Prevalence of canalis sinuosus and accessory canals of canalis sinuosus on cone beam computed tomography: a systematic review and meta-analysis.

The aim of this systematic review was to determine the prevalence of the canalis sinuosus (CS) and accessory canals of the canalis sinuosus (ACCS) as identified on cone beam computed tomography (CBCT). Online searches were conducted in the MEDLINE (via PubMed), Scopus, LILACS, Cochrane CENTRAL, Web of Science, and SIGLE (via OpenGrey) databases. Primary studies that determined the prevalence of canalis sinuosus and/or its anatomical variations using CBCT were included. The risk of bias assessment was performed using the AQUA tool. The quality effects model using double arcsine transformation was used for the meta-analysis of prevalence. Heterogeneity, publication bias, and sensitivity analyses were performed. Of 3237 initial results, 17 papers were included for systematic review. The meta-analysis comprising 1994 patients showed a pooled prevalence of CS of 0.80 (95% confidence interval (CI) 0.51-0.99; P = 0.001; I2 = 99%). Publication bias analysis revealed minor asymmetry (LFK index 1.84). The meta-analysis of 4605 patients showed a pooled prevalence of ACCS of 0.54 (95% CI 0.38-0.69; P = 0.001; I2 = 99%). The sensitivity analysis showed a pooled prevalence of ACCS of 0.53 (95% CI 0.32-0.74; P = 0.001; I2 = 99%) for studies with ≥ 1000 patients and 0.55 (95% CI 0.33-0.76; P = 0.001; I2 = 98%) for studies with< 1000 patients. Canalis sinuosus showed a pooled prevalence of 0.80 and ACCS showed a pooled prevalence of 0.54; hence both should be considered as anatomical structures, which means that they are present in most people. Surgeons must be aware of the CS and ACCS on CBCT analysis during pre-surgical planning. PROSPERO REGISTRATION NUMBER: CRD42020154195.

Immediate dental implants placed into infected sites present a higher risk of failure than immediate dental implants placed into non-infected sites: Systematic review and meta-analysis.

BACKGROUND: Alveolar infection is known as a risk factor for implant failure. Current meta-analysis on the theme could not prove statistically that immediate dental implants placed into infected sites have a higher risk of failure than immediate dental implants placed into non-infected sites. The purpose of this meta-analysis was to determine the effectiveness of immediate dental implants placed into infected versus non-infected sites. MATERIAL AND METHODS: Seven databases were sought by two reviewers. Randomized or non-randomized clinical trials that compared the placement of dental implants into infected versus non-infected sites were eligible for the study. Exclusion criteria were: papers in which the survival rate was not the primary outcome; papers without a control group; studies with less than one year of follow-up; studies whose patients did not receive antibiotic therapy; studies with medically compromised patients; duplicated papers. Risk of bias assessment was performed with the Cochrane Collaboration tool. RESULTS: Of the 3.253 initial hits, 8 studies were included in both qualitative and quantitative synthesis (kappa=0.90; very good agreement). Forest plot for implant failure showed that immediate implants placed into infected sites presented a statistically significant risk of failure that is almost 3 times higher than when placed into non-infected sites (risk ratio= 2.99; 95% confidence interval: 1.04, 8.56; p= 0.04; 935 implants; i2= 0%). Peri-implant outcomes showed no statistical difference. CONCLUSIONS: Immediate dental implants placed into infected sites presented a statistically significant higher risk of failure than immediate dental implants placed into non-infected sites. Peri-implant outcomes were not statistically affected in this intervention.

Quality assessment of systematic reviews regarding dental implant placement on diabetic patients: an overview of systematic reviews.

BACKGROUND: Since implant placement on diabetic patients still is a controversial topic and systematic reviews are at the top of scientific evidence hierarchy, a thorough assessment of the methodological quality of these reviews must be performed to inform clinicians if their conclusions and recommendations can be followed on clinical practice. An overview of systematic reviews was performed with the purpose to assess the methodological quality of systematic reviews regarding dental implant placement on diabetic patients. In addition, we presented a synthesis of clinical outcomes about the focused theme. MATERIAL AND METHODS: An online search was performed on MEDLINE via PubMed, EMBASE, DARE-Cochrane, Scopus, Web of Science, LILACS, and SIGLE via Open Grey. Searches were conducted from database inception to May 2018. Systematic review articles with or without meta-analysis about the placement of dental implants on diabetic patients were included. Exclusion criteria were: articles whose primary outcome was not the survival/success rate of dental implants on diabetic patients; studies that do not relate the survival/success rate of dental implants with diabetes; duplicated papers. Methodological quality assessment was performed with AMSTAR. A descriptive synthesis of clinical outcomes was performed. RESULTS: We identified 1.661 initial hits and eight articles were selected for overview (kappa=0.83; strong agreement). Six studies presented moderate methodological quality and two showed high methodological quality. Implant survival rate ranged from 31.8% to 100% and data from four meta-analysis showed that diabetes does not affect implant survival rate. On the other hand, data from two meta-analysis for marginal bone loss showed that diabetes statistically affects this outcome. CONCLUSIONS: Two of the eight included studies presented high methodological quality and their meta-analysis showed that implant placement on diabetic patients does not affect implant survival rate and statistically affects marginal bone loss. However, clinicians must be aware that marginal bone loss values were not clinically relevant and may not be safe to follow the conclusions and recommendations of these studies.

Nonsyndromic cleft lip and palate, gastric cancer and tooth agenesis.

BACKGROUND: To determine the frequency of nonsyndromic cleft lip and/or palate (NSCL/P) in first-degree relatives and to analyze the prevalence of tooth agenesis in patients with gastric cancer. MATERIAL AND METHODS: This cross-sectional, observational, case-control study included 798 patients attended at hospital Santa Casa in Montes Claros, Minas Gerais and Alfa Institute of Gastroenterology of the Federal University of the Minas Gerais. Information on basic demographic data and tooth agenesis of both groups and their family history of NSCL/P in first-degree relatives were evaluated. The collected information was stored in a database and analyzed using statistical program SPSS version 21.0 and the values with p<0.05 were considered statistically significant. RESULTS: Of the 798 patients, 113 (14.16%) consisted of the case group and 685 of the control group (85.84%). Non-Caucasian males were the most affected, although no differences among the groups were detected. Of all participants (n=798), 66 (8.27%) presented tooth agenesis and 25 (3.13%) presented oral cleft in first degree relative. CONCLUSIONS: Our results no found increase in the frequency of tooth agenesis in patients with gastric cancer and in the frequency of NSCL/P in the first-degree relatives of patients with gastric cancer.

In vitro evaluation of the antimicrobial effects of different intracanal medications in necrotic immature teeth.

AIM: This was to assess the antimicrobial effectiveness of pastes used as intracanal medicaments against Enterococcus faecalis in necrotic immature teeth. METHOD: An agar-disc diffusion method over a period of 30 days was used. The following medications were analysed: triple antibiotic paste (TAP) I; double antibiotic paste (DAP) I; DAP I with calcium hydroxide; calcium hydroxide paste with saline solution 0.9 %; calcium hydroxide paste with chlorhexidine 2 % gel; DAP II; DAP II with zinc oxide; DAP II with calcium hydroxide; and saline solution 0.9 % as control. The diameters of the halos of inhibition (in mm) of tested medicaments were determined and analysed with one-way analysis of variance and Tukey's post hoc tests. RESULTS: TAP I (G1) was significantly more effective against E. faecalis, and showed the largest halo of inhibition during all the experiments. DAP groups (G2 and G6) also showed inhibiting bacterial growth with said inhibition remaining stable throughout the 30-day period. In contrast, G4 and G5 groups, in which Ca(OH)2 was added to saline and chlorhexidine, had no antibacterial effect. CONCLUSIONS: TAP and DAP showed better antibacterial efficacy and remained active for 30 days. Combination of Ca(OH)2 with antibiotics should be avoided, due to the possibility of antibiotic hydrolysis.

Occurrence of the accessory foramina of the mandibular ramus in Brazilian adults and its relation to important mandibular landmarks / Presencia de forámenes accesorios de la rama mandibular en adultos brasileños y su relación con importantes puntos de referencia de la anatomía mandibular

The presence of the Accessory Foramina of the Mandibular Ramus (AFMR) may be related to anaesthetic failures in the inferior alveolar nerve block and complications in the ramus surgeries. The purpose of the present investigation was to determine the occurrence of the AFMR in adults and, when present, measure its distance to the Mandibular Foramen (MF), to the Mandibular Lingula (ML) and to the posterior margin of the mandibular ramus (PM), comparing data obtained in both sides of the mandible. Thirty dry human mandibles were selected to the present study. The AFMR was considered as every foramina identified between the MF and the PM. When present, its distance to the MF, to the ML and to the PM was measured. The AFMR was identified in 15 of the 30 examined mandibles (50 %), presenting exclusively on the right side in four cases (13.33 %), exclusively on the left side in other four cases (13.33 %) and simultaneously on both mandibular antimeres in seven of the 30 inspected mandibles (23.33 %). The AFMR is a structure considered as anatomic vari4ation but it was present in one of each two mandibles investigated, with the same occurrence in both mandibular sides. For the cases of occurrence of the AFMR, the professional will be able to locate it in a central position between the MF and the PM, distant about seven millimeters to the MF and 10.50 mm to the ML in both sides of the mandible.

La presencia de forámenes accesorios de la rama mandibular (FARM) puede estar relacionada con fallas que ocurren en el bloqueo anestésico del nervio alveolar inferior y con complicaciones durante cirugías de la rama mandibular. El propósito del presente estudio fue determinar la presencia de FARM en adultos brasileños y cuando éstos estuvieren presentes, medir la distancia al foramen mandibular (FM), a la língula de la mandíbula (LM) y al margen posterior de la rama mandibular (MP), comparando estos datos en ambos lados de la mandíbula. Para ello fueron seleccionadas 30 mandíbulas humanas secas. El FARM fue considerado como cada foramen identificado entre el FM y MP. El FARM fue identificado en 15 de las 30 mandíbulas examinadas (50 %), presentándose en el lado derecho en 4 casos (13,33 %), en el lado izquierdo en 4 (13,33 %) y en ambos lados en 7 (23,33 %). Los FARM son considerados como una variación anatómica pero en este estudio estuvo presente en una de cada dos mandíbulas, con la misma frecuencia en ambas mandíbulas. En el caso de presencia del FARM, el profesional será capaz de identificarlo en una posición central entre el FM y el MP, distante 7 mm aproximadamente del FM y a 10,5 mm de la LM en ambos lados de la mandíbula.

Location, shape and anatomic relations of the mandibular foramen and the mandibular lingula: a contribution to surgical procedures in the ramus of the mandible.

PURPOSE: The purpose of this study was to obtain morphological parameters of the mandibular foramen (MF) and the mandibular lingula (ML) as well as to use biometric data to locate these structures in the medial aspect of the mandibular ramus and to measure the angle that the inferior alveolar sulcus makes with the posterior margin of the ramus. METHODS: The sample was composed of 30 dry human mandibles. The quantitative variables were the distances between the MF and the ML, as well as the distances between these structures and the margins of the mandibular ramus. The angle between the inferior alveolar sulcus and the posterior margin was also measured. The qualitative variables were the shape of the MF and the ML. All variables were analyzed using statistical softwares and the admitted level of statistical significance was 5 %. RESULTS: The statistical analysis indicated a bilateral central positioning of the MF and the ML in relation to the medial surface of the mandibular ramus, however, with a more superior and posterior positioning when the relatives values-which also indicated an oval morphology of the MF and trapezoidal shape of the ML-were considered. The inferior alveolar sulcus was in an acute angle with the posterior margin of the ramus with a larger opening in the left side of the mandible-but equals, however, considering the margins of error. CONCLUSIONS: With the data presented in this study, the surgeon will obtain quantitative and qualitative parameters that can be added to the surgical literature available, facilitating the identification and preservation of the anatomic structures in check, reducing, thus, the risk of iatrogenic injuries.

Apéndices testicular y epididimario en individuos brasileños / Testicular and epididymal appendices in Brazilian individuals

Los apéndices testiculares y epididimarios son remanescentes embriológicos del conducto paramesonéfrico y del conducto mesonéfrico, respectivamente. Estos apéndices pueden sufrir torsión causando un cuadro conocido como escroto agudo. El presente trabajo tuvo como objetivo determinar las variaciones de los apéndices testicular y epididimario, registrando su forma y tamaño. Se utilizaron 30 cadáveres de indivíduos adultos, Brasileños, con edades comprendidas entre 18 y 70 años, fijados en formaldehído 40%, facilitados por el Laboratorio de Anatomía Descriptiva y Topográfica de la Universidad Federal de Alagoas (UFAL), Maceió, Brasil. A través de disección se identificó la presencia de los respectivos apéndices, los que fueron medidos con un caliper manual (MetricaR), registrando su longitud y anchura. Los apéndices testiculares fueron observados en 41 testículos (68,3%) y los apéndices epididimarios en 15 casos (25%). El promedio de la longitud fue de 4,9 mm (DE=1,7) para el apéndice testicular y de 5,2 mm (DE=2,4) para el epididimario. Con respecto a la anchura de los apéndices, el promedio registrado fue de 3,2 mm (DE=1,7) para el testicular y de 2,6 mm (DE=0,9) para el epididimario. Los datos obtenidos puede ser utlizados como soporte morfológico a la clínica urológica y cirugía testicular.

Testicular and epididymal appendages are embryologic remnants of the mesonephric duct and paramesonephric, respectively. These appendices are subject to a torsion causing condition known as acute scrotal syndrome. This study aimed to determine the variations of testicular and epididymal appendices, registering its presence and size. We studied 30 cadavers of adult individuals, Brazilians, aged 18 and 70, fixed in formaldehyde 40%, provided by the Laboratory of Descriptive and Topographic Anatomy of the Federal University of Alagoas (UFAL), Maceió, Brazil. By dissecting these, the presence of the respective appendixes were identified, which were measured with a manual caliper (Metrica), recording its length and width. The testicular appendices were observed in 41 testes (68.3%) and epididymal appendices in 15 cases (25%). The average length was 4.9 mm (SD=1.7) for the appendix testis and epididymis to 5.2 mm (SD=2.4). With respect to the width of the appendices, the average recorded were 3.2 mm (SD=1.7) and 2.6 mm (SD=0.9) for testicular and epididymal, respectively. The data obtained can be used as morphological support in urological clinical and testicular surgery.

Effect of D-alpha-tocopherol on tubular nephron acidification by rats with induced diabetes mellitus.

The objective of the present study was to determine if treatment of diabetic rats with D-alpha-tocopherol could prevent the changes in glomerular and tubular function commonly observed in this disease. Sixty male Wistar rats divided into four groups were studied: control (C), control treated with D-alpha-tocopherol (C + T), diabetic (D), and diabetic treated with D-alpha-tocopherol (D + T). Treatment with D-alpha-tocopherol (40 mg/kg every other day, ip) was started three days after diabetes induction with streptozotocin (60 mg/kg, ip). Renal function studies and microperfusion measurements were performed 30 days after diabetes induction and the kidneys were removed for morphometric analyses. Data are reported as means +/- SEM. Glomerular filtration rate increased in D rats but decreased in D + T rats (C: 6.43 +/- 0.21; D: 7.74 +/- 0.45; D + T: 3.86 +/- 0.18 ml min-1 kg-1). Alterations of tubular acidification observed in bicarbonate absorption flux (JHCO3) and in acidification half-time (t/2) in group D were reversed in group D + T (JHCO3, C: 2.30 +/- 0.10; D: 3.28 +/- 0.22; D + T: 1.87 +/- 0.08 nmol cm-2 s-1; t/2, C: 4.75 +/- 0.20; D: 3.52 +/- 0.15; D + T: 5.92 +/- 0.19 s). Glomerular area was significantly increased in D, while D + T rats exhibited values similar to C, suggesting that the vitamin prevented the hypertrophic effect of hyperglycemia (C: 8334.21 +/- 112.05; D: 10,217.55 +/- 100.66; D + T: 8478.21 +/- 119.81 microm(2)). These results suggest that D-alpha-tocopherol is able to protect rats, at least in part, from the harmful effects of diabetes on renal function.

Effect of D-alpha-tocopherol on tubular nephron acidification by rats with induced diabetes mellitus

The objective of the present study was to determine if treatment of diabetic rats with D-alpha-tocopherol could prevent the changes in glomerular and tubular function commonly observed in this disease. Sixty male Wistar rats divided into four groups were studied: control (C), control treated with D-alpha-tocopherol (C + T), diabetic (D), and diabetic treated with D-alpha-tocopherol (D + T). Treatment with D-alpha-tocopherol (40 mg/kg every other day, ip) was started three days after diabetes induction with streptozotocin (60 mg/kg, ip). Renal function studies and microperfusion measurements were performed 30 days after diabetes induction and the kidneys were removed for morphometric analyses. Data are reported as means ± SEM. Glomerular filtration rate increased in D rats but decreased in D + T rats (C: 6.43 ± 0.21; D: 7.74 ± 0.45; D + T: 3.86 ± 0.18 ml min-1 kg-1). Alterations of tubular acidification observed in bicarbonate absorption flux (JHCO3) and in acidification half-time (t/2) in group D were reversed in group D + T (JHCO3, C: 2.30 ± 0.10; D: 3.28 ± 0.22; D + T: 1.87 ± 0.08 nmol cm-2 s-1; t/2, C: 4.75 ± 0.20; D: 3.52 ± 0.15; D + T: 5.92 ± 0.19 s). Glomerular area was significantly increased in D, while D + T rats exhibited values similar to C, suggesting that the vitamin prevented the hypertrophic effect of hyperglycemia (C: 8334.21 ± 112.05; D: 10,217.55 ± 100.66; D + T: 8478.21 ± 119.81æm²). These results suggest that D-alpha-tocopherol is able to protect rats, at least in part, from the harmful effects of diabetes on renal function.