Effectiveness of Using a Mobile App to Improve Dental Students' Ability to Identify Endodontic Complications from Periapical Radiographs.

The aim of this study was to evaluate the feasibility and effectiveness of a mobile application as a supplementary tool in the radiographic diagnosis of endodontic complications by dental students. Radiographic images of the following endodontic conditions were selected: 1) absence of endodontic treatment (ET) without periapical lesion (PL); 2) absence of ET with PL; 3) satisfactory ET without PL; 4) satisfactory ET with PL; 5) unsatisfactory ET without PL; 6) unsatisfactory ET with PL; 7) fractured instrument; 8) deviated cast post; 9) root fracture; and 10) root resorption. In 2018, images were evaluated by 20 students at a dental school in Brazil who had been divided into experimental and control groups. The experimental group was permitted to use the Kahoot! mobile application (app) to access reference images of endodontic conditions. Reference standards were established through consensus by two endodontists and three oral radiologists. The results showed that intraobserver agreement ranged from moderate to substantial for both groups. Significant differences from the specialists' reference standards were found in the evaluation of conditions 4 and 10 for the experimental group, which used the app (p<0.001), and conditions 1, 4, 6, 7, 8, and 10 for the control group, which did not use the app (p<0.05). No statistically significant differences were found in accuracy, sensitivity, or specificity values between the groups for any of the endodontic conditions evaluated (p>0.05). This study found that the use of a mobile app containing reference images improved the students' ability to diagnose endodontic complications, suggesting it would be a valuable supplementary tool in dental education.

Tomografia computadorizada de feixe cônico como método de avaliação da pneumatização da articulação temporomandibular / Cone-beam computed tomography as a method of evaluating pneumatization of the temporomandibular joint

Introdução: A pneumatização, considerada um processo fisiológico, são cavidades cheias de ar no interior dos ossos do crânio resultante de áreas de células epiteliais. Objetivo: Determinar a prevalência de pneumatização na fossa articular (PFA) e da eminência articular (PEA) do osso temporal por meio de exames de tomografia computadorizada de feixe cônico (TCFC). Material e métodos: Trezentas e noventa imagens de articulações temporomandibulares foram avaliadas por dois examinadores, devidamente calibrados, com experiência em imagens de TCFC. Nos casos em que foi detectada pneumatização, esta foi classificada de acordo com o tipo (unilocular e multilocular) e lateralidade (unilateral ou bilateral). Resultados: A PFA ou a PEA foi diagnosticada em 97 (49,74%) pacientes. Destes pacientes, 61 (31,3%) apresentaram PFA e 36 (18,5%) PEA. Em relação à lateralidade, na PFA, 36 (59%) apresentaram a condição unilateralmente e 25 (41%) bilateralmente. Dentre os pacientes com PEA, 24 (66,7%) apresentaram a condição unilateralmente e 12 (33,3%) bilateralmente. A pneumatização foi correlacionada entre os lados pelo coeficiente de correlação de Spearman e foi significativa para os casos multiloculares (fossa articular: rs=0,52 / p<0,0001 e eminência articular: rs=0,42 p<0,0001). Conclusão: A pneumatização da região temporomandibular é uma característica relativamente comum e, apesar de não necessitar de tratamento, a observação é fundamental para evitar complicações do tratamento ou diagnóstico errôneo na região.

Introduction: Pneumatization, considered a physiological process, are air-filled cavities within the skull bones resulting from areas of epithelial cells. Objective: To determine the prevalence and characteristics of pneumatization of the glenoid fossa and articular eminence on cone beam computed tomography. Material and methods: Images of 195 patients (195 temporomandibular joints) were evaluated and the age and gender of the individuals were collected. In cases where pneumatization was detected, this was classified according to type (unilocular and multilocular) and laterality (unilateral or bilateral). Results: The pneumatization of the glenoid fossa and articular eminence were diagnosed in 63 (32.3 %) patients. Of these patients, 61 (31.3%) had pneumatization of glenoid fossa and 36 (18.5%) had pneumatization of articular eminence. Regarding laterality, in PGF 36 (59%) presented the condition unilaterally and 25 (41%) bilaterally. The patients with PAE, 24 (66.7%) presented the condition unilaterally and 12 (33.3%) bilaterally. Pneumatization was correlated between the sides using the Spearman correlation coefficient and was significant for multilocular cases (glenoid fossa: rs= 0,52/p<0,0001 and articular eminence: rs=0,50 p<0,0001). Conclusion: The pneumatization of temporomandibular region is a relatively common feature, and even though it does not require treatment, observation is crucial to avoid complications of treatment or wrong diagnosis in the region.

Three-dimensional analysis of impacted maxillary third molars: A cone-beam computed tomographic study of the position and depth of impaction.

PURPOSE: The classification of impacted maxillary third molars (IMTMs) facilitates interdisciplinary communication and helps estimate the degree of surgical difficulty. Thus, this study aimed to develop a 3-dimensional classification of the position and depth of impaction of IMTMs and to estimate their prevalence with respect to gender and age. MATERIALS AND METHODS: This cross-sectional retrospective study analyzed images in sagittal and coronal cone-beam computed tomography (CBCT) sections of 300 maxillary third molars. The proposed classification was based on 3 criteria: buccolingual position (buccal, lingual, or central), mesial-distal position (mesioangular, vertical, or distoangular), and depth of impaction (low, medium, or high). CBCT images of IMTMs were classified, and the associations of the classifications with gender and age were examined using analysis of variance with the Scheffé post-hoc test. To determine the associations among the 3 classifications, the chi-square test was used (P<.05). RESULTS: No significant association of the classifications with gender was observed. Age showed a significant relationship with depth of impaction (P=.0001) and mesial-distal position (P=.005). The most common positions were buccal (n=222), vertical (n=184), and low (n=124). Significant associations among the 3 tested classifications were observed. CONCLUSION: CBCT enabled the evaluation of IMTMs in a 3-dimensional format, and we developed a proposal for a new classification of the position and depth of impaction of IMTMs.

Influence of lip retraction on the cone beam computed tomography assessment of bone and gingival tissues of the anterior maxilla.

OBJECTIVE: To evaluate the influence of lip retraction on cone beam computed tomography (CBCT) assessment of bone and gingival tissues on the labial surface of the anterior maxilla. STUDY DESIGN: A retrospective study was conducted using measurements of bone and gingival tissues collected from 120 maxillary incisors. The thicknesses of the bone and gingival tissues of different regions were measured on CBCT images, with and without a lip retractor. The thicknesses of the gingival tissues obtained from CBCT were correlated with measurements performed by clinical probing. RESULTS: The thickness of bone in the more cervical region presented a higher mean value for exams performed with a lip retractor (P = .021). The thickness of bone found a significant correlation with the thickness of the gingiva (P ≤ .020) with a lip retractor in CBCT exams. The thickness of the gingival tissue obtained from CBCT scans with lip retraction found significant correlations with those obtained clinically (P ≤ .001). CONCLUSIONS: The use of lip retractors is a simple and reliable practice that allows the measurement of gingival tissues on CBCT images. This practice can exempt a patient from an invasive clinical procedure for measuring the thickness of the gingival tissue for implant cases of the anterior segment.

A Study of the Association Between Sleep Bruxism, Low Quality of Sleep, and Degenerative Changes of the Temporomandibular Joint.

The aim of this study was to evaluate the presence of degenerative bone changes of the temporomandibular joint (TMJ) in individuals suffering from sleep bruxism (SB), associating these characteristics with the quality of sleep. For this, we followed the International Classification of Sleep Disorders for the diagnosis of SB, in addition to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the classification of TMD and cone beam computed tomography. It was found that 97.7% of the individuals with bruxism had at least 1 RDC/TMD group III diagnosis, 75.6% of the subjects considered their sleep quality as poor, and the largest group (23%) had centric bruxism. There was no significant association between the pattern of sleep quality (P = 0.36), the type of SB (P = 0.277), and the presence of degenerative changes of the TMJ. Regardless of the quality of sleep and the type of bruxism presented, the prevalence of degenerative bone disorders was high (67%) among women with a mean age of 46 years and a clinical diagnosis of SB.