Radiographic evaluation of maxillofacial region in oncology patients treated with bisphosphonates.

OBJECTIVE: This study aimed to identify radiographic alterations in patients administered bisphosphonate treatment that would permit early diagnosis of osteonecrosis of the jaw. STUDY DESIGN: A prospective study was conducted with clinical and radiographic analysis of 60 patients divided into 2 groups. Thirty patients treated with zoledronate were included in group 1, and 30 patients that had never been treated with bisphosphonate were included in group 2. Digital panoramic radiographs were performed on all patients and subsequently evaluated by 2 radiologists. RESULTS: Data analysis revealed that patients treated with zoledronate presented a statistically significant increase in the number of radiographic abnormalities compared with the control group. Female patients presented significantly more alterations than male patients, and the posterior region of the mandible was the most affected region. CONCLUSIONS: Analysis of the data obtained revealed that the use of panoramic radiographs facilitates early identification of bone alterations, which can improve early diagnosis of bisphosphonate-associated osteonecrosis of the jaw.

Postmortem acinar autolysis in rat sublingual gland: a morphometric study.

OBJECTIVE: To analyze and to quantify morphological acinar postmortem changes in rat sublingual glands (SLG). MATERIAL AND METHODSs: Fifty rats were divided into two groups of 25 animals each. Group I was used for morphological and morphometric evaluations and group II for the determination of gland density and processed gland volume. Acinar autolytic changes were studied at 0 (control group), 3, 6, 12 and 24 h postmortem periods. The morphometric analysis of the volume density (Vv) and total volume (Vt) of intact (ia) and autolyzed (aa) acini was performed under light microscopy using a Zeiss II integration grid with 100 symmetrically distributed points. RESULTS: Morphologically, temporal progressive nuclear alterations and gradual loss of the structural architecture of acinar cells were found. Regarding quantitative results, both the Vvaa and the Vvia showed statistically significant differences among all postmortem periods (p<0.05). Vvaa increased from 0.42% at 0 h to 75.84% at 24 h postmortem and Vvia decreased from 71.16% to 0% over the same period. For Vtaa and Vtia, no statistically significant differences occurred between 12-24 h and 0-3 h (p>0.05), respectively. Vtaa increased from 0.18 mm³ at 0 h to 38.17 mm³ at 12 h, while Vtia showed a decrease from 33.47 mm³ to 0 mm³ between 3-24 h postmortem. Data concerning Vtaa were adjusted by two-variable linear regression, obtaining the equation: y=-3.54+3.38x (r²=0.90). The Vtaa growth rate calculated by this equation was 3.38 mm³/h between 0-12 h. CONCLUSION: Acinar autolysis on rat SLG demonstrated the most significant signs during the first 6 h postmortem and was widely spread through the gland at 12 h.

Postmortem acinar autolysis in rat sublingual gland: a morphometric study

ABSTRACT OBJECTIVE: To analyze and to quantify morphological acinar postmortem changes in rat sublingual glands (SLG). MATERIAL AND METHODSs: Fifty rats were divided into two groups of 25 animals each. Group I was used for morphological and morphometric evaluations and group II for the determination of gland density and processed gland volume. Acinar autolytic changes were studied at 0 (control group), 3, 6, 12 and 24 h postmortem periods. The morphometric analysis of the volume density (Vv) and total volume (Vt) of intact (ia) and autolyzed (aa) acini was performed under light microscopy using a Zeiss II integration grid with 100 symmetrically distributed points. RESULTS: Morphologically, temporal progressive nuclear alterations and gradual loss of the structural architecture of acinar cells were found. Regarding quantitative results, both the Vvaa and the Vvia showed statistically significant differences among all postmortem periods (p<0.05). Vvaa increased from 0.42 percent at 0 h to 75.84 percent at 24 h postmortem and Vvia decreased from 71.16 percent to 0 percent over the same period. For Vtaa and Vtia, no statistically significant differences occurred between 12-24 h and 0-3 h (p>0.05), respectively. Vtaa increased from 0.18 mm³ at 0 h to 38.17 mm³ at 12 h, while Vtia showed a decrease from 33.47 mm³ to 0 mm³ between 3-24 h postmortem. Data concerning Vtaa were adjusted by two-variable linear regression, obtaining the equation: y=-3.54 + 3.38x (r²=0.90). The Vtaa growth rate calculated by this equation was 3.38 mm³/h between 0-12 h. CONCLUSION: Acinar autolysis on rat SLG demonstrated the most significant signs during the first 6 h postmortem and was widely spread through the gland at 12 h.

Validação de medidas maxilofaciais por meio da tomografia computadorizada por feixe cônico em 3D / Assessment of linear and angular measurements on three-dimensional cone-beam computed tomographic images

O objetivo deste estudo foi demonstrar a precisão e a acurácia de medidas maxilofaciais lineares e angulares obtidas por tomografia computadorizada por feixe cônico (TCFC). A amostra consistiu de quinze crânios humanos secos submetidos à TCFC. Medidas lineares e angulares foram realizadas em imagens em terceira dimensão (3D) após a identificação de pontos craniométricos convencionais. As imagens em 3D-TCFC foram analisadas por dois radiologistas, duas vezes, independentemente. Medidas físicas foram realizadas por um terceiro examinador utilizando paquímetro e goniômetro digitais. Os resultados não demonstraram diferenças estatísticas significantes para as análises intra e interexaminadores. As comparações entre as medidas físicas e as obtidas em 3D-TCFC para ambos os examinadores também não foram estatisticamente significantes tanto para as medidas lineares quanto paras as angulares (p= 0,968 e 0,915, p= 0,844 e 0,700, respectivamente). As imagens em 3D-TCFC podem ser utilizadas com precisão e acurácia para a obtenção de medidas lineares e angulares a partir de estruturas anatômicas e pontos craniométricos.

The purpose of this research was to provide further evidence to demonstrate the precision and accuracy of maxillofacial linear and angular measurements obtained by cone-beam computed tomography (CBCT) images. The study population consisted of 15 dry human skulls that were submitted to a CBCT, and three-dimensional (3D) images were generated. Linear and angular measurements based upon conventional craniometric anatomical landmarks, were identified in 3D-CBCT images by two radiologists twice each independently. Subsequently physical measurements were made by a third examiner using a digital caliper and a digital goniometer. The results demonstrated no statistically significant difference between inter and intra-examiner analysis. Regarding accuracy test, no statistically significant difference were found of the comparison between the physical and CBCT-based linear and angular for both examiners (p= 0.968 and 0.915, p= 0.844 and 0.700 respectively). 3D-CBCT images can be used to obtain dimensionally accurate linear and angular measurements from bony maxillofacial structures and landmarks.

Evaluation of TMJ articular eminence morphology and disc patterns in patients with disc displacement in MRI.

The aim of this study was to assess the shape of the temporomandibular joint (TMJ) articular eminence and the articular disc configuration and position in patients with disc displacement. TMJ magnetic resonance images (MRI) of 14 patients with bilateral disc displacement without unilateral reduction were analyzed. Articular eminence morphology was characterized as box, sigmoid, flattened, or deformed. Articular disc configuration was divided into biconcave, biplanar, biconvex, hemiconvex or folded, and its position, as "a" (superior), "b" (anterosuperior), "c" (anterior) or "d" (anteroinferior). The images were divided and the sides with disc displacement with reduction (DDWR) and without reduction (DDWOR) were compared. Regarding articular eminence shape, the sigmoid form presented the greatest incidence, followed by the box form, in the DDWR side, although this was not statistically significant. In the DDWOR side, the flattened shape was the most frequent (p = 0.041). As to disc configuration, the biconcave shape was found in 79% of the DDWR cases (p = 0.001) and the folded type predominated in 43% of the DDWOR cases (p = 0.008). As to disc position, in the DDWR side, "b" (anterosuperior position) was the most frequent (p = 0.001), whereas in the DDWOR side, "d" (anteroinferior position) was the most often observed (p = 0.001). The side of the patient with altered disc configuration and smaller shape of TMJ articular eminence seems to be more likely to develop non-reducing disc displacement as compared to the contralateral side.

Comparative study of single and multislice computed tomography for assessment of the mandibular canal

OBJECTIVE: The purpose of this study was to evaluate the accuracy of relative measurements from the roof of the mandibular canal to the alveolar crest in multislice (multidetector) computed tomography (MDCT) and single-slice computed tomography (SSCT). MATERIAL AND METHODS: The sample consisted of 26 printed CT films (7 SSCT and 19 MDCT) from the files of the LABI-3D (3D Imaging Laboratory) of the School of Dentistry of the University of São Paulo (FOUSP), which had been acquired using different protocols. Two observers analyzed in a randomized and independent order a series of 22 oblique CT reconstructions of each patient. Each observer analyzed the CT scans twice. The length of the mandibular canal and the distance between the mandibular canal roof and the crest of the alveolar ridge were obtained. Dahlberg test was used for statistical analysis. RESULTS: The mean error found for the mandibular canal length measurements obtained from SSCT was 0.53 mm in the interobserver analysis, and 0.38 mm for both observers. On MDCT images, the mean error was 0.0 mm in the interobserver analysis, and 0.0 and 0.23 mm in the intraobserver analysis. Regarding the distance between the mandibular canal roof and the alveolar bone crest, the SSCT images showed a mean error of 1.16 mm in the interobserver analysis and 0.66 and 0.59 mm in the intraobserver analysis. In the MDCT images, the mean error was 0.72 mm in the interobserver analysis and 0.50 and 0.54 mm in the intraobserver analysis. CONCLUSION: Multislice CT was demonstrated a more accurate method and demonstrated high reproducibility in the analysis of important anatomical landmarks for planning of mandibular dental implants, namely the mandibular canal pathway and alveolar crest height.

Clinical and imaging correlations of Treacher Collins syndrome: report of two cases.

Mandibulofacial dysostosis (Treacher Collins Syndrome) is an autosomal dominant genetic disorder that probably derives from inhibition of the facial structures from the first and second branchial arches. The facial pattern of the syndrome is a convex facial profile with a prominent nose above a retruded chin. The eyes are deformed by antimongoloid slant of the palpebral fissures and facial bones are hypoplastic. The alterations are caused by mutation in gene 5q32-33.1, which encodes the nucleolar phosphoprotein treacle. Computed tomography images are able to demonstrate craniofacial bones, allowing the morphological analysis of these bones in individuals with complex deformities. The purpose of this paper is to present the results of a clinical and computed tomography investigation of two patients with Treacher Collins syndrome.

Malignant fibrous histiocytoma (undifferentiated high-grade pleomorphic sarcoma) occurring in tuberous sclerosis: a case report.

Tuberous sclerosis is an autosomal dominant genetic disorder that is characterized by the early development of hamartomas, malformations, and congenital tumors of the nervous system, skin, kidneys, lungs, and heart. Variable clinical expressivity has been reported and more than one gene can be responsible for the disorder. Benign neoplasias accompanying the syndrome are common but malignant neoplasias are rare, being generally mesenchymal and possibly affecting the jaws. We report here a clinical case of a malignant fibrous histiocytoma (undifferentiated high-grade pleomorphic sarcoma) of the mandible in a patient with tuberous sclerosis.

Comparative study of single and multislice computed tomography for assessment of the mandibular canal.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of relative measurements from the roof of the mandibular canal to the alveolar crest in multislice (multidetector) computed tomography (MDCT) and single-slice computed tomography (SSCT). MATERIAL AND METHODS: The sample consisted of 26 printed CT films (7 SSCT and 19 MDCT) from the files of the LABI-3D (3D Imaging Laboratory) of the School of Dentistry of the University of São Paulo (FOUSP), which had been acquired using different protocols. Two observers analyzed in a randomized and independent order a series of 22 oblique CT reconstructions of each patient. Each observer analyzed the CT scans twice. The length of the mandibular canal and the distance between the mandibular canal roof and the crest of the alveolar ridge were obtained. Dahlberg test was used for statistical analysis. RESULTS: The mean error found for the mandibular canal length measurements obtained from SSCT was 0.53 mm in the interobserver analysis, and 0.38 mm for both observers. On MDCT images, the mean error was 0.0 mm in the interobserver analysis, and 0.0 and 0.23 mm in the intraobserver analysis. Regarding the distance between the mandibular canal roof and the alveolar bone crest, the SSCT images showed a mean error of 1.16 mm in the interobserver analysis and 0.66 and 0.59 mm in the intraobserver analysis. In the MDCT images, the mean error was 0.72 mm in the interobserver analysis and 0.50 and 0.54 mm in the intraobserver analysis. CONCLUSION: Multislice CT was demonstrated a more accurate method and demonstrated high reproducibility in the analysis of important anatomical landmarks for planning of mandibular dental implants, namely the mandibular canal pathway and alveolar crest height.

Evaluation of TMJ articular eminence morphology and disc patterns in patients with disc displacement in MRI

The aim of this study was to assess the shape of the temporomandibular joint (TMJ) articular eminence and the articular disc configuration and position in patients with disc displacement. TMJ magnetic resonance images (MRI) of 14 patients with bilateral disc displacement without unilateral reduction were analyzed. Articular eminence morphology was characterized as box, sigmoid, flattened, or deformed. Articular disc configuration was divided into biconcave, biplanar, biconvex, hemiconvex or folded, and its position, as "a" (superior), "b" (anterosuperior), "c" (anterior) or "d" (anteroinferior). The images were divided and the sides with disc displacement with reduction (DDWR) and without reduction (DDWOR) were compared. Regarding articular eminence shape, the sigmoid form presented the greatest incidence, followed by the box form, in the DDWR side, although this was not statistically significant. In the DDWOR side, the flattened shape was the most frequent (p = 0.041). As to disc configuration, the biconcave shape was found in 79 percent of the DDWR cases (p = 0.001) and the folded type predominated in 43 percent of the DDWOR cases (p = 0.008). As to disc position, in the DDWR side, "b" (anterosuperior position) was the most frequent (p = 0.001), whereas in the DDWOR side, "d" (anteroinferior position) was the most often observed (p = 0.001). The side of the patient with altered disc configuration and smaller shape of TMJ articular eminence seems to be more likely to develop non-reducing disc displacement as compared to the contralateral side.

Objetivou-se avaliar a morfologia da eminência e a configuração e a posição do disco da articulação temporomandibular (ATM) em pacientes com deslocamento de disco. Foram analisadas imagens por ressonância magnética (IRM) da ATM de 14 pacientes com deslocamento de disco bilateral, sem redução unilateral. A morfologia da eminência articular foi caracterizada como caixa, sigmóide, aplainada e deformada. A configuração do disco articular foi dividida em bicôncava, biplanar, biconvexa, hemiconvexa e dobrada e a sua posição em "a" (superior), "b" (ântero-superior), "c" (anterior) e "d" (ântero-inferior). As imagens foram divididas e comparadas entre o lado com deslocamento de disco com redução (DDCR) e o lado sem redução (DDSR). Quanto à forma da eminência articular, a forma sigmóide foi a mais incidente, seguida da caixa, no lado com DDCR, embora esta diferença não tenha sido estatisticamente significante. No lado com DDSR, a forma aplainada foi a mais freqüente (p = 0,041). Na configuração do disco, a forma bicôncava foi observada em 79 por cento dos casos de DDCR (p = 0,001) e a dobrada em 43 por cento dos casos de DDSR (p = 0,008). Em relação à posição do disco, a posição "b" (ântero-superior) foi a mais freqüente no lado com DDCR (p = 0,001), enquanto que no lado com DDSR, foi a "d" (ântero-inferior) (p = 0,001). O lado do paciente com alteração na configuração do disco e uma forma menor da eminência articular da ATM parece ter mais chance de desenvolver o deslocamento do disco sem redução quando comparado ao outro lado.

Aplicação de medidas cefalométricas em 3D-TC / Application of cephalometric measurements in 3D-TC

OBJETIVO: o objetivo desta pesquisa foi avaliar a precisão e acurácia (validade) de medidas cefalométricas lineares em imagens reconstruídas em terceira dimensão (3D), pela técnica de volume, a partir da tomografia computadorizada (TC) multislice. METODOLOGIA: o material da pesquisa consistiu de 10 (dez) crânios secos, previamente selecionados, sem distinção de etnia ou gênero, os quais foram submetidos à TC multislice 16 cortes com 0,5mm de espessura por 0,3mm de intervalo de reconstrução. Posteriormente, os dados obtidos foram enviados para uma estação de trabalho independente, contendo o programa Vitrea®. Os pontos cefalométricos (n=13) foram localizados e as respectivas medidas ósseas lineares (n=15) foram realizadas por 2 examinadores, previamente treinados, medindo cada um duas vezes, independentemente, em 3D. As medidas físicas foram obtidas por um terceiro examinador, utilizando um paquímetro digital. A análise dos dados foi realizada mediante um estudo comparativo entre as medidas inter e intra-examinadores, em 3D-TC, e entre estas e as medidas físicas obtidas diretamente nos crânios, utilizando ANOVA (análise de variância). RESULTADOS: não foram encontradas diferenças estatisticamente significantes entre os valores das medidas inter e intra-examinadores, nem entre as medidas físicas e em 3D, com p>0,6 para todas as medidas. O erro percentual foi de 2,05 por cento para as medidas interexaminadores e de 2,11 por cento para as medidas intra-examinadores. A média do erro percentual entre as medidas físicas e em 3D variou de 0,96 por cento a 1,47 por cento. CONCLUSÃO: todas as medidas cefalométricas lineares foram consideradas precisas e acuradas utilizando a técnica de volume em 3D por meio da TC multislice.

AIM: To test the precision and accuracy of conventional linear cephalometric measurements in 3D reconstructed images using a multislice CT. METHODS: The study population consisted of 10 dry skulls, previously selected, without distinction of ethnic group and sex, which were submitted to a multislice CT 16 slices using 0.5mm of slice thickness and 0.3mm of interval of reconstruction. Subsequently the data was sent to an independent workstation. Conventional craniofacial landmarks (n=13), usually applied to facial orthopedic and orthodontic treatment planning, were localized and linear measurements (n=15) were obtained by 2 radiologists, twice each, independently, in 3D-CT images. In total 600 measurements were made. The correspondent physical measurements were obtained by a third examiner using a digital caliper. Statistical evaluation of the measurements was carried out regarding to inter and intra-examiner, in 3D-CT, and between image and physical measurements from dry skulls, using analysis of variance. RESULTS AND CONCLUSIONS: There were no statistically significant differences between inter and intra-examiner measurements or between imaging and physical measurements. The results also showed an inter-examiner variability error of 2.05 percent, and an intra-examiner variability error of 2.11 percent. There were also no statistically significant differences between imaging and physical measurements with p>0.6 for all measurements. The mean difference was from 0.96 percent to 1.47 percent for all measurements. The validity of linear cephalometric measurements was established using 3D volume rendering from a multislice CT with high precision and accuracy.

Fibroma odontogênico periférico: revisão da literatura e relato de caso / Peripheral odontogenic fibroma: review of the literature and case report

O fibroma odontogênico periférico (FOP) é uma neoplasia benigna com origem a partir do ectomesênquima odontogênico. A lesão possui crescimento lento e acomete a gengiva, com maior incidência na região da papila interdentária. Apresenta-se com uma massa gengival frequentemente séssil, de consistência firme, recoberta por mucosa aparentemente normal. O presente trabalho objetiva relatar um caso de FOP na região anterior da maxila, relacionando os achados da literatura pertinente, especialmente, quanto aos aspectos clínicos e histopatológicos do tumor.

Quantitative age-related differences in human sublingual gland.

OBJECTIVE: To quantify morphological age- and gender-related differences in human sublingual glands (SLG). DESIGN: Ninety right human SLG from necropsies were distributed by gender and age groups. Individuals with ages ranging from 7 months to 92 years were divided into Groups I (0-30 years), II (31-60 years) and III (61-92 years). The glandular volume of each SLG was calculated. The morphometric quantifications of the volume density and total volume of acini, ducts, stroma, adipose tissue and septa were realized under light microscopy using a Zeiss II integration grid with 100 points symmetrically distributed. RESULTS: The glandular volume decreased, on average, 33.78% across the groups. The volume density (V(V)) of acini reduced 60.54% and of septa 34.82%, being replaced partly by an increase of 58.82%, 551.22% and 2,783.33% in the volume density of ducts, stroma and adipose tissue, respectively. In absolute terms, with aging, the total volume (V(T)) of the acini decreased by 54.04% and by 34.84% in the septa. In contrast, the total volume of ducts, stroma and adipose tissue showed increases of 62.53%, 363.25% and 2,308.64%, respectively. Both the V(V) and the V(T) of acini, ducts, stroma and adipose tissue and the V(V) of septa were statistically different with age. No significant difference was observed between genders. CONCLUSION: The decrease of parenchyma accompanied by an increase of stroma observed here in SLG is a common feature of aging in human salivary glands.

Avaliação do índice de acerto no diagnóstico radiográfico de defeitos ósseos periodontais: estudo in vitro / Evaluation of the accuracy in radiographic diagnosis of periodontal bony defects: an in vitro study

O presente estudo teve como objetivo avaliar a acurácia no diagnóstico radiográfico de defeitos ósseos periodontais por radiologistas e periodontistas. Diferentes tipos de defeitos ós-seos foram confeccionados em duas mandíbulas humanas secas. Radiografias periapicais foram realizadas em regiões pré-determinadas antes (controle) e depois da confecção dos defeitos ósseos. O tempo de exposição variou de 0,1 a 0,5 segundos. As radiografias e o processamento radiográfico foram padronizados. As radiografias foram analisadas por especialistas previamente calibrados. A acurácia no diagnóstico radiográfico foi de 61%. O defeito ósseo horizontal foi o mais visualizado, seguido do vertical, sendo o cratera o de maior dificuldade no diagnóstico.

Paracoccidioidomicose: aspectos gerais e relatos de caso / Paracoccidioidomycosis: general aspects and case reports

Os autores apresentam casos clínicos de Paracoccidioidomicose e realizam uma análise da doença, abordando os sinais e sintomas, aspectos radiográficos e histológicos e suas possíveis complicaçöes