Development of a correction coefficient for radiographic evaluation of the alveolar bone crest: a pilot study.

OBJECTIVES: To analyze the differences in cusp height on radiographs, establishing proportional relationships between cusp and alveolar bone crest (ABC) measurements. The goal of this study was to develop a correction coefficient by considering this proportion. MATERIALS AND METHODS: Twenty-one artificial teeth, molars and premolars, and bovine ribs were used. Interproximal radiographs were taken with the aid of a positioner. The vertical angles used were: 0°, + 5°, and + 10°, and processed using three spatial resolutions measured in line pairs per mm (lp/mm): 20, 25 and 40. The Perio filter was applied to each image, in addition to the original one. Combinations of angle, resolution, and filter were made. Eighteen images were analyzed by three specialists, resulting in 252 measurements for each evaluator, totaling 756 measurements. RESULTS: The overall variability of the measurements can be explained mainly by the variation in tooth anatomy. The 0° 25 lp/mm Perio filter method was the closest one to the actual clinical scenario for both cusps and ABC. The correction factor managed to explain 71.45% of the errors. CONCLUSIONS: The variation in vertical angulation interferes with cusp and ABC measurements, and the angulation at 0º and spatial resolution of 25 lp/mm showed better results. The use of correction coefficients allowed approaching actual measurement values. CLINICAL RELEVANCE: More accurate ABC height measurements are essential even in radiographic exams that do not meet the standard of excellence because the need to repeat radiographic exams is then eliminated.

The variation in crown-root morphology of anterior teeth assessed with cone-beam computed tomography.

OBJECTIVE: To determine the discrepancy of crown-root morphology of anterior teeth, using cone-beam computed tomography (CBCT), and to provide a guidance for proper torque expression. METHODS: A total of eligible 200 CBCT were imported into Invivo v. 5.4 software, to obtain the middle labio-lingual sections of anterior teeth. AutoCAD 2007 software was applied to measure the crown-root angulation (Collum angle) and the angle formed by a tangent to the center of the labial surface and the long axis of the crown (labial surface angle). SPSS 18.0 was used for statistical comparisons of the two measurements, at the level of p< 0.05, and the Pearson correlation analysis was applied to investigate the association between the two measurements. RESULTS: The value of Collum angle in maxillary central incisor was close to 0°. Significantly negative Collum angle in lateral incisors and maxillary canine, and positive value in mandibular canine were detected (p < 0.001). The labial surface angle in canine was significantly greater than the intra-arch incisors (p< 0.001), and no significant difference was detected between the central and lateral incisors (p > 0.05). Notably, there was also a significant positive correlation between the two measurements. CONCLUSIONS: The crown-root angulations were greatly different among anterior teeth. Accompanying the obvious crown-root angulations, the canines both in maxillary and mandibular arches presented considerable labial surface curvatures. Hence, equivalent deviation during bracket bonding might cause greater torque expression error and increase the risk of alveolar fenestration and dehiscence.

Prevalence of Short Root Anomaly in a Group of Puerto Ricans.

OBJECTIVE: To estimate the prevalence of short root anomaly (SRA) in a group of Puerto Ricans at the Advanced Education Program in Orthodontics of the University of Puerto Rico. METHODS: A cross-sectional study was conducted with digital panoramic x-rays of 203 patients (112 females and 91 males; mean age: 17 years) in Puerto Rico. Utilizing the modified Lind's method, 406 maxillary right and left central incisors (1) were measured and evaluated for SRA. Root and crown length and R/C ratio were compared by sex and side. Linear regression was used to evaluate the associations between the R/C ratio and age, sex, and side (right/left). All the statistical analyses were evaluated using significance level of .05 (2). RESULTS: The prevalence of SRA was 0.49%. The average root and crown lengths for the maxillary right and left central incisors were 19.47 and 10.28 mm, respectively. Sex was associated with root and crown length, not with the R/C ratio. No differences were observed in the R/C ratio by the side. There were no significant associations between age, sex, and side and R/C ratio in the multivariate analysis. CONCLUSION: The prevalence of SRA in our population is lower than any reported in the literature. The R/C ratio in our Hispanic population was the highest compared with those of other ethnicities. Neither the sex nor the side of the incisor was associated with the R/C ratio. These findings are contrary to those of prior reports stating that males have higher R/C ratios than females.

Correlación entre el Diagnóstico Clínico y Radiográfico de Sujetos Adultos con Erupción Pasiva Alterada / Correlation Between Clinical and Radiographic Diagnosis of Adult Subjects with Altered Passive Eruption

El objetivo de este estudio fue determinar la correlación entre el diagnóstico clínico y radiográfico de sujetos adultos con erupción pasiva alterada. La muestra estuvo conformada por los incisivos centrales del cuadrante I de 30 sujetos adultos. Se registraron 2 mediciones clínicas: longitud de corona clínica y distancia del margen gingival (MG) a la unión cemento esmalte (UCE); y 2 mediciones radiográficas: longitud de corona anatómica y distancia del MG-UCE. Para diagnosticar EPA, se comparó el promedio de la resta entre corona anatómica y corona clínica; con el valor hipotético ( ³ 2,5 mm según Zucchelli). La muestra estuvo conformada por: 36,7 % incisivos de sujetos de sexo masculino y 63,3 % de sexo femenino; con la edad media de 25,17 años. Clínicamente, se obtuvo la media de 8,5 mm para longitud de corona clínica y 2,267 mm para sondaje MG-UCE. Radiográficamente, se obtuvo la media de 10,767 mm para longitud de la corona radiográfica y 2,47 mm para MG-UCE. Según la Rho de Spearman, el sondaje MG-UCE (clínico) con MG-UCE (radiográfico) no muestra una correlación estadísticamente significativa (p=0,227), sin embargo, al comparar la media (2,48 mm) con el valor hipotético (³2,5 mm) según la prueba t de una muestra, se determina que no existe diferencia estadísticamente significativa (p=0,864) entre ambos resultados. La radiografía con técnica paralela de Zucchelli es una excelente alternativa para un adecuado diagnóstico diferencial de la erupción pasiva alterada; de manera simple, económica y reproducible para el beneficio de clínicos y pacientes.

The aim of the study was to determine the correlation between the clinical and radiographic diagnosis of adult subjects with altered passive eruption. The population consisted of the central incisors of quadrant I of 30 adult subjects. Two clinical measurements were recorded: length of clinical crown and distance from the gingival margin (GM) to the cementum enamel junction (CEJ); and 2 radiographic measurements: length of anatomical crown and distance from the GM-CEJ. To diagnose APE, the average of the subtraction between anatomical crown and clinical crown was compared; with the hypothetical value (³ 2.5 mm according to Zucchelli). The population were: 36.7 % incisors of male subjects and 63.3 % female; with the average age of 25.17 years. Clinically, the average was 8.5 mm for clinical crown length and 2,267 mm for GM-CEJ probing. Radiographically, the average 10.767 mm was obtained for the length of the radiographic crown and 2.47 mm for GM- CEJ. According to Spearman's Rho, the GM-CEJ (clinical) probing with GM-CEJ (radiographic) does not show a statistically significant correlation (p = 0.227), however, when comparing the average (2.48 mm) with the hypothetical value (³ 2.5 mm) according to the t-test of a sample, it is determined that there is no statistically significant difference (p = 0.864) between both results. The radiography with Zucchelli technique is an excellent alternative for an adequate differential diagnosis of altered passive eruption; in a simple, economical and reproducible way for the benefit of clinicians and patients.

Coronectomy of partially erupted lower third molars performed by an undergraduate dentistry student: a case series.

PURPOSE: The coronectomy technique is an alternative to conventional impacted tooth removal which aims to reduce the risk of damage to the inferior alveolar nerve (IAN). The technique is usually performed by senior oral surgeons or residents in training. Herein, patients were treated in a single service, in which coronectomy was performed by an undergraduate dental student on partially erupted lower third molars. METHODS: A prospective analysis was performed on 21 individuals submitted to a total of 35 coronectomies. Clinical and radiographic follow-up was performed for at least 12 months. RESULTS: Overall, healing was within normal limits, without major complications and without permanent IAN injury. However, one case showed temporary IAN paraesthesia resolved within a month and two required repetitions of coronectomy due to the remaining enamel, but with a good final result. Root migration was observed in all cases, but no other surgery was required. CONCLUSION: Coronectomy may be an important option for treating partially erupted teeth in close nerve relationships, which could also be performed by trained undergraduate dental students. This series is interesting because it can encourage oral and maxillofacial surgeons to train undergraduate students and to stimulate their attraction and passion for surgery.

Caries status in young Colombian children expressed by the ICCMS™ visual/radiographic combined caries staging system.

OBJECTIVE: To report (1) the caries experience prevalence and mean, and the caries severity and distribution patterns, expressed clinically and combined with radiographs with the conventional and ICCMS™ systems in young children from Bogotá, Colombia; (2) the contribution of including radiographs to the clinical caries scoring and (3) in which surfaces the radiograph adds to the clinical caries registration. MATERIAL AND METHODS: Six hundred children from kindergartens/schools were enrolled: Cohort A: 2-year (n = 200), Cohort B: 4-year (n = 200) and Cohort C: 6-year (n = 200) olds. Radiographs were taken of the 4- and 6- year olds. Children were examined clinically using the Clinical (C) and Radiographic (R) ICCMS™-epi Caries Scoring Systems, staging caries lesions (d) as: Initial (Cepi/RA), Moderate (CM/RB) or Extensive (CE/RC). Caries experience including missing (m) and filled (f) surfaces was expressed as follows: clinical conventional (CdMEmfs); clinical ICCMS™ (CdepiMEmfs); combined conventional (C + RdMEmfs) and combined ICCMS™ (C + RdepiMEmfs). RESULTS: The prevalence of CdMEmfs was: Cohort A: 32%; Cohort B: 59%; Cohort C: 67.5%, increasing to 73.5%, 99.8% and 100%, respectively, with the C + R depiMEmfs. The CdMEmfs means doubled when initial caries lesions (Cdepi) and radiographs (R) were included. The d component corresponded to over two-thirds of the caries experience. Findings on the radiographs significantly raised caries experience prevalence and means (p < .02), detecting primarily approximal lesions. Surfaces with highest caries frequency were occlusal/approximal of molar teeth and buccal of upper incisor teeth. CONCLUSION: Participants' caries experience was high. The radiographic assessment significantly contributed to caries experience. Molar and upper incisor teeth were most prone to caries.

Pre-eruptive intracoronal resorption in a third upper molar: clinical, tomographic and histological analysis.

Radiolucent or hypodense lesions in the crown of unerupted teeth may be due to pre-eruptive intracoronal resorption. Clinicians must be aware of this risk so that they can diagnose and appropriately treat this condition. The purpose of this study is to present a well-documented clinical case of pre-eruptive intracoronal resorption in an impacted third upper left molar of a 63 year old female patient. This was an unexpected finding, which occurred after cone-beam computed tomography was used to investigate the first upper left molar, which had an acute periradicular abscess. A multidisciplinary team followed up the case to describe clinical, radiographic and histological findings. The available treatment options were discussed, and the tooth extraction was the option chosen. Previous case studies describing such resorption in third upper molars have not been reported. This case shows that all permanent teeth in a pre-eruptive stage must be analysed radiographically to detect early pre-eruptive intracoronal resorption.

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.

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. .

Characterization of short root anomaly in a Mexican cohort--hereditary idiopathic root malformation.

OBJECTIVE: The purpose of this study was to systematically characterize individuals with short root anomaly (SRA) without any history of orthodontic treatment. The long-term objective of the study was to improve diagnosis and treatment planning and determine risk factors for developing SRA. SETTING AND SAMPLE POPULATION: Twenty-seven patients including two families and 16 unrelated individuals from (9-48 years) reported to orthodontic and/or dental practitioners within the USA. MATERIALS AND METHODS: Digital panoramic and periapical films were analyzed to document pattern and frequency of SRA-affected teeth. Crown-to-root (CR) ratios of the affected teeth were used to characterize the extent of malformation. Pedigree analysis by inspection was completed for one family to determine pattern of inheritance. RESULTS: Twenty-six of the twenty-seven individuals were of Latino descent, and one was of Filipino descent. Hard tissues including enamel, dentin, pulp chambers and canals, and surrounding soft tissues were normal. We found that 25 of 27 individuals had localized SRA and two Latino individuals had generalized SRA. Teeth were affected bilaterally with maxillary central incisors (~63%) and mandibular second premolars most commonly involved (~33%). Affected teeth had a distinct, similar radiographic appearance; in the generalized cases, there was a more severe affection with larger (~twice) CR ratios. Ninety-four percent of affected individuals did not show a significant difference in the CR ratios at different ages. Pedigree analysis suggests an autosomal dominant inheritance pattern in one family. CONCLUSION: This is the first report to show that SRA occurs more frequently in Latino individuals and has a predilection for anterior teeth. The occurrence of SRA in two families further confirms a hereditary component and supports a distinct nosology and nomenclature, hereditary idiopathic root malformation (HIRM) and warrants further investigation.

An in vivo comparison of radiographic and clinical examination with separation for assessment of approximal caries in primary teeth.

AIM: To compare in vivo, clinical examination (CE) and bitewing radiographs (BW) for the detection of cavitations and initial approximal lesions in deciduous molars with validation after temporary separation (TS) and direct visual examination (DE) of the approximal surfaces. MATERIALS AND METHODS: Thirty children aged 4 to 8 years without visual cavitations or restorations and with at least one approximal contact. Two calibrated examiners evaluated 355 surfaces of primary molars, which were then validated through TS and DE. RESULTS: Of the 280 surfaces considered sound by CE, 24.6% were cavitated after separation. Comparing BW and DE, it was observed that, when the radiolucency involved the inner half of dentin, 68.4% of lesions were cavitated. The sensitivity and specificity of CE and BW were 0.14 and 0.43, and 0.80 and 0.75, respectively. CONCLUSION: DE identified a greater number of pre-cavitated lesions and cavities. BW were useful for detection of decayed surfaces, but with low specificity for diagnosis of sound surfaces, while detection of sound or decayed approximal areas by means of CE alone was not possible. The combination of methods was effective in obtaining an accurate diagnosis of caries in the primary dentition.

Dentoskeletal effects of 3 maxillary expanders in patients with clefts: A cone-beam computed tomography study.

INTRODUCTION: The purpose of this study was to evaluate the skeletal and dental changes in the maxillae of patients with clefts treated with 3 expanders: hyrax, fan-type, and inverted mini-hyrax supported on the first premolars. METHODS: Thirty patients with unilateral cleft lip and palate with transverse maxillary deficiency were divided into 3 groups, according to the type of expander that they used. Cone-beam computed tomography images were taken before and 3 months after expansion, and the paired t test was used to evaluate the changes in each group. RESULTS: The subjects in the inverted mini-hyrax group showed significant forward displacement of the maxilla (P <0.05). On the transversal plane, the hyrax group showed greater expansion in the posterior region than in the anterior region (P <0.05). However, the fan-type and the inverted mini-hyrax groups showed significantly greater maxillary expansion anteriorly than posteriorly (P <0.05). There was a greater tendency for buccal inclination of the supporting teeth when the fan-type was used. The cleft and the noncleft sides expanded symmetrically with all appliances, and there was no difference in dental tipping between these sides (P >0.05). CONCLUSIONS: The hyrax expander showed better results for cleft patients requiring anterior and posterior maxillary expansion. The inverted mini-hyrax most effectively restricted posterior expansion, optimizing anterior expansion without causing as much buccal tipping of the supporting teeth as did the fan-type.

Reliability of CBCT in the diagnosis of dental asymmetry.

OBJECTIVE: The aim of this study was to validate a method used to assess dental asymmetry, in relation to the skeletal midline, by means of CBCT. METHODS: Ten patients who had CBCT scans taken were randomly selected for this study. Five different observers repeated 10 landmarks (x, y and z variables for each) and 12 linear measurements within 10 days. Measurements were taken in both arches to evaluate symmetry of first molars, canines and dental midline in relation to the skeletal midline. Intraclass correlation coefficient (ICC) was carried out to assess intra- and interobserver reliability for landmarks and distances. Average mean difference was also assessed to check measurement errors between observers. RESULTS: ICC for the landmarks was, respectively, ≥ 0.9 for 27 (90%) and 25 (83%) variables for intra- and interobserver; ICC for distances was ≥ 0.9 for 7 (58%) and 5 (42%), respectively. All ICC landmarks for distances were >0.75 for both intra- and interobserver. The mean difference between observers was ≤ 0.6 mm for all the distances. CONCLUSION: The method used to assess dental asymmetry by means of CBCT is valid. Measurements of molars, canines and dental midline symmetry with the skeletal midline are reproducible and reliable when taken by means of CBCT and by different operators.

Uncommon true isolated macrodontia of a maxillary tooth.

Macrodontia is a rare dental anomaly which consists on the presence of any tooth or teeth larger than the average. In the present report the case of a child with an uncommon true isolated macrodontia of a maxillary central incisor is presented. The maxillary left central incisor was considered a macrodontic tooth since its mesiodistal crown dimension was 12.41 mm while the mesiodistal crown dimension of the maxillary right central incisor was 10.06 mm. The radiographic examination confirmed an enlarged maxillary left central incisor and a normal developing dentition. The patient did not report esthetic complaints, however, due the presence of anterior open bite and crowding, he was referred to orthodontic clinic. Thus, it must be point out the importance of the radiographic diagnosis to support the clinical findings, helping to plan and provide better treatment for the patient.

Measurement accuracy and reliability of tooth length on conventional and CBCT reconstructed panoramic radiographs.

INTRODUCTION: This in vivo study assessed accuracy and reliability of tooth length measurements obtained from conventional panoramic radiographs and CBCT panoramic reconstructions to that of a digital caliper (gold standard). METHODS: The sample consisted of subjects who had CBCT and conventional panoramic radiographic imaging and who required maxillary premolar extraction for routine orthodontic treatment. A total of 48 teeth extracted from 26 subjects were measured directly with digital calipers. Radiographic images were scanned and digitally measured in Dolphin 3D software. Accuracy of tooth length measurements made by CBCT panoramic reconstructions, conventional panoramic radiographs and digital caliper (gold standard) were compared to each other by repeated measures one-way ANOVA with Bonferroni correction and by single measures intraclass correlation coefficient. RESULTS: Repeated root length measures with digital calipers, panoramic radiographs and CBCT constructed panoramic-like images were all individually highly reliable. Compared to the caliper (gold standard), tooth measurements obtained from conventional panoramic radiographs were on average 6.3 mm (SD = 2.0 mm) longer, while tooth measurements from CBCT panoramic reconstructions were an average of 1.7 mm (SD = 1.2 mm) shorter. CONCLUSIONS: In comparison to actual tooth lengths, conventional panoramic radiographs were relatively inaccurate, overestimating the lengths by 29%, while CBCT panoramic reconstructions underestimated the lengths by 4%.

Analysis of correlation between initial alveolar bone density and apical root resorption after 12 months of orthodontic treatment without extraction.

OBJECTIVE: The aim of the present study was to investigate the correlation between initial alveolar bone density of upper central incisors (ABD-UI) and external apical root resorption (EARR) after 12 months of orthodontic movement in cases without extraction. METHODS: A total of 47 orthodontic patients 11 years old or older were submitted to periapical radiography of upper incisors prior to treatment (T1) and after 12 months of treatment (T2). ABD-UI and EARR were measured by means of densitometry. RESULTS: No statistically significant correlation was found between initial ABD-UI and EARR at T2 (r = 0.149; p = 0.157). CONCLUSION: Based on the present findings, alveolar density assessed through periapical radiography is not predictive of root resorption after 12 months of orthodontic treatment in cases without extraction.

Assessment of factors associated with surgical difficulty during removal of impacted maxillary third molars.

PURPOSE: Estimating the difficulty of removing third molars is a common dilemma. However, the estimation of the difficulty associated with maxillary third molar surgery has not yet been defined. The aim of the present study was to determine the degree of difficulty and identify predictor variables associated with the occurrence of difficulty in the removal of impacted maxillary third molars. MATERIALS AND METHODS: A prospective cohort study was carried out involving patients who underwent at least 1 surgical removal of an impacted maxillary third molar at the Oral and Maxillofacial Surgery Unit, University of Pernambuco (Pernambuco, Brazil). Predictor variables indicative of surgical difficulty were classified by their demographic, clinical, and radiographic aspects. Degree of surgical difficulty was categorized as low, moderate, or high based on the surgical technique used. Descriptive and bivariate statistics were computed. RESULTS: In total, 106 patients fulfilled the eligibility criteria and 204 surgeries were performed. Patients' mean age was 22.8 ± 2.2 years and the proportion of women to men was 3:1. Approximately 20% of patients were overweight. Surgical difficulty was generally low and 5 variables were significantly associated with the occurrence of a high degree of surgical difficulty. CONCLUSION: Surgical difficulty during the removal of impacted maxillary third molars is generally low. However, for cases with a high degree of difficulty, identification of predictor variables may be useful for students and inexperienced clinicians to consider the decision not to execute the procedure, thus avoiding complications that often require complex management.

Altered passive eruption diagnosis and treatment: a cone beam computed tomography-based reappraisal of the condition.

AIM: To characterize anatomical features of altered passive eruption (APE)-affected teeth using cone beam computed tomography (CBCT) and to present a novel combined surgical approach to its correction. CLINICAL INNOVATION REPORT: Eighty-four teeth from 14 subjects affected by APE were subjected to CBCT. Periodontal variables were recorded before surgery, and anatomical variables were measured on CBCTs. Clinical crown length was measured on study casts. Surgical treatment was carried out based on the lengths of the anatomical crowns transferred to a surgical guide that served as a reference for the incisions. The mean distance between the CEJ and the bone crest was on average <1 mm, facial bone thickness was ≥ 1 mm and soft tissue thickness was >1 mm for every tooth analysed; no association between the soft and the hard tissue thicknesses was observed. CONCLUSION: The CBCT can be used in the diagnosis and treatment planning of APE cases. Anatomically, the APE cases described often presented a thick facial bone plate.

The performance of conventional and fluorescence-based methods for occlusal caries detection: an in vivo study with histologic validation.

BACKGROUND: The authors conducted an in vivo study to determine clinical cutoffs for a laser fluorescence (LF) device, an LF pen and a fluorescence camera (FC), as well as to evaluate the clinical performance of these methods and conventional methods in detecting occlusal caries in permanent teeth by using the histologic gold standard for total validation of the sample. METHODS: One trained examiner assessed 105 occlusal surfaces by using the LF device, LF pen, FC, International Caries Detection and Assessment System (ICDAS) criteria and bitewing (BW) radiographic methods. After tooth extraction, the authors assessed the teeth histologically. They determined the optimal clinical cutoffs by means of receiver operating characteristic curve analysis. RESULTS: The specificities and sensitivities for enamel and dentin caries detection versus only dentin caries detection thresholds were 0.60 and 0.93 and 0.77 and 0.52 (ICDAS), 1.00 and 0.29 and 0.97 and 0.44 (BW radiography), 1.00 and 0.85 and 0.77 and 0.81 (LF device), 0.80 and 0.89 and 0.71 and 0.85 (LF pen) and 0.80 and 0.74 and 0.49 and 0.85 (FC), respectively. The accuracy values were higher for ICDAS, the LF device and the LF pen than they were for BW radiography and the FC. CONCLUSIONS: The clinical cutoffs for sound teeth, enamel carious lesions and dentin carious lesions were, respectively, 0 through 4, 5 through 27 and 28 through 99 (LF device); 0 through 4, 5 through 32 and 33 through 99 (LF pen); and 0 through 1.2, 1.3 and 1.4 through 5.0 (FC). The ICDAS, the LF device and the LF pen demonstrated good performance in helping detect occlusal caries in vivo. The ICDAS did not seem to perform as well at the D(3) threshold (histologic scores 3 and 4) as at the D(1) threshold (histologic scores 1-4). BW radiography and the FC had the lowest performances in helping detect lesions at the D(1) and D(3) thresholds, respectively. CLINICAL IMPLICATIONS: Occlusal caries detection should be based primarily on visual inspection. Fluorescence-based methods may be used to provide a second opinion in clinical practice.

How to predict the timing of eruption of mandibular second premolars.

OBJECTIVE: To evaluate the relationship between the stages of dental formation and the timing of eruption of mandibular second premolars. MATERIALS AND METHODS: The sample comprised panoramic radiographs of 25 children, 7 to 12 years old, observed by space supervision during development of dentition. The initial radiograph (T1) was taken in the mixed dentition period and the progress radiograph (T2) close to the eruption of mandibular second premolars. The stages of dental formation were determined by the proportion between crown length and total length (CL/TL) as well by the Simpson and Kunos index. Average values between right and left sides (35, 45) were correlated to the time elapsed until dental eruption (T2-T1). Statistical analysis was performed by Pearson correlation analysis. RESULTS: The proportion CL/TL presented higher correlation index with time to eruption than the Simpson and Kunos index. The linear regression equation for prediction of timing of eruption showed high coefficient of determination, low deviation, and good accuracy. According to survival analysis, mean deviation at 95% confidence level was between 3.6 and 6.4 months. There was no difference in contralateral measurements, with high intraclass correlation coefficient for both CL/TL proportion and Simpson and Kunos index. CONCLUSIONS: More advanced stages of dental formation indicate less time until dental eruption. The strong correlation with crown length/total length proportion (CL/TL) provides a linear regression equation for prediction of the timing of eruption of mandibular second premolars.