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Objectives:  This article reappraises the accuracy and factors associated with the detection of the cementoenamel junction (CEJ) using the tactile method., Materials and Methods:  A total of 111 tooth sites of 7 patients scheduled for flap surgery were selected for the study. The CEJ was detected in a blind manner using the conventional tactile method with a standard periodontal probe by a single, trained examiner. A custom-made stent was prepared to standardize the measurements and the distance from a fixed reference point on the stent to the CEJ was measured before (apparent CEJ) and after (real CEJ) opening a gingival flap. To evaluate the effect of local anesthesia (LA) on the measurement error, assessment with and without LA given prior to the measurement was also evaluated. The bone crest-CEJ distance at each site was also recorded in all sites., Statistical Analysis:  The measurement error of apparent versus real distance, if any, was compared using Cohen's weighted kappa coefficient (WKC) (± 1 mm)., Results:  A weak WKC (WKC = 0.539) was found between the apparent and real CEJ distance. Higher WKCs were noted at posterior and proximal sites than the anterior and buccal/lingual sites, respectively (0.840 and 0.545 vs. 0.475 and 0.488). A higher confluence of the agreements was noted when CEJ distance was measured in anesthetized sites (WKC = 0.703). Sites without bone loss showed more coronal deviation of CEJ detection, as opposed to apical deviation seen at sites with bone loss., Conclusion:  The conventional CEJ detection using the tactile method was relatively imprecise depending on the anatomical location of the tooth and the bone loss at the site of measurement. However, the detection accuracy improved when the sites were anesthetized. In clinical terms, our data, reported here for the first time imply that, in the absence of visual cues, posterior tooth site measurements of periodontal attachment loss were more reliable in comparison to the other sites. The bone crest level also impacted the measurement deviation to some extent, implying that, possible overestimate of clinical attachment loss may occur at sites without bone loss., Competing Interests: None declared, (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Aim: The aim of the study was to assess the most common patterns of cementoenamel junction (CEJ) in permanent tooth and most common pattern of CEJ in males and females in permanent tooth. Materials and Methods: A total number of 120 permanent teeth were selected. The ground sections of these teeth were prepared in longitudinal plane. The cementoenamel junction of prepared ground sections was then analyzed and studied. Results: The edge-to-edge pattern of cementoenamel junction was the most common pattern observed, was followed by gap junction, cementum over enamel, and enamel over cementum. In males and females, the most common pattern of CEJ seen was same (edge-to-edge pattern), followed by gap, cementum over enamel, and enamel over cementum. Conclusion: In the present study, out of four patterns of cementoenamel junction, edge-to-edge pattern was the most commonly seen, followed by gap junction, cementum over enamel pattern, and enamel over cementum pattern.

Extensive invasive cervical resorption (ICR) defects involving the cementoenamel junction has a poor periodontal, restorative, and structural prognosis. However, some patients may insist upon surgical restorative repair of these lesions. Two such treated cases are reported with 15 and 12 month follow–up, respectively. In one case, glass ionomer cement, and in the other case, composite resin with fiber post, were used for restoration, after thorough surgical debridement. Both the patients were available for close follow-ups and maintained scrupulous oral hygiene. In both cases, the teeth had poor prognosis due to high chance of tooth fracture and possible continued periodontal breakdown with bone loss. However, at the above-stated follow-up periods, the teeth remained asymptomatic, periodontally stable, and structurally intact. This supports that a surgical restorative treatment, of the extensive ICR lesion, may result in short-term success and tooth retention.

In human teeth, the cementoenamel junction (CEJ) can have different morphologies, known as Choquet cases or types: in type 1, the cementum overlaps the enamel; in type 2, the enamel overlaps the cementum; in type 3, the relationship between the cementum and enamel is edge-to-edge; and in type 4, there is a gap between the enamel and the cementum, with exposed dentin. Since little is known on the morphology of the CEJ in animals, the aim of this study was to characterize the structure of the CEJ of dog teeth by SEM. We studied 82 permanent teeth extracted from 4 dogs of similar size, aged from 7 months to 2 years. Teeth were grouped according to their size, sectioned and prepared for SEM. The teeth evaluated showed the 4 CEJ types. Type 3 was the most prevalent, being present, either alone or in combination, in 90.79% of the samples, followed by type 4 (present in 31.58% of the samples). Of the samples, 65.13% showed only one type, while 34.87% presented a combination of them. Types 3 and 4 were the only ones present alone (in 55.92% and 9.21% of the samples respectively), whereas the combinations between types 3 and 4 (20.40%) and types 1 and 3 (9.87%) were the most frequent. In all combinations, type 3 was predominant. The CEJ of the dogs evaluated showed a high degree of variability in the different types of teeth, within a same tooth, within the dentition of a single individual, and among individuals. [ABSTRACT FROM AUTHOR]

Injury to the contents of the mental foramen (MF) can be minimized by using cone beam computed tomography (CBCT) to determine the exact location of the MF prior to surgical procedures. In this retrospective study, variations in the vertical position of the MF between adult men and women older than 18 years were investigated using CBCT. The distance between the superior border of the MF and the most apical aspect of the cementoenamel junction (CEJ) of the mandibular second premolar was measured. Among the randomly accessed CBCT records of 200 patients, 176 MF-CEJ measurements met the inclusion criteria. There was a statistically significant difference (P < 0.001) between the sexes in the location of the MF. The distance in women was shorter by an average of 2.00 mm, irrespective of the side of the mandible. Additionally, a within-sex asymmetry between right and left sides was observed; the asymmetry was significantly greater in men than in women (P < 0.05). Clinicians should be cognizant of the influence of the patient's sex on the vertical position of the MF and the presence of asymmetry in the position of the MF between the right and left sides of the mandible within the sex groups. [ABSTRACT FROM AUTHOR]

Objective: Our goal was to automatically identify the cementoenamel junction (CEJ) location in ultrasound images using deep convolution neural networks (CNNs)., Methods: Three CNNs were evaluated using 1400 images and data augmentation. The training and validation were performed by an experienced nonclinical rater with 1000 and 200 images, respectively. Four clinical raters with different levels of experience with ultrasound tested the networks using the other 200 images. In addition to the comparison of the best approach with each rater, we also employed the simultaneous truth and performance level estimation (STAPLE) algorithm to estimate a ground truth based on all labelings by four clinical raters. The final CEJ location estimate was obtained by taking the first moment of the posterior probability computed using the STAPLE algorithm. The study also computed the machine learning-measured CEJ-alveolar bone crest distance., Results: Quantitative evaluations of the 200 images showed that the comparison of the best approach with the STAPLE-estimate yielded a mean difference (MD) of 0.26 mm, which is close to the comparison with the most experienced nonclinical rater (MD=0.25 mm) but far better than the comparison with clinical raters (MD=0.27-0.33 mm). The machine learning-measured CEJ-alveolar bone crest distances correlated strongly (R = 0.933, p < 0.001) with the manual clinical labeling and the measurements were in good agreement with the 95% Bland-Altman's lines of agreement between -0.68 and 0.57 mm., Conclusions: The study demonstrated the feasible use of machine learning methodology to localize CEJ in ultrasound images with clinically acceptable accuracy and reliability. Likelihood-weighted ground truth by combining multiple labels by the clinical experts compared favorably with the predictions by the best deep CNN approach., Clinical Significance: Identification of CEJ and its distance from the alveolar bone crest play an important role in the evaluation of periodontal status. Machine learning algorithms can learn from complex features in ultrasound images and have potential to provide a reliable and accurate identification in subsecond. This will greatly assist dental practitioners to provide better point-of-care to patients and enhance the throughput of dental care., (Copyright © 2021. Published by Elsevier Ltd.)

Panoramic radiography can be used in most dentomaxillofacial procedures, that can give a wide coverage of teeth and supporting tissue for assisting diagnosis. The aim of this research was to obtain data about the validity of panoramic radiography for measuring radioanatomy alveolar bone crest, cementoenamel junction (CEJ), and dental apex which is useful in measuring the level of alveolar bone resorption. This descriptive research and measurement was done to 25 sample which fulfilled sample criteria from panoramic radiography result by orthopantomograph 100. This research was done with Ramfjord criteria radioanatomy point. The result of this research showed that the average value measured of alveolar bone crest from the entire region was about 41.67%, most value at the mandibular molar was about 92%, the least value at the maxillary premolar was about 0%. The average value measured of CEJ from entire region was about 11%, most value at the maxillary molar and mandibular molar about 26%, at least value at the maxillary incisor, mandibular incisor, and maxillary premolar were about 0%. The average value measured of dental apex from the entire region was about 56.33%, most value at the mandibular molar was about 96%, the least value at the maxillary premolar was about 8%. The conclusion of this research was a part of radioanatomy alveolar bone crest and a part of dental apex could be measured, while CEJ at least measured. Measurement from the three of radioanatomy point showed the mandibular molar region which was at most measured.

Introduction: Presence of intact interdental papilla is considered as an essential component of aesthetic dentistry. Loss or absence of interdental papilla creates black triangles which are unpleasing. Aim: The purpose of the present study was to determine relation of interproximal distances and cementoenamel junction with the classification of interdental papilla recession after surgical exposure in chronic periodontitis patients. Materials and Methods: This cross-sectional, single masked study group involved 198 interdental papillae in 50 chronic periodontitis patients subjected to open flap debridement. The subjects were divided into three groups according to loss of height of interdental papillae: Class I papilla, Class II papilla, Class III papilla. The interproximal distances included vertical and horizontal distance. The vertical distance was measured from apical point of the contact area to alveolar crest; horizontal distance was measured between roots at the alveolar crest. Distance from mid buccal cementoenamel junction to apical point of the contact area was also measured. Results: The vertical distance was found to be significantly affecting all the classes of loss of papillary height (p

The location and nature of cemento-enamel junction (CEJ) are more than descriptive terms used simply to describe some aspects of tooth morphology; however, CEJ gains a lot of clinical significance due to various measurements dependent on it. It may be necessary to determine the location and pathological changes occurring at CEJ to make a diagnosis and treat diseases pertaining to epithelial attachment and gingival margin. However, the information related to CEJ is not discussed commonly. Hence, the present review paper provides an insight on CEJ in both primary and permanent dentition.

The article provides information on a research study based on analysis of distance between cementoenamel junction and alveolar crest using cone beam computed tomography. Topics discussed include nonextraction of orthodontic treatment, analysis of central incisors and cementoenamel junction, and changes in marginal bones.

Statement of Problem: In spite of the limitations of Radiography, diagnosing of periodontal diseases without having accurate radiographs is inadequate because it provides a visible image of the supporting bone to the clinician and works as a fixed measure of the supporting bone during the study.Purpose: The aim of this study is to compare the precision of preiapical, bitewings and panoramicradiographs in determining the distance between the alveolar crest (AC) and cementoenamel junction (CEJ) of teeth. Materials and Methods: Statistically this is a survey study in which 120 interproximal surfaces of teeth were measured during surgery by periodontal probing and recorded as the actual measurement. Then 40 sites underwent bitewing, 40 sites preapical and 40 others panoramic radiography and the distance of CEJ up to the alveolar crest of bone was measured on them by periodontal probe and recorded. Then each group was analyzed separately and the Pearson's correlation coefficient was examined for the data.Results: The results of this study showed that when the thickness of the remaining bone in a millimeter limit is important for (he surgeon, the bitewing radiography has a prime importance, but when bone loss ismoderate, the panoramic radiography showing %89 of the cases close to the actual measure, can be acceptable. On the other hand, in anterior sites for determining the bone alteration, preiapical radiography with a 0.93 correlation coefficient is superior to the panoramic radiography with a correlation coefficient of 0.72 and we suggest it for examining the changes of bone in these sites. Conclusion: whenever the bone alteration is moderate or severe, it seems that, bitewing radiography is of particular importance, but when the bone loss is little, panoramic radiography can be used and there is no needto put the patient on unnecessary radiation.

Background: Cementoenamel junction represents the demarcation between enamel covered crown and cementum covered root surface. There is paucity of population specific data of the morphological variability of cementoenamel junctions of permanent and primary teeth. The objective of this study was to investigate the morphological diversity and interrelationship of cementoenamel junction of premolar and molar teeth in permanent dentition of a sample of Pakistani population with potential forensic and anthropological implications., Methods: This cross-sectional study was conducted at Oral Biology department of Dr Ishrat ul Ebad khan institute of oral health science, Dow University from March till September 2016. Seventy-five maxillary and mandibular permanent premolar and molars from adult patients of both sexes were selected and sectioned. Longitudinal ground sections were prepared to study the morphological interrelationship between Cementum and Enamel in each specimen to be viewed under light microscope. A chi-square test was applied between the categorical variables., Results: Results showed 57.3% of sections had cementum overlapping enamel interrelation, 32% showed edge to edge cementum and enamel relation and 9.3% showed that cementum and enamel failed to meet resulting in exposed dentine, while 1.3% sample showed enamel over cementum relation. No significant correlation was found between gender, type of tooth, maxillary, mandibular arches and the morphological variation of CEJ (p>0.05)., Conclusions: It can be concluded that there are considerable morphological variations in CEJ of premolars and molars with preponderance of cementum overlapping enamel in these teeth. Based on these findings, dentists are advised to be mindful of dental procedures involving the CEJ and that these interventions should be performed meticulously avoiding any detachment of cementum and subsequent exposure of dentin resulting in dentin hypersensitivity.

Background: The purpose of this cross-sectional study was to evaluate radiologically, the relation between the distance from the cementoenamel junction (CEJ) to the facial bone crest (FBC), and the facial alveolar bone (FAB) width at maxillary anterior teeth. A further aim was to assess if the CEJ-FBC distance had an impact in the prevalence to find a FAB thickness greater than one mm., Study Design: CBCT images were retrospectively obtained from the database of the Oral Surgery Unit of the University of Valencia. The teeth were divided in 3 groups according to the CEJ-FBC distance: Shorter (≤3mm), Middle (>3 ≤4.5 mm) and Larger (>4.5 mm). FAB thickness was measured by two different examiners at 1, 2 and 3 mm apical to the FBC. Normality of means were evaluated by Kolmogorov-Smirnov test and an ANOVA-type linear model was performed., Results: 82 patients were included in the study, with 156 central incisors, 149 lateral incisors and 152 canines analyzed. A significant greater FAB thickness in Shorter (≤3mm CEJ-FBC) than Middle and Larger group was observed in all distances measured apical to the FBC. There was a significant inverse relation between the distance CEJ-FBC and FAB thickness at all distances measured. The prevalence of a FAB thickness equal or greater than one mm was 35.9% of all teeth analyzed from Shorter, 17.4% of Middle and 8.9% of Larger group at 1 mm apical to the FBC., Conclusions: When the distance from the CEJ to the FBC is augmented, thinner FAB thickness has to be expected in all teeth of the anterior maxilla. The prevalence to find a FAB thicker than one mm decreases as the distance from the FBC to the CEJ increases.

In the study of orthodontically induced inflammatory root resorption, many researchers use the cementoenamel junction (CEJ) as a bisecting reference point to measure the amount of root shortening. The accuracy of the identification of the CEJ point might affect the conclusions of those studies. This study aims to find the effects of angular changes between the tooth and the film on the validity and reproducibility of identifying three different CEJ points, ie, the most apical CEJ point between the crown and the root, the most mesial CEJ point, and the most distal CEJ point. An extracted maxillary central incisor was placed in a special jig and radiographed at four different tooth to film angulations. Eight examiners were asked to identify the buccal and palatal CEJ, whereas six examiners were asked to identify the mesial and distal CEJ points, all on a computer monitor. The distances between the identified points and the apex were computed and compared with the actual ones. The angular changes between the tooth and the film did have a statistically significant effect on the identification of some of these CEJ points. The difference was significant on the identification of the buccal and palatal points but not on the mesial and the distal ones. [ABSTRACT FROM AUTHOR]

Abstract Purpose Morphological analysis of permanent anterior dentition is essential for achieving an ideal treatment outcome and avoiding unnecessary failure. This study aimed to analyze the morphologies of anterior teeth in the Chinese population in depth. Methods In this retrospective study, 4309 anterior teeth from 401 Chinese patients were investigated using cone-beam computed tomography (CBCT) from 2019–2021. We summarized the morphological characteristics of the anterior teeth in terms of the root length, cementoenamel junction curvature (CEJ-C), root furcation and canal variations. Results We found that the root lengths of the maxillary anterior incisors were similar (13.3 mm), while the root lengths of the mandibular central (12.2 mm) and lateral incisors (13.4 mm) varied significantly (p

Intracoronal bleaching of nonvital teeth with 30% hydrogen peroxide is occasionally associated with external cervical root resorption. The exact mechanism by which bleaching induced root resorption occurs is not yet fully understood. The relationship of cementum to the enamel at the cementoenamel junction may have clinical significance. Seventeen single rooted human mandibular premolars extracted atraumatically for orthodontic reasons were used. The radicular hydrogen peroxide penetration in each tooth was measured in vitro by an indirect colorimetric method. Thereafter, the teeth were examined with a scanning electron microscope to determine the type of the cementoenamel junction. It was found that the radicular penetration of 30% hydrogen peroxide was related to the type of cementoenamel junction. [ABSTRACT FROM AUTHOR]