Frecuencia y características de hallazgos y variaciones óseas en radiografías panorámicas de personas con edentulismo total / Frequency and characteristics of incidental findings in panoramic radiographs and bone variations in people with total edentulism

Antecedentes: Según el Estudio Nacional de Salud Bucal del 2014, el 5,20 % de la población colombiana presenta edentulismo total y el 32,8 % en la población de más de 65 años. Sin embargo, otros parámetros relevantes para el correcto abordaje del edentulismo, deben ser analizados con estudios radiográficos. Objetivo: Identificar la frecuencia y características de los hallazgos y las variaciones óseas en radiografías panorámicas de pacientes totalmente edéntulos. Métodos: Se realizó un estudio observacional descriptivo en 10.000 radiografías panorámicas de las cuales se analizaron las que correspondían a pacientes con edentulismo total mediante el programa CliniView 9.3. Se registraron variables de sexo, edad, altura de rebordes alveolares, altura de rama y cóndilo mandibulares, así como los hallazgos radiográficos. Resultados: Se encontraron 112 radiografías de pacientes con edentulismo total, 51,8 % con algún tipo de hallazgo. El más frecuente fueron los implantes 33,9 % seguido por restos radiculares en 13,4 %. No hubo diferencias en los promedios de las medidas óseas en los dos lados. Los hombres tienen mayor altura de reborde alveolar en el maxilar inferior que las mujeres (p<0,05). Los valores de altura condilar fueron similares para ambos sexos. Se encontró mayor valor de la altura de la rama mandibular en los hombres (p<0,05). Conclusiones: La frecuencia de hallazgos radiográficos en pacientes edéntulos totales es considerable. Las variaciones óseas ocasionadas por la ausencia de dientes, deben ser tenidas en cuenta para la toma de las decisiones clínicas de restauración con prótesis total o con implantes.

Background: According to the 2014 National Oral Health Study, 5.20 % of the Colombian population has total edentulism and 32.8 % in the population over 65 years of age. However, other parameters relevant to the correct approach to edentulism should be analyzed with radiographic studies. Purpose: To identify the frequency and characteristics of the findings and bone variations in panoramic radiographs of totally edentulous patients. Methods: A descriptive, observational study was carried out on 10.000 panoramic radiographs, from which those corresponding to patients with total edentulism were analyzed using the CliniView 9.3 program. Variables of sex, age, alveolar ridge height, mandibular branch height and condyle, as well as radiographic findings were recorded. Results: 112 radiographs of patients with total edentulism were found, 51.8 % with some type of incidental finding. Most frequent were implants 33.9 % followed by root remains in 13.4 %. There were no differences in the averages of the bone measurements on both sides. Men have higher alveolar ridge height in the lower jaw than women (p <0.05). Condylar height values were similar for both sexes. A higher value of the height of the mandibular branch was found in men (p <0.05). Conclusions: Frequency of radiographic incidental findings in total edentulous patients is considerable. The bony variations caused by the absence of teeth must be taken into account when making clinical decisions of restoration with total prosthesis or with implants.

Frequency and position of the mental foramen in panoramic X-rays: literature review / Frecuencia y posición del foramen mental en radiografías panorámicas: revisión bibliográfica

The mental foramen (MF), located in the body of mandible in the region below the inferior premolars, is the anatomical structure through which the mental neurovascular bundle emerges. The MF can be seen clearly in panoramic X-rays. The object of the present study was to carry out a literature review in order to identify the frequency and position of the MF in panoramic X-rays. We looked for articles in the SCiELO, Pubmed, Scopus, LILACS, Web of Science and EBSCOhost databases, for the years 2006 to 2016. The key words used were "mental foramen", "mandibular canal", "inferior alveolar nerve", "anatomy" and "panoramic X-ray". Once the articles had been selected, an analysis was made of their methodological quality; poor-quality articles were excluded. In each article the frequency and position of the MF in each hemi-mandible was analyzed. We found 82 articles, of which 20 were retained after application of the exclusion criteria. The MF was found in 4,824 hemi-mandibles (95.2 %), with greater presence on the left side (50.29 %) than the right (49.71 %). The MF is most commonly located between the apices of the inferior premolars (42.22 %), coincident with the root of the second inferior premolar (33.98 %) or distal of the root of the second inferior premolar (10.98 %). The MF is a very frequent anatomical structure. Knowledge of its location is fundamental for reducing the risk of accidents and unexpected events during clinical and surgical manoeuvres.

El foramen mental (FM), ubicado en el cuerpo de la mandíbula, inferiormente a la región de los dientes premolares inferiores, es la estructura anatómica por donde emerge el paquete vásculonervioso mental. El FM se logra visualizar con buena precisión en una radiografía panorámica. El objetivo del presente estudio fue realizar una revisión de la literatura para identificar la frecuencia y posición del FM en radiografías panorámicas. Se buscaron artículos en las bases de datos SCiELO, Pubmed, Scopus, LILACS, Web of Science y EBSCOhost, entre los años 2006 y 2016. Las palabras clave utilizadas fueron "foramen mental", "canal mandibular", "nervio alveolar inferior", "anatomía" y "radiografía panorámica". Tras la selección de los artículos se realizó un análisis de la calidad metodológica de los mismos, donde se excluyó artículos de baja calidad. Se analizó en cada artículo la frecuencia y posición del FM en cada hemimandíbula. Se encontraron 82 artículos, de los cuales quedaron sólo 20 al aplicar criterios de exclusión. El FM fue encontrado en 4824 hemimandíbulas (95,2 %), siendo el lado izquierdo donde hubo mayor presencia de forámenes (50,29 %) en comparación al lado derecho (49,71 %). El FM se localiza entre los ápices de los premolares inferiores en 42,22 %, es coincidente con la raíz del segundo premolar inferior en 33,98 %, y es distal a la raíz del segundo premolar inferior en 10,98 %, siendo éstos los más relevantes. El FM es una estructura anatómica muy frecuente, ubicada en general inferiormente a los premolares inferiores. Es una estructura de gran importancia clínica, por ello el conocimiento detallado de sus características y variaciones anatómicas es muy importante para evitar complicaciones y disminuir el riesgo de accidentes durante procedimientos clínico-quirúrgicos en la región. Además, a pesar de que la RP presenta buena precisión en la identificación del FM hay condiciones clínicas que requieren otros métodos imagenológicos para su identificación.

Caracterización de la Impactación de Segundos Molares Mandibulares Permanentes en una Población Sudamericana / Characterization of Permanent Mandibular Second Molars Impaction in a Southamerican Population

El objetivo de este estudio fue describir las características epidemiológicas de segundos molares mandibulares permanentes impactados unilateralmente en una muestra de la ciudad de Medellín, Colombia. Se trató de un estudio retrospectivo en el cual se evaluaron radiografías panorámicas de 6785 pacientes, de las cuales se analizaron un total de 28 radiografías en la muestra final. Fueron correlacionados el segundo molar mandibular impactado (grupo de estudio) y el contralateral no impactado (grupo control) con respecto a tres ángulos de referencia (intermolar, del plano oclusal e interplanar), el sexo y lado de impactación. Se encontró una prevalencia de 3,5 por cada 1000 radiografías evaluadas. El lado de mayor impactación fue el derecho; dos de los tres ángulos analizados (intermolar e interplanar) fueron los que arrojaron las diferencias más grandes entre el grupo de estudio y el grupo control. No se encontraron diferencias estadísticamente significativas según el sexo. Se concluyó que la prevalencia de segundos molares mandibulares permanentes impactados es baja, siendo mayor en el lado derecho, sin diferencias por sexo, y de preferencia el uso del ángulo interplanar como medida para la evaluación del riesgo de impactación (>7,9°).

The objective of this study was to describe the epidemiological characteristics of unilateral permanent mandibular second molars impacted, in a sample from Medellín, Colombia. It was a retrospective study in which we evaluated panoramic radiographs of 6785 patients, for a total of 28 radiographs analyzed in the final sample. The mandibular second molar impacted (study group) and the contralateral not impacted (control group) were correlated, with respect to three reference angles (intermolar, of the oclussal plane and interplanar), sex and impaction side. We found a prevalence of 3.5 for every 1000 radiographs evaluated. The most frequent side of impaction was the right side; two of the three angular measurements (intermolar and interplanar) had the biggest differences between the study and control group. We did not find significant statistical differences between males and females. It was concluded that the prevalence of impacted permanent mandibular second molars is low, there is a highest impaction in the right side, there are no differences between genders, and the use of the interplanar angle is preferable as a measurement to predict the impaction of permanent mandibular second molars (>7.9°).

Concordancia inter-examinador en la evaluación de hallazgos periodontales mediante radiografías panorámicas / Inter-examiner concordance in the assessment of periodontal findings by means of panoramic X-rays

RESUMEN Objetivo Estimar el grado de concordancia inter-examinador en la interpretación de hallazgos periodontales en radiografías panorámicas en estudiantes de último año de la Facultad de Odontología de la Universidad de Cartagena. Material y métodos Se realizó un estudio descriptivo de concordancia-consistencia inter-observador para la interpretación de hallazgos periodontales en radiografías panorámicas entre estudiantes de último año de pregrado de la Facultad de Odontología de la Universidad de Cartagena, con relación a un especialista en periodoncia. La evaluación de la concordancia se realizó a través del coeficiente kappa utilizando SPSS Statistics 2.0. Resultados Se evaluaron a 80 estudiantes del último año de pregrado. Cada uno valoró dos radiografías panorámicas, para un total de 160 observaciones. La concordancia general estableció un valor de kappa mínimo de 0.011 y un valor máximo de 0.720. Conclusiones La concordancia entre los estudiantes observadores y el estándar de oro fue pobre. Lo que indica que los estudiantes no aplican los conocimientos obtenidos durante el pregrado de odontología, dando así una errónea impresión del estado periodonto.

ABSTRACT Objective To assess the degree of inter-examiner concordance in the interpretation of periodontal findings in panoramic X-rays in last year students of the School of Dentistry at the University of Colombia. Material and methods A descriptive inter-observer concordance-consistency study was conducted for interpretation of periodontal findings in panoramic X-rays among last year students of the School of Dentistry of the University of Colombia and compared results to thos obtained by a periodontics specialist. Concordance evaluation was achieved by means of a kappa coefficient using SPSS Statistics 2.0 program. Results 80 last year students (undergraduate seniors) were evaluated each one assessed two panoramic X-rays, for a total of 160 observations. General concordance established a minimum kappa value of 0.011, and maximum value of 0.720. Conclusions Concordance among observing students and the gold standard was poor. This indicated that students did not apply acquired knowledge during their undergraduate dental studies, and provided thus a misleading impression on the circumstances of the periodontium.

Influence of treatment including second molars on final and postretention molar angulation

OBJECTIVE: Evaluate axial mesiodistal inclinations of the mandibular molars in orthodontically treated cases, analyzing whether inclusion of second mandibular molars in treatment mechanics has any influence on final and postretention molars angulations. METHODS: The sample comprised 150 panoramic radiographs of 50 patients. Patients were treated with extraction of four first premolars and divided into 2 groups: Group 1 comprised 25 subjects without inclusion of mandibular second molars during orthodontic treatment, whereas Group 2 comprised 25 subjects with inclusion of mandibular second molars. Panoramic radiographs at three observation times were evaluated: pretreatment, posttreatment and postretention. The statistical analysis included one-way analysis of variance (ANOVA) for intragroup evaluation and independent t-tests for intergroup comparisons. RESULTS: Intragroup analysis demonstrated significant uprighting of mandibular first and second molars during treatment in Group 2, which remained stable during the postretention stage. Intergroup comparison demonstrated that Group 2 presented first and second molars significantly more uprighted in relation to Group 1 in both post-treatment and postretention stages. CONCLUSIONS: It was concluded that inclusion of mandibular second molars in the orthodontic mechanics is relevant not only to correct the angulation of these teeth, but also to aid mandibular first molars uprighting.

OBJETIVO: analisar a influência da inclusão dos segundos molares inferiores durante a mecânica ortodôntica nas angulações dos molares ao final do tratamento e na fase de pós-contenção. MÉTODOS: a amostra consistiu em 150 radiografias panorâmicas de 50 pacientes avaliados antes, após o tratamento e no período de pós-contenção. Os pacientes foram tratados com extrações dos quatro primeiros pré-molares, e divididos em dois grupos: grupo 1, composto por 25 pacientes com segundo molares incluídos na mecânica ortodôntica; grupo 2, 25 pacientes cujos segundos molares não foram incluídos na mecânica ortodôntica. As angulações dos primeiros e segundos molares inferiores foram comparadas nas fases estudadas utilizando-se a Análise de Variância (análise intragrupo) e o teste t independente (análise intergrupos). RESULTADOS: a análise intragrupo, realizada no grupo 2, demonstrou que ocorreu uma verticalização significativa dos primeiros e segundos molares inferiores durante o tratamento, que se manteve estável na fase de pós-contenção. Os resultados da análise intergrupos demonstraram diferenças significativas na angulação dos primeiros e segundos molares após o tratamento e na fase de pós-contenção. CONCLUSÃO: a inclusão dos segundos molares inferiores à mecânica ortodôntica apresenta-se relevante, não apenas para corrigir a angulação desses dentes, mas, também, para auxiliar a correção da angulação dos primeiros molares permanentes.

Edad dental según los métodos Demirjian y Nolla en niños peruanos de 4 a 15 años / Dental age according to Demirjian and Nolla methods in peruvian children of 4 to 15 years old

Objetivo. Determinar qué método, Demirjian o Nolla, es más preciso en la determinación de la edad en niños peruanos de 4 a 15 años. Material y métodos. Se evaluaron 59 radiografías panorámicas, 25 del sexo masculino y 34 del femenino; se determinó la edad dental según los métodos mencionados, y posteriormente se comparó esta con la edad cronológica. Resultados. Se encontró una diferencia significativa entre la edad dental y la edad cronológica determinada con método Demirjian; la edad fue sobrestimada en 0.94 años. Con el método Nolla no se encontró una diferencia significativa entre ambas edades; la edad fue subestimada en -0.24 años. Conclusiones. El método Nolla es más preciso para estimar la edad dental, según la muestra de estudio empleada, por no haber diferencias significativas entre la edad dental y la edad cronológica.

Objective. To determine which method, Demirjian or Nolla, is more accurate in determining the age in peruvian children of 4 to 15 year old. Materials and methods. 59 panoramic radiographs were evaluated, 25 of male and 34 of female; dental age was determined according to both methods, and then compared this one with chronological age. Results. When using the Demirjian method a significant difference between dental age and chronological age was found, the age was overestimated in 0.94 years. With the Nolla method we found no significant difference between the two ages, age was underestimated -0.24 years. Conclusions. The Nolla method is more accurate to estimate the dental age, according to the study sample used, there is no significant difference between dental age and chronological age.

La hiperdontia en región de molares / Hyperdontia in molar region

La hiperdontia constituye una de las anomalías más estudiadas de la dentición humana. Esa alteración representa la aparición de uno o más dientes en cantidades mayores de lo normal, que puede ocurrir en la mandíbula o maxila y de manera unilateral o bilateral. La etiología de los dientes supernumerarios puede ser explicada principalmente por hiperactividad de la lámina dentaria en la fase inicial. Es importante la detección precoz de dientes supernumerarios porque se ha visto una serie de complicaciones como los diastemas, que pueden causar en la cavidad bucal: retardo de la erupción o dientes impactados, posicionamiento inadecuado de dientes permanentes, desajuste oclusal y el desarrollo de quistes y tumores odontógenos. Así el diagnóstico es normalmente realizado a partir de un examen radiográfico convencional, principalmente la radiografía panorámica. Este trabajo tuvo como objetivo relatar 4 casos clínicos de pacientes con presencia de molares supernumerarios, que fueron atendidos en el Servicio de Radiología de la Escuela de Odontología de la Universidad Federal de Ceará(AU)

Hyperdontia is one of the more studied anomalies of human dentition. This alteration represents the appearance of one or more teeth in a number greater of normal, occurring in mandible or in maxilla and could be unilateral or bilateral. The etiology of supernumerary teeth may be explained mainly due to the hyperactivity of dental plate in its initial phase; its early detection is important because of there have been a series of complications that may to cause diastemata, eruption retard or impacted teeth, inappropriate positioning of permanent teeth, occlusal misalignment and the development of odontogenic cysts or tumors. Thus, the diagnosis is normally made from a conventional radiographic examination, mainly the panoramic X-ray. The objective of present paper is the present four clinical cases of patients presenting with supernumerary molars, seen in the Radiology Service during the course of stomatology of the Federal University of Ceará(AU)

Avaliação ortopantomográfica das angulações mesiodistais de caninos, pré-molares e molares inferiores com e sem a presença dos terceiros molares / Panoramic evaluation of the mesiodistal angulations of canine teeth, premolar and inferior molars with and without the presence of the third molars

OBJETIVOS: comparar os valores médios normais das angulações mesiodistais dentárias, propostos por Ursi, em 1989, com as angulações mesiodistais de caninos, pré-molares e molares inferiores em indivíduos com e sem a presença dos terceiros molares inferiores e idades entre 18 e 25 anos. Além disso, foram comparados os valores das angulações mesiodistais desses dentes nessas duas situações. MÉTODOS: foram utilizadas 40 radiografias ortopantomográficas de indivíduos, de ambos os gêneros, que não receberam tratamento ortodôntico, divididos em dois grupos: Grupo I, constituído por 20 radiografias que não apresentavam os terceiros molares inferiores; e Grupo II, formado por 20 radiografias com os terceiros molares inferiores presentes. RESULTADOS E CONCLUSÕES: a análise dos resultados e a análise estatística permitiram concluir que ambos os grupos exibiram pré-molares e molares inferiores mais angulados em sentido mesial, quando comparados à oclusão normal. Por outro lado, a angulação mesiodistal de caninos inferiores mostrou-se semelhante àquela apresentada em casos de oclusão normal. Os dois grupos, quando comparados entre si, exibiram semelhantes valores angulares dos caninos, pré-molares e molares inferiores, de modo que a presença dos terceiros molares não exerceu influência sobre essas angulações mesiodistais dentárias.

AIM: To compare the normal mean values of the mesiodistal axial angulation, proposed by Ursi in 1989, with the mesiodistal axial angulation of canine teeth, premolar and inferior molars in individuals with and without the presence of the third inferior molars and ages between 18 and 25 years. Besides, the values of the mesiodistal axial angulation of these teeth were compared in these two situations. METHODS: Forty panoramic x-rays were used from individuals of both genders that didn't receive orthodontic treatment, divided in two groups: Group I, constituted by 20 x-rays that didn't present the third inferior molars, and Group II, formed by 20 x-rays with the presence of the third inferior molars. RESULTS AND CONCLUSIONS: The results analysis and the statistical analysis allowed to conclude that both Groups exhibited inferior premolar and molars more angled in mesial direction when compared to the normal occlusion. On the other hand, the mesiodistal axial angulation of inferior canine teeth was similar to the presented in cases of normal occlusion. The two groups, when compared amongst themselves, exhibited similar angular values of the canine teeth, premolar and inferior molars, so that the presence of the third molars didn't exercise influence on these dental angulations.

Agenesia dental en pacientes jóvenes: [revisión] / Dental agenesia in young patients

La agenesia dental o ausencia dental congénita, es un síndrome que se manifiesta en diversas poblaciones del mundo y genera múltiples consecuencias si su diagnóstico no se realiza oportunamente. Para determinar su prevalencia en los pacientes de cuatro Instituciones Prestadores de Servicios de Salud (IPS) del sector privado de Santiago de Cali se realizó un estudio descriptivo a partir de la revisión de 1.440 historias clínicas con sus correspondientes radiografías panorámicas. Estos registros pertenecían a usuarios de las cuatro instituciones cuyas edades oscilaron entre 14 y 21 años. Determinada la agenesia dental en 141 de las radiografías, se procedió a verificar clínicamente el impacto de la anomalía para establecer la correlación de la falta de formación de los gérmenes dentales con algunas variables como género, edad, grupo de dientes afectado, tipos de dientes, cantidad de dientes faltantes por la patología de desarrollo, cuadrantes y arcadas involucradas. Además se tomó nota de la posible presencia de algún síndrome que pudiera estar relacionado con la falta genética. Se puso especial atención en la proporción de agenesia de terceros molares respecto a los otros grupos de dientes afectados.

Dental Ageneses or dental congenital absence is a syndrome seen in world diverse populations and generates a lot of consequences that could be avoided if its diagnosis were opportune done. To determine its prevalence among young between 14 to 21 years old users of four private or public health services providers located at Santiago de Cali city, a descriptive study was carried out by 1.440 dental stories and its correspondent panoramic x-ray revision in order to determine the number and ratio of dental ageneses present on the age groups. It was found that 141 patients (10) had been diagnosed at least one ageneses tooth. On this information basis a clinical examination was accorded whit each patient in order to determine relationships among some variables as young gender, age, dental group affected, type of tooth involved, quadrant an arches and, in addition if there were some kind of syndrome that could be related. Special attention was placed on a possible association among third molar and other teeth agenesis.

Application of oral imaging instrument / 医疗卫生装备

Oral imaging techniques have been widely and increasingly used in clinical practice.This article reviews the functions,characteristics and principles of three kinds of oral imaging instruments including panoramic x-ray unit,intraoral x-ray unit and stomatology endoscope.

RADOGRAPHIC STUDY OF HEIGHT OF MANDIBULAR CANAL

Mandibular canal is an important anatomic structure for implant surgery. Many clinicians favor a panoramic procedure instead of tomographic or computed tomographic procedure for the pre-surgery because of low cost & easy manipulation. But mandibular canal will not be observable on panoramic X-ray film when bony surrounding structure of mandibular canal is not thick. In this case, we should predict the location of mandibular canal by comparing the opposite side or supposing the relative height of mandibular canal in mandibular body if other obserable methods unusable, The author takened the 261 panoramic views of healthy adults and measured the distance (alveolar process) between alveolar crest and superior border of mandibular canal, distance(basal bone) between superior border of mandibular canal and inferior cortex of mandible, respectively The obtained results were as followings. 1. 56 cases(21.4%) from 261 cases showed inevident walls of mandibular canal on X-ray films. 2. In comparing the 1st molar area and the 2nd molar area, the portions of mandibular 1st molar showed greater height of alveolar process area and the portions of mandibular 2nd molar showed greater height of basal bone area. respectively. 3. Distances from alveolar crest to inferior cortex represented 2.02-2.04 times(mental foramen), 2.47-2.52 times(2nd molar), 2.84-2.86 times(1st molar) of distance from mandibular canal to inferior cortex. 4. Usually each measurements showed non-significant differences (P>0.05) between right and left side of mandible. 5. The average length of anterior loops of mental foramens was measured about 2.285mm.