper) and PTN (ProTaper Next) systems by using cone-beam computed tomography on apical, middle, and coronal thirds of the pre-created large canals with different apical sizes. METHODS: Seventy-two teeth with single canal were divided into 3 groups, and then large root canals were created with apical diameter #30 (Group 1), #35 (Group 2), or #40 (Group 3) by using hand files. Each group was again divided into 2 experimental groups, and root canals were instrumented with either XPS or PTN. Canals were scanned before and after instrumentation by using cone-beam computed tomography scanner to evaluate mesiodistal transportation, buccolingual transportation, centering ratio, percent increased prepared area (PA) (mm2), and percent increased prepared outline (PO) (mm) at 2, 5, and 8 mm from the apex. Data were statistically analyzed, and the significance level was set at P < .05. RESULTS: There were no statistically significant differences in PA, PO, and centering ratio values between instruments in size 30 and size 35. The mean increases in PA and PO (P < .021) were statistically higher with XPS in size 40. PTN had statistically higher buccolingual transportation in size 30 and size 35. XPS had lower mesiodistal transportation values in all 3 apical sizes. CONCLUSIONS: PTN system is able to remove the dentin even in cases of increased apical diameter. However, XPS has less canal transportation and better centering ability compared with PTN.

Perceived sources and levels of stress, general self-efficacy and coping strategies in preclinical dental students.

Dental education programs are known to be highly stressful and stress can affect general health. The aims were to identify sources of stress among preclinical students and to evaluate their perceived levels of stress, self-efficacy and effective coping strategies in a private dental school. One hundred preclinical students in a Turkish private dental school were surveyed using dental environment stress (DES), perceived stress (PSS), general self-efficacy (G-SES) and brief coping scales (Brief-COPE). Age, gender, history of psychiatric treatment, factors that affected the choice of dentistry, choice rank of dental school, scholarship and income was recorded. 'Exams and grades' followed by 'Fear of failing course or year' were found to be the most stressprovoking factors. The most and the least stressprovoking DES domains were 'Workload' and 'Social stressors', respectively. 'Social stressors' affected male more than female (p < .05). The most and the least common coping strategies were found to be 'Planning', and 'Drug', respectively. Female used 'Instrumental support' more than male (p < .05). Demographic factors had impact on the perceived stress factors and levels, as well as coping strategies. Unlike previous studies establishing high stress levels in dental students, preclinical students displayed moderate level of stress. Clinical dental education might be more responsible for creating stress.

Percentage and severity of periodontal diseases in Turkish adults aged 35+ years, 2009-10.

OBJECTIVE: This article presents data on the burden of periodontal diseases in Turkish adults aged 35 years or older. METHODS: Within each region of Turkey, a rural and an urban area or city were selected in 2009-10 using a probability proportional to size method. In the selected towns, local officials who were familiar with their communities assisted in recruiting subjects. Loss of Attachment (LOA) was measured at six sites around each tooth present in the mouth, excluding third molars. Additionally, the Community Periodontal Index was used to assess the severity of periodontal diseases around 12 index teeth. Self-reported data on key risk factors were also collected. Weights were computed using a raking ratio adjustment procedure and used in all analyses. RESULTS: Almost all examined adults had some loss of periodontal attachment. The proportion of those with more than 3 mm LOA ranged from 43 percent in 35-44 year olds to 91 percent in those aged 65+ years. Among females, older age, low education status, smoking 11-40+ cigarettes a day, being employed, and presence of high number of missing tooth surfaces were associated with LOA > 3 mm. Among males LOA >3 mm was associated with older age, use of alcohol, and unemployment. The CPI data did not yield the same associations with periodontal diseases and risk factors. CONCLUSIONS: Periodontal diseases in Turkish adults are highly prevalent. A tailored common risk factor health promotion program is recommended to reduce the burden of periodontal infection in Turkey.

Perceived sources and levels of stress, general self-efficacy and coping strategies in clinical dental students.

The aims of this study were to identify sources of stress among clinical students and to evaluate the students' perceived levels of stress, general self-efficacy and effective coping strategies in a private dental school environment. The study group consisted of 130 undergraduate clinical dental students in a Turkish private dental school, during the academic year 2014-2015. The students were surveyed using modified version of the dental environment stress (DES) survey, the perceived stress scale, the general self-efficacy scale (G-SES) and the brief coping scale. Age, sex, year of study, history of psychiatric treatment and factors that affected the choice of dentistry were also recorded. Final year and female clinical dental students, who were found to be the most stressful students, had moderate to high perceived stress scores. Total and 'Faculty and administration' related DES scores increased with the year of study. Stressors related to 'Workload' and 'Clinical training' affected females more than males. G-SES scores were higher in male students and students, who had no history of psychiatric treatment. The most and the least common coping strategies were 'Planning' and 'Substance abuse', respectively. 'Religion' was found to be one of the main coping strategies. Stress factors affecting Turkish clinical dental students studying at private dental school differed from the previously reported stress factors affecting students studying at a governmental dental school. Advanced year and female students experienced more stress than the other students.

Evaluation of pneumatization in the articular eminence and roof of the glenoid fossa with cone-beam computed tomography.

BACKGROUND: Detection of air cavities, so called pneumatizations, nearby to the temporomandibular joint (TMJ) area is important, as they represent sites of minimal resistance and facilitate the spread of various pathologies into the joint as inflammation, tumor or fractures and serve as a possible complicating factor in TMJ surgery. AIMS: To determine the prevalence of pneumatization of the articular eminence (PAT) and roof of the glenoid fossa (PRGF) using cone-beam computed tomography (CBCT). STUDY DESIGN: Cross-sectional study. METHODS: Acquired images of 111 patients (222 TMJs) were evaluated. The presence of pneumatization was recorded at the articular eminence and roof of the glenoid fossa. Age and gender were recorded for all patients and type (unilocular or multilocular) and laterality were noted for the cases of pneumatization. RESULTS: The mean age of the study group was 48.86±18.31 years. Among all the patients, 73 (65.8%) had PAT, while 13 (11.7%) had PRGF. Forty-two (37.8%) of the patients had PAT bilaterally; whereas 3 of them (2.7%) presented PRGF bilaterally. The percentage of PAT was higher for females (73.6%) than males (51.3%) (p<0.05). CONCLUSION: CBCT images are an accurate and reliable means of detection of the exact size and type of pneumatization and the relationship of pneumatization to the adjacent tissues. This is especially significant before a surgical intervention is planned in this region, in order to make a sound diagnosis.

Comparison of case-based and lecture-based learning in dental education using the SOLO taxonomy.

The aim of this study was to compare the impact of case-based learning (CBL) and lecture-based learning (LBL) on fourth-year dental students' clinical decision making by using the Structure of Observed Learning Outcome (SOLO) taxonomy. Participants in the study were fourth-year dental students (n=55) in academic year 2012-13 taught in a large-group LBL context and fourth-year dental students (n=54) in academic year 2013-14 taught with the CBL methodology; both took place in the oral diseases course at Yeditepe University Faculty of Dentistry, Istanbul, Turkey. All eligible students participated, for a 100 percent response rate. A real case was presented to the students in both groups to assess their clinical decision making on the topic of oral diseases. Their performance was evaluated with the SOLO taxonomy. Student t-test was used for statistical evaluation, and significance was set at the p<0.05 level. A statistically significant difference was found between the mean scores of the relational and extended abstract categories of the CBL and LBL groups (p<0.05). Students who were taught with CBL had higher scores at the top two levels of the SOLO taxonomy than students taught with LBL. These findings suggest that an integrated case-based curriculum may be effective in promoting students' deep learning and it holds promise for better integration of clinical cases likely to be encountered during independent practice.

Articular eminence inclination, height, and condyle morphology on cone beam computed tomography.

AIM: The aim of the present study was to examine the relationship between articular eminence inclination, height, and thickness of the roof of the glenoid fossa (RGF) according to age and gender and to assess condyle morphology including incidental findings of osseous characteristics associated with osteoarthritis (OA) of the temporomandibular joint (TMJ) using cone beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT images of 105 patients were evaluated retrospectively. For articular eminence inclination and height, axial views on which the condylar processes were seen with their widest mediolateral extent being used as a reference view for secondary reconstruction. Condyle morphology was categorized both in the sagittal and coronal plane. RESULTS: The mean values of eminence inclination and height of males were higher than those of females (P < 0.05). There were significant differences in the RGF thickness in relation to sagittal condyle morphology. Among the group of OA, the mean value of the RGF thickness for "OA-osteophyte" group was the highest (1.59 mm), whereas the lowest RGF values were seen in the "OA-flattening." CONCLUSION: The sagittal osteoarthritic changes may have an effect on RGF thickness by mechanical stimulation and changed stress distribution. Gender has a significant effect on eminence height (Eh) and inclination.

In Vitro Detection of Dental Root Fractures with Cone Beam Computed Tomography (CBCT).

BACKGROUND: Since the diagnosis of non-displaced longitudinal fractures present difficulties for the dentist, three-dimensional evaluation is necessary. OBJECTIVES: The aim of this study is to demonstrate the accuracy of cone beam computed tomography (CBCT) in detecting dental root fractures in vitro. MATERIALS AND METHODS: An in vitro model consisting of 210 recently extracted human mandibular teeth was used. Root fractures were created by mechanical force. The teeth were placed randomly in the empty dental alveoli of a dry human mandible and 15 different dental arcs were created. Images were taken with a unit Iluma ultra cone-beam CT scanner (Imtec Corporation, Germany). Three dental radiologists separately evaluated the images. RESULTS: According to the fracture types and fracture presence, there was an overall statistically significant agreement between the key and readings. Kappa values for intra observer agreement ranged between 0.705 and 0.804 indicating that each observer gave acceptable ratings for the type and presence of fractures. CONCLUSIONS: Detailed information about root fractures may be obtained using CBCT.

Measurements of the foramen magnum and mandible in relation to sex using CBCT.

The purpose of this study was to evaluate pre-existing CBCT images of a large sample of adult females and males to provide data on foramen magnum and mandibular measures of sexual dimorphism for use as a reference sample in cases of establishing identity in unknown fragmentary skulls. The study group consisted of 161 adult patients. 3D images of the patients were assessed retrospectively. FM measurements were obtained from reformatted axial sections. Six mandibular measurements were taken. According to the results, the study identified four mandibular measurements as final predictors of sex which are as follows: the gonial angle (G-angle) and ramus length (Ramus-L), gonion-gnathion length (G-G-L) and bigonial breadth (BG-Br). It was found that the cross-validated grouped overall predictive accuracy was 83.2% for FM and mandible measurements. It could correctly identify males in 77.3% and females in 87.4% of the cases. To assess sexual dimorphism, the gonial angle and ramus, gonion-gnathion lengths, and bigonial breadth of the mandible and sagittal diameter of the FM may be used on CBCT images.

Evaluation of the posterior superior alveolar artery and the maxillary sinus with CBCT.

Assessment of the maxillary sinus anatomy before sinus augmentation is important for avoiding surgical complications, because of the close anatomical relationship between the posterior maxillary teeth and the maxillary sinus. The posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and overlying membrane. We evaluated the location of the PSAA and its relationship to the alveolar ridge and maxillary sinus using cone beam computed tomography (CBCT). The study group consisted of 135 CBCT scans (270 sinuses) obtained from the archive of the dentomaxillofacial radiology department at Yeditepe University Faculty of Dentistry, Istanbul, Turkey. The distance between the lower border of the artery and the alveolar crest, bone height from the sinus floor to the ridge crest, distance from the artery to the medial sinus wall, and the diameter and location of the artery were determined. The occurrence of septa and pathology were recorded from CBCT scans. The PSAA was observed in 89.3% of sinuses, and 71.1% of arteries were intraosseous with diameters mostly < 1 mm (68.9%). The prevalence of sinus septa was 55.2%, and that of sinus pathology was 57.4%. The mean age was 43.07 ± 17.55 years. There was a statistically significant difference between the location of the artery and gender (p < 0.05). The prevalence of sinus membrane thickening was 57.4%. Detailed knowledge about the location of the PSAA and sinus morphology may be obtained with CBCT before maxillary sinus surgery.

Evaluation of the posterior superior alveolar artery and the maxillary sinus with CBCT

Assessment of the maxillary sinus anatomy before sinus augmentation is important for avoiding surgical complications, because of the close anatomical relationship between the posterior maxillary teeth and the maxillary sinus. The posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and overlying membrane. We evaluated the location of the PSAA and its relationship to the alveolar ridge and maxillary sinus using cone beam computed tomography (CBCT). The study group consisted of 135 CBCT scans (270 sinuses) obtained from the archive of the dentomaxillofacial radiology department at Yeditepe University Faculty of Dentistry, Istanbul, Turkey. The distance between the lower border of the artery and the alveolar crest, bone height from the sinus floor to the ridge crest, distance from the artery to the medial sinus wall, and the diameter and location of the artery were determined. The occurrence of septa and pathology were recorded from CBCT scans. The PSAA was observed in 89.3% of sinuses, and 71.1% of arteries were intraosseous with diameters mostly < 1 mm (68.9%). The prevalence of sinus septa was 55.2%, and that of sinus pathology was 57.4%. The mean age was 43.07 ± 17.55 years. There was a statistically significant difference between the location of the artery and gender (p < 0.05). The prevalence of sinus membrane thickening was 57.4%. Detailed knowledge about the location of the PSAA and sinus morphology may be obtained with CBCT before maxillary sinus surgery.

Assessment of root canal treatment outcomes performed by Turkish dental students: results after two years.

The aim of this study was to evaluate radiographically the periapical status and technical standard of root canal therapies performed by a group of undergraduate dental students in Turkey two years following completion of the treatments. A random sample of 264 patients who received root canal treatment from undergraduate students at the Yeditepe University Faculty of Dentistry in 2009 were recalled after two years. The study sample consisted of 319 root-filled teeth in 158 dental patients (females=97, males=61) who presented to the student clinics during that time frame. For each root-filled tooth, two periapical radiographs were examined to identify the periapical status, one showing pre-treatment and the other showing post-treatment status. The quality of endodontic treatment was examined according to the distance between the end of root filling and radiographic apex and the density of the obturation according to presence of voids within the root filling material. This examination found that 54.2 percent of roots had fillings of acceptable length, while 37.3 percent were short, 7.8 percent were overfilled, and 0.6 percent was unfilled; 2.5 percent of the teeth were observed with broken root canal instruments. After two years, PAI scores of teeth with acceptable length of root canal filling (0-2 mm from the radiographic apex) were found to be lower than those of the overfilling and short filling cases (>2mm) (p<0.01). Moreover, voids were detected in the root canal fillings of 52.7 percent of endodontically treated teeth. The PAI scores of root fillings with inadequate density were significantly higher than adequate ones (p<0.01). Although endodontic treatments performed by undergraduate students do not appear to be unqualified compared to those performed by general practitioners, more emphasis must be placed on the technical quality of endodontic treatment to obtain better results.

Assessment of the stylohyoid complex with cone beam computed tomography.

BACKGROUND: Orientation of the stylohyoid complex (SHC) may be important for evaluation of the patient with orofacial pain or dysphagia. OBJECTIVES: Our purpose was to assess the length and angulations of SHC using cone beam computed tomography (CBCT). PATIENTS AND METHODS: In this study, 3D images provided by CBCT of 69 patients (36 females, 33 males, age range 15-77 years) were retrospectively evaluated. All CBCT images were performed because of other indications. None of the patients had symptoms of ossified SHC. The length and the thickness of SHC ossification, the anteroposterior angle (APA) and the mediolateral angle (MLA) were measured by maxillofacial radiologists on the anteroposterior, right lateral and left lateral views of CBCT. Student's t test, Pearson's correlation and Chi-square test tests were used for statistical analysis. RESULTS: According to the results, the mean length of SHC was 25.3 ± 11.3 mm and the mean thickness of SHC was 4.8 ± 1.8 mm in the study group. The mean APA value of SHCs was 25.6° ± 5.4° and the mean MLA value was 66.4° ± 6.7°. A positive correlation coefficient was found between age and APA (r = 0.335; P < 0.01); between thickness and APA (r = 0.448; P < 0.01) and also between length and thickness was found (r=0.236). CONCLUSION: The size and morphology of the SHC can be easily assessed by 3D views provided by CBCT. In CBCT evaluation of the head and neck region, the radiologist should consider SHC according to these variations, which may have clinical importance.

Diagnosis of jaw and dentoalveolar fractures in a traumatized patient with cone beam computed tomography.

The purpose of this case report is to discuss and illustrate the clinical usage of Cone Beam Computed Tomography (CBCT) for the diagnosis of maxillofacial fractures in a traumatized patient. In this presentation, a 30-year-old male patient who was referred to Oral Diagnosis and Radiology Department with a limitation of mouth opening was reported. The history of the patient revealed a traumatic injury on his face because of a fall. The patient was initially examined by a medical practitioner in the emergency department of a public hospital. According to 2D cephalometric analysis, no fracture existed. Panoramic radiograph and postero-anterior reverse-town showed bilateral condyle fractures. In addition, a fracture in the left mandibular incisor region could clearly be detected on the panoramic radiograph. For further diagnosis, digital images were taken with CBCT. Cross-sectional views showed two vertical fracture lines on the alveolar bone between teeth numbers 17, 18 and 14, 15. A palatal root fracture was observed associated with tooth number 18. A fracture line in the left mandibular incisor region as well as bilateral condyle fractures could be seen clearly on CBCT views. CBCT is becoming a popular tool in modern dental practise. In the diagnosis of dentoalveolar fractures, CBCT has made it possible for the practitioner to get more detailed information.