RESUMEN
This report describes a case of reactional osteogenesis associated with the residual roots of the maxillary left first molar (tooth 14) in a 42-year-old woman. During intraoral examination, an extensive carious lesion was observed in the residual roots of tooth 14. On the periapical radiograph, a radiolucent area with well-defined limits and regular shape was observed in association with these roots. The 3-dimensional cone beam computed tomographic evaluation revealed that the hyperdense mass was homogenous, not corticated, of defined limits, and irregular in shape and had the density of bone tissue. The mass was clearly associated with an inflammatory periapical lesion. In this clinical case, volumetric analysis established a diagnosis of reactional osteogenesis and facilitated removal of the focus of infection associated with its development. Three-dimensional examination of possible changes in the maxillary sinus is crucial when infectious processes are present in the posterior region of the maxilla.
Asunto(s)
Seno Maxilar , Osteogénesis , Adulto , Tomografía Computarizada de Haz Cónico/métodos , Femenino , Humanos , Maxilar , Seno Maxilar/diagnóstico por imagen , Diente Molar/diagnóstico por imagen , Diente Molar/cirugía , Raíz del DienteRESUMEN
PURPOSE: This study evaluated the influence of a metal artifact reduction (MAR) tool in a cone-beam computed tomography (CBCT) device on the diagnosis of vertical root fractures (VRFs) in teeth with different root filling materials. MATERIALS AND METHODS: Forty-five extracted human premolars were classified into three subgroups; 1) no filling; 2) gutta-percha; and 3) metallic post. CBCT images were acquired using an Orthopantomograph 300 unit with and without a MAR tool. Subsequently, the same teeth were fractured, and new CBCT scans were obtained with and without MAR. Two oral radiologists evaluated the images regarding the presence or absence of VRF. Receiver operating characteristic (ROC) curves and diagnostic tests were performed. RESULTS: The overall area under the curve values were 0.695 for CBCT with MAR and 0.789 for CBCT without MAR. The MAR tool negatively influenced the overall diagnosis of VRFs in all tested subgroups, with lower accuracy (0.45-0.72), sensitivity (0.6-0.67), and specificity (0.23-0.8) than were found for the images without MAR. In the latter group, the accuracy, sensitivity, and specificity values were 0.68-0.77, 0.67-083, and 0.53-087, respectively. However, no significant difference was found between images with and without MAR for the no filling and gutta-percha subgroups (P>0.05). In the metallic post subgroup, CBCT showed a significant difference according to MAR use (P<0.05). CONCLUSION: The OP 300 MAR tool negatively influenced the detection of VRFs in teeth with no root canal filling, gutta-percha, or metallic posts. Teeth with metallic posts suffered the most from the negative impact of MAR.