RESUMEN
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.
Asunto(s)
Endodoncistas , Tomografía Computarizada de Haz Cónico , Humanos , Encuestas y CuestionariosRESUMEN
Objetivo: Investigar a prevalência e localização de canais mandibulares bífidos (CMB) por meio de tomografia computadorizada de feixe cônico (TCFC). Materiais e métodos: Três radiologistas odontológicos treinados e calibrados avaliaram individualmente 1254 exames tomográficos por meio do software I-Cat Vision (Imaging Sciences International®) e classificaram em quatro tipos distintos (Retromolar, Dental, Anteriorizado e Bucolingual). Os dados de frequência, coletados a partir de um formulário Access (Microsoft® Office), foram analisados por meio dos testes de Fischer e Friedman. O nível de significância estatística foi estabelecido em 5%. Resultados: CMBs foram encontrados em 276 casos (22%), sem predileção por gênero (P=0,186). Houve diferença estatisticamente significante entre os tipos (P=0,001). Discussão: O reconhecimento de um CMB é de grande relevância quando associado a procedimentos anestésicos e cirúrgicos na região posterior da mandíbula. Apesar de muitos estudos demostrarem que o CMB não é comumente visto, uma falha em sua identificação pode resultar em danos ao nervo alveolar inferior (NAI) ou em dificuldade na obtenção do bloqueio anestésico. Conclusão: O tipo mais frequente de CMB em ambos os gêneros, foi o retromolar (P=0,001), representando 18,5%, e visualizado com taxas de 47,1% nas mulheres e 52,9% nos homens. A frequência de CMBs analisada por meio da TCFC foi significativa na população avaliada e apresentou-se com diferentes configurações. Desta forma, sua investigação não deve ser negligenciada frente a procedimentos cirúrgicos que envolvam a região posterior da mandíbula.
Aim: To investigate the prevalence and location of bifid mandibular canals (CMB) using cone beam computed to-mography (CBCT). Materials and methods: Three trained and calibrated dental radiologists individually evaluated 1254 CT scans using the I-Cat Vision software (Imaging Sciences International®) and classified them into four distinct types (Retromolar, Dental, Forward and Buco-lingual). Frequency data, collected from an Access form (Microsoft® Office), were analyzed using the Fischer and Friedman test. The level of statistical significance was set at 5%. Results: CMBs were found in 276 cases (22%), with no gender predilection (P = 0.186). There was a statistically significant difference between the types (P = 0.001). Dis-cussion: The recognition of a CMB is of great relevance when associated with anesthetic and surgical procedures in the posterior region of the mandible. Although many studies have shown that CMB is not commonly seen, a failure to identify it can result in damage to the lower alveolar nerve (NAI) or difficulty in obtaining anesthetic block. Conclusion: The most frequent type of CMB in both genders was retromolar (P = 0.001), representing 18.5%, and visualized with rates of 47.1% in women and 52.9% in men. The frequency of CMBs analyzed using the CBCT was significant in the population evaluated and presented in different configurations. Thus, its investigation should not be neglected in the face of surgical procedures that involve the posterior region of the mandible