RESUMO
BACKGROUND: This study aimed to investigate the effect of automatic exposure compensation (AEC) of intraoral radiographic systems on the gray values of dental tissues in images acquired with or without high-density material in the exposed region using different exposure times and kilovoltages. The influence of the distance of the high-density material was also investigated. METHODS: Radiographs from the molar region of two mandibles were obtained using the RVG 6100 and the Express systems, operating at 60 and 70 kV and 0.06, 0.10, and 0.16 s. Subsequently, a titanium implant was inserted in the premolar's socket and other images were acquired. Using the ImageJ software, two regions of interest were determined on the enamel, coronary dentine, root dentine, and pulp of the first and second molars to obtain their gray values. RESULTS: In the RVG 6100, the implant did not affect the gray values (p > 0.05); the increase in kV decreased it in all tissues (p < 0.05), and the exposure time affected only the root dentine and pulp. In the Express, only enamel and coronary dentine values changed (p < 0.05), decreasing with the implant presence and/or with the increase in exposure factors. The distance of the implant did not affect the results (p > 0.05). CONCLUSIONS: AEC's performance varies between the radiographic systems. Its effect on the gray values depends not only on the presence or absence of high-density material but also on the kV and exposure time used.
Assuntos
Processamento de Imagem Assistida por Computador/métodos , Radiografia Dentária Digital/métodos , Esmalte Dentário/diagnóstico por imagem , Polpa Dentária/diagnóstico por imagem , Dentina/diagnóstico por imagem , Humanos , Mandíbula/diagnóstico por imagemRESUMO
OBJECTIVES: To present an image processing framework to improve the detection of vertical root fractures (VRFs) in digital periapical radiography. MATERIALS AND METHODS: Thirty endodontically treated human teeth (15 of them fractured with a metal post inserted into them, and 15 for the control) were enclosed in a dry mandible and radiographed individually. The proposed framework was applied to the raw data, as a preprocessing step, and was composed of four stages: geometric adjustment and negative, denoising, adaptive contrast enhancement, and gamma correction. The contrast-to-noise ratio (CNR) and sharpness of the image's VRF region were used for the objective evaluation of the method. In addition, five examiners evaluated the original and enhanced images, using a 5-point scale to assess confidence. RESULTS: The objective results showed that the proposed framework increased the CNR of the VRF region by 173% compared to the standard preprocessing method provided by the detector's manufacturer. The results found by the human observers indicated that the area under the curve (AUC) and sensitivity of the diagnosis of VRF significantly increased by 4% and 17% (p ≤ 0.05), respectively, when the examiners evaluated the image with the proposed method concomitantly with the image available in the commercial software. However, the specificity was reduced. CONCLUSIONS: The proposed image processing framework can be used as an additional tool to that provided by the manufacturer to increase the sensitivity and AUC of the diagnosis of VRF. CLINICAL RELEVANCE: The proposed method can be easily used in clinical practice to aid VRF detection, since it does not incur high computational costs and does not increase the radiation dose applied to the patient.
Assuntos
Fraturas dos Dentes , Dente não Vital , Tomografia Computadorizada de Feixe Cônico , Humanos , Radiografia Dentária Digital , Fraturas dos Dentes/diagnóstico por imagem , Raiz DentáriaRESUMO
INTRODUCTION: Imaging methods are essential for the correct identification of root canal anatomy, which is a key factor for successful endodontic therapy. This study aimed to evaluate the performance of periapical radiography (PR) and cone-beam computed tomographic (CBCT) imaging in identifying the apical delta (AD) using micro-computed tomographic imaging as the gold standard. METHODS: PR and CBCT images of 110 human premolars (120 root canals) were obtained using the VistaScan digital intraoral system (Durr Dental, Beitigheim-Bissinger, Germany) and the 3D Accuitomo CBCT unit (J Morita, Kyoto, Japan), respectively. Two oral radiologists assessed the PR and CBCT images for the presence of ADs using a 5-point scale. Additionally, in the CBCT images, the number of apical foramina was also evaluated. The gold standard was established by means of micro-computed tomographic imaging. The diagnostic values related to PR and CBCT imaging were compared using the McNemar test. The detection of the number of foramina was compared using the paired t test (α ≤ 0.05). RESULTS: ADs were present in 40 root canals (33.3%). Both PR and CBCT images differed significantly from the gold standard (P < .05) in the detection of ADs. CBCT imaging showed higher values than PR for all diagnostic tests (P < .05). Despite the moderate accuracy of PR (0.62) and CBCT imaging (0.73), these methods presented very low sensitivity values (0.07 and 0.35 for PR and CBCT, respectively). CBCT imaging had a tendency of underestimating the number of foramina (P < .05). CONCLUSIONS: CBCT imaging showed better performance than PR in the detection of ADs; both imaging modalities underestimate its presence when compared with the gold standard. In general, the number of apical foramina cannot be reliably assessed using CBCT imaging.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Cavidade Pulpar , Raiz Dentária , Dente Pré-Molar , Cavidade Pulpar/diagnóstico por imagem , Alemanha , Humanos , Raiz Dentária/anatomia & histologia , Raiz Dentária/diagnóstico por imagem , Microtomografia por Raio-XRESUMO
INTRODUCTION: The aim of this study was to compare the sensitivity and specificity of digital periapical radiography and cone-beam computed tomographic (CBCT) imaging in the detection of natural and simulated external root resorptions (ERRs) with micro-computed tomographic (micro-CT) imaging as the reference standard. METHODS: One hundred twenty-six teeth were scanned using the SkyScan 1172 micro-CT scanner (Bruker microCT, Kontich, Belgium), and the images were evaluated using NRecon software (Bruker microCT). After micro-CT imaging, the teeth were divided into 3 groups: control, 42 teeth that did not present any ERR cavities; natural, 42 teeth that presented 1 or more ERR cavities; and artificial, 42 teeth without ERRs but perforations were created to simulate the cavities. Ortho-, mesio-, and distoradial digital periapical radiographs and CBCT images were obtained, and the images were evaluated by 2 double-blinded qualified radiologists. RESULTS: The sensitivities and specificities for the radiographic and tomographic methods were 78.18% and 97.27% and 59.52% and 97.62%, respectively. Within the individual groups, both methods had lower sensitivity and specificity for natural and artificial resorptions, and the differences were statistically significant. CONCLUSIONS: CBCT imaging was the best method for the detection of ERRs. Only 74.5% of natural ERR gaps were observed on the digital periapical radiographs and 94.5% on CBCT imaging; in the artificial group, this number increased to 81.8% and 100%, respectively. The configuration of the natural ERR gaps is different from those artificially simulated and is much more difficult to observe.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Radiografia Dentária , Reabsorção da Raiz/diagnóstico por imagem , Ápice Dentário/diagnóstico por imagem , Estudos Transversais , Humanos , Doenças Periapicais/diagnóstico por imagem , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Microtomografia por Raio-XRESUMO
INTRODUCTION: The study aimed to correlate the Periapical Index (PAI), obtained by way of periapical radiographs, with the volume of chronic periapical lesion, obtained through cone-beam computed tomography (CBCT), in the permanent teeth. METHODS AND MATERIALS: Radiographs and CBCT images were selected from 35 single-rooted permanent teeth, with fully formed apices, with a diagnosis of pulp necrosis and chronic apical periodontitis that was radiographically visible. Two independent raters evaluated the radiographs on two separate occasions and classified the periapical lesions in accordance with Ørstavik's PAI. The periapical lesion volume was calculated in the CBCT images. The correlation between the PAI and the lesion volume was calculated using Spearman's correlation test. RESULTS: There was a positive, moderate correlation between the PAI and the volume (rs=0.596; P<0.001) where rs2 is equal to 0.355, showing that only 35% of the PAI variation was dependent upon the variation in periapical lesion volume. CONCLUSION: The radiographic evaluation of the periapical lesion does not reflect the lesion's volumetric characteristics as the volume had a moderate effect on the choice of PAI score.
RESUMO
Antecedentes: Las radiografías periapicales presentan distorsiones que podrían conducir a un mayor desgaste de la estructura dental aumentando el riesgo de debilitamiento y de perforación o fractura vertical cuando se realiza la preparación del conducto radicular para la colocación de postes. Objetivo: El objetivo de la presente investigación es determinar la diferencia entre las medidas del espesor radiográfi co y el espesor anatómico mediante un calibrador de la dentina residual, luego de la preparación para poste en conductos ovales de premolares. Material y métodos: 50 premolares fueron tratados endodóncicamente y posteriormente fueron desobturados con fresas Pesso #1 y 2 dejando 4 mm de sellado apical, se realizó la toma radiográfi ca y se comparó con medidas realizadas con un calibrador digital. Las medidas fueron comparadas con una t de Student. Resultados: Las medidas radiográfi cas fueron 24.63% más grandes en comparación con las medidas del calibrador. Las medidas radiográfi cas no fueron signifi cativamente mayores en comparación con las del calibrador digital. Conclusiones: La radiografía periapical presenta una sobrestimación de la medida de la dentina residual, por lo tanto se debe escoger el protocolo más conservador para obtener resultados predecibles y exitosos (AU)
Background: Periapical radiographs have distortions that lead to greater wear of the dental structure, increasing the risk of weakening, perforation or vertical fracture when the root canal is preparation for post placement. Objective: The investigation is to determine the diff erence between the measurements of the radiographic thickness and the anatomical thickness by means of a calibrator of the residual dentine after the preparation for post placement. Material and methods: Root canal treatment was performed in 50 premolars and was unsealed with Pesso #1 and 2 leaving 4 mm of the apical seal, the radiographic was made and compared with measurements made with a digital calibrator. The measurements were compared with a Student t. Results: The radiographic measurements were 24.63% larger than the caliper measurements. The radiographic measurements were signifi cantly higher in comparison with the digital calibrators. Conclusions: The periapical radiography presents an overestimation residual dentin measurement, therefore the most conservative protocol should be chosen to obtain predictable and successful results (AU)
Assuntos
Humanos , Cavidade Pulpar , Técnica para Retentor Intrarradicular , Preparo do Dente , Dente não Vital , Dente Pré-Molar , Radiografia Dentária , Preparo de Canal Radicular , Tratamento do Canal Radicular , Interpretação Estatística de DadosRESUMO
OBJECTIVE: Demonstrate the use of wide-field optical fluorescence as an adjunctive examination in a clinical routine to oral diagnosis. BACKGROUND DATA: Use of wide-field optical fluorescence in the oral cavity has been restricted to topics related to the detection and diagnosis of oral cancer. MATERIALS AND METHODS: In a regular medical appointment, a 58-year-old female patient, without any complaint or oral symptom, underwent the complementary examination by wide-field optical fluorescence. A device with high-power light-emitting diode emitting light centered at a wavelength of (400 ± 10) nm and maximum irradiance of (0.040 ± 0.008) W/cm2 was used for fluorescence visualization. RESULTS: We report the location of a firearm projectile, intraosseous, in the maxillary tuberosity using wide-field optical fluorescence. CONCLUSIONS: It is evidenced that wide-field optical fluorescence, within a clinical routine, can provide relevant images and data, with an immediate result, without the use of ionizing radiation, enabling an efficient oral diagnosis.
Assuntos
Maxila/diagnóstico por imagem , Maxila/lesões , Boca/diagnóstico por imagem , Espectrometria de Fluorescência , Feminino , Balística Forense , Humanos , Pessoa de Meia-Idade , Boca/fisiopatologia , Imagem Óptica/métodos , Saúde Bucal , Exposição à Radiação/prevenção & controle , Radiografia DentáriaRESUMO
Reabsorção é o termo utilizado na literatura médica e odontológica, para definir o processo pelo qual, tecidos mineralizados do organismo são destruídos e eliminados pela ação de células especializadas. As reabsorções dentárias podem ser classificadas de acordo com a superfície dentária afetada (interna, externa, interna-externa), a evolução do processo (transitória ou progressiva) e a natureza biológica do processo (inflamatória ou por substituição). Os traumatismos dentários representam a causa mais frequente de reabsorções radiculares externas na dentição permanente e resultam em um dano irreversível que pode levar à perda do elemento dental. Considerando-se que as reabsorções radiculares, na maioria das vezes, são eventos assintomáticos, os exames de imagem se tornam essenciais na fase de diagnóstico desta patologia. Tradicionalmente estes exames complementares eram realizados através de radiografias convencionais e posteriormente digitais. Entretanto, imagens fornecidas através de radiografias apresentam algumas limitações, como sobreposições, distorções e a formação de uma imagem bidimensional de uma estrutura tridimensional. Para suprir tais limitações, as imagens multiplanares têm sido amplamente utilizadas, destacando-se entre elas, a tomografia computadorizada de cone beam. Sendo assim, a proposta do presente trabalho foi, através do levantamento bibliográfico, avaliar o emprego da tomografia computadorizada de cone beam no diagnóstico das reabsorções radiculares externas. A literatura pesquisa demonstra a superioridade das TCCB para o diagnóstico das RRE, quando comparadas à radiografia periapical. Quanto menor o tamanho do voxel maior a acurácia do exame, principalmente para identificação de pequenas cavidades na região apical. Entretanto a literatura pertinente é dominada por estudos realizados ex vivo e não faz distinção entre os diferentes tipos de RR
Resorption is the term used in medical and dental literature to define the process which mineralized tissues are destroyed and eliminated by aclastic cells. Dental resorptions can be classified according to the affected dental surface (internal, external, internal-external), process evolution (transient or progressive) and the biological nature of the process (inflammatory or replacement). Dental trauma represents the most frequent cause of progressive external root resorption in the permanent dentition not rare resulting in irreversible loss of dental tissue that can lead to tooth loss. Considering that root resorptions are asymptomatic events, imaging procedures are essential in the diagnosis of such pathologies. Traditionally, these complementary examinations were performed through conventional and later digital radiographs. However, images provided through radiographs present some limitations, such as overlaps, distortions and a two-dimensional image of a three-dimensional structure. In order to overcome these limitations, the multiplanar images have been widely used, among them the computerized tomography of cone beam. Therefore, the present study aimed to review the use of CBCT to improve diagnosis and treatment planning of external root resorption. CBCT imaging appears to provide a superior validity and reliability in the detection of inflammatory external root resorption. The superior accuracy of CBCT imaging may result in the early detection of IERR and may help to determine their exact locations and extents. The smaller the voxel size the greater the accuracy of the exam, being important to identify small cavities in the apical region. However, literature is dominated by ex vivo studies and does not distinguish between different types of RER
Assuntos
Reabsorção de Dente/classificação , Reabsorção de Dente/diagnóstico , Reabsorção de Dente/diagnóstico por imagem , Radiografia Dentária/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricosRESUMO
PURPOSE: The aim of this study was to analyze the presence of the RMF in mandibles, considering gender and ethnic group. The RMC was also analyzed using periapical radiography. METHODS: Eighty-six mandibles from adult individuals of both sexes, of white and black skin colours were analyzed. The presence of RMF (bilateral or unilateral) was observed, with the side and the number of foramina in each hemimandible. Five mandibles were selected for RMC evaluation by periapical radiography. RESULTS: We observed at least 1 RMF in 16 mandibles out of a total of 86 (18.60%) and in 21 out of 172 sides (12.20%). The percentages were 27% in black individuals, 15.6% in white individuals, 23.8% in females and 13.8% in males. CONCLUSIONS: The RMF is a reasonably frequent anatomical variation and shows no differences between sexes or ethnic group, can be unilateral or bilateral and presents no side preference. The RMC presents different types of course and can even establish contact with the alveolar cortical, which might further complicate surgical and anaesthetic procedures in this region.
RESUMO
O objetivo deste estudo foi avaliar a acurácia, sensibilidade, especificidade e concordância inter e intra-observador dos exames radiográficos: radiografia periapical digital indireta (RP) por meio de placas de fósforo e tomografia computadorizada por feixe cônico (TCFC) na detecção de defeitos ósseos peri-implantares quimicamente simulados com Ácido Perclórico a 70%. 80 implantes foram instalados em blocos de costela bovina. Os implantes foram divididos em 2 grupos (grupo controle e grupo teste), em seguida o grupo teste foi dividido em 2 subgrupos (G1 e G2). O grupo G1 foi exposto a 4h de ácido causando defeitos de aproximadamente 3-4 mm de profundidade e largura <=1 mm, enquanto o grupo G2 foi exposto a 12h . Posteriormente, as amostras foram submetidas a um sistema de Radiografia digital indireta por meio de placa de fósforo (CS 7600) e a dois diferentes tomógrafos, utilizando variados protocolos (iCAT Next Generation e 3D Accuitomo 170). Os observadores avaliaram as imagens em um programa de visualização independente (OsiriX MD) utilizando a ferramenta a 3D-RMP que permite explorar cortes axiais, coronais, sagitais, parassagitais e circunferenciais simultaneamente. Nas amostras avaliadas por radiografia periapical, os valores da ASC encontrados nas amostras com defeitos ósseo menores variaram entre 0,442 a 0,534; no iCAT Next Generantion, variaram entre 0,645 a 0.828 em dois protocolos diferente. No 3D Accuitomo 170, variaram entre 0.563 a 0.904, em protocolos diferentes. No grupo com defeito ósseos maiores os resultados foram superiores. Na radiografia periapical, os valores encontrados variaram entre 0,652 a 0,771; no iCAT Next Generation, variaram entre 0,708 a 0,946 em dois protocolos diferentes e no 3D Accuitomo 170, entre 0.628 a 0.962 em 4 protocolos diferentes...
The aim of this study was to test the accuracy, sensitivity, specificity, inter and intra-observer and area AZ values of two radiographic examinations: digital periapical radiographs and cone beam computed tomography (CBCT) in the detection of two sizes of peri-implant bone defects chemically simulated with Perchloric Acid 70%. PR and CBCT were performed in 80 dental implants installed in blocks of bovine rib. An indirect digital radiography system using smart phosphor plates (CS 7600) and two different CBCT scanners, using different protocols (iCAT Next Generation 3D Accuitomo 170) were evaluated. Observers evaluated the images in a separate DICOM viewer (OsiriX MD) using the 3D-RMP tool. This tool allows the visualization of axial, coronal, sagittal, cross-section and circumferential images. In samples evaluated by periapical radiography, the AZ values found in the samples with smaller bone defects ranged from 0.442 to 0.534; in iCAT Next Generantion, ranged from 0.645 to 0.828 in two different protocols. In the group with larger bone defect results were superior. In periapical, the values found ranged from 0.652 to 0.771; iCAT the Next Generation ranged from 0.708 to 0.946 in two different protocols and 3D Accuitomo 170, 0.628-0.962 in 4 different protocols...
Assuntos
Carga Imediata em Implante Dentário/métodos , Carga Imediata em Implante Dentário , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: To evaluate the diagnostic accuracy of different radiographic methods in the assessment of proximal alveolar bone loss (ABL). MATERIALS AND METHODS: ABL, the distance between cement-enamel junction and alveolar bone crest, was measured in 70 mandibular human teeth - directly on the mandibles (control), using conventional periapical radiography with film holders (Rinn XCP and Han-Shin), digital periapical radiography with complementary metal-oxide semiconductor sensor, conventional panoramic, and cone-beam computed tomography (CBCT). Three programs were used to measure ABL on the images: Image tool 3.0 (University of Texas Health Sciences Center, San Antonio, Texas, USA), Kodak Imaging 6.1 (Kodak Dental Imaging 6.1, Carestream Health(®), Rochester, NY, USA), and i-CAT vision 1.6.20. Statistical analysis used ANOVA and Tukey's test at 5% significance level. RESULTS: The tomographic images showed the highest means, whereas the lowest were found for periapical with Han-Shin. Controls differed from periapical with Han-Shin (P < 0.0001). CBCT differed from panoramic (P = 0.0130), periapical with Rinn XCP (P = 0.0066), periapical with Han-Shin (P < 0.0001), and digital periapical (P = 0.0027). Conventional periapicals with film holders differed from each other (P = 0.0007). Digital periapical differed from conventional periapical with Han-Shin (P = 0.0004). CONCLUSIONS: Conventional periapical with Han-Shin film holder was the only method that differed from the controls. CBCT had the closest means to the controls.
RESUMO
Os dentes incisivos inferiores apresentam, em sua maioria, canal radicular único, que pode ter conformações distintas. De acordo com a literatura científica, a presença de um segundo canal radicular pode ser constatada em 10 a 40% dos casos. A não-detecção do segundo canal é um importante fator para o insucesso do tratamento endodôntico. Esta pesquisa foi realizada com os seguintes objetivos: 1) comparar a eficácia na identificação de padrões anatômicos internos em incisivos inferiores permanentes extraídos com uso de imagem radiográfica periapical digital e de tomografia computadorizada de feixe cônico (TCFC); e 2) determinar a prevalência de 2 canais radiculares em incisivos inferiores em imagens de TCFC de um banco de dados de exames previamente realizados, associando com localização do dente, gênero e idade do paciente. Na primeira etapa da pesquisa, 40 dentes incisivos inferiores foram submetidos a escaneamento em microtomógrafo computadorizado da FOB-USP (Skyscan 1074) para estabelecer o padrão ouro do tipo anatômico interno de cada dente. Os dentes foram então classificados em: Tipo I (1 canal radicular regular, n=12), Tipo Ia (1 canal radicular oval, n=12) e Tipo III (2 canais radiculares, n=16). Em seguida, os dentes foram divididos em 10 grupos de 4 dentes e posicionados em alvéolos de uma mandíbula humana para exposição radiográfica periapical digital direta com duas tomadas variando o ângulo horizontal de incidência (Schick CDR) e para escaneamento em 3 tomógrafos (Kodak 9000 3D, Veraviewepocs 3De e NewTom 5G) da Universidade de Loma Linda, CA, EUA. Dois examinadores treinados classificaram o tipo anatômico de cada dente e suas respostas foram comparadas ao padrão ouro estabelecido por microtomografia. Para descrição dos resultados, utilizou-se a porcentagem (%) de respostas certas / erradas. Aplicou-se o teste do qui-quadrado (X2), com nível de significância estatística de 5%, para verificação da associação entre variáveis. As concordâncias inter...
Mandibular incisors most commonly have a single root canal, which can present with different anatomic configurations. According to the literature, the presence of a second root canal can be observed in 10 - 40% of the teeth. Difficulty in detecting the second root canal is an important factor for the endodontic treatment failure. The aim of this research was: 1) to compare the efficacy of digital periapical radiography (PA) with double exposure and cone beam computed tomography (CBCT) in the identification of internal anatomic patterns in mandibular incisors, and 2) to determine the prevalence of 2 root canals in mandibular incisors using cone beam computed tomographic images of a patient database, comparing to tooth position and patients gender and age. In the first part of this research, 40 extracted mandibular incisors underwent microcomputed tomographic (micro-CT) scanning (Skyscan 1074) in order to establish the gold standard for internal anatomic pattern. The teeth were classified according to: Type I (1 regular root canal, n=12), Type Ia (1 oval root canal, n=12), and Type III (2 root canals, n=16). Then, the teeth were divided into 10 groups of 4 teeth and placed in a preserved human mandible for direct digital periapical radiographic double exposure (Schick CDR) and CBCT scans using Kodak 9000 3D, Veraviewepocs 3De and NewTom 5G. Two blinded examiners classified the anatomic pattern of each tooth and their answers were compared to the gold standard (microtomographic images). Percentage (%) of right / wrong answers was used for the statistical analysis of the results. Chi-square test (X2) was used to verify the association between variables (p <.05). Inter and intraexaminer agreements were determined using kappa values. In the second part of this research, CBCT images of a 100 patients database from FOB-USP were examined. Two examiners assessed the internal anatomy of mandibular incisors in axial, sagittal and coronal...
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Cavidade Pulpar/anatomia & histologia , Cavidade Pulpar , Incisivo/anatomia & histologia , Incisivo , Tomografia Computadorizada por Raios X/métodos , Fatores Etários , Ilustração Médica , Microtomografia por Raio-X/métodos , Variações Dependentes do Observador , Valores de Referência , Reprodutibilidade dos Testes , Fatores SexuaisRESUMO
Os dentes incisivos inferiores apresentam, em sua maioria, canal radicular único, que pode ter conformações distintas. De acordo com a literatura científica, a presença de um segundo canal radicular pode ser constatada em 10 a 40% dos casos. A não-detecção do segundo canal é um importante fator para o insucesso do tratamento endodôntico. Esta pesquisa foi realizada com os seguintes objetivos: 1) comparar a eficácia na identificação de padrões anatômicos internos em incisivos inferiores permanentes extraídos com uso de imagem radiográfica periapical digital e de tomografia computadorizada de feixe cônico (TCFC); e 2) determinar a prevalência de 2 canais radiculares em incisivos inferiores em imagens de TCFC de um banco de dados de exames previamente realizados, associando com localização do dente, gênero e idade do paciente. Na primeira etapa da pesquisa, 40 dentes incisivos inferiores foram submetidos a escaneamento em microtomógrafo computadorizado da FOB-USP (Skyscan 1074) para estabelecer o padrão ouro do tipo anatômico interno de cada dente. Os dentes foram então classificados em: Tipo I (1 canal radicular regular, n=12), Tipo Ia (1 canal radicular oval, n=12) e Tipo III (2 canais radiculares, n=16). Em seguida, os dentes foram divididos em 10 grupos de 4 dentes e posicionados em alvéolos de uma mandíbula humana para exposição radiográfica periapical digital direta com duas tomadas variando o ângulo horizontal de incidência (Schick CDR) e para escaneamento em 3 tomógrafos (Kodak 9000 3D, Veraviewepocs 3De e NewTom 5G) da Universidade de Loma Linda, CA, EUA. Dois examinadores treinados classificaram o tipo anatômico de cada dente e suas respostas foram comparadas ao padrão ouro estabelecido por microtomografia. Para descrição dos resultados, utilizou-se a porcentagem (%) de respostas certas / erradas. Aplicou-se o teste do qui-quadrado (X2), com nível de significância estatística de 5%, para verificação da associação entre variáveis. As concordâncias inter...
Mandibular incisors most commonly have a single root canal, which can present with different anatomic configurations. According to the literature, the presence of a second root canal can be observed in 10 - 40% of the teeth. Difficulty in detecting the second root canal is an important factor for the endodontic treatment failure. The aim of this research was: 1) to compare the efficacy of digital periapical radiography (PA) with double exposure and cone beam computed tomography (CBCT) in the identification of internal anatomic patterns in mandibular incisors, and 2) to determine the prevalence of 2 root canals in mandibular incisors using cone beam computed tomographic images of a patient database, comparing to tooth position and patients gender and age. In the first part of this research, 40 extracted mandibular incisors underwent microcomputed tomographic (micro-CT) scanning (Skyscan 1074) in order to establish the gold standard for internal anatomic pattern. The teeth were classified according to: Type I (1 regular root canal, n=12), Type Ia (1 oval root canal, n=12), and Type III (2 root canals, n=16). Then, the teeth were divided into 10 groups of 4 teeth and placed in a preserved human mandible for direct digital periapical radiographic double exposure (Schick CDR) and CBCT scans using Kodak 9000 3D, Veraviewepocs 3De and NewTom 5G. Two blinded examiners classified the anatomic pattern of each tooth and their answers were compared to the gold standard (microtomographic images). Percentage (%) of right / wrong answers was used for the statistical analysis of the results. Chi-square test (X2) was used to verify the association between variables (p <.05). Inter and intraexaminer agreements were determined using kappa values. In the second part of this research, CBCT images of a 100 patients database from FOB-USP were examined. Two examiners assessed the internal anatomy of mandibular incisors in axial, sagittal and coronal...
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Cavidade Pulpar/anatomia & histologia , Cavidade Pulpar , Incisivo/anatomia & histologia , Incisivo , Tomografia Computadorizada por Raios X/métodos , Fatores Etários , Ilustração Médica , Microtomografia por Raio-X/métodos , Variações Dependentes do Observador , Valores de Referência , Reprodutibilidade dos Testes , Fatores SexuaisRESUMO
INTRODUCTION: This in vitro study compared cone-beam computed tomography (CBCT) exam with different voxel sizes with digital periapical radiography in the detection of vertical root fractures in teeth with and without intracanal metallic posts. METHODS: Eighteen single-rooted human teeth were endodontically treated, prepared for cast metal posts, and artificially fractured. After positioning the teeth in dry mandibular sockets, the samples were subjected twice (with and without posts) to digital periapical radiography at 3 different angles and to CBCT examinations with 2 voxel sizes, 0.125 and 0.25 mm. The images were evaluated by 3 oral radiologists. Indices of sensitivity, specificity, and positive and negative predictive values, in addition to the areas under the receiver operating characteristic curves (accuracy), were calculated. Comparison of the accuracy of the imaging methods was assessed by using the χ(2) test. Comparison of the accuracy between teeth with and without posts was determined by using the Fisher exact test. RESULTS: The accuracy of the imaging methods showed no significant differences (P = .08). The comparison between teeth with and without posts in each examination revealed significant differences for CBCT with a voxel of 0.125 mm (P = .04) and for periapical radiography (P = .04). CONCLUSIONS: No significant differences were observed between CBCT and periapical radiography in the detection of vertical root fractures, except for teeth with metallic posts in images from CBCT with a voxel of 0.125 mm and in digital periapical radiography. Furthermore, voxel size did not significantly influence the diagnosis of vertical root fractures.
Assuntos
Tomografia Computadorizada de Feixe Cônico/estatística & dados numéricos , Ligas Dentárias/química , Técnica para Retentor Intrarradicular/instrumentação , Radiografia Interproximal/estatística & dados numéricos , Radiografia Dentária Digital/estatística & dados numéricos , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/lesões , Área Sob a Curva , Artefatos , Ligas de Cromo/química , Dente Canino/lesões , Reações Falso-Positivas , Humanos , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Incisivo/lesões , Variações Dependentes do Observador , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Raiz Dentária/diagnóstico por imagem , Dente não Vital/diagnóstico por imagemRESUMO
INTRODUCTION: The periapical film radiograph (PFR) and digital periapical radiograph (DPR) techniques have some limitations in the visualization of small periapical lesions (PLs) when compared with cone-beam computed tomography (CBCT). However, the evidence supporting their effectiveness is very limited. This retrospective longitudinal cohort study evaluated the outcome of endodontic treatments measured/monitored by PFR, DPR, and CBCT during a 5-year follow-up and also determined the prognostic factors that influenced treatment success. METHODS: A total of 132 teeth (208 roots) with vital pulps received endodontic treatment. The periapical indexes with scores ≥2 for PFR and DPR and ≥1 for CBCT indicated the presence of PLs. Prognostic factors were determined by bivariate and multivariate analyses. Statistical significance was defined at a P level <.05. RESULTS: CBCT detected a higher number of PLs (18.7%, n = 39 roots), followed by DPR (7.7%, n = 16 roots) and PFR (5.7%, n = 12 roots). Likewise, CBCT was more sensitive than PFR and DPR in detecting deficiencies in extension and density of the root canal filling (P ≤ .001). Of the 17 prognostic factors evaluated, 4 were significantly associated with poor outcome to the treatment (P < .05): root canal curvature, disinfection of gutta-percha, presence of missed canals, and the quality of definitive coronal restoration. CONCLUSIONS: The success outcome of endodontic treatment after 5 years in teeth with vital pulps varied with each radiographic method: 94.3%/PFR, 92.3%/DPR, and 81.3%/CBCT.
Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Cavidade Pulpar/diagnóstico por imagem , Radiografia Interproximal/métodos , Radiografia Dentária Digital/métodos , Tratamento do Canal Radicular/métodos , Variação Anatômica , Sulfato de Cálcio/química , Estudos de Coortes , Restauração Dentária Permanente/normas , Restauração Dentária Temporária/normas , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Metilmetacrilatos/química , Microscopia/instrumentação , Pessoa de Meia-Idade , Doenças Periapicais/diagnóstico por imagem , Doenças Periapicais/terapia , Estudos Retrospectivos , Materiais Restauradores do Canal Radicular/uso terapêutico , Irrigantes do Canal Radicular/uso terapêutico , Obturação do Canal Radicular/métodos , Preparo de Canal Radicular/instrumentação , Preparo de Canal Radicular/métodos , Diques de Borracha , Hipoclorito de Sódio/uso terapêutico , Raiz Dentária/diagnóstico por imagem , Resultado do Tratamento , Cimento de Óxido de Zinco e Eugenol/química , Sulfato de Zinco/químicaRESUMO
A Ortopedia Funcional dos Maxilares visa o restabelecimento das condições adequadas para o correto desempenho das funções do aparelho estomatognático utilizando-se, para tal fim, forças leves e intermitentes. O objetivo é avaliar radiograficamente os comprimentos radiculares de incisivos centrais e laterais, superiores e inferiores, frente ao estímulo de forças ortopédicas funcionais, após o término do tratamento. Foram selecionados aleatoriamente 30 indivíduos, com idade média de I 1,5 anos, de um universo de 60 indivíduos, totalizando 107 incisivos com rizogênese completa, 80 incisivos com rizogênese incompleta e a altura de 141 cristas alveolares entre os incisivos. A análise das imagens obtidas por radiografias periapicais antes e após otérminodo tratamento, foi feita por um único examinador. Após análise estatística dos resultados (teste "t" de Student e análise de variância) observou-se alongamento adicional médio de 9% nos dentes com rizogênese completa, de 30% nos dentes comrizogênese incompleta e a altura da crista óssea manteve-se inalterada. O tratamento utilizando técnicas ortopédicas funcionais parece não induzir reabsorções radiculares nem perdas ósseas alveolares, possibilitando também o final normal da rizogênese.
Jaw Functional Orthopedics aims to lhe adequate conditions restoration for lhe correct development of stomatognatic system functions, using for this objective light ant intermittent forces. The aim of this study was avaliate trough periapical radiographies lherootlenght of central and lateral, lower and upper; incisors, after intermittent forces stimuli, used on treatment, 30 individual swith11. 5average age were selected randomly from a total sample of60 subjects, totalizing 107 incisors with complete rhizogenesis,80 incisors with incomplete rhizogenesis and 141 alveolar crests high. The digital analysis was done by a single examinator through periapical radiographies taken before and afier treatment. There was a medium adicional enlargement of 9% in complete rhizogenesis incisors, abou/ 30% in incomplete rhizogenesis incisors and alveolar crest high kept lhe same. Treatment with Jaw Functional Orthopaedics technics seems didn 'I induces root resorption neighter alveolar bone losses, making possible lhe normal endingof rhizogenesis process.
Assuntos
Processo Alveolar , Doenças Periapicais , Odontometria , Ortopedia , Radiografia Panorâmica , Reabsorção da Raiz , Incisivo , Sistema Estomatognático/anatomia & histologia , Sistema EstomatognáticoRESUMO
The dental gemination is a morphological alteration that can occur during the development of the dental germ, resulting in a total or partial formation of two teeth which are not completely separate. The aim of this work was to relate an unusual case of gemination by the periapical radiography of superior central incisive in the permanent dentition.
La geminación dental es una alteración morfológica que puede suceder durante el desarrollo dental del embrión, dando por resultado la formación parcial o total de dos dientes que no estén separados totalmente. El objetivo de este trabajo fue describir un caso infrecuente de geminación, a través de la radiografía periapical en incisivos centrales superiores en la dentición permanente.
Assuntos
Humanos , Masculino , Adolescente , Ápice Dentário/anormalidades , Ápice Dentário/embriologia , Ápice Dentário , Incisivo/anormalidades , Incisivo/crescimento & desenvolvimento , Incisivo/embriologia , Incisivo , Dentição Permanente , Radiografia Dentária/métodosRESUMO
A morfometria in vivo dos implantes dentários poderá permitir a identificação do tipo de implante usado. O objetivo deste estudo foi comparar as medidas dos implantes dentários com as medidas das suas imagens radiográficas digitais e estabelecer as suas respectivas correlações, utilizando um programa de computador para realizar as mensurações das imagens radiográficas. Para isso foram utilizados seis implantes de cinco fabricantes, com diâmetro da plataforma variando de 3,5 a 4,6 mm e comprimento variando de 8,5 a 14 mm, medidos com um paquímetro digital. Os implantes foram radiografados com as películas periapicais em três angulações diferentes, zero, 20 e 40 graus em relação ao plano do objeto junto a uma esfera adotada como padrão de calibração radiográfica. As radiografias geradas foram digitalizadas e calibradas e medidas computacionalmente. Estas medidas obtidas foram então correlacionadas com as medidas dos implantes dentários, obtidas através do paquímetro digital. Os resultados expressaram que: a) A comparação das medidas dos implantes com as medidas das suas imagens radiográficas, calibradas no mesmo sentido do padrão nas diferentes angulações não foram estatisticamente diferentes; b) As medidas das imagens obtidas com a angulação de zero, 20 e 40 graus não apresentaram distorção apreciável entre si, quando calibradas no mesmo sentido do padrão; c) Houve forte correlação entre as medidas dos implantes e das suas imagens radiográficas, quando calibradas no mesmo sentido do padrão (r = 0,99); d) O programa desenvolvido para mensuração de radiografias periapicais permitiu a realização das medidas com precisão em variações de até 40 graus de angulação do filme em relação ao implante, quando calibradas no mesmo sentido do padrão, provando que o paralelismo é importante, porém não indispensável na identificação de implantes.
The in vivo morphometry of dental implants may allow identification of the type of implant used. The objective of this study was to compare the measurements of dental implants with the measurements of their digital radiographic images and to establish their respective correlations, using a computer program to perform the measurements of the radiographic images. For this, six implants of five manufacturers were used, with platform diameter varying from 3.5 to 4.6 mm and length ranging from 8.5 to 14 mm, measured with a digital caliper. The implants were radiographed with the periapical films at three different angles, zero, 20 and 40 degrees to the plane of the object next to a sphere adopted as a radiographic calibration standard. The radiographs generated were digitalized and calibrated and measured computationally. These measurements were then correlated with the measurements of dental implants obtained through the digital caliper. The results showed that: a) The comparison of the measurements of the implants with the measurements of their radiographic images, calibrated in the same direction of the pattern in the different angulations were not statistically different; b) The measurements of the obtained images with the zero, 20 and 40 degrees angulation did not show appreciable distortion among themselves, when calibrated in the same sense of the standard; c) There was a strong correlation between the measurements of the implants and their radiographic images, when calibrated in the same direction as the standard (r = 0.99); d) The program developed for the measurement of periapical radiographs allowed measurements to be performed accurately at variations of up to 40 degrees of film angulation in relation to the implant, when calibrated in the same sense as the standard, proving that parallelism is important, but not indispensable in the identification of implants