Influence of endodontic sealers artifacts in the detection of vertical root fractures

Abstract The aim of this study was to compare the influence of endodontic sealers artifacts on the detection of vertical root fracture in cone beam computed tomography (CBCT). Premolars and central incisors were assigned into five different groups: Control, Pulp Canal Sealer, AH Plus, Sealer 26, and BC Sealer (n= 10, per group). VRFs were mechanically induced and the teeth were inserted into an image phantom. Subsequently, CBCT (Cranex 3Dx, Soredex, Tuusula, Finland) images were obtained and two observers were asked separately to identify root fracture, by visual analysis. For both premolar and central incisors, kappa coefficients of intraobserver agreement varied from good to excellent (K: 80% - 87%), and the values for interobserver agreement varied from fair to moderate (K: 30% - 35%). As follows, the area under the curve (AUC) of receiver operating characteristic (ROC) values for VRFs highlighted that the use of BC sealer reduced the observers' ability to discriminate VRFs relative to other sealers. Moreover, sensitivity values for premolars teeth ranged from 20% to 60%, and specificity ranged from 60% to 100%; while sensitivity values for central incisors ranged from 30% to 70%, and specificity ranged from 70% to 100%. In conclusion, the low sensitivity values, mainly for premolars, demonstrated the difficulty in VRF diagnosis. Furthermore, BC Sealer induced significantly more imaging artifacts than other sealers. These results highlighting that endodontic sealers may interfere with the diagnosis of VRFs.

Resumo O objetivo deste estudo foi comparar a influência dos artefatos de cimentos endodônticos na detecção de fratura radicular vertical (FRV) em tomografia computadorizada de feixe cônico (TCFC). Pré-molares e incisivos centrais foram divididos em cinco grupos diferentes: Controle, Pulp Canal Sealer, AH Plus, Sealer 26 e BC Sealer (n = 10, por grupo). As FRVs foram induzidas mecanicamente e os dentes inseridos em uma réplica da mandibula humana. Posteriormente, imagens de TCFC (Cranex 3Dx, Soredex, Tuusula, Finlândia) foram obtidas e dois observadores foram solicitados a identificar fratura radicular separadamente, o critério utilizado foi a análise visual. Tanto para pré-molares quanto para incisivos centrais, os coeficientes kappa de concordância intraobservador variaram de bom a excelente (K: 80% - 87%), e os valores de concordância interobservador variaram de regular a moderado (K: 30% - 35%). A seguir, a área sob a curva (AUC) dos valores da característica de operação do receptor (ROC) para FRVs destacou que o uso do cimento BC Sealer reduziu a capacidade dos observadores de discriminar FRVs em relação a outros cimentos endodônticos. Além disso, os valores de sensibilidade para pré-molares variaram de 20% a 60%, e a especificidade variou de 60% a 100%; enquanto os valores de sensibilidade para incisivos centrais variaram de 30% a 70%, e a especificidade variou de 70% a 100%. Em conclusão, os baixos valores de sensibilidade, principalmente para pré-molares, demonstraram uma dificuldade no diagnóstico de FRV. Além disso, o BC Sealer induziu significativamente mais artefatos de imagem do que outros cimentos. Esses resultados evidenciam que os cimentos endodônticos podem interferir no diagnóstico das FRVs.

Diagnosis of alveolar and root fractures: an in vitro study comparing CBCT imaging with periapical radiographs

Abstract Objective To compare periapical radiograph (PR) and cone-beam computed tomography (CBCT) in the diagnosis of alveolar and root fractures. Material and Methods Sixty incisor teeth (20 higid and 40 with root fracture) from dogs were inserted in 60 anterior alveolar sockets (40 higid and 20 with alveolar fracture) of 15 macerated canine maxillae. Each fractured socket had a root fractured tooth inserted in it. Afterwards, each maxilla was submitted to PR in two different vertical angulation incidences, and to CBCT imaging with a small field of view (FOV) and high-definition protocol. Images were randomized and posteriorly analyzed by two oral and maxillofacial radiologists two times, with a two-week interval between observations. Results Sensitivity and specificity values were good for root fractures for PR and CBCT. For alveolar fractures, sensitivity ranged from 0.10 to 0.90 for PR and from 0.50 to 0.65 for CBCT. Specificity for alveolar fractures showed lower results than for root fractures for PR and CBCT. Areas under the ROC curve showed good results for both PR and CBCT for root fractures. However, results were fair for both PR and CBCT for alveolar fractures. When submitted to repeated measures ANOVA tests, there was a statistically significant difference between PR and CBCT for root fractures. Root fracture intraobserver agreement ranged from 0.90 to 0.93, and alveolar fracture intraobserver agreement ranged from 0.30 to 0.57. Interobserver agreement results were substantial for root fractures and poor/fair for alveolar fractures (0.11 for PR and 0.30 for CBCT). Conclusion Periapical radiograph with two different vertical angulations may be considered an accurate method to detect root fractures. However, PR showed poorer results than CBCT for the diagnosis of alveolar fractures. When no fractures are diagnosed in PR and the patient describes pain symptoms, the subsequent exam of choice is CBCT.

Detection of horizontal root fracture using four different protocols of cone-beam computed tomography

The purpose of this study was to analyze four different cone-beam computed tomography (CBCT) protocols to identify horizontal root fractures (HRF) in endodontically treated teeth, with or without the presence of a metallic post. Thirty extracted single-rooted human premolars were treated endodontically. Afterwards, an observer induced a horizontal fracture in 15 teeth. Each tooth was inserted in an empty mandibular socket and submitted to a computed tomography scan taken with and without the metallic post. The acquisition followed four different protocols, with different fields of view (FOV) and voxel sizes, as follows: FOV 6X16 cm/0.2 mm voxel; FOV 6X16 cm/0.25 mm voxel; FOV 8X8 cm/0.2 mm voxel; FOV 8X8 cm/0.25 mm voxel. Two observers checked all the acquisitions within a two-week interval, and the values of sensitivity, specificity, accuracy and kappa were calculated. The sensitivity, specificity and accuracy values were better for the 8X8 cm/0.2 mm and 16X6 cm/0.25 mm protocols, ranging from 0.60 to 0.86 and 0.53 to 0.80, respectively. The intra- and interobserver concordance ranged from 0.65 to 0.72. The protocols where FOV and voxel were proportional showed better results. The 8x8 cm/0.2 mm protocol had the least interference from the metallic artifact. All four protocols showed a decline in values in the presence of the metallic artifact.

CBCT-based evaluation of integrity of cortical sinus close to periapical lesions

The purpose of the present study was to test the applicability of cone beam computed tomography (CBCT) to evaluate the integrity of the cortical sinus close to periapical lesions. Two observers analyzed samples of 64 alveoli of first molar roots in macerated swine maxillas prepared with perchloric acid to simulate periapical lesions. The specimens were evaluated using CBCT (55-mm high and 100-mm diameter cylinder at 0.2-mm voxel resolution) for the presence of oroantral communication (OAC) caused by the simulated lesions. Sensitivity, specificity, and accuracy were calculated. Fair values were obtained for accuracy (66%-78%) and good values for specificity (70%-98%), whereas the values for sensibility showed relevant variation (41%-78%). For this reason, the interobserver agreement score was weak. CBCT proved capable of evaluating the integrity of the cortical sinus (absence of oroantral communication) when it lies close to an apical periodontitis lesion. However, the low interobserver agreement reflects the difficulty in performing diagnoses when OAC is adjacent to a periapical lesion, using the acquisition protocol adopted in this research. This could be attributed to the high level of image noise.

Tomografia por emissão de pósitrons em tumores malignos de cabeça e pescoço / Positron-emission tomography in head and neck cancer

Head and neck cancer is considered a public health problem worldwide, given its high morbidity and mortality. The more advanced is the histopathologic grade, the more aggressive may be the therapies. The development of health policies, diagnosis and treatments lead to better prognostic perspectives. This paper aimed to review the literature regarding the application of positron emission tomography in headand neck cancer, including its impact in the diagnosis, image principles, radiotracers, positron emission tomography / computed tomographyimage fusion and other advantages. The review was performed following systematized search strategies reported in the literature. It could be observed that the use of positron emission tomography improves the diagnostic approach of the patients, especially when positron emission tomography is allied to computed tomography. As it provides physiological information, positron emission tomography also benefits the prognostic and reduces the morbidity related to the treatment of head and neck cancer.

Apresentando-se como um problema de saúde pública em todo o mundo, o câncer de cabeça e pescoço caracteriza-se por sua alta morbidadee mortalidade. Quanto mais avançado o grau de diferenciação tumoral, mais mutiladoras tendem a ser as terapias empregadas. Desta forma,os avanços nos âmbitos da promoção de saúde, diagnóstico e tratamento são extremamente benéficos ao prognóstico. Esta revista daliteratura tem por objetivo discorrer sobre a aplicação da tomografia por emissão de pósitrons no diagnóstico e planejamento terapêuticode pacientes portadores de tumores malignos de cabeça e pescoço, princípios de formação da imagem, radiofármacos utilizados, fusãode imagens tomografia por emissão de pósitrons e tomografia computadorizada e suas contribuições. O levantamento bibliográfico foiefetuado segundo estratégias sistematizadas relatadas em literatura. Fornecendo informações relativas à fisiologia das lesões através daadministração de radiofármacos, pode ser observado que a tomografia por emissão de pósitrons, especialmente quando aliada à tomografiacomputadorizada, maximiza as possibilidades diagnósticas em determinadas indicações, favorecendo ao prognóstico e sugerindo redução na morbidade decorrente do tratamento no câncer de cabeça e pescoço.

Assessment of open source software for CBCT in detecting additional mental foramina

The purpose of this study was to evaluate which post-processing imaging protocol would be better to analyze the additional mental foramen (AMF) in preoperative planning with cone-beam computed tomography (CBCT) exams, and to test reproducibility of measurements, using open source software (OsiriX). The software was used to detect the cases of AMF from among 58 exams for dental implant planning in edentulous mandible areas-three cases were found. The case images were submitted to qualitative analysis using 2D orthogonal MPR, 3D-MPR and 3D volume rendering protocols by two oral and maxillofacial radiologists. Quantitative analysis used the 3D-MPR protocol; the closed polygon tool measured the mental foramen (MF) and the AMF areas; the length tool measured the distance between foramina. The measurements were performed independently by the examiners, at two different times. Intra- and interexaminer agreement was assessed using the intraclass correlation coefficient. The panoramic view did not show the MF and the AMF clearly. The AMF could be detected in the parasagittal view. 2D Orthogonal MPR was effective to observe the AMF in some cases. The 3D-MPR and 3D view protocols were the most effective to locate and analyze the AMF. In conclusion, a 3D view improves visualization when anatomical points are not clearly visible. 3D-MPR was considered a more effective post-processing imaging protocol to observe foramina relationships. The high reproducibility of measurements for anatomical MF variations was established using specific tools featured in open source software for CBCT. OsiriX is realistic and recommended for preoperative planning.

Clinical and imagiological findings of central giant cell lesion and cherubism

Cone beam computed tomography (CBCT) is the best examination for bone lesions of the maxilla, allowing the dentist to evaluate precisely the behavior and components of the lesion and their relationship to the surrounding structures. Central giant cell lesion and cherubism are histologically very similar lesions. Therefore clinical and radiological examinations are fundamentally important for the diagnosis. The aim of this paper is to report two cases diagnosed as central giant cell lesions and cherubism using CBCT. This imaging modality was very important for the diagnosis of the lesions presented in the current study. It also allowed observing precisely the limits of the lesions, the components, the behavior and the exact relationship to adjacent structures.

A tomografia computadorizada de feixe cônico (TCFC) é o melhor exame para lesões ósseas da maxila, permitindo que o dentista possa avaliar com mais confiabilidade o comportamento, os componentes da lesão, e sua relação com estruturas adjacentes. A Lesão central de células gigantes e o querubismo são patologias muito semelhantes histologicamente, portanto, exames clínicos e radiológicos são de fundamental importância para o diagnóstico. O objetivo deste trabalho é relatar dois casos diagnosticados usando TCFC, um de lesões centrais de células gigantes e um de querubismo. Esta modalidade de imagem foi muito importante para o diagnóstico das patologias apresentadas neste estudo. Também permitiu observar com mais confiabilidade os limites das lesões, os componentes, o comportamento e a relação exata com as estruturas adjacentes.

Detection of simulated incipient furcation involvement by CBCT: an in vitro study using pig mandibles

The aim of the present study was to test the reproducibility, sensitivity, and specificity of cone-beam computed tomography (CBCT) in detecting incipient furcation involvement. Fifteen macerated pig mandibles, with intact second molar teeth and preserved adjacent cortical areas, were used. Simulated lesions were created in the furcation region of these teeth by applying 70% perchloric acid in up to four possible buccal/lingual sites in the right/left sides of each mandible. The mandibles were then submitted to a CBCT scan. Two blinded and calibrated experienced oral and maxillofacial radiologists interpreted the exams. Furcation involvement was also assessed in the regions without simulated lesions. CBCT showed high levels of accuracy, ranging from 78% to 88%. The variations in Kappa values for intra- and inter-observer agreement (0.41-0.59) were considered moderate. CBCT can be considered a reliable and accurate method for detecting incipient furcation involvement.

Peri-orbital bone dimensional analysis using computed tomography for placement of osseointegrated implants

Craniofacial osseointegrated implants enabled producing implant-retained facial prosthesis, namelythe orbital prosthesis. Aim: To evaluate the length and width of the bone structure of the peri-orbitalregion and to present the method validation. Methods: Computed tomography scans of 30 dryhuman skulls were obtained in order to register linear length and width measurements of the periorbitalregion. Two examiners made the measurements twice with intervals of at least 7 daysbetween them. Data were analyzed by descriptive statistics and the paired Student’s t-test wasused as inferential technique (SAS, α=0.05). Results: In most cases, the intra- and inter-examinervariations were not significant (p>0.05). Therefore, the method proposed was considered asprecise and valid for the measurement of the peri-orbital region. The measured points correspondto the hours of a clock. The major lengths were observed at 1 h (18.32 mm) for the left peri-orbitalbone and at 11h (19.28 mm) for the right peri-orbital bone, followed by the points situated at 2h(13.05 mm) and 12h (11.37 mm) for the left side and at 10 h (12.34 mm) and 12 h (11.56 mm) forthe right side. It was verified that the three points with lowest values followed the same anatomicalsequence in the supraorbital rim for the right and left orbits, showing compatibility with the insertionof the intraoral osseointegrated implants. The medial wall of both orbits did not present sufficientlength to allow the insertion of intraoral or craniofacial implants. Conclusions: The largest widthpoints were observed in the supraorbital rim and in the infralateral region of both orbits and thoseof smallest width were found in the supralateral region of both orbits.

Comparison between cone-beam and multislice computed tomography for identification of simulated bone lesions

There are many studies that compare the accuracy of multislice (MSCT) and cone beam (CBCT) computed tomography for evaluations in the maxillofacial region. However, further studies comparing both acquisition techniques for the evaluation of simulated mandibular bone lesions are needed. The aim of this study was to compare the accuracy of MSCT and CBCT in the diagnosis of simulated mandibular bone lesions by means of cross sectional images and axial/MPR slices. Lesions with different dimensions, shape and locularity were produced in 15 dry mandibles. The images were obtained following the cross sectional and axial/MPR (Multiplanar Reconstruction) imaging protocols and were interpreted independently. CBCT and MSCT showed similar results in depicting the percentage of cortical bone involvement, with great sensitivity and specificity (p < 0.005). There were no significant intra- or inter-examiner differences between axial/MPR images and cross sectional images with regard to sensitivity and specificity. CBCT showed results similar to those of MSCT for the identification of the number of simulated bone lesions. Cross sectional slices and axial/MPR images presented high accuracy, proving useful for bone lesion diagnosis.

Assessment of simulated mandibular condyle bone lesions by cone beam computed tomography

There are many limitations to image acquisition, using conventional radiography, of the temporomandibular joint (TMJ) region. The Computed Tomography (CT) scan is a better option, due to its higher accuracy, for purposes of diagnosis, surgical planning and treatment of bone injuries. The aim of the present study was to analyze two protocols of cone beam computed tomography for the evaluation of simulated mandibular condyle bone lesions. Spherical lesions were simulated in 30 dry mandibular condyles, using dentist drills and drill bits sizes 1, 3 and 6. Each of the mandibular condyles was submitted to cone beam computed tomography (CBCT) using two protocols: 1) axial, coronal and sagittal multiplanar reconstruction (MPR); and 2) sagittal plus coronal slices throughout the longitudinal axis of the mandibular condyles. For these protocols, 2 observers analyzed the CBCT images independently, regarding the presence or not of injuries. Only one of the observers, however, performed on 2 different occasions. The results were compared to the gold standard, evaluating the percentage of agreement, degree of accuracy of CBCT protocols and observers' examination. The z test was used for the statistical analysis. The results showed there were no statistically significant differences between the 2 protocols. There was greater difficulty in the assessment of small-size simulated lesions (drill # 1). From the results of this study, it can be concluded that CBCT is an accurate tool for analyzing mandibular condyle bone lesions, with the MPR protocol showing slightly better results than the sagittal plus coronal slices throughout the longitudinal axis.

Influence of dental metallic artifact from multislice CT in the assessment of simulated mandibular lesions

OBJECTIVE: This study evaluated the influence of metallic dental artifacts on the accuracy of simulated mandibular lesion detection by using multislice technology. MATERIAL AND METHODS: Fifteen macerated mandibles were used. Perforations were done simulating bone lesions and the mandibles were subjected to axial 16 rows multislice CT images using 0.5 mm of slice thickness with 0.3 mm interval of reconstruction. Metallic dental restorations were done and the mandibles were subjected again to CT in the same protocol. The images were analyzed to detect simulated lesions in the mandibles, verifying the loci number and if there was any cortical perforation exposing medullar bone. The analysis was performed by two independent examiners using e-film software. RESULTS: The samples without artifacts presented better results compared to the gold standard (dried mandible with perforations). In the samples without artifacts, all cortical perforation were identified and 46 loci were detected (of 51) in loci number analysis. Among the samples with artifacts, 12 lesions out of 14 were recognized regarding medullar invasion, and 40 out of 51 concerning loci number. The sensitivity in samples without artifacts was 90 percent and 100 percent regarding loci number and medullar invasion, respectively. In samples with artifacts, these values dropped to 78 percent and 86 percent, respectively. The presence of metallic restorations affected the sensitivity values of the method, but the difference was not significant (p>0.05). CONCLUSIONS: Although there were differences in the results of samples with and without artifacts, the presence of metallic restoration did not lead to misinterpretation of the final diagnosis. However, the validity of multislice CT imaging in this study was established for detection of simulated mandibular bone lesions.

Aplicações da tomografia computadorizada em Ortodontia: "o estado da arte" / Computed tomography applications in Orthodontics: the state of the art

O objetivo deste artigo é informar, ao ortodontista e ao pesquisador, sobre o atual estágio de desenvolvimento tecnológico das imagens craniofaciais geradas por Tomografia Computadorizada Helicoidal Multislice (TC Multislice) e por Tomografia Computadorizada de Feixe Crônico (TCFC), bem como suas aplicações em Ortodontia, Ortopedia Facial e Cirurgia Ortognática. Pretende-se apresentar as múltiplas aplicações clínicas e potenciais para pesquisas científicas das imagens tridimensionais (3D-TC) em Ortodontia. Como as modalidades atuais de tratamento ortodôntico estão se tornando mais sofisticadas, a necessidade de registros tridimensionais (3D) precisos dos pacientes se torna cada vez mais crítica, e a adoção da TCFC em conjunto com a TC Multislice levará os ortodontistas a uma mudança de paradigma com relação aos meios de diagnóstico por imagem, inclusive com potenciais alterações nos planejamentos dos tratamentos ortodônticos e ortodôntico-cirúrgicos.

Dificuldade no diagnóstico de osteoblastoma atípico de face: relato de caso / Difficulty in diagnosing atypical osteoblastoma of the face: case report

Introdução: Osteoblastoma é um tumor benigno rara do osso, ocorrendo geralmente em vértebras, ossos longo tubulares. Sua ocorrência na região craniofacial é extremamente rara, especialmente nas áreas nasal e paranasal. Relato do Caso: Nós relatamos um caso atípico de osteoblastoma do seio maxilar com envolvimento de palato duro e estruturas nasal. Características clínicas e radiológicas foram inconclusivas, com padrão de tomografia computadorizada (TC) atípicos que foi sugestiva de vários lesões fibro-ósseas (LFO) como a displasia fibrosa, displasia cementificante, fibroma cemento ossificante. Exames histopatológicas revelou osteoblastoma. Comentários Finais: Dada as imagens de TC atípicas e o enorme envolvimento facial, diagnósticos diferenciais de tais lesões devem ser cuidadosamente avaliados sobre aparência radiográfico e critérios histológicos.

Introduction: Osteoblastoma is a rare benign tumor of the bone, usually occurring in vertebrae and in long tubular bones. Its occurrence in the craniofacial region is extremely rare, especially in the nasal and paranasal areas. Case Report: We report an atypical case of osteoblastoma of the maxillary sinus with involvement of hard palate and nasal structures. Clinical and radiological features were inconclusive, with atypical computed tomography (CT) pattern that was suggestive of various fibrous osseous lesions (FOL) like fibrous dysplasia, cementifying dysplasia, cemento-ossifying fibroma. Final Comments: Given the anomalous CT features and massive facial involvement, differential diagnoses of such lesions must be carefully evaluated regarding radiographic appearance and histological criteria.

Osteochondroma of the temporomandibular joint: a case report

Osteochondroma of the mandibular condyle has been found in the oral and maxillofacial region rarely. This paper describes a case of osteochondroma of the mandibular condyle in a 20-year-old woman, who was referred to our service with facial asymmetry, prognathic deviation of chin, cross-bite to the contralateral side, changes in condylar morphology, limited mouth opening, and malocclusion. Computed tomography (CT) was performed for better evaluation to the pathological conditions on the temporomandibular joint. Based on the clinical examination, patient history, and complementary exams, the hypothesis of osteochondroma was established. Condylectomy was performed using a preauricular approach with total removal of the lesion. After 3 years of postoperative follow up and orthodontic therapy, the patient is symptom-free, and has normal mouth opening with no deviation in the opening pattern.

Osteocondroma de côndilo mandibular é raro na região craniofacial. Este artigo descreve um caso de osteocondroma de côndilo mandibular em uma mulher de 20 anos que foi encaminhada ao nosso serviço apresentando assimetria facial, desvio de mento, mordida cruzada para o lado contralateral, alterações na morfologia condilar, limitação de abertura bucal e maloclusão. Tomografia computadorizada foi realizada para melhor avaliação da condição patológica da ATM. Devido à base no exame clínico, histórico do paciente e exames complementares, foi estabelecida uma hipótese de osteocondroma. Um procedimento de condilectomia utilizando abordagem preauricular com uma total remoção da lesão foi executado. Após três anos de acompanhamento pós-operatório e ortodôntico, o paciente está livre dos sintomas e tem uma abertura normal sem desvio de padrão durante a abertura.

Accuracy assessment of human sphenoidal sinus volume and area measure and its relationship with sexual dimorphism using the 3D-CT / Avaliação da precisão das medidas de volume e área do seio esfenoidal humano em relação ao dimorfismo sexual utilizando a TC-3D

Introduction - The purpose of this study was to evaluate the precision of volumetric measurements of sphenoidal sinuses and the obtention of sexual dimorphism, using spiral computed tomography (CT). Materials and Methods - Fifty individuals were studied (25 male and 25 female),examined with CT multiplanar reconstructions in sagital and coronal views, and in 3DCT. The statistical analysis was obtained by using the Levene test, and t-test. Results - The method used is over the inadequate limit for area measurements, and the method is acceptable for volume, but needs improvement. Male individuals showed a mean higher than that female's, and a higher variation for area and volume. Conclusion - The spiral CT is helpful in sphenoidal sinus region study, showing precision for volume only. There was a significant difference between the mean values of the two genders, so the method can be used to determine sexual dimorphism.

Introdução - O objetivo deste estudo foi avaliar a precisão das medidas de volume e área do seio esfenoidal humano, e a possibilidade de obtenção do dimorfismo sexual. Materiais e Métodos - Foram estudados 25 indivíduos do gênero masculino e 25 do feminino, examinados por meio da tomografia computadorizada, com reconstrução em terceira dimensão, e recursos de computação gráfica. A análise estatística foi feita utilizando os métodos de Análise de Variância para medidas repetidas (ANOVA), teste de Levene e teste-t. Resultados - O método utilizado está pouco acima do limite de não aceitação, e, quanto ao volume, é aceitável precisando ainda de melhoria. Notamos que o gênero masculino apresenta uma média aparentemente maior que o sexo feminino, bem como uma variação maior tanto em área quanto em volume. Conclusão - A tomografia computadorizada em espiral foi útil no estudo da região de seios esfenoidais, apresentando precisão adequada apenas para volume. A diferença significativa entre as médias dos valores dos grupos masculino e feminino possibilita afirmar que há possibilidade de utilização do método para avaliação do dimorfismo sexual.

Avaliação da precisão das medidas de volume e área do seio esfenoidal humano em relação ao dimorfismo sexual utilizando a TC-3D / Accuracy assessment of human sphnoidal sinus volume and area measure and its relationship with sexual dimorphism the 3D-CT

Introdução - O objetivo deste estudo foi avaliar a precisão das medidas de volume e área do seio esfenoidal humano, e a possibilidade de obtenção do dimorfismo sexual. Materiais e Métodos - Foram estudados 25 indivíduos do gênero masculino e 25 do feminino, examinados por meio da tomografia computadorizada, com reconstrução em terceira dimensão, e recursos de computação gráfica. A análise estatística foi feita utilizando métodos de Análise de Variância para medidas repetidas (ANOVA), teste de Levene e teste-t. Resultados - O método utilizado está pouco acima do limite de não aceitação, e, quanto ao volume, é aceitável precisando ainda de melhoria. Notamos que o gênero masculino apresenta uma média aparentemente maior que o sexo feminino, bem como uma variação maior tanto em área quanto em volume. Conclusão - A tomografia computadorizada em espiral foi útil no estudo da região de seios esfenoidais, apresentando precisão adequada apenas para volume. A diferença significativa entre as médias dos valores dos grupos masculino e feminino possibilita afirmar que há possibilidade de utilização do método para avaliação do dimorfismo sexual

Evaluation of simulated bone lesion in the head of the mandible by using multislice computed tomography

Conventional radiography has shown limitation in acquiring image of the ATM region, thus, computed tomography (CT) scanning has been the best option to the present date for diagnosis, surgical planning and treatment of bone lesions, owing to its specific properties. OBJECTIVE: The aim of the study was to evaluate images of simulated bone lesions at the head of the mandible by multislice CT. MATERIAL AND METHODS: Spherical lesions were made with dental spherical drills (sizes 1, 3, and 6) and were evaluated by using multislice CT (64 rows), by two observers in two different occasions, deploying two protocols: axial, coronal, and sagittal images, and parasagittal images for pole visualization (anterior, lateral, posterior, medial and superior). Acquired images were then compared with those lesions in the dry mandible (gold standard) to evaluate the specificity and sensibility of both protocols. Statistical methods included: Kappa statistics, validity test and chi-square test. Results demonstrated the advantage of associating axial, coronal, and sagittal slices with parasagittal slices for lesion detection at the head of the mandible. RESULTS: There was no statistically significant difference between the types of protocols regarding a particular localization of lesions at the poles. CONCLUSIONS: Protocols for the assessment of the head of the mandible were established to improve the visualization of alterations of each of the poles of the mandible's head. The anterior and posterior poles were better visualized in lateral-medial planes while lateral, medial and superior poles were better visualized in the anterior-posterior plane.

CT assessment of the correlation between clinical examination and bone involvement in oral malignant tumors

Oral cancers have a tendency to invade the surrounding bone structures, and this has a direct influence on the treatment management and on outcomes. The objective of this study was to correlate the clinical parameters (location, clinical presentation and TNM staging) of oral malignant tumors that can be associated with a potential of bone invasion and determine the accuracy of clinical examination to predict bone involvement, using computed tomography (CT). Twenty five patients, with oral malignant tumors were submitted to clinical and CT examinations. CT was considered the standard parameter to evaluate the presence of bone involvement. Clinical assessment of location, presentation form and TNM staging of the tumors were then compared to the CT findings in predicting bone involvement. Bone involvement was observed in 68 percent of the cases. It was predicted that tumors located in the retromolar trigone and hard palate, with a clinical aspect of infiltrative ulcer or nodule and classified in stage IV had a high potential to cause bone involvement. The clinical examination assessment of these tumors showed to be a valuable tool to predict bone invasion, with high sensitivity (82 percent) and specificity (87.5 percent), based on the results found in the CT images. No statistical significance was found between the CT and clinical examinations regarding bone involvement. The identification of some clinical parameters such as location, clinical presentation, and TNM stage, associated with a detailed clinical examination, was considered a valuable tool for the assessment of bone destruction by oral malignant tumors.

Fibroma ossificante periférico atípico em mandíbula / Atypical peripheral ossifying fibroma in mandible

Este é um relato de caso de Fibroma Ossificante Periférico (FOP) atípico na mandíbula do lado direito, em paciente do sexo masculino de 17 anos. A importância desse caso inclui o tamanho da lesão, comprometimento de tecido mole, dentes e osso. Exames complementares foram realizados, como radiografia panorâmica convencional, punção, tomografia computadorizada e a biópsia incisional. Após o diagnóstico definitivo, foi feita a excisão completa da lesão, juntamente com os dentes envolvidos. O objetivo deste relato éevidenciar esse caso atípico de FOP e as ferramentas utilizadas para o auxílio de seu diagnóstico e planejamento cirúrgico.

This is a case report of Peripheral Ossifying Fibroma (POF) on the right side of the mandible in a seventeen-year-old male. The importance of the case includes the size of the lesion, soft tissue, teeth and bone involved. Complementary exams were performed, like panoramic radiography, punction, computed tomography and incisional biopsy. After the definitive diagnosis, total excision of the lesion was made, together with the teeth involved. The objective of this case report is to show this atypical case of POF and the tools used to help the diagnosis and surgical planning.