Quality analysis of four filling techniques in ovoid root canals prepared with M® instruments

Aims: This study aimed to assess the quality of various filling techniques in ovoid root canals prepared using M® instruments. Materials and Methods: Sixty ovoid root canals underwent endodontic treatment with M® instruments and were subsequently divided randomly into four experimental groups, each employing a different obturation technique: TU - single cone; TL - active lateral condensation; TH - Tagger hybrid; TS - Schilder technique. Digital radiographs were taken in both mesiodistal and buccolingual directions to examine the filled teeth. The percentage of filling material and empty spaces was quantified using Photoshop® software. Data were subjected to statistical analysis using the one-way ANOVA test and T test (? = 0.05). Results: In the TL and TS groups, there was a significantly lower average percentage of unfilled spaces compared to the TU and TH groups (P<0.0001). When analyzing the radiographic directions, the mesiodistal view exhibited the highest mean percentage of unfilled spaces, with differences in filling quality observed only in the TU and TL groups. Conclusions: Active lateral condensation and Schilder techniques demonstrated superior performance in achieving effective filling of ovoid root canals.

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

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.

Influência do tipo de compósito e tempo de exposição aos raios-x na produção de artefatos radiográficos em modelo de restaurações classe II / Influence of the composite type and exposure time to x-rays on the production of radiographic artifacts in a class II restoration model

Aim: To evaluate the effect of the exposure time and the type of composite in the production of radiographic artifact at the tooth / restorative interface. Materials and Methods: In 20 healthy bovine incisors, cavity preparations and class II restorations were made using composite resins Filtek Bulk Fill One (group 1) and Filtek Z350 (group 2). Then, the teeth were exposed to obtain digital radiographs, varying the exposure time by 0.07, 0.10, 0.14, 0.20 and 0.25s. The images were evaluated for investigation of the presence of artifact through the analysis of the modified number of pixels (QPXD) and the average gray value in class II (MGVR) restorations, using the Image J software (National Health Institute). Results: The presence of artifact was observed in all evaluated samples, regardless of the type of restorative material and the exposure time employed. There was no statistically significant difference in QPXD and MGVR between the resins used (ANOVA 2 factors, p p> 0.05). The MGVR analysis indicated that there were no statistically significant differences between resins or between exposure times (p> 0.05). There was a correlation between QPXD and MGVR (r = 0.29) for Filtek Bulk Fill One resin. Discussion: This study reveals the importance of attention to the region of the tooth-restoration interface by the Surgeon-Dentist, who must combine the radiographic findings diagnosed using digital tools to clinical signs in order to compose a unique therapeutic project with a real need for intervention, if there is such need. Conclusion: The presence of altered pixels on dentin in the region of the tooth-restoration interface was identified in all specimens. The variation in the exposure time as well as the type of the restorative composite did not influence the increase or decrease of QPXD and neither in MGVR. However, there was a correlation between QPXD and MGVR for Filtek Bulk Fill One resin.

Objetivo: Avaliar o efeito do tempo de exposição e do tipo de compósito na produção de artefato radiográfico na interface dente/material restaurador. Materiais e Métodos: Em 20 incisivos bovinos hígidos foram feitos preparos cavitários e restaurações classe II utilizando resinas compostas Filtek Bulk Fill One (grupo 1) e a Filtek Z350 (grupo 2). Em seguida, os dentes foram expostos para obtenção das radiografias digitais, variando o tempo de exposição em 0,07, 0,10, 0,14, 0,20 e 0,25s. As imagens foram avaliadas para investigação da presença de artefato através da análise do número de pixels modificado (QPXD) e do valor médio de cinza nas restaurações de classe II (MGVR), utilizando o software Image J (Instituto Nacional de Saúde, Bethesda, MD, EUA). Resultados: Observou-se a presença de artefato em toda amostra avaliada, independente de tipo de material restaurador e tempo de exposição empregado. Não se observou diferença estatisticamente significativa na QPXD e nos MGVR entre as resinas utilizadas (ANOVA 2 fatores, p p>0,05). A análise do MGVR indicou que não houve diferenças estatisticamente significativas entre as resinas nem entre os tempos de exposição (p>0,05). Observou-se uma correlação entre a QPXD e o MGVR (r=0,29) para a resina Filtek Bulk Fill One. Discussão: Como significado clínico, o presente estudo revela a importância da atenção à região da interface dente-restauração por parte do Cirurgião-Dentista, o qual deve aliar os achados radiográficos diagnosticados com o auxílio de ferramentas digitais aos sinais clínicos, para compor um projeto terapêutico singular com uma real necessidade de intervenção, caso haja. Conclusão: Foi identificado a presença de pixels alterados sobre a dentina na região da interface dente-restauração em todos os corpos de prova. A variação do tempo de exposição como também o tipo do compósito restaurador não influenciou no aumento ou diminuição do QPXD e nem tão pouco no MGVR. Contudo houve correlação entre o QPXD e o MGVR para a resina Filtek Bulk Fill One.

Inteligência artificial aplicada aos exames de imagem odontológicos: uma revisão da literatura / Artificial intelligence applied to dental imaging: a review

Objetivo: investigar a literatura relacionada à aplicação e desempenho da Inteligência Artificial (IA) em exames de imagem odontológicos. Revisão de literatura: foram incluídos 70 trabalhos experimentais e revisões sistemáticas da literatura, publicados em inglês, no período entre 2018 e 2021, que analisaram a aplicabilidade da IA na detecção automática de: pontos cefalométricos, lesões de cárie, lesões apicais, perda óssea periodontal, sistemas de implantes, cistos e tumores odontogênicos, osteoporose, sinusite maxilar, terceiros molares e canal mandibular, ateromas em carótida, fratura radicular vertical, osteoartrite em articulação temporomandibular, avaliação de morfologia radicular e numeração dentária. Resultados:58,73% dos trabalhos analisados mostrou acurácia diagnóstica acima de 80% com a utilização de IA. Discussão: A maior limitação encontrada foi em relação à aquisição de amostras em quantidade suficiente para treinamento e teste dos modelos, já que imagens radiográficas têm sua disponibilidade limitada por questões éticas e legais relativas aos pacientes e Instituições. A falta de padronização na segmentação e processamento das imagens foi outro fator a influenciar os resultados obtidos, dificultando comparação e generalização. Apesar disso, diversos estudos apresentaram sugestões ou possíveis aperfeiçoamentos para pesquisas futuras, de forma a reduzir estas limitações. Conclusão: A aplicação da IA no diagnóstico por imagens mostrou-se promissora nas diversas áreas pesquisadas, com desempenhos muito semelhantes ou mesmo superiores, muitas vezes, ao desempenho dos profissionais humanos. Contudo, para a legitimação de sua utilização como parte do fluxo de trabalho na clínica, limitações ainda presentes devem ser superadas, especialmente no treinamento dos algoritmos para obtenção de melhores valores de acurácia.

Aim:to investigate the literature related to the application and performance of Artificial Intelligence (AI) in the analysis of dental imaging. Literature review: 70 experimental studies and systematic literature reviews published in English between 2018 and 2021 were included, which analyzed the applicability of AI models in the automatic detection of the following: cephalometric landmarks, dental caries, periapical diseases, alveolar bone loss, dental implant, odontogenic cysts and tumors, osteoporosis, maxillary sinusitis, third molars and mandibular canal, carotid atheromas, vertical root fracture, osteoarthritis in temporomandibular joint, evaluation of root morphology and numbering of dental elements. Results: 58.73% of the analyzed studies showed diagnostic accuracy above 80%.Discussion:the greatest methodological limitation was the acquisition of samples in sufficient quantity for training and testing phases, since radiographic images are limited to their availability due to ethical and legal issues related to patients and institutions. Lack of standardization in the segmentation and image processing was another factor to influence the results, which was difficult to compare and generalize. Despite this, several studies presented suggestions or possible improvements for future research, in order to reduce the impact of these limitations. Conclusion:the investigation of the applicability of AI in theanalysis of dental radiographic images seems to be still in its early days. The implementation of AI tools as radiologists'auxiliaries in their daily practice depends on overcoming the limitations of current studies and obtaining better diagnostic accuracy indices in future evaluations.

Niveles de referencia diagnósticos en equipos de radiografía dental en Bogotá, Colombia

Introducción: Las radiografías dentales son una de las exposiciones médicas más frecuentes a la radiación ionizante. El uso de radiación ionizante está asociado a un riesgo probable de desencadenar efectos biológicos adversos y posibles daños a la salud del paciente. Para evitar que los pacientes reciban dosis innecesariamente altas durante estas exposiciones, la Comisión Internacional de Protección Radiológica recomienda la utilización de los niveles de referencia para diagnóstico, como una herramienta efectiva de ayuda a la optimización de la protección radiológica de los pacientes. Objetivo: Estimar los niveles de referencia para diagnóstico en radiografía dental intraoral y panorámica en la ciudad de Bogotá, D. C. Metodología: Se evaluaron los parámetros de exposición radiográficos de los equipos y la calidad de imagen en 68 equipos de radiografía dental periapical y 23 equipos de radiografía panorámica. Se estimaron las magnitudes dosimétricas de kerma incidente en aire (Kai) en equipos intraorales para la radiografía de un maxilar molar de un adulto y el producto kerma aire-área (PKA) en equipos de radiografía panorámica en un examen de un adulto estándar. Resultados: El tercer cuartil de la distribución de kerma incidente en aire para radiografía intraoral fue de 3,3 mGy y del producto kerma aire-área para radiografía panorámica fue de 103,9 mGycm2. En la distribución de frecuencias de kerma incidente en aire para radiografía intraoral, el porcentaje más alto de equipos estuvo en el rango de 2,0-3,0 mGy. En la distribución de frecuencias del producto kerma aire-área para los equipos de radiografía panorámica, el porcentaje más alto de equipos estuvo en el rango de 60 a 80 mGycm2. Discusión: Las instituciones consideradas para establecer los Niveles de Referencia para Diagnóstico en este estudio contaron con una adecuada calidad de la imagen evaluada con un maniquí dental, pero las variaciones en las dosis de radiación entre instituciones señalan la necesidad de implementar herramientas que contribuyan a la optimización de las prácticas. Conclusiones: Se recomienda usar los valores de los niveles de referencia para diagnóstico encontrados en esta investigación para optimizar la protección radiológica en las exposiciones radiológicas dentales, y se espera que este estudio sirva de base para nuevas investigaciones en las demás ciudades del país.

Introduction: Dental X-rays are one of the most frequent medical exposures to ionizing radiation. The use of ionizing radiation is associated with a probable risk of triggering adverse biological effects and possible damage to the patient's health. To prevent patients from receiving unnecessarily high doses during these exposures, the International Commission on Radiological Protection recommends the use of diagnostic reference levels as an effective tool to help optimize radiological protection for patients. Objective: To estimate diagnostic reference levels in intraoral and panoramic dental radiography in the city of Bogotá, D.C. Methodology: In 68 periapical dental radiography equipment and 23 panoramic radiography equipment, the radiographic exposure parameters of the equipment and image quality were evaluated. The dosimetric magnitudes of incident air kerma (Ka,i) in intraoral equipment for the radiography of a maxillary molar of an adult and the air kerma-area product (PKA) in panoramic radiography equipment in a standard adult examination were estimated. Results: The third quartile of the incident air kerma distribution for intraoral radiography was 3,3 mGy and the air kerma-area product for panoramic radiography was 103,9 mGycm2. In the frequency distribution of incident air kerma for intraoral radiography, the highest percentage of equipment was in the range of 2,0-3,0 mGy, and in the frequency distribution of the air kerma-area product for equipment of panoramic radiography, the highest percentage of the equipment was in the range of 60 to 80 mGy cm2. Discussion: The institutions considered to establish the diagnostic reference levels in this study had an adequate quality of the image evaluated with a dental phantom, but the variations in radiation doses between institutions indicate the need to implement tools that contribute to the optimization of the practices. Conclusions: It is recommended to use the values of the diagnostic reference levels found in this research to optimize radiological protection in dental radiological exposures, and it is expected that this study will serve as a basis for further research in other cities of the country.

A Importância dos Métodos de Determinação das Idades Esquelética e Dentária na Ortodontia e Odontopediatria ­ uma Revisão de Literatura / The Importance of Methods for Determination of Squeletal and Dental Age in Orthodontics and Pediatric Dentistry ­ a Literature Review

O estágio de desenvolvimento humano é intimamente relacionado à sua maturidade óssea ou dentária, sendo essencial para a escolha do tratamento de alterações dentofaciais em crianças e adolescentes por ortodontistas e odontopediatras. Existem diversos indicadores biológicos para determinar a maturação do indivíduo, como a idade cronológica e as alterações hormonais, porém esses indicadores podem sofrer interferências. Visando uma determinação de desenvolvimento e dos picos de crescimento mais precisa, para um melhor diagnóstico e plano de tratamento, foram desenvolvidos diversos métodos para determinar a idade esquelética e a idade dentária, sendo estes a avaliação da maturação carpal, da morfologia das vértebras cervicais, da fusão óssea da sincondrose esfeno-occipital e da sutura palatina mediana, bem como dos estágios da calcificação dentária. A avaliação das radiografias de mão e punho é o padrão ouro da predição da idade esquelética, e sua correlação com outros métodos já é evidente. Sendo assim, é possível utilizar a avaliação das vértebras cervicais e das idades dentárias de Nolla e Demirjian.

The stage of human development is closely related to bone or dental maturity, being essential for the choice of treatment for dentofacial changes in children and adolescents by orthodontists and pediatric dentists. There are several biological indicators to determine an individual's maturation, such as chronological age and hormonal changes, but these indicators can suffer interference. Aiming at a more accurate determination of development and growth peaks, for a better diagnosis and treatment plan, several methods have been developed to determine skeletal age and dental age, these being the assessment of carpal maturation, the morphology of the cervical vertebrae, bone fusion of the spheno-occipital synchondrosis and the median palatal suture, as well as the stages of dental calcification. The evaluation of hand and wrist radiographs is the gold standard for predicting skeletal age, and its correlation with other methods is already evident. Therefore, it is possible to use the assessment of cervical vertebrae and dental ages by Nolla and Demirjian.

Effect of Different Cone Beam Computed Tomography Devices and Protocols on Image Quality for the Evaluation of Periodontal Structures / Efeito de Diferentes Dispositivos e Protocolos de Tomografia Computadorizada deFeixe Cônico na Qualidade de Imagem para Avaliação de Estruturas Periodontais

The quality of Cone Beam Computed Tomography (CBCT) images is directly influenced by scanning and visualization protocols. Evaluate the subjective quality of the Cone Beam Computed Tomography (CBCT) image of different devices and protocols for diagnosing periodontal structures and correlate the findings with the contrast-to-noise ratio (CNR). One dry dentate mandible was scanned by six CBCT devices: Accuitomo 3D 170, CS 9000, CS 9300, Eagle 3D, i-CAT Classic, and Orthophos XG 3D. All CBCT devices were adjusted to provide a spatial resolution closest to 0.2 mm, and a FOV height limited to less than 100 mm. Cross-sectional images were evaluated randomly. The buccal bone coverage, the periodontal ligament space and the amount of image noise were assessed. The statistics were calculated based on a logistic regression model with the significance level set at 5%. Protocols with large FOVs demonstrated significantly lower image quality. No statistical differences were found regarding buccal bone coverage between the CBCT devices. The CNR showed the highest value for the Accuitomo 60mm x 60mm HiFi 180°, followed by the Accuitomo 60mm x 60mm HiFi 360°, and lower values for the i-Cat Classic and Orthophos XG 3D devices. Most protocols studied presented good image quality in evaluating the buccal bone coverage and periodontal ligament space. However, the exam with the lowest FOV of the Accuitomo 60mm x 60mm HiFi 180° device showed superiority concerning the others.(AU)

A qualidade das imagens de tomografia computadorizada de feixe cônico (CBCT) é diretamente influenciada pelos protocolos de digitalização e visualização. Avaliar a qualidade subjetiva da imagem da Tomografia Computadorizada de Feixe Cone (CBCT) de diferentes aparelhos e protocolos para o diagnóstico de estruturas periodontais e correlacionar os achados com a razão contraste-ruído (RCR). Uma mandíbula dentada seca foi digitalizada por seis dispositivos CBCT: Accuitomo 3D 170, CS 9000, CS 9300, Eagle 3D, i-CAT Classic e Orthophos XG 3D. Todos os dispositivos CBCT foram ajustados para fornecer uma resolução espacial próxima a 0,2 mm e uma altura de FOV limitada a menos de 100 mm. Imagens transversais foram avaliadas aleatoriamente. A cobertura óssea vestibular, o espaço do ligamento periodontal e a quantidade de ruído da imagem foram avaliados. As estatísticas foram calculadas com base em um modelo de regressão logística com nível de significância de 5%. Protocolos com grandes FOVs demonstraram qualidade de imagem significativamente inferior. Não foram encontradas diferenças estatísticas em relação à cobertura óssea vestibular entre os dispositivos CBCT. O CNR apresentou o maior valor para o Accuitomo 60mm x 60mm HiFi 180°, seguido pelo Accuitomo 60mm x 60mm HiFi 360°, e valores menores para os dispositivos i-Cat Classic e Orthophos XG 3D. A maioria dos protocolos estudados apresentou boa qualidade de imagem na avaliação da cobertura óssea vestibular e do espaço do ligamento periodontal. Entretanto, o exame com menor FOV do aparelho Accuitomo 60mm x 60mm HiFi 180° apresentou superioridade em relação aos demais. (AU)

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.

Avaliação da radiopacidade dos cimentos MTA Angelus Branco®, MTA Repair HP e Biodentine por meio de radiografia digital / Radiopacity evaluation of White MTA Angelus®, MTA Repair HP and Biodentine cements by means of digital radiography

Introdução: A radiopacidade é um requisito importante para um material odontológico, pois permite que as estruturas dentárias sejam distinguidas do material substituto, facilitando o diagnóstico radiográfico. Portanto, com o surgimento de novas formulações de materiais endodônticos, é fundamental que esta propriedade esteja em conformidade com as normas vigentes. Objetivo: Avaliar as radiopacidades dos cimentos MTA Angelus Branco, MTA Repair HP e Biodentine entre si e compará-las com as das estruturas dentais humanas, por meio de radiografia digital. Material e Métodos: Foram confeccionados cinco corpos de prova para cada cimento estudado. Cada amostra foi radiografada, pelo método digital, juntamente com uma fatia de um dente molar inferior humano hígido e uma escala de densidade de alumínio (Al). Para cada conjunto, três imagens foram obtidas e avaliadas quanto às densidades por meio da ferramenta histograma do software Image J. Em cada estrutura avaliada, foi usada uma região de interesse pré-definida e as densidades foram apresentadas utilizando-se médias, desvios-padrões e medianas. Para avaliar a normalidade dos dados e comparar a radiopacidade dos três cimentos testados, foram aplicados os testes de Shapiro-Wilk e o de Kruskal-Wallis, respectivamente. Foi utilizado o programa SPSS com nível de significância de 5% (p≤0,05). Resultados: Foi observado para o esmalte e a dentina radiopacidades equivalentes a 2 mm de Al e 1 mm respectivamente. Ambos os cimentos MTA Branco e MTA Repair HP, apresentaram radiopacidade equivalente a 3 mm de Al. O cimento Biodentine apresentou radiopacidade inferior aos demais materiais (2 mm de Al). Conclusão: As radiopacidades dos cimentos MTA Branco e MTA Repair HP foram semelhantes entre si e maiores que às da dentina e do esmalte dental. Em contrapartida, a radiopacidade do cimento Biodentine foi inferior às do MTA Branco e MTA Repair HP, e semelhante à do esmalte.

Introduction: Radiopacity is an important requirement for a dental material, as it allows tooth structures to be distinguished from the substitute material, facilitating radiographic diagnosis. Therefore, with the emergence of new formulations of endodontic materials, it is essential that this property complies with current regulations. Objective: To evaluate the radiopacities of MTA Angelus White, MTA Repair HP and Biodentine cements among themselves and compare them with those of human dental structures, using digital radiography. Material and Methods: Five specimens were made for each studied cement. Each sample was radiographed, using the digital method, along with a slice of a sound human lower molar tooth and an aluminum (Al) density scale. For each set, three images were obtained and evaluated for densities using the histogram tool of the Image J software. In each evaluated structure, a predefined region of interest was used and the densities were presented using means, standard deviations and medians. To assess data normality and compare the radiopacity of the three cements tested, the Shapiro-Wilk and Kruskal-Wallis tests were applied, respectively. The SPSS program was used with a significance level of 5% (p≤0.05). Results: Radiopacities equivalent to 2 mm of Al and 1 mm of Al, respectively, were observed for enamel and dentin. Both MTA Branco and MTA Repair HP cements presented radiopacity equivalent to 3 mm of Al. Biodentine cement presented lower radiopacity than the other materials (2 mm of Al). Conclusion: The radiopacities of MTA Branco and MTA Repair HP cements were similar to each other and greater than those of dentin and dental enamel. In contrast, the radiopacity of Biodentine cement was lower than that of White MTA and MTA Repair HP, and similar to that of enamel.

Factors Influencing Anxiety Levels During Dental Radiographic Examination Among Dental Students

@#Introduction: : Dental anxiety was found to be related to the radiographic procedure and can be influenced by sociodemographic characteristics of patients such as age, gender, level of education, and provoking factors such as past dental examination experience. Evaluating the anxiety regarding dental radiographic examination could be beneficial in ensuring the procedure’s continuance. This study aimed to measure the radiology knowledge among dental students and its association with anxiety due to dental radiographic examination. Methods: A cross-sectional study was conducted to collect the data using a questionnaire packet that included a knowledge and anxiety questionnaire, demographic data, and information about the experience of dental radiographic examination. A total sampling of 1st and 2nd year undergraduate and clerkship dental students at the Faculty of Dentistry, Universitas Gadjah Mada, Indonesia was selected based on inclusion and exclusion criteria. Anxiety-related factors were assessed using descriptive statistics and multiple linear regression conducted with STATA 15.1. Results: Results showed that knowledge and anxiety were negatively correlated but the correlation was not statistically significant. Gender, radiographic technique, and presence/absence of a companion during the examination were not correlated with anxiety. Meanwhile, the anxiety level was negatively and significantly correlated with age and examination frequency (p < 0.05). Multiple linear regression results showed strong evidence that age and examination frequency were the main factors for predicting anxiety. Conclusion: Although age, radiographic examination frequency, and educational level are significant bivariate predictors of anxiety, subsequent regression analysis indicated that only age and radiographic examination frequency influence anxiety.

Radiolucent image in lower third molar: hidden caries or pre-eruptive resorption?: a case report / Imagem radiolucente em terceiro molar inferior: cárie oculta ou reabsorção pré-eruptiva?: um relato de caso

ABSTRACT Caries is a multifactorial disease due to the imbalance of the de/re-mineralization process. Complementary radiographic examinations are able to detect hidden caries. The purpose of this short communication was to investigate the radiolucent image suggestive of hidden caries in lower third molar. The extraction of the tooth, decalcification, inclusion and preparation were performed for histological analysis of the lesion. Histological findings revealed a pre-eruptive resorption, and the etiological factors of this coronary resorption were undefined. The professional should be aware of the occurrences of these lesions to early diagnose and propose appropriate treatment to avoid future complications to the patient.

RESUMO A cárie é conceituada como uma doença multifatorial condicionada ao desequilíbrio no processo de desmineralização e remineralização das estruturas dentárias. O propósito desse trabalho foi investigar a imagem radiolúcida sugestiva de cárie oculta em terceiro molar. Foi realizado a exodontia do elemento dentário, descalcificação e confecção de lâminas para posterior estudo histológico da lesão. O achado histológico conclui-se tratar de uma reabsorção pré-eruptiva. O profissional deve estar atento às ocorrências dessas lesões para diagnosticar precocemente e propor o tratamento adequado, evitando complicações futuras ao paciente.

Calidad radiográfica obtenida por estudiantes de Odontología mediante la técnica de bisectriz / Radiographic quality obtained by dental students using the bisecting angle technique

Objetivo: Evaluar la calidad radiográfica mediante técnica de la bisectriz ejecutada por estudiantes de Odontología de tercer año. Material y Método: Estudio observacional descriptivo. Se evaluaron 220 radiografías ejecutadas por 55 estudiantes de Odontología de tercer año. La calidad radiográfica fue evaluada por dos investigadores, mediante una pauta creada con cuatro parámetros: posición de la película, angulación horizontal, angulación vertical y rayos X centrado. Fue comparada la calidad según sector radiográfico, anterior y posterior. Se realizó estadística descriptiva y prueba de chi-2 para establecer diferencias entre calidad y sector radiográfico, con un valor de significancia estadística de p0.05. Conclusión: Las radiografías periapicales tomadas mediante técnica de la bisectriz por estudiantes de Odontología de tercer año, son mayoritariamente de calidad inaceptable, sin diferencias significativas entre sectores.

Objective: To evaluate radiographic quality using the bisecting angle technique performed by third-year dental students. Material and Method: Descriptive observational study. 220 radiographs were evaluated, performed by 55 third-year dental students. Radiographic quality was evaluated by two researchers, using a guideline created with four parameters: film position, horizontal angulation, vertical angulation and centered X-ray (conecut). The quality was compared according to the radiographic sector, anterior and posterior. Descriptive statistics and chi-2 test were applied to establish differences between radiographic sector and radiographic quality, setting a value of statistical significance of p 0.005. Conclusions: The periapical radiographs taken by third-year dental students using the bisecting angle technique is mostly of unacceptable quality, with no significant differences between sectors.

Materiales de restauración dental / Dental restorative materials

Objetivo: Identificar los efectos que producen la utilización de materiales restauradores en los tejidos dentarios luego de utilizarlos como una solución funcional y estética ante los problemas provocados por cualquier tipo de microorganismo es necesario. Método: de tipo bibliográfica mediante una búsqueda de artículos en base PubMed y Scielo. Resultados: Se encontraron 30 artículos, de los cuales solo se pudieron utilizar 15 de ellos, ya que contribuyeron a cumplir con el objetivo de esta investigación y el resto no. Conclusiones: Los materiales dentales son la base fundamental de la odontología restauradora, protésica y de varias especialidades y procedimientos realizados por parte del odontólogo. Por lo tanto, es necesario tener conocimientos de cómo actúa cada uno de estos materiales restaurativos, con base en su estructura interna, para poder ver cuál va a ser su comportamiento físico, mecánico y fisicoquímico en su uso odontológico.

Objective: To identify the effects produced by the use of restorative materials on dental tissues after using them as a functional and esthetic solution to the problems caused by any type of microorganism. Method: bibliographic type by means of a search of articles in PubMed and Scielo databases. Results: 30 articles were found, of which only 15 of them could be used, since they contributed to fulfill the objective of this research and the rest could not. Conclusions: Dental materials are the fundamental basis of restorative dentistry, prosthetic dentistry and various specialties and procedures performed by the dentist. Therefore, it is necessary to have knowledge of how each of these restorative materials acts, based on their internal structure, in order to be able to see what their physical, mechanical and physicochemical behavior will be in their dental use.

In Vivo Detection of External Apical Root Resorption Induced by Apical Periodontitis Using Periapical Radiography and Cone-Beam Computed Tomography

Abstract Objective: To compare the accuracy of periapical radiography (PR) and cone-beam computed tomography (CBCT) for the detection of external apical root resorption (EARR) due to root canal contamination. Material and Methods: Dog's teeth with experimentally induced root resorption due to root canal contamination underwent or not root canal treatment (n=62). True positives (TP), false positives (FP), true negatives (TN), and false negatives (FN) in PR and CBCT diagnoses were determined using histopathologic findings as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (TP + TN) in the diagnosis of EARR were calculated. Data were compared using chi-squared test (α=0.05). Results: EARR was detected in 35% of roots by PR, in 47% by CBCT, and in 50% of the roots by microscopy (p=0.03 PR versus microscopy; p=0.67 CBCT versus microscopy). Overall, CBCT produced more accurate diagnoses than PR (p=0.008). PR and CBCT allowed the identification of large resorption in 100% of the cases and showed the same accuracy. However, for small resorptions, PR showed an accuracy of 0.83, whereas CBCT showed an accuracy of 0.96 (p=0.003). Conclusion: Cone-beam computed tomography showed higher accuracy in detecting external apical root resorption of endodontic origin.

Imaginologic resources used in diagnosis of root resorptions: comparative study / Recursos imaginológicos utilizados no diagnóstico de reabsorções radiculares: estudo comparativo

ABSTRACT Objective: Compare the accuracy of early diagnosis of simulated internal root resorptions and external root resorption, using digital periapical radiography and cone beam computed tomography. Methods: Root resorption were simulated in extracted human teeth by demineralization with 5% nitric acid solution and 8% Sodium Hypochlorite in different periods (1 and 5 days). For the group external root resorption (n=12) composite resin cylinders were positioned on middle third of buccal surface of roots, to delimit application of demineralization substances. In group internal root resorptions (n=12) the teeth were sectioned longitudinally, and the composite resin cylinders were positioned in the middle third of root canals. The teeth were mounted in a dry mandible and evaluated by digital radiography and tomography. The images were evaluated by two examiners. Results: Analyzing the tomographic images in period of 1 day, the examiner 2 identified internal root resorptions that were not identified in radiographic images (p<0.05). No examiner was capable of diagnosing external root resorption irrespective of exam, in the group of 1 day (p>0.05). In 5 day period of induction, both exams identified internal root resorptions (p>0.05), however, the tomographic images were more effective in identifying external root resorption (p <0.05) for both examiners. Conclusion: Cone beam computed tomography was shown to be more effective than digital periapical radiography for detecting internal root resorptions with 1 day of induction. The imaginological resources used in this study were not able to early detect external root resorption.

RESUMO Objetivo: Comparar a acurácia do diagnóstico precoce de reabsorções radiculares interna (RRI) e reabsorções radiculares externa (RRE) simuladas, por meio de radiografia periapical digital e tomografia computadorizada de feixe cônico. Métodos: Reabsorções radiculares foram simuladas em dentes humanos extraídos utilizando a desmineralização com ácido nítrico 5% e hipoclorito de sódio 8% em diferentes períodos (1 e 5 dias). Para o grupo reabsorções radiculares externa (n=12) cilindros de resina composta foram posicionados no terço médio das faces vestibulares das raízes, delimitando a aplicação das substâncias de desmineralização. No grupo reabsorções radiculares interna (n=12) os dentes foram seccionados longitudinalmente, e os cilindros de resina posicionados no terço médio dos canais radiculares. Os dentes foram montados em mandíbula seca e avaliados por meio de radiografia digital e tomografia por dois examinadores. Resultados: Nas imagens tomográficas no período de 1 dia, o examinador 2 identificou reabsorções radiculares interna as quais não foram identificadas nas radiografias (p<0,05). Nenhum examinador foi capaz de diagnosticar as reabsorções radiculares externa independente do exame no grupo de 1 dia (p>0.05). No período de indução de 5 dias ambos os exames identificaram as reabsorções radiculares interna (p>0,05), entretanto, as tomografias foram mais eficazes na identificação das reabsorções radiculares externa (p<0,05) para ambos os examinadores. Conclusão: A tomografia computadorizada de feixe cônico mostrou-se mais eficaz do que a radiografia periapical digital na detecção de reabsorções radiculares interna com 1 dia de indução. Os recursos imaginológicos utilizados neste estudo não foram capazes de detectar precocemente a reabsorção radicular externa.

Evaluation of the microstructure, chemical composition, and image quality of different PSP receptors

Abstract This study aimed to assess the microstructure, chemical composition, and image quality of different photostimulable phosphor plates (PSP). Four PSP systems, Express®, Digora®, VistaScan®, and Apixia,® were assessed. Five radiographs of a homogeneous acrylic phantom were obtained with the PSP of each system, to acquire a total of 20 images. The images were objectively evaluated for uniformity using mean grey and standard deviation (SD) of their grey values. PSP receptors were analyzed using scanning electron microscopy (SEM) to determine the thickness of the granule layer and the size of the granules. The chemical composition of the PSP receptors was analyzed using total reflection X-ray fluorescence (TXRF). VistaScan showed more uniform and higher density images than the other tested systems (p < 0.05), as well as the lowest SD of grey values (p < 0.05). Regarding the microstructure of the receptors, Digora and VistaScan had thicker granule layers than Express and Apixia, and VistaScan had smaller granules than Digora and Express (p < 0.05). Fourteen chemical elements were detected in the receptors, with barium being the element with the highest concentration in all PSP systems. The microstructure, chemical composition, and image quality varied among all four PSP receptors studied. VistaScan receptors showed the smallest variation in granule size, one of the thickest granule layers, and the most uniform and least noisy images.

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.

Accuracy of digital bitewing radiographs with and without applying horizontal tube shift in the diagnosis of residual excess cement around dental implants: an in vitro study / Precisión de las radiografías digitales bitewing con y sin aplicación de desplazamiento horizontal del tubo en el diagnóstico del exceso de cemento residual alrededor de los implantes dentales: un estudio in vitro

Purpose: This study was designed to evaluate the diagnostic value of digital Bitewing (BW) radiographs with and without horizontal tube shift in detecting Residual excess cement (REC) on the proximal and non-proximal surfaces of implant restorations. Material and Methods: Eight mandibular models were fabricated with two implants placed on each side in the premolar and first molar positions. Excess cement was applied to either proximal or non-proximal surfaces of the restorations intentionally during the process of crown cementation. BW radiographs with and without applying horizontal tube shift were acquired. Three maxillofacial radiologists were asked to determine the presence and location of REC in the radiographs. Sensitivity and specificity of the radiographic technique were assessed according to the restoration surface that contained REC. Results: Sensitivity of BW radiographs was 100% for the detection of REC on the proximal surfaces and 41-18, 80% on the non-proximal surfaces. Specificity of the technique was 85.71%-100% for the proximal surfaces and 75-94. 12% for the non-proximal areas. Specificity of the radiographic method was generally greater than its sensitivity for the non-proximal surfaces while in the proximal areas, the two variables had quite similar values. Conclusion: Digital BW radiography is generally more useful for detection of REC on the proximal surfaces. Higher specificity of this technique for the bucco-lingual surfaces suggests more reliability of the negative diagnoses in the non-proximal areas.

Objetivo: Evaluar el valor diagnóstico de las radiografías digitales bitewing (BW), con y sin desplazamiento horizontal del tubo, para detectar el exceso de cemento residual (ECR) en las superficies proximales y no proximales de las restauraciones con implantes. Material y Métodos: Se fabricaron ocho modelos mandibulares con dos implantes colocados a cada lado en las posiciones premolar y primer molar. El exceso de cemento se aplicó intencionalmente en las superficies proximales o no proximales de las restauraciones durante el proceso de cementación de la corona. Se adquirieron radiografías BW con y sin aplicación de desplazamiento horizontal del tubo. Se pidió a tres radiólogos maxilofaciales que determinaran la presencia y ubicación de ECR en las radiografías. La sensibilidad y la especificidad de la técnica radiográfica se evaluaron según la superficie de restauración que contenía ECR. Resultados: La sensibilidad de las radiografías de BW fue del 100% para la detección de ECR en las superficies proximales y del 41,18-80% en las superficies no proximales. La especificidad de la técnica fue 85-71, 100% para las superficies proximales y 75-94, 12% para las áreas no proximales. La especificidad del método radiográfico fue generalmente mayor que su sensibilidad para las superficies no proximales, mientras que en las áreas proximales, las dos variables tuvieron valores bastante similares. Conclusión: La radiografía digital BW es generalmente más útil para la detección de ECR en las superficies proximales. La mayor especificidad de esta técnica para las superficies buco-linguales sugiere una mayor confiabilidad de los diagnósticos negativos en las áreas no proximales.

Qualitative Analysis of Root Canal Treatments performed by Undergraduate Students: A Retrospective Study

ABSTRACT Objective: Toanalyze the technical quality of endodontic treatment carried out at the undergraduate dental clinics. Material and Methods: Random radiographic records of 92 patients' were selected who received endodontic treatment by the undergraduate students from June 2018 to July 2019. The quality of root canal filling was determined in relation to the adequate density, length, and taper. Statistical analysis was performed by using GraphPad (Prism 5), and to determine the association between different variables Chi-square test was used. Results: Adequate technical quality of canal obturation conducted by the undergraduate students was found in less than 65% of the cases. The frequency of adequate root canal taper was significantly greater in maxillary teeth (75%) as compared to mandibular teeth (33%); however, adequacy of acceptable density was found more in maxillary teeth (62%) as compared to mandibular teeth (55%).A statistically significant difference was seen in the quality of root canal fillings between anterior and posterior teeth (p=0.001). Conclusion: The root canal therapy performed by undergraduate students was less than optimum in terms of technical quality. Hence, it is suggested that the endodontic training courses delivered at pre-clinical and clinical levelsfor undergraduate students must be thoroughly revised.