Influence of the metal post material, tooth location in the dental arch, and metal artifact reduction tool on vertical root fracture diagnosis in cone beam CT.

This study aimed to evaluate the influence of the metal post composition, tooth location in the dental arch, and metal artifact reduction (MAR) on vertical root fracture (VRF) diagnosis in cone beam computed tomography (CBCT). Twenty-two unirradicular premolars (12 sound and 10 fractured) and two alveolar sockets of a mandible (anterior and posterior regions) composed the sample. CBCT scans of each tooth with a metal post placed into the root canal-silver-palladium (Ag-Pd), cobalt-chromium (Co-Cr), or nickel-chromium (Ni-Cr)-were individually acquired for each mandibular region, and two conditions of MAR, using a OP300 device (Instrumentarium, Finland). Images were assessed by five evaluators independently for VRF detection. Diagnostic values were calculated and compared among all groups using multi-way ANOVA with Tukey post hoc test to investigate the effect of post material, anatomical region, and MAR on VRF diagnosis (α = 0.05). Values of area under the receiver operating curve and specificity were not influenced by the studied factors (p > 0.05). Sensitivity was influenced by the MAR in both mandibular regions (p < 0.05). In the anterior region, sensitivity values increased when the MAR was enabled, regardless of the metal post material (p < 0.05). Similar behavior was noticed in the posterior region for Ni-Cr (p < 0.05) but not for Ag-Pd and Co-Cr posts (p > 0.05). The MAR improved the sensitivity in VRF diagnosis for all tested metal posts in the mandibular anterior region and for the Ni-Cr post in the mandibular posterior region. Therefore, for images obtained in the OP300 CBCT device, activation of the MAR is suggested in these cases.

Radiographic evaluation of mandibular third molars: an ex vivo comparative study between multilayer and conventional panoramic radiography.

OBJECTIVES: To compare the multilayer panoramic radiography (MPAN) and conventional panoramic radiography (CPAN) in the evaluation of mandibular third molars using cone-beam computed tomography (CBCT) as a reference. METHODS: CPAN, MPAN, and CBCT scans from 33 dry human mandibles were acquired using the OP300 Maxio unit, totalizing 56 mandibular third molars to be evaluated. Three examiners evaluated each third molar according to their position, depth of impaction in the mandibular ramus, proximity between the dental root apexes and the mandibular canal, and the presence of radiographic signs of proximity to the mandibular canal. In addition, when there was a distance between the root apexes and the mandibular canal, it was measured. As a reference, these same parameters were assessed in the CBCT scans by a fourth examiner. For the statistical analysis, the weighted Kappa, Bland Altman, and Wilcoxon tests were performed (α = 0.05). RESULTS: The agreement between the assessments performed in the panoramic modalities with the CBCT ranged from 66.1% to 100.0% for the categorical variables. Overall, the agreement values of CPAN and MPAN with CBCT were similar. The distances between the dental root apex and the mandibular canal for both CPAN and MPAN were significantly underestimated compared to CBCT (p < 0.05). The intra- and interexaminer agreements of the examiners ranged from poor to almost perfect; in general, the agreements were higher in the evaluation performed in the MPAN than in the CPAN. CONCLUSIONS: The MPAN performs similarly to CPAN for evaluating mandibular third molars and their proximity relationship to the mandibular canal. CLINICAL RELEVANCE: Preoperative evaluation of lower mandibular third molars is usually performed using CPAN. Recently, a new tool, MPAN, was developed, which has not yet been tested for the evaluation of mandibular third molars and showed similar performance to CPAN in the present study. Future studies using MPAN are encouraged to evaluate other diagnostic tasks.

The Intracellular and Secreted Sides of Osteopontin and Their Putative Physiopathological Roles.

Classically, osteopontin (OPN) has been described as a secreted glycophosprotein. Indeed, most data concerning its physiological and pathological roles are mainly related to the secreted OPN (sOPN). However, there are several instances in which intracellular OPN (iOPN) has been described, presenting some specific roles in distinct experimental models, such as in the immune system, cancer cells, and neurological disorders. We herein aimed to highlight and discuss some of these secreted and intracellular roles of OPN and their putative clinical and biological impacts. Moreover, by consolidating data from the OPN protein database, we also analyzed the occurrence of signal peptide (SP) sequences and putative subcellular localization, especially concerning currently known OPN splicing variants (OPN-SV). Comprehending the roles of OPN in its distinct cellular and tissue environments may provide data regarding the additional applications of this protein as biomarkers and targets for therapeutic purposes, besides further describing its pleiotropic roles.

Do the location and dimensions of the mental foramen differ among individuals of different facial types and skeletal classes? A CBCT study.

STATEMENT OF PROBLEM: Knowledge about the location and dimensions of the mental foramen is important for surgical planning and implant placement in the posterior mandibular region. PURPOSE: The purpose of this clinical study was to assess the location and dimensions of the mental foramen in individuals of different facial type, skeletal class, and sex by means of cone beam computed tomography (CBCT) images. MATERIAL AND METHODS: CBCT images of 142 individuals (72 women and 70 men) were classified according to the facial type (dolichocephalic, mesocephalic, or brachycephalic) and skeletal class (I, II, or III). The vertical and horizontal locations of each mental foramen were evaluated on panoramic reconstructions, and the greatest height and width of the mental foramen were determined on multiplanar reconstructions. Also, the distances from the mental foramen to the alveolar crest and to the inferior cortex of the mandible were obtained. The data were compared by using the Kruskal-Wallis test and multiway analysis of variance (α=.05). RESULTS: The facial type, skeletal class, and sex did not influence the vertical (P=1.00) or the horizontal (P>.15) location of the mental foramen. The most frequent location of the mental foramen was between the first and second premolars and below their apices. The dimensions of the mental foramen were not influenced by the studied factors in men (P>.07); conversely, the mental foramen dimensions were influenced for women (P<.03). CONCLUSIONS: The most frequent location of the mental foramen was between the first and second premolars and below their apices. An influence of the facial type and skeletal class was observed on the dimensions of the mental foramen in women.

Fish feed mycobiota and aflatoxins in round fish tissues.

BACKGROUND: Round fish is one of the most consumed fish in Brazil. Farmed fish feed is based mainly on grains, which are susceptible to contamination by mold and mycotoxins. Aspergillus spp., Penicillium spp. and Fusarium spp. are the major mycotoxins producers. The presence of potentially toxigenic fungi in the diet is a concern due to the possibility of cumulative toxins in fish tissues, becoming a risk to food safety. This study aims to assess the mycobiota of fish feed and the occurrence of aflatoxin residues in round fish tissues. Feed and fish samples were collected from fish farming and fish pay properties. Feed was submitted to mold counting and mold identification. The round fish liver and muscle were submitted to the detection and quantification of aflatoxins B1 , B2 , G1 and G2 by high-performance liquid chromatography. RESULTS: In evaluated feed, mold counts in the samples ranged from 2.0 to 4.7 log colony forming units g-1 and the major genera found were Penicillium (61.5%) and Aspergillus (34.6). Aflatoxin B1 (AFB1 ) was detected in 70% liver samples and 43.3% muscle samples, at levels up to 5.70 and 1.13 µg kg-1 , respectively. CONCLUSION: It is concluded that, although the levels were lower than those recommended by Brazilian legislation, round fish are being exposed to diets naturally contaminated by aflatoxins and are susceptible to toxins accumulation in tissues. Therefore, regulations regarding feed should consider limits for mold and aflatoxin contamination in fish edible tissues should be monitored in order to ensure consumers' safety. © 2021 Society of Chemical Industry.

Classification and Morphological Analysis of the Hard Palate in Cone-Beam Computed Tomography Scans: A Retrospective Study.

PURPOSE: As the hard palate is a central structure of the skull and is involved in orthodontic and surgical procedures, it would be of interest to study the morphological aspects of this bone and its possible variations as per different patterns of skeletal development. Thus, this study aimed to develop a classification for the different morphological characteristics of the hard palate and to evaluate the relationship between these characteristics and the different skeletal patterns, using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This retrospective and cross-sectional study used CBCT scans of patients seen from January 2014 to December 2016. Carestream Dental 3D Imaging software was applied to classify each patient according to vertical and sagittal skeletal patterns, and to evaluate the 3 morphological characteristics of the hard palate: depth (flat, regular, or deep), inclination (superior, parallel, or inferior), and presence of a bony projection (S-shaped). χ2 and Fisher's exact tests evaluated the relationship between the hard palate characteristics and the different skeletal patterns. RESULTS: A total of 298 CBCT scans (144 males and 154 females) were evaluated. The depth of the hard palate was significantly related to both skeletal patterns in males (P < .05), with Class II and dolichocephalics presenting a greater amount of deep palates, while classes I and III and brachycephalics had a greater amount of regular palates. The inclination of the hard palate was significantly associated with the facial type in females (P < .05), with brachycephalics and mesocephalics presenting a greater amount of parallel palates, whereas dolichocephalics had a greater number of inferiorly inclined palates. Regarding the presence of the S-shape in the hard palate, there was a greater number of this projection in Class II males and brachycephalic females. CONCLUSIONS: A morphological classification for the hard palate was developed. The morphology of the hard palate varied among the different skeletal patterns.

Do the tube current and metal artifact reduction influence the diagnosis of vertical root fracture in a tooth positioned in the vicinity of a zirconium implant? A CBCT study.

AIM: To evaluate the influence of the tube current and metal artifact reduction (MAR) tool on the diagnosis of vertical root fractures (VRF) in a tooth adjacent to a zirconium implant, in cone-beam computed tomography (CBCT) images. METHODOLOGY: Thirty single-rooted teeth (15 with VRF and 15 control group) were individually positioned in a mandible, and scanned with the OP300 CBCT unit. Images were acquired using a standardized protocol: 5 × 5 cm field of view, 0.08-mm voxel size, and 90 kVp. Each tooth was scanned with and without a zirconium implant in its vicinity, using different tube currents (4 mA, 8 mA, and 10 mA) and conditions of MAR (enabled × disabled). Diagnostic values were calculated for each protocol, and compared by multi-way analysis of variance. RESULTS: The ROC curve and sensitivity values did not differ significantly among the tube currents, regardless of the presence of the implant and MAR condition (p > 0.05). There were also no significant differences among the tube currents for the specificity values (p > 0.05); however, the specificity differed significantly between the "with implant" and "without implant" conditions, within the same MAR condition and tube current (p < 0.05). Specificity was significantly lower when the implant was present (p < 0.05). CONCLUSION: The presence of a zirconium implant impairs the diagnosis of VRF in teeth adjacent to the artifact-generator material. Neither the tube current nor the MAR tool is effective in improving this diagnostic task. Therefore, in this clinical scenario, the use of the lowest tube current (4 mA), without MAR activation, is recommended. CLINICAL RELEVANCE: Considering that the tube current is one of the main factors that influence the radiation dose and image quality in CBCT, and that metal artifacts negatively influence the diagnosis of VRF in areas adjacent to the artifact-generator material, it is important to evaluate the effect of this energetic parameter in the diagnosis of VRF in teeth adjacent to zirconium implants.

Mapping the expression of beam hardening artefacts produced by metal posts positioned in different regions of the dental arch.

OBJECTIVES: To objectively assess the expression and direction of artefacts in the vicinity of metal posts positioned in different mandibular regions. MATERIALS AND METHODS: A human mandible had two sockets prepared-anterior and posterior regions-to accommodate a single-rooted tooth. Two CBCT units, Picasso Trio and OP300, were used. CBCT images of the tooth without metal post, and with silver-palladium, nickel-chromium, or cobalt-chromium posts (experimental groups) were individually acquired. Then, 8 lines of interest (LOIs) were determined around the root canal, in an axial reconstruction: 4 in orthogonal (buccal, lingual, mesial, and distal) directions, and 4 in oblique (mesiobuccal, distobuccal, mesiolingual, and distolingual) directions. The mean of gray values was measured for each LOI. RESULTS: For the OP300, in general, all experimental groups showed greater expression of hyperdense streaks in orthogonal LOIs and greater expression of hypodense streaks in oblique LOIs. For the Picasso Trio, for both mandibular regions, the buccal LOI showed greater expression of hypodense streaks; conversely, greater expression of hyperdense streaks was observed in the distal and distobuccal LOIs in the anterior region and in the mesiolingual LOI in the posterior region. The silver-palladium group showed significantly greater expression of beam hardening artefacts in the posterior region of the mandible, regardless of the CBCT unit (p < 0.05). The mandibular posterior region showed significantly lower gray values than the anterior region (p < 0.05). CONCLUSION: The expression and direction of artefacts produced in the vicinity of metal posts vary according to the mandibular region, composition of the post, and CBCT unit. CLINICAL RELEVANCE: The mapping of artefacts produced by metal posts reveals the root regions with greater expression of hypodense and hyperdense artefacts, which may contribute to recognizing regions more likely to mimic or hide root fracture lines.

Do the dimensions of the hard palate have a relationship with the volumes of the upper airways and maxillary sinuses? A CBCT study.

BACKGROUND: As the hard palate is a central structure of the skull, and its close relationship with the nasal cavity, oral cavity, and maxillary sinuses, it would be of interest to study if there is a relationship between this bone and other structures of the stomatognathic system. Thus, this study aimed to assess the dimensions of the hard palate and associate them with sex, and skeletal and breathing patterns. Also, to investigate if there is a relationship between these dimensions and the volumes of the upper airways and maxillary sinuses. METHODS: Two hundred and ninety-eight CBCT scans of patients were classified according to sex, and skeletal and breathing patterns. Then, the linear dimensions of width and height of the hard palate at the regions of the first premolars and first molars, and the volumes of the upper airways and maxillary sinuses were measured using the CS 3D Imaging and ITK-SNAP software, respectively. Data were submitted to multi-way analysis of variance and linear regression, with a significance level of 5% (α = 0.05). RESULTS: Sex and facial type influenced the hard palate dimensions (p < 0.05). Males had greater width and height of the hard palate than females (p < 0.0001). It was observed greater width for brachycephalics at the first premolars region (p = 0.0032), and greater height for dolichocephalics at the first premolars (p = 0.0154) and first molars (p = 0.0038) regions. Skeletal malocclusion and breathing pattern did not influence the measurements of the hard palate (p > 0.05). There was a significant relationship between the width and height of the hard palate at the premolar's region and the total volume of the upper airways (p = 0.018, and p = 0.038), and between both dimensions of the hard palate at the molar's region and the total volume of the maxillary sinuses (p < 0.0001). CONCLUSIONS: The hard palate dimensions are influenced by sex and facial type, but not by skeletal malocclusion or breathing pattern. Also, there is an association between these dimensions and the volumes of the upper airways and maxillary sinuses.

Volumetric evaluation of temporomandibular joints in patients with a chewing-side preference: a CBCT study.

This study evaluated the influence of chewing-side preference on the volume of the mandibular condyle and coronoid process and the dynamic parameters of the temporomandibular joint (TMJ). Cone beam computed tomographic scans of both TMJs of 90 individuals with a chewing-side preference were obtained while the patients were in the closed-mouth and maximum mouth-opening positions (test power ≥ 0.80). The preferred chewing side was identified with a chewing gum test as well as by patient self-reports of preferred side and hemispheric dominance (ie, dominant side of the body). Two trained examiners assessed the volume of the mandibular condyle and coronoid process and the dynamic parameters of the TMJs on both sides. The volumes of the mandibular condyle on the 2 sides were compared using a paired t test (α = 0.05). McNemar and Bowker tests of symmetry (α = 0.05) were used for concordance analyses of the dynamic parameters of the TMJ on the chewing and nonchewing sides. No statistically significant difference was observed in the volume of the mandibular condyle (chewing gum test, P = 0.4548; interview, P = 0.7191; hemispheric dominance, P = 0.3471) or coronoid process (chewing gum test, P = 0.7718; interview, P = 0.8072; hemispheric dominance, P = 0.8301) on the chewing and nonchewing sides, regardless of the method used to identify chewing preference. The preferred chewing side also did not significantly affect the dynamic parameters of the mandibular condyle (P = 0.5538). Chewing-side preference does not influence the volume of the mandibular condyle or coronoid process or the dynamic parameters of the TMJ.

Evaluation of the antigenotoxic and antioxidant activity induced by Croton antisyphiliticus.

This study aimed to investigate antigenotoxicity and antioxidant potential of extract, fractions and vitexin from C. antisyphiliticus. Methanolic extract was fractionated through solvents of increasing polarity. The composition of extracts and fractions were evaluated through phytochemical screening. Micronucleus test was performed in mice to evaluate the antigenotoxicity. Antioxidant activity was measured using the assay 1,1-diphenyl-2-picrylhydrazyl (DPPH), iron ion chelating, thiobarbituric acid assay and nitric oxide scavenging. Treatment with extract, fractions and vitexin did not produce an increase in Micronucleus mean values. However, Micronucleus (MN) mean values decreased in relation to control. methanolic extract presented antioxidant potential for DPPH (81%), iron ion chelating (77.8%), Thiobarbituric Acid (TBARS) (32.49%) and Nitric Oxide (NO) (80.97%). Ethyl acetate fraction showed the highest antioxidant activity (65.46%). The vitexin showed a Inhibitory Concentration (IC50) of DPPH value smaller in relation to control. Vitexin flavonoid was detected by High Performance Liquid Chromatography (HPLC), infrared spectrometry and nuclear magnetic resonance. It can be inferred that methanolic extract, fraction ethyl acetate and vitexin isolated from C. antisyphiliticus is endowed with antigenotoxic and antioxidant potential.

Variations in pulp volume between normotensive and hypertensive individuals on CBCT imaging.

OBJECTIVES: To compare the pulp volume of individuals with altered and normal systemic blood pressure (BP) in order to verify if high BP promotes dimensional modifications in the pulp space. MATERIALS AND METHODS: Cone beam computed tomography scans of 91 patients (49 females and 42 males, mean age 31.7 ± 6.38 years) who had a healthy maxillary canine were selected. Values of arterial BP measured at two dental visits were used to classify the sample as normal BP (< 130 × 80 mmHg) and altered BP (≥ 130 × 80 mmHg); 49 patients had normal BP and 42 had altered BP. One oral radiologist evaluated each patient's pulp and tooth volumes, using semi-automatic segmentation, and the tooth length. Data were submitted to Student's t test and logistic regression, with a significance level of 5% (p < 0.05). RESULTS: Pulp volume (p = 0.0027), pulp volume/tooth volume (p = 0.0013), and pulp volume/tooth length (p = 0.0007) ratios were greater in the altered BP group. Conversely, there was no difference in tooth volume between the groups (p = 0.0697). A logistic regression model (p = 0.0002) using pulp volume and age enabled the development of a formula for predicting altered BP, with 68% accuracy. CONCLUSIONS: Individuals with altered systemic BP have greater pulp volumes than those with normal BP. The formula developed in this study may indicate the presence of altered BP. CLINICAL RELEVANCE: As arterial hypertension is a silent disease that produces no warning signs or symptoms, identification of modifications in the pulp volume in cone beam computed tomography scans may be an adjuvant sign of the diagnosis of this disease.

C-shaped canals in mandibular molars of a Brazilian subpopulation: prevalence and root canal configuration using cone-beam computed tomography.

OBJECTIVES: To assess C-shaped root canal configuration by identifying its prevalence and each configuration type proportion, according to tooth (mandibular first or second molar) and demographic characteristics in a Brazilian population, using cone-beam computed tomography (CBCT). Moreover, it was verified if there is a relationship between root canal configuration observed in two-dimensional reconstructions of CBCT and presence of C-shape. METHODS: Mandibular jaw CBCT scans (184 males and 220 females, aged 15 to 80 years), which presented 1464 mandibular molars (710 first molars and 754 second molars), were assessed. Teeth were evaluated for the presence and type of C-shaped root canals by observing the roots at five levels in CBCT axial reconstructions. Root canal configuration was assessed in panoramic reconstructions. Data were statistically analyzed at a significance level of 5%. RESULTS: Of the 1464 mandibular molars, 125 (8.5%) were classified as C-shaped. This variation was more prevalent in females (n = 107, 85.6%) and in second molars (n = 108, 86.4%). C1 (uninterrupted C-shaped canal) was the most prevalent type of C-shaped configuration (41.76%), while C5 (no canal lumen) was the least prevalent type (0.96%). Single root with single canal in panoramic reconstructions was the most predominant configuration for C-shaped teeth (n = 54, 43.2%). Fused roots presented 17.2 higher odds of being associated with C-shaped root canals than non-fused roots. CONCLUSIONS: C-shaped root canals were more prevalent in mandibular second molars and in females. Additionally, clinicians should bear in mind the greater possibility of C-shaped configuration in mandibular molars with fused roots. CLINICAL RELEVANCE: Mandibular molars with C-shaped canals present a clinical challenge. A higher C-shaped proportion was noted in radiographic fused root types, which had 17.2 higher odds of presenting such anatomy when compared to radiographic non-fused roots. Root radiographic features may help in diagnosis of complex C-shaped morphologies.

Artifact expression of polylactic acid/hydroxyapatite/graphene oxide nanocomposite in CBCT: a promising dental material.

OBJECTIVE: To evaluate the artifact expression of a new material-polylactic acid (PLA)/hydroxyapatite (HA)/graphene oxide (GO) nanocomposite-and compare it with that of commonly used dental materials, using cone-beam computed tomography. MATERIALS AND METHODS: Cylinders of amalgam alloy, metal alloy, titanium, gutta-percha, and PLA/HA/GO were individually placed in the center of an acrylic phantom. Three images of each phantom + cylinder set were acquired using a Picasso Trio unit (Vatech, Hwaseong, South Korea) set at 90 kVp, 3.7 mA, 0.2 mm3 voxel size, and 12 × 8.5 cm FOV. Three images of a control group (sound phantom) were also obtained. Eight ROIs were established in each image to evaluate the standard deviation (S.D.) of gray values in the ImageJ Software. The Kruskal-Wallis test with the Student-Newman-Keuls post hoc was employed, considering a significance level of 5%. RESULTS: There were no significant differences in S.D. between the control and PLA/HA/GO images (p = 0.712). Both control and PLA/HA/GO showed fewer image artifacts than the other materials (p < 0.05). The images of the amalgam alloy did not differ from the metal alloy images (p = 0.691), showing more artifacts than the gutta-percha (p = 0.028) and titanium (p = 0.051). CONCLUSIONS: The PLA/HA/GO produced fewer artifacts and a better-quality image than the other tested materials. CLINICAL RELEVANCE: The PLA/HA/GO has physical and biological properties similar to those of dental materials. Since it has produced fewer image artifacts, this new nanocomposite may be employed in the near future, enhancing the diagnosis in CBCT.

Characterization of a bacteriophage with broad host range against strains of Pseudomonas aeruginosa isolated from domestic animals.

BACKGROUND: Pseudomonas aeruginosa is an opportunistic pathogen and one of the leading causes of nosocomial infections. Moreover, the species can cause severe infections in cystic fibrosis patients, in burnt victims and cause disease in domestic animals. The control of these infections is often difficult due to its vast repertoire of mechanisms for antibiotic resistance. Phage therapy investigation with P. aeruginosa bacteriophages has aimed mainly the control of human diseases. In the present work, we have isolated and characterized a new bacteriophage, named Pseudomonas phage BrSP1, and investigated its host range against 36 P. aeruginosa strains isolated from diseased animals and against P. aeruginosa ATCC strain 27853. RESULTS: We have isolated a Pseudomonas aeruginosa phage from sewage. We named this virus Pseudomonas phage BrSP1. Our electron microscopy analysis showed that phage BrSP1 had a long tail structure found in members of the order Caudovirales. "In vitro" biological assays demonstrated that phage BrSP1 was capable of maintaining the P. aeruginosa population at low levels for up to 12 h post-infection. However, bacterial growth resumed afterward and reached levels similar to non-treated samples at 24 h post-infection. Host range analysis showed that 51.4% of the bacterial strains investigated were susceptible to phage BrSP1 and efficiency of plating (EOP) investigation indicated that EOP values in the strains tested varied from 0.02 to 1.72. Analysis of the phage genome revealed that it was a double-stranded DNA virus with 66,189 bp, highly similar to the genomes of members of the genus Pbunavirus, a group of viruses also known as PB1-like viruses. CONCLUSION: The results of our "in vitro" bioassays and of our host range analysis suggested that Pseudomonas phage BrSP1 could be included in a phage cocktail to treat veterinary infections. Our EOP investigation confirmed that EOP values differ considerably among different bacterial strains. Comparisons of complete genome sequences indicated that phage BrSP1 is a novel species of the genus Pbunavirus. The complete genome of phage BrSP1 provides additional data that may help the broader understanding of pbunaviruses genome evolution.

Development and validation of a formula based on maxillary sinus measurements as a tool for sex estimation: a cone beam computed tomography study.

BACKGROUND: As sex estimation is an important step to delineate the biological profile, the development of tools employing anatomical structures which may maintain their integrity even after extreme events, such as the maxillary sinus, become useful for forensic identification. Thus, the aim in the present study was to develop and validate a formula for sex estimation through measurements in the maxillary sinuses in a Brazilian population, using cone beam computed tomography (CBCT) scans. MATERIAL AND METHODS: Linear and volumetric measurements in the maxillary sinus were performed bilaterally in 94 CBCT scans from 45 males (mean age 25.2 ± 0.79) and 49 females (mean age 23.7 ± 0.50). The OnDemand 3D software was employed for linear measurements (height, length and width of, and the largest distance between the right and left maxillary sinuses), while the ITK-SNAP 3.0 segmentation software was used to acquire the volume. The data obtained was applied to a mathematical model for sex estimation. To validate the developed formula, another sample composed of 60 CBCT images of Brazilian individuals was tested. RESULTS: Overall, maxillary sinuses' measurements were significantly higher in males, without statistically significant differences between the right and left sides within each group. The most dimorphic measurement was the height, with an accuracy of 77.7% regarding sex estimation. The formula created lead to a sex estimation of 87.8% for females and 80% for males, with an overall accuracy of 84%. When the formula validity was tested in another sample, it showed an accuracy of 82.4%. CONCLUSION: The formula developed through measurements in the maxillary sinus using CBCT scans showed an accuracy of 84% for sex estimation and can be applied as a complementary method for human identification in the Brazilian population.

Geographic distribution of ATP7B mutations in Wilson disease.

CONTEXT: Geographic distribution of ATP7B mutations in different populations. OBJECTIVE: To summarise common mutations in the ATP7B gene and graphically illustrate their prevalence in different populations. METHODS: A literature search was done using PubMed and the Wilson Disease Mutation Database (http://www.wilsondisease.med.ualberta.ca/database). RESULTS: p.His1069Gln is the most prevalent mutation seen in Europe. In the Mediterranean countries, the array of prevalent mutations is different from the rest of Europe. In Far East Asian countries, the mutation p.Arg778Leu is the most common. In India, no single mutation seems to be dominant, owing to the vast ethnic diversity of the country. The p.Cys271* mutation is dominant in the east, west and south, but not reported in the north. In the Middle East, data from Saudi Arabia shows the p.Gln1399Arg mutation as the most prevalent. In the US, the p.His1069Gln is dominant, whereas in Brazil the mutation c.3402delC dominates. CONCLUSION: Clinical features in WD patients can be misleading and often absent. Genetic testing is used to confirm the diagnosis. However, owing to the large gene size and vast diversity in the mutations, genetic testing can be time-consuming and tedious. This study reviews ATP7B mutations seen in different populations and can help develop time-saving methods and expediate the process of genetic analysis of WD.

The influence of number of line pairs in digital intra-oral radiography on the detection accuracy of horizontal root fractures.

AIM: Line pairs are the unit for measurement of resolution and are related to the spatial quality of the system. Thus, the objective of this study was to evaluate the influence of number of line pairs in digital intra-oral radiography on the detection accuracy of horizontal root fractures. MATERIALS AND METHODS: Sixty-four extracted single-root human teeth were used. Thirty-two had horizontal root fractures created and were mounted in dry human mandibles. The teeth were radiographed with two digital receptors: the Digora Optime (14.3 lp mm-1) and the Digora Toto (26.3 lp mm-1). Images were viewed under standardized conditions by 3 calibrated examiners using the respective dedicated software (Digora for Windows 2.6(®) and Scanora(®) ). Digora Toto(®) images were also evaluated through the Digora for Windows 2.6(®) software. The results were statistically analyzed based on the area under the ROC curve for each examiner. RESULTS: Pairing Digora Toto(®) with Scanora(®) allowed for greater accuracy in horizontal root fractures diagnosis, while images acquired with that same system seem to lose accuracy when visualized with Digora for Windows 2.6(®) . Pairing Digora Optime(®) with Digora for Windows 2.6(®) resulted in the lowest accuracy for horizontal root fractures diagnosis. CONCLUSIONS: The higher number of line pairs and the consequent higher image resolution provided by the Digora Toto(®) system and its dedicated software seem to enhance the accuracy of horizontal root fractures diagnostic imaging.

Interobserver variability in transient elastography analysis of patients with chronic hepatitis C.

BACKGROUND & AIMS: Transient elastography based on liver stiffness measurement is a non-invasive method to assess hepatic fibrosis. However, interobserver variability has led to controversy over its use in fibrosis evaluation. To evaluate the interobserver variation in transient elastography in chronic hepatitis C. METHODS: We performed a cross-sectional study, analysing findings from two experienced operators who each assessed 195 patients by transient elastography on the same day. Liver stiffness measurement used to define fibrosis stages, based on METAVIR score, was: <7.1 as F0F1, 7.1-9.4 as F2, 9.5-12.4, as F3 and >12.4 kPa as F4. We also assessed interobserver variation in identification of potential oesophageal varices screening based on transient elastography. RESULTS: The interobserver intraclass correlation coefficient was 0.940 (95% CI 0.863-0.967) and measurements made by operators correlated [Spearman's ρ = 0.924; P < 0.001]. However, the median liver stiffness measurement assessed by first operators was higher (11.5 vs 9.8 kPa; P < 0.001). The discordance between operators was 35% for at least one stage of fibrosis and 5% for two or more stages. Interobserver reliability values were κ = 0.61 for fibrosis stages F ≥ 2 and κ = 0.80 for cirrhosis. Among the 74 patients determined to have cirrhosis by at least one operator, there was considerable discordance in identification of those with indication for oesophageal varices screening (κ values from 0.13 to 0.61) according to several cut-offs. CONCLUSION: Although a high correlation of liver stiffness measurement between operators, interobserver variability in transient elastography was not negligible. This method should not be used as the only screening tool for oesophageal varices in chronic hepatitis C.

Assessment of Volume and Height of the Coronoid Process in Patients With Different Facial Types and Skeletal Classes: A Cone-Beam Computed Tomography Study.

PURPOSE: To determine the height and volume of the mandibular coronoid process (CP) by cone-beam computed tomography (CBCT) and to identify the presence of any correlations of these measurements with age, gender, facial type, and skeletal class. MATERIALS AND METHODS: The sample consisted of 132 patients from a departmental routine patient base. After CBCT, CP height was determined using OnDemand 3D software (CyberMed, Seoul, Republic of Korea), and CP volume was obtained using ITK-SNAP 3.0 software (Cognitica, Philadelphia, PA). Measurements were subjected to analysis of covariance against facial type, skeletal class, gender, and age, with a significance level of 5%. RESULTS: CP height and volume were similar regardless of age, facial type, and skeletal class. However, the 2 measurements were statistically different regarding gender, with larger values for men than for women. CONCLUSIONS: These observations suggest that gender is the only factor influencing the height and volume of the CP.