Accuracy of CBCT images in the volumetric assessment of residual root canal filling material: Effect of voxel size.

AIMS: Our aim was to compare three different voxel sizes of CBCT images for the determination of residual filling material volume in root canals when compared with micro CT. MATERIAL AND METHODS: Forty-two root canals of 14 extracted human maxillary molar teeth were retreated by using ProFile® instruments. Images were obtained after retreatment by using ProMax 3D Max CBCT at 3 different voxel sizes (1) High resolution (0.1 mm); (2) High definition (0.15 mm); and (3) Normal resolution (0.2 mm). Two observers measured volumes of residual filling materials in exported CBCT images by means of 3D Doctor Software. Micro CT measurements were served as gold standard. Mann-Whitney U test and Wilcoxon Test were used for the comparison of CBCT and micro CT measurements. Statistical significance was set at P < 0.05. RESULTS: No statistically differences were found between the two observers for all measurements (P > 0.05). There were no significant differences among different CBCT voxel sizes used (0.1 mm, 0.15 mm, and 0.2 mm) (P > 0.05). The Spearman correlation coefficients between CBCT at different voxel sizes significantly highly correlated with micro CT measurements for each observer (P < 0.05). Furthermore, no significant differences were found between the measurements obtained by the two observers in consideration to root canal location (P > 0.05). CONCLUSION: CBCT images may provide useful information in the volumetric assessment of the amount of residual filling material in root canals for retreatment procedures.

Micro-CT evaluation of the removal of root fillings using the ProTaper Universal Retreatment system supplemented by the XP-Endo Finisher file.

AIM: To compare the removal of root fillings in extracted teeth using the ProTaper Universal Retreatment system (PTUR) followed by a supplementary preparation with the XP-Endo Finisher file. METHODOLOGY: The mesiobuccal root canals of 30 extracted mandibular first molars were instrumented with ProTaper Universal NiTi files up to F2 and filled with one of the following sealers using a single-cone technique (n = 10): AH Plus, NeoMTA Plus and EndoSequence BC. The root fillings were removed using the PTUR system with additional apical preparation using ProTaper F2 and F3 files. Then, an additional preparation with an XP-Endo Finisher file was performed. The samples were scanned using micro-CT before and after retreatment and again after the use of the XP-Endo Finisher to assess the volume of remaining filling material. Data were analysed by Kruskal-Wallis and Friedman's two-way analysis of variance tests with Bonferroni correction. RESULTS: No significant difference in the initial filling volume was observed amongst the groups (P > 0.05). The amount of filling materials in each group decreased significantly after retreatment with rotary files (P < 0.05). After initial retreatment, the volume of the remaining filling amongst the groups was similar (P > 0.05). Additional preparation with the XP-Endo Finisher improved the removal of filling materials regardless of the sealer type (P < 0.05). CONCLUSIONS: In the mesiobuccal root canals of extracted mandibular first molars, additional preparation using an XP-Endo Finisher file, after using the PTUR system and F3 ProTaper instruments, enhanced the removal of filling materials from root canals.

The morphometry of the cavernous part of the internal carotid artery.

BACKGROUND: In the study, the morphometric evaluation of internal carotid artery (ICA) was performed in order to show the differences between the age groups and genders. MATERIALS AND METHODS: In the study, descriptive measurements of intercarotid distance on the computed tomography of 173 (88 male [M], 85 female [F]) pa- tients and the intercavernous distance on magnetic resonance images (MRIs) of 49 (19 M, 30 F) individuals were reviewed. RESULTS: Intercarotid distance was found to be close to the border of statistical significance and for results of the comparative measurements that were per- formed in the study; no significant sex-associated difference was observed for the distance between the gender and midpoint of the sella turcica and medial margin of the right ICA. Compared to gender, the distance between the base of the sella turcica and the base of the left ICA is found to be closed to of statistical significance. A statistically significant difference was obtained for the distance between the midpoint of sella turcica and medial margin of the left ICA and for the distance between the base of the sella turcica and the base of right ICA. Although it is observed that there is a weak correlation between the age and the distance between midpoint of the sella turcica and medial margin of the right ICA, statistically there is a significant difference between them. CONCLUSIONS: Obtained results, planning of surgical interventions are supportive and guiding in terms of prevention of damage of to ICA in three dimensional thinking and operations.

Evaluation of hyaluronic matrix efficacy in sinus augmentation: a randomized-controlled histomorphometric and micro-computed tomography analysis.

The objective of the present study was to test the hypothesis that the addition of hyaluronic acid-based matrix to collagenated heterologous bone graft for sinus augmentation would enhance bone formation compared to collagenated heterologous bone graft alone in the early healing period, by micro-computed tomography and histomorphometry. Thirteen systemically healthy patients requiring bilateral two-stage maxillary sinus augmentation (residual crest height≤4mm) were enrolled in this split-mouth prospective randomized controlled study. One sinus side as a control group was grafted with only collagenated heterologous bone graft; the other region as a test group was grafted with hyaluronic matrix and collagenated heterologous bone graft. Bone biopsy samples were taken after 4 months during the dental implant surgery and analyzed using micro-computed tomography and histomorphometric parameters. According to the micro-computed tomography and histomorphometric results, a significantly higher percentage of new bone was observed in the test group when compared to the control group after 4 months of healing. This study confirmed the hypothesis that the addition of hyaluronic matrix to collagenated heterologous bone graft for sinus augmentation enhances bone formation compared to collagenated heterologous bone graft alone in the early healing period.

The prevalence and distribution of the atherosclerotic plaques in the abdominal aorta and its branches.

BACKGROUND: The aim of our study was to determine the existence, distribution, type and burden of the atherosclerotic plaques which are found in the abdominal aorta, its branches and the branching points. MATERIALS AND METHODS: Two hundred and sixty-one patients (117 female, 144 male; mean age 53.34 ± 16.02, range 12-84) who underwent dual-source computed tomography angiography (CTA) were retrospectively analysed. The prevalence and distribution of the plaques in the proximal, middle and distal parts of abdominal aorta and its branches; coeliac trunk, superior and inferior mesenteric arteries, renal arteries, splenic artery and common, external and internal iliac arteries and in the aortic orifices, the type and severity of these plaques and their relations with age and gender were studied. RESULTS: In our study, 69.3% of the patients had atherosclerotic plaques, mostly at the distal part of abdominal aorta. The existence of the plaques increased with age. The types of these plaques were mixed (43%), calcified (24%) and soft (3%). Mixed and calcified plaques were more common in the abdominal aorta and its branches, respectively. All of the arteries except for inferior mesenteric artery mostly had mild plaques. The plaques at the branching points, which were most frequently localised in the aortic bifurcation, were found in the 41.8% of the patients. The plaques in the branches were usually accompanied by atherosclerosis of abdominal aorta. CONCLUSIONS: Dual-source CTA enables mapping of atherosclerotic burden in abdominal arteries. Knowing the localisation, type and severity of the atherosclerotic plaques can be important to predict the clinical results and choose the proper treatment.

An anatomical study of the origins of the medial circumflex femoral artery in the Turkish population.

The medial circumflex femoral artery (MCFA) usually branches from the deep femoral artery (DFA). It may also branch from the femoral artery (FA). In this study 100 inguinal regions of 50 cadavers were investigated. In 79 extremities (79%) MCFA branched from DFA, while in 15 (15%) it branched from FA. In four extremities (4%) MCFA was found to be double; in each case one of MCFAs branched from FA and the other from DFA. In one of these four cases the lateral circumflex femoral artery (LCFA) was also double. In one case we found a common trunk of DFA and MCFA and in another case a common trunk of MCFA, DFA and LCFA. Clinicians must be familiar with the variations of this clinically important artery to improve their success in the diagnosis and treatment of pathologies in the region.

Multiple variations of the deep artery of arm: double deep artery of arm and deep artery of arm with the superior ulnar collateral artery. A case report.

Multiple variations of the deep artery of arm were observed during routine gross anatomic dissection of the right upper extremity of a 54-year-old male cadaver. In this case study, a double deep artery of arm and the deep artery of arm with the superior ulnar collateral artery were reported. The anatomic origin of the deep artery of arm is variable. In the literature, a double deep brachialis since its origin is reported in 0.7% and the deep brachial with the superior ulnar collateral artery in 22.3%. Such variations are considered to be occurring during embryologic development. These type of variations are important both in surgical and clinical situations.

Right internal iliac vein joining the left common iliac vein: case report demonstrated by CT angiography.

An unusual variation of the iliac veins was detected by computed tomography (CT) angiography in a 35-year-old man. In coronal CT reconstructions, it was shown that the right internal iliac vein of this patient crossed to the left side and drained to the left common iliac vein. This variation is important in retroperitoneal, laparoscopic and orthopedic surgery. We present the CT findings and discuss the embryological origin of this unusual congenital anomaly.

Quantitative analysis of myelinated axons of commissural fibers in the rat brain.

In this study, the myelinated axons of the rostrum, genu, truncus and splenium parts of the corpus callosum and of the anterior, posterior and habenular commissures were counted in the rat brain by using a camera lucida. The numerical densities of these axons were compared with each other by means of quantitative analytical statistical methods. In parts of the corpus callosum, a statistically significant difference was found between the rostrum and genu, rostrum and truncus, rostrum and the splenium, genu and truncus, and the genu and splenium. However, no statistically significant difference was found between the truncus and splenium. When comparing the number of myelinated axons of the anterior, posterior and habenular commissures, statistically significant differences were found between the anterior and posterior commissures, and between the anterior and habenular commissures. No statistically significant difference was found between the posterior and habenular commissures. Small sized myelinated axons were present in all parts of the corpus callosum and in the anterior commissure. However, a heterogeneous distribution of myelinated axons was present in the posterior and habenular commissures.

Studies on the location of the mental foramen in Turkish mandibles.

The position of the mental foramen was studied in 58 adult Turkish skulls which were divided into two groups according to age. A previously published method was used to determine the position of the mental foramen. The most common position of the mental foramen lies in line with the longitudinal axis passing between the first and second premolars. This result was in accordance with classical textbooks. Another measurement was also performed on the mental foramen in both groups. The distance between the mental foramen and the mandibular symphysis (A) and the distance between the mental foramen and the inferior border of the mandible (B) were measured. There was a significant difference between the two groups in B, but not in A.

Anatomy of the celiac trunk examined by CT imaging of 104 individuals.

The diameter, length and emergence level of the celiac trunk is measured with CT angiography in 104 patients who have no shown abnormality in the abdomen. The celiac trunk emerged at T 12 level in 79.8%, at L 1 level in 14.4% and at T 11 level in 3.8% of the patients. The mean length of the celiac artery was 6.69 +/- 1.22 mm in the females and 7.13 +/- 1.18 in the males. The mean diameter of the celiac artery was 2.87 +/- 0.52 cm in the males and 2.75 +/- 0.59 in the females. There was no correlation between the diameter and the length. The values are in accordance with cadaveric studies and can be used as criteria for diagnosis of celiac narrowing and aneurysms.

Multiple variations in the azygos venous system: a preaortic interazygos vein and the absence of hemiazygos vein.

Multiple variations of the azygos venous system were detected during routine dissection. The hemiazygos vein was underdeveloped. On the left side of the thorax, posterior intercostal veins between the 8th and 11th intercostal spaces and the subcostal vein drained into the azygos vein independently. In addition, the posterior 4th, 5th, 6th and 7th intercostal veins united and formed two superior and inferior trunks. The superior common trunk, at the level of the T4 vertebra, crossed the vertebral column obliquely, lying anterior to the aorta and posterior to the esophagus, opening into the azygos vein at the level of the T4 vertebra. The other structures in this part were normal. There were different courses of the azygos vein system. This variation is important in mediastinal surgery and also in the interpretation of radiographs.

Abnormal digastric muscle with unilateral quadrification of the anterior belly.

During dissection of the submental region we observed that the anterior belly of the left digastric muscle had four separate insertions. These muscle bands united in a common tendon as they continued with the posterior belly. This is an anatomical variation in the mylohyoid digastric muscle group in the floor of the mouth. When an asymmetry in the floor of the mouth is detected during diagnostic procedures, such as radiologic studies, anomalies of the anterior belly of the digastric muscle should be considered besides other reasons of asymmetry. Additionally, possible occurrence of such anomalies should be remembered during surgical procedures involving the submental region. This unique variation has not been reported in the literature.

Three-dimensional (3-D) reconstruction of the human coccygeal body.

The three-dimensional reconstructions of the human coccygeal bodies were undertaken using semi-thin serial sections which were cut from the tissue specimens taken from the ventral parts of the tip of the coccyges of four patients. The coccygeal bodies were observed in the form of convoluted, irregular helical tubes. The diameters of the coccygeal bodies in serial sections were measured and a statistical analysis performed. The lumens of the coccygeal bodies were not observed in the twisted parts of the tissue specimens. Depending upon to the irregular courses of the lumens and their lack of appearances in the twisted areas, we are unable to show the three-dimensional reconstructions of the lumens of the coccygeal bodies. In conclusion, this is the first study reporting the three-dimensional reconstruction of the contours of the coccygeal body. These type of studies, which were done by using serial sections will be very helpful for the understanding of the little known organs of the human body.

A study of variations of transverse foramens of cervical vertebras in human: accessory foramina in shape and number.

Transverse foramens of 250 cervical vertebras were examined. There were accessory foramina and variations in shape and number in 10 out of 250 cervical vertebras. Since such a variation of foramens, through which the vertebral artery passes, has not been detected in the literature, these ten cases are to be considered.

Origin of the radial and ulnar arteries: variations in 81 arteriograms.

In a retrospective review of 81 upper extremity arteriograms, 8 (9.8%) origin anomalies of the major arteries were detected. High origin of the radial artery from the brachial artery was the most frequent variation, found in 7 (8.6%) cases representing 87.5% of all variations in this series. In one case, the left ulnar artery originated from the axillary artery, accounting for 12.5% of the variations. These anomalous origins of the upper extremity arteries can be explained on the basis of the embryologic development. It is important for the surgeons and radiologists to be aware of the possible arterial variations in order to prevent complications during surgical and diagnostic procedures.

Frequency of cavum veli interpositi in non-psychotic population: a magnetic resonance imaging study.

This prospective MRI investigation was performed to determine the incidences of the cavum veli interpositi (CVI) in 505 (242 Male, 263 Female) non-psychotic persons. The mean age of the population was 39,179 +/- 0,904 (40,461 +/- 1,395 Male, 38 +/- 1,166 Female). There was no significant difference between the means of age in male and female groups (t-test, DF=479, p>0,05). The incidences of the CVI were 5.77%, 1.89%, 5.66%, 8.24%, 5%, 4.55%, 7.94%, 3.03% for age group of 0-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79 respectively. There was no significant difference between the incidences of the CVI in age-groups (chi(2)=3.804, DF=7, p>0.05). The incidences of the CVI were 5.54%, 6.61%, 4.56% for whole, male, and female populations respectively. There was no significant difference between the incidences of the CVI in both sexes (chi(2)=1.01, DF=1, p>0.05).

A bilateral location anomaly of the parotid gland (case report).

During an anatomic dissection of the parotid region inferiorly located parotid glands were noted on both sides. Because within the glands lies the external carotid artery, retromandibular vein and the facial nerve, surgeons should have detailed knowledge of the anatomy of this region and possible variations to avoid risk of damaging, especially the facial nerve. Also the unusual location of the gland may be confused with pseudomass during CT or MRI.

A connecting branch between the musculocutaneous nerve and the median nerve.

We report here a connecting branch between the musculocutaneous and the median nerves in a 42 years old male cadaver. The connecting branch was 8 cm in length and 3 mm in width. One of the brachial veins and the brachial artery were located between the roots of the median nerve and the second brachial vein was present between the connecting branch and the median nerve. These kinds of variations may effect the venous return and may cause edema in the upper extremities. Additionally, variations of these nerves have an importance during operations of this region.

Ultrastructure of the lens epithelium in Alport's syndrome.

The ultrastructure of the lens epithelium in Alport's syndrome was studied. In a transmission electron-microscopic examination, a large number of tonofilaments, swollen mitochondria, a dilated Golgi complex, a dilated rough endoplasmic reticulum with electron-dense (osmiophilic) material in some of these irregular structures and myelin figures were observed. Most of the cells had regularly shaped and only a few of them irregularly shaped nuclei. Additionally, polymorphism and marked degeneration in the transitional zone were observed in the scanning electron-microscopic examination of the lens epithelium. After the transitional zone, there were no epithelial cells present under the lens capsule, an observation that has never been reported in the literature.