Correlación entre el Diagnóstico Clínico y Radiográfico de Sujetos Adultos con Erupción Pasiva Alterada / Correlation Between Clinical and Radiographic Diagnosis of Adult Subjects with Altered Passive Eruption

El objetivo de este estudio fue determinar la correlación entre el diagnóstico clínico y radiográfico de sujetos adultos con erupción pasiva alterada. La muestra estuvo conformada por los incisivos centrales del cuadrante I de 30 sujetos adultos. Se registraron 2 mediciones clínicas: longitud de corona clínica y distancia del margen gingival (MG) a la unión cemento esmalte (UCE); y 2 mediciones radiográficas: longitud de corona anatómica y distancia del MG-UCE. Para diagnosticar EPA, se comparó el promedio de la resta entre corona anatómica y corona clínica; con el valor hipotético ( ³ 2,5 mm según Zucchelli). La muestra estuvo conformada por: 36,7 % incisivos de sujetos de sexo masculino y 63,3 % de sexo femenino; con la edad media de 25,17 años. Clínicamente, se obtuvo la media de 8,5 mm para longitud de corona clínica y 2,267 mm para sondaje MG-UCE. Radiográficamente, se obtuvo la media de 10,767 mm para longitud de la corona radiográfica y 2,47 mm para MG-UCE. Según la Rho de Spearman, el sondaje MG-UCE (clínico) con MG-UCE (radiográfico) no muestra una correlación estadísticamente significativa (p=0,227), sin embargo, al comparar la media (2,48 mm) con el valor hipotético (³2,5 mm) según la prueba t de una muestra, se determina que no existe diferencia estadísticamente significativa (p=0,864) entre ambos resultados. La radiografía con técnica paralela de Zucchelli es una excelente alternativa para un adecuado diagnóstico diferencial de la erupción pasiva alterada; de manera simple, económica y reproducible para el beneficio de clínicos y pacientes.

The aim of the study was to determine the correlation between the clinical and radiographic diagnosis of adult subjects with altered passive eruption. The population consisted of the central incisors of quadrant I of 30 adult subjects. Two clinical measurements were recorded: length of clinical crown and distance from the gingival margin (GM) to the cementum enamel junction (CEJ); and 2 radiographic measurements: length of anatomical crown and distance from the GM-CEJ. To diagnose APE, the average of the subtraction between anatomical crown and clinical crown was compared; with the hypothetical value (³ 2.5 mm according to Zucchelli). The population were: 36.7 % incisors of male subjects and 63.3 % female; with the average age of 25.17 years. Clinically, the average was 8.5 mm for clinical crown length and 2,267 mm for GM-CEJ probing. Radiographically, the average 10.767 mm was obtained for the length of the radiographic crown and 2.47 mm for GM- CEJ. According to Spearman's Rho, the GM-CEJ (clinical) probing with GM-CEJ (radiographic) does not show a statistically significant correlation (p = 0.227), however, when comparing the average (2.48 mm) with the hypothetical value (³ 2.5 mm) according to the t-test of a sample, it is determined that there is no statistically significant difference (p = 0.864) between both results. The radiography with Zucchelli technique is an excellent alternative for an adequate differential diagnosis of altered passive eruption; in a simple, economical and reproducible way for the benefit of clinicians and patients.

A comparison of the sealing abilities between Biodentine and MTA as root-end filling materials and their effects on bone healing in dogs after periradicular surgery.

OBJECTIVES: To compare the sealing ability and biocompatibility of Biodentine with mineral trioxide aggregate (MTA) when used as root-end filling materials. METHODOLOGY: The Cell Counting Kit-8 (CCK-8) assay was used to compare the cytotoxicity of MTA and Biodentine. Twenty-one extracted teeth with a single canal were immersed in an acidic silver nitrate solution after root-end filling. Then, the volume and depth of silver nitrate that infiltrated the apical portion of the teeth were analyzed using micro-computed tomography (micro-CT). Seventy-two roots from 3 female beagle dogs were randomly distributed into 3 groups and apical surgery was performed. After six months, the volume of the bone defect surrounding these roots was analyzed using micro-CT. RESULTS: Based on the results of the CCK-8 assay, MTA and Biodentine did not show statistically significant differences in cytotoxicity (P>0.05). The volume and the depth of the infiltrated nitrate solution were greater in the MTA group than in the Biodentine group (P<0.05). The volume of the bone defect was larger in the MTA group than in the Biodentine group. However, the difference was not significant (P>0.05). The volumes of the bone defects in the MTA and Biodentine groups were smaller than the group without any filling materials (P<0.05). CONCLUSIONS: MTA and Biodentine exhibited comparable cellular biocompatibility. Biodentine showed a superior sealing ability to MTA in root-end filling. Both Biodentine and MTA promoted periradicular bone healing in beagle dog periradicular surgery models.

Importância da radiografia intra-oral em tratamentos periodontais de cães e gatos: relato de três casos / The importance of intra-oral radiographs in periodontal treatmentsof dogs and cats: three cases reports

A radiografia intra-oral é um método de diagnóstico por imagem essencial em pacientes submetidos a tratamento odontológico de qualquer natureza, especialmente em casos de doença peridontal. Permite a avaliação de estruturas ósseas e dentárias, elucidando múltiplos diagnósticos que não são firmados clinicamente. Inclui-se no estudo radiográfico a análise da integridade da lâmina dura, do ligamento periodontal, de afecções dentárias como abscessos periapicais, cistos, alterações de desenvolvimento coronário e radicular, agenesias, dentes inclusos ou supranumerários, raízes fraturadas remanescentes na região subgengival, reabsorções dentárias ou ósseas (associadas à doença periodontal ou neoplasias) e estruturas internas do dente (diâmetro da câmara pulpar e canal radicular). O presente artigo visa, portanto, mostrar através da apresentação de casos clínicos, a relevância do exame radiográfico para a correta abordagem diagnóstica e terapêutica de afecções subclínicas, mesmo em pacientes sem sinais de dor ou supostamente portadores de apenas gengivite. Foram relatados um caso de hipoplasia radicular, um de cisto de origem dentária e outro de reabsorção dentária, todos diagnosticados após a realização da documentação radiográfica intra-oral.(AU)

The intra-oral radiography is an essential diagnosis imaging method, in patients submitted to dental treatment of any nature, especially cases of periodontal diseases. It allows the evaluation of structural bone and dental diseases, elucidating multiple diagnoses, which are not clinically proven. The radiographic study includes the analysis of the periodontal ligament and lamina dura integrity, dental anomalies such as periapical abscesses, cysts, coronary and root development failures, agenesis, unerupted or supernumerary teeth, fractured roots remaining in the subgingival area, tooth or bone resorption, (associated with neoplasia or periodontal disease) and Internal tooth structures such as diameter of pulp chamber and root canal. The present article aims to show, through clinical case reports, the relevance of the radiographic examination towards the correct diagnosis and therapeutic approach of subclinical infections, even in patients without signs of pain or supposedly gingivitis bearers. Amongst the reported cases, there is a root hipoplasia, a dental origin cyst and a tooth resorption, all diagnosed after intra-oral radiographic completion.(AU)

Importância da radiografia intra-oral em tratamentos periodontais de cães e gatos: relato de três casos / The importance of intra-oral radiographs in periodontal treatmentsof dogs and cats: three cases reports

A radiografia intra-oral é um método de diagnóstico por imagem essencial em pacientes submetidos a tratamento odontológico de qualquer natureza, especialmente em casos de doença peridontal. Permite a avaliação de estruturas ósseas e dentárias, elucidando múltiplos diagnósticos que não são firmados clinicamente. Inclui-se no estudo radiográfico a análise da integridade da lâmina dura, do ligamento periodontal, de afecções dentárias como abscessos periapicais, cistos, alterações de desenvolvimento coronário e radicular, agenesias, dentes inclusos ou supranumerários, raízes fraturadas remanescentes na região subgengival, reabsorções dentárias ou ósseas (associadas à doença periodontal ou neoplasias) e estruturas internas do dente (diâmetro da câmara pulpar e canal radicular). O presente artigo visa, portanto, mostrar através da apresentação de casos clínicos, a relevância do exame radiográfico para a correta abordagem diagnóstica e terapêutica de afecções subclínicas, mesmo em pacientes sem sinais de dor ou supostamente portadores de apenas gengivite. Foram relatados um caso de hipoplasia radicular, um de cisto de origem dentária e outro de reabsorção dentária, todos diagnosticados após a realização da documentação radiográfica intra-oral.

The intra-oral radiography is an essential diagnosis imaging method, in patients submitted to dental treatment of any nature, especially cases of periodontal diseases. It allows the evaluation of structural bone and dental diseases, elucidating multiple diagnoses, which are not clinically proven. The radiographic study includes the analysis of the periodontal ligament and lamina dura integrity, dental anomalies such as periapical abscesses, cysts, coronary and root development failures, agenesis, unerupted or supernumerary teeth, fractured roots remaining in the subgingival area, tooth or bone resorption, (associated with neoplasia or periodontal disease) and Internal tooth structures such as diameter of pulp chamber and root canal. The present article aims to show, through clinical case reports, the relevance of the radiographic examination towards the correct diagnosis and therapeutic approach of subclinical infections, even in patients without signs of pain or supposedly gingivitis bearers. Amongst the reported cases, there is a root hipoplasia, a dental origin cyst and a tooth resorption, all diagnosed after intra-oral radiographic completion.

A comparison of the sealing abilities between Biodentine and MTA as root-end filling materials and their effects on bone healing in dogs after periradicular surgery

ABSTRACT Objectives: To compare the sealing ability and biocompatibility of Biodentine with mineral trioxide aggregate (MTA) when used as root-end filling materials. Methodology: The Cell Counting Kit-8 (CCK-8) assay was used to compare the cytotoxicity of MTA and Biodentine. Twenty-one extracted teeth with a single canal were immersed in an acidic silver nitrate solution after root-end filling. Then, the volume and depth of silver nitrate that infiltrated the apical portion of the teeth were analyzed using micro-computed tomography (micro-CT). Seventy-two roots from 3 female beagle dogs were randomly distributed into 3 groups and apical surgery was performed. After six months, the volume of the bone defect surrounding these roots was analyzed using micro-CT. Results: Based on the results of the CCK-8 assay, MTA and Biodentine did not show statistically significant differences in cytotoxicity (P>0.05). The volume and the depth of the infiltrated nitrate solution were greater in the MTA group than in the Biodentine group (P<0.05). The volume of the bone defect was larger in the MTA group than in the Biodentine group. However, the difference was not significant (P>0.05). The volumes of the bone defects in the MTA and Biodentine groups were smaller than the group without any filling materials (P<0.05). Conclusions: MTA and Biodentine exhibited comparable cellular biocompatibility. Biodentine showed a superior sealing ability to MTA in root-end filling. Both Biodentine and MTA promoted periradicular bone healing in beagle dog periradicular surgery models.

Influence of apical enlargement on the repair of apical periodontitis in rats.

AIM: To evaluate the influence of different apical enlargement protocols on the radiographic and histological healing of apical periodontitis in rats. METHODOLOGY: Apical periodontitis was induced bilaterally in the mandibular right and left first molars of 24 Wistar rats by pulp exposure to the oral cavity for 3 weeks. A standard serial root canal preparation technique was performed in the molar of one side, whilst the opposite side was the control group. Rats were randomly divided into three experimental groups (n = 8), according to the diameter of apical enlargement during root canal preparation: K-files size 20 (EG1), size 25 (EG2) and size 30 (EG3). Each animal was its own positive control, because the opposite arch remained untreated. Root canals were filled with a standard technique. After 3 weeks, the animals were euthanized. The main outcome of apical periodontitis healing was evaluated radiographically (mm2 ) and histologically (ordinal scores of inflammation) using a HE staining technique. The measurement of effect was obtained between the three experimental groups by carrying out generalized estimating equations, with Poisson regression with robust variance, pairing each experimental group with its respective control group within animals, adjusted for the mean within animal differences, with α = 5%. RESULTS: The mean and standard deviations of radiographic apical periodontitis size (mm2 ) and intensity of histological inflammatory scores were, respectively: EG1 (0.44 ± 0.27; 2.25 ± 0.46), EG2 (0.33 ± 0.10; 2.50 ± 0.53) and EG3 (0.22 ± 0.08; 2.63 ± 0.74). After 3 weeks, a significantly more favourable radiographic repair was observed when larger apical enlargement was performed (EG3), compared to EG1 and EG2 (P = 0.001). All experimental groups were associated with a significant difference on the radiographic and histological healing of apical periodontitis compared with its respective control group. CONCLUSION: Under the experimental conditions of this study, a larger apical enlargement protocol favoured a more rapid radiographic repair of apical periodontitis in rats after a 3-week follow-up.

Tomografia computadorizada de feixe cônico no diagnóstico de reabsorção radicular externa em dentes permanentes reimplantados: uma investigação em vivo / Reabsorção externa radicular associada ao traumatismo dentário: comparação entre radiografia periapical e tomografia computadorizada cone beam - uma investigação in vivo / Cone beam computed tomography in the diagnosis of external root resorption in replanted permanent teeth: an in vivo investigation

As reabsorções radiculares externas progressivas inflamatórias (RREI) e por substituição (RRES) representam a sequela mais frequente em dentes permanentes reimplantados ou que sofreram luxações intrusivas. O exame clínico, incluindo os sinais e sintomas e ainda os exames complementares, em destaque os exames radiográficos são fatores determinantes para o diagnóstico. A radiografia periapical (RP) é o exame complementar de escolha para o acompanhamento em casos de RRE, no entanto, as imagens bidimensionais apresentam sobreposições de estruturas anatômicas. Para suprir as limitações apresentadas pelas radiografias convencionais as imagens multiplanares vêm sendo amplamente utilizadas, destacando-se a tomografia computadorizada de feixe cônico. O objetivo do presente estudo foi fazer uma avaliação do desempenho de exames de imagem da TCFC e de radiografias periapicais para diagnóstico dos diferentes tipos de RRE pós-traumáticas, em diferentes estágios. A amostra foi composta por 29 pacientes, com 39 incisivos superiores reimplantados após avulsão. Radiografias periapicais e TCFC realizadas no mesmo dia foram examinadas de forma independente por 2 avaliadores, a fim de identificar a presença, o tipo e a extensão da reabsorção radicular nos dois exames. As reabsorções leves e as inflamatórias foram mais frequentemente identificadas pela TCFC enquanto as reabsorções moderadas a severas e por substituição nas radiografias periapicais. Pode-se concluir que apenas uma técnica radiográfica não é suficiente para o diagnóstico de todos os tipos e gravidade de RRE, sendo assim a TCFC é importante para complementar o exame periapical, principalmente em estágios iniciais.

The progressive external inflammatory root resorptions (IERR) and substitution (RERR) represent the most frequent sequelae in permanent teeth replanted or that suffered intrusive dislocations. The clinical examination, including the signs and symptoms and the complementary exams, highlighting the radiographic examinations are determining factors for the diagnosis. Periapical radiography (PR) is the complementary exam of choice for follow-up in RRE cases, however, two-dimensional images show overlaps of anatomical structures. In order to overcome the limitations presented by conventional radiographs, multiplanar images have been widely used, particularly concomitant computed tomography. The objective of the present study was to make a evaluation of the performance of CBCT and periapical radiographs for the diagnosis of different types of posttraumatic RRE at different stages. The sample consisted of 29 patients, with 39 superior incisors reimplanted after avulsion. Periapical radiographs and CBCT performed on the same day were independently examined by 2 evaluators in order to identify the presence, type and extent of root resorption in both examinations. Mild and inflammatory resorptions were more frequently identified by CBCT while moderate to severe resorptions and by replacement in periapical radiographs. It can be concluded that only one radiographic technique is not sufficient for the diagnosis of all types and severity of RER, so CBCT is important to complement periapical examination, especially in the early stages.

Influence of Endodontic Treatment and Coronal Restoration on Status of Periapical Tissues: A Cone-beam Computed Tomographic Study.

INTRODUCTION: This cross-sectional study determined the prevalence of apical radiolucency in 1290 root canal-treated teeth and the correlation between endodontic treatment quality and the presence of coronal restorations with apical radiolucency using cone-beam computed tomographic imaging. METHODS: Cone-beam computed tomographic scans were analyzed, and teeth were classified as healthy or diseased according to the periapical status. Other factors were also evaluated for their association with the apical diagnosis including sex, quality of endodontic treatment, presence of coronal restorations and posts, and apical level of filling. RESULTS: Of the treated teeth, 48.83% were classified as healthy. Only 55.11% of the teeth had endodontic treatment rated as adequate. The quality of endodontic treatment and the presence of coronal restoration were statistically correlated with the presence or absence of an apical radiolucency (P < .0001). Combined data revealed that teeth with both adequate endodontic treatment and the presence of coronal restoration showed significantly better apical status than the other combinations (P < .001). Canals filled up to 0-2 mm short of the apex had a significantly higher number of teeth rated as healthy compared with overfilled or underfilled cases (P = .001). The presence of a post was not found to be a statistical significant factor (P = .81). CONCLUSIONS: Data showed a relatively high prevalence of apical radiolucencies in root canal-treated teeth. The quality of the endodontic treatment, the presence of coronal restoration, and apical extent of the root canal filling were significantly associated with healthy apical tissues.

Prevalence of Treponema spp. in endodontic retreatment-resistant periapical lesions.

This study investigated the presence of the Treponema species in longstanding endodontic retreatment-resistant lesions of teeth with apical periodontitis, the association of this species with clinical/radiographic features, and the association among the different target species. Microbial samples of apical lesions were collected from twenty-five adult patients referred to endodontic surgery after unsuccessful root canal retreatment. Nested-PCR and conventional PCR were used for Treponema detection. Twenty-three periradicular tissue samples showed detectable levels of bacterial DNA. Treponema species were detected in 28% (7/25) of the cases. The most frequently detected species were T. socranskii (6/25), followed by T. maltophilum (3/25), T. amylovorum (3/25), T. lecithinolyticum (3/25), T. denticola (3/25), T. pectinovorum (2/25) and T. medium (2/25). T. vicentii was not detected in any sample. Positive statistical association was found between T. socranskii and T. denticola, and between T. maltophilum and T. lecithinolyticum . No association was detected between the presence of any target microorganism and the clinical or radiographic features. Treponema spp. are present, in a low percentage, in longstanding apical lesions from teeth with endodontic retreatment failure.

Traumatized immature teeth treated with 2 protocols of pulp revascularization.

INTRODUCTION: Pulp revascularization may be considered a promising alternative for traumatized necrotic immature teeth. The aim of this study was to evaluate traumatized immature teeth treated with 2 protocols of pulp revascularization. METHODS: Twenty-three teeth of young patients (7-17 years old) with necrotic upper incisors caused by dental trauma were divided into 2 groups; one group was treated with triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) (TAP) (n = 12), and the other was medicated with combination of calcium hydroxide and 2% chlorhexidine gel (CHP) (n = 11). Patients were treated and followed up for a period from 9-19 months in 2 dental institutions for evaluation of clinical and radiographic data. RESULTS: Most of the teeth were affected by lateral luxation (47.8%). Clinical evaluation in group TAP showed significant reduction in spontaneous pain (P = .01), pain on horizontal percussion (P = .007), and pain on palpation (P = .03), whereas group CHP showed significant reduction in pain on vertical percussion (P = .03). Crown discoloration was observed significantly more in teeth of group TAP (83.3%) (P < .002). On radiographic exam, periapical repair was found in all TAP-treated teeth (P = .03). Similarly, the same findings were found for all teeth treated with CHP with exception of 1 tooth (P = .21). Apical closure was significantly observed in both groups (P < .05). Increase in root length was demonstrated in 5 teeth (41.7%) and 3 teeth (27.3%) of groups TAP and CHP, respectively. Thickening of lateral dentinal walls was observed in 5 teeth of each group. CONCLUSIONS: Revascularization outcomes for traumatized patients treated with the tested protocols presented similar clinical and radiographic data. However, TAP caused esthetic problem leading to tooth discoloration, which can be considered a disadvantage when compared with CHP.

Success rate of single- versus two-visit root canal treatment of teeth with apical periodontitis: a randomized controlled trial.

INTRODUCTION: The aim of this study was to evaluate the outcome of single- versus 2-visit root canal treatment of teeth with apical periodontitis after a 2-year follow-up period. METHODS: Three hundred maxillary and mandibular nonvital teeth with apical periodontitis were treated in either a single visit or 2 visits. The main inclusion criteria were radiographic evidence of apical periodontitis (minimum size ≥ 2.0 × 2.0 mm) and a diagnosis of pulpal necrosis confirmed by a negative response to hot and cold tests. Radiographically, all teeth showed small and irregular periapical radiolucencies before treatment. The canals were enlarged with LightSpeedLSX (Discus Dental, Culver City, CA) root canal instruments to a final apical preparation size #60 for anterior and premolar teeth and size #45 to #55 for molars. The EndoVac negative-pressure irrigation system (Discus Dental) was used for disinfecting irrigation, and all canals were filled by lateral compaction of gutta-percha and Sealapex sealer (SybronEndo, Orange, CA). The healing results were clinically and radiographically evaluated 2 years postoperatively. RESULTS: Of the 300 teeth treated, 18 were lost to follow-up, 9 in the 2-visit group and 9 in the 1-visit group. Of the 282 teeth studied, the randomization procedure had allocated 146 teeth to 1-visit treatment and 136 teeth to 2-visit treatment. Teeth with symptoms of persisting periapical inflammation were scored as not healed. Teeth with a reduced periapical rarefaction were judged as uncertain. Teeth with complete restitution of the periodontal contours were judged as healed. In the 1-visit group, 141 of 146 teeth (96.57%) were classified as healed as compared with 121 (88.97%) of 136 teeth in the 2-visit group. Eleven cases were classified as uncertain in the 2-visit group (8.08%) compared with 4 (2.73%) in the 1-visit group. Two of 10 teeth in the 2-visit group presented with pain before the 2-year follow-up and were classified as not healed. The hypothesis tests were conducted at the 0.05 level of significance. Statistical analysis of the healing results did not show any significant difference between the groups (P = .05). CONCLUSIONS: Several factors play an important role in the decision-making process of 1- versus 2-visit endodontics. Among these are objective factors like preoperative diagnosis, the ability to obtain infection control, root canal anatomy, procedural complications, and subjective factors like patients' signs and symptoms. This study provided evidence that with a treatment protocol with instrumentation to predefined larger apical instrumentation sizes and irrigation with a negative apical pressure system can lead to healing in cases of apical periodontitis, which is a significant finding compared with more dated studies that showed average healing of apical periodontitis cases. With the given sample size, there was no statistically significant difference between the 2 treatment modalities.

Surgical experience influences 2-stage implant osseointegration.

PURPOSE: With the increasing number of surgical procedures for osseointegrated implant placement, there has also been an increase in the number of professionals performing this procedure. Surgeons undergo different types of training, and this may influence their surgical experience. The objective of this study was to evaluate the effect of surgical experience on the osseointegration of dental implants. MATERIALS AND METHODS: A retrospective study was conducted using clinical charts from 2002 through 2008, during which time 265 implants were performed in 110 patients by 2 professionals who completed a postgraduate program in implant dentistry in 2002. Cases were selected for degree of difficulty, avoiding those involving areas that required bone grafts for the placement of implants, with a regular platform (3.75) and a height ranging from 10 to 13 mm. The criteria for evaluating implant osseointegration included clinical and radiographic evidence observed for a minimum period of 1 year, in accordance with the success criteria proposed by Albrektsson et al:(1)1) individual, unattached implant is immobile when tested clinically; 2) radiograph does not demonstrate evidence of peri-implant radiolucency; 3) vertical bone loss is less than 0.2 mm annually after the first year postimplantation; and 4) individual implant performance is characterized by an absence of signs and symptoms such as pain, infections, neuropathies, paresthesia, or violation of the mandibular canal. Implantation was performed in 2 stages. To relate the osseointegration rate with professional experience, cases were arranged by increasing order of placement date and were then evaluated per year and region. They were then separated into 2 groups: first 50 implants performed and implants performed after the first 50. RESULTS: The osseointegration rate of implants performed was 92.5%, with rates of 87.6% for those placed in the maxilla and 95.6% for those in the mandible. For the first 50 implants, the osseointegration rate was 84.0%, whereas in the implants performed thereafter, the rate was 94.4%. CONCLUSION: Surgical experience acquired during and after a postgraduate program in implant dentistry appears to influence osseointegration of dental implants, with a higher osseointegration rate found in implants performed by more experienced professionals.

Quantitative analysis of bone density in direct digital radiographs evaluated by means of computerized analysis of digital images.

OBJECTIVES: minimal density variations of mineralized tissues can be reliably detected with quantitative image subtraction analysis. The aim of this study was to evaluate quantitative variations of in vitro mineral density by varying the exposure time of direct digital radiographs using a computer assisted densitometric image analysis (CADIA) program. METHODS: in a human mandibular segment a three-wall periodontal defect was created mesial to a molar. Bone chips were created from the marrowbone of the same mandible with masses of 1 to 5 mg. A triplicate radiograph of the defect was taken as a baseline for seven different exposure times. The bone chips were inserted into the defect and another triplicate series of radiographs for the seven exposure times were taken as follow-up images. The images were analysed using CADIA software to detect variations in bone density. RESULTS: the results of CADIA revealed increased density when the size of the inserted bone chip increased. The 2 mg chip was underestimated owing to mass reduction during insertion. The regression line of the CADIA values was consistent with the weight of the bone chips of 1, 3, 4 and 5 mg. The exposure time f6 (0.178 s) showed the best correlation with the bone chip weight. Loss of information in the images occurred when the exposure time exceeded the sensor's latitude. CONCLUSIONS: CADIA analysis is a reliable and sensitive tool for detecting subtle bone density variations. More reliable results are obtained with increased exposure time; however, excessive exposure should be avoided.

Outcome of root canal treatment in dogs determined by periapical radiography and cone-beam computed tomography scans.

The purpose of this study was to compare the favorable outcome of root canal treatment determined by periapical radiographs (PRs) and cone beam computed tomography (CBCT) scans. Ninety-six roots of dogs' teeth were used to form four groups (n= 24). In group 1, root canal treatments were performed in healthy teeth. Root canals in groups 2 through 4 were infected until apical periodontitis (AP) was radiographically confirmed. Roots with AP were treated by one-visit therapy in group 2, by two-visit therapy in group 3, and left untreated in group 4. The radiolucent area in the PRs and the volume of CBCT-scanned periapical lesions were measured before and 6 months after the treatment. In groups 1, 2, and 3, a favorable outcome (lesions absent or reduced) was shown in 57 (79%) roots using PRs but only in 25 (35%) roots using CBCT scans (p = 0.0001). Unfavorable outcomes occurred more frequently after one-visit therapy than two-visit therapy when determined by CBCT scans (p = 0.023).

Comparison of radiographic measurements obtained with conventional and indirect digital imaging during endodontic treatment.

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

In vitro evaluation of a method for obtaining periapical radiographs for diagnosis of external apical root resorption.

This in vitro study was conducted to evaluate a method to obtain reproducible periapical radiographs, using individualized positioning devices, of upper central incisors submitted to simulated orthodontic movement. Linear measurements of tooth length were carried out on 29 extracted human central incisors. The teeth were radiographed in a tissue simulator, at different inclinations in the bucco-lingual direction (0 initial, 0 control, -10, -5, +5, and +10 degrees). The radiographs were digitized and quantitative analysis of tooth length was carried out using an electronic ruler. The linear measurements of tooth length were reproducible (r = 0.99) for repeated measurements as well as in the comparison of the initial and control images at 0 degree, where measurements did not differ significantly (analysis of variance, P = 0.827) in radiographs with different angulations. These results show that the method proposed for obtaining in vitro periapical radiographs results in reproducible images of tooth length, even when orthodontic movement is simulated by inclination of the tooth up to 20 degrees in the bucco-lingual direction.

Comparison of hard tissue density changes around implants assessed in digitized conventional radiographs and subtraction images.

OBJECTIVES: The aim of this in vivo study was to compare peri-implant bone density assessed by the mean gray value of the histogram in digitized conventional radiographs and two digital subtraction images (DSI) methods: linear and logarithmic. MATERIAL AND METHODS: Thirty-four patients were monitored by standardized periapical radiographs 1 week after surgery and 4 months later. The radiographs were digitized and manipulated by means of EMAGO software. Linear and logarithmic DSI were obtained, and a filter was added to the logarithmic image. Control and test regions were selected and the mean value of the gray level of the histogram of these selected areas was obtained. This process was carried out in the digitized conventional radiographs (DCR) and the two methods of DSI. After that, the images were divided into two groups, with and without bone loss, and statistical analysis was performed. RESULTS: The results indicate that differences between the jaws did not reach significance, in all the images and in the two groups with and without bone loss. Furthermore, there was no statistically significant difference between the radiographic density assessed in the DCR and the two methods of subtraction images. CONCLUSIONS: Monitoring of peri-implant bone density by the mean gray value of the histogram in a selected area can be assessed either by linear and logarithmic DSI or by DCR.

Conventional and digital radiographic methods in the detection of simulated external root resorptions: a comparative study.

OBJECTIVES: The purpose of this study was to evaluate and to compare the efficacy of a conventional and a digital radiographic method in diagnosing simulated external root resorption cavities. METHODS: Human dry mandibles containing teeth were covered with bovine muscle slices in order to simulate the soft tissues. Nine teeth from each dental group were investigated. Three periapical radiographs of each tooth were taken in an orthoradial, mesioradial and distoradial aspect using conventional film (Insight Kodak F-speed; Eastman Kodak, Rochester, NY) and a digital sensor (DRS Gnatus System; Gnatus, Ribeirao Preto, Brasil). The teeth were extracted using a forceps and had 0.7 mm and 1.0 mm deep cavities prepared on their vestibular, mesial and distal surfaces at the cervical, middle and apical thirds. Following preparation, each tooth was replaced in its alveolus and new radiographs were taken. Three dental professionals, an endodontist, a radiologist and a general practioner, evaluated the images. RESULTS: A larger number of cavities (P<0.05) were detected by the digital method when compared with the conventional method, for all depths of lesions. CONCLUSIONS: The results of this study suggest that the digital radiographic method is more sensitive than conventional radiography to detect simulated external root resorption cavities.

Radiographic evaluation of the effect of endotoxin (LPS) plus calcium hydroxide on apical and periapical tissues of dogs.

The aim of this study was the radiographic evaluation of the apical and periapical region of dog teeth submitted to intracanal bacterial endotoxin (lipopolysaccharide, LPS), associated or not with calcium hydroxide. After removal of the pulp, 60 premolars were divided into four groups and were filled with bacterial endotoxin (group 1), bacterial endotoxin plus calcium hydroxide (group 2), saline solution (group 3), or periapical lesions were induced with no treatment (group 4), for a period of 30 days. Similar periapical lesions were observed in groups 1 and 4. The lamina dura was intact in groups 2 and 3. Bacterial endotoxin (LPS) caused radiographically visible periapical lesions, but when associated with calcium hydroxide, this endotoxin was detoxified.

The contribution of trabecular bone to the visibility of the lamina dura: an in vitro radiographic study.

OBJECTIVE: The objective of this study was to determine the degree to which trabecular bone contributes to the radiographic visibility of lamina dura. STUDY DESIGN: Segments of human cadaver mandible were obtained and split longitudinally. Two identical radiographs were made of each segment (1) before the removal of any additional bone and after (2) the removal of a small amount of the lamina dura at the apex of a tooth, (3) block removal of trabecular bone, and (4) smoothing of the endosteal surface of the external cortex. The radiographs were projected in random pairs for each sample. Six dentists judged whether a difference in the amount of lamina dura could be detected between 2 sets of radiographs. RESULTS: Chi-square analysis revealed a significant radiographic difference between radiographs made initially and after removal of the lamina dura and trabecular bone. CONCLUSIONS: Fewer than half of the changes of lamina dura loss alone could be detected radiographically by the observing dentists, whereas nearly all cases of the loss of periapical lamina dura in conjunction with loss of trabecular bone could be detected.