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INTRODUCTION: Mesiodistal angulation of premolars and molars can be altered by forces of open bite malocclusion. The aim of this study was to compare the mesiodistal angulations of the posterior teeth in class I, II, and III individuals with anterior open bite (AOB) versus individuals with harmonious occlusion. METHODS: This comparative cross-sectional study used 299 lateral head radiographs of individuals with permanent dentition. There were 4 groups (harmonious occlusion [n=89], Class I open bite [OB] [n=75], Class II OB [n=66], and Class III OB [n=69]). Premolar (1UPM, 2UPM) and molar (1UM, 2UM) angulations were measured relative to the occlusal plane and the palatal or mandibular plane by a trained and calibrated evaluator. ANOVA and Scheffe tests were used for statistical analyses (P<0.05). RESULTS: The mesial angulation of the upper premolars showed greater angulation of between approximately 2° and 5° in the OB groups compared to the harmonious occlusion group (P<0.05). Only in the Class II OB group did the first and second upper molars show distal angulation in relation to the palatal plane (1UM 81.85°±5.42°; 2UM 75.32±7.4°) (P<0.05). The Class III OB group presented the greatest distal angulations of the lower premolars and molars (between 3° to 5° of difference, P<0.05) in relation to those of the harmonious occlusion group. CONCLUSIONS: The upper first premolars in all the AOB groups and the lower second premolars in the Class II OB group had greater mesioangulation. Additionally, the upper molars of the Class II OB group and the lower molars of the Class III OB group showed distoangulation compared with the molars in the group with harmonious occlusion.
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Maloclusión , Mordida Abierta , Humanos , Mordida Abierta/diagnóstico por imagen , Diente Premolar/diagnóstico por imagen , Estudios Retrospectivos , Estudios Transversales , Maloclusión/diagnóstico por imagen , Diente Molar/diagnóstico por imagenRESUMEN
BACKGROUND: Using different software to evaluate the airways, with different thresholds, but within the range for airway recognition, could yield different measurements in the same patient with or without craniofacial disharmony. OBJECTIVES: The aim of the present study was to compare the volume and the most constricted area (MCA) of the oropharynx in individuals with or without an open bite by using 2 software programs meant for cone-beam computed tomography (CBCT). MATERIAL AND METHODS: This comparative study included 60 cases selected from 137 CBCT scans obtained from individuals with the presence or absence of an open bite. Each group included adults of both genders - in total 30 women and 30 men - with a mean age of 27.57 ±11.85 years in the open bite group and 26.23 ±6.78 years in the control group. The oropharyngeal volume and MCA were measured with 2 three-dimensional (3D) software packages: Planmeca Romexis®; and Nemotec NemoStudio®. Two calibrated orthodontists trained in the use of the software made the measurements. Data was analyzed using Student's t tests for independent and paired samples (p < 0.05). RESULTS: In general, the oropharynx volume measurements obtained with the NemoStudio software were significantly higher than those obtained with Romexis (19,007.17 ±8005.79 mm3 and 17,823.47 ±7148.62 mm3, respectively) (p = 0.020). However, when the groups were analyzed separately, the measurements of the group with an open bite did not differ according to the software used (p = 0.352). The measurements of the MCA of the oropharynx were significantly higher when obtained with the NemoStudio software (MD (mean difference) = 19.02 mm2) (p = 0.005). In contrast, no difference in the MCA results for the 2 software packages was found in the open bite group (p = 0.728). CONCLUSIONS: The volumetric and cross-sectional measurements of the oropharyngeal airway, particularly in individuals without an open bite, were affected by the software used.
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Mordida Abierta , Tomografía Computarizada de Haz Cónico Espiral , Adolescente , Adulto , Tomografía Computarizada de Haz Cónico/métodos , Estudios Transversales , Femenino , Humanos , Imagenología Tridimensional/métodos , Masculino , Programas Informáticos , Adulto JovenRESUMEN
Purpose: Computer-guided surgery has been increased in recent years. Nonetheless, few data are available on the validation of this technique for immediate implant placement. The purpose of this in vitro study was to evaluate the accuracy of computer-guided surgery in immediate implant placement. Materials and Methods: Cone-beam computed tomography scans (CBCTs) and virtual models were obtained of eight fresh pigs hemi-mandibles to perform the digital planning of implants placement. Fifteen implants were simulated, and surgical guides were designed to transfer the digital planning to the surgical procedure. Postsurgical CBCTs were performed to compare the position of the planned implants versus the real implant position. Paired t-test and the intra-class correlation coefficient (ICC) were used to assess the mean differences and correlations in each outcome variable evaluated twice by one experienced researcher. Furthermore, variations were compared with the results reported in the scientific literature using a one-sample t-test P < 0.05. Results: The measurements of the outcome variables (implants position at the neck and apex level and the angular deviation) showed significant reproducibility (mean difference-0.01 mm, 0.07 mm, and 0.30°, respectively, P > 0.05). The ICC values ranged from 0.888 to 0.949. Furthermore, the mean deviation was 1.43 mm at the implant neck, 2.19 mm at the apex, and 6.81° for the angular deviation. Similarly, significant differences (P < 0.05) were found at the neck and angular deviation when comparing the results with values reported in the literature. Conclusions: Although some variations were observed, they did not have a clinically significant impact. Therefore, computer-guided surgery could be satisfactorily used in immediate implants placement.
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INTRODUCTION: The aim of this study was to identify whether cone-beam computed tomographic (CBCT) imaging affects endodontists' diagnostic thinking, treatment option, and confidence in dental trauma cases. METHODS: Twelve endodontists reviewed 15 dental trauma cases with clinical histories and periapical radiography (PR) and answered questions regarding their diagnostic thinking and treatment decisions and their confidence in both. One month later, the same participants reviewed the same cases and answered similar questionnaires with the aid of CBCT imaging. A statistical analysis of their responses was conducted. RESULTS: Differences were observed in diagnostic thinking when using PR or CBCT imaging (P < .05), and the use of PR was associated with a higher number of "unsure" answers to questions about diagnoses. After reviewing periapical radiographic images, the approach most frequently endorsed was "don't start conventional endodontic treatment and order CBCT," whereas the most common decision made after analyzing the CBCT images was "start conventional endodontic treatment." Clinical interventions were proposed more often when participants evaluated the clinical case using CBCT imaging than when using PR (P < .05). The participants' degree of confidence in their diagnostic thinking was not different after analysis using PR or CBCT imaging (P > .05). However, there was a difference between PR and CBCT imaging in participants' confidence in their treatment decisions (P < .05). Participants who initially indicated a lack of confidence in their diagnosis or treatment option gained confidence when CBCT images were available. However, the inverse behavior was also observed for participants who were initially confident on the basis of PR (P < .05). Participants who decided to start treatment after CBCT analysis were less confident than when using PR (P < .05). CONCLUSIONS: In dental trauma cases, CBCT imaging influenced participants' diagnostic thinking and choice of treatment modality and affected their confidence in the decision-making process.
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Endodoncistas , Tomografía Computarizada de Haz Cónico , Humanos , Encuestas y CuestionariosRESUMEN
OBJECTIVES: This study aimed to evaluate the impact of enhancement filters in detecting small simulated internal root resorptions (IRR). METHODS:: Forty-two extracted human teeth were sectioned, connected, and stored in a dry human jaw and X-rayed with photostimulable phosphor plates (PSPs), composing the control group (CG). In the middle-third of the root canals, IRR lesions were simulated using Da Silveira protocol. Later, the specimens were X-rayed to create the test group (TG). All images acquired were exported with seven enhancement filters plus the original image. Three examiners used a five-point Likert scale to evaluate the images regarding the presence/absence of IRR. Diagnostic efficacy was assessed from sensitivity and specificity results. Comparison among filters was performed by using receiver operating characteristic (ROC) curve analysis. RESULTS:: Moderate values of Kappa interexaminer (0.403-0.620) and high values of Kappa intraexaminer (0.757-0.915) were observed. The best performance occurred in the CG (p < 0.05). Original images presented the greatest sensitivity and area under the ROC curve (0.595-0.750), while the Endo filter presented the greatest specificity (0.952). Inversion and Pseudo-3D images produced the greatest doubt in the diagnosis, significant for CG with the Pseudo-3D filter (p < 0.05). CONCLUSIONS:: The Original and 'Endo' filters should be chosen as it offers greater diagnostic ability and allows more confidence during the evaluation.
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Resorción Radicular , Humanos , Curva ROC , Radiografía , Radiografía Dental Digital/métodos , Resorción Radicular/diagnóstico por imagen , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: The aim of this study was to three-dimensionally compare the root angulation changes after orthodontic traction of buccally versus palatally maxillary impacted canines (MICs). MATERIAL AND METHODS: This retrospective study included patients from a private dental office of both sexes, older than 12 years, with at least one unilateral or bilateral buccal or palatal MIC, no loss of permanent teeth, with complete apical closure at the beginning of traction, and with CBCTs taken at pretreatment (T0) and after orthodontic traction (T1). The sample was divided in two groups according to their impaction site: buccal versus palatal. In all the scans, the MIC was segmented and the root angulation changes after traction were evaluated. The assessment included the sigma angle (projected on the XZ plane or coronal tomographic view), the delta angle (projected on the XY plane or axial view) and the epsilon angle (projected on the YZ plane, or sagittal view). Intragroup comparisons were performed with Wilcoxon signed-rank tests. Intergroup comparisons were performed with t-tests or Mann-Whitney U tests. Finally, the influence of MIC characteristics on the measured angles were evaluated with multiple linear regression analyses (α=0.05). RESULTS: Thirty-three patients (16 men, mean age: 20.38; 17 women, mean age 18.37) with forty-five orthodontically treated MIC (19 buccal versus 26 palatal) were finally included. The palatal MICs showed greater mediolateral uprighting than the buccal MICs, root displacement towards the midsagittal plane, as demonstrated by the sigma angle (palatal group: 37.58±15.08°; buccal group: 29.17±31.15°; P=0.164) and delta (palatal group: -76.90±26.55°; buccal group: -30.56±41.67°; P<0.001)angle changes. The buccal MICs showed greater anteroposterior uprighting, anterior root displacement, as demonstrated by the epsilon angle (palatal group: -4.63±12.37°; buccal group: -25.96±17.79°; P<0.001). CONCLUSIONS: Mediolateral and anteroposterior root angulation show significant differences after traction between buccal and palatal MICs. Palatal MICs showed greater medial root displacement while buccal MICs showed greater anterior root displacement. This condition should be considered for better planning of traction and orthodontic finishing.
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Incisivo , Diente Impactado , Adolescente , Tomografía Computarizada de Haz Cónico , Diente Canino/diagnóstico por imagen , Femenino , Humanos , Masculino , Maxilar/diagnóstico por imagen , Estudios Retrospectivos , Diente Impactado/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVE: Maxillary impacted canines (MIC) could suffer root changes after canine traction. The aim of this study was to evaluate the 3-dimensional root changes in buccal versus palatal MIC after orthodontic traction. MATERIALS AND METHODS: This longitudinal and retrospective study included pre-treatment and after traction cone beam computed tomography scans (CBCTs) of 30 subjects with unilateral/bilateral MIC. A total of 43 MIC were divided into 2 groups: buccal (n=17) or palatal (n=26). Root changes in length and area after orthodontic traction were measured at sagittal, coronal and axial sections. Intergroup comparison was carried out by t or U Mann-Whitney tests, depending on normality. Multiple linear regression analysis was used to evaluate the influence of all predictor variables on root changes (P<0.05). RESULTS: Significant difference between groups was found for root area changes in the upper limit of the cervical third at axial section that showed greater appositional values for the palatal impacted canine group (-1.18mm2) and resorptive values for the buccal impacted canine group (0.62mm2) (P=0.024). Position of impaction palatal influenced the increase of root area in the coronal section and in the upper limit of the cervical third at axial section. Age directly influenced the decrease of total length and root area in sagittal and coronal sections, respectively. CONCLUSION: Orthodontic traction of MIC produced an important appositional root change in the palatal impaction group in the axial root area of the upper limit of the cervical third. Impaction position and age influenced the increase and decrease of root area and length of some specific radicular regions.
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Maxilar/patología , Boca/patología , Hueso Paladar/patología , Raíz del Diente/patología , Diente Impactado/patología , Tracción/métodos , Adolescente , Niño , Tomografía Computarizada de Haz Cónico , Diente Canino/diagnóstico por imagen , Diente Canino/patología , Femenino , Humanos , Incisivo/diagnóstico por imagen , Incisivo/patología , Estudios Longitudinales , Masculino , Maxilar/diagnóstico por imagen , Boca/diagnóstico por imagen , Métodos de Anclaje en Ortodoncia/efectos adversos , Métodos de Anclaje en Ortodoncia/métodos , Aparatos Ortodóncicos Fijos , Ortodoncia Correctiva/efectos adversos , Hueso Paladar/diagnóstico por imagen , Estudios Retrospectivos , Resorción Radicular , Raíz del Diente/diagnóstico por imagen , Diente Impactado/diagnóstico por imagen , Adulto JovenAsunto(s)
Diente Impactado , Tracción , Tomografía Computarizada de Haz Cónico , Diente Canino , Humanos , IncisivoRESUMEN
INTRODUCTION: This study evaluated the influence of cone-beam computed tomography (CBCT) on endodondists' level of confidence in their diagnosis of endodontic cases and their treatment plans. METHODS: Twenty clinical cases with periapical radiographs and small-volume CBCT scans were classified according to the American Association of Endodontists guidelines. Information was provided on patient clinical history, and both extraoral and intraoral examinations were simulated. Fifteen endodontists filled out 2 questionnaires. In the first (Q1), the clinical description and a periapical radiograph were presented, followed by the questions. Thirty days later, they answered a second questionnaire (Q2) containing the same clinical description and CBCT. Their confidence in diagnosis and treatment planning was analyzed before and after receiving the tomographic images. Responses were recorded on a 5-point Likert scale, and the Wilcoxon test was used to investigate before and after levels of confidence in diagnosis and treatment planning. RESULTS: The CBCT images influenced confidence in diagnosis and treatment planning of endodontic cases classified as complex (Wilcoxon test; P ≤ .05). There was a substantial change in the treatment planned in both moderate and complex cases after CBCT. Case complexity did not affect the participants' decision to request complementary information through CBCT. CONCLUSIONS: In complex cases, CBCT increased endodontists' confidence to diagnose and plan treatment, when compared with periapical radiographs. Endodontists tended to recommend intervention when periapical images were supplemented with CBCT. CBCT proved to be an imaging method that influences endodontists' preoperative evaluation and treatment choice.
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Tomografía Computarizada de Haz Cónico , Endodoncistas , Planificación de Atención al Paciente , Humanos , Encuestas y CuestionariosAsunto(s)
Resorción Radicular , Diente Impactado , Adulto , Tomografía Computarizada de Haz Cónico , Diente Canino/diagnóstico por imagen , Humanos , Incisivo , Maxilar , Resorción Radicular/diagnóstico por imagen , Resorción Radicular/terapia , Diente Impactado/diagnóstico por imagen , Diente Impactado/terapia , TracciónRESUMEN
BACKGROUND: The aim of this study was to evaluate the midpalatal suture maturation stages in adolescents and young adults using cone-beam computed tomography (CBCT). METHODS: The sample comprised 200 CBCT scans of individuals aged 10 to 25 years old (95 males and 105 females) divided into three groups, adolescents (n = 48), post-adolescents (n = 52), and young adults (n = 100). The Planmeca ProMax 3D software was used for the midpalatal suture maturation stage evaluation according to Angieleri's method, using cross-sectional axial slice. Two previously calibrated examiners analyzed the images and classified according to five different maturation stages. A, B, and C stages were considered with open midpalatal suture, and D and E were considered without open midpalatal suture. Association tests were performed using chi-square test also, and a binary logistic regression was evaluated (P < 0.05). RESULTS: The possibility to find open midpalatal suture in individuals of 10 to 15 years old was 70.8%, in subject aged 16 to 20 and 21 to 25 years old was 21.2% and 17%, respectively. Furthermore, this possibility in individuals older than 16 years was greater in males than in females. CONCLUSIONS: The possibility to find open midpalatal suture in post-adolescents and young adults is greater than the orthodontists considered years ago. Furthermore, men are more likely to find midpalatal suture opening. These implications might be considered by the orthodontists when maxillary expansion is required. Besides, the ossification of the middle palatal suture is very variable, and therefore, the use of CBCT might be recommended to clarify this possibility.
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Tomografía Computarizada de Haz Cónico , Suturas Craneales , Adolescente , Adulto , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Maxilar , Técnica de Expansión Palatina , Suturas , Adulto JovenAsunto(s)
Resorción Radicular , Humanos , Incisivo , Estudios Longitudinales , Estudios Retrospectivos , TracciónRESUMEN
This article describes an intraoral radiographic technique for identifying lesions located on the buccal surfaces of the maxillary alveolar process. An intraoral film is placed behind the maxillary tuberosity and the X-ray beam exposes the film perpendicularly, running laterally to the buccal surface of the cortical bone. As a result, any external alteration can be seen clearly, with no superimposed maxillary teeth or osseous tissues.