Imaging diagnosis of compound - complex odontoma and impacted dental elements: a case report

O odontoma é o mais comum tumor odontogênico, definido como malformação benigna, geralmente descoberto na segunda década de vida, durante a investigação de erupção tardia de dentes adjacentes ou retenção prolongada de dentes decíduos. O odontoma é subdividido em composto e complexo. O Odontoma classificado como Composto é constituído por um conjunto de estruturas similares a dentes, de formas e tamanhos diversos, cercados por uma área delgada radiolúcida. Já o Odontoma Complexo se assemelha a uma massa calcificada que apresenta a mesma radiopacidade do tecido dentário, também cercado por uma área delgada radiolúcida. Ocasionalmente, esses dois aspectos podem ser vistos em uma mesma lesão. Frequentemente os odontomas podem provocar um aumento de volume ósseo local devido ao seu desenvolvimento. O diagnóstico é feito através de exames radiográficos de rotina e quando necessário pode-se também lançar mão de Radiografias Panorâmicas e Tomografia Computadorizada Cone Beam com o intuito de verificar sua extensão, as malformações e alterações de erupção causadas aos dentes adjacentes, assim como a classificação do tumor. Este relato de caso apresenta um Odontoma Composto-Complexo em um paciente de 13 anos, do sexo masculino, atendido em 2016 na Clínica de Diagnóstico Bucal II da Universidade Federal Fluminense, que apresentou elementos dentários 22 e 23 impactados, retenção prolongada do elemento 63 e aumento de volume na região anterior do lado esquerdo da maxila. Para obtenção do diagnóstico foram realizadas: Radiografias Periapicais, Radiografia Panorâmica e Tomografia Computadorizada Cone Beam. O objetivo deste trabalho foi elucidar as formas de diagnóstico por imagem que foram utilizadas neste caso clínico e quais as vantagens de cada exame.

Odontomas are the most common type of odontogenic tumors, defined as a benign malformation, usually diagnosed in the second decade of life, during the investigation of late adjacent teeth eruption or a delay in exfoliation of deciduous teeth. They are divided into two types: compound and complex. The odontoma classified as compound is composed of multiple small tooth-like structures, in several shapes and sizes, surrounded by a thin radiolucent rim. On the other hand, complex odontomas resemble a mass of calcified tissue that presents the same dental tissue radiopacity, also surrounded by a thin radiolucent rim. Occasionally, both aspects can be seen in the same lesion. Often, odontomas can cause a local increase in bone volume due to their development. The diagnosis is made through routine radiographic examination and, when it is necessary, it is possible to make use of panoramic radiographies and cone beam computed tomography with the purpose of verifying its extension, malformations and erupted alterations caused to the adjacent teeth, as well as the tumor classification. This case report presents a Compound-Complex Odontoma in a 13-year-old male patient, treated in 2016 at the Oral Diagnosis Clinic II of the Federal Fluminense University. He presented impacted teeth 22 and 23, delayed eruption of tooth 63 and volume increase in the left anterior maxilla site. Aiming the patient's diagnosis, the following exams were necessary: periapical radiographies, panoramic radiography, cone beam computed tomography. The aim of this paper is to explain the different image diagnostic tools which were used in this clinical study and what are the advantages of each exam.

Factores etiopatogénicos de maloclusión: el factor dentario en la organización de la oclusión. Parte III / Etiopathogenic factors of malocclusion: the dental effect in occlusal organization. Part III

Esta publicación es la última de una serie de tres, dirigida a la organización de la oclusión, en el marco de un enfoque sistémico. En las anteriores fueron desarrollados los temas referidos al espacio en los arcos dentarios restando analizar, entonces, aspectos de la erupción dentaria. Al respecto, se sintetizarán conceptos de la evolución deseable desde el origen de los folículos dentarios hasta su inclusión en el arco y contacto con el antagonista y se presentarán ejemplos de alteraciones ordenadas según el avance biológico de la dentición (AU)

This publication is the last in a series of three, aimed at the organization of occlusion, within the framework of a systemic approach. In the previous ones, the topics related to the space in the dental arches were developed, leaving to analyze, then, aspects of the dental eruption. In this regard, concepts of the desirable evolution from the origin of the dental follicles to their inclusion in the arch and contact with the antagonist will be synthesized, and examples of alterations ordered according to the biological progress of the dentition will be presented (AU)

Unusually Pronounced and Expansive Mandibular Foramen. A Incidental Radiological Finding / Foramen Mandibular Inusualmente Pronunciado y Expansivo: Un Hallazgo Radiológico Incidental

SUMMARY: The mandibular foramen and its canal are one of the most important structures in the skull, as they solely supply the mandible through their associated nerves and vessels. Many anatomical variations have been reported in the literature until now, and this case report represents a clear-cut appearance of its shape in a panoramic radiograph, which is not mostly seen in normal panoramic radiographs. These factors are of utmost importance when it comes to performing various surgeries and preventing complications due to their varied anatomy, which will allow dentists to create a better treatment plan and provide better treatments without any complications.

El foramen mandibular y su canal son algunas de las estructuras más importantes del cráneo y cara, ya que a través de ellos la mandíbula es inervada por nervios e irrigada por vasos. Hasta ahora, en la literatura consultada, se han informado de numerosas variaciones anatómicas. En este trabajo reportamos la forma y trayecto del foramen y canal mandibular, obtenidos en una radiografía panorámica, que no es observada normalmente en este tipo de radiografía. Los factores anatómicos son de importancia a la hora de realizar las cirugías para prevenir complicaciones debido a su variada anatomía, permitiendo a los odontólogos crear un mejor plan de tratamiento sin ningún tipo de complicaciones.

Displasia dentinaria tipo I: Manejo clínico y estudio histológico a propósito de dos casos / Dentin dysplasia type I: clinical management and histological study based on two cases

La displasia dentinaria tipo I (DD-I) corresponde a una alteración dentinaria de heterogeneidad genética y penetrancia completa, en donde se presenta un defecto en el desarrollo de las raíces de los dientes tanto temporales como definitivos. Clínicamente se observan dientes con extrema movilidad junto con antecedentes de exfoliación prematura o espontánea. Los defectos estructurales de los tejidos dentarios, tales como DD-I; implican un desafío ya que son pocos los casos documentados en la literatura que hablan de esta condición. Además implican un tratamiento multidisciplinario y altamente invasivo. El objetivo de este artículo es presentar dos casos de DD-I, enfatizando en su tratamiento y características histopatológicas.

Dentin Dysplasia Type I (DD-I) consists of a pathological dentinary alteration with genetic heterogeneity that results in a defectuous development of dental roots both in primary and secondary dentition. Clinically we can appreciate teeth with extreme pathological mobility and premature or spontaneous exfoliation. Alterations within normal dental structure, such as DD-I imply a challenge for the common practitioner, because of the scarce number of case reports with in the scientific literature regarding this condition and also, because of the need for a highly invasive and multidisciplinary approach they require. The aim of this article is to present two DD-I cases, emphasizing on their treatment and histopathological features.

Glandular Odontogenic Cyst: a Case Report and Literature Review / Quiste Odontogénico Glandular: reporte de Caso y Revisión de la Literatura

The glandular odontogenic cyst (GOC) is a pathological entity that most commonly develops in the anterior region of the mandible and can emulate other lesions, including other cysts, odontogenic tumors, and even malignant lesions of glandular origin. Therefore, the aim of this manuscript is to report a new case of GOC treated conservatively and to discuss its clinical, radiological, histopathological, and therapeutic aspects.

El quiste odontogénico glandular (QOG) es una entidad patológica que se desarrolla con mayor frecuencia en la región anterior de la mandíbula y que puede mimetizar otras lesiones incluyendo otros quistes, tumores odontogénicos y hasta lesiones malignas de origen glandular. Por lo tanto, el objetivo del presente manuscrito es reportar un nuevo caso de QOG tratado de forma conservadora y discutir sus aspectos clínicos, imagenológicos, anatomopatológicos y terapéuticos.

Quistes Dentígeros Asociados a Mesiodens: revisión de la Literatura a Propósito de Dos Casos / Dentigerous Cysts Associated with Mesiodens: review of the Literature Regarding Two Cases

El mesiodens es el diente supernumerario que se origina en la premaxila, siendo considerado el más prevalente o el más diagnosticado debido a las numerosas alteraciones que producen y que incluyen malposición de los dientes permanentes, formación de diastemas, retraso en la erupción de los incisivos anteriores superiores, y formación de quistes. La etiología de los mesiodens no está completamente comprendida, aunque se piensa que pueda deberse a la proliferación de la lámina dental u otros factores genéticos. El diagnóstico generalmente es tardío debido a que la mayoría permanece sin erupcionar, pudiendo generar complicaciones dentomaxilares que finalmente son el motivo de consulta de los pacientes. El quiste dentígero es un quiste odontogénico del desarrollo asociado a la corona de un diente incluido, numerario o supernumerario y su tratamiento es quirúrgico. El diagnóstico temprano y la planificación del tratamiento debe considerar una anamnesis minuciosa, un examen clínico e imágenes 3D. La cirugía debe consistir en la desinclusión del diente causal, la exéresis y legrado de la lesión, con o sin regeneración ósea inmediata del lecho quirúrgico con injerto. Se presentan dos casos de quiste dentígero asociado a un mesiodens que se diagnosticaron como hallazgo radiográfico. El plan de tratamiento consistió en evaluación y tratamiento endodóntico de los dientes desvitalizados, enucleción y legrado del quiste, junto a la desinclu sión del diente supernumerario, y seguimiento clínico y radiográfico en el largo plazo.

Mesiodens is the supernumerary tooth that originates in the premaxilla, considered the most prevalent or, the most diagnosed due to the multiple alterations that produce and that include malposition of the permanent teeth, formation of gaps, delayed eruption of the upper anterior incisors and cyst formation. The etiology of mesiodens is not fully established, although it is thought that it may be due dental lamina alteration or other genetic factors. Diagnosis is usually late because most remain unerupted, and can generate dentomaxillary complications that are ultimately the reason for patient consultation. The dentigerous cyst is a developmental odontogenic cyst associated with the crown of an included, numerary or supernumerary tooth and its treatment is surgery. Early diagnosis and treatment planning should consider a careful history, clinical examination, and 3D imaging. The surgery must consist of the disinclusion of the offending tooth, the exeresis and curettage of the lesion, with or without immediate bone regeneration of the surgical bed with a graft. Two cases of a dentigerous cyst associated with a mesiodens that were diagnosed as a radiographic finding are presented. The treatment plan consisted in evaluation and endodontic treatment of devitalized teeth, enucleation and curettage of the cyst, together with the disinclusion of the supernumerary tooth, and long-term clinical and radiographic follow-up.

Asociación entre Calcificaciones del Complejo Estilohioideo y Síntomas Clínicos en Pacientes Atendidos en el Centro de Salud de la Universidad San Sebastián, Sede Santiago, Chile / Association Between Calcifications of the Stylohyoid Complex and Clinical Symptoms in Patients Treated at the San Sebastián University Health Center, Santiago Campus, Chile

Hoy en día es común recibir pacientes en la clínica odontológica relatando dolor uni o bilateral en la zona lateral de la cara, más específicamente en la zona de las ramas mandibulares. Este dolor puede ser muchas veces de origen dental, muscular masticatorio, de las articulaciones temporomandibulares, o incluso tonsilar. Debido a que las anteriores son patologías más frecuentes, muchas veces el clínico no considera que la causa de estos dolores podría estar asociada al síndrome de Eagle. Esta investigación se fundamentó en la necesidad de utilizar las radiografías panorámicas como herramienta para asociar dolores que no remiten a tratamientos convencionales a calcificaciones del complejo estilohioideo, muchas veces hallazgos radiográficos que no son comúnmente tomados en consideración por el clínico. El objetivo del estudio fue eterminar la asociación entre calcificaciones del complejo estilohioideo en radiografías panorámicas y sintomatología clínica dolorosa en pacientes del centro de salud de la Universidad San Sebastián, sede Santiago, Chile. Se realizó un estudio correlacional, analítico y retrospectivo en el Centro de Salud de la Universidad San Sebastián. Se tomó una muestra aleatoria de 815 radiografías y fichas clínicas asociadas, en las cuáles se analizó la presencia, tipo y ubicación de calcificaciones del complejo estilohioideo, así como, si los pacientes relataron sintomatología dolorosa asociable al Síndrome de Eagle. Posteriormente se realizó un análisis descriptivo, exploratorio e inferencial de asociación entre variables. El porcentaje de pacientes que presentó calcificaciones del complejo estilohioideo alcanzó un 85,4%, siendo la mayoría de tipo elongado (70,98%), seguida del tipo segmentado (26,72%) y muy por debajo el tipo pseudoarticulado (2,3%). Con respecto a la prevalencia de sintomatología la gran mayoría de los pacientes no presentó (96,32%), sin verse diferencias según sexo o edad. Por último, al realizar el análisis de asociación el valor de X 2 calculado fue de 3,171, menor al valor de X2 crítico tabulado de 3,841. Al obtener un X2 calculado menor a un X2 crítico tabulado se demostró que no existe una asociación entre la presencia de calcificaciones del complejo estilohioideo y sintomatología clínica asociada. Además, las prevalencias de calcificaciones y sus tipos no variaron según la edad o género, lo que no nos permitió establecer una relación causal entre las variables.

Nowadays it is very common to receive patients in the dental clinic reporting unilateral or bilateral pain in the lateral area of the face, more specifically in the mandibular rami area. The origin of this pain can often be dental, muscular, from the temporomandibular joint or even tonsillar. Because the named pathologies are more frequent, many times the clinician does not consider that the cause of this pain could be associated with Eagle syndrome. This research was based on the need to use panoramic radiographs as a tool to associate pain that does not refer to conventional treatments with calcifications of the stylohyoid complex, many times radiographic findings that are not commonly considered by the clinician. This correlational cross analytical study was carried out at San Sebastián University Health Center. A random sample of 815 radiographs and associated clinical records was taken, in which the presence, type and location of calcifications of the stylohyoid complex were analyzed, as well as whether the patients reported painful symptoms associated with Eagle syndrome. Subsequently, a descriptive, exploratory, and inferential analysis of association between variables was conducted. The percentage of patients who presented calcifications of the stylohyoid complex reached 85.4%, being the majority the elongated type (70.98%), followed by the segmented type (26.72%) and far below the pseudoarticulated type (2.3%). Regarding the prevalence of symptoms, the vast majority of patients did not present (96.32%), without seeing differences according to gender or age. Finally, when performing the association analysis, the calculated X2 value was 3.171, lower than the critical tabulated X2 value of 3.841. Obtaining a calculated X2 lower than a critical tabulated X2 showed that there is no association between the presence of calcifications of the stylohyoid complex and associated clinical symptoms. In addition, the prevalence of calcifications and their types did not vary according to age or gender, which did not allow us to establish a causal relationship between the variables.

Protocolo BAMP: reporte de Caso Clínico / BAMP Protocol: a Case Report

El presente reporte tiene como objetivo presentar de manera secuencial y visual la protracción maxilar de un paciente clase III esqueletal, utilizando el protocolo BAMP. Una vez realizado el análisis clínico del caso se decidió realiza un tratamiento ortopédico a través del uso de miniplacas de titanio con elásticos intermaxilares de clase III siguiendo el protocolo BAMP, junto a un tratamiento ortodóncico dento alveolar con aparatología fija bimaxilar prescripción Roth 0.22" Mini sprint forestadent. Se observa el éxito del enfoque interceptivo utilizando el protocolo BAMP. Este enfoque logró reducir tanto el tiempo como la complejidad del tratamiento ortodóncico, y también disminuyó la necesidad de someterse a una cirugía ortognática en la edad adulta. El tratamiento BAMP, diseñado para ciertas edades y crecimiento, se demostró exitoso en un paciente de 12 años sin potencial de crecimiento. Las miniplacas como anclaje son efectivas para protracción maxilar en varios casos, aunque se necesita seguimiento y educación postquirúrgica. Se recomienda retirar las miniplacas cuando no sean necesarias, adaptando el protocolo a cada paciente. En resumen, el tratamiento con miniplacas es eficaz para corregir anomalías Clase III esqueléticas.

The present report aims to sequentially and visually present the maxillary protraction of a Class III skeletal patient using the BAMP protocol. After conducting a clinical analysis of the case, it was decided to perform orthopedic treatment using titanium miniplates with Class III intermaxillary elastics following the BAMP protocol, in conjunction with dentoalveolar orthodontic treatment using fixed bimaxillary appliances with Roth prescription 0.022" Mini Sprint Forestadent. The success of the interceptive approach using the BAMP protocol is observed. This approach managed to reduce both the time and complexity of orthodontic treatment and also decreased the need for orthognathic surgery in adulthood. The BAMP treatment, designed for specific ages and growth stages, proved successful in a 12-year-old patient without growth potential. Miniplates as anchorage are effective for maxillary protraction in various cases, although post-surgical follow-up and education are required. It is recommended to remove the miniplates when they are no longer necessary, adapting the protocol to each patient. In summary, miniplate treatment is effective in correcting Class III skeletal anomalies.

Utility of Panoramic Radiographs in the Screening of Individuals with Edentulous Arches: A Need-Analysis Study

Abstract Objective: To evaluate the utility of panoramic radiographs in pre-prosthetic screening of edentulous arches. Material and Methods: Panoramic radiographs taken for three years were retrospectively analyzed. Observations from the radiographs shall be categorized and classified into either of the two categories, namely: 'findings with minimal impact on denture fabrication' and 'findings which affect denture fabrication and require further evaluation.' Anatomic variations, jaw pathologies, and residual ridge resorption patterns were assessed. Results: This study included the initial screening of 23,020 panoramic radiographs, out of which 505 (showing either one or both edentulous arches) were included for the study purpose. The age range of the subjects was from 21 to 94 years. 52.6% of the radiographs showed positive findings. More than half of the radiographs belonged to the males (52.5%). Hyperpneumatization of the maxillary sinus, crestal position of the mental foramen, and retained root fragments were the most common entities noted in the radiographs. Changes in the mental foramen were significantly higher in males than females (p=0.002). Conclusion: Observations from this study showed that panoramic radiographs have high utility for screening edentulous arches, and they should be used in routine clinical practice before denture fabrication.

Análisis radiográfico comparativo de tratamientos endodónticos: su posible aporte en la identificación forense / Comparative radiographic analysis of endodontic treatments: its possible contribution to forensic identification

Introducción: La identificación por cotejo de regis-tros odontológicos representa una metodología científicamente consolidada. La estrategia más co-mún reside en la comparación de odontogramas impresos o digitalizados, aunque se ha cuestionado cierta subjetividad al asentar dicha información. Los recursos imagenológicos constituyen una evidencia más confiable y objetiva, reduciendo el sesgo iden-tificatorio. La obtención de radiografías post mor-tem (PM) reproduciendo en lo posible las técnicas que han generado las imágenes ante mortem (AM) recuperadas, otorga una eficaz modalidad compa-rativa, aumentando su valor probatorio. Materiales y Métodos: Se efectuó la comparación entre radio-grafías panorámicas y periapicales tomadas a 10 pacientes atendidos en un consultorio particular de la ciudad de Quilmes, Provincia de Buenos Aires, don-de se visualizaban tratamientos de endodoncia. Los registros de ambas técnicas de imágenes se realiza-ron sobre los mismos sujetos entre los años 2010 y 2022. Se cotejaron 11 radiografías periapicales y 10 panorámicas, procediéndose a la digitalización de la totalidad de la muestra. Se clasificaron las imágenes de cada persona conforme a la fecha de obtención de las mismas. A las más antiguas se las catalogó con el color verde, representando el material AM, mien-tras que las más recientes se marcaron en color rojo, constituyendo la información PM. Resultados: Teniendo en cuenta los criterios estipulados por la Junta Americana de Odontología Forense (ABFO) se identificaron positivamente 7 casos estudiados, 2 fueron catalogados como identificación posible, en tanto que 1 se clasificó como insuficiente. No se re-gistraron exclusiones. Conclusión: Los tratamientos endodónticos podrían suministrar información pon-derable en procesos de identificación humana en virtud de la escasa probabilidad de sufrir alteracio-nes morfológicas y estructurales por su estratégica localización intradentaria, otorgando posibilidades concretas de establecer la identidad categórica de sujetos desconocidos (AU)

Introduction: Identification by comparison of dental records represents a scientifically consolidated methodology. The most common strategy lies in the comparison of printed or digitised odontograms, although certain subjectivity has been questioned when recording said information. Imaging resources constitute more reliable and objective evidence, reducing identification bias. Obtaining post-mortem (PM) radiographs reproducing the techniques that have generated the recovered ante-mortem (AM) images, provides an effective comparative modality, increasing its evidentiary value. Materials and Methods: A comparison was made between panoramic and periapical radiographs taken to 10 patients treated in a private office in the city of Quilmes, Province of Buenos Aires, where endodontic treatments were visualized. The records of both imaging techniques were carried out on the same subjects between 2010 and 2022. 11 periapical and 10 panoramic radiographs were collected, and the entire sample was digitized. The images of each person were classified according to the date they were obtained. The oldest ones were cataloged with the color green, representing the AM material, while the most recent ones were marked in red, constituting the PM information. Results: Taking into account the criteria stipulated by the American Board of Forensic Odontology (ABFO), 7 cases studied were positively identified, 2 were classified as possible identification, while 1 was classified as insufficient. No exclusions were recorded. Conclusion: Endodontic treatments could provide valuable information in human identification processes due to the low probability of suffering morphological and structural alterations due to their strategic intradental location, providing concrete possibilities of establishing the categorical identity of unknown subjects (AU)

Control radiográfico de trasplante dentario: reporte de caso / Radiographic control of dental transplantation: a case report

El trasplante dentario es una opción terapéutica para reemplazar un órgano dental perdido, causado por un proceso carioso extenso, agenesia, trauma-tismos o iatrogenias. Este procedimiento quirúrgico traslada un órgano dental íntegro desde un alveolo donante hacia su lecho receptor; para lo cual debe poseer ciertas características que permitan tener un pronóstico favorable a largo plazo. El presente estudio describe la evolución de un trasplante dental autólogo realizado hace 14 años a una paciente que acudió a la consulta para valoración del órgano den-tal 4.7, el que presentó un pronóstico desfavorable, por lo cual se realizó exodoncia y trasplante inme-diato del diente vital 4.8 al alveolo del órgano dental 4.7. Tras la planificación quirúrgica se procedió con la intervención conservando la vitalidad pulpar del diente a ser trasplantado, se realizó control clínico y radiográfico a los 15 días, 30 días, 6 meses, 1 año, 5 años y 14 años, en el que se observó conservación del paquete vasculonervioso y ligamento periodontal del órgano dental; a su vez se pudo evidenciar rizo-génesis en el diente trasplantado y un aumento de la altura del proceso alveolar, mediante mediciones realizadas en Auto CAD 2023 (AU)

Tooth transplantation is a therapeutic option to re-place a lost dental organ, caused by an extensive carious process, agenesis, trauma or iatrogenesis. This surgical procedure transfers a complete den-tal organ from a donor alveolus to its recipient bed; for which it must have certain characteristics that allow it to have a favorable long-term prognosis. The present study describes the evolution of an autolo-gous dental transplant carried out 14 years ago to a female patient who attended the consultation for evaluation of the dental organ 4.7, the same one that presented an unfavorable prognosis, for which an extraction and immediate transplantation of the 4.8 vital tooth was performed to the alveolus of the den-tal organ 4.7. After surgical planning, the intervention was carried out preserving the pulpal vitality of the tooth to be transplanted; clinical and radiographic control was performed at 15 days, 30 days, 6 months, 1 year, 5 years and 14 years, in which preservation of the vascular-nervous bundle and periodontal liga-ment of the dental organ was observed; in turn, rhizo-genesis in the transplanted tooth and an increase in the height of the alveolar process could be evidenced, through measurements made in Auto CAD 2023 (AU)

Evaluation of Diagnostic Values of a Gender Discrimination Function, Based on Mandibular Dimorphic Parameters in Iranian Population

Abstract Objective: To evaluate mandibular dimorphic parameters for sex determination by using panoramic radiographs and comparing the results with another equation. Material and Methods: In this analytical-descriptive study, the mandible variables, including the ramus height, the coronoid height, the mental height, and the distance between the right and left condyle, were measured in 326 panoramic radiographs. The discriminant function of the statistical method has previously been used to evaluate the diagnostic value of sex. The level of significance was considered 0.05. Results: The detection function obtained was statistically significant in quantitative correlation (p<0.001) with 99% agreement. Moreover, good sensitivity (81.72%), specify (80.25%), and moderate to good predictive values (PPV: 62.29 and NPV:91.6) were found. Among the mandibular parameters, chin height, ramus height, coronoid height, and distance between two condyles showed the highest gender dimorphism. Conclusion: Chin height, and ramus height have the most quality in gender dimorphism. A unique gender discrimination function has been obtained from the results.

Sex Determination in the Contemporary Chilean Population by Mandible Analysis in Panoramic Radiographies / Estimación Sexual de la Población Chilena Contemporánea Mediante Análisis de la Mandíbula en Radiografías Panorámicas

SUMMARY: Sex identification of a deceased human individual by means of the mandible is very important for forensic dentistry. The aim of the present study was to determine the sex of Chilean individuals by mandible analysis in panoramic radiographies. Linear and angular parameters of the mandible were analyzed from panoramic radiographies (PR). The study included PR of adult Chilean individuals, of both sexes, with optimum solution and contrast, and which allowed the angles and rami of the mandible to be viewed. Sex was determined by univariate and bivariate discriminant function analysis. The sample consisted of 594 PR of individuals aged between 18 and 84 years. The best sex predictor using univariate discriminant function analysis was the mandibular ramus height (MRH) (74.1 %), followed by the distance from the mental foramen - mandibular base (DMF-MB) (69.1 %) and the bicondylar breadth (BC) (66.7 %). The parameters that presented the lowest sex prediction were the angle of the mandible (AM) with 55.0 % and the distance between mental foramina (DMF) with 53.7 %. The best sex prediction was obtained by the step model of discriminant function analysis (80.2 %), including only three parameters: MRH, BC and DMF-MB. The parameters height of the mandibular ramus, bicondylar breadth and distance from the mental foramen - base of the mandible are good predictors of sex in Chilean individuals when used in conjunction; they are therefore indicated for sex determination in the contemporary Chilean population.

La identificación humana de un individuo fallecido a través de la mandíbula es muy relevante para la odontología forense. El objetivo de este estudio fue estimar el sexo de individuos Chilenos a través del análisis de la mandíbula, utilizando radiografías panorámicas. Fueron analizados parámetros lineales y angulares de la mandíbula, a través de radiografías panorámicas (RP). Se incluyeron RP de individuos chilenos adultos, ambos sexos, con solución y contraste óptimos, y que permitían la visualización de los ángulos y ramas de la mandíbula. Se realizó análisis por función discriminante univariada y bivariada para estimación del sexo. Fueron incluidas 594 RP de individuos entre 18 y 84 años. Para el análisis de función discriminante univariado, la altura de la rama mandibular (ARM) fue el parámetro más predictivo (74,1 %), seguido de la distancia foramen mentoniano - base de la mandíbula (DFM-BM) (69,1 %) y el ancho bicondilar (ABCo) (66,7 %). Los parámetros que presentaron menor predicción sexual fueron el ángulo de la mandíbula (AM) con un 55,0 % y la distancia inter-forámenes mentonianos (DIFM), con el 53.7 %. El análisis por pasos fue el modelo de análisis de función discriminante que presentó la mayor predicción sexual (79,5 %), en el cual fueron incluidos sólo tres parámetros: ARM, ABCo y DFM-BM. Los parámetros altura de la rama de la mandíbula, ancho bicondilar y distancia desde el foramen mentoniano hasta la base de la mandíbula son buenos predictores del sexo en individuos Chilenos cuando utilizados en conjunto y están indicados para estimar el sexo en la población chilena contemporánea.

Exodoncia de diente supernumerario geminado en maxilar superior / Extraction of a geminated supernumerary tooth in upper jaw

Introducción: Los dientes supernumerarios constituyen una anomalía de número en la cual se excede la cantidad normal de piezas dentales. La geminación es una anomalía de forma que se caracteriza por la presencia de una corona bífida y una raíz común. Los dientes supernumerarios geminados son de rara aparición; indicar exámenes imagenológicos son importantes para determinar sus características y su relación con las estructuras vecinas. Objetivo: Presentar el caso clínico de un paciente con un diente supernumerario geminado. Caso clínico: Paciente de sexo masculino de 23 años de edad, acude a la consulta odontológica por presentar una elevación del lado izquierdo en el paladar, sin molestias. En el examen clínico se observa un aumento de volumen de mucosa palatina de piezas dentales 24 y 25. Los exámenes de imagen fueron realizados y se diagnosticó un diente supernumerario geminado retenido, se realizó tratamiento quirúrgico y el paciente evolucionó favorablemente. Conclusión: Los dientes supernumerarios geminados son poco frecuentes, una oportuna y correcta evaluación imagenológica, le permitirá al clínico realizar un adecuado diagnóstico y tratamiento(AU)

Introduction: Supernumerary teeth constitute an anomaly of number where the normal number of teeth is exceeded and gemination is an anomaly of shape characterized by the presence of a bifid crown, a common root. Geminate supernumerary teeth are of rare occurrence; indicating imaging examinations are important to determine their characteristics and their relationship with neighboring structures. Objective: To present the clinical case of a patient with a geminate supernumerary tooth. Clinical case: A 23-year-old male patient came to the dental office due to an elevation on the left side of the palate, without discomfort. In the clinical examination, an increase in the volume of the palatal mucosa of teeth 24 and 25 was observed. The imaging examinations were performed and a retained geminated supernumerary tooth was diagnosed, surgical treatment was performed and the patient progressed favorably. Conclusion: Geminate supernumerary teeth are rare; a timely and correct imaging evaluation will allow the clinician to make an adequate diagnosis and treatment(AU)

Variation in mandible shape and size due to osteoporosis: Geometric morphometrics study

Objective: Assessing whether it is possible screening women with osteoporosis through geometric morphometrics based on panoramic x-ray. Materials and Methods: Leukoderma women, after menopause, 40 years old (or older), with confirmed medical diagnosis of presence, or absence, of osteoporosis through bone densitometry examination. (N = 62). Measurements taken through panoramic X-ray based on geometric morphometrics. All x-rays were taken twice by the same researcher. Procrustes superimposition was assessed through Cartesian coordinates generated from anatomic landmark and semilandmarks. Regression Analysis, Multivariate Analysis of Variance (MANOVA), discriminant function and cross validation analysis, and Thin plate spliness in MorphoJ software were carried out. Subsequently, Fluctuating Asymmetry Analysis (FA) was conducted and ANOVA was performed to assess differences in centroid size. Results: Significant values were recorded for mandible shape (p<0.01) through MANOVA. Significant values (P<0.01) were also found through discriminant function analysis between groups of women with, and without, osteoporosis. Fluctuating asymmetry analysis showed significant differences in mandible shape and size between sides (p<0.01). Conclusions: Geometric morphometrics proved to be effective in screening and identifying elderly leukoderma women with, or without, osteoporosis based on panoramic x-rays. This is a promising technique to diagnose or identify patients with some health condition.

Quiste dentígero en relación con tercer molar inferior retenido / A Dentigerous Cyst Related to Retained Lower Third Molar

Introducción: El quiste dentígero es un quiste odontogénico, casi siempre asociado a la corona de un diente retenido. Sus ubicaciones más frecuentes son la zona de tercer molar inferior y canino superior. Objetivo: Caracterizar la presentación de un quiste dentígero en un paciente adulto. Presentación de caso: Se presentó el caso de una paciente de 27 años de edad que acude a consulta por presentar sensación de opresión, dolor e inflamación en región de tercer molar inferior izquierdo. Al examen oral se observa tejido dentario en correspondencia con molar 38 parcialmente brotado con ligero edema de la mucosa a su alrededor. En radiografía panorámica se observa imagen radiolúcida en relación con cara mesial del 38 con discreto halo radiopaco, redondeada, compatible con un quiste dentígero. Conclusiones: Un diagnóstico a tiempo de estas lesiones constituye la clave para un tratamiento exitoso y menos invasivo, lo cual evitaría complicaciones mayores como la malignización, el crecimiento exagerado que puede ocasionar deformidad facial y la disfunción masticatoria permanente(AU)

Introduction: Dentigerous cyst is an odontogenic cyst, almost always associated with the crown of a retained tooth. Its most frequent locations are the areas of the lower third molar and the upper canine. Objective: To characterize the presentation of a dentigerous cyst in an adult patient. Case presentation: The case is presented of a 27-year-old female patient who came to the clinic with a sensation of pressure, pain and inflammation in the region of the lower left third molar. Oral examination permits to observe some dental tissue corresponding with molar 38 partially erupted with slight edema of the surrounding mucosa. Panoramic radiograph shows a radiolucent image related to the mesial side of 38, with a discrete radiopaque halo, rounded, compatible with a dentigerous cyst. Conclusions: A timely diagnosis of these lesions is the key to a successful and less invasive treatment, which would avoid major complications, such as malignization, the exaggerated growth that can cause facial deformity and permanent masticatory dysfunction(AU)

Nasopalatine Duct Cyst in a 31 Year-Old Male: Imaging Findings in Computed Tomography / Quiste del Canal Nasopalatino en un Hombre de 31 años: Hallazgos en Imágenes de Tomografía Computarizada

A 31-year-old man is presented and is evaluated by panoramic radiography. As a finding, an extensive lesion with a cystic appearance was detected in the anterior part of the maxilla. Computed tomography shows a lesion corresponding to the characteristics of a cyst. In the histology the combination of two types of epithelium is observed, pseudostratified columnar and stratified squamous, confirming that this was a nasopalatine duct cyst.

Se presenta el caso de un hombre de 31 años, evaluado mediante radiografía panorámica. Como hallazgo se detecta una extensa lesión de aspecto quístico en la parte anterior del maxilar. En la tomografía computada se observa una lesión que corresponde a las carácterísticas de un quiste. La histología muestra una combinación de dos tipos de epitelio, pseudostratificado columnar y estratificado escamoso, confirmando que se trataba de un quiste del canal nasopalatino.

Aspectos clínicos, radiográficos e estratégias terapêuticas da Síndrome de Eagle: revisão de literatura / Clinical, radiographic aspects and therapeutic strategies of Eagle Syndrome: literature review

Objetivo: Este trabalho tem como propósito fornecer uma análise abrangente das características anatômicas, clínicas e radiográficas da Síndrome de Eagle, além de abordar os métodos de diagnóstico e estratégias terapêuticas. Materiais e métodos: Foi realizada uma busca por artigos científicos publicados no período de 2016 a 2024, utilizando as bases de dados Scientific Electronic Library Online (SciELO), US National Library of Medicine (PubMed) e Google Scholar. A coleta de artigos foi realizada nos idiomas inglês e português, utilizando as palavras-chave: "síndrome de eagle", "síndrome estiloide", "síndrome da artéria carótida", "estilalgia", "eagle syndrome", "styloid syndrome", "carotid artery syndrome" e "stylalgia". Conclusão: Os profissionais devem estar atentos à síndrome de Eagle em casos de dor unilateral ao realizar atividades como engolir, bocejar e chorar, sem causa aparente, especialmente em mulheres adultas que não encontram alívio com analgésicos. Devido à frequência de casos assintomáticos, a realização precoce de exames radiológicos desempenha um papel crucial na avaliação diagnóstica. É essencial que profissionais de Otorrinolaringologia, Neurologia e Odontologia estejam cientes dessa síndrome, pois está associada a uma significativa deterioração na qualidade de vida. (AU)

Objective: This work aims to provide a comprehensive analysis of the anatomical, clinical and radiographic characteristics of Eagle Syndrome, in addition to addressing diagnostic methods and therapeutic strategies. Materials and methods: A search was carried out for scientific articles published between 2016 and 2024, using the Scientific Electronic Library Online (SciELO), US National Library of Medicine (PubMed) and Google Scholar databases. Articles were collected in English and Portuguese, using the keywords: "eagle syndrome", "styloid syndrome", "carotid artery syndrome", "stilalgia", "eagle syndrome", "styloid syndrome", "carotid artery syndrome" and "stylalgia". Conclusion: Professionals should be aware of Eagle syndrome in cases of unilateral pain when performing activities such as swallowing, yawning and crying, without an apparent cause, especially in adult women who do not find relief with analgesics. Due to the frequency of asymptomatic cases, early radiological examinations play a crucial role in diagnostic evaluation. It is essential that Otorhinolaryngology, Neurology and Dentistry professionals are aware of this syndrome, as it is associated with a significant deterioration in quality of life. (AU)

Abordagem de incisivos centrais superiores traumatizados: relato de caso / Approach to traumati zed maxillary central incisors: case report

Introdução: O traumatismo dentário é uma ocorrência frequente durante a infância e adolescência. Geralmente, o diagnóstico acontece de forma tardia, devido à falta de conhecimento da população. Cada tipo de trauma necessita de uma conduta única e especializada. Nos casos de comprometimento pulpar, é necessário cuidado quanto à escolha da técnica a ser empregada, bem como a seleção da medicação intracanal que, por sua vez, apresenta grande interferência no sucesso do tratamento. Não obstante o avanço das técnicas de instrumentação, a troca da medicação entre as sessões nesses casos é mandatória. Relato de caso: Um paciente, sexo masculino, em idade escolar (15 anos) apresentou-se ao serviço de saúde bucal com relato de escurecimento e dores na mastigação após trauma dentário durante a infância. Os testes de vitalidade pulpar revelaram necrose pulpar, com resultado negativo no teste térmico e positivo na percussão. O exame radiológico evidenciou uma lesão apical, juntamente com reabsorção externa no elemento 21, confirmado em tomografia. O paciente foi submetido a um tratamento endodôntico. Resultado: Após o tratamento, foi solicitado novo exame tomográfico, em que se evidenciou um processo de cicatrização óssea no periápice e reabsorção por substituição na lesão cervical. Conclusão: A partir deste caso clínico, pôde-se evidenciar a importância do diagnóstico adequado, do manejo e da técnica endodôntica eficaz na resolução de problemas decorrentes de traumas dentários em pacientes jovens.

Introduction: Dental trauma is a frequent occurrence during childhood and adolescence. Generally, diagnosis happens late, due to lack of knowledge among the population. Each type of trauma requires a unique and specialized approach. In cases of pulp involvement, care must be taken when choosing the technique to be used, as well as the selection of intracanal medication, which, in turn, has a major impact on the success of the treatment. Despite advances in instrumentation techniques, changing medication between sessions in these cases is mandatory. Case report: A male patient of school age (15 years old) presented to the oral health service with reports of darkening and pain when chewing following dental trauma during childhood. Pulp vitality tests revealed pulp necrosis, with a negative result in the thermal test and positive in percussion. The radiological examination showed an apical lesion, together with external resorption in element 21, confirmed on tomography. The patient underwent endodontic treatment. Result: After treatment, a new tomographic examination was requested, which showed a process of bone healing in the periapex and resorption by replacement in the cervical lesion. Conclusion: From this clinical case, it was possible to highlight the importance of adequate diagnosis, management, and effective endodontic technique in solving problems arising from dental trauma in young patients.

Lesión Fibro-ósea de Mandíbula: Un Hallazgo Radiográfico / Fibro-osseous Lesion of the Mandible: A Radiographic Finding

Las lesiones fibro-óseas son consideradas benignas y componen un grupo de patologías de desórdenes que se caracterizan por el reemplazo de un hueso normal por un tejido compuesto de fibras colágenas, fibroblastos y tejido mineralizado. Presentamos un hallazgo radiográfico obtenido de un paciente de sexo masculino de 41 años de edad que asiste a un centro de radiología para realizarse una radiografía panorámica, el examen revela un interesante hallazgo radiográfico en la hemi mandíbula izquierda, donde se observa una lesión fibro-ósea con expansión ósea a nivel de reborde marginal y cortical basal mandibular, desplazamiento de canal mandibular, desplazamiento dentario, compromiso de cortical alveolar y rizálisis en diferentes niveles en los dientes adyacentes a la lesión. De acuerdo a los antecedentes anteriores se establece una hipótesis diagnóstica de Fibroma Osificante de larga data debido a su radiopacidad. La Organización Mundial de la Salud lo clasifica como una neoplasia ósea benigna con afección al esqueleto craneofacial, de mayor incidencia en mandíbula, se presenta generalmente entre la 3º y 4º década de vida. Concluimos que las lesiones fibro-óseas pueden ser detectadas como un hallazgo radiográfico, esto es relevante para un tratamiento precoz, sin embargo, el diagnóstico debe realizarse complementando los antecedentes clínicos e histopatológicos de la lesión, poniendo especial atención en el diagnóstico diferencial.

Fibro-osseous lesions are considered benign and make up a group of disorder pathologies that are characterized by the replacement of normal bone by tissue composed of collagen fibers, fibroblasts, and mineralized tissue. We present a radiographic finding obtained from a 41-year-old male patient who attended a radiology center for a panoramic radiograph. The examination revealed an interesting radiographic finding in the left hemi-mandible, where a fibro-osseous lesion was observed. with bone expansion at the level of the marginal ridge and basal mandibular cortex, displacement of the mandibular canal, dental displacement, compromise of the alveolar cortex and rizalysis at different levels in the teeth adjacent to the lesion. According to the previous antecedents, a long-standing diagnostic hypothesis of Ossifying Fibroma is established due to its radiopacity. The World Health Organization classifies it as a benign bone neoplasm affecting the craniofacial skeleton, with the highest incidence in the jaw, generally presenting between the 3rd and 4th decade of life. We conclude that fibro-osseous lesions can be detected as a radiographic finding, this is relevant for early treatment, however the diagnosis must be made by complementing the clinical and histopathological history of the lesion, paying special attention to the differential diagnosis.