What is the image appearance of juvenile idiopathic arthritis in MRI, CT, and CBCT of TMJ? A systematic review.

OBJECTIVE: We performed a systematic review to investigate the appearance of imaging signs on magnetic resonance imaging (MRI), cone-beam computed tomography (CBCT), and conventional computed tomography (CT) scans of the temporomandibular joints (TMJs) of patients with juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS: We performed electronic searches of the PubMed, Embase, Web of Science, Scopus, Lilacs, and the Cochrane Library databases to identify studies investigating JIA and its related imaging findings. Inclusion criteria were as follows: original article studies based on humans and systematic reviews, studies enrolling patients under 18 years of age with a diagnostic of JIA, the use of International League of Associations for Rheumatology (ILAR) criteria and one type of medical imaging (MRI, CBCT, or CT), and papers published in the English language. RESULTS: A total of six studies met the inclusion criteria, four involving MRI and two involving CBCT. Additionally, all six studies analyzed the imaging findings of pathological TMJ affected by JIA. The results showed that synovial membrane enhancement, condylar erosions, and condylar flattening were the most prevalent imaging findings in JIA. CONCLUSION: MRI examinations are more specific for detecting anomalies in the TMJ than CBCT and CT. Additionally, these results must be correlated with clinical signs to verify the correct diagnosis. CLINICAL RELEVANCE: This study identified the most prevalent imaging signs of JIA to provide an early and correct diagnosis of the disease.

An Alternative Approach Using Circummandibular Wiring for Treatment of Dentoalveolar Fractures in Children: A Case Report.

The prevalence of dentoalveolar injuries in children is approximately 25%, with falls from own height being one of the main etiologies. Diagnosis is based on the clinical evaluation associated with complementary imaging tests. The treatment of choice depends on the type of damage and structure affected. For alveolar process fractures, closed reduction and semi-rigid dental splinting for 4 to 6 weeks is generally satisfactory. However, some cases, such as severe segmental fractures, require open treatment to ensure adequate reduction and stabilization of the displaced alveolar segment, which is usually achieved by titanium miniplates and screws. Nevertheless, there are situations where this type of fixation is not possible, requiring alternative methods. Therefore, this article describes a surgical technique performed by open reduction, associating semi-rigid dental splint and circummandibular wiring in pediatric patient diagnosed with dentoalveolar fracture through clinical examination (with bone fracture displacement) and tomography. The technique promoted a good prognostic to the patient, proving to be a viable alternative for treating dentoalveolar fractures.

Oral Rehabilitation With Dental Implants and the Importance of a Preventive Evaluation for Osteonecrosis of the Jaws Associated With Medications.

Osteonecrosis of the jaw is a possible oral complication resulting from antiresorptive therapies, such as bisphosphonates (Bfs). Although the etiology is not entirely clear, it has been shown to be dependent on several factors, with the traumatic stimulation caused by the placement of teeth implants indicated as one of the predisposing factors to this pathology. The indications and preventive methods for performing these procedures have been questioned, making it essential to determine the proper protocols. Thus, the present study aims to discuss the risks of the development of osteonecrosis in patients undergoing dental implant surgery who use Bfs as well as to discuss related local and systemic factors and possible methods for preventing this side effect. The study also aims to present a clinical case of an osteopenic patient who used Bfs and underwent rehabilitation through implants according to specific protocols, which resulted in successful treatment.

Analysis of bone formation and membrane resorption in guided bone regeneration using deproteinized bovine bone mineral versus calcium sulfate.

Guided Bone Regeneration (GBR) is a technique based on the use of a physical barrier that isolates the region of bone regeneration from adjacent tissues. The objective of this study was to compare GBR, adopting a critical-size defect model in rat calvaria and using collagen membrane separately combined with two filling materials, each having different resorption rates. A circular defect 8 mm in diameter was made in the calvaria of Wistar rats. The defects were then filled with calcium sulfate (CaS group) or deproteinized bovine bone mineral (DBBM group) and covered by resorbable collagen membrane. The animals were killed 15, 30, 45 and 60 days after the surgical procedure. Samples were collected, fixed in 4% paraformaldehyde and processed for paraffin embedding. The resultant sections were stained with H&E for histological and histomorphometric study. For the histomorphometric study, the area of membrane was quantified along with the amount of bone formed in the region of the membrane. Calcium sulfate was reabsorbed more rapidly compared to DBBM. The CaS group had the highest percentages of remaining membrane at 15, 30, 45 and 60 days, compared to the DBBM group. The DBBM group had the highest amount of new bone at 45 and 60 days compared to the CaS group. Based on these results, it was concluded that the type of filling material may influence both the resorption of collagen membrane and amount of bone formed.

Comparison of the diagnostic accuracy of direct digital radiography system, filtered images, and subtraction radiography.

BACKGROUND: TO COMPARE THE DIAGNOSTIC ACCURACY OF THREE DIFFERENT IMAGING SYSTEMS: Direct digital radiography system (DDR-CMOS), four types of filtered images, and a priori and a posteriori registration of digital subtraction radiography (DSR) in the diagnosis of proximal defects. MATERIALS AND METHODS: The teeth were arranged in pairs in 10 blocks of vinyl polysiloxane, and proximal defects were performed with drills of 0.25, 0.5, and 1 mm diameter. Kodak RVG 6100 sensor was used to capture the images. A posteriori DSR registrations were done with Regeemy 0.2.43 and subtraction with Image Tool 3.0. Filtered images were obtained with Kodak Dental Imaging 6.1 software. Images (n = 360) were evaluated by three raters, all experts in dental radiology. RESULTS: Sensitivity and specificity of the area under the receiver operator characteristic (ROC) curve (Az) were higher for DSR images with all three drills (Az = 0.896, 0.979, and 1.000 for drills 0.25, 0.5, and 1 mm, respectively). The highest values were found for 1-mm drills and the lowest for 0.25-mm drills, with negative filter having the lowest values of all (Az = 0.631). CONCLUSION: The best method of diagnosis was by using a DSR. The negative filter obtained the worst results. Larger drills showed the highest sensitivity and specificity values of the area under the ROC curve.

Induced hypotension in orthognathic surgery: a comparative study of 2 pharmacological protocols.

PURPOSE: The objective of this comparative study was to report on the use of 2 different pharmaceutical protocols involving 2 different anesthetic techniques (IV and balanced) to induce hypotension in patients submitted to orthognathic surgery by assessing the patients' intra- and postoperative physiologic response and hemodynamic stability. PATIENTS AND METHODS: Twenty ASA I patients, between 17 and 44 years of age who had dental and skeletal deformities were subdivided into 2 groups: group I (clonidine associated to remifentanil), and group II (dexmedetomidine associated to isoflurane), in addition, other drugs were common to both groups. The following responses were assessed: arterial blood pressure, heart rate, temperature during intra- and postoperative periods, incidence of nausea and vomiting, postoperative pain, awakening time, extubation time, and postanesthetic recovery time. RESULTS: The results of the study using Repeated Measures Test statistical analysis showed that there were no significant differences between the 2 groups in respect to physiologic responses or surgery time. CONCLUSION: Both protocols tried in this study proved to be effective and safe, and they seem to be interesting alternatives in longer orthognathic surgeries with the expectation of an important blood loss. The choice for either protocol should be based on the inherent risks involved in their use and their cost-benefit ratio.

Estudo epidemiológico das deformidades dentofaciais de Maringá/PR - 1997 - 2003 / Dentofacial deformities an epidemiologic study in Maringá/PR - 1997 - 2003

Atualmente observa-se que grande parte da população apresenta algum tipo de desvio morfológico e/ou funcional do sistema estomatognático (BOECK; GIMENEZ; COLETA, 2003). O desenvolvimento dos centros de correção de deformidades dentofaciais em nossos pais e o notável aumento na demanda destes serviços cria a necessidade de realizar estudos de prevalência destas deformidades para planejar e efetuar tratamentos de maneira mais adequada (BELLO; RODRIGUEZ, 1985).O tratamento das deformidades dentofaciais está focado na correção da má-oclusão severa, deformidade facial, e consequentemente a relção maxilo-mandibular por uma combinação de ortodontia e cirurgia ortognática (BARBER et al., 1992). O presente trabalho visa um estudo epidemiológico das deformidades dentofaciais tratadas na região de Maringá

Cisto odontogênico calcificane: aspectos clínicos, radiográficos e microscópicos e relato de caso / Calcifying odontogenic cyst: clinical, radiographic and microscopic aspects and a case report

O cisto odontogênico calcificante (COC) é uma lesão sobre a qual os autores discordam, em razão de seu diversificado comportamento microscópico e clínico. Desde o primeiro relato, o COC mostra pontos que ainda permanecem abscuros e que geram interpretações controversas. O propósito deste artigo é revisar e analisar a bibliografia e buscar informações que permitam caracterizar os aspectos clínico, radiográfico e microscópico do COC, bem como de suas variações, além de apresentar um caso clínico da referida lesão. É consenso entre os autores que o COC é uma lesão bastante rara, cujo diagnóstico só é definido pelo exame microscópico. O tratamento é a enucleação cirúrgica, com acompanhamento clínico e radiográfico para identificação precoce das possíveis recidivas