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.

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.

Validation of micro-computed tomography for occlusal caries detection: an in vitro study

Conventional methods of caries detection, including the gold standard of histological examination, have certain disadvantages that must be addressed prior to validating any other diagnostic technique—current or new. Here we evaluated the validity of micro-computed tomography (micro-CT) as an alternative gold-standard technique for caries detection. Sixty teeth with suspected occlusal caries were chosen from a pool of teeth extracted for orthodontic, periodontal, or surgical reasons. Identical reference points were marked on photographs taken for teeth and were used to evaluate each method. Dimensions of caries were assessed by two calibrated examiners using the ICDAS-II visual examination system, bitewing radiographs, and micro-CT. The teeth included in the study were selected randomly from solution before all measurements. For micro-CT, the device was set to 50 kV, 800 µA, pixel size 15 µm (at 1024 × 1024 resolution), and 1° rotation step. NRecon software (SkyScan) was used to obtain reconstructed images. For each diagnostic method, results were compared with histology results using the McNemar test. Receiver operator characteristic (ROC) analysis was also performed for each method (Z-test; p < 0.05). Besides showing a high correlation with histology results, micro-CT yielded the greatest values at the D3 threshold; moreover, accuracy and area under the ROC curve (AUC) values were greatest at the D1threshold. Our results indicate that micro-CT performs as well as or better than histological examination for the purpose of comparing methods for caries detection.

Extreme root resorption associated with induced tooth movement: A protocol for clinical management

Cases in which teeth have only the cervical third remaining from orthodontically induced external root resorption, cast the following doubts: 1) What care should be taken to keep these teeth in mouth with the least risk possible? 2) What care should be taken with regards to reading of imaging exams, particularly in terms of accurately determining cervical root and bone loss? 3) Why is not endodontic treatment recommended in these cases? The present study aims at shedding light on the aforementioned topics so as to induce new insights into the theme.

Nos casos em que os dentes têm apenas o terço cervical remanescente de uma reabsorção radicular externa induzida ortodonticamente: 1) Quais seriam os cuidados para que permaneçam na boca, com o menor risco possível de perda? 2) Quais seriam os cuidados na interpretação imaginológica desses casos, quanto à determinação precisa da perda radicular e óssea cervical? 3) Por que o tratamento endodôntico não estaria indicado? No presente trabalho, procura-se esclarecer esses pontos e respondendo os questionamentos, para induzir novos insights sobre o assunto.

Radiographic versus electronic root canal working length determination.

Purpose: The aim of this ex vivo study was to compare the accuracy of radiographic and electronic root canal length determination methods, compared with actual root canal length obtained with stereomicroscope. Materials and Methods: Thirty extracted single-rooted permanent teeth were used for this study. After access preparation, actual length (AL) of the root canal were determined for each tooth by inserting a #15 file until the tip of the file was visible at the apical foramen under a stereomicroscope. The radiographic working length determination was determined with a digital radiographic system and for the electronic measurement all teeth were embedded in an alginate model to test apex locator in-vitro. Data was analyzed using the descriptive statistic and intraclass correlation coefficient. Results: No significant difference was found between the radiographic and electronic root canal working length determination (P>0.05). The percentage of electronic measurements within ±0.5 mm to the apical constriction was 93.34% and 90% for radiographic methods within ±0.5 mm of all cases compared with AL. Conclusions: The present ex vivo study showed that electronic root canal working length determination is not superior to radiographic methods. Both methods provided a good performance in determining the root canal working length.

Cárie Proximal em Dentes Decíduos Posteriores: Diagnóstico e Fatores Associados / Approximal Caries in Primary Posterior Teeth: Diagnosis and Associated Factors

Objetivo: O objetivo desse estudo foi avaliar as lesões de cárie proximais posteriores em dentes decíduos, comprovar a melhora no diagnóstico clínico com o uso da imagem radiográfica interproximal e verificar associações com variáveis demográficas, socioeconômicas, clínicas e com o relato de frequência de escovação e do uso do fio dental. Método: Cinquenta crianças com idades entre cinco e oito anos, atendidas na Clínica Infantil da Faculdade de Odontologia da Universidade Federal de Pelotas, foram submetidas ao exame clínico e radiográfico interproximal bilateral realizado pelo único operador treinado, seguindo técnica padronizada. Dados demográficos e de higiene bucal foram coletados da entrevista com a mãe. O diagnóstico da imagem radiográfica foi conduzido por dois avaliadores calibrados (Kappa 0,85), a partir dos critérios de Rolla et al.,1996 modificados. Os resultados foram analisados utilizando de estatística descritiva e teste T (α=0.05). Resultados: Houve incremento de lesões de cárie proximais posteriores com o exame radiográfico, de 5,48 para 6,14 (p=0,001), ou seja, 25% das lesões. Dessas, 84,6% eram lesões em esmalte e 10,8% lesões em dentina. As lesões de cárie proximais posteriores em dentes decíduos mostraram-se associadas com a faixa etária (p=0,005), aumentando de 4,29 (5-6 anos) para 7,48 (7-8anos), com o estágio de irrupção dos primeiros molares permanentes (p=0,018), com a presença de sangramento gengival (p=0,040) e com a escolaridade materna (p=0,049). Não houve associação com o sexo, renda e com o relato da frequência de escovação e do uso do fio dental. Conclusão: Mesmo considerando a dificuldade técnica, a radiografia interproximal incrementa o diagnóstico clínico de lesões proximais posteriores em crianças

Objective: The aim of this study was to evaluate the posterior approximal caries in primary teeth, show improvement in clinical diagnosis with the use of radiography bitewing and explore associations with demographic, socioeconomic, clinical and reporting of frequency of brushing and flossing. Method: Fifty children (5 to 8 years old), attending in the Pediatric Clinic of the College of Dentistryû Federal University of Pelotas, were clinically examined and a bilateral bitewing radiographic was taken by one previously trained operator with a standard technique. Demographic data and information on oral hygiene were collected from an interview answered by the childrenÆs mothers. The diagnostic assessment from the radiographic images was conducted by 2 calibrated examiners (Kappa 0.85), following Rolla et al., 1996 modified criteria. Results were analyzed with descriptive statistics and t test (α=0.05). Results: Posterior approximal caries identification increased with the bitewing examination, from 5.48 to 6.14 (p=0.001). From the 25% lesions detected with the radiographic exam, 84.6% were enamel lesions and 10.8% were dentine lesions. Posterior approximal caries in primary teeth showed statistically significant association with: age range (increasing from 4.29 at 5-6 years to 7.48 at 7-8 years, p=0.005); first permanent molars eruption stage (p=0.018); the gingival bleeding (p=0.040); and with mother´s educational level (p=0.049). Associations with gender, family income, frequency of brushing and use of dental floss were not observed (p>0.05). Conclusion: Even considering the difficulties of the technique, bitewing radiographs improve the clinical diagnosis of posterior approximal carious lesions in children

Diagnosis of secondary caries in esthetic restorations: influence of the incidence vertical angle of the X-ray beam

The aim of this study was to evaluate the accuracy on the diagnosis of secondary caries-like lesions simulated on esthetic restorations of different materials, changing the incidence vertical angle (IVA) of the x-ray beam. Twenty human teeth received MOD inlay preparations. In the experimental group (n=10), a round cavity was made in the floor of the proximal box to simulate the caries-like lesion. All teeth were restored with 3 composite resins (Charisma, Filtek-Z250 and TPH-Spectrum) at 3 moments. Two radiographic images were acquired with 0º and 10º IVA. Ten observers evaluated the images using a 5-point confidence scale. Intra- and interobserver reliability was analyzed with the Interclass Correlation Coefficient and the diagnostic accuracy was evaluated using the area under the ROC curve (Az), Friedman test and Wilcoxon test (α=0.05). Higher accuracy values were obtained with 10º IVA (Az=0.66, Filtek-Z250>Az=0.56, TPH-Spectrum) compared to 0º (Az=0.55, Charisma>Az=0.37, TPH-Spectrum), though without statistically significant difference (p>0.05). The detection of secondary caries-like lesions simulated on esthetic restorations of different materials suffered no negative influence by changing the IVA of the x-ray beam.

O objetivo deste estudo foi avaliar a precisão no diagnóstico de lesões iguais-à-cárie secundárias simuladas em restaurações estéticas de materiais diferentes, mudando o ângulo vertical de incidência (AVI) do feixe de raios-x. Vinte dentes humanos foram submetidos a preparo cavitário inlay MOD. No grupo experimental (n=10), no soalho da caixa de proximal, foi confeccionada uma cavidade esférica para simular lesões iguais-a-cárie. Todos os dentes foram restaurados com 3 resinas compostas (Charisma, Filtek-Z250, TPH-Spectrum), em três tempos diferentes. Duas imagens radiográficas foram adquiridas com 0 e 10 graus de AVI o feixe de raios-x. Dez observadores avaliaram as imagens usando uma escala de confiança de 5-pontos. A reprodutibilidade intra- e inter- observador foi analisada com o coeficiente de correlação interclasse e a precisão do diagnóstico foi avaliada usando a área sob a curva ROC (Az), o teste de Friedman e de Wilcoxon (α=0,05). Os mais altos valores de precisão (p>0,05) foram observados com o AVI em 10º (Filtek-Z250 Az=0,66>TPH-Spectrum Az=0,56) comparado com 0º (Charisma Az=0,55>TPH-Spectrum Az=0,37), porém, sem diferenças estatisticamente significantes (p>0,05). A detecção de lesões iguais-à-cárie secundárias simulada em restaurações estéticas de diferentes materiais não foi influenciada pela mudança de AVI do feixe de raios-x.

Comparison of radiographic measurements obtained with conventional an indirect digital imaging during endontic treatment

The aims of this study were to evaluate the quality of indirect digitized radiographic images taken during endodontic procedures and to compare the measurements recorded with this technique to those obtained from conventional radiographs. Two-hundred conventional periapical radiographs taken at the undergraduate Endodontics Clinic of the Dental School of Bauru were digitized. The conventional and indirect digitized images were compared by three examiners as to the quality and accuracy of the measurements recorded during endodontic treatment, in canal length determination, gutta-percha adaptation, lateral condensation and final obturation. The conventional radiographs were observed on a film viewer, surrounded by a dark card, and measured with magnifying glass and a millimeter ruler; the indirect digitized images were evaluated on the Digora® for Windows software, with free utilization of the bright/contrast tool. Unlike the conventional radiographic images, all indirect digitized images were considered as having a high quality. The distance between the filling material and the root apex was 0.117 mm larger, on average, for the Digora® system (p<0.01). The measurements achieved by the investigated radiographic methods were clinically similar and they are thus equivalent. Changes in brightness and contrast of the images using Digora®software improved the diagnosis.

Comparação in vitro entre os métodos: inspeção visual, exame radiográfico interproximal e fluorescência a laser no diagnóstico de lesões cariosas oclusais / An in vitro comparison among the methods: visual inspection, interproximal radiographic test and laser fluorescence in diagnostic of occlusal carious lesions

Introdução - Objetivou-se comparar, in vitro, a performance da inspeção visual (IV), radiografia interproximal (RXI) e fluorescência a laser (L) no diagnóstico de lesões cariosas oclusais. Métodos - Os 72 dentes posteriores permanentes foram examinados pelos três métodos de diagnóstico: IV, RXI e L. O estudo foi validado histologicamente tanto na presença de cárie em dentina quanto em esmalte. Resultados - Os resultados mostraram em média, para o L, IV e RXI, respectivamente, uma sensibilidade de 59%, 64% e 15%; uma especificidade de 96%, 96% e 89%; valores preditivos positivo (99%, 99% e 89%) e negativo (32%, 38% e 17%), e área sobre a curva ROC de 0,778, 0,804 e 0,518. As reprodutibilidades médias intra-examinadores para p L, RXI e IV foram respectivamente de 0,89, 0,74 e 0,80, sendo o RXI, o único método a apresentar uma baixa reprodutibilidade intra-examinador. A flutuação máxima dos escores do aparelho KaVo DIAGNOdent (L) em relação aos pontos de corte estabelecidos pelo fabricante variou de +/- 1% em dentes com escores entre 0 e 5, +/- 3% em escores entre 6-10 +/- 5% em escores entre 11-20, +/- 8% em escores entre 21-30, podendo variar em até +/- 15% em escores acima de 30. Conclusão - A inspeção visual e a fluorescência a laser são os métodos mais indicados, dentre os estudados, para diagnóstico de lesões cariosas oclusais. Apesar da alta reprodutibilidade do KaVo DIAGOdent, esses resultados devem ser interpretados de forma cautelosa quanto sua utilização no monitoramento de lesões cariosas em superfícies oclusais

Manejo preventivo de la ventana de la infectividad, estudio prospectivo a 5 años / Preventive management of the infectivity window, a 5-year prospective study

El período de colonización de la cavidad bucal del niño con los S. mutans de su madre se ha establecido en la llamada ventana de la infectividad. El objetivo del presente estudio fue evaluar la efectividad de un Programa Odontológico Preventivo POP iniciado en la madre embarazada y continuado en el binomio, hasta los 5 años del hijo. 30 binomios madre-hijo fueron incluidos en el programa y comparados con 30 binomios de similares características como grupo control. El examen dental de los niños pertenecientes al POP se efectuó cada 6 meses, en paralelo con su control médico pediátrico del niño sano. Simultáneamente, 30 madres y sus hijos de 5 años, pertenecientes a un consultorio de la misma región y de similar situación socio-económica y cultural, que asistían a su control pediátrico, fueron examinados con el objeto de determinar su salud buco-dental mediante el índice CPO-D y ceo-d, según el criterio de la OMS. No se tomaron radiografías bite-wing a ninguno de los grupos del estudio. A los 5 años de edad, el 86,7 por ciento de los niños pertenecientes al POP estaba libre de experiencias de caries comparado con el 50 por ciento del grupo control. El promedio del índice ceo-d para los niños del programa fue de 0,4 +/- 1,4 versus 1,3 +/- 1,7 del grupo control. Las diferencias encontradas en ambos indicadores fueron estadísticamente significativas (p<0,05). Una estrecha relación entre el estatus buco-dental de la madre y su hijo fue establecida en los binomios de ambos grupos (p<0,01 y p<0,001). Acorde con estos resultados, se concluyó que el manejo preventivo de la ventana de la infectividad, iniciado precozmente en la madre embarazada y continuado con sus hijos hasta los 5 años de edad, resultó ser altamente efectivo al compararlo con un grupo control de similares características, aún en una comunidad que recibe los beneficios del agua potable fluorada

Medición de la altura ósea en radiografías digitalizadas / Measurement of bone height in digitalized radiographs

La distancia radiográfica del límite amelo-cementario (LAC) a la cresta ósea alveolar (COA) ha sido muy utilizada como medida de pérdida o ganancia de hueso alveolar. El objetivo de este estudio fue evaluar: 1)el error asociado a dos técnicas (secuencial vs. "side by side") asistidas por computadora, para la medición de la distancia LAC-COA en radiografías digitalizadas; y 2)la reproducibilidad del sistema para radiografías "bite-wing" verticales XCP Rinn con modificaciones, comparándolo con una técnica convencional. Para cada técnica se tomaron 44 radiografías por duplicado con intervalo de 1 hora en 22 sujetos. Se obtuvieron las diferencias entre mediciones de pares de radiografías. Los resultados indicaron que el método "side by side" produjo un menor error (p<0,001). Ambos procedimientos combinados demostraron ser lo suficientemente sensibles para detectar un cambio en la altura ósea de 0,36mm. en estudios longitudinales (intervalo de confianza=95 por ciento)

Metodología del análisis diagnóstico para la operatoria dental clínica / A methodology of diagnostic analysis for clinical operative dentistry

El diagnóstico en operatoria dental clínica es un tópico de difícil resolución en la práctica diaria y más aún en el proceso de enseñanza aprendizaje. Arribar a un correcto diagnóstico presupone un proceso ordenado, meticuloso y responsable. En el presente informe se describe el "diseño diagnóstico" utilizado en la Cátedra de Operatoria II "A" de la Facultad de Odontología de la Universidad Nacional de Córdoba, el cual comprende: 1. Relevamiento de datos con la H. CL. 2. Confección de un odontograma general. 3. Confección de un foto-odontograma individualizado. 4. Utilización de la radio-anatomía aplicada a la radiografía bitewing

Desarrollo tardío de dientes supernumerarios en la región de premolares: reporte de un caso / Late development of supernumerary teeth in the premolar region: report of a case

Este reporte describe el desarrollo tardío de premolares suplementales supernumerarios en tres cuadrantes de la región premolar. El descubrimiento de estas piezas fue por medio de radiografías de aleta de mordida y posterior confirmación con radiografías periapicales

Reliability of caries prevalence in the determination of bitewing radiographic intervals

The objective of the present study was to evaluate the reliability of caries prevalence in the prediction of future caries activity, and hence, in the determination of bitewing radiographic intervals. DMFS scores of an adult patient population were determined and subsequently related to their caries activity detected one year later using posterior bitewing radiographs. The results showed that caries activity was not limited to those with baseline high caries prevalence [DMFS scores > 20]. Significant proportions of those initially classified as moderate [DMFS score between 5 and 20] or low [DMFS score < 5] caries prevalent, showed caries activity as well, and accounted for more than 50% of the newly developed carious lesions one year later. In all, initial DMFs score could account for only 17% of the variations in caries increment. On the other hand, all of the newly developed carious lesions were confined to the enamel regardless of the initial patient classification as high, moderate or low caries prevalent. The results indicated that caries prevalence is not a satisfactory predictor of future caries activity, and so, might not be a reliable parameter in the determination of bitewing radiographic intervals. The clinical implications of the findings are discussed