Prevalence of middle mesial root canal in mandibular molars in an Iranian population: A micro-computed tomography study

Background

Knowledge about the anatomic variations of the root canal system and their prevalence is necessary for clinicians to ideally clean the root canal system. The anatomic complexity of the root canal system is one of the reasons for its inadequate debridement, resulting in residual microorganisms and root canal treatment failure. The present study aimed to evaluate the prevalence of middle mesial root canals in mandibular molars in an Iranian population.

Materials and Methods

The samples in the present descriptive/cross-sectional study consisted of mandibular first and second molars (n = 100, with 50 first and 50 s molars). A convenient sampling method was used to collect samples. The teeth were mounted in gypsum and scanned using a micro-computed tomography unit. The images were reconstructed with software, and the relevant checklist was completed by the observers. The data were analyzed with SPSS v26 using the Chi-squared test at a significance level of P < 0.05.

Results

The prevalence of the middle mesial root canal in the present study was 36% for mandibular first molars and 22% for mandibular second molars, with an overall prevalence of 29%. The prevalence of the middle mesial root canal was not significantly different between the first and second mandibular molars (P = 0.12). The mean distance between the mesiobuccal and mesiolingual root canal orifices in the teeth with a middle mesial root canal was significantly higher than in those without the middle mesial root canal (P < 0.001). In addition, there was no significant difference in the prevalence of the middle mesial root canal between the teeth with and without the second distal root canal (P = 0.89).

Conclusion

The prevalence of the middle mesial root canal in the studied population was 29%, which is significant clinically. In addition, the mean distance between the mesiobuccal and mesiolingual root canal orifices in teeth with a middle mesial root canal was higher than that in teeth without this root canal.

The effect of voxel size on the measurement of mandibular thickness in cone-beam computed tomography

BACKGROUND

Cone-beam computed tomography (CBCT) is a new imaging technology that has been widely used in implantology, oral and maxillofacial surgery and orthodontics. This method provides 3-D images that are composed of voxel, which is the smallest image unit, and determines image resolution. Smaller voxel is associated with the higher resolution and also greater radiation exposure. This study was aimed to find out the effect of voxel size on the measurement of mandibular thickness.

MATERIALS AND METHODS

Using voxel sizes of 0.30 mm and 0.15 mm, two CBCT protocols (protocol 1: Field of view (FOV) of 15 cm, 85 kVp, 42 mAs, 0.15 mm voxel, 14 s scan time; protocol 2: FOV of 15 cm, 85 kVp, 10 mAs, 0.30 mm voxel, 14 s scan time) were carried out on 16 dry human mandibles with permanent dentition. Mandibular thickness was measured at seven different sites (midline region, bilateral canine regions, bilateral mental foramen regions and bilateral molar regions). Analysis of variance was used for analysis of data using the Statistical Package for the Social Sciences version 20 (SPSS Inc., Chicago, IL, USA). P < 0.05 considered to be statistically significant.

RESULTS

No statistically significant differences were found between different protocols regarding the mandibular thickness (P > 0.05).

CONCLUSION

Considering the insignificant differences of the mandibular thickness measurements using different voxel sizes, it would be more reasonable to use 0.30 mm voxel size instead of 0.15 mm voxel size to avoid unnecessary radiation exposure.

Removing Distortion of Periapical Radiographs in Dental Digital Radiography Using Embedded Markers in an External frame

To carry out in vivo and in vitro comparative pilot study to evaluate the preciseness of a newly proposed digital dental radiography setup. This setup was based on markers placed on an external frame to eliminate the measurement errors due to incorrect geometry in relative positioning of cone, teeth and the sensor. Five patients with previous panoramic images were selected to undergo the proposed periapical digital imaging for in vivo phase. For in vitro phase, 40 extracted teeth were replanted in dry mandibular sockets and periapical digital images were prepared. The standard reference for real scales of the teeth were obtained through extracted teeth measurements for in vitro application and were calculated through panoramic imaging for in vivo phases. The proposed image processing thechnique was applied on periapical digital images to distinguish the incorrect geometry. The recognized error was inversely applied on the image and the modified images were compared to the correct values. The measurement findings after the distortion removal were compared to our gold standards (results of panoramic imaging or measurements from extracted teeth) and showed the accuracy of 96.45% through in vivo examinations and 96.0% through in vitro tests. The proposed distortion removal method is perfectly able to identify the possible inaccurate geometry during image acquisition and is capable of applying the inverse transform to the distorted radiograph to obtain the correctly modified image. This can be really helpful in applications like root canal therapy, implant surgical procedures and digital subtraction radiography, which are essentially dependent on precise measurements.

Radiographic Evaluation of Bone Formation and Density Changes after Mandibular Third Molar Extraction: A 6 Month Follow up

BACKGROUND

There is a controversy about exact time of bone healing. The aim of this study was evaluation of bone formation and change of density after mandibular third molar extraction.

METHODS

Radiographs were taken from 16 empty tooth sockets immediately after extraction of mandibular third molars and 2, 4 and 6 months later under similar condition. The radiographs were digitized and the density numbers of pixels were calculated. Then, socket and neighbor regions were compared using Photoshop software. Three expert observers evaluated and compared the radiographs by the longitudinal radiographic assessment (LRA) method. Paired t-test and McNemar test were used to analyze the data and investigate the inter-observer reliability, respectively.

RESULTS

Analysis of the quantitative digital subtraction radiography (QDSR) data indicated that the difference between the digital numbers of interest points and reference points has been decreased during the months 2, 4 and 6 but the difference between the month 4 and 6 was not significant. The alternative method indicated that the mean digital numbers in the socket within 0and 2 months period was less than 128 and within 4 and 6 months was more than 128. In evaluation of LRA method, lamina dura started to change gradually in month 2 and it might disappear completely after 6 months.

CONCLUSION

Both QDSR and LRA methods can be used in evaluation of the rate of bone formation in the tooth socket but the former is more precise.

Comparison of accuracy of uncorrected and corrected sagittal tomography in detection of mandibular condyle erosions: an exvivo study

BACKGROUND

Radiographic examination of TMJ is indicated when there are clinical signs of pathological conditions, mainly bone changes that may influence the diagnosis and treatment planning. The purpose of this study was to evaluate and to compare the validity and diagnostic accuracy of uncorrected and corrected sagittal tomographic images in the detection of simulated mandibular condyle erosions.

METHODS

Simulated lesions were created in 10 dry mandibles using a dental round bur. Using uncorrected and corrected sagittal tomography techniques, mandibular condyles were imaged by a Cranex Tome X-ray unit before and after creating the lesions. The uncorrected and corrected tomography images were examined by two independent observers for absence or presence of a lesion. The accuracy for detecting mandibular condyle lesions was expressed as sensitivity, specificity, and validity values. Differences between the two radiographic modalities were tested by Wilcoxon for paired data tests. Inter-observer agreement was determined by Cohen's Kappa.

RESULTS

The sensitivity, specificity and validity were 45%, 85% and 30% in uncorrected sagittal tomographic images, respectively, and 70%, 92.5% and 60% in corrected sagittal tomographic images, respectively. There was a significant statistical difference between the accuracy of uncorrected and corrected sagittal tomography in detection of mandibular condyle erosions (P = 0.016). The inter-observer agreement was slight for uncorrected sagittal tomography and moderate for corrected sagittal tomography.

CONCLUSION

The accuracy of corrected sagittal tomography is significantly higher than that of uncorrected sagittal tomography. Therefore, corrected sagittal tomography seems to be a better modality in detection of mandibular condyle erosions.