Development and validation of a method for creating incomplete vertical root fracture in extracted teeth.

The present study reported a method for inducing incomplete root fracture in human extracted teeth for the purpose of evaluating the merits of different diagnostic imaging techniques. Thirty-five single-rooted teeth were inspected under magnification and transillumination to exclude previously fractured teeth. Tooth crowns were removed, and the root canals were prepared up to the ProTaper Next X4 (40.06) file. Each root was lined with wax and embedded in a polystyrene resin block. The setup was attached to a universal testing machine for pressing a customized conical wedge (diameter at tip: 0.6 mm; taper: 0.2 mm/mm) into the instrumented canal with a 2 kN load at 5 mm/min. The machine was programmed to stop after a sudden 10% drop in loading force. Each specimen was removed from the resin block and inspected under × 20 magnification and transillumination to identify the fracture characteristics (pattern, surfaces and root-third affected). The gap width of each specimen was measured at different locations along the fracture line. The protocol induced incomplete vertical root fractures in all specimens. Fracture widths were < 100 µm in all specimens (mean gap width: 34.9 µm). The proposed methodology was successful in inducing incomplete vertical root fractures with characteristics that resemble the clinical presentation of these conditions. The method is easy to execute, highly reproducible and helps to minimize bias in laboratory studies that aims to mimic vertical root fractures.

High Performance of Metallic Thin Films for Resistance Temperature Devices with Antimicrobial Properties.

Titanium-copper alloy films with stoichiometry given by Ti1-xCux were produced by magnetron co-sputtering technique and analyzed in order to explore the suitability of the films to be applied as resistive temperature sensors with antimicrobial properties. For that, the copper (Cu) amount in the films was varied by applying different DC currents to the source during the deposition in order to change the Cu concentration. As a result, the samples showed excellent thermoresistivity linearity and stability for temperatures in the range between room temperature to 110 °C. The sample concentration of Ti0.70Cu0.30 has better characteristics to act as RTD, especially the αTCR of 1990 ×10-6°C-1. The antimicrobial properties of the Ti1-xCux films were analyzed by exposing the films to the bacterias S. aureus and E. coli, and comparing them with bare Ti and Cu films that underwent the same protocol. The Ti1-xCux thin films showed bactericidal effects, by log10 reduction for both bacteria, irrespective of the Cu concentrations. As a test of concept, the selected sample was subjected to 160 h reacting to variations in ambient temperature, presenting results similar to a commercial temperature sensor. Therefore, these Ti1-xCux thin films become excellent antimicrobial candidates to act as temperature sensors in advanced coating systems.

Evaluation of Mandibular Bone After Dental Extraction in Rats Treated With Antiresorptive Drugs.

PURPOSE: Zoledronic acid (ZOL) and denosumab (Dmab) are commonly used to treat bone pathologies. Because these drugs suppress bone metabolism, this study sought to compare their effect on bone repair after tooth extraction. MATERIALS AND METHODS: Four-week-old male Wistar rats were randomly assigned to 1 of 3 groups: ZOL 0.125 mg/kg, Dmab 0.25 mg/kg, or saline solution 10 mL/kg (control). After 1 week of treatment, the first left molar was extracted; the rats were euthanized at 28 days. The jaws were removed and photographed for macroscopic analysis of wound healing and then subjected to tomographic and histologic analyses. Immunohistochemistry was carried out against the receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG). RESULTS: No difference in wound healing, presence of inflammatory infiltrate and bone sequestration, or osteocyte expression of RANKL and OPG was found among groups. Tomographic analysis showed that the ZOL group had less alveolar resorption and more complete alveolar repair compared with the other groups. There was a statistically significant difference in the OPG marker in the control (P = .008) and ZOL (P = .05) groups when comparing the extracted and non-extracted sides. CONCLUSION: Systemic use of ZOL can improve alveolar bone healing; however, the potential risk for the development of osteonecrosis should be considered. Higher expression of OPG seems to be associated with the control of osteoclastogenesis during bone repair.

Ridge Preservation After Maxillary Third Molar Extraction Using 30% Porosity PLGA/HA/ß-TCP Scaffolds With and Without Simvastatin: A Pilot Randomized Controlled Clinical Trial.

OBJECTIVE: To evaluate clinically and radiographically, in humans, the healing of maxillary third molars postextraction sockets after application of different ridge preservation techniques 3 months after tooth extraction. MATERIALS AND METHODS: Twenty-six sockets (13 patients) were randomly assigned to 4 treatment modalities: deproteinized bovine bone mineral with 10% collagen (DBBM-C), poly(D,L-lactide-co-glycolide) with hydroxyapatite/ß-TCP scaffold (PLGA/HA), PLGA/HA/ß-TCP with 2.0% simvastatin scaffold (PLGA/HA/S), and spontaneous healing (control). Clinical complications were assessed, and cone-beam computed tomographies were taken in 5 patients 3 months after surgeries. For statistical purposes, the Fisher exact test was used (P < 0.05). RESULTS: After 3 months, 6 of 9 grafts from the PLGA/HA group were lost (P < 0.05). PLGA/HA/S' loss was only 2 of 8 (P > 0.05), but no loss was observed in the DBBM-C group. Pain was present in 3 of 8 sites that lost the graft (37.5%) (P > 0.05) and infection in 1 of 8 (12.5%) (P > 0.05), with these only occurring in the PLGA/HA group. CONCLUSIONS: Poly (D, L-lactide-co-glycolide) with hydroxyapatite/ß-TCP (PLGA/HA/ß-TCP) scaffolds, with and without simvastatin, failed to obtain the initial expected results and presented more complications. Scaffolds with simvastatin showed to be superior, with less clinical complications than scaffolds without simvastatin.

Analysis of Bone Repair and Inflammatory Process Caused by Simvastatin Combined With PLGA+HA+ßTCP Scaffold.

PURPOSE: This study evaluated the tissue and inflammatory responses to the use of simvastatin and poly(lactic-co-glycolic acid) + hydroxyapatite + ß-tricalcium phosphate (PLGA+HA+ßTCP) scaffold for bone repair. MATERIALS AND METHODS: Two defects of 5 mm in diameter were made in the calvaria of rats, which were shared into the following 6 groups: naive, sham, vehicle, PLGA+HA+ßTCP scaffold, simvastatin (4 mg/mL), and simvastatin with the scaffold. Tissue samples were collected at 1, 7, 15, 30, and 60 days after surgery. Inflammation was evaluated by interleukin-1 beta and tumor necrosis factor alpha quantification and by a hemogram, whereas bone repair was evaluated using densitometry and scanning electron microscopy. Data were statistically analyzed using ANOVA followed by post hoc tests (P < 0.05). RESULTS: There was an increased cytokine expression in the scaffold and simvastatin groups (P < 0.001 and P < 0.05, respectively) 1 day after surgery but no alterations on the hemogram were observed. It was found on bone tissue samples that 60 days after surgery all groups presented similar densitometry values and morphology characteristics, despite the occurrence of bone formation delay in the simvastatin group (P < 0.01). CONCLUSION: The use of simvastatin and PLGA+HA+ßTCP scaffold, associated or not, did not lead to improvement in bone repair.

Three-dimensional assessment of buccal alveolar bone after rapid and slow maxillary expansion: a clinical trial study.

INTRODUCTION: The purposes of this study were to analyze and compare the immediate effects of rapid and slow maxillary expansion protocols, accomplished by Haas-type palatal expanders activated in different frequencies of activation on the positioning of the maxillary first permanent molars and on the buccal alveolar bones of these teeth with cone-beam computerized tomography. METHODS: The sample consisted of 33 children (18 girls, 15 boys; mean age, 9 years) randomly distributed into 2 groups: rapid maxillary expansion (n = 17) and slow maxillary expansion (n = 16). Patients in the rapid maxillary expansion group received 2 turns of activation (0.4 mm) per day, and those in the slow maxillary expansion group received 2 turns of activation (0.4 mm) per week until 8 mm of expansion was achieved in both groups. Cone-beam computerized tomography images were taken before treatment and after stabilization of the jackscrews. Data were gathered through a standardized analysis of cone-beam computerized tomography images. Intragroup statistical analysis was accomplished with the Wilcoxon matched-pairs test, and intergroup statistical analysis was accomplished with analysis of variance. Linear relationships, among all variables, were determined by Spearman correlation. RESULTS AND CONCLUSIONS: Both protocols caused buccal displacement of the maxillary first permanent molars, which had more bodily displacement in the slow maxillary expansion group, whereas more inclination was observed in the rapid maxillary expansion group. Vertical and horizontal bone losses were found in both groups; however, the slow maxillary expansion group had major bone loss. Periodontal modifications in both groups should be carefully considered because of the reduction of spatial resolution in the cone-beam computerized tomography examinations after stabilization of the jackscrews. Modifications in the frequency of activation of the palatal expander might influence the dental and periodontal effects of palatal expansion.

Influence of a Metal Artifact Reduction Filter on the Diagnostic Accuracy of Complete and Incomplete Vertical Root Fractures.

INTRODUCTION: This study aimed to assess the influence of the e-vol DX BAR filter on the diagnostic accuracy of complete and incomplete vertical root fractures (VRFs). METHODS: Twenty single-rooted teeth were selected. The tooth crowns were removed, and the root canals were prepared up to a 40/.06 instrument (ProTaper Next). Each specimen was scanned in a Prexion 3D cone-beam computed tomography (CBCT) device, in a dry human skull, in 4 different situations: no root canal filling, gutta-percha, fiberglass post, and metal post. The specimens were fractured in a universal testing machine by using a customized wedge. Each specimen was reinspected to confirm the presence of incomplete VRFs. Another set of CBCT scans was performed. Then, the fractures were completed in the universal testing machine, the teeth were reinspected, and the CBCT images were acquired again. Images were assessed by using the e-Vol DX software system, with the BAR filter and with the original images, for the diagnosis of VRFs. Statistical analysis was performed by using the DeLong and McNemar tests for the comparison of the area under the receiver operating characteristic curves (AUC), accuracy, sensitivity, and specificity values. RESULTS: The use of the BAR filter did not improve the diagnostic values of AUC, accuracy, sensitivity, and specificity in both fracture patterns (P > .05). Incomplete VRFs presented significantly lower AUC, accuracy, and sensitivity compared with complete VRFs (P < .0001). CONCLUSIONS: The BAR filter did not improve the diagnostic accuracy of VRFs. The intracanal materials also did not influence the diagnosis. Incomplete VRFs were highly associated with a decrease in sensitivity.

Structural, Mechanical, and Decorative Properties of Sputtered TiN and Ti (N, C) Films for Orthodontic Applications; an In Vitro Study.

In this paper, we explore and modify the structural, mechanical, and decorative properties of films composed by TiN and Ti (N, C) with a wide range of N2 gas flow during the deposition in order to be used on orthodontic systems. The films were grown using reactive DC magnetron sputtering from a pure Ti target and customized with C pellets onto Si and stainless steel 316L substrates. The structural properties were studied using X-ray diffraction and scanning electron microscopy, while the mechanical ones were obtained through hardness, elastic modulus, and friction coefficient. Moreover, the wear rate has been measured under an artificial saliva medium to simulate the oral cavity. The color of the films deposited onto stainless steel 316 L substrate was characterized through CIELab color code. Our findings show that the addition of N2 and C in the Ti matrix improves the mechanical properties of the films. With the increase in the amount of N2 and C, the hardness reaches a value of 739 HV, higher than the one reported in the literature (600 HV), a low value of the coefficient of elasticity (8.0 GPa), and also a low friction coefficient (0.30). Moreover, with the addition of N2 and C in the Ti films, the color of the films changes from metallic aspect until "with" gold, which means that our coatings exhibit versatile mechanical and color characteristics to be used in orthodontic wires applications.

Increasing the Thickness of the Collagen Xenogeneic Matrix Prevents Early Matrix Degradation and Improves the Proliferation, Adhesion, and Viability of Human Gingival Fibroblasts and Mesenchymal Stem Cells.

Using autogenous grafts in mucogingival surgeries is related to postoperative morbidity and limited tissue availability, and thus xenogeneic matrices are increasingly used. This in vitro study evaluated the influence of xenogeneic collagen matrix thickness on cell adhesion, morphology, viability, proliferation, and matrix degradation. Matrices were divided into three groups: SLC: single layer of Lumina Coat, as commercially available (2-mm thickness); DLC: double layer of SLC (Lumina Coat); and MG: single layer of Mucograft, as commercially available (4-mm thickness). SEM was used to evaluate the matrix surface topographies. To evaluate the cell viability, proliferation, adhesion, and morphology, human gingival fibroblasts (HGF) and stem cells from human exfoliated deciduous teeth (SHED) were used. Cell viability was evaluated through MTS colorimetric method evaluating HGF and SHED on days 1, 3, and 7. Cell proliferation was assessed by PicoGreen assay, evaluating HGF and SHED on days 3 and 7. Sample degradation was evaluated on days 1, 3, 7, 14, 21, 28, and 35. All groups were biocompatible for HGF and SHED, showing viabilities > 70% on days 1, 3, and 7. DCL promoted HGF viabilities similar to MG (P = .2828) and the highest SHED viability (P < .0001) on day 1. DLC also demonstrated HGF and SHED proliferations higher than the positive control (MG; P < .05) on day 7. SLC was completely degraded on day 14, while DLC and MG presented 48.41% and 20.52% of their initial mass, respectively, on day 35. Increasing the matrix thickness improved HGF and SHED viability and proliferation and prevented early matrix degradation. DLC demonstrated better results than SLC and MG concerning matrix degradation and HGF and SHED viability and proliferation.

Diagnostic performance of periapical and panoramic radiography and cone beam computed tomography for detection of circumferential gaps simulating osseointegration failure around dental implants: A systematic review.

OBJECTIVE: The objective of this study was to appraise the diagnostic performance of periapical (PR) and panoramic (PANO) radiographs and cone beam computed tomography (CBCT) in detecting artificial circumferential gaps simulating osseointegration failure around dental implants in ex vivo studies. STUDY DESIGN: Seven electronic databases and three gray literature sources were searched. Studies reporting diagnostic performance measures or data allowing calculation of those measures compared with the reference standard of in situ direct measurements were considered eligible. Either the area under the receiver operating characteristic curve or accuracy was chosen to summarize findings, with diagnostic performance interpreted as poor, acceptable, excellent, or outstanding. Risk of bias (RoB) was also assessed. RESULTS: The ten included studies mostly suggested overall excellent to outstanding diagnostic capability with PR and CBCT. Various enhancement filters, CBCT voxel sizes, and/or fields of view were associated with acceptable to outstanding efficacy. PANO had the poorest results, with most research demonstrating acceptable to excellent discrimination. The RoB was high for seven studies, moderate for two, and low for -one. CONCLUSIONS: PR and CBCT images were generally superior to PANO for the detection of artificial bone gaps. Results should be interpreted with caution because most studies had a high RoB.

Palatal expansion in a patient with solitary median maxillary central incisor syndrome.

The objective of this article was to report a clinical case of a patient with solitary median maxillary central incisor syndrome. He was treated with rapid maxillary expansion and evaluated with computed tomography. The boy, aged 6 years 7 months, had a single maxillary central incisor in the midline, posterior crossbite, prominent midpalatal ridge, indistinct philtrum, no incisive papilla, and no labial frenulum. No other systemic anomalies were found. Posteroanterior cephalometric radiography showed skeletal atresia of the maxilla that was corrected with rapid maxillary expansion. A Haas expander was used and activated twice per day (quarter turn per activation) for 15 days. The procedure was monitored with computed tomography to evaluate any effect on the intermaxillary suture and tooth. Although the crossbite was clinically corrected after the expansion, radiographs and tomographs showed no opening of the midpalatal suture. Rapid maxillary expansion resulted in neither midpalatal suture opening nor transverse increase of the maxillary skeletal base in this patient.

Accuracy of Cone-Beam Computed Tomography in Measuring the Thickness of Radicular Dentin.

The purpose of this study was to evaluate the accuracy of Cone-Beam Computed Tomography (CBCT) in measuring radicular dentin thickness focused on intraradicular post placement planning treatment. Ten single-rooted human premolars were selected. The teeth were divided into three segments (cervical, middle and apical). The coronal face of the apical and middle sections was selected for the dentin thickness assessment; which was measured from the external root surface to the root canal wall, on the buccal, lingual, mesial, and distal surfaces of each tooth. In situ anatomical measurement was the reference standard, and the corresponding axial CBCT imaging were evaluated by the i-CAT software. The one-way ANOVA test and the Bonferroni post hoc test were applied to compare the groups (p>0.05). CBCT imaging measurements (p=0.003) overestimated the radicular dentin thickness compared to the reference standard. Descriptive analysis showed that the greatest difference between the reference standard and the tomographic measurement means were 0.20 mm. One-way ANOVA test found the statistical significant difference among group's measurements. Bonferroni correction demonstrated statistically significant difference only related lingual surface for the CBCT imaging measurements. CBCT imaging measurements overestimated the radicular dentin thickness. However, the measurement difference was clinically acceptable.

A new heterofunctional support for enzyme immobilization: PEI functionalized Fe3O4 MNPs activated with divinyl sulfone. Application in the immobilization of lipase from Thermomyces lanuginosus.

Lipase from Thermomyces lanuginosus (TLL) was immobilized onto a novel heterofunctional support, divinyl sulfone (DVS) superparamagnetic nanoparticles (SPMNs) functionalized with polyethyleneimine (PEI). Particle size and zeta potential measurements, elemental analysis, X-ray powder diffraction, magnetic measurements, and infrared spectroscopy analysis were used to characterize the TLL preparations. At pH 10, it was possible to achieve 100 % of immobilization yield in 1 h. The immobilization pH gives TLL preparations with different stabilities; indeed the TLL preparation immobilized at pH 5.0 was the most stable during the thermal inactivation at all pH values. For the hydrolysis of racemic methyl mandelate, the nanobiocatalysts immobilized at pH 5.0 and blocked with ethylenediamine (EDA) and ethanolamine (ETA) obtained good enantioselectivities (68 % and 72 %, respectively) with high catalytic activities in the reaction medium at pH 7.0. The operational stability of the systems was evaluated in the esterification reaction of benzyl alcohol, obtaining up to 61 % conversion after the seventh reaction cycle. These results show that SPMN@PEI-DVS support is a robust strategy for the easy and rapid recovery of the nanobiocatalyst by applying a magnetic field, showing great potential for industrial applications.

Physical Activity Reduces the Prevalence of Periodontal Disease: Systematic Review and Meta-Analysis.

Background: Regular physical activity boosts several physical capacities and reduces many inflammatory markers of several diseases. In this sense, periodontal disease is a multifactorial inflammatory disease of tooth supporting tissues that has been claimed to trigger processes of systemic alterations. The aim of this systematic review and meta-analysis was to assess the effects of physical activity on periodontal disease. Methods: Observational studies published until August 2018 were searched in online databases (PubMed, Scopus, Web of Science, The Cochrane Library, LILACS, OpenGrey, and Google Scholar) after developing a PECO statement that focused on the comparison between adults that followed a routine of exercises or presented a sedentary lifestyle and its effects on periodontal disease. Searching and data extraction were conducted by following PRISMA guidelines. Registration protocol: CRD42016049661. Quality assessment and risk of bias were analyzed by following Fowkes and Fulton protocol. Results: A total of 512 references were retrieved, while only seven were considered eligible. Two meta-analysis involving the prevalence of periodontal disease and unadjusted/adjusted Odds ratio were performed. One of studies did not find association between clinical periodontal parameters and physical activity. Six articles suggested an association between periodontal disease and regular practice of physical activity since a reduction of periodontal prevalence was observed. Moderate level of evidence was demonstrated on GRADE analysis. Conclusion: Physical activity was associated as a potential tool for reduction of periodontal disease prevalence. The frequency of physical activity is directly related to a low occurrence of periodontitis. However, it is important that further investigations evaluate the effects of other exercise variables, such as volume and intensity, on the periodontal disease prevalence.

Precision of cone beam CT to assess periodontal bone defects: a systematic review and meta-analysis.

OBJECTIVES: Evaluate the diagnostic validity of CBCT in measuring periodontal bone defects when compared with the reference standard (in situ measurement). METHODS: Studies in which the main objective was to evaluate the diagnostic validity of CBCT in measuring periodontal bone defects when compared with the reference standard were selected. Four databases were searched. The studies were selected by two independent reviewers. The methodology of selected studies was assessed using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies. The quality of evidence and strength of recommendation was assessed by The Grading of Recommendations Assessment Tool, Development and Evaluation. RESULTS: Using a selection process in two phases, 16 studies were identified and, in seven articles meta-analysis was performed. The results from these meta-analyses showed that no difference between the measurements of CBCT and in situ for alveolar bone loss, and demonstrated a concordance of 82.82% between CBCT and in situ for the classification of the degree of furcation involvement. CONCLUSIONS: Based on a moderate level of evidence, CBCT could be useful for furcation involvement periodontal cases, but it should only be used in cases where clinical evaluation and conventional radiographic imaging do not provide the information necessary for an adequate diagnosis and proper periodontal treatment planning.

Main incidental findings from cone beam computed tomography in the head and neck region and the impact in patients' lives: an integrative literature review / Principais achados incidentais em tomografia computadorizada de feixe cônico na região de cabeça e pescoço e o impacto na vida dos pacientes: uma revisão integrativa de literatura

ABSTRACT To identify the main incidental findings (IFs) in the head and neck region using Cone-Beam Computed Tomography (CBCT) and the impact on patient's live. The study was carried out using an integrative review method, starting with a guiding question followed by searches in the databases Pubmed, Scopus, Virtual Health Library and Dentistry & Oral Sciences Source for articles from 2009 until 2019. Forty-one articles became the object of this work. The incidental findings most reported by the articles are present in the bone and TMJ regions, with 35 different AIs being found. However, they are also common in the airways, such as mucosal thickening and retention mucosal cysts. Among the dental, the most pointed are impacted and supernumerary teeth. In the group of soft tissue calcifications, tonsillolite and calcification of the hyoid-style process are the most frequent. Atheroma and malignant lesions are less prevalent, but important due to the impact on patient's life. The main incident findings are bone / TMJ, followed by dental, soft tissue calcifications, airways and other findings. Most of them do not affect patient's life. However, some IFs require immediate interventions and are generally associated with elderly patients. Finally, more than half of the studies pointed out that the incidental findings are located in an extragnatic region.

RESUMO Identificar os principais achados incidentais na região de cabeça e pescoço com o uso de Tomografia Computadorizada de Feixe Cônico (TCFC) e os impactos na vida dos pacientes. O estudo foi realizado utilizando como método a revisão integrativa, iniciado com pergunta norteadora seguida de buscas nas bases de dados Pubmed, Scopus, Biblioteca Virtual em Saúde e Dentistry & Oral Sciences Source por trabalhos de 2009 até o ano de 2019. Tornaram-se objeto deste trabalho quarenta e um artigos. Os achados incidentais mais relatados pelos artigos estão presentes nas regiões ósseas e de ATM, sendo encontrados 35 diferente AIs. No entanto, eles também são comuns em vias aéreas, como o espessamento de mucosa e cistos de retenção mucoso. Entre os dentários, os mais apontados são dentes impactados e supranumerários. Já no grupo das calcificações de tecidos moles, o tonsilólito e as calcificação do processo estilo-hióide são as mais frequentes. Ateromas e lesões malignas são achados com menor prevalência, mas importantes devido ao impacto na vida do paciente. Os principais achados incidentais são os ósseos/ATM, seguidos pelos dentários, as calcificações de tecidos moles, os das vias aéreas e outros achados. A maioria deles não afetam a vida do paciente. Porém, alguns AIs requerem intervenções imediatas e geralmente estão associadas a pacientes idosos. Por fim, mais da metade dos estudos apontaram que os achados incidentais estão localizados em região extragnática.

Influence of Intracanal Materials in Vertical Root Fracture Pathway Detection with Cone-beam Computed Tomography.

INTRODUCTION: Investigating the vertical root fracture (VRF) pathway under different clinical scenarios may help to diagnose this condition properly. We aimed to determine the capability and intrareliability of VRF pathway detection through cone-beam computed tomographic (CBCT) imaging as well as analyze the influence of different intracanal and crown materials. METHODS: VRFs were mechanically induced in 30 teeth, and 4 clinical situations were reproduced in vitro: no filling, gutta-percha, post, and metal crown. A Prexion (San Mateo, CA) 3-dimensional tomographic device was used to generate 104 CBCT scans. The VRF pathway was determined by using landmarks in the Avizo software (Version 8.1; FEI Visualization Sciences Group, Burlington, MA) by 1 observer repeated 3 times. Analysis of variance and post hoc tests were applied to compare groups. RESULTS: Intrareliability demonstrated an excellent agreement (intraclass correlation coefficient mean = 0.93). Descriptive analysis showed that the fracture line measurement was smaller in the post and metal crown groups than in the no-filling and gutta-percha groups. The 1-way analysis of variance test found statistically significant differences among the groups measurements. The Bonferroni correction showed statistically significant differences related to the no-filling and gutta-percha groups versus the post and metal crown groups. CONCLUSIONS: The VRF pathway can be accurately detected in a nonfilled tooth using limited field of view CBCT imaging. The presence of gutta-percha generated a low beam hardening artifact that did not hinder the VRF extent. The presence of an intracanal gold post made the fracture line appear smaller than it really was in the sagittal images; in the axial images, a VRF was only detected when the apical third was involved. The presence of a metal crown did not generate additional artifacts on the root surface compared to the intracanal gold post by itself.

Anatomical variations of mandibular canal detected by panoramic radiography and CT: a systematic review and meta-analysis.

OBJECTIVES: To investigate the anatomical variations of the mandibular canal through assessment in situ, panoramic radiography, CT or CBCT and assess their frequency. METHODS: Articles were selected from databases (Cochrane Library, LILACS, ProQuest, PubMed, Scopus, Web of Science and Google Scholar), articles without limitations of language, in which the main objective was to evaluate the frequency of bifurcation of the mandibular canal through assessment in situ, panoramic radiography, CT or CBCT were selected. A meta-analysis of prevalence using random effects was performed. RESULTS: Using a selection process in two phases, 15 articles were identified, and a meta-analysis was conducted. The results from these meta-analyses showed that the overall prevalence of anatomical variations for in situ studies was 6.46%, and through assessment of panoramic radiography and CT or CBCT the overall prevalence shown was 4.20% and 16.25%, respectively. CONCLUSIONS: There are two types of variations of the mandibular canal: the retromolar canal and bifid mandibular canal. The frequency variations through assessing in situ, panoramic radiography and CT or CBCT were 6.46%, 4.20% and 16.25%, respectively.

Diagnostic Accuracy of Cone-beam Computed Tomography and Conventional Radiography on Apical Periodontitis: A Systematic Review and Meta-analysis.

INTRODUCTION: Endodontic diagnosis depends on accurate radiographic examination. Assessment of the location and extent of apical periodontitis (AP) can influence treatment planning and subsequent treatment outcomes. Therefore, this systematic review and meta-analysis assessed the diagnostic accuracy of conventional radiography and cone-beam computed tomographic (CBCT) imaging on the discrimination of AP from no lesion. METHODS: Eight electronic databases with no language or time limitations were searched. Articles in which the primary objective was to evaluate the accuracy (sensitivity and specificity) of any type of radiographic technique to assess AP in humans were selected. The gold standard was the histologic examination for actual AP (in vivo) or in situ visualization of bone defects for induced artificial AP (in vitro). Accuracy measurements described in the studies were transformed to construct receiver operating characteristic curves and forest plots with the aid of Review Manager v.5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark) and MetaDisc v.1.4. software (Unit of Clinical Biostatistics Team of the Ramón y Cajal Hospital, Madrid, Spain). The methodology of the selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. RESULTS: Only 9 studies met the inclusion criteria and were subjected to a qualitative analysis. A meta-analysis was conducted on 6 of these articles. All of these articles studied artificial AP with induced bone defects. The accuracy values (area under the curve) were 0.96 for CBCT imaging, 0.73 for conventional periapical radiography, and 0.72 for digital periapical radiography. No evidence was found for panoramic radiography. CONCLUSIONS: Periapical radiographs (digital and conventional) reported good diagnostic accuracy on the discrimination of artificial AP from no lesions, whereas CBCT imaging showed excellent accuracy values.

Facial and occlusal esthetic improvements of an adult skeletal Class III malocclusion using surgical, orthodontic, and implant treatment.

The aim of this clinical report is to describe the complex treatment of an adult Class III malocclusion patient who was disappointed with the outcome of a previous oral rehabilitation. Interdisciplinary treatment planning was performed with a primary indication for implant removal because of marginal bone loss and gingival recession, followed by orthodontic and surgical procedures to correct the esthetics and skeletal malocclusion. The comprehensive treatment approach included: (1) implant removal in the area of the central incisors; (2) combined orthodontic decompensation with mesial displacement and forced extrusion of the lateral incisors; (3) extraction of the lateral incisors and placement of new implants corresponding to the central incisors, which received provisional crowns; (4) orthognathic surgery for maxillary advancement to improve occlusal and facial relationships; and finally, (5) orthodontic refinement followed by definitive prosthetic rehabilitation of the maxillary central incisors and reshaping of the adjacent teeth. At the three-year follow-up, clinical and radiographic examinations showed successful replacement of the central incisors and improved skeletal and esthetic appearances. Moreover, a Class II molar relationship was obtained with an ideal overbite, overjet, and intercuspation. In conclusion, we report the successful esthetic anterior rehabilitation of a complex case in which interdisciplinary treatment planning improved facial harmony, provided gingival architecture with sufficient width and thickness, and improved smile esthetics, resulting in enhanced patient comfort and satisfaction. This clinical case report might be useful to improve facial esthetics and occlusion in patients with dentoalveolar and skeletal defects.