Does the administration of meloxicam before head and neck radiotherapy reduce the risk of mandibular osteoradionecrosis? An animal model study.

OBJECTIVE: To assess whether the administration of meloxicam before head and neck radiotherapy reduces the risk of mandibular osteoradionecrosis in rats. MATERIAL AND METHODS: Sixty male Wistar rats were randomly divided into 6 groups (n = 10) according to the meloxicam administration and radiation therapy: control (C), irradiated (I), single dose of meloxicam (M1), single dose of meloxicam and irradiated (M1I), triple dose of meloxicam (M3), triple dose of meloxicam and irradiated (M3I). Meloxicam was administrated (20 mg/kg per dose) 1 h before the radiation therapy (single dose of 20 Gy) and 24 h and 48 h after the radiation therapy for groups with two additional doses. Ten days after the radiation therapy, the three right mandibular molars were extracted from all rats, who were euthanatized after 21 or 35 days (n = 5 per group). The mandibles were assessed by macroscopic evaluation and micro-CT analysis. RESULTS: The right hemimandibles of the irradiated groups revealed macroscopic signs of osteoradionecrosis, and those of the non-irradiated groups revealed complete gingival healing. A significant delay in alveolar socket healing in all irradiated groups was observed in the micro-CT assessment regardless meloxicam treatment. CONCLUSION: The administration of meloxicam before head and neck radiotherapy does not reduce the risk of mandibular osteoradionecrosis when associated to dental extractions. CLINICAL RELEVANCE: Since meloxicam has been shown to be a potential radiation-protective agent, and osteoradionecrosis physiopathology is believed to be related to an inflammatory process, possible interactions are relevant to be investigated.

A modified protocol of mandibular osteoradionecrosis induction in rats with external beam radiation therapy.

OBJECTIVE: To propose a modified protocol of mandibular osteoradionecrosis induction in rats with external beam radiation therapy. MATERIAL AND METHODS: A total of 45 male Wistar rats were used in this study. Firstly, 25 rats were divided into 5 groups (n = 5) according to the radiation dose protocol: without irradiation and irradiated with 15 Gy, 20 Gy, 25 Gy, or 30 Gy using a linear accelerator. Secondly, 15 other rats were divided into 3 groups (n = 5) according to the time of extraction of the three right mandibular molars: 7, 10, or 14 days after irradiation of 20 Gy. Lastly, dental extractions were performed in 5 other rats without irradiation (C-E10) for comparison with those of the group of dental extractions 10 days after irradiation (I-E10). RESULTS: The irradiated animals survived throughout the study period only at single doses of 15 Gy and 20 Gy. The suitable time for dental extractions after irradiation to induce mandibular osteoradionecrosis was defined as 10 days. Macroscopic evaluation of the right hemimandibles showed presence of osteoradionecrosis in I-E10 group and complete gingival healing in C-E10 group. CONCLUSION: A single radiation dose of 20 Gy focused on head and neck region combined with the extraction of the three mandibular molars 10 days after irradiation constitutes a feasible protocol of mandibular osteoradionecrosis induction in rats with external beam radiation therapy. CLINICAL RELEVANCE: Establishing a solid and widely available protocol of mandibular osteoradionecrosis induction is essential in the search for methods to prevent this complex disease.

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.

Fracture resistance of weakened bovine teeth after long-term use of calcium hydroxide.

BACKGROUND/AIM: In some parts of the world, revascularization may not be the most feasible treatment option for necrotic immature teeth. Therefore, apexification remains the most widely utilized treatment option for these cases. This study aimed to evaluate the fracture resistance of weakened bovine tooth roots treated with various irrigant solutions as well as long-term application of calcium hydroxide intracanal medication (ICM). MATERIAL AND METHODS: One hundred seventy bovine teeth were randomly divided into three experimental groups (n = 50) and two control groups (n = 10). Group SS was irrigated with physiologic solution; group CHX was treated with 2% chlorhexidine gel and group NaOCl was irrigated with 1% sodium hypochlorite. After instrumentation, root canals were dressed with calcium hydroxide and evaluated at different periods (15, 60, 90, 180, and 360 days). The specimens were loaded at a 45° angle to measure fracture resistance through the use of an EMIC test machine. RESULTS: A decrease in fracture resistance was observed during the time of ICM dressing. The highest values of fracture resistance were observed in group SS with 15 days of ICM, not differing from the control group. Irrigation with NaOCl associated with ICM for 15 days presented the lowest fracture resistance; however, a statistically significant difference was not observed when compared with SS and CHX in the same time period. In longer periods of exposure to ICM (180 and 360 days), root canals irrigated with NaOCl and CHX showed significantly lower fracture resistance than SS (P < 0.05). CONCLUSION: Apexification with periodic changes of calcium hydroxide medicament leads to weakness of the teeth independent of the irrigation solution used.

Artificial intelligence for detection of periapical lesions on intraoral radiographs: Comparison between convolutional neural networks and human observers.

OBJECTIVE: The aim of this study was to compare the diagnostic performance of convolutional neural networks (CNNs) with the performance of human observers for the detection of simulated periapical lesions on periapical radiographs. STUDY DESIGN: Ten sockets were prepared in bovine ribs. Periapical defects of 3 sizes were sequentially created. Periapical radiographs were acquired of each socket with no lesion and with each lesion size with a photostimulable storage phosphor system. Radiographs were evaluated with no filter and with 6 image filter settings. A CNN architecture was set up using Keras-TensorFlow. Separate CNNs were evaluated for randomly sampled training/validation data and for data split up by socket (5-fold cross-validation) and filter (7-fold cross-validation). CNN performance on validation data was compared with that of 3 oral radiologists for sensitivity, specificity, and area under the receiver operating characteristic curve (ROC-AUC). RESULTS: Using random sampling, the CNN showed perfect accuracy for the validation data. When data were split up by socket, the mean sensitivity, specificity, and ROC-AUC values were 0.79, 0.88, and 0.86, respectively; when split up by filter, they were 0.87, 0.98, and 0.93, respectively. For radiologists, the values were 0.58, 0.83, and 0.75, respectively. CONCLUSIONS: CNNs show promise in periapical lesion detection. The pretrained CNN model yielded in this study can be used for further training on larger samples and/or clinical radiographs.

Radioprotective Effect of Sodium Selenite on Mandible of Irradiated Rats.

The purpose of this study was to test the radioprotective effect of selenium in the bone microarchitecture of irradiated rats mandibles. Forty rats were separated into 4 groups with 10 animals: control group (CG), irradiated group (IG), sodium selenite group (SSG) and sodium selenite irradiated group (SSIG). A single dose of 0.8 mg/kg sodium selenite was administered intraperitoneally in the SSG and SSIG groups. One hour later, animals of IG and SSIG groups were irradiated with 15 Gy of x-rays. Forty days after radiation a bilateral extraction of the mandibular first molars was performed. After the extraction procedure, five rats were killed after fifteen days and others five after thirty days. Micro- computed tomography was used to evaluate cortical and trabecular bone of each rat. The mean and standard deviation of each bone microarchitecture parameter were analyzed using the statistical test of two-way Analysis of Variance (ANOVA). At 15 days, the bone volume presented higher values in the CG and SSG groups (p=0.001). The same groups presented statistically significant higher values when bone volume fraction (p<0.001) and trabecular thickness (p<0.001) were analyzed. At 30 days, it was observed that in relation to the bone volume fraction, SSG group presented the highest value while SSIG group had the lowest value, with statistically significant difference (p=0.016). Sodium selenite demonstrated a median radioprotective effect in the bone microarchitecture of irradiated mandibles, which indicates the substance may be a potential radioprotective agent against chronic effects of high doses of ionizing radiation.

Influence of VistaScan image enhancement filters on diagnosis of simulated periapical lesions on intraoral radiographs.

OBJECTIVE:: To evaluate whether image enhancement filters of VistaScan system improve the diagnostic accuracy of simulated periapical lesions. METHODS:: 10 sockets were prepared on bovine ribs to fit a bovine tooth. Bone defects were created and successively enlarged providing four groups (n = 10): Group 0, absence of lesions; Group 1, periapical lesions with 1.6 mm in diameter; Group 2, with 1.8 mm in diameter; and Group 3, with 2.1 mm in diameter. Periapical radiographs were taken using a photostimulable storage phosphor plate and DBSWIN software. VistaScan filters were applied and the images were allocated into seven groups: Nonfiltered, Fine, Caries 1, Caries 2, Endodontic, Periodontal and Noise Reduction. All the 280 images were assessed about the presence or absence of periapical lesions. Pixel intensities standard deviation were compared between nonfiltered and filtered images. Two-Way Analysis of Variance and the post hoc Tukey's test were used to compare area under the ROC curve, sensitivity and specificity. RESULTS:: VistaScan filters showed no significant difference for area under receiver operating characteristic curve (p = 0.124), sensitivity (p = 0.835) and specificity (p = 0.832). Area under receiver operating characteristic curve (p = 0.000) and sensitivity (p = 0.000) in 2.1 mm lesions size were significantly higher than in 1.6 mm and 1.8 mm lesions size. Pixel intensities standard deviation was significantly changed in the filtered images compared to nonfiltered ones (p < 0.01), except for Fine in the bone region (p > 0.05). CONCLUSION:: VistaScan enhancement filters do not influence the diagnostic accuracy of simulated periapical lesions. On the other hand, larger lesions were more frequently detected. The filters change the pixel intensities reducing or intensifying the differences between similar regions.

Meloxicam as a Radiation-Protective Agent on Mandibles of Irradiated Rats.

This study evaluated the action of ionizing radiation and the possible radioprotective effect of the non-steroidal anti-inflammatory drug meloxicam on the bone physiology of rat mandibles by assessing the alveolar socket healing and bone strength. Forty male Wistar rats were divided in 4 groups (n=10): control (CG), irradiated (IG), meloxicam (MG), meloxicam irradiated (MIG). A dose of 0.2 mg/kg meloxicam was administered to MG and MIG. After this, IG and MIG were irradiated with 15 Gy radiation dose in the mandible. Forty days after the above procedures, the mandibular first molars were extracted and the animals were killed after 15 or 30 days (n=5). Micro-computed tomography and bending test were used to evaluate alveolar socket healing and bone strength, respectively. At 15 days, bone volume, bone volume fraction and trabecular thickness were higher in the CG and MG than in the IG and MIG; and trabecular separation was higher in the IG compared with the others. At 30 days, there was a difference only in trabecular separation, which was higher in IG than in CG and MG, and MIG did not differ from the others. Bone strength was lower in IG compared with CG and MG, and MIG did not differ from the others. In conclusion, the ionizing radiation affected the bone physiology of rat mandibles, delaying the alveolar socket healing and reducing the bone strength. Moreover, the meloxicam had a positive effect on the trabecular separation in alveolar socket healing and on the bone strength.

Validation study of a new method for sexual prediction based on CBCT analysis of maxillary sinus and mandibular canal.

OBJECTIVE: The aim of this study was to evaluate the accuracy of two craniometric methods for sexual prediction (SP) using cone-beam computed tomography (CBCT) in the Dutch population and to construct a formula for each method and then the two combined. DESIGN: One-hundred sixty CBCT images were selected from a Dutch database (80 males and 80 females). The images were analyzed by two examiners taking seven measurements in the maxillary sinus (MS) region (first method) and nine in the mandibular canal (MC) region (second method). The most predictive measurements in both methods were used to develop an equation to determine the accuracy of each method. RESULTS: All measurements showed statistical difference between genders. Logistic regression results showed two variables with greater SP index with 75% accuracy in the first method and four variables with 71.9% accuracy in the second. The two methods combined showed another four variables with 78.5% accuracy. CONCLUSION: All measurements showed statistically significant differences between sexes. The SP accuracy values were 75% for first 71.9% for the second method. When the two methods were combined, the accuracy increased to 78.5%. The formulas developed in this study can be applied as a complementary method for human identification in the Dutch population.

Detection of Fractured Endodontic Instruments in Root Canals: Comparison between Different Digital Radiography Systems and Cone-beam Computed Tomography.

INTRODUCTION: This study compared the detection of fractured instruments in root canals with and without filling by periapical radiographs from 3 digital systems and cone-beam computed tomographic (CBCT) images with different resolutions. METHODS: Thirty-one human molars (80 canals) were used. Root canals were divided into the following groups: the control group, without fillings; the fracture group, without fillings and with fractured files; the fill group, filled; and the fill/fracture group, filled and with fractured files. Digital radiographs in ortho-, mesio-, and distoradial directions were performed in 2 semidirect systems (VistaScan [Dürr Dental, Beitigheim-Bissinger, Germany] and Express [Instrumentarium Imaging, Tuusula, Finland]) and a direct system (SnapShot [Instrumentarium Imaging]). CBCT images were acquired with 0.085-mm and 0.2-mm voxel sizes. All images were assessed and reassessed by 4 observers for the presence or absence of fractured files on a 5-point scale. The sensitivity, specificity, and accuracy were calculated. RESULTS: In the absence of filling, accuracy values were high, and there were no statistical differences among the radiographic techniques, different digital systems, or the different CBCT voxels sizes. In the presence of filling, the accuracy of periapical radiographs was significantly higher than CBCT images. In general, SnapShot showed higher accuracy than VistaScan and Express. CONCLUSIONS: Periapical radiographs in 1 incidence were accurate for the detection of fractured endodontic instruments inside the root canal in the absence or presence of filling, suggesting that this technique should be the first choice as well as the direct digital radiographic system. In the presence of filling, the decision to perform a CBCT examination must take into consideration its low accuracy.

Meloxicam as a Radiation-Protective Agent on Mandibles of Irradiated Rats

Abstract This study evaluated the action of ionizing radiation and the possible radioprotective effect of the non-steroidal anti-inflammatory drug meloxicam on the bone physiology of rat mandibles by assessing the alveolar socket healing and bone strength. Forty male Wistar rats were divided in 4 groups (n=10): control (CG), irradiated (IG), meloxicam (MG), meloxicam irradiated (MIG). A dose of 0.2 mg/kg meloxicam was administered to MG and MIG. After this, IG and MIG were irradiated with 15 Gy radiation dose in the mandible. Forty days after the above procedures, the mandibular first molars were extracted and the animals were killed after 15 or 30 days (n=5). Micro-computed tomography and bending test were used to evaluate alveolar socket healing and bone strength, respectively. At 15 days, bone volume, bone volume fraction and trabecular thickness were higher in the CG and MG than in the IG and MIG; and trabecular separation was higher in the IG compared with the others. At 30 days, there was a difference only in trabecular separation, which was higher in IG than in CG and MG, and MIG did not differ from the others. Bone strength was lower in IG compared with CG and MG, and MIG did not differ from the others. In conclusion, the ionizing radiation affected the bone physiology of rat mandibles, delaying the alveolar socket healing and reducing the bone strength. Moreover, the meloxicam had a positive effect on the trabecular separation in alveolar socket healing and on the bone strength.

Resumo Este estudo avaliou a ação da radiação ionizante e o possível efeito radioprotetor do anti-inflamatório não esteroide meloxicam na fisiologia óssea de mandíbulas de rato por meio da análise da reparação alveolar e da resistência óssea. Quarenta ratos Wistar machos foram divididos em 4 grupos (n=10): controle (GC), irradiado (GI), meloxicam (GM), meloxicam irradiado (GMI). Administrou-se uma dose única de 0,2 mg/kg de meloxicam no GM e GMI. Posteriormente, o GI e GMI foram irradiados com dose de 15 Gy na região de mandíbula. Decorridos 40 dias dos procedimentos acima, extraiu-se os primeiros molares inferiores dos animais, que foram mortos após 15 e 30 dias (n=5). Utilizou-se a microtomografia computadorizada e o teste de flexão para avaliação da reparação alveolar e da resistência óssea, respectivamente. Aos 15 dias, o volume ósseo, a fração de volume ósseo e a espessura trabecular foram maiores no GC e GM comparados ao GI e GMI; já a separação trabecular foi maior no GI em relação aos demais. Aos 30 dias, houve diferença apenas na separação trabecular, que foi maior no GI em comparação ao GC e GM, não tendo o GMI diferido dos demais. A resistência óssea no GI foi menor em relação ao GC e GM, não tendo o GMI diferido dos demais. Concluiu-se que a radiação ionizante afetou a fisiologia óssea das mandíbulas de rato, promovendo atraso na reparação alveolar e redução da resistência óssea; além disso, o meloxicam, apresentou efeito positivo na separação trabecular da reparação alveolar e na resistência óssea.

Estudo da ocorrência de micro deformações ao redor de três implantes de hexágono externo, sob a influência da fundição de coifas plásticas e usinadas / Strain gauge analysis of three external hexagon implants of casting of plastics copings and machined copings

Este estudo in vitro analisou, por meio da extensometria, as micro deformações que ocorreram ao redor de implantes de hexágono externo ao variar o tipo de coifa, plástica e usinada, após o aperto dos parafusos de retenção da prótese. No bloco de poliuretano três implantes de hexágono externo foram inseridos linearmente. Pilares protéticos Microunit foram conectados aos implantes com torque de 20 Ncm. Coifas plásticas (n=5) e usinadas (n=5) receberam enceramentos padronizados e foram fundidos em monobloco em liga de cobalto-cromo. No bloco de poliuretano, tangenciando os implantes foram colados os extensômetros, sendo dois para o central. As estruturas metálicas foram fixadas aos pilares protéticos com parafusos de retenção com torque de 10 Ncm, quando foram registradas as micro deformações (με) em cada extensômetro. Os valores médios obtidos dos extensômetros para as coifas plásticas foram de 363,37 με ± 237,66 e para as usinadas de 338,12 με ± 223,01. Estes foram avaliados pelo teste t-Student, que demonstrou não haver diferença estatística significante ao variar o tipo de coifa (p=0,867). Concluiu-se que, para implantes de hexágono externo posicionados linearmente, o tipo de coifa não influenciou na quantidade de micro deformação gerada após o aperto dos parafusos de retenção da prótese.

The objective of this in vitro study was quantify the micro strain development around the external hexagon implants, varying the type of prosthetic coping. Three implants of external hexagon were inserted into one polyurethane block. Microunit abutments were screwed onto the implants, applying a torque of 20Ncm. Plastic prosthetic copings (n=5) and machined copings (n=5) which received standard wax patterns were cast in Co-Cr alloy. On the surface of poliurtehane block tangentially the implants were bonded the strain gauges, two to the center implant. The super structure’s occlusal screws were tightened onto microunit abutments with 10 Ncm torque, the magnitude of micro strain was recorded. The mean values of each strain gauge of each plastic copings were 363,37 με ± 237,66 and the machined copings were 338,12 με ± 223,01. The data were analyzed statistically by t-Student test. No statistically significant difference was found between the prosthetic copings (p=0,867) It was concluded that to external hexagon implants in line placement, the type of coping presented similar magnitude of micro strain after prosthetic occlusal screw was tightened