Translucency and Radiopacity of Dental Resin Composites - Is There a Direct Relation?

OBJECTIVES: The purpose of this study was to correlate the translucency degree of varying resin composites with their radiopacity. METHODS AND MATERIALS: Twenty-four resin composites (conventional or bulk-fill) of various shades and opacities were selected from the following manufacturers: 3M ESPE (nanofilled), Ivoclar (nanohybrid), and FGM (microhybrid). Resin composite samples (n=5) were prepared (5-mm diameter × 1.5-mm thickness) for comparison using prepared samples of human dentin and enamel as controls. The translucency of each sample was measured using the translucent parameter (TP) method with a digital spectrophotometer (Vita Easyshade) and CIEL*a*b* color system over white and black backgrounds. The samples were also x-rayed using a photostimulable phosphor plate system for measurement of their radiopacity (in mmAl). All data were analyzed using one-way ANOVA and Student-Newman-Keuls (α=0.05); data for TP and radiopacity were correlated using the Spearman correlation test. RESULTS: Overall, the translucent shades and bulk-fill resin composites showed greater translucency than the other resins. While "body" and "enamel" shades demonstrated intermediate translucency to dentin and enamel, the "dentin" shades were more standardized, showing similar translucency to human dentin. All tested resin composites showed similar or greater radiopacity to human enamel, except the Empress Direct (Ivoclar) resin with Trans Opal shade, which was not radiopaque. Dentin and enamel showed radiopacity similar to 1 and 2 mmAl (millimeters of aluminum), respectively. CONCLUSIONS: The resin composites investigated in this study differed regarding their translucency degree and radiopacity level, without any positive relationship between the two properties.

Use of the metal artefact reduction tool in the identification of fractured endodontic instruments in cone-beam computed tomography.

AIM: To evaluate the influence of the metal artefact reduction (MAR) tool in the diagnosis of fractured instruments in root canals of extracted mandibular molars, with or without root canal fillings. METHODOLOGY: The root canals of 31 mandibular molars were divided into four groups: (i) the control group, without root fillings; (ii) the fracture group, without fillings and with fractured files; (iii) the fill group, with root filling; and (iv) the fill/fracture group, root filled and with fractured files. The following instruments were used as fractured endodontic instruments: stainless steel hand files, NiTi reciprocating files and NiTi rotary files. Each tooth was inserted in a dry mandible to obtain cone-beam computed tomography (CBCT) images using a CBCT OP300 3D Maxio (Instrumentarium Dental, Tuusula, Finland) and Picasso Trio (Vatech, Hwaseong, Republic of Korea), with and without application of the MAR tool. All images were evaluated by three radiologists for the presence or absence of fractured files on a 5-point scale. The diagnostic accuracy (area under ROC curve) was calculated. Image noise was measured in regions of trabecular and cortical bone and soft tissue. The comparison between the ROC curve values with the MAR tool enabled or disabled was performed using a t-test. A t-test was also employed for comparing image noise when the MAR tool was enabled and disabled. The significance level was set at 5%. RESULTS: The use of the MAR tool did not influence the diagnostic accuracy for identifying fractured endodontic instruments in root canals with and without fillings in both CBCT systems (P > 0.05), nor did it influence the image noise (P > 0.05). CONCLUSIONS: The MAR tool on these two devices did not increase the detection of fractured endodontic instruments and did not reduce image noise using extracted mandibular molars. Therefore, the MAR tool is not recommended for evaluation of fractured endodontic instruments in teeth with and without root fillings in mandibular molars.

Root canal configuration and its relation with endodontic technical errors in premolar teeth: a CBCT analysis.

AIM: To evaluate the association between endodontic technical errors and the root canal configuration (RCC) of human premolars, as well as their relationship with periapical lesions through cone-beam computed tomography (CBCT) images. METHODOLOGY: The sample consisted of CBCT scans belonging to 136 patients, totalling 152 root filled premolars (185 roots). CBCT images were evaluated by two oral radiologists. RCC was recorded according to Vertucci's classification, and the endodontic treatment quality was judged on the presence and type of technical endodontic errors (underfilling, overfilling, nonhomogeneous filling, nonfilled canal, fractured instruments, root deviation and absence of coronal restoration). In addition, the presence of periapical lesions associated with each RCC was recorded. Data were expressed by frequencies and percentages, and intraobserver agreement was calculated using the Kappa test. RESULTS: The most common RCC was type I (71%), followed by type IV (15%), type II (8%), type V (3%), type VI (1%) and type III (1%). Types VII and VIII were not observed in the sample. Underfilling was the most frequent endodontic technical error for most RCCs, except for types IV, V and 'other', whose most frequent error was a nonfilled canal. The presence of technical errors was greater with an increase in the proportion of the periapical lesions. The intraobserver agreement was excellent. CONCLUSIONS: There was an increase in the prevalence of endodontic technical errors and in the presence of periapical lesions as the anatomical complexity of the root canals increased. Underfilled and nonfilled canal were the most frequent endodontic technical errors.

Correlation between temporomandibular joint temporal component pneumatization and morphology: analysis by cone beam computed tomography.

The aim of this study was to evaluate whether a correlation exists between temporal bone pneumatization and the morphology of the articular eminence and glenoid fossa. A sample of 100 cone beam computed tomography scans was used, for a total of 200 temporomandibular joints (TMJ). Paracoronal and parasagittal images of the TMJ were evaluated by two examiners. For all TMJ, pneumatization was classified in the mid-lateral direction using a score of 0 or 1, and in the anteroposterior direction using a score ranging from 0 to 3. The inclination and height of the articular eminence and the thickness of the roof of the glenoid fossa were obtained. Pneumatization was found in the mid-lateral direction in 83.5% of the cases and in the anteroposterior direction in 88%. The age of the patient and side did not influence the prevalence or degree of pneumatization (P=0.051-0.953), but female patients showed more pneumatization in the mid-lateral direction than male patients (P=0.014). The presence of pneumatization did not affect articular eminence and mandibular fossa morphology. It is concluded that the presence and extent of pneumatization of the TMJ temporal component does not affect its morphology. However, professionals should be aware of the high prevalence of pneumatization and take this into account when performing TMJ assessment.

Diagnosis of external root resorption in teeth close and distant to zirconium implants: influence of acquisition parameters and artefacts produced during cone beam computed tomography.

AIM: To assess the influence of artefacts, the metal artefact reduction (MAR) tool and kilovoltage (kVp) on the diagnosis of simulated external root resorption (ERR) in teeth close and distant to zirconium implants in cone beam computed tomography (CBCT) images. METHODOLOGY: Cavities (0.62 mm in diameter and 0.19 mm deep) were created in the apical thirds of 12 roots on the buccal, lingual, distal or mesial surface; ten roots served as controls. The roots were randomly positioned in the first and second right and left premolar sockets of a dry human mandible, and a zirconium implant was placed in the socket of the first right molar. A ProMax 3D unit varying kVp (70, 80, or 90 kVp) and with the MAR tool activated or not was used to obtain CBCT scans. Five examiners evaluated all images to determine the area under the receiver operating characteristic (ROC) curve, sensitivity and specificity. RESULTS: The ROC values and sensitivity were not affected by MAR or artefacts regardless of the distance to the implant (P > 0.05), whilst increasing kVp from 70 to 90 led to a significant increase in these values (P = 0.0202 and 0.0199, respectively). Specificity was not affected by the factors studied (P > 0.05). CONCLUSIONS: Amongst the factors studied, only kVp influenced the diagnosis of simulated external root resorption in CBCT images. Increasing kVp from 70 to 90 improved the accuracy in diagnosing the simulated lesions.

Prevalence of soft tissue calcifications in the maxillofacial region detected by cone beam CT.

OBJECTIVE: To determine the prevalence of soft tissue calcifications in cone beam computed tomography (CBCT) scans with different fields of view (FOV) and to assess its relation with the clinical relevance of the CBCT findings. MATERIAL AND METHODS: One thousand CBCT scans were grouped according to FOV's size and region scanned (MX-FOV, maxilla; MD-FOV, mandible; and MM-FOV, maxilla/mandible) and evaluated for the presence of soft tissue calcifications. Laterality and length of the elongated styloid processes (ESP) were also assessed. RESULTS: Eight hundred and eighty-two soft tissue calcifications were detected in 626 (62.6%) patients. MM-FOV presented the highest prevalence (76.8%), followed by MD-FOV (60.6%) and MX-FOV (57.2%). ESP and tonsillolith were the most frequent calcifications. Calcifications requiring treatment or not and those in need of follow-up accounted for 6.9%, 92.7%, and 0.3% of cases, respectively. There was no association between calcifications and subjects' gender or age (p > .05). Most cases of ESP occurred bilaterally and were longer in males (p < .05). CONCLUSIONS: There is a high prevalence of soft tissue calcifications in CBCT, and ESP and tonsilloliths are the most common types in all evaluated FOVs. While most cases do not require treatment, we emphasize the importance of detailed CBCT assessment for its diagnosis.

Changes in condylar volume and joint spaces after orthognathic surgery.

The aim of this study was to evaluate the changes in condylar volume and joint spaces occurring in patients undergoing bimaxillary orthognathic surgery for the treatment of class II deformities, by means of cone beam computed tomography (CBCT). Initial and follow-up (at least 6 months) CBCT examinations of 114 condyles (57 patients) were studied retrospectively. Linear measurements of the joint space and volumetric analysis of changes in condylar volume were performed using Dolphin 3D Imaging in association with ITK-SNAP 3.0.0 segmentation software. The paired t-test and Pearson correlation coefficient were applied, and a descriptive analysis was performed. Mean condyle volumes were significantly smaller at follow-up (P=0.0125). There were significant reductions in superior and medial joint spaces in the follow-up examinations (both P<0.05). Positive correlations were found when comparing the mean changes in anterior, superior, and posterior space values between the right and left sides. No significant correlation was observed between changes in volume and joint spaces. In conclusion, there was a reduction in mean condylar volume after orthognathic surgery in class II patients. However, changes in volume for each condyle may be variable. Such changes in condylar volume may occur independently on the left and right sides, and do not correlate with changes in joint spaces.

Efficacy of new natural biomodification agents from Anacardiaceae extracts on dentin collagen cross-linking.

OBJECTIVES: Several polyphenols from renewable sources were surveyed for dentin biomodification. However, phenols from cashew nut shell liquid (CNSL, Anacardium occidentale) and from Aroeira (Myracrodruon urundeuva) extract have never been evaluated. The present investigation aimed to compare the dentin collagen crosslinking (biomodification) effectiveness of polyphenols from Aroeira stem bark extract, proanthocyanidins (PACs) from grape-seed extract (Vitis vinifera), cardol and cardanol from CNSL after clinically relevant treatment for one minute. METHODS: Three-point bending test was used to obtain the elastic modulus of fully demineralized dentin beams before and after biomodification, whilst color change and mass variation were evaluated after four weeks water biodegradation. Color aspect was assessed by optical images after biodegradation whereas collagen cross-linking was investigated by micro-Raman spectroscopy. Statistical analysis was performed with repeated-measures two way ANOVA and Tukey's test (p<0.05). RESULTS: The increase in elastic modulus after biomodification was in the order cardol>cardanol>aroeira=PACs with cardol solution achieving mean 338.2% increase. The mass increase after biomodification followed the same order aforementioned. Nevertheless, after four weeks aging, more hydrophobic agent (cardanol) induced the highest resistance against water biodegradation. Aroeira and cardol attained intermediate outcomes whereas PACs provided the lower resistance. Tannin-based agents (Aroeira and PACs) stained the specimens in dark brown color. No color alteration was observed with cardol and cardanol treatments. All four agents achieved crosslinking in micro-Raman after one minute application. SIGNIFICANCE: In conclusion, major components of CNSL yield overall best dentin biomodification outcomes when applied for one minute without staining the dentin collagen.

Complex Odontoma: A Case Report with Micro-Computed Tomography Findings.

Odontomas are the most common benign tumors of odontogenic origin. They are normally diagnosed on routine radiographs, due to the absence of symptoms. Histopathologic evaluation confirms the diagnosis especially in cases of complex odontoma, which may be confused during radiographic examination with an osteoma or other highly calcified bone lesions. The micro-CT is a new technology that enables three-dimensional analysis with better spatial resolution compared with cone beam computed tomography. Another great advantage of this technology is that the sample does not need special preparation or destruction in the sectioned area as in histopathologic evaluation. An odontoma with CBCT and microtomography images is presented in a 26-year-old man. It was first observed on panoramic radiographs and then by CBCT. The lesion and the impacted third molar were surgically excised using a modified Neumann approach. After removal, it was evaluated by histopathology and microtomography to confirm the diagnostic hypothesis. According to the results, micro-CT enabled the assessment of the sample similar to histopathology, without destruction of the sample. With further development, micro-CT could be a powerful diagnostic tool in future research.

Effect of delayed scanning on imaging and on the diagnostic accuracy of vertical root fractures in two photostimulable phosphor plates digital systems.

AIM: To evaluate the influence of delayed scanning on images obtained with two PSPs digital systems and on the diagnostic accuracy of vertical root fracture (VRF) by means of objective and subjective analyses. METHODOLOGY: Forty single-rooted human teeth were divided into two groups, one without VRFs and another with VRFs induced by a universal testing machine. Two digital systems (VistaScan(®) and Express(®) ) were used to radiograph all teeth, and the resulting plates were scanned at four time-points: T0-immediately, T1-30 min, T2-2 h and T3-4 h after exposure. An aluminium (Al) wedge was used to evaluate the change in mean grey values as each scan was delayed. Three observers screened all images for VRFs, and one-fourth of the sample was revaluated after thirty days. Areas under the receiver operating characteristic (ROC) curve, sensitivity, specificity and accuracy values were compared by anova. RESULTS: Intra- and interobserver agreement ranged from moderate to substantial and fair to moderate, respectively. There was no significant difference amongst scan delays with regard to sensitivity, specificity and accuracy; however, there were significant differences in the area under the ROC curve, with the 4-h delayed scan being associated with lower values compared to the others (P = 0.019). As for objective analysis, there was a significant difference amongst all different scanning time-points for the two systems (P = 0.001), except between the 30-min and 2-h delayed scans in the VistaScan(®) system. CONCLUSION: Whilst delayed scanning caused changes to the density of images acquired with the systems studied, it did not seem to interfere with VRF diagnosis except when scanning was delayed for 4 h, which should therefore be avoided.

Digital radiographs displayed on different devices: effect on the detection of vertical root fractures.

AIM: To evaluate whether the type of display device affects the detection of vertical root fractures (VRFs) on digital radiographs in unfilled canals and canals with fibreglass posts. METHODOLOGY: Forty single-rooted human teeth were decoronated, and the root canals were prepared. The teeth were divided into 2 groups: controls (20 teeth) and with VRF (20 teeth). The VRFs were induced using an universal testing machine. Periapical radiographs of all teeth, with canal unfilled or with a fibreglass post, were obtained using the parallel technique in 3 directions (ortho-, mesio- and distoradial) on storage phosphor plates (VistaScan®). All images were evaluated and re-evaluated after 30 days by 3 examiners on a 5-point scale using 4 different devices (notebook display with full high definition resolution, desktop display with a standard resolution, 8-inch Android(™) tablet with high definition resolution and a 9.7-inch iPad® tablet with Retina resolution). Areas under ROC curves, sensitivity, specificity and accuracy values were compared by anova. RESULTS: The weighted kappa values for intra- and interobserver reproducibility were 0.55-0.88 and 0.31-0.65, respectively. There was a significant difference (P < 0.05) in relation to the area under the ROC curve, specificity and sensitivity when unfilled canals were compared with canals with a fibreglass post; however, no difference was observed for the different devices studied. CONCLUSIONS: The type of display device did not affect the detection of VRFs. Thus, the detection of VRFs can be performed using different screen sizes and resolutions.

Influence of the artefact reduction algorithm of Picasso Trio CBCT system on the diagnosis of vertical root fractures in teeth with metal posts.

OBJECTIVES: To assess the influence of the artefact reduction algorithm (AR) available on the Picasso Trio 3D(®) imaging system (Vatech, Hwaseong, Republic of Korea) on image quality [greyscale values, contrast-to-noise ratio (CNR) and artefact formation] and diagnosis of vertical root fractures (VRFs) in the teeth with intracanal metal posts. METHODS: 30 uniradicular teeth had their crowns removed and their roots endodontically treated to receive intracanal metal posts. In 20 teeth, both complete (n = 10) and incomplete (n = 10) VRFs were created. Each tooth was scanned twice, with and without AR activation. The mean and variation of greyscale values, as well as CNR, were calculated for all images. Subsequently, an evaluator compared the amount of artefact (cupping, white streaks and dark bands) in all images. Five evaluators rated for VRF presence using a five-point scale. RESULTS: Mean greyscale values and CNR were significantly decreased in images acquired with the AR. The usage of the algorithm promoted an overall reduction of image artefacts. Regarding the diagnosis of complete and incomplete VRFs, the use of the AR had an overall negative impact on specificity and accuracy. CONCLUSIONS: While indeed reducing artefact formation, the use of the AR, instead of improving the impact on the diagnosis of VRFs in teeth with intracanal metal posts, had a negative impact on the diagnosis.

Influence of CBCT enhancement filters on diagnosis of vertical root fractures: a simulation study in endodontically treated teeth with and without intracanal posts.

OBJECTIVES: To evaluate the influence of CBCT enhancement filters on the diagnosis of vertical root fractures (VRFs) in teeth with and without metal posts. METHODS: The crowns of 40 uniradicular human teeth were removed and all roots were prepared. 20 teeth were randomly selected, and VRFs were induced using a universal testing machine. The i-CAT (Imaging Sciences International, Hatfield, PA) CBCT was used to scan teeth with and without intracanal metal posts using the following parameters: 0.2 voxel size, 8 × 8-cm scan size and acquisition time of 26.9 s. Images were evaluated by three observers with and without the use of the following filters: S9, smooth, smooth 3 × 3, sharpen, sharpen-mild and sharpen 3 × 3. RESULTS: Intra- and interobserver agreement ranged from poor to moderate. Images with and without CBCT filters did not show significant differences regarding the area under the receiver operating characteristic curve, as well as sensitivity (p > 0.05). As for accuracy, the sharpen-mild filter was superior to the sharpen (p = 0.03), but these filters did not differ from all others. For specificity, S9, smooth and original images were superior to sharpen (p < 0.01). Results for teeth without posts differed from those for teeth with metal posts in all cases (p < 0.05). CONCLUSIONS: The use of enhancement filters in CBCT images has no influence on the diagnosis of VRFs in teeth with metal posts, and their use is not justified.

Impact of root fillings and posts on the diagnostic ability of three intra-oral digital radiographic systems in detecting vertical root fractures.

AIM: To evaluate (i) the accuracy of three intra-oral digital systems in detecting vertical root fractures (VRFs); and (ii) the influence of different intracanal conditions (without filling, filled with Gutta-percha and metal or fibreglass post). METHODOLOGY: Forty single-rooted human teeth were decoronated and the root canals prepared. VRFs were induced using a universal testing machine on 20 teeth. Radiographic images were obtained using the paralleling technique with three different horizontal angulations on conventional E/F film, two storage phosphor plates (Digora Optime and VistaScan) and one sensor system (SnapShot). All teeth were radiographed with all intracanal conditions tested. All images were evaluated by five examiners. After 30 days, 25% of the images were reviewed. Areas under ROC curves, sensitivity, specificity, accuracy, positive predictive and negative predictive values were compared by anova. RESULTS: The weighted kappa values for intra- and interobserver reproducibility were 0.48-0.74 and 0.57-0.66, respectively. The sensitivity revealed a significant difference between imaging modalities, with higher values for SnapShot (0.53) and VistaScan (0.46), followed by the film (0.41) and Digora (0.38). The area under the ROC curve for SnapShot (0.82) was greater than for the other systems in the teeth with a fibreglass post (VistaScan: 0.70; Digora: 0.64; film: 0.60). CONCLUSION: All systems gave a similar performance for detecting VRFs; all gave a good performance in the absence of intracanal materials, but performed less well in the presence of a metal post or Gutta-percha. In teeth with a fibreglass post, digital systems with higher resolution should be used.

The 'Sharpen' filter improves the radiographic detection of vertical root fractures.

AIM: To compare the diagnostic accuracy of digital enhancement filters in the diagnosis of vertical root fractures. METHODOLOGY: The sample consisted of 40 single-rooted teeth randomly divided into two groups: experimental and control. Vertical root fractures were induced in the experimental group using a universal testing machine. All teeth were individually radiographed with three different horizontal angles using the Digora Optime(®) digital system. Three observers separately examined the original and filtered images (3D Emboss, Negative, Sharpen and Shadow). The area under Receiver Operating Characteristic curve values (Az) for each protocol were compared by one-way anova with post hoc Bonferroni test. The significance level was set at 5%. RESULTS: The highest Az value was obtained using the Sharpen filter, with significant differences from the original and other filtered images (P < 0.05). The 3D Emboss filter had the lowest Az value, which was significantly different from the other filtered images (P < 0.05). CONCLUSION: When using the Digora Optime(®) system, the 'Sharpen' filter is recommended to improve the radiographic detection of vertical root fractures.

Influence of exposure factors on the variability of CBCT voxel values: a phantom study.

OBJECTIVES: To assess the influence of milliamperage and kilovolt peak (kVp) on the variability of cone beam CT (CBCT) voxel values. METHODS: CBCT scans were obtained from radiographic phantoms in varying concentrations of dipotassium hydrogen phosphate solutions (200-1200 mg ml(-1)) under different protocols of milliamperage and kVp. In addition, scans were performed with and without a dental implant and exo-mass. The variability of CBCT voxel values was measured on each scan, and factorial analysis of variance and the post hoc Tukey test were performed (α = 0.05). Linear regression was performed to assess the relationship between voxel value variability and dipotassium hydrogen phosphate concentration. RESULTS: milliamperage and the presence of a dental implant did not produce significant interference (p = 0.28 and 0.87, respectively) in voxel value variability. Scans at the highest kVp value presented a significant reduction (p ≤ 0.0001) in voxel value variability when only exo-mass was not present. Voxel value variability was not influenced by exo-mass in scans at the highest levels of milliamperage and kVp. The presence of exo-mass produced a significant reduction (p ≤ 0.0001) in voxel value variability in most of the scans. Higher concentrations yielded greater variations in voxel values in all scans, except for those operating at the highest levels of mAs and kVp. CONCLUSIONS: mAs did not influence the variability of CBCT voxel values; higher kVp reduced such variability when only the object was smaller than the field of view.

Prevalence and characteristics of pneumatization of the temporal bone evaluated by cone beam computed tomography.

The aim of this study was to determine the prevalence and characteristics of pneumatization of the glenoid fossa and articular eminence by means of cone beam computed tomography (CBCT) images. CBCT images of 658 patients (1316 joints) were evaluated to determine pneumatization in the articular eminence (PAT) and roof of the glenoid fossa (PGF). Age and gender were recorded for all patients and, for the cases of pneumatization, laterality and type (unilocular or multilocular) were noted. Its prevalence was correlated with gender, age and laterality by statistical analyses. 21.3% of individuals presented with PAT and 38.3% presented with PGF. Considering the temporomandibular joint, PAT was in 15.5% and PGF in 30.2%. Of PAT cases, 54.3% were unilateral and 45.7% bilateral; 3.4% were unilocular and 96.6% were multilocular. In the PGF cases, 42.5% were unilateral and 57.5% bilateral; 0.02% was unilocular and 99.8% were multilocular. There was no statistical difference regarding gender and age; but there was statistical difference regarding laterality, with higher frequency on the left side. In conclusion, there was a significant prevalence of PAT and PGF in the studied population; their prevalence seems higher than has been previously supposed.

Correlation of panoramic radiography and cone beam CT findings in the assessment of the relationship between impacted mandibular third molars and the mandibular canal.

OBJECTIVES: The aim of this study was to assess the reliability of four panoramic radiographic findings, both individually and in association, in predicting the absence of corticalization between the mandibular canal and the third molar on cone beam CT (CBCT) images. METHODS: The sample consisted of 72 individuals (142 mandibular third molars) who underwent pre-operative radiographic evaluation before extraction of impacted mandibular third molars. On panoramic radiographs, the most common signs of corticalization (darkening of roots, diversion of mandibular canal, narrowing of mandibular canal and interruption of white line) and the presence or absence of corticalization between the mandibular third molar and the mandibular canal on CBCT images were evaluated. RESULTS: Darkening of roots and interruption of white line associated with the absence of corticalization between the mandibular third molar and the mandibular canal on CBCT images were statistically significant, both as isolated findings (p = 0.0001 and p = 0.0006, respectively) and in association (p = 0.002). No statistically significant association was observed for the other panoramic radiographic findings, either individually or in association (p > 0.05). CONCLUSION: Darkening of roots and interruption of white line observed on panoramic radiographs, both as isolated findings and in association, were effective in determining the risk relationship between the tooth roots and the mandibular canal, requiring three-dimensional evaluation of the case.

Evaluation of reconstructed images with different voxel sizes of acquisition in the diagnosis of simulated external root resorption using cone beam computed tomography.

AIM: To evaluate the diagnosis of simulated external root resorption in cone beam computed tomography (CBCT) images acquired with different voxel sizes, then reconstructed with the same voxel size. METHODOLOGY: Buccal, mesial and distal root surfaces of twenty single-rooted premolar teeth were evaluated for the presence or absence of simulated resorption defects. Images were obtained using a Classic i-CAT CBCT unit with two different voxel sizes (0.25 and 0.30 mm). Then all images were reconstructed to 0.25 mm voxel size. The McNemar's test was applied to evaluate the agreement between the two protocols (different voxel sizes/reconstruction parameters) with the gold standard (defects created in the root). Accuracy, sensitivity, specificity, positive and negative predictive values were calculated for each voxel and defect sizes. RESULTS: Better sensitivity and accuracy were obtained with 0.25 (0.25 mm) voxel size. Specificity, positive and negative predictive values were highest with the 0.25 (0.30 mm) voxel size. McNemar's test results revealed significant differences between the protocols with the gold standard (P < 0.0001). The results revealed that as the cavity size increased, sensitivity, accuracy, positive and negative predictive values also increased. When correlating the voxel size and root third, better sensitivity, accuracy, positive and negative predictive values were obtained in the middle third. CONCLUSIONS: In the diagnosis of simulated external root resorption with the Classic i-CAT CBCT unit, images acquired with 0.30 mm voxel size and reconstructed with 0.25 mm voxel size provided the best protocol with a lower radiation dose than the 0.25 mm voxel size.

Evaluation of temporomandibular joint in stress-free patients.

OBJECTIVES: The aetiology of temporomandibular disorders (TMD) is presently considered to be multifactorial, and stress has been regarded as an important factor in their onset. Many studies have evaluated the importance of stress in TMD; however, only patients with TMD and stress have been assessed. This study aimed at evaluating signs and symptoms of TMD in stress-free patients. METHODS: The temporomandibular joints (TMJs) of 40 stress-free patients were evaluated during clinical examination and in MRI. RESULTS: The individuals lived in an area without electric power supply or telephone services. They worked in agriculture and fishery. 77.5% of the patients presented normal mandibular function; 70% presented normal mandibular trajectory; 61.25% did not present sounds in TMJ and 93.75% did not present joint pain during palpation. Image screening showed that 70% of TMJ presented normal disc position. Only one patient (1.25%) presented TMD. CONCLUSIONS: The absence of stress is a strong factor for the non-development of TMD.