Introduction: Increasing the imaging demand in the dental field has lead to a dramatic increase in the number of CBCT machines in the U.S. market with a variety of new models and features, as well as different radiation exposures. These differences in exposure among the different CBCT machines and the potential for radiation accumulation over a life time are major concerns for aiming for a reduction in patients’ radiation exposure. Most of the studies have aimed to measure the radiation dose in different CBCT units with different field of views. Up to date, few studies have aimed to measure the radiation dose in different CBCT devices with similar fields of view. The aim of the study was to compare the dosimetry levels with relatively small FOV in different scan protocols in two CBCT units. Materials and methods: A 16-cm diameter PMMA phantom with 10-cm pencil ionization chamber were used to measure the radiation exposure from two CBCT devices: i-CAT FLX and CS9000. A smallest FOV in both CBCT (8 x 8 cm in the i-CAT FLX and 5 x 3.7 cm in the CS9000) was selected at different scan protocols. The scan settings included in the i-CAT FLX HD (120 kVp; 5 mA; 7.4 sec; 0.125, 0.250, 0.200 mm voxel sizes; 360° rotation) Quick HD (120 kVp; 5 mA; 4.1 sec; 0.200, 0.250 mm voxel sizes; 180° rotation), Quick+ (90 kVp; 3 mA; 2 sec; 0.300, 0.400 mm voxel sizes; 180° rotation) , Quick (120 kVp; 5 mA; 2 sec; 0.300, 0.400 mm voxel sizes; 180° rotation), and standard scans (120 kVp; 5 mA; 3.7 sec; 0.300, 0.400 mm voxel sizes; 360° rotation). In the CS9000 scan settings included voxel sizes (CS9000: 0.076 mm, 0.100 mm, and 0.200 mm), 80 kVp, 10 mA, 10.8 sec, and 360° rotation. The phantom was exposed three times at the same position to calculate the average measurement of dose by the ionization chamber. All the radiation exposure doses were read by one examiner. Results: The radiation exposure of the phantom slots in different resolutions and scan protocols in the both CBCT units ranged from 4.31 to 60.73 mR. There were statistically significant differences in radiation value between i-CAT FLX and CS9000 due to voxel size (P < 0.001). Each voxel size was significantly different from the other in both scanners, except between CS9000 0.076 and HD 0.125; CS9000 0.200 and HD 0.125; and CS9000 0.100 and HD 0.200. Also, there were no statistically significant differences between the voxel size within the same scan protocols in the i-CAT FLX, especially the Quick HD, Quick+, Quick, and Standard scans. Conclusion: The selection of x-ray parameters (mainly scan time), voxel size, and rotation angle have a significant radiation expsoure reduction in both the i-CAT FLX and CS9000 units and hence should be appropriately selected to minimize the radiation dose.

Thesis (MSD) --Boston University, Henry M. Goldman School of Dental Medicine, 2015 (Department of Orthodontics and Dentofacial Orthopedics). / Includes bibliographic references: leaves 37-42. / Background: Craniofacial skeletal asymmetry is a common finding in the general population that often goes undetected. Interest in this topic has led to many studies aimed at describing this type of asymmetry, its distribution and etioIogy. The cranial base, being cIosely related to the face and brain, is a key component in craniofacial growth and may also display varying amounts of asymmetry contributing to this anomaly. Though many studies have explored underlying skeletal asymmetry, most of them were limited by their two-dimensional method of investigation. With the advent of three-dimensional technology, more recent studies have had the advantage of studying the cranial base in its true anatomic form, resulting in greater accuracy of analysis. Despite access to this technoIogy, there is still a lack of literature regarding the cranial base in a normal population. Determining average skull base dimensions will provide a set of normative data that can be used as a reference for future studies. Material and Methods: Pre-treatment Cone Beam Computed Tomography (CBCT) films of 160 esthetic human subjects previously used by another investigator were screened for use in our current research. These DICOM files were imported into InVivoDental5.3 software (Anatomage[TM]; San Jose, Calif.) for screening and 70 CBCT scans were selected for analysis. All patients were classified as cervical vertebral stage 4 and above. The images were oriented in all three planes of space for uniformity and 14 bilateral anatomic landmarks were identified on each scan. A mid-sagittal reference plane was created using crista galli as the origin, and extending a perpendicular passing through the middle of the right and left clinoid points connected by a line, and through posterior points basion and opisthion. Each landmark was given an x-, y- and z- coordinate representing its three dimensional position and bilateral linear measurements to the reference plane were recorded using the software system. Statistical Analysis: InVivoDental5.3 software was used to calculate linear distances between each landmark and the mid-sagittal plane. This data was exported into Microsoft excel for analysis. Descriptive statistics of our sample and paired t-tests with a 5% significance level, or p value of 0.05, were performed. Results: The means of the right and left measurements of each bilateral landmark were calculated along with their standard deviations. A comparison between right and left means was accomplished with the use of paired t-tests. 12 1andmarks did not show a statistical difference in their locations on either side of the mid-sagittal plane. However, the means of 2 landmarks were found to be statistically significant. These were euryon (p = 0.01) and the jugular foramen (p = 0.00) Conclusion: The overall trend of our data indicated that the cranial base in a normal population, without craniofacial anomaly, displays symmetry, with the exception of the location of euryon and the jugular foramen. These findings are in accordance with those of similar three-dimensional studies. It is likely that the significant findings were due to tracing error, given the indiscrete location of euryon and the large, relatively asymmetric shape of the jugular foramen. However, if these structures are truly asymmetric, we can infer from our sample of symmetric patients, that there is no clinical relevance. Further studies with an increased sample size, additional landmarks or a more discrete sample can be performed to continue describing the skull base. The results of this study offer valuable reference data that can be used as a baseline for future studies.

Resumo: O objetivo neste estudo foi avaliar as diferenças no espaço aéreo faríngeo em crianças com diferentes padrões faciais. Foram avaliadas as tomografias computadorizadas de feixe cônico de 98 indivíduos em crescimento, com idade média de 8,9 anos, divididas por sexo e faixa etária, e subdivididas de acordo com o padrão de crescimento (horizontal, vertical normal e produtores) e tipo de má oclusão (Classe I e Classe II). Utilizando um programa tridimensional, foram analisados o volume, área sagital, menor área de seção transversal e as dimensões ântero-posteriores da faringe superior e inferior. As dimensões ântero-posterior da faringe superior e inferior foi significativamente menor em indivíduos com Classe II em crianças na faixa etária entre 9 a 11 anos e a faringe superior em foi significativamente menor em crianças na faixa etária entre 5 e 7 anos com padrão de crescimento vertical. Porém, quando a faringe foi avaliada tridimensionalmente, não foram encontradas diferenças nas demais dimensões sugerindo que diferenças no padrão vertical e no tipo de má oclusão ântero-posterior (Classe I e II) não influenciam as dimensões da faringe. Não foi encontrado dimorfismo sexual. A região de maior constrição da faringe esteve presente mais freqüentemente na orofaringe (86%). Embora as dimensões lineares possam variar entre os diferentes padrões faciais, quando avaliadas tridimensionalmente, elas não foram influenciadas pelas diferentes morfologias faciais / Abstract: The aim of this study was to assess the differences in pharyngeal airway space in children with different facial patterns. Cone-beam computed tomography records of 98 growing patients with mean age of 8.9 years divided by sex and age groups and subdivided according to growth pattern (horizontal, normal and vertical growers) and type of malloclusion (Class I and Class II) were evaluated .Using a 3-dimensional virtual program the volume, sagital area, smallest cross section area, anteroposterior dimensions of superior and inferior pharynx were obtained. The anteroposterior linear dimensions of superior and inferior pharynx in children with 9 to11 years was significant smaller in patients with Class II relationship but in 3D evaluation differences were not found suggesting that anteroposterior malocclusion do not influence pharynx dimensions. The anteroposterior linear dimensions of superior , pharynx in children with 5 to7 years was significant smaller in patients with vertical growth pattern when compared to normal growers, but in 3D evaluation differences were not found suggesting that vertical pattern do not influence pharynx dimensions. No sexual dimorphism was found. The most constricted region of pharynx were mostly found at oropharynx(96%).Although linear dimensions can vary among different facial patterns, the 3-dimensional dimensions weren't influenced by different facial morphologies / Orientador: Luiz Cesar de Moraes / Coorientador: Weber José da Silva Ursi / Banca: Jefferson Luis OshiroTanaka / Banca: Edmundo Medici Filho / Mestre

The aim of this study was to evaluate whether volumetric changes in persistent periapical lesions can be detected in follow-ups six months to five years after apicoectomy using cone-beam computed tomography. Patients with a previous treatment history of apicoectomy and for whom a pre-surgical CBCT scan was taken between November 2010 and December 2015 were invited to participate in the study. A post-surgical CBCT image of the treated tooth was obtained at the recall visit. Volumetric and linear measurements of periapical lesions on initial and postoperative CBCT images were performed using DiThreshGUI software and two calibrated examiners—a board-certified endodontist and a board-certified oral radiologist. Repeated-measures ANOVA were used to estimate the magnitude of reduction and to test for differences (at alpha=0.05). A total of 20 patients with 27 surgically treated teeth were recalled at an average interval of 37 months. Reduction in the size of lesions was observed in 24 teeth (88%); overall, the volumes significantly decreased as detected by software-assisted measurement of volume (P = .0002) and by calculation from linear measurements (P < .0001). Volumetric analysis detected a reduction of 86% in lesions while the linear-derived volume measurements yielded an average reduction of 96%. These two methods of lesion assessment were strongly correlated with one another in pre-surgical scans (r>0.88) when apical lesions are measurable.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

AIM: Extraction of a tooth can lead to alveolar ridge resorption which can be minimized by socket preservation. The aim of this study is to analyze vertical and horizontal alveolar ridge dimensions clinically and by CBCT immediately following extraction and 3-4 months following socket preservation. METHODS: The preserved group (P) consisted of 20 patients with1-2 non-molar teeth requiring extraction with socket preservation, while the control group (C) consisted of 5 patients requiring extraction alone. An acrylic stent was fabricated presurgically in order to measure vertical and horizontal ridge dimensions clinically and radiographically immediately following extraction and 3-4 months following socket preservation. RESULTS: Overall, P sites gained ridge height and lost minimal ridge width over 3-4 months, while C sites lost both ridge height and width. Preserved sites in which the teeth were extracted due to caries had the most significant gain in the radiographic vertical occlusal dimension (RVO). Overall, high correlations were found between the clinical and radiographic measurements at the initial surgery and at the 3-4 month follow up. CONCLUSIONS: The preserved group had minimal ridge resorption and more socket bony fill when compared to the non-preserved group 3-4 months following tooth extraction, especially when the tooth was extracted due to caries. Additionally, the CBCT can be a useful diagnostic tool to evaluate socket preservation healing, as it compares well to clinical assessments of socket healing.

Objective : To determine the relationship of tongue volume as determined from Cone Beam Computed Tomography (CBCT) scan reconstructions with maxillary and mandibular arch width, axial cross-sectional palatal perimeter, palatal index and axial inclination of upper and lower first premolars and molars. Method: Thirty subjects without prior orthodontic treatment swished barium sulfate to coat the tongue prior to CBCT imaging. The scan reconstructions were analyzed with three after-market softwares and intra-examiner reliability was assessed. Results: Absolute agreement intra-class correlation coefficients were used to determine reliability of the measurements. Pearson correlation coefficients and regression analysis were used to determine relationships. Conclusions: Tongue volume was strongly correlated with upper inter-molar width and palatal perimeter at the molar level, and least correlated with lower inter-molar width and axial inclination of the upper and lower first premolars and molars. The differences in measurements obtained from the three softwares were not statistically significant.

This thesis aims at introducing a methodology for clinical evaluation of orthodontic treatments using three-dimensional dento-maxillofacial images. Since complementary information is achieved by integrating multiple modalities, cone-beam computed tomography (CBCT) and stereophotogrammetry technologies are used to develop a methodology for tracking bone and facial skin variations over time. Our proposed methodology consists of a two-phase registration procedure. In the first phase, the multimodal images are registered using an extrinsic landmark-based registration followed by a robust Iterative Closest Points (ICP) method. In the second phase, by utilizing specific anatomical landmarks, single modal images of the skull and the mandible are registered over time using an intrinsic landmark-based registration method followed by the robust ICP algorithm. The results of registrations show that the signed error distribution of both mandible and skull registrations follow a normal distribution while all the errors fall within the CBCT precision range.

Objective: To evaluate three-dimensional position of the TMJ condyle within the glenoid fossa in different types of skeletal patterns. Materials and methods: Ninety CBCT images were consecutively selected and divided into skeletal class I, class II and class III. The images were analyzed locating landmarks in the different areas of the condyle and glenoid fossa. All landmarks presented acceptable reliability. The mean results were compared using ANOVA and Bonferroni post-hoc test (p < 0.05). Results: There was a tendency for the anterior joint space to be smaller than the posterior joint space. Statistical analysis, however, evidenced no significant differences between the anterior, superior and posterior joint spaces and the different skeletal patterns or between sides. Conclusion: There was non-concentricity of the condyle for all the groups studied, and no particular direction was statistically significantly favored. It is unclear whether the differences found would be clinically significant, considering anatomical individual variations.

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