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

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

Peracetic Acid Efficacy on Disinfection of Photostimulable Phosphor Plates.

OBJECTIVES: To evaluate the antimicrobial efficacy of white vinegar, acetic acid and peracetic acid on photostimulable phosphor (PSP) plates disinfection, and to assess the disinfectant influence on the radiographic quality. METHODS: Eight PSP plates (Express system) were contaminated with Streptococcus mutans and Candida albicans. These plates were wiped with tissues without any substance, with white vinegar, acetic acid, and peracetic acid, followed by an agar imprint. Number of microbial colonies formed was recorded. Afterwards, the quality of radiographs was tested using the more efficient disinfectant. Before disinfection and after every five disinfections, two radiographs of an acrylic-block and two radiographs of an aluminum step-wedge were acquired for each plate. Density, noise, uniformity, and contrast were analyzed. Three oral radiologists evaluated the images for the presence of artifacts. One-way Analysis of Variance compared changes on gray values among the disinfections (α = 0.05). Intra- and inter-examiner agreement for the presence of artifacts was calculated by weighted Kappa. RESULTS: Peracetic acid was the only one that eliminated both microorganisms. Density and uniformity decreased after 100 disinfections, and contrast changed without a pattern in the course of disinfections (P ≤ 0.05). Small artifacts were observed after 30 disinfections. Intra- and inter-examiner agreements were almost perfect. CONCLUSIONS: Disinfection with peracetic acid eliminated both microorganisms. However, it also affected density, uniformity and contrast of radiographs, and led to the formation of small artifacts.

Convex triangular vs. cylindrical field of view: how does the shape of the FOV affect radiation dose?

OBJECTIVE: To compare the dosimetry between convex triangular fields of view (FOV) and similar dimension cylindrical FOVs of two cone-beam computed tomography (CBCT) models. METHODS: Optically stimulated luminescence dosimeters (OSLDs) were placed in fiducial anatomical locations in an anthropomorphic phantom representing an adult head male for dosimetry scans. Convex triangular FOVs (100 × 80 mm/maxilla-mandible; 100 × 50 mm mandible; 100 × 50 mm/maxilla) from Veraviewepocs 3D R100 (J. Morita, Kyoto, Japan) (R100) and Veraview® X800 (J. Morita, Kyoto, Japan) (X800) and cylindrical FOVs from R100 and X800 (80 × 80 mm/maxilla-mandible; 80 × 50 mm/mandible; 80 × 50 mm/maxilla) were obtained, resulting in 12 different scan protocols. Equivalent doses for each relevant organ/tissue and the effective dose for each protocol were calculated. Mean effective doses were compared by the two-way analysis of variance (ANOVA) with Tukey's post hoc test to evaluate the effect of the FOV and device (α = 0.05). RESULTS: The effective doses ranged between 69 and 324 µSv for the convex triangular FOVs and 76 and 332 µSv for the cylindrical FOVs. Convex triangular FOVs from the R100 device had effective doses 2.3 to 15.3% lower than their corresponding cylindrical FOVs with similar height (p < 0.05), and that difference ranged between 8.8 and 11.8% for the X800 device (p < 0.05). CONCLUSION: Convex triangular fields of view delivered slightly lower effective doses than the cylindrical fields of view of similar dimensions in the R100 and X800 CBCT devices. CLINICAL RELEVANCE: Understanding the influence of the image geometry formation in effective dose allows optimization to reduce patient dose.

Tridimensional assessment of the mandibular angle in patients with different skeletal patterns by cone-beam computed tomography scans: a retrospective study.

BACKGROUND: Since the muscles of chewing are involved in the region of the mandibular angle, important structures in surgical and orthodontic procedures, to study its morphological aspects and the possible influence of different patterns of skeletal development would be of interest. Thus, this study aimed to assess the influence of patient characteristics - such as sex, skeletal malocclusion (Class I, Class II, and Class III) and facial type (brachycephalic, mesocephalic, and dolichocephalic) - on the width, height, thickness, and volume of the mandibular angle, using cone-beam computed tomography (CBCT) scans. METHODS: CBCT scans were assessed - 144 men and 154 women, total of 298 - and classified according to skeletal patterns (skeletal malocclusions and facial types). Width, height, and thickness of the mandibular angle were measured using OnDemand 3D software. The volumetric measures of the mandibular angle were obtained using the ITK-SNAP software. Analysis of Variance (multiway ANOVA) with Tukey's post-hoc test compared the data, with a 5% significance level. RESULTS: Among the factors studied, sex significantly influenced all the analyzed variables (height, width, thickness, and volume of the mandibular angle) (p < 0.05); in general, male individuals presented higher values than females. In some cases, the skeletal malocclusion and facial type factors influenced only the width and height variables (p < 0.05); in general, the Class III and dolichocephalic individuals presented higher values in relation to the other types of skeletal malocclusions and facial types. CONCLUSIONS: Variations in the craniofacial growth pattern, considering the different skeletal malocclusions and facial types, had some influence in the width and height dimensions of the mandibular angle. Furthermore, sex influenced all the studied variables.

Comparison of the expression of the volumetric alteration artifact in cylindrical and triangular fields of view in two cone-beam computed tomography devices.

OBJECTIVE: To compare the expression of the volumetric alteration (VA) artifact between cylindrical and convex triangular fields of view (FOVs) using high-density materials in different positions in two cone-beam computed tomography (CBCT) devices. MATERIALS AND METHODS: Cylinders of five high-density materials (amalgam, chromium-cobalt, gutta-percha, titanium, and zirconium) with known physical volume were individually submitted to CBCT acquisition in four positions inside a polymethylmethacrylate phantom using two different FOV shapes (convex triangular and cylindrical) on the Veraviewepocs® R100 (R100) and Veraview® X800 (X800) devices. Two oral radiologists obtained the tomographic volumes by segmenting each cylinder. The difference between the tomographic and physical volumes corresponded to the VA. These values were analyzed by intraclass correlation coefficient and analysis of variance for repeated measures with Tukey post hoc test (α = 5%). RESULTS: The FOV influenced the VA only in the X800 device (p = 0.014): the VA in the triangular FOV was greater than in the cylindrical FOV. The VA in the triangular FOV of the X800 device was greater than the R100 device (p < 0.0001). The material influenced the expression of the VA only in the R100 device (p < 0.0001); gutta-percha presented the highest VA, being underestimated, and differing from the other materials (p < 0.01). CONCLUSION: The triangular FOV increased the VA of high-density materials in the X800 device. CLINICAL RELEVANCE: It is important to know if there is an influence on the volumetric alteration artifact of dental materials due to the different image formation geometry in the convex triangular FOV.

Influence of the image file format of digital periapical radiographs on the diagnosis of external and internal root resorptions.

OBJECTIVES: To evaluate the influence of different image file formats of digital radiographic images on the diagnosis of external (ERR) and internal root resorption (IRR). MATERIALS AND METHODS: Thirty-four human teeth were selected. For ERR, 20 teeth were used (10 control and 10 with simulated ERR), and for IRR, 14 teeth were used (before and after IRR simulation). Digital periapical radiographs were acquired using the Digora Toto system and exported in four different image file formats: TIFF, BMP, PNG, and JPEG, totaling 192 radiographs. Five examiners evaluated the images using the JPEGView software and scored the detection of ERR or IRR on a 5-point scale. Sensitivity, specificity, accuracy, and the area under the ROC curve were obtained for the diagnosis of ERR and IRR in the different image file formats. Two-way ANOVA compared the diagnostic values between the file formats and the Kappa test assessed intra- and inter-examiner agreement. The significance level was set at 5% (α = 0.05). RESULTS: The mean values of intra-examiner agreement were substantial (0.740) for ERR and almost perfect (0.836) for IRR and, inter-examiner was fair (0.263) and moderate (0.421), respectively. No statistically significant differences were found among the different file formats for the diagnostic values of ERR and IRR. CONCLUSION: The file format of digital radiographs does not influence the diagnosis of ERR and IRR. CLINICAL RELEVANCE: Digital radiographic images may be susceptible to computational factors; however, they can be stored in multiple file formats without affecting the diagnosis of dental root resorptions.

Does dose optimisation in digital panoramic radiography affect diagnostic performance?

OBJECTIVES: To compare the overall diagnostic performance of digital panoramic radiographs obtained with low-dose protocols and to estimate the absorbed dose in the head and neck. MATERIALS AND METHODS: Forty-eight panoramic radiographs were obtained from eight imaging phantoms using six exposure protocols of progressively lower tube voltages (kVp) and currents (mA), as follows: (1) 70 kVp and 12.5 mA, (2) 66 kVp and 10 mA, (3) 66 kVp and 8 mA, (4) 66 kVp and 5 mA, (5) 66 kVp and 4 mA and (6) 66 kVp and 3.2 mA. Five oral radiologists independently evaluated the images and reported all detectable radiographic findings. Intra-examiner reproducibility was assessed by re-evaluation of 25% of the images. The data were analysed using the McNemar and weighted Kappa tests. Absorbed doses of the six protocols were obtained from thermoluminescent dosimeters placed inside a Rando phantom and compared using one-way ANOVA with post hoc Tukey (α = 0.05). RESULTS: The overall diagnostic performance of panoramic radiographs obtained with low-dose protocols did not differ from that of panoramic radiographs obtained with the highest dose (p > 0.05). Moreover, substantial agreement was observed between all protocols. Protocol 1 resulted in the highest absorbed dose and protocols 4, 5 and 6 in the lowest absorbed doses, with the difference being significant (p ≤ 0.05). CONCLUSION: Although digital panoramic radiography is considered a relatively low-dose examination, the radiation dose can be further reduced without negatively affecting its overall diagnostic performance. CLINICAL RELEVANCE: Considering the risks associated with X-rays, digital panoramic radiographs can be obtained at even lower exposure levels.

Effect of resveratrol on the progression of experimental periodontitis in an ovariectomized rat model of osteoporosis: Morphometric, immune-enzymatic, and gene expression analysis.

OBJECTIVE: This study aimed to determine the role of resveratrol (RESV) on the progression of experimental periodontitis (EP) in ovariectomy rats (OVT). BACKGROUND: Estrogen deficiency is the main cause of osteoporosis and is related to higher periodontal attachment loss and reduction of alveolar bone. Zoledronate (ZLD) is an antiresorptive drug used to control osteoporosis but can lead to osteonecrosis of the jaw. RESV, a natural product, can reduce bone loss and control and prevent osteoporosis. Thus, this study aimed at investigating the effect of RESV on the progression of EP in estrogen-deficient rats. MATERIAL AND METHODS: The animals were subjected to the OVT or sham surgery to induce estrogen-deficiency and then were divided into the groups: OVT + RESV (n: 10); OVT + PLAC (n: 10): OVT + placebo; OVT + ZLD +PLA (n: 10); OVT + RESV +ZLD (n: 10): OVT + RESV and ZLD; SHAM (n: 10): non-ovariectomized animals + placebo. To induce estrogen deficiency, the rats were subjected to ovariectomy. Experimental periodontitis was induced by the placement of a ligature at the second maxillary molars. Daily administration of the placebo solution, resveratrol (10 mg/kg), and ZLD (0.1 mg/kg) was carried out for a period 42 days prior to initiation of EP, and then for another 28 days following ligature placement. After euthanasia, the specimens were processed for micro-CT and morphometric analysis of bone loss (linear measurement), and the gingival tissue surrounding the maxillary second molar was collected for the quantification of inflammatory markers using Luminex/MAGPix, of oxidative stress markers using ELISA assay, and gene expression analysis of bone markers, by real-time PCR. RESULTS: Morphometric and micro-CT analysis showed higher bone loss and lower bone density, respectively, in OVT + PLAC when compared to the other groups (P < .05). ZLD treated groups had lower alveolar bone loss, as well as, higher density and percentage of bone volume, when compared to OVT + RESV and SHAM + PLAC groups (P < .05). IL-4 levels were significantly lower in the OVT + PLAC group versus OVT + ZLD +RESV and SHAM + PLAC (P < .05). NADPH oxidase (nicotinamide adenine dinucleotide phosphate oxidase) levels were significantly lower OVT + RESV group when compared to OVT + PLAC (P < .05). OPG mRNA levels were lower in OVT + PLAC compared with the SHAM + PLAC group (P < .05). CONCLUSION: It can be concluded that resveratrol modulated alveolar bone loss during experimental periodontitis progression in estrogen-deficient rats by downregulating NADPH oxidase levels.

Artifact expression of polylactic acid/hydroxyapatite/graphene oxide nanocomposite in CBCT: a promising dental material.

OBJECTIVE: To evaluate the artifact expression of a new material-polylactic acid (PLA)/hydroxyapatite (HA)/graphene oxide (GO) nanocomposite-and compare it with that of commonly used dental materials, using cone-beam computed tomography. MATERIALS AND METHODS: Cylinders of amalgam alloy, metal alloy, titanium, gutta-percha, and PLA/HA/GO were individually placed in the center of an acrylic phantom. Three images of each phantom + cylinder set were acquired using a Picasso Trio unit (Vatech, Hwaseong, South Korea) set at 90 kVp, 3.7 mA, 0.2 mm3 voxel size, and 12 × 8.5 cm FOV. Three images of a control group (sound phantom) were also obtained. Eight ROIs were established in each image to evaluate the standard deviation (S.D.) of gray values in the ImageJ Software. The Kruskal-Wallis test with the Student-Newman-Keuls post hoc was employed, considering a significance level of 5%. RESULTS: There were no significant differences in S.D. between the control and PLA/HA/GO images (p = 0.712). Both control and PLA/HA/GO showed fewer image artifacts than the other materials (p < 0.05). The images of the amalgam alloy did not differ from the metal alloy images (p = 0.691), showing more artifacts than the gutta-percha (p = 0.028) and titanium (p = 0.051). CONCLUSIONS: The PLA/HA/GO produced fewer artifacts and a better-quality image than the other tested materials. CLINICAL RELEVANCE: The PLA/HA/GO has physical and biological properties similar to those of dental materials. Since it has produced fewer image artifacts, this new nanocomposite may be employed in the near future, enhancing the diagnosis in CBCT.

Development and validation of a formula based on maxillary sinus measurements as a tool for sex estimation: a cone beam computed tomography study.

BACKGROUND: As sex estimation is an important step to delineate the biological profile, the development of tools employing anatomical structures which may maintain their integrity even after extreme events, such as the maxillary sinus, become useful for forensic identification. Thus, the aim in the present study was to develop and validate a formula for sex estimation through measurements in the maxillary sinuses in a Brazilian population, using cone beam computed tomography (CBCT) scans. MATERIAL AND METHODS: Linear and volumetric measurements in the maxillary sinus were performed bilaterally in 94 CBCT scans from 45 males (mean age 25.2 ± 0.79) and 49 females (mean age 23.7 ± 0.50). The OnDemand 3D software was employed for linear measurements (height, length and width of, and the largest distance between the right and left maxillary sinuses), while the ITK-SNAP 3.0 segmentation software was used to acquire the volume. The data obtained was applied to a mathematical model for sex estimation. To validate the developed formula, another sample composed of 60 CBCT images of Brazilian individuals was tested. RESULTS: Overall, maxillary sinuses' measurements were significantly higher in males, without statistically significant differences between the right and left sides within each group. The most dimorphic measurement was the height, with an accuracy of 77.7% regarding sex estimation. The formula created lead to a sex estimation of 87.8% for females and 80% for males, with an overall accuracy of 84%. When the formula validity was tested in another sample, it showed an accuracy of 82.4%. CONCLUSION: The formula developed through measurements in the maxillary sinus using CBCT scans showed an accuracy of 84% for sex estimation and can be applied as a complementary method for human identification in the Brazilian population.

Juxta-Apical Radiolucency: Prevalence, Characterization, and Association With the Third Molar Status.

PURPOSE: This study aimed to investigate the prevalence of juxta-apical radiolucency (JAR), assessing its association with third molar status and describing its radiologic features through panoramic radiography. MATERIALS AND METHODS: We evaluated 1,050 radiographs (1,830 third molars) for the presence of JAR. The JAR and control groups were classified according to the third molar's angulation, impaction, and root development. The presence of radiographic signs of proximity between the mandibular canal and third molar and the imaging features of JAR also were recorded. RESULTS: JAR was identified in 116 patients (11%) and 130 third molars (7.1%), being significantly associated with female patients and with the second and third decades of life. There also was an association with teeth with a vertical angulation and complete root formation. Radiographic signs of proximity to the mandibular canal were absent in 66.2% of JAR cases. In most cases, there was lamina dura in the juxta-apical area that appeared to overlap the mandibular canal and to have a cortical outline. CONCLUSIONS: JAR is not a rare imaging finding. Given its possible relationship with nerve injuries and its differential diagnostic possibilities, knowing the characteristics of JAR is important to assist professionals in treatment planning and making the correct diagnosis.

Evaluation of metal artefact reduction in cone-beam computed tomography images of different dental materials.

OBJECTIVE: The aim of this study is to evaluate the efficacy of metal artefact reduction (MAR) in different dental materials with Picasso Trio cone-beam computed tomography (CBCT) scanner. MATERIALS AND METHODS: Three imaging phantoms were custom-made of acrylic resin. Each phantom presented three cylinders of the same material: dental amalgam alloy, gutta-percha or aluminium-copper alloy. CBCT scans were performed on Picasso Trio unit with and without MAR, and artefact expression (standard deviation of grey values) was obtained and compared by Kruskal-Wallis and Student-Newman-Keuls (post hoc) (α = 0.05). RESULTS: Significant reduction of artefact expression (p < 0.05) was observed with MAR on areas around dental alloys. No significant difference (p > 0.05) was observed with or without MAR when gutta-percha was scanned. CONCLUSION: MAR was effective in reducing artefacts arising from dental alloys on CBCT images. CLINICAL RELEVANCE: Dental materials of high atomic number and density are widely used in dentistry and can produce artefact that compromise CBCT image. The present study demonstrated that metal artefact reduction algorithm is an effective tool to improve image quality.

Resorptive potential of impacted mandibular third molars: 3D simulation by finite element analysis.

OBJECTIVES: Previous studies have suggested a relationship between resorption in second molars and pressure from the eruptive force of the third molar. The aim of this study was to simulate functional forces in a mandible model by means of finite element analysis and then assess the biomechanical response produced by impacted third molars on the roots of the second molar. MATERIALS AND METHODS: A cone beam computed tomography scan presenting an impacted mandibular third molar was segmented (Mimics V17 software). The modeling process was performed using the reverse engineering technique provided by the Rhinoceros 3D 5.0 software. The third molar position was changed in order to produce different inclinations of the impacted tooth. Bite forces were simulated to evaluate total deformation, the equivalent von Mises stress, minimum principal stress on hard tissue, and equivalent elastic strain on soft tissue. RESULTS: Areas of high energy dissipation and compression stress were detected in the second molar root, independently of the inclination of the impacted third molar. In general, the horizontal position was the situation in which major stress and the amount of deformation occurred in the second and third molar regions. CONCLUSION: Impacted third molars in close proximity with the adjacent tooth can generate areas of compression concentrated at the site of contact, which suggests an involvement of mechanical factors in the triggering of resorption lesions. CLINICAL RELEVANCE: The results of these computational experiments contribute to the understanding of the triggering and progression of resorptive lesions in the adjacent second molar.

Cone-Beam Computed Tomography-Based Three-Dimensional McNamara Cephalometric Analysis.

This article introduces a method that extends the McNamara cephalometric analysis to produce 3-dimensional (3D) measurement values from cone-beam computed tomography images. In the extended method, the cephalometric landmarks are represented by 3D points; the bilateral cephalometric landmarks are identified on both sides of the skull; the cephalometric lines, with the exception of the facial axis, are represented by 3D lines; the cephalometric planes, with the exception of the facial plane, are represented by planes; the effective mandibular length, the effective midfacial length, and the lower anterior facial height are measured as 3D point-to-point distances; the nasion perpendicular to point A, the pogonion to nasion perpendicular, the upper incisor to point A vertical, and the lower incisor to point A-pogonion line are measured each as components of a vector; the facial axis angle is measured as a line-to-plane angle; and the mandibular plane angle is measured as a plane-to-plane angle. As a result, the method provides real effective lengths of the maxilla and mandible on both sides of the skull; real height of the lower anterior face; directed distances from the point A to the nasion perpendicular, from the pogonion to the nasion perpendicular, from the left and right upper incisor to the point A vertical, and from the left and right lower incisor to the point A-pogonion line for both the lateral and posteroanterior views of the skull; and real angles of the facial axis and the mandibular plane. Additionality, the method enables the identification of craniofacial asymmetries.

Evaluation of pharyngeal space and its correlation with mandible and hyoid bone in patients with different skeletal classes and facial types.

INTRODUCTION: The purpose of this article was to evaluate the pharyngeal space volume, and the size and shape of the mandible and the hyoid bone, as well as their relationships, in patients with different facial types and skeletal classes. Furthermore, we estimated the volume of the pharyngeal space with a formula using only linear measurements. METHODS: A total of 161 i-CAT Next Generation (Imaging Sciences International, Hatfield, Pa) cone-beam computed tomography images (80 men, 81 women; ages, 21-58 years; mean age, 27 years) were retrospectively studied. Skeletal class and facial type were determined for each patient from multiplanar reconstructions using the NemoCeph software (Nemotec, Madrid, Spain). Linear and angular measurements were performed using 3D imaging software (version 3.4.3; Carestream Health, Rochester, NY), and volumetric analysis of the pharyngeal space was carried out with ITK-SNAP (version 2.4.0; Cognitica, Philadelphia, Pa) segmentation software. For the statistics, analysis of variance and the Tukey test with a significance level of 0.05, Pearson correlation, and linear regression were used. RESULTS: The pharyngeal space volume, when correlated with mandible and hyoid bone linear and angular measurements, showed significant correlations with skeletal class or facial type. The linear regression performed to estimate the volume of the pharyngeal space showed an R of 0.92 and an adjusted R2 of 0.8362. CONCLUSIONS: There were significant correlations between pharyngeal space volume, and the mandible and hyoid bone measurements, suggesting that the stomatognathic system should be evaluated in an integral and nonindividualized way. Furthermore, it was possible to develop a linear regression model, resulting in a useful formula for estimating the volume of the pharyngeal space.

Simple bone cyst: rare incidental finding in the mandibular condyle by cone beam computed tomography.

The simple bone cyst (SBC) is a benign intraosseous lesion that is considered to be a pseudocyst because the cystic cavity does not present an epithelial lining. The most accepted theory regarding its etiology is that the SBC develops when the blood clot fails to organize subsequent to bleeding caused by trauma. The SBC is asymptomatic, and therefore the diagnosis is made through routine imaging examinations. In imaging examinations, the lesion is characterized by a radiolucent, unilocular, well-delimited appearance and an irregular or scalloped contour with or without a sclerotic halo. This case report describes an SBC in the mandibular condyle region, discovered incidentally on imaging examinations.

Quantitative evaluation of metal artifacts using different CBCT devices, high-density materials and field of views.

OBJECTIVE: To objectively compare the influence of different cone-beam computed tomography (CBCT) devices, high-density materials and field of views (FOVs) on metal artifact expression. MATERIAL AND METHODS: For this in vitro study, three customized acrylic resin phantoms containing high-density materials cylinders: titanium, copper-aluminum alloy and amalgam were scanned on three CBCT devices using high-resolution protocols, same voxel size (0.2 mm) and different FOVs. After fully automatic segmentation and image registration, the same region of interest was defined for the small and medium FOVs. The difference between the segmented and the real volume of the metal cylinders was assessed. Moreover for each segmented slice, the area difference between the segmented and the real axial section was determined. The artifacts on the background were measured as normalizing standard deviation of voxel values in the vicinity of the cylinder, in three different distances. RESULTS: Considerable differences were observed in volume measurements for all CBCTs devices and materials for both FOV sizes (up to 67%). The slice per slice area analysis indicated higher artifacts at the edges of the metal cylinder. Within the materials, amalgam and titanium had, respectively, the worst and best artifact expression in all the CBCT devices. Standard deviation values varied differently between the three distances in each device. CONCLUSION: Our in vitro study showed that different CBCT devices, high-density materials and FOV should be considered while evaluating CBCT images. More carefully, diagnosis conclusions should be drawn in images containing amalgam and copper-aluminum alloy.

Assessing pulp stones by cone-beam computed tomography.

OBJECTIVES: The aim of this study was to evaluate the occurrence of pulp stones by cone-beam computed tomography (CBCT) and to correlate their prevalence with patient's gender, location of tooth (right or left of maxillary or mandibular arch), group of teeth, and restorations. MATERIALS AND METHODS: CBCT images of 382 patients randomly selected from the database of the University Oral Radiology Department were retrospectively examined. A total of 2833 tooth images obtained using the i-CAT 3D Imaging System were evaluated. Image analysis was performed with the i-CAT software, and all teeth were evaluated in sagittal, axial, and coronal views. All the measurements were subjected to chi square test, odds ratio, and Fisher's exact tests (p < 0.05). RESULTS: The prevalence of pulp stones was similar between patient's genders and tooth locations. Pulp stones were detected in 31.9% of patients and 9.5% of teeth. Maxillary and mandibular molars were the groups of teeth with the highest frequency of pulp stones. The presence of restorations increased the chance of occurrence of pulp stones by 2.1 times in all teeth examined (p < 0.0001) and by 4.7 times in maxillary teeth (p < 0.0001). CONCLUSIONS: Pulp stones had a high prevalence with molar teeth showing the highest prevalence. The presence of restorations increased the chance of occurrence of these calcifications, specifically in maxillary teeth. CLINICAL RELEVANCE: CBCT provides accurate anatomical details in three dimensions, offering the possibility to view an individual tooth in axial, sagittal, and coronal views. This study performed an investigation of the occurrence of pulp stones by CBCT.

Impact of cone-beam computed tomography scan mode on the diagnostic yield of chemically simulated external root resorption.

INTRODUCTION: The aim of this in-vitro study was to evaluate the influence of cone-beam computed tomography scans on the diagnosis of chemically simulated external root resorption. METHODS: One hundred extracted anterior teeth were selected. Subsurface demineralization was induced on a limited area of the apical third of the root of 49 teeth. Each tooth was placed in an empty socket of a partially edentulous dry mandible. Cone-beam computed tomography images were obtained according to 3 protocols: (1) half scan, 0.40-mm voxel size; (2) full scan, 0.40-mm voxel size; and (3) full scan, 0.125-mm voxel size. Three observers evaluated the images. Sensitivity, specificity, accuracy, and area under the curve were compared with the Cochran Q and Mann-Whitney U tests. RESULTS: Protocol 3 had the highest sensitivity (81.63%), accuracy (80.67%), and area under the curve (0.807). There were statistically significant differences between protocol 3 and the other 2 protocols (P <0.001). The specificity of protocol 1 (84.97%) was greater than that of protocols 2 (69.93%) and 3 (79.74%); however, a statistically significant difference was found only between protocols 1 and 2 (P = 0.005). CONCLUSIONS: A more dedicated, high-resolution scan should be acquired when one intends to investigate the early stage of external root resorption during orthodontic treatment. However, this does not imply that all orthodontic patients should be subjected to high-dose cone-beam computed tomography scans.

Influence of different setups of the Frankfort horizontal plane on 3-dimensional cephalometric measurements.

INTRODUCTION: The Frankfort horizontal (FH) is a plane that intersects both porions and the left orbitale. However, other combinations of points have also been used to define this plane in 3-dimensional cephalometry. These variations are based on the hypothesis that they do not affect the cephalometric analysis. We investigated the validity of this hypothesis. METHODS: The material included cone-beam computed tomography data sets of 82 adult subjects with Class I molar relationship. A third-party method of cone-beam computed tomography-based 3-dimensional cephalometry was performed using 7 setups of the FH plane. Six lateral cephalometric hard tissue measurements relative to the FH plane were carried out for each setup. Measurement differences were calculated for each pair of setups of the FH plane. The number of occurrences of differences greater than the limits of agreement was counted for each of the 6 measurements. RESULTS: Only 3 of 21 pairs of setups had no occurrences for the 6 measurements. No measurement had no occurrences for the 21 pairs of setups. Setups based on left or right porion and both orbitales had the greatest number of occurrences for the 6 measurements. CONCLUSIONS: This investigation showed that significant and undesirable measurement differences can be produced by varying the definition of the FH plane.