Karla Rovaris

Enhancement cone beam computed tomography filters improve in vitro periimplant dehiscence detection.

OBJECTIVE To investigate whether cone beam computed tomography filters would improve periimplant dehiscence detection. STUDY DESIGN A hundred titanium implants were placed in bovine ribs in which defects simulating periimplant dehiscence had previously been created. After images acquisition, three oral radiologists assessed them with and without the following filters: Angio Sharpen high 5 × 5, Shadow, Sharpen 3 × 3, Sharpen Mild, and Smooth. The McNemar test verified the disagreement between all images versus the reference standard and original images versus images with filters; P < .05 was considered statistically significant. RESULTS Dehiscence detection using the original images and the Shadow filter disagreed from the reference standard (P < .05), as well as when using the filters instead of the original images (P < .05). CONCLUSION All the filters tested, with the exception of the Shadow, improved periimplant dehiscence detection. The Sharpen 3 × 3 filter was considered best for this task.

Impact of micronutrients supplementation on bone repair around implants: microCT and counter-torque analysis in rats

ABSTRACT The use of natural substances and micronutritional approaches has been suggested as a therapeutic alternative to benefit the bone healing associated with no side effects. Nevertheless, the influence of micronutritional interventions with therapeutic proprieties on the bone repair has yet to be intensely evaluated, and no evidence is available exploring the impact of micronutrient supplementation on the peri-implant bone healing. Objective This study investigated the effect of micronutrients supplementation on the bone repair around implants. Material and Methods One screw-shaped titanium implant was inserted in each tibia of each rat, which were assigned to: daily administration, for 30 d, of the placebo solution (Placebo group-n:18) or micronutrients supplementation (Micronutrients group-n:18), based on calcium, magnesium, zinc, and vitamin D3 intake. After, the animals were sacrificed. One of the implants was removed by applying a counter-torque force to evaluate the force to rupture the bone-implant interface. The other implant was evaluated by microcomputed tomography (CT) examination to determine the bone-to-implant contact (BIC) and the bone volume (BV/TV). Results No statistically significant differences were observed between the groups for both counter-torque values and microCT parameters (p>0.05). Conclusion Within the limits of this study, micronutrients supplementation did not provide additional benefits to the bone healing around dental implants.

Effect of Low Shrinkage Monomers on Physicochemical Properties of Dental Resin Composites

UNLABELLED The aim of this study was to evaluate the effect of low shrinkage monomers on physicochemical properties of dental resin composites. Two low shrinkage resin composites: one with a crosslink branching monomer (Kalore, GC Corp) and a novel monomer (Venus Diamond, Heraeus Kulzer) were compared to a conventional resin composite formulation (Filtek Z250, 3M/ESPE). The volumetric shrinkage was evaluated by µCT analysis (n=5) and the physicochemical properties by degree of C=C conversion (DC), flexural strength (FS) and Youngs modulus (YM) (n=10). All samples were light cured by a LED device (Radii, SDI) with 16 J/cm2. The results were analysed by one-way ANOVA and Tukey test for multiple comparisons (α=0.05). No statistical difference was found between µCT shrinkage values to Kalore (1.8%) and Venus Diamond (1.7%) (p≥0.05); Z250 presented statistical highest shrinkage value (2.0%). Kalore presented higher statistical DC (60.8%) than Venus Diamond (49.5%) and Z250 (49.6%). No statistical difference was found between FS or YM properties to Venus Diamond and Z250; Kalore presented statistical lowest FS and YM properties (p≥0.05). CONCLUSION Using novel monomers seem to reduce polymerization shrinkage without affecting the physicochemical properties evaluated of resin composites rather than using crosslink branching monomers.

Feasibility of micro‑computed tomography to detect and classify proximal caries lesions in vitro

Background: Micro-computed tomography (micro-CT) has been widely described as a nondestructive in vitro imaging method although its accuracy for caries detection is still unclear. The aim of this study was to investigate the feasibility of micro-CT to detect and classify proximal caries lesions in posterior teeth, using different protocols. Materials and Methods: In this in vitro study, crowns of 122 human teeth were scanned with Skyscan 1174 (Bruker, Kontich, Belgium) using the full-scan mode (360°). Reconstruction of 900 basis images was performed using NRecon Software (Bruker, Kontich, Belgium) for the protocol 1 (full-scan mode 360°), and 450 basis images were used to reconstruct the protocol 2 (half-scan mode 180°). Three observers analyzed the reconstructed images concerning the presence and depth of proximal caries lesions (244 surfaces). To determine the presence/absence and depth of caries lesions, histological examination was conducted as reference standard level of significance McNemar and McNemar-Bowker tests compared the methods studied and the gold standard (P < 0.05). Results: The intra- and inter-observer agreement for both methods ranged from moderate to excellent. There was no difference between both micro-CT methods and histology for the presence of lesions (P > 0.05). However, both methods differed with the reference standard for depth (P < 0.05). The disagreement occurred mostly in cases of enamel lesions. The highest diagnostic values were found for 180° rotation. Micro-CT performed well in detecting caries lesions compared to histology, meanwhile the classification of their depth presented lower values. Scan mode did not influence the detection. Conclusion: Both protocols of micro-CT tested presented an overall satisfactory performance in detecting proximal caries lesions; however, for the depth classification, the method was not accurate.

Brazilian young dental practitioners' use and acceptance of digital radiographic examinations

Purpose The aim of this study was to investigate the use and acceptance of digital radiographic examinations by Brazilian dental practitioners in daily practice and to evaluate the advances that have occurred over the past 5 years. Materials and Methods Dental practitioners enrolled in extension courses at the Piracicaba Dental School, University of Campinas, Brazil, responded to a self-administered questionnaire in the years 2011 and 2015. They were asked about sociodemographic factors and their knowledge and use of digital radiographic examinations. Descriptive analysis was performed, as well as the chi-square and Fisher exact tests, with a significance level of 5% (α=0.05). Results A total of 181 participants responded to the questionnaire in the years 2011 and 2015. Most of the respondents worked in private practice, had graduated within the last 5 years, and were between 20 and 30 years old. In 2011, 55.6% of respondents reported having ever used digital radiographic examinations, while in 2015 this number increased significantly to 85.4% (p<.0001), out of which 71.4% preferred it to conventional images. Moreover, 21.4% of respondents reported having used digital radiographic examinations for more than 3 years. A significant increase in use of intraoral digital radiography (p=0.0316) was observed in 2015. In both years, image quality and high cost were indicated, respectively, as the main advantage and disadvantage of digital radiographic examinations. Conclusion This study showed that digital radiology has become more common in Brazil over the past 5 years. Most of the Brazilian dental practitioners evaluated in 2015 used digital radiographic examinations.

A survey on dental undergraduates' knowledge of oral radiology

Dentists’ incorrect behavior with regards to Oral Radiology, as reported in the literature, has been related to inadequate training of undergraduates. Aim: This study assessed dental undergraduates’ knowledge of Oral Radiology. Methods: A questionnaire containing 30 questions pertaining to three domains - General Principles, Radiobiology/Radioprotection and Technique/Interpretation - was used as data collection instrument. A total of 195 students answered the questionnaires. Results: No statistically significant differences were found between second-, third- and fourthyear students (p>0.05) when the whole questionnaire and the General Principles domain (p>0.05) were considered. The Technique/Interpretation domain presented a borderline statistical significance level (p=0.051), with more correct answers attributed to second-year students. A statistically significant difference (p<0.05) was seen for the Radiobiology/Radioprotection domain, in which the fourth-year students performed better. Conclusions: Dental undergraduates’ knowledge of Oral Radiology did not increase or decrease significantly comparing the undergraduate years. However, with the exception of the Technique/Interpretation domain, students of more advanced undergraduate years answered more correctly the questions. Nevertheless, the Technique/ Interpretation domain should be reinforced throughout the undergraduate course.

Beam hardening correction tool improves the diagnosis of incipient caries lesions in Micro-CT images

OBJECTIVE To evaluate the effect of Beam Hardening Correction tool (BHC) on Micro-CT images used in the diagnosis of incipient caries lesions. METHODS Six posterior teeth, with 6 sound proximal surfaces and 6 natural white spot lesions, were scanned using a SkyScan1174 device. Each tooth was imaged 16 times in various acquisition parameters, and reconstructed 3 times applying different levels of BHC (0, 15 and 30%). The 288 datasets were analyzed by three examiners. Gold-standard was obtained by microscopic analyses under polarized light. Area under the ROC curve was obtained for each protocol and the BHC parameter was isolated to individually observe the influence of such parameters of reconstruction. RESULTS Microtomographic images were accurate for the diagnosis of incipient caries lesions even when the BHC tool was not applied. Accuracy was perfect in 50 % of the protocols without BHC. When adding the artefact correction, the number of protocols that reached perfect accuracy increased to 81.25%. No difference was found between the protocols that used 15 or 30% BHC. Statistically significant differences were found only in four comparisons, and on those the images that had BHC were more accurate. Two non-BHC protocols reached accuracy scores of 0.653 and 0.881, and were improved to perfect accuracy with BHC application. CONCLUSION The use of the BHC tool should be encouraged when using Micro-CT to detect incipient caries lesions, especially when low-quality parameters aiming less acquisition and processing time are used.

Segmentation Methods for Micro CT Images: A Comparative Study Using Human Bone Samples

X-ray microtomography (microCT) is a nondestructive technique used to assess bone morphometry. For an accurate analysis, it is necessary to segment the bone tissue from the background images, avoiding under- or overestimation of the real bone volume. Thus, segmentation methods for microCT can influence the accuracy of bone morphometry analysis. The purpose of this study was to compare two different image segmentation methods available on microCT software (subjective and objective) regarding to the human bone morphometric analysis. Sixteen samples containing a fixation screws covered by 0.5-1mm of bone were scanned using the SkyScan 1173 scanner. Three examiners segmented the microCT images subjectively and recorded the threshold values. Subsequently, an objective segmentation was also done. The 3D analysis was performed for both images using the values​ previously determined in CTAn software. Five bone morphometric parameters were calculated (BV/TV, Tb.Th, Tb.N, Tb.Sp, Conn.Den) and used as dependent variables. ANOVA showed no significant differences between the methods concerning BV/TV (p=0.424), Tb.N (p=0.672), Tb.Th (p=0.183), Tb.Sp (p=0.973) and Conn.Den (p=0.204). Intra- and interobserver agreement ranged from satisfactory to excellent (0.55-1 and 0.546-0.991, respectively). Therefore, results obtained with subjective threshorlding were similar to those obtained with objective segmentation. Since objective segmentation does not have human input and it is a truly objective method, it should be the first choice in microCT studies that concern homogeneity and high resolution human bone sample.

Influence of Artifact Reduction Tools in Micro–computed Tomography Images for Endodontic Research

Introduction Micro‐computed tomography (&mgr;CT) is an imaging modality of growing application in endodontic research because of its nondestructive technology that enables visualization at the micrometer level. In the presence of high‐density material, images acquired with &mgr;CT may present artifacts. Thus, the aim of this study was to evaluate subjectively and objectively the influence of artifact reduction tools available for &mgr;CT image reconstruction to determine whether their use can influence endodontic research outcomes. Methods Ten teeth were scanned in a &mgr;CT device, and these images were reconstructed by applying 13 protocols of artifact reduction tools, combining ring artifact reduction (RAR) and beam‐hardening artifact reduction (BAR). Images were assessed subjectively (observers preference) and objectively (root canal surface area and volume). Observers preference for RAR and BAR protocols was tested by χ2. Analysis of variance was used to compare volumes and surface area of root canals on different protocols. Intraobserver and interobserver reproducibility was calculated by the weighted kappa test. Results There was no preference for a particular protocol for BAR (P = .91) or RAR (P = .80). There were no statistically significant differences for volume (P = .999) or surface area (P = .972) of root canals for all protocols. Conclusions To evaluate root canal volume and root canal surface area, artifact reduction tools applied to &mgr;CT images can be used according to the observers visual preference without influence on objective image analysis. HIGHLIGHTSThis study aimed to evaluate the influence of artifact reduction tool in &mgr;CT images for endodontic research.Thirteen protocols of artifact reduction were applied and assessed subjectively and objectively.Artifact reduction protocols applied to &mgr;CT images did not influence the objective image analysis.

Comparison of automatic and visual methods used for image segmentation in Endodontics: a microCT study

Abstract To calculate root canal volume and surface area in microCT images, an image segmentation by selecting threshold values is required, which can be determined by visual or automatic methods. Visual determination is influenced by the operators visual acuity, while the automatic method is done entirely by computer algorithms. Objective: To compare between visual and automatic segmentation, and to determine the influence of the operators visual acuity on the reproducibility of root canal volume and area measurements. Material and methods: Images from 31 extracted human anterior teeth were scanned with a μCT scanner. Three experienced examiners performed visual image segmentation, and threshold values were recorded. Automatic segmentation was done using the “Automatic Threshold Tool” available in the dedicated software provided by the scanners manufacturer. Volume and area measurements were performed using the threshold values determined both visually and automatically. Results: The paired Students t-test showed no significant difference between visual and automatic segmentation methods regarding root canal volume measurements (p=0.93) and root canal surface (p=0.79). Conclusion: Although visual and automatic segmentation methods can be used to determine the threshold and calculate root canal volume and surface, the automatic method may be the most suitable for ensuring the reproducibility of threshold determination.