Digital Periapical Radiographs Research Articles

Platelet-rich fibrin as an apical barrier for MTA placement in the treatment of teeth with open apices: a pilot study

ObjectiveThe aim of the present pilot study was to assess the effectiveness of the platelet-rich fibrin (PRF) apical barrier for the placement of MTA for the treatment of teeth with periapical lesions and open apices.MethodsA total of thirty teeth on twenty-eight patients with open apices and periapical periodontitis were enrolled and divided into two groups in the present pilot study. In the PRF group (fourteen teeth in thirteen patients), nonsurgical endodontic treatment was performed using PRF as an apical matrix, after which the apical plug of the MTA was created. For the non-PRF group (fourteen teeth in fourteen patients), nonsurgical endodontic therapy was performed using only the MTA for an apical plug with no further periapical intervention. Clinical findings and periapical digital radiographs were used for evaluating the healing progress after periodic follow-ups of 1, 3, 6, and 9 months. The horizontal dimension of the periapical lesion was gauged, and the changes in the dimensions were recorded each time. The Friedman test, Dunn-Bonferroni post hoc correction, and Mann-Whitney U test were used for statistical analysis, with P < 0.05 serving as the threshold for determining statistical significance.ResultsAll patients in both groups in the present pilot study had no clinical symptoms after 1 month, with a significant reduction in the periapical lesion after periodic appointments. The lesion width of the PRF group was significantly smaller than that of the non-PRF group in the sixth and ninth month after treatment.ConclusionsPRF is a promising apical barrier matrix when combined with MTA for the treatment of teeth with open apices and periapical periodontitis. Small number of study subjects and the short time of follow-up period limit the generalizability of these results.Trial registrationTCTR, TCTR20221109006. Registered 09 November 2022 - Retrospectively registered, https://www.thaiclinicaltrials.org/show/TCTR20221109006.

Bone-level Tapered Implants for Single Tooth Replacement. Immediate vs Delayed Placement: A Randomized, Controlled, Multi-center One-year No-inferiority Clinical Study.

Post-market, prospective, randomized, controlled, multi-center study with a primary endpoint of one year. 53 subjects were randomized to receive either immediate implant placement (test group) or delayed implant placement (control group). The mean crestal bone-level changes from implant loading to 12 months post-implant loading were measured using standardized, digital periapical radiographs. Changes in facial plate thickness measured on cone-beam computed tomography (CBCT) images, implant success and survival, implant stability, soft tissue changes, patient-centered outcomes, and adverse effects were measured to assess outcomes between the test and control treatments at 12 months post-loading. 46 subjects completed the study (23 in each group). Mean bone changes from loading to the 12 month follow-up were recorded with no statistically significant difference (p=0.950) between both groups. The hypothesis was confirmed that immediate implant placement (Test) in extraction sockets is similar to delayed placement (Control). The test group was found to be similar to the control group (P=0.022) in terms of mean changes in facial plate thickness. Implant survival and success were 95.8% in the test group and 92% in the control group. Stability in the control group was superior at the time of surgery, but there was no difference between both groups at implant loading, producing a non-significant p-value of (0.563). This randomized, controlled, multi-center one-year study showed comparable outcomes 1-year after prosthetic loading in the immediate and delayed placement groups.

Prognostic Factors Affecting the Outcome of Surgical Root Canal Treatment-A Retrospective Cone-Beam Computed Tomography Cohort Study.

Aim: To assess the association between demographic and clinical variables and the outcome of root-end surgery using digital periapical radiographs (PA) and cone-beam computed tomography (CBCT). Methodology: One hundred and fifty teeth that received endodontic microsurgery were clinically and radiographically examined (PA and CBCT scans) after 1 and 2 years. Two calibrated endodontists evaluated the radiographic healing based on a six-point outcome classification. The outcome was classified using both strict (healed) and loose (healing) criteria. The success rates were calculated, and several outcome prognostic factors were assessed. Results: One hundred and fifty teeth were assessed with both radiographic systems. When "loose" success criteria were applied using PA, 90% (n = 135) of teeth were assessed as having had a favourable outcome (90%; 95% CI: 85.2-94.8%), whereas 90.7% (n = 136) of teeth showed a successful outcome when assessed with CBCT (90.7%; 95% CI: 86.0-95.3%). When "strict" success criteria were applied, there was a statistically significant difference (p = 0.018) between the success rates of mineral trioxide aggregate (MTA) (63.7%) and Biodentine (95.5%). Conclusions: Within the limitations of this study, endodontic microsurgery showed a high success rate. Among all the demographic and clinical variables assessed, in the multiregression analysis, only the use of Biodentine was associated with a higher proportion of "complete" healings compared to MTA or Intermediate Restorative Material (IRM) when assessed using CBCT. MTA and Biodentine performed similarly when "incomplete" healings were regarded as successful outcomes.

Comparison of periapical radiography, panoramic radiography, and CBCT in the evaluation of trabecular bone structure using fractal analysis.

The aim of this study is to compare imaging techniques to evaluate trabecular bone structure using Fractal Analysis (FA). Fifteen sheep hemimandibles were used for this study. Digital images were obtained using periapical radiography, panoramic radiography, and cone-beam computed tomography (CBCT). CBCT imaging was performed in standard (STD) and high-resolution (HR) modes. FA was conducted using ImageJ 1.3 software with the box-counting method on the images. The fractal dimension (FD) values were analyzed by the statistical software Jamovi 1.6.23. Statistical significance was accepted as p < 0.05. The highest mean FD value was the FD on digital periapical radiographs (PaFD) (1.28 ± 0.04), and the lowest mean FD value was the FD on standard resolution cone-beam computed tomography images (STD-CBCTFD) (1.12 ± 0.10). Although there was no statistically significant difference between the PaFD and the FD on digital panoramic radiographs (PanFD) (p = 0.485), the PaFD was found to be significantly higher than STD-CBCTFD (p < 0.001), and the FD on high-resolution cone-beam computed tomography images (HR-CBCTFD) (p = 0.007). The PanFD was found to be significantly higher than the STD-CBCTFD (p = 0.004). According to our results, in the evaluation of trabecular bone structure using FA, periapical radiographs and panoramic radiographs have similar image quality for assessment of the FD. On the other hand, CBCT results did not correlate with results from any of the other techniques in this study.

Platelet rich fibrin and MTA in the treatment of teeth with open apices

BackgroundThe present study aimed to evaluate the effectiveness of using platelet-rich fibrin (PRF) as the apical matrix for the placement of MTA in nonsurgical endodontic therapy for teeth with periapical lesions and open apices.MethodsTwelve teeth from eleven patients with periapical periodontitis and open apices were enrolled in the study. Nonsurgical endodontic therapy was performed with the PRF used as an apical barrier and the MTA manipulated as an apical plug for further thermoplasticized gutta percha in the remaining part of the root canal. Clinical signs and periapical digital radiographs were recorded and analyzed to evaluate the curing progress after periodical follow-ups of 1, 3, and 6 months. The horizontal dimension of the periapical lesion was determined, and the changes in the dimensions were recorded each time. The Friedman test was used for statistical analysis, with P < .05 serving as the threshold for determining statistical significance.ResultsAll patients had no clinical symptoms after the first month of treatment, with a significant reduction in the periapical lesion after periodical appointments.ConclusionsPRF is an effective barrier when combined with MTA for the treatment of teeth with periapical periodontitis and open apices.

Pericervical Dentin Metrics in Mandibular First Molars Determined with Digital Periapical Radiography and Cone-beam Computed Tomography

IntroductionPericervical root dentin is decisive for the long-term mechanical integrity of root-filled teeth. Current treatment protocol does not include a customized step to determine the pretreatment residual pericervical root dentin. ObjectiveTo determine and compare the residual root dentin and canal width using digital periapical radiography (DPR) and cone-beam computed tomography (CBCT) at the apical limit of the pericervical area (PCA) in mandibular first molars. MethodsDPR and CBCT images of 60 patients with age between 22 and 76 years were used to determine (a) the mesiodistal widths of the root canal (pericervical dimensions [PCL]-C) and the root (PCL-R) of mandibular first molars at the apical limit of the PCA and (b) the intracanal distance from the apical limit of the PCA to the radiographic apex (intracanal distance [ICD]). The correlation between the PCL and ICD measurements obtained from DPR and CBCT were evaluated. ResultsValues between 0.10–0.80 mm and 0.00–1.10 mm were obtained for PCL-C using DPR and CBCT respectively (95% CI). The PCL values between 0.90–2.30 mm and 0.00–2.30 mm were obtained from DPR and CBCT respectively (95% CI). The ICD ranged between 4.6–12.3 mm in DPR and 4.40–12.0 mm in CBCT (95% CI). The comparative analysis showed differences from −0.9 to 0.5 mms for PCL and −2.00 to 1.5 mms for ICD between DPR and CBCT techniques respectively. ConclusionThe PCL and ICD determined from DPR and CBCT provided the pericervical dentin metrics that could be utilized clinically as a guideline for decision-making in endodontic treatment.

A 1 year follow-up of a molar root canal treatment using periapical radiographs and CBCT

CBCT offers many significant advantages in dentistry, while the periapical radiographs provide a cheaper technique and a lower radiation compared to CT scan. The aim of this clinical case was to compare the outcome 1 year after root canal treatment, using digital periapical radiographs versus CBCT. Tooth 46 with necrotic pulp and periapical periodontitis was rotary prepared and filled using continuous wave condensation and AH Plus. X-rays and CBCT scans were made both before and after the treatment, at 1 year recall. On x-ray the lesion appeared to be healed, while on CBCT one can still see a smaller lesion, so the tooth is healing. The increased accuracy of CBCT offers the most relevant information for the outcome of endodontic treatment.

Accuracy of Selective Laser Melted Bar Retaining Mandibular Implant-Assisted Overdenture: An In Vitro Comparison of Different Impression Materials and Techniques.

This study aimed to assess the accuracy of the marginal fit of 2 implant-supported overdenture bars fabricated with selective laser melting technology, using polyvinyl siloxane and vinyl siloxane ether impression materials and different impression techniques. Two implants with multi-unit abutments were inserted in a 3D-printed mandibular model and used as a reference model, then duplicated into a stone cast to fabricate custom trays for obtaining impressions with polyvinyl siloxane and vinyl siloxane ether impression materials, using both open and closed-tray techniques. This resulted in a total of 4 groups, each with 8 specimens. The impressions were poured and scanned, and 32 cobalt-chromium bars were fabricated using selective laser melting technology. Each bar was screwed onto one abutment of the reference model, and a standardized digital periapical radiograph of the opposite unscrewed side was taken; this process was repeated to the other abutment. The vertical misfit was measured at 3 predetermined positions on the unscrewed side, and 6 values per bar were recorded. The mean gap distance was measured, and the data were subjected to statistical analysis; the present study found that the open-tray technique with vinyl polyether siloxane impression material may offer improved accuracy for obtaining impressions for 2 implant-supported bars. The open-tray technique groups also showed better marginal fit than the closed-tray groups. However, further clinical research is required to confirm these findings.

Fractal analysis of the mandible cortical bone: correlation among fractal dimension values obtained by two processing methods from periapical radiograph and micro-computed tomography with cone-beam computed tomography.

The objectives of the present study were to assess Fractal Dimension (FD) values in the mandible cortical bone obtained from digital periapical radiographs (DPR), high-resolution microtomography (µCT), and cone-beam computed tomography (CBCT), by two processing methods: binarization (FD.b) and grayscale-based method (FD.f) and, finally, to identify the correlation among these values with other micro-architectural parameters. For this, a prospective study was conducted on 18 healthy individuals (mean age 23 ± 2.4years old) who underwent third molar extraction. Pre-operative CBCT scans were conducted, bone fragments were removed from the retro-molar region, and DPR and µCT were performed on those bone samples. FD.b and FD.f values were calculated using three parasagittal sections for CBCT, one image for DPR, and three sections for µCT. The 3D bone microarchitecture was analyzed in µCT (voxel size: 19µm). As a result, FD.b mean values of 1.55 ± 0.02 and 1.80 ± 0.01 were obtained for CBCT and µCT, respectively. Furthermore, FD.f mean values of 1.22 ± 0.12 for DPR, 0.99 ± 0.04 for CBCT, and 1.30 ± 0.07 for µCT were obtained. Both FD.b and FD.f values showed a good agreement. FD.f was negatively correlated with the standard deviation of the mean gray value (p = 0.003) for DPR and intra-cortical bone surface (p = 0.02) for µCT. In conclusion, image processing with or without binarization revealed different values for FD, although showing agreement. The grayscale-based method retrieved FD values correlated with the gray levels and the cortical porous network, which means that FD can be a valuable index for mandibular cortical bone evaluation. FD is associated with mineralization and microarchitecture. Nevertheless, there was no correlation between FD values obtained from low- (DPR) and high-resolution (µCT) X-ray modalities with FD obtained from the in vivo CBCT.

Assessment of the Correlation Between Systemic Conditions and Pulp Canal Calcification: A Case-Control Study.

Pulp canal calcification is a dental condition that is characterized by the deposition of mineralized tissue within the dental pulp space. While it is primarily a local phenomenon, recent studies have suggested a potential link between pulp calcification and systemic diseases. This study aimed to determine the correlation between certain systemic diseases, medications, and the presence of pulp canal calcification. Second, it aimed to estimate the prevalence of pulp calcification in the smoker population. A pair-matched case-control observational study was conducted from June 2022 to June 2023 at the Faculty of Dentistry, King Abdulaziz University. Digital periapical and bitewing radiographs were used for case-based sampling. Patients were categorized into two study groups: the cases group (n=100), consisting of patients with pulp canal calcification including either pulp stone, pulp canal obliteration, or both. Whereasthe control group (n=100), consisted of patients without pulp canal calcification.Detailed medical histories were obtained to identify the presence of systemic diseases. Additionally, systemic medications and smoking status were documented. The participants were divided into two groups; cases (n=100), diagnosed with teeth calcifications and confirmed by radiographic examination, and controls (n=100), showing no evidence of teeth calcifications. Among the patients in the calcification group, 26% had a history of systemic disease compared to 17% in the control non-calcification group with no significant difference between both groups. No correlation between certain medications and pulp canal calcification. Smoking did not demonstrate a statistically significant association with teeth calcifications (p > 0.05). Pulp calcification on routine radiographic examination could indicate an underlying unnoticed systemic disorderthat demands accurate referral and subsequent therapy.

Detection of the pathological exposure of pulp using an artificial intelligence tool: a multicentric study over periapical radiographs

BackgroundIntroducing artificial intelligence (AI) into the medical field proved beneficial in automating tasks and streamlining the practitioners’ lives. Hence, this study was conducted to design and evaluate an AI tool called Make Sure Caries Detector and Classifier (MSc) for detecting pathological exposure of pulp on digital periapical radiographs and to compare its performance with dentists.MethodsThis study was a diagnostic, multi-centric study, with 3461 digital periapical radiographs from three countries and seven centers. MSc was built using Yolov5-x model, and it was used for exposed and unexposed pulp detection. The dataset was split into a train, validate, and test dataset; the ratio was 8–1-1 to prevent overfitting. 345 images with 752 labels were randomly allocated to test MSc. The performance metrics used to test MSc performance included mean average precision (mAP), precision, F1 score, recall, and area under receiver operating characteristic curve (AUC). The metrics used to compare the performance with that of 10 certified dentists were: right diagnosis exposed (RDE), right diagnosis not exposed (RDNE), false diagnosis exposed (FDE), false diagnosis not exposed (FDNE), missed diagnosis (MD), and over diagnosis (OD).ResultsMSc achieved a performance of more than 90% in all metrics examined: an average precision of 0.928, recall of 0.918, F1-score of 0.922, and AUC of 0.956 (P<.05). The results showed a higher mean of 1.94 for all right (correct) diagnosis parameters in MSc group, while a higher mean of 0.64 for all wrong diagnosis parameters in the dentists group (P<.05).ConclusionsThe designed MSc tool proved itself reliable in the detection and differentiating between exposed and unexposed pulp in the internally validated model. It also showed a better performance for the detection of exposed and unexposed pulp when compared to the 10 dentists’ consensus.

Effect of 10% kepok banana peel extract gel (musa paradisiaca linn. kepok) application on periodontal regeneration process in periodontal healing of wistar rat (rattus norvegicus): In vivo study

Objective: The aim of our study was to determine the effect of application of 10% Kepok banana peel extract gel (Musa paradisiaca linn. Kepok) on periodontal regeneration process in periodontal healing of wistar rat (Rattus norvegicus).&#x0D; Methods: Fourty-eight wistar rats were divided into 3 groups, namey 16 rats as the positive control group (Aloclair gel), 16 rats as the negative control group (CMC-Na gel 2%) and 16 rats as the treatment group (10% Kepok banana peel extract gel). The induction of periodontitis was performed using modified ligation technique for 7 days with additional injection of Aggregatibacter actinomycetemcomitans bacteria on the first day. Wistar rats were euthanized on days 1, 3, 5, 7, 14 for histological analysis to evaluate the number of macrophages, lymphocytes, osteoclasts, osteoblasts and fibroblasts. Radiographs were taken on day 21 using digital periapical radiograph (PaloDex Oy). Data were analyzed using Two-Way ANOVA and Post Hoc LSD tests.&#x0D; Results: Data analysis showed a significant difference in the cell numbers among the groups. A decreasing number of lymphocytes, macrophages, and osteoclasts could already be observed since the 1st day, so could an increasing number of fibroblasts and osteoblasts. The fibroblasts and osteoblasts of the treatment group already reached their peak on the 5th day, faster than the negative control and positive control groups that reached their peaks on the 7th day.&#x0D; Conclusion: The application of 10% Kepok banana peel extract gel (Musa paradisiaca linn. Kepok) caused significant acceleration of periodontal regeneration process in periodontal healing of wistar rat (Rattus norvegicus).

Influence of binarization methods on the fractal dimension of alveolar bone using digital radiographs

The aim of this study was to evaluate the influence of binarization methods (BnMs) on the fractal dimension (FD) of the alveolar bone in digital radiographic images. Five identical periapical radiographs were obtained from each of 20 anatomic regions. Using ImageJ/Fiji software, a standardized region of interest was positioned in the trabecular bone of all radiographs, 14 BnMs were independently applied, and FD was calculated. The Friedman test and Dunn post hoc tests were used to evaluate the influence of BnMs on FD (α=0.05). The intraclass correlation coefficient (ICC) was used to assess correlation among BnMs. No significant differences were observed in the threshold value between the BnMs. No significant differences in FD were observed among 9 BnMs (Default, Huang, Iso Data, Li, Mean, Min Error[I], Moments, Otsu, and Shanbhag). These methods presented significantly higher FDs than those from 3 other BnMs (Max Entropy, Renyi Entropy, and Yen), which did not significantly differ from each other. The Triangle method significantly differed from all BnMs, and the Percentile method produced significantly higher FDs than Huang, IsoData, Li, Moments, Otsu, and Shanbhag. Most BnMs presented good or excellent correlation (ICC ≥ 0.76). Binarization methods influence FD of the alveolar bone from digital periapical radiographs; thus, this technical aspect is relevant for comparison purposes and should be standardized. For comparison of published FD research, the Default method is recommended.

Effect of cantilever extension on bone loss in mandibular complete-arch implant-supported fixed prosthesis about 3 and 4 implants.

The assessment of bone loss around implants has been widely studied, but the effect of cantilever length as a risk factor is not fully understood. The objective of this randomized controlled clinical trial was to compare the peri-implant bone loss of mandibular complete-arch implant-supported fixed prosthesis supported (FPS) by 3 and 4 implants and to correlate with the size of the horizontal and vertical distal cantilever at prosthesis installation (T1) and after one year (T2). 72 external hexagon (EH) type implants were installed in 20 participants. Of these, 24 support FPS with 3 implants (GI3) and 48 with 4 implants (GI4). The inferior implants were named 1, 2, 3, and 4 according to their location in the mandibular arch, in a clockwise direction. Digital periapical radiographs were taken at times T1 and T2 for analysis and measurement of peri-implant bone loss. The horizontal and vertical distal cantilevers were measured with a digital caliper and correlated with peri-implant bone loss. The survival rate of implants in GI3 was 91.66%, in GI4 it was 97.91%. The mean bone loss in GI3 was 0.88 (± 0.89) mm and in GI4 it was 0.58 (± 0.78) mm (P = 0.225). There was no correlation between distal horizontal cantilevers and bone loss in the studied groups, with GI3 being -0.25 (P=0.197) and GI4-0.22 (0.129). Larger vertical cantilevers of implants 1 (P=0.018), 3 (P=0.015) and 4 (P=0.045) correlated with greater bone loss in GI4. The number of implants in FPS did not influence peri-implant bone loss after 1 year of follow-up. Larger vertical cantilevers influenced greater bone loss in complete-arch implant-supported fixed prosthesis supported by 4 implants. Int J Prosthodont. 10.11607/ijp.8347.

Does endodontics influence radiological detection of external root resorption? an in vitro study

BackgroundExternal root resorption (ERR) has a multifactorial etiology and is difficult to diagnose, which means that is continues to be of research interest. This work mainly aims to determine whether external root resorption can be differentially detected in root-filled versus non-endodontically treated teeth using digital periapical radiography (DPR) and cone-beam computed tomography (CBCT).MethodsThe Checklist for Reporting In-vitro Studies (CRIS) guidelines were followed throughout this study. This experiment highlights the preparation and generation of standardized synthetic teeth measured on three-dimensional records converted into Digital Imaging and Communication on Medicine (DICOM) file format. Twelve replicate maxillary incisors were randomized into two groups: (G1) six non-endodontically treated, and (G2) six endodontically treated teeth. In both groups, actual tooth lengths of all specimens were measured and compared with measurements obtained using DPR and CBCT. Simulated ERR lesions [0.12, 0.18, 0.20 mm × 0.5 mm depth in the mesial, distal and palatal apical regions] were created progressively, radiographic images were recorded, and 24 DPRs and 96 CBCTs were obtained in total. Eight blinded, previously calibrated researchers made a total of 1920 measurements (using Horos Software). Data were analyzed using the Shapiro–Wilk, ANOVA, Kruskal–Wallis and Wilcoxon rank post-hoc tests [Bonferroni correction in multiple comparison tests (p < 0.05)].ResultsICC values for intra- and inter-examiner agreement were appropriate. DPR overestimated ERR detection compared to the actual and CBCT measurements [Mean diff = 0.765 and 0.768, respectively]. CBCT diagnosis of ERR lesions in specimens without root canal treatment was significantly more accurate than DPR diagnoses on both non-endodontically and endodontically-treated specimens [p = 0.044; p = 0.037, respectively]. There was an 18.5% reduction in sensitivity in all DPR diagnoses made on endodontic teeth versus those made on non-endodontically treated teeth. For the smallest ERR lesions, this sensitivity was even more marked, with 27.8 and 25% less sensitivity, respectively.ConclusionsThe results of this study highlight that both CBCT and DPR are good diagnostic methods for ERR. Nevertheless, root canal filling material influences diagnostic capability in ERR. The clinical significance was that the presence of intracanal material reduces the detection and diagnosis of ERR by DPR in teeth with root canal treatment.

The diagnostic performance of the Java-based software colorization tool in the diagnosis of dental caries: an in vitro study.

This in vitro study aimed to compare the diagnostic outcomes of caries detection in premolar and molar teeth on digital periapical radiographs viewed as grayscale images and in the Java-based software (JBS) pseudocolor spectrum. The study comprised 92 premolar or molar human teeth (n = 46 with caries and n = 46 without clinical caries). For each tooth, digital periapical radiographic images (DPRIs), JBS pseudocolor images, and stereomicroscope images were collected, and caries presence and depth were recorded. In JBS pseudocolor images, regions of interest (ROIs) were detected, and ROI values for caries area (ROI1), non-caries area (ROI2), mesial area (ROI3), and distal area (ROI4) were obtained. The degree of inter-observer agreement was determined using the kappa coefficient, and the sensitivity and specificity of the methods were assessed using ROC analysis. While neither method was consistent with stereomicroscopy in determining caries depth (P < .005), for both observers the kappa value of JBS pseudocolor images were slightly higher than those for DPRIs. ROI1 was found to be significantly lower than ROI2 (P < .001), whereas no difference was found between ROI3 and ROI4 (P = .877). For both observers, the sensitivity and specificity obtained from JBS pseudocolor were above 89%. JBS pseudocolor images can be used for caries detection and offer high sensitivity and specificity.

Implant stability and marginal bone level changes: A 2-year prospective pilot study

Background/purposeImplant stability is crucial for successful osseointegration. Marginal bone level is considered an important indicator of long-term implant success and stability. The purposes of this study were to investigate 1) the effect of age, gender, bone density, implant length, and implant diameter on insertion torque (IT), primary implant stability quotient (ISQ), and secondary ISQ, 2) the impact of age, gender, bone density, implant length, implant diameter, IT, and ISQ on marginal bone loss (MBL). Materials and methodsNinety patients who needed implant therapy were enrolled and overall 156 implants were installed to support single crowns. IT and ISQ were recorded for all implants during surgery and ISQ measurements were performed at follow-up visits. Age, gender, bone density, implant length and diameter were also registered. Radiographic evaluation of MBL was performed postoperative immediate (baseline), 3, 6, 9, 12, 18, and 24 months using digital periapical radiographs. ResultsAge had little effect on IT and primary ISQ (P > 0.05). Generally, males had higher IT and primary ISQ, but no significant differences between genders were detected. Bone density showed significant effects on IT and primary ISQ. Correlation analysis revealed high positive correlations between IT/bone density and primary ISQ/implant diameter. Significant impacts of bone density and IT on MBL were found. ConclusionImplant diameter had a more profound impact than length on IT/primary ISQ. Bone density played a considerable role in IT/primary ISQ determination. Bone density and IT had more impacts than primary ISQ on MBL.

Periapical Radiography versus Cone Beam Computed Tomography in Endodontic Disease Detection: A Free-response, Factorial Study

AimTo assess and compare reader performance in interpreting digital periapical (PA) radiography and cone beam computed tomography (CBCT) in endodontic disease detection, using a free-response, factorial model. Materials and MethodsA reader performance study of 2 image test sets was undertaken using a factorial, free-response design, accounting for the independent variables: case type, case severity, reader type, and imaging modality. Twenty-two readers interpreted 60 PA and 60 CBCT images divided into 5 categories: diseased–subtle, diseased–moderate, diseased–obvious, nondiseased–subtle, and nondiseased–obvious. Lesion localization fraction, specificity, false positive (FP) marks, and the weighted alternative free-response receiver operating characteristic figure of merit were calculated. ResultsCBCT had greater specificity than PA in the obvious nondiseased cases (P = .01) and no significant difference in the subtle nondiseased category. Weighted alternative free-response receiver operating characteristic values were higher for PA than CBCT in the subtle diseased (P = .02) and moderate diseased (P = .01) groups with no significant difference between in the obvious diseased groups. CBCT had higher mean FPs than PA (P < .05) in subtle diseased cases. Mean lesion localization fraction in the moderate diseased group was higher in PA than CBCT (P = .003). No relationships were found between clinical experience and all diagnostic performance measures, except for in the obvious diseased CBCT group, where increasing experience was associated mean FP marks (P = .04). ConclusionsReader performance in the detection of endodontic disease is better with PA radiography than CBCT. Clinical experience does not impact upon the accuracy of interpretation of both PA radiography and CBCT.

The effect of a convergent transmucosal neck on soft tissues and radiographic outcomes: a 1-year follow-up randomized controlled trial

PurposeThe aim of this randomized controlled clinical trial was to evaluate peri-implant marginal bone levels (MBLs) and soft tissue dimension changes 1 year after loading. Patients in the control group received bone-level implants, whereas in the test group, tissue-level implants with a convergent transmucosal neck were used.Material and methodsMBLs were calculated by measuring the distance from the implant shoulder to the first visible bone-to-implant contact using standardized periapical digital radiographs. Baseline (day of loading) and follow-up digital models obtained with an intraoral scanner were used to quantify the changes in the peri-implant soft tissue dimensions with a best-fit algorithm.ResultsThe difference between final and baseline MBLs showed a mean bone loss of 0.16 ± 0.01 mm in the test group (n = 15) and 0.45 ± 0.09 mm in the control group (n = 14) (p > 0.05). Soft tissue contour at the level of the gingival margin (GM) increased by 1.96 ± 2.69 mm in the test group and 0.65 ± 0.42 mm in the control group (p = 0.167). Both groups showed a coronal displacement of the gingival margin with no significant differences among them.ConclusionsThe present study demonstrated peri-implant hard and soft tissues stability at both implant designs with no significant differences 12 months after loading.Clinical relevanceThere is still insufficient scientific evidence to demonstrate the role and advantages of the convergent transmucosal neck on the behavior of the peri-implant soft and hard tissues stability compared to a straight neck in bone-level implants 12 months after loading.

Comparison of Calcium Enriched Material Cement and Mineral Trioxide Aggregated Radiopacity with 3 Endodontic Sealers in Digital Periapical Radiography

Introduction: The purpose of this research was to evaluate the radiopacity of calcium enriched material cement and mineral trioxide aggregated fillapex with 3 types of sealers: Endoseal, and AH26 at different focal distances of 15 cm and 30 cm.&#x0D; Methods: The research method was an experimental and lab trial. In this research, 3 endodontic sealers: Pulpdent, Endoseal, and AH26 and two root filling material: mineral trioxide aggregated fillapex and calcium enriched material cement were studied. From each material 6 samples were prepared. The samples were prepared on a glass slab by stirring with the help of a spatula and placed in molds with dimensions of 1 x 5 x 5 mm. Radiographs were prepared with the PSP Fire CR digital sensor system at a distance of 15 and 30 cm from the samples. Radio opacity information obtained was interpreted by Quantor Dent for Windows software. The obtained results were analyzed by SPSS version 16 statistical software and Two-way ANOVA and Tukey test.&#x0D; Results: The results showed that AH26 had the highest optical density value and calcium enriched material cement had the lower radiopacity. There was a significant difference between the radiopacity value of the 5 studied materials (P&lt;0.05).&#x0D; Conclusion: All the studied materials had the minimal standard of radiopacity.