Comparison of different methods of analysis of maxillary sinus volume and validation of a new proposal using cone beam computed tomography.

PURPOSE: develop and validate a formula, through a discriminant analysis of sex estimation, evaluating maxillary sinus in cone beam computed tomography scans in a Brazilian population, comparing this formula with two other existing ones. METHODS: 190 cone beam CT scans of Brazilian adults were retrospectively evaluated by an independent examiner. Measurements were performed in the right and left MS region: height, width, length, distance between the breasts, distance between infraorbital foramina, and volume in the ITK software. The sample was divided into female and male. T test, ANOVA, Tukey test and the ROC Curve was performed (p > 0,05). RESULTS: statistically significant differences were found in relation to the maximum height of the MS both right (p = 0,001) and left (p = 0,026) between sexes and the maximum length in the right MS (p = 0,01). Regarding the comparison of MS volume according to the different analysis methods, statistically significant differences were found between sexes for the right MS when using the method by Bangi et al. (p = 0,012) and the volume of the left MS in females (p < 0,001). Comparing the three classification models, statistically significant differences were found between the proposed method and the classification by Bangi et al. (p < 0.007). The ROC curve showed greater accuracy in the classification proposed in this work. CONCLUSION: the new proposed formula obtained better predictions of sexual dimorphism, when compared to classifications already described in the literature.

Prevalence, morphology, and morphometry of anatomical variations of the clivus: a cone beam computed tomographic study.

The purpose of this study was to evaluate the prevalence and characteristics of 3 anatomical variations of the clivus: fossa navicularis magna (FNM), canalis basilaris medianus (CBM), and craniopharyngeal canal (CPC). Findings were correlated with sex, age, and facial skeletal pattern. A total of 602 cone beam computed tomography scans of Brazilian adults were retrospectively evaluated by 2 independent examiners. The presence of an FNM, CBM, or CPC was recorded, and length, depth, and width were measured. The CBM was classified according to type (3 complete and 3 incomplete varieties). All data were correlated with sex, age, and facial skeletal pattern. Results were tested using chi-square, Mann-Whitney U, and Kruskal-Wallis tests (P < 0.05). The prevalence rates for FNM, CBM, and CPC were 15.78% (n = 95), 6.64% (n = 40), and 0.17% (n = 1), respectively. No significant differences in the prevalence of the variations were found based on sex or facial skeletal patterns (P > 0.05). The median length, depth, and width of FNM were 5.55, 1.83, and 4.81 mm, respectively, with no significant differences (P > 0.05) between the variables. The prevalence of FNM was significantly higher in patients aged 18 to 33 years than in those aged 34 and older (P < 0.001). An incomplete variant of the CBM, presenting as an inferior recess, was more common (32.5%). The FNM is the most prevalent anatomical variation of the clivus, especially in young adults. The sex and facial skeletal pattern of the individual do not affect the frequency of FNM, CBM, or CPC. Because of their clinical relevance, recognition of these anatomical variations is essential, as they can be misdiagnosed as pathologies.

Anatomical variations in the maxillary anterior region: a cone beam computed tomographic study of the canalis sinuosus and its accessory canals.

The objective of this study was to verify the frequency, diameter, and location of the canalis sinuosus (CS) and its accessory canals (ACs) using cone beam computed tomographic (CBCT) images and to correlate these findings with patient sex, age, and skeletal facial pattern. This observational retrospective study assessed the CBCT scans of 398 patients. The laterality, diameter, and location of the terminal portion of the canals were recorded. Linear measurements of the nasal cavity floor, buccal cortical bone, and alveolar ridge crest were also made. The χ2 and Fisher exact tests were used to verify the relationships between patient sex, age, and facial pattern and the presence of CS and ACs. The presence of CS and ACs was verified in 195 (48.99%) and 186 (46.73%) individuals, respectively, and showed no correlations with sex, age, or facial pattern. In 165 cases (84.61%), the CS emerged bilaterally. For ACs, most cases (n = 97; 52.14%) were unilateral. A total of 277 ACs were detected, and 161 (58.12%) of these were located in the palatal or incisive foramen region and 116 (41.88%) in the buccal region. Their terminal portions were located more frequently in the central incisor region (38.26%). The mean CS diameter was significantly larger in men than in women (P < 0.001). The linear measurements of the nasal cavity floor, buccal cortical bone, and alveolar ridge crest did not reveal statistically significant differences between the sexes. This knowledge is helpful for maxillary surgical planning to avoid damage to the neurovascular bundle and subsequent complications.

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.

Non-surgical treatment as an alternative for the management of central giant cell granuloma: a systematic review.

OBJECTIVE: To evaluate the effectiveness of non-surgical treatment as an alternative in the management of central giant cell granuloma (CGCG). MATERIAL AND METHODS: A literature search was carried out in accordance with the PRISMA statement in order to answer the question "Are non-surgical treatments effective as an alternative in the treatment of CGCG?". Two examiners independently assessed eligibility, risk of bias, and extracted data, which included therapeutic protocol, side effects, and need for surgical supplementation. RESULTS: Among 1712 studies, 15 were included, totaling 145 patients. Calcitonin, intralesional corticosteroids, and denosumab were the medications used. For calcitonin (n = 61), complete remission was found in 30 cases. For intralesional triamcinolone (n = 68), reduction in size was observed in most cases (n = 39). Four cases received subcutaneous denosumab and showed absence of active bone metabolism in the region, of which three presented ossification. Combination of drug therapies (n = 29) was reported in one study and included subcutaneous interferon and oral imatinib. More and less side effects were found for interferon and corticosteroids, respectively. Forty percent of patients required additional surgical treatment. CONCLUSION: Despite the side effects presented and the need for additional surgery in some patients, in general, all non-surgical treatments could provide positive results as an alternative for the management of CGCG, especially with regard to reducing the size of the lesion. CLINICAL RELEVANCE: CGCG is a benign bone lesion that mainly affects young individuals. Although the most common therapy is surgery, its contraindication in some patients, the large extension, and high recurrence rate of the aggressive variant have led the search for non-surgical therapies.

Monoethanolamine oleate sclerotherapy for the treatment of intraoral vascular anomalies: retrospective study and suggestion for a clinical guideline.

Vascular anomalies are common in the head and neck, and oral lesions are most commonly found on the lips, tongue, mucosa, and palate. Monoethanolamine oleate sclerotherapy (MOS) is an option for treatment, although we know of no established protocols yet. We report the prevalence and characteristics of intraoral vascular anomalies (IVA) and the results achieved with the use of 5% MOS, and suggest a clinical guideline. Data from the medical records of patients with IVA were collected (age, sex, ethnicity, site, size, duration, and treatment). Cases treated with MOS were detailed, and data about number of applications, interval between them, dose, adverse effects, and results were recorded. A total of 65 cases of IVA were found. White-skinned women aged from 61 to 70 years (n=21) were most likely to be affected, and the lower lip (n=25) was the most common site. Twenty-seven were treated with MOS using a mean of 1-2 applications with a seven-day interval. The mean dose applied was 0.3ml/section, which was diluted in local anaesthetic in 38 cases. Twenty-two resolved completely. In summary, we found a prevalence of 4.8% of IVA and European women aged 61 to 70 years were most affected. MOS 5% was effective and safe in the treatment of IVA more than 3cm in size, with minimal morbidity and adverse effects. We therefore suggest a sclerotherapy protocol of 0.3ml of the drug (undiluted with anaesthetic) for each 1cm lesion (maximum 3cm), with weekly revaluations and further applications when necessary within a 14-day period.

Mandibular Reconstruction With Block Iliac Crest: An Institutional Experience.

STUDY DESIGN: Mandibular reconstruction is a challenge. Several reconstructive techniques are available, and the individualization of choice for each patient leads to better results and quality of life for the individual. OBJECTIVE: The aim of this study is to evaluate the characteristics and complications of cases submitted to mandibular reconstruction with autogenous bone graft block of the iliac crest. METHODS: Records of 45 patients undergoing mandibular reconstruction with autogenous bone graft block of the iliac crest were analyzed from January 2000 to December 2014. The data collected included age, gender, etiology and graft size, surgical approach, complications, comorbidities, and habits and addictions. Analysis of variance, chi-square test, and Fisher exact test were used for analysis of the variables with a significance level of P < .05. RESULTS: The success rate of the 45 charts analyzed was 75.6%. No statistical differences were found between age and presence of complications, between defect size and presence or absence of complications, and between type of surgical approach and presence or absence of complications. CONCLUSION: According to our study, medical history may influence postoperative complications and require attention, though further studies should be performed to further elucidate the relationship between diseases and postoperative complications.

Uso do PRP com enxertos autógeno e de banco de tecido ósseo para levantamento do seio maxilar em um modelo em cães: desenho tipo split-mouth com resultados microscópico / The use of PRP with autogenous and tissue bone bank grafting for sinus lift procedures in the dog model: split-mouth design with microscopic results

Objetivo: avaliar microscopicamente a contribuição do plasma rico em plaquetas (PRP) no processo de reparo do enxerto ósseo de banco de ossos humanos e de osso autógeno em seios maxilares de cães. Material e métodos: quatro cães da raça Beagle, com dois anos de idade e aproximadamente 10 kg, foram submetidos a cirurgias de levantamento de seio maxilar utilizando-se enxerto ósseo autógeno (lado direito) como grupo-controle e enxerto de banco de ossos humanos (lado esquerdo) associados ao PRP em dois cães, e sem nos outros. As amostras para análise foram removidas com broca trefina no período de 60 dias pós-enxertia. Resultados: o enxerto autógeno mostrou processo de reparo em desenvolvimento; quando associado ao PRP apresentou organização lamelar e presença de medula óssea. No enxerto alógeno foram observadas fibrilas colágenas desorganizadas com grande quantidade de osteócitos; quando associado ao PRP, notou-se ausência de infiltrado inflamatório e processo de reparo em fase final. Conclusão: 1) através da análise histológica, o processo de ossificação do enxerto autógeno associado ao PRP foi superior; 2) a associação do PRP ao enxerto de banco de ossos humanos demonstrou reparo ósseo superior, quando comparado ao enxerto autógeno utilizado isoladamente.

Objectives: to microscopically evaluate the contribution of Platelet Rich Plasma (PRP) in the process of repairing bone human bones graft stock and autogenous bone in maxillary sinus of dogs. Material and methods: four Beagle dogs, aged 2 years old and about 10 pounds underwent maxillary sinus surgery using autogenous bone graft (right) as a control group and grafting of human bone bank (hand left) associated with the PRP in two dogs, and no other. Samples for analysis were removed with trephine drill within 60 days after grafting. Results: the autograft showed the repair process in development, when combined with PRP showed lamellar organization and the presence of bone marrow. In the allograft was observed disorganized collagen fibrils with loads of osteocytes, and when combined with PRP, it was noted the absence of inflammatory infiltrate, and repair process in the final stage. Conclusion: 1) by histological analysis, the process of ossification of the autogenous PRP was associated with higher; 2) association of PRP to the graft database of human bones showed higher bone healing compared to autograft used alone.

O uso de biomateriais de origem bovina e equina, associados ou não ao plasma rico em plaquetas, em alvéolos mandibulares de cães: estudo split-mouth com análise quantitativa / The use of bovine and equine biomaterials associated or not to platelet-rich plasma in mandibular alveolar dog model: a quantitative analysis

Objetivo: avaliar biomateriais de origem equina (Bio-Gen) e bovina (Genox), associados ou não ao plasma rico em plaquetas (PRP). Material e métodos: seis cães Beagle, fêmeas (entre dois e três anos de idade, pesando 10 kg), tiveram seis pré-molares mandibulares extraídos. No lado direito, os alvéolos receberam Bio-Gen (B), coágulo (C) e Genox (G); no lado esquerdo, o PRP foi adicionado em cada grupo (BP, CP e GP). Após 30, 60 e 90 dias, dois cães foram sacrificados em cada período, e as peças foram processadas. As imagens microscópicas e a contagem dos osteoblastos aderidos às trabéculas ósseas e osteócitos presentes em lacunas no tecido ósseo neoformado foram realizadas pelo mesmo operador. Os testes Anova e Tukey (nível de significância de 5%) foram empregados na análise estatística. Resultados: para a contagem de osteoblastos, aos 30 dias, houve diferença estatisticamente significante dos grupos G e GP, quando comparados aos grupos B, BP, C e CP (p < 0,05). Na análise de 60 dias, os grupos BP e GP apresentaram diferença estatisticamente significativa, quando comparados aos grupos B (p < 0,001) e G (p < 0,000001), respectivamente. Para a contagem de osteócitos, aos 30 dias, houve diferença estatisticamente significante quando os grupos BP e GP foram comparados aos grupos B (p < 0,00001) e G (p < 0,002), respectivamente. Os grupos GP e G apresentaram diferença estatisticamente significativa entre si, em 60 dias (p < 0,0009) e 90 dias (p < 0,0004). Conclusão: o grupo GP apresentou maior quantidade de osteócitos e osteoblastos em todos os períodos analisados, sendo considerado o mais efetivo para a neoformação óssea.

O uso de osso equino (Bio-gen) e bovino (Genox) associados ou não ao PRP em alvéolos mandibulares de cães: desenho split-mouth com análise histológica / The use of equine (Bio-gen) and bovine (Genox) bones associated or not to PRP in the mandibular alveolar dog model: split-mouth design and histological analysis

O objetivo deste estudo foi avaliar histologicamente dois biomateriais (Genox e Bio-gen) associados ou não ao PRP e implantados em alvéolos mandibulares. Quatro cães da raça Beagle foram selecionados, entre dois a três anos de idade e pesando aproximadamente dez quilos. Extraiu-se os três pré-molares mandibulares de ambos os lados e imediatamente os alvéolos foram preenchidos, respectivamente: lado direito, no primeiro alvéolo foi aplicado Bio-gen (grupo 1), no segundo foi mantido coágulo (grupo 2) e no terceiro Genox (grupo 3); lado esquerdo, no primeiro alvéolo foi aplicado Bio-gen + PRP (grupo 4), no segundo coágulo + PRP (grupo 5) e no terceiro Genox + PRP (grupo 6). Após 30 dias, os animais foram sacrificados e realizou-se o processamento das peças cirúrgicas. Na análise histológica observou-se uma aceleração do processo de reparo nos grupos 4 e 6. Notou-se ainda que no grupo 4, o processo de reparo era o mais evoluído, apresentando um trabeculado ósseo mais maduro em comparação aos demais

The objective of this study was to evaluate bone repair with two biomaterials (Genox, Bio-gen) associated or not with the plasma-rich platelet (PRP) in the mandibular dog model. Four beagle dogs (2-3-years-old, 10 pounds each) had their first, second, and third premolars extracted and immediately filled on the right side with Bio-gen (Group 1), clot (Group 2), and Genox (Group 3). On the left side, the same was performed but with PRP (groups 4, 5, and 6). After thirty days, animals were sacrificed and processed for histological analysis. Acceleration of healing process was observed in groups 4 and 6. Further, Group 4 presented more mature trabecular bone when compared among groups