Melissa Feres Damian

Influence of X-ray beam angulations on the detection of horizontal root fractures

Aims: The aim of this study was to evaluate the variation of vertical angle for detection of fractures. Materials and Methods: Twenty-five (25) single-rooted premolar teeth were divided into two groups, fractured teeth (n = 15) and non-fractured teeth (n = 10). Artificially fractured teeth were classified according to location, number of fragments, and direction of fracture line: Horizontal, oblique, or complex. The tooth fragments were juxtaposed with cyanoacrylate, and the specimens (fractured and non-fractured) were placed individually in the dental alveolus of a human jaw with the aid of silicone rubber impression material and submitted to eight periapical radiographs in a digital sensor with a vertical range of 10 degrees (−40, −30, −20, −10, 0, +10, +20, +30). Three examiners evaluated the characteristics of the fractures and their correlation with the radiographic diagnosis (perceived or not) by varying the vertical angle. Statistical Analysis: Descriptive analysis was performed through the analytical comparison and Kappa test inter-examiner. Results: Among the three examiners, inter-examiner Kappa value was 0.536. The radiographic identification of root fracture in the 15 prepared samples was 60% (nine) at angle 0, and at the angles of +10, −10, and −20, it was less than 50%. Conclusions: Multiple radiographs with variations of vertical angle are fundamental to facilitate the diagnosis of horizontal root fractures in premolars.

Preoperative evaluation of third molar root characteristics: Correlation between clinical and radiographic findings

Purpose: In this study, periapical and panoramic radiographic tests were compared to the clinical examination (after extraction, gold standard) to verify their accuracy in identifying number of roots, root morphology, and presence of root dilaceration in impacted third molars. Methods: In total, 98 third molars were extracted (50 maxillary, 48 mandibular). Three dental surgeons and one radiologist were calibrated to analyze the root characteristics before (radiography) and after extraction. Agreement between clinical and radiographic findings was analyzed with weighted kappa (κ) statistics. Correlation between radiographic and clinical data was assessed using Spearman correlation test. A 5% significance level was set for all analyses. Results: Upper teeth with single/fused roots and lower teeth with two roots were predominant. Higher agreement and correlation for number of roots and root morphology was observed for periapical (κ=0.258–0.612; R2=0.463–0.612; P<0.001) compared with panoramic exam (κ=0.164–0.365; R2=0.175–0.417; P<0.01), and for lower compared with upper teeth. For lower teeth, convergent/parallel roots were predominant in the clinical analysis, while divergent roots were predominant in the imaging tests. For root dilaceration, poor agreement (κ=0.199–0.273) and low correlation (R2=0.185–0.306) was observed for either radiographic examinations. Conclusion: The accuracy of radiographic examinations in identifying the root characteristics of impacted third molars was generally low. Compared with the panoramic test, periapical radiography had better agreement and higher correlation with the clinical findings for all root features.

Endodontic treatment of the maxillary central incisor with sequelae of dental trauma

Dental trauma in immature teeth with necrotic pulp and apical foramen with large thin and fragile walls becomes a challenge to treat conventional endodontic treatment. The objective of this report is to demonstrate a clinical case in which the apexification through calcium hydroxide-based dressing, succeeded in forming a calcified apical barrier. It concluded that a barrier with mineral trioxide aggregate superimposed with the endodontic obturation of gutta-percha advocated in the central incisor led to a successful endodontic procedure.