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.

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

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

Digital file format does not influence the radiographic diagnosis of vertical root fracture.

OBJECTIVE: To evaluate the influence of the file format of digital periapical radiographs on the diagnosis of vertical root fracture (VRF). STUDY DESIGN: Periapical radiographic images of 34 single-rooted teeth-19 with VRF, and 15 without VRF were acquired using two digital systems-Digora Toto, and Digora Optime, and exported into four different file formats-TIFF, BMP, PNG, and JPEG, totaling 272 radiographs. The radiographs were assessed by five examiners for the detection of VRF, using a 5-point scale (1-definitely absent; 2-probably absent; 3-uncertain; 4-probably present; 5-definitely present). Diagnostic values of area under the ROC curve, specificity, and sensitivity for the diagnosis of VRF were calculated. The results were compared by two-way Analysis of Variance with post hoc Tukey's test. The intra- and inter-examiner agreements were measured by the Kappa test. The significance level was set at 5% for all analyses. RESULTS: The values of intra-examiner agreement varied from moderate (0.56) to almost perfect (0.81), while the values of inter-examiner agreement varied from fair (0.29) to moderate (0.60). The image file format did not influence the diagnostic values for VRF for any of the radiographic systems tested (p > 0.05). Digora Toto had significantly greater values of area under the ROC curve than Digora Optime for all file formats (p = 0.001). CONCLUSION: The image file format of periapical radiographs does not influence the diagnosis of VRF, regardless of the digital radiography system.

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

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

Do the dimensions of the hard palate have a relationship with the volumes of the upper airways and maxillary sinuses? A CBCT study.

BACKGROUND: As the hard palate is a central structure of the skull, and its close relationship with the nasal cavity, oral cavity, and maxillary sinuses, it would be of interest to study if there is a relationship between this bone and other structures of the stomatognathic system. Thus, this study aimed to assess the dimensions of the hard palate and associate them with sex, and skeletal and breathing patterns. Also, to investigate if there is a relationship between these dimensions and the volumes of the upper airways and maxillary sinuses. METHODS: Two hundred and ninety-eight CBCT scans of patients were classified according to sex, and skeletal and breathing patterns. Then, the linear dimensions of width and height of the hard palate at the regions of the first premolars and first molars, and the volumes of the upper airways and maxillary sinuses were measured using the CS 3D Imaging and ITK-SNAP software, respectively. Data were submitted to multi-way analysis of variance and linear regression, with a significance level of 5% (α = 0.05). RESULTS: Sex and facial type influenced the hard palate dimensions (p < 0.05). Males had greater width and height of the hard palate than females (p < 0.0001). It was observed greater width for brachycephalics at the first premolars region (p = 0.0032), and greater height for dolichocephalics at the first premolars (p = 0.0154) and first molars (p = 0.0038) regions. Skeletal malocclusion and breathing pattern did not influence the measurements of the hard palate (p > 0.05). There was a significant relationship between the width and height of the hard palate at the premolar's region and the total volume of the upper airways (p = 0.018, and p = 0.038), and between both dimensions of the hard palate at the molar's region and the total volume of the maxillary sinuses (p < 0.0001). CONCLUSIONS: The hard palate dimensions are influenced by sex and facial type, but not by skeletal malocclusion or breathing pattern. Also, there is an association between these dimensions and the volumes of the upper airways and maxillary sinuses.

Do the tube current and metal artifact reduction influence the diagnosis of vertical root fracture in a tooth positioned in the vicinity of a zirconium implant? A CBCT study.

AIM: To evaluate the influence of the tube current and metal artifact reduction (MAR) tool on the diagnosis of vertical root fractures (VRF) in a tooth adjacent to a zirconium implant, in cone-beam computed tomography (CBCT) images. METHODOLOGY: Thirty single-rooted teeth (15 with VRF and 15 control group) were individually positioned in a mandible, and scanned with the OP300 CBCT unit. Images were acquired using a standardized protocol: 5 × 5 cm field of view, 0.08-mm voxel size, and 90 kVp. Each tooth was scanned with and without a zirconium implant in its vicinity, using different tube currents (4 mA, 8 mA, and 10 mA) and conditions of MAR (enabled × disabled). Diagnostic values were calculated for each protocol, and compared by multi-way analysis of variance. RESULTS: The ROC curve and sensitivity values did not differ significantly among the tube currents, regardless of the presence of the implant and MAR condition (p > 0.05). There were also no significant differences among the tube currents for the specificity values (p > 0.05); however, the specificity differed significantly between the "with implant" and "without implant" conditions, within the same MAR condition and tube current (p < 0.05). Specificity was significantly lower when the implant was present (p < 0.05). CONCLUSION: The presence of a zirconium implant impairs the diagnosis of VRF in teeth adjacent to the artifact-generator material. Neither the tube current nor the MAR tool is effective in improving this diagnostic task. Therefore, in this clinical scenario, the use of the lowest tube current (4 mA), without MAR activation, is recommended. CLINICAL RELEVANCE: Considering that the tube current is one of the main factors that influence the radiation dose and image quality in CBCT, and that metal artifacts negatively influence the diagnosis of VRF in areas adjacent to the artifact-generator material, it is important to evaluate the effect of this energetic parameter in the diagnosis of VRF in teeth adjacent to zirconium implants.

Assessment of Ramifications in the Apical Region of Root Canals: A Micro-CT Study in a Brazilian Population.

The present study used microcomputed tomography (micro-CT) images to assess the prevalence, number, and location of apical ramifications (ARs) in the root canals of different dental groups in a Brazilian population. Three hundred and sixty-seven extracted human teeth, totaling 475 roots, were scanned by micro-CT at 19.6 µm spatial resolution. The obtained images were evaluated by two observers in consensus, and a descriptive analysis was performed to verify the prevalence, number, and location of ARs in each dental group. Chi-square test was used to compare the prevalence of ARs in different types of roots, and one-way analysis of variance compared the number of ARs in the apical 1 mm, 2 mm, and 3 mm of the root. Significance level was established at 5% (α=0.05). ARs were present in 253 (53.3%) of the 475 roots evaluated. A total of 607 ARs were detected, with the vast majority (530) located at one and two millimeters from the main foramen. The highest prevalence of ARs was observed in maxillary canines (65%); maxillary premolars - single-rooted (83.3%), buccal root (80%), and palatine root (73.3%); mandibular premolars (64.2%); mesiobuccal root of maxillary molars (76.6%); and mesial root of mandibular molars (66.6%). For the Brazilian population, most of the ARs are located in the apical 1 and 2 mm of the root, with greater prevalence in the posterior teeth and maxillary canines. These findings suggest the need for additional attention while planning endodontic treatments, including strategies to effectively clean and fill the apical region.

Variations in pulp volume between normotensive and hypertensive individuals on CBCT imaging.

OBJECTIVES: To compare the pulp volume of individuals with altered and normal systemic blood pressure (BP) in order to verify if high BP promotes dimensional modifications in the pulp space. MATERIALS AND METHODS: Cone beam computed tomography scans of 91 patients (49 females and 42 males, mean age 31.7 ± 6.38 years) who had a healthy maxillary canine were selected. Values of arterial BP measured at two dental visits were used to classify the sample as normal BP (< 130 × 80 mmHg) and altered BP (≥ 130 × 80 mmHg); 49 patients had normal BP and 42 had altered BP. One oral radiologist evaluated each patient's pulp and tooth volumes, using semi-automatic segmentation, and the tooth length. Data were submitted to Student's t test and logistic regression, with a significance level of 5% (p < 0.05). RESULTS: Pulp volume (p = 0.0027), pulp volume/tooth volume (p = 0.0013), and pulp volume/tooth length (p = 0.0007) ratios were greater in the altered BP group. Conversely, there was no difference in tooth volume between the groups (p = 0.0697). A logistic regression model (p = 0.0002) using pulp volume and age enabled the development of a formula for predicting altered BP, with 68% accuracy. CONCLUSIONS: Individuals with altered systemic BP have greater pulp volumes than those with normal BP. The formula developed in this study may indicate the presence of altered BP. CLINICAL RELEVANCE: As arterial hypertension is a silent disease that produces no warning signs or symptoms, identification of modifications in the pulp volume in cone beam computed tomography scans may be an adjuvant sign of the diagnosis of this disease.

Evaluation of metal artefacts for two CBCT devices with a new dental arch phantom.

OBJECTIVES: To create a new phantom design to evaluate the real impact of artefacts caused by titanium on bone structures in cone beam CT images considering different positions and quantity of metals in the dental arch, with and without metal artefact reduction (MAR). METHODS: A three cylindrical polymethyl methacrylate (PMMA) plate phantom was designed containing eight perforations arranged to simulate the lower dental arch in the intermediate plate. Three titanium cylinders were positioned in different locations and quantities to test different clinical conditions and to quantify the impact of the metal artefact around five bone cylinders. Scans were carried out in seven different protocols (Control, A-F) in two cone beam CT devices (OP300 Maxio and Picasso Trio). Eight regions of interest around each cortical and trabecular bone were used to measure the grey value standard deviation corresponding the artefact expression in the Image J software. Both the artefact expression and the MAR effect were assessed using the Wilcoxon, Friedman (Dunn) and Kruskal-Wallis tests (significance level of 5%). RESULTS: For both devices, MAR was statistically efficient only for the protocols E, and F. Protocol F (three metals on the adjacent area of the analysis region) showed higher artefact expression when compared to the others. CONCLUSION: In conclusion, the new phantom design allowed the quantification of the metal artefact expression caused by titanium. The metal artefact expression is higher when more metal objects are positioned in the adjacent bone structures. MAR may not be effective to reduce artefact expression on the adjacencies of those objects for the devices studied.

Does the addition of a lead foil to digital radiographic receptors influence image contrast and approximal caries lesions diagnosis?

OBJECTIVES: To access the influence of the addition of a lead foil to intraoral digital radiographic receptors on image contrast and approximal caries lesions diagnosis. METHODS: 40 posterior teeth were distributed in silicone phantoms composed of two premolars, two molars and a non-test canine. Radiographic images of the phantoms were obtained with and without the incorporation of a lead foil, using the Digora Optime and Digora Toto systems. Four observers scored the images for the presence of caries lesions, using a 5-point scale. Images of an aluminum step wedge were acquired with and without the incorporation of a lead foil. Gray values and standard deviation of gray values were calculated in different thickness of the step wedge and, then, contrast variation was calculated. RESULTS: Presence of a lead foil did not influence caries lesions diagnostic values, regardless of the type of digital system (p > 0.05). In general, the objective analysis was not influenced by the presence of a lead foil in any of the tested systems (p > 0.05). However, Digora Toto images showed greater gray values, lower standard deviation of gray values and lower contrast variation, regardless of the presence of the lead foil (p < 0.05). CONCLUSIONS: The addition of a lead foil to intraoral digital receptors did not influence image contrast nor caries lesions diagnosis.

C-shaped canals in mandibular molars of a Brazilian subpopulation: prevalence and root canal configuration using cone-beam computed tomography.

OBJECTIVES: To assess C-shaped root canal configuration by identifying its prevalence and each configuration type proportion, according to tooth (mandibular first or second molar) and demographic characteristics in a Brazilian population, using cone-beam computed tomography (CBCT). Moreover, it was verified if there is a relationship between root canal configuration observed in two-dimensional reconstructions of CBCT and presence of C-shape. METHODS: Mandibular jaw CBCT scans (184 males and 220 females, aged 15 to 80 years), which presented 1464 mandibular molars (710 first molars and 754 second molars), were assessed. Teeth were evaluated for the presence and type of C-shaped root canals by observing the roots at five levels in CBCT axial reconstructions. Root canal configuration was assessed in panoramic reconstructions. Data were statistically analyzed at a significance level of 5%. RESULTS: Of the 1464 mandibular molars, 125 (8.5%) were classified as C-shaped. This variation was more prevalent in females (n = 107, 85.6%) and in second molars (n = 108, 86.4%). C1 (uninterrupted C-shaped canal) was the most prevalent type of C-shaped configuration (41.76%), while C5 (no canal lumen) was the least prevalent type (0.96%). Single root with single canal in panoramic reconstructions was the most predominant configuration for C-shaped teeth (n = 54, 43.2%). Fused roots presented 17.2 higher odds of being associated with C-shaped root canals than non-fused roots. CONCLUSIONS: C-shaped root canals were more prevalent in mandibular second molars and in females. Additionally, clinicians should bear in mind the greater possibility of C-shaped configuration in mandibular molars with fused roots. CLINICAL RELEVANCE: Mandibular molars with C-shaped canals present a clinical challenge. A higher C-shaped proportion was noted in radiographic fused root types, which had 17.2 higher odds of presenting such anatomy when compared to radiographic non-fused roots. Root radiographic features may help in diagnosis of complex C-shaped morphologies.

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.

Radioprotective Effect of Sodium Selenite on Mandible of Irradiated Rats.

The purpose of this study was to test the radioprotective effect of selenium in the bone microarchitecture of irradiated rats mandibles. Forty rats were separated into 4 groups with 10 animals: control group (CG), irradiated group (IG), sodium selenite group (SSG) and sodium selenite irradiated group (SSIG). A single dose of 0.8 mg/kg sodium selenite was administered intraperitoneally in the SSG and SSIG groups. One hour later, animals of IG and SSIG groups were irradiated with 15 Gy of x-rays. Forty days after radiation a bilateral extraction of the mandibular first molars was performed. After the extraction procedure, five rats were killed after fifteen days and others five after thirty days. Micro- computed tomography was used to evaluate cortical and trabecular bone of each rat. The mean and standard deviation of each bone microarchitecture parameter were analyzed using the statistical test of two-way Analysis of Variance (ANOVA). At 15 days, the bone volume presented higher values in the CG and SSG groups (p=0.001). The same groups presented statistically significant higher values when bone volume fraction (p<0.001) and trabecular thickness (p<0.001) were analyzed. At 30 days, it was observed that in relation to the bone volume fraction, SSG group presented the highest value while SSIG group had the lowest value, with statistically significant difference (p=0.016). Sodium selenite demonstrated a median radioprotective effect in the bone microarchitecture of irradiated mandibles, which indicates the substance may be a potential radioprotective agent against chronic effects of high doses of ionizing radiation.

Influence of the incorporation of a lead foil to intraoral digital receptors on the image quality and root fracture diagnosis.

OBJECTIVE: To evaluate the quality of images obtained with the addition of a lead foil to intraoral digital receptors. METHODS: Radiographic images of 34 single-rooted human teeth - 19 with vertical root fracture (VRF) and 15 of the control group - were obtained with and without the addition of a lead foil, using the VistaScan, Express, Digora Optime and Digora Toto systems. Images were evaluated by five observers regarding the diagnosis of VRF, using a 5-point scale. In a second moment, an observer preference analysis related to the presence of the lead foil was performed. Images of an acrylic phantom were also obtained with and without the addition of a lead foil, and the quantities of uniformity, grey value and standard deviation of grey values were obtained. RESULTS: There were no significant differences in the VRF diagnostic values, considering the presence of the lead foil. Regarding the image quality preference, the observers preferred images acquired with the lead foil for all systems tested, but with greater values for Digora Optime (61.33%) and Express (61.33%). The presence of the lead foil did influence the image uniformity in all systems tested ( p < 0.05). Moreover, the lead foil increased the mean of grey values for Digora Optime and Express images ( p < 0.05), however it did not influence the SD in any of the digital systems ( p > 0.05). CONCLUSION: The addition of a lead foil to intraoral digital receptors produces a positive effect in the image quality objectively detected by means of uniformity and subjective visual preference.

Morphological Evaluation of the Nasopalatine Canal in Patients With Different Facial Profiles and Ages.

PURPOSE: To evaluate the influence of facial profile and age on the morphology of the nasopalatine canal. MATERIALS AND METHODS: One hundred thirty-two cone-beam computed tomograms were classified according to facial profile-mesofacial, brachyfacial, and dolichofacial-and divided into the following age groups: 21 to 30, 31 to 40, 41 to 50, and 51 to 60 years. Measurements were obtained for openings of the incisive and nasopalatine foramina, alveolar bone thickness, and the full length, most constricted region, and volume of the nasopalatine canal. Intra- and inter-examiner agreements were calculated using the intraclass correlation coefficient. After exploratory and descriptive analysis, data were subjected to 2-way analysis of variance and Tukey test for comparisons between facial profiles and age groups. The significance level was 5% (α = 0.05). RESULTS: Intra- and inter-examiner reproducibilities were excellent for all measurements. Patients older than 50 years presented a significantly larger nasopalatine canal than patients 21 to 30 years old for all facial profiles (P ≤ .05). Linear measurements obtained from the nasopalatine canal showed no significant difference between facial profiles and age groups (P > .05). CONCLUSIONS: The nasopalatine canal was not influenced by facial profile but did exhibit an increased volume with aging, particularly after 50 years of age.

The fundaments of CBCT and its use for evaluation of paranasal sinuses: review of literature

Image methods such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and Cone Beam Computed Tomography (CBCT) are powerful tools to help clinicians on diagnosis and preoperative planning. They provide an accurate view of regional anatomy, anatomical variations and the presence of diseases. Compared to CT, CBCT produces images with adequate spatial resolution with smaller fields of view at lower radiation doses. It has emerged as a potential alternative for obtaining 3D evaluation of the paranasal sinus at relatively modest costs. The aim of this review was to verify whether CBCT images offer an additional value to the evaluation of paranasal sinus

Meloxicam as a Radiation-Protective Agent on Mandibles of Irradiated Rats.

This study evaluated the action of ionizing radiation and the possible radioprotective effect of the non-steroidal anti-inflammatory drug meloxicam on the bone physiology of rat mandibles by assessing the alveolar socket healing and bone strength. Forty male Wistar rats were divided in 4 groups (n=10): control (CG), irradiated (IG), meloxicam (MG), meloxicam irradiated (MIG). A dose of 0.2 mg/kg meloxicam was administered to MG and MIG. After this, IG and MIG were irradiated with 15 Gy radiation dose in the mandible. Forty days after the above procedures, the mandibular first molars were extracted and the animals were killed after 15 or 30 days (n=5). Micro-computed tomography and bending test were used to evaluate alveolar socket healing and bone strength, respectively. At 15 days, bone volume, bone volume fraction and trabecular thickness were higher in the CG and MG than in the IG and MIG; and trabecular separation was higher in the IG compared with the others. At 30 days, there was a difference only in trabecular separation, which was higher in IG than in CG and MG, and MIG did not differ from the others. Bone strength was lower in IG compared with CG and MG, and MIG did not differ from the others. In conclusion, the ionizing radiation affected the bone physiology of rat mandibles, delaying the alveolar socket healing and reducing the bone strength. Moreover, the meloxicam had a positive effect on the trabecular separation in alveolar socket healing and on the bone strength.

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.

Erratum to: Panoramic radiographs underestimate extensions of the anterior loop and mandibular incisive canal.

[This corrects the article on p. 159 in vol. 46, PMID: 27672611.].

Panoramic radiographs underestimate extensions of the anterior loop and mandibular incisive canal.

PURPOSE: The purpose of this study was to detect the anterior loop of the mental nerve and the mandibular incisive canal in panoramic radiographs (PAN) and cone-beam computed tomography (CBCT) images, as well as to determine the anterior/mesial extension of these structures in panoramic and cross-sectional reconstructions using PAN and CBCT images. MATERIALS AND METHODS: Images (both PAN and CBCT) from 90 patients were evaluated by 2 independent observers. Detection of the anterior loop and the incisive canal were compared between PAN and CBCT. The anterior/mesial extension of these structures was compared between PAN and both cross-sectional and panoramic CBCT reconstructions. RESULTS: In CBCT, the anterior loop and the incisive canal were observed in 7.7% and 24.4% of the hemimandibles, respectively. In PAN, the anterior loop and the incisive canal were detected in 15% and 5.5% of cases, respectively. PAN presented more difficulties in the visualization of structures. The anterior/mesial extensions ranged from 0.0 mm to 19.0 mm on CBCT. PAN underestimated the measurements by approximately 2.0 mm. CONCLUSION: CBCT appears to be a more reliable imaging modality than PAN for preoperative workups of the anterior mandible. Individual variations in the anterior/mesial extensions of the anterior loop of the mental nerve and the mandibular incisive canal mean that is not prudent to rely on a general safe zone for implant placement or bone surgery in the interforaminal region.