Molar Teeth Research Articles

Evaluation of the effect of different attachment configurations on molar teeth in maxillary expansion with clear aligners – a finite element analysis

ObjectiveTo evaluate the effects of different attachment configurations with and without buccal root torque on expansion movements achieved with aligners through finite element analysis (FEA).MethodsFEA modelling was done with 0.25 mm buccal expansion force application to the maxillary molars with different attachment configurations: Eight models were tested (1) no attachment (NA), (2) horizontal attachment (HA), (3) gingivally beveled horizontal attachment (GHA), and (4) occlusally beveled horizontal attachment (OHA), as well as models with 6obuccal root torque, (5) no attachment (TNA), (6) horizontal attachment (THA), (7) gingivally beveled horizontal attachment (TGHA), and (8) occlusally beveled horizontal attachment (TOHA).ResultsThe first and second molars exhibited buccal tipping in all models. The highest amount of buccal tipping for the molars was observed in the NA (6CMB, 0.232 mm; 6CMP, 0.246 mm; 7CMB, 0.281 mm; 7CMP, 0.312 mm) and GHA (6CMB, 0.230; 6CMP, 0.245; 7CMB, 0.279 mm; 7CMP, 0.311 mm) models, respectively, while the least tipping was observed in the TOHA model (6CMB, 0.155 mm; 6CMP, 0.168 mm; 7CMB, 0.216 mm; 7CMP, 0.240 mm). In all groups, the buccal tipping of the second molars was higher than that of the first molars.ConclusionThis FEA study showed that expansion with aligners tip maxillary molars buccally and the use of occlusally beveled attachments and addition of buccal root torque reduces uncontrolled buccal tipping.

Assessment of Incomplete Apical Bone Coverage of Maxillary Premolar and Molar Roots Using Cone Beam Computed Tomography in 161 Dogs.

This retrospective study assessed maxillary premolar and molar teeth and identified roots with incomplete apical bone coverage using cone beam computed tomography in 161 dogs. The associated dorsal anatomic sites that the roots communicated with were the ventral nasal meatus, maxillary recess, infraorbital canal, and pterygopalatine fossa. The study found that all roots of the maxillary premolar and molar teeth have the potential for incomplete apical bone coverage, with 26.7% having incomplete apical bone coverage. No significant association with sex was found. A significant association with weight was found, and this lowered with increasing body weight. Facial index, as a determinate of skull shape, was found to be significant in only 35.7% of roots in univariate and 14.2% of roots in multivariate modeling. Knowledge of the anatomy of these roots plays an important role in safe and effective extraction techniques, in reducing iatrogenic trauma, and in understanding the potential local effects of periodontal and endodontic disease.

Dentition Anomalies and Cranial Abnormalities in Invasive Beavers (Castor canadensis) in Tierra Del Fuego, Argentina.

The study of dentition anomalies and pathologies in wildlife contributes, together with other indicators, to understanding the relevance of some factors on the health status of populations. This has not been properly evaluated in invasive mammals. To test the feasibility of eradication, the government of Tierra del Fuego performed the eradication of beavers (Castor canadensis) from 2016 to 2018: 1121 animals were removed and 970 examined. These beavers were examined to analyze the incidence of dentition anomalies and other dentition and cranial conditions. The beavers presented two dentition anomalies: hypodontia and hyperdontia (0.41% in both cases), and for the first time, a dentition anomaly in the upper quadrants was reported. Beavers also presented artifactual tooth loss (0.30%) and acquired tooth loss (0.61%) but with low incidence. The presence of fractured teeth (0.41%) and caries (0.31%) occurred in all age classes, also with low incidence. The third molar tooth was the most affected, showing a female bias. The 0.93% of skulls had a cranial abnormality represented as a buccal curvature. Malocclusion cases also were recorded (0.51%). The low prevalence of dentition anomalies, fractured teeth, caries, and cranial abnormalities would not compromise the lifespan of beavers. These results leave a precedent of dentition anomalies and dentition and cranial conditions in an invasive mammal.

Effect of the Time Interval of Functional Loading on the Periapical Healing of Endodontically Treated Mandibular Molar Teeth with Pulp Necrosis and Asymptomatic Apical Periodontitis: A Split-mouth Randomized Clinical Study

IntroductionThis prospective study evaluated the effect of immediate functional loading (IFL) of a full-coverage prosthesis on the clinical and radiographic outcome of nonsurgical endodontic therapy (NSET) performed on mandibular molar teeth with pulp necrosis and asymptomatic apical periodontitis. MethodsIn 20 subjects, standardized 2-visit NSET was performed in bilateral mandibular first molar teeth (split-mouth model) with a diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting a radiographic periapical index (PAI) score ≥3. In each subject, the nonvital bilateral mandibular first molar teeth were randomized to 1 of 2 groups: the IFL group or the functional loading after a time interval of 6 months group. Provisional full-coverage prostheses were provided within 7 days after the completion of endodontic therapy. The cases were followed up clinically and radiographically at 6 and 12 months. Radiographs were assessed for periapical healing based on PAI scores, which were dichotomized as healed (PAI score ≤2) or nonhealed (PAI score ≥3). The data were compared using chi-square and Fisher exact tests. ResultsA recall rate of 100% was achieved at the end of 12 months. All teeth in the IFL group and the functional loading after a time interval of 6 months group were clinically asymptomatic. According to an intergroup comparison between the proportion of teeth healed and nonhealed (radiographic), there was a significant difference (P < .05). ConclusionsIFL of a full-coverage prosthesis in endodontically treated mandibular molar teeth with pulp necrosis and asymptomatic apical periodontitis delayed periapical healing.

Modified Hybrid Hydroxyapatite-Silver Nanoparticles Activated via a Blue Light Source in Various Concentrations in Two-Step Self-Etch Adhesive to Caries-Affected Primary Dentin.

Aims: To evaluate hydroxyapatite-silver (HA-Ag) hybrid nanoparticles (NPs), as an antibacterial agent when integrated in self-etch (SE) adhesive. Blue light activated HA-Ag hybrid NP incorporation on mechanical properties, degree of conversion (DC), and microtensile bond strength (μTBS). Method: Eighty primary molar teeth have carious lesions reaching the dentin but not involving the pulp. The infected dentin was removed and carious-affected dentin (CAD) was preserved. Forty samples were inoculated with Streptococcus mutans. All primary teeth (n = 80) were allocated into four groups based on the incorporation of HA-Ag hybrid NPs in different concentrations (0%, 1%, 5%, and 10%). Group 1: 0% HA-Ag hybrid NPs + Clearfil SE bond primer, group 2: 1% HA-Ag hybrid NPs + Clearfil SE bond primer, group 3: 5 wt% HA-Ag NPs + Clearfil SE bond primer, and group 4: 10 wt% HA-Ag NPs + Clearfil SE bond primer. The survival rate assessment of S. mutans was conducted on 40 inoculated samples. On the remaining primary teeth (n = 40), Clearfil SE bonding agent was applied uniformly via a blue light source. The composite buildup was performed on the samples and μTBS and failure analysis assessed. Fourier transform infrared spectroscopy was performed to assess DC. Survival rates of S. mutans and μTBS among the tested groups were compared using ANOVA and Tukey post hoc analysis. Results: 10 wt % HA-Ag NPs + Clearfil SE bond primer exhibited the highest level of antibacterial efficacy (0.14 ± 0.02 CFU/mL) against S. mutans. The highest μTBS (18.38 ± 0.78 MPa) at the composite/CAD interface was in group 2 (1 wt % HA-Ag NPs + Clearfil SE bond primer + Clearfil SE bonding agent + activation with a blue light source). The highest DC was observed in the control group with Clearfil SE bond primer + Clearfil SE bonding agent + activation with a blue light source. Conclusion: 1 wt% HA-Ag hybrid NPs showed enhanced antibacterial effectiveness, DC, and bond strength of the SE adhesive to the primary CAD.

Endodontic management and outcome of non-surgical root canal treatment for radix entomolaris associated mandibular molar teeth: A scoping review of case reports

Radix entomolaris (RE) is an anatomical variant of the permanent mandibular molar (MM) with various complex anatomy. However, there is limited literature on the guideline on endodontic management of RE, resulting in unclear understanding on the endodontic treatment outcomes. Hence, this study aimed to map current case reports on endodontic treatment modalities, occurrence of endodontic mishaps, and outcome of MM associated with RE. A systematic search was performed in PubMed, Google Scholar, Scopus, Science Direct, PLOS, and Lilac databases for English articles published between 2000 and 2022 that met the inclusion criteria. The search yielded 1435 results; after screening was completed, only 58 articles were included in the study and critically appraised using JBI critical appraisal tool. Amongst the modifications made in endodontic management of RE were utilising angulated periapical radiograph supplemented with cone-beam computed tomography, extending the access cavity distolingually, and maintaining a small apical size of #25. There were 12% incidence of endodontic mishaps (separated instrument, ledge, missed canal, and extruded sealer) on RE. The success and survival rate of MM associated with RE were 58.7% and 40% respectively, at an average of 8.4 months. The basic management of MM with RE is similar to that of other MM. However, emphasis should be made on RE identification to prevent endodontic mishaps that can influence the endodontic treatment outcome.

Radiographical examination of pulp stone distribution by cone beam computed tomography

Aims: The present study aimed to ascertain the association between pulp stone production and tooth type, jaw, arch orientation, and dental status in a Turkish subpopulation in the southern region of Turkiye by analyzing cone beam computed tomography images. Methods: The study included a retrospective examination of cone beam computed tomography images obtained at Gaziantep Private Dental Clinic and Gaziantep University Faculty of Dentistry between 2014 and 2020 for various purposes, and a recording of teeth with pulp calcification in the pulp chamber. The study did not include any teeth that had root canal therapy or porcelain crowns. Data was gathered from radiographs of people in the 19-90 age range. In all, 1676 teeth had pulp stones found in them. To compare proportions, two proportion z-tests were employed. Results: Male individuals possessed 774 teeth with pulp stones, while female individuals possessed 902 teeth with the same condition. The prevalence of pulp stones in first and second molar teeth (1092, 65.16%) is statistically farther than central and lateral incisors (238, 4.2%), canine (207, 12.35%) and premolar (139, 8.29%). The rate of pulp calcifications is statistically higher; in intact (1065, 63.54%) teeth compared to the teeth with filling materials (443, 26.43%) and teeth with caries (173, 10.32%); in the maxilla (874, 52.15%) compared to mandible (802, 47.85%). Pulp stone occurrence was higher on the right side (888, 52.98%) than on the left side (788, 47.02) (p

Gender-Specific Variations in Greater Palatine Foramen Anatomy: Insights from CBCT Scans in the North Cyprus Population.

BACKGROUND The greater palatine foramen (GPF) is anatomically located distal to the third maxillary molar tooth, midway between the midline of the palate and the dental arch. The GPF contains the major palatine artery, vein, and nerve, traversing the palatine sulcus. This study aimed to evaluate the anatomical position of the GPF in 93 women and 67 men at a single center in Cyprus using cone beam computed tomography (CBCT). MATERIAL AND METHODS A retrospective analysis was conducted on 160 CBCT scans. Measurements of the GPF's horizontal and vertical diameters, distances from GPF to the incisive foramen, posterior nasal spine, anterior nasal spine, and midaxillary suture, and positional relationships to molars were recorded. Statistical analyses compared these measurements between males and females. RESULTS The study included 93 females and 67 males with an average age of 46.6 (±11.6) years. Significant sex differences were observed in most GPF measurements, with males showing larger dimensions such as the anterior nasal spine, posterior nasal spine, mid-maxillary suture, and incisive foramen to the GPF. The GPF was predominantly located in the third molar region (96.25% on the right, 96.9% on the left). The left GPF showed a significantly larger horizontal diameter than the right (P<0.05). CONCLUSIONS There was a significant difference in the average distances from the anterior nasal spine, posterior nasal spine, mid-maxillary suture, and incisive foramen to the GPF, as well as in the size of the GPF, between males and females. Recognizing these variations enhances clinical planning and reduces the risk of complications.

Assessment of caries frequency and severity in immature permanent first molar teeth using panoramic radiograph in Elazig city, Turkey

Assessment of caries frequency and severity in immature permanent first molar teeth using panoramic radiograph in Elazig city, Turkey

The Effect Of Different Caries Removal Methods On The Surface Hardness and Micro-tensile Bond Strength

Objective: This study aims to evaluate the effects of five different caries removal methods on caries removal effectiveness according to microhardness and micro tensile bond strength values. Materials: In this study, for the microhardness test, micro-tensile bond strength test (n = 10) SEM analysis (n = 2), and a total of 72 human molar teeth were used. Caries lesions were removed with conventional (steel bur, ceramic bur, polymer bur) methods, chemomechanical method (Brix-3000), and fluorescence-aided caries excavation method (Siroinspect). Then, teeth were sectioned longitudinally through the cavity center and were subjected to the microhardness test, micro tensile test, and SEM atomic analysis. Statistical analyses were performed using one-way ANOVA and Duncan post-hoc tests. Results: A statistically significant difference was found between all caries removal methods and measurement levels at certain distances from the cavity floor (0, 25, 50, 75 μm) (p

Radiopacity and Microleakage Evaluation of Different Intermediate Materials

Objective: The aim of this study is to compare the radiopacities of different types of materials with indications for application as a base under restorations and the microleakage of the final restorations with these materials applied as bases. Methods: Standart Class I cavities were prepared in 90 caries-free molar teeth. The cavities were randomly divided into 9 groups according to the type of intermediate material to be applied (n=10): 1. High flowable composite, 2. Low flowable composite, 3. Fiber reinforced composite, 4. Giomer, 5. Ormocer, 6. Alkasite, 7. Bioactive composite, 8. High viscosity glass ionomer, 9. Glass carbomer. The base materials in each group were applied to the cavity floor and restoration was completed using a nanohybrid composite resin and an universal adhesive system. To evaluate radiopacity, radiographic images were taken using direct digital system and mean gray values were measured with ImageJ software. To analyse microleakage, specimens were subjected to thermocycling, immersed in 2% methylene blue solution for 24 hours, sectioned buccolingually and leakage values observed on the half-piece surfaces were examined under a stereomicroscope and recorded. Data were analysed using One-way Analysis of Variance, Tukey HSD Test and Pearson Chi-Square with Bonferroni-corrected Z Test (p˂0.05). Results: In terms of radiopacity, while alkasite and low flowable composite showed the highest radiopacity, glass carbomer gave the lowest (p

Endodontic radiography - what’s displaying the radiograph? The yield of commercial computer screens vs. DICOM calibrated medical screens in endodontic radiography

ObjectiveA comparison between commercial computer screens and DICOM-calibrated medical screens for characterizing anatomy and diagnosing dental pathologies was performed. The aim of this study was to evaluate and compare the ability of each of those screens to identify root apices and widening of the periodontal ligament (PDL) in the posterior maxillary area.Materials and MethodsDigital X-ray images of 53 maxillary molar teeth were examined by means of a commercial computer screen and again two months later with a DICOM screen to compare their ability to help identify and diagnose PDL widening and to locate the root apices of those teeth.ResultsThe DICOM screen had a significantly better ability to identify widened PDLs (from 31.4% to 34.8% of the cases compared to 19% to 26.1% for the commercial screens, P < .001), depending upon the observer. The DICOM screen was also significantly superior in depicting the root apices compared to the commercial screens (from 77.4% to 83.6% of the cases compared to 56% to 66.7% for the commercial screens, P < 0.001), depending upon the observer.ConclusionDICOM-calibrated medical screens were significantly superior to commercial computer screens for identifying widened PDLs and locating the root apex in the posterior maxillary area.

Evaluation of the effect of dental anxiety on vital signs in the order of third molar extraction

BackgroundDental anxiety is a prevalent concern affecting patients undergoing various dental procedures, particularly surgical interventions. Understanding the impact of patients’ anxiety levels on their physiological responses during dental surgeries, such as third molar impaction surgery, is crucial for optimizing patient care and outcomes. Therefore, this study aimed to investigate the effect of patients’ anxiety levels on vital signs during third molar teeth impaction surgery.MethodsA cross-sectional study was conducted, including 45 randomly selected, healthy patients. Demographic information was recorded after obtaining consent from the patients prior to surgical intervention. Preoperative anxiety levels were determined using the Modified Dental Anxiety Scale (MDAS). Pupil measurements were taken from the patients before surgery, at 10 min after the surgery began, and at 10 min after the surgery ended. Systolic (SBP) and diastolic (DBP) blood pressure, pulse rate, temperature, and haemoglobin oxygen saturation (SpO2) values were recorded.ResultsThe MDAS test results were statistically significantly higher in women compared to men (p < 0.001). Positive correlations were observed between MDAS score and both preoperative pulse rate (r = 0.344, p = 0.021) and SpO2 level during the operation (r = 0.462, p = 0.001). However, no significant correlations were found between MDAS and DBP (p = 0.575), SBP (p = 0.176), fever (p = 0.238), or pupil diameter (p = 0.338).ConclusionsThird molar impaction surgery induces anxiety in adult patients 20 years and older. Vital sign monitoring provides information about the patient’s emotional state, both before and during the procedure. Since anxiety causes changes in vital signs during dental procedures, it is important to follow these findings to have an idea about the general condition of the patients.

Real-world diagnostic potential of bacterial biomarkers of canine periodontitis.

The objective of this study was to investigate the diagnostic potential of bacterial biomarkers by comparing the performance of molecular detection assays with clinical assessments of dog's oral health performed by veterinarians. Supragingival and subgingival plaque samples were collected from 127 client-owned dogs, pre-booked for procedures under general anesthesia, visiting veterinary practices in the United States. DNA was extracted and bacterial biomarkers quantified using quantitative polymerase chain reaction. Gingivitis and periodontitis were recorded by a trained clinician using the Weighted Gingivitis Periodontitis Score which involved assessing the buccal surfaces of 18 teeth while under general anesthesia. Intraoral dental radiographs of the left and right mandibular first molar teeth were also obtained. These data were then used to establish the diagnostic performance of the molecular assay to detect periodontitis. An initial conscious, visual oral examination performed by the veterinarian identified 67.7% of dogs as having periodontitis, but examination under general anesthesia indicated a higher proportion (86.6%). Analysis of supragingival plaque samples collected by veterinarians from conscious and unconscious dogs demonstrated the assay had an accuracy of 77.7 to 80.9%, a sensitivity of 77.6 to 81.0%, and a specificity of 80.0%. Use of this molecular screening tool in conscious dogs has the potential to improve early periodontal disease detection and support veterinary decision making, ultimately improving the oral health of dogs and consequently their quality of life.

Effect of mandibular third molar tooth germ extraction on mandibular development: a retrospective study

Objective: To investigatethe effect of extraction of mandibular third molar (M3) tooth germon the development of the mandible in orthodontic patients, with a view to providing a reference for clinical M3 tooth germ extraction. Methods: One hundred and twenty-nine Angel class Ⅰ patients aged 10-16 years who attended the Department of Orthodontics Division 1, School & Hospital of Stomatology, Wuhan University from 1 January 2013 to 30 December 2021 and fulfilled the criteria for nativity were included. Those who had their M3 extracted in the Department of Oral and Maxillofacial Surgery were included in the study group, with a total of 66 cases; and those who did not have their M3 extracted were included in the control group, with a total of 63 cases. The average annual growth was calculated by tracing point measurements on cephalometric films before and after orthodontic treatment according to the Jarabak and McNamara methods, with measurements of the mandibular ramus height (Ar-Go'), mandibular body length (Go'-Me), and overall mandibular length (Co-Gn) values, respectively. The average annual growth of Ar-Go', Go'-Me, and Co-Gn were compared between the two groups for the overall sample of patients, patients of the same sex (male/female), patients of the same age group (A, B, and C), and patients of the same cervical vertebral maturation stage (stages Ⅱ, Ⅲ, and Ⅳ), respectively, to see if there was any difference in the average annual growth of Ar-Go', Go'-Me, and Co-Gn. Results: There was no statistically significant difference in the average annual growth of Ar-Go', Go'-Me, and Co-Gn between the study group [0.88 (0.40, 1.80), 0.67 (0.15, 1.18), and 0.86 (0.40, 1.90) mm, respectively] and the control group [1.08 (0.45, 1.60), 0.53 (0.25, 1.13), and 1.20 (0.46, 2.28) mm, respectively] (P>0.05). In addition, there was no significant difference in the average annual growth in the Ar-Go', Go'-Me, and Co-Gn between the groups for patients of the same sex group (male/female), patients of the same age group (A, B, and C), and patients of the same cervical vertebral maturation stage group (stages Ⅱ, Ⅲ, and Ⅳ) (P>0.05). Conclusions: Extraction of the mandibular third molar tooth germ has no significant effect on the development of the mandible in Angle class Ⅰ orthodontic patients.

Reliability of impedance spectroscopy versus digital radiograph and ICDAS-II in occlusal caries detection: a prospective clinical trial

The traditional methods in early caries detection had many limitations. So, this study aimed to evaluate the clinical performance of alternating current impedance spectroscopy ACIST in comparison with digital radiograph and ICDAS-II in detection of occlusal carious lesions. Occlusal surfaces of molar and premolar teeth from 40 adult participants were examined by two observers using three diagnostic methods: (1) international caries detection and assessment system (ICDAS-II) (2) digital radiograph (DR) and (3) Cariescan Pro device (ACIST). Agreement analysis and the difference in sensitivities and specificities were evaluated. The results showed an excellent agreement in the different groups. The difference from the visual tactile against ACIST scoring for enamel caries detection, was statistically significant (p = 0.012) and the agreement was moderate (k = 0.509). For dentinal caries the difference was not statistically significant (p > 0.05) and the agreement was similarly moderate (k < 0.6). The difference from the digital radiograph against ACIST scoring, for enamel caries, digital radiography had significantly higher sensitivity and specificity than ACIST (p < 0.001) while for dentinal caries detection and overall, ACIST had higher sensitivity and digital radiography had higher specificity and the difference was statistically significant (p < 0.001). Visual-tactile examination is a considered as feasible and valid technique for occlusal caries detection, digital radiography is superior to ACIST in diagnosing enamel caries, but it could underestimate the caries depth, ACIST is a reliable tool for detecting occlusal caries in dentin.

A nomogram-based predictive model for tooth survival in Chinese patients with periodontitis: An 11-year retrospective cohort study.

To develop a nomogram-based predictive model of tooth survival by comprehensively analysing clinical and radiographic risk factors of tooth loss (TL). In this study, 3447 teeth of 131 subjects who underwent non-surgical periodontal treatment were examined retrospectively within a mean follow-up period of 11.6 years. The association of risk factors including clinical and radiographic parameters with TL was assessed using univariate and multivariate Cox regression analyses. A nomogram-based predictive model was developed, and its validation and discriminatory ability were analysed. In all, 313 teeth were lost in 94 patients in this study (overall tooth loss [OTL] 9.08%; 0.21 teeth/patient/year). Male, heavy smoking, molar teeth, probing depth (PD), attachment loss (AL), tooth mobility and radiographic bone loss were significantly associated with TL (p < .05). A gradient effect of tooth mobility on TL increased from degree I to III versus none (p < .0001). The area under the curve (AUC) of the model was 0.865. Calibration curve and decision curve analysis demonstrated good performance and high net benefit, respectively. Adopting a specific nomogram could facilitate the prediction of tooth survival and the development of tailored treatment plans in Chinese patients with advanced periodontitis.

Radicular (periapical) cyst causing exophthalmos in a dog

AbstractA 10‐year‐old male neutered Bichon Frise presented for assessment of right unilateral exophthalmos. The ophthalmological assessment revealed signs of retrobulbar disease. Computed tomography of the head showed a cavitary, well‐defined, fluid‐filled structure, which displayed a strong peripheral rim of contrast enhancement, and was centred around the tooth roots of the right maxillary first and second molar teeth (109 and 110). Focused ultrasound‐guided fluid sampling and fine needle aspirates were obtained for diagnostic purposes. After discussing the case with a veterinary dentist, extraction of the 109 and 110 and debridement of the cyst were performed. Histopathology supported the suspicion of a radicular cyst. Radicular cysts, despite being benign lesions, need to be included as a possible differential in cases with exophthalmos due to their potential retrobulbar mass effect.

In vitro accuracy of ultra-low dose cone-beam CT for detection of proximal caries.

This study aimed to assess the accuracy of ultra-low dose (ULD) cone-beam CT (CBCT) for detection of proximal caries. This in vitro study evaluated 104 molar and premolar teeth. The teeth were mounted in dry skulls and underwent CBCT with 4 protocols of high-resolution (HR), normal (NORM), ULD-HR, and ULD-NORM; 78 CBCT images were scored by 3 observers for the presence and penetration depth of caries twice with a 2-week interval using a 5-point Likert scale. The teeth were then sectioned and observed under a stereomicroscope (gold standard). The 4 protocols were compared with each other and with the gold standard. The receiver operating characteristic curve was drawn, and the area under the curve (AUC) was calculated and compared by the Chi-square test (alpha = .05). The interobserver agreement ranged from 0.5233 to 0.6034 for ULD-NORM, 0.5380 to 0.6279 for NORM, 0.5856 to 0.6300 for ULD-HR, and 0.6614 to 0.7707 for HR images. The intra-observer agreement ranged from 0.6027 to 0.8812 for ULD-HR, 0.7083 to 0.7556 for HR, 0.6076 to 0.9452 for ULD-NORM, and 0.7012 to 0.9221 for NORM images. Comparison of AUC revealed no significant difference between NORM and ULD-NORM (P > .05), or HR and ULD-HR (P > .05). The highest AUC belonged to HR (0.8529) and the lowest to NORM (0.7774). Considering the significant reduction in radiation dose in ULD CBCT and its acceptable diagnostic accuracy for detection of proximal caries, this protocol may be used for detection of proximal carious lesions and assessment of their depth.

A Unique Case of Joubert Syndrome with Concurrent IgA Nephropathy and Nephronophthisis in an Adult Patient

A 30-year-old male born from a consanguineous marriage, with intellectual disability, developmental delay and Type 1 diabetes presented with polyuria and uremic symptoms. Physical examination revealed hypertension, retinitis pigmentosa, bilateral rotatory grade 3 nystagmus, eyelid droop, truncal obesity, acanthosis nigricans, and muscle hypotonia. Laboratory tests indicated kidney dysfunction. Magnetic resonance imaging of the brain showed the “molar tooth sign,” a hallmark of Joubert syndrome. The kidney biopsy highlighted features of IgA nephropathy, diabetic nephropathy, and nephronophthisis. Whole exome sequencing identified a homozygous nonsense variant in the AHI1 gene, known to cause Joubert syndrome 3. This case is unique due to its genetic proof of an AHI1 mutation causing Joubert syndrome in an Indian patient and the co-occurrence of IgA nephropathy with nephronophthisis.