Convenient model of hard tissue simulation for dental radiographic research and instruction.

BACKGROUND: The authors describe a technique for building an alternative jawbone phantom using dental gypsum and rice for research and dental radiology instruction. AIM: To investigate the potential of an alternative phantom to simulate the trabecular bone aspect of the human maxilla in periapical radiographs. METHODS: Half-maxillary phantoms built from gypsum-ground rice were exposed to X-rays, and the resulting images (experimental group) were compared to standardized radiographic images produced from dry human maxillary bone (control group) (n = 7). The images were blindly assessed according to strict criteria by three examiners for the usual trabecular aspects of the surrounding bone, and significant differences between groups and in assessment reliability were compared using Fisher's exact and kappa tests (α = 0.05). RESULTS: The differences in the trabecular aspects between groups were not statistically significant. In addition, interobserver agreement among observers was 0.43 and 0.51 for the control and experimental groups, respectively, whereas intraobserver agreement was 0.71 and 0.73, respectively. CONCLUSION: The tested phantom seemed to demonstrate potential for trabecular bone image simulation on maxillary periapical radiographs.

Palliative oral care in terminal cancer patients: Integrated review.

BACKGROUND: Palliative care (PC) aims to improve quality of life in patients and its families against life threatening diseases, through suffering's prevention and relief. It is the duty of the dental surgeon to possess the knowledge needed to treat a patient with little life span, in order to establish an adequate treatment plan for each situation. AIM: To synthesize the published evidence on oral conditions, impact, management and challenges in managing oral conditions among palliative patients. METHODS: Articles were selected from PubMed and Scopus electronic platforms, using a research strategy with diverse descriptors related to "palliative care", "cancer" and "oral health". The article's selection was done in two phases. The first one was performed by the main researcher through the reading of the abstracts. In the second phase two researchers selected eligible articles after reading in full those previous selected. Data was tabulated and analyzed, obtaining information about what is found in literature related to this subject and what is necessary to be approached in future researches about PC. RESULTS: As results, the total of 15 articles were eligible, being one a qualitative analysis, 13 (92.8%) clinical trials and one observational study. Of the 15 articles, 8 (53.4%) involved questionnaires, while the rest involved: one systematic review about oral care in a hospital environment, 2 oral exams and oral sample collection, one investigation of terminal patient's (TP) oral assessment records, 2 collection of oral samples and their respective analysis and one treatment of the observed oral complications. CONCLUSION: It can be concluded that the oral manifestations in oncologic patients in terminal stage are, oral candidiasis, dry mouth, dysphagia, dysgeusia, oral mucositis and orofacial pain. Determining a protocol for the care of these and other complications of cancer - or cancer therapy - based on scientific evidence with the latest cutting-edge research results is of fundamental importance for the multidisciplinary team that works in the care of patients in PC. To prevent complications and its needed to initial the dentist as early as possible as a multidisciplinary member. It has been suggested palliative care protocol based on the up to date literature available for some frequent oral complications in TP with cancer. Other complications in terminal patients and their treatments still need to have further studying.

Tomographic late evaluation of xenogeneic bone grafts in sockets of impacted third molars.

OBJECTIVE: It is necessary to preserve height and thickness of the alveolar bone to facilitate rehabilitation with osteointegratable implants or simply to maintain bone integrity after extraction. Biomaterials associated with resorbable or non-resorbable membranes, when placed in the region of the socket, may contribute to avoid this unwanted reabsorption. OBJECTIVE: The objective of this study was to evaluate the distance of the crest of alveolar ridge to the cementoenamel junction (CEJ) of the lower second molars and the bone density of the third molar socket filled with Gen-Tech®, 5 years after an exodontia using cone beam computed tomography (CBCT) to visualize the central region of the sockets, without overlapping of the buccal and lingual cortical bones. MATERIAL AND METHODS: A total of 12 individuals from an initial group of 39 patients submitted to extraction of the unruptured lower third molars and grafting of an association of inorganic bovine bone matrix, organic bovine bone matrix, collagen and bone morphogenetic proteins (BMP) (Gen-Tech®) on one side and the contralateral sockets filled only by clot, returned to control after 5 years, and were submitted to CBCT. The distance from the crest of alveolar bone to the CEJ and the bone density (BD) were measured using the i-CAT Vision Software. RESULTS: The results showed that the distance from the crest of alveolar bone to the CEJ in the control group was similar to that observed before the exodontia; in the experimental group, this distance was smaller. Considering the BD measurement, a significantly higher density was observed in the experimental group (p<0.05). CONCLUSION: Part of the biomaterial was not absorbed and allowed the stability of the evaluated parameters after 5 years, being able to be used as a bone substitute in the socket.

Tomographic late evaluation of xenogeneic bone grafts in sockets of impacted third molars

Abstract It is necessary to preserve height and thickness of the alveolar bone to facilitate rehabilitation with osteointegratable implants or simply to maintain bone integrity after extraction. Biomaterials associated with resorbable or non-resorbable membranes, when placed in the region of the socket, may contribute to avoid this unwanted reabsorption. Objective The objective of this study was to evaluate the distance of the crest of alveolar ridge to the cementoenamel junction (CEJ) of the lower second molars and the bone density of the third molar socket filled with Gen-Tech®, 5 years after an exodontia using cone beam computed tomography (CBCT) to visualize the central region of the sockets, without overlapping of the buccal and lingual cortical bones. Material and Methods A total of 12 individuals from an initial group of 39 patients submitted to extraction of the unruptured lower third molars and grafting of an association of inorganic bovine bone matrix, organic bovine bone matrix, collagen and bone morphogenetic proteins (BMP) (Gen-Tech®) on one side and the contralateral sockets filled only by clot, returned to control after 5 years, and were submitted to CBCT. The distance from the crest of alveolar bone to the CEJ and the bone density (BD) were measured using the i-CAT Vision Software. Results The results showed that the distance from the crest of alveolar bone to the CEJ in the control group was similar to that observed before the exodontia; in the experimental group, this distance was smaller. Considering the BD measurement, a significantly higher density was observed in the experimental group (p<0.05). Conclusion Part of the biomaterial was not absorbed and allowed the stability of the evaluated parameters after 5 years, being able to be used as a bone substitute in the socket.

Impact of Inorganic Xenograft on Bone Healing and Osseointegration: An Experimental Study in Rabbits.

PURPOSE: To evaluate if an inorganic graft applied before implant insertion interferes with osseointegration. MATERIALS AND METHODS: The bilateral mandibular incisors of 12 rabbits were extracted. One of the sockets was randomly filled with an inorganic xenogenic bone graft, whereas the remaining socket was allowed to heal naturally and served as a control. After 60 days, titanium implants were inserted into healing areas. The animals were killed 60 days after. Bone depositions were marked with fluorochrome oxytetracycline, alizarin, and calcein and evaluated using confocal laser scanning microscopy. Bone-to-implant contact (BIC) and bone area (BA) within the limits of the implant threads were analyzed. Data were compared statically by paired t tests, one-way ANOVA, and Bonferroni post hoc tests (α = 0.05). RESULTS: No differences between the control and experimental groups in bone deposition for each marker, in either the BIC or BA analysis were observed. The bone deposition marked by alizarin (14-21 days) was the highest, followed by oxytetracycline (0 and 7 days) and calcein (45 and 52 days) in both groups (P < 0.05). CONCLUSION: The bone healing or the course of osseointegration was not impaired by the use of an inorganic xenogenic graft before insertion of a titanium implant.

Low-concentrated nonvital bleaching effect on bond strength of composite resin restorations / Efeito de clareadores não-vitais pouco concentrados sobre a força de cisalhamento de restaurações de resina composta

Objective: To investigate if short-term dentin bleaching with low-concentrated substances affects the bond strength of immediate resin composite restorations. Material and Methods: The buccal surfaces of fifty molar crowns were ground for dentin exposure and randomly assigned into 5 groups (n=10), according to the following treatments: sodium perborate + water; sodium perborate + 6% hydrogen peroxide; 6% hydrogen peroxide; 35% hydrogen peroxide (positive control), or no bleaching agent (negative control). The specimens were immediately restored with resin composite. Seven days after treatments, the shear bond test was performed in a universal test machine at a crosshead speed of 0.5 mm/min. Data were analyzed using ANOVA and Tukey’s HSD test (α = 0.05). Results: The shear bond strength mean values for the negative control group were higher than all experimental and positive control groups (p < 0.000), whose differences were not statistically significant (p > 0.05). Conclusion: Short-term dentin bleaching with sodium perborate+water, 6% hydrogen peroxide, or sodium perborate mixed with 6% hydrogen peroxide reduced the shear bond strength of immediate resin composite restorations.

Objetivo: Investigar se o clareamento rápido da dentina com substâncias de baixa concentração afeta a resistência de união ao cisalhamento de restaurações imediatas de resina composta. Material e Métodos: As superfícies vestibulares de cinquenta molares foram desgastadas para exposição da dentina e então aleatoriamente alocadas em 5 grupos (n = 10), de acordo com as substâncias clareadoras: perborato de sódio + água; perborato de sódio + peróxido de hidrogênio a 6%; peróxido de hidrogênio a 6%; peróxido de hidrogênio a 35% (controle positivo); ou nenhum agente clareador (controle negativo). Os espécimes foram imediatamente restaurados com resina composta. Sete dias após os tratamentos, testes de resistência ao cisalhamento foram realizados em uma máquina de ensaios universal a uma velocidade de cruzeta de 0,5 mm/min. Os dados foram analisados com os testes ANOVA e Tukey HSD (α = 0,05). Resultados: Os valores de resistência ao cisalhamento do grupo controle negativo foram maiores do que os dos grupos experimentais e controle positivo (p < 0,001), cujas diferenças não foram estatisticamente significativa (p > 0,05). Conclusão: Clareamentos dentinários rápidos com perborato de sódio, peróxido de hidrogênio 6% ou perborato de sódio misturado com peróxido de hidrogênio 6% reduziram a força de resistência ao cisalhamento de restaurações imediatas de resina composta.

Disseminated paracoccidioidomycosis diagnosis based on oral lesions.

Paracoccidioidomycosis (PCM) is a deep mycosis with primary lung manifestations that may present cutaneous and oral lesions. Oral lesions mimic other infectious diseases or even squamous cell carcinoma, clinically and microscopically. Sometimes, the dentist is the first to detect the disease, because lung lesions are asymptomatic, or even misdiagnosed. An unusual case of PCM with 5 months of evolution presenting pulmonary, oral, and cutaneous lesions that was diagnosed by the dentist based on oral lesions is presented and discussed.

Pigmented lesion with characteristics of malignancy: a case report.

Pigmentations of the oral mucosa include a range of lesions or conditions that manifest as changes in the color of oral tissues; these changes may show melanocytic activity. A melanotic macule is a small, well-circumscribed melanocytic benign lesion. It can occur on the lips and intraorally and ranges in color from brown to black. Microscopically, it is characterized by elevated levels of melanin production by basal melanocytes, which appear normal in terms of number, morphology, and distribution. A 48-year-old woman sought treatment for a pigmented lesion that had been present for 4 months. Intraoral examination revealed a non-homogenous brownish spot (measuring 0.7 cm) with irregular borders on the left side of the soft palate. Since the lesion had an atypical clinical appearance, melanocytic nevus, oral melanoacanthoma, and oral malignant melanoma were considered in differential diagnoses. After an incisional biopsy, the lesion was diagnosed as a melanotic macule. Due to their varying clinical appearance, benign pigmented lesions can be mistaken for malignant tumors, especially when the lesions exhibit similar coloration, symmetry, and borders. Through this report on a case with atypical clinical characteristics, we aim to reinforce the ubiquitous nature of oral pigmented lesions, and the importance of employing different approaches to diagnosing these lesions.

Influence of root canal sealer on the radiographic appearance of filling voids in maxillary single-rooted teeth.

OBJECTIVE: This study compared the influence of three epoxy resin-based sealers with distinct radiopacities on the observers' ability to detect root canal filling voids during radiographic analysis. MATERIAL AND METHODS: The root canals of 48 extracted maxillary canines were prepared and divided into three groups. Each group was laterally condensed with one sealer (AH Plus®, Acroseal® or a non-radiopaque sealer), and a longitudinal void was simulated in half of the specimens from each group (n=8). Buccolingual radiographs were obtained and randomly interpreted for voids by a radiologist and an endodontist in a blinded fashion. Teeth were cut and inspected under a microscope to confirm the position of void. Differences in sensitivity and specificity between groups and examiners were compared using the Fisher's Exact and McNemar tests, respectively (α=0.05). RESULTS: Significantly lower sensitivity levels (p<0.05) were observed in the coronal portion of fillings performed with both radiopaque sealers. Specificity values for Acroseal® were significantly higher (p<0.05) in the coronal and apical portions of fillings. CONCLUSIONS: The type of root canal sealer can affect the observers' ability to detect root canal filling voids during radiographic analysis of upper single-rooted teeth.

Influence of root canal sealer on the radiographic appearance of filling voids in maxillary single-rooted teeth

OBJECTIVE: This study compared the influence of three epoxy resin-based sealers with distinct radiopacities on the observers' ability to detect root canal filling voids during radiographic analysis. MATERIAL AND METHODS: The root canals of 48 extracted maxillary canines were prepared and divided into three groups. Each group was laterally condensed with one sealer (AH Plus®, Acroseal® or a non-radiopaque sealer), and a longitudinal void was simulated in half of the specimens from each group (n=8). Buccolingual radiographs were obtained and randomly interpreted for voids by a radiologist and an endodontist in a blinded fashion. Teeth were cut and inspected under a microscope to confirm the position of void. Differences in sensitivity and specificity between groups and examiners were compared using the Fisher's Exact and McNemar tests, respectively (α=0.05). RESULTS: Significantly lower sensitivity levels (p<0.05) were observed in the coronal portion of fillings performed with both radiopaque sealers. Specificity values for Acroseal® were significantly higher (p<0.05) in the coronal and apical portions of fillings. CONCLUSIONS: The type of root canal sealer can affect the observers' ability to detect root canal filling voids during radiographic analysis of upper single-rooted teeth.