Digital analyses of Bolton tooth size ratios and their association to gender, angle class, and other occlusal traits: a study using a partially automated digital 3D model analysis.

BACKGROUND: This study aims to verify Bolton's values for tooth size ratios and to evaluate possible relationships to different occlusal traits using precise digital measurement methods. MATERIALS AND METHODS: Including 1000 consecutively selected patients from three study centres a digital, partially automated model analysis was performed utilizing the software OnyxCeph. The measurements comprised tooth width for calculation of anterior (AR) and overall ratio (OR) as a percentage, arch width, length, perimeter, overjet, overbite, space analysis in millimetre and the assessment of the angle classification. RESULTS: AR and OR were significantly increased compared to Bolton's ratios of 77.2% (AR) and 91.3% (OR). In the gender comparison, male patients showed larger tooth size ratios, especially in the OR. Patients with Angle Class II/1 and II/2 had smaller tooth size ratios than patients with Angle Class III and I. Thus, patients with Angle Class II/1 had the largest tooth diameters in all maxillary teeth and with Angle Class II/2 the smallest tooth sizes in the mandible. The largest tooth widths in the lower jaw were observed in the Angle Class III patient group. Furthermore, a negative correlation from AR/OR to overjet, overbite, and available space in lower jaw as well as a positive correlation to available space in upper jaw was detected. CONCLUSIONS: There is a clear correlation between the tooth size ratios and the present dysgnathia as well as other orthodontically relevant occlusal traits. This prior knowledge about our patients is extremely important to create an individualized treatment plan and enable sufficient occlusion. To achieve a functionally good occlusion with correct overjet and overbite, it is essential that the maxillary and mandibular teeth are proportional in size. Any deviation from the ideal patient in terms of tooth size, number, shape, or arch must be considered in the pre-therapeutic treatment plan in combination with the existing dysgnathia in order to be able to achieve a stable anterior and posterior occlusion with appropriate adjustments to the therapy post-therapeutically.

Comparative evaluation of the accuracy of electronic apex locators and cone-beam computed tomography in detection of root canal perforation and working length during endodontic retreatment.

BACKGROUND: To evaluate the accuracy of the electronic apex locators (EALs), and Cone-Beam Computed Tomography (CBCT) scanning, both in working length (WL) determination and in the detection of root canal perforations in retreatment cases. METHODS: Sixty human mandibular premolars were selected. After crown removal partially and canal access, root canals were instrumented and irrigated. The obturation process utilized gutta-percha and sealer with warm vertical compaction. Two groups were distinguished: one without perforation (Group 1) and the other with an apical third perforation (Group 2). Retreatment included filling removal, apical preparation, and irrigation. Actual working lengths (AWL) were determined using a stereomicroscope. CBCT images were used to measure CBCT working length (CWL), with adjustments for optimal views. Propex II and Dentaport ZX were used to measure electronic working length (EWL). Differences between EWL and AWL, as well as CWL, were analyzed to gauge accuracy. Data underwent Two-way ANOVA analysis. Measurements within ± 0.5 and ± 1 mm tolerance ranges were deemed successful for each device, followed by applying the Pearson Chi-square test. RESULTS: The study reveals no significant inter-group variations in device performance (p > .05). Dentaport ZX missed detecting perforation in two Group 2 (apical perforation) cases. For ± 1 mm tolerance, Propex II displayed the highest success in Group 2 (apical perforation). CONCLUSION: This study demonstrates the comparable performance of Propex II, Dentaport ZX, and CBCT in endodontic retreatment, providing insights into diagnostic reliability.

Clinicians' perspectives, inducements, preferences, and clinical experiences regarding the use of electronic apex locator and apex locator integrated engine-driven instrumentation: a cross-sectional study.

BACKGROUND: This study aimed to investigate the perspectives, preferences, and clinical experiences regarding using electronic apex locator and apex locator integrated instrumentation of dentists and endodontists. METHODS: A web-based questionnaire consisting of 3 parts and 23 closed-ended questions to achieve the objective of the study was carried out in ethical conditions between August and October 2023. The first part of survey included demographic information, while the second part was about evaluating electronic apex locator usage. In the last part, only participants' use of apex locator-integrated instrumentation was evaluated. Data were analyzed at a significance level of p < 0.05. RESULTS: A total of 297 clinicians, including 59 endodontists and 34 endodontic residents/Ph.D. students participated in the questionnaire. Endodontists and endodontic residents/Ph.D. students perform statistically significantly more root canal treatments per week on average (p = 0.001). For the working length determination method (multiple option question), 78.5% of participants use an electronic apex locator and 39.7% apex locator-integrated engines. However, the preference rate for electronic apex determination technique was generally 95.6%, with the full rate confirmation of endodontists and endodontic residents/Ph.D. students (100%). A total of 21 endodontists out of 59 prefer apex locator integrated engine-driven instrumentation. Although many of these specialized clinicians use this technique, they stated that they measure electronic working length passively for confirmation of the working length before (90.5%) and after the preparation (66.7%). CONCLUSIONS: Dentists, as well as endodontists, are skeptical about apex locator-integrated engine-driven instrumentation. Using this technique as a supporter rather than a primary way for preparation within safe limits may give safer results in terms of treatment outcomes.

Accuracy of Working Length Measurement Using Cone Beam Computed Tomography at Three Field of View Settings, Conventional Radiography, and Electronic Apex Locator: An Ex-vivo Study.

OBJECTIVES: Determining the working length (WL) in root canal treatment facilitates the treatment prognosis. The introduction of apex locators and new CBCT devices in dentistry influenced this consideration. This comparative study evaluated the accuracy of working length measurement by cone-beam computed tomography (CBCT) in three fields of view (FOVs), conventional radiography, and the apex locator Raypex 5. METHODOLOGY: The descriptive-analytical study was performed on 40 lower premolar teeth that met the inclusion criteria. Direct observation under the microscope was considered the gold standard and compared with measurements by the electronic apex locator, CBCT, and periapical images. RESULTS: The results were analyzed by paired t-tests and Wilcoxon tests. A significance level of 0.05 was considered in this study. CBCT 5×5 FOV with a p-value of 0.733 and analog radiography with a p-value of 0.001 achieved the working lengths with the highest and lowest accuracy, respectively. In addition, the difference between actual and measured working length using analog radiography was significant (p-value <0.05). CONCLUSIONS: According to the results of this study, CBCT images at different FOVs and those taken by the apex locator Raypex 5 can be used as a reliable method for estimating the working length. (EEJ-2023-10-141).

The usefulness of ultrasonography as a dynamic measurement system for visualizing root canal working length: an in vivo study.

OBJECTIVE: Although apex locators are generally effective tools for determining root canal working length, they may produce inaccurate results in some cases. The present study aimed to evaluate the efficacy of ultrasonography as an alternative method for measuring root canal length. MATERIALS AND METHODS: Forty-seven anterior teeth with apical lesions were selected for the study. Initially, an electronic apex locator was used to measure the working length. Subsequently, ultrasonography was employed to visualize the root apex and determine the working length. During ultrasound imaging, a K-file No. 15 was inserted into the root canal until its tip was visible on the ultrasound monitor. Measurements obtained from both methods were compared using an independent sample t-test. Correlations were assessed with the Pearson correlation coefficient, and agreement was determined using the Bland‒Altman plot. RESULTS: The mean working canal length was 19.9 mm for the apex locator and 20.6 mm for the ultrasonography-guided method. No significant differences were observed between the data obtained using the apex locator method and the data obtained using the ultrasonography guidance method. Furthermore, a high level of agreement was identified between the two techniques. CONCLUSION: Ultrasonography can be used to visualize the apex effectively and determine canal length, especially when canal length determination is uncertain for various reasons.

Reliability of predictive models based on the mesiodistal and buccolingual diameters of permanent canine teeth for sex estimation in forensic contexts: A systematic review and meta-analysis.

This study aimed to assess the reliability of predictive models for sex estimation based on permanent canine size. A systematic literature review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Six electronic databases were searched as the primary source of information. As a secondary source of information, a manual search was performed to identify additional relevant studies not captured in the initial search. After assessing the methodological quality and risk of bias with the Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews, the data were subjected to statistical tests for a meta-analysis of diagnostic test accuracy and Higgin's I2 statistic to evaluate the heterogeneity between the eligible studies. The systematic search resulted in 21 studies for qualitative synthesis, and 13 of them were selected for quantitative analysis. The analysis of 25 univariate predictive models showed an estimated sensitivity of 77.2 % and specificity of 67.1 %. Meta-regression analyses were performed for dental arch, the type of diameter and dental region outcomes for these univariate predictive models. Dental arch (p = 0.029) and the dental region of measurement (p = 0.001) were significant modifiers. The analysis of 25 multivariate predictive models showed an estimated sensitivity of 82.6 % and specificity of 70.1 %. There were significant methodological limitations and substantial heterogeneity among the included studies. Based on the results, there is insufficient high-quality scientific evidence to support the safe use of predictive models based on permanent canine measurements as the exclusive method for sex estimation in forensic settings.

Evaluation of the Golden Proportion, Golden Percentage, and Recurring Esthetic Dental Proportion in Kenyans of African Descent.

OBJECTIVES: To evaluate the validity of the Golden Proportion, Golden Percentage, and Recurring Esthetic Dental (RED) Proportion among Kenyans of African descent with naturally well-aligned teeth. MATERIALS AND METHODS: Standardized frontal photographic images of the smiles of 175 participants aged 18-35 years were obtained, and Adobe Photoshop was used to analyze and measure the frontal widths of the maxillary central and lateral incisors and canines in triplicate. The average teeth widths were calculated to determine the existence of the Golden Proportion, Golden Percentage, and RED Proportion, and their validity using independent sample t-tests to compare the differences in the mean teeth widths at α < 0.05. RESULTS: The number of male and female participants was 107 (61.1%) and 68 (38.9%), respectively. The Golden Proportion between the maxillary central and lateral incisors was found in 4.0% on the right and 2.8% on the left of all the participants, but between the maxillary lateral incisors and canines was found in only 0.6% on the right of male participants (p < 0.0001). The RED Proportion between the maxillary lateral and central incisors was in the range of 67%-70%, and between the canines and lateral incisors was 82%-84% (p < 0.0001). The proportion of RED was not constant, and gradually increased distally. The Golden Percentage of 15% was observed in the lateral incisors bilaterally; however, in the central incisors and the canines, the Golden Percentage was 22% and 12%, respectively. CONCLUSION: The Golden and RED Proportions were invalid determinants of anterior teeth proportions. The Golden Percentage existed only in the lateral incisors. The Golden Proportion, RED Proportion, and Golden Percentage theories may not be applicable to all populations when designing smiles. Racial and ethnic backgrounds are important considerations to establish objective quantifiable values of anterior tooth proportions that are beneficial for esthetic restorations.

Efficacy of electronic apex locators in comparison with intraoral radiographs in working length determination- a systematic review and meta-analysis.

BACKGROUND: Successful endodontic treatment needs accurate determination of working length (WL). Electronic apex locators (EALs) were presented as an alternative to radiographic methods; and since then, they have evolved and gained popularity in the determination of WL. However, there is insufficient evidence on the post-operative pain, adequacy, and accuracy of EALs in determining WL. OBJECTIVE: The systematic review and meta-analysis aims to gather evidence regarding the effectiveness of EALs for WL determination when compared to different imaging techniques along with postoperative pain associated with WL determination, the number of radiographs taken during the procedure, the time taken, and the adverse effects. METHODS: For the review, clinical studies with cross-over and parallel-arm randomized controlled trials (RCTs) were searched in seven electronic databases, followed by cross-referencing of the selected studies and related research synthesis. Risk of bias (RoB) assessment was carried out with Cochrane's RoB tool and a random-effects model was used. The meta-analysis was performed with the RevMan software 5.4.1. RESULTS: Eleven eligible RCTs were incorporated into the review and eight RCTs into the meta-analysis, of which five had high RoB and the remaining six had unclear RoB. Following meta-analysis, no significant difference in postoperative pain was found among the EAL and radiograph groups (SMD 0.00, CI .29 to .28, 354 participants; P value = 0.98). Radiograph group showed better WL accuracy (SMD 0.55, CI .11 to .99, 254 participants; P value = 0.02), while the EAL group had 10% better WL adequacy (RR 1.10, CI 1.03-1.18, 573 participants; P value = 0.006). CONCLUSION: We found very low-certainty evidence to support the efficacy of different types of EAL compared to radiography for the outcomes tested. We were unable to reach any conclusions about the superiority of any type of EAL. Well-planned RCTs need to be conducted by standardizing the outcomes and outcome measurement methods.

Three-dimensional evaluation of dental characteristics in patients with Cleidocranial dysplasia.

BACKGROUND: Cleidocranial dysplasia (CCD) is an autosomal dominant hereditary disorder. Besides skeletal abnormalities, CCD is often associated with dental complications, such as multiple supernumerary teeth and permanent teeth impaction or delayed eruption. METHODS: Supernumerary teeth of axial, sagittal and coronal CBCT view was characterized in detail and 3D image reconstruction was performed. Number and location of teeth, morphology of supernumerary teeth, positional relationship between supernumerary and adjacent permanent teeth, direction of supernumerary teeth in CCD patients were analyzed. RESULTS: The mean age of the 3 CCD patients in this study was 16.7 years. Among 36 supernumerary teeth, the majority of them were identified as apical side located and lingual side located. Normal orientation was the most common type in this study, followed by sagittal orientation, and horizontal orientation. Horizontal orientation teeth were all distributed in the mandible. Supernumerary teeth exhibited significantly shorter crown and dental-root lengths, as well as smaller crown mesiodistal and buccolingual diameters (P < 0.01). There was no difference in the number of supernumerary teeth between the maxilla and mandible, and the premolars region had the largest number of supernumerary teeth and the incisor region had the smallest number. CONCLUSIONS: This study compares number and location of teeth, morphology of supernumerary teeth, positional relationship between supernumerary and adjacent permanent teeth and direction of supernumerary teeth, this study also provides a reference for the comprehensive evaluation of CCD patients before surgery.

Canine sexual dimorphism in crown and root dimensions: a cone-beam computed tomographic study.

The primary step in forensic odontological analysis is sex determination. The present study is one of the few studies that evaluated the accuracy of the combination of canine tooth root length and crown measurements for sex determination. The study sample comprised 196 cone-be am computed tomographic scans of individuals aged 20-80 years distributed in five age categories: 20-29, 30-39, 40-49, 50-59, and 60+ years old. Different parameters, such as width, length, and ratio measurements for the crown and root of each maxillary and mandibular canine tooth, were examined and recorded. The findings indicated that maxillary canines had greater sex dimorphism ability (87.3%) than mandibular canines (80.6%). Total tooth length and root length of maxillary canine were the most pronounced variables in the differentiation of sex groups. When the combination of the mandibular and maxillary measurements was considered, the accuracy for sex dimorphism was 85.7%. By using ratio variables, the accuracy was reduced to 68.9%. According to the findings of this study, total tooth length and root length are the most discriminant variables of canine teeth. These variables are more reliable sex indicators than crown measurements.

[A two-dimensional photographic and three-dimensional digital dental model comparative analysis in maxillary anterior teeth].

Objective: To assess the accuracy of two-dimensional (2D) photographs in measuring esthetic parameters of the maxillary anterior teeth by comparing them with measurements obtained from three-dimensional (3D) dental models. Methods: A total of one hundred volunteers (49 males, 51 females, aged 18-23 years) were recruited from School and Hospital of Stomatology, Wuhan University from January to February 2024. 3D digital models of their dentitions were obtained using an intraoral scanner, and standardized frontal 2D intraoral photographs were captured with a digital camera. The lengths, widths and width/length ratio of the bilateral incisors, lateral incisors and canines were measured on both the 3D digital models and the 2D intraoral photographs. The width ratios of adjacent maxillary anterior were also calculated on the 2D intraoral photographs and the frontal view of 3D digital models. Results: The widths of lateral incisors [(5.85±0.60) mm] and canines [(4.73±0.71) mm] and the lengths of canines [(8.72±0.96) mm] in the 2D intraoral photographs were significantly lower than those in 3D digital models [(6.65±0.59), (7.76±0.60), (8.90±0.86) mm] (t=-18.24, P<0.001; t=-54.43, P<0.001; t=-4.40, P<0.001), while there were no significant differences in the lengths and widths of the other teeth (P>0.05). The width/length ratios measured from the 2D intraoral photographs for the lateral incisors and canines (0.74±0.08, 0.55±0.08) were significantly lower than those measured in the 3D digital models (0.84±0.09, 0.88±0.09) (t=-19.68, P<0.001; t=-50.21, P<0.001), and the width/length ratio of the central incisors showed no significant difference between the two groups (P>0.05). The width ratios of canines/lateral incisors and lateral incisors/central incisors measured on the 2D intraoral photographs (0.72±0.06, 0.85±0.11) were significantly smaller than those measured in the frontal view of 3D digital models (0.75±0.06, 0.89±0.11) (t=-9.31, P<0.001; t=-6.58, P<0.001). Conclusions: There is a difference between 2D and 3D measurement results of teeth in the esthetic area and the magnitude of the difference varies with their position in the dental arch. When analyzing the measurement of the anterior teeth, it is necessary to choose the appropriate method according to the target tooth position.

Are deciduous upper molars and lower canines useful for sex estimation?

OBJECTIVE: This paper investigates whether deciduous upper molars and lower canines have sexual dimorphic features, exploring these teeth' dimensions and the presence of Zuckerkandl's tubercle and Carabelli's cusp on the first and second upper molars. DESIGN: We analyzed 64 pairs of dental plaster casts from 34 females and 30 males aged between 3 and 12 years. We measured the first and second deciduous upper molars and the lower deciduous canines (maximum mesiodistal and buccolingual length), and we registered the presence of the Zuckerkandl's tubercle and the Carabelli's cusp on the first and second upper molars, respectively. RESULTS: Regarding the differentiation between sexes using Carabelli's cusp and Zuckerkandl's tubercle, the classification was not independent of Carabelli's cusp presence only for tooth 65 (p = 0.035). In all other teeth, whether for Carabelli's cusp or Zuckerkandl's tubercle, their presence was similar for both sexes. There were statistically significant differences between sexes (p < 0.05) for the buccolingual measurements of both upper second molars, the first right upper molar, and the right canine. The developed model allowed for a 64.1% accuracy in sex estimation. CONCLUSIONS: The study suggests that while Carabelli's cusp and Zuckerkandl's tubercle in upper deciduous molars don't consistently differ between sexes, tooth size, particularly the buccolingual measurements of certain teeth, including upper deciduous molars and lower canines, may provide a more reliable criterion for sex estimation. The developed model depicted moderate accuracy, underscoring the need for a multifactorial approach when estimating sex from skeletal remains. It suggests that while dental features can contribute to sex estimation, they should be used in conjunction with other skeletal or molecular markers to improve accuracy.

Determining the widths of the maxillary anterior teeth for esthetics: comparison of the Mondelli and Albers formulas, esthetic proportion, and golden ratio.

The purpose of this study was to compare various formulas for idealized proportions of the maxillary incisors to the actual dimensions of natural teeth. The Mondelli formula 1 (MF1), Mondelli formula 2 (MF2), Albers formula (AF), esthetic proportion (EP) for width and height of anterior teeth, and golden ratio (GR) were calculated for a total of 50 dental students (30 women and 20 men) who participated in the study. The following measurements were obtained directly in the participant's mouth with a digital caliper: the mesiodistal and incisogingival dimensions of the maxillary central incisors, lateral incisors, and canines; the intercanine distance; and the smile width. The participants were photographed, and the smile width was also measured on the photographs. The MF1 and MF2 were each calculated twice, using both direct measurements and photographic measurements. The projected central incisor widths calculated using the MF1, MF2, and AF were compared among themselves and against the actual measurements using analysis of variance and Fisher test for multiple comparisons (α = 0.05). The EP and GR were analyzed using descriptive statistics. There was a statistically significant difference between all of the widths projected by the formulas and the actual widths of the central incisors (P < 0.05). Whether calculated from a direct or a photographic measurement, the incisor widths projected by the MF1 and MF2 were statistically similar to each other (P > 0.05). The EP values were similar to those reported in the literature. Only 2% of the participants had an incisor width ratio (central incisor/lateral incisor) that matched the GR of 1.618, while 86% fell within the range of 1.2 to 1.4. Overall, the proportions calculated with the MF1, MF2, AF, EP, and GR did not exactly match the actual dimensions of natural teeth. The formulas and the proportions available in the literature can assist in esthetic planning, but the individual characteristics of each patient and expertise of the dentist should guide treatment for each case.

Comparison of the different methods of width estimation in unerupted canine and premolars.

BACKGROUND: There are different methods for determining the required space for unerupted teeth. However, the accuracy of these techniques varies depending on ethnic differences. Therefore, the current study was performed to compare the accuracy of four methods for estimating the mesiodistal width of unerupted canines and premolars in a population of northern Iran. METHODS: The present cross-sectional study was conducted on 50 pairs of dental casts of patients aged 12-24 years old. The mesiodistal width of the teeth was measured with a digital caliper by two observers (ICC < 0.9), and the mean value was recorded. The space required for eruption of canines and premolars was obtained by the Tanaka-Johnson formula and the Moyers tables and compared with the actual value by paired t test. RESULTS: The Tanaka-Johnson formula had overestimation in the maxilla and mandible, which was statistically significant (p < 0.001). The values obtained from the Moyers tables in different confidence levels were not accurate. However, the 65% level for the mandible had almost no difference from the actual value (P = 0.996 and r2 = 0.503). Furthermore, linear regression was obtained based on the total mesiodistal width of the maxillary first molar and mandibular central incisor (maxilla: Yx= 0.613X + 2.23 and mandible: Ym= 0.618X + 1.6) and the total mesiodistal width of the mandibular first molar and maxillary central incisor in each jaw (maxilla: Yx = 0.424X + 5.021 and mandible: Ym = 0.447X + 3.631). CONCLUSION: The Tanaka-Johnson method was overestimated in the population of northern Iran. The 85% and 75% confidence levels of the Moyers table have the best clinical results for the maxilla and mandible, respectively. Regression based on maxillary first molars and mandibular central incisors has better results.

Digital measurement of deciduous tooth dimensions in China: A cross-sectional survey.

OBJECTIVE: Crown dimensions data of deciduous teeth hold anthropological, forensic, and archaeological value. However, such information remains scarce for the Chinese population. This multi-center study aimed to collect a large sample of deciduous crown data from Chinese children using three-dimensional measurement methods and to analyze their dimensions. DESIGN: A total of 1592 children's deciduous dentition samples were included, and the sample size was distributed according to Northeast, North, East, Northwest, Southwest and South China. Digital dental models were reconstructed from plaster dental models. Independent sample t test, paired t test, principal component analysis (PCA), and factor analysis (FA) were used to analyze the tooth crown dimensions. RESULT: 18,318 deciduous teeth from 1592 children were included. Males exhibited slightly larger values than females. The range of sexual dimorphism percentages for each measurement was as follows: mesiodistal diameter (0.40-2.08), buccolingual diameter (0.13-2.24), and maxillogingival diameter (0.48-3.37). The FA results showed that the main trend of crown dimensions changes was the simultaneous increase or decrease in mesiodistal diameter, buccolingual diameter and maxillogingival diameter in three directions. CONCLUSION: This is the first large-scale survey of deciduous tooth crown dimensions in China, which supplements the data of deciduous tooth measurement and provides a reference for clinical application.

A Global Overview on Electronic Apex Locator Use From 1968 to 2023: A Bibliometric Analysis.

INTRODUCTION: This bibliometric review analyzed the research trends and main characteristics of articles related to Electronic Apex Locators (EALs). METHODS: The search was conducted in November 2023 on the Web of Science Core Collection. Narrative and systematic reviews, observational and intervention studies, laboratory, and clinical studies were included. Two researchers selected the articles and extracted the number of citations, year of publication, journal, study design, theme, country, continent, institutions, author, and keywords. Collaborative networks were generated using the VOSviewer software. The relationship between data were determined by Spearman's correlation. RESULTS: The search resulted in 374 articles, of which 294 were included. Most cited article had 175 citations. The most prevalent journal was the Journal of Endodontics (n = 84). The predominant study design was the laboratory-based (n = 223). The predominant theme was the EALs accuracy (n = 175). Piasecki L was the author with the highest number of articles (n = 11). Only 8.16% of the studies were conducted in deciduous teeth. The country with the most studies was Brazil (n = 46). Asia (n = 107) was the continent with the highest number of publications. There was a weak positive correlation between the number of citations and impact factor (rho = .294), and a strong negative correlation between citations and year of publication (rho = -.710). CONCLUSIONS: The majority of articles were laboratory-based studies conducted on permanent teeth, focusing on the accuracy of EALs. Future studies should prioritize research on deciduous teeth, systematic reviews, and, notably, clinical trials.

An Ex-Vivo Study Comparing the Accuracy of the E-Connect S+ and Morita Tri Auto ZX2+ Endodontic Handpieces in Root Canal Length Determination.

INTRODUCTION: This ex vivo study evaluated the accuracy of the Electronic Apex Locator (EAL) and Automatic Apical Stop (AAS) functions of the E-Connect S+ and Morita Tri Auto ZX2+ cordless apex locators in determining patency length. METHODS: Sixty-four human teeth with a single root were randomly allocated into E-connect or Morita groups (n = 32). The canals were accessed and preflared, after which a size 15 K-file was inserted into the canal to the major foramen and recorded as the actual length (AL). Matched measurements were taken using the AAS and EAL functions and visually confirmed with confocal microscopy. The variance between canal length (mm), the persons correlation (ρ) between function and AL, and the accuracy (%) of the canal length relative to the AL (Δmm) between devices and functions were assessed. RESULTS: Regardless of device or function, all measurements were within 1±Δmm and correlated strongly (ρ > 0.97) with the AL. When considering a more stringent clinically acceptable range of 0.5±Δmm from the AL, all devices and functions demonstrated similar accuracy levels (84%-94%). However, at lower tolerance ranges, the E-connect device with the EAL function exhibited the highest accuracy. On average, all devices and functions stopped short of the AL (mean Δmm>0). CONCLUSION: The E-Connect S+ and Morita Tri Auto ZX2+ apex locators provided reliable accuracy in determining the position of the major foramen. These findings demonstrate a high level of reproducibility in canal length measurements using both cordless endodontic handpieces, regardless of whether the EAL or AAS functions were employed.

Morphometric variations and nonmetric anatomical traits or anomalies of the primary molar teeth, plus the molars' size thresholds for sex identification.

INTRODUCTION: Morphological and morphometric features of the teeth are of interest to various clinical and academic dental and medical fields including prosthodontics, orthodontics, anatomy and anthropology, pathology, archeology, and forensic dentistry. These have been more or less researched in the case of the permanent dentition. However when it comes to the primary dentition, the literature is scarce and controversial. No study worldwide exists on the cutoff points (thresholds) for sex identification; no study exists on metric or nonmetric traits of deciduous teeth in Iranians. Hence, the aim of the study was to assess both the metric and nonmetric traits of primary molars, as well as their cut-off points for sex identification. METHODS: In this epidemiological cross-sectional study, pretreatment casts of 110 children (51 boys and 59 girls) aged 6 to 12 years were collected. Maxillary and mandibular first and second primary molars were evaluated regarding their metric traits (mesiodistal and buccolingual widths) and 9 nonmetric traits (Accessory cusp on the upper D, Accessory cusp on the lower D, Fifth cusp on the upper E, Carabelli's cusp on the upper E, Protostylid on the lower E, Fifth cusp on the lower E, Sixth cusp on the lower E, Tuberculum intermedium [metaconulid] on the lower E, and Deflecting wrinkle on the lower E). ROC curves were used to identify cut-off points for sex determination as well as the usefulness of metric measurements for this purpose. Data were analyzed using independent-samples and paired-samples t-tests, McNemar, Fisher, and chi-square tests, plus Pearson and Spearman correlation coefficients (α = 0.05). RESULTS: All the primary molars' coronal dimensions (both mesiodistal and buccolingual) were extremely useful for sex identification (ROC curves, all P values ≤ 0.0000099). Especially, the mandibular primary molars (areas under ROC curves [AUCs] between 85.6 and 90.4%, P values ≤ 0.0000006) were more useful than the maxillary ones (AUCs between 80.4 and 83.1%, P values ≤ 0. 0000099). In the mandible, the first primary molar (maximum AUC = 90.4%) was better than the second molar (maximum AUC = 86.0%). The optimum thresholds for sex determination were reported. Sex dimorphism was significant in buccolingual and mesiodistal crown widths of all the primary molars (all P values ≤ 0.000132), but it was seen only in the case of 2 nonmetric traits: Deflecting wrinkle (P = 0.001) and Tuberculum intermedium (metaconulid, P = 0.029) on the lower Es, taking into account the unilateral and bilateral cases. The occurrence of nonmetric traits was symmetrical between the right and left sides (all P values ≥ 0.250). All mesiodistal and two buccolingual molar measurements were as well symmetrical (P > 0.1); however, two buccolingual measurements were asymmetrical: in the case of the maxillary E (P = 0.0002) and mandibular D (P = 0.019). There were three weak-to-moderate correlations between the nonmetric traits of the mandibular second molars (Spearman correlations between 22.7 and 37.5%, P values ≤ 0.045). Up to 6 concurrent nonmetric traits were observed in the sample, with 53.6% of the sample showing at least 2 concurrent nonmetric traits at the same time, without any sex dimorphism (P = 0.658). CONCLUSION: Sex dimorphism exists considerably in primary molars' sizes, but it is not as prevalent in their nonmetric traits or abnormalities. Primary molars' crown sizes are useful for sex identification; we calculated optimum cut-off points for this purpose, for the first time.

Avaliação da precisão de localização foraminal de um motor endodôntico integrado em diferentes velocidades de rotação / Evaluation of foraminal location accuracy of an integrated endodontic motor employed with different rotational speeds

Objetivo: avaliar a precisão do controle do limite apical de instrumentação do motor endodôntico SENSORY, acionado em três velocidades de rotação (300, 600 e 900 RPM) e função de parada automática apical (Auto Apical Stop - AAS). Material e métodos: sessenta pré-molares inferiores humanos unirradiculados tiveram seus acessos realizados e diâmetro foraminal padronizado em 300 µm. Os dentes foram aleatoriamente divididos em três grupos (n=20) e tiveram seus canais preparados instrumento Logic 30/05, acionado na velocidade predefinida e função AAS ajustada para a marca 0,0. Os instrumentos foram medidos em paquímetro digital e o comprimento real do canal foi aferido pelo método visual direto sob magnificação. Resultados: os valores absolutos dos erros médios e de precisão (±0,5 mm), obtidos foram respectivamente: 0,21 mm e 95% (300 RPM), 0,26 mm e 95% (600 RPM), 0,20 mm e 95% (900 RPM). Não houve diferença significativa entre os grupos (P>0,05). Conclusão: nas condições deste estudo, o uso da função de parada automática forneceu um controle adequado e preciso do limite apical durante a modelagem endodôntica em todas as velocidades testadas.

Objective: to evaluate the accuracy of the control of the apical limit of instrumentation of the SENSORY endodontic motor, activated at three rotation speeds (300, 600 and 900 RPM) and apical automatic stop function (Auto Apical Stop - AAS). Material and methods: Sixty single-rooted human mandibular premolars had their access performed and the foraminal diameter was standardized at 300 µm. The teeth were randomly divided into three groups (n=20) and had their canals prepared with a Logic 30/05 instrument, activated at the predefined speed and the AAS function set to the 0.0 mark. The instruments were measured using a digital caliper and the actual canal length was measured using the direct visual method under magnification. Results: the absolute values of mean and precision errors (±0.5 mm) obtained were respectively: 0.21 mm and 95% (300 RPM), 0.26 mm and 95% (600 RPM), 0.20 mm and 95% (900 RPM). There was no significant difference between groups (P>0.05). Conclusion: Under the conditions of this study, the use of the automatic stop function provided adequate and accurate control of the apical limit during endodontic shaping at all speeds tested.