Surgical treatment of nasal fractures may benefit from intraoperative 3D imaging.

This retrospective study aimed to assess the effects of the use of intraoperative three-dimensional (3D) imaging on outcomes in surgical treatment of nasal fractures. Furthermore, we investigated whether the use of intraoperative imaging improves outcomes and decreases the frequency of corrective surgeries compared to published literature. This retrospective descriptive study included patients who underwent operative treatment for nasal fractures with the use of intraoperative 3D imaging between January 2015 and January 2020 at a University Hospital. The primary outcome measure was patient satisfaction, which was assessed through patient charts about subjective esthetic problems and nasal obstruction. The secondary outcome measures were the number of intraoperative images and necessity of intra- and postoperative revisions. All the outcomes were evaluated using regression analysis. Of the 172 patients, secondary rhinoplasty and intraoperative revision were performed in 10 (6 %) and 93 (54 %) patients, respectively. Postoperatively, 19 (11 %) and 12 (7 %) patients complained of subjective esthetic problems and nasal obstruction, respectively. The intraoperative revision rate in patients undergoing surgical treatment of nasal fractures with intraoperative 3D imaging was >50 %. However, the incidence of postoperative secondary revision, nasal obstruction, and subjective esthetic problems was lower than that reported in the literature not having an intraoperative imaging. Our findings suggest that prompt quality control of the operative result enables immediate correction and prevents postoperative revision.

Influence of CBCT filters and contrast adjustments on peri-implant buccal bone thickness measurement and blooming expression.

OBJECTIVES: To assess whether filter and contrast adjustments can improve the accuracy of CBCT in measuring the buccal bone thickness (BBT) adjacent to dental implants by reducing blooming artifacts. MATERIALS AND METHODS: Homogeneous bone blocks with peri-implant BBT of 0.3 mm, 0.5 mm, and 1 mm were scanned using the Orthophos SL system. Three dentists measured the BBT in 234 CBCT scans under different settings of contrast adjustments and 'Sharpen' filter activation. Additionally, implant diameter measurements were taken to assess blooming artifact expression. The differences between tomographic and actual measurements of BBT and implant diameter [(CBCT - actual) * 100 / actual] were subjected to Mixed ANOVA (α = 0.05). RESULTS: The group with the thinnest BBT (0.3 mm) had the greatest difference between tomographic and actual measurements (79.9% ± 29.0%). Conversely, the 0.5 mm (36.1% ± 38.4%) and 1 mm (29.4% ± 12.3%) groups exhibited lower differences (p < 0.05). 'Sharpen' filter activation reduced blooming expression since it resulted in a lower difference for implant diameter (p < 0.05), but it did not influence BBT measurements (p = 0.673). Contrast settings had no impact on BBT (p = 0.054) or implant diameter measurements (p = 0.079). CONCLUSION: Although filter activation reduced blooming artifacts, neither filter nor contrast adjustments improved the accuracy of CBCT in measuring peri-implant BBT; actual BBT influenced this task. CLINICAL RELEVANCE: When assessing the peri-implant buccal bone plate in the CBCT system studied, dental surgeons may find it beneficial to adjust contrast and apply filters according to their preferences, since such adjustments were found to have no adverse effects on the diagnostic accuracy of this task. The use of the 'Sharpen' filter may lead to improved representation of implant dimensions.

Periapical Lesions in Panoramic Radiography and CBCT Imaging-Assessment of AI's Diagnostic Accuracy.

Background/Objectives: Periapical lesions (PLs) are frequently detected in dental radiology. Accurate diagnosis of these lesions is essential for proper treatment planning. Imaging techniques such as orthopantomogram (OPG) and cone-beam CT (CBCT) imaging are used to identify PLs. The aim of this study was to assess the diagnostic accuracy of artificial intelligence (AI) software Diagnocat for PL detection in OPG and CBCT images. Methods: The study included 49 patients, totaling 1223 teeth. Both OPG and CBCT images were analyzed by AI software and by three experienced clinicians. All the images were obtained in one patient cohort, and findings were compared to the consensus of human readers using CBCT. The AI's diagnostic accuracy was compared to a reference method, calculating sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and F1 score. Results: The AI's sensitivity for OPG images was 33.33% with an F1 score of 32.73%. For CBCT images, the AI's sensitivity was 77.78% with an F1 score of 84.00%. The AI's specificity was over 98% for both OPG and CBCT images. Conclusions: The AI demonstrated high sensitivity and high specificity in detecting PLs in CBCT images but lower sensitivity in OPG images.

Dentigerous cyst in the medial wall of maxillary sinus.

This is the image of dentigerous cyst detected in the medial wall of maxillary sinus, a rare location for the mentioned cyst, which emphasizes the superiority of radiographic features from the site of the lesion. Moreover, the present case showed no facial asymmetry despite the extension of the lesion.

[The use of fixed expanders with orthodontic miniscrews support in children with mesial occlusion]. / Ispol'zovanie nes"emnykh rasshiritelei s vnutrikostnoi oporoi u detei s mezial'noi okklyuziei.

OBJECTIVE: Prevention of the development of pronounced skeletal abnormalities in patients with mesial occlusion. MATERIALS AND METHODS: Biometric analysis of control and diagnostic models of dentition was performed in 60 patients with dental anomalies before and after treatment in 3 mutually perpendicular planes to identify violations in the formation of dental arches by sagittal and transversal dimensions, and alveolar processes - by vertical dimensions (methods of A. Pont, G. Korkhaus). Measurements of 23 parameters of TRG and sections of CBCT were carried out using the modified Nad-Ars technique with analysis of skeletal parameters before and after treatment. Treatment was carried out using dilators for the upper jaw in combination with a facial mask and further dynamic observation using active retention devices. RESULTS: The results of treatment showed an increase in the length of the anterior segment of the upper dental arch by 2.8±0.55 mm (p<0.05 mm); expansion in the area of temporary molars by 2.85±0.65 mm (p<0.05); in the area of permanent molars by 2.75±0.55 mm (p<0.05); in the area of the apical basis of HF by 3.82±0.45 mm (p<0.05). The length of the lower dental arch in the anterior segment has not changed. Analysis of TRG parameters showed a significant increase in the values of

Recommendation for reducing the crystalline lens exposure dose by reducing imaging field width in cone-beam computed tomography for image-guided radiation therapy: an anthropomorphic phantom study.

In cone-beam computed tomography (CBCT) for image-guided radiation therapy (IGRT) of the head, we evaluated the exposure dose reduction effect to the crystalline lens and position-matching accuracy by narrowing one side (X2) of the X-ray aperture (blade) in the X-direction. We defined the ocular surface dose of the head phantom as the crystalline lens exposure dose and measured using a radiophotoluminescence dosimeter (RPLD, GD-352 M) in the preset field (13.6 cm) and in each of the fields when blade X2 aperture was reduced in 0.5 cm increments from 10.0 to 5.0 cm. Auto-bone matching was performed on CBCT images acquired five times with blade X2 aperture set to 13.6 cm and 5.0 cm at each position when the head phantom was moved from - 5.0 to + 5.0 mm in 1.0 mm increment. The maximum reduction rate in the crystalline lens exposure dose was - 38.7% for the right lens and - 13.2% for the left lens when blade X2 aperture was 5.0 cm. The maximum difference in the amount of position correction between blade X2 aperture of 13.6 cm and 5.0 cm was 1 mm, and the accuracy of auto-bone matching was similar. In CBCT of the head, reduced blade X2 aperture is a useful technique for reducing the crystalline lens exposure dose while ensuring the accuracy of position matching.

Preoperative assessment of bone density for dental implantation: a comparative study of three different ROI methods.

BACKGROUND: Dental cone beam computed tomography (CBCT) is commonly used to evaluate cancellous bone density before dental implant surgery. However, to our knowledge, no measurement approach has been standardized yet. This study aimed to evaluate the relationship between three different regions of interest (ROI) methods on cancellous bone density at the dental implant site using dental CBCT images. METHODS: Patients' dental CBCT images (n = 300) obtained before dental implant surgery were processed using Mimics (Materialise, Leuven, Belgium). At the potential implant sites, the rectangle, cylinder, and surrounding cylinder ROI methods were used to measure bone density. Repeated measures one-way analysis of variance was performed to compare the three ROI methods in terms of measurement results. Pearson correlation analysis was performed to identify the likely pair-wise correlations between the three ROI methods. RESULTS: The density value obtained using the surrounding cylinder approach (grayscale value [GV],523.56 ± 228.03) was significantly higher than the values obtained using the rectangle (GV, 497.04 ± 236.69) and cylinder (GV,493 ± 231.19) ROI methods in terms of results. Furthermore, significant correlations were noted between the ROI methods (r > 0.965; p < 0.001). CONCLUSIONS: The density measured using the surrounding cylinder method was the highest. The choice of method may not influence the trends of measurement results. TRIAL REGISTRATION: This study was approved by the Institutional Review Board of China Medical University Hospital, No. CMUH111-REC3-205. Informed consent was waived by the Institutional Review Board of China Medical University Hospital, CMUH111-REC3-205, owing to the retrospective nature of the study.

Effect of Orthodontic Treatment on the Outcomes of Endodontically Treated Teeth: a CBCT analysis.

INTRODUCTION: Objective: Often there is the need of moving endodontically treated teeth. Orthodontic movement may have no effect on the prognosis of teeth with root canal treatment (RCT). To verify this subject, we evaluated the effect of orthodontic movement on the prognosis of RCT teeth using cone-beam computed tomography (CBCT) and further explored the influence of orthodontic movement on the prognosis of RCT teeth with and without apical periodontitis (AP). MATERIALS AND METHODS: This retrospective study was conducted by evaluating 169 RCT teeth of 100 patients who had undergone fixed orthodontic treatment. AP was assessed and classified using the CBCT periapical index. Univariate analysis of RCT outcome was performed for the total RCT group, RCT without AP group and RCT with AP group. Multivariate logistic regression was performed for the total RCT group and RCT without AP group, respectively, but not for the RCT with AP group. Variables related to the prognosis of RCT were included, such as age, gender, tooth position, RCT quality, coronal restoration quality, periodontal condition, orthodontic traction distance, and orthodontic rotation angle. RESULTS: The orthodontic traction distance and rotation angle were not significantly correlated to the RCT outcomes, regardless of the presence of AP. Among the total RCT group, teeth with unqualified RCT (OR = 3.42, P = 0.004) and inadequate coronal restoration (OR = 4.40, P = 0.031) had a lower success rate. Of the 97 RCT teeth without AP, unqualified RCT was a risk factor for treatment failure (OR = 3.55, P = 0.041). Of the 72 RCT teeth with AP, the univariate analysis showed that RCT quality were significantly related to the outcome (p = 0.042). CONCLUSION: Orthodontic movement had no effect on the prognosis of RCT teeth regardless of the presence of AP.

Anatomy and function of the canalis sinuosus and its injury prevention and treatment strategies in implant surgery. / çª¦ç®¡çš„è§£å‰–ä¸ŽåŠŸèƒ½åŠå ¶åœ¨ç§æ¤æœ¯ä¸­æŸä¼¤çš„é˜²æ²»ç­–ç•¥.

The canalis sinuosus, a canal containing the anterior superior alveolar nerve bundle, originates from the infraorbital canal and extends along the maxillary sinus and nasal cavity edges to the anterior maxilla. It was once regarded as an anatomical variation. However, with the widespread application of cone beam computed tomography (CBCT), the detection rate of canalis sinuosus in the population has increased. The canalis sinuosus exhibits diverse courses, branching into multiple accessory canals and terminating at the nasal floor or the anterior tooth region, with the majority traversing the palatal side of the central incisor. The anterior superior alveolar nerve bundle within the canalis sinuosus not only innervates and nourishes the maxillary anterior teeth, their corresponding soft tissues, and the maxillary sinus mucosa, but also relates to the nasal septum, lateral nasal wall, and parts of the palatal mucosa. To minimize surgical complications, implantologists need to investigate strategies for preventing and treating canalis sinuosus injuries. Preoperatively, implantologists should use CBCT to identify the canalis sinuosus and virtually design implant placement at a distance of more than 2 mm from the canalis sinuosus. Intraoperatively, implantologists should assess bleeding and patient comfort, complemented by precision surgical techniques such as the use of implant surgical guide plates. Postoperatively, CBCT can be employed to examine the relationship between the implant and the canalis sinuosus, and treatment of canalis sinuosus injuries can be tailored based on the patient's symptoms. This review summarizes the detection of canalis sinuosus in the population, its anatomical characteristics, and its physiological functions in the anterior maxilla, and discusses strategies for effectively avoiding canalis sinuosus injuries during implant surgery, thereby enhancing implantologists' awareness and providing references for clinical decision-making.

Key insights into antiresorptive drug use and osteonecrosis in osteoporotic patients undergoing tooth extractions: A clinical and CBCT assessment.

This study investigates the effects of antiresorptive drugs and risk factors for medication-related osteonecrosis of the jaws in osteoporotic patients undergoing tooth extraction. Among the findings, antiresorptive-treated patients had thicker lamina dura and longer healing times. Additionally, corticosteroid intake and multi-rooted teeth carried a higher osteonecrosis risk. Bone sequestrum indicated osteonecrosis. PURPOSE: To describe the effects of antiresorptive drugs (ARD) in the maxilla and mandible and risk factors for medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients undergoing tooth extractions using clinical data and cone beam computed tomography (CBCT). METHODS: This retrospective cohort study collected clinical and CBCT data from 176 patients. The study group (n = 78; 224 extractions) received ARD treatment, underwent tooth extraction, and had a pre-operative CBCT. Additionally, age-, sex-, and tooth-matched controls were selected (n = 98; 227 extractions). Radiographic examinations were performed independently by three calibrated examiners. Statistical analysis included Chi-square, Fisher's exact, Mann-Whitney U, and t-tests to contrast clinical and radiographic data between study and control, MRONJ + and MRONJ - , and bisphosphonate and denosumab patients/sites. Significance was set at p ≤ 0.05. RESULTS: From the study group, 4 patients (5%) and 5 sites (2%) developed MRONJ after tooth extraction. ARD-treated patients exhibited significantly more thickening of the lamina dura and a longer average mucosal healing time (4.4 weeks) than controls (2.6 weeks). In the study group, MRONJ risk significantly increased with corticosteroid intake and in multi-rooted teeth. No significant differences between bisphosphonates and denosumab use were seen in the tomographic features (p > 0.05). Lastly, bone sequestrum was exclusively observed in osteoporotic patients, who exhibited post-operative exposed bone or histological evidence of osteonecrosis. CONCLUSION: Osteoporotic patients under ARD may exhibit thickening of the lamina dura and prolonged post-operative healing. Among these patients, multi-rooted teeth are at higher risk for MRONJ than single-rooted teeth. Sequester formation is a radiographic indicator of osteonecrosis.

Central giant cell granuloma in the posterior region of mandible mimicking a fibro-osseous lesion and hemangioma: a case report.

BACKGROUND: A central giant cell granuloma (CGCG) is a benign, proliferative, intraosseous, and non-odontogenic lesion occurring primarily in children and young adults. On the histological level, it is characterized by numerous multinucleated giant cells scattered randomly throughout a sea of spindle-shaped mesenchymal stromal cells which are dispersed throughout the fibrovascular connective tissue stroma containing areas of haemorrhage. When it comes to radiographic features, CGCG can have an array of variations, ranging from well-defined expansile lesions to ill-defined and destructive lesions, with or without expansion. CASE PRESENTATION: This case report reviews an 11-year-old Caucasian patient with a chief complaint of slow-growing swelling involving the right posterior mandibular region. The cone beam computed tomography (CBCT) revealed an ill-defined mixed lesion mimicking both fibro-osseous lesion and hemangioma. However, microscopic examination revealed multinucleated giant cells in a fibrous stroma suggestive of central giant cell granuloma. CONCLUSION: Our intent in reporting this case is to highlight the importance of thorough clinical, radiographical and histopathological examination for accurate diagnosis and therapeutic interventions as well as to emphasize the importance of taking different possibilities into consideration when examining bony swellings in the head and neck region.

Exploring age and gender variations in root canal morphology of maxillary premolars in Saudi sub population: a cross-sectional CBCT study.

BACKGROUND: In complex teeth like maxillary premolars, endodontic treatment success depends on a complete comprehension of root canal anatomy. The research on mandibular premolars' root canal anatomy has been extensive and well-documented in existing literature. However, there appears to be a notable gap in available data concerning the root canal anatomy of maxillary premolars. This study aimed to explore the root canal morphology of maxillary premolars using cone-beam computed tomography (CBCT) imaging, considering age and gender variations. METHODS: From 500 patient CBCT scans, 787 maxillary premolar teeth were evaluated. The sample was divided by gender and age (10-20, 21-30, 31-40, 41-50, 51-60, and 61 years and older). Ahmed et al. classification system was used to record root canal morphology. RESULTS: The most frequent classifications for right maxillary 1st premolars were 2MPM1 B1 L1 (39.03%) and 1MPM1 (2.81%), while the most frequent classifications for right maxillary 2nd premolars were 2MPM1 B1 L1 (39.08%) and 1MPM1 (17.85%). Most of the premolars typically had two roots (left maxillary first premolars: 81.5%, left maxillary second premolars: 82.7%, right maxillary first premolars: 74.4%, right maxillary second premolars: 75.7%). Left and right maxillary 1st premolars for classes 1MPM1 and 1MPM1-2-1 showed significant gender differences. For classifications 1MPM1 and 1MPM1-2-1, age-related changes were seen in the left and right maxillary first premolars. CONCLUSION: This study provides novel insights into the root canal anatomy of maxillary premolars within the Saudi population, addressing a notable gap in the literature specific to this demographic. Through CBCT imaging and analysis of large sample sizes, the complex and diverse nature of root canal morphology in these teeth among Saudi individuals is elucidated. The findings underscore the importance of CBCT imaging in precise treatment planning and decision-making tailored to the Saudi population. Consideration of age and gender-related variations further enhances understanding and aids in personalized endodontic interventions within this demographic.

Automatic cephalometric landmark identification with artificial intelligence: An umbrella review of systematic reviews.

OBJECTIVES: The transition from manual to automatic cephalometric landmark identification has not yet reached a consensus for clinical application in orthodontic diagnosis. The present umbrella review aimed to assess artificial intelligence (AI) performance in automatic 2D and 3D cephalometric landmark identification. DATA: A combination of free text words and MeSH keywords pooled by boolean operators: Automa* AND cephalo* AND ("artificial intelligence" OR "machine learning" OR "deep learning" OR "learning"). SOURCES: A search strategy without a timeframe setting was conducted on PubMed, Scopus, Web of Science, Cochrane Library and LILACS. STUDY SELECTION: The study protocol followed the PRISMA guidelines and the PICO question was formulated according to the aim of the article. The database search led to the selection of 15 articles that were assessed for eligibility in full-text. Finally, 11 systematic reviews met the inclusion criteria and were analyzed according to the risk of bias in systematic reviews (ROBIS) tool. CONCLUSIONS: AI was not able to identify the various cephalometric landmarks with the same accuracy. Since most of the included studies' conclusions were based on a wrong 2 mm cut-off difference between the AI automatic landmark location and that allocated by human operators, future research should focus on refining the most powerful architectures to improve the clinical relevance of AI-driven automatic cephalometric analysis. CLINICAL SIGNIFICANCE: Despite a progressively improved performance, AI has exceeded the recommended magnitude of error for most cephalometric landmarks. Moreover, AI automatic landmarking on 3D CBCT appeared to be less accurate compared to that on 2D X-rays. To date, AI-driven cephalometric landmarking still requires the final supervision of an experienced orthodontist.

Novel AI-based tool for primary tooth segmentation on CBCT using convolutional neural networks: A validation study.

BACKGROUND: Primary teeth segmentation on cone beam computed tomography (CBCT) scans is essential for paediatric treatment planning. Conventional methods, however, are time-consuming and necessitate advanced expertise. AIM: The aim of this study was to validate an artificial intelligence (AI) cloud-based platform for automated segmentation (AS) of primary teeth on CBCT. Its accuracy, time efficiency, and consistency were compared with manual segmentation (MS). DESIGN: A dataset comprising 402 primary teeth (37 CBCT scans) was retrospectively retrieved from two CBCT devices. Primary teeth were manually segmented using a cloud-based platform representing the ground truth, whereas AS was performed on the same platform. To assess the AI tool's performance, voxel- and surface-based metrics were employed to compare MS and AS methods. Additionally, segmentation time was recorded for each method, and intra-class correlation coefficient (ICC) assessed consistency between them. RESULTS: AS revealed high performance in segmenting primary teeth with high accuracy (98 ± 1%) and dice similarity coefficient (DSC; 95 ± 2%). Moreover, it was 35 times faster than the manual approach with an average time of 24 s. Both MS and AS demonstrated excellent consistency (ICC = 0.99 and 1, respectively). CONCLUSION: The platform demonstrated expert-level accuracy, and time-efficient and consistent segmentation of primary teeth on CBCT scans, serving treatment planning in children.

Alveolar bone retention following treatment of dilacerated labial inversely impacted maxillary central incisors-a retrospective study.

The root of late-dental-age labial inversely impacted maxillary central incisors (LIIMCIs) typically develops to severe dilacerated morphology. Therefore, reliable posttreatment periodontal estimates of orthodontic treatment prognosis would be critical to the treatment value of impacted incisors. This study aims to analyze further changes in dimensions of the alveolar bone following the closed-eruption treatment of late-dental-age dilacerated LIIMCIs. Cone beam computed tomography (CBCT) scanning data of 16 patients with unilateral dilacerated late-dental-age LIIMCIs were collected, including the pretreatment (T1) and at the 2.23 ± 0.78 years follow-up stage (T2) respectively. Patients underwent closed-eruption treatments to bring the impacted incisor into the dental arch. Dolphin imaging software was used to measure alveolar bone height labially, palatally, and proximally to the site at T1 and T2, as well as alveolar bone thicknesses at 0, 2, 4, 6 and 8 mm below the initial measurement plane (IMP). The alveolar bone heights on the impacted and contralateral sides increased from T1 to T2 (p < 0.05). Alveolar bone growth on both sides had no significant difference. In T2, the mean values of labial and distal alveolar heights on the contralateral sides were greater than on the impacted sides (p < 0.05). The mean values of total alveolar bone thicknesses on the impacted sides in T1 were significantly smaller than those on the contralateral sides in IMP-0, 2, 4, 6, 8 (p < 0.05). The total thicknesses on the impacted sides in T2 increased and were significantly greater than on the contralateral sides (p < 0.05), except for the thickness in IMP-0. The closed-eruption treatment of dilacerated late-dental-age LIIMCIs results in no significant changes to alveolar bone height, except on the labial and distal sides, with increased alveolar bone thickness, suggesting that this approach may be viable first choice therapy for non-extraction orthodontic cases.

Investigation of the relationship of the maxillary sinus floor with maxillary posterior teeth using cone beam CT.

BACKGROUND: Any intervention to the maxillary posterior teeth (MPT) and alveola pose a risk of sinus perforation. Given the proximity of these structures, this study aimed to investigate the relationship between the maxillary sinus (MS) and MPT. MATERIALS AND METHODS: CBCT images obtained from 207 patients (mean age, 45 ± 17 years; age range: 18-92 years) including 99 females and 108 males were examined retrospectively. Patients with sinus pathologies affecting the structure of MS and a history of oral and maxillofacial surgery were excluded from the study. On these images, the relationship of maxillary sinus floor (MSF) with 2 premolars and 3 molars was examined bilaterally for each patient using Kwak H. H. et al.'s classification. The presence, number, frequency and location of septa within the MSF were investigated. RESULTS: Examination of a total of 410 maxillary sinuses on the images of 207 patients with no sinus perforation or pathology revealed that septa were most commonly (48.7%) located in the middle segment (second molars). When the relationship between the MSF and MPT was evaluated, molar teeth were found to have a closer relationship with the MSF than premolars. CONCLUSIONS: It is believed that the findings of this study may provide further guidance to the dental practitioners and other clinicians for future studies.

Tomographic Planning of Dental Implants Using a Smartphone: Linear Measurements and Implant Selection-A Cross-Sectional Study.

PURPOSE: This study assessed the accuracy of linear measurements and dental implant selection performed in a smartphone application compared to a computer software. MATERIALS AND METHODS: Forty-four DICOM files from partially edentulous patients in the posterior region of the mandible were evaluated by three trained and calibrated examiners. Images were analyzed using three visualization methods: cross-sectional view (CScr) and coronal (CSco) plane using the CS 3D Imaging software, and coronal (DRco) plane using the DroidRender smartphone application. For the purpose of standardization, measurements of bone width and height were taken in the edentulous posterior region of the mandible, 10 mm posterior to the mental foramen. Dental implant selection was made according to Straumann® Standard implant catalog 2022/2023. Linear measurements were compared using the ANOVA test for repeated measurements and implant selection was compared using the Friedman test. Statistical analysis was performed using the SPSS software, considering a significance level of 5%. RESULTS: Linear measurements showed a statistically significant difference for bone width (p = 0.030), but not for height (p = 0.685). The choice of implant was not influenced by the visualization method (p = 0.614). CONCLUSION: It is possible to suggest the use of smartphone applications as an additional diagnostic tool for DICOM evaluation and dental implant planning in the posterior region of the mandible. Smartphone applications allow an assessment not limited to 2D images or to static environments. Therefore, information exchange and diagnostic opinion in emergency situations may be facilitated.

Two- and three-dimensional healing assessment after endodontic microsurgery in through-and-through periapical lesions: 5-year follow-up from a randomized controlled trial.

AIM: To evaluate clinical and radiographic outcome of endodontic microsurgery in through-and-through periapical lesions at 1-year and 5-year follow-up with adjunct use of platelet-rich plasma (PRP). METHODOLOGY: Thirty-two patients with large through-and-through periapical lesions were randomized in platelet-rich plasma (PRP) group and control group. Two-dimensional (2D) healing was evaluated with Molven's criteria and three-dimensional (3D) healing with modified PENN 3D criteria. Healing at resection plane (R), apical area (A), buccal cortex (BC), palatal cortex (PC) and overall bone healing (B) was assessed using CBCT scans. The volume of lesion was measured using ITK-Snap software. The analysis included comparison of 1- to 5-year intragroup (Friedman test/McNemar test) and intergroup scoring (Chi-square/ Mann-Whitney test). Logistic regression analysis was performed to determine the effect of various factors on healing at 5 years. RESULTS: Out of 32 patients/59 teeth evaluated after 1-year of endodontic microsurgery, 24 patients/44 teeth reported at 5 - year follow-up. Healing assessment with modified PENN 3D criteria revealed improvement in overall success rate of 66.7% at 1 year to 83.3% at 5 years, with no deterioration in any healing category. PRP group exhibited significantly better 3D healing than control group; both at 1 year (84.6% vs. 45.5%) and 5 years (100% vs. 63.6%). A significantly higher number of completely healed teeth were observed in PRP group than the control group at 5 years with respect to R, BC and B parameters. A volume reduction of 88% (91.4% PRP, 84% control) was depicted at 1 year and 94% (97.1% PRP, 91.1% control) at 5 years. None of the recorded factors including age, gender, size of lesion, preoperative swelling and sinus, histology of lesion, use of PRP, tooth location, preoperative buccal bone had significant effect on 3D healing at 5 years. CONCLUSIONS: This 5-year study suggested improvement in 3D radiographic healing of large through-and-through periapical lesions from 1 to 5 years with no deterioration in any healing parameter in both control and PRP groups. The additional use of PRP led to significantly better healing in such lesions. RACB index using CBCT allows better estimation of healing at resected, apical and cortical plane over modified PENN 3D or Molven's criteria.

Morphology and classification of the second mesiobuccal canal in maxillary first molars: a cone-beam computed tomography analysis in a Chinese population.

BACKGROUND: Understanding the tooth anatomy is crucial for ensuring effective endodontic treatment. This study investigated the root canal morphology of the second mesiobuccal (MB2) canal in maxillary first molars (MFMs) in a Chinese population using cone-beam computed tomography (CBCT). METHODS: This study evaluated 486 MFMs with MB2 canals from 285 participants undergoing CBCT examination and determined the Vertucci's classification and position of the MB2 canal orifice. The prevalence of the MB2 canal was correlated with the sex, age, and tooth side. The correlations between the prevalence of the MB2 canal and sex and tooth side were assessed using the Fisher's exact test. The chi-square test was used for evaluating the correlation between the prevalence of the MB2 canal and age. RESULTS: The number of type II, III, IV, V, VI, VII, and other root canals in the MFMs was 30.9%, 0.6%, 65.0%, 1.2%, 1.2%, 0.4%, and 0.6%, respectively. Among the 201 cases with bilateral inclusion, 87.6% showed consistent canal configuration. Results of the first clear apparent position (FCAP) of the MB2 canals showed that 434, 44, and 3 teeth had FCAP at the upper, middle, and bottom one-third of the root, respectively. The FCAPs of the MB2 canal in the MFMs with types II, IV, and VI, as well as types III and V canals showed significant differences (p<0.05). The horizontal distance between the MB1 and MB2 canal orifices in the type II canals of MFMs was significantly lesser than those in the type IV canals of MFMs (p < 0.01). The longitudinal distance between the pulp chamber floor plane and MB2 canal orifice significantly correlated with age (p < 0.05). CONCLUSIONS: The morphology of the mesiobuccal root canal in the MFMs is complex. Complete understanding of the anatomical morphology of the root canal combined with the CBCT and dental operating microscope is necessary for the accurate detection of the MB2 canal and consequently improved success rate of root canal treatment. Our study findings can help endodontists improve endodontic treatment outcomes.

Assessment of Mesiobuccal Canals in Endodontically Treated Teeth in Indore Population by Cone Beam Computed Tomography: A Cross-Sectional Study.

BACKGROUND: Owing to the complicated anatomical nature of maxillary molars, untreated root canals may directly affect the outcome of root canal therapy. Therefore, cone beam computed tomography (CBCT) scan is an important tool in the evaluation of root canal systems, particularly for the detection of the second mesiobuccal (MB2) canal in maxillary molars. AIMS AND OBJECTIVES: The current study was undertaken to detect and evaluate filled/unfilled MB2 canals in endodontically treated, asymptomatic maxillary molars, and its correlation with periapical pathology by utilizing cone beam computed tomography (CBCT). MATERIAL AND METHOD: A retrospective study of 80 CBCTs of patients underwent scanning for various treatment modalities, with asymptomatic endodontically treated permanent maxillary first molars selected. Data collection occurred between January and June 2023. CBCT machine used was KODAK 9000 (Rochester, NY: Carestream Health) (Complementary Metal Oxide Semiconductor {CMOS} sensor, continuous mode and 12-28 sec scan time, 90-500 µm voxel size, and 5x3.5 cm field of view {FOV}). The axial images at mid-root level were used to assess the presence of the MB2 canal. RESULT: The study included 39 (48.8%) right maxillary first molars and 41 (51.3%) left maxillary first molars. Overall, in 62 (77.5%) maxillary first molars, MB2 was missed by the practicing dentist, and in 13 (16.3%) maxillary first molars MB2 canal was not present. Of all the maxillary first molars with MB2 canal (n=67), 53 (79.1%) canals had a periapical infection, five (7.5%) showed widening of periodontal ligament space whereas nine (13.4%) had no abnormality. CONCLUSION: MB2 canals were present in the majority of cases and most of the unfilled MB2 canals showed evidence of periapical radiolucencies and showed a direct impact on the prognosis.