Estudio de la longitud y diámetro radicular de incisivos laterales primarios utilizando la tomografía computarizada cone beam: un estudio in vitro

Objetivo: Determinar la longitud y el diámetro radicular de los incisivos laterales superiores deciduos a través de la Tomografía Computarizada Cone Beam. Metodología: Estudio descriptivo y transversal. Se recolectaron 20 incisivos deciduos laterales superiores recién extraídos o avulsionados de la clínica odontológica de la Universidad Nacional Mayor de San Marcos, en el año 2016. Los dientes fueron escaneados utilizando la Tomografía Cone Beam, se empleó el equipo OP300 Maxio, Orthopantomograph ®. Las imágenes resultantes fueron analizadas en el software de análisis de imagen ONDEMAND3DDENTAL. Se midió el eje axial, la longitud de la corona, raíz y la longitud total de la pieza dentaria. Para el análisis estadístico se utilizó el software Stata v14 (Stata Corporation College Station, Texas), previo al análisis los datos obtenidos fueron sometidos a la prueba de normalidad de Shapiro-Wilk, cumpliendo con esto, se usaron las pruebas paramétricas ANOVA y T de Student. Resultados: El 100% de los incisivos laterales superiores deciduos presentó un único canal radicular. La longitud promedio de la corona y de la raíz fue de 3.8mm y 11,86mm respectivamente. El diámetro medio del canal radicular según profundidad fue de 1.11 mm a nivel cervical, de 0.94 mm a nivel medio y de 0.74 mm a nivel apical, estos mostraron diferencias estadísticamente significativas (p<0.05).Conclusiones: La longitud promedio de los incisivos laterales superiores deciduos fue de 15,68mm y el diámetro radicular disminuyo de cervical a apical.

Association between maxillary sinus pathologies and healthy teeth / Relação entre doenças no seio maxilar e dentes hígidos

ABSTRACT INTRODUCTION: The proximity of the roots to the maxillary sinus can create a variety of risks. OBJECTIVE: To evaluate the relationship between the roots of healthy teeth and the maxillary sinus, as well as the occurrence of sinus pathologies. METHODS: Three radiologists analyzed 109 cone beam computed tomography (CBCT) images. The Kappa test was used to assess the intra- and inter-rater agreement. The chi-squared test and prevalence ratio were used to test the hypothesis that roots of healthy teeth in the maxillary sinus favored the occurrence of sinus pathologies ( p = 0.01). RESULTS: Intra- and inter-rater agreement ranged from good to excellent. The chi-squared test demonstrated a statistically significant difference ( p = 0.006) between the tooth roots in diseased maxillary sinuses (6.09%) and those in normal sinuses (3.43%). The prevalence ratio test showed a statistically significant higher prevalence of tooth roots in diseased sinuses than in normal sinuses ( p < 0.0001). Roots in the maxillary sinus were 1.82 times more associated with diseased sinuses. CONCLUSION: Dental roots in the maxillary sinus are almost twice as likely to be associated with diseased sinuses than normal sinuses. Healthy teeth whose roots are inside the maxillary sinus may induce an inflammatory response in the sinus membrane. It is suspected that dental procedures may exacerbate the condition.

RESUMO INTRODUÇÃO: A proximidade das raízes com o seio maxilar pode criar uma variedade de riscos. OBJETIVO: Avaliar a relação entre as raízes dos dentes hígidos com o seio maxilar, assim como com a ocorrência de doenças sinusais. MÉTODO: Três radiologistas analisaram 109 imagens de tomografia computadorizada de feixe cônico (TCFC). O teste Kappa avaliou a concordância intra e interexaminadores. Os testes de Qui-quadrado e Razão de Prevalência foram utilizados para testar a hipótese de que raízes de dentes hígidos dentro do seio maxilar favorecem a ocorrência doenças sinusais (nível de significância = 0,01). RESULTADOS: A concordância intra e interexaminadores variou de boa a excelente. O teste Qui-quadrado mostrou uma diferença estatisticamente significante (p = 0,006) entre as raízes dentárias dentro do seio maxilar patológico (6,09%) e aquelas dentro do seio normal (3,43%). O teste de Razão de Prevalência mostrou uma ocorrência de raízes dentárias dentro de seios patológicos estatisticamente maior do que dentro de seios normais (p < 0,0001). As raízes dentro do seio maxilar foram encontradas 1,82 vezes mais associadas a seios patológicos. CONCLUSÃO: Raízes dentárias dentro do seio maxilar são quase duas vezes mais associadas a seios patológicos do que a seios normais. Dentes hígidos que têm raízes dentro do seio maxilar podem induzir uma resposta inflamatória da mucosa sinusal. Suspeita-se que procedimentos odontológicos possam agravar tal situação.

Comparison of palatal bone height in different facial morphological patterns by cone beam computed tomography

Abstract Aim: To evaluate the relationship between palatal bone height and facial types using cone beam computed tomography (CBCT) images. Methods: The study sample consisted of 110 CBCT images. Subjects aged 18 to 35 years old were classified as brachyfacial, mesofacial and dolichofacial, according to SN.GoGn angle, measured in cephalometric analysis with Nemotec 3D software. Three observers evaluated the bone height of the palate in the anterior region, at the level of the maxillary first premolars. The measurements were performed in sagittal and coronal views, in median and paramedian regions of the palate, also using Nemotec 3D software. Measurements were repeated after 15 days on 25% of the sample to analyse intra and interobserver agreements by CCI test. Analysis of variance was performed to calculate statistical differences between the bone heights of the three facial types, with a significance level of 5%. Results: The correlation level of intra-observer agreement was excellent. No significant differences were observed between the palatal bone height in the region of first premolars and the different facial types (p>0.05). Conclusions: Based on CBCT evaluations, there is no association between palatal bone height and facial morphological patterns.

2D and 3D imaging of the relationship between maxillary sinus and posterior teeth

Aim: To compare the qualitative and quantitative information yielded by imaging modalities on the evaluation of the relationship between the maxillary sinus and the apices of posterior teeth. Methods: Three oral radiologists examined 109 panoramic radiographs and cone-beam computed tomography (CBCT) images obtained from a digital archive. A total of 1,875 apices were classified according to their topographic relationship in both imaging modalities. Agreements between the two imaging techniques were examined statistically. The evaluation was repeated in 25% of the sample to statistically evaluate the intraobserver agreement, with a 30-day interval. Results: The values found in the Kappa test for qualitative assessment and the intraclass correlation coefficient (ICC) for quantitative assessment showed nearly perfect and excellent correlation, respectively. Regarding the correlation between the two images, the Kappa test in the quality assessment showed a slight correlation between the palatal roots of the right first molars and second molars. Moreover, the quantitative evaluation by ICC showed poor agreement for the palatal roots of the left first molar and second molar, as well as for the buccomesial of the right second molars and for the buccodistal of the left second molars.Conclusions: There is low correlation between panoramic radiography and CBCT when roots are in contact or above the maxillary sinus floor. A high level of agreement was observed when roots are below the maxillary sinus floor.

Canino mandibular con dos raíces / Mandibular canine with two roots

El canino inferior es un diente con raíz larga y ancha que le permite una adecuada implantación en el arco dentario. Es considerado un pilar valioso en muchos tratamientos rehabilitadores. Con la finalidad de mantener este elemento dentario es necesario realizar un correcto diagnóstico, para lo que se tendrá en cuenta el conocimiento de las variaciones anatómicas. El objetivo del artículo es presentar un caso de canino mandibular con dos raíces con sus respectivos canales radiculares .Paciente femenina de 21 años, que acudió a la Clínica de Radiología de la Facultad de Odontología de Piracicaba con indicación de una radiografía panorámica para valorar cirugía de terceros molares. Llamó la atención una configuración inusual de las raíces de los caninos mandibulares. En el examen de tomografía computarizada de haz cónico se observó que el canino mandibular del lado derecho presentaba dos raíces separadas, cada una con sus respectivos canales radiculares. Se concluyó que a pesar de la baja prevalencia de las variaciones anatómicas, estas pueden ocurrir en el número de raíces y canales de los caninos mandibulares, tal como se presenta en este reporte de caso(AU)

The mandibular canine is a robust and long tooth which allows an adequate implantation in the dental arch. It is considered a valuable pillar in many rehabilitating treatments. In order to maintain this important dental element, it is necessary to make a correct diagnosis, for which the knowledge of the different anatomic variations should be kept in mind. The objective of this article is to present a case of a mandibular canine with two roots with their respective root canals. A 21-year-old female patient went to the Radiology Clinic at the Faculty of Odontology of Piracicaba with the indication of a panoramic radiography for preoperative third molars surgery. An unusual root configuration of the mandibular canines was observed. In the cone beam CT, it was observed that the right mandibular canine presented two separate roots, each one with their respective radicular canals. It was concluded that, despite of the low prevalence of anatomical variations, these can occur in the root system of the mandibular canines, as presented in this case report(AU)

Detection of bifid mandibular condyle by panoramic radiography and cone beam computed tomography

Aim: To compare panoramic radiography and cone beam computed tomography (CBCT) in the diagnosis of bifid mandibular condyle. Methods: The sample consisted of 350 individuals who underwent panoramic radiography and CBCT. In the panoramic radiographs and CBCT images, the presence or absence of bifid mandibular condyle was determined. Results: Presence of bifid mandibular condyle was detected in four cases (1.1%). In all cases, the relation of one condylar process to the other was mediolateral and history of trauma was reported. None of the individuals had symptoms. In two cases, panoramic radiography did not reveal the presence of bifid mandibular condyle. Conclusions: Initial screening for bifid mandibular condyle can be performed by panoramic radiography; however, CBCT images can reveal morphological changes and the exact orientation of the condyle heads.

Cóndilo mandibular bífido: un desafío diagnóstico / Bífid mandibular condyle: a diagnostic challenge

El cóndilo mandibular bífido es una condición rara, observada frecuentemente como hallazgo radiográfico, caracterizada por la división de la cabeza de la mandíbula. Su prevalencia varía entre 0,0018 por ciento a 0,3 por ciento, donde múltiples causas han sido sugeridas en la literatura para justificar su desarrollo, sin embargo no hay concordancia entre los estudios acerca del factor causal principal. El objetivo de este artículo es relatar un caso de cóndilo mandibular bífido observado en una mujer de 21 años de edad, el cual fue revelado por una radiografía panorámica donde se observó hipoplasia del cóndilo mandibular izquierdo, con presencia de una aparente calcificación en la región de la articulación temporomandibular izquierda; otros exámenes convencionales fueron realizados (radiografía postero-anterior, con apoyo frente-nasion en boca abierta, transcraniana y panorámica), sin embargo, apenas en la tomografía computarizada de haz cónico, fue posible obtener el diagnóstico de cóndilo mandibular bífido...

The mandibular bifid condyle is a rare condition, frequently observed in routine X-rays, characterized by division of the mandible head. According to the literature, the prevalence varies from 0.018 percent to 0.3 percent. Several causes have been suggested to justify the development of bifid mandibular condyle, however there is no agreement between studies about the main causative factor. The aim of this paper is to report a case of mandibular bifid condyle in a 21-years-old girl. The panoramic radiograph showed hypoplasia of the left mandibular condyle, with an apparent presence of calcification in the left temporomandibular joint. Other conventional extraoral radiographs were performed (postero-anterior with fronto-nasal support, open mouth; panoramic and trascranial radiographs), however, only in the cone beam computed tomography ir was possible to obtain the diagnosis of mandibular bifid condyle...

Terceiro molar intrassinusal: relato de caso / Intra-sinusal third molar: case report

Ectopic tooth eruption into an area other than the oral cavity is rare. Nasal septum, mandibular condyle, coronoid process and infratemporal fossa space have been reported as frequent locations for ectopic tooth eruption. Ectopic teeth located within the maxillary sinus may be asymptomatic, found only in routine examinations. Headache, sinusitis and nasal obstruction are some of the associated symptoms. The differential diagnosis includes foreign bodies (rhinolith), infections (syphilis and tuberculosis), benign lesions (hemangioma, osteoma, calcified polyp) and malign lesions (osteosarcoma). Upper third molars located within the maxillary sinus may be associated with the development of mucocele or dentigerous cyst. The aim of this paper was to describe the case of a 24-year old female patient with an ectopic right upper third molar in the maxillary sinus. A hyperdense area was observed with sinus obliteration, consistent with mucous material.

Erupção ectópica dos dentes em outras regiões além da cavidade oral é rara. O desenvolvimento ectópico desses dentes tem sido relatado no septo nasal, côndilo mandibular, processo coronoide e no espaço da fossa infratemporal. Dentes ectópicos localizados no seio maxilar podem ser assintomáticos, descobertos em exames radiográficos de rotina. Dentre os sintomas associados estão cefaleia, sinusite e obstrução nasal. Corpos estranhos (rinólitos), processos infecciosos (sífilis ou tuberculose), lesões benignas (hemangioma, osteoma, pólipos calcificados) e malignas (osteossarcoma) podem ser considerados no diagnóstico diferencial de dentes ectópicos. Os terceiros molares superiores, quando localizados no seio maxilar, podem estar associados ao desenvolvimento de mucocele, assim como de cistos dentígeros. Dessa forma, o objetivo deste artigo foi relatar o caso de uma paciente do gênero feminino, com 24 anos de idade, em que se observou terceiro molar superior direito com localização intrassinusal associado a uma área de hiperdensidade média, causando parcial obliteração do seio maxilar, compatível com material mucoide.