Three-dimensional evaluation of mandibular condyle and coronoid process according to sex, age, and skeletal deformities.

OBJECTIVE: To correlate the volume of the mandibular condyle (MC) and the coronoid process (CP) with sex, age, and skeletal deformities. METHODS: The structures were visualized through semi-automatic segmentation of the 3D model and complemented with manual segmentation, using the ITK-SNAP 3.0 software. Mann-Whitney, Kruskal-Wallis, and the Dunn test were performed (p < 0.05). RESULTS: The MC volume showed statistical differences between sex and skeletal deformities. Men and Class III patients showed higher values. CP volume was not influenced by age or skeletal deformities. However, statistical differences were found between sex, with higher values for men. CONCLUSION: MC volume was influenced by sex and skeletal deformities, while CP was influenced only by sex. Women have smaller volumes for these structures. Age is not correlated with the volume of MC and CP. The highest and lowest values of condylar volume were found for Class III and II individuals, respectively.

Accuracy of three-dimensional soft tissue profile prediction in orthognathic surgery.

PURPOSE: To evaluate the accuracy of three-dimensional (3D) soft tissue prediction in bimaxillary orthognathic surgery. METHODS: Cone-beam computed tomographs of 88 patients with class II (n = 46) and class III (n = 42) malocclusions, who underwent bimaxillary orthognathic surgery, were included in this retrospective study. 3D soft tissue prediction and postoperative outcome were compared by using ten landmarks of facial soft tissues. Patients' sex and age were also assessed. Results were analyzed using a mixed model methodology (p < 0.05). RESULTS: The success criterion adopted was a mean discrepancy of < 2 mm. Most mandibular landmarks indicated a tendency for underprediction with a downward direction in class II patients, with some values > 2 mm. In class III, there was overprediction with a downward direction for the mandibular landmarks, with values < 2 mm. More accurate results were found in female and older patients. CONCLUSIONS: 3D surgical planning showed clinically acceptable results for predicting soft tissues in patients undergoing bimaxillary orthognathic surgery, with more accurate results for class III patients. Although some differences were found when age and sex were interacted, a consistent association between these variables could not be stated. These results support the clinician, as accuracy can provide a strong guide to the surgeon when planning surgical orthodontic treatment.

Accuracy of cone-beam CT in detecting vertical root fractures in teeth with post-endodontic restorations: an in vitro study

The aim of this study was to evaluate the accuracy of cone-beam CT (CBCT) for the detection of artificially created vertical root fractures (VRF) in extracted teeth restored with metallic (MP) and fiberglass (FGP) posts. After root canal obturation, 60 extracted human premolars were scanned by using the highest-resolution settings of a CBCT unit. Theprepared roots were randomly divided into three groups: group C (control group): non-restored and non-endodontically treated teeth (n = 20); group MP (n = 20); group FGP (n = 20). In all groups, 10 teeth were artificially fractured. Two external and independent observers blindly recorded the presence or absence of VRF. Sensitivity, specificity, accuracy, intra-and interobserver agreement were calculated. Kappa value for inter-and intraobserver agreement was 0.82 and 0.84 respectively, demonstrating goodagreement. The highest values for sensitivity (0.80 -0.90), specificity (1.00) and accuracy (0.90 -0.95) were found in the control group. The teeth with FGP restoration presented the lowest sensitivity (0.30 -0.50) and accuracy (0.60 -0.65) values. Both examiners had a good performance in the diagnosis of fractures in teeth with MP, with accuracy ranging between 0.85 -0.90. The presence of MP did not influence accuracy; however, the presence of FGP reduced the diagnostic capacity of CBCT.

How does bimaxillary orthognathic surgery change dimensions of maxillary sinuses and pharyngeal airway space?

OBJECTIVES: To assess changes in the maxillary sinus (MS) and pharyngeal airway space (PAS) after bimaxillary orthognathic surgery using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The CBCT scans of 48 patients were divided into two groups: group 1: maxillary advancement and mandibular setback (n = 24); group 2: maxillomandibular advancement (n = 24). The CBCTs were acquired 1 to 2 months preoperatively and 6 to 8 months postoperatively. A kappa test was used to determine intra- and interexaminer agreement. Area, volume, and linear measurements of MSs and PASs obtained before and after surgery were compared using a mixed model (P < .05). RESULTS: All variables of the MS showed significant postsurgical reductions in both groups, except the MS length, which showed a significant increase in group 2. Volume and minimum axial area of PAS showed statistically significant postsurgical increases in both groups (P < .05). CONCLUSIONS: Despite the reduction in the MS and the increase in the PAS, results indicated that the airway was not negatively affected after maxillomandibular advancement and maxillary advancement with mandibular setback.

Observational study of adverse reactions related to articaine and lidocaine.

PURPOSE: This study determined the frequency of adverse reactions related to the administration of local dental anesthesia with 4% articaine compared with 2% lidocaine, both associated with epinephrine 1:100,000. The null hypothesis was that there is no difference between the administrations of both dental local anesthesia. METHODS: From a total of 727 patients in an emergency service, 338 and 389 patients were subjected to local anesthesia with lidocaine and articaine, respectively. A questionnaire was completed for each patient that contained patient data, the local anesthesia applied, and any reactions. RESULTS: The overall frequency of adverse reactions was 3.71%, with sweating and pallor being the most frequently observed. There was an association between adverse reactions and the use of daily medication by patients anesthetized with articaine (p = 0.0266). In contrast, in patients anesthetized with lidocaine, there was an association among the duration of the procedure (p = 0.0423), the type of procedure (p = 0.0146), and first anesthesia exposure (p = 0.0448). CONCLUSIONS: The low frequency of adverse reactions with use of articaine and lidocaine led to the conclusion that both solutions are safe for use in dentistry.

Accuracy of 3D virtual surgical planning for maxillary positioning and orientation in orthognathic surgery.

OBJECTIVE: This retrospective and observational study evaluated the accuracy of a 3D virtual surgical planning (VSP) for the maxillary positioning and orientation in patients undergoing bimaxillary orthognathic surgery, comparing the planned and postoperative outcomes. SETTING AND SAMPLE POPULATION: Seventy consecutive patients of both sexes, who were submitted to bimaxillary orthognathic surgery between 2015 and 2019 were included in our study. MATERIAL AND METHODS: The patients were evaluated by fusing preoperative planning and postoperative outcome using cone-beam computed tomography scan evaluation. Three-dimensional VSP and postoperative outcomes were compared by using three linear and three angular measurements. The main outcome interest was the difference between the VSP movement, and the surgical movement obtained. The success criterion adopted was a mean linear difference of <2 mm and a mean angular difference of <4°. RESULTS: Results were analysed using a linear mixed model with fixed and random effects, at α = .05. No significant statistical differences were found for linear and angular measurements between the planned and postsurgical outcomes (P > .05). All overlapping points presented values within the range considered clinically irrelevant (<2 mm; <1°). CONCLUSIONS: Three-dimensional VSP was executed with a high degree of accuracy. When comparing the planned and postsurgical outcomes, all overlapping points presented values within the range considered clinically irrelevant.

Three-dimensional alterations in pharyngeal airspace, soft palate, and hyoid bone of class II and class III patients submitted to bimaxillary orthognathic surgery: A retrospective study.

INTRODUCTION: The aim of this retrospective study was to evaluate changes in pharyngeal airway space (PAS), soft palate, and hyoid bone position after bimaxillary orthognathic surgery in skeletal Class II and Class III patients. METHODS: Patients were divided into Group 1: Class III patients who underwent maxillary osteotomies and mandibular setback surgery (N = 43); and Group 2: Class II patients who underwent maxillomandibular advancement surgery (N = 36). Cone beam computed tomography (CBCT) images were acquired one month before and six to eight months after orthognathic surgery. PAS area, volume and minimum axial area (MAA), soft-palate morphology, and hyoid bone position measurements obtained before and after orthognathic surgery were compared using the Gamma family test (p ≤ 0.10). RESULTS: In Class II group the maxillomandibular advancement surgery significantly increased the PAS area, volume, and MAA and significantly affected hyoid bone position and soft-palate morphology. In Class III group, maxillary osteotomies and mandibular setback also showed increase in PAS area, however without statistically significant values for most of the evaluated measurements. CONCLUSION: The results of the present study indicate that PAS and related structures are expected to be improved in Class II patients submitted to bimaxillary surgery, and they are not negatively affected by bimaxillary surgery in Class III patients.

Análisis Descriptivo y Cualitativo de Tres Software Gratuitos Usados para la Conversión de Formato DICOM para STL / Descriptive and Qualitative Analysis of Three Free Software Used to Convert From DICOM to STL Format

RESUMEN: Los exámenes imagenológicos tridimensionales en odontología son cada día mas frecuentes, contando también con algunas tecnologías gratuitas; el objetivo de este estudio fue analizar tres software gratuitos de conversión desde el formato DICOM al STL. Se evaluaron los programas computacionales 3DSlicer, InVesalius e ImageVis3D. La metodología empleada para evaluar fue basada en el modelo del proceso de evaluación de calidad, según la norma NBR ISO / IEC 9126-, incluyendo 6 observadores en la investigación. Se determinó que el programa más fácil de manipular en la etapa de segmentación, en la representación de volumen y en la conversión de archivos STL fue InVesalius, pero el programa más completo y preciso, para estas fases fue el software 3DSlider. Se puede concluir es necesario un entrenamiento adecuado para que la manipulación de estos programas sea lo más preciso posible.

ABSTRACT: The three-dimensional imaging in medical sciences nowadays is increasing and some of these technologies are free; the aim of this study was to analyze three free conversion software: 3DSlicer, InVesalius and ImageVis3D. The methodology used to evaluate the software was based on the model of the quality evaluation process, according to the standard NBR ISO/IEC 9126-1. It was observed that the easiest software to manipulate in the segmentation stage, in the representation of volume and in the conversion of STL (Standard Tessellation Language) files was InVesalius, but the most complete and precise software for these phases was the 3DSlider software. Thus, it was concluded that adequate training is necessary so that the handling of these three software is as accurate as possible.

Accuracy of two-dimensional pharyngeal airway space prediction for bimaxillary orthognathic surgery.

PURPOSE: The aim of this retrospective study was to evaluate the accuracy of two-dimensional (2D) virtual surgical planning (VSP) of pharyngeal airway space (PAS) in patients submitted to bimaxillary orthognathic surgery. METHODS: This study was conducted with lateral cephalograms acquired through cone-beam computed tomography records of 33 patients, divided into group 1-patients submitted to maxillary advancement and mandibular setback (n = 17) and group 2-patients submitted to maxillomandibular advancement (n = 16). Records were taken 1 to 2 months prior to surgery, which was used to perform the 2D VSP (Tp), and 6 to 8 months after surgery (T1). In Dolphin Imaging software, the anteroposterior size of the PAS was calculated at the level of four craniometric points: A, occlusal plane (Mx), B, and pogonion (Pog). Two previously calibrated examiners performed these measurements. Statistical analyses were conducted using Kendall and t tests at a 5% level of significance. RESULTS: There was a concordance between the two examiners at all points and times. In group 1, points A and B have statistically significant differences between the PAS measurements performed in Tp and T1, while in group 2, none of the PAS points showed statistically significant differences when comparing Tp to T1. CONCLUSIONS: 2D computer-based cephalometric prediction in Dolphin Imaging software offers a good orientation to professionals during the surgical procedure of bimaxillary surgeries since its use is considered clinically relevant in daily practice.

Surgical Treatment of Synovial Chondromatosis in the Inferior Compartment of the Temporomandibular Joint With Articular Disc Involvement.

The authors report an unusual case of painful synovial chondromatosis originated in the inferior compartment of the temporomandibular joint (TMJ) with articular disc involvement in a 56-year-old woman with complaint of severe pain in the right preauricular region. Magnetic resonance images showed advanced destruction of the right articular disc anteriorly displaced, condylar erosion, and distinct nodules within an extremely expanded inferior joint compartment with large amount of fluid, as well as a large TMJ effusion. A scintigraphy showed elevated bone uptake in the right TMJ, demonstrating intense bone remodeling activity in the region. After a right internal maxillary artery embolization, the patient underwent open surgery. The intraoperative procedures, including articular disc removal, condylar remodeling, and replacement of the articular disc, are described in detail. Synovial chondromatosis of the TMJ is a rare disease, especially when it affects the inferior compartment and the articular disc. Initial diagnosis is challenging and imaging techniques (magnetic resonance imaging and scintigraphy) play an important role in identifying signs, making accurate diagnosis, and offering additional information not available with conventional imaging, such as TMJ inflammation or remodeling. In these patients, open surgery may be considered a definitive treatment, since the postoperative recurrence rate is very low.

Three-dimensional analysis of the pharyngeal airway space and hyoid bone position after orthognathic surgery.

PURPOSE: The aim of this study was to evaluate changes in the pharyngeal airway space (PAS) and hyoid bone position after orthognathic surgery with cone-beam computed tomography (CBCT). MATERIAL AND METHODS: This study was conducted with the tomographic records of 30 patients with skeletal class II or III deformities submitted to two different types of orthognathic surgery: Group 1 (n = 15), maxillary advancement, and mandibular setback; and Group 2 (n = 15), maxillomandibular advancement. CBCT scans were acquired preoperatively (T0); and at around 1.5 months (T1) and 6.7 months (T2) postoperatively. PAS volume, minimum cross-sectional area (min CSA), and hyoid bone position changes were assessed with Dolphin Imaging 3D software, and results analyzed with ANOVA and a Tukey-Kramer test (p < 0.05). RESULTS: The hyoid bone was significantly displaced in the horizontal dimension, moving posteriorly in Group 1, and anteriorly in Group 2. Although PAS volume and min CSA increased after both surgeries, these measurements were significantly larger only in Group 2. The significant differences that existed between groups preoperatively no longer existed after the surgeries. CONCLUSIONS: Both orthognathic surgeries assessed resulted in changes in hyoid bone position and increased PAS volume and min CSA, particularly after maxillomandibular advancement surgery.

Treatments and supportive therapies for oral manifestations of chronic graft-versus-host disease / Tratamentos e terapias de suporte para manifestações orais da doença crônica do enxerto contra hospedeiro

The aim of this study was to conduct a systematic review of treatments and therapies for oral manifestations of chronic graft-versus-host disease, aiming at improving patients' quality of life and mainly the reduction of mortality caused by graft- versus-host disease. A systematic review was carried out by two evaluators, a Dentistry professor and an undergraduate student. A selection of open-access full-text online articles, carried out on PubMed, GoPubmed, NLM Gateway, LILACS, BIREME, SciELO, IBECS, and Web of Science. The survey was completed in July 2012. Of the 1147 studies found, 52 fit the selection criteria. Patients (n = 2130) received different treatment regimens, either systemic or topical. Drugs for systemic therapy were divided into those with action on the inhibition of proliferation and/or release of T and B cells, with action on inflammatory disorders, and of immunomodulatory effect. Topical drugs were divided into their pattern of mucosal absorption and their ability to act on tissue growth factors. The analysis of articles concluded that the most used systemic drugs were Methylprednisolone and corticosteroids, and Tacrolimus and topical Cyclosporine for topical and local therapy.

O objetivo do trabalho foi realizar uma revisão sistemática sobre tratamentos e terapias de suporte para manifestações orais da doença crônica do enxerto contra hospedeiro, visando à melhoria da qualidade de vida dos pacientes e, principalmente, a redução da mortalidade causada pela doença do enxerto contra hospedeiro. A revisão sistemática foi realizada por dois examinadores, um professor e um graduando de odontologia. A seleção de acesso aberto de artigos online de texto completo, realizadas no PubMed, GoPubmed, NLM Gateway, LILACS, BIREME, SciELO, IBECS e Web of Service. A revisão foi concluída em julho de 2012. Dos 1.147 estudos encontrados, 52 se enquadraram nos critérios de seleção. Os pacientes (n = 2130) receberam diferentes tratamentos, seja de forma sistêmica ou tópica. Os medicamentos para tratamento sistêmico foram divididos entre aqueles com ação na inibição da proliferação e / ou liberação de células T e B, com ação em doenças inflamatórias, e de efeito imunomodulador. Drogas tópicas foram divididas em seu padrão de absorção da mucosa e a sua capacidade para atuar sobre os fatores de crescimento de tecidos. A análise dos artigos permitiu concluir que os medicamentos sistêmicos mais utilizados foram Metilprednisolona e corticosteróides, e Tacrolimus e Ciclosporina tópica para a terapia tópica e local.

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

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

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

Prevalência de lesões cervicais não cariosas e da hiperestesia dentinária em alunos de Odontologia / Prevalence of non-carious cervical lesions and dentin hypersensitivity in Odontology students

O objetivo deste estudo foi determinar a prevalência de lesões cervicais não cariosas (LCNCs) e de hiperestesia dentinária em estudantes do curso de Odontologia da Universidade Estadual de Maringá (UEM) e registrar as variáveis bucais, comportamentais e sistêmicas comuns aos pacientes portadores, Foram examinados 80 alunos, utilizando um questionário como instrumento de coleta de dados. O exame clínico foi utilizado para verificar a presença de lesões na face vestibular de pré-molares e primeiros molares de todos os quadrantes, além da hiperestesia dentinária. A análise estatística foi analisada através do teste qui-quadrado com nível de significância de 5%. 77,5% apresentaram LCNCs, com média de 2,5 ± 2,8. O dente mais acometido foi o 1° pré-molar seguido do 2° pré-molar e do 1° molar. Quanto à hiperestesia dentinária houve diferença estatisticamente significante em um único elemento dentário (p=0,00540). Idade, hábitos parafuncionais, tipo de escova dental e dieta ácida não apresentaram relação com a presença das LCNCs. Assim, a ocorrência das LCNCs não pode ser atribuida a um único fator etiológico.

The aim of this study was to determine the prevalence of non-carious cervicallesions (NC-CLs) and dentin hypersensitivity in Odontology students of the State University of Maringá (UEM) and correlate them to variables oral, behavioral and systemic. Data of 80 students were collected via a questionnaire and clinical examination. The clinical examination was used to verify the dentin hypersensitivity and the presence of lesions on the buccal surface of premolars and first molars. Statistical analysis was performed by chi-square test at 5% significance level. 77,5% had NCCLs, with mean of 2.5 ± 2.8. The teeth with most NCCLs were the first premolar, foliowed by second premolar and then first molar. The dentin hypersensitivity was statistical in a single tooth (p = 000540). No significant diference for age, parafunctional habits, type of toothbrush and acidic diet, between the groups with or without NCCLs. Thus, the occurrence of NCCLs cannot be attributed only to a single etiological factor.

Avaliação digital da densidade base velamento e contraste obtidos de filmes radiográficos periapicais processados em diferentes câmaras escuras portáteis. (AU) / The digital evaluation of the base density plus fog and contrast obtained from periapical

O objetivo deste artigo foi verificar a qualidade de três câmaras escuras e de três filmes radiográficos disponíveis comercialmente, analisando digitalmente a densidade base e velamento (DBV) e o contraste. Foram utilizados 72 filmes radiográficos periapicais, marcas Agfa®, Dentix® e Kodak®, divididos em quatro grupos submetidos a diferentes dispositivos de processamento. Os filmes foram processados, digitalizados e analisados no software Image Tool®. No filme Agfa®, ocorreu diferença estatisticamente significante na DBV em relação aos grupos. No Dentix®, a DBV e o contraste do grupo controle diferiram de forma significante. No Kodak®, a DBV permaneceu constante em todos os grupos. A DBV do filme Kodak® permaneceu constante em todas as câmaras escuras, ao contrário dos outros filmes. O contraste dos três filmes radiográficos sofreu alteração.