Depth and proximity of third molars to the inferior alveolar canal in panoramic radiographs of a Latin American population

Introduction: extraction of lower third molars involve the possible occurrence of complications such as injury of the content of the Inferior Alveolar Canal. Methods: a cross-sectional study was conducted with a sample of 6488 lower molar records of digital panoramic radiographs of patients from 6 Latin American countries from 2010-2015. The variables studied were the depth of lower third molar according to the Pell and Gregory classification, and the proximity of a third molar to the Inferior Alveolar Canal that was evaluated according to the proposed classification, based on a modification of the Langlais et al classification.20 Descriptive and bivariate statistical analyses were performed. Results: in terms of the proximity, the highest frequency was Intact with 27.45%(n=1781). Regarding the depth of the lower third molar, the most frequent were the Position B with 46.90%(n=3043) and Position A with 46.75%(n=3033). The proximity and depth of the lower third molar had statistical difference according to age(p<0.01) and sex (p<0.001). The overall proximity of the lower third molar to the Inferior alveolar canal, according to depth was 37.52%(n=1766) in Position A, in Position B it was 54.51%(n=2566) and Position C was 7.97%(n=375) and had association between variables(p<0.001). Conclusions: taking into consideration the modified classification of Langlais et al.20, lower third molars are close to the Inferior Alveolar Canal, and according to the Pell and Gregory classification for the depth, the most frequent positions are A and B. In addition, proximity and depth were associated with each other, and with the co-variables country, age, and sex.

Introducción: la extracción de terceros molars inferiores implica la posible aparición de complicaciones, como la lesión del contenido del Canal Alveolar Inferior. Métodos: se realizó un estudio transversal con una muestra de 6488 registros de terceros molares inferiores de radiografías panorámicas digitales en pacientes de 6 países latinoamericanos, entre 2010-2015. Las variables fueron profundidad del tercer molar inferior según la clasificación de Pell y Gregory, y proximidad del tercer molar al Canal Alveolar Inferior, evaluada según una clasificación propuesta, basada en la clasificación modificada de Langlais et al.20 Se realizaron análisis estadísticos descriptivos y bivariados. Resultados: en la proximidad, la mayor frecuencia se presentó en Intacto con 27,45%(n=1781); en cuanto a la profundidad del tercer molar inferior, las más frecuentes fueron la Posición B con 46,90%(n=3043) y la Posición A con 46,75%(n=3033). La proximidad y profundidad del tercer molar inferior presentaron diferencias estadísticas de acuerdo con la edad (p<0,01) y sexo (p<0,001). La proximidad total del tercer molar inferior al canal alveolar inferior, según la profundidad fue de 37,52%(n=1766) en Posición A, en Posición B de 54,51%(n=2566) y Posición C de 7,97%(n=375). Además, se presentó asociación entre las variables (p<0,001). Conclusiones: considerando la clasificación modificada de Langlais et al.20, la mayoría de los terceros molares inferiores están próximos al canal alveolar inferior; y según la profundidad de Pell y Gregory, las posiciones más frecuentes son A y B. Además, la proximidad y la profundidad se asociaron entre sí, y con las co-variables país, edad y sexo.

Prevalence of soft tissue calcifications in the maxillofacial region: a radiographic study

Aim: To evaluate the prevalence of soft tissue calcifications in orofacial region and their panoramic radiographic characteristics using digital panoramic radiographs among patients reporting to a tertiary dental hospital. Methods: 1,578 digital panoramic radiographs were retrieved from the archives and scrutinized for the presence of calcifications. Soft tissue calcifications were recorded according to age, gender, site (left or right). Data were analysed using Chi-square and Fisher's exact test using SPSS software and a p < 0.05 was considered statistically significant. Results: Among the total number of radiographs, calcified carotid artery (34.3%), calcified stylohyoid ligament (21%), tonsillolith (10.3%), phlebolith (17.6%), antrolith (6.3%), sialolith (5.9%), rhinolith (2.5%) and calcified lymph nodes (1.9%) were identified. The most commonly observed calcifications were calcification of carotid artery and stylohyoid ligament and the least commonly observed calcifications were rhinolith and calcified lymph node. A statistically significant association of the presence of calcifications of carotid artery and stylohyoid ligament on the left and right side was observed in females and tonsillolith on the right side in males (p-value < 0.05). Considering the gender and age group, the occurrence of antrolith among males and rhinolith among females of young-adult population, tonsillolith among the males, calcified carotid artery and stylohyoid ligament among the females of middle-aged population was found to be significant. Conclusion: Soft tissue calcifications are often encountered in dental panoramic radiographs. Our study revealed that the soft tissue calcifications in orofacial region were more common in women and were found to be increased above 40 years of age

Panoramic radiography and cone-beam computed tomography to measure distances between root apexes and anatomical structures / Radiografía panorámica y tomografía computarizada de haz cónico para medir distancias entre ápices radiculares y estructuras anatómicas

Aim: To compare the accuracy of the panoramic radiography with cone-beam computed tomography (CBCT) scans in measuring the distances between root apexes and the adjacent anatomical structures including the maxillary sinus and the mandibular canal. Material and Methods: A total of 200 CBCT scans (100 maxillary and 100 mandibular) from patients who also had corresponding panoramic radiography were selected. Linear measurements (in mm) presenting centralized image were made between the apexes of the maxillary teeth and the inferior wall of the maxillary sinus, and between the apexes of the mandibular teeth and the superior border of the mandibular canal by using specific software for panoramic radiography and the measurements on the coronal sections in CBCT scans. Data were submitted to inferential statistical analysis and Student's t-test for comparison between measurements. Results: CBCT scans were significantly more accurate than panoramic radiography to measure the distances between the apexes of the maxillary teeth and the inferior wall of the maxillary sinus (p<0.05) and between the apexes of the mandibular teeth and the superior border of the mandibular canal or mental foramen (p<0.05). Conclusion: CBCT scans present more accurate measurements than panoramic radiography.

Objetivo: Comparar la precisión de la radiografía panorámica con las exploraciones de la tomografía computarizada dental de haz en cónico (CBCT) para medir las distancias entre los vértices radiculares y las estructuras anatómicas adyacentes, incluidos el seno maxilar y el canal mandibular. Material y Métodos: Se seleccionaron un total de 200 tomografías CBCT (100 maxilares y 100 mandibulares) de pacientes que además tenían la correspondiente radiografía panorámica. Se realizaron mediciones lineales (en mm) que presentaban imagen centralizada entre los ápices de los dientes maxilares y la pared inferior del seno maxilar, y entre los ápices de los dientes mandibulares y el borde superior del canal mandibular mediante software específico para radiografía panorámica. y las mediciones en las secciones coronales en escaneos CBCT. Los datos se sometieron a análisis estadístico inferencial y prueba t de Student para comparación entre mediciones. Resultados: Las exploraciones CBCT fueron significativamente más precisas que la radiografía panorámica para medir las distancias entre los ápices de los dientes maxilares y la pared inferior del seno maxilar (p<0,05) y entre los ápices de los dientes mandibulares y el borde superior de los dientes mandibulares. canal o agujero mentoniano (p<0.05). Conclusión: Las exploraciones CBCT presentan mediciones más precisas que la radiografía panorámica.

Impact of dental cone-beam computed tomography on diagnostic evaluation and treatment plan for the maxillary sinus in dental implant planning / Impacto de la tomografía computarizada de haz cónico en el diagnóstico y plan detratamiento preimplantologico de senos maxilares

Objective: To determine the impact of CBCT on diagnostic evaluation and treatment plan for the maxillary sinus in dental implant planning. Material and Methods: Diagnostic evaluation and treatment plan for the maxillary sinus were evaluated by eight specialists experienced in dental implant placement. Eight panoramic radiographs (PAN) and CBCT examinations were obtained from five adult patients with a specific clinical need for dental implants. Evaluation was performed first on PAN then, at least 2 weeks later, on CBCT. Residual alveolar ridge height, mucosal thickening, radiographic findings and treatment plan were recorded. The confidence level was evaluated for both diagnostic evaluation and treatment plan. The kappa statistic for intra-observer reproducibility and McNemar test were performed. Results: In the diagnostic evaluation, CBCT showed significant impact on the diagnosis of radiographic findings. Availability of CBCT significantly changed the treatment plan, for less invasive treatment, or no treatment need. Observers had significantly greater confidence when using CBCT than PAN, when indicating presence of mucosal thickening and radiographic findings in the maxillary sinus. In addition, CBCT increased confidence in the treatment plan. Conclusion: The present study suggests that CBCT has an impact on the diagnostic evaluation of radiographic findings in the maxillary sinus and on the decision to place implants, owing to misdiagnosis of pathology and planning of more invasive treatments when using PAN. Availability of CBCT also improves clinician confidence. Further studies at higher levels of diagnostic efficacy should be performed, to justify the use of CBCT, by evaluating the actual treatment performed and its outcome.

Objetivo: Determinar el impacto de la tomografía computarizada de haz cónico (CBCT) en la evaluación diagnóstica y el plan de tratamiento del seno maxilar en la planificación de implantes dentales. Material y Métodos: La evaluación diagnóstica y el plan de tratamiento del seno maxilar fueron evaluados por ocho especialistas con experiencia en la colocación de implantes dentales. Se obtuvieron ocho radiografías panorámicas (PAN) y exámenes CBCT de cinco pacientes adultos con una necesidad clínica específica de implantes dentales. La evaluación se realizó primero en PAN y luego, al menos dos semanas después, en CBCT. Se registraron la altura del reborde alveolar residual, el engrosamiento de la mucosa, los hallazgos radiográficos y el plan de tratamiento. Se evaluó el nivel de confianza tanto para la evaluación diagnóstica como para el plan de tratamiento. Se realizó el estadístico kappa para la reproducibilidad intraobservador y la prueba de McNemar. Resultados: En la evaluación diagnóstica, CBCT mostró un impacto significativo en el diagnóstico de los hallazgos radiográficos. La disponibilidad de CBCT cambió significativamente el plan de tratamiento, para un tratamiento menos invasivo o sin necesidad de tratamiento. Los observadores tuvieron una confianza significativamente mayor al usar CBCT que PAN, al indicar la presencia de engrosamiento de la mucosa y hallazgos radiográficos en el seno maxilar. Además, CBCT aumentó la confianza en el plan de tratamiento. Conclusión: El presente estudio sugiere que la CBCT tiene un impacto en la evaluación diagnóstica de los hallazgos radiográficos en el seno maxilar y en la decisión de colocar implantes, debido al diagnóstico erróneo de la patología y la planificación de tratamientos más invasivos al usar PAN. La disponibilidad de CBCT también mejora la confianza del clínico. Se deben realizar más estudios a niveles más altos de eficacia diagnóstica para justificar el uso de CBCT, evaluando el tratamiento real realizado y su resultado.

Factors related to apical periodontitis in a southern Brazilian population: a multilevel analysis

Abstract The aim of this cross-sectional study was to evaluate the effects of individual-level and tooth-level factors on apical periodontitis (AP) in an urban population in southern Brazil. A random sample of digital panoramic radiographs (n = 545) from a dental school database was evaluated. The diagnosis of AP was determined by using a dichotomous scale (yes/no). AP was assessed according to gender, age, presence and quality of endodontic treatment (ET), presence of an intracanal post, coronal condition, and dental group. Data were analyzed descriptively and through multilevel Poisson regression analysis, considering teeth characteristics (level 1) nested in individuals (level 2). In this sample of 545 participants, the prevalence of AP was 49.5% (n =2 70) and ET was 43.5% (n = 237). Considering 13,595 teeth, AP was identified in 596 (4.4%) and ET in 617 (4.5%). Of the teeth with ET, 153 (24.8%) presented AP. Among individual-level factors, the disease was not significantly associated with gender or age. For tooth-level factors, AP was significantly associated with ET quality: teeth with short fillings (< 3 mm) and teeth with over-fillings had 2.77 (CI: 1.95-3.94, p < 0.001) and 1.08 (CI: 0.39-2.98, p < 0.001) higher prevalence of AP, respectively. There was no association between AP and age, gender, dental group, coronal condition, or the presence of an intracanal post. AP was highly prevalent in this population, and multilevel analysis indicated a significant association with ET quality.

Prevalência das posições e grau de dificuldade cirúrgica de terceiros molares inferiores: um estudo radiográfico retrospectivo / Prevalence of positions and degree of surgical difficulty in lower third molars: a retrospective radiographic study

Objetivo: Os objetivos deste estudo foram avaliar a prevalência do posicionamento dos terceiros molares inferiores seguindo a classificação de Winter e Pell & Gregory, e determinar os níveis de dificuldade para a exodontia através do índice de Pederson. Materiais e Métodos: Estudo radiográfico, transversal e retrospectivo avaliou 100 radiografias panorâmicas provenientes dos prontuários odontológicos atendidos nos ambulatórios de Cirurgia bucal, de pacientes entre 15 e 61 anos de idade, no período de 2015 a 2017. As radiografias panorâmicas foram avaliadas por meio do software ImageJquanto aos posicionamentos dos terceiros molares inferiores pela classificação de Winter e Pell & Gregory, enquanto o nível de dificuldade foi avaliado pelo índice de Pederson. Os resultados obtidos foram submetidos à análise estatística descritiva. Resultados: A maior prevalência de terceiros molares inclusos foi observada em mulheres, com idade média de 26 anos. Quanto a posição dos dentes inclusos, a posições vertical (44,0%), nível A (74,7%) e classe III (69,9%) foram as mais prevalentes. Na escala de Pederson, a dificuldade cirúrgica "muito difícil" foi a mais encontrada. Discussão: nossos resultados sugerem estabelecer um melhor planejamento cirúrgico e prognóstico aos pacientes, minimizando a possibilidade de complicações durante e após as extrações de terceiros molares inferiores. Conclusão: Ambas classificações auxiliam o cirurgião-dentista a estabelecer um melhor planejamento e prognóstico aos pacientes. A aplicabilidade das radiografias panorâmicas, associados a avaliação clínica, justificam menores possibilidades de complicações pós-cirúrgicas em terceiro molar inferior.

Aim: The objectives of this study were to evaluate the prevalence of the mandibular third molars position in according to the Winter and Pell & Gregory classification, and to determine the levels of difficulty for exodontia through the Pederson index. Materials and Methods: Radiographic, cross-sectional and retrospective study evaluated 100 panoramic radiographs of patients between 15 and 61 years old, from dental records seen at the Oral Surgery department in the period from 2015 to 2017. The panoramic radiographs were evaluated using ImageJ software regarding the positioning of the lower third molars by the Winter and Pell & Gregory classification, while the level of difficulty was evaluated by the Pederson index. The results obtained were submitted to descriptive statistical analysis.Results: The highest prevalence of included third molars was observed in women, with an age average of 26 years. Regarding the position of the included teeth, the vertical position (44.0%), level A (74.7%), and class III (69.9%) were the most prevalent. In the Pederson scale, the "very difficult" surgical difficulty was the most found. Discussion: results suggest establishing better surgical planning and prognosis for patients, minimizing the possibility of complications during and after extractions of mandibular third molars.Conclusion: Both classifications help the dental surgeon to establish better planning and prognosis for patients. The applicability of panoramic radiographs, associated with clinical evaluation, justifies a fewer possibility of complications in the lower third molar post-extraction

Dental developmental anomalies and post-eruption dental disorder: a series of panoramic radiographs

Panoramic radiographs are complementary exams to evaluate oral alterations in an early manner, these changes can be dental developmental anomalies, and post-eruption dental disorder. Aim: This study evaluated the findings in panoramic radiographs and correlated the variables of gender and dental location. Methods: A retrospective study was through the observation of 1.111 panoramic radiographs from the Radiology Department in Brazil. It was included patients from 5 to 79 years of age of both gender, and it classified the anomalies in shape, size, and number and post-eruption dental changes in and correlated with gender and location. Patients with syndromes were excluded from the sample. Results: The majority of the sample was composed of fameles 752 (67.7%), as to the frequency of dental developmental anomalies related lesions 684 cases (61.6%) and post-eruption dental disorder 567 (51.8%), in the radiographs. The most prevalent change was endodontic treatment (32.6%), followed by root dilaceration (25.9%), and included tooth (19.5%). The most prevailing alteration when correlated with the gender variables was the cyst root (p<0.01) in females, and orthodontic treatment (p=0.02) in males and the variable location in the mandible was root dilaceration, giroversion, impacted tooth, taurodontia, microdontia, and endodontic treatment (p<0.01). Conclusion: Our findings provide evidence that dental developmental anomalies e post-eruption dental disorder are frequent alterations in the population with particular characteristics of distribution by sex and location

Alteration of mucosa cell maturation pattern after exposure to different radiographic imaging methods

Aim: Dental imaging has been widely used for diagnosis in dentistry. However, dental X-ray may induce cytotoxicity leading to apoptosis in oral mucosa cells. The present study aimed to observe the maturation pattern of buccal and gingival cells after exposure to X-ray radiation from analog/digital panoramic scanning and cone beam computed tomography (CBCT). Methods: The research samples were 40 subjects who fulfilled the inclusion and exclusion criteria. The subjects were divided into the exposed (patients who received analog/digital panoramic radiography or CBCT) and controlled (patients who had no radiography examinations) groups, with 10 subjects in each group. Exfoliative cytology smears were obtained from buccal mucosa and gingiva before exposure (or on day 0 for the control group) and 10 days later. The cells were stained with the Papanicolaou method. Then, the superficial, intermediate, and parabasal cells were counted in each glass slide. Results: No significant differences (p > 0.05) were observed among all cell types between day 0 and 10 in the control group. Meanwhile, after exposure to three kinds of radiography examinations, the frequency of intermediate cells in buccal mucosa and gingiva increased (p < 0.05), but that of superficial cells decreased (p < 0.05) significantly. No significant difference was found in the parabasal cells (p > 0.05). The frequency differences between intermediate and superficial cells showed no significant difference between the buccal mucosa and gingiva. Conclusion: Analog/digital panoramic radiography and CBCT exposure can induce cytotoxicity by altering the maturation pattern of buccal mucosa cells and gingiva, so it is strongly recommended to only perform these procedures if necessary and avoid repeated exposure to the same patient

One-year retrospective radiographic assessment of marginal bone loss around basal implants and impact of multiple risk factors using multivariate analysis / Evaluación radiográfica retrospectiva de un año de la pérdida ósea marginal alrededor de los implantes basales y el impacto de múltiples factores de riesgo mediante análisis multivariado

Background: Factors like medical and periodontal conditions, implant location and smoking can affect marginal bone loss (MBL) of basal implants. Objectives: The purpose of this study is to explore the association of MBL with multiple variables including gender, age, smoking status, diabetes, implant placement protocol, location of implant, and type of prosthesis. Material and Methods: A total of 156 single-piece basal implants (Dr. Ihde Dental AG in Gommiswald, Switzerland) were placed in 44 patients. Dental panoramic tomographs were obtained postoperatively and following a one-year of service to determine MBL on mesial and distal sides. The association of MBL with the multiple variables was analysed using the multivariate and the random forest analysis. Results: The mean mesial and distal MBL was 0.64 millimetres. None of the implants presented MBL exceeding 1 millimetre. All implants were retained without complications during the firstyear of service. The MBL was remarkably associated with the smoking status, diabetes, location of implant and implant placement protocol. Diabetes mellitus is the most vital parameter in predicting MBL. Conclusion: The mean MBL of all implants did not exceed the threshold of 1 millimetre during the first year of service. When placing implants in patients who smoke and have diabetes, care should be taken.

Antecedentes: Factores como las condiciones médicas y perio-dontales, la ubicación del implante y el tabaquismo pueden afectar la pérdida marginal de hueso (PMH) de los implantes basales. Objetivo: La finalidad de este estudio es explorar la asociación de PMH con múltiples variables, incluido el sexo, la edad, el tabaquismo, la diabetes, el protocolo de colocación del implante, la ubicación del implante y el tipo de prótesis. Material y Métodos: Se colocaron 156 implantes basales de una sola pieza (Dr.Ihde Dental AG, Gommiswald, Suiza) en 44 pacientes. Se obtuvieron tomografías panorámicas dentales después de la operación y después de un año de servicio para deter-minar la MBL en los lados mesial y distal. La asociación de la PMH con las múltiples variables se analizó mediante el análisis multivariado y de bosque aleatorio. Resultados: La PMH media mesial y distal fue de 0,64 milímetros. Ninguno de los implantes presentó PMH superior a 1 milímetro. Todos los implantes se mantuvieron sin complicaciones durante el primer año de servicio. La PMH se asoció nota-blemente con el tabaquismo, la diabetes, la ubicación del implante y el protocolo de colocación del implante. La diabetes mellitus es el paráme-tro más importante para predecir la MBL. Conclusion: La PMH media de todos los implantes no superó el umbral de 1 milímetro durante el primer año de servicio. Se debe tener especial cuidado al colocar implantes en pacientes que fuman y tienen diabetes.

Elongated Styloid Process in Panoramic Radiographs / Processo Estilóide Alongado nas Radiografias Panorâmicas

The aim of this study is to evaluate the prevalence of the elongated styloid process in panoramic radiographic exams, in a subpopulation of northern Brazil in relation to age, sex and side. Panoramic radiographs were selected, and the apparent size of the styloid process was measured from the point where the styloid leaves the tympanic plate to the tip of the process. The data were analyzed using chi-square tests and variance analysis with a 5% significance level. Approximately 30% of the elongated styloid process was observed in patients between 18 to 35 years. Of the styloid processes that measured more than 30 mm (elongated), 764 styloid processes (81%) showed Type I elongation pattern, 97 styloid processes (10%) showed Type II calcification patterns, and 85 styloid processes (9%) showed Type III calcification patterns. The prevalence of the elongated styloid process was high, and no statistically significant correlation was found between the presence of the elongated styloid process and the variables studied. (AU)

O objetivo deste estudo é avaliar a prevalência do processo estilóide alongado em exames radiográficos panorâmicos, em uma subpopulação do norte do Brasil em relação à idade, sexo e lado. Radiografias panorâmicas foram selecionadas, e tamanho aparente do processo estilóide foi medido a partir do ponto em que o estilóide deixa a placa timpânica até a ponta do processo. Os dados foram analisados por meio de testes qui-quadrado e análise de variância com nível de significância de 5%. Aproximadamente 73% do processo estilóide alongado foi observado em pacientes entre 18 e 53 anos (p <0,05). Dos processos estilóides que mediram mais de 30 mm (alongados), 543 processos estiloide (82,9%) mostraram padrão de alongamento do Tipo I, 33 processos estiloide (5,03%) mostraram padrões de calcificação do Tipo II, e 79 processos estilóide (12,06%) mostraram padrões de calcificação do Tipo III. A prevalência do processo estilóide alongado foi alta e não foi encontrada correlação estatisticamente significante entre a presença do processo estilóide alongado e as variáveis estudadas. (AU)

Diagnosis of ameloblastic fibro-odontoma: case report / Diagnóstico de fibro-odontoma ameloblástico: relato de caso

Objective: the present report describes the clinical, radiographic, and histopathological features of an ameloblastic fibro-odontoma (AFO) lesion. Case report: we report a clinical case of a 14-year-old boy with asymptomatic edema. Panoramic radiography detected a unilocular lesion with defined margins located in the posterior region of the mandible. The internal structure of the lesion presented several degrees of radiopacity with the involvement of the third molar. Cone-beam computed tomography revealed expanded buccal and lingual cortical bones, perforation of the lingual cortical bone, and displacement of the mandibular canal. AFO was suspected based on the radiographic and clinical characteristics. Total excision was performed and histologically examined, confirming the diagnosis of AFO. No recurrence occurred during a 24-month follow-up period. Final considerations: the evaluation of the clinical, radiographic, and histopathologic findings needs to be accurate for a correct diagnosis and appropriate treatment for case of AFO since the presentation is often asymptomatic.(AU)

Objetivo: o presente relato descreve as características clínicas, radiográficas e histopatológicas de uma lesão de fibro-odontoma ameloblástico (FOA). Relato de caso: relatamos o caso clínico de um menino de 14 anos com edema assintomático. A radiografia panorâmica detectou lesão unilocular com margens definidas e localizada na região posterior da mandíbula. A estrutura interna da lesão apresentava vários graus de radiopacidade com envolvimento do terceiro molar. A tomografia computadorizada de feixe cônico revelou as corticais ósseas vestibular e lingual expandidas, perfuração da cortical óssea lingual e deslocamento do canal mandibular. FOA foi a hipótese diagnóstica com base nas características radiográficas e clínicas. A excisão total foi realizada e examinada histologicamente, confirmando o diagnóstico de FOA. Nenhuma recorrência ocorreu durante um período de acompanhamento de 24 meses. Considerações finais: a avaliação das características clínicas, radiográficas e histopatológicas contribuíram para um diagnóstico correto e o tratamento adequado para o caso de FOA, uma vez que a lesão é frequentemente assintomática.(AU)

Sitios anatómicos para la inserción de microtornillos interradiculares como dispositivos de anclaje temporal en tratamientos de ortodoncia / Anatomical sites for the insertion of interradicular miniscrews as temporary anchoring devices in orthodontic treatments

Los microtornillos interradiculares (MTI) son dispositivos de uso temporal diseñados para ser insertados en el hueso alveolar con la finalidad de mejorar el anclaje. El objetivo de este estudio fue presentar una guía para odontólogos que permita identificar los sitios anatómicos más apropiados para la inserción de estos dispositivos, logrando así, una mayor tasa de éxito clínico en los tratamientos. PUBMED, Google Académico y SciELO fueron las bases de datos utilizadas para la búsqueda de la literatura, se consideraron artículos publicados entre los años 2000 y 2020, en inglés y en español. Nuestra revisión sugiere según la bibliografía actual, realizar una planificación al comienzo del tratamiento de ortodoncia, utilizando guías generales para la inserción de MTI a través de mapas visuales de "zonas seguras" que existen entre los espacios interradiculares. Para estos, se consideró que la mínima cantidad de hueso alveolar debía ser de 3 mm.

Interradicular miniscrews (MTI) are temporary devices designed to be inserted into the alveolar bone in order to improve anchorage. The aim of this study was to present a guide for dentists that allows identifying the most appropriate anatomical sites for the insertion of these devices, thus achieving a higher clinical success rate in treatments. PUBMED, Google Scholar and SciELO were the databases used to search the literature; articles published between 2000 and 2020, in English and Spanish, were considered. Our review suggests, according to the current bibliography, planning at the beginning of orthodontic treatment, using general guidelines for the insertion of MTI through visual maps of "safe areas" that exist between the inter-root spaces. For these, it was considered that the minimum amount of alveolar bone should be 3 mm.

Age Estimation by Modified Demirjian's Method in a Hospital-Based Population: A Radiographic Study

ABSTRACT Objective: To test the modified Demirjian's method of dental age estimation on the South Indian population and correlate it with the patient's chronological age. Material and Methods: This retrospective radiographic study was performed on digital panoramic radiographs taken during a one-year duration. Radiographs of patients in the age range from 8 to 18 years were included in the study. The radiographs were examined and according to the stage of the crown and root status of the left side mandibular teeth. The stage of calcification was observed for eight teeth in the mandibular arch and was recorded in a specially designed proforma. Each rated tooth with stage was converted into a score using a conversion table specified for girls and boys. Results: 224 digital panoramic radiographs were retrieved from the radiologic database. Out of total study sample, 49.5% (n=111) were boys and 50.5% (n=113). The mean chronological and estimated dental age using dental maturity scores resulted in an overestimation of 3 years and eight months. Also, it was noted that there was a strong positive association between chronological (real) and dental age. Conclusion: It was observed that there was a strong correlation between chronological and dental age. A new formula for determining the chronological age from the estimated dental age was derived. Further studies on a larger population may prove the reliability of this age estimation method.

Vertical Mandibular and Trunk Symmetry in Indonesian Orthodontic Patients

Abstract Objective: To analyze differences in vertical mandibular and trunk symmetry in orthodontic patients. Material and Methods: This was a cross-sectional study of 129 growing orthodontic patients who sought orthodontic treatment at the Dental Hospital Universitas Sumatera Utara, Indonesia. Mandibular symmetry index was observed with pre-treatment panoramic radiography based on Kjellberg's technique and trunk symmetry was evaluated based on questionnaires and visual observation. Vertical mandibular asymmetry was decided if the index of asymmetry was lower than 93.7%. The bivariate analysis used the chi-squared and Fisher's exact tests, with a significance level of 5%. Results: There was a significant association between vertical mandibular and trunk symmetry (p<0.05). The prevalence odds ratio for the association with vertical mandibular asymmetry was 3.007 (95% CI = 1.016-8.905) for trunk asymmetry. Conclusion: The necessity to consider trunk symmetry could be included in orthodontics treatment of any malocclusion with vertical mandibular asymmetry that might require a multidisciplinary approach in the future.

Impact of Early Loss of Lower First Permanent Molars on Third Molar Development and Position

ABSTRACT Objective: To evaluate the effects of unilateral loss of the lower first permanent molar (L6) on the position and development of the lower third molar (L8). Material and Methods: Fifty-four panoramic radiographs of subjects with unilateral loss of L6 were examined. The L8 on the side of the L6 loss was compared with the L8 in the hemiarch without L6 loss (contralateral). The effect of L6 loss on the positioning of L8 was examined in all the samples (n=54), whereas the effect on the development of the third molar was examined in 38 patients with L8 with incomplete root formation. The Signs statistical test was used to evaluate the comparison between loss and contralateral hemiarches. Results: In 20 (37%) of 54 subjects, the L8 was better positioned in the hemiarch with loss of the lower first molar (p<0.001) compared with the control side. In the remaining 34 subjects, no difference was found. When only the L8 considered as impacted on the control side was examined (n=30), the cases with better positioning on the side with L6 loss increased to 66.6% (p<0.001). Conclusion: The loss of lower first molars improves the position of the lower third molar during its active eruption, mainly when the lower third molar is impacted. However, L6 loss does not affect the root development of lower third molars.

Shape differences among symmetrically shaped skeletal growth patterns in a panoramic view: a Fourier analysis

Abstract The objective of this study was to apply elliptic Fourier analysis (EFA) to find shape differences among skeletal growth patterns in both radiographic and tomographic panoramic views, controlling for asymmetry. Lateral and panoramic images were obtained from 350 patients. After screening patients with asymmetric linear and angular values and natural asymmetric hemimandibular shape, 240 patients were included in the study: 48 with tomographic information and 192 with radiographic information. The images were classified according to the mandibular plane angle and the ANB angle. Mandibular contours were digitized on the panoramic images and EFA was performed with 20 harmonics, filtering rotation, translation and size properties. As there were no differences between radiographic and tomographic panoramic mandibular contours and normal distribution was found in all groups, MANOVA was conducted to determine differences using a Hotelling's p-values with Bonferroni correction and an XY graph tool was applied to visualize these differences graphically. A 95% confidence level was used. Significative differences were found among hypodivergent, normodivergent, and hyperdivergent patterns in Class I, II, and III (p < 0.05), located mainly in the symphyseal region. The results of this study suggest that EFA is a useful tool to mathematically analyze mandibular contours and their morphological differences given by facial biotypes. This method could improve the precision of the mandibular prediction models.

Panoramic radiography for detection of bilateral carotid calcified atheroma: an unusual case report / Radiografía panorámica para la detección de ateroma calcificado carotídeo bilateral: reporte de un caso inusual

Introduction: Atherosclerosis is a progressive inflammatory disease that can trigger serious medical consequences like acute myocardial infarction or stroke. Case Report: The purpose of this study is to report an unusual case of finding calcified atheromatous plaques in the carotid arteries bilaterally using a panoramic radiography (PR). A 75-year-old female with a morbid history, attends the Teaching Dental Clinic of the Pontifical Catholic University with complementary exams. PR showed well-defined radiopaque structures adjacent to C4. Using a Doppler ultrasound, the presence of calcified atheromas in the right and left carotid arteries were confirmed. The patient was informed of these findings and is currently under medical follow-up. Conclusion: PR is a useful complementary resource in the detection of atherosclerotic plaques of the upper carotid region.

Introducción: La aterosclerosis es una enfermedad inflamatoria progresiva que puede desencadenar graves consecuencias médicas como infarto agudo de miocardio o accidente cerebrovascular. Case Report: El propósito de este estudio es reportar un caso inusual de hallazgo de placas ateromatosas calcificadas en las arterias carótidas de forma bilateral mediante una radiografía panorámica. Mujer de 75 años con antecedentes mórbidos, acude a la Clínica Odontológica Docente de la Pontificia Universidad Católica con exámenes complementarios. La radiografía panorámica mostró estructuras radiopacas bien definidas adyacentes a C4. Mediante ecografía Doppler se confirmó la presencia de ateromas calcificados en las arterias carótidas derecha e izquierda. El paciente fue informado de estos hallazgos y actualmente se encuentra en seguimiento médico. Conclusión: La radiografía panorámica es un recurso complementario útil en la detección de placas ateroscleróticas de la región carotídea superior.

Occurrence of nonarticular incidental findings on panoramic radiographs in painful temporomandibular disorders / Ocurrencia de hallazgos incidentales no articulares en ortopantomografias en los trastornos temporomandibulares dolorosos

Facial pain is one of the symptoms of temporomandibular disorders (TMDs) but can be associated with other pathological conditions. The present study retrospectively evaluated the occurrence of nonarticular incidental findings in panoramic radiographs in a group of patients with painful TMDs. Outpatients with a diagnosis of TMD were included and distributed into three groups: arthralgia, myalgia or arthralgia and myalgia, according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Nonarticular incidental findings of their panoramic radiographs were classified in relation to pathological, dental and endodontic status. The dependency relationships among the variables were analyzed using the likelihood test. Sixty patients (38 women and 22 men; mean age: 36.9 years) were evaluated. There was a predominance of arthralgia plus disc displacement (43.4 %), followed by myopain plus arthralgia and disc displacement (38.3 %) and myopain (18.3 %). Pathologic radiographic changes such as bone loss, caries, maxillary sinus opacification and periapical lesions were frequent. Dental alterations such as the absence and altered position of teeth and impacted teeth were frequent. Endodontic changes such as periapical lesions with or without endodontic treatment were frequent. There was no significant difference between groups except for gyroversion. The incidental findings were compatible with caries, sinusitis, impacted tooth and periapical lesion, which may be associated with orofacial pain and could potentially be superimposed on the initial diagnosis, although this hypothesis was discarded. Findings such as the absence and altered position of teeth were also frequent, which may represent occlusal factors associated with TMDs.

El dolor orofacial es uno de los síntomas de los trastornos temporomandibulares (TTM), pero puede estar asociado con otras afecciones patológicas. El presente estudio evaluó retrospectivamente la aparición de hallazgos incidentales no articulares a través de ortopantomografías en un grupo de pacientes con TTM dolorosas. Se incluyeron pacientes con diagnóstico de TTM y se distribuyeron en tres grupos: artralgia, mialgia o artralgia y mialgia, de acuerdo con los criterios de diagnóstico para los trastornos temporomandibulares (DC/TMD). Los hallazgos incidentales no articulares de las ortopantomografias se clasificaron en relación al estado patológico, dental y endodóncico. Las relaciones de dependencia entre las variables se analizaron mediante la prueba de probabilidad. Fueron evaluados 60 pacientes (38 mujeres y 22 hombres; edad media: 36,9 años). Hubo predominio de artralgia más desplazamiento de disco (43,4 %), seguido de mialgia más artralgia y desplazamiento de disco (38,3 %) y mialgia (18,3 %). Las alteraciones radiográficas patológicas como pérdida ósea, carie dentaria, opacificación del seno maxilar y lesiones periapicales fueron frecuentes. Entre las alteraciones dentales, las impactaciones, malposiciones o ausencias dentarias fueron frecuentes. Entre las alteraciones endodóncicas, las lesiones periapicales frecuentes. No hubo diferencias significativas entre los grupos, excepto para la girosversión dentaria. Los hallazgos incidentales fueron compatibles con carie dentaria, sinusitis, diente impactado y lesión periapical, lo que podría estar asociado con el dolor orofacial y así estar sobrepuesto en el diagnóstico inicial, aunque esta hipótesis fue descartada. Hallazgos como la ausencia y la posición alterada de los dientes también fueron frecuentes, lo que puede representar factores oclusales asociados con TTM.

Agenesis of third molars and its association with other dental anomalies in a peruvian population / Agenesia de terceros molares y su asociación con otras anomalías dentales en una población peruana

Objective: The purpose of the present study was to determine the association between agenesis of the third molar and other dental anomalies. Materials and Methods: This was an observational, retrospective, cross-sectional and analytical study. The sample included 367 patients, aged 14 to 20 years old with adequate digital panoramic radiography. Patients with syndromes, who had extractions of any third molar and with orthodontic treatment prior to panoramic radiographic examination, were excluded. For data collection, each radiograph was recorded with patient code, sex and age. Results: The prevalence of third molar agenesis was 20.71%. Subsequently, patients were divided into two groups, with agenesis of at least one third molar and a control group; the prevalence of other dental anomalies was 48.69% of third molar agenesis group and 21.31% in the control group. A highly significant association was found between the presence of third molar agenesis and the presence of other tooth abnomalities (p= 0.0000; contingency coefficient = 0.2425).The most frequent dental anomaly was dental inclusion with 20.44% of the population studied; followed by the agenesis of other teeth (7.90%) and finally the presence of supernumerary teeth (1.63%). Conclusions: This study demonstrates that there is an association between third molar agenesis and other dental abnormalities, with a higher prevalence of dental abnormalities in patients with third molar agenesis.

Objetivo: La presente investigación tuvo como finalidad determinar la asociación que existe entre la agenesia del tercer molar y otras anomalías dentarias. Material y Métodos: El estudio fue observacional, retrospectivo, transversal y analítico. La muestra que incluyó 367 pacientes de 14 a 20 años de edad con radiografía panorámica digital con parámetros adecuados. Se excluyeron pacientes con algún tipo de condición sindrómica, con exodoncias de algún tercer molar y con tratamiento ortodóntico previo al examen radiográfico panorámico. Para la recolección de datos, cada radiografía fue registrada con código de paciente, sexo, edad. Resultado: Se reportó una prevalencia de 20,71% de casos con agenesia de terceros molares. Los pacientes fueron divididos en 2 grupos, con agenesia de al menos un tercer molar y un grupo control, en ambos se calculó la prevalencia las otras anomalías dentarias, la cual fue de 48.69% de los pacientes que presentan agenesia de tercer molar tienen otra anomalía dentaria y 21.31% del grupo control tienen otra anomalía dentaria. Se encontró una asociación altamente significativa entre la presencia de agenesia de tercer molar y presencia de otras anomalías dentales (p=0.0000; coeficiente de contingencia=0.2425). La anomalía dental encontrada con más frecuencia es la inclusión dentaria con 20,44% del total de la población estudiada; seguido de la agenesia de otros dientes con 7,90% y finalmente la presencia de dientes supernumerarios con 1,63%. Conclusion: Este estudio demuestra que existe asociación entre la agenesia de tercer molar y otras anomalías dentarias, existiendo una mayor prevalencia de anomalías dentales en pacientes con agenesia del tercer molar.

Análisis ortopantomográfico en la determinación de la posición recurrente de terceros molares / Orthopantomographic analysis in determining the recurrent position of third molars

Objetivo: caracterizar las posiciones recurrentes en terceros molares a través del análisis ortopantomográfico en pacientes del Centro Especializado en Odontología "Dr. Mario Cerda e Hijos" en la ciudad de Riobamba durante el periodo 2015-2018. Material y Métodos: se realizó un estudio de tipo observacional, descriptivo y de corte transversal, en el que se analizaron ortopantomografías de pacientes del entorno de investigación. Se trabajó con la totalidad de la población, constituida por de 172 radiografías, analizando la posición de 688 terceros molares, en pacientes con edades comprendidas entre 15 a 50 años. Los datos fueron recolectados a partir de la técnica de la medición, utilizando el negatoscopio y la regla milimetrada, los que fueron agrupados según las clasificaciones de Winter y de Pell y Gregory. Resultados: de 688 terceros molares analizados, el 48,1% se observó en posición vertical, seguido de la posición mesioangular con el 31,2%; clase II con 43,3%, clase I en 31,8% y clase III con 18,8%; nivel B con 35,6%, nivel C en 34,9% y nivel A con 23,4%. Conclusión: la posición vertical, la clase I y el nivel C, resultaron más frecuente en los terceros molares del maxilar; mientras que en la mandíbula fueron la posición mesioangular, la clase II y el nivel B.

Objective: to characterize the recurrent positions in third molars through the orthopantomographic analysis in patients of the Specialized Center in Dentistry "Dr. Mario Cerda e Hijos" in the city of Riobamba-Ecuador during the period 2015-2018. Material and Methods: an observational, descriptive, and cross-sectional study was carried out, in which orthopantomographies of patients were analyzed in this research. The studied population was made up of 172 radiographs, the position of 688 third molars was analyzed in patients aged between 15 to 50 years. Considering the technique, the data collected was the measurement using the negatoscope and the millimeter ruler, which were grouped according to the Winter and Pell and Gregory classifications. Results: 688 third molars were analyzed, the 48.1% was observed in vertical position, followed by the mesioangular position with 31.2%; class II with 43.3%, class I in 31.8% and class III with 18.8%; level B with 35.6%, level C with 34.9% and level A with 23.4%. Conclusion: The vertical position, class I and level C were more frequent in the maxillary third molars; while in the mandible they were the mesioangular position, class II, and level B.