Cone Beam Computed Tomography Examinations Research Articles

Automated Diagnosis and Classification of Temporomandibular Joint Degenerative Joint Disease via Artificial Intelligence Using CBCT Imaging.

In this study, artificial intelligence techniques were used to achieve automated diagnosis and classification of temporomandibular joint (TMJ) degenerative joint disease (DJD) on cone beam computed tomography (CBCT) images. An AI model utilizing the YOLOv10 algorithm was trained, validated and tested on 7357 annotated and corrected oblique sagittal TMJ images (3010 images of normal condyles and 4347 images of condyles with DJD) from 1018 patients who visited Peking University School and Hospital of Stomatology for temporomandibular disorders and underwent TMJ CBCT examinations. This model could identify DJD as well as the radiographic signs of DJD, namely, erosion, osteophytes, sclerosis and subchondral cysts. The diagnosis and classification performances of the model were evaluated on the test set. The accuracy of the model for evaluating images with one to four DJD signs was also evaluated. The accuracy, precision, sensitivity, specificity, F1 score and mean average precision (mAP) at an intersection over union (IoU) threshold of 0.5 of the model for DJD detection all exceeded 0.95. The accuracies for identifying erosion, osteophytes, sclerosis and subchondral cysts were 0.91, 0.96, 0.91 and 0.96, respectively. The precisions, specificities and F1 scores for the DJD signs were all >0.90. The sensitivity ranged from 0.88-0.95, and the mAP (IoU=0.5) ranged from 0.87-0.97. The accuracies of the model for detecting one to four DJD signs in one image were 94%, 84%, 66% and 63%, respectively. A deep learning model based on the YOLOv10 algorithm can not only detect the presence of TMJ DJD on CBCT images but also differentiate the typical radiographic signs of DJD, including erosion, osteophytes, sclerosis and subchondral cysts, with acceptable accuracy. TMJ DJD is a very common disease that causes joint pain and mandibular dysfunction and affects patients' quality of life; therefore, early diagnosis and intervention are particularly important. However, identifying radiographic signs of early-stage TMJ DJD is difficult. AI can quickly review CBCT images and assist in the accurate and rapid diagnosis and classification of TMJ DJD.

Knowledge and experience in using 2D and 3D diagnostic imaging among dentists in Surabaya

Background: Radiography is essential in dentistry for diagnosis and treatment planning, with two-dimensional imaging such as panoramic and periapical radiographs being commonly used. The advancement to three-dimensional imaging, specifically Cone Beam Computed Tomography (CBCT), provides more detailed visualization but remains underutilized due to limited availability and knowledge among dentists in Indonesia. Purpose: This research is aimed to determine the knowledge and experience of using 2D and 3D diagnostic imaging among dentists in Surabaya. Methods: This research is using an observational descriptive study with a cross-sectional design consisting of 100 dentists who are domiciled in Surabaya and registered with PDGI in Surabaya. Results: The result showed that dentists’ knowledge of 2D diagnostic imaging with a good category has a percentage of 18%, quite good category with 49% and poor category with 33%. Meanwhile, the dentists’ knowledge of 3D diagnostic imaging with a good category has a percentage of 9%, quite good category with 36% and poor category with 55%. Around 88% of respondents have referred their patients for panoramic and periapical radiographs, while only about 22% of dentists have referred their patients for CBCT examinations. Conclusion: The knowledge of dentists regarding 2D diagnostic imaging is quite good, while the knowledge of dentists regarding 3D diagnostic imaging is low. The majority of dentists in Surabaya often refer their patients for panoramic and periapical radiographic examinations compared to referring them for CBCT examinations.

A New Approach for Analyzing Root Development in Autogenous Tooth Transplants Using Computed Tomography.

The aim of this study was to evaluate root development in autotransplanted teeth using cone-beam computed tomography (CBCT) images. Twelve premolars with incomplete root formation, which were selected to replace prematurely lost upper central incisors, were analyzed by CBCT on two different occasions. The first CBCT examination (T1) was conducted before tooth autotransplantation. The second CBCT examination (T2) was performed over a follow-up period of at least 12 months and < 5 years. Three previously calibrated evaluators assessed root development. The positions of the tomographic planes were standardized. The mean root length in sagittal and coronal tomographic sections was used to validate the root length at T1 and T2. Longitudinal root development of the transplanted tooth was determined by calculating the difference in root length between T2 and T1. The intraclass correlation coefficient (ICC), paired t-test, and Pearson test were applied, with significance set at 5%. The mean time elapsed between T1 and T2 was 962 days/2.6 years. The ICC was > 0.75. The measurements obtained at T2 were significantly greater than at T1 (p = 0.001). The mean increase in root length was 2.83 mm. There was no significant correlation (p = 0.413; r = 0.261) between root length increase and the time elapsed between T1 and T2. Premolar teeth with incompletely formed roots transplanted to the upper central incisor region showed continued root development during postoperative follow-up.

Biological Markers in the Gingival Crevicular Fluid Associated with External Invasive Resorption: A Split-Mouth Cross-Sectional Study

IntroductionThis study aimed to investigate the levels of interleukin-1 receptor antagonist (IL-1RA), receptor activator of nuclear factor-κB ligand (RANKL), osteoprotegerin (OPG), interleukin-1β (IL-1β), osteopontin (OPN), and tissue necrotizing factor-α (TNF-α) in teeth with external invasive resorption (EIR) in comparison to the contralateral healthy tooth of the same patient. Materials and MethodsTwenty-nine patients with at least one tooth with EIR and a healthy tooth on the contralateral side (33 paired teeth) were included. Data on patient demographics and medical and dental history were collected. Gingival crevicular fluid was collected from the subject and control teeth. Clinical, radiographical, and cone-beam computed tomography examinations were performed. Wilcoxon signed-rank test was used to compare biomarker concentrations, RANKL/OPG, and IL-1RA/IL-1β ratios in the diseased and healthy teeth. Teeth pairs were grouped based on Heithersay and Patel’s classification, and the differences in biomarker concentrations between diseased and healthy teeth were compared using a Kruskal-Wallis test. ResultsTeeth with EIR had significantly lower concentrations of IL-1RA and OPG compared to their respective healthy control teeth (p<0.05). The RANKL/OPG ratio in teeth with EIR was significantly higher than in their paired healthy teeth (p<0.05). A history of herpes zoster infection (HZI) was associated with a higher IL-1RA concentration and RANKL/OPG ratio (p<0.05). Orthodontic treatment was significantly associated with lower OPG concentration (p<0.05). ConclusionsThere is a significant association between EIR and specific biological markers. A history of orthodontic treatment and HZI are significantly associated with altered levels of biomarkers in the GCF.

Initial Clinical and Cone-Beam Computed Tomography (CBCT) Outcomes of Enamel Matrix Derivative-Based Regenerative Therapy in Vertical Bone Defects.

Background and objective Enamel matrix derivatives (EMD) arebiomaterials extracted from porcine dental germs. They consistof amelogenins (90%), ameloblastine, enamelin, and amelotin. New evidence has shown that all these proteins can be absorbed onto hydroxyapatite crystals and collagen fibers on the root surface of teeth and initiate regeneration of root cementum as well as stimulate periodontal cell proliferation. Currently, the most preferred method of periodontal regenerative therapy in clinical dental practice involves EMD, thanks to its facilitated surgical protocol and the many postoperative complications associated with guided tissue regeneration. There is scarce dataregarding when the first and earliest signs of healing occur after the application of this method. Hence, this study focused on the evaluation and analysis of clinical outcomes and cone-beam CT (CBCT) results at sixmonths after the application of the EMD technique. It aimed to evaluate the efficacy of regenerative therapy with EMDin vertical bone defects six months post-surgical intervention. Material and methods The study was conducted between August 2022 and July 2023 in the Faculty of Dental Medicine, the Medical University - Varna, using the University Medical-Dental Center as a base. The study included 12 cases characterized by bilateral, trilateral, or a combination of the mentioned vertical bone defects. The participants were aged between 31 and 57 years, of both genders, with satisfactory personal oral hygiene. They were in good general condition with no established systemic diseases and gave prior written informed consent. Between the sixth and eighth weeks after the hygiene phase was completed, the patients were re-evaluated, a new periodontal status was recorded, and a CBCT examination was ordered. Three clinical (probing pocket depth, gingival margin level, andclinical attachment level) and three radiographic parameters (A, B, and C) were evaluated in areas of vertical bone defect. Six months after the regenerative therapy using EMD, the same parameters were again recorded in all patients. Finally, after statistical processing of the results, an analysis of the data was performed regarding the early effectiveness of EMD application in regenerative therapy of vertical bone defects. Results The clinical results observed at the six-month mark following regenerative therapy using EMDin vertical bone defects indicated an average reduction in probing depth of 4.50 mm, an average apical migration of the gingival margin by 0.5 mm, and an average clinical attachment level of 4.00 mm. Bone filling was noted on the CBCT, corroborated by the following parameters: A - an average decrease of 1.51 mm; B - an average decrease of 0.50 mm; and C - an average decrease of 0.24 mm. Conclusions The results of our study confirm the remarkable effectiveness of EMD as a regenerative biomaterial. Furthermore, both clinical and CBCT studies demonstrated a very good healing process at an extremely early stage after the surgical intervention.

Monte Carlo simulation study of the effect of thyroid shielding on radiation dose in dental cone beam CT in an adult male phantom.

In this paper, the effect of thyroid collars on radiation dose during dental cone-beam computed tomography (CBCT) was evaluated using Monte Carlo simulations and to calculate the effective dose underestimated for the actual CBCT examination due to accounting only for the head and neck. Three thyroid collar models that covered the surface of the phantom were established according to the International Commission on Radiological Protection (ICRP) adult-male mesh-type reference computational phantoms, and a Particle and Heavy Ion Transport code System was used to calculate the equivalent and effective doses of ICRP phantom when different thyroid shielding protocols were used in NewTom VGi evo CBCT, considering one medium (12×8cm) and one small (8×5cm) fields of view (FOVs), and two centre positions were used for each FOV. In four CBCT scanning scenarios, thyroid shielding reduced the equivalent dose for many tissues. The results indicate that the portion of the thyroid collar that wraps around the neck has the main role in reducing the effective dose during dental CBCT examinations, and the higher the axial level of the top of the shielding, the better the effectiveness of the shielding. In this study, the underestimation of the effective dose due to considering only the head and neck was 3.1%-8.1%, and the underestimation was more pronounced in larger FOVs.

Effects of Different Fields of View and Rotation Angles on Radiation Doses to Highly Radiosensitive Organs in Children Using Dental Cone Beam Computed Tomography

Dental cone beam computed tomography (CBCT) is a diverse 3D X-ray imaging technique that has enabled clear visualization of the teeth and surrounding structures. The most common diagnostic purpose of dental CBCT examination in children is ectopic eruption and impacted teeth, and a small field of view (FOV) is often used. Since it is difficult for children to control their body movements, reducing the rotation angle is effective. However, no studies have examined the effects of different rotation angles on radiation doses to highly radiosensitive organs in children using small FOVs. The purpose of this study was to examine the effects of small FOVs (4 × 4 cm and 6 × 6 cm) and rotation angles (360° and 180°) on doses that highly sensitize organs in children using dental CBCT. The entrance surface doses to lenses, thyroid lobes, parotid glands, and sublingual glands of a pediatric whole-body phantom were measured. By reducing the FOV from 6 × 6 cm to 4 × 4 cm, the dose to the sublingual gland could be significantly decreased. Additionally, by reducing the rotation angle from 360° to 180°, the lens dose can be decreased significantly. As the rate of dose reduction varies among organs, it is important to consider the relative positions of different organs with respect to the FOV and the trajectory of the X-ray tube.

The Sensitivity and Specificity of Susceptibility Weighted Imaging Phase (Swip) in Detecting Intracranial Large Artery Calcium Stenosis Compared to Cone Beam CT

Introduction: Intracranial calcifications are common and often associated with advanced stages of atherosclerosis. Studies estimating the prevalence of intracranial calcifications using other imaging modalities are common, however, studies comparing the diagnostic accuracies of cone-beam computed tomography (CBCT) and susceptibility-weighted imaging (SWI) and generated scoring systems for SWI are not well established. Aims: The objectives of the present study are to identify locations of intracranial calcifications; estimate the sensitivity and specificity rates for each intracranial vessel and each modality; estimate the sensitivity and specificity rates for diagnosing each grade of stenosis for each modality; and generate cutoff value for predicting each grade of intracranial stenosis and for each modality; as well as to develop a scoring system for estimating intracranial stenosis using SWI. Material and Methods: The study employs a prospective cross-sectional study design to collect brain data from 146 stroke patients who had initially undergone CBCT and SWI examinations. Data were collected using pro forma from January 2021 to December 2022 at Hospital Pengajar Universiti Putra Malaysia. Results: The results show an estimated prevalence of intracranial calcification of 87.7% and 92.5% for CBCT and SWI respectively. Regarding intracranial calcium grades, the prevalence of minimum – mild, moderate, and severe grade stenosis were 18.5%, 58,9%, and 10.3% respectively for CBCT and 2.7%, 33.8%, and 57.5% for SWI. Further, the results revealed that CBCT attained a sensitivity of 100% for the anterior cerebral artery, 71% for the middle cerebral artery, and 100% for the vertebral artery as well as a specificity of 90%, 80%, and 42% for the anterior cerebral artery, middle cerebral artery, and vertebral artery respectively. However, with the SWI modality, basilar, vertebral, and middle cerebral arteries reached a sensitivity of 90%, 63%, and 87% and a specificity of 82%, 95%, and 59%. Conclusion: In conclusion, both CBCT and SWI demonstrate reliable means of detecting intracranial calcifications and vessel stenosis with SWI outperforming CBCT.

Assessment of cone beam computed tomography use in pediatric and adolescent patients: a cross-sectional study

BackgroundThe use of cone beam computed tomography (CBCT) for dentomaxillofacial diagnostics in pediatric dentistry is expanding and concerns have been raised about the radiation risks associated with this imaging modality, especially for children. Dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks (DIMITRA) is a multidisciplinary project focused on optimizing CBCT exposure for children and adolescents. This study aims to clarify the indications behind CBCT scans in children aligned with DIMITRA’s recommendations.MethodsFor each CBCT examination, data were collected on patient age at the time of the CBCT examination, gender, reason for request, referring department, CBCT-requested region, and the field of view (FOV) dimension of imaging. The CBCT indications were categorized under six headings according to an adaptation of the DIMITRA project recommendations: impacted teeth, dentoalveolar trauma, orofacial clefts, dental anomalies, bone pathology, syndromes. Indications not categorized in DIMITRA were recorded below the heading “other”.ResultsThe most common indication was the “other” category (34.8%), which included implant, temporomandibular joint dysfunction, orofacial anomalies, foreign object and root canal morphology. The least common indication was “orofacial cleft” (1.9%) and no requests were made for cases related to syndromes. Detection of supernumerary tooth in dental anomalies (68.6%) was the most common CBCT indication, while dentigerous cysts (37.6%) were among the most common CBCT indication in bone pathologies and orofacial anomalies (68.1%) in the other category. The most common size was External Center (15 × 15 cm) (27%) and the least common size was Both Arches/small (8 × 8 cm) (0.4%) when the CBCT FOV was analysed.ConclusionsAlthough the option of a smaller FOV size was available, the larger FOV size that included the both jaws were most frequently used. When justifying CBCT requests, patient-specific radiation dose risks should be considered and specific guidelines should be followed.

Cone-Beam Computed Tomography (CBCT) Analysis of Mandibular Condyles' Diameters in Patient with Juvenile Idiopathic Arthritis and Temporomandibular Joint Affection: A Cross-Sectional Investigation.

Objectives: The aim of this study was to evaluate through analysis using CBCT the transverse and axial diameters of the mandibular condyles in subjects affected by juvenile idiopathic arthritis (JIA) and compare them with those of healthy subjects. Methods: The study was conducted on CBCT scans from the digital archive of the Department of Biomedical Surgical and Dental Sciences, University of Milan, including patients with JIA and using healthy subjects as controls. Inclusion criteria: aged between 7 and 25 years old at the time of the CBCT examination; Caucasian ethnicity; diagnosis of JIA according to the International League of Associations for Rheumatology (ILAR) criteria documented in patients' records; TMJ involvement; good quality CBCTs covering our region of interest (ROI), from the glabella to the mandibular inferior border; no previous orthodontic/orthopedic treatment; no history of craniofacial trauma or congenital birth defects involving the craniofacial area. Each CBCT scan underwent examination using 3Diagnosys® software. Since data were normally distributed, parametric tests were used for analysis. The sample was divided into three groups: (1) bilateral JIA subjects, (2) unilateral JIA subjects, and (3) healthy controls. Results: We found a statistically significant reduction (p < 0.0001) in the transverse diameter (TR-Diam) of the affected condyles by an average of 1.7 mm, while the axial diameter (AX-Diam) again showed a slight reduction, on average by 0.1 mm, with a non-statistically significant value. Another comparison was made between the unaffected condyles of patients with unilateral JIA and the healthy condyles of the control group. The unilateral unaffected condyles were found to be slightly smaller than those of healthy patients, but without statistically significant differences. We found that in both JIA males and females, the condylar growth tends to stop earlier than the healthy ones. Conclusions: The transverse diameter was found to be more affected than the axial one, causing typical bone resorption and condylar shape. Moreover, we showed that the pathology, in the case of unilateral JIA, does not compromise only the affected condyles; the corresponding condyle that seems to be healthy is actually partially compromised. In addition, we observed that the growth of affected condyles of JIA subjects tends to stop earlier than the condyles of the healthy controls.

Three-dimensional anatomical analysis of the optic nerve canal with virtual model based on CBCT

The optic nerve canal (ONC) is a fine skeletal structure that contains the optic nerve. However, it has not been thoroughly examined. This necessitates establishing a baseline knowledge of the geometrical and volumetric parameters of the ONC. The data of twenty patients who received a cone beam computed tomography examination were prepared using a voxel-based segmentation. The measurement was performed separately by two examiners on virtual skull models in stereolithography format in Geomagic Wrap®. The results showed that the volume of the ONC varied between 92.48 mm3 and 162.7 mm3 (M = 123.46 mm3, SD = 26.61 mm3). Sex-specific statistically significant differences in volume were detected only for the right side. The angle of the ONC to the skull base was independent of the diameter of the canal. Both the intrarater and interrater comparisons of the measurements showed high values of reproducibility of the results. This study showed that a virtual anatomical model provides a feasible and reliable method to investigate the ONC. The examination technique could have a wider range of application in anthropology and application in clinical medicine. Advances in the automation of radiological diagnostics and the digital analysis of X-ray images could help to reduce examination times.

Variations in head tilt during the acquisition of cone beam computed tomography scans and their effects on effective radiation dose.

This study evaluated the impact of variations in anteroposterior and lateral tilts of patients head on radiation-weighted doses to organs/tissues and effective doses using 3 different cone beam computed tomography (CBCT) machines. An anthropomorphic phantom was used to estimate radiation doses in 3 CBCT machines (OP300, Eagle X 3D, and Eagle Edge). Thermoluminescent dosimeters were placed in regions corresponding to pre-stablished organ/tissues. CBCT examinations from the posterior mandible and anterior maxilla regions were acquired, with 3 different anteroposterior angulations (0°, 30°, and 45°), and from the posterior mandible in 3 different lateral angulations (0°, 20° to the left, and 20° to the right side). Radiation-weighted doses for each organ/tissue and effective doses were calculated for each machine and angulation. For the posterior mandible acquisitions, anteroposterior angulations of the head at 30° and 45° yielded a reduction in effective doses in all 3 devices. A 20° tilt to the right side resulted in lower doses than to the left [same side as the field of view (FOV)]. For the anterior maxilla, increased anteroposterior angulation was associated with reduction in effective dose in 2 devices. Effective doses are lower when small FOV CBCT exams of the posterior mandible and anterior maxilla are acquired with increased anteroposterior head angulation at 30° and 45°. For FOV in the posterior mandible, a 20° lateral tilt towards the side opposite to the FOV also yields lower effective doses. The main contribution to these dose reductions is the decrease in dose to salivary glands.

Evaluation of gingival thickness obtained from intraoral scanning registration with cone beam computed tomography at different acquisition modes

To investigate the reliability of gingival thickness measurements obtained from the registration of intraoral scans with cone beam computed tomography (CBCT) examinations at different acquisition modes. CBCT examinations of 9 porcine hemimandibles were acquired using the OP300 Maxio unit operating at the highest-dose protocol with the smallest voxel size as the reference standard for visualizing the gingival surface. Subsequently, the hemimandibles were surrounded by water to simulate soft tissue attenuation of radiation, and additional CBCT examinations were acquired in 4 modes: Endo, High-resolution, Standard-resolution, and Low-dose. These CBCT datasets were registered with corresponding intraoral scans obtained with the Carestream Dental 3600 intraoral scanning system using the Blue Sky Plan 4 software. Four oral radiologists measured the buccal gingival thickness on cross-sectional reconstructions at 4 measurement sites and 2 distances from the gingival margin in the CBCT reference standard examinations and examinations obtained with water and intraoral scan registration. Multifactorial analysis of variance was used to assess the influence of acquisition mode, measurement site, and distance from the gingival margin on measurements (α = 5%; statistical power = 90%). Buccal gingival thickness measurements obtained via CBCT after registration with intraoral scanning were not significantly influenced by acquisition mode (P = .153) or measurement site (P = .089). Gingival thickness measurements derived from the registration of intraoral scans with CBCT examinations at different acquisition modes appear to be reliable.

Is a Pre-Existent Cone-Beam Computed Tomography Able to Detect Metal Dental Posts?

(1) Background: In this study, the efficacy of cone-beam computed tomography (CBCT) in detecting dental posts was compared to periapical radiography. (2) Methods: A retrospective evaluation of 53 patients' periapical radiographs and CBCT images was performed. The presence and type of the intra-canal dental post were initially determined on the periapical images (PA) radiographs' examination and were then compared to the observer's ability to detect the dental post on a CBCT image. The effect of the post's type (metal cast or prefabricated) on its detection on CBCT images was determined. (3) Results: 10.5% of teeth that were identified as having a post on a PA radiograph were not identified as having a post on the CBCT examination (p < 0.05). Approximately 17.6% of teeth that were identified as not having a post on a PA radiograph were identified as having a post on the CBCT examination (p < 0.05). Moreover, 16.3% and 50% of teeth with a prefabricated or cast posts on PA radiographs were falsely identified on the CBCT examination, respectively (p < 0.05). (4) Conclusions: A CBCT image is an insufficient tool for the identification of metal prefabricated and cast posts. A PA image is the recommended radiographic tool for achieving information about the post-endodontic restoration status of teeth candidates for endodontic retreatment in patients with a former CBCT scan.

Evaluation of a prototype metal artifact reduction algorithm for cone beam CT in patients undergoing radioembolization

Metal artifacts notoriously pose significant challenge in computed tomography (CT), leading to inaccuracies in image formation and interpretation. Artifact reduction tools have been designed to improve cone beam computed tomography (CBCT) image quality by reducing artifacts caused by certain high-density materials. Metal artifact reduction (MAR) tools are specific algorithms that are applied during image reconstruction to minimize or eliminate artifacts degrading CBCT images. The purpose of the study is to evaluate the effect of a MAR algorithm on image quality in CBCT performed for evaluating patients before transarterial radioembolization (TARE). We retrospectively included 40 consecutive patients (aged 65 ± 13 years; 23 males) who underwent 45 CBCT examinations (Allura FD 20, XperCT Roll protocol, Philips Healthcare, Best, The Netherlands) in the setting of evaluation for TARE between January 2017 and December 2018. Artifacts caused by coils, catheters, and surgical clips were scored subjectively by four readers on a 5-point scale (1 = artifacts affecting diagnostic information to 5 = no artifacts) using a side-by-side display of uncorrected and MAR-corrected images. In addition, readers scored tumor visibility and vessel discrimination. MAR-corrected images were assigned higher scores, indicating better image quality. The differences between the measurements with and without MAR were most impressive for coils with a mean improvement of 1.6 points (95%CI [1.5 1.8]) on the 5-point likert scale, followed by catheters 1.4 points (95%CI [1.3 1.5]) and clips 0.7 points (95%CI [0.3 1.1]). Improvements for other artifact sources were consistent but relatively small (below 0.25 points on average). Interrater agreement was good to perfect (Kendall’s W coefficient = 0.68–0.95) and was higher for MAR-corrected images, indicating that MAR improves diagnostic accuracy. A metal artifact reduction algorithm can improve diagnostic and interventional accuracy of cone beam CT in patients undergoing radioembolization by reducing artifacts caused by diagnostic catheters and coils, lowering interference of metal artifacts with adjacent major structures, and improving tumor visibility.

Dens invaginatus Type II in an Immature Lateral Incisor With Apical Periodontitis Treated With Regenerative and Strategic Antimicrobial Procedures: A Case Report

Dens invaginatus is a developmental dental anomaly that can predispose the tooth to pulp and periradicular disease. Management of this condition can be challenging because of anatomic and microbiologic issues. This case report describes the regenerative endodontic treatment using a strategic antimicrobial protocol for management of an immature maxillary lateral incisor with type-II dens invaginatus associated with apical periodontitis in a 13-year-old patient. The tooth presented with a complex anatomy and was associated with an active sinus tract. Because the true root canal was not negotiable in its coronal part due to the presence of the dens invaginatus, the closed end of the invagination (pseudocanal) was perforated to permit access to the apical segment of the true root canal for cleaning and disinfection. Both the invagination and the true canal were treated using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation, supplementary disinfection with passive ultrasonic irrigation and interappointment calcium hydroxide medication. After 2 exchanges of calcium hydroxide medication, the sinus tract did not disappear, then the antimicrobial protocol was changed to include an antibiotic solution for irrigation and antibiotic paste for intracanal medication. After signs and symptoms disappeared, regenerative endodontic treatment was performed by inducing blood clot formation within the root canal. The coronal canal segment including the invagination was filled with Biodentine. Follow-up including cone-beam computed tomography examination showed complete healing of the apical periodontitis lesion and mineralized tissue formation at the apical portion of the true root canal.

Sinus membrane thickness of healthy endodontically treated maxillary molars

ObjectiveThe study aimed to investigate the sinus membrane thickness (SMT) adjacent to healthy endodontically-treated maxillary molars with or without protruded apical foramen into the sinus cavity using cone-beam computed tomography (CBCT).Materials and methodsImages of 207 non-smoker patients aged 18–40 were retrospectively analyzed, 140 were endodontically treated, and 136 were without endodontic treatment. Patients with any sinus pathology, teeth that have symptoms, or poor root filling were excluded. Study groups consisted of Group EM-I (endodontically treated and protruded apical foramen), Group EM-C (endodontically treated and contacted apical foramen), and similarly without endodontic treatment; Group M-I and Group M-C. SMT upon the mesial, distal, and palatal roots was measured. One-way ANOVA and Student’s t-tests were performed.ResultsGroup EM-I had the thickest sinus membrane compared to other groups (p = 0.013). SMT values were 2.37–2.60 mm in Group EM-I, and 1.34–1.58 mm in other groups. Thickening (> 2 mm) percentages were 33.45% in Group EM-I and between 4.25 and 8.25% in other groups. No statistical difference was detected between first and second molars and genders (p > 0.05).ConclusionWhen the apical foramen protruded into the sinus cavity, the conventional root canal treatment caused a minimal (between 2.37 mm and 2.60 mm) sinus membrane thickening with a rate of 33.45% based upon CBCT examinations.

Cone beam computed tomography and cross-sectional anatomy of the region of the fetlock in the horse (Equus caballus).

This study aimed to delineate the detailed anatomy of the metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints in healthy horses using cone beam computed tomography (CBCT). The fetlock region of 15 cadaveric forelimbs and 14 cadaveric hindlimbs from nine adult horses without orthopaedic disease underwent CBCT scanning. Additionally, arthrography CBCT scans were conducted following intra-articular injection of a radiopaque contrast medium containing blue epoxy resin dye. Subsequently, limbs were frozen and sectioned to visualize anatomical structures in sectional planes corresponding to selected CBCT images. CBCT proved suitable for detailed visualization of the bony components of the fetlock region. Furthermore, the common digital extensor tendon, superficial and deep digital flexor tendons, suspensory ligament, and straight and oblique sesamoidean ligaments were identifiable on CBCT images. However, certain ligaments, such as the collateral sesamoidean ligaments and intersesamoidean ligaments, were not clearly identified. The hyaline cartilage of the MCP and MTP joint facets was assessable on the post-contrast sequence. In cases where a radiographic or ultrasound examination cannot provide a definitive diagnosis and determine the extent of disease, CBCT can provide additional valuable data on the equine MCP and MTP joint. The images obtained in this study can serve as a reference for CBCT examination of the equine MCP and MTP joint.

Variations in Root Canal Morphology of Mandibular Incisors in a North Indian SubPopulation: A Retrospective Cone-Beam Computed Tomography Analysis.

There is a high failure rate of endodontic treatment in the mandibular incisors due to insufficient knowledge of the morphology. The aim of this study was to analyze the root canal morphology in mandibular incisor teeth in the North Indian subpopulation to improve the outcome of endodontic treatment. A cross-sectional study was conducted at the OPD of a tertiary care institute. A total of 200 mandibular central incisors and 200 mandibular lateral incisors were selected from available cone-beam computed tomography examinations of 100 patients aged 18-79 years. They were evaluated for root canal system configuration and symmetry between right and left elements in the same individual. Chi-square/Fisher's exact test was used to find the association between different study variables. For mandibular central incisors, type I Vertucci classification was present in 69% of cases, type II in 3.5%, type III in 18.5%, type IV in 2%, and type V in 7% of cases. For mandibular lateral incisors, type I was present in 70.5% of cases, type II in 4% of cases, type III in 19.5%, type IV in 2%, and type V in 4% of cases. There was no evidence of types VI, VII, and VIII. Symmetry of root canal morphology between left and right teeth was observed in 90% of central incisors and 93% of lateral incisors. Type I Vertucci configuration was the most prevalent; however, the prevalence of other configurations is also evident. Therefore, endodontists should explore the morphology of these teeth carefully while performing root canal treatments.

Soft Tissue Retraction Maneuver in Cone Beam Computed Tomography Prior to Crown-Lengthening Procedure-A Technical Note.

Background: An accurate determination of the biological width and the relationship of the cemento-enamel junction with the border of the alveolar bone is crucial during a clinical crown-lengthening (CCL) procedure. The aim of this study was to present a technical note about the retraction techniques in cone beam computed tomography (CBCT) prior to CCL, highlighting the significant enhancement in procedural accuracy and predictability that these techniques offer. Methods: Clinical and radiological examinations should be performed before a CCL procedure. It is necessary to determine the length of the tooth crowns, the periodontal pockets' depth, and the phenotype of the gingiva. The ideal CBCT examination should be performed with soft tissue retraction. This can be achieved using retractors or cotton rolls. Results: Retraction of the lips, cheeks, and tongue allows one to assess the marginal gingiva, the cemento-enamel junction, and the alveolar bone. A detailed plan of the CCL procedure, which involves retraction, ensures both the aesthetic appeal and the achievement of a newly defined gingival zenith, enhancing the overall visual harmony. Conclusions: Compared with conventional radiographic imaging, the soft tissue retraction maneuver in CBCT prior to CCL surgery offers an effective approach to the evaluation and diagnosis of soft and hard tissue. This is because of the detailed planning of the aesthetic CCL procedure. Such an approach leads to superior aesthetic outcomes in dentistry, contributing to the advancement of aesthetic dentistry through a harmonious blend of art and science.