Indices in dental image exams for bone mineral density evaluation of aromatase inhibitor users.

We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI.

Phleboliths of the Head and Neck Region - A Case Report.

Rationale: Phleboliths are idiopathic calcifications resulting from mineralised structures inside veins, venules or blood vessels. Patient Concerns: A 48-year-old woman presented with multiple hard bodies on palpation. Diagnosis: Imaging studies revealed multiple, round, well-defined radiopaque lesions, extending from the coronoid process region down to the base of the mandible. The diagnosis was vascular malformation with multiple phleboliths. Treatment and Outcome: No treatment was proposed and the patient is under follow-up. Take-Away Lessons: Asymptomatic phleboliths of the head and neck region in an adult woman have been under surveillance.

Indices in dental image exams for bone mineral density evaluation of aromatase inhibitor users

Abstract We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI.

New mandibular indices in cone beam computed tomography to identify low bone mineral density in postmenopausal women.

OBJECTIVE: The aim of this study was to evaluate new radiomorphometric indices in cone beam computed tomography (CBCT) for assessing bone mineral density (BMD) status in postmenopausal women. STUDY DESIGN: Mandibular inferior cortical bone thickness was evaluated in 48 postmenopausal women in cross-sectional images at 4 sites: (1) symphysis (S): cross-sectional image equidistant from the centers of the right and left mental foramina (MF); (2) anterior (A): 10 mm anterior to the MF; (3) molar (M): 10 mm posterior to the MF; and (4) posterior (P): 25 mm posterior to the MF. Participants underwent dual-energy x-ray absorptiometry and were divided into normal, osteopenia, and osteoporosis groups. In the study, t tests with Bonferroni correction were conducted. Statistical significance was set at P < .017. Receiver operator characteristic (ROC) analyses were performed. RESULTS: Mean S index was significantly lower in osteoporosis than in osteopenia (P = .005). Mean M index was significantly lower in osteopenia (P < .001) and osteoporosis (P = .001) than in normal individuals. Mean P index was significantly lower in osteoporosis than in normal patients (P = .008). ROC values ranged between 0.643 and 0.740. Cortical thicknesses separating normal from abnormal varied from 1.73 mm to 3.37 mm. CONCLUSIONS: M and P indices in CBCT may be useful for identifying low BMD in postmenopausal women.

Parâmetros imaginológicos em pacientes com alteração de massa óssea / Imaginological parameters in patients with bone mass alteration

Os inibidores de aromatase (IAs) são medicamentos mais comumente utilizados para tratamento para pacientes com câncer de mama. Os IAs atuam inibindo a enzima aromatase, que é responsável pela conversão de hormônios esteroidais. Vários estudos mostram a importância do estrógeno para a formação óssea. Acredita-se que a privação do estrógeno possa ter um efeito deletério no osso causando o aumento da reabsorção óssea, diminuição da densidade mineral óssea (DMO) e com isso o aumento do risco de osteoporose e fraturas. A osteoporose é uma doença sistêmica multifatorial caracterizada pela redução da massa óssea e desorganização estrutural do tecido ósseo. O diagnóstico da osteoporose é baseado em critérios densitométricos da Organização Mundial de Saúde (OMS) com referência na classificação do T-score, realizada pela técnica de absorciometria de energia dupla de raios X (DXA), cujo valor avalia a DMO. Por se tratar de uma doença sistêmica, a osteoporose também afeta os ossos maxilares. Desta forma, o trabalho tem como objetivo avaliar parâmetros imaginológicos em pacientes mulheres que fazem tratamento com; IAs e encaminhadas para investigação de perda de massa óssea em um hospital de referência no tratamento dessas pacientes. Foram avaliadas 40 mulheres sob terapia com IAs. Foram avaliados índices radiomorfométricos (IR) de tomografia computadorizada de feixe cônico (TCFC) e análise fractal (AF) para algumas regiões de interesse (RI), espessura da cortical mandibular (ECM) e índice cortical mandibular (ICM) em radiografias panorâmicas digitais (RPD). Todas as pacientes foram submetidas ao exame DXA para avaliar a condição de DMO e divididas nos grupos: normal e baixa DMO. Para cada IR e para as RI da dimensão fractal, foram estabelecidas a curva característica de operação do receptor (ROC), a área sob a curva (AUC), a sensibilidade e a especificidade com seus receptivos intervalos de confiança. Os valores de AUC para os índices de RPD variaram de 52,6%-75,8%. O índice com a maior AUC foi a ECM, apresentando sensibilidade de 38,1%-100,0% e especificidade de 36,8%-84,2%. Para a AF, a RI do trabeculado total teve a maior sensibilidade, enquanto a RI anterior ao forame mentual teve a maior especificidade. Na análise da TCFC, os valores de AUC variaram de 51,8%-62,0%. Os índices com a AUC mais elevada foram o índice molar (M), com sensibilidade 18,1%-61,6% e especificidade de 66,9%-98,7% e o índice anterior (A) com sensibidade de 25,7%- 70,2% e especificidade de 48,8%-90,9%. O índice da sínfise (S) apresentou a maior sensibilidade e o índice posterior (P) apreentou a maior especificidade. Os índices de tomografia computadorizada inferior (ITC I) apresentou sensibilidade e especificidade razoáveis. Assim a ECM, a AF das RI do ângulo da mandíbula e do trabeculado total da RPD, bem como os índices ITC (I), M, P e A na TCFC mostraram-se úteis para identificar mulheres na pós-menopausa que usavam AI com baixa DMO.

Aromatase inhibitors (AIs) are the most commonly used drugs to treat breast cancer patients. AIs work by inhibiting the aromatase enzyme, which is responsible for converting steroid hormones. Several studies show the importance of estrogen for bone formation. It is believed that estrogen deprivation can have a deleterious effect on bone, causing increased bone resorption, decreased bone mineral density (BMD) and thus an increased risk of osteoporosis and fractures. Osteoporosis is a multifactorial systemic disease characterized by reduced bone mass and structural disorganization of bone tissue. The diagnosis of osteoporosis is based on densitometric criteria of the World Health Organization (WHO) with reference to the T- score classification, performed by the dual energy X-ray absorptiometry (DXA) technique, whose value assesses the BMD. As it is a systemic disease, osteoporosis also affects the maxillary bones. Thus, the study aims to evaluate imaging parameters in female patients undergoing treatment with AIs and referred for investigation of bone mass loss in a reference hospital in the treatment of these patients. Forty women undergoing therapy with AIs were evaluated. Radiomorphometric indices (RI) of cone beam computed tomography (CBCT) and fractal dimension (FD) were evaluated for some regions of interest (ROI), mandibular cortical width (MCW) and mandibular cortical index (MCI) in digital panoramic radiographs (DPR). All patients underwent the DXA exam to assess the status of BMD and divided into groups: normal and low BMD. The AUC values for the DPR indices ranged from 52.6%-75.8%. The index with the highest AUC was the mandibular cortical width ([MCW]; sensitivity: 38.1%-100.0%; specificity: 36.8%-84.2%). For FD, the total trabecular index had the greatest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT analysis, the values of AUC ranged from 51.8%-62.0%. The indices with the highest AUC were the molar index (M, sensitivity: 18.1%-61.6% and specificity: 66.9%-98.7%) and anterior (A, sensitivity: 25.7%-70.2% and specificity 48.8%-90.9%). The symphysis (S) index had the highest sensitivity, and the posterior (P) index presented the highest specificity. Sensitivity and specificity reasonable were obtained to computed tomography index (Inferior) [CTI (I)]. The MCW, FD of ROI of the mandible angle and total mandibular in the DPR, as well as the CTI (I), M, P, and A indices in the CBCT are useful to identify postmenopausal women who were using AI with low BMD.

Cone-beam computed tomography analysis of cemento-osseous dysplasia-induced changes in adjacent structures in a Brazilian population.

OBJECTIVES: To describe the effects of cemento-osseous dysplasia (COD) on anatomical structures. METHODS: CBCT scans were retrospectively selected from a database of individuals who attended an Oral Medicine service. Cases with a confirmed diagnosis of periapical, focal, or florid COD were included. Two oral and maxillofacial radiologists assessed the scans. Frequencies of the variables were described according to COD case, lesion areas, and teeth. RESULTS: Sixty COD cases affected 244 areas and 426 teeth. Florid COD was the most common (n = 48). Cortical bone (buccal, lingual, palatine, or mandibular) (n = 42) and the maxillary sinus (n = 13) were the structures most frequently affected by displacement or perforation. Thinning (n = 80), expansion (n = 62), and perforation (n = 60) of the cortical bone were common effects. The median size of the lesions was 12 mm in the mesiodistal direction, 8 mm in the buccal-lingual/palatal direction, and 9 mm in the superior-inferior direction. Root resorption was observed in 18.1% of all teeth, while tooth displacement was uncommon (0.6%). All teeth affected by COD had a discontinuous lamina dura and non-uniformly visible periodontal ligament space. CONCLUSIONS: CBCT images revealed that cortical bone, lamina dura, and periodontal ligament space were the structures most affected by COD and the effects of COD on anatomical structures were more frequent than previously described. CLINICAL RELEVANCE: CODs are fibro-osseous lesions common in the clinical practice, and relationship with anatomical structures is poorly described. CBCT is an appropriate method for the diagnosis and follow-up of patients with COD.

Mandibular canal branching assessed with cone beam computed tomography.

PURPOSE: The mandibular canal must be considered in dental procedures to avoid injuries of the alveolar inferior nerve. The occurrence of anatomical variations of the mandibular canal increases the risk of neurovascular injuries. The purpose of this study was to identify and describe the prevalence of mandibular canal branching (MCB) using cone beam computer tomography (CBCT). METHODS: Seven hundred standardized CBCTs were selected. The images were evaluated for the presence of MCB and for the detection of pathologies that could affect the structure of the canals. The data were analyzed using descriptive statistics and the Chi-squared test. RESULTS: The prevalence of MCB was 41.1%. There was no statistical difference between genders with the presence of the branches (p > 0.005). The highest prevalence was in the premolar and retromolar regions. Pathologies found in the molar region were frequently connected with MCB (77.8%), and the most common pathology related to branches was periapical lesion. CONCLUSIONS: Mandibular canal branching presented a high prevalence in CBCT imagery, more frequently located in regions of the premolar and retromolar. An adequate diagnosis of the MCB is necessary to perform dental procedures and verify possible associated pathologies.

Pre-interruptive intracoronal resorption: clinical and radiographic follow-up / Reabsorção intracoronária pré-eruptiva: acompanhamento clinico e radiográfico

ABSTRACT Pre-interruptive intracoronal resorption is a radiolucent lesion localized in dentin, immediately below the amelodentin junction of unerupted teeth. It is rare, asymptomatic, and of idiopathic etiology, generally diagnosed in routine radiographs or in those for orthodontic purposes. A conservative approach, with radiographic follow-up is the treatment recommended until the tooth erupts, and then the intervention is made. However, in cases with symptoms or progression of the lesion, surgical intervention is advisable. To report a case of pre-interruptive intracoronal resorption, with a conservative approach, showing the clinical and radiographic follow-up of this condition. The patient, a nine-year-old Caucasian girl, presented to the Dental Clinic for routine examination. An initial panoramic radiograph was requested, which showed an intracoronal radiolucence in tooth 45 that had not yet erupted. Clinical and radiographic follow-up was made until the affected tooth was completely established in the oral cavity. The treatment recommended for pre-interruptive intracoronal resorption is to have knowledge of the phenomenon, associate its probable etiology and radiographic aspect, as well as its prevalence, occurrence and treatment options, by considering a conservative approach when there are no symptoms.

RESUMO A reabsorção intracoronária pré-eruptiva é uma lesão radiolúcida localizada na dentina, logo abaixo da junção amelo-detinária de dentes não irrompidos. É rara, assintomática e de etiologia idiopática, geralmente diagnosticada em exames radiográficos de rotina ou com fins ortodônticos. Uma abordagem conservadora com acompanhamento radiográfico é o tratamento recomendado até que o dente erupcione para ser feita a intervenção. Porém, em casos de sintomatologia ou progressão da lesão, aconselha-se a intervenção cirúrgica. Objetivo: Relatar o caso de reabsorção intracoronária pré-eruptiva, com uma abordagem conservadora mostrando a o acompanhamento clínico e radiográfico periódico desta condição. Paciente, sexo feminino, nove anos de idade, caucasiana, que compareceu a Clínica Odontológica para exame de rotina. Foi solicitada uma radiografia panorâmica inicial, sendo evidenciada uma radioluscência intracoronária no dente 45 ainda não erupcionado. Foi feito uma acompanhamento clínico e radiográfico até na total estabelecimento do dente acometido na cavidade oral. Conhecer a reabsorção intracoronária pré-eruptiva, associando sua provável etiologia e aspecto radiográfico, bem como sua prevalência e ocorrência e opções de tratamento, considerando uma abordagem conservadora, quando não houver sintomatologia, como tratamento recomendado.

Radiographic and computed tomography monitoring of a fractured needle fragment in the mandibular branch.

Some complications can arise with the usage of local anesthesia for dental procedures, including the fracture of needles in the patient. This is a rare incident, usually caused by the patient's sudden movements during anesthetic block. Its complications are not common, but can include pain, trismus, inflammation in the region, difficulty in swallowing, and migration of the object, which is the least common but has the ability to cause more serious damage to the patient. This report describes a case in which, after the fracture of the anesthetic needle used during alveolar nerve block for exodontia of the left mandibular third molar, the fragment moved significantly in the first 2 months, before stabilizing after the third month of radiographic monitoring.