Oral manifestations of systemic fungal infections: 25-year experience in an endemic region

Some mycoses are endemic. They develop through hematogenous spread, causing a generalized infection, usually with secondary mucosal involvement.The aim of this observational and retrospective study was to report the prevalence and characteristics of oral lesions in patients diagnosed with systemic fungal infections (SFI) over a 25-year period in southern Brazil. Demographic (age, sex, ethnicity, occupation) and clinical (anatomical location, symptoms,histopathological diagnosis and management) data from the medical records of patients with SFI were collected from 1995 to 2019. 34 cases of SFI were found, of which 31 (91.18%) were diagnosed as paracoccidioidomycosis (PCM) and 3 (8.82%) as histoplasmosis. Men were much more affected (n = 31; 91.18%), with an average age of 46.9 years. Most patients (n = 18; 58.06%) were Caucasian; 48% (n = 15) were farm/rural workers and the most affected region was the jugal mucosa (n = 13; 25.49%) followed by the alveolar ridge (n = 12; 23.52%). All patients with histoplasmosis were immunocompetent men (mean age: 52.67 years), and the palate was the most affected. All patients underwent incisional biopsy and were referred to an infectologist. The dentist has an essential role in the recognition of SFI, whose oral manifestations may be the first sign. SFI should be included in differential diagnosis in patients from endemic areas. In addition, the inevitable human mobility and globalization make knowledge of these mycosesnecessary worldwide, especially since advanced cases in immunocompromised patients can be fatal.

Differential diagnosis for an unusual calcification in the maxillary sinus: case report / Diagnóstico diferencial para calcificação incomum em seio maxilar: relato de caso

ABSTRACT The aim of this study was to report a rare case of an asymptomatic calcification of unusual size and shape, inside the maxillary sinus identified on a cone beam computed tomography exam and to discuss the importance of knowledge of the anatomy of maxillary sinus and its changes carefully evaluating the entire volume of the images, regardless of the region of interest. An 83-year-old female patient underwent a cone beam computed tomography exam for other diagnostic purposes in the maxillofacial region. When analyzing the entire volume, an image of unusual limits, hyperdense and calcified was found in the right maxillary sinus, close to the anterior and medial wall, with a rounded and homogeneous shape, occupying approximately one third of the maxillary sinus. There was no lytic or erosive lesions on the maxillary sinus wall. The main diagnostic hypotheses raised were giant anthrolith, mucous retention phenomenon and osteoma. Due to the anatomical complexity of the maxillary sinus, diagnosis in this region becomes a challenge. Considering the limitations of 2D exams, the cone beam computed tomography exam can be used to evaluate these structures. Knowledge of differential hypotheses is extremely important for the case to be conducted correctly, but it does not replace biopsy and histopathological examination.

RESUMO O objetivo desse estudo foi relatar um caso raro de uma calcificação assintomática de tamanho e formato incomum, no interior do seio maxilar, diagnosticado em um exame de tomografia computadorizada de feixe cônico, além de discutir a importância do conhecimento da anatomia do seio maxilar e suas alterações, avaliando cuidadosamente todo o volume das imagens, independentemente da região de interesse. Paciente do sexo feminino, 83 anos de idade, realizou uma tomografia computadorizada de feixe cônico para outros fins de diagnóstico na região bucomaxilofacial. Ao analisar todo volume da tomografia encontrou-se uma imagem de limites incomuns, hiperdensa e calcificada, no seio maxilar direito, próximo a parede anterior e medial, com formato arredondado e homogêneo, ocupando aproximadamente um terço do seio maxilar, com as suas paredes intactas e sem nenhuma lesão lítica ou erosiva. As principais hipóteses diagnosticas levantadas foram antrólito gigante, fenômeno de retenção mucoso e osteoma. Devido a complexidade anatômica do seio maxilar, o diagnóstico nessa região se torna um desafio. Considerando as limitações dos exames 2D, a tomografia computadorizada de feixe cônico pode ser empregada para a avaliação dessas estruturas. O conhecimento do raciocínio diagnóstico e das hipóteses diferenciais são de extrema importância para o que o caso seja conduzido corretamente, porém não substituem a biópsia e o exame histopatológico.

Sialolito gigante do ducto da glândula submandibular: relato de caso / Giant sialolith of submandibular gland duct: case report

Introdução: A sialolitíase é um distúrbio da glândula salivar que afeta 12 em cada 1.000 indivíduos adultos. É caracterizada pela deposição de minerais dentro de seu ducto ou parênquima, sendo a glândula submandibular a mais afetada. Os sialolitos têm tamanhos variados, quando maiores que 15 mm são raros e relatados como sialolitos gigantes. Sialolitos gigantes dentro do parênquima glandular ou porção proximal do ducto são geralmente tratados de forma invasiva por via extraoral com excisão da glândula associada. Relato de caso: Este estudo relata um caso incomum de um paciente diagnosticado com sialolito salivar gigante localizado na porção proximal de um ducto da glândula submandibular, assintomática, tratado por remoção cirúrgica por via intraoral, minimizando riscos potenciais e obtendo sucesso no tratamento. Considerações finais: Mesmo sialolitos localizados em regiões mais profundas do ducto submandibular, o acesso intraoral pode ser uma alternativa viável e de menor risco... (AU)

Introduction: Sialolithiasis is a disorder of the salivary gland that affects 12 out of 1,000 adult individuals. It is characterized by the deposition of minerals within its duct or parenchyma, with the submandibular gland being the most affected. Sialolites have varying sizes, when larger than 15 mm they are rare and reported as giant sialolites. Giant sialoliths within the glandular parenchyma or proximal portion of the duct are usually treated invasively by the extraoral route with excision of the associated gland. Case report: This study reports an unusual case of a patient diagnosed with giant salivary sialolith located in the proximal portion of a submandibular gland duct, asymptomatic, treated by intraoral surgical removal, minimizing potential risks and achieving treatment success. Final considerations: Even sialoliths located in deeper regions of the submandibular duct, intraoral access can be a viable and less risky alternative... (AU)

What has Changed in the Daily Practice of the Dental Imaging Center During the COVID-19 Pandemic?

ABSTRACT: A new type of RNA coronavirus (SARS-CoV-2) related to acute respiratory syndrome (SARS) and responsible for COVID-19 disease has spread around the world, resulting in an unprecedented pandemic. COVID-19 has become an international public health emergency and countless people and sectors have been affected. In this context, individual and collective protection measures were taken, mainly in health care. Dentistry, considered a high risk area, had to undergo changes in relation to biosecurity, including in radiological clinical practice. Thus, this letter aims to comment on these changes during visits to dental imaging centers.

RESUMEN: Un nuevo tipo de coronavirus de ARN (SARS-CoV-2) relacionado con el síndrome respiratorio agudo (SARS) responsable de la enfermedad COVID-19 se ha extendido por todo el mundo y ha provocado una pandemia sin precedentes. COVID-19 se ha convertido en una emergencia de salud pública internacional y un sinnúmero de personas y sectores se han visto afectados. En este contexto, se tomaron medidas de protección individual y colectiva, principalmente en el ámbito de la salud. La atención dental, considerada de alto riesgo, tuvo que sufrir cambios en relación con la bioseguridad, incluida la práctica clínica radiológica. Así, esta carta tiene como objetivo comentar estos cambios durante los atendimientos a los centros de imagenología dental.

Biosecurity Perspectives in Oral and Maxillofacial Radiology in Times of Coronavirus disease (COVID-19): a Literature Review

ABSTRACT: The aim of this work was to report biosecurity measures in the Oral and Maxillofacial Radiology (OMR) clinic in the current context of COVID-19, based on a literature review. An electronic search for scientific papers was perform ed using PubMed, Embase, Web of Science, and Scopus database. Although the literature related to care in the OMR clinic regarding COVID-19 is still scarce, this unprecedented scenario created by the pandemic generated an urgent need for measures to prevent the transmission of the virus. Dentists are at maximum risk of contagion and, although the practice of OMR generally does not produce aerosols, radiologists and technicians are continually in contact with body fluids, such as saliva. In additio n, imaging exams are often indispensable for emergency or elective dental diagnosis and treatment. Training in infection control practices during major outbreaks of infectious diseases should be quickly reinforced and dental settings have unique characteristics that warrant specific infection control considerations. Some recommendations have been proposed and were discussed, which cover patient flow, equipment handling and environment, radiographic technique and processing, personal protective equipment and preparation and issuance of radiological reports and access to exam results. Due to the COVID-19 pandemic, biosecurity measures in the routine of the OMR clinic are indispensable to enable emergency dental care and the perspectives of returning to elective treatment. Biosecurity measures and staff training at the OMR clinic should be instituted immediately, since imaging exams are an important and often indispensable part of dental diagnosis and treatment.

RESUMEN: El objetivo de este trabajo fue reportar las medidas de bioseguridad en la clínica de Radiología Oral y Maxilofacial (OMR) en el contexto actual del COVID-19, a partir de una revisión de la literatura. Se realizó una búsqueda electrónica de artículos científicos utilizando PubMed, Embase, Web of Science y la base de datos Scopus. Si bien la literatura relacionada con la atención en la clínica OMR respecto al COVID- 19 aún es escasa, este escenario inédito creado por la pandemia generó una urgente necesidad de medidas para prevenir la transmisión del virus. Los dentistas tienen el máximo riesgo de contagio y, aunque la práctica en la OMR generalmente no produce aerosoles, los radiólogos y técnicos están continuamente en contacto con fluidos corporales, como la saliva. Además, los exámenes por imágenes a menudo son indispensables para el diagnóstico y el tratamiento dental de emergencia o electivo. La capacitación en prácticas de control de infecciones durante brotes importantes de enfermedades infecciosas debe reforzarse rápidamente y los entornos dentales tienen características únicas que justifican consideraciones específicas de control de infecciones. Se han propuesto y discutido algunas recomendaciones que cubren el flujo de pacientes, el manejo y el entorno del equipo, la técnica y el procesamiento radiográfico, el equipo de protección personal y la preparación y emisión de informes radiológicos y el acceso a los resultados de los exámenes. Debido a la pandemia de COVID-19, las medidas de bioseguridad en la rutina de la clínica OMR son indispensables para posibilitar la atención dental de emergencia y las perspectivas de volver al tratamiento electivo. Las medidas de bioseguridad y la capacitación del personal en la clínica OMR deben instituirse de inmediato, ya que los exámenes por imágenes son una parte importante y, a menudo, indispensable del diagnóstico y tratamiento dental.

Accuracy of cone-beam CT in detecting vertical root fractures in teeth with post-endodontic restorations: an in vitro study

The aim of this study was to evaluate the accuracy of cone-beam CT (CBCT) for the detection of artificially created vertical root fractures (VRF) in extracted teeth restored with metallic (MP) and fiberglass (FGP) posts. After root canal obturation, 60 extracted human premolars were scanned by using the highest-resolution settings of a CBCT unit. Theprepared roots were randomly divided into three groups: group C (control group): non-restored and non-endodontically treated teeth (n = 20); group MP (n = 20); group FGP (n = 20). In all groups, 10 teeth were artificially fractured. Two external and independent observers blindly recorded the presence or absence of VRF. Sensitivity, specificity, accuracy, intra-and interobserver agreement were calculated. Kappa value for inter-and intraobserver agreement was 0.82 and 0.84 respectively, demonstrating goodagreement. The highest values for sensitivity (0.80 -0.90), specificity (1.00) and accuracy (0.90 -0.95) were found in the control group. The teeth with FGP restoration presented the lowest sensitivity (0.30 -0.50) and accuracy (0.60 -0.65) values. Both examiners had a good performance in the diagnosis of fractures in teeth with MP, with accuracy ranging between 0.85 -0.90. The presence of MP did not influence accuracy; however, the presence of FGP reduced the diagnostic capacity of CBCT.

Influence of mandibular positioning on the accuracy and reliability of linear measurements on cone beam CT using different voxels and two software programs / Influência do posicionamento mandibular na acurácia e confiabilidade de medidas lineares em tomografia computadorizada de feixe cônico utilizando diferentes voxels e dois softwares

Objetivo: este estudo avaliou a acurácia e confiabilidadedas medidas lineares em exames detomografia computadorizada de feixe cônico(TCFC), em dois softwares, utilizando diferentesvoxels e variando o posicionamento da mandíbula.Material e Métodos: 10 imagens de TCFC demandíbulas humanas com 25 pontos foram obtidas,usando diferentes protocolos de aquisição(0.250, 0.300, 0.400-mm voxels) e orientações damandíbula (centralizada, rotacionada 10° lateralmentepara direita e esquerda, inclinada 10° para cima e para baixo); 14 medidas foram realizadasnas reconstruções multiplanares nos softwares XoranCate OsiriX. Os achados foram comparadoscom as medidas físicas através de um paquímetrodigital. O teste ANOVA e o coeficiente de correlaçãoforam utilizados com p < 0,05. Resultados:não houve diferença estatisticamente significantequando as medidas foram comparadas em aquisiçõescom diferentes tamanhos de voxels emambos os softwares. A posição da mandíbula nãoinfluenciou nas medidas. Nenhuma diferença foiencontrada quando os valores foram comparadosentre os softwares e o paquímetro digital. Conclusão:as medidas lineares em ambos os softwaresforam confiáveis e acurados comparados a mensuraçãofísica em todos os protocolos. A acuráciae a confiabilidade das mensurações não influenciaramde acordo com as variações de posicionamentoda mandíbula.(AU)

Objective: this study evaluated the accuracy and reliability of linear measurements on cone beam CT (CBCT) scans in two software programs, using different voxels and varying mandible positioning. Material and methods: CBCT images of 10 human mandibles with 25 markers were obtained using different acquisition protocols (0.250, 0.300, 0.400-mm voxels) and mandible orientations (centered, rotated 10° laterally to right and left, tilted 10 up and down); fourteen measurements were carried out on the multiplanar reconstructions in XoranCat and OsiriX Lite software programs. The findings were compared to physical measurements using a digital caliper. ANOVA and correlation coefficient tests were used, at α = 0.05. Results: there was no statistically significant difference when the measurements were compared in acquisitions with different voxel sizes analysed in both software programs. Mandibular positioning changes did not influence the measurements. No differences were found when the values were compared between the software programs and the digital caliper. Conclusion: linear measurements in both programs were reliable and accurate compared with physical measurements when using all acquisition protocols. The accuracy and reliability of the measurements were not influenced by variations in the mandible positioning.(AU)

Inflammatory and developmental odontogenic cysts: 23-year observational and retrospective study / Cistos odontogênicos inflamatórios e de desenvolvimento: estudo observacional e retrospectivo de 23 anos

Objective: This observational and retrospective study evaluated the prevalence and characteristics of odontogenic cysts, outlining the epidemiological profile of these lesions. Material and methods: The following data were collected from the medical records of patients with a diagnosis confirmed by microscopy: age, sex, ethnicity, anatomical location, histopathological diagnosis and treatment, between 1995 and 2018. Results: Of the 70 cysts, 75.7% were inflammatory and 24.2% development. The inflammatory periapical cyst was the most prevalent (62.8%) followed by the dentigerous cyst (71.0%). The lateral radicular cysts and odontogenic keratocysts obtained the same percentage (5.7%), followed by the residual cyst (4.3%), paradental (2.8%) and the orthokeratinized variable (1.5%). Women were slightly more affected (1.12: 1) with greater involvement of leucodermas (80%). Age and anatomical location differed according to each lesion, although the anterior maxilla region was more affected. Enucleation was the most used treatment (75.7%), except for odontogenic keratocysts, in which marsupialization was performed in 75% of the cases. Conclusion: Epidemiological data provide an important insight into the prevalence, extent and severity of these lesions, allowing early diagnosis and prevention, in order to guarantee the reduction of cases and improve the quality of life of the population.

Objetivo: Avaliar a prevalência e características dos cistos odontogênicos de forma observacional e retrospectiva, delineando o perfil epidemiológico destas lesões. Material e Métodos: Foram coletados os seguintes dados dos prontuários de pacientes com diagnóstico confirmado microscopicamente: idade, sexo, etnia, localização anatômica, diagnóstico histopatológico e tratamento, entre os anos de 1995 a 2018. Resultados: Dos 70 cistos, 75,7% eram inflamatórios e 24,2% de desenvolvimento. O cisto periapical inflamatório foi o mais prevalente (62,8%) seguido pelo cisto dentígero (71,0%). O cisto radicular lateral e queratocisto odontogênico obtiveram o mesmo percentual (5,7%), seguidos do cisto residual (4,3%), paradentário (2,8%) e a variável ortoqueratinizada (1,5%). As mulheres foram ligeiramente mais afetadas (1,12:1) com maior acometimento de leucodermas (80%). Idade e localização anatômica diferiram de acordo com cada lesão, embora a região anterior de maxila tenha sido mais afetada. A enucleação foi o tratamento mais utilizado (75,7%), exceto para o queratocisto odontogênico, no qual a marsupialização foi realizada em 75% dos casos. Conclusão: Os dados epidemiológicos fornecem uma visão importante para o entendimento da prevalência, extensão e gravidade dessas lesões, viabilizando o diagnóstico precoce e medidas preventivas, a fim de garantir a redução dos casos e melhorar a qualidade de vida da população.

Limitation of diagnostic value of cone-beam CT in detecting apical root isthmuses

Abstract Isthmuses are reported as common anatomic complexities in teeth often associated with failures in endodontic treatment. They should be considered before starting treatment and a preoperative computed tomography scan (CT) may demonstrate these complexities. Objective To assess the diagnostic value of the highest resolution settings of a cone-beam CT (CBCT) system in identifying and measuring apical isthmuses, using micro-CT as reference. Methodology After micro-CT scanning, 40 humans' lower first molars with isthmuses in the apical-3 mm of mesial roots were scanned by the highest resolution settings of the New Generation i-Cat ® CBCT equipment. Two blinded observers recorded the detection of isthmuses in CBCT scans. The lengths of isthmuses were compared between micro-CT and CBCT to assess the diagnostic value of CBCT. Quantitative data for sensitivity were represented as percentages (95% confidence interval). The Bland-Altman method was used to assess differences between gold standard lengths (micro-CT) and CBCT lengths. Results BCT demonstrated 30 positive findings, representing sensitivity for isthmus identification of 75% (95% CI=0.4114-1.1364). Differences between the lengths in micro-CT (1.99±0.40 mm) and CBCT (1.53±0.41 mm) were significant (p<0.0001). Conclusion The CBCT device used presented limited diagnostic value in the identification and measurement of apical isthmuses in the mesial roots of lower molars. In some cases, the actual anatomy of the apical root canal may not be completely delineated in this type of CBCT system, even using the highest resolution settings.

Estudo da anatomia de pré-molares inferiores por meio de tomografia computadorizada de feixe cônico / Study of mandibular premolar anatomy by conebeam computed tomography

Introdução: os pré-molares inferiores representam um desafio no tratamento endodôntico, devido às suas variações anatômicas. Assim, emprega-se a tomografia computadorizada de feixe cônico (TCFC) para o estudo detalhado da anatomia dentária. Objetivo: avaliar, por meio da TCFC, a anatomia dentária de pré-molares inferiores. Métodos: a amostra incluiu imagens de TCFC, nos cortes coronal, sagital e axial, de 200 pré-molares inferiores. O número de raízes, canais e a configuração, de acordo com Vertucci, foram analisados. As variáveis foram associadas e comparadas, a um nível de significância de 5%. Resultados: a configuração do tipo I predominou em ambos os sexos, masculino e feminino, e nos primeiros e segundos pré-molares. Contudo, o teste exato de Fisher apontou que não foi possível confirmar uma associação entre os sexos e a conformação dos canais de acordo com a classificação de Vertucci. Por meio do teste Mann-Whitney, houve evidências amostrais de que o número de raízes (p = 0,04) e de canais (p = 0,01) difere entre os sexos. Em 62% dos primeiros pré-molares e 92% dos segundos pré-molares, foi observada a presença de uma raiz e um canal. O teste de Friedman indicou que o número de raízes e canais também diferiu entre os tipos de dentes (p = 0,02). Conclusões: a TCFC possibilitou a análise, de maneira eficaz e não invasiva, da morfologia dentária, verificando-se que o tipo I foi o mais frequente em ambos os sexos e nos primeiros e segundos pré-molares. Foi possível verificar que o número de raízes e canais difere significativamente tanto entre os sexos quanto entre os tipos de dentes.

Introduction: The mandibular premolars represent a challenge in endodontic treatment due to their anatomical variations. Thus, cone-beam computed tomography (CBCT) is used for the detailed study of the dental anatomy. Objective: To evaluate dental anatomy of the mandibular premolars using CBCT. Methods: The sample included CBCT images in the coronal, sagittal and axial sections of 200 mandibular premolars. The number of roots, root canals and configuration according to Vertucci were analyzed. The variables were associated and compared at a significance level of 5%. Results: The type I configuration predominated in males and females and in the first and second premolars. However, Fisher's exact test evidenced that it is not possible to confirm an association between the sexes and the configuration of the root canals according to the Vertucci classification. The Mann-Whitney test indicated that the number of roots (p=0.04) and canals (p=0.01) are different between genders. The presence of a single root and a single canal was observed in 62% of the first premolars and 92% of the second premolars. The Friedman test indicated that the number of roots and canals also differs between teeth (p=0.02). Conclusion: CBCT enabled noninvasive and effective way to analyze the morphology of teeth and it was found that type I was the most frequent in both genders and in the first and second premolars. The number of roots and canals differs significantly between genders and between teeth (AU).

Análisis Descriptivo y Cualitativo de Tres Software Gratuitos Usados para la Conversión de Formato DICOM para STL / Descriptive and Qualitative Analysis of Three Free Software Used to Convert From DICOM to STL Format

RESUMEN: Los exámenes imagenológicos tridimensionales en odontología son cada día mas frecuentes, contando también con algunas tecnologías gratuitas; el objetivo de este estudio fue analizar tres software gratuitos de conversión desde el formato DICOM al STL. Se evaluaron los programas computacionales 3DSlicer, InVesalius e ImageVis3D. La metodología empleada para evaluar fue basada en el modelo del proceso de evaluación de calidad, según la norma NBR ISO / IEC 9126-, incluyendo 6 observadores en la investigación. Se determinó que el programa más fácil de manipular en la etapa de segmentación, en la representación de volumen y en la conversión de archivos STL fue InVesalius, pero el programa más completo y preciso, para estas fases fue el software 3DSlider. Se puede concluir es necesario un entrenamiento adecuado para que la manipulación de estos programas sea lo más preciso posible.

ABSTRACT: The three-dimensional imaging in medical sciences nowadays is increasing and some of these technologies are free; the aim of this study was to analyze three free conversion software: 3DSlicer, InVesalius and ImageVis3D. The methodology used to evaluate the software was based on the model of the quality evaluation process, according to the standard NBR ISO/IEC 9126-1. It was observed that the easiest software to manipulate in the segmentation stage, in the representation of volume and in the conversion of STL (Standard Tessellation Language) files was InVesalius, but the most complete and precise software for these phases was the 3DSlider software. Thus, it was concluded that adequate training is necessary so that the handling of these three software is as accurate as possible.

Manifestações imaginológicas distintas na displasia cemento-óssea florida

Objetivo: o objetivo do presente trabalho é relatar dois casos clínicos de pacientes com displasia cemento-óssea florida (DCOF) com características distintas no exame de tomografia computadorizada de feixe cônico (TCFC). Relato de caso: no primeiro caso, paciente do gênero feminino, melanoderma, 49 anos de idade com lesões hipodensas assintomáticas distribuídas por toda a mandíbula, sugestivas de DCOF em estágio imaturo. No segundo caso, uma paciente do gênero feminino, melanoderma de 48 anos de idade, as lesões apresentavam-se hiperdensas com halo hipodenso, em mandíbula localizada bilateralmente, assintomáticas, caracterizando o estágio maduro da DCOF. Em ambos os casos, o diagnóstico de DCOF foi estabelecido por meio das imagens de TCFC associadas às características clínicas das pacientes. Nenhum tratamento foi instituído, apenas o controle periódico. Considerações finais: os casos clínicos apresentados ressaltam a importância da TCFC no diagnóstico das lesões fibro-ósseas, que, como ilustrado, podem apresentar características imaginológicas bastante distintas. Por possuir um amplo espectro de apresentações e ser encontrada em exames de imagens realizados para outros fins, a DCOF pode levar o cirurgião dentista à tomada de decisões precipitadas e, muitas vezes, condutas inadequadas, visto que procedimentos cirúrgicos são contraindicados nesses casos.

Myofascial trigger points in patients with temporomandibular joint disc displacement with reduction: a cross-sectional study

Abstract Objective The objective of this retrospective study was to evaluate the impact of myofascial trigger points (MTrPs) in patients with articular disc displacement with reduction (DDWR) and to identify which clinical variables are associated with the concomitant presence of DDWR and MTrPs. Material and Methods 130 patients were selected that sought treatment due to joint pain, with ages ≥18 years, of both genders, with DDWR confirmed by magnetic resonance imaging. The sample was divided into two groups: Group 1, patients with DDWR and MTrPs (N=101); and Group 2, patients with DDWR and no MTrPs (N=29). Information on gender, age, pain duration, pain scores, and maximal interincisal distance (MID) were collected. The logistic regression model was used and the odds ratios (OR) was calculated (p<0.05). Results Group 1 presented statistically significant higher mean pain scores (p=0.007), and smaller MID (p=0.0268) than Group 2. OR were significant for the pain scores (1.429), MID (0.937) and gender (women) (2.810). Conclusions Patients with DDWR and MTrPs had increased pain scores and a MID decrease compared to patients with DDWR and no MTrPs. The variables pain scores, MID, and gender (women) showed a significant association with the concomitant presence of DDWR and MTrPs.

Association between oral lichen planus and hepatitis C: retrospective study and case report / Associação entre líquen plano oral e hepatite C: estudo retrospectivo e relato de caso

Oral Lichen Planus (OLP), a chronic inflammatory disease of unknown etiology, which affects the skin and/or mucosal tissues, is an autoimmune disease (pathology) of special interest to dentists due to its oral manifestations and its possible association with Hepatitis C virus (HCV). Although a possible association has been extensively discussed in the literature, the results have been controversial. So that the relationship between Oral Lichen Planus (OLP) and infection by HCV (OLP-HCV) may be investigated, current study conducted an epidemiological survey of all OLP cases diagnosed in two reference projects, with regard to diagnosis, treatment and epidemiology of oral lesions in Maringá, Paraná, Brazil. In addition, the clinical case of a patient with HCV and the clinical manifestation of severe OLP will be provided. A total of 3,488 clinical records of biopsies performed between 1994 and 2014 and 85 cases of OLP were selected for the present study. The reticular type of OLP showed significant prevalence but only 2.3% of OLP cases revealed any association with HCV.

Líquen Plano (LP) é uma doença inflamatória crônica de etiologia desconhecida, que acomete pele e/ou mucosas. Esta doença autoimune é de especial interesse para o cirurgião-dentista pelo fato de apresentar manifestações bucais e pode estar associado ao vírus da hepatite C (VHC). Esta possível associação tem sido muito discutida na literatura, apresentando resultados controversos. Com o intuito de investigar a relação entre o Líquen Plano Oral (LPO) e a infecção pelo VHC (LPO-VHC), o presente trabalho objetivou conduzir um levantamento de todos os casos de LPO diagnosticados em dois projetos de referência quanto a diagnóstico, tratamento e epidemiologia de lesões bucais na cidade de Maringá, Paraná, Brasil. Adicionalmente, um caso clínico de um paciente portador do VHC com manifestação clínica severa de líquen plano será apresentado. Foram selecionados para o presente estudo um total de 3.488 prontuários de biópsias realizadas entre os anos de 1994 e 2014 e 85 casos de LPO. O LPO do tipo reticular apresentou prevalência estatisticamente significante e apenas 2.3% dos casos de LPO apresentaram associação com o VHC.

Treatments and supportive therapies for oral manifestations of chronic graft-versus-host disease / Tratamentos e terapias de suporte para manifestações orais da doença crônica do enxerto contra hospedeiro

The aim of this study was to conduct a systematic review of treatments and therapies for oral manifestations of chronic graft-versus-host disease, aiming at improving patients' quality of life and mainly the reduction of mortality caused by graft- versus-host disease. A systematic review was carried out by two evaluators, a Dentistry professor and an undergraduate student. A selection of open-access full-text online articles, carried out on PubMed, GoPubmed, NLM Gateway, LILACS, BIREME, SciELO, IBECS, and Web of Science. The survey was completed in July 2012. Of the 1147 studies found, 52 fit the selection criteria. Patients (n = 2130) received different treatment regimens, either systemic or topical. Drugs for systemic therapy were divided into those with action on the inhibition of proliferation and/or release of T and B cells, with action on inflammatory disorders, and of immunomodulatory effect. Topical drugs were divided into their pattern of mucosal absorption and their ability to act on tissue growth factors. The analysis of articles concluded that the most used systemic drugs were Methylprednisolone and corticosteroids, and Tacrolimus and topical Cyclosporine for topical and local therapy.

O objetivo do trabalho foi realizar uma revisão sistemática sobre tratamentos e terapias de suporte para manifestações orais da doença crônica do enxerto contra hospedeiro, visando à melhoria da qualidade de vida dos pacientes e, principalmente, a redução da mortalidade causada pela doença do enxerto contra hospedeiro. A revisão sistemática foi realizada por dois examinadores, um professor e um graduando de odontologia. A seleção de acesso aberto de artigos online de texto completo, realizadas no PubMed, GoPubmed, NLM Gateway, LILACS, BIREME, SciELO, IBECS e Web of Service. A revisão foi concluída em julho de 2012. Dos 1.147 estudos encontrados, 52 se enquadraram nos critérios de seleção. Os pacientes (n = 2130) receberam diferentes tratamentos, seja de forma sistêmica ou tópica. Os medicamentos para tratamento sistêmico foram divididos entre aqueles com ação na inibição da proliferação e / ou liberação de células T e B, com ação em doenças inflamatórias, e de efeito imunomodulador. Drogas tópicas foram divididas em seu padrão de absorção da mucosa e a sua capacidade para atuar sobre os fatores de crescimento de tecidos. A análise dos artigos permitiu concluir que os medicamentos sistêmicos mais utilizados foram Metilprednisolona e corticosteróides, e Tacrolimus e Ciclosporina tópica para a terapia tópica e local.

Solitary bone cyst: an analysis of 12 cases / Cisto ósseo solitário: uma análise de 12 casos

Apresentar informações adicionais sobre o COS a partir da revisão de 12 casos, com a descrição das características clínicas e radiográficas, comparando-as com a literatura recente. Realizou-se um estudo retrospectivo observacional de casos de COSs apresentados por pacientes do projeto de extensão: 'Diagnóstico, tratamento e epidemiologia das doenças da cavidade bucal ­ Lebu', da Universidade Estadual de Maringá ­ Paraná, Brasil, entre os anos de 1995 e 2014. Dos 2.424 prontuários de pacientes que foram submetidos a diferentes tipos de biópsia, 12 casos de COS foram encontrados e selecionados para pesquisa. Todos os casos ocorreram na mandíbula, preferencialmente em pacientes jovens na segunda década de vida. Ocasionalmente, a expansão da tábua óssea cortical foi notada e, por meio de exame histopatológico, o diagnóstico da lesão foi confirmado. A maioria dos COS são, geralmente, assintomáticos e diagnosticados por acaso em exames radiográficos de rotina. No entanto, o COS pode causar expansão óssea ou rompimento de cortical óssea, visível apenas com métodos de imagem mais sofisticados. O presente trabalho de pesquisa mostrou que o diagnóstico de COS é beneficiado pelo uso da radiografia convencional e tomografia computadorizada, associada a exames clínicos cuidadosos.

To present further information about SBCs based on a retrospective study of 12 cases, by describing their clinical and radiographic characteristics, and comparing them with recent findings. The study examined SBCs from the Projeto Lesões Bucais 'treatment and epidemiology of diseases of the oral cavity', run at State University of Maringá, Paraná State, Brazil, between 1995 and 2014. Twelve cases were found among the records of 2.424 patients who had been submitted to different types of biopsy. All cases occurred in the mandible, predominantly in patients in the second decade of life, in the region posterior to canines, and among women. All lesions were solitary, 75% of them unilocular. Helicoidal CT showed expansion and rupture of the cortical bone in one case. Differential diagnosis was confirmed by means of histopathological examination. Treatment consisted of surgical exploration in all cases. Most SBCs are usually asymptomatic and diagnosed by chance on routine X-ray examination. However, SBC can cause bone expansion or bone rupture, only visible with more sophisticated imaging systems. This study showed that the diagnosis of SBC benefits with the use of conventional radiography and CT, associated with careful clinical examinations.

Effects of rapid maxillary expansion with six months of retention and no further orthodontic treatment / Efeitos da expansão rápida da maxila com 6 meses de contenção e sem posterior tratamento ortodôntico

Previous investigations addressing the long-term effects of rapid or slow expansion on the face and teeth involved the use of a orthodontic fixed appliance following expansion therapy. The present study evaluated changes in dentoskeletal aspects following rapid maxillary expansion (RME) and determine the stability of these changes over three years of follow up. Ten children with bilateral posterior crossbite were evaluated (experimental group). Dental casts and lateral cephalograms were evaluated prior to RME (T0) as well as three months (T1), one year (T2) and three years (T3) after RME. The measures were compared to a control group composed of 21 individuals using ANOVA and the Student's t-test (p > 0.05). Changes on the transverse plane revealed significant expansion of the upper dental arch three months after RME, stable after three years. Expansion at the cusp level was similar to that at the gingival level. No significant changes were found in the angular and linear cephalometric measures among T0, T1, T2 and T3, and in comparison to the control group (p > 0.05). We concluded that early RME produces stable transverse increases in the upper arch after three years without significantly altering sagittal and vertical dentoskeletal relationships, and neither inclined teeth.

A expansão rápida ou lenta da maxila seguida do uso de aparelhos ortodônticos fixos altera a face e os dentes. Este estudo avaliou as mudanças dentoesqueléticas após a expansão rápida da maxila (ERM) e determinou a estabilidade dessas mudanças em três anos de acompanhamento. Dez crianças com mordida cruzada posterior bilateral foram avaliadas (grupo experimental). Modelos de estudo e telerradiografias laterais foram avaliadas antes da ERM (T0), assim como três meses (T1), um ano (T2) e três anos (T3) após a ERM. As medidas foram comparadas às de um grupo controle composto de 21 pacientes por meio do teste ANOVA e teste t Student (p > 0,05). As mudanças no plano transversal revelaram uma expansão significante no arco superior três meses após a ERM, que se manteve estável após três anos. A expansão ao nível das cúspides foi similar à do nível gengival. Mas nenhuma diferença significante foi encontrada estre as medidas cefalométricas angulares e lineares ao longo dos períodos T0, T1, T2, e T3 e nem quando se comparou essas medidas às do grupo controle (p > 0,05). Conclui-se que A ERM precoce produz aumentos transversais estáveis no arco superior sem alterar significantemente as relações sagitais e verticais dentoesqueléticas e nem inclinar dentes.

Potencial de transformación maligna del liquen plano oral: estudio retrospectivo / Potential malignant transformation of oral lichen planus: retrospective study

El liquen plano oral (LPO) es una enfermedad mucocutánea inflamatoria más común en las mujeres. Su etiología aún no es bien definida y esta condición puede estar relacionada, por ejemplo, a la ansiedad, estrés, diabetes, las enfermedades autoinmunes, infecciones y predisposición genética. El LPO se manifiesta en dos formas principales: reticular y erosivo. El objetivo de esta investigación es, a través de un estudio retrospectivo, analizar el posible potencial maligno del LPO. Se analizaron los registros de los pacientes atendidos en dos proyectos de lesiones bucales de dos diferentes instituciones en el período de 1995 a 2014. Se recogieron datos como género, edad, presencia de enfermedad sistémica, presencia de lesiones en la piel, tabaquismo, duración de la lesión, localización, síntomas, tratamiento, proservación y transformación maligna. Los resultados mostraron que, de los 3488 analizados, 85 (2,4%) tuvieron un diagnóstico confirmado de LPO, que afecta fundamentalmente a pacientes de sexo femenino (85%) siendo el LP reticular más común. En relación a la transformación maligna del LPO, 1 paciente (0,85%) tenía carcinoma de células escamosas 4 años después del diagnóstico inicial de LPO. Además, 3 pacientes mostraron atipia celular moderada en el diagnóstico. Los resultados refuerzan el potencial de transformación maligna del LPO. Aunque esta asociación es especulativa, la posibilidad debe ser considerada por los profesionales, que deben presentar estos pacientes a largos periodos de preservación.

Oral lichen planus (OLP) is an inflammatory mucocutaneous disease, more common in females. Its etiology is not yet well defined; this condition may be related, for example, to anxiety, stress, diabetes, autoimmune diseases, infections and genetic predisposition. The OLP manifests itself in two main forms: reticular and erosive. This work aims to perform a retrospective study analyzing the possible malignant potential of OLP. Records of the patients were analyzed in two projects of oral lesions in two different institutions in the period from 1995 to 2014. Data as gender, age, presence of systemic disease, presence of skin lesions, smoking, duration of the injury, location, symptoms, treatment, follow-up time and malignant transformation were collected. The results showed that, of the 3488 analyzed, 85 (2.4%) had a confirmed diagnosis of OLP, which mainly affected female patients (85%) being the most common the reticular LP. Regarding the malignant transformation of OLP, one patient (0.85%) had squamous cell carcinoma 4 years after the initial diagnosis of OLP. In addition, 3 patients showed moderate cellular atypia. The results reinforce the potential of malignant transformation of OLP. Although this association is speculative, this possibility must be considered by the dental practitioners, who must submit these patients to long periods of monitoring.

Comparison of diagnostic accuracy of root perforation, external resorption and fractures using cone‑beam computed tomography, panoramic radiography and conventional & digital periapical radiography.

Context: Some radicular changes are challenging for clinicians to diagnose, such as of root perforations, external root resorption (ERR), and vertical root fractures (VRFs). This study aims to facilitate it by comparing the diagnostic accuracy of cone‑beam computed tomography (CBCT), orthopantomography, and conventional and digital periapical radiography (DPR) in the diagnosis of such problems. Is it worth doing CBCT despite the radiation dose? Aims: To evaluate and compare the diagnostic accuracy of CBCT, panoramic radiography, and conventional and DPR in the diagnosis of root perforation (RP), ERR, and VRF. Materials and Methods: The sample consisted of 40 extracted human teeth and 10 macerated human mandibles. RPs were performed using diamond burs, ERRs using spherical carbide burs, and RFs using a universal machine EMIC‑DL 1000. The images were evaluated by 6 dentomaxillofacial radiologists. Results: Receiver operating characteristic (ROC) revealed that CBCT showed the highest area under the ROC curve (Az) values for RP, ERR, and VRF (0.903, 0.950, and 0.849, respectively). The worst Az values for RP, ERR, and VRF (0.718, 0.494, and 0.611, respectively) were for panoramic radiography. Conclusions: CBCT showed the best results in the diagnosis of ERR and VRF. The diagnosis of ERR was the least accurate, panoramic radiography being not appropriate for its diagnosis. CBCT and conventional periapical radiography obtained similar results for the evaluation of RP. So for, RP indicate the conventional periapical radiography because CBCT has a higher radiation dose.

Effect of orthognathic surgery on pharyngeal airway space: a cephalometric evaluation using Dolphin Imaging software / Avaliação cefalométrica do espaço aéreo faríngeo após cirurgia ortognática por meio do software Dolphin Imaging

Orthognathic surgery is widely used in the treatment of dento- maxillofacial deformities, which changes both the facial appearance and the pharyngeal airway space. The aim of this study was to evaluate cephalometric changes in the pharyngeal airway space before and after orthognathic surgery in patients with Class II and Class III malocclusions. The sample consisted of 38 lateral cephalograms, 17 of patients with Class II who had undergone mandibular advancement, and 21 of patients with Class III who had undergone mandibular setback. Cephalometric analysis of Arnett-Gunson FAB Surgery using Dolphin Imaging 11.5 evaluated point B' and Pog'. Statistical analysis used Paired t- test at 5% significance level. The increase in the means of point B' and Pog' after mandibular advancement was not statistical. Similarly, the means of point B' and Pog' did not differ after mandibular setback. Thus, the pharyngeal airway space at the level of B' and Pog' kept constant pre and post orthognathic surgery for both Class II and Class III.

A cirurgia ortognática é amplamente utilizada no tratamento de deformidades dento -maxilo-faciais, alterando a aparência facial e o espaço aéreo faríngeo. O objetivo deste estudo foi analisar a variação cefalométrica do espaço aéreo faríngeo antes e após a cirurgia ortognática. Foram analisadas 38 radiografias cefalométricas laterais, 17 de pacientes com Classe II submetidos ao avanço mandibular e 21 de pacientes com Classe III submetidos ao recuo mandibular. O espaço aéreo faríngeo foi analisado por meio do software Dolphin Imaging 11.5 utilizando a análise de Arnett-Gunson FAB Surgery, observando os pontos B' e Pog'. Os dados foram analisados com o Teste t para Amostras Pareadas com nível de significância de 5%. O aumento da média dos pontos B' e Pog' após o avanço mandibular não foi estatisticamente significante. Para a cirurgia de recuo mandibular, as médias dos pontos B' e Pog' mantiveram-se estáveis. Assim, o espaço aéreo faríngeo em nível dos pontos B' e Pog' mantiveram-se constantes antes e após a cirurgia ortognática para Classe II e Classe III.