RESUMO
AIM: The purpose of the present study was to evaluate permanent teeth with post-traumatic transversal root fractures, for their initial healing modality, the effect of candidate predictors and their long-term prognosis. METHODOLOGY: A retrospective longitudinal clinical study was conducted to evaluate records from patients bearing transversal root fractures in permanent teeth in order to radiographically assess short-term healing and non-healing events in the fracture line, their prognostic factors and their relationship with long term outcomes. The inter-fragmentary tissues were classified as healing: hard tissue (HT), connective tissue (CT) or connective tissue and bone (CT + B) and non-healing: interposition of granulation tissue (GT). A competing risk survival analysis was conducted to estimate the hazards of healing and non-healing events in the short-term and the effect of demographic, clinical, and treatment variables was assessed using the subdistribution regression model (Fine & Gray). RESULTS: Radiographic findings showed 61.4% of healing in the short-term being strongly influenced by the presence and type of concomitant injuries to the coronal fragment. Teeth with concomitant crown fractures (sHR 24.38, 95% CI [3.16-188.3], p = 0.0022), luxations with dislocations (sHR 10.58, 95% CI [1.37-81.9], p = 0.0240) and subluxations (HR 9.66, 95% CI [1.14-81.7], p = 0.0370) were more likely to present non-healing of root fractures in the short-term. The healing rate in the long-term was of 75.9%, most of them with interposition of bone and connective tissue. Kappa statistics demonstrated an overall agreement of 67.1% between short and long-term healing patterns, in special HT and CT + Bone modalities. CONCLUSION: Healing at the fracture site was the most frequent outcome, both in the short-term and in the long-term. Short-term healing modality was strongly influenced by the presence and type of concomitant injuries to the crown fragment, being the worst prognosis observed in root-fractured teeth with concomitant crown fractures, followed by concomitant luxations with dislocation. CLINICAL RELEVANCE: Post-traumatic transversal root fractures have a positive prognosis supporting therefore, a more conservative approach for these teeth before considering more radical treatments.
Assuntos
Fraturas Ósseas , Fraturas dos Dentes , Humanos , Estudos Longitudinais , Estudos Retrospectivos , Necrose da Polpa Dentária , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/lesões , Fraturas dos Dentes/diagnóstico por imagem , PrognósticoRESUMO
This study aimed to evaluate the influence of the metal post composition, tooth location in the dental arch, and metal artifact reduction (MAR) on vertical root fracture (VRF) diagnosis in cone beam computed tomography (CBCT). Twenty-two unirradicular premolars (12 sound and 10 fractured) and two alveolar sockets of a mandible (anterior and posterior regions) composed the sample. CBCT scans of each tooth with a metal post placed into the root canal-silver-palladium (Ag-Pd), cobalt-chromium (Co-Cr), or nickel-chromium (Ni-Cr)-were individually acquired for each mandibular region, and two conditions of MAR, using a OP300 device (Instrumentarium, Finland). Images were assessed by five evaluators independently for VRF detection. Diagnostic values were calculated and compared among all groups using multi-way ANOVA with Tukey post hoc test to investigate the effect of post material, anatomical region, and MAR on VRF diagnosis (α = 0.05). Values of area under the receiver operating curve and specificity were not influenced by the studied factors (p > 0.05). Sensitivity was influenced by the MAR in both mandibular regions (p < 0.05). In the anterior region, sensitivity values increased when the MAR was enabled, regardless of the metal post material (p < 0.05). Similar behavior was noticed in the posterior region for Ni-Cr (p < 0.05) but not for Ag-Pd and Co-Cr posts (p > 0.05). The MAR improved the sensitivity in VRF diagnosis for all tested metal posts in the mandibular anterior region and for the Ni-Cr post in the mandibular posterior region. Therefore, for images obtained in the OP300 CBCT device, activation of the MAR is suggested in these cases.
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Artefatos , Tomografia Computadorizada de Feixe Cônico , Técnica para Retentor Intrarradicular , Fraturas dos Dentes , Humanos , Tomografia Computadorizada de Feixe Cônico/métodos , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/lesões , Dente Pré-Molar/diagnóstico por imagem , Arco Dental/diagnóstico por imagem , Metais , Técnicas In Vitro , Sensibilidade e Especificidade , Mandíbula/diagnóstico por imagemRESUMO
OBJECTIVES: To evaluate the influence of image acquisition parameters (voxel, FOV, kVp, mA) on the accuracy of cone-beam computed tomography (CBCT) in detecting vertical root fracture (VRF). MATERIAL AND METHODS: Searches were performed in 6 main databases and the gray literature, without restrictions of language or date. Observational clinical studies (OCS) and in vitro-extracted teeth (IV) studies were considered eligible for inclusion when investigating the accuracy (sensitivity, specificity) of CBCT in detecting VRF in human teeth. The risk of bias was assessed using QUADAS-2, and a meta-analysis was performed using Review Manager v5.4 software and Jamovi software v1.6. RESULTS: A total of 60 out of 132 articles was included after fulfilling the eligibility criteria. Of these, 54 were IV studies while 6 were OCS. In the IV studies, it was seen that smaller FOV sizes tended to present higher accuracy values. The meta-analysis of the 6 OCS showed that the overall sensitivity and specificity values for 0.08 mm and 0.1 mm voxels were greater (0.84 and 0.79, respectively) than the sensitivity and specificity values for 0.125 mm and 0.2 mm voxels (0.70 and 0.55, respectively). CONCLUSIONS: Despite the uncertain risk of bias found for the IV and OCS studies, smaller voxel and FOV sizes seem to provide more accurate VRF detection values when using CBCT. CLINICAL RELEVANCE: This information is crucial for supporting the clinician when prescribing CBCT in cases of a clinical suspicion of VRF, and contributes to the personalization of the CBCT prescription, thereby ensuring greater accuracy in the VRF diagnosis. Registration This protocol was registered at the PROSPERO database (International Prospective Register of Systematic Review) under registration number CRD42020210118.
Assuntos
Fraturas Ósseas , Tomografia Computadorizada de Feixe Cônico Espiral , Fraturas dos Dentes , Humanos , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Sensibilidade e Especificidade , Tomografia Computadorizada de Feixe Cônico/métodosRESUMO
OBJECTIVES: To evaluate the influence of sharpening filters in the detection of root fractures using low-dose cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Eighty-four CBCT volumes acquired at three mA levels of 28 teeth inserted in the dental socket of dry human skull were selected from a previous study. The teeth were divided into four groups according to the presence and absence of root fracture and endodontic filling. Five radiologists evaluated all CBCT volumes for the presence of root fracture with and without the application of "Sharpen 1x" and "Sharpen 2x" filters in OnDemand3D software. Area under the ROC curve (AUC), sensitivity, specificity, and inter- and intra-observer concordance were calculated and compared (α = 0.05). RESULTS: Sharpening filters did not lead to significant differences in AUC, sensitivity, and specificity at the three mA levels tested (p > 0.05), regardless of the presence of endodontic filling (p > 0.05). However, the significant reduction of AUC observed in CBCT volumes at 4 mA without filter (p < 0.05) ceased to exist after the application of filters (p > 0.05). Sensitivity and specificity ranged from low and moderate. CONCLUSIONS: The use of sharpening filters can be recommended in CBCT volumes at 4 mA for root fracture detection for leading to the same performance as those at 6.3 and 10 mA. The presence of endodontic filling material did not influence the action of filters in the diagnosis of root fracture. CLINICAL RELEVANCE: Sharpening filters seem to contribute to the diagnosis of root fracture in CBCT volumes acquired with reduced radiation dose.
Assuntos
Fraturas Ósseas , Fraturas dos Dentes , Tomografia Computadorizada de Feixe Cônico/métodos , Humanos , Sensibilidade e Especificidade , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagemRESUMO
The aim of this study was to compare the influence of endodontic sealers artifacts on the detection of vertical root fracture in cone beam computed tomography (CBCT). Premolars and central incisors were assigned into five different groups: Control, Pulp Canal Sealer, AH Plus, Sealer 26, and BC Sealer (n= 10, per group). VRFs were mechanically induced and the teeth were inserted into an image phantom. Subsequently, CBCT (Cranex 3Dx, Soredex, Tuusula, Finland) images were obtained and two observers were asked separately to identify root fracture, by visual analysis. For both premolar and central incisors, kappa coefficients of intraobserver agreement varied from good to excellent (K: 80% - 87%), and the values for interobserver agreement varied from fair to moderate (K: 30% - 35%). As follows, the area under the curve (AUC) of receiver operating characteristic (ROC) values for VRFs highlighted that the use of BC sealer reduced the observers' ability to discriminate VRFs relative to other sealers. Moreover, sensitivity values for premolars teeth ranged from 20% to 60%, and specificity ranged from 60% to 100%; while sensitivity values for central incisors ranged from 30% to 70%, and specificity ranged from 70% to 100%. In conclusion, the low sensitivity values, mainly for premolars, demonstrated the difficulty in VRF diagnosis. Furthermore, BC Sealer induced significantly more imaging artifacts than other sealers. These results highlighting that endodontic sealers may interfere with the diagnosis of VRFs.
Assuntos
Materiais Restauradores do Canal Radicular , Fraturas dos Dentes , Artefatos , Dente Pré-Molar/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/métodos , Humanos , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagemRESUMO
OBJECTIVE: To evaluate the influence of the file format of digital periapical radiographs on the diagnosis of vertical root fracture (VRF). STUDY DESIGN: Periapical radiographic images of 34 single-rooted teeth-19 with VRF, and 15 without VRF were acquired using two digital systems-Digora Toto, and Digora Optime, and exported into four different file formats-TIFF, BMP, PNG, and JPEG, totaling 272 radiographs. The radiographs were assessed by five examiners for the detection of VRF, using a 5-point scale (1-definitely absent; 2-probably absent; 3-uncertain; 4-probably present; 5-definitely present). Diagnostic values of area under the ROC curve, specificity, and sensitivity for the diagnosis of VRF were calculated. The results were compared by two-way Analysis of Variance with post hoc Tukey's test. The intra- and inter-examiner agreements were measured by the Kappa test. The significance level was set at 5% for all analyses. RESULTS: The values of intra-examiner agreement varied from moderate (0.56) to almost perfect (0.81), while the values of inter-examiner agreement varied from fair (0.29) to moderate (0.60). The image file format did not influence the diagnostic values for VRF for any of the radiographic systems tested (p > 0.05). Digora Toto had significantly greater values of area under the ROC curve than Digora Optime for all file formats (p = 0.001). CONCLUSION: The image file format of periapical radiographs does not influence the diagnosis of VRF, regardless of the digital radiography system.
Assuntos
Fraturas dos Dentes , Humanos , Compostos de Quinolínio , Radiografia , Radiografia Dentária Digital/métodos , Tiazóis , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagemRESUMO
OBJECTIVE: The aim of this study was to evaluate the diagnostic ability of dental undergraduate students to detect horizontal and oblique root fractures (ORFs) using different imaging techniques. MATERIALS AND METHODS: Nine teeth were selected and randomly divided in three groups in order to create a fracture line without fragments separation: control (without fracture), horizontal root fracture (HRF), and ORF. The root fracture was created using perpendicular force and was confirmed by transillumination. A model with two adjacent teeth was created, and different imaging techniques were performed: conventional periapical radiograph; mesially and distally shifted periapical radiographs; cone-beam computer tomography (CBCT). Twenty students that had participation on dental trauma clinic at the year of 2019 were invited to identify root fractures by a five-point scale: (i) fracture definitely not present, (ii) fracture probably not present, (iii) uncertain whether fracture is present or not, (iv) fracture probably present, and (v) fracture definitely present. Data were analyzed by Kappa test for agreement evaluation. RESULTS: Comparing each student to the gold standard, there was a variation in reproducibility and performance from poor to substantial (0.042-0.667). Reproducibility values ranged from poor to good for all periapical radiographs both in the diagnosis of ORF (-0.33-0.667) and in HRF (0-1). CONCLUSIONS: In CBCT images, the students' ability was lower in HRF detection in comparison with the oblique ones. The students showed limited capacity to diagnose root fractures; however when CBCT was used, the performance was more satisfactory than when periapical radiographs were used.
Assuntos
Fraturas dos Dentes , Tomografia Computadorizada de Feixe Cônico/métodos , Humanos , Reprodutibilidade dos Testes , Estudantes , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagemRESUMO
The objective of this critical review of literature is to discuss relevant clinical factors associated with root fractures (RF) visualized by using a new CBCT software. RF constitutes a common occurrence and a challenge in clinical practice, in which the diagnosis becomes essential for the definition of rapid and precise decision-making. The characterization of RF may involve different aspects, such as orientation of the fracture line (horizontal, vertical, oblique), root position of the fracture (cervical, middle, apical third), fracture's coronal-radicular position (coronary, coronal-radicular, radicular), continuity of the fracture (crack, incomplete fracture, complete), bone extension of the fracture (supraosseous, bone level, infraosseous fracture). Imaging examinations have been routinely used to aid in the RF diagnosis. Even with high-resolution cone-beam computed tomography (CBCT) scans, many doubts often remain about the diagnostic outcome. Many interferences in the analysis of image quality to determine the diagnosis are identified, such as the sharpness, the noise, light and dark artifacts, among others. The professional's knowledge is essential for identifying the different patterns of fracture lines and their repercussions on adjacent bone tissues, as well as for the analysis of artifacts that may hide or show similarities to fracture lines. Fractures lines and root fractures that may be associated with phantom conditions that mimic fractures should be carefully analyzed. CBCT is the exam indicated to identify a root fracture. It is also added to the success of the diagnosis that the professional has scientific knowledge, training and mastery of advanced CBCT software.
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Tomografia Computadorizada de Feixe Cônico Espiral , Fraturas dos Dentes , Tomografia Computadorizada de Feixe Cônico , Diagnóstico Diferencial , Humanos , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagemRESUMO
BACKGROUND: The effectiveness of the metal artefact reduction (MAR) tool for the detection of vertical root fracture (VRF) by cone beam computed tomography (CBCT) images is controversial. OBJECTIVE: To evaluate the effectiveness of the MAR tool on VRF detection involving teeth with intracanal materials in CBCT images. METHODOLOGY: In September 2019, an electronic search was performed in six databases (PubMed, Scopus, Web of Science, Cochrane, Lilacs and Embase). The electronic search was updated in May 2020 through searches in Google Scholar and references of included studies (embracing the electronic and gray literature searches). No language or year restrictions were applied. Independently, two reviewers examined titles, abstracts and full texts according to the eligibility criteria that were as follows: diagnostic studies that evaluated the effectiveness of the MAR tool on the diagnosis of VRF in human teeth (laboratory or in vivo studies) on CBCT images. The risk of bias was evaluated using the Quality Assessment Tool for Diagnostic of Accuracy Studies-2 (QUADAS-2). For conducting the meta-analysis, the values of sensitivity, specificity, diagnostic odds ratio (DOR) and area under the ROC curve (AUC) were obtained, considering the subgroups with and without MAR active. The Grading of Recommendation, Assessment, Development and Evaluation instrument was applied to assess the level of evidence across the studies using GRADEpro software. RESULTS: A total of 8 laboratory studies were included in both systematic review and meta-analysis. The values of sensitivity, specificity, DOR and AUC to VRF diagnosis with and without MAR active were, respectively, 0.586 and 0.603; 0.699 and 0.713, 3.037 and 3.767; 0.67 and 0.71. The quality of the evidence suggested low confidence in estimating the outcomes. DISCUSSION: The MAR tool decreased slightly the diagnostic values of VRF involving teeth with intracanal materials in laboratory studies. However, it is important to highlight that most studies had an uncertain risk of bias. CONCLUSIONS: Although a low level of evidence and high heterogeneity were observed in the included studies, the meta-analysis revealed better diagnosis values for VRF detection when the MAR was deactivated when analysing extracted teeth in a laboratory setting. REGISTRATION: PROSPERO-CRD42020145222. FUNDING: This study was financed in party by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES).
Assuntos
Fraturas dos Dentes , Dente não Vital , Artefatos , Tomografia Computadorizada de Feixe Cônico , Humanos , Fraturas dos Dentes/diagnóstico por imagem , Raiz DentáriaRESUMO
Root fractures vary in severity, extent, and location, according to the physical and mechanical aspects of the accident. Root fractures are rare in primary teeth and they affect dentin, cementum, periodontal ligament and the pulp. This paper reports a case of a two-and-a-half-year-old baby who had a root fracture of the upper right primary central incisor (tooth 51) as a consequence of trauma that was managed with minimally invasive intervention. After clinical and radiographic examinations, the presence of tooth mobility, pain, bleeding and a horizontal apical root fracture was diagnosed on tooth 51. The treatment of choice was splinting for 120 days, which can deliver excellent results regardless of the patient's age. The tooth was preserved without needing endodontic intervention until its physiologic exfoliation and normal eruption of its permanent successor. As sequelae to the fractured tooth 51, there was some coronal color alteration and dystrophic calcification of the root canal. This tooth did not develop ankylosis or mobility during the follow-up period. After 57 months of follow-up, repositioning and splinting were appropriate ways to manage this horizontal root fracture in the apical third of this primary tooth. It allowed the tooth to be preserved in the arch with normal function.
Assuntos
Anquilose Dental , Fraturas dos Dentes , Pré-Escolar , Seguimentos , Humanos , Incisivo , Tratamento do Canal Radicular , Fraturas dos Dentes/diagnóstico por imagem , Fraturas dos Dentes/terapia , Raiz Dentária/diagnóstico por imagem , Dente DecíduoRESUMO
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
OBJECTIVE: To assess the influence of field of view (FOV) size, scanning position within the FOV and scanning mode on the detection of root fracture and artifact perception. METHODS: Forty single-rooted premolars restored with NiCr and AgPd posts were divided into two groups: fractured and sound. All teeth were scanned using four CBCT scanning protocols varying FOV sizes (80 × 80 mm and 50 × 55 mm) and scanning modes (Standard and High Definition). The sample was positioned within the FOV in two pre-set positions (central and lateral) and in four positions established by the operator (quadrants). Detection of root fracture and artifact perception were assessed by two observers using 5-point and 4-point scales. Sensitivity, specificity, accuracy, and AUC values were calculated and compared by ANOVA two-way and Tukey's test. Chi-square and Fisher's exact test were used to assess artifact perception. The level of significance was set at p < 0.05. RESULTS: The central position within the FOV presented higher sensitivity, specificity, accuracy, and AUC values and differed from the lateral position within the FOV for the studied metal posts (p<0.05). Quadrant 2 presented the best sensitivity, accuracy, and AUC values (p<0.05). The lateral position within the FOV, AgPd posts, quadrants 1 and 3 and protocols 1 (SM, 80 × 80) and 2 (HD, 80× 80) presented higher frequency of artifacts classified as "severe". CONCLUSION: Positioning the object in the center or closer to the anterior periphery of the FOV while using a small FOV improved the detection of root fracture and decreased artifact perception.
Assuntos
Tomografia Computadorizada de Feixe Cônico Espiral , Fraturas dos Dentes , Artefatos , Tomografia Computadorizada de Feixe Cônico , Humanos , Percepção , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagemRESUMO
AIM: To evaluate the influence of the tube current and metal artifact reduction (MAR) tool on the diagnosis of vertical root fractures (VRF) in a tooth adjacent to a zirconium implant, in cone-beam computed tomography (CBCT) images. METHODOLOGY: Thirty single-rooted teeth (15 with VRF and 15 control group) were individually positioned in a mandible, and scanned with the OP300 CBCT unit. Images were acquired using a standardized protocol: 5 × 5 cm field of view, 0.08-mm voxel size, and 90 kVp. Each tooth was scanned with and without a zirconium implant in its vicinity, using different tube currents (4 mA, 8 mA, and 10 mA) and conditions of MAR (enabled × disabled). Diagnostic values were calculated for each protocol, and compared by multi-way analysis of variance. RESULTS: The ROC curve and sensitivity values did not differ significantly among the tube currents, regardless of the presence of the implant and MAR condition (p > 0.05). There were also no significant differences among the tube currents for the specificity values (p > 0.05); however, the specificity differed significantly between the "with implant" and "without implant" conditions, within the same MAR condition and tube current (p < 0.05). Specificity was significantly lower when the implant was present (p < 0.05). CONCLUSION: The presence of a zirconium implant impairs the diagnosis of VRF in teeth adjacent to the artifact-generator material. Neither the tube current nor the MAR tool is effective in improving this diagnostic task. Therefore, in this clinical scenario, the use of the lowest tube current (4 mA), without MAR activation, is recommended. CLINICAL RELEVANCE: Considering that the tube current is one of the main factors that influence the radiation dose and image quality in CBCT, and that metal artifacts negatively influence the diagnosis of VRF in areas adjacent to the artifact-generator material, it is important to evaluate the effect of this energetic parameter in the diagnosis of VRF in teeth adjacent to zirconium implants.
Assuntos
Implantes Dentários , Tomografia Computadorizada de Feixe Cônico Espiral , Fraturas dos Dentes , Artefatos , Tomografia Computadorizada de Feixe Cônico , Humanos , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , ZircônioRESUMO
OBJECTIVES: To evaluate the effect of enhancement tools of intraoral digital radiographs on the assessment of vertical root fracture (VRF) and to quantify the resultant image noise. MATERIALS AND METHODS: Thirty single-rooted human teeth (15 control and 15 fractured) were each radiographed in four intracanal conditions: no filling, gutta-percha, metal post, and fiberglass post, totaling 120 original images. Two filters were applied to the original images-Sharpen filter (SF) and Edge Enhancement filter (EE), and brightness and contrast were adjusted in four combinations (B&C1 to 4), resulting in 840 images. Five oral radiologists analyzed the images for VRF detection. Pixel intensity was obtained in two regions from the radiographs. Diagnostic values were calculated and compared by two-way ANOVA, and the SD values of pixel intensity values were compared by one-way ANOVA (α = 0.05). RESULTS: There were no significant differences in accuracy for VRF detection between the experimental groups (p > 0.05). Teeth with metal post presented the lowest sensitivity (p < 0.05) for all experimental conditions, except for SF and EE (p > 0.05). B&C2, B&C3, and B&C4 had higher specificity than SF (p ≤ 0.05) for all intracanal conditions. Analysis of pixel intensity showed that all enhanced images presented statistically significant higher noise compared to those of the original images (p ≤ 0.05). CONCLUSION: Digital enhancement tools in digital radiography increase image noise; however, they can be used without compromising VRF detection. CLINICAL RELEVANCE: The use of digital enhancement does not impair the detection of VRF and, therefore, can be applied for this purpose according to the observer preference.
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Fraturas dos Dentes , Tomografia Computadorizada de Feixe Cônico , Guta-Percha , Humanos , Radiografia Dentária Digital , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagemRESUMO
OBJECTIVES: This study evaluated factors associated with vertical root fracture in endodontically treated teeth, using a cone-beam computed tomography (CBCT) image database. MATERIALS AND METHODS: The sample for this case-control study consisted of 81 CBCT scans of teeth with vertical root fracture (VRF) and 81 CBCT scans of non-fractured teeth, matched by age, sex, and tooth position. The analyzed variables included dentin thickness, an intraradicular post, an adjacent implant, and a missing adjacent tooth. Student's t test test was used to compare the quantitative variables. The chi-square test was used to compare the categorical variables. Logistic regression was performed to evaluate the association between the presence of VRF and the independent factors assessed. RESULTS: The mean dentin thickness of fractured teeth was 1.3 mm, whereas that of non-fractured ones was 1.5 mm (p < 0.001). There was no difference between the fractured and non-fractured groups, regarding implant frequency or missing adjacent tooth (p > 0.05). There were a significantly larger number of teeth with posts in the fractured versus non-fractured group (p = 0.007). However, dentin thickness ≤ 1.3 mm was the only factor associated with VRF in the multiple regression model (OR = 3.60, 95%CI = 1.76-7.37). CONCLUSIONS: Dentin thickness may influence the development of VRF. Dentin thickness ≤ 1.3 mm is associated with a greater likelihood of fracture than ≥ 1.4 mm. CLINICAL RELEVANCE: This study suggests there may be a minimum amount of safe dentin thickness that should be preserved after endodontic instrumentation.
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Fraturas dos Dentes , Dente não Vital , Estudos de Casos e Controles , Tomografia Computadorizada de Feixe Cônico , Dentina/diagnóstico por imagem , Humanos , Fatores de Risco , Fraturas dos Dentes/diagnóstico por imagem , Fraturas dos Dentes/etiologia , Raiz Dentária/diagnóstico por imagem , Dente não Vital/diagnóstico por imagemRESUMO
OBJECTIVES: To evaluate the influence of exomass-related metal artefacts on the detection of simulated vertical root fracture (VRF) in cone-beam computed tomography (CBCT). METHODS: 20 teeth were endodontically instrumented and VRF was induced in half of them. All teeth were individually placed in an empty socket of a human mandible. Metallic materials were differently arranged in the exomass [zone outside of the field of view (FOV) but between the X-ray source and the receptor] and/or endomass (zone inside of the FOV), and CBCT scans were obtained. Four radiologists evaluated the presence of VRF using a 5-point scale. Sensitivity, specificity, and area under the receiver operating curve (AUC) were compared using ANOVA. Also, the tooth of interest was replaced with a tube filled with a radiopaque solution and all CBCT scans were repeated to analyse the data objectively. Mean grey and noise values were obtained from the tube and compared using ANOVA followed by Tukey's test (α = 0.05). RESULTS: Mean grey values were significantly lower and noise was significantly higher when metallic materials were present in the endomass or both the exomass and endomass. Sensitivity, specificity, and AUC were not influenced by the artefacts from the metallic materials irrespective of the arrangement condition. CONCLUSIONS: Exomass-related metal artefacts did not influence the diagnosis of simulated VRF in CBCT.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Fraturas dos Dentes , Artefatos , Humanos , Metais , Rotação , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagemRESUMO
OBJECTIVES: The aim of this study was to compare the accuracy of vertical root fracture (VRF) detection using three tomography devices and two software systems in teeth with different endodontic fillings. METHODS: The sample consisted of 45 premolars divided into 3 groups: No filling (NF, n=15); Gutta percha (GP, n=15) and Metallic Post (MP, n=15). Cone-beam computed tomography (CBCT) images were acquired in Kodak 9000 3D, Orthopantomography 300 (OP300) and PreXion 3D devices, before and after induced root fractures. Two oral radiologists analyzed all images using InVivoDental and e-Vol DX software systems. The analysis was repeated after 15 days in 30% of the sample. Data analysis compared receiver operating characteristic (ROC) curves, as well the areas under the ROC curves. Accuracy, sensitivity, specificity, positive and negative predictive value were calculated according to each tomographic device and software. Intra- and interexaminer reliability were tested using the Kappa coefficient. RESULTS: The highest accuracy was seen in the image set from the PreXion 3D, using InVivo (0.96) or e-Vol DX (0.92) in image analysis. The OP300 device presented a similar performance of the PreXion 3D in teeth with different endodontic fillings. When using e-Vol DX, the accuracy of Kodak 9000 3D improved from 0.62 to 0.74. CONCLUSIONS: The PreXion 3D device is the most accurate when detecting VRF, with a performance similar to the OP300 in endodontic filled teeth. Kodak 9000 3D is indicated for teeth without fillings, with better accuracy using e-Vol DX software.
Assuntos
Fraturas dos Dentes , Tomografia Computadorizada de Feixe Cônico , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Software , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagemRESUMO
AIM: To investigate a potential cause-effect relationship between dentinal microcracks and fracture resistance of mandibular incisors that had not been endodontically treated. METHODOLOGY: Sixty mandibular incisors with circular-shaped canals were selected based on micro-computed tomographic scans to create a homogeneous sample. The cross-sectional images of the specimens were screened to identify and quantify the presence of dentinal microcracks. Then, teeth were embedded in polystyrene resin and subjected to axial compressive loading using a universal testing machine. After fracture, the roots were re-scanned and fractography analysis was performed by inspection of 3D models to verify crack propagation. Spearman's rank correlation was used to assess the correlation between the number of microcracks and force required to fracture. RESULTS: Dentinal microcracks were detected in 79% of the specimens (n = 44). The incidence of microcracks varied between teeth from 6% to 42% of the total slices per sample (average of 14 ± 17%). The number of microcracks per sample varied from 0 to 1605, with an average of 412 ± 484 (median = 221 and IQR 25% = 15/75% = 658). The load at failure values varied from 227 to 924 N, with an average of 560.3 ± 168.1 N (median = 561 and IQR 25% = 458/75% = 694). The Spearman correlation coefficient (rho) equalled 0.065. CONCLUSIONS: There was no cause-effect relationship between the number of dentinal microcracks and the fracture resistance of nonendodontically treated mandibular incisors. The presence and quantity of microcracks did not make these roots more prone to fracture.
Assuntos
Preparo de Canal Radicular , Fraturas dos Dentes , Estudos Transversais , Dentina , Humanos , Laboratórios , Papel (figurativo) , Fraturas dos Dentes/diagnóstico por imagem , Fraturas dos Dentes/etiologia , Microtomografia por Raio-XRESUMO
INTRODUCTION: The aim of this study was to assess 2 cone-beam computed tomographic systems on the detection of artificially induced vertical root fractures (VRFs) and artifact intensity using birooted teeth restored with different intracanal materials. METHODS: The sample consisted of 20 extracted birooted premolars. Root fracture was induced in half of the sample. Seven intracanal material combinations were used in each tooth, 1 at a time: unrestored, gutta-percha, a buccal root with gutta-percha and a lingual root with a fiberglass post, a buccal root with gutta-percha and a lingual root with a metal core fiberglass post, fiberglass posts, metal core fiberglass posts, and NiCr posts. Cone-beam computed tomographic scans were acquired using CS 9000 3D (Carestream Dental Rochester, NY) and OP300 (Instrumentarium Dental Inc, Tuusula, Finland) units. Exposure parameters were fixed at 90 kV and 8 mA. The voxel size and field of view were set at 0.085 mm and 5 × 5 cm for OP300 and 0.076 mm and 5 × 3.75 cm for CS 9000, respectively. Two observers assessed all images using a 5-point confidence scale for VRF detection and a 4-point score for artifact interference. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were compared using 2-way analysis of variance and the Tukey test (α = 0.05). Artifact interference was evaluated by descriptive statistics and the chi-square test. RESULTS: There were significant differences between scanners (P > .05) and among the different intracanal material groups (OP300) (P < .05) for specificity. When a metal post was present in both roots, severe artifact interference was observed in all images. CONCLUSIONS: CS 9000 3D presented better performance than OP300 on VRF detection of endodontically treated teeth. Unrestored teeth and teeth filled with fiberglass posts were considered the groups with the lowest artifact interference and the highest VRF detection results.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Fraturas dos Dentes , Dente não Vital , Finlândia , Guta-Percha , Humanos , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Dente não Vital/diagnóstico por imagemRESUMO
Abstract Objective: To evaluate the influence of cavosurface vestibular bevel (CSVB) application on the clinical success (CS) of class IV restorations of traumatized permanent teeth, the influence of the number of fracture angles and dental trauma recurrence (DTR) on the restorations retention rate (RRR) and incidence of pulp necrosis (PN). Material and Methods: Fifty-seven children and adolescents with enamel and dentin fractures requiring C-IV restorations were randomly allocated in groups with CSVB and without CSVB. The primary outcomes were the CS of restorations, evaluated using modified USPHS criteria, and the incidence of PN after a 6-months follow-up. As secondary outcomes, the influence of the number of fractured angles and the DTR on the RRR and on the incidence of PN were evaluated (p>0.05). Results: Of 57 children and adolescents, 74 teeth were restored, and 71 completed the six-month follow-up analysis. Teeth restored with and without CSVB displayed similar CS as well as the same incidence of PN (p>0.05). The number of fractured angles did not influence the RRR and DTR was not associated with PN (p>0.05). DTR was associated with a lower RRR (p<0.001). Conclusion: Cavosurface vestibular bevel did not influence the clinical success of Class IV restorations or incidence of PN after 6-months follow-up. DTR did not influence the incidence of pulp necrosis, but did negatively influence the restorations retention rate. The number of fracture angles did not influenced in the restorations retention rate.