Browsing by Author "Dutra, Vinicius"
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Item ACCURACY OF GUIDED ENDODONTICS IN ENDODONTIC MICROSURGERY(2024-06) Grayson, Michelle Sarah; Spolnik, Kenneth; Ehrlich, Ygal; Dutra, Vinicius; Hine, Charlie; Warner, NedItem Accuracy of Guided Endodontics in Simulated Perforated Teeth with Calcified Canals(2023) Eidelstein, Dyana M.; Spolnik, Kenneth; Ehrlich, Ygal; Dutra, Vinicius; Hine, Charles; Warner, NedIntroduction: Endodontic treatment in teeth following iatrogenic accidents can be challenging and difficult to correct. Guided Endodontic Access (GEA) has been used as an adjunct in endodontic treatment to in in treating teeth with complex anatomy and may assist in treating teeth with procedural accidents. The accuracy of GEA stents in teeth with a simulated procedural accident will be assessed. Objective: This in vitro study will utilize a 3D model of a tooth with a simulated procedural accident: deviation and perforation during root canal treatment(RCT). GEA stents will be fabricated designed to overcome and compare the previous ledge formation and perforation. The influence on the degree of deviation of the designed access path from the prepared path will be determined by assessing the degree of angle of deviation and amount of deviation in millimeters. Materials and Methods: A 3-D printed maxillary model of an anonymous patient will be used. The deviated path and perforation will be simulated in a 3D printed tooth #4 using the meshmixer software tooth at two levels: apical and mid-root. The stent extends from tooth #3 to tooth #14 and was designed using coDiagnostiX software over tooth #4 with a simulated perforation. 15 GEA stents will have guides for the mid root perforation, 15 GEA stents will have guides for the canals not in contact with the perforation, and 15 GEA stents will have guides for canals apical to the perforation. All cases will be accessed with a 1.0 mm drill that is planned to fit the access sleeve. Results: The distal( base), the distal(tip) and the vestibular (tip) for the guided access in which the canal was in contact with the deviated path had no significant difference in deviation. The angle was significantly deviated in all models, but the model in which the canal was in contact with the deviated canal had a significantly lower angle, distal base, and vestibular base that both models in which the canal was not in contact with the deviated path and at different heights. The degree of deviation for all samples ranged from 1.40° to 10.60°. The largest degree of deviation corresponds with the increased depth of the original canal system. Conclusion: In conclusion, our study revealed that the utilization of GEA in calcified teeth with PCO and a deviated path demonstrated greater effectiveness in canals located in closer proximity compared to those located farther away from the deviated path. Therefore, we can infer that the use of a GEA stent in calcified teeth with PCO and a deviated path is favorable only under certain conditions.Item Comparison of guided endodontic access with and without pin fixation in 3D printed teeth with simulated pulp canal obliteration(2021-06) Long, Jacob Daniel; Spolnik, Kenneth; Ehrlich, Ygal; Dutra, Vinicius; Bringas, Josef; Warner, NedIntroduction: In order to successfully treat an infected root canal system (RCS), it is required to locate all root canals and have an access path to the apex of each canal. This can be challenging in teeth with pulp canal obliteration (PCO), often leading to increased chair time and increased risk of iatrogenic errors. Guided endodontic access (GEA) combines information from a cone-beam computed tomography (CBCT) scan with an intra-oral scan to create a stent. GEA stents with or without fixation pins have been shown to be successful in accurately negotiating a RCS with PCO. Objective: Compare the degree of deviation and difference in 3D offset at the base to apical tip of the drill from the designed access path when a GEA stent with and without pin fixation is used to access tooth #8 with PCO. Materials and Methods: A 3-D printed maxillary model of an anonymous patient had a GEA stent designed using coDiagnonstiX software. The stent extended from tooth #3 to tooth #14 with the guide sleeve over tooth #8. Tooth #8 with no calcification, calcification to the cervical third, and calcification to the middle third of the RCS were designed in the coDiagnostiX software. Tooth #8 will be accessed using a 1.3 mm drill that fits a 1.3 mm sleeve used for both access and pin fixation. 15 of the 30 GEA samples will utilized pin fixation, while the other 15 samples did not utilize pin fixation. Following GEA in all 30 samples a CBCT was taken of each sample. Each post-operative CBCT was aligned with the pre-operative CBCT in the coDiagnostiX software. The coDiagnostiX software was able to calculate the degree of deviation and difference in 3D offset between the base and apical tip of the drill during GEA. Paired t-tests were used to test each group for significant differences in 3D offset between base and tip. Two-way ANOVA was used to evaluate the effects of pin fixation and calcification on the degree of deviation and the deviation of 3D offset of the entry point and tip. Results: There was a significant interaction between use of pin fixation and calcification level on the degree of deviation of GEA. GEA with pin fixation had a significantly larger degree of deviation than GEA without pin fixation with calcification extending to the middle third of the RCS. GEA with and without pin fixation did not have a significant difference when calcification extended to the cervical third of the RCS or no calcification was present. There was a significant interaction between use of pin fixation and calcification level on 3D offset difference. GEA with pin fixation had a significantly larger 3D offset difference than GEA with no pin fixation for calcification in the middle third of the RCS. For GEA with and without pin fixation there was no significant difference when calcification extended to the cervical third of the RCS or no calcification was present. Conclusion: The use of pin fixation did not result in a decrease of degree of deviation or difference in 3D offset during GEA access. It can be concluded that the use of pin fixation is not necessary for GEA of teeth with PCO when a full dentition is present to provide stability and retention of the stent.Item Evaluation of the accuracy of the soft tissue thickness measurements with three different methodologies: an in-vitro study(Wiley, 2022) Ferry, Katherine; AlQallaf, Hawra; Blanchard, Steven; Dutra, Vinicius; Lin, Wie-Shao; Hamada, Yusuke; Prosthodontics, School of DentistryBackground Soft tissue thickness (STT) influences esthetics, peri-implant, and periodontal health. Non-invasive methods of STT evaluation include cone-beam computed tomography (CBCT) with Digital Imaging and Communications in Medicine (DICOM) files and registration of DICOM files with an intraoral scan or Standard Tessellation Language (STL) files. This study compares three methodologies: bone sounding, DICOM data alone, and DICOM and STL registration to absolute histomorphologic values. Materials and Methods Five human maxillas, including teeth #s 6-11, provided 90 sites for analysis. For standardization, reference grooves were placed at the cervical margin and the long axis of each tooth. Direct measurements with a no. 25 K-file were completed at the facial soft tissues at 3.00, 5.00, and 7.00 mm from the apical marginal reference. Indirect measures were performed with implant planning software. Histological measurements were rendered with imaging software. One-way analysis of variance (ANOVA) was used to compare the three techniques for the differences from histologic measurements (α = .05). Results Seventy-two sites were included for final analysis. The overall mean histological STT (mSTT) was 0.73 ± 0.31 mm. Bone sounding overestimated mSTT, 0.22 ± 0.20mm (p<.001); whereas, DICOM alone underestimated mSTT, -0.23 ± 0.19 mm (p<.001). DICOM and STL registration had non-statistically significant differences, -0.04 ± 0.21mm (p = .429). Intraclass correlation coefficient (ICC) of DICOM and STL registration achieved the highest agreement with histology (ICC: 0.74). Conclusions DICOM and STL file registration had the highest agreement with histological STT supporting the use of DICOM and STL registration for the evaluation of soft tissue thickness.Item Evaluation of the follicular space volume of lower third molars with different impaction positions and angulations: A cone-beam computed tomography and histopathological study(Elsevier, 2023-03-30) Barroso, Marlene; Arriola-Guillén, Luis E.; Dutra, Vinicius; Rodríguez, Julio Escoto; Suárez, Gerardo Ruales; Oral Pathology, Medicine and Radiology, School of DentistryObjective: To quantify the volume of the follicular spaces of impacted lower third molars (ILTMs) with different impaction positions and angulations using cone-beam computed tomography (CBCT) and to determine its association with the histopathological findings. Study design: This study included 103 ILTMs of 33 men and 70 women aged 18-46 years (mean age, 29.18 years). The follicular space volumes were measured on CBCT by manual segmentation and correlated with the histopathological diagnosis of each ILTM having different impaction positions and angulations. Statistical Product and Service Solutions, version 24, was used for statistical analyses by applying the t-test and binary logistic regression and multiple linear regression tests (p < 0.05). Results: Overall, 83 (80.6%) dental follicles presented a non-pathological diagnosis (mean follicular volume, 0.10 cm3), whereas 20 (19.4%) presented a pathological diagnosis (mean follicular volume, 0.32 cm3; p = 0.001). Similarly, the impaction depth in Position C cases was associated with a pathological diagnosis (p = 0.010). Conclusion: The follicular volume of the ILTMs varied significantly in teeth with a histopathological diagnosis of a follicular cyst and was associated with the impaction depth, mainly in Position C cases, and its relationship with the mandibular ramus. A mean follicular volume of 0.32 cm3 was associated with a greater probability of a pathological diagnosis.Item In-House Digital Workflow for the Management of Acute Mandible Fractures(Elsevier, 2019-10) Marschall, Jeffrey S.; Dutra, Vinicius; Flint, Robert L.; Kushner, George M.; Alpert, Brian; Scarfe, William; Azevedo, Bruno; Oral Pathology, Medicine and Radiology, School of DentistryComputer-aided design and additive manufacturing are revolutionizing oral and maxillofacial surgery. Current methods use virtual surgical planning sessions and custom plate milling via third-party vendors, which is costly and time-consuming, negating the effectiveness in acute facial trauma. This technical note describes a state-of-the-art in-house expedited digital workflow for computer-aided virtual fracture reduction, 3-dimensional printing, and preoperative reconstruction plate adaptation for the management of an acute mandible fracture. This process uses the computed tomographic scan a patient receives in the emergency department or clinic. The DICOM (Digital Imaging and Communications in Medicine) data are transferred into US Food and Drug Administration–approved software, in which the fracture is segmented and virtually reduced based on condylar position, midline symmetries, and occlusion if present. The reduced mandible is then printed, which serves as a template for preoperative reconstruction plate adaptation. This method facilitates a virtually reduced fractured mandible, 3-dimensionally printed model, and ideally adapted plates ready for sterilization before surgery within 2 hours after DICOM upload.Item Incisal Endodontics Access vs Traditional Palatal Access to Negotiate Simulated Obliterated Canals Using Guided Endodontic Techniques(2022-06) Gohil, Arjun A.; Spolnik, Kenneth J.; Dutra, Vinicius; Ehrlich, Ygal; Warner, NedIntroduction: Endodontic treatment in teeth with pulp canal obliteration (PCO) is challenging. Guided Endodontic Access (GEA) combines information from a cone-beam computed tomography (CBCT) scan with an intra-oral scan to create a stent that can be used as a guide to treat teeth with PCO. GEA stents designed with traditional palatal accesses were shown to be successful in accurately negotiating these 3D printed teeth with simulated PCO, however, the difference in accuracy between the traditional palatal access compared to a conservative incisal access is not yet known. Objective: This in vitro study compares GEA stents designed with an incisal access approach to GEA stents designed with a traditional palatal access approach. The effect on the overall degree of deviation of the designed access path from the prepared path is evaluated by measuring the degree of angle of deviation and amount of deviation in millimeters. Materials and Methods: A 3-D printed maxillary model of an anonymous patient was used. PCO was simulated in a 3D printed natural #8 using the coDiagnostiX software tooth at two levels: coronal and mid-root. A GEA stent that extended from tooth #3 to tooth #14 with a guide sleeve over the simulated tooth #8 was accessed with a dedicated 1.0 mm diameter and 20 mm length drill that is designed to fit the access sleeve. 15 GEA stents had guides utilized for the incisal access approach, and 15 GEA stents had guides utilized for the traditional palatal access approach. Results: Angle, mesio-distal (base), and mesio-distal (tip) deviations were significantly lower for the incisal access compared to the traditional access. Inciso-apical (base) deviation was significantly more negative for incisal access compared to the traditional access. Bucco-lingual (base) deviation was significantly more negative for traditional access compared to the incisal access, while incisal and traditional accesses were not significantly different for bucco-lingual (tip) deviation. Coronal 1/3 calcification groups had significantly more mesio-distal (base) deviation than the middle 1/3 and no PCO groups. The no PCO group had significantly more negative inciso--apical (base) deviation than the coronal 1/3 calcification and middle 1/3 calcification groups, and the coronal 1/3 calcification group was significantly more negative than the middle 1/3 calcification group. The coronal 1/3 calcification group had significantly more mesio-distal (tip) deviation than the no PCO group. PCO level did not have a significant effect on angle, bucco-lingual (base), or bucco-lingual (tip) deviations. Conclusion: The utilization GEA via incisal access resulted in less degree and amount of drill deviation compared to the traditional access at all levels of calcification, however, the level of PCO did not influence the degree and amount of drill deviation between the incisal and traditional access approaches. It can be concluded that the use of a GEA stent that utilizes an incisal access approach in teeth with PCO will result in a more predictable outcome.Item Influence of exposure protocol, voxel size, and artifact removal algorithm on the trueness of segmentation utilizing an artificial-intelligence-based system(Wiley, 2024-07) Alrashed, Safa; Dutra, Vinicius; Chu, Tien-Min G.; Yang, Chao-Chieh; Lin, Wei-Shao; Biomedical and Applied Sciences, School of DentistryPurpose To evaluate the effects of exposure protocol, voxel sizes, and artifact removal algorithms on the trueness of segmentation in various mandible regions using an artificial intelligence (AI)-based system. Materials and methods Eleven dry human mandibles were scanned using a cone beam computed tomography (CBCT) scanner under differing exposure protocols (standard and ultra-low), voxel sizes (0.15 mm, 0.3 mm, and 0.45 mm), and with or without artifact removal algorithm. The resulting datasets were segmented using an AI-based system, exported as 3D models, and compared to reference files derived from a white-light laboratory scanner. Deviation measurement was performed using a computer-aided design (CAD) program and recorded as root mean square (RMS). The RMS values were used as a representation of the trueness of the AI-segmented 3D models. A 4-way ANOVA was used to assess the impact of voxel size, exposure protocol, artifact removal algorithm, and location on RMS values (α = 0.05). Results Significant effects were found with voxel size (p < 0.001) and location (p < 0.001), but not with exposure protocol (p = 0.259) or artifact removal algorithm (p = 0.752). Standard exposure groups had significantly lower RMS values than the ultra-low exposure groups in the mandible body with 0.3 mm (p = 0.014) or 0.45 mm (p < 0.001) voxel sizes, the symphysis with a 0.45 mm voxel size (p = 0.011), and the whole mandible with a 0.45 mm voxel size (p = 0.001). Exposure protocol did not affect RMS values at teeth and alveolar bone (p = 0.544), mandible angles (p = 0.380), condyles (p = 0.114), and coronoids (p = 0.806) locations. Conclusion This study informs optimal exposure protocol and voxel size choices in CBCT imaging for true AI-based automatic segmentation with minimal radiation. The artifact removal algorithm did not influence the trueness of AI segmentation. When using an ultra-low exposure protocol to minimize patient radiation exposure in AI segmentations, a voxel size of 0.15 mm is recommended, while a voxel size of 0.45 mm should be avoided.Item Is There a Correlation Between Airway Volume and Maximum Constriction Area Location in Different Dentofacial Deformities?(Elsevier, 2020) dos Santos, Liseane F.; Albright, David A.; Dutra, Vinicius; Bhamidipall, Surya S.; Stewart, Kelton T.; Polido, Waldemar D.; Orthodontics and Oral Facial Genetics, School of DentistryPurpose The purpose of the present study was to correlate the airway volume and maximum constriction area (MCA) with the type of dentofacial deformity in patients who required orthognathic surgery. Materials and Methods The present retrospective cohort study included orthognathic surgery patients selected from the private practice of one of us. The selected cases were stratified into 5 different groups according to the clinical and cephalometric diagnosis of their dentofacial deformity. The preoperative airway volume and anatomic location of the MCA were calculated using the airway tool of the Dolphin Imaging software module (Dolphin Imaging and Management Solutions, Chatsworth, CA) and correlated with the diagnosed dentofacial deformity. Differences in the pretreatment airway volumes and MCA location were compared among the deformities. Results The MCA location was more often the nasopharynx for maxillary deficiency and the oropharynx for mandibular deficiency deformities. The nasopharynx volume was significantly smaller statistically ( P < .005) for maxillary deficiency plus mandibular excess compared with mandibular deficiency. The hypopharynx volume was significantly smaller statistically ( P < .005) for vertical maxillary excess plus mandibular deficiency than for both maxillary deficiency and maxillary deficiency plus mandibular excess. No statistically significant difference was found among the different deformity groups in relation to the mean airway volume ( P > .005). Conclusions The location of the airway MCA seems to have a strong correlation with the horizontal position of the maxilla and mandible. The MCA in maxillary deficiencies (isolated or combined) was in the nasopharynx, and the MCA in mandibular deficiencies (isolated or combined) was in the oropharynx. Clinicians should consider these anatomic findings when planning the location and magnitude of orthognathic surgery movements to optimize the outcomes.Item Precision and Accuracy Assessment of Cephalometric Analyses Performed by Deep Learning Artificial Intelligence with and without Human Augmentation(MDPI, 2023-06-08) Panesar, Sumer; Zhao , Alyssa; Hollensbe, Eric; Wong, Ariel; Bhamidipalli, Surya Sruthi; Eckert, George; Dutra, Vinicius; Turkkahraman, Hakan; Orthodontics and Oral Facial Genetics, School of DentistryThe aim was to assess the precision and accuracy of cephalometric analyses performed by artificial intelligence (AI) with and without human augmentation. Four dental professionals with varying experience levels identified 31 landmarks on 30 cephalometric radiographs twice. These landmarks were re-identified by all examiners with the aid of AI. Precision and accuracy were assessed by using intraclass correlation coefficients (ICCs) and mean absolute errors (MAEs). AI revealed the highest precision, with a mean ICC of 0.97, while the dental student had the lowest (mean ICC: 0.77). The AI/human augmentation method significantly improved the precision of the orthodontist, resident, dentist, and dental student by 3.26%, 2.17%, 19.75%, and 23.38%, respectively. The orthodontist demonstrated the highest accuracy with an MAE of 1.57 mm/°. The AI/human augmentation method improved the accuracy of the orthodontist, resident, dentist, and dental student by 12.74%, 19.10%, 35.69%, and 33.96%, respectively. AI demonstrated excellent precision and good accuracy in automated cephalometric analysis. The precision and accuracy of the examiners with the aid of AI improved by 10.47% and 27.27%, respectively. The AI/human augmentation method significantly improved the precision and accuracy of less experienced dental professionals to the level of an experienced orthodontist.