Lilian Cristina Vessoni Iwaki

Comparison of periapical radiography with cone beam computed tomography in the diagnosis of vertical root fractures in teeth with metallic post

Aim: To compare the diagnostic accuracy of conventional periapical radiography and cone beam computed tomography (CBCT) in detecting vertical root fracture (VRF) in tooth with metallic post (MP). Materials and Methods: Twenty endodontically-treated teeth received MPs, artificial fractures were created in 10 teeth, and they were all examined with tomography and radiography. The sample consisted of periapical radiography with post and without post, and tomography with post and without post; each group with five fractured and five non-fractured teeth. The images were evaluated by three dental/maxillofacial radiologists and statistical validations were carried out using receiver operating characteristic (ROC) analysis. Results: Sensitivity and specificity of the area under the ROC (Az) of tomography with post (Az = 0.953) and without post (Az = 0.956) were significantly higher than those of periapical radiography with post (Az = 0.753) and without post (Az = 0.778). Conclusion: CBCT was more accurate than conventional periapical radiography in detecting VRF.

Evaluation of diagnostic accuracy of conventional and digital periapical radiography, panoramic radiography, and cone-beam computed tomography in the assessment of alveolar bone loss

Background: To evaluate the diagnostic accuracy of different radiographic methods in the assessment of proximal alveolar bone loss (ABL). Materials and Methods: ABL, the distance between cement-enamel junction and alveolar bone crest, was measured in 70 mandibular human teeth – directly on the mandibles (control), using conventional periapical radiography with film holders (Rinn XCP and Han-Shin), digital periapical radiography with complementary metal-oxide semiconductor sensor, conventional panoramic, and cone-beam computed tomography (CBCT). Three programs were used to measure ABL on the images: Image tool 3.0 (University of Texas Health Sciences Center, San Antonio, Texas, USA), Kodak Imaging 6.1 (Kodak Dental Imaging 6.1, Carestream Health®, Rochester, NY, USA), and i-CAT vision 1.6.20. Statistical analysis used ANOVA and Tukeys test at 5% significance level. Results: The tomographic images showed the highest means, whereas the lowest were found for periapical with Han-Shin. Controls differed from periapical with Han-Shin (P < 0.0001). CBCT differed from panoramic (P = 0.0130), periapical with Rinn XCP (P = 0.0066), periapical with Han-Shin (P < 0.0001), and digital periapical (P = 0.0027). Conventional periapicals with film holders differed from each other (P = 0.0007). Digital periapical differed from conventional periapical with Han-Shin (P = 0.0004). Conclusions: Conventional periapical with Han-Shin film holder was the only method that differed from the controls. CBCT had the closest means to the controls.

Accuracy in the diagnosis of vertical root fractures, external root resorptions, and root perforations using cone-beam computed tomography with different voxel sizes of acquisition

Aim: The aim of this study is to assess the accuracy of images acquired with cone-beam computed tomography (CBCT) in the identification of three different root alterations. Materials and Methods: Forty human premolars were allocated to four experimental groups (n = 10): sound teeth (control), vertical root fracture (VRF), external root resorption (ERR), and root perforation (RP). After the root alterations had been produced, four teeth were randomly assembled into 10 macerated mandibles and submitted to CBCT. Images were acquired with five voxel sizes (0.125, 0.200, 0.250, 0.300, and 0.400 mm) and assessed by three experienced dental radiologists. Sensitivity, specificity, positive and negative predictive values, and the areas under the receiver operating characteristic curve (accuracy) were calculated. The accuracy of imaging in different voxel sizes was compared with Tukey exact binomial test (α=5%). Results: Accuracy with voxel sizes 0.125, 0.200, and 0.250 mm was significantly higher in the detection of ERRs and VRFs than voxel sizes 0.300 and 0.400 mm. No statistical difference was found in terms of accuracy among any of the studied voxel sizes in the identification of RPs. Conclusions: Voxel size 0.125 mm produced images with the best resolution without increasing radiation levels to the patient when compared to voxel sizes 0.200 and 0.250 mm. Voxel sizes 0.300 and 0.400 mm should be avoided in the identification of root alterations.

Single-Needle Arthrocentesis with Upper Compartment Distension versus Conventional Two-Needle Arthrocentesis: Randomized Clinical Trial

The objective of this study was to compare single-needle arthrocentesis with distension of the upper compartment of the temporomandibular joint (TMJ) with the conventional two-needle arthrocentesis. Twenty-six patients with articular disc displacement without reduction (DDWOR) were included in the study and assigned to two groups (n = 13): single-needle arthrocentesis with distension of the upper compartment of the TMJ (1N) and conventional two-needle arthrocentesis (2N). The maximum interincisal distance (MID) and TMJ pain as measured by the visual analog scale (VAS) were compared. MID and VAS data were obtained: before (T1), seven days after (T2), fifteen days after (T3), one month after (T4), three months after (T5), six months after (T6), nine months after (T7), and one year after the arthrocentesis procedures (T8). Considering each group individually, results of the VAS scores and MID measurements showed a significant difference between T1 and T2–T8 (p < 0.001) in both groups. Between two groups, results show no significant differences (p > 0.05). Both techniques tested were effective in reducing pain and increasing MID. Due to the advantages over the conventional two-needle arthrocentesis, single-needle arthrocentesis with distension of the upper compartment should be considered as the first treatment option for patients with painful hypomobilized TMJ of DDWOR.

Comparison of diagnostic accuracy of root perforation, external resorption and fractures using cone-beam computed tomography, panoramic radiography and conventional & digital periapical radiography

CONTEXT Some radicular changes are challenging for clinicians to diagnose, such as of root perforations, external root resorption (ERR), and vertical root fractures (VRFs). This study aims to facilitate it by comparing the diagnostic accuracy of cone-beam computed tomography (CBCT), orthopantomography, and conventional and digital periapical radiography (DPR) in the diagnosis of such problems. Is it worth doing CBCT despite the radiation dose? AIMS To evaluate and compare the diagnostic accuracy of CBCT, panoramic radiography, and conventional and DPR in the diagnosis of root perforation (RP), ERR, and VRF. MATERIALS AND METHODS The sample consisted of 40 extracted human teeth and 10 macerated human mandibles. RPs were performed using diamond burs, ERRs using spherical carbide burs, and RFs using a universal machine EMIC-DL 1000. The images were evaluated by 6 dentomaxillofacial radiologists. RESULTS Receiver operating characteristic (ROC) revealed that CBCT showed the highest area under the ROC curve (Az) values for RP, ERR, and VRF (0.903, 0.950, and 0.849, respectively). The worst Az values for RP, ERR, and VRF (0.718, 0.494, and 0.611, respectively) were for panoramic radiography. CONCLUSIONS CBCT showed the best results in the diagnosis of ERR and VRF. The diagnosis of ERR was the least accurate, panoramic radiography being not appropriate for its diagnosis. CBCT and conventional periapical radiography obtained similar results for the evaluation of RP. So for, RP indicate the conventional periapical radiography because CBCT has a higher radiation dose.

Evaluation of accuracy of portable fingertip pulse oximeter, as compared to that of a hospital oximeter with digital sensor

CONTEXT The pulse oximeter is a device that noninvasively provides continuous information about the peripheral oxygen saturation (SpO2) rate. This device is utilized in the detection of hypoxemia, due to its able to sense changes in hemoglobin oxygen saturation. AIMS The objective of this study was to verify the accuracy of the Choice® Medical MD300C3 Fingertip Pulse Oximeter, as compared to that of a hospital oximeter coupled with a Drager® Infinity Delta monitor, with the purpose of using this first methodology in dental procedures to monitor the peripheral oxygen saturation (SpO2) of patients submitted to dental treatments. MATERIALS AND METHODS Fifty-five adult patients, both genders, were selected in the Santa Casa Hospital of Maringa, Brazil. The volunteers did not present cardiac problems, prosthetic cardiac valves, pacemakers, or pulmonary diseases, and were not pregnant or children. Each patient received a portable fingertip pulse oximeter (PPO) on the middle finger of the left hand and the hospital oximeter (control device) on the forefinger of the same hand. A total of six measurements were developed. The Pearson correlation coefficient and the Bland and Altman method was used to calculate the statistical analysis. RESULTS No statistically significant difference was found between the measurements taken by the utilized devices. The average of comparative analysis presented by the devices was 0.2337 ± 0.4355 (mean ± SD), suggesting a strong correlation between the obtained results. CONCLUSION According to the methodology of the research, the PPO has similar accuracy to the conventional hospital oximeter with digital sensor. The PPO can be used in dental treatments.

Is there correlation between alveolar and systemic bone density

OBJECTIVE The present study assessed the correlation between maxillomandibular alveolar bone density and systemic bone mineral density (BMD). METHODS Dual-energy X-ray absorptiometry of the anterior and posterior maxillomandibular alveolar bone, of the standard sites for the measurement of BMD (lumbar spine and femur) and the third cervical vertebra was performed on 23 middle-aged women. Periapical radiographs were also obtained, with an aluminum step-wedge as reference for the digital reading of apical bone density of the upper incisors. RESULTS Spearmans correlations coefficients revealed that density in the apical region was correlated with that of the femoral neck (r = 0.433; p < 0.05); BMDs of the posterior regions of the mandible and maxilla were significantly correlated with that of the cervical vertebra (r = 0.554, p ≤ 0.01 and r = 0.423, p ≤ 0.05, respectively); and the anterior maxilla was correlated with the posterior mandible (r = 0.488, p ≤ 0.05). CONCLUSION Bone density of the maxillary alveolar bone was significantly correlated with that of the femoral neck. Among the bone densities of the alveolar regions, only the anterior maxilla and the posterior mandible were significantly correlated. The findings suggested that bone densitometry might be individually and locally evaluated.

Continuity resection of the mandible after ameloblastoma – feasibility of oral rehabilitation with rhBMP-2 associated to bovine xenograft followed by implant installation

Recombinant human morphogenetic protein (rhBMP) is a graft alternative for extensive mandibular reconstruction after tumor resections. However, the feasibility of rhBMP-2 to receive osseointegrated implants and prosthetic rehabilitation has been rarely reported. This study reports on a case of an extensive solid ameloblastoma along the mandibular body. The treatment consisted of resection followed by off-label use of rhBMP type 2 associated with bovine bone xenograft. Eleven months postoperatively, the patient was prosthetically rehabilitated with dental implants, without evidence of resorption or complications. The literature on mandibular reconstructions using rhBMP and their feasibility for future osseointegrated implant placement was also reviewed. Based on the presented case, the association between rhBMP-2 and a bovine bone xenograft could be considered a feasible option for the reconstruction and rehabilitation of large mandibular defects after tumor resection. According to the literature, the use of rhBMP as a graft material is encouraging, with good clinical outcome. However, there are no long-term studies demonstrating success and survival rates of implants placed in these grafts. Future investigations will be required to ascertain the long-term survival of implants in areas grafted with rhBMP. Also, there is a lack of information regarding the prosthetic rehabilitation of these patients.

Analysis of correlation between initial alveolar bone density and apical root resorption after 12 months of orthodontic treatment without extraction

OBJECTIVE: The aim of the present study was to investigate the correlation between initial alveolar bone density of upper central incisors (ABD-UI) and external apical root resorption (EARR) after 12 months of orthodontic movement in cases without extraction. METHODS: A total of 47 orthodontic patients 11 years old or older were submitted to periapical radiography of upper incisors prior to treatment (T1) and after 12 months of treatment (T2). ABD-UI and EARR were measured by means of densitometry. RESULTS: No statistically significant correlation was found between initial ABD-UI and EARR at T2 (r = 0.149; p = 0.157). CONCLUSION: Based on the present findings, alveolar density assessed through periapical radiography is not predictive of root resorption after 12 months of orthodontic treatment in cases without extraction.

Predictors of ARTHROCENTESIS outcome on JOINT effusion in PATIENTS with DISC displacement without REDUCTION

OBJECTIVES The aim of this study was to investigate the preoperative variables in patients with articular disk displacement without reduction that may influence the results of arthrocentesis on joint effusion (JE). STUDY DESIGN The records of 203 patients with clinical signs and symptoms of unilateral painful disk displacement without reduction and JE, confirmed by magnetic resonance imaging (MRI), and treated with arthrocentesis were selected. The following preoperative data were recorded: sex; age; joint side; pain duration; pain intensity, measurement with the visual analogue scale; and maximum interincisal distance (MID). All patients underwent a second MRI examination 3 to 4 months postoperatively to assess JE. The sample was then divided into 2 groups: group 1 (n = 160) comprised patients with no signs of JE; and group 2 (n = 43) comprised patients still showing signs of JE. Univariate and multivariate analyses were used to compare the groups. RESULTS Among the studied variables, pain duration (P = .0175), pain intensity (P < .0001), and MID (P = .0085) were shown to affect arthrocentesis outcomes. The longer the pain duration (odds ratio [OR] = 0.930), the more intense was the pain (OR = 0.346), and the smaller the MID (OR = 0.562), the less were the chances of arthrocentesis completely eliminating JE. CONCLUSIONS Pain duration, pain intensity, and MID can be used as predictors for the effect of arthrocentesis on JE outcomes and considered during treatment planning.