Comprehensive analysis of bone tissue in extraction sockets of third molars after leukocyte and platelet rich fibrin and photobiomodulation applications.

OBJECTIVES: The aim of this study was to compare leukocyte and platelet-rich fibrin (L-PRF) and photobiomodulation (PBM) applications, which have been repeatedly reported to be superior to control groups, in terms of pain, soft tissue and bone healing in tooth extraction sockets. MATERIALS AND METHODS: This double-blind, randomized clinical study was completed with 34 patients, who had an indication for extraction of their bilaterally impacted teeth. The right and left teeth of the patients were randomly divided into L-PRF and PBM groups. L-PRF group was treated with the blood product centrifuged for 12 min at 2700 rpm, and the PBM group was treated with a diode laser at different points for 60 s with a wavelength of 940 nm in repeated sessions. Postoperative pain was evaluated using Visual Analogue Scale (VAS), soft tissue healing with Landry Index (LI), tissue healing in the distal region of mandibular second molar by probing depth measurement, and bone healing via panoramic x-ray using the Image J program. RESULTS: No statistically significant difference was found for any variable compared between the groups. CONCLUSION: L-PRF and PBM applications provide similar support in the healing of extraction sockets. Nevertheless, the advantages and disadvantages of both methods determine their usage areas. CLINICAL RELEVANCE: While L-PRF is advantageous in the early healing of extraction sockets, PBM may be preferred in terms of bone trabeculation in the long term.

Radiologic evaluation of associated symptoms and fractal analysis of unilateral dens invaginatus cases.

OBJECTIVE: The aim of this study is to determine the age-based prevalence of dens invaginatus cases and to learn the radiologic findings. In addition, fractal analysis of the periapical regions of unilateral dens invaginatus cases and contralateral teeth was performed to determine the effect of possible microleakage on fractal dimension. METHODS: A total of 136 patients (170 teeth) identified in panoramic radiographs taken for diagnostic purposes between January 2018 and December 2023 at our Department of Oral and Maxillofacial Radiology were included in the study. Data were analysed using IBM SPSS V23. The Chi-square test was used for comparing categorical variables between groups. The relationship between the FD values calculated around the apexes of the teeth with unilateral dens invaginatus and the contralateral teeth was analyzed by paired t test. A significance level of p < 0.050 was adopted. RESULTS: The mean age of the cases was calculated as 28.1 (8-63) years. 66 (48.5%) of the cases were female, and 70 (51.1%) were male. The lateral incisor was the most affected tooth among these cases. Bilateral cases were observed in 34 patients. Type 2 was detected in 93 patients, Type 1 in 35 patients, and Type 3 dens invagination in 8 patients. Dens invaginatus cases were observed in 134 maxillary and 2 mandibular teeth. Periapical lesions were seen in 22 of these cases. CONCLUSIONS: Dens invaginatus cases are a congenital anomaly encountered at any age. Early diagnosis is crucial to prevent the loss of pulp vitality due to these invaginations. It should be noted that these invaginations can affect both jaws. However, due to the prevalence of occurrence in the maxillary anterior teeth and asymptomatic nonvitality, particular attention should be paid to evaluating this region.

The current overview of the devices of temporary anchorage placed on the palatal bone: CBCT study.

Temporary anchorage devices (TADs) are frequently applied to different anatomic areas with different protocols to increase skeletal effects and anchorage in orthodontic treatment planning. It has been reported in many literatures that primary stability for orthodontic TADs is significant for long-term survival rate. For this reason, different areas of the palatal region, which has many indications, have been widely used in the studies. In this evaluation where bone quality and thickness are important, density, bone thickness, and fractal dimension (FD) on cone beam computed tomography (CBCT) will provide more predictable clinical results. The aim of this study was to evaluate bone thickness, density, and FD in the palatal region of the first, and second premolars, and first molars. There was a remarkable difference (p < 0.05) between the parameters of FD, thickness and density of bone in the identified areas in the palatal region. In terms of thickness and FD, the 1st premolar region had significantly higher values than the other regions (p < 0.05). In terms of density, the values in the right 1st molar and right 1st premolar regions were significantly higher (p < 0.05). The 1st premolar region is an ideal site for placement of palatal TADs. CBCT-assisted preliminary evaluation of FD value, bone density, and thickness may increase clinical success when selecting the location of TADs to be applied to the palatal bone.

Variation of Mandibular Canal Branching Related to Anatomical Regions in Mandible: A Radiographic Study Without Contrast.

PURPOSE: Screening mandibular canal branches and awareness of these possible canal branches is vital for patient safety and surgical success. The aim of this study was to evaluate the prevalence and localization of mandibular canal branching (MCB). METHODS: This is an institutional and retrospective cohort study of patients who presented for evaluation of cone beam computed tomography (CBCT) between 2019 and 2020. The prevalence of MCB and the related foramina was estimated according to anatomical regions. Predictor variables were gender, age, anatomical region, and side of branches. Outcome variable of the study was MCB. Thus, multiple correspondence analysis was performed to determine the relationships between the categories of the variables, as well as between variables. RESULTS: CBCT images were obtained from 180 patients (n = 360 hemimandible; 90 males, 90 females). MCB was observed in 130 (72.2%) of 180 patients (mean age = 38.2 ± 11.8 years). MCB was observed in 63 (48.5%) males and 67 (51.5%) females, and the prevalence of MCB did not differ significantly according to gender (P = .618). MCB was mostly observed in the molar region (69 branches, 34.3%). Foramina were detected in 60 of 248 branches (24.19%) and were mostly observed in the retromolar region (28 foramina, 46.7%). "Quadrafid" branching was detected in 2 females (1.11%). Female patients aged 19-38 years were more prone to have MCB in molar and retromolar regions. MCB was more likely to occur bilaterally. There was also a high positive correlation among the MCB, side, and anatomical regions. CONCLUSIONS: MCB is not a rare anatomical variation, and even quadrafid branching can be observed in the hemimandible. CBCT images should be examined carefully for possible MCB to minimize postoperative complications during dental surgery.

Is there an association between proton pump inhibitors and radiomorphometric parameters of the mandible? A preliminary study.

OBJECTIVES: This study aimed to analyze the association between the use of proton pump inhibitors (PPIs) and radiomorphometric parameters of trabecular and cortical bone of the mandible. METHODS: A total of 64 patients (37 females and 27 males) using PPIs (PPI group) and 64 age- and gender-matched healthy individuals (control group) were included in this study. The analyzed radiomorphometric parameters were fractal dimension (FD), mandibular cortical width (MCW), and mandibular cortical index (MCI). RESULTS: There were no significant differences in the mean FDs of selected regions and MCW between the two groups (p > 0.05). The mean MCW was 1.95 mm in the PPI group and 2 mm in the control group. The MCI C3 category, which represents the most porous state of the mandibular cortex, was 2.5 times more frequent in the PPI group (p = 0.002). PPI use duration did not correlate with FD or MCW. No significant differences were observed in FD, MCW, and MCI distribution according to PPI type (p > 0.05). CONCLUSIONS: Although not all radiomorphometric parameters indicated osteoporotic effects of PPI use, the mandibular cortex of PPI users is prone to erosive defects.

Accuracy of the London atlas, Willems, and Nolla methods for dental age estimation: a cross-sectional study on Eastern Turkish children.

OBJECTIVES: This study aimed to estimate the dental age (DA) using the London Atlas, Willems, and Nolla methods and to compare their accuracies. METHODS: The DA was estimated using the aforementioned methods on panoramic radiograms of a total of 919 Eastern Turkish patients aged 6-14 years, of whom 459 were female and 460 were male. The overestimation and underestimation values were determined in relation to the chronological age (CA) values. The paired t test was used to compare the mean DA and CA values. Multiple regression analysis was used to derive gender-specific formulations for the three methods. RESULTS: The most accurate method for estimating the DA was the Willems method (mean prediction error 0.80), followed by the London Atlas (mean prediction error 0.83) and Nolla (mean prediction error 0.89) methods. Statistically significant differences were found only between the Willems and Nolla methods. CONCLUSION: All three methods can be used for DA estimations of Eastern Turkish children. CLINICAL RELEVANCE: Willems was the most suitable method for this patient sample. However, the London Atlas method may be preferred due to its practicability and comparable accuracy.

Is it possible to estimate volume of bone defects formed on dry sheep mandibles more practically by secondarily reconstructing section thickness of cone beam computed tomography images?

OBJECTIVES: The purpose of this study was to evaluate the effect of section thickness on volume estimations of bone defects scanned using cone beam computed tomography (CBCT). METHODS: 25 bone defects were prepared on sheep mandibles and scanned using a KaVo 3D eXam (KaVo Dental, Biberach, Germany) CBCT device. Section thickness of images were reconstructed at 0.25, 0.5, and 0.75 mm to estimate the volume of these defects using the semiautomatic segmentation method. The volume averages obtained using microcomputed tomography and Archimedes' method served as reference values. The estimated volumes at each section thickness were compared with the actual volumes using the Friedman test. The accuracy of volume estimation was determined by the percentage error with respect to the reference values, and the mean absolute error (MAE) was calculated. RESULTS: Volumetric values of bone defects obtained with CBCT at section thicknesses up to 0.5 mm were compatible with the actual volumes (p > 0.05). The percentage errors at section thicknesses of 0.25, 0.5, and 0.75 mm were -5.4%, -7.3%, and -13.1%, respectively. The mean absolute errors were 13.6 mm3, 15.7 mm3, and 18.2 mm3, respectively. CONCLUSIONS: The section thickness values of CBCT images can be increased to a reasonable level to obtain accurate volume estimation results and save time. The semiautomatic segmentation method can be used reliably for volume estimations of bone defects.

Prevalence of foramen Huschke: evaluation of the association between mastoid pneumatization volume and the existence of foramen Huschke using cone beam computed tomography.

PURPOSE: The study examined the association between mastoid pneumatization (MP) volume and the existence of foramen Huschke (FH). METHODS: Cone beam computed tomography (CBCT) images of 1117 patients (2234 mastoid regions) were analyzed. The prevalence of FH was calculated. The association of MP volume calculated in 83 patients (48 women, 35 men) with sex, side, and the existence of FH analyzed. T test and Pearson's Chi-square test were used for statistical analyses. RESULTS: FH was observed in 223 (20%) patients. FH was unilateral in 141 (63.7%) patients (74 left-sided, 68 right-sided) and bilateral in 81 (36.3%) patients. Six patients with FH had herniation into the external auditory canal. MP volume was significantly greater in females (p = 0.016). Additionally, MP volume was significantly greater in patients having FH (p = 0.009). CONCLUSION: It is possible to speculate that the volume of MP, which is in close neighborhood with the external auditory canal, somehow affects the existence of FH located in the tympanic segment.

Three-Dimensional Analysis of Impacted Maxillary and Mandibular Canines and Evaluation of Factors Associated With Transmigration on Cone-Beam Computed Tomography Images.

PURPOSE: The aim of this study was to determine the prevalence of canine transmigration in the maxilla and mandible and to perform a 3-dimensional examination of impacted canines (ICs) on cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: CBCT images of 35 transmigrated and 35 nontransmigrated canines (control group) were analyzed. Associations between gender, jaw, dental anomalies associated with ICs, adjacent lateral status, the status of deciduous canine, contact of the apical region with the cortex, contact of the crown with the cortex, canine location, resorption of adjacent teeth and severity, periodontal contour of adjacent teeth, odontoma, root status of the canine, cyst formation, and age groups of patients with transmigration were evaluated. RESULTS: The prevalence of unilateral canine transmigration was 1.14%. Unilateral canine transmigration was less common in the mandible (0.52%) than in the maxilla (0.62%). ICs were significantly more frequently located on the lingual side. Resorption, the absence of contact between permanent and deciduous canines, and older age were significantly associated with transmigration. Resorption of adjacent teeth did not show significant differences according to transmigration status and gender, whereas nontransmigrated canines were significantly more commonly associated with periodontal destruction. CONCLUSIONS: The status of associated deciduous canines, location on the lingual side, and older age may be associated with transmigration of ICs. Conversely, transmigration is not significantly associated with the destruction of adjacent structures. CBCT is a valuable tool for comprehensive evaluations of impacted and transmigrated teeth.

Evaluation of Risk Factors for External Root Resorption and Dental Caries of Second Molars Associated With Impacted Third Molars.

PURPOSE: Impacted third molars (M3s) may lead to external root resorption (ERR) and dental caries (DC) in the adjacent second molars (M2s). The aim of this study was to identify the risk factors for ERR and DC in M2s associated with impacted M3s. MATERIALS AND METHODS: We implemented a cross-sectional study and enrolled a sample composed of patients with M3s and M2s present and cone-beam computed tomography (CBCT) scans available for review. If there was contact between the M2 and the adjacent M3 and the border of radiolucency was more distinct, the case was considered ERR. Apart from that, the case was considered DC. Potential predictor variables were defined as age, gender, tooth location, M2-M3 contact, root development in M3, M3 inclination, M3 impaction type, and M3 follicular diameter. Outcomes of the study were DC and ERR in M2s. CBCT was used to detect the presence of DC and ERR in M2s. RESULTS: A total of 250 eligible images of M3s in the upper and lower jaws of 167 patients were included. The mean age of the patients with CBCT images available was 26.08 ± 4 years (range, 18 to 40), and 43.6% of the patients were men. Factors associated with a significantly increased frequency of ERR in M2s included maxillary location, presence of M2-M3 contact, and mesioangular inclination (P < .005). DC in M2s was significantly more likely to occur in those with absence of contact between M2 and M3 (P < .005). CONCLUSIONS: The results of this study showed an increased risk of ERR to be associated with maxillary molars, mesioangular inclination, and presence of M2-M3 contact. The variable associated with an increased risk of DC was the absence of M2-M3 contact.

Comparing different planimetric methods on volumetric estimations by using cone beam computed tomography.

PURPOSE: The purpose of this study was to compare the accuracy of the planimetric methods on volume estimations by using cone beam computed tomography (CBCT). MATERIALS AND METHODS: Thirty-one prepared intraosseous bone defects from thirteen bovine femur condyles were scanned with CBCT. The defect volumes were estimated by point counting (PC), manual segmentation (MS) and semiautomatic segmentation (SAS) methods at 0.3-mm section thickness without any intersection gap. The estimated volumes were compared with the results of the Archimedes' method. The planimetric methods were analyzed using a Friedman's two-way analysis of variance test. RESULTS: The estimated volumes of MS and SAS methods were compatible with the volumes of Archimedes' method (p = 0.768, p = 0.140, respectively), but the volumes from the PC method were not compatible with Archimedes' method (p < 0.001). CONCLUSION: SAS was approximately 2.5 times faster than MS. Both MS and SAS are valid methods for volume estimation; however, SAS may be preferred due to its practicability.

Assessment of prevalence and volumetric estimation of possible Stafne bone concavities on cone beam computed tomography images.

OBJECTIVES: Our study aimed to determine the prevalence and volumetric estimates of Stafne bone cavities (SBC) on cone beam computed tomography (CBCT) images. METHODS: This retrospective study, which involved the CBCT images of 1141 men and 1260 women with an age range of 10-90 years, aimed to determine the prevalence of SBCs and to calculate their volumes using the semi-automatic segmentation method. RESULTS: A total of 15 SBCs were diagnosed in 14 patients. Among the detected SBCs, 7.14% were found in a female patient and 92.86% were found in 13 male patients. Of the total number of SBCs, 6.67% were anteriorly located and 93.33% were posteriorly located. Bilateral SBCs had a prevalence of 0.04%; unilateral posterior SBCs 0.54% and anterior SBCs 0.04%. The mean SBC volume was calculated as 338.05 mm3. CONCLUSIONS: The results of our study showed that SBC is a rare anomaly. In contrast to two-dimensional imaging techniques, CBCT allows a precise determination of SBCs' pattern of impact on adjacent bony structures, relationship with the mandibular canal and dimensions.