Frequency and Risk Factors of Maxillary Sinusitis of Endodontic Origin Evaluated by a Dynamic Navigation and a New Filter of Cone-Beam Computed Tomography.

INTRODUCTION: The aim of this study was to determine the frequency and risk factors of maxillary sinusitis of endodontic origin (MSEO) on posterior maxillary teeth evaluated using dynamic navigation and a novel filter of cone-beam computed tomographic (CBCT) imaging. METHODS: CBCT scans of 453 patients (814 teeth) were selected. Data were divided into 4 groups: (1) root canal treatment (RCT), (2) relation of the root apex to the maxillary sinus, (3) apical periodontitis (AP), and (4) maxillary sinus inflammation (no inflammation, periapical osteoperiostitis, periapical mucositis, partial obstruction, or total obstruction). Frequency distribution and cross-tabulation were used for data analysis. The association of maxillary sinus abnormalities with other variables was analyzed using the chi-square test. The significance level was set at 5%, and the association between dependent and independent variables was analyzed using robust Poisson regression models. RESULTS: MSEO was found in 65.6% of the cases, and the highest frequency rates were in the periapical mucositis (44%) and partial obstruction (15.8%) groups. The rates of risk factors were highest in the cases of RCT (54.9%), AP (34.3%), and the root apex in contact with the maxillary sinus (53.8%). The most frequent sex and age group were female (55.8%) and 41-50 years (30.5%). CONCLUSIONS: The frequency of MSEO was high and positively associated with RCT, AP, and the root apex's position in contact with the floor of the maxillary sinus. The maxillary sinus filter of the CBCT software provides a clear image of maxillary sinus abnormalities.

A computational modeling method for root canal endoscopy using a specific CBCT filter: A new era in the metaverse of endodontics begins.

A contemporary technological revolution has started a new era in the metaverse of Endodontics, a world of virtual operational possibilities that use an exact replica of the natural structures of the maxillofacial complex. This study describes a modeling method for root canal endoscopy using modern cone-beam CT (CBCT) software in a series of clinical cases. The method consists in acquiring thin CBCT slices (0.10mm) in the coronal, sagittal, and axial planes. A specific 3D volume filter, the pulp cavity filter of the e-Vol DX CBCT software, was used to navigate anatomical root canal microstructures, and to scan them using root canal endoscopy. The pulp cavity filter should be set to synchronize CBCT scans from 2D mode - multiplanar reformations (MPR) - to 3D mode - volumetric reconstruction. This filter, when adopting the option of volumetric reconstruction, the developed algorithm leaves the dentin density in transparent mode so that the pulp cavity may be visualized. The algorithm applied performs the suppression (visual) of areas with dentin density. This ensures 3D visualization of the slices and the microanatomy of the root canal, as well as a dynamic navigation throughout the pulp cavity. This computational modeling method adds new resources to Endodontics, which may impact the predictability of root canal treatments positively. The virtual visualization of the internal anatomy of an exact replica of the canal ensures better communications, reliability, and clinical operationalization. Root canal endoscopy using this novel CBCT filter may be used for clinical applications together with innovative digital and virtual-reality resources that will be naturally incorporated into the principles of Endodontics.

A computational modeling method for root canal endoscopy using a specific CBCT filter: A new era in the metaverse of endodontics begins

Abstract A contemporary technological revolution has started a new era in the metaverse of Endodontics, a world of virtual operational possibilities that use an exact replica of the natural structures of the maxillofacial complex. This study describes a modeling method for root canal endoscopy using modern cone-beam CT (CBCT) software in a series of clinical cases. The method consists in acquiring thin CBCT slices (0.10mm) in the coronal, sagittal, and axial planes. A specific 3D volume filter, the pulp cavity filter of the e-Vol DX CBCT software, was used to navigate anatomical root canal microstructures, and to scan them using root canal endoscopy. The pulp cavity filter should be set to synchronize CBCT scans from 2D mode - multiplanar reformations (MPR) - to 3D mode - volumetric reconstruction. This filter, when adopting the option of volumetric reconstruction, the developed algorithm leaves the dentin density in transparent mode so that the pulp cavity may be visualized. The algorithm applied performs the suppression (visual) of areas with dentin density. This ensures 3D visualization of the slices and the microanatomy of the root canal, as well as a dynamic navigation throughout the pulp cavity. This computational modeling method adds new resources to Endodontics, which may impact the predictability of root canal treatments positively. The virtual visualization of the internal anatomy of an exact replica of the canal ensures better communications, reliability, and clinical operationalization. Root canal endoscopy using this novel CBCT filter may be used for clinical applications together with innovative digital and virtual-reality resources that will be naturally incorporated into the principles of Endodontics.

Resumo Uma revolução tecnológica contemporânea deu início a uma nova era no metaverso da Endodontia, um mundo de possibilidades operacionais virtuais que utilizam uma réplica exata das estruturas naturais do complexo dentomaxilofacial. Este estudo descreve um método de modelagem computacional para a endoscopia do canal radicular, usando um moderno software de tomografia computadorizada de feixe cônico (TCFC), em uma série de casos clínicos. O método consiste na aquisição de finos slices de TCFC (0,10mm) nos planos coronal, sagital e axial. Um filtro específico de TCFC (filtro cavidade pulpar do software e-Vol DX) foi usado para navegar nas microestruturas anatômicas do canal radicular, e escanear para a aplicação da endoscopia do canal radicular. Este filtro foi configurado para sincronizar as imagens de TCFC em modo 2D - reformações multiplanares (MPR) para o modo 3D - reconstrução volumétrica. O filtro Pulp Cavity ao adotar a opção de reconstrução volumétrica, um algoritmo desenvolvido deixa a densidade dentinária em modo transparente, para que a cavidade pulpar possa ser melhor visualizada. O algoritmo aplicado realiza a supressão (visual) das áreas com densidade dentinária. Este modo de aplicação garante a visualização 3D da microanatomia do canal radicular, bem como permite uma navegação dinâmica por toda a cavidade pulpar. O método de modelagem computacional agrega novos recursos à Endodontia, o que pode impactar positivamente na previsibilidade dos tratamentos endodônticos. A visualização virtual da anatomia interna de uma réplica exata do canal radicular garante melhor comunicação, confiabilidade e operacionalização clínica. O exame de endoscopia do canal radicular com este novo filtro (Pulp cavity) pode ser usada para aplicações clínicas juntamente com recursos digitais e de realidade virtual inovadores que serão naturalmente incorporados aos princípios da Endodontia.

Planned Apical Preparation Using Cone-Beam Computed Tomographic Measures: A Micro-Computed Tomographic Proof of Concept in Human Cadavers.

INTRODUCTION: This study assessed the amount of unprepared surface areas at the apical 4-mm segment of the root canal after a planned preparation based on cone-beam computed tomography (CBCT) measurements. METHODS: Eighteen posterior mandible segments were obtained from cadavers and scanned using CBCT and micro-computed tomographic (micro-CT) imaging. CBCT images were used to measure the largest initial canal diameter from 29 root canals of premolars at 1, 2, 3, and 4 mm short of the apical foramen. Each measurement was used to select a master apical instrument with size/taper that was 1 diameter larger to prepare the apical 4 mm of each particular root canal. A post-preparation micro-CT scan was obtained, and the unprepared canal areas were calculated. RESULTS: A very high amount of surface areas over the apical 4 mm of the root canal was included in the final preparation (mean >90%). The unprepared areas ranged from as low as 3.7% to a maximum of 14.6% (mean and median, 9.2% and 9.1%, respectively). CONCLUSIONS: The proposed planned apical root canal preparation resulted in optimized root canal shaping with a substantial amount of prepared surface areas. The protocol used also resulted in a conservative canal enlargement using final instruments that were 1 size larger than the initial largest canal diameter.

Treatment of Class II malocclusion with a customized lingual appliance combined with a Class II corrector.

Correcting a complete Class II malocclusion in an adult patient can be quite difficult. If the patient has a large skeletal discrepancy, orthognathic surgery is the treatment of choice. However, if the discrepancy is small or if the situation is borderline and the mandibular incisors are retroclined, Class II correctors can be used. This clinical report presents the orthodontic treatment of a 24-year-old woman with Class II malocclusion. Clinically, her maxilla was slightly protruded, and the mandible was well-positioned. She had uprighted maxillary and mandibular anterior teeth and a deepbite, and she opted for a more esthetically appealing orthodontic appliance. The treatment plan included leveling and alignment of the teeth in both arches, Class II correction, establishing Class I molar and canine relationships, correction of overbite and overjet, adjustment of midlines, and improvement of facial and dental esthetics. Orthodontic treatment consisted of customized lingual appliances combined with a Class II fixed corrector.

A Critical Review of the Differential Diagnosis of Root Fracture Line in CBCT scans.

The objective of this critical review of literature is to discuss relevant clinical factors associated with root fractures (RF) visualized by using a new CBCT software. RF constitutes a common occurrence and a challenge in clinical practice, in which the diagnosis becomes essential for the definition of rapid and precise decision-making. The characterization of RF may involve different aspects, such as orientation of the fracture line (horizontal, vertical, oblique), root position of the fracture (cervical, middle, apical third), fracture's coronal-radicular position (coronary, coronal-radicular, radicular), continuity of the fracture (crack, incomplete fracture, complete), bone extension of the fracture (supraosseous, bone level, infraosseous fracture). Imaging examinations have been routinely used to aid in the RF diagnosis. Even with high-resolution cone-beam computed tomography (CBCT) scans, many doubts often remain about the diagnostic outcome. Many interferences in the analysis of image quality to determine the diagnosis are identified, such as the sharpness, the noise, light and dark artifacts, among others. The professional's knowledge is essential for identifying the different patterns of fracture lines and their repercussions on adjacent bone tissues, as well as for the analysis of artifacts that may hide or show similarities to fracture lines. Fractures lines and root fractures that may be associated with phantom conditions that mimic fractures should be carefully analyzed. CBCT is the exam indicated to identify a root fracture. It is also added to the success of the diagnosis that the professional has scientific knowledge, training and mastery of advanced CBCT software.

Digital Planning on Guided Endodontics Technology.

The aim of this review is to discuss the digital planning and the use of guided technology in Endodontics. The complexity of the root canals anatomy and the challenges in the microorganism's control represent risk factors for failure after the infected root canal's treatment. Scientific improvements associated with technological advances have enabled better predictability of therapeutic procedures results. The development of efficient and modern devices provided safer root canal treatments, with shorter clinical visits and greater patient comfort. Digital endodontics incorporated different tools and developed its own, advancing even further in resolving complex cases. The faithful copy of the internal anatomy provided by the advancement of CBCT devices and software's, associated with the digital resources of 3D planning and printing, enabled the advent of guided endodontics. This technique is used at different stages of endodontic treatment, with specific indications and greater result predictability. Therefore, this study critically reviewed the potential clinical application of this guided access technique, and the operative steps for its safe performance in managing complex endodontic cases. The main indications are accessing calcified root canals, performing endodontic surgeries in difficult access areas, removing fiberglass posts, and accessing teeth with developmental anomalies. In summary, guided endodontics has been a precise strategy, effective, safe, and clinically applicable. This procedure represents incorporating technological resources and digital planning in the Endodontist clinical practice, increasing predictability to complex cases.

Digital Planning on Guided Endodontics Technology

Abstract The aim of this review is to discuss the digital planning and the use of guided technology in Endodontics. The complexity of the root canals anatomy and the challenges in the microorganism's control represent risk factors for failure after the infected root canal's treatment. Scientific improvements associated with technological advances have enabled better predictability of therapeutic procedures results. The development of efficient and modern devices provided safer root canal treatments, with shorter clinical visits and greater patient comfort. Digital endodontics incorporated different tools and developed its own, advancing even further in resolving complex cases. The faithful copy of the internal anatomy provided by the advancement of CBCT devices and software's, associated with the digital resources of 3D planning and printing, enabled the advent of guided endodontics. This technique is used at different stages of endodontic treatment, with specific indications and greater result predictability. Therefore, this study critically reviewed the potential clinical application of this guided access technique, and the operative steps for its safe performance in managing complex endodontic cases. The main indications are accessing calcified root canals, performing endodontic surgeries in difficult access areas, removing fiberglass posts, and accessing teeth with developmental anomalies. In summary, guided endodontics has been a precise strategy, effective, safe, and clinically applicable. This procedure represents incorporating technological resources and digital planning in the Endodontist clinical practice, increasing predictability to complex cases.

Resumo O objetivo desta revisão é discutir o planejamento digital e o uso da tecnologia guiada em Endodontia. A complexidade e variabilidade da anatomia dos canais radiculares, em conjunto com o desafio no processo de sanificação e controle de micro-organismos representam fatores de risco ao fracasso após o tratamento dos canais radiculares infectados. O aprimoramento técnico-científico e os avanços tecnológicos tem possibilitado uma melhor previsibilidade de resultados nos procedimentos terapêuticos. O desenvolvimento de ferramentas de trabalho eficientes e modernas proporcionou tratamentos endodônticos seguros, com menor tempo clínico operacional e maior conforto ao paciente. A endodontia digital incorporou diferentes ferramentas e desenvolveu suas próprias, avançando ainda mais na resolução de casos complexos. A cópia fiel da anatomia interna proporcionada pelo avanço dos aparelhos e softwares de TCFC, associada aos recursos digitais de planejamento e impressão 3D possibilitaram o surgimento da endodontia guiada. Esta técnica é utilizada em diferentes etapas do tratamento endodôntico, com indicações específicas e maior previsibilidade de resultados. Este estudo revisou criticamente o potencial de aplicação clínica da técnica de acesso guiado, e os passos operatórios para sua realização de forma segura no manejo de casos endodônticos complexos. As principais indicações da Endodontia Guiada incluem o acesso a canais radiculares calcificados; as cirurgias parendodônticas em áreas de difícil acesso; a remoção de pinos de fibra de vidro; e o acesso a dentes com anomalias de desenvolvimento. Em síntese, a endodontia guiada é uma técnica precisa, eficaz e de fácil aplicação clínica. Esta técnica representa a incorporação dos recursos tecnológicos e planejamentos digitais do Endodontista, dando maior previsibilidade aos casos em que é aplicada na prática clínica.

A Critical Review of the Differential Diagnosis of Root Fracture Line in CBCT scans

Abstract The objective of this critical review of literature is to discuss relevant clinical factors associated with root fractures (RF) visualized by using a new CBCT software. RF constitutes a common occurrence and a challenge in clinical practice, in which the diagnosis becomes essential for the definition of rapid and precise decision-making. The characterization of RF may involve different aspects, such as orientation of the fracture line (horizontal, vertical, oblique), root position of the fracture (cervical, middle, apical third), fracture's coronal-radicular position (coronary, coronal-radicular, radicular), continuity of the fracture (crack, incomplete fracture, complete), bone extension of the fracture (supraosseous, bone level, infraosseous fracture). Imaging examinations have been routinely used to aid in the RF diagnosis. Even with high-resolution cone-beam computed tomography (CBCT) scans, many doubts often remain about the diagnostic outcome. Many interferences in the analysis of image quality to determine the diagnosis are identified, such as the sharpness, the noise, light and dark artifacts, among others. The professional's knowledge is essential for identifying the different patterns of fracture lines and their repercussions on adjacent bone tissues, as well as for the analysis of artifacts that may hide or show similarities to fracture lines. Fractures lines and root fractures that may be associated with phantom conditions that mimic fractures should be carefully analyzed. CBCT is the exam indicated to identify a root fracture. It is also added to the success of the diagnosis that the professional has scientific knowledge, training and mastery of advanced CBCT software.

Resumo O objetivo desta revisão crítica da literatura é discutir os fatores clínicos relevantes associados às fraturas radiculares FR visualizados por meio de um novo software de CBCT. As fraturas radiculares constituem uma ocorrência comum e um desafio na prática clínica, em que o diagnóstico torna-se essencial para a definição de uma tomada de decisão rápida e precisa. A caracterização da FR pode envolver diversos aspectos, como orientação da linha de fratura (horizontal, vertical, oblíqua), posição radicular da fratura (cervical, médio, apical), posição coronoradicular da fratura (coronária, coronorradicular, radicular), continuidade da fratura (trinca, fratura incompleta, completa), extensão óssea da fratura (supraóssea, nível ósseo, fratura infraóssea). Os exames de imagens têm sido usados ​​rotineiramente para auxiliar no diagnóstico de RF. Mesmo com a tomografia computadorizada de feixe cônico (TCFC) de alta resolução, muitas vezes permanecem muitas dúvidas sobre o resultado do diagnóstico. São identificadas muitas interferências na análise da qualidade da imagem para determinar o diagnóstico, como a nitidez, o ruído, artefatos claros e escuros, dentre outros. O conhecimento do profissional é fundamental para identificar os diferentes padrões de linhas de fraturas e suas repercussões nos tecidos ósseos adjacentes, bem como para a análise de artefatos que podem ocultar ou apresentar semelhanças com as linhas de fraturas. As linhas de fraturas e fraturas radiculares que podem estar associadas às condições fantasmas que mimetizam fraturas devem ser analisadas cuidadosamente. A TCFC constitui o exame por imagem indicado para identificar uma fratura radicular. Acrescenta-se ao sucesso do diagnóstico o fato do profissional apresentar conhecimento científico, treinamento e domínio de softwares avançados de TCFC.

Preserving the Neurovascular Bundle in Targeted Endodontic Microsurgery: A Case Series.

Endodontic microsurgery encompasses the use of microscopy, specialized instruments, and advanced imaging with cone-beam computed tomographic (CBCT) imaging. This treatment modality results in high clinical success rates and facilitates the enucleation of osteolytic lesions, the resection of apical root canal complexities harboring persistent bacterial biofilms, and the evaluation of possible root defects and fractures. However, there is the risk of injury to important anatomic structures, particularly when treating posterior teeth. Neurovascular bundles are among these structures at risk for injury. Fortunately, high-resolution CBCT scans can be used to detect these structures that are known to have a high anatomic variability. In addition, CBCT information can be combined with high-resolution intraoral scans to plan, design, and fabricate surgical guides to be used in a targeted endodontic microsurgery (TEMS) approach. We report 3 cases with previous endodontic treatment having persistent apical periodontitis that were treated with TEMS to avoid damage to the neurovascular bundles at risk of injury. In the first case, the palatal root of tooth #14 was adjacent to the greater palatine artery. In the second case, the mental nerve exited through 2 separate foramina close to the predictive osteotomy site for the mesial root of tooth #19. In the third case, the posterior superior alveolar artery was in close proximity to the mesiobuccal root of tooth #14. Collectively, these cases illustrate the diagnostic value of CBCT imaging for detecting neurovascular bundles and the use of TEMS to mitigate the risk of injury to these important structures. Thus, the combination of CBCT imaging and TEMS can potentially minimize the risk of intraoperative complications and postoperative sequelae while increasing the predictability of endodontic microsurgeries in complex cases.

Aplicação de um novo software de TCFC com filtros específicos para redução de artefatos: série de casos / Application of a new CBCT software with specific filters for blooming artifact reduction: case series

Introdução: As obturações dos canais radiculares e os pinos intrarradiculares geralmente produzem artefatos de contraste branco e possíveis alterações volumétricas nas imagens de tomografia computadorizada de feixe cônico (TCFC). Esses artefatos, induzidos pela maior densidade dos materiais obturadores de canais radiculares, cimentos para colocação de coroa e pinos intracanais, podem potencialmente levar a interpretações incorretas, interferindo no diagnóstico de um volume adquirido de TCFC, principalmente na avaliação de potenciais fraturas e perfurações radiculares. Objetivos: Avaliar em seis casos clínicos os efeitos positivos e negativos dos artefatos de contraste branco no diagnóstico de fraturas radiculares, perfurações radiculares e cimentação de restaurações de porcelana. Métodos: O software e-Vol DX, que possui filtros específicos para redução de artefato de contraste (BAR, Blooming Artifact Reduction), foi usado para melhorar o valor diagnóstico dos volumes adquiridos de TCFC. Conclusões: O em- prego do software e-Vol DX para a reconstrução de imagens de TCFC melhorou a visualização das estruturas anatômicas e reduziu os artefatos. A visualização aprimorada de da- dos nas imagens pode auxiliar na identificação de detalhes essenciais que, em conjunto com os achados clínicos, são úteis para uma correta estruturação do diagnóstico (AU).

Introduction: Root canal fillings and intraradicular posts often create white contrast artifacts and possible volumetric changes on CBCT scans known as blooming artifacts. These alterations could lead to the incorrect interpretations reducing the diagnostic of an acquired CBCT volume, particularly when evaluating potential root fractures and root perforations. Methods and Results: In six clinical cases, the positive and negative effects of beam hardening artifacts on the diagnosis of root fractures, root perforations and porcelain restoration cementation were evaluated. These artifacts, induced by the higher density of root canal filling materials, cements for crown placement and intracanal posts, may potentially lead to inaccurate or false interpretations. A novel software, e-Vol DX, which has specific filters for blooming artifact reduction (BAR), was used to improve the diagnostic value of acquired CBCT volumes. Conclusions: The use of the e-Vol DX software package for the reconstruction of CBCT scans improved visualization of anatomical structures and reduced blooming artifacts. Improved data visualization may help reveal essential details that, in conjunction with clinical findings, are useful to achieve a correct diagnosis (AU).

Potential of a New Cone-Beam CT Software for Blooming Artifact Reduction.

This study evaluated the dimensions of intraradicular posts using a new cone beam CT (CBCT) software, and verified the potential of blooming artifact reduction. Sixty-three single-rooted human teeth were shaped, obturated, prepared for intracanal post placement and distributed into three groups: G1: anatomically customized prefabricated glass fiber posts; G2: low-fusion alloy posts; G3: gold alloy posts. After post fabrication and luting with RelyX U200®, specimens were sectioned axially at 9 mm from the root apex, and markings were made on the root surfaces (X-, Y- and Z-axes). The dimensions of the original posts (control group) were measured using a digital micrometer. CBCT scans of the teeth were obtained using a PreXion 3D Elite® scanner. Posts were measured on CBCT scans using DICOM files and the e-Vol DX software. A specific filter, Blooming Artefact Reduction (BAR), was developed to analyze intracanal posts. Statistical data were evaluated using the Van de Waerden nonparametric analysis of variance and, after that, normalized data were analyzed using the Tukey test. The level of significance was set at α = 5%. The measures of the anatomical prefabricated, low-fusion alloy and gold alloy intracanal posts obtained using the e-Vol DX CBCT software and a micrometer were not significantly different (p>0.05). The use of the BAR filter of the e-Vol DX software application did not induce any dimensional differences on CBCT scans of intracanal posts when compared with measurements made with a micrometer on original posts. The use of the BAR filter eliminated blooming artifacts.

Lateral Luxation of Incisor - A Case Report of Using a New Cone-Beam Computed Tomography Software and Reposition Guideline.

Lateral luxation injuries are one of the most severe periodontal injuries in dental trauma. The correct diagnosis followed by repositioning of the tooth on the right position is fundamental for the periodontal ligament healing. This study reported a clinical case of lateral luxation of maxillary central incisor involving a new cone beam computed tomography (CBCT) software for reconstruction (e-Vol DX) to confirm the lateral luxation after no conclusive dental trauma injury definition by using conventional exam. The lateral luxation injury was digitally reduced by insertion of tooth back to its alveolus, and at the same session, the tooth was stabilized with a rigid splint and further changed to a semi-rigid nylon splint. During the pulpal status monitoring, the pulp was diagnosed necrotic, then the root canal was treated to prevent root resorption. External office-bleaching and restorative procedure was performed. The 4-years follow up and new imaging exam and digital reconstruction confirmed bone healing and no complication. CBCT images analyzed by eVol DX can be used to determine and to guide lateral luxation treatment.

Root Canal Shape of Human Permanent Teeth Determined by New Cone-Beam Computed Tomographic Software.

INTRODUCTION: The purpose of this study was to determine root canal cross-sectional shapes (RCCSSs) of human permanent teeth using new cone-beam computed tomographic (CBCT) software. METHODS: RCCSS was determined on CBCT scans of 1400 teeth (422 patients) as follows: (1) circular, (2) conical/pyramidal, (3) oval/long oval, (4) flat/ribbonlike, (5) 8 shaped, (6) C shaped, (7) calcified, (8) trapezoidal, (9) drop shaped, and (10) other shapes. Root canal shapes were evaluated in the coronal and middle thirds, 2 mm below their beginning, and in the apical third, 1 and 2 mm short of the apical foramen. Categoric variables were described as frequencies and percentages and analyzed using the chi-square test. The level of significance was set at P = .05. RESULTS: Maxillary anterior teeth and maxillary first and second premolars had a circular RCCSS at 1 and 2 mm from the apical foramen in more than 45% of the cases. The most frequent RCCSS in the buccal canal of maxillary first premolars at 1 mm from the apical foramen was circular (71%) followed by flat/ribbonlike (10%) and oval/long oval (6%). In mesiobuccal roots of maxillary and mandibular first molars at 1 mm from the apical foramen, the circular shape was found in 52% and 49%, respectively. CONCLUSIONS: The RCCSSs in human permanent teeth are variable according to the tooth group and root thirds. The highest frequency of the circular-shaped canal at 1 and 2 mm from the apical foramen was found in maxillary central incisors and mandibular first and second premolars. Oval-shaped canals were detected in practically all tooth groups and root thirds.

Lateral luxation of incisor - a case report of using a new cone-beam computed tomography software and reposition guideline

Abstract Lateral luxation injuries are one of the most severe periodontal injuries in dental trauma. The correct diagnosis followed by repositioning of the tooth on the right position is fundamental for the periodontal ligament healing. This study reported a clinical case of lateral luxation of maxillary central incisor involving a new cone beam computed tomography (CBCT) software for reconstruction (e-Vol DX) to confirm the lateral luxation after no conclusive dental trauma injury definition by using conventional exam. The lateral luxation injury was digitally reduced by insertion of tooth back to its alveolus, and at the same session, the tooth was stabilized with a rigid splint and further changed to a semi-rigid nylon splint. During the pulpal status monitoring, the pulp was diagnosed necrotic, then the root canal was treated to prevent root resorption. External office-bleaching and restorative procedure was performed. The 4-years follow up and new imaging exam and digital reconstruction confirmed bone healing and no complication. CBCT images analyzed by eVol DX can be used to determine and to guide lateral luxation treatment.

Resumo Lesões de luxação lateral são uma das lesões periodontais mais graves no traumatismo dental. O diagnóstico seguido do reposicionamento do dente na posição correta é fundamental para o reparo do ligamento periodontal. Este estudo relata um caso clínico de luxação lateral do incisivo central superior envolvendo um novo software de reconstrução (e-Vol DX) por tomografia computadorizada de feixe cônico (TCFC) para confirmar a luxação lateral após nenhuma definição de lesão por trauma dental conclusivo pelo exame convencional. A lesão de luxação lateral foi reduzida digitalmente pela inserção do dente de volta ao seu alvéolo e, na mesma sessão, o dente foi estabilizado com uma contenção rígida e posteriormente trocada para uma contenção de nylon semirrígida. Durante o monitoramento da condição pulpar, foi diagnosticada necrose da polpa e, em seguida, o canal radicular foi tratado para evitar a reabsorção radicular. Procedimento externo de clareamento e restauração foi realizado. O acompanhamento de 4 anos e o novo exame de imagem e reconstrução digital não confirmaram reparo ósseo e nenhuma complicação. Imagens de TCFC analisadas pelo e-Vol DX podem ser utilizadas para determinar e orientar lesão de luxação lateral.

Impacto de um novo software de tomografia computadorizada de feixe cônico nas tomadas de decisões clínicas em Endodontia / Impact of a new cone beam computed tomography software on clinical decision-making in Endodontics

As conquistas incorporadas à Endodontia em decorrência das novas tecnologias de informação permitiram avanços que impactaram no êxito clínico e no prognóstico. Essas novas aquisições influenciaram o mundo contemporâneo, que presencia uma profunda mudança proporcionada pela velocidade e qualidade das informações, economia de investimento e tempo, assim beneficiando a área da saúde. Uma revolução do pensamento e modo de viver contemporâneo que se experimenta nos dias atuais é a biotecnologia. O impacto da tomografia computadorizada de feixe cônico na Endodontia foi capaz de superar várias limitações das radiografias periapicais, como a eliminação das sobreposições, a extraordinária possibilidade de navegação pela imagem, a qualidade das imagens em alta resolução e contraste, entre outras. Esse estudo objetiva apresentar algumas características de um novo software de tomografia computadorizada de feixe cônico chamado de e-Vol DX, capaz de impactar nas tomadas de decisões clínicas em Endodontia. O software de TCFC e-Vol DX se constitui em um recurso imprescindível na obtenção de imagens de alta qualidade. Vários filtros, com diferentes propriedades, foram desenvolvidos e incorporados, como o filtro BAR, que permite a redução de artefatos de contraste do branco, entre outros. Essa ferramenta é efetiva em tomadas de decisões clínicas para a execução do protocolo terapêutico de casos endodônticos complexos.

The achievements incorporated into endodontics, resulting from new information technologies allowed advances that impacted prognosis and clinical success. These new acquisitions have influenced the contemporary world, that is witnessing a profound change brought about by the speed and quality of information, investment savings and time, thus benefiting the health areas. A revolution in contemporary thinking and living that is being experienced today is biotechnology. The impact of cone beam computed tomography on endodontics was able to overcome several limitations of periapical radiography, such as the removal of overlaps, the extraordinary possibility of image navigation, the quality of high resolution and contrast images, among others. This study aims to present some characteristics of a new cone beam computed tomography software named e-Vol DX which may impact the clinical decision-making in endodontics. The e-Vol DX CBCT software is an indispensable resource for high quality images. Various filters with different properties have been developed and incorporated, such as the Blooming Artifact Reduction (BAR) filter that allows the reduction of white contrast artifacts, among others. This tool is effective in clinical decision-making for the implementation of the therapeutic protocol of complex endodontic cases.

Method to Determine the Root Canal Anatomic Dimension by using a New Cone-Beam Computed Tomography Software.

This study discusses a method to determine the root canal anatomic dimension by using e-Vol DX software. The methodology consists in initially establishes the correct positions which will be measured, define the point on the edge of the anatomical structure, and next adjust the intermediate position in the grayscale of CBCT image. Afterward, thin sections (0.10 mm) are obtained from 3D reconstructed slices in the filter for the measurements, in order to determine the edge of the anatomical surface in the axial plane. A replication of positions in 3D mode is done in multiplanar reconstruction (MPR) of CBCT images, where the correct position is established with the aid of a positioning guide. The 3D density is adjusted so that it is in the same dimension as the 2D image, and a dimension calibration occurs to the point where there is a coincidence between 3D and 2D. This calibration is done only at the beginning of the measurement. Next, the intermediate position of the division between the grayscale is verified in the CBCT scan. Once one side has been completed, it is moved to the other side and follows the same guidelines described above. When setting the position of the courses in the other margin, being that 2D mode is used as reference. Thus, one obtains the required measure, being checked in the two points. The creation of this filter in the e-Vol DX software for measurement, and its appropriate management, allows more effective applications when it is desired to obtain diameters of anatomical structures.

Method to determine the root canal anatomic dimension by using a new cone-beam computed tomography software

Abstract This study discusses a method to determine the root canal anatomic dimension by using e-Vol DX software. The methodology consists in initially establishes the correct positions which will be measured, define the point on the edge of the anatomical structure, and next adjust the intermediate position in the grayscale of CBCT image. Afterward, thin sections (0.10 mm) are obtained from 3D reconstructed slices in the filter for the measurements, in order to determine the edge of the anatomical surface in the axial plane. A replication of positions in 3D mode is done in multiplanar reconstruction (MPR) of CBCT images, where the correct position is established with the aid of a positioning guide. The 3D density is adjusted so that it is in the same dimension as the 2D image, and a dimension calibration occurs to the point where there is a coincidence between 3D and 2D. This calibration is done only at the beginning of the measurement. Next, the intermediate position of the division between the grayscale is verified in the CBCT scan. Once one side has been completed, it is moved to the other side and follows the same guidelines described above. When setting the position of the courses in the other margin, being that 2D mode is used as reference. Thus, one obtains the required measure, being checked in the two points. The creation of this filter in the e-Vol DX software for measurement, and its appropriate management, allows more effective applications when it is desired to obtain diameters of anatomical structures.

Resumo Este estudo discute um método para determinar a dimensão anatômica do canal radicular usando o software e-Vol DX. A metodologia consiste em inicialmente estabelecer as posições corretas que serão medidas, definir o ponto na borda da estrutura anatômica e ajustar a posição intermediária na escala de cinza na imagem em tomografia computadorizada de feixe cônico (TCFC). A seguir, slices finos (0,10mm) são obtidos a partir de cortes 3D reconstruídos no filtro para as medidas, a fim de determinar a borda da superfície anatômica no plano axial. Uma replicação de posições no modo 3D é feita em reconstrução multiplanar (MPR) em imagens de TCFC, onde a posição correta é estabelecida com o auxílio de um guia de posicionamento. A densidade 3D é ajustada de modo a ficar na mesma dimensão da imagem 2D, e então realiza-se uma calibração de dimensão até o ponto em que há uma coincidência entre o modo 3D e 2D. Essa calibração é feita apenas no início da medição. Posteriormente, a posição intermediária da divisão entre a escala de cinza é verificada na TCFC. Uma vez que um lado tenha sido concluído, o guia é movido para o outro lado, e segue-se as mesmas diretrizes descritas. Define-se a posição do marcador na outra margem, sendo que o modo 2D usado como referência. Assim, obtém-se a medida necessária, sendo verificado nas duas margens do canal radicular. A criação deste filtro no software e-Vol DX para medição e seu uso apropriado permite aplicações eficazes quando se deseja obter diâmetros de estruturas anatômicas.

Development of a New Cone-Beam Computed Tomography Software for Endodontic Diagnosis.

Cone-beam computed tomography (CBCT) has promoted changes in approaches in Endodontics, and enhanced decision-making in complex clinical cases. Despite the technological advancements in CBCT hardware, the interpretation of the acquired images is still compromised by viewing software packages that often have limited navigational tools and lack adequate filters to overcome some challenges of the CBCT technology such as artefacts. This study reviews the current limitations of CBCT and the potential of a new CBCT software package (e-Vol DX, CDT- Brazil) to overcome these aspects and support diagnosing, planning and managing of endodontic cases. This imaging method provide high resolution images due to submillimeter voxel sizes, dynamic multi-plane imaging navigation and ability to change the volume parameters such as slice thickness and slice intervals and data correction applying imaging filters and manipulating brightness and contrast. The main differences between e-Vol DX and other software packages are: compatibility with all current CBCT scanners with the capacity to export DICOM Data, a more comprehensive brightness and contrast library, as other applications, in which adjustments are limited, do not usually support all the DICOM dynamic range features; Custom slice thickness adjustment, often limited and pre-defined in other applications; Custom Sharpening adjustment, often limited in other applications; advanced noise reduction algorithm that enhances image quality; preset imaging filters, dedicated endodontic volume rendering filters with the ability to zoom the image over 1000x (3D reconstructions) without loss of resolution and automatic imaging parameters customization for better standardization and opportunities for research; capture screen resolution of 192 dpi, with a 384 dpi option, in contrast to the 96 dpi of most similar applications. This new CBCT software package may support decision-making for the treatment of complex endodontic cases and improve diagnosis and treatment results. Effective improvement of image quality favors the rational prescription and interpretation of CBCT scans.

Development of a new cone-beam computed tomography software for endodontic diagnosis

Abstract Cone-beam computed tomography (CBCT) has promoted changes in approaches in Endodontics, and enhanced decision-making in complex clinical cases. Despite the technological advancements in CBCT hardware, the interpretation of the acquired images is still compromised by viewing software packages that often have limited navigational tools and lack adequate filters to overcome some challenges of the CBCT technology such as artefacts. This study reviews the current limitations of CBCT and the potential of a new CBCT software package (e-Vol DX, CDT- Brazil) to overcome these aspects and support diagnosing, planning and managing of endodontic cases. This imaging method provide high resolution images due to submillimeter voxel sizes, dynamic multi-plane imaging navigation and ability to change the volume parameters such as slice thickness and slice intervals and data correction applying imaging filters and manipulating brightness and contrast. The main differences between e-Vol DX and other software packages are: compatibility with all current CBCT scanners with the capacity to export DICOM Data, a more comprehensive brightness and contrast library, as other applications, in which adjustments are limited, do not usually support all the DICOM dynamic range features; Custom slice thickness adjustment, often limited and pre-defined in other applications; Custom Sharpening adjustment, often limited in other applications; advanced noise reduction algorithm that enhances image quality; preset imaging filters, dedicated endodontic volume rendering filters with the ability to zoom the image over 1000x (3D reconstructions) without loss of resolution and automatic imaging parameters customization for better standardization and opportunities for research; capture screen resolution of 192 dpi, with a 384 dpi option, in contrast to the 96 dpi of most similar applications. This new CBCT software package may support decision-making for the treatment of complex endodontic cases and improve diagnosis and treatment results. Effective improvement of image quality favors the rational prescription and interpretation of CBCT scans.

Resumo A tomografia computadorizada de feixe cônico (TCFC) promoveu mudanças nas abordagens de Endodontia e melhorou a tomada de decisões em casos clínicos complexos. Apesar dos avanços tecnológicos no hardware da TCFC, a interpretação da imagem adquirida ainda é comprometida pela visualização dos softwares, que muitas vezes têm ferramentas de navegação limitadas e falta de filtros adequados para superar estes desafios, como artefatos. Este estudo analisa as limitações atuais da TCFC e o potencial de um novo software (e-Vol DX, CDT-Brasil) para superar estes aspectos e apoiar o diagnóstico, planejamento e monitoramento de casos endodônticos. Este método de imagem fornece imagens em alta resolução devido a tamanhos submilimétricos de voxel, navegação dinâmica de imagens em vários planos e capacidade de alterar os parâmetros de volume como espessura de corte, intervalos de corte, correção de dados por meio de filtros de imagem, e manipulação do brilho e do contraste. As principais diferenças entre o e-Vol DX e outros software são: compatibilidade com todos os scanners de TCFC atuais com capacidade de exportar dados DICOM, com ajuste de brilho e contraste mais abrangente comparado a outros aplicativos, em que os ajustes são limitados, e geralmente não suportam todos os recursos da faixa dinâmica DICOM; ajuste de espessura de corte personalizado, muitas vezes limitado e pré-definido em outras aplicações; ajuste de nitidez personalizado, muitas vezes limitado em outras aplicações; algoritmo avançado de redução de ruído que melhora a qualidade da imagem; filtros de imagem predefinidos, filtros de para análise de volume do canal radicular com a capacidade de ampliar a imagem em mais de 1000x (reconstruções em 3D) sem perda de resolução, e personalização de parâmetros de imagem automática para melhor padronização e oportunidades de pesquisa; captura com resolução da tela de 192 dpi, com uma opção de 384 dpi, em contraste com os 96 dpi das aplicações similares. Este novo software de TCFC pode apoiar as tomadas de decisões para o tratamento de casos endodônticos complexos e melhorar os resultados do diagnóstico e do tratamento. A melhoria efetiva da qualidade da imagem favorece a prescrição e a interpretação racional das imagens de TCFC.