Reproducibility of cone-beam computed tomographic measurements of bone plates and the interdental septum in the anterior mandible

PURPOSE: This study aimed to introduce a novel method to evaluate the alveolar bone and interdental septum in the anterior mandible using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Fifty-six CBCT scans from adult patients were selected. The CBCT scans were obtained before and after orthodontic treatment. The following measurements were taken: width of the alveolar bone and the interdental septum, height of the interdental septum, height of the bone plates, distance between the cementoenamel junction and marginal bone crests, and vertical positioning of the mandibular incisor, using the lingual plane as a reference. To test the reproducibility and the stability of the lingual plane, a triangle was traced in the anterior mandible. The intra-class correlation coefficient (ICC) was used to determine intra- and inter-examiner agreement. The paired Student t-test was used to evaluate the area of the triangle and the reproducibility of all measurements. RESULTS: The ICC was excellent for the alveolar bone and dental measurements (0.9989 and 0.9977, respectively), as well as for the interdental septum (0.9987 and 0.9961, respectively). The area of the triangles showed stability in the lingual plane (P>0.05). For the alveolar bone, mandibular incisor, and interdental septum measurements, no statistically significant differences were found between the 2 examiners (P>0.05), confirming the technical reliability of the measurements. CONCLUSION: The method used in this study provides a valid and reproducible assessment of alveolar bone dimensions in the anterior mandible measured on CBCT images.

Mandibular coronoid process hyperplasia: a case report / Hiperplasia do processo coronóide da mandíbula: relato de caso

ABSTRACT Coronoid Process Hyperplasia is a rare condition characterized by the increase in size of a histologically normal bone. It can be confused with Temporomandibular Joint Dysfunction, due to the presence of major signs/symptoms, including the limitation of mouth opening, pain, and facial asymmetry. Although several theories have been proposed, the etiology remains unknown. The recommended treatment is mandibular coronoidectomy. In the present study, the importance of computed tomography to reach the proper diagnosis and the surgical treatment plan is demonstrated.

RESUMO A hiperplasia do processo coronóide é uma condição rara caracterizada pelo aumento de tamanho de um osso histologicamente normal. É comumente confundida com a Disfunção da Articulação Temporomandibular por apresentar como principais sinais/ sintomas a limitação da abertura bucal, dor e assimetria facial. Sua etiologia ainda é desconhecida e várias teorias têm sido propostas. O tratamento de escolha é a coronoidectomia mandibular. Nesse trabalho a proposta é demonstrar a importância da tomografia computadorizada para o diagnóstico e para o plano de tratamento cirúrgico.

Utilização de tomografia computadorizada de feixe cônico para identificação de fissuras palatinas: relato de caso clínico

Objetivo: o objetivo deste trabalho é relatar o caso de uma paciente do sexo feminino, de 14 anos de idade, submetida a alguns exames radiográficos e tomográficos para iniciar um tratamento cirúrgico-reabilitador associado à fissura palatina. Relato de caso: em todos os exames realizados, foi possível identificar tal anomalia, mas, por meio da tomografia computadorizada cone beam e suas reconstruções tridimensionais, foi possível observar toda extensão e profundidade das fendas, contribuindo para realização de um planejamento cirúrgico seguro e previsível. Considerações finais: a tomografia computadorizada de feixe cônico (cone beam) favorece o diagnóstico por imagem em diversas especialidades odontológicas. Porém, devemos saber exatamente quais são as suas indicações e vantagens frente aos exames radiográficos convencionais. Os pacientes com fissuras palatinas necessitam de intervenção cirúrgica de acordo com o tipo e o grau de sua fenda palatina para reabilitação estética e funcional.

Accuracy of various imaging methods for detecting misfit at the tooth-restoration interface in posterior teeth

PURPOSE: The present study aimed to evaluate which of the following imaging methods best assessed misfit at the tooth-restoration interface: (1) bitewing radiographs, both conventional and digital, performed using a photostimulable phosphor plate (PSP) and a charge-coupled device (CCD) system; (2) panoramic radiographs, both conventional and digital; and (3) cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Forty healthy human molars with class I cavities were selected and divided into 4 groups according to the restoration that was applied: composite resin, composite resin with liner material to simulate misfit, dental amalgam, and dental amalgam with liner material to simulate misfit. Radiography and tomography were performed using the various imaging methods, and the resulting images were analyzed by 2 calibrated radiologists. The true presence or absence of misfit corresponding to an area of radiolucency in regions subjacent to the esthetic and metal restorations was validated with microscopy. The data were analyzed using a receiver operating characteristic (ROC) curve, and the scores were compared using the Cohen kappa coefficient. RESULTS: For bitewing images, the digital systems (CCD and PSP) showed a higher area under the ROC curve (AUROC) for the evaluation of resin restorations, while the conventional images exhibited a larger AUROC for the evaluation of amalgam restorations. Conventional and digital panoramic radiographs did not yield good results for the evaluation of resin and amalgam restorations (P .05), but showed no discriminatory ability for amalgam restorations (P < .05). CONCLUSION: Bitewing radiographs (conventional or digital) should be the method of choice when assessing dental restoration misfit.

Radiographic and computed tomography monitoring of a fractured needle fragment in the mandibular branch

Some complications can arise with the usage of local anesthesia for dental procedures, including the fracture of needles in the patient. This is a rare incident, usually caused by the patient's sudden movements during anesthetic block. Its complications are not common, but can include pain, trismus, inflammation in the region, difficulty in swallowing, and migration of the object, which is the least common but has the ability to cause more serious damage to the patient. This report describes a case in which, after the fracture of the anesthetic needle used during alveolar nerve block for exodontia of the left mandibular third molar, the fragment moved significantly in the first 2 months, before stabilizing after the third month of radiographic monitoring.

Ossifying fibroma: report on a clinical case, with the imaging and histopathological diagnosis made and treatment administered / Fibroma ossificante: relato de caso clínico, diagnóstico imaginológico e histopatológico e tratamento feito

The aim was to report on a case of ossifying fibroma, consisting of a benign fibro-osseous lesion characterized by slow growth and proliferation of fibrous cellular tissue, bone, cement or a combination. A 29-year-old male patient was attended at a hospital, after he had suffered a car accident. During the clinical examination, increased volume in the region of the right side of the mandible was observed, and a fracture in the middle third of the face was suspected. The tomographic examination showed an image suggestive of fracturing of the left-side zygomatic complex, without displacement, and with a well-delimited radiopaque image of the mandible. The patient was sent to a hospital where panoramic radiography, posteroanterior radiography of the face and teleradiography were performed in order to better document the case. An incisional biopsy was performed. Histopathological examination showed the presence of a benign bone lesion suggestive of ossifying fibroma. Surgery was performed in order to completely remove the lesion, with fixation using a reconstruction plate. A new anatomopathological examination confirmed the diagnosis.

Relatar um caso de fibroma ossificante, uma lesão fibro-óssea benigna caracterizada por crescimento lento e proliferação de tecido celular fibroso, osso, cemento ou uma combinação. Paciente do sexo masculino, 29 anos, foi atendido em um serviço de emergência, após sofrer um acidente automobilístico. Durante o exame clínico observou-se um aumento de volume na região mandibular direita e suspeita de fratura no terço médio da face. O exame tomográfico demonstrou imagem sugestiva de fratura do complexo zigomático esquerdo, sem deslocamento, e imagem radiopaca bem delimitada na mandíbula. O paciente foi levado para o hospital, onde foram feitos uma radiografia panorâmica, PA de face e telerradiografia para melhor documentação do caso. Foi feita uma biópsia incisional. O exame histopatológico teve como resultado lesão óssea benigna, sugestiva de fibroma ossificante. Fez-se uma cirurgia para remoção completa da lesão e fixação com uma placa de reconstrução. O novo exame anatomopatológico confirmou o diagnóstico.

The use of digital periapical radiographs to study the prevalence of alveolar domes

PURPOSE: In the present study, we coined the term 'alveolar dome' and aimed to demonstrate the prevalence of alveolar domes through digital periapical radiographs. MATERIALS AND METHODS: This study examined 800 digital periapical radiographs in regard to the presence of alveolar domes. The periapical radiographs were acquired by a digital system using a photostimulable phosphor (PSP) plate. The χ2 test, with a significance level of 5%, was used to compare the prevalence of alveolar domes in the maxillary posterior teeth and, considering the same teeth, to verify the difference in the prevalence of dome-shaped phenomena between the roots. RESULTS: The prevalence of alveolar domes present in the first pre-molars was statistically lower as compared to the other maxillary posterior teeth (p<0.05). No statistically significant difference was observed in the prevalence of alveolar domes between the maxillary first and second molars. Considering the maxillary first and second molars, it was observed that the palatal root presented a lower prevalence of alveolar domes when compared to the distobuccal and mesiobuccal roots (p<0.05). CONCLUSION: The present study coined the term 'alveolar dome', referring to the anatomical projection of the root into the floor of the maxillary sinus. The maxillary first and second molars presented a greater prevalence of alveolar domes, especially in the buccal roots, followed by the third molars and second pre-molars. Although the periapical radiograph is a two-dimensional method, it can provide dentists with the auxiliary information necessary to identify alveolar domes, thus improving diagnosis, planning, and treatment.

Amelogênese imperfeita: relato de caso clínico / Amelogenesis imperfecta: clinical case report

Objetivos: ilustrar as alterações da Amelogênese Imperfeita no esmalte dentário e suas possíveis causas, com base na história clínica apresentada; determinar um diagnóstico preciso, segundo o exame clínico e radiográfico, assim como um plano de tratamento adequado para o caso. Relato de caso: paciente com 10 anos de idade apresentando alteração de cor (amarelo acastanhado) e superfície rugosa em todos os dentes, além de mordida aberta anterior. Na radiografia panorâmica, foram observadas coroas mais quadrangulares nos incisivos e cúspides de molares e pré-molares baixas, não bem-definidas, além de imagem radiolúcida nas coroas de todos os dentes permanentes, inclusive os que estão em formação, compatível com amelogênese imperfeita do tipo hipocalcificada. Considerações finais: alterações durante a amelogênese podem acarretar distúrbios no desenvolvimento do esmalte dentário, promovendo quantidade e qualidade deficiente. Clinicamente, podemos ter tanto um comprometimento estético (alteração de cor e superfícies rugosas dos dentes) como funcional (mordida aberta, alteração da dimensão vertical, etc.), além da possibilidade de sensibilidade aumentada. O diagnóstico precoce da Amelogênese Imperfeita é de suma importância para um tratamento mais conservador e com enfoque na prevenção dos efeitos dessa patologia.