Francielle Silvestre Verner

Detection of Fractured Endodontic Instruments in Root Canals: Comparison between Different Digital Radiography Systems and Cone-beam Computed Tomography

Introduction This study compared the detection of fractured instruments in root canals with and without filling by periapical radiographs from 3 digital systems and cone‐beam computed tomographic (CBCT) images with different resolutions. Methods Thirty‐one human molars (80 canals) were used. Root canals were divided into the following groups: the control group, without fillings; the fracture group, without fillings and with fractured files; the fill group, filled; and the fill/fracture group, filled and with fractured files. Digital radiographs in ortho‐, mesio‐, and distoradial directions were performed in 2 semidirect systems (VistaScan [Dürr Dental, Beitigheim‐Bissinger, Germany] and Express [Instrumentarium Imaging, Tuusula, Finland]) and a direct system (SnapShot [Instrumentarium Imaging]). CBCT images were acquired with 0.085‐mm and 0.2‐mm voxel sizes. All images were assessed and reassessed by 4 observers for the presence or absence of fractured files on a 5‐point scale. The sensitivity, specificity, and accuracy were calculated. Results In the absence of filling, accuracy values were high, and there were no statistical differences among the radiographic techniques, different digital systems, or the different CBCT voxels sizes. In the presence of filling, the accuracy of periapical radiographs was significantly higher than CBCT images. In general, SnapShot showed higher accuracy than VistaScan and Express. Conclusions Periapical radiographs in 1 incidence were accurate for the detection of fractured endodontic instruments inside the root canal in the absence or presence of filling, suggesting that this technique should be the first choice as well as the direct digital radiographic system. In the presence of filling, the decision to perform a CBCT examination must take into consideration its low accuracy.

Tomografía Computarizada de Haz Cónico como Instrumento Complementario de Diagnóstico y Planeamiento Quirúrgico de Quiste Dentígero: Reporte de un Caso

El quiste dentigero es una de las patologias oseas que mas frecuentes en el maxilar y la mandibula. Se evidencia radiograficamente como una imagen radiolucida y unilocular en la mayoria de los casos. Generalmente es detectado en examenes de rutina o cuando se investiga la presencia de dientes no erupcionados. El quiste dentigero aparece principalmente en las tres primeras decadas de vida, con crecimiento lento y asintomatico. Los terceros molares,asi como dientes supernumerarios, pueden estar relacionados con su formacion, sin embargo, su etiopatologia no es totalmente conocida. La descompresion, marsupializacion y la enucleacion son las principales formas de tratamiento, pero algunos criterios deben ser considerados, como tamano del quiste, edad del paciente, proximidad con estructuras anatomicas nobles e importancia clinica del diente involucrado. Para que se establezca un correcto diagnostico y plan de tratamiento es esencial la utilizacion de examenes complementarios de calidad, siendo, actualmente, la tomografia computarizada de haz conico el mas completo y preciso metodo de diagnostico por imagen empleado en estas lesiones. El objetivo de este estudio fue resaltar, por medio de la presentacion de un caso clinico, la importancia de la tomografia computarizada de haz conico en el diagnostico y planeamiento quirurgico de un quiste dentigero asociado a un diente no erupcionado.

Development of estimation models of bone height considering the potential presence of anterior extension of the mandibular canal.

Purpose:To evaluate the presence of the anterior extension (AE) of the mandibular canal and to measure the bone height (BH) at different points along the extension. Materials and Methods:Cone-beam computed tomography examinations of 108 patients were bilaterally evaluated regarding the presence of the AE, and linear measurements of the AE and BH were obtained. For comparisons between sides and genders, Student t test was applied. Variations in BH measurements were assessed by a 2-way analysis of variance. Through a simple linear regression analysis, formulas were determined for calculations of the BH in the AE. Results:A right AE was detected in 76.9% and left AE in 77.8% of the samples. In the majority of the cases, the extension was of the rectilinear type. The mean length of the AE was 8.5 mm, and there was no statistically significant difference observed in relation to gender or side. It was observed that the BH increases as it approaches the midline. Conclusion:The AE of the mandibular canal must be evaluated during presurgical planning. The formulae presented in this study provide a method to calculate BH values in the interforaminal region and can be used to assist in presurgical planning, especially in the cases in which the identification of the hipodense site, which corresponds to the AE, is not evident.

Analysis of the correlation between dental arch and articular eminence morphology: a cone beam computed tomography study

OBJECTIVE The aim of the study was to assess the correlation between the morphology of the dental arches (DAs) of patients with normal occlusion and of the articular eminence (AE) by using cone beam computed tomography (CBCT). STUDY DESIGN CBCT scans of 60 patients were evaluated in terms of height and inclinations (angles α, β, and δ) of the AE. DAs were classified according to their shapes (tapered, square, ovoid), and their perimeters, widths, and depths were measured. One-way analysis of variance, Pearsons correlation coefficients, and simple and multivariate linear regression models were used for the calculations. RESULTS The ovoid arch was the most predominant shape (n = 66/120). Inclination of the AE (angle β) had the greatest difference between DA shapes, with this angle usually being greater in the ovoid arch and smaller in the square arch (P < .05). The height of the AE presented greater correlation with DA measurements, with tapered arches having the most significant correlations (P < .05). DA depth had no influence on AE measurements (P > .05). The perimeter and width of the DAs had some influence (P < .05). CONCLUSIONS Correlations were found between the DA and AE morphologies. The correlations should be taken into consideration, although the results do not prove absolute association between the variables. Whenever possible, the morphologic features of DAs should be preserved to avoid possible changes in AE.

Diagnosis of ethmoid sinolith by cone-beam computed tomography: case report and literature review

IntroductionThe aim of this study was to report the first case of diagnosis of a rare ethmoid sinolith by cone-beam computed tomography (CBCT) and discuss the importance of carefully assessing the entire volume of the images regardless of the region of interest.Case presentationA 22-year-old woman underwent CBCT examination to assess the upper permanent canine teeth. Analysis of the entire volume of CBCT revealed an oval-shaped hyperdense, homogeneous, expansive formation with defined boundaries located in the ethmoid bone. The differential diagnosis of a sinolith in the ethmoid sinus was confirmed after removal of the lesion by nasoendoscopy and histopathological examination.ConclusionThe diagnosis of lesions in the ethmoid sinus is challenging because of the complex anatomy of this region. Considering the limitations of two-dimensional X-ray examination, CBCT examination has become an important imaging modality for the diagnosis of these calcifications. In addition, the ability of the dental surgeon to assess the entire volume of the CBCT images and the knowledge of imaging features of these calcifications allows for recognition of incidental findings, facilitating early diagnosis and appropriate treatment.

Tomografía Computarizada de Haz Cónico en el Diagnóstico de Diente Invaginado: Presentación De Un Caso

The aim of this report is to present a case of dens invaginatus asymptomatic discovered after exam cone beam computed tomography. A 20-year-old patient attended the clinic Radiology to perform tomography to fracture research at the root of the tooth 15. However, the examination was observed the presence of a conoid supernumerary tooth between the tooth located roots 11 and 12, which had a hyperdense line to the apex of the root, representing the invagination of the enamel, dens invaginatus feature. It was also observed extensive hypodense image in the periapical region, with areas of external resorption both in supernumerary tooth as we ll as the roots of teeth 11 and 12. The treatment consisted of surgery for dens invaginatus extraction. The dentists should be aware of the imaginological characteristics of the anomalies that can affect the teeth/jaws, which can be discovered in tests for routine imaging and proper conduct for the treatment of patients.

Ankylosis of Permanent First Molar: Diagnosis by Cone Beam Computed Tomography

Ankylosis is an anomaly of tooth eruption characterized by the fusion of cementum and alveolar bone, and may affect from small regions to the entire root surface. Clinical assessment combined with imaging exams can aid diagnosis. Radiographic testing enables assessing only proximal regions of possibly affected roots. Whereas cone beam computed tomography (CBCT) allows a three-dimensional assessment of axial, coronal, and sagittal planes of all dental extension, eliminating thus overlapping images and helping to confirm the correct diagnosis. The present study contains a case report of a male patient with ankylosis in tooth 16 diagnosed by CBCT, aiming at providing information for dentists about this anomaly, its characteristics and situations in which CBCT should be indicated.