ORAL CARE TO REDUCE COSTS AND INCREASE CLINICAL EFFECTIVENESS IN PREVENTING NOSOCOMIAL PNEUMONIA: A SYSTEMATIC REVIEW.

BACKGROUND: Nosocomial pneumonia ranks among the top 5 diseases that lead to additional financial costs due to hospitalization. This study aimed to evaluate the cost of oral care and its clinical effectiveness in preventing pneumonia in a systematic review. METHODS: The search was conducted in the following databases: PubMed, Cochrane Library, Web of Sciences, Scopus, CINAHL, LILACS, complemented by gray literature and manual search, between January/2021 and August/2022. Two independent reviewers extracted data from the selected articles, individually analyzing each study's quality using the BMJ Drummond checklist. The data were tabulated by clinical or economic type. RESULTS: A total of 3,130 articles were identified; the eligibility criteria were verified, and 12 articles were selected for qualitative analysis. Only 2 achieved satisfactory quality assessment for economic analysis studies. There was heterogeneity between clinical and economic data. Eleven of the 12 studies reported a decrease in the incidence of nosocomial pneumonia following the application of oral care practices. Most authors reported a reduction in the estimate of individual costs, followed by a decrease in the need for antibiotic therapy. The costs of oral care were very low compared to other costs. CONCLUSIONS: Despite the low level of evidence in the literature, heterogeneity and poor quality of the selected studies, most studies concluded that oral care seemed to lead to reduced costs in hospital expenses for treating pneumonia.

Salivary protein candidates for biomarkers of oral disorders in people with a crack cocaine use disorder.

The use of cocaine and its main derivative, crack, can cause some systemic effects that may lead to the development of some oral disorders. To assess the oral health of people with a crack cocaine use disorder and identify salivary protein candidates for biomarkers of oral disorders. A total of 40 volunteers hospitalized for rehabilitation for crack cocaine addiction were enrolled; nine were randomly selected for proteomic analysis. Intraoral examination, report of DMFT, gingival and plaque index, xerostomia, and non-stimulated saliva collection were performed. A list of proteins identified was generated from the UniProt database and manually revised. The mean age (n=40) was 32 (±8.88; 18-51) years; the mean DMFT index was 16±7.70; the mean plaque and gingival index were 2.07±0.65 and 2.12±0.64, respectively; and 20 (50%) volunteers reported xerostomia. We identified 305 salivary proteins (n=9), of which 23 were classified as candidate for biomarkers associated with 14 oral disorders. The highest number of candidates for biomarkers was associated with carcinoma of head and neck (n=7) and nasopharyngeal carcinoma (n=7), followed by periodontitis (n=6). People with a crack cocaine use disorder had an increased risk of dental caries and gingival inflammation; less than half had oral mucosal alterations, and half experienced xerostomia. As possible biomarkers for 14 oral disorders, 23 salivary proteins were identified. Oral cancer and periodontal disease were the most often associated disorders with biomarkers.

Salivary protein candidates for biomarkers of oral disorders in people with a crack cocaine use disorder

Abstract The use of cocaine and its main derivative, crack, can cause some systemic effects that may lead to the development of some oral disorders. Objective To assess the oral health of people with a crack cocaine use disorder and identify salivary protein candidates for biomarkers of oral disorders. Methodology A total of 40 volunteers hospitalized for rehabilitation for crack cocaine addiction were enrolled; nine were randomly selected for proteomic analysis. Intraoral examination, report of DMFT, gingival and plaque index, xerostomia, and non-stimulated saliva collection were performed. A list of proteins identified was generated from the UniProt database and manually revised. Results The mean age (n=40) was 32 (±8.88; 18-51) years; the mean DMFT index was 16±7.70; the mean plaque and gingival index were 2.07±0.65 and 2.12±0.64, respectively; and 20 (50%) volunteers reported xerostomia. We identified 305 salivary proteins (n=9), of which 23 were classified as candidate for biomarkers associated with 14 oral disorders. The highest number of candidates for biomarkers was associated with carcinoma of head and neck (n=7) and nasopharyngeal carcinoma (n=7), followed by periodontitis (n=6). Conclusions People with a crack cocaine use disorder had an increased risk of dental caries and gingival inflammation; less than half had oral mucosal alterations, and half experienced xerostomia. As possible biomarkers for 14 oral disorders, 23 salivary proteins were identified. Oral cancer and periodontal disease were the most often associated disorders with biomarkers.

An eye-tracking and visual analogue scale attractiveness evaluation of black space between the maxillary central incisors.

OBJECTIVE: To study the influence of black space between the maxillary central incisors on the aesthetic visual perception of the face, via eye-tracking and visual analogue scale (VAS). METHODS: Black space between the central incisors was created, for both sexes, as follows: control, 1-mm black space, 2-mm black space and 3-mm black space. Ninety raters participated in this study, divided into three groups: 30 laypeople, 30 nonorthodontists, and 30 orthodontists. After the visual calibration of each observer, eight photographs were presented in the Ogama® software concomitant with the use of the hardware The Eye Tribe®. Ogama generated information depending on the eye-tracking of each rater, regarding the time until the first fixation, time of fixation, heatmap, scanpath, and total time of fixation, to evaluate the areas deemed to be of interest according to the raters. Later on, the VAS was used, where each rater evaluated the images in an album on a scale of zero to 10 points. RESULTS: The eyes and mouth were the areas more often noticed by the raters according to the heatmaps, while no significant difference was observed in time until the first fixation between the three groups of raters (p> 0.05). However, regarding the time of fixation on the mouth, a significant difference was observed (p< 0.05) when comparing the three groups. CONCLUSION: Black space has a negative effect on the aesthetic perception of the face. The amount of attention on the mouth is correspondent to the size of the black space.

An eye-tracking and visual analogue scale attractiveness evaluation of black space between the maxillary central incisors

ABSTRACT Objective: To study the influence of black space between the maxillary central incisors on the aesthetic visual perception of the face, via eye-tracking and visual analogue scale (VAS). Methods: Black space between the central incisors was created, for both sexes, as follows: control, 1-mm black space, 2-mm black space and 3-mm black space. Ninety raters participated in this study, divided into three groups: 30 laypeople, 30 nonorthodontists, and 30 orthodontists. After the visual calibration of each observer, eight photographs were presented in the Ogama® software concomitant with the use of the hardware The Eye Tribe®. Ogama generated information depending on the eye-tracking of each rater, regarding the time until the first fixation, time of fixation, heatmap, scanpath, and total time of fixation, to evaluate the areas deemed to be of interest according to the raters. Later on, the VAS was used, where each rater evaluated the images in an album on a scale of zero to 10 points. Results: The eyes and mouth were the areas more often noticed by the raters according to the heatmaps, while no significant difference was observed in time until the first fixation between the three groups of raters (p> 0.05). However, regarding the time of fixation on the mouth, a significant difference was observed (p< 0.05) when comparing the three groups. Conclusion: Black space has a negative effect on the aesthetic perception of the face. The amount of attention on the mouth is correspondent to the size of the black space.

RESUMO Objetivo: Avaliar a percepção visual e estética do espaço negro entre os incisivos centrais superiores, via rastreamento do olhar e escala visual analógica (EVA). Métodos: Manipulou-se o espaço negro entre os incisivos centrais superiores, para ambos os sexos, da seguinte forma: imagem controle, espaço negro de 1 mm, espaço negro de 2 mm e espaço negro de 3 mm. Participaram desse estudo noventa avaliadores, divididos em três grupos: 30 leigos, 30 cirurgiões-dentistas e 30 ortodontistas. Após a calibração visual de cada observador, foram projetadas oito fotografias no software OGAMA® em conjunto com o hardware The Eye Tribe®. O OGAMA gerou informações do rastreamento do olhar de cada avaliador com relação ao tempo até a primeira fixação, mapa de calor, trajetória do olhar e tempo total de fixação para avaliar as áreas consideradas de interesse, de acordo com os avaliadores. Posteriormente, utilizou-se a EVA para avaliar as imagens a partir de um álbum, em uma escala de 0 a 10 pontos. Resultados: Os olhos e a boca foram as áreas com maior fixação pelos avaliadores, de acordo com os mapas de calor. Os resultados estatísticos não apresentaram diferença estatisticamente significativa entre os três grupos de avaliadores (p> 0,05), quanto ao tempo até a primeira fixação. Porém, em relação ao tempo de fixação na boca, observou-se diferença estatisticamente significativa (p< 0,05) na comparação dos três grupos. Conclusão: O espaço negro apresentou um efeito negativo na percepção estética da face. O aumento de fixação na boca correspondeu ao aumento do tamanho do espaço negro.

Sialochemical analysis in polytraumatized patients in intensive care units.

The profiles of polytraumatized patients in intensive care units were characterized. Serum and salivary markers were compared with normality between Classes I and II of APACHE II and between periods of hospitalization; these results were correlated. This was a prospective study on saliva charts and collection (n = 70). Profile: male, 27 years old, blunt traumas and collisions. Serum parameters with normality: decrease in pH, creatinine at admission to Class I, and at 48 and 72 hours in both classes; K+ at 48 h in Class II; Ca+ on admission in both classes and at 72 h in Class I. Increase in urea at 72 h in Class II, glucose at all times and in all classes, and Ca+ at 48 h in both classes. Class II had high Na+ at 48 and 72 h compared to Class I. In Class I, creatinine reduction occurred in 48 h and 72 h compared to admission and an increase of Ca+ at 48 h with admission. In Class II, pH and Na+ increased at 48 h and 72 h compared to admission. K+ decreased from admission to 48 h and increased from 48 h to 72 h. Urea increased from 48 to 72 hours. Creatinine decreased from admission to 48 and 72 hours. Ca+ increased from admission to 48 hours and decreased from 48 to 72 hours. There was an increase in the saliva levels in both classes and times in relation to normality. There was an increase in urea at admission, glucose at 72 h, and Ca+ at 48 h in Class II compared with Class I. Class I urea increased from admission to 48 h and Ca+ decreased from admission to 48 h. Class II urea decreased from 48 h to 72 h. Strong or very strong positive correlation was identified between blood and creatinine saliva at all times and regular and negative Ca+ at 72 h. This study provides evidence that salivary and serum biomarkers can be used together to monitor the evolution of the clinical symptoms of ICU patients.

Anxiety and genetic polymorphisms in catechol-O-methyltransferase (COMT) and serotonin transportation gene (5HTT) are associated with benign migratory glossitis.

OBJECTIVE: The aim of this case-control study was to investigate whether benign migratory glossitis (BMG) is associated with catechol-O-methyltransferase (COMT) and serotonin transportation gene (5HTT) polymorphisms and anxiety. STUDY DESIGN: The study comprised 43 patients with BMG and 114 patients without a history of BMG. We used the Hamilton Anxiety (HAM-A) rating scale to assess each individual's anxiety. We collected DNA from buccal cells and analyzed polymorphisms of COMT and 5HTT. We conducted statistical evaluations by using SPSS software (SPSS Inc., Chicago, IL) and STATA (StataCorp, College Station, TX). Alpha value was set at 0.05. RESULTS: Overall anxiety level was significantly higher in the case group than in the control group (P < .001). In adjusted multiple logistic regression, the COMT markers were not associated with BMG. Individuals with the CC genotype, in rs3813034 of 5HTT, presented an odds ratio (OR) of 2.85 (95% confidence interval [CI] 1.03-7.82; P = .042). Individuals with the TT genotype, in the rs1042173 of 5HTT, presented an OR of 3.77 (95% CI 1.32-10.74; P = .013). For each incremental increase in the anxiety score, there was an 8% increase in the probability of BMG (ORa=1.08; 95% CI 1.03-1.14; P = .007). CONCLUSIONS: Anxiety increases the risk of BMG. Moreover, the occurrence of BMG was associated with polymorphisms in the 5HTT gene.

Primary Diffuse Large B Cell Lymphoma Mimicking Hyperplastic Reactive Lesion (Lymphoma of the Oral Cavity).

OBJECTIVE: To report a case of a challenging oral diagnosis involving a primary diffuse large B cell lymphoma of the oral cavity mimicking a hyperplastic reactive lesion. CASE REPORT: A 72-year-old male patient was referred to the Department of Stomatology presenting a proliferative nodular lesion in the anterior region of the mandible involving the anterior teeth. The clinical examination revealed anterior teeth affected by periodontal disease, suggesting the nodular cession hyperplastic reaction. Incisional biopsy was performed under local anesthesia. The histopathological examination revealed a diffuse proliferation of atypical large lymphoid cells. The tumor cells showed immunopositivity for CD20 and Ki67 (100%) and negativity for CD3, CD30, and CD15. The diagnosis of diffuse large B cell lymphoma was established. The patient underwent chemotherapy and progressed to death after nine months. CONCLUSION: Lymphomas of the oral cavity are rare and may have nonspecific clinical features, mimicking inflammatory and reactive lesions. Therefore, a detailed clinical evaluation associated with histopathological and immunohistochemical analysis should be performed to enable early and accurate diagnoses in suspected oral lesions.

Mechanical Ventilation and Cytopathological Changes in the Oral Mucosa.

BACKGROUND: The oral mucosa is an important defense barrier to penetration of microorganisms. Thus, changes in the oral epithelium might indicate risk for infection in intensive care patients receiving mechanical ventilation. OBJECTIVE: To evaluate the oral mucosa of intensive care patients who did or did not receive mechanical ventilation by using liquid-base exfoliative cytology. METHODS: The sample consisted of 3 groups: 27 patients admitted to intensive care during a 7- to 14-day period who received mechanical ventilation, 29 patients admitted during the same period who did not receive mechanical ventilation, and 27 healthy patients who had no lesions in the mouth. For all 3 groups, samples were collected from the buccal mucosa by using cytology brushes. Smears were applied to glass slides before Papanicolaou staining and were codified for blind analyses by a cytopathologist. Kruskal-Wallis and Dunn tests were used to analyze the results. RESULTS: Patients receiving mechanical ventilation had higher prevalence and intensity of karyomegaly, perinuclear halos, cell keratinization, deep cells, and leukocyte infiltrates than did patients in the other 2 groups (P < .05). No significant differences were observed between the control group and the group who did not receive mechanical ventilation. CONCLUSIONS: Liquid-base exfoliative cytology can be used to detect preclinical alterations in the oral mucosa. Patients treated with mechanical ventilation are vulnerable to infections, and oral care may be valuable in their prognosis.

Host and clinical aspects in patients with benign migratory glossitis.

OBJECTIVE: Investigate the association of clinical, cytological and genetic characteristics with benign migratory glossitis (BMG). STUDY DESIGN: Sample consisted of 175 patients, 44 with BMG and 131 control patients. Clinical examination and DMFT index were assessed. Cytological evaluation determined cell morphology and morphometry. Genetic evaluation was performed by analysing IL6 polymorphisms by real-time PCR. Univariate and multivariate analyses were performed (p<0.05). RESULTS: There was a higher level of anxiety, DMFT score and a prevalence of fissured tongue in BMG group. A high mean nuclear/cytoplasmic area ratio was observed in patients with BMG. There was predominance of Papanicolaou class II I BMG group. IL6 allele G rs2069843 polymorphism was associated with BMG in the dominant model. In multivariate analysis, DMFT and anxiety scale remained associated with BMG.

Validation of 3d metric and superimposition tools in three software packages for the morphological comparison of laser scanned anterior dentition models / Validação de ferramentas tridimensionais de três softwares para mensuração e sobreposição tridimensional de modelos odontológicos visando à comparação morfológica

Introduction: Few studies succeeded on demonstrating that dentitions are unique. Methodological limitations may have influenced these outcomes. Objective: The present study aims to validate software packages for comparing human dentitions. Material and methods: A pool of 40 dental casts were laser scanned (XCAD 3D®, XCADCAM Technology®, São Paulo, Brazil) and implemented in Geomagic Studio® (GS) (3D Systems®, Rock Hill, USA), Cloud Compare® (CC) (Telecom Paris Tech® and EDF®, Paris, France), and Maestro 3D Ortho Studio® (MS) (AGE Solutions®, Pontedera, Italy) software packages to evaluate metric and superimposition tools. Results: Software performances did not significantly differ (p>0.05) considering cropping, landmarking and superimposition functions. GS was more precise for detecting identical models (p>0.05. Inter and intra examiner reproducibility reached optimal outcomes. Calibration was assured for software measuring tools and scanning process. Conclusion: Both GS and CC may be used for comparing 3D anterior dentitions. However, more practical and less operator-depending procedures are available in GS.

Introdução: Poucos estudos obtiveram êxito em demonstrar a unicidade da dentição humana. Falhas metodológicas podem ter influenciado os resultados destes estudos. Objetivo: O presente estudo objetivou validar ferramentas contidas em pacotes de software existentes para comparar dentições humanas. Material e método: Uma amostra de 40 modelos odontológicos digitalizados (XCAD 3D®, XCADCAM Technology®, São Paulo, Brazil) foi selecionada e analisada utilizando os seguintes softwares: Geomagic Studio® (GS) (3D Systems®, Rock Hill, USA), Cloud Compare® (CC) (Telecom Paris Tech® and EDF®, Paris, France), and Maestro 3D Ortho Studio® (MS) (AGE Solutions®, Pontedera, Italy). Resultados: Os softwares não apresentaram performances com diferença estatisticamente significante (p>0.05) considerando os procedimentos de recorte, colocação de pontos de referência (landmarks) e sobreposição de modelos. O software GS apresentou maior precisão para detectar modelos idênticos ((p>0.05). Testes intra e interexaminador resultaram em ótima concordância. Os softwares apresentaram ótima calibração de ferramentas métricas. Conclusão: Ambos os softwares GS e CC podem ser utilizados para comparar modelos odontológicos digitalizados. Contudo, performances mais práticas e independentes do operador podem ser alcançadas por meio do software GS.

The uniqueness of the human dentition as forensic evidence: a systematic review on the technological methodology.

The uniqueness of human dentition is routinely approached as identification evidence in forensic odontology. Specifically in bitemark and human identification cases, positive identifications are obtained under the hypothesis that two individuals do not have the same dental features. The present study compiles methodological information from articles on the uniqueness of human dentition to support investigations into the mentioned hypothesis. In April 2014, three electronic library databases (SciELO®, MEDLINE®/PubMed®, and LILACS®) were systematically searched. In parallel, reference lists of relevant studies were also screened. From the obtained articles (n = 1235), 13 full-text articles were considered eligible. They were examined according to the studied parameters: the sample size, the number of examined teeth, the registration technique for data collection, the methods for data analysis, and the study outcomes. Six combinations of studied data were detected: (1) dental shape, size, angulation, and position (n = 1); (2) dental shape, size, and angulation (n = 4); (3) dental shape and size (n = 5); (4) dental angulation and position (n = 2); (5) dental shape and angulation (n = 1); and (6) dental shape (n = 1). The sample size ranged between 10 and 1099 human dentitions. Ten articles examined the six anterior teeth, while three articles examined more teeth. Four articles exclusively addressed three-dimensional (3D) data registration, while six articles used two-dimensional (2D) imaging. In three articles, both imaging registrations were combined. Most articles (n = 9) explored the data using landmark placement. The other articles (n = 4) comprised digital comparison of superimposed dental contours. Although there were large methodological variations within the investigated articles, the uniqueness of human dentition remains unproved.

Evaluation of Cellular Proliferative Activity in Patients with Oral Lichen Planus and Hepatitis C through AgNOR Method

The objective of this study was to evaluate the cellular proliferative potential of oral lichen planus (OLP) lesions from patients without hepatitis C virus (HCV) by means of AgNOR method, as well as the cellular proliferative potential of the normal oral mucosa from patients with HCV, treated or untreated by interferon and ribavirin. A cross-sectional study was developed to investigate four groups: 10 HCV+ patients without clinical signs of OLP who had never been treated for HCV infection - Group 1; 10 HCV+ patients that were under interferon and ribavirin treatment - Group 2; 15 patients with reticular OLP lesions histopathologically confirmed, without HCV - Group 3; and 15 blood donors without HCV infection and no clinical signs of OLP GROUP 4 Control Group. The cytological material of all groups was collected by the liquid-based cytology technique. Then, the sedimented material from each patient was filled with the Nucleolar Organizer Regions impregnation by silver method (AgNOR). The count of NORs was performed on 100 epithelial cell nuclei per patient using the Image Tool(tm) software. The Tukey HSD test was used to compare the median value of NORs among the groups and showed that the oral mucosa of HCV+ patients previously treated with anti-HCV drugs (GROUP 2), presented a higher average number of NORs in relation to others (p<0.05). The anti-HCV treatment may be related to increased cell proliferation of oral mucosa, indicating a possible relationship between OLP and HCV+ patients treated with interferon and ribavirin.

O propósito deste estudo foi avaliar o potencial proliferativo celular das lesões de líquen plano bucal (LPB) de pacientes sem vírus da hepatite C (VHC) por meio do método AgNOR, comparando-o ao potencial proliferativo celular da mucosa bucal normal de portadores de VHC, tratados ou não com interferon e ribavirina. Um estudo transversal foi realizado para investigar 4 grupos: 10 pacientes VHC+ sem sinais clínicos de LPB que nunca haviam sido tratados para a infecção por VHC - Grupo 1; 10 pacientes VHC+ que estavam sob tratamento com interferon e ribavirina - Grupo 2; 15 pacientes com LPB reticular histopatologicamente confirmado, sem VHC - Grupo 3; e 15 doadores de sangue sem infecção por VHC e sem sinais clínicos de LPB (Grupo 4 - Grupo de Controle). O material celular de todos os grupos foi coletado pela técnica da citologia em base líquida. Então, o material sedimentado de cada paciente foi submetido ao método da impregnação das regiões organizadoras nucleolares pela prata (AgNOR). A contagem das NORs foi realizada em 100 núcleos celulares epiteliais por paciente por meio do programa Image Tool(r). O teste Tukey HSD foi utilizado para comparar o valor médio de NORs entre os grupos e mostrou que a mucosa bucal dos pacientes VHC+ previamente tratados com fármacos anti-VHC (Grupo 2) apresentou maior número médio de NORs por núcleo em relação aos outros (p<0,05). O tratamento anti-VHC pode estar relacionado ao aumento da atividade proliferativa celular da mucosa bucal, aventando uma possível relação entre LPB e pacientes VHC+ tratados com interferon e ribavirina.

Evaluation of cellular proliferative activity in patients with oral lichen planus and hepatitis C through AgNOR method.

The objective of this study was to evaluate the cellular proliferative potential of oral lichen planus (OLP) lesions from patients without hepatitis C virus (HCV) by means of AgNOR method, as well as the cellular proliferative potential of the normal oral mucosa from patients with HCV, treated or untreated by interferon and ribavirin. A cross-sectional study was developed to investigate four groups: 10 HCV+ patients without clinical signs of OLP who had never been treated for HCV infection - Group 1; 10 HCV+ patients that were under interferon and ribavirin treatment - Group 2; 15 patients with reticular OLP lesions histopathologically confirmed, without HCV - Group 3; and 15 blood donors without HCV infection and no clinical signs of OLP GROUP 4 Control Group. The cytological material of all groups was collected by the liquid-based cytology technique. Then, the sedimented material from each patient was filled with the Nucleolar Organizer Regions impregnation by silver method (AgNOR). The count of NORs was performed on 100 epithelial cell nuclei per patient using the Image Tool(tm) software. The Tukey HSD test was used to compare the median value of NORs among the groups and showed that the oral mucosa of HCV+ patients previously treated with anti-HCV drugs (GROUP 2), presented a higher average number of NORs in relation to others (p<0.05). The anti-HCV treatment may be related to increased cell proliferation of oral mucosa, indicating a possible relationship between OLP and HCV+ patients treated with interferon and ribavirin.

Position of the greater palatine foramen: an anatomical study through cone beam computed tomography images.

PURPOSE: The block anesthesia of the greater palatine foramen (GPF) is largely used in minor oral surgeries, periodontics and general dentistry. Furthermore, the area of the GPF serves as a donor of soft tissue graft. So, the aim of this study was to evaluate the position and characteristics of the GPF in Brazilian patients using cone beam computed tomography (CBCT) providing anatomical information for the greater palatine nerve block anesthesia and indicate site to collect palatal donor tissue. METHODS: Fifty CBCT exams of Brazilian patients with a mean age of 35.8 years (27 male/23 female) were evaluated. All patients had erupted first, second and third upper molars. A total of 100 GPF were evaluated bilaterally. The GPFs were assessed regarding position, diameter and distances to the midline maxillary suture (MMS) and to alveolar ridge (AR). Guidelines were drawn in the CBCT axial image depicting all molar interproximal surfaces, bilaterally. The guidelines were located between first, second and third molar and in the center of the second and third, performing five guidelines in each side. These guidelines and the molars were landmarks to assess the GPF anatomic position. RESULTS: From the 100 GPF analyzed, 92 were located in the third molar region (24 male/22 female). The 92 GPF were distributed as 47 in the left side and 45 in the right side. The average GPF diameter and the distance to both the AR and the MMS were 3.1 mm; 7.9 and 15.3 mm, respectively. CONCLUSIONS: Within the limits of this study, we concluded that the in Brazilian patients studied, the GPF location was more closely related to third molar. Therefore, whenever the third molar is erupted, it could be used as landmark for successful GPN block anesthesia. Moreover, harvesting palatal mucosa graft around the third molar should be done cautiously to prevent damage to the GPF vascular-nerve complex.

Applicability of Willems model for dental age estimations in Brazilian children.

Several studies described tooth development as a reliable pathway for age estimations. Depending on the considered life span, the dental age indicators vary. In children, combinations of developing teeth provide the best information about age. In sub adults third molar mineralization is almost exclusively considered. The aim of this study was, firstly, to verify the Willems model in a Brazilian sample. Secondly, to observe differences between the Willems model and a new developed Brazilian model. Thirdly, the information of permanent teeth (PM) and third molar (TM), development was combined for age estimation in children. A sample of 1357 panoramic radiographs of Brazilian males (M) and females (F), with age between 5 and 23 years was collected. The technique of Gleiser and Hunt modified by Kohler (1955) [34] was applied for third molar staging in the entire sample. The Demirjian staging technique was used on the mandibular left permanent teeth (except third molars) of all individuals from 5 to 15 years. Kappa and weighted Kappa statistics were performed to verify inter- and intra-observer reliabilities. Based on the obtained Demirjian scores the Willems model was verified. Next the data were split to develop a new Brazilian model based on the Willems method and to verify the established model. The accuracy in age prediction between the Willems model and the new Brazilian model was compared. Additionally, regression models including PM, TM and PM plus TM information were compared. The Kappa and weighted Kappa statistics revealed high agreement between observers (0.88 Kappa; 0.93 weighted Kappa). The differences between predicted and chronological age for the verified Willems model were expressed in mean errors of -0.17 and -0.38 year for F and M respectively. The differences in mean error between the new developed Brazilian model and the Willems model were 0.02 (F) and 0.20 (M) year. The regression models combining PT and TM information provided only in the age range between 14 and 15.99 years a small decrease in root mean squared error (0.2 year) in females. The new developed Brazilian model provided similar age predicting performances as the Willems et al. model. Added TM was only providing more accurate age estimations in the ages of 14 and 15 year in F.

Orthodontic treatment of a patient with dentin dysplasia type I.

Dentin dysplasia is a genetic disorder of the teeth that affects the dentin and the pulp. Type I is sometimes called "rootless teeth," because of the loss of organization of the root dentin, which often leads to a shortened root length. The purpose of this article was to present a rare clinical case of a girl who was diagnosed with dentin dysplasia type I when she was referred for an orthodontic evaluation. Panoramic and periapical radiographs showed defective root formation and areas with periapical radiolucencies in several teeth. Her Angle Class I malocclusion was successfully treated, providing esthetic and functional results, without clinical symptoms or signs of periodontitis or odontogenic infections.

Assessment of variations of the mandibular canal through cone beam computed tomography.

The neurovascular bundle may be vulnerable during surgical procedures involving the mandible, especially when anatomical variations are present. Increased demand of implant surgeries, wider availability of three-dimensional exams, and lack of clear definitions in the literature indicate that features of anatomical variations should be revisited. The objective of the study was to evaluate features of anatomical variations related to mandibular canal (MC), such as bifid canals, anterior loop of mental nerve, and corticalization of MC. Additionally, bone trabeculation at the submandibular gland fossa region (SGF) was assessed and related to visibility of MC. Cone beam computed tomography exams from 100 patients (200 hemimandibles) were analyzed and the following parameters were registered: diameter and corticalization of MC; trabeculation in SGF region; presence of bifid MC, position of bifurcations, diameter, and direction of bifid canals; and measurement of anterior loops by two methods. Corticalization of the MC was observed in 59% of hemimandibles. In 23%, MC could be identified despite absence of corticalization. Diameter of MC was between 2.1 and 4 mm for nearly three quarters of the sample. In 80% of the sample trabeculation at the SGF was either decreased or not visible, and such cases showed correlation with absence of MC corticalization. Bifid MC affected 19% of the patients, mostly associated with additional mental foramina. Clinically significant anterior loop (>2 mm of anterior extension) was observed in 22-28%, depending on the method. Our findings, together with previously reported limitations of conventional exams, draw attention to the unpredictability related to anatomical variations in neurovascularization, showing the contribution of individual assessment through different views of three-dimensional imaging prior to surgical procedures in the mandible.