Evaluation of renal osteodystrophy in the dental clinic by assessment of mandibular and phalangeal cortical indices.

OBJECTIVES: Secondary hyperparathyroidism (SHPT) is a disease that affects patients with chronic kidney disease, and is characterized by mineral disturbance and bone loss, known as renal osteodystrophy. The aim of this study was to assess the validity of using intraoral phosphor storage plates to take radiographs of the middle phalanges to evaluate bone loss resulting from SHPT during follow-up of these patients. METHODS: The sample consisted of 24 patients with chronic kidney disease, 12 with parathyroid hormone (PTH) levels ≥500 pg/ml, and 12 with PTH levels <500 pg/ml, who underwent hemodialysis weekly. For each patient, a panoramic radiograph and digital radiographs of the ring, index, and middle fingers of both hands were taken. The Mandibular Cortical Index (MCI) and the Trabecular Bone Pattern Index (TBP) were applied to the panoramic radiographs, while the Phalangeal Cortical Index (PCI) was applied to the digital radiographs of the phalanges. Three evaluators performed all analyses. RESULTS: Significant correlations were found between the PTH levels and the MCI (p = 0.023), the PCI (p = 0.039) and the TBP index (p = 0.032). These parameters were also significantly interrelated (MCI × PCI = 0.001; MCI × TBP = 0.004 and PCI × TBP = 0.009). The PCI was shown to have the highest correlation with PTH levels. CONCLUSION: In patients with chronic renal disease, it is clinically relevant to use panoramic and digital radiographs using intraoral storage plates to assess a number of quantitative parameters that can be linked to PTH levels.

Quantitative evaluation of posterior mandibular region by cone beam computerized tomography as a donor site for autogenous bone grafts / Avaliação quantitativa da região posterior de mandíbula por meio da tomografia computadorizada cone beam como área doadora para enxertos ósseos autógenos

Knowledge of the craniofacial anatomic structures is fundamental for successful autogenous bone grafting surgeries in implant dentistry. In view of the limitations of panoramic radiography, as a bidimensional image, Cone Beam Computerized Tomography (CBCT) has become necessary, as it makes possible to observe potential segments of autogenous bone grafting for implant placement in edentulous regions. The aim of this paper was quantify the bone thickness using CBCT to measure the thickness of the vestibular cortical-medullary bone in the mandibular retromolar and molar regions, as donor segments for the patients. The scans were obtained from a Newtom QVT 9000 3G Aperio ® Tomograph. They were taken from mandibles of 50 patients. We obtained statistically significant differences between measurements of molar areas of men and retromolar area of women (p<0.05). The results of this research broaden the dentist's knowledge about evaluating potential donor areas in the posterior region of the mandible, as regards the requirement of predictability. In conclusion, greater thickness of donor area was observed in both the male and female gender bilaterally, in the mandibular retromolar and third molar regions. Furthermore, upper segment region presented greater cortical thickness in all the studied regions.

O conhecimento das estruturas anatômicas craniofaciais é fundamental para o sucesso de cirurgias de enxerto ósseo autógeno em implantodontia. Tendo em vista as limitações da radiografia panorâmica, como uma imagem bidimensional, a tomografia computadorizada Cone Beam (TCCB) tornou-se necessária, uma vez que torna possível observar segmentos ósseos com potencial para serem utilizados como enxertos autógenos para a colocação de implante em regiões desdentados. O objetivo deste estudo foi quantificar a espessura de osso usando TCCB para medir a espessura óssea cortical-medular vestibular nas regiões retromolar e molar inferior, como segmentos de doadores para os pacientes. Os exames foram obtidos a partir de um Newtom QVT 9000 3G Aperio ® Tomograph. Estes foram retirados de mandíbulas de 50 pacientes. Observamos diferenças estatisticamente significativas entre as medidas de áreas molares de homens e área retromolar das mulheres (p <0,05). Os resultados desta pesquisa ampliam o conhecimento do cirurgião-dentista sobre a avaliação de áreas doadoras potenciais na região posterior da mandíbula, no que diz respeito à exigência de previsibilidade. Em suma, observamos uma maior espessura da área doadora, tanto no sexo masculino quanto no feminino, na retromolar mandibular e na região de terceiros molares. A região do segmento superior apresentou maior espessura cortical em todas as regiões estudadas.

Correlation between hand/wrist and panoramic radiographs in severe secondary hyperparathyroidism.

OBJECTIVES: Hand/wrist and dental radiographs are important for osteoporosis analysis in secondary hyperparathyroidism (SHPT). This study evaluated whether a correlation exists between the effects of the disease on the hands and jaws, and investigated the association between osteoporosis progression in the hands and parathyroid hormone (PTH) levels in chronic kidney disease (CKD) patients. MATERIALS AND METHODS: Four panoramic radiographic parameters (mental index, mandibular cortical index, trabecular bone pattern, and calcification/resorption) and four corresponding hand/wrist radiographic parameters (metacarpal cortical thickness, phalangeal cortical index, trabecular bone pattern, and calcification/resorption) were applied to investigate possible correlation between the effects of SHPT on the jaws and hands/wrists, by Spearman's correlation coefficient. PTH levels and the hand/wrist radiographic parameters were also tested by spearman's correlation coefficient (p < 0.05). The presence of brown tumors, vascular calcifications, and acroosteolysis on the hands was also evaluated. RESULTS: Mandibular cortical index was strongly correlated with the phalangeal cortical index (p = 0.000). Phalangeal cortical index and trabecular bone pattern of hand/wrist correlated with PTH levels (0.002 and 0.000, respectively). Brown tumors occurred in four CKD patients, while both vascular calcifications and acroosteolysis were observed in 19 patients. CONCLUSION: There is a significant correlation between the morphological changes caused by secondary hyperparathyroidism in hand and jaw bones. The morphological status can be assessed using the mandibular cortical index, besides the phalangeal cortical index. The latter correlates well with parathyroid hormone levels of advanced chronic kidney disease. CLINICAL RELEVANCE: Panoramic images reveal morphological changes in the jaw bone, indicating likewise changes in the hand/wrist in severe secondary hyperparathyroidism. The severity of the bone changes may be a reflection of the parathyroid hormone levels in advanced chronic kidney disease.

Autopercepção da saúde bucal e anamnese em idosos / Self-perception of oral health and anamnesis in the elderly

Objetivo: Avaliar a autopercepção dos idosos com relação à própria saúde bucal e a anamnese, abrangendo as alterações sistêmicas e bucais presentes. Métodos A amostra consistiu de 52 idosos, com idade entre 60 e 90 anos, participantes da Universidade Aberta à Terceira Idade, Núcleo São José dos Campos, Faculdade de Odontologia da Universidade Estadual Paulista Júlio de Mesquita Filho. Foi utilizado o Questionário Geriatric Oral Health Assessment Index para aferir a autopercepção dos idosos quanto à própria condição bucal, seguido de anamnese e exames clínicos intrabucais a fim de identificar as alterações sistêmicas e bucais existentes Resultados:De acordo com a análise estatística descritiva, 86,0% dos indivíduos apresentaram alta autopercepção em avaliar a própria condição bucal (ótima capacidade); 12,0% tiveram média autopercepção (boa capacidade) e 2,0% dos indivíduos apresentaram baixa autopercepção (baixa capacidade). Hipertensões arteriais (30,7%) e fibromas (12,4%) foram, respectivamente, as doenças sistêmicas e bucais mais prevalentes. Conclusão: Embora os cuidados e as orientações para uma adequada saúde dos idosos continuem aquém do desejado pela Organização Mundial de Saúde, esses indivíduos majoritariamente apresentaram uma boa autopercepção da saúde bucal.

Objective:Evaluate the self-perception of the elderly with respect to their own oral health and anamnesis including systemic and oral disorders.Methods: The sample consisted of 52 elderly aged 60 to 90 years attending the Open University of the Third Age, São José dos Campos, School of Dentistry of Universidade Estadual Paulista Júlio de Mesquita Filho. The Geriatric Oral Health Assessment Index questionnaire was used to assess how the elderly perceived their own oral condition,followed by anamnesis and clinical intra-oral exams to establish systemic and oral disorders.Results: Descriptive statistical analysis showed that 86.0% of the elderly had high self-perception of their own oral condition (optimum capacity); 12.0% had average self-perception good capacity); and 2.0% of individuals presented low self-perception (low perception).Hypertension (30.7%) and fibromas (12.4%) were the most prevalent systemic and oral disorders, respectively.Conclusion: Although care and advice for appropriate elderly health continue far from the expected by the World Health Organization, these individuals in general have good selfperception of oral health.

Noninvasive aspergillosis as a maxillary antrolith: report of a rare case.

Maxillary antrolithiasis is characterized by masses of tissue of endogenous or exogenous origin that calcify within the maxillary sinuses. Aspergillosis is a fungal disease in which the maxillary sinus is a primary site of infection. Aspergillosis mycetoma, its noninvasive form, is the most prevalent modality of the disease in the maxillary sinuses. In approximately half of the cases reported in the literature, calcification of the fungal mycelia, which later became antroliths, was verified. This article reports a rare case of the accidental discovery of a maxillary antrolith associated with noninvasive aspergillosis in an immunocompetent and asymptomatic 56-year-old woman. The diagnosis and therapeutic procedures used in treating the patient are discussed as well as the probable iatrogenic origin of the fungal pathology.

Radiographic study of patients with ectodermal dysplasia and partial.

AIM: To investigate the association between gender and type of cleft with hypodontia and to verify if the presence of the cleft interferes with hypodontia of one or more type of teeth in patients with ectodermal dysplasia attending the Hospital for Rehabilitation of Craniofacial Anomalies (HRCA), University of São Paulo (USP). MATERIALS AND METHODS: Panoramic radiographs of 54 patients of both genders (29 males, 25 females), from the files of the oral radiology sector of HRCA/USP, presenting with ectodermal dysplasia and cleft lip and/or palate were evaluated by radiographic observation of hypodontia of one or more types of teeth. STATISTICAL ANALYSIS: We performed descriptive statistics and statistical analysis by Fisher test. RESULTS: Hypodontia was observed in 50% of females and 50.88% of males; 50% for cleft palate and 50.59% for complete cleft lip and palate. Only 22.22% of patients with cleft palate and 6.67% with complete cleft lip and palate presented with hypodontia of one type of teeth, whereas 77.78% of cases with cleft palate and 93.33% with complete cleft lip and palate displayed hypodontia of more than one type of teeth. CONCLUSION: Based on the present methodology, there were no statistically significant differences in hypodontia of one or more types of teeth between genders or types of cleft.

Relação do tamanho do processo estilóide e sintomatologia dolorosa na região de cabeça e pescoço / Relation of size of styloid process and painful symptomatology in head and neck

O objetivo neste estudo foi verificar a presença ou ausência da sintomatologia dolorosa na região de cabeça e pescoço, relacionando-a com o comprimento do processo estilóide. Foram analisados ambos os lados de 48 radiografias panorâmicas, de pacientes dos sexos feminino e do masculino, totalizando 96 lados observados. Como critério de avaliação foi utilizada a classificação de acordo com trabalho de outros autores. Foram também realizados anamnese e exame físico. Os resultados indicaram que 42 ligamentos da amostra apresentaram tamanhos normais (até 25 mm). 37 pouco alongados (25 a 30 mm). 10 segmentados e 7 muito alongados (acima de 30 mm). Concluímos que a relação da dor na região de cabeça e pescoço com o alongamento do processo estilóide e a ossificação do ligamento estilo-hióideo é pequena, pois apenas 6,16% do total de casos analisados apresentaram sintomatologia dolorosa.

The Eagle' syndrome is defined by the ossification of the stylohyoid ligament or elongated styloid process causing limitation of the cervical movements and intense pains in head and neck. The aim of this study was to verify the presence or absence of the painful symptomatology in head and neck, in association with the styloid process length. Both gender and sides in 48 panoramic radiographies were taken and the physical examination and anamnesis were analyzed. The analysis of the styloid process length was made according Grossman et al. Milner et al. classification. The conclusion showed that the relation of pain in head and neck, with styloid process is small, therefore only 6.16% of the total of analyzed cases had presented painful symptomatology.

O uso da tomografia computadorizada 3D cone beam no diagnóstico e na localização de caninos impactados / The use of computer tomography 3D cone beam to diagnosis and location of impacted canines

O diagnóstico e a localização de dentes caninos impactados superiores sempre foi um desafio para os ortodontistas. Métodos tradicionais radiográficos em duas dimensões vêm nos auxiliando na detecção dos dentes e possíveis problemas associados. Seguindo a evolução das tomografias computadorizadas o método definido como Cone Beam ou feixe cônico permite agora exames detalhados e com menor índice de radiação sobre as estruturas crânio-faciais, sendo de grande utilidade principalmente para a odontologia. O presente trabalho tem como objetivo apresentar as vantagens do uso da tomografia computadorizada na localização de dentes caninos superiores ectópicos, assim como detalhar o diagnóstico de três casos clínicos relacionados ao tema.

The diagnosis and location of impacted upper canine teeth has always been a challenge for orthodontists. Traditional radiographic methods in two dimensions have been assisting in the detection of dental problems and possible associates. Following the evolution of computed tomography the method defined as "Cone Beam" permits detailed examinations and with the lowest level of radiation on the skull-facial structures, and a very useful mainly for dentistry. This paper aims to present the advantages of using the CT scan in locate higher ectopic canine teeth, and detailing the diagnosis of three cases as well.

Técnica radiográfica alternativa para o tratamento endodôntico / Alternative radiographic technique for endodontic treatment

Objetivo O propósito deste estudo foi adaptar angulações verticais a uma técnica radiográfica extrabucal, utilizando filmes radiográficos periapicais para que possa ser empregada de forma fácil e simplificada. Métodos Onze crânios macerados com suas respectivas mandíbulas foram utilizados. Quatro fios ortodônticos de aço medindo um centímetro de comprimento foram fixados nos espaços interproximais dos dentes posteriores. Um transferidor foi empregado para estabelecer o ângulo bissetor entre dentes e filme. Uma fórmula matemática permitiu determinar as angulações verticais para cada região. As imagens radiográficas foram digitalizadas e mensuradas no software UTHSCSA Image Tool. A análise estatística empregou o teste"t" de Student. Resultados A diferença de 0,477 milímetros entre o comprimento real do fio de aço e sua respectiva imagem, encontrada neste estudo, não se apresentou clinicamente significativa. Conclusão Além da vantagem de não afetar significativamente a qualidade do diagnóstico radiográfico, a técnica extrabucal apresentou-se útil para ser empregada em grupo seletivo de pacientes.

Objective The objective of this study was to adapt vertical angles to an extraoral radiographic technique using periapical radiographic film so that it can be used in an easy and simple manner. Methods Eleven macerated skulls with their respective mandibles were used. Four 1 centimeter stainless steel wires were fixed in the interproximal spaces of the posterior teeth. A protractor was employed to establish the bisector angle between the teeth and the film. A mathematic formula allowed the determination of the vertical angulations for each region. The radiographic images were digitized and measured by specific computer software (UTHSCSA Image Tool). The statistic analysis employed the "t" Student test. Results A difference of 0.477 millimeters between the actual length of the stainless steel wire and its image was found in our study and this difference was not clinically significant. Conclusion Besides the advantage of not affecting the diagnostic quality of the radiograph significantly, the extraoral technique can also be efficiently used in a select group of patients.