Search

Objectives: This systematic review and meta-analysis aimed to investigate the diagnostic accuracy of Artificial Intelligence (AI) for approximal carious lesions on bitewing radiographs., Methods: This study included randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) reporting on the diagnostic accuracy of AI for approximal carious lesions on bitewing radiographs. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. A systematic search was conducted on November 4, 2023, in PubMed, Cochrane, and Embase databases and an updated search was performed on August 28, 2024. The primary outcomes assessed were sensitivity, specificity, and overall accuracy. Sensitivity and specificity were pooled using a bivariate model., Results: Of the 2,442 studies identified, 21 met the inclusion criteria. The pooled sensitivity and specificity of AI were 0.94 (confidence interval (CI): ± 0.78-0.99) and 0.91 (CI: ± 0.84-0.95), respectively. The positive predictive value (PPV) ranged from 0.15 to 0.87, indicating a moderate capacity for identifying true positives among decayed teeth. The negative predictive value (NPV) ranged from 0.79 to 1.00, demonstrating a high ability to exclude healthy teeth. The diagnostic odds ratio was high, indicating strong overall diagnostic performance., Conclusions: AI models demonstrate clinically acceptable diagnostic accuracy for approximal caries on bitewing radiographs. Although AI can be valuable for preliminary screening, positive findings should be verified by dental experts to prevent unnecessary treatments and ensure timely diagnosis. AI models are highly reliable in excluding healthy approximal surfaces., Clinical Significance: AI can assist dentists in detecting approximal caries on bitewing radiographs. However, expert supervision is required to prevent iatrogenic damage and ensure timely diagnosis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Intraoral scanners commonly used in orthodontic offices now offer near-infrared imaging (NIRI) technology, advertised as a screening tool to identify interproximal caries. This study aimed to evaluate the reliability and validity of NIRI detection of interproximal carious lesions in a common intraoral scanner (iTero Element 5D; Align Technology, San Jose, Calif) with and without bitewing radiograph complement, compared with a microcomputed tomography (micro-CT) reference standard., Methods: Extracted human posterior teeth (premolars and molars) were selected for early (noncavitated) interproximal carious lesions (n = 39) and sound control surfaces (n = 47). The teeth were scanned via micro-CT for evaluation by 2 blinded evaluators using consensus scoring. The teeth were mounted to simulate anatomic interproximal contacts and underwent a NIRI scan using iTero Element 5D and bitewing radiographs. Two trained, calibrated examiners independently evaluated (1) near-infrared images alone with clinical photograph, (2) bitewing radiograph alone with clinical photograph, and (3) near-infrared images with bitewing radiograph and clinical photograph in combination, after at least a 10-day washout period between each evaluation., Results: Interrater reliability was highest for NIRI alone (k = 0.533) compared with bitewing radiograph alone (k = 0.176) or in combination (k = 0.256). NIRI alone showed high specificity (0.83-0.96) and moderate sensitivity (0.42-0.63) compared with a micro-CT reference standard. Dentin lesions were significantly more reliably detected than enamel lesions., Conclusions: After rigorous training and calibration, NIRI can be used with moderate reliability, high specificity, and moderate sensitivity to detect noncavitated interproximal carious lesions., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to assess the reliability of AI-based system that assists the healthcare processes in the diagnosis of caries on intraoral radiographs., Methods: The proximal surfaces of the 323 selected teeth on the intraoral radiographs were evaluated by two independent observers using an AI-based (Diagnocat) system. The presence or absence of carious lesions was recorded during Phase 1. After 4 months, the AI-aided human observers evaluated the same radiographs (Phase 2), and the advanced convolutional neural network (CNN) reassessed the radiographic data (Phase 3). Subsequently, data reflecting human disagreements were excluded (Phase 4). For each phase, the Cohen and Fleiss kappa values, as well as the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of Diagnocat, were calculated., Results: During the four phases, the range of Cohen kappa values between the human observers and Diagnocat were κ=0.66-1, κ=0.58-0.7, and κ=0.49-0.7. The Fleiss kappa values were κ=0.57-0.8. The sensitivity, specificity and diagnostic accuracy values ranged between 0.51-0.76, 0.88-0.97 and 0.76-0.86, respectively., Conclusions: The Diagnocat CNN supports the evaluation of intraoral radiographs for caries diagnosis, as determined by consensus between human and AI system observers., Clinical Significance: Our study may aid in the understanding of deep learning-based systems developed for dental imaging modalities for dentists and contribute to expanding the body of results in the field of AI-supported dental radiology.., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: David Manulis, Matyey Ezhov and Alex Sanders are employees of Diagnocat Co. Ltd.. Kaan Orhan is a scientific research advisor for the Diagnocat Co. Ltd., San Francisco CA., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: Deep networks have been preliminarily studied in caries diagnosis based on clinical X-ray images. However, the performance of different deep networks on caries detection is still unclear. This study aims to comprehensively compare the caries detection performances of recent multifarious deep networks with clinical dentist level as a bridge., Methods: Based on the self-collected periapical radiograph dataset in clinic, four most popular deep networks in two types, namely YOLOv5 and DETR object detection networks, and UNet and Trans-UNet segmentation networks, were included in the comparison study. Five dentists carried out the caries detection on the same testing dataset for reference. Key tooth-level metrics, including precision, sensitivity, specificity, F1-score and Youden index, were obtained, based on which statistical analysis was conducted., Results: The F1-score order of deep networks is YOLOv5 (0.87), Trans-UNet (0.86), DETR (0.82) and UNet (0.80) in caries detection. A same ranking order is found using the Youden index combining sensitivity and specificity, which are 0.76, 0.73, 0.69 and 0.64 respectively. A moderate level of concordance was observed between all networks and the gold standard. No significant difference (p > 0.05) was found between deep networks and between the well-trained network and dentists in caries detection., Conclusions: Among investigated deep networks, YOLOv5 is recommended to be priority for caries detection in terms of its high metrics. The well-trained deep network could be used as a good assistance for dentists to detect and diagnose caries., Clinical Significance: The well-trained deep network shows a promising potential clinical application prospect. It can provide valuable support to healthcare professionals in facilitating detection and diagnosis of dental caries., Competing Interests: Declaration of competing interest The authors declared that they have no conflicts of interest. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: We compared the effective dose (E) and thyroid equivalent dose of 2 extraoral bitewing (EOBW) units and compared E with their respective panoramic (PAN) modes and with intraoral bitewing radiography (IOBW)., Study Design: Child and adult anthropomorphic phantoms with dosimeters were used to evaluate Orthophos SL, Rayscan α+, and 1 intraoral unit using rectangular and circular collimation. Extraoral bitewing thyroid equivalent dose was assessed without and with thyroid shielding., Results: Child and adult E values of EOBW were lower with Orthophos (3.6 and 8.6 μSv) than with Rayscan (28.1 and 30.2 μSv). For IOBW, E was lower with rectangular vs circular collimation for child (7.0 vs 11.8 μSv) and adult (4.6 vs 14.2 μSv). E values of EOBW were lower than PAN for Orthophos. The IOBW E was lower than Rayscan EOBW for child (≤11.8 vs 28.1 μSv) and adult (≤14.2 vs 30.2 μSv). Adult E for rectangular IOBW (4.6 μSv) was lower than EOBW with Orthophos (8.6 μSv) and Rayscan (30.2 μSv). Thyroid shielding reduced EOBW thyroid equivalent dose with Rayscan in the adult from 190.7 to 89.0 μSv., Conclusion: Orthophos provides significantly lower EOBW E than Rayscan, thus EOBW recommendations must be unit specific. For children, Orthophos EOBW could be an alternative to IOBW, for which rectangular collimation is recommended. Thyroid shielding reduced adult Rayscan equivalent dose but added imaging artifacts., Competing Interests: Declarations of Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to validate the near-infrared imaging (NIRI) in comparison with visual inspection (VI) for early detection of proximal caries in primary molars., Methods: VI and intraoral scans were performed on 126 patients aged 3-12 years with at least one non-cavitied and non-restored proximal tooth surface, who were scheduled for bite wing radiography (BWR) as part of their standard care. Teeth with signs of proximal cavities, restorations or residual caries were excluded in this study. BWR, a gold standard to diagnose proximal caries in primary molars, was used to validate the findings of NIRI and VI. The accuracy, sensitivity, specificity and the area under the curve (AUC) of NIRI and VI were calculated., Results: The accuracy, sensitivity and specificity of NIRI were 82.89%, 74.10% and 90.97%, while those of VI were 71.64%, 43.88% and 97.14%, respectively. NIRI showed higher accuracy and sensitivity, and lower specificity (P < 0.001). The AUC of NIRI was higher than that of VI (0.826 vs 0.706; P < 0.05)., Conclusions: NIRI showed higher sensitivity and lower specificity compared with VI when detecting proximal caries in primary molars. Therefore, it is recommended to use NIRI in combination with BWR to improve the detection rate of proximal caries in primary molars., Clinical Significance: In children, there is a high incidence of proximal caries in primary molars, which require high technical sensitivity for detection. NIRI shows high sensitivity in detecting proximal caries, which may improve their detection rate in primary molars., The Clinical Trial Registration Number: ChiCTR2300070916., Competing Interests: Declaration of Competing Interest The Authors deny any conflict of interest related to this study/manuscript., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: We developed a web-based tool to measure the amount and rate of skill acquisition in pediatric interproximal caries diagnosis among pre- and postdoctoral dental students and identified variables predictive for greater image interpretation difficulty., Study Design: In this multicenter prospective cohort study, a convenience sample of pre- and postdoctoral dental students participated in computer-assisted learning in the interpretation of bitewing radiographs of 193 children. Participants were asked to identify the presence or absence of interproximal caries and, where applicable, locate the lesions. After every case, participants received specific visual and text feedback on their diagnostic performance. They were requested to complete the 193-case set but could complete enough cases to achieve a competency performance standard of 75% accuracy, sensitivity, and specificity., Results: Of 130 participants, 62 (47.7%) completed all cases. The mean change from initial to maximal diagnostic accuracy was +15.3% (95% CI, 13.0-17.7), sensitivity was +10.8% (95% CI, 9.0-12.7), and specificity was +15.5% (95% CI, 12.9-18.1). The median number of cases completed to achieve competency was 173 (interquartile range, 82-363). Of these 62 participants, 45 (72.6%) showed overall improvement in diagnostic accuracy. Greater numbers of interproximal lesions (P < .001) and the presence of noninterproximal caries (P < .001) predicted greater interpretation difficulty., Conclusions: Computer-assisted learning led to improved diagnosis of interproximal caries on bitewing radiographs among pre- and postdoctoral dental students., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: This study measured effective (E) and equivalent doses from adult and child 3-dimensional (3D) and 2D posterior bitewing (PBW) examinations using the PORTRAY stationary-intraoral tomosynthesis radiography system., Study Design: Adult and child phantoms and optically stimulated luminescent dosimeters were used to measure doses for adult-4 and child-2 projection PBW examinations acquired without (W/O) and with (W) a direct digital sensor in the beam path. Child doses without and with thyroid shielding were measured., Results: Three-dimensional examination E values (μSv) W/O and W were 16.7 and 7.3 for adult, 9.2 and 3.5 for child, and 8.7 and 3.0 with thyroid shielding, respectively. Two-dimensional examination E values W/O and W were 4.3 and 1.5 for adult, 2.1 and 0.6 for child, and 2.0 and 0.5 with shielding, respectively. Sensor presence reduced E for all adult and child examinations (P = .0001). Child E was reduced compared with adult E for both sensor conditions in 3D (P < .0001) and 2D (P ≤ .0043) imaging. Adult and child 3D W/O and W equivalent thyroid doses did not differ (P ≥ .9996). However, child 2D W/O and W doses were lower (P ≤ .0002). Shielding produced no reduction (P ≥ .1128) for either 3D condition or 2D with the sensor (P = .6615) but reduced child 2D dose without the sensor., Conclusions: Inclusion of a sensor yielded significant reductions in adult and child E. Sensor presence impacted thyroid dose reduction more than shielding., Competing Interests: Declaration of interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: Understanding dentists' gaze patterns on radiographs may allow to unravel sources of their limited accuracy and develop strategies to mitigate them. We conducted an eye tracking experiment to characterize dentists' scanpaths and thus their gaze patterns when assessing bitewing radiographs to detect primary proximal carious lesions., Methods: 22 dentists assessed a median of nine bitewing images each, resulting in 170 datasets after excluding data with poor quality of gaze recording. Fixation was defined as an area of attentional focus related to visual stimuli. We calculated time to first fixation, fixation count, average fixation duration, and fixation frequency. Analyses were performed for the entire image and stratified by (1) presence of carious lesions and/or restorations and (2) lesion depth (E1/2: outer/inner enamel; D1-3: outer-inner third of dentin). We also examined the transitional nature of the dentists' gaze., Results: Dentists had more fixations on teeth with lesions and/or restorations (median=138 [interquartile range=87, 204]) than teeth without them (32 [15, 66]), p<0.001. Notably, teeth with lesions had longer fixation durations (407 milliseconds [242, 591]) than those with restorations (289 milliseconds [216, 337]), p<0.001. Time to first fixation was longer for teeth with E1 lesions (17,128 milliseconds [8813, 21,540]) than lesions of other depths (p = 0.049). The highest number of fixations were on teeth with D2 lesions (43 [20, 51]) and lowest on teeth with E1 lesions (5 [1, 37]), p<0.001. Generally, a systematic tooth-by-tooth gaze pattern was observed., Conclusions: As hypothesized, while visually inspecting bitewing radiographic images, dentists employed a heightened focus on certain image features/areas, relevant to the assigned task. Also, they generally examined the entire image in a systematic tooth-by-tooth pattern., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Objective: The aim of this study was to evaluate the influence of the extensive use of a photostimulable phosphor (PSP) receptor on the diagnosis of proximal carious lesions., Study Design: Forty posterior teeth were paired and mounted in 20 phantoms. Using a PSP receptor of the Express intraoral system, 1 radiograph of each phantom was acquired, totaling 20 radiographs (group 1). After 400 acquisitions, another radiograph of each phantom was obtained, totaling 20 new radiographs (group 2). This procedure was also done after 800 (group 3), 1,200 (group 4), and 1,600 (group 5) acquisitions, resulting in 100 radiographs. Another 40 radiographs (20 phantoms × 2 groups) were obtained with a second PSP sensor to evaluate the diagnostic replicability of the receptors. All 140 radiographs were assessed independently by 5 examiners for the presence of proximal caries. Area under the receiver operating characteristic curve, sensitivity, and specificity were calculated and compared among the groups by analysis of variance. The Student t test evaluated the diagnostic replicability of the receptors. The significance level was set at 5% (P < .05)., Results: The diagnostic outcomes for proximal caries did not differ among the groups (P ≥ .37). The diagnostic values did not differ among the radiographs acquired with the 2 PSP receptors (P ≥ .75)., Conclusions: The diagnosis of proximal carious lesions was not affected by extensive use of the PSP receptor., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to evaluate the use of digital bitewing radiographs using photostimulable phosphor (PSP) plates in the estimation of the true extension of proximal carious lesions., Methods: The sample size was calculated to be 70 teeth. Adult patients with a minimum of one posterior tooth with primary proximal caries lesions were included. A preoperative bitewing radiograph was taken and the extension of the carious lesion was measured from the most prominent point on the adjacent sound tooth to the deepest axial point of the lesion. An experienced general dentist provided the restorative treatment and made a polyvinyl siloxane impression of the cavity preparation. Clinical caries extension was measured from the most prominent point of the adjacent tooth until the deepest boundary of the axial wall of the preparation on the impression. Postoperative radiographs were taken at the completion of restorative care. The bitewing radiographs were done using PSP plates and caries extension measurements were performed using measuring tools of the digital radiography software. Pairwise comparisons were made between preoperative and postoperative radiographs, and the true clinical depth measurements using paired t-tests., Results: In total, 73 teeth from 44 subjects were included. A significant difference of 0.82 mm was found between preoperative radiographs and clinical measurements (p<0.001). Similarly, comparisons between preoperative and postoperative radiographic measurements showed significant differences of 0.99 mm (p<0.001)., Conclusions: The study found that the true clinical extension of proximal caries after non-selective caries removal was significantly deeper than the preoperative radiographic extension assessment. This was not influenced by the tooth type, the location of the tooth, or the affected tooth surfaces., Clinical Significance: When a non-selective caries removal strategy is adopted, clinicians should be aware that PSP bitewing radiographs underestimate the true clinical extension of proximal caries lesions. This will have an impact on clinicians' practice and restorative treatment decisions., (Copyright © 2022. Published by Elsevier Ltd.)

Objective: The aim was to assess the value of sociodemographic, behavioral, and clinical characteristics in identifying adolescents who would benefit from radiographs for dental caries detection in a high-caries experience population., Study Design: In total, 356 adolescents answered a validated questionnaire on sociodemographic characteristics and oral health behavior and were clinically and radiographically examined for caries. The outcome was the benefit arising from radiographs for caries detection at the patient level, defined as the number of surfaces clinically classified as sound but presenting radiolucency., Results: A total of 169 participants (47.5%) benefited from radiographs. One-third of approximal lesions were detected clinically, whereas two-thirds, mostly initial lesions, were detected radiographically only. Adolescents who reported frequent consumption of soft drinks and sugary food, those with D 1 MFS (noncavitated and cavitated caries experience) ≥12, D 5 MFS (cavitated caries experience) ≥1, clinically detected approximal lesions, and active caries were significantly more likely to benefit from radiographs (P ≤ .002). Although some indicators showed moderate-to-good sensitivity (consumption of sugary food, caries activity) or specificity (absence of clinically diagnosed approximal lesions), the accuracy of indicators evaluated (isolated or combined) never reached 0.60., Conclusions: The possibility of correctly identifying which adolescents would benefit from radiographs for caries detection purposes was limited in a population with high-caries experience., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To compare technical errors in bitewing radiographs acquired with round vs rectangular collimation in a hospital-based pediatric dentistry training program., Study Design: A retrospective chart review was conducted of 176 digital bitewing radiographs exposed with round collimation and 106 exposed with rectangular collimation. The number of re-exposures was calculated, and errors in central ray entry (CRE; "cone cuts"), horizontal and vertical positioning, and angulation were measured., Results: There were no greater re-exposures but significantly more CRE errors with rectangular collimation (21.7%; n = 23; 95% confidence interval [CI], 13.9%-30.0%) than with round collimation (3.4%; n = 6; 95% CI, 0.7%-6.1%). CRE error location, horizontal positioning errors, and size of horizontal overlapped contacts were statistically different but not clinically important., Conclusions: Use of rectangular collimation resulted in increased CRE errors but no other clinically significant problems. This technique should be used to reduce radiation exposure to patients., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The aim of the authors was to evaluate prescription patterns for bite-wing and panoramic radiographs (PRs) for pediatric and adolescent dental patients after the implementation of the most recent guidelines from the American Dental Association and US Food and Drug Administration., Methods: The authors accessed paid insurance claims data for all 50 states from January 1, 2013, through June 30, 2019, for patients 18 years and younger and extracted a 5% random sample population. The authors performed statistical analyses to evaluate various imaging metrics for pediatric dentists (PDs) and general practitioners (GPs)., Results: A total of 2,123,735 bite-wing images were ordered during 4,734,249 office visits. The average (standard deviation [SD]) time interval between bite-wing examinations ordered by GPs was 13.9 (7.4) months, and for PDs the average (SD) was 13.0 (6.7) months (P < .0001). When divided by age group, 3.5% of all bite-wings were obtained from patients aged 0 through 4 years. For PRs, the authors included 286,824 images in this study. The average (SD) time interval between PRs ordered for the same patient was 3.4 (1.3) years for PDs and 3.3 (1.4) years for GPs. One percent of all PRs were ordered for patients aged 0 through 4 years, with 403 images attributed to PDs and 2,348 to GPs., Conclusions: PDs were more likely to comply with the guidelines on radiograph prescriptions for pediatric and adolescent patients than GPs., Practical Implications: Inclusion of patient caries risk with insurance claims data could be considered for more appropriate administration of dental radiography. Future guidelines should be developed to include more explicit recommendations for prescribing PRs., (Copyright © 2022 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the radiographic pattern of inactive enamel caries lesions (IECL) in the occlusal surfaces of permanent molars and to investigate whether the presence of radiolucency at baseline could predict lesion progression over 4-5 years., Methods: A prospective cohort study followed 193 schoolchildren from southern Brazil. At baseline, clinical and radiographic examinations were performed. After 4-5 years, clinical examination was repeated following the same protocol. Logistic regression models were used to investigate the relationship between the presence of radiolucency at baseline and caries progression., Results: This study included 916 permanent molars, classified as sound occlusal surfaces (n = 434), non-cavitated IECL (n = 438), or cavitated IECL (n = 44) at baseline. The proportion of lesions with radiolucency increased as lesion severity increased (p<0.001, chi-square test). The proportion of cases that progressed was significantly higher among teeth showing radiolucency at baseline than among teeth without radiolucency (p<0.001, chi-square test). The presence of radiolucency at baseline was found to be a predictor of caries progression (activity criteria, adjusted OR=3.37, 95%CI=1.66-6.82, p<0.001; severity criteria, adjusted OR=4.01, 95%CI=1.85-8.72, p<0.001)., Conclusion: Occlusal surfaces (either sound or with IECL) presenting radiolucency at baseline were more likely to progress over 4-5 years of monitoring and should be monitored more closely., Clinical Relevance: Bitewing radiographs, when available, may be used to identify which surfaces/lesions are more likely to progress and thus, to define proper recall intervals for patient monitoring., (Copyright © 2021. Published by Elsevier Ltd.)

Background: The development of specialized panoramic radiograph machine software has spawned the introduction of an innovative and promising dental radiographic examination type: extraoral bite-wings. But does this unconventional type of imaging belong in the bite-wing family? Is there any relationship at all to the conventional bite-wing radiograph?, Objectives: The purpose of this article is not to make a case for the diagnostic effectiveness of one system over the other; this is best left to further clinical evaluation. Instead, the authors intend to provide an outline of a few key and distinguishing elements of the intraoral bite-wing radiographic examination followed by those of the extraoral panoramic substitute and draw attention to the importance of reimagining the increasingly universal naming convention of this novel radiographic examination, the paradoxical "extraoral bite-wing radiograph", based on the fundamental principles of each of these imaging systems., Practical Implications: The accuracy of clinical and technical terminology in oral radiography is of paramount importance to both the profession and patients, especially when considering emerging technologies., (Copyright © 2021 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Objectives: This study assessed effective doses (E) from conventional and stationary intraoral tomosynthesis (s-IOT) radiography for posterior bitewing (PBW) examinations and evaluated the effect of sensor attenuation., Study Design: An adult human tissue-equivalent phantom and optically stimulated luminescent dosimeters were used. Series of 4 PBW radiographs were acquired with circular and rectangular collimation. s-IOT PBW radiographs were acquired with built-in rectangular collimation. Radiographs were acquired without and with a sensor in the beam path., Results: E (in µSv) was 15.7 and 8.2 for conventional-circular, 4.6 and 1.1 for conventional-rectangular, and 11.9 and 5.9 for s-IOT in sensor-absent and sensor-present scenarios, respectively. For sensor-absent exposures, E for conventional-rectangular was 29.3% and E for s-IOT was 75.8% of the conventional-circular dose. With the sensor present, these values were 13.4% and 72.0%, respectively (P < .001). Sensor-present E was lower than sensor-absent E for all modalities (P < .001). Reductions in equivalent doses were similar to effective dose reductions., Conclusions: For PBW examinations, E for s-IOT was smaller than for conventional radiography with circular collimation, but larger than for conventional radiography with rectangular collimation. The presence of a sensor maintained these differences but reduced E for all modalities., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To evaluate the accuracy of the near-infrared light transillumination (NILT) for the detection of interproximal dental caries in permanent dentition when compared to bitewing X-ray (BW)., Data: In vivo studies that detected interproximal primary caries in permanent teeth by using NILT and BW were selected. QUADAS-2 was used to assess the risk of bias. Pooled sensitivity and specificity forest plots were calculated, summary receiver operator characteristics (SROC) curves were constructed. The certainty of the evidence was rated using the GRADE system., Sources: Pubmed, Cochrane Library, Web of Science, Scopus, Lilacs/BBO and grey literature databases were surveyed., Study Selection: From 1594 retrieved articles, 13 studies were included. Six studies had a low risk of bias and a low level of concern regarding applicability. Four studies had an unclear risk of bias, while three presented a high risk of bias. The meta-analysis of six studies demonstrated that NILT presented good overall accuracy. Of 6110 teeth, 92.3 % (5639) were accurately classified (776 as true positive and 4863 as true negative). The pooled sensitivity was 0.97 (0.96 to 0.98; p = 0.0000; I 2  = 93.2 %) with moderate certainty of evidence, and the pooled specificity was 0.91 (0.91 to 0.92; p = 0.0000; I 2  = 98.3 %) with high certainty of evidence. Symmetric (0.9837) and asymmetric (0.9836) SROC showed a high discrimination and determination effect of NILT., Conclusion: The current literature, with moderate certainty and a middling quality of evidence, demonstrates that NILT presents a reasonably comparable accuracy to that of BW for detecting interproximal carious lesions in the permanent dentition., Clinical Significance: Since NILT presented good overall accuracy for the detection of interproximal primary caries, it could be routinely used in dental check-ups, especially in high-risk caries populations and in patients where the use of radiation should be reduced, like pregnant women or children., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this in vivo prospective clinical study was to validate a near-infrared light transillumination (NILT) device for the detection of proximal caries lesions and compare it to the established diagnostic method of bitewing radiography (BWR)., Materials and Methods: A total of 116 interproximal posterior teeth/surfaces without gross cavitation were included and assessed with BWR and NILT. After clinical examination, the teeth with sound surfaces or non-cavitated caries lesions were separated with the use of an orthodontic separation rubber for 24h. Upon removal of the separator a silicon impression was obtained and the teeth surfaces were directly investigated. Intra- and inter-examiner reproducibility, sensitivities (SE) and specificities (SP) as well as the area under ROC curves (AUC) were calculated., Results: The SE of NILT was 0.92 in D 1 lesions and 1.00 in D 2 and D 3 lesions, respectively. BWR showed SE values of 0.81 in D 1 lesions, 0.74 in D 2 and 1.00 in D 3 lesions, respectively. However, NILT showed lower values of SP (D 1 0.38, D 2 0.42 and D 3 0.99) compared to BWR (D 1 0.65, D 2 0.88, D 3 1.00). Intra-examiner reproducibility increased for both examiners from the initial examination (0.68 and 0.62) to the recall appointment (0.89 and 0.76) respectively., Conclusion: The performance of NILT in detection of enamel caries was comparable to BWR. NILT could be considered as a useful and reliable tool in clinical practice. However, monitoring of enamel lesions might not be accurate, since a low specificity of NILT at D 1,2 level and a tendency to false positive ratings have been shown. Therefore, it is recommended that treatment decisions should not be based on NILT alone., Clinical Relevance: This study might indicate that NILT can be used for routine patient screening but the use of BWR is still important for treatment decisions., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: The aim of this study was to compare the performance of panoramic radiography (PAN), extraoral bitewing radiography (EBW), and cone beam computed tomography (CBCT) in the assessment of mandibular third molars., Study Design: PAN and EBW were obtained to visualize 34 third molars. The teeth were evaluated by using PAN and EBW according to their positions, the presence of radiographic signs of proximity of the roots to the mandibular canal, the relationship of the roots to the canal, and the relationship of the second and third molars. Third molar position and root relationship with the canal were also assessed with CBCT., Results: PAN and EBW showed significantly closer relationships compared with CBCT between the tooth and the mandibular canal (P ≤ .002). With regard to all other parameters, no differences were seen between PAN and EBW (P ≥ .072), although EBW, in comparison with PAN, showed a decreased overlap between the proximal surfaces of the second and third molars and a greater trend toward approximating root apices and the canal., Conclusions: In comparison with PAN, EBW showed a tendency to project the roots closer to the mandibular canal, but there was a decrease in the proximal surfaces overlapping the second molar. The relationship between the third molar and the mandibular canal appeared closer in PAN and EBW than in CBCT., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Alveolar bone loss is regarded as a potential adverse event during orthodontic treatment, especially in adults. The purposes of this study were to evaluate the prevalence and severity of interdental alveolar crest height loss in adult orthodontic patients compared with an untreated control group and to identify comorbidity risk factors for such bone loss (high BMI score, high blood pressure, high cholesterol levels, and smoking)., Methods: Standardized bitewing radiographs of patients' buccal segments were taken before and after treatment of 34 consecutive adults treated in an orthodontic clinic. The control group included 29 patients from the operative dental clinic matched according to age and sex. Mean ages of the participants before treatment were 35.7 ± 6.7 and 35.6 ± 7.3 years for the control and treatment groups, respectively. Before orthodontic treatment, the patients were evaluated, treated as needed, and approved by a periodontist. They were periodontically healthy before treatment. Interdental alveolar crest height loss was calculated by subtracting the distance on a bitewing x-ray from the cementoenamel junction to the interdental alveolar crest at each interproximal tooth surface from the mesial aspect of the first premolar to the distal aspect of the second molar (8 sites per quadrant). Changes in interdental alveolar crest height were calculated by subtracting the cementoenamel junction-interdental alveolar crest distance before treatment from the corresponding distance after treatment., Results: The mean individual bone losses of all interproximal surfaces were 0.130 ± 0.192 and 0.072 ± 0.280 mm in the treatment and control groups, respectively. These differences did not reach statistical significance (P = 0.353). Twenty-two patients (65%) from the treatment group and 10 patients (34%) from the control group had an increase in the cementoenamel junction-interdental alveolar crest distance of more than 1 mm in at least 1 site, with borderline significance between the groups (P = 0.079). Notably, no association was observed between bone loss with any comorbidity factor., Conclusions: The results of this study correspond to the conventional understanding in the orthodontic and periodontal literature that orthodontic tooth movement per se does not cause attachment loss. However, orthodontists should always be aware of the possibility of periodontal deterioration during orthodontic treatment. Therefore, comprehensive periodontal examination is necessary during orthodontic treatment, especially in adults., (Copyright © 2018 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to compare decision-making based on bitewing analysis of restored proximal surfaces by general dental practitioners (GDPs) with diagnossis and clinical decisions made by experts in cariology and restorative dentistry., Methods: This practice-based study used a database of 7 general dental practices. Posterior bitewing radiographs were selected from the electronic patient files of patients, and 770 cases of proximal restored surfaces were selected. Fifty percent of the cases which lead to the restorative decision, and the other half were cases decided for monitoring by the GDPs. Three experts performed radiographic assessment. The outcome variables were agreement of diagnosis and decision of treatment. Cohen's kappa statistic was used., Results: For the experts, moderate to substantial intraexaminer agreement was observed for the diagnostic criteria, and kappa values of 0.77, 0.79, and 0.88 were obtained for each expert regarding the treatment assignment. Agreement between GDPs and the majority of experts for secondary caries varied between 67 and 83%. One hundred seventy-three out of 385 cases that were treated by GDPs were decided for monitoring by the experts, while 8 cases that were decided for monitoring by the GDPs were decided for treatment. The agreement between experts and GDPs was moderate for secondary caries detection, and fair for treatment decision., Conclusion: The GDPs tend to have a less conservative approach regarding the decision to intervene or not concerning the reassessment of restorations, showing moderate agreement with the experts for secondary caries detection and fair agreement regarding the treatment decision., Clinical Significance: This study highlights that GDPs tend to have a less conservative approach to the decision to intervene or not in posterior restorations, compared to experts in cariology and restorative dentistry. Efforts should be made to reduce these differences based on minimally invasive dentistry., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Extraoral bite-wing (EB) radiography is an imaging technology used in dentistry. The authors conducted an in vivo study comparing the accuracy of intraoral bitewing (IB) radiographs and EB radiographs for proximal caries and bone loss diagnosis., Methods: The authors recruited 116 patients who received IB radiographs to receive EB radiographs. The 5 calibrated authors made a consensus radiographic diagnosis of proximal caries and crestal bone loss. For this study, they assumed IB radiographs as the criterion standard. Next, they obtained EB radiographs for the 116 patients and calculated sensitivity, specificity, and false-positive rates against each patient's IB radiograph., Results: The patients' EB radiographs revealed a significantly greater number of caries and crestal bone loss findings compared with their IB radiographs. The EB radiographs had a high to excellent sensitivity and moderate to low specificity of caries and crestal bone loss findings, respectively. Considering IB radiographs to be the criterion standard, the false-positive rate for EB radiographs was moderate for caries and high for bone loss diagnosis., Conclusions: The EB radiographs, which generate fewer images of overlapping proximal surfaces, have the advantage of detecting more carious lesions and bone loss findings than the IB radiographs do, but with the disadvantage of more false-positive diagnoses. Further research is needed to evaluate if the false-positive findings represent true carious lesions and bone loss., Practical Implications: EB radiography is a promising technology, which has several advantages over traditional IB radiography. Clinicians should be aware of false-positive diagnosis of caries and bone loss with EB radiography., (Copyright © 2018 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Objective: It has been suggested that the level of sexual dimorphism in deciduous dentition is relatively lower than that in permanent dentition. However, in sub adult skeletal remains whose osseous morphological traits of the sex have not defined yet, predicting sex on the basis of odontometric features may be the most precise technique. The aim of the present study was to assess the degree of sexual dimorphism in marginal enamel, dentin and pulp dimensions of second molar deciduous teeth in a pediatric population., Method and Materials: The present study was conducted on bitewing radiographs of 64 males and 60 females. The greatest width of enamel, dentin and pulp on mandibular and maxillary second molar deciduous teeth were measured. Student's t-test and discriminant analysis were used to compare the differences in the odontometric parameters between females and males., Results: Among the second molar measurements, only the maxillary pulp width did significantly discriminate the sex groups. The accuracy of sex identification of a case based on deciduous second molar tooth was approximately 68%., Conclusions: The application of second molar deciduous teeth in sex prediction showed moderate level of sexual dimorphism. In this respect, the maxillary pulp width had the greatest amount of contribution in sex discrimination. Therefore, these odontometric traits, in conjunction with other skeletal features, can be used as a supplementary sexing tool for gender prediction in forensic anthropology., (Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Purpose: The aim of the present study was to investigate, in posterior teeth, the association between the characteristics of the margins of a restoration visually inspected and the presence, under restorations, of recurrent or residual dental caries detected by radiographic examination. Furthermore, the agreement between visual inspection and radiographs to detect dental caries was assessed., Methods: Eighty-five permanent molars and premolars with resin restorations on the interproximal and/or occlusal faces, from 18 patients, were submitted for visual inspection and radiographic examination. The visual inspection involved the criteria of the International Caries Detection and Assessment System (ICDAS). Bitewing radiographs were used for the radiographic examination. Logistic regression was used to analyse the association between the characteristics of the margins of a restoration assessed by visual inspection (absence of dental caries, or early, established, inactive and active lesions) and the presence of recurrent caries detected by radiographs. Kappa coefficients were calculated for determining agreement between the two methods., Results: The Kappa coefficient for agreement between visual inspection and radiographic examination was 0.19. Established lesions [odds ratio (OR) = 9.89; 95% confidence interval (95% CI): 2.94-33.25; P < 0.05] and lesion activity (OR = 2.57; 95% CI: 0.91-7.27; P < 0.05) detected by visual inspection, were associated with recurrent or residual dental caries detected by radiographs. Restorations with established and active lesions at the margins had a greater chance of exhibiting recurrent or residual lesions in the radiographic examination., Clinical Significance: The present findings demonstrate that restorations with established and active lesions at the margins when visually inspected often require removal and retreatment., (© 2015 FDI World Dental Federation.)

Introduction: Radiographic images may lead to misinterpretations of lesions of endodontic and nonendodontic origin. This report describes a case of a 10-year follow-up of a calcifying odontogenic cyst (COC) in the periapical region of a vital maxillary central incisor in a 9-year-old boy., Methods: The patient revealed a history of a swelling in the periapical area of tooth #9. The patient denied any dental trauma or history of pain. Clinical examination revealed no mobility, but there was discrete discomfort when horizontal pressure was applied. Pulp vitality was present in all maxillary anterior teeth. Radiographs revealed an oval radiolucent lesion in the periapical region of maxillary central incisor. The therapeutic option was enucleation of the periapical lesion and histologic examination of the specimen. Microscopic findings suggested the diagnosis of a COC., Results: At a follow-up visit 10 years after surgery, panoramic and periapical radiographs showed new bone formation; the patient did not have any pain, and pulp vitality was maintained in all teeth in this area., Conclusions: A COC should be part of the differential diagnosis of other jaw lesions, such as apical periodontitis. The definitive diagnosis of a COC can only be made after microscopic evaluation of the specimen. The follow-up is a helpful reference because it confirms the survival of pulp tissue and no recurrence of the COC., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to perform a systematic review and meta-analysis on the effectiveness of sealing non-cavitated proximal caries lesions in primary and permanent teeth., Data: Only controlled clinical trials and randomized controlled clinical trials that evaluated the effectiveness of sealing on non-cavitated proximal caries with a minimum follow-up of 12 months were included in the study. The primary outcome should be arrestment/progression of proximal caries evaluated by bitewing radiographs. A risk of bias evaluation based on the Cochrane Collaboration common scheme for bias was carried out for each study. The meta-analysis was performed on the studies considered low risk of bias and with pair-wise visual reading results through RevMan software., Sources: A comprehensive search was performed in the Systematic Electronic Databases: Pubmed, Cochrane Library, Scopus, IBI Web of Science, Lilacs, SIGLE, and on website Clinical trials.gov, through until June 2013., Study Selection: From 967 studies identified, 10 articles and 3 studies with partial results were assessed for eligibility. However three articles were excluded and our final sample included 10 studies. According to the risk of bias evaluation, six studies were considered "high" risk of bias, and four "low" risk of bias. The forest plot of the meta-analysis showed low heterogeneity (I(2)=29%) and a favourable outcome for the Infiltrant. The chance of caries progression when this technique was used was significantly lower (p=0.002) compared with Placebo., Conclusion: Our results suggest that the technique of sealing non-cavitated proximal caries seems to be effective in controlling proximal caries in the short and medium term. Further long-term randomized clinical trials are still necessary to increase this evidence., Clinical Significance: Contemporary dentistry is focused in minimally invasive approaches that prevent the destruction of sound dental tissues next to carious lesions. This paper searches for evidence of the efficacy of sealing/infiltrating non-cavitated proximal caries in arresting caries progression both in permanent and primary teeth., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Introduction: In regenerative endodontic treatment (RET) for immature permanent tooth, better treatment results could be obtained by applying platelet-rich plasma (PRP) as the scaffold rather than the blood clot. The goal of this study was to compare the histologic differences between using PRP and blood clot in RET., Methods: Three 6-month-old beagles each carrying 9 premolars with double root canals were randomly assigned to the PRP group, blood clot group, or negative control group. All experimental teeth suffered apical periodontitis, and RET was performed. In the blood clot group, bleeding was induced from the periapical tissues to fill the canal space. In the PRP group, autologous PRP was injected into each root canal. The animals were sacrificed 3 months later. Histologic sections were stained with hematoxylin-eosin. Statistical analysis was performed by the Fisher exact test, with the significance set at 0.05., Results: With the ingrowth of cellular cementumlike tissues, the canal wall was thickened, and the apical apex was closed in both the PRP and blood clot groups. Cementocytelike cells were present in the newly formed tissues. Meanwhile, no statistical difference was found in both experimental groups for the average percentage of apical closure, new tissue formation, and pulplike tissue formation. Noticeably, a large number of inflammatory cells were present in some root canals in both groups although the postoperative radiograph revealed the disappearance of periapical radiolucency., Conclusions: PRP application could be an option for clinical cases in which little or no bleeding were found when irritating the apical tissue during RET., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Experimental studies show that dental pulp cells respond unfavorably to contact with resin composite restorative material. Hypothetically, in a random population, the frequency of apical periodontitis should be higher for teeth restored with resin composite than with amalgam. Therefore, the aim was to compare the periapical status of non-root-filled teeth restored with resin composite, amalgam, or laboratory-fabricated crowns in an adult Swedish population., Methods: The subjects comprised 440 individuals from a randomly selected sample of 1,000 adult residents of a Swedish county. The type, material, and quality of the restorations were recorded for all non-root-filled teeth by clinical examination and intraoral clinical photographs. Periapical status was evaluated on panoramic radiographs. The association between periapical status and type, material, and quality of the restorations was analyzed using the chi-square test and logistic regression analysis., Results: There was no significant difference in the frequency of apical periodontitis (AP) between teeth restored with resin composite or amalgam (1.3% and 1.1%, respectively). The frequency of AP for teeth restored with laboratory-fabricated crowns was significantly higher (6.3%). Regression analysis showed no association between AP and resin composite restorations but a significant association with laboratory-fabricated crowns., Conclusions: The results indicate that the risk of damage to the pulp-dentin complex from exposure to resin composite material and dentin bonding agents shown in experimental studies is not reflected in the clinical setting. However, in the study sample, AP was diagnosed in a significantly higher proportion of teeth restored with laboratory-fabricated crowns., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Treatment of an impacted maxillary central incisor poses a unique challenge to the orthodontist because of its position within the esthetic zone, requiring careful management of the soft tissues and an effective biomechanical setup for alignment. This article describes a novel method of extending an extrusion wire from cross tubes attached on the base archwire for forced eruption of impacted central incisors. The effectiveness and versatility of this method are demonstrated with 2 patients., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: The aim of this retrospective study was to evaluate the outcome of endodontic microsurgery and to examine prognostic factors related to healing., Methods: The clinical records of all patients who had undergone endodontic microsurgery from 1997-2003 at the National Dental Centre of Singapore were examined. Teeth with a recall period of 1-2 years were selected. All surgical procedures, except for flap raising and suturing, were performed under a surgical operating microscope. Root-end cavities prepared with ultrasonic tips were filled with Intermediate Restorative Material (Caulk, Milford, DE) or mineral trioxide aggregate. Teeth were evaluated for clinical signs and symptoms after surgery. Preoperative and postoperative radiographs were evaluated independently by 2 endodontists., Results: Of 243 root-end surgeries performed, 93 were eligible for the study. Outcomes were categorized as healed, healing, or persistent disease; 78.5% of teeth were assessed to be healed or healing, and 21.5% had persistent disease. The percentages of healed and healing teeth for anterior and posterior root-end surgeries were 76.5% and 80.4%, respectively, with no significant difference in the procedures (P = .8). Ordinal logistic regression showed a higher likelihood of healing in females compared with males (P = .001) and maxillary anterior teeth compared with mandibular anterior teeth (P = .03). Preoperative probing depths of ≤3 mm were significantly associated with healing (P = .05)., Conclusions: The use of modern endodontic surgical techniques resulted in 78.5% healed and healing teeth with a recall period of 1-2 years. Prognostic factors affecting successful healing include sex, tooth type, and preoperative probing depths., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Recent meta-analyses of the outcome of apical surgery using modern techniques including microsurgical principles and high-power magnification have yielded higher rates of healing. However, the information is mainly based on 1- to 2-year follow-up data. The present prospective study was designed to re-examine a large sample of teeth treated with apical surgery after 5 years., Methods: Patients were recalled 5 years after apical surgery, and treated teeth were classified as healed or not healed based on clinical and radiographic examination. (The latter was performed independently by 3 observers). Two different methods of root-end preparation and filling (primary study parameters) were to be compared (mineral trioxide aggregate [MTA] vs adhesive resin composite [COMP]) without randomization., Results: A total of 271 patients and teeth from a 1-year follow-up sample of 339 could be re-examined after 5 years (dropout rate = 20.1%). The overall rate of healed cases was 84.5% with a significant difference (P = .0003) when comparing MTA (92.5%) and COMP (76.6%). The evaluation of secondary study parameters yielded no significant difference for healing outcome when comparing subcategories (ie, sex, age, type of tooth treated, post/screw, type of surgery)., Conclusions: The results from this prospective nonrandomized clinical study with a 5-year follow-up of 271 teeth indicate that MTA exhibited a higher healing rate than COMP in the longitudinal prognosis of root-end sealing., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: To date, evidence of the effectiveness of endodontic treatment and criteria of success have mainly been considered in terms of clinical outcome, and there is a lack of information of treatment outcomes from patients' perspectives. This study aimed to assess changes in quality of life after endodontic treatment and to determine if changes in quality of life were associated with changes in patient-perceived oral health and clinical assessments of success., Methods: This longitudinal study involved 279 subjects. Patient-reported outcome measures based on oral health-related quality of life was assessed using the short form of the Oral Health Impact Profile (OHIP-14). The patients completed the assessments before endodontic treatment and 1 month and 6 months after root canal obturation. A global oral health transition assessment was ascertained by a single (global) item rating of oral health improvement and clinical assessment mainly based on the Periapical Index (PAI) of periapical radiographs., Results: There were significant changes in OHIP-14 scores over the study period after conventional orthograde endodontic treatment (from pretreatment-6 months postobturation) (P < .001). The magnitude of statistical change (effect size) was moderate (0.61) in the short-term (after 1 month) and large (0.71) in the longer-term (after 6 months). Changes in the OHIP-14 was associated with changes in patient self-rating oral health status (P < .001), which was also associated with changes in PAI scores (P < .05)., Conclusions: Endodontic treatment improves quality of life. The OHIP-14 measure is both sensitive and responsive to endodontic treatment and is likely to be useful in understanding patients' perspectives of outcomes from endodontic care., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Pulp revascularization may be considered a promising alternative for traumatized necrotic immature teeth. The aim of this study was to evaluate traumatized immature teeth treated with 2 protocols of pulp revascularization., Methods: Twenty-three teeth of young patients (7-17 years old) with necrotic upper incisors caused by dental trauma were divided into 2 groups; one group was treated with triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) (TAP) (n = 12), and the other was medicated with combination of calcium hydroxide and 2% chlorhexidine gel (CHP) (n = 11). Patients were treated and followed up for a period from 9-19 months in 2 dental institutions for evaluation of clinical and radiographic data., Results: Most of the teeth were affected by lateral luxation (47.8%). Clinical evaluation in group TAP showed significant reduction in spontaneous pain (P = .01), pain on horizontal percussion (P = .007), and pain on palpation (P = .03), whereas group CHP showed significant reduction in pain on vertical percussion (P = .03). Crown discoloration was observed significantly more in teeth of group TAP (83.3%) (P < .002). On radiographic exam, periapical repair was found in all TAP-treated teeth (P = .03). Similarly, the same findings were found for all teeth treated with CHP with exception of 1 tooth (P = .21). Apical closure was significantly observed in both groups (P < .05). Increase in root length was demonstrated in 5 teeth (41.7%) and 3 teeth (27.3%) of groups TAP and CHP, respectively. Thickening of lateral dentinal walls was observed in 5 teeth of each group., Conclusions: Revascularization outcomes for traumatized patients treated with the tested protocols presented similar clinical and radiographic data. However, TAP caused esthetic problem leading to tooth discoloration, which can be considered a disadvantage when compared with CHP., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Individuals with Pierre Robin sequence (PRS) frequently have tooth agenesis, especially in the mandible. The aims of this study were to characterize permanent tooth agenesis patterns and to determine their prevalence in patients with nonsyndromic PRS., Methods: Radiographs and clinic charts of 146 children with nonsyndromic PRS were examined for permanent tooth agenesis, excluding third molars, and the tooth agenesis patterns were identified with the tooth agenesis code., Results: The overall prevalence of permanent tooth agenesis was 32.9% (48 of 146 patients), with about two thirds having bilateral tooth agenesis. No sex or racial predilection was found for tooth agenesis. The most common tooth agenesis pattern was the absence of both mandibular second premolars. Among the children with tooth agenesis, almost half had agenesis patterns involving both mandibular second premolars. Other common patterns of permanent tooth agenesis involved the maxillary lateral incisors and the maxillary premolars., Conclusions: Symmetric agenesis of individual tooth types occurs much more frequently in the mandible than in the maxilla in patients with nonsyndromic PRS. Bilateral absence of the mandibular second premolars is the predominant pattern of dental agenesis., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: Recently, case reports have shown that immature teeth diagnosed with necrotic pulp and periapical periodontitis can be repaired through a regenerative endodontic procedure. True regeneration depends on the presence of stem cells in the remaining vital tissues. The aim of this study was to evaluate the histologic condition of the pulp tissue, root apical papilla, and periapical tissues after inducing endodontic infection in immature rat teeth for different periods., Methods: This study evaluated 18 first upper rat molars (36 roots). Periapical lesions were induced and were confirmed radiographically, and the animals were divided into 3 groups according to the days of pulp exposure for endodontic infection induction: 30, 60, and 90 days. Histologic analysis was performed in 5 different areas (ie, cervical, middle, and apical root canal thirds; the apical papilla; and the periapex surrounding the apical papilla)., Results: At 30 days, one third of the specimens still showed vital but intensely inflamed pulp tissue in the apical third and vital apical papilla with varying degrees of inflammation. After 60 days, the results were similar with respect to the apical pulp tissue and apical papilla. Completely necrotic pulp tissue in the space canal and vital apical papilla were observed in about 67% of the cases after 90 days., Conclusions: Vital pulp tissue was observed in the apical third until 60 days and in the vital apical papilla until 90 days of infection in a rat model., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

This case report describes the successful treatment of an adult with lip protrusion and a previously traumatized maxillary central incisor that had experienced replacement root resorption. An extracted premolar was transplanted into the incisor space and retracted orthodontically. Autotransplantation was successful with complete root formation and, combined with orthodontic treatment, provided a satisfying esthetic outcome., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: This retrospective study assessed the effects of microsurgical treatment of post-treatment endodontic disease using SuperEBA (Bosworth, Skokie, IL) as the root-end filling material and evaluated the potential prognostic factors in relation to outcome., Methods: Data were collected from patients diagnosed with post-treatment endodontic disease who then underwent endodontic microsurgery between April 2007 and October 2010. The effect was evaluated 2 years after the operation. Surgical procedures were performed by a single endodontic specialist. After surgery, operation records were recorded including preoperative, intraoperative, and postoperative factors from the clinical and radiographic measures. For statistical analysis of the predisposing factors, the dependent variable was the dichotomous outcome (ie, success vs failure)., Results: Eighty-two patients with 101 treated teeth met the inclusion criteria. The recall rate was 87.2%. Of these microsurgically treated cases, the overall healing rate was 93.1%. At the 0.05 significance level, age, sex, tooth position, size of periapical radiolucency, biopsy result of periapical lesion, and presence of a sinus tract appeared to have no significant effects on the outcome (P > .05)., Conclusions: Microsurgical endodontic treatment using SuperEBA as the root-end filling material is a favorable option for post-treatment endodontic disease., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: External root resorption (ERR) is a serious complication after replantation, and its progressive inflammatory and replacement forms are significant causes of tooth loss. This retrospective study aimed to evaluate the factors related to the occurrence of inflammatory ERR (IERR) and replacement ERR (RERR) shortly after permanent tooth replantation in patients treated at the Dental Trauma Clinic at the School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil., Methods: Case records and radiographs of 165 patients were evaluated for the presence, type, and extension of ERR and its association with age and factors related to the management and acute treatment of the avulsed tooth by using the logistic regression model., Results: The patient's age at the moment of trauma had a marked effect on the ERR prevalence and extension. The patients older than 16 years at the moment of trauma had less chance of developing IERR and RERR (77% and 87%, respectively) before the pulp extirpation, regardless of the extension of the resorption. The patients older than 11 years of age at the moment of trauma showed the lowest indices of IERR (P = .02). Each day that elapsed between the replantation and the pulp extirpation increased the risk of developing IERR and RERR by 1.2% and 1.1%, respectively, and also raised the risk of severe IERR by 0.5% per day., Conclusions: The risk of mature teeth developing severe IERR before the onset of endodontic therapy was directly affected by the timing of the pulpectomy and was inversely proportional to age. Systemic antibiotic therapy use had no effect on the occurrence and severity of IERR in mature teeth. The occurrence of RERR before the onset of endodontic treatment stimulates further investigations of the early human host response to trauma and subsequent infection., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Recent reviews lament the lack of evidence on the efficacy of regenerative procedures to induce further root maturation despite claims of a paradigm shift in the way infected, necrotic immature teeth with arrested root development can be endodontically treated. The majority of reports are either case series or successful case reports where nonstandardized images may make interpretation uncertain., Methods: This prospective clinical study reports on preliminary outcomes of regenerative endodontic procedures carried out on 16 teeth, 3 mandibular premolars and 13 traumatized central incisors, after 18-month reviews. Qualitative analysis of resolution of periapical radiolucencies and apical closure was undertaken. Quantitative analysis compared preoperative and recall radiographs by using a geometrical imaging program that calculated percentage changes in root length and dentin wall thickness., Results: Qualitative assessment showed 90.3% resolution of the periapical radiolucency. Apical closure was assessed as incomplete in 47.2% and complete apical closure in 19.4% of cases. Quantitative assessment showed change in root length varying from -2.7% to 25.3% and change for root dentin thickness of -1.9% to 72.6%., Conclusions: Patterns of continued root maturogenesis were variable at 18-month review. Reviews at 36 months showed continued root maturogenesis for 2 cases. Quantitative analysis can control for changes in angulation but may introduce other measurement errors. However, not all anterior teeth were suitable for TurboReg assessment because overlapping of the cementoenamel junctions and/or further eruption of teeth often precluded stable landmark positioning. Discoloration of the crown was a common consequence, with unaesthetic results in 10 of the 16 cases., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this in vivo study was to evaluate the influence of apical periodontitis (AP) on the accuracy of Dentaport ZX (J Morita, Kyoto, Japan), Raypex 5 (VDW, Munich, Germany), and i-Root (S-Denti, Seoul, Korea) electronic root canal length measurement devices (ERCLMDs)., Methods: Thirty-two single-rooted teeth scheduled for extraction, consisting of 16 teeth with AP and 16 teeth with normal periapex (NP), were selected. The access cavity was prepared, and the coronal portion of the canal was flared. The electronic working length (EWL) was determined by each ERCLMD according to each manufacturer's instructions. Each tooth was extracted, and the actual working length (AWL) was determined by inserting a size 15 K-file until the tip could be seen at a position tangential to the major foramen and then 0.5 mm was subtracted from the measurement. The distance from the file tip (EWL) to the point 0.5 mm coronal to the major foramen (AWL) was calculated. Data were analyzed using the nonparametric Fisher exact test and the chi-square test. Statistical significance was set at P < .05., Results: The accuracies of Dentaport ZX, Raypex 5, and i-Root within ± 0.5 mm in the AP group were 93.8%, 81.3%, and 75.0%; they were 93.3%, 86.7%, and 73.3% in the NP group, respectively. There were no significant differences between the accuracy of each device in the 2 groups (P > .05). Considering the 2 groups of AP and NP, there were no statistically significant differences in the accuracy of the ERCLMDs (P > .05)., Conclusions: The presence of AP did not influence the accuracy of ERCLMDs., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to examine non-cavitated approximal caries using non-invasive treatment methods., Materials and Methods: Molar and premolar teeth with approximal caries were used in this in vivo study. Approximal caries lesions were evaluated with visual and radiographic inspection and with the DIAGNOdent device. Five groups were formed to study non-invasive treatment, and each had at least 25 early approximal carious lesions. Patients in the control group were not treated. After the separation, either ozone application, acidulated phosphate fluoride gel, CPP-ACP-containing material (Tooth Mousse), or an antibacterial bonding agent (Clearfil Protect Bond) was used. For 18 months after the non-invasive treatment, radiological controls were used to observe the progress of the initial and approximal caries in the 1st, 3rd, 6th and 12th months of follow-up. A Mann-Whitney U-test was used to perform the statistical analysis; in-group comparisons were made with the Wilcoxon signed-rank test, and a quantitative assessment was performed using a chi-squared test., Results: At the end of 18 months, the caries lesions in the control group were observed to progress (P < 0.01). The lesions that were scored as 1a during a visual inspection recovered by using non-invasive treatments., Conclusion: Approximal caries lesions that were detected at the early stages remained stationary when using antibacterial agents and materials that promoted remineralisation., Clinical Relevance: Antibacterial agents and remineralisation materials can be used in treatment of early approximal caries lesions., (© 2013 FDI World Dental Federation.)

Introduction: Salivary leakage after root canal therapy is of great concern and can lead to failure of the endodontic therapy. The aim of this study was to investigate whether the use of a rubber dam (RD) during post placement impacts the success of root canal-treated teeth., Methods: Retrospective chart reviews of 185 patients with an average recall of 2.7 years were assessed for the incidence of a new periapical lesion (periapical index score >2) after root canal therapy and post placement. The patients were divided into 2 groups based on the presence or absence of an RD clamp in the verification radiograph during post placement., Results: Twenty-six patients (30 teeth) had a post placed with the use of an RD, and 159 patients (174 teeth) had a post placed without an RD. In the non-RD group, 128 (73.6%) teeth were considered successful at follow-up. In the RD group, 28 (93.3%) teeth were considered successful at follow-up. Based on the bivariate GEE model, the difference in success between these 2 groups was statistically significant (P = .035)., Conclusions: The use of an RD during prefabricated post placement provides a significantly higher success rate of root canal-treated teeth. Using an RD is already considered a standard of care for nonsurgical root canal therapy; in addition, using an RD during restorative procedures that involve open teeth should also become a standard of care., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Of 3,216 root canals treated endodontically at the Creighton University School of Dentistry from September 1, 2005, to August 31, 2007, with LightSpeedLSX instruments (LightSpeed Technology, Inc, San Antonio, TX), there were 12 cases of irretrievable instrument separation. More than 5 years after the separations, an attempt was made to contact the patients and assess for healing and tooth retention., Methods: Third- and fourth-year dental students performed root canal procedures according to protocol from September 1, 2005, to August 31, 2007. A database was collected during the 24-month period recording cases with irretrievable LightspeedLSX separation. Efforts were made from July 2011 to December 2011 to contact the 12 patients for endodontic follow-up. Clinical and radiographic evaluations of healing were performed., Results: Of the 12 patients with irretrievable separations, 8 patients were contacted and 5 returned to Creighton University School of Dentistry for follow-up. All 8 contacted patients confirmed the presence of the root canal-treated tooth in question, and the teeth of the 5 evaluated patients were determined to be asymptomatic and functional. Radiographic analysis resulted in 2 teeth being classified as complete healing, 2 as uncertain healing, and 1 as no healing., Conclusions: The 100% tooth retention rate and the lack of symptoms in 8 contacted (5 evaluated) patients 5 years after treatment suggests that long-term retention and functionality can occur after irretrievable instrument separation. Although tooth retention and functionality are desirable outcomes, radiographic findings may be indicative of inadequate periapical healing, thus requiring the clinician to evaluate whether additional treatment is necessary., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: In this retrospective study, the success rate for the repair of root perforations using mineral trioxide aggregate was investigated., Methods: One hundred forty consecutive cases of teeth with perforations were included in the sample; 128 finally met the inclusion criteria. All treatments were performed between 1999 and 2009 in a dental office limited to endodontics. Perforations were sealed with mineral trioxide aggregate using a dental operating microscope. Treatment success was assessed by analyzing clinical data and radiographs 1-10 years after treatment. The radiographs were evaluated by 2 independent calibrated examiners. The outcome measure was dichotomized as "healed" or "failure." The relationship between preoperative data and treatment outcome was examined to determine potential prognostic factors., Results: From 128 teeth, 90 were accessible for recall (70.3%). The mean follow-up interval was 3.4 years. Sixty-six teeth (73.3%) were classified as healed. A significant relationship between treatment success and the presence of a preoperative lesion at the perforation site was found. Those teeth in which a lesion at the perforation site was present before treatment showed a lower healing rate. Teeth with a preoperative communication between the perforation and the oral cavity showed the lowest success rate., Conclusions: Two prognostic factors for healing of teeth with perforations were identified. The presence of a preoperative lesion at the perforation site and direct contact between the perforation and the oral cavity were related to lower treatment success rates., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to compare the prevalence of agenesis of the maxillary lateral incisors in the cleft area of patients with unilateral cleft lip and palate with and without Simonart's band., Methods: A sample of panoramic radiographs of 121 patients with a mean age of 7 years was divided into 2 groups: group 1 included 60 patients with Simonart's band, and group 2 included 61 patients without Simonart's band. Patients with syndromes were not included. Chi-square tests were used for intergroup comparisons (P <0.05)., Results: In the pooled subgroup, the prevalences of maxillary lateral incisor agenesis, supernumerary maxillary lateral incisors, 1 maxillary lateral incisor mesial to the cleft, and 1 maxillary lateral incisor distal to the cleft were 40.5%, 12.5%, 8.2%, and 38.8%, respectively. In group 1, these frequencies were 35%, 10%, 6.7%, and 48.3%; in group 2, they were 45.9%, 13.1%, 11.5%, and 29.5%. There was a statistically significant difference between the groups for the prevalence of a maxillary lateral incisor distal to the cleft., Conclusions: The presence of Simonart's band is associated with a higher frequency of maxillary lateral incisor development in the maxillary process., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)