Intraoral Periapical Radiographs Research Articles

Combined Effect of Platelet-Rich Fibrin Matrix (PRFM) and Demineralized Freeze-Dried Bone Allograft (DFDBA) in Immediate Implant Placement: A Single-Arm Clinical Trial

Introduction Placement of immediate implants in contrast to delayed implant placement may be favorable. The factors contributing to this are shortened overall treatment time, aid in ideal orientation andfixture placement, bone preservation following extraction, and achieving optimal aesthetics involving soft tissue. However,the gap distance between the surface of the implant and the buccal bony wall during implant placement is critical for subsequent bone healing in a fresh extraction socket. Considering that as the gap broadens, the amount of bone-to-implant contact (BIC) decreases, causing an apical shift of the highest bone-implant contact. Incorporating a bone substitute material (BSM) within the fixture-socket gap preserves alveolar ridge volume by minimizing socket remodeling and encouraging de-novo bone formation. Aim and objectives To evaluate the efficacy of platelet-rich fibrin matrix (PRFM) and demineralized freeze-dried bone allograft (DFDBA) in fresh extraction socket with simultaneous implant placement. Methods Implants were immediately placed in 12 patients following a two-stage submerged protocol. The combination of PRFM and DFDBA was used to fill the gap between the implant body and the surrounding socket wall. The final restoration was placed after 3 months following implant placement. The full mouth plaque, gingival bleeding index, and gingival esthetics scores were assessed at baseline, 3, and 6 months. The crestal changes were evaluated using intraoral periapical radiographs (IOPA) at baseline, 3, and 6 months. Cone beam computed tomography (CBCT) images were obtained at baseline and 6 months after implant loading to analyze the buccolingual changes. Results At 6 months follow-up, the coronal bone remodeling detected on CBCT revealed a minimal (0.1 mm) narrowing of the alveolar ridge in a buccolingual direction, with a mean bone loss of 0.10+0.09, which was statistically non-significant (p > 0.05). Implant success was 100% at 6 months after loading as determined by Akbrektsson's criteria for implant success. Conclusions The adjunctive use of PRFM with DFDBA following immediate implant placement yielded a significant reduction in bone resorption and maintenance of buccolingual dimensions.

Assessment of Bone Density around Dental Implants Using Two Platelet-Rich Fibrin Protocols (A Comparative Clinical Study)

Aims: The current study aimed to compare bone density means around dental implants covered with one of two platelet rich fibrin preparation protocols (Standard-Platelet Rich Fibrin and Advanced-Platelet Rich Fibrin) using standard intraoral digital periapical radiographs. Materials and methods: A total of ten male patients with an age range of 28-51 years participated in this split-mouth clinical study. The patients were divided into two groups based on the platelet rich fibrin (PRF) protocol to be used with dental implant insertion into positive control (S-PRF) and study group (A-PRF). Each patient represented the two groups in which he received 2 dental implants; ten implants for each group (a total of 20 dental implants) of standard length and diameter in the posterior mandibular extraction sites of ipsilateral or contralateral side. In the positive control group, the standard PRF protocol was to be used to prepare the PRF clot. In the study group, the advanced PRF protocol was to be used to prepare the PRF clot. Both PRF membranes were to be instilled inside the osteotomy bed during dental fixture installation. Following the installation of dental implants and as a basis for comparison between both groups, densitometric analysis of bone around dental implants at immediate, four, eight and twelve weeks scheduled visits were made. Results: Total densitometric analysis results showed no significant difference within S-PRF group, within A-PRF group and between both groups, with the highest mean (167.07) being at twelve weeks after surgery in the A-PRF group. Conclusions: Both S-PRF and A-PRF, similarly enhanced and maintained bone density (synergistic effect) throughout the of study and as disclosed by densitometric values. The use of PRF in its current forms seems to be an accepted minimally invasive approach with good clinical results.

Radiographical Assessment of Mandibular Molars of children and young Adults to determine the probability at 16-year threshold: Sri Lankan study

• 16-year threshold was established successfully using mandibular 2 nd and 3rd Molars. • The probability for an individual to be identified correctly as above or below 16 year threshold was 93% and identified incorrectly with 7% probability. • According to the present study, the investigators can continue to use Tables of ABFO study of Mincer et al. in children and young adults. But Tables 4 and 5 are more appropriate for local applications. • Estimation of dental age can be done satisfactorily using mandibular molars recorded on Intra Oral Peri-Apical radiographs. Main objective was to determine the probability at 16-year age threshold by using unilateral second and third developing mandibular molars in a group of Sri Lankan children. The above threshold is one of the specific ages for children in Sri Lanka legislature. This retrospective cross sectional study used 783 Orthopantomographs (385 males and 398 females) of Sri Lankan children and young adults ranging in age from 8.00 to 24.99 years both males and females and analysed based on Demirjian maturity stages A to H. The Mean (SD) age of assessments to the different Demirjian stages for two molars were calculated using SPSS. The probability assessment for a child being reached the 16-year threshold was calculated using NORMDIST function in Excel. The validity was tested on a validation sample of 50 males and 50 females. Third molar comparison of mean ages of assessments to Demirjian stages was done with other population studies. The Mean and (SD) in the reference sample was 15.02(3.77) years for males 15.51(4.98) years for females. The probability estimates correctly identified individuals above or below the reference age was 93% and only 7% was identified incorrectly. This study has confirmed that the second and third molars in the mandible can reliably be used to determine the probability at 16-year threshold. The Mean (SD) ages of assessment to corresponding Demirjian stages from D to H of third mandibular molar in the present study are fairly compatible with that of ABFO study of Mincer et al. which is widely used as a reference data for Forensic age estimation procedure in Sri Lanka.

The effect of a deep-learning tool on dentists' performances in detecting apical radiolucencies on periapical radiographs.

To determine the efficacy of a deep-learning (DL) tool in assisting dentists in detecting apical radiolucencies on periapical radiographs. Sixty-eight intraoral periapical radiographs with CBCT-proven presence or absence of apical radiolucencies were selected to serve as the testing subset. Eight readers examined the subset, denoted the positions of apical radiolucencies, and used a 5-point confidence scale to score each radiolucency. The same subset was assessed by readers under two conditions: with and without Denti.AI DL tool predictions. For the two sessions, the performance of the readers was compared. The comparison was performed with the alternate free response receiver operating characteristic (AFROC) methodology. Localization of lesion accuracy (AFROC-AUC), specificity and sensitivity (by lesion) detection demonstrated improvements in the DL aided session in comparison with the unaided reading session. Subgroup performance analysis revealed an increase in sensitivity for small radiolucencies and in radiolucencies located apical to endodontically treated teeth.. The study revealed that the DL technology (Denti.AI) enhances dental professionals' abilities to detect apical radiolucencies on intraoral radiographs. DL tools have the potential to improve diagnostic efficacy of dentists in identifying apical radiolucencies on periapical radiographs.

Anatomical Risk Factors of Nerve Injuries Following Surgical Removal of Mandibular Third Molar

Introduction: Surgical removal of the mandibular third molar has its own set of complications. The mandibular impacted teeth are in proximity to the Inferior Alveolar Nerve (IAN), Buccal Nerve, and Lingual Nerve (LN). Therefore, each of these nerves is always at risk of injury during extraction. Objectives: This study was to evaluate the anatomical risk factors of nerve injury after the surgical extraction of mandibular third molars in patients visiting the department of oral and maxillofacial surgery of People’s Dental College and Hospital. Methods: This prospective study was conducted with 315 participants who presented with a mandibular third molar impaction and underwent Intraoral Periapical Radiograph (IOPAr), panoramic radiograph, as well as Cone Beam, Computed Tomography (CBCT). CBCT was done in those patients in which the mandibular third molar was in close contact with the mandibular canal. Results: Collected data from 315 patients showed that the incidence of Inferior alveolar nerve (IAN) and lingual nerve(LN)injury was 0.31%. Of which one had mesioangular class B, level II type of impaction in 17year male and the other had horizontal class C, level II type of impaction in 47year female respectively. In both cases, the tooth was lingually placed in relation to IAN. Conclusions: Various factors are responsible for nerve injury after the removal of the mandibular third molar. In our study, the incidence of nerve injury to IAN and LN was comparatively low and the most common risk factor was angulation and anatomical position of the impacted mandibular third molar.

Efficacy and Safety of Concentrated Growth Factors and Platelet- Rich Fibrin on Stability and Bone Regeneration in Patients with Immediate Dental Implants: A Randomized Controlled Trial.

Immediate dental implants revolutionized the field of implant dentistry with significant advantages over conventional implants. The lack of adequate bone in the extraction socket raises the question of the appropriate timing of implant loading. Platelet concentrates have been used widely to accelerate bone regeneration in the maxillofacial region. This study evaluates the effect of platelet concentrates on bone healing and implant stability in the maxillary and mandibular molar regions. Bone regeneration is regulated by several growth factors, particularly vascular endothelial growth factor (VEGF) and transforming growth factor-β1 (TGF-β1); therefore, quantification of these factors in platelet concentrates and its correlation with bone healing has been assessed in this study. The primary aim of this randomized clinical trial was to compare the stability of immediate dental implants in the maxillary and mandibular molar regions treated with platelet-rich fibrin (PRF) versus concentrated growth factors (CGF) using resonance frequency analysis (RFA). The secondary objectives were to evaluate the bone regenerate around implants with the use of PRF and CGF and to quantify growth factors VEGF and TGF-β1 in the prepared CGF and PRF and their correlation with bone healing, if any. A total of 36 patients were randomized into three groups (12 each): control, PRF, and CGF. In all patients, immediate implants were placed either with or without platelet concentrate (PRF or CGF). Implant stability was measured using RFA immediately postoperatively and at 4, 8, and 12 or 16 weeks (12 weeks for mandible and 16 weeks for maxilla) postoperatively. Radiodensity and the bone gap (horizontal/vertical) were measured on intraoral periapical radiographs immediately postoperatively and at 8 weeks and 12 or 16 weeks postoperatively. On comparing the implant stability quotient (ISQ), radiodensity/grayscale (GS), and horizontal and vertical bone gap (HG and VG), there was no significant difference noted between the three groups at any point in time. On ISQ analysis at 8 weeks, the control group showed a significant improvement (P = .04), whereas at 12 or 16 weeks, significant improvement was seen in PRF (P = .03) and CGF groups (P = .02). In GS assessment, only the control group showed significant improvement at 12 or 16 weeks (P = .009). In horizontal and vertical bone gap analysis all three groups showed significant improvement at 8 weeks (control [P < .001], PRF [P = .001], CGF [P = .01]) as well as 12 or 16 weeks (control [P < .001], PRF [P < .001], CGF [P = .006]). The enzyme-linked immunosorbent assay (ELISA) quantification of VEGF and TGF-β1 showed significant concentration of VEGF in PRF as compared to the plasma, while concentration of TGF-β1 was found to be comparable in both groups. The application of platelet concentrates seems to enhance stability of implants, but intergroup results were nonsignificant at all time points. There was no statistically significant difference between the three groups when comparing quality (radiodensity/grayscale) and quantity (horizontal and vertical gap reduction) of bone regenerate. Studies with larger sample sizes are required to make conclusive assertions regarding efficacy of platelet concentrates in dental implants.

Evaluation of marginal bone level after implant placement and before loading, by digital radiography

Background: Marginal bone loss around dental implant is one of the criteria for evaluating implant success. Objectives: To evaluate the marginal bone loss around dental implants using digital radiographs and to determine correlation of mesial and distal bone loss around dental implants with gender and location in either arch in a period of 3-6 months after placement and before prosthetic loading. Methods: An analytical study was undertaken from July 2021 till December 2021, after ethical clearance, in 18 patients on whom 23 implants had been placed at Dhulikhel hospital. After implant placement first radiograph was taken by CE 0297 size 2 PSP plate and Carestream (CS2100) intraoral periapical radiograph machine using paralleling technique (XcpRinn Device) and second at 3-6 months later. The radiographs were viewed using image viewer software (Vistasoft2.0.1) to calculate the bone level. Calculating the difference in bone level at zero month and at 3-6 months gave us the amount of bone loss which was entered in Excel sheet and transferred to SPSS v.22 for analysis and student unpaired-t test was used.Results: The mean bone loss was 0.27 ± 0.2 mm on mesial aspect and 0.13 ± 0.3 mm on distal aspect at the end of the study period. No statistically significant bone loss in relation to gender and location of implant placement was found. Conclusion: Within the limitation of the study, no significant difference was found in the mesial and distal aspect of bone loss around dental implant when compared with different parameters.

Prevalence of nutrient canals in mandibular anterior intra-oral periapical radiographs (IOPARS) in patients with chronic systemic diseases - a cross-sectional study.

Nutrient canals (NCs) are passages containing neurovascular bundles (blood vessels, lymph vessels, and nerves). Best visualized on mandibular anterior intraoral periapical radiographs (IOPAR), their presence is usually associated with underlying pathological such as diabetes mellitus (DM), hypertension (HTN), advanced periodontitis, calcium deficiency, tuberculosis, and disuse atrophy. This study aimed to (a) evaluate NC prevalence in patients with DM, HTN, and chronic periodontitis and (b) correlate the detection of NCs as an important preliminary screening tool for inherent systemic diseases like DM, HTN, and chronic periodontitis and as an investigative clue in age and gender determination. This cross-sectional study was conducted on 200 subjects. Patients with complaints of pain in the mandibular anterior teeth, deep dentinal caries, abrasion, and attrition were subjected to IOPAR of the mandibular anterior teeth region to assess NCs. An increased frequency of NCs in DM (84%), HTN (66%), and periodontitis (52%) with a significant p-value was observed. Most NCs were seen beyond the root apex (72.4%). A notable association between the duration of disease and the presence of NCs in the diabetic and hypertensive cohorts (p-value 0.047 & 0.012, respectively) was observed. However, we could not establish any association between the prevalence of nutrient canals with age and gender. Our study suggested that a higher frequency of NCs on mandibular anterior IOPAR may be employed as an ancillary screening and investigative support in underlying systemic disorders.

The accuracy of extraoral periapical radiography on determining the working length in endodontic treatment: narrative review

Objectives: This review article is aimed to determine the accuracy of extraoral periapical radiography as a determinant of the working length in endodontic treatment and the advantages and disadvantages of this technique.&#x0D; Review: Endodontic treatment is a dental treatment for damages reaching the pulp which aims to maintain the tooth. One way to succeed in endodontic treatment is to determine an accurate working length. The working length can be determined by intraoral periapical radiography examination but some people are sensitive to intraoral film placement. The placement of film on periapical radiography extraorally is needed.&#x0D; Conclusion: The study showed that the extraoral periapical radiography had more than 75% accuracy in determining the working length depending on angulation used. This review concludes that extraoral periapical radiography can be used in patients who can not tolerate to intraoral film placement with an accuracy that is not significantly different from that of the intraoral periapical radiography but is not meant to be replaced intraoral periapical radiography.

Endodontic Management of Mandibular First Molar with Four Roots - A Rare Case Report with Clinical Management Guidelines

Mandibular molar is usually two rooted with one mesial and one distal root. Additional roots are rare which requires accurate diagnosis and a methodical and scrupulous endodontic treatment. Objective: This paper aims to report the endodontic management of an unusual case of a mandibular permanent first molar with four roots (two mesial &amp; two distal) and provide a clinical guideline to detect and manage these variant cases. Case report: A 15-year-old boy reported with a deep carious lesion in the lower left first molar (#36). The apical root contour of #36 on an intraoral periapical radiograph taken in different angulations suggested the presence of extra roots. A Spiral Computed Tomographic scan with multiplanar three-dimensional reconstructed images confirmed a fourrooted mandibular molar. Endodontic treatment of #36 was planned based on a diagnosis of pulpal necrosis with symptomatic apical periodontitis. The pulp chamber floor was assiduously explored along the developmental root fusion line (DRFL) to guide a trapezoidal access cavity and expose two mesial and two distal orifices. Conclusion: The present case report highlights the successful endodontic treatment of an atypical four rooted mandibular first molar by following a systematic approach from diagnosis to its clinical management.

Vitamin D Deficiency and its Correlation with Coronal Pulp Morphology Changes – A Preliminary Study

Background: Vitamin D deficiency (VDD) is a pandemic and usually under-diagnosed, under-treated nutritional deficiency globally. Among the Indian population, VDD may be due to lower dietary vit D and calcium intake, low socioeconomic status, etc. VDD can manifest as delayed tooth eruption, absence of secondary dentin formation, altered coronal pulp morphology, enlarged pulp space, and high pulp horns. Radiographic changes can be detected by various advanced imaging techniques but with multiple drawbacks. Intraoral radiographs (IOPA) can be an easy, chair-side and routine method of detecting coronal pulp morphology (CPM) changes due to VDD. Aims and Objectives: To assess correlation of vit D deficiency (VDD) and changes in coronal pulp morphology (CPM) using dental radiographs among young adults. Material and Methods: 60 subjects were included in the study and divided into two groups: one with CPM changes and the second group without CPM changes. All the subjects underwent digital intraoral imaging and serum evaluation for vit D. The subjects were classified into deficient, optimal, and overdose categories. At the same time, the tooth morphology was divided into normal and chair/constricted types. Results: The correlation of vitamin D levels with the pulp horn heightof all three molars were negative and statistically insignificant. Pulp chamber height and width showed negligible and insignificant relationships with vitamin D levels. Conclusion: This study could not prove a significant correlation, but the data generated might help carry out advanced research in a related context. Using an Intraoral Periapical radiograph for evaluating VDD can also be a baseline screening in largepopulations in the future.

Clinical and radiographic assessment of post-treatment endodontic disease by primary healthcare professionals: A hospital-based 1-year follow-up.

Background:The comprehensive healthcare approach including prophylactic guidance and motivation by the primary healthcare professionals towards oral and maxillofacial diseases such as post-treatment endodontic disease (PTED) plays a significant role in diagnosing and managing the condition. Especially in the developing countries like India where the hygiene practices are severely compromised, the primary healthcare professional plays an upfront role.Objectives:The present study was conducted to assess the clinical and radiographic characteristics of PTED by primary healthcare professional.Materials and Methods:The cross-sectional study was conducted in a dental hospital in Kutch, Gujarat, India. In the present study, out of a total of 755, 96 patients were diagnosed with PTED, met the inclusion criteria, and were enrolled for the study. After performing intraoral and extraoral examination, intraoral periapical radiographs were taken of the concerned teeth. Under dark room conditions, radiographs were examined using dentsply light box and magnifying glass by healthcare professionals.Results:Out of 755 patients, 96 (12.71%) patients were enrolled in the study with 98 concerned teeth. The most common teeth diagnosed with PTED were maxillary molars with 25.51% (21) individuals. Well-defined radiolucent lesions were seen in 62.24% (61) individuals. Voids in both coronal and apical region were seen in majority (38.77%) of patients. The length of root-end fillings with respect to the radiographic apex was satisfactory in 44.89% (44) individuals. The present study showed strong correlation between sinus formation and presence of periapical lesion with P value of 0.0219*.Conclusion:The proper guidance and preventive care by primary healthcare professionals leads to the relatively less prevalence of post-treatment endodontic disease in Indian population. The present study further suggests the higher substandard quality of root-end fillings of endodontically treated teeth.

Biomonitoring of Genotoxic Effect in Children Exposed to Dental Radiographs during Pulpectomy Procedure-BMCyt Assay.

BackgroundRadiography is one of the most valuable diagnostic tools used in comprehensive dental care. Radiation from dental radiographs was thought to cause cytogenetic changes and its plausible effects can remain for some hours, months, or generations especially in children.Aims and objectivesTo evaluate and compare the possible genotoxic effect of routinely used intraoral periapical radiographic exposure and radiovisiographic exposure in exfoliated epithelial cells as measured by the formation of micronuclei during single visit pulpectomy procedure using Buccal Micronucleus Cytome (BMCyt) assay in children.Materials and methodsStudy comprised 60 healthy children who has undergone either intraoral periapical radiography (IOPAR; group 1, n = 30) or radiovisiography (RVG; group 2, n = 30) during various steps of single visit pulpectomy procedure. Cytological smears were taken from the buccal mucosa immediately before the X-ray exposure and 10 ± 2 days after exposure. The cells were stained with Feulgen and evaluated for micronuclei by scoring 1,000 cells per sample.ResultsThe genotoxic effect of radiation exposure from intraoral periapical radiography higher than that of RVG showing significant increase in micronucleus (MN) formation.ConclusionThe X-ray radiation emitted during IOPAR or RVG does induce genotoxic changes in the form of increased frequency of micronuclei. So, great care and standard protocol should be followed to advice radiographs if necessary and reduce the cumulated biological effects of radiation exposure.KeynoteTaking into account the strong evidence of a relationship between DNA damage and carcinogenesis and the extensive application of intraoral radiographs in pediatric dentistry, it would be useful to know to what extent these dental X-rays cause genotoxic effects resulting in DNA damage on oral mucosa.How to cite this articleJulu Y, Nagarathna C. Biomonitoring of Genotoxic Effect in Children Exposed to Dental Radiographs during Pulpectomy Procedure—BMCyt Assay. Int J Clin Pediatr Dent 2022;15(S-1):S63-S70.

ATM technique - a novel radiographic technique to assess the position of buccal shelf implants.

Success of the buccal shelf implants depends on its proper placement. Radiographic techniques like cone beam computed tomography (CBCT), posteroanterior cephalogram (PA cephalogram) have been used to evaluate the position of buccal shelf implant placement. However, these techniques have disadvantages like increased radiation exposure, metal artifact, less availability in dental offices and are more expensive.The aim of Arvind's Trans Mandibular (ATM) technique is to overcome this drawback by using an intraoral periapical radiograph (IOPA) film or radiovisiography (RVG) sensor to assess the post-operative placement of buccal shelf implants. Radiographs were taken for four patients after the placement of buccal shelf implants. The IOPA sensor was placed beneath the lower border of the mandible using this modified extraoral technique to assess the position of the buccal shelf implants in relation to the adjacent molars. The findings from the IOPA image were verified with CBCT images. The radiographic images taken using ATM technique were compared with the gold-standard CBCT technique. The ATM technique was able to accurately assess the postoperative buccolingual position of the implant with respect to the roots of molars in all the four cases. The proximity of the implant to the roots of the molar can be clearly visualized in all the cases. ATM is a novel radiographic technique using IOPA radiographic film or RVG sensor to assess the post-operative buccolingual placement of buccal shelf implants in relation to lower molar roots.

Radiographic Prescription Practices Among Implant Practitioners In India: A Cross-sectional Survey

Aim: To identify the contemporary radiographic prescription practices among the dental implant practitioners in India. Materials and method: Two clinicians interviewed four hundred dentists using a 13-question questionnaire for commonly prescribed imaging modality options for implant treatment planning and assessment. The parameters included commonly available imaging techniques, exposure of radiation to the patient, coverage area of teeth and surrounding facial bones, ease of availability and the cost effectiveness. The interview was conducted by two operators to eliminate subject bias. CbctThe data collected was analyzed using Statistical Package for the Social Science (SPSS version 22, Armonk, NY: IBM Corp). Results: Cone beam computed tomography (CBCT) was found to be the most prescribed imaging modality prescribed by 44.2% of the dentists followed by orthopantograph (OPG) (17.9%). A combination of imaging modalities was preferred by 21.9% of dentists. The intraoral periapical radiographs (IOPA) were prescribed by 12.3% while conventional tomography was prescribed by 2.5% of the dentists. Precision of the imaging modality (51.2) reduced exposure to radiation (19.8) and ease of availability (13%) were the reasons for selection of radiograph prescription. Conclusion: According to the study, cone beam computerized tomography (CBCT) appeared as the most prescribed imaging modality followed by OPG. Precise measurements were cited as the main reason for selecting a radiographic technique followed by the less exposure of the patient to radiation and easy availability of the modality.

Evaluation of Alveolar Bony Trabecular Pattern in Subjects with Crossbite Malocclusion using Intraoral Periapical Radiographs: A Cross-sectional Study

Introduction: Trajectories of force determines the trabecular pattern of bone. In transverse malocclusions, force trajectories are altered which can affect the trabecular pattern. Hence, it is important to study the trabecular pattern associated with transverse malocclusions. Aim: Assessment of trabecular pattern changes on Intraoral Periapical Radiographs (IOPA) in subjects with dental crossbites using fractal analysis. Materials and Methods: This cross-sectional study was conducted in Department of Orthodontics at Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India, from October 2021 to December 2021. The study involved 30 IOPAs in 15 patients with unilateral first mandibular molar teeth in crossbite. The sample was divided into two groups. Group A has 15 IOPAs of mandibular molars in crossbite side, group B has 15 IOPAs of mandibular molars not in crossbite. A region of interest (ROI) of 256×256 pixels were selected between the roots of the premolar and mandibular molars and converted into an 8-bit image with image J software. Fractal dimensional analysis with box counting was used to assess trabecular perimeter and the trabecular number. Normality of the data was assessed by Shapiro-Wilk test and an Independent t-test was carried out to find intergroup differences. Results: Shapiro-wilk tests p-values were not significant (p-value &gt;0.05) for both groups ensuring normality of data. The mean fractal dimensions measured were 0.867 (group A) and 1.213 (group B). The mean trabecular perimeter in group A was 86.37±29.31 whereas in group B it was 194.62±43.26 and the intergroup difference was significant (p-value&lt;0.001). Conclusion: Fractal analysis of IOPAs revealed that the alveolar bone surrounding the teeth in crossbite presented with significant reduction in the trabecular perimeter and number when compared with teeth not in crossbite.

Evaluation of blood clot, platelet-rich plasma, and platelet-rich fibrin-mediated regenerative endodontic procedures in teeth with periapical pathology: a CBCT study.

This study compared the clinical and radiological outcomes of regenerative endodontic procedures (REPs) using blood clots (BCs), platelet-rich plasma (PRP), and platelet-rich fibrin (PRF) through intraoral periapical radiography (IOPAR) and cone-beam computed tomography (CBCT). Forty-five single-rooted necrotic teeth with periapical pathology were randomly allocated to receive BC, PRP, or PRF as an individual scaffold. Outcomes were evaluated in 35 teeth in 23 patients with a follow-up period of 12-24 months through qualitative IOPAR scoring and quantitative CBCT measurements. Healing of periapical lesions and in immature teeth, changes in the apical foramen diameter (AFD), root wall thickness (RWT), and root length (RL) were assessed. A p value less than 0.05 was considered to indicate statistical significance. All teeth were asymptomatic except 1 in the PRP group. Periapical lesion healing was seen in all except 2 teeth in the BC group and 3 in the PRP group. Both IOPAR and CBCT revealed no significant differences in bone healing or changes in AFD, RWT, and RL among the 3 groups. A positive pulp sensibility response to the cold test was seen in 2 teeth in the BC group, but none to the electric pulp test. Intracanal calcification (ICC) was evident in more teeth in the BC group than in the PRP and PRF groups, and was also significantly higher in immature teeth. Our results revealed that BC, PRP, and PRF have similar potential as scaffolds in REPs, and ICC may be a concern for long-term outcomes.

Evaluation of skeletal maturation based on permanent mandibular second molar calcification

Objective: To investigate the relationship between permanent mandibular second molar calcification stages and cervical vertebrae skeletal maturity and to evaluate whether second molar calcification stages can be used as a reliable diagnostic tool to determine skeletal maturity.Materials and Methods: The Panoramic and intraoral periapical radiographs and lateral cephalogram of 240 subjects (120 males and 120 females) with age group between 8 to 17 years were examined. The Calcification stages of mandibular second molar were rated according to Demirjian index (DI) and skeletal maturity were determined using Cervical vertebrae maturation index (CVMI) given by Hassel and Farman.Results: A highly significant association was found between CVMI and DI. DI stage E corresponded to stage 2 of CVMI (pre-pubertal growth spurt). DI stages F and G corresponded to stage 3 and 4 of CVMI (pubertal growth spurt). DI Stage H corresponded to CVMI stage 5 and 6 (end of pubertal growth spurt).Conclusion: A highly significant association exists between DI and CVMI. Mandibular second molar DI stages can be used as a reliable indicator for growth evaluation in clinical practice.

ASTOL Technique: A Novel Method for Localisation of Impacted Mandibular Tooth

Introduction: Object localisation is one of the challenges encountered in diagnosis of impacted teeth, which requires sophisticated two-dimensional and three-dimensional radiographic techniques. These sophisticated radiographs are not readily available in all clinics, and also they carry the risk of increased radiation exposure and increase burden of care. Aim: To evaluate the accuracy of ASTOL (Arvind-Seerab Transmandibular Object Localisation) technique for object localisation in the dried mandible of a cadaver. Materials and Methods: This cross-sectional study was conducted in Chennai city, Tamil Nadu between March 2021 to April 2021. A dried mandible of a cadaver and an extracted premolar was used to simulate 10 cases scenarios of impacted teeth at different regions of the mandible. Two intraoral periapical (IOPA) radiographs were taken for each scenario, from two different projections: first a conventional IOPA of the impacted tooth was taken and second radiograph was taken with the beam projected from the base of the mandible with the sensor placed on the occlusal surface. Both the radiographs taken for each scenario were incorporated into a questionnaire survey and were circulated to 30 dental practitioners. The results were tabulated and represented graphically. Cronbach’s alpha test and Kappa statistics were done to evaluate the internal and interobserver reliability between the validators and respondents respectively. Results: Out of the 30 dental practitioners, a total of 25 responses (14 Males and 11 Females) were received from dental practitioners across the state. The response rate was 83.33% and the mean age of the respondents were 34±5 years. The vertical position of the crown tip of the impacted tooth had a correct response rate of 85.60% (214/250). Angulation of the impacted tooth had a correct response rate of 75.20% (188/250). Mesiodistal positioning of the crown tip of the impacted tooth had a correct response rate of 78% (195/250). Buccolingual positioning of the impacted tooth had a correct response rate of 92.80% (232/250). Conclusion: The ASTOL technique is a novel radiographic technique which can be used as an accurate, reliable and economic alternative to other sophisticated 2D and 3D imaging techniques for object localisation in the mandibular arch.

Guided endodontics: Management of calcified tooth with a large periapical lesion using cone beam computed tomography and three-dimensional printed guide: A case report

The aim of this case report is to depict novel guided endodontic approach for the management of calcified tooth with a large periapical lesion using cone beam computed tomography (CBCT) and three-dimensional (3D) printed guide. The patient presented with swelling on the upper left front tooth region. Intraoral periapical radiograph revealed periapical radiolucency associated with upper left lateral incisor. Due to pulp canal calcification, location of the root canal was judged to be difficult and associated with a high risk of perforation. A CBCT and an intraoral surface scan were performed and matched using software for virtual planning of guided endodontics. After planning the position of the drill for root canal location, a virtual template was designed and 3D printed which was then used for guided endodontic access.