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Background and Objectives: This study investigates the efficacy of 4% articaine buccal infiltration in patients with mandibular molar irreversible pulpitis. The goal is to understand the anatomical factors contributing to articaine’s success in mandibular infiltrations. Materials and Methods: A randomized controlled trial was conducted with 50 patients diagnosed with symptomatic irreversible pulpitis in mandibular molars. Patients were divided into two groups: 4% articaine buccal infiltration (n = 30) and 2% lidocaine nerve block (n = 20). Pain was assessed using visual analog scales (VASs) before diagnosis, after thermal pulp sensitivity testing, and 5 and 10 min post-anesthetic application. Cone beam computed tomography (CBCT) was used to measure mandibular bone parameters. Results: The success rate for articaine buccal infiltration was 36.55%, with no significant difference between the efficacy in the first and second molars. CBCT measurements indicated no significant influence of buccal cortical bone thickness or distance from the mental foramen on anesthetic efficacy. However, articaine administration achieved anesthesia in some cases where lidocaine did not. Conclusions: Anatomical structures such as cortical bone thickness and distance from the mental foramen do not significantly influence the anesthetic efficacy of articaine in mandibular posterior infiltration for irreversible pulpitis treatment. These findings suggest that factors other than anatomical variations contribute to articaine’s superior performance in some clinical scenarios.

Abstract Given today’s higher demand for online transmission of radiographic images, clinicians and regulatory agencies should be given the evidence they need to guide them in choosing the best image file format to be adopted. To this end, the present scoping review aims to explore, map, and evaluate the literature, with the object of reporting the influence of image file formats on dental diagnostic tasks by assessing intraoral radiographic images. This scoping review complies with PRISMA-ScR. It was customized to assess the risk of bias of the included studies, and was registered on the Open Science Framework platform. The data extraction protocol was developed based on the PCC acronym. An electronic search was conducted in six databases (Pubmed, Web of Science, Scopus, Embase, Lilacs, Cochrane) in December 2023. Original articles were screened, having observational, diagnostic accuracy, and consisting of in vivo or ex vivo laboratory studies investigating the influence of file formats on different diagnostic tasks in dentistry. Eighteen studies, published between the years 1996 and 2022, were included. The following data were extracted from the selected articles: article title, authors’ citation, publication date, country, diagnostic task, image file formats tested, compression level, and main conclusion. The most widely investigated diagnostic task was caries lesions (n = 10), led by root resorptions (n = 3), root fractures (n = 2), periapical lesions (n = 2), and periodontal disease (n = 1). The most commonly used radiographic techniques were periapical (n = 12) and bitewing (n = 6). The most frequently investigated image file formats were JPEG (all studies) and TIFF (n = 10 studies). BMP, PNG, and JPEG2000 were also included in 7, 3 and 3 studies, respectively. No studies included the DICOM file format. In regard to the subjective assessment of the several dental diagnostic tasks, the studies mostly showed that the influence of the file formats was not significant (n = 10/55.5%). As for the quality assessment of the included papers, more than 70% of the studies featured a low risk of bias. Current evidence on image file formats and dental radiographic diagnosis is reliable. Any image file format can be used without impairing diagnostic accuracy.

Abstract Background Since the muscles of chewing are involved in the region of the mandibular angle, important structures in surgical and orthodontic procedures, to study its morphological aspects and the possible influence of different patterns of skeletal development would be of interest. Thus, this study aimed to assess the influence of patient characteristics - such as sex, skeletal malocclusion (Class I, Class II, and Class III) and facial type (brachycephalic, mesocephalic, and dolichocephalic) - on the width, height, thickness, and volume of the mandibular angle, using cone-beam computed tomography (CBCT) scans. Methods CBCT scans were assessed − 144 men and 154 women, total of 298 - and classified according to skeletal patterns (skeletal malocclusions and facial types). Width, height, and thickness of the mandibular angle were measured using OnDemand 3D software. The volumetric measures of the mandibular angle were obtained using the ITK-SNAP software. Analysis of Variance (multiway ANOVA) with Tukey’s post-hoc test compared the data, with a 5% significance level. Results Among the factors studied, sex significantly influenced all the analyzed variables (height, width, thickness, and volume of the mandibular angle) (p

Introduction: The aim of this study was to assess the agreement between oral and maxillofacial radiologists (OMFR) and oral and maxillofacial surgeons (OMFS) for the detection of bifid mandibular canal (BMC) and accessory mental foramen (AMF) using cone-beam computed tomography (CBCT). Material and Methods: This retrospective study involved 22 examiners (11 OMFR and 11 OMFS) who independently assessed 30 CBCT volumes from patients (n = 60 hemi-mandibles) under preoperative radiographic evaluation for implant placement. The examiners scored the presence of BMC and AMF in each hemimandible. The interexaminer agreements were assessed using Fleiss' kappa statistics. Results: For intra-examiner agreement, 40% of the sample was reevaluated. The interexaminer agreement between OMFR and OMFS was slight (0.12) for the detection of BMC and fair (0.24) for AMF. The agreement among OMFR for detection of BMC was fair (0.22), and it was slight among OMFS (0.15). The agreement among OMFR for detection of AMF was substantial (0.61), and among OMFS it was fair (0.22). Agreements between OMFR and OMFS were slight for BMC and fair for AMF, independently of the years of experience. Intraexaminer agreement ranged from 60% to 90% among OMFR and from 55% to 90% among OMFS. Conclusion: A slight and a fair agreement between OMFR and OMFS was found for the detection of BMC and AMF, respectively. In general, OMFR obtained higher agreement among themselves, mainly for detection of AMF.

Abstract Dose optimisation has been revisited in the literature due to the frequent use of cone beam computed tomography (CBCT). Although the reduction of the field-of-view (FOV) size has shown to be an effective strategy, this indirectly increases the negative effect from the exomass. The aim of this study was to evaluate the diagnostic accuracy of an optimised CBCT protocol in the detection of simulated vertical root fracture (VRF) in the presence of metal in the exomass and/or inside the FOV. Twenty teeth were endodontically instrumented and VRF was induced in half of them. All teeth were individually placed in a human mandible covered with a soft tissue equivalent material, metallic materials were placed at different dispositions in the exomass and/or endomass, and CBCT scans were obtained at two dose protocols: standard and optimised. Five radiologists evaluated the images and indicated the presence of VRF using a 5-point scale. Area under the ROC curve (AUC), sensitivity, and specificity were calculated and compared using ANOVA (α = 0.05). Overall, AUC, sensitivity, and specificity did not differ significantly (p > 0.05) between the dose protocols. In conclusion, optimised dose protocols should be considered in the detection of simulated VRF irrespective of the occurrence of artefacts from metallic materials in the exomass and/or inside the FOV.

Abstract This study aims to assess the influence of high-density material on the radiographic diagnosis of proximal caries in digital systems with automatic exposure compensation, and to evaluate the effect of subjective adjustment of brightness and contrast to undertake this diagnostic task. Twenty bitewing radiographs of forty posterior human teeth with non-cavitated carious lesions, confirmed by micro-CT, were obtained with two digital systems. A porcelain-fused-to-metal crown attached to a titanium implant was inserted into the exposed area, and all the radiographs were repeated. Five radiologists assessed the radiographs and diagnosed proximal carious lesions. Afterwards, the observers were asked to adjust image brightness and contrast, based on their subjective perception, and to reassess the images. Thirty percent of each experimental group was reassessed to test intraobserver reproducibility, totaling 208 images per observer. Intraobserver and interobserver agreements ranged from fair to substantial. Sensitivity, specificity, predictive values, and area under the ROC curve were calculated and compared for each radiographic system, using ANOVA (α = 0.05). Overall, presence of high-density material and adjustment of brightness and contrast did not significantly influence the radiographic diagnosis of proximal caries (p ≥ 0.05). Regarding Digora Optime, adjustment of brightness and contrast significantly increased (p < 0.05) the diagnostic accuracy of proximal carious lesions in the presence of high-density material. In conclusion, the presence of high-density material in the X-rayed region does not influence radiographic diagnosis of proximal caries. However, when it is present in the X-rayed area, subjective adjustment of brightness and contrast is recommended for use with the Digora Optime digital system.

Objectives: The aim of this study was to assess, using the CDR Wireless®, the effect of different exposure times on caries detection and pixel intensity values. Materials and Methods: Forty teeth were x-rayed using a Schick CDR Wireless sensor at eight different exposure times – 0.06, 0.10, 0.13, 0.16, 0.20, 0.25, 0.30, and 0.32 s. Four observers evaluated the images for presence of carious lesions scoring proximal surfaces of each tooth on a 5-point scale. Scores were compared to histological sections of the teeth. Accuracy was evaluated by means of ROC curve analysis. Radiographs of an aluminum step wedge were obtained using the same eight exposure times. Pixel intensity measurements were obtained, and mean pixel values were statistically analyzed using linear regression. Results: The Az for each exposure time varied from 0.53 to 0.62. Two-way analysis of variance and Tukey test demonstrated that the exposure time of 0.25 s presented the best result and was significantly higher than 0.30 s and 0.35 s. In regard to mean pixel values, two different behaviors were observed, and the exposure time of 0.20 s presented mean pixel values in both phases. Conclusion: The performance of the exposure times from 0.06 s to 0.25 s was satisfactory for proximal caries detection, and 0.25 s is the best as indicated for this finality. Clinical Relevance: Considering that a reduction of exposure time represents a reduction of patient exposure dose, and this reduction cannot neglect image quality, the behavior of any digital system must be carefully evaluated.

Background: Micro-computed tomography (micro-CT) has been widely described as a nondestructive in vitro imaging method although its accuracy for caries detection is still unclear. The aim of this study was to investigate the feasibility of micro-CT to detect and classify proximal caries lesions in posterior teeth, using different protocols. Materials and Methods: In this in vitro study, crowns of 122 human teeth were scanned with Skyscan 1174 (Bruker, Kontich, Belgium) using the full-scan mode (360°). Reconstruction of 900 basis images was performed using NRecon Software (Bruker, Kontich, Belgium) for the protocol 1 (full-scan mode 360°), and 450 basis images were used to reconstruct the protocol 2 (half-scan mode 180°). Three observers analyzed the reconstructed images concerning the presence and depth of proximal caries lesions (244 surfaces). To determine the presence/absence and depth of caries lesions, histological examination was conducted as reference standard level of significance McNemar and McNemar-Bowker tests compared the methods studied and the gold standard (P < 0.05). Results: The intra- and inter-observer agreement for both methods ranged from moderate to excellent. There was no difference between both micro-CT methods and histology for the presence of lesions (P > 0.05). However, both methods differed with the reference standard for depth (P < 0.05). The disagreement occurred mostly in cases of enamel lesions. The highest diagnostic values were found for 180° rotation. Micro-CT performed well in detecting caries lesions compared to histology, meanwhile the classification of their depth presented lower values. Scan mode did not influence the detection. Conclusion: Both protocols of micro-CT tested presented an overall satisfactory performance in detecting proximal caries lesions; however, for the depth classification, the method was not accurate.

This study assessed the safety and efficacy of three different doses of BoNT-A for persistent myofascial pain (MFP). One hundred female subjects were randomly assigned into five groups (n = 20): oral appliance (OA), saline solution (SS) and three BoNT-A groups with different doses. Pain intensity and pressure pain threshold were evaluated up to 24 weeks after treatment. Adverse effects related to muscle contraction, masticatory performance, muscle thickness and mandibular bone volume were also assessed. Changes over time were compared within and between groups. The “nparLD” package and Wilcoxon signed-rank test were used to analyze the data. BoNT-A reduced pain intensity (p < 0.0001) and increased pressure pain threshold (p < 0.0001) for up to 24 weeks compared to the placebo. No differences were found between BoNT-A and OA at the last follow-up. A transient decline in masticatory performance (p < 0.05) and muscle contraction (p < 0.0001), and a decrease in muscle thickness (p < 0.05) and coronoid and condylar process bone volume (p < 0.05) were found as dose-related adverse effects of BoNT-A. Regardless of the dose, BoNT-A was as effective as OA on MFP. Notwithstanding, due to BoNT-A dose-related adverse effects, we suggest the use of low doses of BoNT-A in MFP patients that do not benefit from conservative treatments.

ABSTRACT Background: Systemic bone loss may lead to more severe periodontal destruction, decreasing local bone mineral density. Aim: A cross-sectional designed was performed to study associations among alveolar bone pattern, salivary leptin concentrations, and clinical periodontal status in premenopausal obese and eutrophic women. Methods: Thirty morbid obese (G1) and 30 normal-weight (G2) women were included. Anthropometric and periodontal measurements (probing depth - PD, clinical attachment levels - CAL, presence of calculus, bleeding on probing -BOP, and plaque accumulation) were assessed. OHIP-14 was used for assessment of oral health impact on quality of life. Panoramic radiography was used to obtain the panoramic mandibular index (PMI), mandibular cortical index (MCI), and mental index (MI). Intraoral periapical (PA) radiography was taken to measure the total trabecular bone volume. Leptin was measured in saliva of fasted overnight women. Results: Groups 1 and 2 differed in all anthropometric aspects, but height. Pocket depth, calculus, BOP, and plaque index were worse in G1. No differences between groups were found considering OHIP. Normal-weight subjects showed higher proportion of dense bone trabeculae than obese subjects for pre-molars, but not for molars. Mental and panoramic mandibular indexes did not differ and were in normal level. Leptin concentration was dependent only on BMI. Conclusion: Obesity affected the periodontal conditions, the alveolar bone pattern, and the salivary leptin concentration.

El conocimiento de la ubicación, trayectoria y características de los haces neurovasculares en la mandíbula es de fundamental importancia para reducir el riesgode lesión en estas estructuras durante procedimientos quirúrgicos, especialmente cuando hay presencia de variaciones anatómicas. La presencia de estas variaciones anatómicas relacionadas con el agujero mentoniano ha sido reportada en algunos casos y no es frecuentemente valorada en los procedimientos clínicos. Alteraciones sensoriales, tales como parestesias en el labio inferior o en las mejillas, pueden ocurrir como resultado de la presión en el agujero mentoniano. Estas variaciones anatómicas pueden ser detectadas en la práctica clínica a través de los exámenes de diagnóstico por imágenes. La tomografía computarizada se ha establecido como una técnica de imagen útil capaz de proporcionar información detallada de las estructuras maxilofaciales, lo que permite una evaluación minuciosa de su topografía y de las variaciones anatómicas, tales como el agujero mentoniano accesorio. El objetivo de este artículo es describir un caso con agujeros mentonianos dobles que solo pudieron ser observados en las imágenes de tomografía computarizada. El uso de la tomografía computarizada de haz cónico se ha incrementado en la odontología, así las variaciones anatómicas que pueden tener influencia sobre el diagnóstico y planificación del tratamiento pueden ser conocidas. El conocimiento de los forámenes mentonianos adicionales puede contribuir a una adecuada técnica de anestesia y evitar errores diagnósticos de lesiones óseas y daño eventual de los nervios y vasos durante procederes quirúrgicos en la región.

Enhancement filters are potentially supposed to improve the diagnostic performance of digital images. Thus, the aim of this study was to compare the performance of digital radiography with and without enhancement filters for the detection of induced proximal caries lesions. The total sample consisted of 120 sound human teeth (40 premolars, 80 molars). Enamel subsurface demineralization was induced in one of the proximal surfaces of 60 teeth. Standardized radiographs of all teeth were acquired after the demineralization phase using the Digora-Optime® system. Four radiologists examined the digital radiographs and applied the following filters provided by the Digora® for Windows 2.6 package: Negative, Sharpen and both (Negative plus Sharpen). Validation of radiographic diagnosis was carried out by Knoop cross-sectional micro-hardness profiling on the proximal surfaces. Intraobserver agreement was estimated using Kappa statistics (k). Sensitivity, specificity and over-all accuracy were compared using ANOVA/Tukey test (α = 5%). Intraobserver agreement ranged from good to very good/optimal (k: 0.65–0.83). Although not statistically significant, the highest sensitivity (0.68 ± 0.22) and accuracy (0.76 ± 0.16) values were observed using the Sharpen filter as opposed to the Negative filter, which presented the lowest performance indices (0.57 ± 0.13 and 0.70 ± 0.10, respectively). Specificity ranged from 0.84 to 0.85, considering all imaging modalities (p > 0.05). Insofar as the Sharpen filter had the highest performance indices, it may be considered a useful adjunct for detecting subtle proximal caries lesions.

In the most recent decades, several developments have been made on impression materials' composition, but there are very few radiodensity studies in the literature. It is expected that an acceptable degree of radiodensity would enable the detection of small fragments left inside gingival sulcus or root canals. OBJECTIVE: The aim of this study was to determine the radiodensity of different impression materials, and to compare them to human and bovine enamel and dentin. MATERIAL AND METHODS: Twenty-five impression materials, from 5 classes, were studied: addition and condensation silicones, polyether, polysulfides and alginates. Five 1-mm-thick samples of each material and tooth structure were produced. Each sample was evaluated 3 times (N=15), being exposed to x-ray over a phosphor plate of Digora digital system, and radiodensity was obtained by the software Digora for Windows 2.5 Rev 0. An aluminum stepwedge served as a control. Data were subjected to Kruskal-Wallis and Dunn's method (α=0.05). RESULTS: Different materials and respective classes had a different behavior with respect to radiodensity. Polysulfides showed high values of radiodensity, comparable to human enamel (p>0.05), but not to bovine enamel (p

OBJECTIVE: The aim of this study was to establish which materials afford better simulation of soft tissues in Oral Radiology studies. MATERIAL AND METHODS: The sample was composed of four materials in eleven different thicknesses to simulate the soft tissues of the face. The mean values of the relative amounts of radiographic contrast of the materials were determined and compared to a gold standard value, which was obtained from 20 patients who were referred to have periapical radiographs taken of the left mandibular molars. Data were subjected to statistical analysis with Dunnett's test (p

OBJECTIVE: This study aimed to evaluate the possibility of any correlation between disc displacement and parameters used for evaluation of skull positioning in relation to the cervical spine: craniocervical angle, suboccipital space between C0-C1, cervical curvature and position of the hyoid bone in individuals with and without symptoms of temporomandibular dysfunction. MATERIAL AND METHODS: The patients were evaluated following the guidelines set forth by RDC/TMD. Evaluation was performed by magnetic resonance imaging for establishment of disc positioning in the temporomandibular joints (TMJs) of 30 volunteer patients without temporomandibular dysfunction symptoms and 30 patients with symptoms. Evaluation of skull positioning in relation to the cervical spine was performed on lateral cephalograms achieved with the individual in natural head position. Data were submitted to statistical analysis by Fisher's exact test at 5% significance level. To measure the degree of reproducibility/agreements between surveys, the kappa (K) statistics was used. RESULTS: Significant differences were observed between C0-C1 measurement for both symptomatic (p=0.04) and asymptomatic (p=0.02). No statistical differences were observed regarding craniocervical angle, C1-C2 and hyoid bone position in relation to the TMJs with and without disc displacement. Although statistically significant difference was found in the C0-C1 space, no association between these and internal temporomandibular joint disorder can be considered. CONCLUSIONS: Based on the results observed in this study, no direct relationship could be determined between the presence of disc displacement and the variables assessed.

The aim of this study was to investigate a model of inducing enamel subsurface demineralization for evaluating diagnostic imaging methods. Fifty sound teeth had their crowns coated with acid-resistant varnish, leaving a 7 mm² circular window of exposed enamel in one of the proximal surfaces. The specimens were assigned to 5 groups (4 experimental and the control) and were kept immersed in a buffer solution at pH 4.8, 50% saturated in relation to enamel, for 60, 75, 90 and 120 days, or were not exposed to the solution. Digital radiographs were taken, prior to and after each immersion period, and interpreted by a radiologist. For validation, the enamel was submitted to microhardness profiling. In addition, the solutions were analyzed for phosphorus (Pi) and calcium (Ca) concentrations. Microhardness data were evaluated using two-way ANOVA (p

OBJECTIVE: The purpose of this study was to investigate whether skeletal maturation using cephalometric radiographs could be used in a Brazilian population. MATERIAL AND METHODS: The study population was selected from the files of the Oral Radiological Clinic of the Dental School of Piracicaba, Brazil and consisted of 128 girls and 110 boys (7.0 to 15.9 years old) who had cephalometric and hand-wrist radiographs taken on the same day. Cervical vertebral bone age was evaluated using the method described by Mito and colleagues in 2002. Bone age was assessed by the Tanner-Whitehouse (TW3) method and was used as a gold standard to determine the reliability of cervical vertebral bone age. An analysis of variance and Tukey's post-hoc test were used to compare cervical vertebral bone age, bone age and chronological age at 5% significance level. RESULTS: The analysis of the Brazilian female children data showed that there was a statistically significant difference (p0.05) was found between cervical vertebral bone age and bone age. Differently, the analysis of the male children data revealed a statistically significant difference (p

OBJECTIVE: The purpose of this investigation was to evaluate the applicability of the methods proposed by Nolla and by Nicodemo and colleagues for assessing dental age and its correlation to chronological age. METHODS: Panoramic radiographs of 360 patients from the city of Fortaleza (CE, Brazil) aged 7-15 years were used to assess the associations between dental and chronological age. Data were submitted to statistical analysis using the BioEstat 2.0 (2000) software. Student-Neuman-Keuls test was performed and Pearson's correlation coefficients were calculated at 5% significance level. RESULTS: When the Nolla method was applied, the mean difference between true and estimated age for males and females was underestimated. The use of the method proposed by Nicodemo and colleagues also resulted in underestimation, although it was more evident in male subjects. The correlation coefficients between chronological age and estimated dental age were high, with mean values ranging between 0.87 and 0.91 for males and between 0.84 and 0.93 for females. CONCLUSION: Although both methods proved to be reliable in estimating age, the use of correction factors is recommended.

In extensive cavities usually calcium hydroxide cements are used in order to protect the pulp. These materials can present a reduction in the radiopacity due solubility resulting from contact with oral fluids. This study investigated the radiopacity of calcium hydroxide cements stored in distilled water at 37o C, with the aim to verify the alteration of radiographic density in function of solubility. Samples of Dycal, Hydro-C and Life cements were submitted to immersion for periods of 3, 7, 30 and 60 days. After each of these periods, the samples were radiographed and their optical densities obtained. The radiopacity values were expressed in equivalent thickness of aluminum and were compared with the values of enamel and dentine. ANOVA was used to determine if there was a significant difference between the radiopacity values of the cements submitted to different immersion times. The results showed that Dycal and Hydro-C cements presented a significant radiopacity reduction after one week of immersion, while Life had its radiopacity significantly reduced only after 2 months. However, the three tested cements kept similar radiopacity values to those of enamel.

Purpose: To compare intraoral Phosphor Stimulable Plate digital system and intraoral film using different tube settings on incipient proximal caries detection. Materials and Methods: Five blocks, with five teeth each, were radiographically examined using phosphor plates and F-speed films. The images were acquired in 07 different tube potentials from 50-80 kV. The films were digitized. Three oral radiologists scored the images for the presence of caries using a 5-point rating scale. The areas under ROC curve were calculated. The influence of tube kilovoltage was verified by ANOVA and pair wise comparisons performed using Tukey test. Results: Mean ROC curve areas varied from 0.446-0.628 for digital images and 0.494–0.559 for conventional images. The tube setting of 70 kV presented the best result both for digital and conventional images. Considering the image type separately, 70 kV scored highest followed by 75 and 65 kV for digital images (p=0.084). For conventional image modality, even though 70 kV presented the best result, it did not differ significantly from 80 kV, not differing from 60 and 55 kV, which did not differ from 75, 65 and 50 kV (p=0.53). Conclusion: Phosphor plate digital images seem to be more susceptible to tube setting potential variations then digitized film images.

Objetivo: Comparar os métodos de Greulich-Pyle (GP), o do Atlas Venezuelano de Maturação Óssea (AV) e o de Tanner-Whitehouse (TW3-RUS), na estimativa da idade em brasileiros. Metodologia: Utilizou- se uma amostra de 240 radiografias carpais de indivíduos de ambos os sexos (129 meninas e 111 meninos), com idades entre 84 e 199 meses (7 e 16,5 anos). As idades ósseas foram calculadas segundo os métodos GP, AV e TW3-RUS e posteriormente se obtiveram diferenças de media entre a idade cronológica (IC) as idades ósseas estimadas. Resultados: Observou-se uma correlação positiva e estatisticamente significativa entre a IC e as idades ósseas estimadas, (0,89- 0,94). Constatou-se uma superestimativa da idade por todos os métodos nas meninas. Nos meninos verificou-se a superestimativa pelo método AV, enquanto que o GP e o TW3-RUS subestimaram a idade. Verificou-se uma diferença significativa entre a IC e as idades ósseas estimadas pelos métodos GP e AV em ambos os sexos (meninas: GP -6,89; AV -6,41. Meninos: GP 4,45; AV-5,06) e para o TW3-RUS somente foi significativa para as meninas (meninas -2,94; meninos 1,56). Conclusões: O método TW3-RUS resultou ser mais preciso na estimativa da idade, porém se recomenda a utilização das equações de regressão calculadas para um melhor ajuste entre as idades inferidas pelos métodos estudados as idades reais dos indivíduos.

OBJECTIVE: The aim of this study was to determine the differences between the skeletal ages estimated by TW2 and TW3 methods through their RUS and Carpal systems. MATERIAL AND METHODS: A sample of two hundred and forty hand and wrist radiographs of male and female Brazilian children aged 84-199 months was evaluated by five observers. The Dunnet test was performed for statistical analysis. RESULTS: Results showed higher skeletal ages estimated by TW2RUS than TW3RUS and Carpal for both genders. For girls a statistically significant difference (pOBJETIVO: O objetivo deste estudo foi determinar as diferenças entre as idades esqueletais estimadas pelos métodos TW2 e TW3, usando os sistemas RUS e Carpal. MATERIAL E MÉTODOS: Uma amostra de 240 radiografias de mão e punho de crianças brasileiras de ambos os sexos com idade cronológica entre 84 e 199 meses foram avaliadas por cinco observadores. Para análise estatística dos dados foi aplicado o Teste de Dunnet. RESULTADOS: Os resultados demonstraram que as idades esqueletais estimadas pelo método TW2RUS foram mais avançadas que aquelas estimadas pelos métodos TW3RUS e Carpal, para ambos os sexos. Para o sexo feminino, uma diferença estatisticamente significante (p

This experimental research aimed at evaluating the accuracy of enamel demineralization detection using conventional, digital, and digitized radiographs, as well as to compare radiographs and logarithmically contrast-enhanced subtraction images. Enamel subsurface demineralization was induced on one of the approximal surfaces of 49 sound third molars. Standardized radiographs of the teeth were taken prior to and after the demineralization phase with three digital systems - CygnusRay MPS®, DenOptix® and DIGORA® - and InSight® film. Three radiologists interpreted the pairs of conventional, digital, and digitized radiographs in two different occasions. Logarithmically contrast-enhanced subtraction images were examined by a fourth radiologist only once. Radiographic diagnosis was validated by cross-sectional microhardness profiling in the test areas of the approximal surfaces. Accuracy was estimated by Receiver Operating Characteristic (ROC) analysis. Chi-square test, at a significance level of 5%, was used to compare the areas under the ROC curves (Az) calculated for the different imaging modalities. Concerning the radiographs, the DenOptix® system (Az = 0.91) and conventional radiographs (Az = 0.90) presented the highest accuracy values compared with the other three radiographic modalities. However, logarithmically contrast-enhanced subtraction images (Az = 0.98) were significantly more accurate than conventional, digital, and digitized radiographs (p = 0.0000). It can be concluded that the DenOptix® system and conventional radiographs provide better performance for diagnosing enamel subsurface demineralization. Logarithmic subtraction significantly improves radiographic detection.O objetivo desta pesquisa experimental foi investigar a acurácia da detecção de desmineralizações em esmalte por meio de radiografias convencionais, digitais e digitalizadas, e compará-las às imagens por subtração logarítmica. Foram induzidas desmineralizações subsuperficiais no esmalte de uma das faces proximais de 49 dentes terceiros molares hígidos. Radiografias padronizadas dos dentes foram obtidas antes e após a fase de desmineralização com o emprego de três sistemas digitais - CygnusRay MPS®, DenOptix® e DIGORA® - bem como do filme InSight®. Três radiologistas interpretaram os pares de radiografias convencionais, digitais e digitalizadas, em duas ocasiões diferentes. As imagens por subtração logarítmica foram avaliadas por um quarto radiologista apenas uma vez. O diagnóstico radiográfico foi validado pela mensuração da microdureza do esmalte seccionado longitudinalmente, nas áreas-teste das faces proximais. A acurácia foi estimada pela análise "Receiver Operating Characteristic" (ROC). Aplicou-se o teste Qui-Quadrado, em um nível de significância de 5%, para comparar as áreas sob as curvas ROC (Az) das diferentes modalidades de imagens radiográficas. Em se tratando das radiografias, o sistema DenOptix® (Az = 0,91) e as radiografias convencionais (Az = 0,90) apresentaram os maiores valores de acurácia em relação às outras três modalidades de imagem. No entanto, as imagens por subtração logarítmica (Az = 0,98) superaram as radiografias convencionais, digitais e digitalizadas (p = 0,0000). Conclui-se que o sistema DenOptix® e as radiografias convencionais demonstram melhor desempenho no diagnóstico das desmineralizações subsuperficiais em esmalte. A subtração logarítmica aprimora significativamente a detecção radiográfica.

AIMS: All materials added to teeth should present an adequate radiopacity to allow the detection of secondary caries. Usually, in extensive cavities, base materials like calcium hydroxide cement are used for the purpose of protecting the pulp. In an attempt to improve the efficiency of radiographic detection of this material, this study aimed to determine the radiopacity of three calcium hydroxide cements and to compare the radiopacity of these materials with dentin and enamel. METHODS: Radiographs were taken of 1-mm thick specimens of three calcium hydroxide cements: Hydro-C, Dycal and Life, an aluminium stepwedge, a lead foil, and one 1-mm thick human tooth slice. Densitometric measurements were obtained after radiographic processing. The radiopacity values of the calcium hydroxide cements, dentin and enamel were expressed in terms of the equivalent thickness of aluminium. RESULTS: The analysis of variance indicated statistically significant difference only for Life, which presented the lowest radiopacity when compared to the other cements. However, all cements and enamel possessed a radiopacity equivalent to 2mm Al, while dentin presented a radiopacity equivalent to 1mm Al. CONCLUSION: All tested cements presented a similar radiopacity to that of enamel and they meet the ISO 4049 specifications.OBJETIVOS: Todos os materiais adicionados aos dentes deveriam apresentar uma adequada radiopacidade para permitir a detecção de cáries secundárias. Geralmente em cavidades extensas, materiais de base, como o cimento de hidróxido de cálcio, são usados com a função de proteger a polpa. Na tentativa de melhorar a eficiência na detecção radiográfica deste material, este estudo foi realizado com o objetivo de determinar a radiopacidade de três cimentos de hidróxido de cálcio e comparar a radiopacidade destes materiais com a da dentina e do esmalte. MATERIAIS E MÉTODO: Foram radiografados corpos de prova de 1 mm de espessura de três cimentos de hidróxido de cálcio: Hydro-C, Dycal e Life, uma escala de densidade de alumínio, uma lâmina de chumbo e um corte de dente humano de 1 mm de espessura. As densidades ópticas foram obtidas após o processamento radiográfico. Os valores de radiopacidade dos cimentos de hidróxido de cálcio, dentina e esmalte foram expressos em espessuras equivalentes de alumínio. RESULTADOS: A análise de variância indicou diferença estatisticamente significativa apenas para o cimento Life que apresentou a menor radiopacidade quando comparado aos outros cimentos. Entretanto, todos os cimentos e o esmalte possuíram uma radiopacidade equivalente a 2 mm de Al, enquanto a dentina apresentava radiopacidade equivalente a 1 mm de Al. CONCLUSÃO: Todos os cimentos testados apresentaram radiopacidades semelhantes à do esmalte, estando de acordo com as especificações da ISO 4049.

The knowledge of the location, trajectory, and characteristics of the neurovascular bundles in the jaws is fundamental to reduce risk of injuries to this structure during surgical procedures, especially when anatomical variations are present. The presence of anatomical variations associated with the mental foramen has been reported in some cases and is frequently undervalued in clinical procedures. Sensorial disturbances, such as paresthesia in the lower lip or cheeks, may occur as result of pressure on the mental foramen. These anatomical variations can be detected in clinical practice by imaging exams. Computed tomography has been established as a valuable imaging modality capable of providing in-depth information about maxillofacial structures, allowing detailed evaluation of their topography and anatomical variations, such as additional mental foramina. The objective of this article was to describe a case with double mental foramina that only could be observed in computed tomography images. The use of cone beam computed tomography has increased in dentistry, thus anatomical variations that may have an influence on the diagnosis and treatment planning must be recognized. Have a good knowledge of additional mental foramina may contribute to adequate anesthetic techniques and to avoid misdiagnosis of bone lesions and eventual damages to the nerves and vessel during surgical procedures in that region.

Abstract To calculate root canal volume and surface area in microCT images, an image segmentation by selecting threshold values is required, which can be determined by visual or automatic methods. Visual determination is influenced by the operator's visual acuity, while the automatic method is done entirely by computer algorithms. Objective: To compare between visual and automatic segmentation, and to determine the influence of the operator's visual acuity on the reproducibility of root canal volume and area measurements. Material and methods: Images from 31 extracted human anterior teeth were scanned with a μCT scanner. Three experienced examiners performed visual image segmentation, and threshold values were recorded. Automatic segmentation was done using the “Automatic Threshold Tool” available in the dedicated software provided by the scanner's manufacturer. Volume and area measurements were performed using the threshold values determined both visually and automatically. Results: The paired Student's t-test showed no significant difference between visual and automatic segmentation methods regarding root canal volume measurements (p=0.93) and root canal surface (p=0.79). Conclusion: Although visual and automatic segmentation methods can be used to determine the threshold and calculate root canal volume and surface, the automatic method may be the most suitable for ensuring the reproducibility of threshold determination.