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Objectives The aim of this ex vivo study was to measure the sensitivity, specificity, and receiver operating characteristic (ROC) area under the curve (AUC) of a caries diagnostic system based on photothermal radiometry and modulated luminescence (PTR/LUM) and compare them with the values for digital intraoral radiography (IR) and cone beam computed tomography (CBCT) in detecting recurrent decay. Study Design Class 2 composite restorations were prepared on 70 proximal surfaces: 35 with caries and 35 without caries. The gingival floor of the restored surfaces was assessed for caries under the restorations using each of the 3 modalities. Statistical calculations and analysis were performed using the R statistical computing environment. Results The average scores for sensitivity among the 6 observers were 0.89 for PTR/LUM, 0.38 for IR, and 0.40 for CBCT. Sensitivity for PTR/LUM was significantly greater than sensitivity for IR and CBCT. Average scores for specificity were 0.83, 0.80, and 0.70 for PTR/LUM, IR, and CBCT, respectively. CBCT had significantly lower specificity. The AUC was 0.65 for IR and 0.59 for CBCT, which were significantly different. PTR/LUM had moderate intraobserver agreement. Conclusions PTR/LUM, which involves non-ionizing radiation, can serve as a sensitive adjunct in early caries detection and monitoring.

Background Magnetic resonance imaging (MRI) or computed tomography/cone beam computed tomography (CT/CBCT) should be performed in implant therapy when the conventional image is not adequate or when more information is needed to improve the patient's treatment. Therefore, 3-D imaging may be required even when the implants are present in the field of view (FOV). Thus, determining the most suitable imaging technique and setting for each type of implant material will facilitate the radiologists ability to give the best care to the patient. Objective(s) The aim of this study was to assess the amount and structure of artifacts caused by titanium grade 4 and 5, zirconium, and titanium–zirconium alloy implants in MRI, CT, and CBCT with several acquisition protocols and to correlate the findings to the radiation dose given by 2 different CT machines and different CBCT exposure settings. Study Design Three phantoms were built by embedding titanium, zirconium, and titanium–zirconium alloy implants in ultrasound gel. MRI, CT, and CBCT images were acquired using multiple sequences and settings. For MRI, the artifact was described as the length of signal void beyond the limits of the implant. For CT and CBCT, the artifact was calculated by subtracting the gray level of the darkest pixel from the one of the lightest pixel. Results Titanium and titanium–zirconium alloy implants created extensive artifacts in MRI as a result of high susceptibility, whereas zirconium implants could be correctly depicted with only minor distortion artifacts. However, in CT and CBCT, titanium and titanium–zirconium alloy implants generated less severe artifacts than zirconium. Discussion/Conclusions MRI images were less affected by the artifacts from zirconium implants, whereas CT and CBCT images showed fewer artifacts from titanium and titanium–zirconium alloy implants. CBCT, especially at low dose settings, produced the least amount of radiation compared with high-resolution settings and 2 CT machines.

Introduction Cone-beam computed tomographic (CBCT) analysis allows for 3-dimensional assessment of periradicular lesions and may facilitate preoperative periapical cyst screening. The purpose of this study was to develop and assess the predictive validity of a cyst screening method based on CBCT volumetric analysis alone or combined with designated radiologic criteria. Methods Three independent examiners evaluated 118 presurgical CBCT scans from cases that underwent apicoectomies and had an accompanying gold standard histopathological diagnosis of either a cyst or granuloma. Lesion volume, density, and specific radiologic characteristics were assessed using specialized software. Logistic regression models with histopathological diagnosis as the dependent variable were constructed for cyst prediction, and receiver operating characteristic curves were used to assess the predictive validity of the models. A conditional inference binary decision tree based on a recursive partitioning algorithm was constructed to facilitate preoperative screening. Results Interobserver agreement was excellent for volume and density, but it varied from poor to good for the radiologic criteria. Volume and root displacement were strong predictors for cyst screening in all analyses. The binary decision tree classifier determined that if the volume of the lesion was >247 mm3, there was 80% probability of a cyst. If volume was Conclusions The good accuracy and high specificity of the decision tree classifier renders it a useful preoperative cyst screening tool that can aid in clinical decision making but not a substitute for definitive histopathological diagnosis after biopsy. Confirmatory studies are required to validate the present findings.

Objective To evaluate zirconium implant artifact production in cone beam computed tomography images obtained with different protocols. Study Design One zirconium implant was inserted in an edentulous mandible. Twenty scans were acquired with a ProMax 3D unit (Planmeca Oy, Helsinki, Finland), with acquisition settings ranging from 70 to 90 peak kilovoltage (kVp) and voxel sizes of 0.32 and 0.16 mm. A metal artifact reduction (MAR) tool was activated in half of the scans. An axial slice through the middle region of the implant was selected for each dataset. Gray values (mean ± standard deviation) were measured in two regions of interest, one close to and the other distant from the implant (control area). The contrast-to-noise ratio was also calculated. Results Standard deviation decreased with greater kVp and when the MAR tool was used. The contrast-to-noise ratio was significantly higher when the MAR tool was turned off, except for low resolution with kVp values above 80. Selection of the MAR tool and greater kVp resulted in an overall reduction of artifacts in images acquired with low resolution. Conclusions Although zirconium implants do produce image artifacts in cone-bean computed tomography scans, the setting that best controlled artifact generation by zirconium implants was 90 kVp at low resolution and with the MAR tool turned on.

Introduction La barriere intestinale est de plus en plus incriminee comme interface entre les activateurs environnementaux de l’immunite innee et l’induction des phenomenes auto-immuns. La rupture des jonctions serrees intestinales permet la translocation du lipopolysaccharide vers le foie et l’induction de la voie TLR4-NF-κB hepatique. Des etudes recentes de modeles lupiques murins mettent en relief le role de la permeabilite intestinale dans la pathogenese du lupus. Cependant, la plupart de ces etudes utilisent des modeles genetiques de lupus murin sans germes bacteriens ou gnobiotiques. Par ailleurs, la calprotectine fecale, utilisee classiquement dans le suivi des maladies inflammatoires intestinales, n’a jamais ete evaluee dans le lupus en association a l’axe intestin-foie. Objectif Notre etude vise a evaluer l’axe intestin-foie dans un modele murin induit de lupus et son association a la calprotectine fecale. Patients et methodes Des souris C57BL/6 sont traitees par une application cutanee sur l’oreille droite de 1,25 mg d’imiquimod a 5 %, trois fois par semaines pour six semaines. Le groupe controle n’a pas recu de traitement. Les selles ont ete collectees a j0, 22 et 45. Apres sacrifice, les deux groupes ont subi une evaluation histologique et biochimique. Resultats A six semaines, la nephrite lupique a ete confirmee avec des glomerules hypercellulaires, une expansion mesangiale, un infiltrat inflammatoire, et une augmentation de l’expression tissulaire de NGAL et KIM-1. La calprotectine fecale a augmente significativement a partir du j22 sans lesions intestinales. L’expression proteique intestinale de Claudine, Occludine et Zonula Occludens-1 etait diminuee dans le groupe lupus associee a une augmentation de l’expression proteique d’E. coli dans le foie, une necro-inflammation et une augmentation de l’expression hepatique de TLR4, TLR7, et pNFκB/NFκB. Conclusion A notre connaissance notre etude est la premiere a demontrer un dysfonctionnement intestinal avec calprotectine fecale elevee associe a une atteinte hepatique dans un modele murin de lupus induit par application cutanee d’un agoniste TLR7. Notre etude ouvre de nouveaux horizons preventifs et therapeutiques.

Background Maxillary anterior teeth play an important role in aesthetics, phonetics, and mastication. Because of the aesthetic and functional significance, it is important to evaluate their position in association with surrounding structures in 3-D before initiating orthodontic treatment. With the advent of cone beam computed tomography (CBCT) in orthodontic diagnosis, it is now possible to identify these structures. One such structure is the incisive canal. Uncertainty in locating the canal can cause root resorption postorthodontic retraction of anterior maxillary teeth. Objective(s) The aim of this study was to calculate the relative distance between the incisive canal and maxillary central incisor using CBCT and utilize the results for orthodontic treatment planning. Study Design All quantitative measurements between the incisive canal and both maxillary central incisors were performed using CBCT on 61 patients. The anteroposterior measurements were taken on both sides, and the average of both values was considered for the statistical analysis. The Steiner cephalometric analysis was performed to select patients with skeletal and dental Class I relationship. All linear measurements were performed on the axial plane at 3 different vertical reference points located on the sagittal plane: (1) the palatal opening of the incisive canal (opening level, P1), (2) midlevel between the opening level and the root apex of the maxillary central incisors (midlevel, P2), and (3) the root apex of the maxillary central incisors (root apex level, P3). Results The average anteroposterior distance between the maxillary central incisor roots and the incisive canal was approximately 56 mm. Discussion/Conclusions The results of our study could be clinically helpful to plan orthodontic treatment that requires significant retraction of maxillary incisors. The authors support the idea of a pretreatment CBCT in cases that require maximum anterior retraction in the maxilla.

Background Cleidocranial dysplasia (CCD), also known as cleidocranial dysostosis or osteodental dysplasia, is an autosomal dominant disorder caused by a microdeletion defect in chromosome 6p21. The causative factor of this disorder is a mutation in the gene encoding in the transcription factor core binding factor α 1 (CBFA1), and its incidence is 1 in 100,000 population. The aims of this clinical paper are to illustrate the ways of diagnosing and treating CCD as stated in the literature, and to report the multidisciplinary management of a patient with this condition. Methods Clinical and radiographic examinations are primordial for diagnosis because the most frequent features of CCD are a pathognomonic deformity of the skull (open skull sutures and delayed closing of cranial fontanels, presence of multiple Wormian bones), midfacial hypoplasia, a wide forehead, pronounced frontal bossing and hypertelorism, supernumerary and impacted teeth, hypoplastic or absent clavicles, and short stature. The diagnosis of CCD is obvious when there is a family history. Results Many solutions for the treatment of dental disorders in CCD have been suggested, and the intervention of several dental specialists, namely, the oral surgeon, orthodontist, periodontist, and maxillofacial surgeon, was required to achieve optimal results. Conclusion Orthodontic treatment brought all of the teeth on the arches, and the patient was able to sustain orthognathic surgery to correct the skeletal open bite and Class III relationship.

Background After endodontic surgery, radiographic assessment is the method of choice to monitor bone defect healing. Cone beam computed tomography (CBCT) scans are useful to identify the cause of surgical intervention failure or to confirm healing; however, the artifacts generated by some root-end filling material might compromise this objective. Objective(s) The aim of this study was to compare the artifact and contrast-to-noise ratios generated by four root-end filling materials at multiple CBCT exposure settings and positions within the field of view (FOV). Study Design Twelve central incisors were endodontically treated, obturated, and then retrograde-filled using amalgam, Biodentine, SuperEBA (ethoxy benzoic acid), and mineral trioxide aggregate (MTA). A phantom was created; then, tooth samples were inserted and scanned in the center and periphery of a 4 × 4 mm field of view (FOV) using a Morita MCT-1 F8 (at multiple kV and degree acquisition settings). Image J was used to determine the artifact and contrast-to-noise generated at the same relative slice image of each tooth. Results Artifacts FOV position: periphery had less artifact than central (P value CNR FOV position: Periphery had higher contrast-to-noise ratio (CNR) than central (P value Discussion/Conclusions Biodentine, MTA, and SuperEBA are biomechanically adequate for retrograde obturation because they generated significantly less artifact compared with amalgam. The use of the 360° image slice acquisition mode generated significantly less artifact than the 180o setting for all materials. Finally, a periphery position led to lower artifact and higher CNR compared with the central position, a finding that was contrary to previous findings in the literature.

Background Despite the development of several modern imaging modalities, radiography remains the first and the most important mode of investigation for evaluating jaw lesions. Osteosarcoma is the most common primary malignant bone tumor, accounting for approximately 20% of the sarcomas, but only 5% of the osteosarcomas occur in the jaws. Malignant lesions are known to quickly grow downward into the periodontal ligament (PDL) space, resulting in an irregular widening and destruction of the lamina dura. Often, root fractures can result in a similar radiographic appearance of the surrounding periodontium. We present a case series of 2 patients with vertical root fractures and 1 case of osteosarcoma of the jaw. Clinical and Radiographic Findings The 3 patients portrayed similar radiographic findings. Cone beam computed tomography (CBCT) images and panoramic radiography images revealed osseous defects resembling periodontal destruction, periradicular radiolucency, and irregular widening of the surrounding PDL space. Clinically, the 3 patients did not suffer from pain. However, the last of the three patients presented with tooth mobility. Differential or Definitive Interpretation Biopsy and histologic analysis revealed case #1 to have osteosarcoma and cases #2 and #3 to have a periodontal defect resulting from a root fracture. Discussion/Conclusions Localized swelling, with or without pain, is the characteristic feature of osteosarcoma. A purely osteolytic lesion demonstrates a radiolucency with “moth-eaten” or irregular borders that seem to infiltrate into the surrounding bone. Early-stage osteosarcoma of the jaw can also appear as symmetric widening of the PDL space. Therefore, when there is suspicion, biopsy should be performed to rule out malignancy.