Premolar Area Research Articles

Non-Extraction Treatment of a Skeletal Class II Adult Patient with Severe Crowding Using Temporary Skeletal Anchorage Devices

In skeletal Class II patients with crowding, decision of extraction is a critical step for treatment planning. Recently, non-extraction treatment has been increased in accordance with advancement of orthodontic devices, widespread use of temporary skeletal anchorage devices (TSADs), and application of appropriate biomechanics. Resolution of crowding can be achieved through interproximal reduction, total distalization, expansion of the dental arches and mandibular incisors proclination. Especially arch form development was observed in arch width of canine and premolar areas after treatment. For treatment of Class II patients with severe crowding, strategic use of arch form development and total distalization can extend the scope of non-extraction treatment with a combination of passive self-ligating brackets, wide archwires and TSADs.

Cone-beam computed tomography-based quantitative analysis of the thickness of mandibular alveolar bone in adult females with different vertical facial patterns

Objectives: The objectives of the study were to investigate the relationship between the thicknesses of the mandibular alveolar bone in the incisor, canine, premolar, and molar areas in adult female patients with different vertical skeletal patterns using cone-beam computed tomography (CBCT). Materials and Methods: CBCT images of 50 adult female patients before orthodontic treatment were analyzed. Based on the mandibular plane angle, they were divided into three groups: Low, average, and high-angle. The thicknesses of the alveolar and cancellous bones of the mandible were measured at the apices of the incisor, canine, first premolar, and first molar on both sides. Results: The thicknesses of the alveolar and cancellous bones were significantly larger in the low-angle group than in the high-angle group in all areas. At the incisal and canine areas, the thicknesses of the alveolar and cancellous bones were significantly larger in the average angle group than in the high-angle group. In the canine and first premolar areas, the thickness of the alveolar bone was larger in the low-angle group than in the average angle group. Conclusions: Vertical facial pattern is a significant factor in the width of the mandibular alveolar bone, especially in the incisor and canine areas. For planning labiobuccal movement in mandibular canines and incisors, information about the mandibular morphology is thought to be important, particularly in high-angle cases.

The Use of a Non-Absorbable Membrane as an Occlusive Barrier for Alveolar Ridge Preservation: A One Year Follow-Up Prospective Cohort Study.

The aims of this study were to obtain preliminary data and test the clinical efficacy of a novel nonporous dense-polytetrafluoroethylene (d-PTFE) membrane (permamem®, botiss) in alveolar ridge preservation (ARP) procedures with a flapless approach. A traumatic extraction was performed in the premolar maxillary area, and a d-PTFE membrane was used to seal the alveolar cavity: no biomaterial was used to graft the socket and the membrane was left intentionally exposed and stabilized with sutures. The membrane was removed after four weeks and dental implants were placed four months after the procedure. The primary outcome variables were defined as the dimensional changes in the ridge width and height after four months. A total of 15 patients were enrolled in this study. The mean width of the alveolar cavity was 8.9 ± 1.1 mm immediately after tooth extraction, while four months later a mean reduction of 1.75 mm was experienced. A mean vertical reduction of 0.9 ± 0.42 mm on the buccal aspect and 0.6 ± 0.23 mm on the palatal aspect were recorded at implant placement. Within the limitations of this study, the d-PTFE membrane proved to be effective in alveolar ridge preservation, with the outcomes of the regeneration not affected by the complete exposure of this biomaterial.

Loss of Functional Dentition is Associated with Cognitive Impairment.

Although tooth loss is known to increase the risk of cognitive impairment and dementia, few studies have investigated the association between functional teeth including rehabilitated lost teeth and cognitive functionObjective:We investigated the associations of the numbers of functional teeth and functional occlusal units with cognitive impairment and cognitive function in late life. The current study was conducted as a part of the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD), a community-based elderly cohort study. We analyzed 411 participants who have agreed with the additional dental exam. Geriatric psychiatrists and neuropsychologists administered the Consortium to Establish a Registry for Alzheimer's disease Assessment Packet Clinical and Neuropsychological Assessment Battery to all participants, and dentists examined their dental status. Higher number of functional teeth (OR = 0.955, 95% CI = 0.914-0.997, p = 0.037) and higher number of functional occlusal units (OR = 0.900, 95% CI = 0.813-0.996, p = 0.042) were associated with lower odds of cognitive impairment. When we analyzed these relationships separated by the location of teeth, only the numbers of functional teeth (OR = 0.566, 95% CI = 0.373-0.857, p = 0.007) and functional occlusal units (OR = 0.399, 95% CI = 0.213-0.748, p = 0.004) in the premolar area were associated with lower odds of cognitive impairment. Loss of functional teeth and functional occlusal units (especially in the premolar region) were associated with increased cognitive impairment.

Fractal and radiomorphometric analysis of mandibular bone changes in patients undergoing intravenous corticosteroid therapy.

To evaluate mandibular bone changes by comparing the fractal dimension (FD), mandibular cortical width (MCW), and panoramic mandibular index (PMI) on panoramic radiographs in patients using intravenous corticosteroids versus controls. In total, 60 patients were divided into 2 groups: 30 patients receiving intravenous corticosteroid treatment and 30 age- and sex-matched healthy people as the control group. Panoramic radiographs of all patients were evaluated. FD was measured in 4 regions: the subcortical area in the condyle, the area superior to the angle of the mandible, the alveolar bone distal to the mandibular left second premolar root, and the alveolar bone mesial to the mental foramen. MCW and PMI were calculated to assess cortical thickness. The FD values in the condyle, angle of the mandible, and mental foramen region were significantly lower in the corticosteroid group (P ≤ .011), but there was no significant difference in the second premolar area (P=.101). MCW values were significantly lower in the corticosteroid group (P < .001). There was no significant difference in PMI between the groups (P=.544). The FD and MCW values of the patients using corticosteroids can be helpful in quantitatively and objectively evaluating osseous changes in patients receiving intravenous corticosteroids.

Evaluation of zirconia and zirconia-reinforced glass ceramic systems fabricated for minimal invasive preparations using a novel standardization method.

Currently, minimal invasive approaches combining less invasive finish line preparations and reduced ceramic thickness are required. The aim of this study was to evaluate the fracture resistance of two ceramic systems fabricated with two preparation designs using CAD/CAM standardization technology. Forty intact human maxillary premolars were divided into two main groups according to the preparation technique. Group H (Horizontal): teeth with shoulder finish line and group V (Vertical): teeth with feather edge. Each main group was subdivided randomly into two subgroups according to the material used. Group CD (Celtra Duo) zirconia-reinforced glass ceramics and group K (KATANA) monolithic zirconia. CAD/CAM was used for standardization of natural teeth preparation. After cementation using self-adhesive resin cement, all specimens were subjected to 5000 thermal cycles and then were loaded until fracture. Failure types were evaluated using Stereomicroscopy and Scanning Electron Microscopy (SEM). Nonsignificant; the higher mean value was recorded with VCD group (482.5 ± 103.8 N) and VK group (1347.6 ± 177.4 N) vs HCD group (471 ± 107.6 N) and HK group (1255.6 ± 121.3 N). SEM findings showed that fractures occurred mainly at the occlusal side of the crowns. Vertical preparation showed a promising alternative to horizontal preparation. Moreover, both Celtra Duo and KATANA crowns can be used in premolar area with 0.5 mm margin thickness. Zirconia-reinforced glass ceramic and monolithic zirconia crowns may not necessitate the preparation of invasive finish lines as the type of finish line did not impair the strength after aging conditions.

Impact of implants number and attachment type on the peri-implant stresses and retention of palateless implant-retained overdenture.

To evaluate the impact of implants number and attachments type on the peri-implant stresses and retention of maxillary palateless implant-supported overdenture. Four edentulous maxillary educational acrylic resin models were used. According to the implants number and type of attachment used, four groups were compared: Group I, 2-locator attachments in the canine area; Group II, 2- OT equator attachments in the canine area; Group III, 4-locator attachments in the canine, second premolar area and Group IV, 4-OT equator attachments in the canine, second premolar area. Implants retained palateless overdenture was constructed on each model. Four self-protected linear strain gauges were cemented on each implant. A digital loading device was used to apply compressive loads to measure the resulting peri-implant stresses. Forcemeter and Universal testing machines were used to test the retention of palateless overdenture. A significant difference between the same implant number and distribution with different attachments was found (P = 0.003, P = 0.020), respectively. Least stresses amount was found around the 4-implant locator palateless overdenture, while the highest was found around the 2-implant OT equator palateless overdenture. Nevertheless; the result was that 2-implant locator palateless overdenture recorded insignificant higher retentive forces than the 4-implant OT equator one. It can be concluded that the implant-retained palateless overdenture with four locator attachments is considered a promising treatment option regarding stress distribution. Using locator attachments, for implant-retained palateless overdenture with either two or four implants considering their superior retentive properties, is advantageous when compared to OT equator attachments.

Computed tomographic imaging and surgical treatment of an acquired dentigerous cyst in a Slovakian Chuvach – a case report

Dentigerous cysts occur infrequently in dogs and they should be a primary consideration in young dogs presented with oral swelling in the edentulous area. They are even less common in cats compared to dogs. Classification of lesions in animals is not very different from those described in humans. Dentigerous cysts are most frequently seen affecting the mandibular first premolar area with unerupted mandibular first premolar teeth. This report describes the clinical case of a four-year-old female Slovakian Chuvach that suffered from long-term difficulties associated with epistaxis and swelling of the facial area. Computed tomography revealed a cyst-like structure associated with an intra-nasal canine, prompting the suspected diagnosis of an odontogenic cyst. Histopathological examination of tissues obtained during the subsequent surgical procedure confirmed the diagnosis of a dentigerous cyst.

Effect of slice inclination and object position within the field of view on the measurement accuracy of potential implant sites on cone-beam computed tomography.

PurposeThe purpose of this study was to evaluate the accuracy of linear measurements in the horizontal and vertical dimensions based on object position and slice inclination in cone-beam computed tomography (CBCT) images.Materials and MethodsTen dry sheep hemi-mandibles, each with 4 sites (incisor, canine, premolar, and molar), were evaluated when either centrally or peripherally positioned within the field of view (FOV) with the image slices subjected to either oblique or orthogonal inclinations. Four types of images were created of each region: central/cross-sectional, central/coronal, peripheral/cross-sectional, and peripheral/coronal. The horizontal and vertical dimensions were measured for each region of each image type. Direct measurements of each region were obtained using a digital caliper in both horizontal and vertical dimensions. CBCT and direct measurements were compared using the Bland-Altman plot method. P values <0.05 were considered to indicate statistical significance.ResultsThe buccolingual dimension of the incisor and premolar areas and the height of the incisor, canine, and molar areas showed statistically significant differences on the peripheral/coronal images compared to the direct measurements (P<0.05). Molar area height in the central/coronal slices also differed significantly from the direct measurements (P<0.05). Cross-sectional images of either the central or peripheral position had no marked difference from the gold-standard values, indicating sufficient accuracy.ConclusionPeripheral object positioning within the FOV in combination with applying an orthogonal inclination to the slices resulted in significant inaccuracies in the horizontal and vertical measurements. The most undesirable effect was observed in the molar area and the vertical dimension.

Mandibular squamous odontogenic tumour misdiagnosed as squamous cell carcinoma: a case report and review of literature

Squamous odontogenic tumor (SOT) is an unusual, benign odontogenic tumor presented in close physical relationship to the dentition and originating from the epithelial rests of Malassez in the periodontal ligament or gingival epithelium. It was first described in 1975 by Pullon et al. and there are few cases reported in the literature. The main characteristic of this lesion is a tendency to arise in the molar region of the mandible and in the premolar-canine region of the maxilla with a simultaneously asymptomatic swelling in the alveolar. SOTs are incidental discoveries on routine dental radiographs or panoramic x-rays in many cases. We report a case of a 60-year-old Caucasian woman with SOT of the mandible in the area of the right premolars.

Yeni Vida Tutuculu Abutment Sistemlerine Simante Edilen İmplant Destekli Zirkonya Restorasyonların Biyomekanik Davranışları: Üç Boyutlu Sonlu Elemanlar Analiz Çalışması

Objective: The purpose of this study was to evaluate the biomechanical behaviors of non-engaging titanium base abutments (NTiBA) bonded to three-unit zirconia restorations in terms of stress distribution in implants and prosthetic components. Material and Methods: Three-dimensional (3D) models of a tissue-level and bonelevel implant systems and their screw-retained abutments (SRA) and NTiBA were created. A bone block representing the maxillary right posterior region was created, and the implants were placed in the first premolar and first molar areas. Six different three-unit implant-supported fixed dental prostheses (I-FDPs) models were created: tissuelevel implant, N-TiBA, 6 mm crown height (TL6); tissue-level implant, N-TiBA, 10 mm crown height (TL10); bone-level implant, SRA, 6 mm crown height (SR6); bone-level implant, SRA, 10 mm crown height (SR10); bone-level implant, N-TiBA, 6 mm crown height (BL6); bonelevel implant, N-TiBA, 10 mm crown height (BL10). The restoration material was determined as monolithic zirconia. In each model, equal vertical (200 N) and oblique (100 N) loads were applied to each tooth simultaneously. The stress distribution in the restoration, implant, abutments, and basal screws was evaluated through the von Mises stres analysis. Results: The TL6 and TL10 exhibited higher von Mises stres values in the implants and lower von Mises stress values in the abutments than in the other FEA models. The increase in the crown height resulted in higher stress values under oblique loading compared to vertical loading. Conclusion: The non-engaging connection type and crown height affected the stress distribution in the implant and prosthetic components.

Uncommon bilateral maxillary exostosis: case report

ABSTRACT Exostoses or hyperostoses are benign bony outgrowths originating from the cortical bone and depend on their location for a more precise designation. The most common types found in the oral cavity are the torus palatinus and the torus mandibularis. Buccal and palatal exostoses are located along the buccal aspect of the maxilla and/or the mandible (commonly in the premolar and molar areas) and on the palatal aspect of the maxilla (usually in the tuberosity area), respectively. The etiology of exostoses still hasn’t been enlightened but an interaction between environmental and genetic factors is accredited. They are usually asymptomatic, unless the mucosa becomes ulcerated. The frequency of exostoses increases with age, having their biggest prevalence from 60 years old, being more common in men and suffering ethnic influences. A thorough evaluation is important for the correct diagnosis since other lesions have similar clinical characteristics to the exostoses such as osteomas. The majority of exostoses are diagnosed clinically along with radiographic interpretations, making the biopsy dispensable and the treatment is usually unnecessary. The aim of this article was to describe a case report of bilateral maxillary exostosis, unusual, in a female patient. If an excessive amount of bone is present the exostoses may exhibit a relative radiopacity on dental radiographs. Initially, periapical and panoramic radiographs were performed to evaluate the alterations. Due to the size of the exostoses a concomitant Cone Beam Computed Tomography was performed to confirm the diagnosis. The patient is in follow-up.

Effects of Different Positions and Angles of Implants in Maxillary Edentulous Jaw on Surrounding Bone Stress under Dynamic Loading: A Three-Dimensional Finite Element Analysis.

Purpose To evaluate the effects of different placements of mesial implants and different angles of distant implants in maxillary edentulous jaws on the stress on the implant and the surrounding bone tissue under dynamic loading. Materials and Methods Cone beam computed tomography was used to acquire images of maxillary edentulous jaws. Using Mimics 17.0, Geomagic, and Unigraphics NX8.5 software, three-dimensional models were established: two mesial implants were placed vertically in the anterior region of the maxilla (bilateral central incisor, lateral incisor, and canine), and two distant implants were placed obliquely in the bilateral second premolar area at different inclined angles (15°, 30°, and 45°). The established models were designated I–IX. The models were subjected to dynamic load using Abaqus 6.12, with the working side posterior teeth loading of 150 N and simulation cycle of 0.875 s. Results During the second to fourth phases of the mastication cycle, the stress was mainly concentrated on the neck of the distal implant. The stress of the distal implants was greater than that of mesial implants. Stress levels peaked in the third stage of the cycle. The stress of the distal cortical bone of distal implant of Model I reached the maximum of 183.437 MPa. The stress of the distal cortical bone and cancellous bone of distal implant of Model VIII represented the minima (62.989 MPa and 17.186 MPa, respectively). Conclusions Our models showed optimal stress reductions when the mesial implants were located in the canine region and the distal implants tilted 30°.

Trueness of digital intraoral impression in reproducing multiple implant position.

The aim of this study was to evaluate the trueness of 5 intraoral scanners (IOSs) for digital impression of simulated implant scan bodies in a partially edentulous model. A 3D printed partially edentulous mandible model made of Co-Cr with a total of 6 bilaterally positioned cylinders in the canine, second premolar, and second molar area served as the study model. Digital scans of the model were made with a reference scanner (steroSCAN neo) and 5 IOSs (CEREC Omnicam, CS3600, i500, iTero Element, and TRIOS 3) (n = 10). For each IOS's dataset, the XYZ coordinates of the cylinders were obtained from the reference point and the deviations from the reference scanner were calculated using a 3D reverse engineering program (Rapidform). The trueness values were analyzed by Kruskal-Wallis test and Mann-Whitney post hoc test. Direction and amount of deviation differed among cylinder position and among IOSs. Regardless of the IOS type, the cylinders positioned on the left second molar, nearest to the scanning start point, showed the smallest deviation. The deviation generally increased further away from scanning start point towards the right second molar. TRIOS 3 and i500 outperformed the other IOSs for partially edentulous digital impression. The accuracy of the CEREC Omnicam, CS3600, and iTero Element were similar on the left side, but they showed more deviations on the right side of the arch when compared to the other IOSs. The accuracy of IOS is still an area that needs to be improved.

Effects of knee pain on postural control excluding the musculature of the craniomandibular system

Knee pain can influence postural control in addition to changes in the anatomical structure of the knee joints. Because the influence of imbalances in the craniomandibular system has been proven multiple times, it is the aim of the present work to investigate the influence of various knee diagnoses on postural control excluding occlusal information by means of symmetrical packing using cotton rolls. One hundred and fifteen patients (74male/41female) aged 18-75years with an average BMI of 25.13 ± 3.66 kg/m2 took part in the study, among them 34patients (26male/8female) with cruciate ligament injury, 26(16male/10female) with meniscal lesions, 24(13male/11female) with arthrosis, 21(11male/10female) with patellar pain, and 10(8male/2female) with other painful knee complaints. Postural control was increased using a force platform, the degree of severity of the disorder was recorded using the "Knee Injury and Osteoarthritis Outcome" questionnaire, and the occlusion packed on both sides with cotton rolls in the premolar area. With increasing age, patients with knee arthrosis are more likely to stand on the hindfoot. In those with patellar disorder, increased weight-bearing on the forefoot correlates with increasing BMI. An increase in weight-bearing on the forefoot on the side of the uninjured knee in people with patellar disorder results not only in a reduction in quality of life but also level of daily activity. The percentage weight-bearing on the zones of the feet differs in unilateral knee injuries (in particular, comparison of the side with the knee injury and the uninjured side). Age, BMI or gender are influencing factors. Because various correlations and/or effects in the subgroups of knee injuries are generated, an injury-specific analysis should be carried out. These effects are also identifiable in the subjective assessment of quality of life.

Marginal bone level evaluation for combined tooth-implant retained Kennedy Class I Partial denture versus implant retained partial denture using extracoronal attachments

Aim: This study was conducted to evaluate and compare marginal bone level for Tooth-implant supported Kennedy class I partial denture compared to implant supported Kennedy class I partial denture using extracoronal attachments. Subjects and Methods : Ten male partially edentulous patients (Kennedy class I) with the canines are the last standing abutments were selected and all patients were rehabilitated with metallic partial denture supported by osseointegrated implants one on each side of the arch positioned in the premolar area and were randomly divided into two equal groups according to type of abutments, Group I; Patients were rehabilitated with Tooth Implant Retained partial denture with extra coronal attachment, Group II; Patients were rehabilitated with splinted Implant Retained partial denture with extra coronal attachment on each side. Evaluation by measuring marginal bone level for last main abutments was made at the time of insertion, after 6 month, after 12 month and last after 18 month using radiographic evaluation. Results: Partial dentures retained by two splinted implants showed better non-significant difference in marginal bone loss as compared with tooth implant retained Partial dentures. Conclusion: Using tooth implant retained partial dentures shows better effect on supporting structure as compared compared with tooth implant retained Partial dentures.

Мodern methods of diagnostic and surgery of dentigerous cysts of the jaws in children

Introduction . Follicular cysts of the jaws is one of the most common types of odontogenic cysts associated with the crown of an impacted tooth. Purpose of the study. To analyze modern methods of diagnosis and surgical treatment of follicular cysts of the jaws in children. Materials and methods . On the basis of the Department of maxillofacial surgery of the Nizhny Novgorod regional children's clinical hospital for the period from 2003 to 2018, 240 patients were treated with a diagnosis of «follicular jaw cyst». The age of children varied from 4 to 17 years (10,5 ± 0,2 years), including 131 boys and 109 girls. The diagnosis of «follicular cyst» was established on the basis of complaints, anamnesis, objective examination, x-ray examination. Preoperative preparation included antibacterial treatment. Subsequently, the children underwent surgery under General anesthesia (cystotomy, cystectomy, plastic cystectomy, cystectomy with sinusitis). Results and discussion. From 183 (76,3%) of patients with follicular cysts were impressed with the lower jaw, situated mainly in the area of premolars (69%). In the case of follicular cysts on the upper jaw, the vast majority of formations developed from the rudiments of fangs and premolars (16%). For an earlier diagnosis of the pathology, an algorithm has been developed, the use of which allows to detect the cyst before the symptoms appear. According to the studies, the leading signs of pathology were identified: the delay in the eruption of the tooth (or teeth) with its (their) presence on the other side and the detection of an increase in the follicle of a permanent tooth more than 2.5 mm on the radiograph. Conclusion . The use of diagnostic algorithm in the treatment of follicular cysts of the jaws in children, followed by the use of cystectomy, reduces the duration of hospitalization, retains the germ of a permanent tooth and contributes to the early recovery of patients.

Preparation and Histological Study of Multi-Walled Carbon Nanotubes Bone Graft in Management of Class II Furcation Defects in Dogs.

BACKGROUND:The main target of periodontal disease and alveolar bone defeat treatment is the regeneration of the lost structures.AIM:This work deals with the evaluation of the effect of functionalised multi-walled carbon nanotubes (MWCNTs), as grafting material in the management of furcation defects created in dogs.MATERIAL AND METHODS:Potential cytotoxicity of the grafting material was assessed. Scanning electron microscope (SEM) and energy dispersive x-ray (EDX) analysis after incubation of the grafting material in simulated body fluid (SBF) at pH 7.4 and 37°C for one week was done. In six healthy mongrel dogs’ full-thickness mucoperiosteal flaps were raised on the buccal aspects to create two walls intrabony defects at the furcation areas. The mandibular premolar area received the grafting material. Histological evaluation was carried out at 1, 2- and 3-months’ period.RESULTS:Cytotoxicity results proved the safety of grafting material application. The prepared material exhibited good Ca-apatite crystal patterns at the surface revealed by SEM and high calcium content showed by EDX results. Good bone formation ability was also apparent histologically.CONCLUSION:The prepared grafting material (MWCNTs) can serve as a delivery vehicle for osteogenic cells and osteogenic growth factor proteins in the bone development process.

Bone-Borne Maxillary Expansion and Traditional Rapid Maxillary Expansion: A Systematic Review and Meta-Analysis

Introduction: The aim of this study was to perform a systematic review and meta-analysis to compare the effect of bone-borne expansion (BBE) and tooth-borne expansion (TBE) in patients with maxillary constriction. Methods: Electronic databases, including MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials, were searched up to February 2019. Eligible clinical trials and cohort studies that studied the effects of bone-borne and tooth-borne expansion appliances on patients with constricted maxilla were selected. The study selection, data extraction, and risk of bias assessment were independently performed by two authors. Then, the random-effects meta-analysis and post-hoc heterogeneity tests were performed. Results: In the end, four studies were included in the present meta-analysis (i.e., a randomized clinical trial, two prospective controlled clinical trials, and a cohort study) that collected data from 117 patients. The mean differences between TBE and BBE were 0.38 mm and -0.28 mm for premolar and molar apices, 0.67 mm and 1.18 mm for premolar and molar crowns, 0.19 mm and 0.17 mm for alveolar bone in premolar and molar areas, and -0.61 mm and 0.02 mm for nasal and maxillary bones, respectively. Moreover, the differences between TBE and BBE for dental angulation were 3.84◦ and 1.52◦ for left and right molars, as well as 4.85◦ and 3.46◦ for left and right premolars, respectively. Conclusion: The BBE appliances do not have any advantages over tooth-borne devices with regard to the amount of skeletal or dental expansion; however, it seems to produce less tipping in posterior teeth.

EVALUATION OF MONITOR PERFORMANCE IN CARIES DETECTION

Background Digital imaging has become a staple of dentistry for diagnosis and treatment planning. Off-the-shelf displays are most commonly used to view acquired images in bright light compared with medical radiology, which almost exclusively uses autocalibrating high-resolution medical grade displays. Objective(s) This study aimed to assess whether medical-grade displays perform better in the detection of confirmed caries on extracted teeth compared with off-the-shelf monitors. The null hypothesis stated that there is no significant difference between medical-grade and off-the-shelf displays. Study Design Thirty noncarious premolars and 31 carious premolars that were extracted for therapeutic reasons were examined independently by 2 evaluators, who visually (with magnification) verified the presence/absence of caries. Teeth were placed in the second premolar area of a model with 2 noncarious molars and a noncarious premolar with standardized distance and positioning from the x-ray source. Teeth were imaged with a Dexis (DEXIS. LLC, Hatfield, PA) sensor using standardized exposure parameters (7 mA, 0.08 seconds, 65 kVp). Images were randomized. Two independent, calibrated, and masked evaluators scored the images on a 5-point Likert scale for the presence or absence of caries on 4 different monitors under standardized ambient light conditions: BARCO 3 MP medical grade, a prototype BARCO 2 MP, DELL Ultrasharp, and WIDE 5 MP monochrome. Results Barco 3 MP and Wide 5 MP monitors led to greater accuracy compared with Barco 2 MP and Dell Ultrasharp monitors with a difference of at least 10%. Barco 3 MP was most sensitive, followed by Barco 2 MP and Wide 5 MP. Specificity was highest for Barco 3 MP and Dell, followed by Barco 2 MP and Wide 5 MP. The interobserver agreement was highest for the Barco 2 MP and Dell displays. None of the findings was statistically significant. Discussion/Conclusions Although there seems to be more information available on higher-resolution monitors with better accuracy in identifying carious lesions, these differences are not statistically significant.