RESUMO
Assessment of apical periodontitis (AP) is a challenging task. This case report highlights the CBCT diagnosis and monitoring of periapical radiolucency (PR) using ITK-SNAP software 3.8v in a complex clinical scenario of three traumatized anterior teeth. An 11-year-old male patient complained of recurrent swelling and pain in the maxillary incisor region (teeth #11 and #21). His parents reported a history of traumatic injury affecting these teeth two years back. Digital periapical radiographic (DPR) and cone-beam computed tomography (CBCT) were requested. PR was identified on teeth #11, #21, and # 22. In tooth #22, besides a PR, an area suggesting internal root resorption or oblique root fracture was observed. The teeth were shaped and dressing with calcium hydroxide Ca(OH)2. MTA repair was delivered to the apical portion of the canals (approximately 3 mm). The remainder of the canal was filled with thermoplastic gutta-percha and Endosequence sealer. After one year, the patient returned complaining of pain in tooth #11. Radiographically, the PR of tooth #11 did not reduce. A CBCT was taken, showing a reduction of radiolucency. The patient was clinical and radiographically re-evaluated for 6 months, and he remained asymptomatic. After three years of follow-up, the patient suffered a new trauma on teeth #11 and #21. As tooth #11 presents mobility and biting pain, a new CBCT was requested due to the risk of a possible root fracture. So, the PR was synchronously monitored with linear measurements and volumetric analysis using ITK-SNAP software 3.8v. In this case, the volumetric evaluation was essential to identify the PR's correct dimensions, reducing image interpretation's subjectivity. At 48-month follow-up, the patient was symptoms free and radiographically showed a reduction in the PR's size, compatible with osseous healing.
RESUMO
ABSTRACT Introduction: Plaster dental casts are routinely used during clinical practice to access maxillary dental arch form and assist on fabrication of individualized orthodontic archwires. Recently introduced, digital model technology may offer a limitation for the obtainment of a dental physical record. In this context, a tool for dental arch form assessment for chairside use is necessary when employing digital models. In this regard, paper print of the dental arch seems thus to be useful. Methods: In the present study, 37 lower arch models were used. Intercanine and intermolar widths and dental arch length measurements were performed and compared using plaster dental casts, digital models and paper print image of the models. Ortho Insight 3D scanner was employed for model digitalization. Results: No statistically significant differences were noted regarding the measurements performed on the plaster or digital models (p> 0.05). Paper print images, however, showed subestimated values for intercanine and intermolar widths and overestimated values for dental arch length. Despite being statistically significant (p< 0.001), the differences were considered clinically negligible. Conclusion: The present study suggests that paper print images obtained from digital models are clinically accurate and can be used as a tool for dental arch form assessment for fabrication of individualized orthodontic archwires.
RESUMO Introdução: os modelos de gesso são usados rotineiramente, durante a prática clínica, para avaliação da forma da arcada inferior e para auxiliar na confecção de arcos ortodônticos individualizados. A tecnologia dos modelos digitais, introduzida recentemente, pode oferecer uma limitação na obtenção de um registro físico da arcada dentária. Assim, quando se utilizam modelos digitais, faz-se necessária uma ferramenta clínica para obtenção da forma da arcada. Com essa finalidade, poderia-se imprimir, em papel, uma imagem da arcada dentária obtida a partir do modelo de gesso. Métodos: nesse estudo, 37 modelos da arcada inferior foram utilizados, nos quais foram realizadas medições das distâncias intercaninos, intermolares e comprimento da arcada; sendo, então, comparadas entre modelos de gesso, modelos digitalizados com um scanner Ortho Insight 3D e imagens impressas em folha de papel A4. Resultados: não foram encontradas diferenças estatisticamente significativas nas medidas realizadas nos modelos de gesso e modelos digitais (p > 0,05). As imagens impressas, contudo, mostraram valores subestimados para as distâncias intercaninos e intermolares, e superestimados para o comprimento da arcada. Apesar de serem estatisticamente significativas (p< 0,001), as diferenças foram consideradas clinicamente insignificantes. Conclusão: o presente estudo sugere que as imagens obtidas por meio dos modelos digitais e impressas em papel são clinicamente acuradas e podem ser utilizadas como uma ferramenta auxiliar na confecção dos arcos ortodônticos individualizados.