Ameloblastic Fibro-odontoma - A Case Report of Two Uncommon Cases.

Rationale: Ameloblastic fibro-odontoma (AFO) is a rare mixed odontogenic tumour with a preferential location in the posterior mandible and with a variety of radiological aspects. We report two clinical cases of AFO in two rare locations and with unusual radiological aspects. Patient Concerns: The first patient is a 37-year-old female with an asymptomatic intraoral swelling located in the anterior mandibular. The second patient is a 16-year-old girl with a chief complaint of missing maxillary canine. Diagnosis: Both cases were diagnosed with AFO. Treatment: For the first patient, a biopsy was performed, and for the second one, the lesion was surgically excised. Outcomes: The first patient is under regular surveillance and the other was followed up for one year without any evidence of recurrences. Take-away Lessons: Despite many efforts, the nature, histology and therapy of these lesions remain very confusing.

Three-dimensional anatomical analysis of the optic nerve canal with virtual model based on CBCT.

The optic nerve canal (ONC) is a fine skeletal structure that contains the optic nerve. However, it has not been thoroughly examined. This necessitates establishing a baseline knowledge of the geometrical and volumetric parameters of the ONC. The data of twenty patients who received a cone beam computed tomography examination were prepared using a voxel-based segmentation. The measurement was performed separately by two examiners on virtual skull models in stereolithography format in Geomagic Wrap®. The results showed that the volume of the ONC varied between 92.48 mm3 and 162.7 mm3 (M = 123.46 mm3, SD = 26.61 mm3). Sex-specific statistically significant differences in volume were detected only for the right side. The angle of the ONC to the skull base was independent of the diameter of the canal. Both the intrarater and interrater comparisons of the measurements showed high values of reproducibility of the results. This study showed that a virtual anatomical model provides a feasible and reliable method to investigate the ONC. The examination technique could have a wider range of application in anthropology and application in clinical medicine. Advances in the automation of radiological diagnostics and the digital analysis of X-ray images could help to reduce examination times.

Cone Beam Computed Tomography for the Interventional Oncologist: A Practical Approach.

Transarterial treatment of liver tumors is becoming increasingly common and is considered first- or second-line therapy for many tumor types and stages. Such therapies are heavily dependent on imaging during the procedures; while angiography remains the mainstay of intraprocedural therapies, cone beam computed tomography (CBCT) is becoming increasingly commonly used to guide therapy. This article describes the role of CBCT during transarterial therapies and offers guidance as to how CBCT can be optimally used for these procedures.

A Comparison and Evaluation of Two Commercially Available Metal Artifact Reduction Applications.

Objective: The angiography systems A (A) and B (B), both incorporated at our hospital, are equipped with metal artifact reduction (MAR) applications. In clinical practice, it is crucial to understand the characteristics of MAR in both systems given that endovascular treatments are occasionally administered with both. In this study, we compared the artifact reduction effects of MAR on equipment A and B and clarified the differences between the two systems. Methods: An artifact evaluation phantom was created using a cylindrical water phantom and an iodine contrast medium. The phantom was imaged, MAR processing was performed on the obtained images, and an isotropic quantitative evaluation of artifacts was performed by extreme value statistical analysis using the Gumbel distribution. Results: The MAR reduction effects were approximately 45% and 40% for equipment A and B at concentrations of 8300 and 6000, respectively. The MAR reduction effect in both devices exhibited different trends depending on the concentration. Conclusion: In clinical procedures that make use of absorbents in medium concentrations of approximately 3000-5000, such as n-butyl-2-cyanoacrylate and Onyx, it is necessary to understand the MAR characteristics of both devices and consider the use of alternative devices as an option.

Clinical and Radiological Insights of Cleidocranial Dysplasia: A Case Report of a Rare Medical Condition.

Cleidocranial dysplasia (CCD) is a rare, congenital disorder characterized by a unique constellation of skeletal and dental abnormalities. The imaging findings, combined with clinical examination, help establish a definitive diagnosis. Understanding the broad spectrum of manifestations in CCD is essential for effective management and treatment. This case report aims to provide a comprehensive overview of a 25-year-old male patient with CCD, highlighting the genetic etiologies, clinical presentation, radiological findings, and a review of current literature to enhance understanding and awareness of this rare condition.

Exceptional bone remodeling over composite restoration in the management of external root resorption: A case report.

A 65-year-old Caucasian male was referred to an endodontic specialist practice in a private clinic in December 2019 for the management of an asymptomatic, radiolucent lesion located at the cervical level of the distal root of his right lower first molar, noticed during a routine periapical radiograph. After an accurate evaluation with cone-beam computed tomography (CBCT), the subgingival lesion was diagnosed as a supracrestal external cervical resorption (ECR), with a circumferential spread ⩽90°, confined to dentine without pulp involvement. The lesion was treated with the following sequence: (1) a full flap accessed the ECR, (2) the granulomatous tissue was removed from the root area, (3) the cavity was refreshed and filled with a well-refined and polished resin composite, (4) the flap was sutured at the cemento-enamel junction. A mandibular CBCT scan was performed before treatment, right after treatment, and 3 years postoperatively. Compared to the 3-year posttreatment CBCT scan, the immediate posttreatment one, revealed the absence of bone loss and an unexpected coronal bone remodeling with new bone formation over the treated lesion.

3D printing and CBCT anatomical reproducibility assessment in forensic scenarios.

INTRODUCTION: The scientific community highlighted the relevance of 3D physical models since the beginning of the XXI century, complementary to three-dimensional(3D) digital volume by computer tomography, to support court discussions on medico-legal issues. The recreation of 3D evidence can be an important tool for investigators and experts, providing a better understanding of the causes and circumstances of the events involved in a crime. OBJECTIVE: The present study aims to assess the reproducibility of 3D printed and 3D tomographic volumes generated from mandibles following simulated forensic injuries, highlighting the recreation of crime tools. MATERIAL AND METHODS: Concerning the study design presented, data collection was performed in three phases. Nine simulated injuries of forensic interest were selected (phase1) and all the mandibles were scanned tomographically, individually, by Cone Beam Computed Tomography CBCT (phase 2). Then, in phase 3, the DICOM images were used for 3D printing with the Ender 3® printer by the Fused Deposition Modeling (FDM) technique. The data analysis followed two procedures: the comparison between the artificial mandible and 3D tomographic volume (AT) and the comparison between the artificial mandible and 3D printed volume, or the copy (AC). Data were analyzed using T-Student and ICC tests and presented in Bland-Altman plots. CONCLUSION: The analogic technique applied in 3D printed volume, when compared with computerized technique, using 3D digital images and measurement, showed to be accurate and reproducible. Further studies are needed in search of standardization for three-dimensional measurements in digitized and printed volumes.

Distribution and influencing factors of pulp stones based on CBCT: a retrospective observational study from southwest China.

BACKGROUND: Pulp stones are a type of pulp calcification, the presence of which tends to hinder endodontic treatment. Thus, this retrospective study aimed to analyze the distribution of pulp stones in the population in southwest China and identify the influencing factors. MATERIALS: Cone-beam computed tomography (CBCT) scans of 5066 teeth of 200 patients (91 males and 109 females) aged 16-45 years were evaluated. Pulp stones were marked as either present or absent when distinct radiopaque masses were found in the pulp cavity, then evaluated the occurrence of pulp stones with regard to tooth type, sex, age group, and contact it with tooth status. The Pearson chi-square test and nonparametric test were used for statistical analysis. RESULTS: Pulp stones were detected in 49.0% of patients and 7.4% of teeth, respectively. The incidence in females was 1.9 times higher than in males (OR = 1.9, 95% CI = 1.1-3.3, p = 0.001). Pulp stones were most prevalent in patients 36-45 years of age. Furthermore, in the age range of 16-45 years, the likelihood of finding pulp stones increased 1.1 times per year with age (OR = 1.1, 95% CI = 1.0-1.1, p = 0.032). A higher incidence of pulp stones was observed in the maxilla and molars. Of the 5066 teeth studied, pulp stones were more common in non-intact teeth. CONCLUSION: Nearly half of the population in southwest China had pulp stones. Pulp stones were found significantly more often in females, maxilla, and non-intact teeth, and their frequency increased with age. For dentists, understanding the distribution of pulp stones is crucial for the proper design of root canal treatment (RCT). TRIAL REGISTRATION: This study was approved by the Ethics Committee of the Affiliated Hospital of Stomatology, Southwest Medical University (certificate number: 20220818001).

Combined biological effects of CBCT and therapeutic X-ray dose on chromosomal aberrations of lymphocytes.

BACKGROUND AND PURPOSE: Cone beam computed tomography (CBCT) is routinely used in radiotherapy to localize target volume. The aim of our study was to determine the biological effects of CBCT dose compared to subsequent therapeutic dose by using in vitro chromosome dosimetry. MATERIALS AND METHODS: Peripheral blood samples from five healthy volunteers were irradiated in two phantoms (water filled in-house made cylindrical, and Pure Image CTDI phantoms) with 6 MV FFF X-ray photons, the dose rate was 800 MU/min and the absorbed doses ranged from 0.5 to 8 Gy. Irradiation was performed with a 6 MV linear accelerator (LINAC) to generate a dose-response calibration curve. In the first part of the investigation, 1-5 CBCT imaging was used, in the second, only 2 Gy doses were delivered with a LINAC, and then, in the third part, a combination of CBCT and 2 Gy irradiation was performed mimicking online adapted radiotherapy treatment. Metaphases were prepared from lymphocyte cultures, using standard cytogenetic techniques, and chromosomal aberrations were evaluated. Estimate doses were calculated from chromosome aberrations using dose-response curves. RESULTS: Samples exposed to X-ray from CBCT imaging prior to treatment exhibited higher chromosomal aberrations and Estimate dose than the 2 Gy therapeutic (real) dose, and the magnitude of the increase depended on the number of CBCTs: 1-5 CBCT corresponded to 0.04-0.92 Gy, 1 CBCT + 2 Gy to 2.32 Gy, and 5 CBCTs + 2 Gy to 3.5 Gy. CONCLUSION: The estimated dose based on chromosomal aberrations is 24.8% higher than the physical dose, for the combination of 3 CBCTs and the therapeutic 2 Gy dose, which should be taken into account when calculating the total therapeutic dose that could increase the risk of a second cancer. The clinical implications of the combined radiation effect may require further investigation.

Practical management recommendations for incidental otolaryngologic findings on cone beam computed tomography.

Cone beam computed tomography (CBCT) frequently captures unexpected structural abnormalities unrelated to the original intent of the diagnostic test. Once identified by dentists, these findings often require appropriate clinical referral for further investigation. This study reviewed recent literature using a comprehensive search to identify and curate common CBCT incidental findings (IFs). Studies were included if they reported CBCT IFs and included more than 10 cases. The review included 16 primary studies in addition to 4 studies described in recent relevant systematic reviews. A total of 51 descriptive terms used to describe key IFs across studies were identified, and terms were organized semantically into 15 core finding categories. Recommendations for management and referral acuity were derived from otolaryngologic clinical practice guidelines and input from practicing otolaryngologists, and the results were integrated into a clinical management algorithm for acuity of referral. This comprehensive review offers practical recommendations to facilitate appropriate clinical management of CBCT IFs via otolaryngologic referral.

Cone-Beam Computed Tomography Study of Incisive Canal and Maxillary Central Incisors in Dravidian Population.

INTRODUCTION:  En-masse maxillary anterior retraction is necessary to attain an esthetic profile in Angle's class I bimaxillary dentoalveolar protrusion and Angle's class II division 1 malocclusion. The objective of this study was to evaluate configurational relationships between maxillary incisors and incisive canal in Angle's class I bialveolar protrusion and Angle's class II division 1 malocclusion by cone-beam computed tomography (CBCT). METHODS: A total of 108 adult CBCT scans of 54-skeletal class I bialveolar protrusion and 54-skeletal class II division 1 malocclusions were retrospectively analyzed. Angles between palatal plane and axis of maxillary alveolar border (θ1), incisive canal (θ2), and maxillary right central incisor (θ3) were measured in relation to the midsagittal plane. Linear measurements such as incisive canal width (IC-IC), medial inter-root distance (Rm-Rm), posterior inter-root distance (Rp-Rp), anteroposterior distance from Rm to tangent of right central incisor (11 Rm-Cat), and left central incisor (21 Rm-Cat) corresponding to three vertical levels (L1, L2, and L3) were assessed in axial cross-sectional plane. Association among angular measurements was examined by Spearman correlation coefficient analysis. Mann-Whitney U test compared variables of linear measurements at three vertical levels. RESULTS:  Estimated distance from incisor root to incisive canal was 5-6 mm in both groups slightly influenced by skeletal class and vertical levels but not gender. Mann-Whitney test demonstrated significant differences between groups at three vertical levels (p<0.05). Only θ2 revealed a significant difference (p<0.05) between malocclusions compared to θ1 and θ3. The angular measurements for both malocclusions were positively correlated (p<0.05). CONCLUSION:  Sagittal root-canal cortical plate distance varied significantly in both malocclusions (5-6 mm). Inter-root distance (Rp-Rp) was greater than incisive canal width (IC-IC) at all three vertical levels indicating a reduced possibility of canal invasion after maximum retraction at posterior levels.

Nonsurgical Endodontic Treatment of Type II Dens Invaginatus in A Maxillary Lateral Incisor: A Case Report.

Dens invaginatus (DI) is one of the developmental dental anomalies that results in an invagination of the enamel organ into the dental papila during odontogenesis. The purpose of this study is to report a case of nonsurgical endodontic treatment of an Oehlers type II DI in a right maxillary lateral incisor with an extensive periapical damage, along with the two-year clinical and tomographic follow-up. A 30-year-old patient was referred for endodontic treatment of tooth #12. On clinical examination, a change in the shape and color of the crown was observed. The tooth responded negative to pulp sensibility, percussion, palpation and mobility tests. After tomographic evaluation, an Oehlers type II DI was visualized, in addition to an extensive periradicular lesion. The diagnosis was asymptomatic apical periodontitis. The treatment was carried out in two sessions, through intense enhancement of the auxiliary chemical substance with passive ultrasonic irrigation, XP-Endo Finisher and the use of hydroxide-based intracanal medication. Appropriate treatment in cases with anatomic variations requires an accurate and early diagnosis based on clinical examination and radiographic images. A two-year follow-up of the present case showed that the correct diagnosis associated with appropriate instrumentation techniques, supplementary disinfection, and adequate three-dimensional sealing of the canal with filling material, resulted in regression of the periradicular lesion and bone repair.

Evaluation of Canal Transportation and Centering Ability of RaCe and Af f-one Systems by Cone-beam Computed Tomography: An in Vitro Study.

Introduction: Rotary systems have made significant advances to improve their root canal preparation efficacy. These instruments can properly preserve the root canal anatomy and morphology. The present in vitro study aimed to compare canal transportation and centering ability of RaCe and Af f-one systems using cone-beam computed tomography. Materials and Methods: Thirty-six mandibular molars were included. The samples were randomly assigned to two groups (n=18): group 1, RaCe, and group 2, Af f-one. Canal preparation was conducted using the respective files according to the manufacturers' instructions. The cone-beam computed tomographic scanning of the samples was performed before and after preparation. The data were analyzed by using two-way ANOVA. Results: In both the RaCe and Af f-one rotary systems, canal centrality and transportation were similar at coronal, middle, and apical cross-sections. In addition, canal transportation and centrality were identical in the RaCe and Af f-one rotary files (P<0.05). Conclusion: The two studied rotary systems did not exhibit significant differences in root canal transportation and preservation of root canal centrality in the apical, middle, and coronal thirds.

Evaluation of Root Canal Morphology of Mandibular Premolars Using Cone-beam Computed Tomography in Golestan Province, North of Iran.

Introduction: Successful endodontic treatment depends on completely clearing, shaping, and filling the prepared canals. Knowledge of the common and aberrant varying pulp anatomies is essential for suitable root canal treatment. Since, this anatomy is complex and varies morphologically in different populations. This study aims to determine the number of roots, canals, and evaluation of mandibular premolars canals using cone-beam computed tomography (CBCT) images in one of Iran's northern provinces (Golestan). Materials and Methods: CBCT axial, coronal, and sagittal slices of two hundred and twelve mandibular premolars were analyzed to determine the number of roots and canals based on Vertucci type. The images were analyzed in a one-millimeter slice in mesiodistal and buccolingual dimensions based on gender. The data were analyzed using the Chi-score test to compare the components if the defaults were not established. A significance level of 0.05 was considered. Result: Of the two hundred twelve teeth evaluated, 130 (61.3%) were first premolars, and 82 (38.6%) were second premolars. Most first premolars (78.5%) and almost all second premolars (97.6%) had one root. Morphological types of root canals were identified based on Vertucci's classification types I, II, III, IV, V, or VIII, and type I was the most frequent. There were no significant associations between number of roots and sex (P>0.05). Conclusion: Mandibular premolars mostly had one root and type I Vertucci morphology. The frequency of two-canal premolars was higher in the male population. Although the abundance of two or three roots with different morphologies was also observed, the possibility of the presence of an additional root canal should be considered.

Guided Endodontic Treatment of Mandibular Incisor with Pulp Canal Obliteration following Dental Trauma: A Case Report.

Root canal obliteration is caused by hard tissue apposition and is often associated with teeth with a history of trauma, orthodontic movement, caries reaction, restorative procedures near the pulp chamber, and teeth of elderly patients. Preoperative planning of root canal treatment should be thorough and include an assessment of the patient's signs and symptoms in addition to the evaluation of complementary examinations. In a 27-year-old patient with dyschromia of the lower central incisor, a history of dental trauma, and a positive response to vertical percussion, an initial periapical radiograph was obtained that showed calcification of the canal and presence of a periapical lesion. The patient presented with pain on chewing, a positive response to palpation and a vertical percussion test. The diagnosis was symptomatic apical periodontitis. A cone-beam computed tomography scan was requested and a surface scan was performed to establish a static guide. The root canal was accessed in the middle third of the root and the canal was located using a minimally invasive approach. The root canal was treated conventionally. Results obtained showed the success of the treatment after a 3-year clinical and radiographic follow-up. Therefore, the use of an endodontic guide in cases of calcified canals significantly reduces the clinician's working time and offers a more predictable approach to the treatment of these pathologies.

Prevalence of Untreated Canals and Their Association with Periapical Periodontitis Using Cone-beam Computed Tomography.

Introduction: Untreated canals represent the primary cause of treatment failure in molars and the second leading cause in other dental groups. This study determined the prevalence of untreated canals and their relationship with periapical periodontitis using cone-beam computed tomography (CBCT) images. Materials and Methods: 385 CBCT images with at least one treated canal were selected from the oral and maxillofacial radiology center. The number of roots and canals, presence, and size of periapical pathology, and presence of untreated canals were recorded. The study used descriptive statistics and Chi-square, Fisher's exact, and odds ratio tests to analyze data. Results: Of the 2053 teeth examined, 14.9% had at least one untreated canal. Untreated canals in teeth increase the chance of having a periapical lesion, raising the prevalence by 11 times. Of these, 91.8% had both untreated canals and periapical lesions. This was more than teeth without untreated canals (35.8%). Most untreated canals were in maxillary molars (65.3%), and mandibular molars (12.54%). There was a statistically significant relationship (P<0.001) between the number of roots, canals, expansion, destruction, and jaw type with the prevalence of untreated canals. The maxillary first molar (68.66%) and second mesiobuccal (MB2) canal (63.27%) had the highest percentages of untreated canals. Conclusions: The MB2 had the highest prevalence of untreated canals. The presence of untreated canals significantly increased the risk of expansion and/or destruction. Therefore, identifying these conditions can also be useful in diagnosing untreated canals. Dentists should assess the anatomy of the tooth and the structure of the root canal to minimize the possibility of an untreated canal. CBCT can assist in this process.

Validation of automated registration of intraoral scan onto Cone Beam Computed Tomography for an efficient digital dental workflow.

OBJECTIVE: This study aimed to validate a newly developed automated method (Relu® Creator, Leuven, Belgium) for multimodal registration of intraoral scan (IOS) and Cone Beam Computed Tomography (CBCT). METHODS: Time point-matched IOS and CBCT scans of forty patients with variable dental statuses (natural dentition, partial edentulism, presence of orthodontic brackets) were selected. Three operators registered IOS and CBCT scans using three state-of-the-art softwares for orthodontics and orthognathic surgery (IPS Case Designer Proplan CMF and Dolphin Imaging). Automated registration was compared to expert-performed semi-automated registration. Time consumption, accuracy, and consistency of the proposed method were benchmarked to semi-automated registration using root mean squared error calculations. The robustness of the automated registration was evaluated in relationship to the dental status of the patients in the dataset. RESULTS: On average, automatic registration was 7.3 times faster than semi-automatic registration performed by an expert operator. Automatic registration yielded reliable results with low deviation errors compared to the differently skilled operators and semi-automated software. Automated registration surpassed human variability as expressed in intra- and inter-operator inconsistencies. Neither orthodontic brackets nor edentulism impacted registration accuracy. CONCLUSIONS: The presented automated method for IOS and CBCT registration is faster, equally accurate, and more consistent than semi-automatic registration performed by an expert or an occasional operator. With similar results among cases with different dental statuses, the clinical feasibility of the method is ensured. CLINICAL SIGNIFICANCE: A validated automated registration method provides accurate and fast multimodal image integration without incorporating operator bias at the very start of the digital workflows for dentistry, periodontics, orthodontics and orthognathic surgery.

Dental Pathophysiology of Odontogenic Sinusitis: Endodontic Infections.

Bacterial odontogenic sinusitis (ODS) arises from maxillary dental issues or oral procedures, and affects at least the maxillary sinuses, with or without other paranasal sinus involvement. It has been historically underreported, in contrast to more recent findings attributing 25-40% of chronic maxillary sinusitis to dental causes. Endodontic infections represent one of the most common causes of ODS. Endodontic factors like root canal infection and microbial proximity to sinus cavities play pivotal roles. Host immunological responses further shape disease severity and progression. This article aims to explore the complexity of endodontic infections that cause ODS, elucidating anatomical, microbial, and immunological aspects.

CBCT based investigation of frequency of Middle Mesial Canal in Mandibular First Molars of Saudi Sub-population.

Objective: One key factor in determining endodontic treatment outcome is the clinicians' comprehension of tooth anatomy, as missed canals may harbor bacteria ultimately leading to apical periodontitis. The study aimed to investigate the prevalence of middle mesial canal (MMC) in Mandibular first molars (MFMs) of Saudi subpopulation. Methods: The cross-sectional retrospective study was conducted at Qassim University Dental College from June to August 2023. Overall, 302 CBCT images with 604 bilateral lower first molars were examined by two calibrated assessors. The existence of MMC was noted. The data were coded, and analysis was done in SPPS-24. The reliability of inter-evaluator and intra-evaluator agreement for detecting MMC were estimated using Cohen's kappa. Results: The patients' average age was 30.95±11.61years. The sample's female to male ratio was 1:1.75. The overall frequency of MMC was 14.2%. The differences in the frequency of MMC on the basis of gender, quadrants and age groups were found to be insignificant. Inter-evaluator and intra-evaluator reliability was noted to be 0.78 and 0.74, depicting acceptable reliability. Conclusions: The MMC is an uncommon occurrence with rare bilateral presentation in MFMs of Saudi population. Endodontists performing endodontic treatment in such subjects should mindfully investigate inter mesiobuccal- mesiolingual canals area for locating, negotiating, and managing any present MMC's.

Root canal morphology of permanent mandibular anterior teeth in a Pakistani population: A cone beam computed tomography assessment.

Objective: To investigate the incidence of accessory canals and the variation in root canal morphology of permanent mandibular incisors and canines in Pakistani population using Cone Beam Computed Tomography (CBCT). Methods: A cross-sectional study was conducted in University College of Dentistry, The University of Lahore, Pakistan after getting institutional ethical permission from January 2020 to September 2022. The data included records of 111 patients consisting of 444 permanent mandibular incisors and 222 permanent mandibular canines. Accessory root, root canals and Vertucci canal configuration for each tooth was recorded. Data analysis was done using SPSS v20. Descriptive statistics were calculated for each anatomical parameter. Chi-square test was applied to determine association of gender with the presence of accessory roots and root canals. Results: Among the 111 records evaluated, 48.6% were males and 51.4% were females. No accessory root was found in the central and lateral incisors. However, an accessory root was found in 4.9% of the canines. The incidence of accessory canals in the central incisors, lateral incisors and canines was 18.9%, 25.2% and 10.4% respectively. The most common canal configuration in teeth with accessory canals was Type-III, followed by Type-II and Type-V. Conclusion: None of the central or lateral incisor showed accessory root while it was detected in 4.9% canines. The frequency of accessory root canal was found to be 18.9%, 25.2% and 10.4% in central incisors, lateral incisors and canines respectively. The most common canal configuration was Type-I, followed by Type-III and Type-II. Type-V, VI and VII were less common.