Periapical Radiographs Research Articles

Incorporation of technology in endodontic treatment of a patient with chronic non-progressive encephalopathy: case report

Objective: This work aims to describe the endodontic treatment performed in a single session in a patient with chronic non-progressive encephalopathy under general anesthesia, using technological devices. Method: A 31-year-old male patient diagnosed with chronic non-progressive encephalopathy, sought dental treatment due to tooth pain. He presented ataxia, atrophy of the upper and lower limbs and involuntary spasms. In the intraoral examination a generalized excessive occlusal wear and temporary restoration on tooth 46 was seen. Periapical radiograph showed increased periodontal space and periapical bone rarefaction. The indication was for endodontic treatment of tooth 46 under general anesthesia. After surgical risk assessment and pre-anesthetic evaluation, endodontic treatment was performed under general anesthesia, using an apical locator, mechanized instrumentation and digital radiography. The tooth restauration was performed in the same clinical moment, without complications. Result: The 8-month follow-up showed absence clinical signs and symptoms and radiographic control without periapical changes. Conclusion: In this case, the incorporation of technology in the endodontic treatment of a patient with chronic non-progressive encephalopathy ensured a safe and effective treatment for the patient and the staff, with case resolution, promotion of oral health and quality of life.

A RETROSPECTIVE CLINICAL AUDIT OF QUALITY OF INDIRECT DIGITAL INTRAORAL RADIOGRAPHS TAKEN BY STUDENTS AND DENTAL ASSISTANTS IN AN UNDERGRADUATE DENTAL CLINIC

Background: Intraoral radiographs are essential diagnostic tools in dentistry. Ensuring their quality is crucial for accurate diagnosis and treatment planning. This study compared the quality of radiographs produced by undergraduate dental students and qualified dental assistants to identify common errors and assess improvements following feedback and interventions. Methods: This retrospective, observational study compared the quality of digital bitewing and periapical radiographs taken by students and assistants across two audit cycles, with feedback provided between cycles. The radiographs were assessed using a modified quality assessment scale based on the Faculty of General Dental Practice (FGDP, UK) guidelines. Data were collected from the radiology imaging software, and a total of 100 intraoral digital radiographs were analyzed for each group in both cycles. Results: Initially, radiographs from both groups had issues, primarily positioning errors. After providing feedback and additional training, significant improvements were observed from Cycle 1 to Cycle 2. Dental assistants had a higher percentage of acceptable periapical radiographs, while students excelled in bitewing radiographs. Both groups demonstrated marked improvements, reflecting the effectiveness of the interventions. Conclusions: Continuous training, feedback, and quality assurance measures are vital for improving radiograph quality. A multifaceted approach, including updated equipment and adherence to quality control protocols, can significantly enhance patient care. The study highlights the importance of regular calibration and training for dental professionals to maintain high standards in radiographic practices. Further research is recommended to identify additional strategies for improving radiographic quality.

Post-operative pain in non-surgical root canal treatment after sealer-based obturation versus warm vertical compaction: A randomized clinical trial.

Post-operative pain may occur after non-surgical root canal treatment (NSRCT). The root filling technique and choice of sealer may be contributing factors. This randomized controlled clinical trial compared post-operative pain and analgesics intake after NSRCT using a sealer-based obturation technique (SBO) with single-cone gutta-percha and calcium silicate sealer (CSS) versus a warm-vertical compaction (WVC) technique with gutta-percha and a resin-based sealer (RBS). This study was designed as a parallel-two arm, double-blind, randomized superiority clinical trial registered at www. gov (NCT04753138). Patients referred for NSRCT fulfilling the inclusion criteria participated in this study. Pre-operative periapical radiographs and CBCT scans were taken and numerical rating scale (NRS) pain scores were recorded. Upon completion of canal instrumentation, participants were randomly allocated to either Group SBO: SBO with CSS or Group WVC: Warm-vertical compaction with RBS. Post-operative pain and analgesics intake were recorded at 1, 3 and 7 days after endodontic treatment completion. Non-parametric Mann-Whitney U and Friedman tests and a generalized estimating equation were used to assess differences in pain scores between the groups, within each treatment group at different time points and for correlations, respectively. The study included 195 participants (212 teeth). One participant declined to submit the NRS form. Therefore, 194 participants (211 teeth) were included in the final analysis (99.5% response rate). No statistically significant differences in post-operative pain or analgesic intake existed between the two groups at any time point (p > .05). Age, pre-operative pain, apical diagnosis and post-operative analgesic intake were significantly related to post-operative pain (p < .05). Sealer-based obturation technique with CSS was associated with similar post-operative pain levels and analgesics intake as WVC with RBS. Regarding post-operative pain, SBO with CSSs may be a suitable clinical alternative.

Tissue changes around dental implants installed in alveolar ridge preservation sites: A 1-year follow-up randomized controlled clinical trial.

This study aimed to assess radiographic marginal bone changes 22 months post extraction, which is 1 year after implant loading in alveolar ridge preservation (ARP) sites grafted with a combination of collagen-embedded xenogenic bone substitute (DBBM-C) and collagen matrix (CMX), comparing them with implants placed in naturally healed sites. This randomized controlled clinical trial was conducted over 22 months. Patients who needed a single tooth extraction and subsequent implant placement in nonmolar areas were enrolled. The test group received deproteinized bovine bone mineral with 10% collagen covered by a procaine collagen membrane, while the control group allowed spontaneous healing. Radiographic bone level changes were documented using periapical radiographs at implant placement and follow-up visits (6, 10, and 22 months postextraction). Early implant soft tissue exposure, clinical parameters, and patient-reported outcomes were recorded. Twenty-two out of 28 participants completed a 22-month follow-up, 9 in the test group and 13 in the control group. At 10-month postextraction follow-up, the mean MBL was 1.01 ± 1.04 mm in the treatment group and 0.81 ± 0.93 mm in the control group (p = 0.804). At 22 months, the mean MBL was 2.09 ± 1.03 mm in the treatment group and 1.58 ± 0.73 mm in the control group (p = 0.339). No statistically significant differences in probing depth (PD) and bleeding on probing (BOP) were found at the 22 -month follow-up as well. Soft tissue mean recession was observed in the control group (0.36 ± 0.84 mm), while no recession was found in the test group (p = 0.2). Early implant soft tissue exposure occurred in 33% of test group participants, while none was observed in the control group (p = 0.047). One year after implant loading, no significant differences in marginal bone resorption were found between implants placed in ARP-treated and naturally healed sites. However, ARP-treated sites exhibited early implant soft-tissue exposure, suggesting a possible impairment in soft tissue healing.

Discomfort/pain due to peri-implant probing at titanium and zirconium implants: A cross-sectional study.

This study was designed to compare discomfort/pain after periodontal and peri-implant probing in patients with titanium compared with zirconium implants. One examiner recruited and examined 70 patients, each of whom had a dental implant with a contralateral tooth; 37 patients had titanium implants of various types and 33 patients had zirconium implants; one implant was analyzed for each patient. Periodontal and peri-implant probing pocket depth (PPD) and clinical attachment level (CAL) were assessed. Immediately after probing, patients rated their discomfort/pain with a visual analog scale (VAS). The emergence profiles of implant crowns were assessed on periapical radiographs of the implants. Seventy patients with a median age of 55 years (interquartile range [IQR]: 42-65 years), including 43 females and 16 current smokers, were examined. The mean PPD and bleeding on probing (BOP) were higher around implants than around teeth (p < .001). CAL and suppuration were well-balanced between implants and teeth. Peri-implant probing caused significantly more discomfort/pain than periodontal probing [median VAS score: 12.5 (IQR 4-22) vs. 9 (2-15); p < .001]. Logistic regression revealed that discomfort/pain after peri-implant probing was less intense in patients who had taken analgesic medication (p = .021) and around titanium implants (p = .037). Peri-implant probing caused significantly more discomfort/pain than periodontal probing. Patients who had taken analgesic medication experienced less discomfort and pain with peri-implant probing than those who had not; furthermore, titanium implants were associated with less pain than zirconium implants.

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.

Radiographic assessment of the quality of post and core restorations performed by general dental practitioners in Saudi Arabia

BackgroundDentists utilize various techniques and materials for post and core restoration of endodontically treated teeth, which remains a noteworthy health concern and can be addressed through interdisciplinary strategies to enhance outcomes. Therefore, this study aimed to evaluate the technical quality of the residual gutta-percha (GP) and posts by analysing the periapical radiographs of endodontically restored teeth. MethodsA total of 594 periapical digital radiographs were evaluated for tooth type, post material, post shape, design, diameter, length, residual GP, GP length, GP tapering, GP homogeneity, and final restoration. Frequency distribution and cross-tabulation of the variables were performed. ResultsMaxillary molars had the highest frequency of restorations, including posts, accounting for 27.4 %, followed by maxillary premolars (25.4 %) and maxillary anterior teeth (19.2 %). The prefabricated metallic posts were most commonly used (81.0 %), among these, 50.4 % were screwed posts. Tapered posts were the most commonly used (65.6 %). The percentage of posts with an acceptable length was 58.2 %. The most commonly used posts exhibited a width of one-third of the root diameter, accounting for 87.0 %. Suitable GP lengths were observed in 61.1 % of the restorations, and 62.8 % demonstrated adequate GP homogeneity. The findings of this study revealed that crown restoration accounted for 42.6 % of the studied sample. ConclusionsThe technical quality of the remaining GP after restoration was comparable to that of previous epidemiological investigations. However, the technical quality of the post was deemed suboptimal.

Outcomes of nonsurgical endodontic treatment under general anesthesia in special health care needs: An observational study

Background and aimThe alarming rise in the number of people with special health care needs (SHCNs) necessitates a paradigm shift in how to approach their oral health needs. General anesthesia (GA) is a valuable technique for facilitating dental procedures in patients with SHCNs who may not be able to tolerate treatment without it. The aim was to assess nonsurgical endodontic treatment and outcomes in patients with SHCNs performed under GA.MethodSeventy-eight permanent teeth in 33 patients who received nonsurgical endodontic treatment under GA were included between 2018 and 2022 in SHCNs hospital clinics. The demographic data, types of SHCNs, pulpal and periapical diagnosis, type of treatment, and material used were analyzed. All patients were recalled for clinical and radiographic examinations. Pre-treatment and recall periapical radiographs were evaluated and scored using the Periapical Index (PAI).ResultsAutism and Attention deficit hyperactivity disorder were 39.4% of patients treated. Most treatments delivered were primary nonsurgical root canal treatment (95%). Warm vertical compaction of gutta-percha for obturation accounted for 88% of cases treated. Single cone obturation technique was used in 9 cases (12%) utilizing tricalcium silicate sealer. At the recall visits, 98.7% of teeth treated had survived. Twelve teeth have pre-treatment periapical lesions, and all healed except one. Female patients were found to have higher scores of PAI compared to male patients (23.7% vs 7.5%), yet insignificant. Only 10 patients with nonsurgical root canal treatment reported recurrent caries.ConclusionThis study demonstrates a high survival rate for nonsurgical endodontic treatment performed under GA in a cohort of patients with SHCNs. Interestingly, patients with social and communication disorders received the highest proportion of treatments under GA. These findings highlight the potential of GA-facilitated endodontics for this population. However, further research is warranted to explore additional methods for optimizing oral health outcomes in SHCNs.

Classification of Periapical and Bitewing Radiographs as Periodontally Healthy or Diseased by Deep Learning Algorithms.

Objectives The aim of this artificial intelligence (AI) study was to develop a deep learning algorithm capable of automatically classifying periapical and bitewing radiography images as either periodontally healthy or unhealthy and to assess the algorithm's diagnostic success. Materials and methods The sample of the study consisted of 1120 periapical radiographs (560 periodontally healthy, 560 periodontally unhealthy) and 1498 bitewing radiographs (749 periodontally healthy, 749 periodontally ill). From the main datasets of both radiography types, three sub-datasets were randomly created: a training set (80%), a validation set (10%), and a test set (10%). Using these sub-datasets, a deep learning algorithm was developed with the YOLOv8-cls model (Ultralytics, Los Angeles, California, United States) and trained over 300 epochs. The success of the developed algorithm was evaluated using the confusion matrix method. Results The AI algorithm achieved classification accuracies of 75% or higher for both radiograph types. For bitewing radiographs, the sensitivity, specificity, precision, accuracy, and F1 score values were 0.8243, 0.7162, 0.7439, 0.7703, and 0.7821, respectively. For periapical radiographs, the sensitivity, specificity, precision, accuracy, and F1 score were 0.7500, 0.7500, 0.7500, 0.7500, and 0.7500, respectively. Conclusion The AI models developed in this study demonstrated considerable success in classifying periodontal disease.Future applications may involve employing AI algorithms for assessing periodontal status across various types of radiography images and for automated disease detection.

Deep learning for determining the difficulty of endodontic treatment: a pilot study

BackgroundTo develop and validate a deep learning model for automated assessment of endodontic case difficulty from periapical radiographs.MethodsA dataset of 1,386 periapical radiographs was compiled from two clinical sites. Two dentists and two endodontists annotated the radiographs for difficulty using the “simple assessment” criteria from the American Association of Endodontists’ case difficulty assessment form in the Endocase application. A classification task labeled cases as “easy” or “hard”, while regression predicted overall difficulty scores. Convolutional neural networks (i.e. VGG16, ResNet18, ResNet50, ResNext50, and Inception v2) were used, with a baseline model trained via transfer learning from ImageNet weights. Other models was pre-trained using self-supervised contrastive learning (i.e. BYOL, SimCLR, MoCo, and DINO) on 20,295 unlabeled dental radiographs to learn representation without manual labels. Both models were evaluated using 10-fold cross-validation, with performance compared to seven human examiners (three general dentists and four endodontists) on a hold-out test set.ResultsThe baseline VGG16 model attained 87.62% accuracy in classifying difficulty. Self-supervised pretraining did not improve performance. Regression predicted scores with ± 3.21 score error. All models outperformed human raters, with poor inter-examiner reliability.ConclusionThis pilot study demonstrated the feasibility of automated endodontic difficulty assessment via deep learning models.

Radiation exposure during orthodontic treatment: risk to children and adolescents.

To estimate radiation risk to children and adolescents during orthodontic treatment by retrieving number and type of radiographs from the patient records. Radiographs, along with justifications for radiation exposure, were obtained retrospectively from the patient records of 1,790 children and adolescents referred to two Swedish orthodontic clinics. Data were grouped according to treatment stage: treatment planning, treatment, and follow-up. Estimated risk was calculated using the concept of effective dose. Each patient had received around seven radiographs for orthodontic purposes. The most common exposures during treatment planning were one panoramic, one lateral, and three intraoral periapical radiographs. A small number of patients received a tomographic examination (8.2%). Few justifications for treatment planning and follow-up, but more in the actual treatment stage, had been recorded. The most common examinations were to assess root resorption and the positions of unerupted teeth, or simply carry out an unspecified control. The estimated risk of developing fatal cancer was considered low. The radiation risk from orthodontic treatment was equivalent to about 5-10 days of natural background radiation. Children and adolescents sometimes undergo multiple radiographic examinations, but despite the low radiation burden, accumulated radiation exposure should be considered and justified in young patients.

Cone Beam Computed Tomography Analysis of Post Space in Bifurcated Premolars Using ParaPost and Peeso Reamer Drills

Introduction Core buildups are usually maintained by the usage of posts. Even so, in curved and narrow canals, such as bifurcated premolars, excessive dentin removal during post-space preparation can result in a vertical root fracture or perforation. In order to preserve root canal dentin during post-space preparation of bifurcated premolars, this study examined and analyzed the effects of two widely used drills: Peeso Reamer (Dentsply Maillefer, Ballaigues, Switzerland) and ParaPost (Coltene/Whaledent, Inc., Altstätten, Switzerland). We also examined the risks associated with using Cone-beam Computed Tomography (CBCT). Methods Three operators with varying levels of experience treated a total of 72 removed bifurcated premolars, dividing them into equal groups. The rotary ProFile system (Dentsply Sirona, Charlotte, NC) was utilized for root canal treatments, and gutta-percha size #30/0.4 was used for obturation. Peeso Reamer #2 and ParaPost #1 were then used to prepare the palatal canals. CBCT was used to assess the total mean intracanal spaces of 3 mm, 5 mm, and 7 mm that were measured both preoperatively and postoperatively. To compare the mean dentin thickness within the canal area across all groups, we used analysis of variance testing. We detected complications, like deviations or perforations, using mesiodistal periapical radiographs. Results When utilizing the Peeso Reamer, the mean dentin thickness (0.749 mm) was slightly more than when using the ParaPost (0.736 mm) with p=0.16. There was no significant difference in the mean dentin thickness of the canal area between the Peeso Reamer and the ParaPost drills. The Pesso Reamer drill had fewer complications since it matched the canal configuration, while the Parapost drill removed somewhat more dentin in the canal area. Only seven teeth with minimum deviation from the center of the canal during preparation were produced by the Peeso Reamer drill (20% of teeth having deviation), whereas twenty-one teeth had deviations (72.2% of teeth) and eight had furcal perforations generated by the ParaPost. Conclusion Within the limitations of our study, the Pesso Reamer drill caused little more dentin removal than the ParaPost drill. However, the Peeso Reamer had fewer risks and was safer to use in bifurcated premolars. The ParaPost drill is not recommended in bifurcated premolars due to the high risks of deviation and perforation because they have narrow canals. The selection of an appropriate drill for post-space use in bifurcated premolars is essential for successful patient outcomes.

Deep learning-based detection of irreversible pulpitis in primary molars.

Changes in healthy and inflamed pulp on periapical radiographs are traditionally so subtle that they may be imperceptible to human experts, limiting its potential use as an adjunct clinical diagnostic feature. This study aimed to investigate the feasibility of an image-analysis technique based on the convolutional neural network (CNN) to detect irreversible pulpitis in primary molars on periapical radiographs (PRs). This retrospective study was performed in two health centres. Patients who received indirect pulp therapy at Peking University Hospital for Stomatology were retrospectively identified and randomly divided into training and validation sets (8:2). Using PRs as input to an EfficientNet CNN, the model was trained to categorise cases into either the success or failure group and externally tested on patients who presented to our affiliate institution. Model performance was evaluated using sensitivity, specificity, accuracy and F1 score. A total of 348 PRs with deep caries were enrolled from the two centres. The deep learning model achieved the highest accuracy of 0.90 (95% confidence interval: 0.79-0.96) in the internal validation set, with an overall accuracy of 0.85 in the external test set. The mean greyscale value was higher in the failure group than in the success group (p = .013). The deep learning-based model could detect irreversible pulpitis in primary molars with deep caries on PRs. Moreover, this study provides a convenient and complementary method for assessing pulp status.

Analysis of the correlation between peri-implant probing depth and radiographic bone level

Objective: To evaluate the correlation between peri-implant probing depth (PPD) and radiographic bone level (rBL) in implants with peri-implantitis. Methods: From January 2019 to December 2022, 24 patients with 30 implants who suffered from peri-implantitis at the Department of Periodontology, Peking University School and Hospital of Stomatology were included in the present research. SPSS 26.0 software was used to simple random sampling select 30 healthy implants from which with electronic examination records in Department of Periodontology, Peking University School and Hospital of Stomatology from January 2007 to June 2023 as the control group. On the premise of retaining the implant prosthesis, PPD (distance between pocket bottom and peri-implant soft tissue margin) was examined using a Williams periodontal probe with a light force (about 0.2 N), and a total of 4 sites were recorded for each implant. Periapical radiography and cone beam CT were applied to measure the rBL (distance between the reference point at the neck of the implant and the apical point of the bone defect) and the width of the bone defect (DW), and the type of the bone defect was recorded. The correlation and consistency between the diagnosis of PPD and rBL were analyzed. Results: PPD was significantly correlated with rBL in a total of 60 implants in 180 sites (r=0.64, P<0.001). The chi-square test showed an 8.15-fold increase in the detection rate of PD≥6 mm at sites with rBL≥1 mm (P<0.001). Multivariate logistic regression analysis showed that rBL was still statistically associated with PPD after adjustment for jaw position and examination position of implants. Take rBL <1 mm as reference, the odds ratios (OR) of 1 mm≤rBL<2 mm, 2 mm≤rBL<3 mm and rBL≥3 mm group with PPD were 6.23 (P=0.014), 2.77 (P=0.183) and 10.87 (P=0.001), respectively. Conclusions: There is a positive correlation between PPD and rBL in implants with peri-implantitis. PPD can be used as a clinical examination index to assist in estimating the level of peri-implant bone under the premise of retaining the prosthesis.

An Artificial Intelligence model for implant segmentation on periapical radiographs.

To segment dental implants on PA radiographs using a Deep Learning (DL) algorithm. To compare the performance of the algorithm relative to ground truth determined by the human annotator. Three hundred PA radiographs were retrieved from the radiographic database and consequently annotated to label implants as well as teeth on the LabelMe annotation software. The dataset was augmented to increase the number of images in the training data and a total of 1294 images were used to train, validate and test the DL algorithm. An untrained U-net was downloaded and trained on the annotated dataset to allow detection of implants using polygons on PA radiographs. A total of one hundred and thirty unseen images were run through the trained U-net to determine its ability to segment implants on PA radiographs. The performance metrics are as follows: accuracy of 93.8%, precision of 90%, recall of 83%, F-1 score of 86%, Intersection over Union of 86.4% and loss = 21%. The trained DL algorithm segmented implants on PA radiographs with high performance similar to that of the humans who labelled the images forming the ground truth.

Artificial Intelligence for Detecting Periodontitis: Systematic Literature Review

Background The determination of the diagnosis of inflammatory periodontitis is generally based on clinical examination, which is then strengthened by radiographic examination. Still, the inequality of assessment of clinical conditions, along with limitations of radiographic interpretation, makes determining the diagnosis of the periodontal disease difficult. The use of artificial intelligence as a digital system approach is believed to reduce costs, time, the need for medical services, and medical errors that may occur due to human factors. Objective This systematic review study is to analyze the use of dental and panoramic radiographs combined with the use of artificial intelligence in establishing the diagnosis of periodontitis based on the parameters of periodontal disease severity according to the 2017 American Academy of Periodontology/European Federation of Periodontology Workshop (pocket depth, clinical attachment loss (CAL) and the pattern and level of alveolar bone damage that occurs). Methods Journal searches for articles published in English were carried out through the PubMed and Scopus databases in the 2011-2021 period, using the search terms periodontitis, periodontal disease, food impaction, trauma occlusion, periapical radiograph, panoramic, machine learning, artificial intelligence, and periodontal bone loss, after going through article selection, two suitable articles were obtained. Results Two studies fell into the analyzed category. Both list periodontal bone loss as a parameter that marks periodontitis, and the use of panoramic photos in detecting this parameter assisted by Convolutional Neural Networks as artificial intelligence. Conclusion The use of panoramic radiographs and Convolutional Neural Networks as artificial intelligence that serves as a tool to detect periodontal bone damage has almost the same results as experienced clinicians In order for this method to be developed in the future to help clinicians establish the diagnosis, more clinical and image data will be required.

The first experiences of preclinical dentistry students with rotary instruments: A pilot study

Abstract Introduction: Rotary instrumentation has been included in the undergraduate endodontic curriculum to improve the quality of endodontic treatment. The aim of this study was to compare the technical quality of root canal fillings performed by preclinical dentistry students trained with hand instrumentation (THI) or not during their initial trial with rotary instruments. Materials and Methods: Twenty-four 3rd-year students were distributed into two groups: 12 students THI group and 12 students not trained with hand instrumentation (NTHI group). Both the groups received a 50-min theoretical lecture and a demonstration about the ProTaper Universal® system before being asked to complete endodontic treatments on one extracted maxillary central incisor, premolar, and molar using rotary instrumentation and obturation with the single-cone technique. The endodontic treatment technical quality was determined by periapical radiographs. Data were statistically analyzed, and P &lt; 0.05 was considered statistically significant. Results: A total of 144 root canals were performed by preclinical students. Although the difference in the technical quality of the canals was nonsignificant among the groups (P &gt; 0.05), the THI group had more adequately filled root canals (45.8%) than the NTHI group (29.2%). Only maxillary central incisors had underfilled canals, whereas teeth with multirooted canals were subjected to various procedural errors in both the groups (P &gt; 0.05). Conclusions: Intensive hand instrumentation (HI) preclinical training did not significantly improve the technical quality of root canals performed by preclinical dentistry students during their initial trial with rotary instruments. The student’s familiarity with HI did not decrease the incidence of procedural errors when performing root canal treatment with rotary instruments.

Does Implant Placement Below the Ridge Reduce Crestal Bone Loss? A Split-Mouth Randomized Controlled Clinical Trial.

Reducing crestal bone loss (CBL) around implants allows for soft tissue stability and long-term success. The aim of the present study was to evaluate the extent of CBL in implants placed with the implant shoulder at the equi-crestal level and 2 mm below the alveolar ridge at 2, 12, 36, and 60 months. A split-mouth randomized controlled clinical trial was conducted by selecting subjects with Kennedy Class IV partial edentulism of the lower jaw. Two implants were inserted, of equal length and diameter, one equi-crestal and the other sub-crestal, in the site corresponding to the lateral incisor. Intraoral periapical radiographs with Rinn centering devices were performed at the time of implant insertion (T0), at 2 (T1), 12 (T2), 36 (T3), and 60 months (T4). Descriptive statistics and the T-test were used, setting the significance to P⩽ 0.05. Twenty-five subjects were recruited, with a mean age of 65 years (SD 9.88, range 42-82). No subject dropped out. A total of 50 implants were inserted, 25 at crestal and 25 sub-crest level. At the 60-month follow-up, no implant or prosthetic failure was recorded. An average loss of -0.81 mm was recorded in the crestal implant group (n.25; SD: 0.40; max-min: -1.6 - -0.1) while in the implants positioned below the crest the average CBL was -0.87mm (n.25; SD: 0.41; max-min: -2 - -0.2); however, the higher CBL in the sub-crestal implant group was not statistically significant (P&#61;0.65). Comparing the mean CBL values of the two groups at the various follow-ups, a greater crestal bone resorption was recorded in sub-crest implants between T0 and T1 (-0.25 vs -0.1) and between T1 and T2 (-0.39 vs -0.23), while in subsequent follow-ups a greater, statistically significant (P&#61;0.01), crestal bone loss was recorded in ridge implants between T3 and T4 (-0.05 vs -0.18). Over time, therefore, the extent of CBL seems to be reduced in implants placed below the crest, with bone retention above the implant shoulder. Ultimately, although the position of the implant shoulder relative to the crestal ridge doesn't affect the CBL, sub-crestal placement is recommended in order to reduce the risk of exposure of the rough surface of the implant.

Efficacy of a radiographic film holder adapter in generating radiographs of dental implants with improved geometric accuracy and sharpness

Some radiographic film holders produce radiographs with geometric distortion that may interfere with diagnosis. However, whether the distortion can be corrected by adjusting the design of the radiographic film holder is unclear. The purpose of the study was to develop an adapter for a radiographic film holder model aiming to generate radiographs with greater sharpness and a more accurate geometric representation of dental implants. The 2-piece adapter was designed using the SketchUp software program and was 3-dimensionally (3D) printed. Implants with internal conical connections were installed in 19 maxillary prototypes in the central incisor region. Five dentists obtained 285 digital periapical radiographs with 3 different radiographic film holders: standard Cone Indicator, Rinn XCP, and adapted Cone Indicator. They then evaluated the radiographic sharpness of the implants threads and their dimensions using the ImageJ software program. The data were analyzed using the Friedman test with the Durbin-Conover post hoc test and MANOVA with the Tukey post hoc test (α=.05). On the mesial surface of the implants, the threads were sharper for the adapted than for the standard Cone Indicator radiographic film holder (P<.05). The adapted Cone Indicator showed a smaller difference between the radiographic and actual implant diameters compared with the Rinn XCP and standard Cone Indicator radiographic film holders (P<.05). The developed adapter provided radiographs of dental implants with improved sharpness and geometric accuracy.

The effect of changing vertical irradiation angle of periapical radiography bisecting technique on the length dimension of mandibular teeth

Objectives: This research is aimed to determine the effect of changing the vertical irradiation angle with a change in angle of +10°, +5°, -5°, -10° in bisecting technique periapical radiography on the length dimension of mandibular teeth. Materials and Methods: This study used a laboratory experimental method with a post test only control group design. The samples used in this study were teeth I1, I2, C, P1, P2, M1, and M2 region 4. All teeth were treated by changing the angle from the standard angle recommended by White and Pharoah with changes of +10°, +5°, -5°, and -10° in each tooth using a Morita Veraview iX 70 Kv, 7mA dental X-ray unit. Results: The results showed that the angle change of -10°, -5° causes foreshortening and +10°, +5° causes elongation. Based on the results of the Saphiro-Wilk and Kruskal-Wallis test, it is known that there are significant differences in the dimensions of tooth length at +10°, +5°, -5°, -10° against changes in the angle 0° or angulation form White and Pharoah (p &lt; 0.05) . Conclusion: There is a significant effect on the change of vertical irradiation angle with angle changes of +10°, +5°, -5°, -10° in bisecting technique periapical radiography on the length dimension of mandibular teeth.