Clinical indications for digital imaging in dento-alveolar trauma. Part 1: traumatic injuries

Preclinical and Preliminary Evaluation of Perceived Image Quality of AI-Processed Low-Dose CBCT Analysis of a Single Tooth

This study assessed AI-processed low-dose cone-beam computed tomography (CBCT) images for single-tooth diagnosis. Human-equivalent phantoms were used to evaluate CBCT image quality with a focus on the right mandibular first molar. Two CBCT machines were used for evaluation. The first CBCT machine was used for the experimental group, in which images were acquired using four protocols and enhanced with AI processing to improve quality. The other machine was used for the control group, where images were taken in one protocol without AI processing. The dose-area product (DAP) was measured for each protocol. Subjective clinical image quality was assessed twice by five dentists, with a 2-month interval in between, using 11 parameters and a six-point rating scale. Agreement and statistical significance were assessed with Fleiss' kappa coefficient and intra-class correlation coefficient. The AI-processed protocols exhibited lower DAP/field of view values than non-processed protocols, while demonstrating subjective clinical evaluation results comparable to those of non-processed protocols. The Fleiss' kappa coefficient value revealed statistical significance and substantial agreement. The intra-class correlation coefficient showed statistical significance and almost perfect agreement. These findings highlight the importance of minimizing radiation exposure while maintaining diagnostic quality as the usage of CBCT increases in single-tooth diagnosis.

Pattern of Traumatic Dental Injuries and Treatment Receipt among Children Attending the University Dental Hospital in Saudi Arabia

Objective

The aim of this study was to investigate the pattern and distribution of traumatic injuries to primary and permanent anterior teeth in 2-14-year-old pediatric dental patients in AlHassa region of Saudi Arabia.

Methods

The study sample consisted of pediatric dental patients visiting the university dental complex seeking treatment for traumatic dental injuries (TDIs) during the period from February 2022 to April 2023. Data were collected by means of interviewing the children and/or parents regarding the history of trauma and clinical examination for evidence of dental trauma to primary and permanent teeth.

Results

A total of 122 children (184 teeth) including 78 (63.9%) boys and 44 (36.1%) girls sustained traumatic injuries to their teeth. The most common reason for dental trauma was falls, and maxillary right central incisor was the most frequently affected permanent teeth. Enamel-dentine fractures in permanent teeth and luxation injuries among primary teeth were predominantly noted. Majority of the injuries (47.5%) have been found to have not received timely attention for treatment.

Conclusions

Early treatment of dental trauma should be emphasized, and preventive strategies targeted at parents and teachers at the community level are needed to promote and reduce the burden of TDIs.

A review of the iadt 2020 guidelines

Traumatic dental injuries (TDIs) are a relatively frequent occurrence, with roughly a third of adults experiencing a dental trauma at some time in their life.1 TDIs may present to dental professionals working within primary or secondary care settings. Patients presenting at the time of acute injury will require immediate management and careful long term follow up. Patients may also present later reporting a history of TDI, with developing complications and onward management required. To support dental care professionals, the International Association of Dental Traumatology's (IADT) Guidelines are available globally as a standardised tool to aid the assessment, management and follow up of dental trauma. These easy to access guidelines were updated in 2020 with four distinct publications:General Introduction,1 Fractures and Luxations,2 Avulsion of Permanent Teeth,3 and Injuries in the Primary Dentition.4 The current guidelines represent the best evidence based on available literature and expert opinion.1This paper aims to support dental professionals by specifically highlighting and describing updates in guidance, using the 2020 IADT published guidelines. By incorporating the 2020 guidelines into our everyday practice we aim to provide the most appropriate, standardised care, based on the highest level of available evidence to our patients.The full published guidelines are available free online via the IADT website.

Craniofacial disorders and headaches. A narrative review

OBJECTIVES

Craniofacial- and headache disorders are common co-morbid disorders. The aim of this review is to provide an overview of the research discussing craniofacial pain, especially temporomandibular disorders, and its relationship and impact on headaches, as well as suggestions for diagnostic assessment tools and physical therapeutic management strategies.

METHOD

A narrative structured review was performed. A search was conducted in MEDLINE using terms related to craniofacial pain and headaches. Additionally, papers regarding this topic were also extracted from the authors' personal libraries. Any study design (i.e., RCT, observational studies, systematic review, narrative review) that reported the concepts of interest was included, using Covidence. Results were narratively synthesized and described.

RESULTS

From an epidemiological perspective, craniofacial pain and headaches are strongly related and often co-existing. This may be due to the neuroanatomical connection with the trigeminal cervical complex, or due to shared predisposing factors such as age, gender, and psychosocial factors. Pain drawings, questionnaires, and physical tests can be used to determine the cause of pain, as well as other perpetuating factors in patients with headaches and craniofacial pain. The evidence supports different forms of exercise and a combination of hands-on and hands-off strategies aimed at both the craniofacial pain as well as the headache.

CONCLUSION

Headaches may be caused or aggravated by different disorders in the craniofacial region. Proper use of terminology and classification may help in understanding these complaints. Future research should look into the specific craniofacial areas and how headaches may arise from problems from those regions. (249 words).

CBCT in contemporary endodontics

Cone-beam computed tomography (CBCT) is a three-dimensional imaging modality which can aid endodontic diagnosis and treatment planning. While there are guidelines available describing the indications, there are divergent philosophies on when this technology should be applied in clinical practice. This paper reviews the applications of CBCT including the clinical relevance of parameters which can be assessed, highlights the limitations of this technology, and provides guidance on how to maximise its clinical utility.

Retrospective Evaluation of Maxillofacial Fractures With Cone-Beam Computed Tomography

ÖZ Amaç: Bu çalışmanın amacı maksillofasiyal bölgede meydana gelen fraktürlerin yaş ve cinsiyete göre dağılımlarını, lokalizasyonlarını, sayısını, deplasman varlığını, radyolojik özelliklerini Konik Işınlı Bilgisayarlı Tomografi (KIBT) ile retrospektif olarak değerlendirmektir. Gereç ve Yöntemler: Zonguldak Bülent Ecevit Üniversitesi Diş Hekimliği Fakültesi, Ağız Diş ve Çene Radyolojisi Anabilim Dalı’na 2019 ve 2021 yılları arasında travma nedeniyle başvuran 84 hastadan alınan KIBT görüntüleri retrospektif olarak incelenmiştir. Yaş, cinsiyet, fraktür lokalizasyonu, fraktürlerde deplasman varlığı kayıt altına alındı. İstatistiksel analiz için tüm hasta grubuna tanımlayıcı ve frekans analizleri uygulanırken, hastaların yaş ve cinsiyetlerini; fraktür hattı ve fraktür bölgesi ile karşılaştırırken ki-kare testi uygulandı. Bulgular: 60 erkek 24 kadın hasta (E/K, 2,5/1) olmak üzere toplam 84 hastanın maksillofasiyal travma nedeniyle KIBT görüntüsü incelendi. Çalışmada incelenen hasta grubunun yaşları 6 ve 72 arasında değişmekte olup yaş ortalaması 33.17±1.48 olarak belirlendi. Farklı etiyolojik nedenlerden kaynaklı çeşitli lokalizasyonlarda meydana gelen 116 fraktür hattı sayısı radyolojik olarak tespit edildi. İncelenen tüm fraktürlerin 73’ünde deplasman izlenirken kalan 43 fraktür hattında deplasman görülmedi. Meydana gelen fraktürler en sık angulus mandibulada (%22,61:n=19) tespit edildi. En az fraktür mandibula ramus (%3,57; n=3) ve koronoid proseste (%3,57; n=3) görüldü. Sonuçlar: Fraktür hatlarının varlığının, lokalizasyonlarının ve kırık parçalarının yer değişiminin doğru radyografik teknikler aracılığıyla tespit edilmesi, gerekli tedavi prosedürlerinin uygulanması açısından önem taşımaktadır. İki boyutlu radyografilerin kullanımının yetersiz kaldığı durumlarda KIBT gibi üç boyutlu görüntüleme yöntemleri tercih edilmelidir. Anahtar Kelimeler: Konik Işınlı Bilgisayarlı Tomografi, Fraktür, Mandibula, Teşhis

Detectability of simulated apical lesions on mandibular premolars and molars between radiographic intraoral and cone-beam computed tomography images: an ex vivo study

Adequate endodontic diagnostic is essential when making a therapy decision. Radiographic imagining acquisition methods (IAMs) are fundamental apical lesions of endodontic (ALE) origin diagnose tool. Thus, the aim of this research was to compare the simulated apical lesions (SALs) diagnose potential of digital intraoral radiography (DIR) and cone-beam computed tomography (CBCT), if there is a relationship between the IAMs, SALs-depth and their correct diagnose likelihood in human mandibular specimens’ datasets. 1024 SALs were prepared in cancellous and cortical bone with different penetration depths. The SALs-stages were radiographed with CBCT and DIR. The IAMs were randomly evaluated by 16 observers in two trials. Possible SAL findings were analyzed according to a five-point scale. The null hypothesis established that SALs detection accuracy does not differ between CBCT and DIR. Significantly differences (first 0.935 and second trial 0.960) were found for the CBCT area under the curve when compared with the DIR (first 0.859 and second trial 0.862) findings. SALs of smaller size were earlier detected by CBCT. In SALs without cortical involvement the probability of detection increased from 90 to 100%. The SALs-depth had the highest detectability influence on cancellous bone lesions and CBCT SALs detectability was 84.9% higher than with DIR images. The CBCT diagnose reproducibility was higher than the one of DIR (Kappa CBCT 75.7–81.4%; DIR 53.4–57.1%). Our results showed that CBCT has a higher SALs IAM diagnosing accuracy and that SALs detection accuracy incremented as the SALs-size increased.

Does clinical experience with dental traumatology impact 2D and 3D radiodiagnostic performance in paediatric dentists? An exploratory study

Background

The aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists’ performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D).

Materials and methods

Both 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer’s self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling.

Results

Overall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P < 0.05). This was not the case regarding interpretation of the findings. Self-assessed confidence was significantly higher in more experienced dentists, both when using 2D and 3D images (P < 0.05).

Conclusion

There was no proof that paediatric dentist’s higher experience with TDI is associated with better radiodiagnostic performance. Neither could it be proven that the use of Cone Beam Computed Tomography (CBCT) contributes to an improved interpretation of findings, for any experience level. More experienced dentists feel more confident, irrespective of the imaging modality used, but this does not correlate with improved performance. The overall poor performance in image interpretation highlights the importance of teaching and training in both dental radiology and dental traumatology.

Re-evaluating the need for orthopantomography in the management of mandibular trauma: is computed tomography enough?

BACKGROUND

Mandibular fractures are frequent indications for computed tomography (CT) and orthopantomography (OPG) scans in emergency rooms. Numerous studies found CT to have higher sensitivity and enhanced accuracy compared to OPG in diagnosing mandible fractures. Controversy exists regarding additional need for OPG when evaluating dental trauma. This study investigates whether OPG adds diagnostic value to CT in mandibular trauma and whether additional OPG significantly alters management.

METHODS

A retrospective chart review identified 100 patients ≥ 18 years of age with known mandibular trauma who received CT and OPG in the emergency department between May 2015 and January 2020. All patients demonstrated a fracture in at least one study. CT and OPG studies were anonymized and randomized. A single attending surgeon evaluated mandible fracture and dental trauma characteristics and subsequently compared findings.

RESULTS

One hundred patient CT and OPG scans were reviewed. CT detected mandible fractures in all patients and OPG detected fractures in 93% (p = 0.01). Twenty-eight patients had different findings between scans. CT demonstrated 1 or more additional fracture(s) than OPG in 20 patients and dental trauma not seen on OPG in 4. OPG detected 1 fracture and no dental trauma that was not seen on CT. CT drove treatment-determining differences in 17 cases and OPG in 0 cases.

CONCLUSIONS

CT appears efficacious in detecting clinically significant mandible fractures and dental trauma with little additional benefit from OPG in emergency settings. Helical CT may be the only imaging necessary in evaluating patients with such trauma.

Conservative endodontic management using a calcium silicate bioceramic sealer for delayed root fracture: A case report and review of the literature

BACKGROUND

The success rate of conservative endodontic management for root fracture varies greatly based on different methods used. It has been rarely reported that calcium silicate-based materials are applied in root fracture treatment.

CASE SUMMARY

A 38-year-old male patient presented with spontaneous pain from the upper left anterior teeth for 1 wk. The spontaneous pain was subsequently relieved, but pain on mastication persisted for 3 d. The patient had a dental trauma from a boxing match 15 years ago. Cone beam computed tomography showed that the maxillary left central incisor had oblique fracture lines and a radiolucent lesion around the fracture line. The tooth was diagnosed with an oblique root fracture with no healing and symptomatic apical periodontitis. In the following conservative endodontic management, the coronal and apical fragments of the canal both were chemo-mechanically prepared and obturated using a single cone gutta-percha with iRoot SP (Innovative BioCreamix Inc, Vancouver, Canada), a new calcium silicate-based bioceramic root canal sealer. At follow-ups at 1, 6, 12, and 24 mo, the patient was asymptomatic and the radiolucency around the fracture line was healing radiographically.

CONCLUSION

Conservative root canal treatment is an alternative treatment in some cases of oblique root fracture with no healing. The application of bioceramic sealers and single core obturation techniques may also be essential to obtain an excellent outcome.

Paediatric dentist's ability to detect and diagnose dental trauma using 2D versus 3D imaging

BACKGROUND

Visualisation of the third dimension has been reported to increase effectiveness of correctly diagnosing traumatic dental injuries.

AIM

To assess the ability of paediatric dentists to detect and diagnose Traumatic Dental Injuries (TDI) using two different imaging modalities, intraoral radiographs (2D) and CBCT scans (3D). In addition, observer's confidence regarding the obtained diagnosis, using either technique, was assessed.

MATERIAL AND METHODS

Both 2D and 3D images of 20 dental trauma cases in children were presented in random order to a panel of thirteen paediatric dentists. Observers received instructions for the screening of the images for radiographic findings related to dental trauma, using structured scoring sheets for 2D and 3D images. Observed data were compared to those recorded by two experienced benchmark observers. A ten-point scale was used for assessing observer's confidence regarding their final diagnosis using 2D versus 3D images.

RESULTS

Performance of individual observers showed wide variation. Statistical significance was reached for correctly detected and correctly diagnosed findings (p = 0.02), in favor of 3D. Most of the observers reported comparable confidence using 2D and 3D, two observers were more confident using 3D and one observer was more confident using 2D.

CONCLUSIONS

Paediatric dentist's ability to detect and diagnose findings in patients with TDI was higher on 3D images. Most observers showed a similar confidence score of their diagnostic performance both on 2D and on 3D.

Diagnosis and Management of Traumatic Dental Injuries Using Intraoral Radiography and Cone-beam Computed Tomography: An In Vivo Investigation

INTRODUCTION

The aim of this study was to compare periapical radiographs (PRs) and upper standard occlusal (USO) radiographs with cone-beam computed tomographic (CBCT) imaging on clinicians' confidence in the diagnosis and management of traumatic dental injuries (TDIs).

METHODS

This study included 35 maxillary anterior teeth from 25 patients with at least 1 PR (parallax view) and a CBCT scan. Fourteen patients also had a USO radiograph. Ten examiners selected a diagnosis and treatment plan, which were compared with a reference standard. Sensitivity, specificity, positive and negative predictor values, and receiver operating characteristic analysis were used to determine the diagnostic accuracy.

RESULTS

CBCT imaging exhibited significantly higher sensitivity than both conventional radiographic techniques combined (PRs and PRs + USO radiographs) for all diagnoses (TDI: 99% vs 84%, lateral luxation: 80% vs 34%, extrusions: 92% vs 42%, and cortical plate fracture: 58% vs 1%) other than horizontal root fractures in which the results were close to statistical significance (88% vs 69%). CBCT imaging was significantly more accurate for all diagnoses (TDI: 91% vs 70%, lateral luxations: 83% vs 61%, extrusive luxations: 92% vs 68%, alveolar cortical plate fractures: 78% vs 48%, and horizontal root fractures: 93% vs 82%). Examiners had the most confidence with CBCT imaging and the least confidence in diagnosing using PRs + USO radiographs than with PRs alone. Agreement with management plans was significantly better using CBCT imaging compared with PRs and PRs + USO radiographs.

CONCLUSIONS

CBCT imaging improved the clinical diagnosis of TDIs. The addition of USO radiographs to PRs did not improve the diagnosis of TDIs in this investigation. CBCT imaging improved confidence in the diagnosis of TDI cases and treatment planning compared with conventional radiography.

Applications of cone beam computed tomography in endodontics

Background

Endodontic disease can adversely affect the quality of life and therefore early diagnosis and consequent timely treatment is of paramount importance for the Endodontist. Radiology is an essential component in treatment planning, disease monitoring and assessment of treatment outcome. Periapical radiographs and panoramic radiography are frequently utilised but they provide only two-dimensional representation of three-dimensional structures. The advent of cone beam computed tomography (CBCT) offers three-dimensional accuracy of the hard tissue images with a reasonable cost and this has revolutionised imaging of the dentomaxillofacial structures. This imaging system has been seen to overcome some limitations of conventional radiography, as brought out in this review. The improvement in the accuracy is, however, accompanied at the cost of increased radiation exposure to the patient. Nevertheless, smaller areas of exposure are normally appropriate for endodontic imaging, and adjustment in the exposure parameters can further moderate the effective dose (Loubele et al. 37(6):309-18, 2008).

Aims and objectives

The aim of this review is to present the pertinent literature on the various applications of cone beam computed tomography in the field of endodontics.

Methods

Literature was electronically searched on the following sources; Medline and Keats Library. Further, a manual search was performed on the following journals: International Endodontic Journal, Journal of Endodontics, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Endodontology, Journal of Dental Research, European Journal of Oral Sciences & Odontology and Dentomaxillofacial Radiology. A preliminary search was performed to gain an idea of the available literature using keywords ‘Cone Beam Computed Tomography’ to view the volume of the literature evident and identify questions to be addressed in this review. The initial search showed 243 potential articles. After scrutinising the titles and abstracts of the retrieved articles, 70 relevant studies were reviewed in full text. Furthermore, ‘published guidelines on the use of CBCT’ were also searched so as to include the results as an additional source material. All the articles eligible to be included in the review were in the English language and ranged from the year 1960 to the present. Also all the studies reviewed were based on the various uses of cone beam computed tomography in the field of endodontics. The keywords used to search were ‘Cone Beam Computed Tomography (CBCT)’, ‘Conventional radiography’, ‘Applications of CBCT in endodontics’, ‘CBCT and tooth morphology’, ‘CBCT and apical periodontitis’, ‘CBCT and vertical root fractures’, ‘CBCT and resorption’, ‘CBCT and pre-surgical assessment’, ‘CBCT and dento-alveolar trauma’ and ‘CBCT and endodontic outcome’.

Results

Every case is unique and CBCT should be considered only after studying each case individually. CBCT imaging needs to be adopted or used where information from conventional imaging systems is either inadequate for the management of endodontic problems or inconclusive. Having said that, it is safe to state that CBCT imaging has the potential to become the first choice for endodontic treatment planning and outcome assessment, especially when new scanners with lower radiation doses and enhanced resolution would be available.

Lateral Luxation of Incisor - A Case Report of Using a New Cone-Beam Computed Tomography Software and Reposition Guideline

Abstract Lateral luxation injuries are one of the most severe periodontal injuries in dental trauma. The correct diagnosis followed by repositioning of the tooth on the right position is fundamental for the periodontal ligament healing. This study reported a clinical case of lateral luxation of maxillary central incisor involving a new cone beam computed tomography (CBCT) software for reconstruction (e-Vol DX) to confirm the lateral luxation after no conclusive dental trauma injury definition by using conventional exam. The lateral luxation injury was digitally reduced by insertion of tooth back to its alveolus, and at the same session, the tooth was stabilized with a rigid splint and further changed to a semi-rigid nylon splint. During the pulpal status monitoring, the pulp was diagnosed necrotic, then the root canal was treated to prevent root resorption. External office-bleaching and restorative procedure was performed. The 4-years follow up and new imaging exam and digital reconstruction confirmed bone healing and no complication. CBCT images analyzed by eVol DX can be used to determine and to guide lateral luxation treatment.

Detection of Simulated Periradicular Lesions in Porcine Bone by Optical Coherence Tomography

INTRODUCTION

The accurate detection of periradicular lesions located under a nonperforated cortical plate poses a challenge in endodontic microsurgery. Optical coherence tomography (OCT) is a noninvasive imaging method that has been successfully used in many dental applications. In this study, we investigated if spectral-domain OCT (SD-OCT) could be used to determine simulated periradicular lesions.

METHODS

Twenty-eight cavities with different depths were prepared on bone plates obtained from 5 porcine mandibles. Both 3-dimensional SD-OCT imaging and micro-computed tomographic (micro-CT) imaging were used to image the bottom of the air-filled cavity and the cavity filled with soft tissue for comparison. The residual bone thickness under the cavity was measured by SD-OCT and micro-CT imaging and compared using the Pearson correlation.

RESULTS

The air-filled lesions were readily detected; yet, filling of the cavity with soft tissue diminished the appearance of the lesion boundaries in the SD-OCT images. The optical values of residual bone thickness obtained from SD-OCT ranged from 0.14-2.11 mm, which corresponded to the range of 0.26-1.18 mm from micro-CT imaging. A strong correlation was found between the 2 imaging modalities (r = 0.96; range, 0.94-0.98). The slope (1.56) of the linear regression matched the bulk refractive index of bone tissues.

CONCLUSIONS

SD-OCT allows for visualization of the lesion boundaries via intact bone surfaces and may be a promising, practical, and nonirradiating adjunct tool for chairside localization of periradicular lesions in bone.

Cone-beam computed tomography imaging of dentoalveolar and mandibular fractures

Three-dimensional imaging methods have an important role in the diagnosis of dentomaxillofacial fractures that can not be seen on the plain films. Cone-beam computed tomography (CBCT) is one of the three-dimensional imaging methods and has facilitated dental professionals' access to cross-sectional imaging. CBCT units allow different technical parameters and the data acquired by CBCT, can be reformatted. Osseous structures are correctly examined with this technique but the technique is not useful for the examination of soft tissues. Therefore, the purpose of its use should be based on the expected diagnostic gain. The aim of this review is to present the use of CBCT with different multi-planar reformatted sections and three-dimensional reconstructions of dentoalveolar and mandibular fractures.

Cone beam computed tomography in Endodontics - a review of the literature

The use of cone beam computed tomography (CBCT) in the diagnosis and/or management of endodontic problems is increasing and is reflected in the exponential rise in publications on this topic in the last two decades. The aim of this paper is to: (i) Review current literature on the endodontic applications of CBCT; (ii) Based on current evidence make recommendations for the use of CBCT in Endodontics; (iii) Highlight the areas in which more research is required.

Accuracy in Detecting Artificial Root Resorption in Panoramic Radiography versus Tomosynthetic Panoramic Radiographs

INTRODUCTION

The aim of this study was to compare the detection accuracy of panoramic radiography (PAN) and tomosynthetically reconstructed panoramic radiography (TPAN) for the detection of artificial external root resorption in a multiobserver approach.

METHODS

Thirty-six teeth in 5 dry human mandibles were prepared with artificial root resorption by means of diamond bur defects (0.8, 1.0, and 1.2 mm). The samples were exposed in a digital panoramic radiographic unit in a predetermined appropriate position using a wax layer (6.25 mm thickness) as soft tissue scatter equivalent and a water-filled plastic bottle to mimic the absorption of the cervical spine. This resulted in 5 panoramic radiographs and 5 tomosynthetically reconstructed panoramic radiographs, which were evaluated by 13 observers regarding the visibility of artificial root resorption by means of a 5-point confidence scale. Seven of these observers repeated the process after a minimum interval of 30 days. A receiver operating characteristic analysis was conducted with the area beneath the receiver operating characteristic curves (Az) as the main accuracy parameter. Inter- and intrarater reproducibility were calculated by means of the intraclass coefficient using a 2-way random effects model.

RESULTS

The mean Az for TPAN (0.76; median = 0.77; range, 0.70-0.85) was slightly yet significantly higher (P < .05, Wilcoxon test) than for PAN (0.75; median = 0.75; range, 0.69-0.82). The Az values for both methods were highest in the premolar and lowest in the molar region. The mean sensitivity for TPAN was 0.54 (specificity = 0.96) and 0.50 (specificity = 0.96) for PAN. Intraclass coefficient values indicated that intra- (PAN: mean = 0.53 ± 0.088; TPAN: mean = 0.55 ± 0.102; P < .05,Wilcoxon test) and interrater (PAN: mean = 0.47 [0.43-0.51], TPAN: mean = 0.47 [0.42-0.51]) reproducibility were both moderate.

CONCLUSIONS

From our ex vivo study, we observed slightly higher accuracy in the detection of artificial root resorption from tomosynthetically reconstructed panoramic radiographs compared with conventional digital panoramic radiographs.

Guidelines for the Management of Traumatic Dental Injuries: 1. Fractures and Luxations of Permanent Teeth

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Endodontic Management of Mandibular Second Premolar with Type IX Canal Configuration Using Cone-Beam Computed Tomography as a Diagnostic Aid: A Rare Case Report

Successful endodontic treatment requires knowledge of the root canal anatomy, cleaning, and shaping followed by three-dimensional filling of the root canals. With the advent of newer diagnostic aids such as cone-beam computed tomography (CBCT) and magnifying tools such as dental operating microscope and loupes, it has become easier for an operator to identify the root canal anatomy of teeth and reduce the risk of procedural accidents and failures. Variations in root canal configuration require modification in access cavity preparation, disinfection, and obturation of the canals. Mandibular premolars are identified to have unusual root and canal anatomy which increases the risk of endodontic failure when additional canals remain undiagnosed. The present case report elaborates successful endodontic management of a mandibular second premolar with Type IX root canal configuration using CBCT as a diagnostic tool.

New and emerging patient-centered CT imaging and image-guided treatment paradigms for maxillofacial trauma

This article reviews the conceptual framework, available evidence, and practical considerations pertaining to nascent and emerging advances in patient-centered CT-imaging and CT-guided surgery for maxillofacial trauma. These include cinematic rendering-a novel method for advanced 3D visualization, incorporation of quantitative CT imaging into the assessment of orbital fractures, low-dose CT imaging protocols made possible with contemporary scanners and reconstruction techniques, the rapidly growing use of cone-beam CT, virtual fracture reduction with design software for surgical pre-planning, the use of 3D printing for fabricating models and implants, and new avenues in CT-guided computer-aided surgery.

Role of Cone Beam Computed Tomography in Diagnosis and Treatment Planning in Dentistry: An Update

Accurate diagnosis and treatment planning are the backbone of any medical therapy; for this reason, cone beam computed tomography (CBCT) was introduced and has been widely used. CBCT technology provides a three-dimensional image viewing, enabling exact location and extent of lesions or any anatomical region. For the very same reason, CBCT can not only be used for surgical fields but also for fields such as endodontics, prosthodontics, and orthodontics for appropriate treatment planning and effective dental care. The aim and clinical significance of this review are to update dental clinicians on the CBCT applications in each dental specialty for an appropriate diagnosis and more predictable treatment.

Use of Cone-Beam Computed Tomography in the Diagnosis and Treatment of an Unusual Canine Abnormality

Diagnosis and treatment planning are important for successful endodontic treatment. We report a 24-year old male who presented to the Government Dental College in Kozhikode, Kerala, India, in 2015 with pain in his right upper canine. A digital periapical radiograph indicated the presence of a supernumerary tooth superimposing the root of the canine. However, cone-beam computed tomography (CBCT) confirmed that the supernumerary tooth was an illusion and that the canine root had a sharp invagination involving the labial and pulpal dentin surfaces, with evidence of periapical bone destruction. A blunt resection was performed at the level of the invagination and the resected end was filled with a dentin substitute. At a one-year follow-up, the patient was asymptomatic and the periapical region appeared to be healing well. This report highlights the importance of CBCT in visualising abnormal canine morphology, thus allowing appropriate endodontic treatment.

Contemporary imaging for the diagnosis and treatment of traumatic dental injuries: A review

Traumatic dental injuries (TDI) have an array of presentations. Diagnostic challenges are common and clinicians' ability to correctly identify specific injuries dictates the optimal course of treatment(s). The aim of this review was to outline and assess all dental imaging techniques and their applications to traumatic dental injuries. A particular interest is given to the advancement of 3D imaging techniques and their role in diagnosis and treatment planning. The benefits of achieving a more accurate diagnosis are paramount to perfecting clinical judgments and outcomes.

Alveolar Bone Fracture: Pathognomonic Sign for Clinical Diagnosis

Aim:

Dental injuries, especially luxation and avulsion, are common. Dental trauma can cause alveolar bone fracture that can lead to tooth loss and malocclusion. Single tooth alveolar bone fractures are difficult to identify unless it protrudes through the overlying mucosa and can be visualized. Pain, malocclusion, and tooth mobility provide signs of suspected alveolar bone fractures. Integrity of the proximate alveolar bone should be examined for fractures where avulsion, luxation, or other tooth trauma is detected. Any suggestion of alveolar fractures should be further investigated with an appropriate radiograph.

Summary:

This case report shows a pathognomonic sign that detects and diagnosis single tooth alveolar bone fractures, i.e., a localized hematoma crossing the attached gingiva from the free gingival margin to the vestibular mucosa. This should serve as a warning for localized alveolar bone fracture.

A visualized hematoma and gentle, careful palpation may help detect covered fractures when the overlying mucosa is not perforated.

Cone Beam CT in Diagnosis and Surgical Planning of Dentigerous Cyst

Diagnosis and preoperative planning are critical in the execution of any surgical procedure. Panoramic radiography is a routine method used in dentistry to assist clinical diagnosis; however, with this technique 3D anatomical structures are compressed into 2D images, resulting in overlapping of structures which are of interest in the diagnosis. In this study we report the case of a patient who presented with a dentigerous cyst of expressive dimensions in the body of the mandible region. The surgery was planned and executed after observing the margins of the lesion by Cone Beam Computed Tomography (CBCT). We conclude that CBCT is a precise method to help diagnosis; it provides greater accuracy in surgical treatment planning through 3D image display, allowing more effective results.

Effects of voxel size and resolution on the accuracy of endodontic length measurement using cone beam computed tomography

An accurate determination of the working length is indispensable for successful endodontic treatment. The aim of this study was to determine the influence of the voxel size and resolution of CBCT on measuring root canal working length. Thirty extracted single-rooted permanent teeth were used for this study. The working lengths of the teeth were determined by a researcher inserted a K-file into each canal until the tip became visible through the major foramen. The file was withdrawn until its tip was seen at the level of the coronal-most border of the major foramen under. The rubber stop was adjusted to the occlusal reference and the distance from the stop to the false tip was measured with digital calipers and recorded as the actual working length. The CBCT images were obtained with a Planmeca ProMax 3D Mid (Planmeca, Helsinki, Finland) using four sets of settings: from voxel size 0.5mm to voxel size 1.0mm. These measurements were compared with actual lengths (as a control group) using Analysis of Variance and the Dunnett Post Hoc Test. The Pearson correlation coefficient (r) and 95% confidence intervals were calculated to compare all measurement methods. The significance level was set at P<0.05. No significant difference was found among CBCT groups and working length. A highest correlation was found between the actual length and smallest voxel size and highest CBCT measurements (r=0.94). CBCT imaging can be used endodontic working length measurement and the smallest voxel size and highest resolution yielded more accurate results.

Three-Dimensional Analysis of the Anatomical Characteristics and Dimensions of the Nasopalatine Canal Using Cone Beam Computed Tomography

AIM

Placement of implants in the maxillary anterior region needs to be preceded by careful analysis of the area as in addition to the functional aspect the esthetic outcome is of prime importance. This descriptive study evaluated anatomical characteristics and dimensions of the nasopalatine canal (NC) from coronal, sagittal and axial aspects using cone beam computed tomography (CBCT) giving it a three dimensional analytical approach. Also the dimensions of the corresponding buccal bone plate (BBP) of the alveolar process were evaluated. Additionally, the influence of age and gender on these characteristics was also analyzed.

METHODS

A total of 81-CBCT scans of patients with one or no upper central incisors present were selected. Sagittal slices were used for measurements of the NC and BBP and to evaluate shape of the NC. Coronal slices were used to assess NC shape and axial slices to assess number of incisive foramina and foramina of Stenson.

RESULTS

The most prevalent canal shape was: cylindrical (48.14 %) in sagittal aspect; Y-type (49.38 %) in coronal aspect; and one incisive foramen with two Stenson's foramina [1-(2-5)] (60.49 %) in axial aspect. Mean NC length was 11.13 ± 3.23 mm; statistically significant differences were detected between genders (p < 0.001). Mean nasopalatine angle was 69.32° ± 7.70. Mean BBP length was 17.12 ± 3.97 mm and mean BBP width was 5.71 ± 1.29 mm, significant differences were detected between genders (p < 0.001).

CONCLUSION

The current study demonstrates variability of the NC in terms of anatomical characteristics and dimensions; hence, a thorough CBCT analysis is highly recommended for better surgical outcomes and to reduce the post-operative complications in implant dentistry.

Evaluation of the Root and Canal Morphology of Maxillary Permanent Molars and the Incidence of the Second Mesiobuccal Root Canal in Greek Population Using Cone-beam Computed Tomography

Objectives: Cone-Beam Computed Tomography is an alternative imaging technique which has been recently introduced in the field of Oral &amp; Maxillofacial Radiology. It has rapidly gained great popularity among clinicians due to its ability to detect lesions and defects of the orofacial region and provide three-dimensional information about them. In the field of Endodontics, CBCT can be a useful tool to reveal tooth morphology irregularities, additional root canals and vertical root fractures. The objective of this study is to evaluate the root and root canal morphology of the maxillary permanent molars in Greek population using Cone-Beam Computed Tomography. Materials and Methods : 273 cone-beam computed tomography (CBCT) images were examined. The number of roots and root canals of the first and second maxillary molars were evaluated. Root canal configuration was classified according to Weine’s classification by two independent examiners and statistical analysis was performed. Results : A total of 812 molars (410 first and 402 second ones) were evaluated. The vast majority of both first and second molars had three roots (89.26% and 85.07%, respectively). Most first molars had four canals, while most second molars had three. In the mesiobuccal roots, one foramen was recorded in 80.91% of all teeth. Other rare morphologic variations were also found, such as fusion of a maxillary second molar with a supernumerary tooth. Conclusion : Within the limitations of this study, it can be concluded that more attention should be given to the detection of additional canals during root canal treatment in maxillary permanent molars. Towards this effort, CBCT can provide the clinician with supplemental information about the different root canal configurations for successful Root Canal Treatment.

Diagnosis of acute dental trauma: the importance of standardized documentation: a review

In 1985 Andreasen and Andreasen published a paper on the diagnosis of luxation injuries and outlined the importance of standardized clinical, radiographic, and photographic techniques. Now 30 years later, these recommendations remain current in the International Association of Dental Traumatology (IADT) guidelines for the management of dental trauma and describe circumstances surrounding the time of injury, the extent of trauma (e.g., type of luxation injury), healing potential (e.g., stage of root development) as well as information concerning subsequent treatment. The purpose of this review was to include findings for other types of trauma and to discuss more recent studies that augment and/or improve on the original findings from 30 years ago. The present review discusses the use of a standardized clinical registration (pulpal sensibility testing, laser Doppler flowmetry, mobility testing), radiographic survey, and photographic registration of the traumatized patient. Moreover, the value of digital radiographs and recent developments in computer tomography with respect to possible enhancement of the trauma diagnosis are discussed.

Management of an Intruded Tooth and Adjacent Tooth Showing External Resorption as a Late Complication of Dental Injury: Three-Year Follow-Up

Treatment and prognosis of intrusive luxation can vary depending on the age of the patient, type of dentition, stage of root development, and time and severity of the trauma. Some studies have demonstrated that intrusions of up to 3.0 mm have an excellent prognosis, whereas teeth with severe intrusion or teeth that are intruded more than 6.0 mm present an unfavorable prognosis because of the occurrence of inflammatory resorption and pulp necrosis. The aim of this case report is to present an 11-year-old male patient with complete intrusion of the permanent maxillary left lateral incisor, associated with the adjacent central tooth presenting external resorption, treated by immediate surgical repositioning and root canal treatment with a favorable prognosis. After long-term (3-year) clinical and radiographic follow-up, the teeth appeared normal and the patient was pleased with the outcome.

Dilaceration and Eruption Disturbances in Permanent Teeth: A Sequelae of Trauma to Their Predecessors-Diagnosis and Treatment Using Cone Beam CT

Alterations in the morphology of permanent teeth following trauma to their predecessors is a challenging task for diagnosis and it may require advanced imaging techniques. Newer imaging modalities have replaced the conventional radiological procedures, as they allow 3D reconstruction images and views which are free of superimposition. Cone Beam CT (CBCT) offers a three-dimensional view, which the conventional two-dimensional dental radiography fails to provide. The current article highlights the advantages of CBCT which are seen in evaluation of the morphological variations and eruptive disturbances in the permanent teeth, as sequelae to trauma in their predecessors.

Three cases of elongated mandibular coronoid process with different presentations

Abnormal elongation of the mandibular coronoid process is rare and its etiology is not yet elucidated. The aim of this report is to demonstrate and discuss the relationship between elongated mandibular coronoid process and limitation of mouth opening with cone beam computed tomography. Although the clinical characteristic of elongation of the coronoid process is mandibular limitation, in this report, one case had problem with mouth opening. Axial scans revealed that the distance between the coronoid process and the inner face of the frontal part of the zygomatic bone may cause limitation in mouth opening. In conclusion, instead of the length, the distance between the coronoid process and the inner face of the frontal part of the zygomatic bone may be the actual reason for limitation of mouth opening. This may prevent misdiagnosis.

Clinical utility of dental cone-beam computed tomography: current perspectives

Panoramic radiography and computed tomography were the pillars of maxillofacial diagnosis. With the advent of cone-beam computed tomography, dental practice has seen a paradigm shift. This review article highlights the potential applications of cone-beam computed tomography in the fields of dental implantology and forensic dentistry, and its limitations in maxillofacial diagnosis.

Evaluation of the nasopalatine canal and variations with cone-beam computed tomography

PURPOSE

Although nasopalatine canal (NPC) is one of the most important anatomical structures in premaxillary region, few documents are available with regard to anatomic variations, size, and morphology of NPC in the literature. In recent years, the need for radiological identification of anatomical structures has grown with increased dental implant applications in anterior maxillary region with higher esthetic expectations. This study aimed at investigating the NPC's shape and anatomical variations by cone-beam computed tomography (CBCT) in the Turkish society, in a particular region.

METHODS

A total of 500 individual CBCT images were investigated in terms of morphological, dimensional, and anatomical features of NPC. In addition, the width of incisive foramen (IF) and foramina of Stenson were evaluated.

RESULTS

There was no statistically significant difference (p = 0.234) between women and men in terms of NPC shape. Morphological assessment of NPC revealed that 38.78 % of NPCs were hourglass-like in shape, 27.35 % of canals were funnel-shaped, 9.18 % of canals were conical shaped, and 8.25 % of canals were cylindrical shaped. The mean IF width and NPC length was found as 5.06 and 12.59 mm, respectively. And the mean canal length was found significantly longer in men than women (p < 0.001).

CONCLUSION

It has been shown that NPC has a lot of anatomical variations with regard to its dimensions as well as its morphological appearance. Therefore, identification of the anatomical structure of this region with two- and three-dimensional imaging techniques maybe thought to be important in facilitating surgical management and preventing possible complications.

In Vitro Detection of Dental Root Fractures with Cone Beam Computed Tomography (CBCT)

BACKGROUND

Since the diagnosis of non-displaced longitudinal fractures present difficulties for the dentist, three-dimensional evaluation is necessary.

OBJECTIVES

The aim of this study is to demonstrate the accuracy of cone beam computed tomography (CBCT) in detecting dental root fractures in vitro.

MATERIALS AND METHODS

An in vitro model consisting of 210 recently extracted human mandibular teeth was used. Root fractures were created by mechanical force. The teeth were placed randomly in the empty dental alveoli of a dry human mandible and 15 different dental arcs were created. Images were taken with a unit Iluma ultra cone-beam CT scanner (Imtec Corporation, Germany). Three dental radiologists separately evaluated the images.

RESULTS

According to the fracture types and fracture presence, there was an overall statistically significant agreement between the key and readings. Kappa values for intra observer agreement ranged between 0.705 and 0.804 indicating that each observer gave acceptable ratings for the type and presence of fractures.

CONCLUSIONS

Detailed information about root fractures may be obtained using CBCT.

CBCT study of root and canal morphology of permanent mandibular incisors in a Chinese population

OBJECTIVE

To evaluate root canal morphology of permanent mandibular incisor teeth in a Chinese population using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

CBCT images of Chinese patients were collected and 1553 permanent mandibular incisors in the images were included. The following observations on the included teeth were to determine the number of roots, root morphology and canal configuration. The root canal configurations were classified. The effect of gender on the incidence of the second canal was investigated.

RESULTS

Of permanent mandibular incisors, 86.8% had a single root with single canal. Mandibular lateral incisors (17.5%) had a higher incidence of a second canal compared with mandibular central incisors (8.9%) (p = 0.000). A slightly higher percentage of incidence of a second canal was found in males (14.6%) than in females (11.9%) (p = 0.129).

CONCLUSIONS

Permanent mandibular incisors with two canals had a relatively low incidence in this Chinese population. The incidence of a second canal did not differ between males and females. CBCT is a valuable aid during root canal treatment.

Comprehensive management of a complex traumatic dental injury

A 24-year-old female patient presented with complaint of palatal swelling and a sinus tract facial to tooth #22. She reported an injury to the tooth 15 years earlier and no recollection of treatment, although there was evidence of an endodontic access into the crown. Radiographically the root appeared to have stopped developing, and it was associated with a large periapical lesion. After 3 unsuccessful attempts at apexification using calcium hydroxide (CH), further examination including use of cone-beam computed tomography (CBCT) was carried out. The latter allowed for better evaluating the situation and for better planning a more comprehensive treatment plan to include surgical removal of the apical lesion. The large radiolucent area extended from tooth #21 to #23. Using a dedicated software tool developed to be used in conjunction with CBCT, volumetric assessment of the lesion was carried out for healing follow up. The root end was filled from the apical direction with newly developed accelerated silicate cement 4-5 mm into the apical part of the canal. Subsequently, the rest of the canal was filled with the same type of cement. At the 1-year postsurgical follow up, the tooth remained asymptomatic, and using the CBCT volumetric program, bony healing could be demonstrated.

Assessment of the stylohyoid complex with cone beam computed tomography

BACKGROUND

Orientation of the stylohyoid complex (SHC) may be important for evaluation of the patient with orofacial pain or dysphagia.

OBJECTIVES

Our purpose was to assess the length and angulations of SHC using cone beam computed tomography (CBCT).

PATIENTS AND METHODS

In this study, 3D images provided by CBCT of 69 patients (36 females, 33 males, age range 15-77 years) were retrospectively evaluated. All CBCT images were performed because of other indications. None of the patients had symptoms of ossified SHC. The length and the thickness of SHC ossification, the anteroposterior angle (APA) and the mediolateral angle (MLA) were measured by maxillofacial radiologists on the anteroposterior, right lateral and left lateral views of CBCT. Student's t test, Pearson's correlation and Chi-square test tests were used for statistical analysis.

RESULTS

According to the results, the mean length of SHC was 25.3 ± 11.3 mm and the mean thickness of SHC was 4.8 ± 1.8 mm in the study group. The mean APA value of SHCs was 25.6° ± 5.4° and the mean MLA value was 66.4° ± 6.7°. A positive correlation coefficient was found between age and APA (r = 0.335; P < 0.01); between thickness and APA (r = 0.448; P < 0.01) and also between length and thickness was found (r=0.236).

CONCLUSION

The size and morphology of the SHC can be easily assessed by 3D views provided by CBCT. In CBCT evaluation of the head and neck region, the radiologist should consider SHC according to these variations, which may have clinical importance.