A single session of antimicrobial photodynamic therapy does not influence the alveolar repair process in rats

Abstract: The aim of this study was to use microscopic and molecular techniques to evaluate the effects of a single session of antimicrobial photodynamic therapy (aPDT) on the alveolar repair process after tooth extraction in rats. The study sample included 84 rats divided into four groups, as follows: a) Control - untreated socket; b) Laser - socket treated using photobiomodulation; c) TBO - socket treated with topic application of the photosensitizer agent, toluidine blue O (TBO); and d) aPDT - socket treated with TBO and laser irradiation. An additional rat was used for thermal mapping during socket irradiation. The animals were euthanatized at 6, 15, and 28 days after unilateral extraction of the upper incisor. Quantitative and qualitative analyses of the connective and bone tissues, blood clot, blood vessel, and inflammatory infiltrate were performed, and real-time polymerase chain reaction was used to study the expression of genes (collagen type I, osteocalcin, alkaline phosphatase [ALP], runt-related transcription factor 2 [RUNX2], and vascular endothelial growth factor [VEGF]) involved in the bone healing process. No statistically significant differences in microscopic and molecular outcomes were observed between the groups (p > 0.05). A positive correlation was seen to exist between blood clot and VEGF (p = 0.000), and a negative correlation was observed between bone tissue and ALP (p = 0.028) and blood vessel and VEGF (p = 0.018). A single session of aPDT in the dental extraction site did not influence the alveolar repair process in rats.

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.

Levantamento de seio maxilar atraumático sem enxertia óssea: uma revisão integrativa / Atraumatic maxillary sinus augmentation without bone grafting: an integrative review

Objetivo: avaliar a eficácia do levantamento do seio maxilar atraumático sem enxerto ósseo e a taxa de sobrevivência da instalação de implantes imediatos. Material e métodos: realizou-se uma estratégia de busca nas bases de dados Pubmed, Web of Science e Science Direct, obtendo 103 artigos, sendo selecionados 07 estudos publicados entre 2008 até 2019. Resultados: foram registrados 576 pacientes com idades entre 19 e 85 anos de idade, de ambos os sexos e 1,113 implantes instalados. Verificou-se uma taxa de sucesso e sobrevivência dos implantes de 96,6%, após um seguimento de 1 a 3 anos e houve um ganho ósseo de aproximadamente 3mm. Considerações finais: o levantamento de seio maxilar atraumático sem enxerto ósseo é eficaz para reabilitação de áreas edêntulas e mostra um bom resultado ao longo do tempo, com uma taxa média de sobrevivência dos implantes de 96,3%. Ainda faltam estudos para determinar qual tipo de implante é melhor para este tipo de técnica. (AU)

Objective: To assess the efficacy of atraumatic maxillary sinus augmentation without bone grafting and the survival rate of the immediate implant installation. Material and methods: A search strategy was performed the in Pubmed, Web of Science, and Science Direct databases, resulting in 103 articles from which seven studies published between 2008 and 2019 were selected. Results: 576 patients of both sexes, aged between 19 and 85 years, were registered, as well as 1,113 implants installed. There was a success rate and survival of implants of 96.6% after a follow-up of 1 to 3 years and there was a bone gain of approximately 3 mm. Final considerations: The atraumatic maxillary sinus augmentation without bone graft is effective to rehabilitate edentulous areas and shows a good outcome over time, with an average rate of implant survival 96.3%. Further studies are still required to determine which type of implant is best for this type of technique.(AU)

Effects of Image Compression on Linear Measurements of Digital Panoramic Radiographs

Abstract This study aimed to evaluate the accuracy of panoramic radiographs obtained by digital system based on charge coupled device (CCD) and a phosphor storage plate (PSP) system with two different file formats, JPEG irreversible type and BMP. Linear measurements of artificial bony defects were made in dry mandibles with a digital caliper. Measures of digital panoramic radiographs were taken in ImageJ(r) software. Each measurement was performed twice by an experienced examiner. The intra-rater agreement was considered very strong (Pearson's correlation coefficient of 0.97). There was no significant difference between the linear measurements of dry mandibles, considered the gold standard, in relation to measurements obtained from digital radiographs (p=0.47). The error of these measures for the CCD was 1.04 mm (9.97%) for JPEG images and 1.03 mm (9.99%) for those with BMP format. For the PSP images, these values were 1.48 mm (14.94%) and 1.43 mm (14.43%), respectively. Although there was no statistical difference between the images with JPEG and BMP format, for both digital systems (p=1.00 for CCD and p=0.98 for PSP system), errors made on radiographs obtained by PSP system were significantly higher than those of CCD (p<0.05). The size of the files saved in JPEG was also significantly lower (p=0.005) compared with the files saved in BMP. It may be concluded that the digital radiographs, both saved in JPEG and BMP formats, are accurate, regardless the used digital system, and JPEG images are more suitable for teleradiology.

Resumo Este estudo teve como objetivo avaliar a acurácia de radiografias panorâmicas digitais obtidas por sistema digital baseado em dispositivo acoplador de carga (DAC) e por sistema de placa de fósforo (PF) com duas diferentes extensões de arquivo (JPEG e BMP, sendo o primeiro do tipo compactador irreversível). Medidas lineares de defeitos ósseos foram realizadas em mandíbulas secas com paquímetro digital. As medidas correspondentes nas radiografias panorâmicas digitais foram realizadas no software ImageJ(r). As medidas foram realizadas duas vezes por um examinador. A concordância intraexaminador foi considerada muito forte (coeficiente de correlação de Pearson de 0,97). Não houve diferença significante entre as medidas lineares das mandíbulas secas, consideradas padrão-ouro, em relação às medidas obtidas das radiografias digitais (p=0,47). Os erros absolutos e relativos dessas medidas para o DAC foram de 1,04 mm (9,97%) para as imagens JPEG e de 1,03 mm (9,99%) para aquelas com extensão BMP. Para o sistema digital com PF esses valores foram de 1,48 mm (14,94%) e 1,43 mm (14,43%), respectivamente. Apesar de não ter havido diferença estatística entre as imagens com extensão JPEG e BMP, para ambos os sistemas digitais (p=1,00 para DAC e p=0,98 para a PF), os erros das medidas realizadas nas radiografias obtidas pelo sistema de PF foram significativamente maiores que os erros do DAC (p<0,05). O tamanho dos arquivos salvos em JPEG também foram significativamente menores (p=0,005) em comparação com os arquivos salvos em BMP. Pode-se concluir que as radiografias digitais tanto com extensão JPEG quanto BMP são acuradas, independente do sistema digital utilizado e as imagens salvas em JPEG são mais indicadas em telerradiologia.

Utilização e vantagens da TomografiaComputadorizada por Feixe Cônico emUniversidade Pública / Use and advantages of Cone Beam Computed Tomography in Public University

Realizar uma análise crítica sobre a utilização da Tomografia Computadorizadapor Feixe Cônico (TCFC) na Faculdade de Odontologia de Bauru - USP e as respectivas indicaçõesdeste exame por imagem. Materiais e Métodos: O estudo foi realizado por um únicoexaminador, que avaliou e registrou todos os dados referentes às imagens de TCFC realizadasno período compreendido entre os anos de 2008 a 2011. Resultados: Um total de 1061 examesde imagem de TCFC foram solicitados em um período de quatro anos. Destes, foram considerados722 exames correspondentes ao critério de inclusão. Os motivos pelas quais os examesforam solicitados: avaliação ortodôntica, avaliação endodôntica, reabsorção dentária, cirurgiaparaendodôntica, localização de sialólito, avaliação óssea, dente supranumerário, avaliação daarticulação temporomandibular,, fratura radicular, dente irrompido, avaliação de terceiro molar,retratamento endodôntico, avaliação do seio maxilar, diagnóstico de lesão maxilar, avaliaçãoperiodontal, diagnóstico de lesão mandibular, controle pós-operatório e avaliação para implante.Conclusão: As solicitações de TCFC na Faculdade de Odontologia de Bauru - USP no períododeterminado no estudo em questão foram coerentes com as indicações apresentadas pela literaturacientífica, o preenchimento completo da requisição para a realização do atendimentoainda não é uma prática frequente e mecanismos para o esclarecimento dos usuários do serviço...

Objective: To conduct a critical analysis on the use of Cone-Beam Computed Tomography(CBCT) scanner at Bauru School of Dentistry (USP/Brazil) and the indications of this imagingtechnique. Materials and Methods: The study was conducted by a single examiner, who evaluatedand recorded all data pertaining to the images of CBCT between the year of 2008 and2011. Results: A total of 1061 imaging of CBCT were requested in the four years of the study.Among them, 722 were considered relevant to the inclusion criteria exams. The reasons whythe tests were requested were: orthodontic evaluation, endodontic evaluation, tooth resorption,paraendodontic surgery, salivary calculi location, bone evaluation, supernumerary teeth,temporomandibular joint assessment, root fracture, erupted teeth, third molar evaluation, endodonticretreatment , evaluation of the maxillary sinus, diagnosis of jaw injury, periodontalevaluation, postoperative control and evaluation for implantation. Conclusion: Applications ofCBCT at Bauru School of Dentistry (USP-Brazil) in the given period in the current study wereconsistent with the indications established by the scientific literature. Filling out the applicationto perform the service is still not a common practice and mechanisms for the clarification ofthe service users...

Analysis of the reproducibility of the gray values and noise of a direct digital radiography system

The aim of this study was to evaluate the reproducibility of the gray values and noise of a direct digital radiography system (Visualix eHD) for various exposure times and analyzed regions. To obtain radiographic images in a standardized manner, the digital sensor of the system and a stepwedge were positioned in a phantom at a focus-film distance of 30 cm in a dental device at 70 kV, 7 mA and 2.2 mm filtration. Ten consecutive repetitions of X-ray imaging were performed at each exposure time (0.05, 0.07, 0.09 and 0.13 s). Gray values were analyzed using ImageJ software in five regions of interest (ROIs): alveolar bone (AB), soft tissue (ST) and three steps of the stepwedge (S1, S2 and S3). The results showed that both the variability of the gray values and the noise were statistically greater (p < 0.05) in the most radiolucent region (ST). Only the noise was affected by the exposure time. In conclusion, the reproducibility of the gray values and the noise of the Visualix eHD system can vary in specific areas with different radiolucency.

Cone beam computed tomography: A tool for the diagnosis of confusing periapical lesions in conventional radiographs.

We report two cases in which cone beam computed tomography (CBCT) was essential for the establishment of the diagnosis of periapical lesions. CBCT allows a three-dimensional assessment of a specific region with no superimposition of structures. Therefore, its use is recommended when radiographic images are not sufficient for the diagnosis.

Forâmen lingual lateral – relato de dois casos clínicos através da tomografia computadorizada de feixe cônico / Lateral lingual foramina (LLF) – two case reports with the use of cone beam computed tomography (CBCT)

O reconhecimento do forâmen lingual lateral (FLL) e muito importante, especialmente na implantodontia. Assim, a tomografia computadorizada feixe cônico (TCFC) permite a visualização de estruturas anatômicas nao detectadas na radiografia convencional, com o FLL. Este artigo relata dois casos de FLL ambos no lado direito em dois pacientes distintos. Ambos os exames foram obtidos pelo I-Cat e avaliados no programa I-Cat Vision. A injúria aos vasos que atravessam a FLL pode causar hematoma no assoalho bucal e, em situações mais graves, a obstrução das vias aéreas superiores

Lateral lingual foramen (LLF) recognition is very important, especially to dental implant practitioners. In this way, cone-beam computed tomography (CBCT) allows visualization of anatomic structures not detected in conventional radiography, such as LLF. This paper reports two LLF cases both at the right side in two different patients. Both exams were obtained through I-CAT Classic device and evaluated with the I-CAT Vision software. Injuries to LLF contained vascular bundles might cause hematoma at the floor of the mouth and, in worst cases, subsequent upper airway obstruction.

Panorâmica versus TCFC para interpretação de ateromas calcificados da carótida / Panoramic versus CBCT exams to suggest carotid artery calcifications

Objetivo: o objetivo deste estudo foi avaliar a prevalência das calcificações na artéria carótida – CACs – em imagens digitais panorâmicas (PD) e de tomografia computadorizada de feixe cônico (TCFC) dos mesmos pacientes. A CAC é uma doença vascular que acomete os pacientes acima dos 50 anos, coincidindo com uma grande maioria de pacientes que procura reabilitação por implantes. Assim sendo, é importante que o implantodontista esteja atento à interpretação da CAC, uma vez que detectada requer encaminhamento do paciente a um cardiologista para confirmação do diagnóstico. Material e métodos: foram avaliadas 100 imagens (200 lados) de panorâmicas digitais (idade média de 48 anos) e a imagem TCFC dos mesmos pacientes. O re-exame das imagens panorâmicas foi realizado com o objetivo de identificar os CACs falso-positivos e falso-negativos em relação à TCFC. Resultados: considerando 200 lados analisadas, 3,5% (n=7/200) foram interpretadas como CACs em radiografias panorâmicas, e 2,5% (n=5/200) em imagens de TCFC. Dos sete casos CACs positivos em radiografias panorâmicas, três foram falso-positivos quando comparados à correspondente TCFC. Quanto aos cinco casos CACs positivos em TCFC, um era falso-negativo, comparado à imagem panorâmica respectiva. Conclusão: calcificações artéria carótida – CACs – podem ser vistas nas imagens panorâmicas e/ou TCFC, no entanto, a panorâmica tendeu a mostrar casos falso-positivos da CAC. A CAC surge como um achado incidental nos exames de panorâmica e de TCFC, mas ainda assim o dentista tem como obrigação encaminhar o paciente para um cardiologista para a confirmação do diagnóstico, uma vez detectada a sua suposta presença.

Microbiologic cross-contamination and infection control in intraoralconventional and digital radiology / Contaminação microbiológica e controle de infecção em radiologia intraoral convencional e digital

The microbiologic contamination can occur in all the steps of an intraoral conventional or digital radiographic examination, unless some measures to avoid the cross-infection are applied. Scientific articles have shown that during the radiograph taking procedure, there is contact with the patient?s oral fluids (saliva and blood) and, consequently, the contamination of the film or digital sensor, film-holding devices, operator?s hands and afterwards, the contamination of the surfaces, the X-Rays equipment, the processing environment and its solutions. Also, the literature shows that the existence of infection control protocols is mandatory for dental offices and colleges. The aim of this article is to review how the microbiologic contamination can occur in Dental Radiology practice and to describe more efficient methods to avoid it, in order to get a safe environment for patients, professionals and workers. It is extremely important that the professional be aware and use efficient protection barriers in all steps of an intraoral radiographic examination, whether conventional or digital.

A contaminação microbiológica pode ocorrer em todas as etapas de um exame radiográfico intra-oral convencional ou digital, caso não sejam tomadas medidas para evitar a infecção cruzada. Artigos científicos têm mostrado que durante a tomada radiográfica, existe o contato com fluidos orais do paciente (saliva e/ou sangue) e consequentemente, a contaminação de filmes radiográficos ou sensores digitais, posicionadores, mãos do operador e posteriormente, de superfícies do ambiente de trabalho, partes do aparelho de Raios-X, ambiente deprocessamento radiográfico e suas soluções. A literatura também mostra que a existência de protocolos de controle de infecção é obrigatóriapara consultórios e faculdades de Odontologia. Este trabalho se propõe a revisar como a contaminação microbiológica pode ocorrer na prática da Radiologia Odontológica e descrever os métodos mais efetivos para combatê-la, garantindo um ambiente seguro para pacientes, profissionais e funcionários que o freqüentam. É de fundamental importância que o profissional esteja consciente e utilize barreiras de proteção eficazes em todas as etapas do exame radiográfico intraoral, seja convencional ou digital.

Variações anatômicas do canal mandibular detectadas em imagens de tomografia computadorizada de feixe cônico / Anatomic variations of mandibular canal detected in cone beam computed tomography images

O canal mandibular é uma estrutura anatômica de extrema importância na Implantodontia. Presenças de variações anatômicas no trajeto do canal podem determinar modificação no planejamento cirúrgico. O exame de tomografia computadorizada de feixe cônico (TCFC) permite a avaliação tridimensional da região de interesse, sendo uma técnica superior aos exames bidimensionais na detecção de variações anatômicas. O objetivo deste artigo foi apresentar as principais variações anatômicas do canal mandibular, que podem ser detectadas em exames de TCFC, e suas implicações clínicas. Foram utilizados 60 exames de TCFC pertencentes ao banco de imagens do Departamento de Estomatologia da Faculdade de Odontologia de Bauru. Os exames tinham o protocolo de escaneamento com campo de visão (FOV) de 6 cm, 8 cm ou 13 cm, e tamanho de voxel de 0,3 mm, tendo sido avaliados no software i-CAT Vision. Os critérios considerados durante a análise foram: presença de deiscências nas corticais ósseas e de ramificações. Observou-se quatro deiscências linguais do lado direito e oito do lado esquerdo, seis ramificações do lado esquerdo e três do lado direito. Ou seja, a presença de deiscências e ramificações no canal mandibular pode ser observada em aproximadamente 10% dos casos, em média, com uso de TCFC. As variações anatômicas no canal mandibular devem ser cuidadosamente avaliadas no volume total capturado pela TCFC, propiciando a realização de um adequado planejamento cirúrgico.

The mandibular canal is an anatomic structure of extreme importance in implantology. The presence of anatomical variations can determine changes in the surgical planning. The cone beam computed tomography (CBCT) exams enable three-dimensional evaluation of the interest region and it is a superior technique in comparison with two-dimensional images for the detection of anatomical variations. The aim of this paper is to present the main anatomical variations of the mandibular canal that can be detected in CBCT exams and its clinical implications. For this, 60 CBCT scans from the database of Department of Stomatology, Bauru Denta School, were used. The exams were obtained using 6 cm, 8 cm or 13 cm field of view (FOV) and 0.3 mm voxel size, evaluated with i-CAT Vision software. The criteria considered during the analysis were dehiscence of the cortical bone and ramifications. We observed four lingual dehiscences in the right side and eight in the left side, six ramifications in the left side and three in the right, which indicates that the ramifications and dehiscences of the mandibular canal can be observed in approximately 10% of cases, in average, using CBCT. The implantodontist should evaluate the entire CBCT image volume to search for anatomical variations in the mandibular canal for appropriate surgical planning.

Avaliacão clínica e tratamento das complicações bucais pós quimioterapia e radioterapia / Clinical evaluation and treatment of oral complications after chemotherapy and radiotherapy

Este caso clínico se propõe a demonstrar a efetividade de opções terapêuticas para a o tratamento de complicações bucais decorrentes da quimioterapia e radioterapia. Paciente do gênero feminino, 48 anos de idade, leucoderma, com histórico de neoplasia de cabeça e pescoço com recidivas, apresentou complicações decorrentes da quimioterapia e radioterapia: mucosite oral, xerostomia, candidíase pseudomembranosa e herpes simples. As lesões foram tratadas respectivamente com laser de baixa intensidade, saliva artificial e lanolina médica, bochechas com nistatina e aciclovir sistêmico. Todos os tratamentos foram efetivos e bem tolerados pela paciente. O conhecimento do Cirurgião-Dentista, especialmente do Estomatologista quanto ao diagnóstico e tratamento das complicações bucais decorrentes da terapia antineoplásica foram fundamentais para a melhora na qualidade de vida da paciente.

This case report aims to demonstrate the effectiveness of therapeutic options for the treatment of oral complications after chemotherapy and radiotherapy. A female patient, a 48-year-old Caucasian with a history of head and neck neoplasms with recurrences, was referred to our clinic 1 month after the end of the radiotherapy sessions. She presented oral mucositis, hyposalivation, pseudomembranous candidiasis, and herpes simplex. The lesions were treated respectively with Low Levei Laser Therapy, artificial saliva, medicallanolin, nystatin oral suspension, and systemic acyclovir. These treatments were successful and sustained by the patient. The knowledge of dentists, especially stomatologists, in the diagnosis and treatment of complications arising from oral antineoplastic therapy were fundamental to improving the patient's quality of life.

Importância do diagnóstico radiográfico de patologias dos maxilares em pacientes ortodônticos / Importance of radiographic diagnosis of pathologies of the jaws in orthodontic patients

Introdução: a Ortodontia como uma especialidade odontológica tem mostrado para a sociedade a sua grande relevância e seu impacto na promoção da saúde da população. Enquanto ciência, os avanços para tratamento e reabilitação de pacientes são incontestáveis,desde situações mais simples às mais complexas, proporcionando saúde e bem-estar a um número cada vez maior de pessoas. Por outro lado, o grande número de profissionais tem gerado preocupações e inquietações à medida que tratamentos podem ser conduzidos deforma inadequada. Objetivo: neste artigo será abordada a importância do diagnóstico de patologias dos maxilares por meio da descrição de quatro situações clínicas, nas quais pacientes sob tratamento ortodôntico, portadores de lesões visíveis ao exame radiográfico panorâmico,tiveram o diagnóstico destas lesões negligenciado ou desconsiderado.Conclusão: a radiografia panorâmica constitui importante meio de diagnóstico de patologias assintomáticas dos maxilares, devendo ser criteriosamente avaliada antes do início da terapia ortodôntica.A parceria com outras especialidades da Odontologia é fortemente aconselhada na rotina do ortodontista.

Introduction: orthodontics as a dental specialty has shown its relevance to society and a great impact on the promotion of public health. The advances in the treatment and rehabilitation of orthodontic patients, from mild to severe cases, provide health and wellness to a growing number of people. On the other hand, the growing number of orthodontic professionals has raised concems,as treatments can be conducted improperly Objective: in this articlewe discuss the importance of diagnosis of pathological changes of the jaws through the description of four clinical situations in which patients under went orthodontic treatment. Lesions which were visible on panoramic radiographs were overlooked or disregarded for these patients. Conclusion: the panoramic radiograph is an important modality of diagnosis of asymptomatic pathological changes of the jaws. The panoramic image must be carefully evaluated before the beginning of orthodontic treatment. Collaboration with other specialties of dentistry is strongly recommended for the orthodontist.

Clinical diagnosis of hyposalivation in hospitalized patients

OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients. MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years). Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom), chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheecks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination. RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9%) presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05). Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05). CONCLUSION: Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.

Avaliação da alça anterior do nervo mentual por meio de tomografia computadorizada de feixe cônico / Evaluation of anterior loop of mental nerve by means of cone beam computed tomography

O forâmen mentual é um importante ponto de referência cirúrgico, sua localização e a possibilidade da existência de uma alça anterior do nervo mentual deve ser levada em consideração no planejamento cirúrgico para evitar traumas ao nervo. Nesse trabalho, avaliamos a presença da alça anterior do nervo mentual em 70 pacientes por meio de tomografia computadorizada de feixe cônico (TCFC). Os resultados revelaram uma prevalência de 32,8% da alça anterior. Nossos resultados e os encontrados na literatura atentam para uma imprevisibilidade das variações anatômicas na região do forâmen mentual. Assim, um planejamento individualizado para cada paciente deveria ser feito para minimizar os riscos de complicações pós-operatórias. A TCFC poderia ser indicada para os pacientes nos quais a anatomia da região do forâmen mentual não possa ser claramente visualizada em outros exames

The mental foramen is a surgical strategically landmark its location and the possibility of an anterior loop of the mental nerve exists mesial to the mental foramen needs to be take in consideration before implant placement to avoid nerve injury. We studied the presence of the anterior loop of mental nerve by means of CBCT in 70 patients. The results revealed a prevalence of 32,8%. Our findings together with the literature reviewed draw attention to the unpredictability of anatomical variations. Therefore, individualized anatomic assessment for each patient should be performed to minimized surgical complications. CBCT can be indicated in the cases where the anatomy of the mental foramen region is not clearly depicted in other exams

Radiological and histopathological evaluation of experimentally-induced periapical lesion in rats

OBJECTIVE: This study evaluated experimentally-induced periapical bone loss sites using digital radiographic and histopathologic parameters. MATERIAL AND METHODS: Twenty-seven Wistar rats were submitted to coronal opening of their mandibular right first molars. They were radiographed at 2, 15 and 30 days after the operative procedure by two digital radiographic storage phosphor plates (Digora®). The images were analyzed by creating a region of interest at the periapical region of each tooth (ImageJ) and registering the corresponding pixel values. After the sacrifice, the specimens were submitted to microscopic analysis in order to confirm the pulpal and periapical status of the tooth. RESULTS: There was significant statistically difference between the control and test sides in all the experimental periods regarding the pixel values (two-way ANOVA; p<0.05). CONCLUSIONS: The microscopic analysis proved that a periapical disease development occurred during the experimental periods with an evolution from pulpal necrosis to periapical bone resorption.

Oral adverse effects of head and neck radiotherapy: literature review and suggestion of a clinical oral care guideline for irradiated patients

Radiotherapy, alone or associated with surgery or chemotherapy, produces a significant increase in cure rates for many malignancies of the head and neck region. However, high doses of radiation in large areas, including the oral mucosa, may result in several undesired reactions that manifest during or after the completion of therapy. The multidisciplinary management is the best alternative to minimize or even prevent such reactions, and the dentist has a fundamental role in this context. This paper reviews the literature related to the main oral sequelae from head and neck radiotherapy and establishes clinical oral management protocol for these irradiated patients.

Visibility of the mandibular canal on CBCT crosssectional images

The identification of the mandibular canal (MC) is an important prerequisite for surgical procedures involving the posterior mandible. Cone beam computed tomography (CBCT) represents an advance in imaging technology, but distinguishing the MC from surrounding structures may remain a delicate task. OBJECTIVES: The aim of this study was to assess the visibility of the MC in different regions on CBCT cross-sectional images. MATERIAL AND METHODS: CBCT cross-sectional images of 58 patients (116 hemi-mandibles) were analyzed, and the visibility of the MC in different regions was assessed. RESULTS: The MC was clearly visible in 53 percent of the hemi-mandibles. Difficult and very difficult visualizations were registered in 25 percent and 22 percent of the hemi-mandibles, respectively. The visibility of the MC on distal regions was superior when compared to regions closer to the mental foramen. No differences were found between edentulous and tooth-bearing areas. CONCLUSIONS: The MC presents an overall satisfactory visibility on CBCT cross-sectional images in most cases. However, the discrimination of the canal from its surrounds becomes less obvious towards the mental foramen region when cross-sectional images are individually analyzed.

Processamento de imagem aplicado à pesquisa em Implantodontia / Image processing in implant dentistry research

Muitas situações exigem o uso de técnicas de processamento de imagens, por exemplo, no realce de bordas, onde a aplicação de ferramentas matemáticas é fundamental para o sucesso da sua visualização. Este artigo apresenta a utilização de ferramentas matemáticas na análise e processamento de imagens digitais obtidas por meio de microscopia eletrônica de varredura. Nesse estudo em particular, o realce da interface entre implante/pilar foi necessário como uma etapa anterior a medição do desajuste vertical entre ambos.

The image processing tools have many applications in Dentistry, including Implantology. Particularly for edge detection, the algorithm operations are fundamental to the edge visualization success. This paper shows the use of such mathematic tool in the analysis and processing of digital images obtaining by means of scanning electron microscope (SEM). In this paper, the edge detection enhancement of the implant/abutment interface allowed for the measurement of the vertical margin fit.

Evaluation of some oral postradiotherapy sequelae in patients treated for head and neck tumors

The aim of this study was to evaluate the oral sequelae of radiotherapy in patients treated between 1999 and 2003 for head and neck tumors. One-hundred patients (24 women, 76 men) ranging in age from 30 to 83 years (mean 59.2 years) were examined. Time since radiotherapy ranged from 1 to 72 months (mean 28 months). The total mean radiation dose received by the patients was 5,955 cGy. The evaluation protocol included anamnesis, intraoral and extraoral examination, measurement of stimulated salivary flow and salivary pH. Symptoms reported by the patients included dry mouth (68 percent), dysphagia (38 percent), and dysgeusia (30 percent). In 64 percent of the patients, the mean stimulated salivary flow rate was less than 0.7 ml/min. The mean salivary pH was 6.97 (± 0.714). Stimulated salivary flow increased with increasing postradiotherapy time (p < 0.05). The prevalence of mucositis was associated with higher radiation doses (p < 0.05), and the prevalence of atrophic candidiasis was related to a longer post-treatment period (p < 0.05). Two cases of recurrence of the primary tumor were detected during the study. The main effect of radiotheraphy in the head and neck region was a reduction of the salivary flow rate, even though our study demonstrated that there was a modest late improvement of the salivary flow.

O objetivo deste estudo foi avaliar as seqüelas bucais provocadas pela radioterapia em pacientes com neoplasias de cabeça e pescoço, tratados entre 1999 e 2003. Foram examinados 100 pacientes (24 mulheres e 76 homens), com idades entre 30 e 83 anos (média de 59,2 anos). O tempo desde a radioterapia variou de 1 a 72 meses (média de 28 meses). A média da dose total de radiação recebida pelos pacientes foi de 5.955 cGy. O protocolo de avaliação consistiu de anamnese, exame físico, aferição do fluxo salivar estimulado e pHmetria da saliva. Os sintomas referidos foram boca seca (68 por cento), disfagia (38 por cento) e disgeusia (30 por cento). Em 64 por cento dos indivíduos o valor médio do fluxo salivar estimulado esteve abaixo de 0.7 ml/min. O pH médio da amostra foi de 6.97 (± 0.714). O fluxo estimulado e a ocorrência de candidíase atrófica aumentaram conforme o aumento do tempo pós-radioterapia (p < 0.05). A ocorrência de mucosite esteve associada a maiores doses de radiação (p < 0.05). Dois casos de segundo tumor primário foram diagnosticados. O principal efeito da radioterapia na região de cabeça e pescoço foi a redução do fluxo salivar, apesar de nosso estudo ter demonstrado que há uma melhora tardia do fluxo salivar.