Efficacy of a radiographic film holder adapter in generating radiographs of dental implants with improved geometric accuracy and sharpness.

STATEMENT OF PROBLEM: Some radiographic film holders produce radiographs with geometric distortion that may interfere with diagnosis. However, whether the distortion can be corrected by adjusting the design of the radiographic film holder is unclear. PURPOSE: The purpose of the study was to develop an adapter for a radiographic film holder model aiming to generate radiographs with greater sharpness and a more accurate geometric representation of dental implants. MATERIAL AND METHODS: The 2-piece adapter was designed using the SketchUp software program and was 3-dimensionally (3D) printed. Implants with internal conical connections were installed in 19 maxillary prototypes in the central incisor region. Five dentists obtained 285 digital periapical radiographs with 3 different radiographic film holders: standard Cone Indicator, Rinn XCP, and adapted Cone Indicator. They then evaluated the radiographic sharpness of the implants threads and their dimensions using the ImageJ software program. The data were analyzed using the Friedman test with the Durbin-Conover post hoc test and MANOVA with the Tukey post hoc test (α=.05). RESULTS: On the mesial surface of the implants, the threads were sharper for the adapted than for the standard Cone Indicator radiographic film holder (P<.05). The adapted Cone Indicator showed a smaller difference between the radiographic and actual implant diameters compared with the Rinn XCP and standard Cone Indicator radiographic film holders (P<.05). CONCLUSIONS: The developed adapter provided radiographs of dental implants with improved sharpness and geometric accuracy.

Identification and classification of pulp calcifications in posterior teeth according to dental condition using digital panoramic radiography and cone beam CT.

OBJECTIVE: To compare digital panoramic radiography (DPR) and cone beam CT (CBCT) in the detection and classification of pulp calcifications in posterior teeth in relation to tooth condition and its location. METHODS: Two hundred and fifty patients with simultaneous DPR and CBCT scans were selected from a dental image bank. For each posterior tooth, its condition was registered (healthy, restored, or decayed). The presence of calcifications was assessed and classified according to location (coronal or radicular) and type (total obliteration, partial obliteration, narrowing, and no calcification). Chi-square and McNemar tests were used to compare DPR and CBCT results, with a significance level of 5%. DPR diagnostic values were calculated using CBCT as reference. RESULTS: Decayed and restored teeth showed a significantly (P < .001) higher prevalence of pulp calcifications than healthy teeth in both imaging exams. There was a significant discrepancy between the imaging modalities in the identification of calcifications (P < .001), especially for radicular calcifications of maxillary teeth (DPR = 55.2%; CBCT = 30.9%). In the case of coronal calcifications, there was a greater discrepancy between CBCT and DPR in the mandibular teeth (10.7%) than in the maxillary teeth (7.7%). Overall, DPR presents higher sensitivity (0.855) than specificity (0.483) for pulp calcifications detection. CONCLUSION: DPR considerably overestimates pulp calcifications in posterior teeth, as compared to CBCT. A higher prevalence of pulp calcifications is related to decayed and restored teeth.

Assessment of Perception of Pain with E-Speed Film, CCD Sensor and Photostimulable Phosphor Plates for Intraoral Radiographs in Children using Three Pain Rating Scales.

BACKGROUND: Dental radiography is an integral part of intraoral evaluation. Children are often uncomfortable during the placement of film or sensor due to the impingement of the soft tissues. Thus, the perception of pain with three intraoral radiographic methods in children was evaluated using three subjective pain rating scales. AIM: To evaluate the discomfort with three different techniques, that is, intraoral periapical (IOPA) radiograph, charge-coupled device (CCD), and photostimulable phosphor (PSP) luminescence (PSPL), using the Wong-Baker Faces Pain Rating Scale (WBFPRS), numerical rating scale, and visual analog scale (VAS). MATERIALS AND METHODS: A sample of 35 children aged 6-12 years were divided into two groups: group 1 (6-8 years) and group 2 (9-12 years). For each child, simulations of the three radiological methods (IOPA, CCD, and PSPL) were performed. The meaning of each facial expression on the WBFPRS, VAS, and the numbers on the numerical rating scale was explained to each child before the procedure. STATISTICAL ANALYSIS USED: A one-way analysis of variance (ANOVA) test and paired-samples t-test are used. RESULTS: The results revealed that the CCD sensors elicited higher pain scores than those obtained with IOPA and PSPL, whereas the IOPA film showed the least pain score. Higher score values were obtained in group 1 than in group 2, indicating that children aged 6-8 years felt higher discomfort than the 9- to 12-year age group for the same procedure. This difference was statistically significant (P < 0.001). CONCLUSION: It was concluded that conventional IOPA films were tolerated better by children when compared to PSP plates and CCD sensors.

Development of a dental digital data set for research in artificial intelligence: the importance of labeling performed by radiologists.

OBJECTIVE: The aim of this study was to present the development of a database (dataset) of panoramic radiographs. STUDY DESIGN: Three radiologists labeled an image set consisting of 936 panoramic radiographs. Labeling includes tooth numbering (including teeth present and missing) and annotation of dental conditions (e.g., caries, dental restoration, residual root, endodontic treatment, implant, fixed prosthesis, incisal wear). The annotation process was performed in a Picture Archive and Communication System software customized for the study purposes using a small bounding box to delimit the entire tooth and items for radiographic diagnosis and a large bounding box to simultaneously delimit the 2 dental arches (maxilla and mandible). A JSON file was generated for each annotation. RESULTS: The database encompassed 23,619 annotations; disagreement between radiologists occurred in 0.7% of the notes. CONCLUSIONS: This work aimed to inform researchers about the importance of the labeling process, in addition to providing the scientific community with a bank of labeled images to implement artificial intelligence systems in clinical practice.

Reliability of impedance spectroscopy versus digital radiograph and ICDAS-II in occlusal caries detection: a prospective clinical trial.

The traditional methods in early caries detection had many limitations. So, this study aimed to evaluate the clinical performance of alternating current impedance spectroscopy ACIST in comparison with digital radiograph and ICDAS-II in detection of occlusal carious lesions. Occlusal surfaces of molar and premolar teeth from 40 adult participants were examined by two observers using three diagnostic methods: (1) international caries detection and assessment system (ICDAS-II) (2) digital radiograph (DR) and (3) Cariescan Pro device (ACIST). Agreement analysis and the difference in sensitivities and specificities were evaluated. The results showed an excellent agreement in the different groups. The difference from the visual tactile against ACIST scoring for enamel caries detection, was statistically significant (p = 0.012) and the agreement was moderate (k = 0.509). For dentinal caries the difference was not statistically significant (p > 0.05) and the agreement was similarly moderate (k < 0.6). The difference from the digital radiograph against ACIST scoring, for enamel caries, digital radiography had significantly higher sensitivity and specificity than ACIST (p < 0.001) while for dentinal caries detection and overall, ACIST had higher sensitivity and digital radiography had higher specificity and the difference was statistically significant (p < 0.001). Visual-tactile examination is a considered as feasible and valid technique for occlusal caries detection, digital radiography is superior to ACIST in diagnosing enamel caries, but it could underestimate the caries depth, ACIST is a reliable tool for detecting occlusal caries in dentin.

Comparison of periapical radiography, panoramic radiography, and CBCT in the evaluation of trabecular bone structure using fractal analysis.

OBJECTIVES: The aim of this study is to compare imaging techniques to evaluate trabecular bone structure using Fractal Analysis (FA). METHODS: Fifteen sheep hemimandibles were used for this study. Digital images were obtained using periapical radiography, panoramic radiography, and cone-beam computed tomography (CBCT). CBCT imaging was performed in standard (STD) and high-resolution (HR) modes. FA was conducted using ImageJ 1.3 software with the box-counting method on the images. The fractal dimension (FD) values were analyzed by the statistical software Jamovi 1.6.23. Statistical significance was accepted as p < 0.05. RESULTS: The highest mean FD value was the FD on digital periapical radiographs (PaFD) (1.28 ± 0.04), and the lowest mean FD value was the FD on standard resolution cone-beam computed tomography images (STD-CBCTFD) (1.12 ± 0.10). Although there was no statistically significant difference between the PaFD and the FD on digital panoramic radiographs (PanFD) (p = 0.485), the PaFD was found to be significantly higher than STD-CBCTFD (p < 0.001), and the FD on high-resolution cone-beam computed tomography images (HR-CBCTFD) (p = 0.007). The PanFD was found to be significantly higher than the STD-CBCTFD (p = 0.004). CONCLUSION: According to our results, in the evaluation of trabecular bone structure using FA, periapical radiographs and panoramic radiographs have similar image quality for assessment of the FD. On the other hand, CBCT results did not correlate with results from any of the other techniques in this study.

Pericervical Dentin Metrics in Mandibular First Molars Determined with Digital Periapical Radiography and Cone-beam Computed Tomography.

INTRODUCTION: Pericervical root dentin is decisive for the long-term mechanical integrity of root-filled teeth. Current treatment protocol does not include a customized step to determine the pretreatment residual pericervical root dentin. OBJECTIVE: To determine and compare the residual root dentin and canal width using digital periapical radiography (DPR) and cone-beam computed tomography (CBCT) at the apical limit of the pericervical area (PCA) in mandibular first molars. METHODS: DPR and CBCT images of 60 patients with age between 22 and 76 years were used to determine (a) the mesiodistal widths of the root canal (pericervical dimensions [PCL]-C) and the root (PCL-R) of mandibular first molars at the apical limit of the PCA and (b) the intracanal distance from the apical limit of the PCA to the radiographic apex (intracanal distance [ICD]). The correlation between the PCL and ICD measurements obtained from DPR and CBCT were evaluated. RESULTS: Values between 0.10-0.80 mm and 0.00-1.10 mm were obtained for PCL-C using DPR and CBCT respectively (95% CI). The PCL values between 0.90-2.30 mm and 0.00-2.30 mm were obtained from DPR and CBCT respectively (95% CI). The ICD ranged between 4.6-12.3 mm in DPR and 4.40-12.0 mm in CBCT (95% CI). The comparative analysis showed differences from -0.9 to 0.5 mms for PCL and -2.00 to 1.5 mms for ICD between DPR and CBCT techniques respectively. CONCLUSION: The PCL and ICD determined from DPR and CBCT provided the pericervical dentin metrics that could be utilized clinically as a guideline for decision-making in endodontic treatment.

Evaluation of the effects of postprocessing settings in digital bitewing radiographs on proximal caries detection.

OBJECTIVE: Radiographs are an integral part of detecting proximal caries. The aim of this study was to evaluate the effect of contrast, brightness, noise, sharpness, and γ adjustment of digital intraoral radiographs on the diagnosis of proximal caries. MATERIALS AND METHODS: In this in vitro study, 40 extracted teeth including 20 premolars and 20 molars with enamel lesions (white spot or dentin discoloration seen through the enamel) were mounted together in groups of eight inside the skull. Bitewing radiographic images of each dental group were obtained by a photostimulable phosphor plate sensor with exposure conditions of 8 mA, 70 kV, and 0.2 s. The images were reconstructed by the built-in software and examined by two oral and maxillofacial radiologists in various settings of contrast, brightness, sharpness, noise, and γ. The teeth were then cut mesiodistally and the presence or absence of caries was confirmed by an oral and maxillofacial pathologist using a stereomicroscope. The data were then analyzed using the κ agreement coefficient, sensitivity, specificity, and accuracy (α = .05). RESULTS: Adjustment of brightness and contrast led to higher diagnostic performance with an accuracy of 82.5% and 83.8 (for observers 1 and 2, respectively) and 82.5% (for both observers), respectively. Noise adjustment was the least helpful approach for diagnosis of proximal dental caries among other adjustments, with an accuracy of 78.8% and 77.5% for observers 1 and 2, respectively. CONCLUSION: Brightness and contrast setting was more efficient in improving the diagnostic potential of bitewing radiographs compared to other adjustments.

Surveying the landscape of diagnostic imaging in dentistry's future: Four emerging technologies with promise.

BACKGROUND: Advances in digital radiography for both intraoral and panoramic imaging and cone-beam computed tomography have led the way to an increase in diagnostic capabilities for the dental care profession. In this article, the authors provide information on 4 emerging technologies with promise. TYPES OF STUDIES REVIEWED: The authors feature the following: artificial intelligence in the form of deep learning using convolutional neural networks, dental magnetic resonance imaging, stationary intraoral tomosynthesis, and second-generation cone-beam computed tomography sources based on carbon nanotube technology and multispectral imaging. The authors review and summarize articles featuring these technologies. RESULTS: The history and background of these emerging technologies are previewed along with their development and potential impact on the practice of dental diagnostic imaging. The authors conclude that these emerging technologies have the potential to have a substantial influence on the practice of dentistry as these systems mature. The degree of influence most likely will vary, with artificial intelligence being the most influential of the 4. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The readers are informed about these emerging technologies and the potential effects on their practice going forward, giving them information on which to base decisions on adopting 1 or more of these technologies. The 4 technologies reviewed in this article have the potential to improve imaging diagnostics in dentistry thereby leading to better patient care and heightened professional satisfaction.

Frecuencia y tipología del segundo conducto mesiovestibular en primeros molares superiores / Frequency and typology of the second mesiobuccal canal in maxillary first molars

Objetivos: Evaluar mediante microscopia quirúrgica la presencia del segundo conducto mesiovestibular (MV2) en el piso de la cámara pulpar de los primeros molares superiores, determinar su abordabilidad, establecer el calibre de lima que llegó al tercio apical y tipificar radiovisiográficamente su morfología se-gún la clasificación de Weine. Materiales y métodos: Se utilizaron 48 primeros molares superiores huma-nos extraídos. Sé tomaron radiovisografías preope-ratorias (Carestream 5200) en sentido orto radial y mesio-distal. Se realizó apertura y se localizó entra-da del MV2 con microscopio quirúrgico (Newton MEC XXI, Argentina) a 16 x. Se cateterizó MV1 y MV2 con limas tipo K #10 y #15 (Dentsply Maillefer). Se cortó raíz distovestibular para mejorar visualización ra-diovisográfica. Se tomó conductometria en sentido mesio-distal para establecer la tipología. Se compa-raron frecuencias y porcentajes mediante test de Chi-cuadrado con corrección de Yates, prueba exac-ta de Fisher y test z para diferencia de proporcio-nes. Se calcularon intervalos de confianza 95% para porcentajes mediante método score de Wilson. Re-sultados: El 54% (26 casos) presentó MV2. De los 26 MV2, el 77% (20 casos) fueron abordables, porcen-taje significativamente mayor al 23% no abordable (z=3,62; P<0,05). Al hacer cateterismo, hubo asocia-ción significativa entre tipo de conducto (MV1 y MV2) y calibre de lima que llegó al tercio apical (Chi-cua-drado=29,12; gl=1; P<0,05). La tipología I (58%) fue significativamente mayor que las tipologías II (21%) y III (21%) (P<0,05 para ambas comparaciones). Con-clusión: El alto porcentaje de piezas que presentó MV2 evidencia la importancia clínica de detectarlo y tratarlo correctamente. Dado el alto porcentaje de piezas donde fue abordable, se concluye que el clíni-co debe tener conocimiento, destreza y la tecnología necesaria para poder abordarlo. Si bien la tipología I (58%) fue la más encontrada, cuando el MV2 termina en foramen independiente (tipo III), su omisión puede conducir al fracaso del tratamiento (AU))

Objectives: To evaluate by surgical microscopy the presence of second mesiobuccal canal (MB2) in the pulp chamber floor of the maxillary first molars, determine its approachability, establish the caliber of the file that reached the apical third, and radiographically typify its morphology according to Weine ́s classification. Materials and methods: 48 extracted human maxillary first molars were used. Preoperative radiovisographies (Carestream 5200) were taken in ortho-radial and mesio-distal direction. Coronal access was made and the entrance of MB2 was located with a surgical microscope (Newton MEC XXI, Argentina) at 16x. MB1 and MB2 were catheterized with K files #10 and #15 (Dentsply Maillefer). Distobuccal root was cut to improve radiovisographic visualization. Conductometry was taken in mesio-distal direction to establish the typology. Frequencies and percentages were compared using Chi-square test with Yates correction, Fisher's exact test and z test for difference in proportions. 95% confidence intervals were calculated for percentages using Wilson score method. Results: 54% (26 cases) presented MB2. Of the 26 MB2, 77% (20 cases) were approachable, a significantly higher percentage than those not approachable (z=3.62; P<0.05). When performing catheterization, there was a significant association between type of canal (MB1 and MB2) and file caliber that reached the apical third (Chi-square=29.12; df=1; P<0.05). Typology I (58%) was significantly higher than typologies II (21%) and III (21%) (P<0.05 for both comparisons). Conclusion: The high percentage of specimens that showed MB2 evidence the clinical importance of detecting and treating it correctly. Given the percentage of pieces where it was approachable (77%), it is concluded that the clinician must have the knowledge, skill and necessary technology to be able to approach it. Although typology I (58%) was the most found, when MB2 ends an independent foramen (type III), its omission can lead to treatment failure (AU)

Odontometria em molares inferiores: comparação entre radiografia convencional e digital / Odontometry in mandibular molars: a comparison between conventional and digital radiograph

Objetivo:Comparar os métodos radiográficos convencional e digital na Odontometria de molares inferiores. Materiais e Métodos: Foram selecionados 26 dentes e inseridos em recipientes com gesso e serragem para simular o osso alveolar. Após adequado acesso endodôntico, limas K#15 foram posicionadas nos canais mésio-vestibular e distal, 1mm aquém da patência foraminal (CT1). Foi construído um dispositivo em resina, onde fixou-se um medidor de ângulos padronizando a angulação horizontal em 20º para distal. O ângulo vertical foi 0º com distância foco-filme de 30 centímetros. Foi utilizado um aparelho de Rx de 70 KVp e 8 mA e exposição de 0,4 segundos. Para obtenção do CT radiográfico (CT2), posicionou-se o paquímetro na borda inferior do cursor até a ponta da lima. As mesmas medidas foram realizadas nas radiografias digitais obtidas com um sensor CMOS. A ferramenta "régua" foi utilizada determinando-se o CT digital (CT3). O teste de Correlação Intraclasse verificou concordâncias intragrupo e intergrupos e os testes Anova OneWay e Tukey (α = 0,05) foram usados para análise comparativa entre CT1, CT2 e CT3. Resultados: Tanto as medidas convencionais quanto as digitais apresentaram excelente concordância intragrupo (0,9842 e 0,9943, respectivamente). A concordância entre as mensurações para o CT digital foi maior em relação às medidas reais (0,8162) que as medidas do CT convencional (0,6761). A média e desvio padrão para CT1, CT2 e CT3 foram 18,4±1,4; 19,2±1,6 e 18,8±1,2mm, respectivamente. O teste de Tukey indicou diferença estatística entre CT1 e CT2 (p = 0,027); já entre CT1 e CT3 (p = 0,499) e entre CT2 e CT3 (p = 0,314) não houve diferenças significativas. Conclusão: As radiografias digitais propiciaram maior precisão na Odontometria de molares inferiores nas condições experimentais avaliadas.

Objective: To compare conventional and digital radiographic methods in Odontometry of lower molars. Materials and Methods:Twenty-six teeth were selected and inserted into containers with plaster and sawdust to simulate the alveolar bone. After adequate endodontic access, K#15 files were positioned in the mesiobuccal and distal canals, 1 mm below the foraminal patency (CT1).A resin device was constructed, where an angle gauge was fixed, standardizing the horizontal angulation at 20º distally. The vertical angle was 0º with a focus-film distance of 30 cm. An Rx device of 70 KVp and 8 mA, with an exposure time of 0.4 seconds, was used. To obtain the radiographic CT (CT2), the caliper was positioned on the lower edge of the cursor up to the tip of the file. The same measurements were performed on digital radiographs, obtained with a CMOS sensor. The "ruler" tool was used to determine the digital CT (CT3). The Intra-Class Correlation test was used to verify intra-group and intergroup agreements, and the Anova One-way and Tukey tests (α = 0.05) were used for comparative analysis between CT1, CT2, and CT3. Results: Both conventional and digital measurements had excellent intra-group agreement (0.9842 and 0.9943, respectively). The agreement between measurements for digital CT was greater in relation to real measurements (0.8162) than conventional CT measurements (0.6761). The mean and standard deviation for CT1, CT2, and CT3 were 18.4±1.4; 19.2±1.6; and 18.8±1.2, respectively. The Tukey test indicated a statistical difference between CT1 and CT2 (p = 0.027); Between CT1 and CT3 (p = 0.499) and between CT2 and CT3 (p = 0.314) no significant differences were observed. Conclusion:Digital radiographs provided greater precision in the odontometry of lower molars according to the experimental conditions evaluated in this study.

Influence of notebook computers screens and undergraduate level of dental students in the radiographic detection of carious lesions

Aim: To evaluate the influence of notebook computers screens and undergraduate level of dental students in the radiographic detection of carious lesions. Methods: Bitewing digital radiographs were presented to 3rd and 5th year dental students in three different notebooks computers: Notebook 1 with anti-glare screen (1366×768 pixels), Notebook 2 without anti-glare screen (1366×768 pixels), and Notebook 3 with anti-glare screen (1920×1080 pixels). A reference standard based on a consensus analysis was set by three senior professors of Oral Radiology and Cariology. Sensitivity, specificity and accuracy values were measured and submitted to two-way ANOVA at a significance level of 5%. Results: Notebook 2 provided significantly lower sensitivity values (Mean 56.5% ± 2.94) than notebook 3 (71.1% ± 2.82) (p = 0.002). We found no statistically significant differences between the two undergraduate years (p > 0.05). Conclusion: The anti-glare screen of notebook computers screens can influence the radiographic detection of carious lesions, but the undergraduate level of dental students does not influence this diagnostic task

Evaluation of the different exposure parameters for the accurate diagnosis of peri-implantitis severity in digital panoramic radiography

Background: To evaluate the accuracy of the diagnosis of peri-implant bone defects' severities in digital panoramic radiographs obtained at different tube voltage and/or tube current settings. Material and methods: Two different sizes of peri-implant bone defects (type 1 and type 2) were prepared after the implants were inserted into 29 bovine rib blocks. Digital panoramic radiographs were obtained at eight different tube voltage and/or tube current settings for all rib blocks. Implant images were cropped separately. The average intensity value (AIV) of cropped images were analyzed using Adobe Photoshop CC software. The Kruskal-Wallis H test was used to compare AIVs. All cropped images were evaluated using a five-point Likert scale for the likelihood of a bone defect being absent or present. The weighted kappa values were calculated to compare observer agreement and ROC analysis was performed to determine the appropriate exposure parameters. Results: The lowest AIV was obtained at 72 kV/6.3 mA (92.162±16.016), and the highest AIV was obtained at 60 kV/3.2 mA (179.050±13.823). The Kruskal-Wallis H test showed significant differences in the AIVs according to the exposure parameters (p<0.001). The kappa coefficient for the inter-observer agreement was excellent (0.864, p<0.001). The AUC values for type 1 defects ranged from 0.778 and 0.860; for type 2 defects ranged from 0.920 and 0.967. The AUC value of type 1 defects was slightly better in panoramic images obtained with high kV and low mA levels (72 kV/3.2 mA), compared to others. Conclusions: In daily clinical routine, peri-implant bone defects might be evaluated by panoramic radiographs obtained with all kV and mA values tested. However, to avoid misdiagnosing and for better accuracy, panoramic radiographs obtained with high kV and low mA levels suitable for patients should be used, especially in the detection of small or initial bone defects. (AU)

Angle class II/2nd division: is there an alignment? / Classe II/2ª divisão de Angle: existe alinhamento?

Introduction: Interdisciplinary investigative study of the stomatognathic-cervical complex, necessary to understand the structure and biomechanics of this system in Angle Class I and II / 2nd Division participants. Objective: To evaluate alignment and position of cranial cervical structures on radiographs and their functional relationship with the stomatognathic system. Material and method: Trans Oral and Profile radiographs were submitted to biomechanical analysis, considered the linear and angular measurement of Atlas and Axis through the application included in the radiogram software. Result: We observed a significant difference in the angular measurements of vertical alignment between the Skull, Axis, and the Mandible (p = <0.001), and in the left joint between the Atlas and the Axis (AE: p = 0.011; SEA: p = 0.042). Among the linear measures of the distances between the Atlas and the Axis, the AOD distance presented statistics quite close to the level of significance (p = 0.0502), but above. There was no statistically significant difference in the other measures. Conclusion: In this study, the alignment between the Atlas and Axis cervical vertebrae and the mandible and angles of the atlanto-occipital joints are altered in Class II / 2nd Division participants. There is no difference in the size and distance of the Atlas and the Axis between the Classes.

Introdução: Estudo interdisciplinar investigativo do complexo cérvico-estomatognático, necessário para compreender a estrutura e a biomecânica desse sistema em participantes Classe I e II/2ª Divisão de Angle. Objetivo: Avaliar o alinhamento e a posição das estruturas crânio cervicais nas radiografias de participantes Classe I e II/2ª Divisão de Angle e sua relação funcional com o sistema estomatognático. Material e método: As imagens digitais Trans Oral e Perfil de participantes com maloclusão Classe I e II/2ª Divisão de Angle foram submetidas à medição linear e angular do crânio, mandíbula, Atlas e do Áxis através do software Advantage Workstation 4.6 (AW4.6 ext. 04). Resultado: Houve diferença significativa nas medidas angulares de alinhamento vertical entre o Crânio, Áxis e a Mandíbula (p = <0,001), e da articulação esquerda entre o Atlas e o Áxis (AE: p = 0,011; AAE: p = 0,042). Das medidas lineares das distâncias entre o Atlas e o Áxis, a distância AOD apresentou estatística bastante próxima do nível de significância (p=0,0502), porém acima. Não houve diferença significativamente estatística nas demais medidas avaliadas. Conclusão: Neste estudo, o alinhamento entre as vértebras cervicais Atlas e Áxis e a mandíbula e os ângulos das articulações atlanto occipitais se mostraram alterados nos participantes Classe II/2ª Divisão de Angle. Não há diferença significativa no tamanho e distância do Atlas e do Áxis entre as Classes.

Comparison Between Radiographs, White and Fluorescent Images in the Diagnosis and Treatment Decisions for Occlusal Caries: An Ex Vivo Study

ABSTRACT Objective: To compare the agreement of images in white light (WL), fluorescence (FL), and digital radiographs (DR), on the diagnosis and treatment decisions for occlusal caries lesions against a micro-CT gold standard. Material and Methods: Ten extracted third molars, with enamel and/or dentin caries (ICDAS 2-4), were included. Occlusal surface images were acquired with an intraoral camera (SoproLife®) in WL and FL modes. DR was obtained using an intraoral X-ray and a semi-direct digital system. A total of 780 images were needed, organized in a template, to be later examined by twenty-six dentists invited to compose the study. The Generalized Estimation Equations model was used to compare the proportions of the correct answers between the three methods and the gold standard. When significant, Bonferroni post-hoc test was used to identify differences (α=5%). Results: Most of the examiners were specialists (76.9%) with 14.5 years of experience. All diagnostic methods were similar and showed low agreement (DR 12.7%, WL 16.5%, and FL 16.5%) compared with gold standard caries diagnostic scores. Regarding treatment decisions, mean agreement for all diagnostic methods was higher (43.2%; p<0.001), and among all methods, WL (48.1%) and FL (51.2%) modes performed better than DR (30.4%, p<0.001). Conclusion: SoproLife® images could help clinicians to propose rational, minimally invasive treatments for occlusal caries lesions.

Avaliação da profundidade da cárie proximal nos exames radiográfico convencional e digitalizado / Evaluation of the size of proximal caries in radiography and digitized

Introdução: A cárie dentária é uma doença multifatorial que compreende vários fatores biológicos e sociais. A superfície proximal dos dentes é uma região de difícil visualização que pode esconder pequenas lesões cariosas no esmalte dentário, impossibilitando o diagnóstico através de inspeções visuais e táteis. Objetivo: O objetivo deste trabalho foi avaliar a profundidade da cárie proximal nos exames radiográficos convencionais e digitais, comparando as profundidades das lesões consideradas nestes exames às do exame histológico. Método: Foram utilizados exames radiográficos interproximais de 40 dentes humanos, 20 pré-molares e 20 molares, com alterações clínicas em uma das superfícies proximais, como lesões de mancha branca ou acastanhada e pequenas cavitações. Três profissionais especializados em radiologia odontológica com mais de cinco anos de experiência clínica mediram a profundidade das lesões pelos exames radiográfico e digital das amostras. Para obter os resultados, utilizou-se a técnica de análise de variância (ANOVA). Resultados: Constatou-se um nível de significância de 5% nas mensurações dos exames radiográficos convencionais e digitalizados, mostrando a fidelidade das imagens radiográficas em relação a real profundidade da lesão. Conclusão: Conclui-se que os exames de imagem avaliados foram eficientes na determinação da profundidade das lesões de cárie proximal.

Introduction: Dental caries is a multifactorial disease that comprises several biological and social factors. The proximal surface of the teeth is a region of difficult visualization that can hide small carious lesions in the dental enamel, making diagnosis through visual and tactile inspection infeasible. Objective: The objective of this study was to evaluate the depth of proximal caries in the conventional and digitized radiographic examinations, comparing the depths of the lesions considered in these examinations to those of the histological examination. Method: Interproximal radiographic examinations of 40 human teeth, 20 premolars and 20 molars, with clinical alterations on one of the proximal surfaces, such as white or brown spot lesions and small cavitations, were used. Three professionals specialized in dental radiology with more than five years of clinical experience measured the depth of the lesions by radiographic examination of the samples. To obtain the results, we used the technique of analysis of variance (ANOVA). Results: A level of significance of 5% was found in conventional and digitized radiographic measurements, showing the fidelity of the radiographic images in relation to the actual depth of the lesion. Conclusion: It was concluded that the imaging tests evaluated were efficient in determining the depth of proximal caries lesions.

Concordância entre medida de comprimento de trabalho por radiografia e localizador eletrônico foraminal na dentição decídua: revisão integrativa / Agreement between work length measurement by radiography and electronic foraminal locator in the primary dentition: an integrative review

Introdução: O estabelecimento do comprimento de trabalho (CT) é uma etapa fundamental para o sucesso do tratamento endodôntico, principalmente na dentição decídua. O exame radiográfico é um dos principais meios de definir o CT. A mensuração desse comprimento também pode ser obtida por meio de dispositivos eletrônicos. Objetivo: Revisar a literatura acerca da concordância entre a medida de CT por radiografia e localizadores eletrônicos foraminais (LEFs) na dentição decídua. Metodologia: A busca bibliográfica foi realizada nas bases de dados PubMed, Cochrane Library e BVS, seguindo uma estratégia de combinação de palavras-chave, filtrando apenas pesquisas clínicas. A seleção dos artigos foi realizada em duas etapas: através da leitura dos títulos e resumos e, em seguida, por meio da obtenção e leitura dos artigos completos selecionados. Resultados: sete artigos foram selecionados, publicados entre 2011 e 2020. Todos foram analisados quanto à qualidade metodológica e à caracterização como tamanho da amostra, objetivo, metodologia, resultados e conclusão. Todos possuíam os dados necessários para contemplar o objetivo desta pesquisa. O uso dos LEFs mostrou-se tão preciso quanto o método radiográfico (n=6), e, em um estudo, o método eletrônico foi superior ao radiográfico para determinação do CT. Conclusão: O método eletrônico possui eficácia na determinação do CT durante o tratamento endodôntico de dentes decíduos sendo comparável ao radiográfico.

Introduction: To establish the working length (CT) is a fundamental step toward the suc-cess of endodontic treatment. Also, the radiographic examination is one of the most important means of determining CT. This length can also be measured by electronic devic-es. Objective: To review the literature on the agreement between the CT measurement by radiography and electronic foraminal locators (LEF) in the primary dentition. Methodology: A bibliographic search was performed on PubMed, Cochrane Library, and BVS, using a keyword combination strategy and filtering only clinical research. The selection of the articles occurred in two stages: by reading the titles and abstracts, and by obtaining and reading the selected full articles. Results: Seven articles, published between 2011 and 2020, were selected and analyzed for methodological quality and characterized for sample size, objectives, methodology, results, and conclusion. They had the essential data to contemplate the purpose of this research. The use of LEF proved to be as accurate as of the radiographic method (n=6), and in one study, the electronic method was superior to the radiographic method for determining TC. Conclusion: The electronic method is effective in determining the CT during the endodontic treatment of primary teeth and is comparable to the radiographic one.

Nuevas técnicas de planificación y tratamiento para la rehabilitación maxilar con implantes cigomáticos. A propósito de un caso / New techniques in planning and restoring for zygomatic implant maxillary rehabilitation approach. A case report

Se expone el caso de una paciente de 76 años con antecedente de carcinoma epidermoide intraoral (2003) que tras la cirugía y radioterapia posterior presenta e dentulismo y atrofia maxilar severa.Tras la exploración clínica y radiológica con una tomografía axial computarizada (TAC) se decide rehabilitar el maxilar superior con implantes cigomáticos y una prótesis completa atornillada de carga inmediata. Mediante exportación DICOM del TAC maxilar al software Mimics (Materialise, Belgium) se realiza una planificación quirúrgica virtual tomando como referencia una propuesta digital protésica (DentalCAD, Exocad, USA). En el entorno 3-Matic (Materialise, Belgium) se diseñandos guías quirúrgicas óseos portadas para la colocación óptima de cuatro implantes cigomáticos combinando la técnica ZAGA (siglas en inglés de Zigoma Anatomy-Guided Approach o lo que es lo mismo, Abordaje Cigomático Guiado Anatómicamente) y Quad approach. Protésicamente, se diseña un prototipado que sirve como la tradicional prueba de dientes en cera y como férula radiológica prequirúrgica. El objetivo es simplificar la sistemática de trabajo con un nuevo método digital combinado gracias a la digitalización de los pilares de cicatrización de tipo Multi-Unit® (denominados healing caps). Con el presente caso clínico se desarrolla un protocolo de trabajo que simplifica toma de registros, abarata los costes y acorta el tiempo quirúrgico y de gabinete para la confección de una prótesis de carga inmediata de polimetil metacrilato acrílico (PMMA). Además, gracias al TAC postquirúrgico se compara y analiza la precisión aportada por las guías empleadas en el proceso de colocación de los implantes en relación con el software de planificación quirúrgica virtual (VSP –Virtual Surgical Planning-), confirmándose así la sencillez, exactitud y seguridad en todo el procedimiento quirúrgico. Se tomó como referencia para la comparación el extremo coronal y apical de cada implante cigomático junto con el ángulo resultante de la discrepancia entre el implante real y el digital. Los resultados obtenidos comparados con la bibliografía, demuestran una desviación sin repercusión en el proceso rehabilitador (AU)

Análise comparativa da precisão de medição dos localizadores apicais eletrônicos Romiapex a15® e Root zx mini®: um estudo in vitro / Comparative analysis of the measuring accuracy of the electronic apex locators Romiapex a15® and Root zx mini®: an in vitro study

Este estudo analisou a precisão de medição dos aparelhos ROMIAPEX A 15® e ROOT ZX MINI®, in vitro, comparativamente pelo método radiográfico e eletrônico no que diz respeito à precisão e confiabilidade na determinação do Comprimento Real de Trabalho (CRT) e Comprimento Real do Dente (CRD). Vinte dentes humanos (incisivos superiores e pré-molares superiores/inferiores) foram avalia das e seus CRD's e CRT's aferidos de forma direta por meio de lima tipo k nº 10 ou 15 (Dentsply Sirona, Ballaigues, Suíça), pelo método radiográfico e método eletrônico. Não foram verificadas diferenças significativas entre as medidas para CRD (p=0,003) e CRT (p=0,042) entre os métodos direto, radio gráfico e eletrônico. Ambos os métodos ficaram próximos da medida real, quando por vezes também definiram a mesma medida real. Os CRD's obtidos pelos métodos radiográfico e eletrônico foram sub metidos ao Teste t de Student (p<0,024) apontando relação estatística significativa para a verificação da odontometria, sugerindo que ambos os métodos são eficazes na determinação do comprimento real do dente quanto de trabalho. O método eletrônico apresentou eficácia satisfatória estatistica mente nos casos comparativamente aos outros métodos também avaliados. Os dados sugerem que os localizadores citados podem auxiliar as tomadas de decisões para determinação do CRD e CRT

This study analyzed the measurement accuracy of the ROMIAPEX A15® and ROOT ZX MINI® locators, in vitro, comparatively by the radiographic and electronic methods with regard to the precision and reliability in the determination of the Real Working Length (RWL) and Real Tooth Length (RTL). Twenty human teeth (upper incisors and upper/lower premolars) were evaluated it had the RTL and RWL measured through rasp k No 10/15 (Dentsply Sirona, Ballaigues, Switzerland) by radiographic and electronic methods. There were no significant differences between the measures for RTL (p = 0,003) and RWL (p = 0,042) for the methods. It means that both methods were very close to the real measure, when sometimes they also defined the same real measure. The RTL obtained by methods radiographic and electronic, were submitted to Student's t test (p <0,024), showed statistical significance in relation to the methods used for verification of odontometry, which means that both methods are effective to determine an actual length of the element and the length of actual work. The electronic method showed statistically satisfactory effectiveness in the cases compared to the other methods.The data suggest that these locators can assist decision making to determine RTL and RWL ... (AU)

Diagnóstico de reabsorção radicular: influência da resolução espacial de captura de imagens digitais periapicais / Root resorption diagnostic: influence of periapical digital image scanning

Introdução: a detecção da reabsorção da raiz dentária é realizada por meio de exames de imagens, pois frequentemente não apresenta sinal e sintoma clínicos. Dentre os exames de imagem disponíveis, o exame radiográfico periapical, é indicado para diagnóstico, prognóstico e acompanhamento da reabsorção radicular. Objetivo: o estudo tem como objetivo investigar a relação de diferentes resoluções espaciais com o diagnóstico de reabsorção radicular. Metodologia: foram realizados desgastes simulando reabsorção externa no terço apical e vestibular de 15 (quinze) incisivos inferiores, radiografados em crânio seco, antes e depois do desgaste. A técnica radiográfica foi realizada utilizando o sistema VistaScan (Durr Dental, Bietigheim-Bissingen, Germany), aparelho CS 2200 (Carestream Dental LLC, Atlanta-GA, USA) usando tempo de exposição de 0,15 segundos e escaneadas sob diferentes protocolos de resolução espacial, a saber, 20 pares de linhas por milímetro (pl/mm) e 40 pl/mm. Posteriormente dois avaliadores experientes fizeram análises das referidas imagens sem conhecimento prévio da resolução de escaneamento. Resultados: 75% das radiografias realizadas com 20 pl/mm foram classificadas como excelentes pelos avaliadores, contra 33% com 40 pl/mm, estatisticamente significativa. Discussão: ao avaliar a reabsorção radicular, obteve-se uma acurácia diagnóstica igual para os dois protocolos sem distinção, estatisticamente significativa, entre localização ou profundidade. Conclusão: tendo em vista que para os examinadores imagens com 20 pl/mm foram satisfatórias, com percentual de qualidade maior quando comparado a imagens obtidas com 40 pl/ mm, este estudo indica o emprego de imagens com 20 pl/mm para avaliação inicial de suspeita de reabsorções nas raízes dentárias.

Introduction: the detection of tooth root resorption is carried out by means of imaging tests, as it often does not present a clinical sign and symptom. Among the imaging tests available, the periapical radiographic examination is indicated for diagnosis, prognosis and monitoring of root resorption. Objective: the study aims to investigate the relationship of different spatial resolutions in the diagnosis of root resorption. Methods: Artificial external root resorptions were simulated using burs by drilling to the entire depth in different locations at the apical and buccal thirds of 15 (fifteen) lower incisors were worn, radiographed on a dry skull, before and after wear. The radiographic technique was performed using the VistaScan system (Durr Dental, Bietigheim-Bissingen, Germany), CS 2200 device (Carestream Dental LLC, Atlanta-GA, USA) using an exposure time of 0.15 seconds and scanned under different resolutions protocols, namely, 20 pairs of lines per millimeters (pl/mm) and 40 pl/mm. Subsequently, two experienced evaluators performed analyzes of these images without prior knowledge of the scanning resolution. Results: seventy-five percent of the radiographs taken at 20 pl/mm were rated as excellent by the evaluators, against 33% at 40 pl/mm, a statistically significant difference. Discussion: When assessing root resorption, a similar diagnostic accuracy was obtained for the two protocols without a statistically significant distinction between location or depth. Conclusions: Considering that for examiners images with 20 pl/mm were satisfactory, with a percentage of quality greater than 40 pl/mm, this study indicates the use of 20 pl/mm for initial evaluation of suspected root resorption.