Quiste periapical: diagnóstico y tratamiento / Periapical cyst: diagnosis and treatment

Los quistes periapicales o radiculares representan una de las patologías periapicales más frecuentes dentro del grupo de las lesiones quísticas de los maxilares. Son el resultado de la extensión de proce- sos inflamatorios-infecciosos. Su diagnóstico sigue siendo un desafío para el profesional odontológico, quien debe diferenciarlo de otros procesos inflama- torios periapicales. El objetivo del presente artículo es presentar, apoyado en una revisión de la literatura, el caso clínico de un paciente masculino de 38 años de edad que se presentó a la consulta por leve tume- facción indolora en zona anterosuperior del maxilar. A la inspección se observó borramiento de la región del surco vestibular a nivel de piezas dentarias 1.1, 1.2 y 1.3, de color rojizo con crepitación de la tabla ósea vestibular a la palpación. La tomografía de haz cónico mostró lesión osteolítica, extendida desde zona apical de la pieza dentaria 1.4 hasta zona del elemento dentario 1.1. Se realizó la extirpación de la lesión y api- cectomía. El estudio histológico corroboró el diagnós- tico presuntivo de quiste periapical. Los controles a distancia mostraron buena evolución del tratamiento. Se concluyó en la importancia de realizar un correcto diagnóstico clínico e imagenológico para la selección de un adecuado tratamiento según el caso (AU)

Periapical or radicular cysts represent one of the most frequent periapical pathologies within the group of cystic lesions of the jaws. They are the result of the spread of inflammatory-infectious processes. Its diagnosis continues to be a challenge for the dentist, who must differentiate it from other periapical inflammatory processes. The objective of this article is to present, supported by a review of the literature, the clinical case of a 38-year-old male patient who presented to the consultation due to mild painless swelling in the anterosuperior maxilla. Upon inspection, effacement of the vestibular sulcus region was observed at the level of teeth 1.1, 1.2 and 1.3, reddish in color with crepitation of the buccal bone table on palpation. Cone beam tomography showed an osteolytic lesion that extended from the apical area of tooth 1.4 to area of tooth 1.1. Excision of the lesion and apicoectomy were performed. The histological study corroborated the presumptive diagnosis of periapical cyst. Remote controls showed a good evolution of the treatment. It was concluded on the importance of carrying out a correct clinical and imaging diagnosis for the selection of an adequate treatment according to the case (AU)

Comparação da expansão óssea promovida pela técnica de osseodensificação com dois tipos de conjunto de fresas / Comparison of bone expansion promoted by the osseodensification technique with two types of drill sets

Introdução: A estabilidade primária é um importante indicador de sucesso da osseointegração. Porém, fatores locais com osso de baixa intensidade podem interferir negativamente na obtenção da estabilidade primária. Objetivo: O presente estudo avaliou o efeito de diferentes direções, velocidades de rotação e sistemas de fresagem na expansão de perfurações e estabilidade de implantes instalados em blocos mimetizando osso do tipo IV. Material e método: Foram instalados 50 implantes em blocos de poliuretano sólido rígido. Esses implantes foram igualmente divididos em cinco grupos (n = 10): 1) Fresa Maximus (utilizadas no sentido horário a 1200rpm); 2) Fresa Maximus (utilizadas no sentido horário a 600rpm); 3) Fresa Neodent (utilizadas no sentido horário a 800rpm); 4) Fresa Neodent (utilizadas no sentido anti-horário a 800rpm); 5) Fresa Neodent (utilizadas no sentido anti-horário a 600rpm). Foram executadas análises de estabilidade dos implantes através de testes de torque de inserção e remoção, além das análises de frequência de ressonância. Adicionalmente, a expansão associada às perfurações promovida pelas brocas foi avaliada por meio de análises tomográficas. Resultado: Verificou-se que os implantes instalados após o preparo da perfuração com as brocas Maximus a 600rpm apresentaram valores de torque de inserção maiores, quando comparados ao grupo de implantes instalados em perfurações confeccionadas com brocas Neodent. Ademais, as brocas Maximus apresentaram valores de expansão maiores que as brocas Neodent. Conclusão: As brocas Maximus são mais eficientes em promover a osseodensificação, e sua utilização está associada ao aumento da estabilidade dos implantes instalados em blocos mimetizando osso do tipo IV.

Introduction: Primary stability is an important indicator to obtain a successful osseointegration. However, local factors like bone with low density can negatively interfere in obtaining primary stability. Objective: This study assessed the effect of different drilling systems, speeds, and movement directions on the expansion of perforations and the stability of implants placed in blocks that mimicked type IV bone. Material and method: Fifty implants were installed in rigid solid polyurethane blocks and equally divided into the following five groups (n = 10): 1) Maximus Driller (on a clockwise direction at 1200rpm); 2) Maximus Driller (on a clockwise direction at 600rpm); 3) Neodent Driller (on a clockwise direction at 800rpm); 4) Neodent Driller (on a counter clockwise direction at 800rpm); 5) Neodent Driller (on a counter clockwise direction at 600rpm). The stability analyses of the implants were performed through insertion and removal torque testing, in addition to resonance frequency analysis. Additionally, the expansion promoted by the drills associated with the perforations was assessed through tomographic analysis. Result: We found that implants placed after drilling preparation with Maximus drills at 600 rpm had higher values of insertion torque than the group of implants installed in drillings made with Neodent drills. In addition, the maximus drills showed higher expansion values than the Neodent drills. Conclusion Maximus drills are more efficient in promoting osseodensification and their use was associated with increased stability of implants installed in blocks that mimicked type IV bone.

Prevalence of radix entomolaris in mandibular first molars by cone-beam computed tomography in a southern Chilean sub-population / Prevalencia de radix entomolaris en primeros molares mandibulares usando tomografía computarizada cone-beam en una subpoblación del sur de Chile

SUMMARY: The aim of this of this study was to evaluate the prevalence and morphology of radix entomolaris (RE) in the mandibular first molar (MFM) in a southern Chilean sub-population by cone-beam computed tomography (CBCT). Two hundred ten CBCT images of MFM were analysed. To detect the presence of RE, the observation and measurements were standardised, advancing 1 mm to apical from the floor of the pulp chamber to the most apical zone of the tooth. The data were analyzed using descriptive statistics, with a value of P < 0.05 being statistically significant. The prevalence of a third root in the permanent MFM was 5.7 % (12/210). The incidence of RE was the same in male patients (2.9 %) as in female patients (2.9 %) (p=0.324). The occurrence of an RE in the left MFM was 7.3 % (3/41 patients) for male patients and 4.5 % (3/66) for female patients (p=0.398). The right MFM in male patients had an incidence of 8.1 % (3/37) and 4.5 % (3/66) for female patients (p=0.340). When the presence of an RE was compared between the left (5.6 %) and right side (5.8 %), no statistically significant differences were found (p=0.998). The frequency of bilateral three-rooted MFM was 71.43 % (5/7) and 28.57 % (2/7) were unilateral. The prevalence of RE in MFM in a southern Chilean sub-population was 5.7 %. The occurrence was bilateral in the majority of cases and no significant differences were observed by sex or side. The commonest type of RE was Type 1 (83.3 %). The use of CBCT can improve the endodontic treatment outcome.

RESUMEN: El objetivo de este estudio fue evaluar la prevalencia y morfología de radix entomolaris (RE) en el primer mo- lar mandibular (MFM) en una subpoblación del sur de Chile mediante tomografía computarizada de haz cónico (CBCT). Se analizaron doscientas diez imágenes CBCT de MFM. Para detectar la presencia de OD se estandarizó la observación y las medidas, avanzando 1 mm apical desde el suelo de la cámara pulpar hasta la zona más apical del diente. Los datos fueron analizados mediante estadística descriptiva, siendo estadísticamente significativo un valor de P < 0,05. La prevalencia de una tercera raíz en el MFM permanente fue de 5,7 % (12/210). La incidencia de ER fue la misma en pacientes masculinos (2,9 %) que en pacientes femeninas (2,9 %) (p=0,324). La aparición de un ER en el MFM izquier- do fue del 7,3 % (3/41 pacientes) para los pacientes masculinos y del 4,5 % (3/66) para las pacientes femeninas (p=0,398). El MFM derecho en pacientes masculinos tuvo una incidencia de 8,1 % (3/ 37) y 4,5 % (3/66) para pacientes femeninos (p=0,340). Cuando se comparó la presencia de un OD entre el lado izquierdo (5,6 %) y derecho (5,8 %), no se encontraron diferencias estadísticamente significativas (p=0,998). La frecuencia de MFM de tres raíces bilaterales fue 71,43 % (5/7) y 28,57 % (2/7) fueron unilaterales. La prevalencia de RE en MFM en una subpoblación del sur de Chile fue de 5,7 %. La presentación fue bilateral en la mayoría de los casos y no se observaron diferencias significativas por sexo o lado. El tipo de ER más frecuente fue el tipo 1 (83,3 %). El uso de CBCT puede mejorar el resultado del tratamiento endodóntico.

Root and root canal system morphology of maxillary first premolars in a Chilean subpopulation: a cone-beam Computed Tomography Study / Morfología radicular y del sistema de canales radiculares de los primeros premolares maxilares en una subpoblación chilena: un estudio de tomografía computarizada de haz de cono

SUMMARY: The maxillary first premolar (MFP) presents a highly variable and complex root morphology; it is also one of the teeth most likely to suffer vertical root fractures. The aim of this study was to describe the morphology of the root and root canal system of the MFP in a Chilean population using Cone-Beam Computed Tomography (CBCT). One hundred and twenty-one MFP were evaluated (60 left and 61 right), belonging to subjects of both sexes. Descriptive and statiscal analysis of the data was carried out, with a value of P < 0.05 being statistically significant. One root was observed in 71 % of teeth and two roots in 29 %; statistically significant differences were observed in the number of roots by sex (p<0.05). Two root canals were found in 69.5 % of teeth and one canal in 30.5 %. In terms of morphological classification, 41.3 % of cases were Vertucci Type IV. The proximal cementodentinal walls were the thinnest. The MFP presented a high degree of morphological variation in a Chilean subpopulation.

RESUMEN: El primer premolar maxilar (PPM) presenta una morfología radicular muy variable y compleja; también es uno de los dientes con mayor probabilidad de sufrir fracturas radiculares verticales. El objetivo de este estudio fue describir la morfología de la raíz y el sistema de conductos radiculares del PPM en una población chilena mediante tomografía computarizada de haz cónico (CBCT). Se evaluaron 121 PPM (60 izquierdas y 61 derechas), pertenecientes a sujetos de ambos sexos. Se realizó un análisis descriptivo y estadístico de los datos, siendo estadísticamente significativo un valor de P < 0,05. Se observó una raíz en el 71 % de los dientes y dos raíces en el 29 %; se observaron diferencias estadísticamente significativas en el número de raíces por sexo (p<0.05). Se encontraron dos conductos radiculares en el 69,5 % de los dientes y un conducto en el 30,5 %. En cuanto a la clasificación morfológica, el 41,3 % de los casos fueron Vertucci Tipo IV. Las paredes cementodentinales proximales fueron las más delgadas. El PPM presentó un alto grado de variación morfológica en una subpoblación chilena.

Lateral luxation of incisor - a case report of using a new cone-beam computed tomography software and reposition guideline

Abstract Lateral luxation injuries are one of the most severe periodontal injuries in dental trauma. The correct diagnosis followed by repositioning of the tooth on the right position is fundamental for the periodontal ligament healing. This study reported a clinical case of lateral luxation of maxillary central incisor involving a new cone beam computed tomography (CBCT) software for reconstruction (e-Vol DX) to confirm the lateral luxation after no conclusive dental trauma injury definition by using conventional exam. The lateral luxation injury was digitally reduced by insertion of tooth back to its alveolus, and at the same session, the tooth was stabilized with a rigid splint and further changed to a semi-rigid nylon splint. During the pulpal status monitoring, the pulp was diagnosed necrotic, then the root canal was treated to prevent root resorption. External office-bleaching and restorative procedure was performed. The 4-years follow up and new imaging exam and digital reconstruction confirmed bone healing and no complication. CBCT images analyzed by eVol DX can be used to determine and to guide lateral luxation treatment.

Resumo Lesões de luxação lateral são uma das lesões periodontais mais graves no traumatismo dental. O diagnóstico seguido do reposicionamento do dente na posição correta é fundamental para o reparo do ligamento periodontal. Este estudo relata um caso clínico de luxação lateral do incisivo central superior envolvendo um novo software de reconstrução (e-Vol DX) por tomografia computadorizada de feixe cônico (TCFC) para confirmar a luxação lateral após nenhuma definição de lesão por trauma dental conclusivo pelo exame convencional. A lesão de luxação lateral foi reduzida digitalmente pela inserção do dente de volta ao seu alvéolo e, na mesma sessão, o dente foi estabilizado com uma contenção rígida e posteriormente trocada para uma contenção de nylon semirrígida. Durante o monitoramento da condição pulpar, foi diagnosticada necrose da polpa e, em seguida, o canal radicular foi tratado para evitar a reabsorção radicular. Procedimento externo de clareamento e restauração foi realizado. O acompanhamento de 4 anos e o novo exame de imagem e reconstrução digital não confirmaram reparo ósseo e nenhuma complicação. Imagens de TCFC analisadas pelo e-Vol DX podem ser utilizadas para determinar e orientar lesão de luxação lateral.

Localización anatómica del foramen mentoniano mediante tomografía computarizada cone-beam en una población de Chile: estudio observacional / Anatomical localization of the mental foramen using cone-beam computed tomography in a population in Chile: observational study

La ubicación del foramen mentoniano (FM) varía desde el canino hasta el primer molar. La confirmación de la ubicación del FM es fundamental para evitar lesiones nerviosas durante procedimientos odontológicos. La distancia del FM al diente adyacente se puede evaluar mediante tomografía computarizada cone beam (CBCT) de forma segura y precisa. El objetivo fue determinar la distancia promedio entre la cortical superior del FM y el ápice dentario más cercano. Se realizó un estudio descriptivo que midió la distancia en milímetros (mm) desde FM al ápice dentario más cercano de 99 exploraciones CBCT. La medición se realizó en un corte que intercepta el FM y el ápice adyacente. Se evaluaron un total de 99 casos (72 mujeres/ 27 hombres), con una edad promedio de 34,7 años, (rango de 18-73 años). La distancia promedio se ubicó a 3,22 mm del ápice dentario más cercano al FM, la distancia mínima encontrada fue de 0,81 mm y la máxima de 6,99 mm. Se relaciona con el segundo premolar en un 79 % de los casos, y primer premolar en un 17 %. El FM se ubica cercano a la zona de premolares, su localización puede variar en relación a los ápices de estos dientes. Este estudio confirma la importancia de ser cautelosos durante los tratamientos endodónticos y/o quirúrgicos, para prevenir lesiones nerviosas en relación a esta estructura anatómica.

The location of the mental foramen (MF) varies from the canine to the first molar. The confirmation of the location of the MF is essential to avoid nerve injuries during dental procedures. The distance from the MF to the adjacent tooth can be assessed by cone beam computed tomography (CBCT) safely and accurately. The objective was to determine the average distance between the upper cortex of the MF and the nearest dental apex. A descriptive study was carried out, where the distance in millimeters (mm) from MF to the nearest dental apex was measured in 99 CBCT exploration. The measurement was realized in a slice that intercepts the MF and the adjacent apex. A total of 99 cases were evaluated (72 women / 27 men), with an average age of 34.7 years (range of 18-73 years). The average distance was located at 3.22 mm from the nearest dental apex to MF, the minimum distance found was 0.81 mm and the maximum was 6.99 mm. It is related to the second premolar in 79 % of cases, and first premolar in 17 %. The MF is located close to the premolar area, its location can vary considerably in relation to the apices of these teeth. This study confirms the importance of being cautious during endodontic and / or surgical treatments to prevent nerve injuries in relation to this anatomical structure.

The application of volumetric modulated arc therapy in postoperative radiotherapy for cervical cancer / 实用肿瘤学杂志

Objective To evaluate the value of volumetric modulated arc therapy ( VMAT) in postopera-tive radiotherapy for cervical cancer .Methods Eighty four cases of cervical cancer patients were retrospectively analyzed after surgery .Thirty-nine patients received volumetric modulated arc therapy , while the other forty -five patients received three -dimensional conformal radiation therapy (3DCRT).The images were collected both before and after treatment.We recorded the setup errors including x (lift-right),y(ventral-dorsal),and z(an-terior-posterior)axes in thirty -nine patients with cone beam CT (CBCT).These images were compared with correponding planning images to calculate the position errors .We also analyzed the radiation dosimetry parameters and adverse reactions .Results The setup errors before and after radiation therapy in x ,y,and z axes were (1.07 ±0.91)cm,(0.76 ±1.07)cm,(0.74 ±0.81)cm and(0.11 ±0.04)cm,(0.11 ±0.09)cm,(0.08 ±0.20) cm,respectively.These data showed that the application of CBCT reduced the setup errors of treatment significant -ly.We analyzed the illuminated volume of bladder and rectum with dose volume histogram (DVH),and found there was no difference between VMAT and 3DCRT groups when 20 Gy irradiation dose was adopted .When the ir-radiation dose increased to 30 Gy and 40 Gy, the corresponding illuminated volume of bladder and rectum in VMAT group were 69.45 ±1.13,41.78 ±2.8 and 75.66 ±3.34,30.12 ±9.59,respctively.In the 3DCRT group,the corresponding illuminated volume of bladder and rectum were 93.37 ±6.59,88.32 ±12.13 and 95.26 ±8.95,90.32 ±6.98,respectively.VMAT can obviously decrease the illuminated volume of bladder and rectum when compared to 3DCRT.Conclusion VMAT can not only decrease the setup errors to improve the accuracy of radiotherapy ,but also reduce the reaction of normal tissues effectively in the cervical cancer patients who accepted postoperative radiotherapy .Therefore,the VMAT technology can improve both patients′treatment compliance and their quality of life .

Clinical application of Cone-beam tomography in disorders of the head of mandible

This article aims to introduce or upgrade health professionals about the applicability of the use of Cone-beam Tomography in clinical and surgical studies of the head of mandible. Due to its location and functionality, the head of mandible has great importance in various specialties and, imaging tests are recommended for therapeutic methods. Regular radiographs show superimposed images of the mandibular region, hampering the morphological assessments. Through more precise images that identify minimal changes, the Cone-beam Tomography is an imaging method that optimizes the routine clinical performance by improving the diagnostic accuracy, since it makes visible three-dimensional bone structures and corrects overlapping areas.