Solitary Median Maxillary Central Incisor in Hartsfield Syndrome: A Case Report.

Hartsfield syndrome is a rare and unique clinical combination of ectrodactyly and holoprosencephaly (HPE) with or without cleft lip and palate, as well as various additional characteristics. Although several genes responsible for HPE and ectrodactyly have been identified, the genetic origin of Hartsfield syndrome remains unknown, as there are few reports in the literature. The objective of this case report is to present dentofacial abnormalities in an 11-year-old boy with Hartsfield syndrome, who presented mental retardation, hearing loss, bilateral hand and foot ectrodactyly, HPE, and solitary median maxillary central incisor (SMMCI) besides 12 dental ageneses. How to cite this article: P Reis PM, Faber J, O Rosa JS, et al. Solitary Median Maxillary Central Incisor in Hartsfield Syndrome: A Case Report. Int J Clin Pediatr Dent 2023;16(1):147-152.

The use of host defense peptides in root canal therapy in rats.

OBJECTIVES: In order to evaluate host defense peptides (HDPs) HHC-10 and synoeca-MP activity in in vitro osteoclastogenesis process and in vivo induced apical periodontitis, testing the effect of molecules in the inflammatory response and in apical periodontitis size/volume after root canal treatment. MATERIALS AND METHODS: In vitro osteoclastogenesis was assessed on bone marrow cell cultures extracted from mice, while in vivo endodontic treatment involved rats treated with Ca(OH)2 or HDPs. In vitro osteoclasts were subjected to TRAP staining, and in vivo samples were evaluated by radiographic and tomographic exams, as well as histologic analysis. RESULTS: None of the substances downregulated the in vitro osteoclastogenesis. Nevertheless, all treatments affected the average of apical periodontitis size in rats, although only teeth treated with HDPs demonstrated lower levels of the inflammatory process. These results demonstrated the in vivo potential of HDPs. Radiographic analysis suggested that HHC-10 and synoeca-MP-treated animals presented a similar lesion size than Ca(OH)2-treated animals after 7-day of endodontic treatment. However, tomography analysis demonstrated smaller lesion volume in synoeca-MP-treated animals than HHC-10 and Ca(OH)2-treated animals, after 7 days. CONCLUSIONS: These molecules demonstrated an auxiliary effect in endodontic treatment that might be related to its immunomodulatory ability, broad-spectrum antimicrobial activity, and possible induction of tissue repair at low concentrations. These results can encourage further investigations on the specific mechanisms of action in animal models to clarify the commercial applicability of these biomolecules for endodontic treatment. CLINICAL SIGNIFICANCE: HDPs have the potential to be adjuvant substances in endodontic therapy due to its potential to reduce inflammation in apical periodontitis.

MARPE Guide: A Case Report.

AIM: This paper presents a prototyped surgical guide for placement of MARPE-mini-implant-assisted rapid palatal expander. BACKGROUND: Investigations conducted in the last decades have increased the technological resources used in orthodontics. This scientific advance applies to several clinical procedures, including the planning of devices used in guided surgeries, using computed tomography images and intraoral scanning. CASE DESCRIPTION: This case report presents maxillary expansion in an adult patient (18 years and 5 months), using the MARPE technique, by virtual planning and fabrication of a surgical guide (laser-printed on a 3D printer MoonRay D225-SprintRay, 2014), after merging of 3 files: digital file of the expander (.stl), computed tomography of the suture, and intraoral scanning of the patient, using the planning software NemoStudio (version 20122, 16.50.0.56). CONCLUSION: Fabrication of a surgical guide for the MARPE technique provides an accurate transfer of the virtual planning to the surgical procedure. It allows three-dimensional orientation of the expander position and perforations of mini-implants, which are necessary to establish anchorage in areas with sufficient bone, assuring the system stability and a successful procedure. CLINICAL SIGNIFICANCE: The mini-implant assisted rapid palatal expansion (MARPE) has been investigated as a promising option for correction of malocclusion related with maxillary atresia in adult patients and is an option to orthognathic surgery. Digital treatment planning is fundamental to establish individual, reproducible, and accurate parameters, as in the present case, which evidenced significant benefits in both occlusal and respiratory aspects.

CBCT Performance and Endodontic Sealer Influence in the Diagnosis of Vertical Root Fractures.

AIM: To evaluate the performance of three cone beam computed tomography (CBCT) machines in detecting vertical root fractures (VRFs) in teeth filled with different sealers. MATERIALS AND METHODS: A total of 80 single-rooted premolars were subjected to instrumentation and restoration with gutta-percha + AH Plus sealer, gutta-percha + sealer 26, gutta-percha + fill canal, and gutta-percha without sealer as the control. Half of the samples were randomly subjected to root fracture and all the teeth were scanned by i-CAT (Imaging Sciences International, Hatfield, USA), PreXion (PreXion Inc., San Mateo, USA), and OrthoPhos XG (Sirona Dental System, Bensheim, Germany). Three examiners analyzed the images for the presence of fractures. RESULTS: The highest accuracy was obtained with the PreXion device, with Az = 0.85, while the i-CAT device provided higher sensitivity (0.93). The specificity values observed ranged between 0.75 and 0.70. Chi-squared tests (p > 0.05) demonstrated that the sealers did not exert a significant influence on the diagnosis of VRF. CONCLUSION: It may be concluded that endodontic sealers do not influence the detection of VRF. The PreXion device was the most accurate, having the highest specificity value. CLINICAL SIGNIFICANCE: Radiopaque materials might affect the diagnosis of VRFs because they can simulate fracture lines, leading to false-positive results. Moreover, CBCT machines present different specificities that could exert some influence on that.

Intraobserver and interobserver reproducibility in linear measurements on axial images obtained by cone-beam computed tomography.

PURPOSE: This study was performed to investigate the intra- and inter-observer variability in linear measurements with axial images obtained by PreXion (PreXion Inc., San Mateo, USA) and i-CAT (Imaging Sciences International, Xoran Technologies Inc., Hatfield, USA) CBCT scanners, with different voxel sizes. MATERIALS AND METHODS: A cylindrical object made from nylon with radiopaque markers (phantom) was scanned by i-CAT and PreXion 3D devices. For each axial image, measurements were taken twice in the horizontal (distance A-B) and vertical (distance C-D) directions, randomly, with a one-week interval between measurements, by four oral radiologists with five years or more experience in the use of these measuring tools. RESULTS: All of the obtained linear measurements had lower values than those of the phantom. The statistical analysis showed high intra- and inter-observer reliability (p=0.297). Compared to the real measurements, the measurements obtained using the i-CAT device and PreXion tomography, on average, revealed absolute errors ranging from 0.22 to 0.59 mm and from 0.23 to 0.63 mm, respectively. CONCLUSION: It can be concluded that both scanners are accurate, although the linear measurements are underestimations, with no significant differences between the evaluators.

Soft tissue cone beam computed tomography (ST-CBCT) for the planning of esthetic crown lengthening procedures.

OBJECTIVE: The aim of this study was to measure the clinical crown, anatomical crown, and amount of gingiva covering the enamel of anterior maxillary teeth with soft tissue cone beam computed tomography (ST-CBCT) and thus propose a protocol for the application of this noninvasive method for the planning of esthetic crown lengthening procedures to prevent undesired root exposure. MATERIALS AND METHODS: Ten young patients (mean age 22.8 years) requiring esthetic crown lengthening surgeries but not restorative procedures were included in this study. The ST-CBCT images were analyzed with an image editor and analysis software (Pixelmator 3.2), and the clinical crown, anatomical crown, and amount of gingiva covering the enamel were measured. RESULTS: The mean value of the length of the anatomical crowns of the central incisors, lateral incisors, and canines were 11.06 mm, 9.55 mm, and 9.77 mm, respectively. Thus, the canines were approximately 1.3 mm shorter than the central incisors. CONCLUSION: It was shown that ST-CBCT is a useful tool to assess the actual length of the anatomical crown and the amount of gingival tissue that needs to be surgically removed in an esthetic crown lengthening procedure to prevent undesired root exposure. Thus, ST-CBCT is a helpful noninvasive procedure for the planning of esthetic crown lengthening surgeries, making it possible to better predict their final outcome.

Preventive and surgical intervention in patient with cerebral palsy: case report

Introduction: Cerebral palsy is defined as a non-progressive brain disorder of movement and posture. The patient is characterized by mental and motor disabilities, sensory impairments of vision and hearing, besides having seizures and contraction joints. Objective: To address a multidisciplinary dental intervention in a patient, leucoderma, 11 years-old, with cerebral palsy who attended the Special Patients Clinic of the Catholic University of Brasilia, Brazil. Case report: Clinical interventions to promote oral health, emphasizing the responsible guidelines regarding oral hygiene techniques, and surgical procedures such as extractions of deciduous teeth #75, #85, #63 (phase 1) and ulectomy in the region of teeth #24 and #25 (phase 2) were performed. Conclusion: The multidisciplinary assistance targeted to the oral health of the patient with cerebral palsy can be considered as an important strategy for promoting the health and quality of life in this population group.

Cone beam computed tomography and intraoral radiography for diagnosis of dental abnormalities in dogs and cats.

The development of veterinary dentistry has substantially improved the ability to diagnose canine and feline dental abnormalities. Consequently, examinations previously performed only on humans are now available for small animals, thus improving the diagnostic quality. This has increased the need for technical qualification of veterinary professionals and increased technological investments. This study evaluated the use of cone beam computed tomography and intraoral radiography as complementary exams for diagnosing dental abnormalities in dogs and cats. Cone beam computed tomography was provided faster image acquisition with high image quality, was associated with low ionizing radiation levels, enabled image editing, and reduced the exam duration. Our results showed that radiography was an effective method for dental radiographic examination with low cost and fast execution times, and can be performed during surgical procedures.

Cone beam computed tomography in the diagnosis of temporomandibular joint alterations in cats.

The aim of this study was to describe the use of cone beam computed tomography as an auxiliary method to diagnose changes to the temporomandibular joints in cats. We used five cats of various ages, breeds and genders that showed clinical signs consistent with changes in the temporomandibular joint. Cone beam computed tomography enables a complete and thorough examination of the temporomandibular joints by allowing the evaluation of selected images as a whole. It also enables the identification of all anatomical structures and any changes that may be present. The results showed that this method is effective in confirming or ruling out changes in the temporomandibular joint in cats, such as disjunctions of the palatine raphe; fractures of the mandibular symphisis, zygomatic bone and condylar; and dental resorption.

Dimension of the facial bone wall in the anterior maxilla: a cone-beam computed tomography study.

OBJECTIVE: To determine the thickness of the facial bone wall in the anterior dentition of the maxilla and at different locations apical to the cemento-enamel junction (CEJ). MATERIAL AND METHODS: Two-hundred and fifty subjects, aged between 17 and 66 years, with all maxillary front teeth present were included. Written informed consents were obtained. Cone-beam computed tomography scans were performed with the iCAT unit. This examination included all tooth and edentulous sites in the dentition. The images were acquired by means of the iCAT software and processed by a computer. Measurements of the (i) distance between the CEJ and the facial bone crest and (ii) the thickness of the facial bone wall were performed. The bone wall dimensions were assessed at three different positions in relation to the facial bone crest, i.e., at distances of 1, 3, and 5 mm apical to the crest. RESULTS: The measurements demonstrated that (i) the distance between the CEJ and the facial bone crest varied between 1.6 and 3 mm and (ii) the facial bone wall in most locations in all tooth sites examined was ≤1 mm thick and that close to 50% of sites had a bone wall thickness that was ≤0.5 mm. CONCLUSION: Most tooth sites in the anterior maxilla have a thin facial bone wall. Such a thin bone wall may undergo marked dimensional diminution following tooth extraction. This fact must be considered before tooth removal and the planning of rehabilitation in the anterior segment of the dentition in the maxilla.

Aggressive spindle cell rhabdomyosarcoma in an 11-month-old boxer dog.

Rhabdomyosarcoma (RMS) is a malignant neoplasm derived from mesenchymal tissue with a tendency toward myogenic differentiation associated with the embryogenesis of skeletal muscle. According to the histological features, it can be classified in embryonal, botryoid, alveolar, and pleomorphic, which usually correspond to clinical behavior and prognosis. The spindle cell (SCRMS) variant is a rare subtype of the embryonal RMS and is considered to be less aggressive lesion. The aim of the present paper is to report an unusual case of SCRMS in an 11-month-old male boxer dog diagnosed as extensive SCRMS that affected the frontal region of the skull. Due to the aggressive nature of the lesion and poor clinical prognosis the dog's owners preferred euthanasia as a treatment. A full postmortem examination was carried out. Microscopically, the lesion was composed of a highly cellular proliferation of spindle cells arranged in long and intersecting fascicles. After performing the immunohistochemical studies (HHF-35, smooth muscle actin, desmin and MyoD1), the present case was diagnosed as SCRMS.

Tomografia computadorizada de feixe cônico na odontologia veterinária: descrição e padronização da técnica / Tapered beam computed tomography in Veterinary Dentistry: description and technical standardization

Onze cães e quatro gatos, portadores de alterações buco-dentárias e atendidos no Centro Veterinário do Gama, em Brasília, DF, foram submetidos à tomografia computadorizada de feixe cônico. Os exames foram realizados em um tomógrafo i-CAT, utilizando para aquisição das imagens, altura de seis centímetros, tempo de 40 segundos, 0,2 voxel, 120 kilovolts e 46,72 miliampéres por segundo. O melhor posicionamento dos animais para realização do exame foi definido neste estudo. Esse é um fator fundamental para a realização do exame, que necessitou um protocolo anestésico simples e seguro, em função do tempo mínimo necessário à obtenção das imagens. Várias alterações e enfermidades foram identificadas, com extrema acurácia, credenciando a tomografia computadorizada de feixe cônico como um exame seguro, acessível e exeqüível e que pode ser incorporado à rotina odontológica das clínicas de pequenos animais.

Eleven dogs and four cats with buccodental alterations, treated in the Centro Veterinário do Gama, in Brasilia, DF, Brazil, were submitted to cone beam computed tomography. The exams were carried out in a i-CAT tomograph, using for image acquisition six centimeters height, 40 seconds time, 0.2 voxel, 120 kilovolts and 46.72 milliamperes per second. The ideal positioning of the animal for the exam was also determined in this study and it proved to be fundamental for successful examination, which required a simple and safe anesthetic protocol due to the relatively short period of time necessary to obtain the images. Several alterations and diseases were identified with accurate imaging, demonstrating that cone beam computed tomography is a safe, accessible and feasible imaging method which could be included in the small animal dentistry routine diagnosis.

A new method to assess and measure palatal masticatory mucosa by cone-beam computerized tomography.

AIM: The aim of this study was to apply a novel method to obtain high-quality images by cone-beam computerized tomography (CBCT) that consistently allowed the determination of the dimensions of the palatal mucosa. MATERIALS AND METHODS: Thirty-one patients participated in this study. At the time of the CBCT scanning, the patients wore a plastic lip retractor and wooden spatulas to retract soft tissues away from the teeth and gingiva. The thickness of the palatal mucosa was obtained at forty different locations on each patient. RESULTS: Retraction of the lips and cheek allowed a clear observation and measurements of the thickness of the palatal masticatory mucosa. The average thickness of the palatal mucosa was 2.92 mm in the canine area, 3.11 mm at the first pre-molar, 3.28 mm at the second pre-molar, 2.89 mm at the first molar and 3.15 mm at the second molar. Statistical differences were observed at different ages and heights of measurements. CONCLUSIONS: A new non-invasive method to consistently obtain high-quality images of the palatal masticatory mucosa is described. Measurements of this mucosa could be obtained at different locations on the palate.

Soft tissue cone-beam computed tomography: a novel method for the measurement of gingival tissue and the dimensions of the dentogingival unit.

UNLABELLED: The dimensions and relationships of the structures of the dentogingival unit have been greatly overlooked because of the inability to easily and precisely determine them. The purpose of the present study was to develop a soft tissue cone-beam computed tomography (ST-CBCT) to improve soft tissue image quality and allow the determination of the dimensions and relationships of the structures of the dentogingival unit. Two separate CBCT scans were obtained from three patients with different periodontal biotypes. The first was a scan following standard methods; however, for the ST-CBCT the patients wore a plastic lip retractor and retracted their tongues toward the floor of their mouths. With the first scan, only measurements of the distance of the cementoenamel junctional (CEJ) to the facial bone crest, and the width of the facial alveolar bone were possible. In contrast, ST-CBCT allowed measurements of the distance of the gingival margin to the facial bone crest, the gingival margin to the CEJ, and width of the facial gingiva. ST-CBCT scans allowed a clear visualization, measurement of the dimensions, and analysis of the relationship of the structures of the periodontium and dentogingival attachment apparatus. CLINICAL SIGNIFICANCE: The dimensions and relationships of the structures of the dentogingival attachment apparatus are essential aspects in many fields of dentistry and this report describes a simple, novel, and noninvasive technique to determine them. This technique may aid clinicians in the planning and execution of procedures in several dental specialties.