Bifurcation of the mandibular canal according to sex, age, and facial skeletal pattern: a morphological and morphometric study of cone beam computed tomography.

PURPOSE: To assess the presence of mandibular canal bifurcation (BMC) and classify these variations by correlating findings with sex, age and facial skeletal pattern, measurements were made, including height, width, and distance from bifurcation to anatomical cortical bones. METHODS: BMC was identified in cone beam CT exams of 301 patients and classified according to its origin, location, direction, configuration and ending. The height and width of the MC before and after the bifurcation; height and width of the BMC; and distance from BMC to alveolar (C1), buccal (C2), lingual (C3) and basal (C4) bone cortices were measured. All data were correlated with sex, age, and facial skeletal pattern (class I, II, III). The significance level was 5%. RESULTS: 67 BMC (22.26%) were identified in 55 patients (18.28%). Bifurcations were more prevalent in females (p = 0.57), aged 18-39 years (p = 0.40), class I (p = 0.77). Single bifurcations, located in the posterior region of the mandible, originating in the MC, with a superior direction and ending in the retromolar foramen were more prevalent (p > 0.05). Mean cortical measurements were higher in male individuals, with significant differences only at C1 (p = 0.03). The mean height and width of BMC were 2.24 (± 0.62) and 1.75 (± 0.45) mm. There was no association between BMC classification and the variables studied (p > 0.05). CONCLUSION: Approximately 1/5 of the population studied had BMC. There were no associations of BMC presence or characteristics with sex, age, and facial skeletal pattern. The distance from bifurcation to alveolar (superior) cortical bone is greater in male individuals.

The relation between persistent foramen tympanicum and degenerative bone alterations in temporomandibular joint region.

OBJECTIVES: The aim of this study was to evaluate, using cone-beam computed tomography (CBCT), the relationship of persistent foramen tympanicum (PFT) with degenerative changes in the temporomandibular joint (TMJ) and the presence of pneumatized glenoid fossae and articular eminences. METHOD: Two experienced oral and maxillofacial radiologists evaluated 510 CBCT scans, from which 94 patients were divided into two groups: G1-patients with PFT and G2-control group. The location of the PFT, presence, or absence of degenerative TMJ changes and morphology were evaluated. Similarly, all images were evaluated for the presence of pneumatized articular eminence and glenoid fossa. The Chi-square test and Fisher's Exact test were used for the categorical variables. A multinomial logistic regression model was performed for subgroup analysis. To assess the estimation-chance occurrence of TMJ alterations the Odds Ratio analysis was used. RESULTS: Statistically significant results were found for erosion, planning, and subchondral cyst. Regarding TMJ morphology, significant results were found for: round, flat, and others. Moreover, it was possible to observe that patients who had the PFT were approximately 48 times more likely to manifest TMJ alterations and approximately 3 times more likely to manifest articular eminence pneumatization. CONCLUSION: Since individuals who have FTP have a greater chance of having TMJ and PEA changes, it is important for the dental radiologist to be aware of these signs in CBCT scans for a correct diagnosis. TRIAL REGISTRATION NUMBER: CAAE: 34328214.3.0000.0104 (11/30/2014).

Oral manifestations of systemic fungal infections: 25-year experience in an endemic region

Some mycoses are endemic. They develop through hematogenous spread, causing a generalized infection, usually with secondary mucosal involvement.The aim of this observational and retrospective study was to report the prevalence and characteristics of oral lesions in patients diagnosed with systemic fungal infections (SFI) over a 25-year period in southern Brazil. Demographic (age, sex, ethnicity, occupation) and clinical (anatomical location, symptoms,histopathological diagnosis and management) data from the medical records of patients with SFI were collected from 1995 to 2019. 34 cases of SFI were found, of which 31 (91.18%) were diagnosed as paracoccidioidomycosis (PCM) and 3 (8.82%) as histoplasmosis. Men were much more affected (n = 31; 91.18%), with an average age of 46.9 years. Most patients (n = 18; 58.06%) were Caucasian; 48% (n = 15) were farm/rural workers and the most affected region was the jugal mucosa (n = 13; 25.49%) followed by the alveolar ridge (n = 12; 23.52%). All patients with histoplasmosis were immunocompetent men (mean age: 52.67 years), and the palate was the most affected. All patients underwent incisional biopsy and were referred to an infectologist. The dentist has an essential role in the recognition of SFI, whose oral manifestations may be the first sign. SFI should be included in differential diagnosis in patients from endemic areas. In addition, the inevitable human mobility and globalization make knowledge of these mycosesnecessary worldwide, especially since advanced cases in immunocompromised patients can be fatal.

Influence of mandibular positioning on the accuracy and reliability of linear measurements on cone beam CT using different voxels and two software programs / Influência do posicionamento mandibular na acurácia e confiabilidade de medidas lineares em tomografia computadorizada de feixe cônico utilizando diferentes voxels e dois softwares

Objetivo: este estudo avaliou a acurácia e confiabilidadedas medidas lineares em exames detomografia computadorizada de feixe cônico(TCFC), em dois softwares, utilizando diferentesvoxels e variando o posicionamento da mandíbula.Material e Métodos: 10 imagens de TCFC demandíbulas humanas com 25 pontos foram obtidas,usando diferentes protocolos de aquisição(0.250, 0.300, 0.400-mm voxels) e orientações damandíbula (centralizada, rotacionada 10° lateralmentepara direita e esquerda, inclinada 10° para cima e para baixo); 14 medidas foram realizadasnas reconstruções multiplanares nos softwares XoranCate OsiriX. Os achados foram comparadoscom as medidas físicas através de um paquímetrodigital. O teste ANOVA e o coeficiente de correlaçãoforam utilizados com p < 0,05. Resultados:não houve diferença estatisticamente significantequando as medidas foram comparadas em aquisiçõescom diferentes tamanhos de voxels emambos os softwares. A posição da mandíbula nãoinfluenciou nas medidas. Nenhuma diferença foiencontrada quando os valores foram comparadosentre os softwares e o paquímetro digital. Conclusão:as medidas lineares em ambos os softwaresforam confiáveis e acurados comparados a mensuraçãofísica em todos os protocolos. A acuráciae a confiabilidade das mensurações não influenciaramde acordo com as variações de posicionamentoda mandíbula.(AU)

Objective: this study evaluated the accuracy and reliability of linear measurements on cone beam CT (CBCT) scans in two software programs, using different voxels and varying mandible positioning. Material and methods: CBCT images of 10 human mandibles with 25 markers were obtained using different acquisition protocols (0.250, 0.300, 0.400-mm voxels) and mandible orientations (centered, rotated 10° laterally to right and left, tilted 10 up and down); fourteen measurements were carried out on the multiplanar reconstructions in XoranCat and OsiriX Lite software programs. The findings were compared to physical measurements using a digital caliper. ANOVA and correlation coefficient tests were used, at α = 0.05. Results: there was no statistically significant difference when the measurements were compared in acquisitions with different voxel sizes analysed in both software programs. Mandibular positioning changes did not influence the measurements. No differences were found when the values were compared between the software programs and the digital caliper. Conclusion: linear measurements in both programs were reliable and accurate compared with physical measurements when using all acquisition protocols. The accuracy and reliability of the measurements were not influenced by variations in the mandible positioning.(AU)

Inflammatory and developmental odontogenic cysts: 23-year observational and retrospective study / Cistos odontogênicos inflamatórios e de desenvolvimento: estudo observacional e retrospectivo de 23 anos

Objective: This observational and retrospective study evaluated the prevalence and characteristics of odontogenic cysts, outlining the epidemiological profile of these lesions. Material and methods: The following data were collected from the medical records of patients with a diagnosis confirmed by microscopy: age, sex, ethnicity, anatomical location, histopathological diagnosis and treatment, between 1995 and 2018. Results: Of the 70 cysts, 75.7% were inflammatory and 24.2% development. The inflammatory periapical cyst was the most prevalent (62.8%) followed by the dentigerous cyst (71.0%). The lateral radicular cysts and odontogenic keratocysts obtained the same percentage (5.7%), followed by the residual cyst (4.3%), paradental (2.8%) and the orthokeratinized variable (1.5%). Women were slightly more affected (1.12: 1) with greater involvement of leucodermas (80%). Age and anatomical location differed according to each lesion, although the anterior maxilla region was more affected. Enucleation was the most used treatment (75.7%), except for odontogenic keratocysts, in which marsupialization was performed in 75% of the cases. Conclusion: Epidemiological data provide an important insight into the prevalence, extent and severity of these lesions, allowing early diagnosis and prevention, in order to guarantee the reduction of cases and improve the quality of life of the population.

Objetivo: Avaliar a prevalência e características dos cistos odontogênicos de forma observacional e retrospectiva, delineando o perfil epidemiológico destas lesões. Material e Métodos: Foram coletados os seguintes dados dos prontuários de pacientes com diagnóstico confirmado microscopicamente: idade, sexo, etnia, localização anatômica, diagnóstico histopatológico e tratamento, entre os anos de 1995 a 2018. Resultados: Dos 70 cistos, 75,7% eram inflamatórios e 24,2% de desenvolvimento. O cisto periapical inflamatório foi o mais prevalente (62,8%) seguido pelo cisto dentígero (71,0%). O cisto radicular lateral e queratocisto odontogênico obtiveram o mesmo percentual (5,7%), seguidos do cisto residual (4,3%), paradentário (2,8%) e a variável ortoqueratinizada (1,5%). As mulheres foram ligeiramente mais afetadas (1,12:1) com maior acometimento de leucodermas (80%). Idade e localização anatômica diferiram de acordo com cada lesão, embora a região anterior de maxila tenha sido mais afetada. A enucleação foi o tratamento mais utilizado (75,7%), exceto para o queratocisto odontogênico, no qual a marsupialização foi realizada em 75% dos casos. Conclusão: Os dados epidemiológicos fornecem uma visão importante para o entendimento da prevalência, extensão e gravidade dessas lesões, viabilizando o diagnóstico precoce e medidas preventivas, a fim de garantir a redução dos casos e melhorar a qualidade de vida da população.

Orientações odontológicas aos pacientes submetidos à quimioterapia antineoplásica / Dental guidelines for patients undergoing antineoplastic chemotherapy

Objetivo: este trabalho propõe condutas bucais aos pacientes com indicação quimioterápica, a partir de uma revisão de literatura, visto que o paciente é pouco orientado em muitos casos. Material e métodos: a busca foi realizada a partir da base de dados PubMed/Medline. Apenas estudos observacionais e revisões da literatura, em inglês, espanhol e português, publicados entre 2001 e 2019, que abordassem o tratamento antineoplásico e apresentassem complicações bucais foram incluídos. Resultados: dez artigos preencheram os critérios de inclusão. Notou-se que a maioria dos efeitos adversos cessam ao fim da quimioterapia. As principais alterações bucais observadas foram mucosite, xerostomia e candidose. Diversas alternativas terapêuticas se mostraram eficazes, sendo fundamental individualizar o paciente e propor a melhor opção para o quadro específico apresentado. Considerações finais: A participação do cirurgião-dentista na equipe oncológica é extremamente importante, realizando intervenções odontológicas e orientando os pacientes, colaborando para uma melhor qualidade de vida e contribuindo significativamente no prognóstico da doença.(AU)

Objective: This study suggests oral management for chemotherapy patients, through a literature review, considering that patients are poorly instructed in most cases. Material and methods: The search was performed in the PubMed / Medline database. Only observational studies and literature reviews in English, Spanish, and Portuguese, published between 2001 and 2019, which discussed antineoplastic treatment and presented oral complications were included. Results: Ten articles met the inclusion criteria. Most adverse effects were observed to cease at the end of chemotherapy. The main oral changes observed were mucositis, xerostomia, and candidosis. Several therapeutic alternatives seem to be effective, and it is essential to individualize the patient and propose the best option for the specific condition. Final considerations: The participation of dentists in the cancer team is extremely important for performing dental interventions, guiding patients, helping to provide a better quality of life, and contributing significantly to the prognosis of the disease.(AU)

Reliability and accuracy of linear measurements in cone-beam computed tomography using different software programs and voxel sizes.

OBJECTIVES: The aim of this study is to evaluate the accuracy of linear measurements on cone-beam computed tomography (CBCT) images using three software programs and different voxel sizes. METHODS: Ten human mandibles with 25 silica markers were scanned for 0.250-, 0.300-, and 0.400-mm voxels in the i-CAT New Generation (Imaging Sciences International, Hatfield, PA, USA). Thirty-five linear measurements were carried out by two examiners two times on the multiplanar reconstructions in the following software programs: XoranCat version 3.1.62 (Xoran Technologies, Ann Arbor, MI, USA), RadiAnt DICOM 2.2.9 Viewer (Medixant, Poznan- Poland) and InVesalius 3.0.0 (Centro de Tecnologia da Informação Renato Archer, Campinas, SP, Brazil). The physical measurements were made by another observer two times using a digital caliper on the macerated mandibles. ANOVA test was used to compare voxels and software programs. Pearson correlation and the Bland-atman tests were used to compare physical and virtual measurements and to evaluate the accuracy of the software programs, respectively (P < 0.05). RESULTS: There was no statistically significant difference when the measurements were compared in acquisitions with different voxel sizes analyzed in the three software programs. There was also no difference when the measurements were compared between the software programs and the digital caliper. Excellent intra- and inter-observer reliability for the markers, physical measurements, and multiplanar reconstructions were found. CONCLUSION: Linear measurements in the XoranCat, Radiant, and InVesalius software programs are reliable and accurate compared with physical measurements. The different acquisition protocols using different voxel sizes did not influence the accuracy of linear measurements in CBCT images.

Manifestações imaginológicas distintas na displasia cemento-óssea florida

Objetivo: o objetivo do presente trabalho é relatar dois casos clínicos de pacientes com displasia cemento-óssea florida (DCOF) com características distintas no exame de tomografia computadorizada de feixe cônico (TCFC). Relato de caso: no primeiro caso, paciente do gênero feminino, melanoderma, 49 anos de idade com lesões hipodensas assintomáticas distribuídas por toda a mandíbula, sugestivas de DCOF em estágio imaturo. No segundo caso, uma paciente do gênero feminino, melanoderma de 48 anos de idade, as lesões apresentavam-se hiperdensas com halo hipodenso, em mandíbula localizada bilateralmente, assintomáticas, caracterizando o estágio maduro da DCOF. Em ambos os casos, o diagnóstico de DCOF foi estabelecido por meio das imagens de TCFC associadas às características clínicas das pacientes. Nenhum tratamento foi instituído, apenas o controle periódico. Considerações finais: os casos clínicos apresentados ressaltam a importância da TCFC no diagnóstico das lesões fibro-ósseas, que, como ilustrado, podem apresentar características imaginológicas bastante distintas. Por possuir um amplo espectro de apresentações e ser encontrada em exames de imagens realizados para outros fins, a DCOF pode levar o cirurgião dentista à tomada de decisões precipitadas e, muitas vezes, condutas inadequadas, visto que procedimentos cirúrgicos são contraindicados nesses casos.

Análise do perfil facial esquelético e de tecidos moles pré e pós-cirurgia ortognática em pacientes Classe II e III, e sua relação com a proporção áurea / Analysis of the skeletal and soft-tissue profiles pre and post orthognathic surgery in Class II and III patients and its relation with the golden proportion

Introdução: A proporção áurea, representada pela razão matemática 1:1.618, tem sido investigada na especialidade Ortodontia e no procedimento de Cirurgia Ortognática, a fim de ser estabelecida como um guia de sucesso clínico relacionado à estética facial. Objetivo: Verificar a estética dos perfis faciais de pacientes Classes II e III de Angle, antes e após tratamento ortodôntico-cirúrgico, além de correlacionar 13 razões dentoesqueléticas e cinco razões de tecidos moles à proporção áurea. Material e método: Um total de 94 radiografias cefalométricas laterais foram analisadas, em que 13 razões dentoesqueléticas e cinco razões em tecidos moles foram medidas e comparadas ao número áureo. Adicionalmente, uma análise subjetiva da estética facial pré e pós-tratamento foi realizada por 270 examinadores. Resultado: As razões dentoesqueléticas 1, 3, 6, 7, 8 e 9 aproximaram-se do número áureo após a cirurgia ortognática, nos pacientes Classe III. Para o perfil mole, apenas a razão 4 se aproximou ao número áureo, em ambos os pacientes Classe II e III. Em relação à avaliação subjetiva da estética, 91,49% dos perfis faciais foram considerados mais harmônicos após o tratamento. Conclusão: Frente à metodologia usada, pode-se concluir que a proporção áurea exerce pouca influência na avaliação da estética facial, não servindo como um guia para o planejamento e o tratamento ortodôntico-ortognático.

Introduction: The golden proportion, represented by the mathematical ratio 1:1.618, has been investigated in Orthodontics and orthognathic surgery in order to be established as a guide to clinical success related to facial aesthetics. Objective: To verify the facial aesthetics of patients with Angle Class II and III deformities pre and post orthodontic-surgical treatment, and to analyze if 13 dental-skeletal patters (ratios) and 5 soft tissue ratios moved closer to or further away from the golden proportion after the orthognathic surgery. Material and method: A total of 94 lateral cephalometric radiographs, in which 13 dental-skeletal ratios and 5 soft tissue ratios were measured and compared to the golden number. In addition, 270 examiners performed a subjective analysis of facial esthetics before and after treatment. Result: Dental-skeletal ratios 1, 3, 6, 7, 8 and 9 moved closer to the golden number after orthognathic surgery in Class III patients. For the soft tissue profile, only ratio 4 moved closer to the golden number in both Class II and III patients. Regarding the subjective evaluation of facial aesthetics, 91.49% of the facial profiles were considered more harmonic after treatment. Conclusion: Considering the methodology, it may be concluded that the golden proportion had little effect on the facial aesthetics evaluation and should not work as a guide for orthodontic-orthognathic planning and treatment.

Effect of orthognathic surgery on pharyngeal airway space: a cephalometric evaluation using Dolphin Imaging software / Avaliação cefalométrica do espaço aéreo faríngeo após cirurgia ortognática por meio do software Dolphin Imaging

Orthognathic surgery is widely used in the treatment of dento- maxillofacial deformities, which changes both the facial appearance and the pharyngeal airway space. The aim of this study was to evaluate cephalometric changes in the pharyngeal airway space before and after orthognathic surgery in patients with Class II and Class III malocclusions. The sample consisted of 38 lateral cephalograms, 17 of patients with Class II who had undergone mandibular advancement, and 21 of patients with Class III who had undergone mandibular setback. Cephalometric analysis of Arnett-Gunson FAB Surgery using Dolphin Imaging 11.5 evaluated point B' and Pog'. Statistical analysis used Paired t- test at 5% significance level. The increase in the means of point B' and Pog' after mandibular advancement was not statistical. Similarly, the means of point B' and Pog' did not differ after mandibular setback. Thus, the pharyngeal airway space at the level of B' and Pog' kept constant pre and post orthognathic surgery for both Class II and Class III.

A cirurgia ortognática é amplamente utilizada no tratamento de deformidades dento -maxilo-faciais, alterando a aparência facial e o espaço aéreo faríngeo. O objetivo deste estudo foi analisar a variação cefalométrica do espaço aéreo faríngeo antes e após a cirurgia ortognática. Foram analisadas 38 radiografias cefalométricas laterais, 17 de pacientes com Classe II submetidos ao avanço mandibular e 21 de pacientes com Classe III submetidos ao recuo mandibular. O espaço aéreo faríngeo foi analisado por meio do software Dolphin Imaging 11.5 utilizando a análise de Arnett-Gunson FAB Surgery, observando os pontos B' e Pog'. Os dados foram analisados com o Teste t para Amostras Pareadas com nível de significância de 5%. O aumento da média dos pontos B' e Pog' após o avanço mandibular não foi estatisticamente significante. Para a cirurgia de recuo mandibular, as médias dos pontos B' e Pog' mantiveram-se estáveis. Assim, o espaço aéreo faríngeo em nível dos pontos B' e Pog' mantiveram-se constantes antes e após a cirurgia ortognática para Classe II e Classe III.

Evaluation of the optical density of composite resins with the use of nanotechnology by means of intraoral radiographic system (CMOS) / Avaliação da densidade óptica de resinas compostas de nanotecnologia por meio de sistema radiográfico intraoral (CMOS)

The aim of this study was investigate the optical density of four different brands of composite resins of nanotechnology. The composite resins Estelite Sigma Quick® (Tokuyama), Esthet ­X HD® (Dentsply), 4 Seasons® (Ivoclar Vivadent) and Filtek Z350XTTM (3M-ESPE) were inserted into cavities in transparent acrylic sheets, separated by thickness into 1, 2 and 3 mm. The images were imported into the software ImageTool® 3.0 (UTHSCSA, EUA). Data were submitted to ANOVA and Tukey. The mean values of the composite resins 4 Seasons® (2.71±0.20) and Filtek Z350XTTM (2.64±0.26) did not differ statistically for samples with thickness of 1 and 2 mm. However, for both thickness Estelite Sigma Quick® (1.92±0.11) and Esthet-X HD® (3.57±0.29) showed significant differences compared to the other composite resins (p = .012). All 3 mm-thick samples showed significant differences among themselves (Estelite Sigma Quick® p < .001, Esthet-X HD® p < .001, 4 Seasons® p=.001 and Filtek Z350XTTM p = .003). Conclusion: Among the three thicknesses evaluated, Estelite Sigma Quick® showed the lowest optical density, whereas the highest values were observed for Esthet X HD®. The resins are studied according to the rules of optical density value thus being favorable clinical use.

O objetivo deste estudo foi investigar a densidade óptica de quatro diferentes marcas comercias de resinas compostas desenvolvidas com nanotecnologia. As resinas Estelite Sigma Quick® (Tokuyama), Esthet ­X HD® (Dentsply), 4 Seasons® (Ivoclar Vivadent) e Filtek Z350 XT ® (3M-ESPE) foram inseridas em orifícios existentes em placas de acrílico com espessuras de 1, 2 e 3 mm. As imagens foram importadas para o programa ImageTool® 3.0 (UTHSCSA, EUA). Os dados foram submetidos à análise de variância Anova e de Tukey. Nas espessuras de 1 e 2 mm, a média das resinas 4 Season® (2.71±0.20) e Z350XT® (2.64±0.26) não diferiram de forma estatística significante entre si (p = .012). No entanto, a Estelite Sigma Quick® (1.92±0.11) e a Esthet-X HD® (3.57±0.29) apresentaram diferenças estatisticamente significantes em relação a 4 Season® e Z350XT® . Na espessura 3 mm, todas apresentaram diferenças estatisticamente significantes entre si (Estelite Sigma Quick® p < .001, Esthet-X HD® p < .001, 4 Seasons® p = .001 and Filtek Z350XTTM p = .003). A Estelite Sigma Quick® apresentou os menores valores nas espessuras estudadas, os maiores valores observados na Esthet X HD®, para as três espessuras avaliadas. As resinas estudadas estão de acordo com a normativa de densidade óptica, portanto favorável ao uso clínico.

Cisto ósseo simples: relato de casos clínicos / Simple bone cyst: report of cases

Introdução: o Cisto Ósseo Simples (COS) é classificado pela Organização Mundial de Saúde (OMS) como uma lesão não neoplásica relacionada aos ossos, sendo definida como um cisto intraósseo. A causa e a patogênese são incertas e controversas. Grande parte das lesões são cavidades vazias, contendo não mais que um pequeno fluido seroso ou serosanguinolento, estando o revestimento epitelial ausente. Os locais mais acometidos são ossos longos e gnáticos. Os ossos gnáticos surgem com maior frequência na mandíbula em área de molares e pré-molares, com caráter assintomático, porém podem ser relatadas dor e parestesia em alguns casos. Objetivo: este trabalho visa relatar três casos de COS com manifestações radiográficas e condutas terapêuticas distintas. Considerações finais: o diagnóstico do COS é baseado, primariamente, em características clínicas e radiográficas juntamente com os achados cirúrgicos. Radiograficamente apresenta-se como uma lesão radiolúcida, bem delimitada, podendo ser observadas interdigitações entre as raízes dentárias. A forma de tratamento indicada é a curetagem da lesão, com acompanhamento radiográfico pós-cirúrgico para preservação do caso, ou em casos em que as características clínicas e radiográficas são bastante sugestivas, pode-se optar somente pela proservação.

Manifestações bucais em pacientes portadores de anemia: estudo clínico e radiográfico / Oral manifestations in patients with anemia: clinical and radiographic study

Manifestações bucais da anemia estão entre os diversos sinais e sintomas associados à doença, tornando a participação do cirurgião-dentista de fundamental importância no processo de diagnóstico e tratamento dos pacientes. Objetivo: avaliar pacientes diagnosticados com anemia e identificar possíveis manifestações bucais, buscando esclarecer o mecanismo causal por trás da relação entre a manifestação bucal encontrada e o tipo diagnosticado de anemia. Materiais e método: por meio da avaliação de pacientes portadores de anemia, este trabalho quer relacionar quadros clínicos de pacientes oriundos do Hemocentro do Hospital Universitário da Universidade Estadual de Maringá com eventuais manifestações bucais passíveis de reconhecimento por meio de exame clínico e/ou radiográfico. Resultados: dos 21 pacientes analisados, as alterações mais identificadas estão na palidez de mucosa (66,67 %), na doença periodontal (38,09 %), na atresia papilar lingual (38,09 %) e na pigmentação dentária (28,57 %). Conclusões: pacientes portadores de anemia falciforme e pacientes com ?-talassemia exibiram alterações extrabucais, ao passo que pacientes portadores de anemia por deficiência vitamínica foram os que mais apresentaram atresia papilar lingual (62,5 %).

Carcinoma in situ in a patient with erythroleukoplakia: challenges in the diagnosis and in the therapeutic choice / Carcinoma in situ in erythroleukoplakia

A 41-year-old Caucasian male smoker presented a red and white plaque on the left jugal mucosa suggestive of oral erythroleukoplakia (OEL). Biopsy followed by microscopic examination revealed carcinoma in situ. Since OEL is considered a precancerous lesion with a high malignant transformation potential, the present case set out to discuss the challenges in diagnosing the condition and choosing the most appropriate treatment. The discussion deals with issues such as whether there is a limit for choosing either a radical or a more conservative approach to treatment and the importance of using a procedure that allows a microscopic examination of the entire lesion. Carcinoma in situ associated with OEL made the treatment planning even more complex in the present case. In order to avoid a mutilating approach, multiple excisions with safety margins were performed, and the patient was instructed not to smoke. A strict 12-month follow-up shows no signs of recurrence of the OEL... (AU)

Contribuição da radiografia panorâmica no diagnóstico da osteoporose / Contribution of the panoramic radiograph on the diagnosis of the osteoporosis

Considerada como a epidemia silenciosa do século pela Organização Mundial de Saúde, a osteoporose afeta milhões de pessoas em todo o mundo. A perda de osso ocorre progressivamente e muitas vezes sem sintomas, até que uma fratura ocorra pela primeira vez. A densitometria é hoje o exame de referência para o diagnóstico da osteoporose. A osteoporose também pode apresentar manifestações na cavidade oral e, baseando-se nesses achados, alguns estudos têm procurado demonstrar que a radiografia panorâmica pode auxiliar no diagnóstico da osteoporose. Este trabalho tem como objetivo discutir a utilização da radiografia panorâmica no diagnóstico precoce da osteoporose por meio de revisão de literatura

Considered the silent epidemic of the century by the World Health Organization, the osteoporosis affects millions of people worldwide. The bone loss occurs gradually and often without symptoms until a fracture occurs. Densitometry is today the reference test for the diagnosis of osteoporosis. Osteoporosis can also present manifestations in the oral cavity and, based on these findings, some studies have attempted to demonstrate that the panoramic radiograph can assist in the diagnosis of osteoporosis. This study aims to discuss the use of panoramic radiography in early diagnosis of osteoporosis by means of literature review

Evaluation of diagnostic accuracy of conventional and digital periapical radiography, panoramic radiography, and cone-beam computed tomography in the assessment of alveolar bone loss.

BACKGROUND: To evaluate the diagnostic accuracy of different radiographic methods in the assessment of proximal alveolar bone loss (ABL). MATERIALS AND METHODS: ABL, the distance between cement-enamel junction and alveolar bone crest, was measured in 70 mandibular human teeth - directly on the mandibles (control), using conventional periapical radiography with film holders (Rinn XCP and Han-Shin), digital periapical radiography with complementary metal-oxide semiconductor sensor, conventional panoramic, and cone-beam computed tomography (CBCT). Three programs were used to measure ABL on the images: Image tool 3.0 (University of Texas Health Sciences Center, San Antonio, Texas, USA), Kodak Imaging 6.1 (Kodak Dental Imaging 6.1, Carestream Health(®), Rochester, NY, USA), and i-CAT vision 1.6.20. Statistical analysis used ANOVA and Tukey's test at 5% significance level. RESULTS: The tomographic images showed the highest means, whereas the lowest were found for periapical with Han-Shin. Controls differed from periapical with Han-Shin (P < 0.0001). CBCT differed from panoramic (P = 0.0130), periapical with Rinn XCP (P = 0.0066), periapical with Han-Shin (P < 0.0001), and digital periapical (P = 0.0027). Conventional periapicals with film holders differed from each other (P = 0.0007). Digital periapical differed from conventional periapical with Han-Shin (P = 0.0004). CONCLUSIONS: Conventional periapical with Han-Shin film holder was the only method that differed from the controls. CBCT had the closest means to the controls.

Comparison of periapical radiography with cone beam computed tomography in the diagnosis of vertical root fractures in teeth with metallic post.

AIM: To compare the diagnostic accuracy of conventional periapical radiography and cone beam computed tomography (CBCT) in detecting vertical root fracture (VRF) in tooth with metallic post (MP). MATERIALS AND METHODS: Twenty endodontically-treated teeth received MPs, artificial fractures were created in 10 teeth, and they were all examined with tomography and radiography. The sample consisted of periapical radiography with post and without post, and tomography with post and without post; each group with five fractured and five non-fractured teeth. The images were evaluated by three dental/maxillofacial radiologists and statistical validations were carried out using receiver operating characteristic (ROC) analysis. RESULTS: Sensitivity and specificity of the area under the ROC (Az) of tomography with post (Az = 0.953) and without post (Az = 0.956) were significantly higher than those of periapical radiography with post (Az = 0.753) and without post (Az = 0.778). CONCLUSION: CBCT was more accurate than conventional periapical radiography in detecting VRF.

Optical density evaluation around the zirconia granules used as graft in rat calvaria / Avaliação da densidade óptica ao redor dos grânulos de zircônia usados como enxerto na calvária de ratos

The aim of this study was to evaluate the optical density of the zirconia granules used as a graft in a rat calvarium model. Forty animals (Rattus Novergicus, albinus, Wistar) were divided into control and experimental groups and submitted to bone detects in the cranial cap using a trephine type burr 6 mm in diameter. The control group had the defect filled with blood coagulum, and the experimental group was filled with zirconia granules of 300 to 850 µm. The animals were sacrificed at intervals of 7, 14, 30, and 60 days. Digital images were obtained from the bone defect region, and optical density of the zirconia granules was measured using the Image Tool® 3.0. software (UTHSCSA, San Antonio, EUA). The histological analysis of the specimens was also evaluated. The values obtained were analyzed by statistical methods: Analysis of Variance, Welch's Anova, and F Test. It was verified that the mean optical density of the bone repair process differs in all analyzed regions, irrespective of time (p < 0.0001). In the region with the zirconia graft, the mean density was always higher than the other regions analyzed, and the control group showed the same behavior of the experimental groups, but for the region with zirconia graft, the average density is always greater.

O objetivo deste estudo foi avaliar, comparativamente, a densidade óptica no processo de reparação óssea utilizando enxertos com grânulos de zircônia em calvária de ratos. Foram utilizados 40 animais (Rattus Novergicus, albinus, Wistar), divididos em grupo controle e experimental, os quais foram submetidos a defeitos ósseos na calota craniana com broca do tipo trefina de 6 mm de diâmetro. Os animais do grupo controle tiveram o defeito preenchido com coágulo e os do grupo experimental com grânulos de zircônia de 300 a 850 µm. Os animais foram sacrificados nos períodos de 7, 14, 30 e 60 dias. Foram obtidas imagens digitais da região do defeito ósseo e a densidade óptica foi mensurada no programa Image Tool® 3.0 (UTHSCSA, San Antonio, EUA). A análise histológica das amostras também foi avaliada. Os valores obtidos foram analisados pelos métodos estatísticos Análise de Variância Welch´s Anova e Teste F. Verificou-se que a média da densidade óptica do processo de reparação óssea difere-se em todas as regiões analisadas, independente do tempo, ou seja, apresenta diferença estatisticamente significante (p < 0,0001), entretanto para a região com o enxerto de zircônia a média da densidade é sempre maior que as demais regiões analisadas.

Digital evaluation of the influence of interruption of the fixation process on radiographic contrast and base-plus-fog density in three commercial brands of radiographic films / Avaliação digital da influência da interrupção da fixação no contraste radiográfico e na densidade base e velamento em três marcas comerciais de filmes radiográficos

Introduction : With the interest in anticipating access to the result of intraoral radiography, the radiographic processing is frequently neglected, compromising image quality. Objective: The aim of this study was to evaluate the influence of interrupting the fixation process on the radiographic contrast and base-plus-fog density (BPFD) in three brands of periapical films. Material and Method: Ninety radiographs were taken of an aluminum stepwedge and a lead plate for each brand, and they were divided according to the time of initial immersion in the fixative in: control group (without interrupting the fixing), 5, 10, 20, 30 and 40 seconds. During processing, films had the fixing stage stopped and were exposed to a negatoscope for 1 minute, then the fixation time of 10 minutes was completed. The radiographs were digitized and exported to Image Tool 3.0.software. Result: Kodak(r) film showed no statistically significant differences between groups, while Agfa(r) film presented difference in BPFD compared with Group 5 seconds, and Dentix(r) film showed statistical difference in all groups in comparison with the control group. Conclusion: Under the conditions studied, Kodak(r) film is not influenced by disruption of fixation as regards BPFD and image contrast, enabling early access to the results of radiographs, whereas Agfa(r) film requires at least 10 seconds of initial fixation, and Dentix(r) film obtains better results when the process of fixation is not interrupted. .

Introdução: Com a preocupação em antecipar o acesso ao resultado de radiografias intrabucais, o processamento radiográfico é muitas vezes negligenciado, comprometendo a qualidade da imagem. Objetivo: O objetivo deste trabalho foi avaliar a influência da interrupção do processo de fixação no contraste radiográfico e na densidade base e velamento (DBV) em 3 marcas comerciais de filmes periapicais. Material e Método: Foram realizadas 90 radiografias de um stepwedge de alumínio e uma placa de chumbo para cada marca, e as mesmas foram divididas de acordo com o tempo de imersão inicial no fixador em: grupo controle (sem interrupção na fixação), 5, 10, 20, 30 e 40 segundos. Durante o processamento, os filmes tiveram a fixação interrompida e foram expostos à luz de um negatoscópio por 1 minuto, e então completaram o tempo de fixação de 10 minutos. As radiografias foram digitalizadas e analisadas no software Image Tool 3.0. Resultado: O filme Kodak(r) não apresentou diferenças estatísticas significantes entre os grupos, enquanto que o filme Agfa(r) apresentou diferença na DBV em relação ao grupo de 5 segundos, e o filme Dentix(r) apresentou diferença estatística em todos os grupos comparando-os ao grupo controle. Conclusão: Sob as condições estudadas, o filme Kodak(r) não sofreu influência da interrupção da fixação na DBV e no contraste da imagem, possibilitando o acesso antecipado ao resultado do exame radiográfico, enquanto que o filme Agfa(r) necessita de pelo menos 10 segundos de fixação inicial e o filme Dentix(r) obtém melhores resultados quando não interrompido o processo de fixação. .

Comparison of the diagnostic accuracy of direct digital radiography system, filtered images, and subtraction radiography.

BACKGROUND: TO COMPARE THE DIAGNOSTIC ACCURACY OF THREE DIFFERENT IMAGING SYSTEMS: Direct digital radiography system (DDR-CMOS), four types of filtered images, and a priori and a posteriori registration of digital subtraction radiography (DSR) in the diagnosis of proximal defects. MATERIALS AND METHODS: The teeth were arranged in pairs in 10 blocks of vinyl polysiloxane, and proximal defects were performed with drills of 0.25, 0.5, and 1 mm diameter. Kodak RVG 6100 sensor was used to capture the images. A posteriori DSR registrations were done with Regeemy 0.2.43 and subtraction with Image Tool 3.0. Filtered images were obtained with Kodak Dental Imaging 6.1 software. Images (n = 360) were evaluated by three raters, all experts in dental radiology. RESULTS: Sensitivity and specificity of the area under the receiver operator characteristic (ROC) curve (Az) were higher for DSR images with all three drills (Az = 0.896, 0.979, and 1.000 for drills 0.25, 0.5, and 1 mm, respectively). The highest values were found for 1-mm drills and the lowest for 0.25-mm drills, with negative filter having the lowest values of all (Az = 0.631). CONCLUSION: The best method of diagnosis was by using a DSR. The negative filter obtained the worst results. Larger drills showed the highest sensitivity and specificity values of the area under the ROC curve.