Lingual Lateral Canal Mimicking Mandible Fracture.

Lingual lateral canal is a rare variation in the trajectory of the mandibular canal, and is usually detected as an incidental finding on radiographic exams, especially on cone-beam computed tomography. Due to its radiographic characteristics, this anatomical variation might be confused with a mandible fracture. Therefore, the knowledge of its presence is essential not only to differentiate it from a fracture, but also for the success of surgical procedures performed in the mandible, making it easier to avoid clinical complications such as swelling, bruising, bleeding, and neurovascular disorders. This report shows the case of a lingual lateral canal mimicking a fracture on the mandibular body.

Can Mental Index be used on CBCT images to determine sexual dimorphism? / O Índice Mentual aplicado em imagens de TCFC pode ser utilizado para determinação do Dimorfismo Sexual?

ABSTRACT Objective: Radiomorphometric indices (RI) vary according to gender and age. The objective of this study was to assess bone quality in men and women, using tomographic images Methods: A total of 78 Cone Beam Computed Tomography (CBCT) images of female and male patients were analyzed. The images were obtained from LAPI-FOUSP database, São Paulo, Brazil, and the Mental Index, which is a quantitative index, was evaluated on those images. The images were divided into 2 groups: Group M - Men and Group W - Women and evaluated by one examiner in two different times (T1 and T2). The data was submitted to a statistical analysis with a 95% level of significance (p <0.05) Results: The ICC tests showed an average to good intra-examiner agreement. The age averages were: 48.46 ± 15.3 for group W and 53.87 ± 13.09 for group M. On the MI evaluation, statistically significant differences were observed between the two groups Conclusion: We concluded that MI can be used to determine sexual dimorphism, once the thickness of the mandible cortex in women is smaller than the thickness found in men.

RESUMO Objetivo: Avaliar o dimorfismo sexual, por meio da aplicação de IR em imagens tomográficas. Métodos: Foram analisados 78 exames de tomografia computadorizada de feixe cônico (TCFC), de pacientes do sexo feminino e masculino. As imagens foram obtidas do banco de dados do LAPI-FOUSP, São Paulo, Brasil, e por meio delas o Índice Mentual, que é um IR quantitativo, foi avaliado. As imagens foram divididas em 2 grupos: Grupo M - Homens e Grupo W - Mulheres e avaliadas por um examinador em dois tempos diferentes (T1 e T2). Os dados foram submetidos a análise estatística com nível de significância de 95% (p<0,05). Resultados: O teste ICC mostrou uma concordância intra-examinador média a boa. As médias de idade foram: 48,46±15,3 para o grupo M e 53,87±13,09 para o grupo H. Na avaliação do IM, foram observadas diferenças estatisticamente significantes entre os dois grupos. Conclusão: Concluímos que o Índice Mentual pode ser utilizado para determinar o dimorfismo sexual, uma vez que a espessura da cortical da mandíbula nas mulheres é menor que a espessura encontrada nos homens.

Mandibular radiomorphometric assessment of bone mineral density in survivors of pediatric hematopoietic stem-cell transplantation.

OBJECTIVE: Hematopoietic stem-cell transplantation (HSCT) childhood survivors of hematologic malignancies are prone to develop late osteopenia and osteoporosis. The purpose of this retrospective study was to quantitatively and qualitatively assess bone mineral density (BMD) in HSCT childhood survivors and to compare the effectiveness of both qualitative and quantitative assessment methods. METHODS: DESIGN BMD assessment using panoramic radiographs of childhood HSCT survivors aged 3.69-18.88 years using two radiomorphometric indexes. Case-control double-blinded comparison of panoramic radiographic images from childhood HSCT survivors and age- and sex-matched healthy controls. Quantitative assessment was performed by measuring the cortical bone width bilaterally at the mental foramen level. Qualitative assessment was performed using the mandibular cortical index bilaterally on all panoramic images. RESULTS: Radiographs were taken 6.59-83.95 months after bone marrow transplantation [median±SD=25.92±24.9 months]. Fifty-two panoramic radiographic images were analyzed: 21 from HSCT survivors and 31 from healthy controls aged 3.69-25.1 years [mean±SD=11.89±5.28 years]. The mandibular cortical bone width was 17% smaller in childhood HSCT survivors than in healthy controls (case group: 2.420, control group: 3.307; p=0.00617). Qualitative analysis revealed an increased frequency of severe mandibular cortical erosion in childhood HSCT survivors, although no significant difference was observed (case group: 1.540, control group: 1.490; p=0.32). The interobserver agreement was 85% (Kappa index). CONCLUSIONS: HSCT childhood survivors exhibit quantitative and qualitative mandibular bone impairments. Further studies are needed to establish an association between mandibular cortical bone impairment and osteoporosis.

Mandibular radiomorphometric assessment of bone mineral density in survivors of pediatric hematopoietic stem-cell transplantation

OBJECTIVE: Hematopoietic stem-cell transplantation (HSCT) childhood survivors of hematologic malignancies are prone to develop late osteopenia and osteoporosis. The purpose of this retrospective study was to quantitatively and qualitatively assess bone mineral density (BMD) in HSCT childhood survivors and to compare the effectiveness of both qualitative and quantitative assessment methods. METHODS: DESIGN BMD assessment using panoramic radiographs of childhood HSCT survivors aged 3.69-18.88 years using two radiomorphometric indexes. Case-control double-blinded comparison of panoramic radiographic images from childhood HSCT survivors and age- and sex-matched healthy controls. Quantitative assessment was performed by measuring the cortical bone width bilaterally at the mental foramen level. Qualitative assessment was performed using the mandibular cortical index bilaterally on all panoramic images. RESULTS: Radiographs were taken 6.59-83.95 months after bone marrow transplantation [median±SD=25.92±24.9 months]. Fifty-two panoramic radiographic images were analyzed: 21 from HSCT survivors and 31 from healthy controls aged 3.69-25.1 years [mean±SD=11.89±5.28 years]. The mandibular cortical bone width was 17% smaller in childhood HSCT survivors than in healthy controls (case group: 2.420, control group: 3.307; p=0.00617). Qualitative analysis revealed an increased frequency of severe mandibular cortical erosion in childhood HSCT survivors, although no significant difference was observed (case group: 1.540, control group: 1.490; p=0.32). The interobserver agreement was 85% (Kappa index). CONCLUSIONS: HSCT childhood survivors exhibit quantitative and qualitative mandibular bone impairments. Further studies are needed to establish an association between mandibular cortical bone impairment and osteoporosis.

Laminated Veneers with Stratified Feldspathic Ceramics.

Currently, there has been a growing demand for restorations of anterior teeth in the routine of doctors in dental offices. With advances in adhesive technology and good properties of the available ceramics, the use of ceramic veneers has been offered as a treatment option for cases where teeth have minor color changes and shape and position changes. Through careful treatment planning, it is possible to conservatively use ceramic veneers in the treatments, applying techniques with minimal wear of the teeth and obtaining excellent aesthetic results with mechanical stability and biocompatibility with the periodontal tissues and clinical longevity. This clinical case report was used to design the digital smile, which guided the production of the diagnostic waxing of the superior model. Silicone guides were then made to create the mock-up, orienting enamel/dentin wear and assisting the preparation of the crowns with bis-acryl resin. When the wear was finished, the gingival separation was performed using the double-thread technique. In the molding process, the second wire was withdrawn and the molding material flowed into the gingival groove, copying the terminal region. After analysis of the quality of the impression, the temporary crowns were made with bis-acryl resin, using the guide. The color of the cementing agent was chosen using a glycerin-based compound which simulates the final color of the cement. After two hours of drying, two different layers of silane were applied for 60 seconds. After the preparation of the piece, gingival isolation and separation were done. The dental substrate was degreased with detergent solution and conditioned with 37% phosphoric acid for 15 seconds and then washed for 45 seconds for subsequent drying, leaving the substrate moistened. The adhesive system was applied for 30 seconds, waiting for the adhesive to penetrate into the conditioned dentinal tubules. A light air jet was applied, and then each tooth was photopolymerized for 30 seconds. The resin cement was placed inside the pieces and placed in position and photopolymerized. The excess cement was removed; after a layer of glycerin in the cervical region, aiming to block the entry of oxygen and polishing was performed. The purpose of this case report was to describe a sequence of clinical steps, from planning to cementation, in a case of aesthetic correction using feldspathic ceramic veneers.

Utilização da tomografia computadorizada de feixe cônico na obtenção dos índices radiomorfométricos em mulheres na pré e pós menopausa / Use of cone beam computed tomography in obtaining radiomorphometric index in women in pre and postmenopausal

O rastreio de osteoporose utilizando imagens de tomografia computadorizada de feixe cônico (TCFC) é um procedimento ainda discutível. O objetivo deste estudo foi avaliar a qualidade óssea de mulheres de diversas faixas etárias (AG) através de índices de radiomorfométricos obtidos em TCFC. Setenta e cinco imagens de TCFC de mulheres (idades compreendidas entre 40 - 70 anos) foram avaliadas. Os pacientes foram agrupados de acordo com AG, em três maneiras diferentes, de acordo com a prevalência de osteoporose em mulheres brasileiras. Os índices avaliados foram: índice cortical mandibular (ICM), índice mentual (IM) e os índices de tomografia computadorizada superior e inferior (ITC). Dois examinadores calibrados avaliaram as imagens em três tempos: Abertura / reconstrução de imagens (1), repetindo este procedimento e salvando a reconstrução (2), e a avaliação das imagens reconstruídas (3). As reconstruções panorâmicas (variando as espessuras: 0,30, 10, e 20 mm) e imagens transaxiais foram avaliadas. A concordância intra e inter-examinador foram avaliadas por meio do teste Kappa e estatísticas de coeficiente de correlação intraclasse. A correlação de Pearson foi utilizada para verificar a relação entre os índices avaliados e AG. O teste de quiquadrado foi utilizado para comparar a prevalência de osteoporose de acordo com cada parâmetro e AG. Os índices avaliados não apresentaram correlação com AG. Alta concordância intra e inter-examinador foi encontrada para IM e ITC, mas não para ICM. A prevalência da osteoporose variou grandemente, de acordo com o índice avaliado e o valor de corte utilizado para definir a doença (com base na qualidade do osso). Os índices radiomorfométricos quantitativos obtidos na TCFC podem ser avaliados de uma forma reprodutível. Não houve correlação entre os índices e AG, o que sugere que as imagens de TCFC não devem ser utilizadas para o rastreio de osteoporose.

Screening for osteoporosis using cone beam CT images (CBCT) is a datable procedure. The aim of this study was to evaluate the bone quality of women from diverse age groups (AG) using CBCT-based radiomorphometric indices. Seventy-five CBCT images of women (age range 40 - 70) years were evaluated. Patients were grouped according to AG, in three diverse manners, according to prevalence of osteoporosis in Brazilian women. The mandibular cortical (MCI), mental (MI), and the superior and inferior computed tomography (CTI) indices were assessed. Two calibrated examiners assessed the images in three instances: opening/reconstructing the images (1), repeating this procedure (2), and assessing the reconstructed images once again (3). Panoramic reconstructions (0.30, 10, and 20 mm thicknesses) and cross-sectional images were assessed. Intra and inter-examiner agreement were assessed by means of Kappa and intraclass correlation coefficient statistics. Pearson correlation was used to verify the relationship between the assessed indices and AG. Chi-square statistics was used to compare the prevalence of osteoporosis according to each index and AG. Assessed indices showed no correlation with AG. High intraand inter-examiner agreement was found for MI and CTI but not to MCI. The prevalence of osteoporosis varied widely, according to the assessed index and to the cutoff used to define the disease (based on bone quality). Quantitative CBCT-based radiomorphometric indices can be assessed in a reproducible manner. No correlation between AG and the assessed indices was found, suggesting that CBCT images should not be used for the screening of osteoporosis.

Efeito do artefato de "beam hardening" na capacidade de identificação das alterações periodontais e peri-implantares / "Beam Hardening" artefact effect in identifying capacity of periodontal and peri-implant changes

O diagnóstico por imagem é um exame complementar importante para o diagnóstico e acompanhamento da doença periodontal e peri-implantar e atualmente a tomografia computadorizada de feixe cônico (TCFC) substitui o uso das tomografias convencionais odontológicas e da tomografia computadorizada médica. No entanto, artefatos ocorrem principalmente, próximos de estruturas de alta densidade como o metal, sendo que essa alteração pode interferir na interpretação das imagens e no diagnóstico. Sendo assim, o presente estudo tem como objetivo realizar uma revisão de literatura relacionada ao efeito do artefato de "beam hardening" na capacidade de identificação das alterações periodontais e peri-implantares. Conclui-se que a TCFC promove uma avaliação tridimensional de doença periodontal e da peri-implantite, mas na presença de artefatos metálicos pode haver uma limitação da qualidade da imagem do nível ósseo ao redor dos dentes e implantes.(AU)

Diagnostic imaging is an important complementary method for the diagnosis and follow up of periodontal disease and peri-implant and nowadays cone-beam computed tomography (CBCT) replaces the use of conventional dental CT scans and medical CT scan. However, artifacts occur mainly near high-density structures such as metal, and this change may interfere interpretation of the images and diagnosis. Therefore, this study aims to conduct a literature review on the effect of "beam hardening" artifact in identifying capacity of periodontal and peri-implant changes. We conclude that CBCT promote three-dimensional evaluation of periodontal disease and peri-implantitis, but presence of metal artifacts could be a limitation of the image quality of bone level around the teeth and implants.(AU)

Assessment of maxillary bone density by the tomodensitometric scale in Cone-Beam Computed Tomography (CBCT) / Avaliação da densidade óssea dos maxilares por meio de escala tomodensitométrica em Tomografia Computadorizada de Feixe Cônico (TCFC)

Objective ­ To analyze bone density in images of the anterior and posterior regions of the mandible and maxilla obtained with ConeBeam Computed Tomography. Planning of surgeries for implant placement requires information about bone density, which is directly related to stability. Methods ­ This retrospective study included female (25) and male (25) patients (50) with ages in the range 30-40/45 years. Images of their exams (200 transaxial slices; 2-mm thick) were analyzed in the anterior (50) and posterior (50) regions of the mandible and anterior (50) and posterior (50) regions of the maxilla using the bone density tool of the Xoran (i-CAT®) software. Our data were compared and correlated with computed tomography data obtained in the literature. Results ­ Mean gray values were utilized to determine the density values for the anterior mandible (562.2, 3.3) and maxilla (531.3, 2.8) and the posterior mandible (503.8, 3.0) and maxilla (394.5, 2.9). The results were statistically analyzed for correlation between our findings and those of the literature. The t test was utilized to obtain additional information related to gender; and the Pearson correlation analysis was utilized to assess the differences between observers 1 and 2. Conclusions ­ Statistically significant differences (p>0.05) between densities in the anterior and posterior regions were not found, and our values were consistent with those in the literature obtained with Computed Tomography.

Objetivo ­ Analisar a densidade óssea nas regiões anterior e posterior dos maxilares em imagens obtidas por meio de Tomografia Computadorizada de Feixe Cônico. O planejamento de cirurgias requer informações sobre a densidade óssea da região escolhida para instalação de implantes. Métodos ­ Este estudo retrospectivo incluiu 50 pacientes, sendo 25 do gênero feminino e 25 masculino com idades na faixa 30-40/45 anos. As imagens de seus exames (200 cortes transaxiais com espessura de 2 mm) foram analisadas nas regiões anterior (50) e posterior (50) da mandíbula e anterior (50) e posterior (50) da maxila usando a ferramenta de densidade óssea do software Xoran (tomógrafo i-CAT®). Os nossos dados foram comparados e correlacionados com aqueles de tomografia computadorizada obtidos na literatura. Resultados ­ Valores médios de cinza foram usados para determinar os valores de densidade para mandíbula (562,2; 3,3) e maxila (531,3; 2,8) anteriores, e mandíbula (503,8; 3,0) e maxila (394,5; 2,9) posteriores. Os resultados foram submetidos à análise estatística para comparação entre os achados deste estudo e aqueles da literatura. O teste t foi usado para obter informações adicionais relacionadas aos gêneros; e a análise de correlação de Pearson foi usada para avaliar a diferença entre os observadores 1 e 2. Conclusões ­ Diferenças estatisticamente significantes (p< 0,05) entre as densidades nas regiões anterior e posterior não foram encontradas, e os valores que nós obtivemos com Tomografia Computadorizada de Feixe Cônico foram compatíveis com aqueles da literatura com Tomografia Computadorizada.

Estudo da tomografia computadorizadade feixe cônico na avaliação morfológicade raízes e canais dos molares e pré-molares da população brasileira / Study of cone beam computed tomography in the morphological evaluation of roots and canals of molars and premolars in theBrazilian population

O sucesso no tratamento endodôntico pode ser influenciado pela falta de conhecimento anatômico do sistema de canais radiculares. Esse conhecimento da morfologia ainda é mais complicado em dentes posteriores devido a sua complexa variação anatômica. Devido as dificuldades apresentadas nas avaliações do número de raízes e canais por métodos radiográficos convencionais, a Tomografia Computadorizada de Feixe Cônico (TCFC) se mostra de grande importância na avaliação morfológica de canais radiculares, assim como em estudos de acordo com etnias diferentes. O objetivo deste trabalho foi fazer uma revisão de literatura a respeito do uso da TCFC na avaliação de raízes e canais dos molares e pré-molares. A revisão foi realizada descrevendo a importância do uso da TCFC e relatando trabalhos a respeito do conhecimento de morfologia de canais. Conclui-se que a Tomografia Computadorizada de feixe cônico é uma importante ferramenta na avaliação de raízes e canais; e que a população brasileira difere de outras populações do mundo em relação a morfologia de canais radiculares...

Success in endodontic treatment can be influenced by the lack of anatomical knowledge of the root canal system. This knowledge of the morphology is further complicated in posterior teeth because of its complex anatomical variation. Because the difficulties presented in the evaluations of the root canals by conventional radiographic methods, Cone Beam Computed Tomography (CBCT) shown of great importance in the morphology of root canals. The objective was to make a review of literature regarding the use of CBCT in the evaluation of roots and canals of molars and premolars. The review was carried out describing the importance of using CBCT and reporting studies about the knowledge of root canals morphology. We conclude that cone beam computed tomography is an important tool in the evaluation of roots and canals; and that the Brazilian population differs from other world populations compared the morphology of root canals...

Anti-infective periodontal therapy promoting improvement in systemic markers of HIV infection.

Research supports the theory that the chronic infectious response occurring in periodontal disease may have a role as a risk modifier of systemic diseases. This study assessed the impact of HIV-associated chronic periodontitis treatment on systemic HIV-related markers (CD4 T lymphocytes cell counts and HIV viral load). Fifteen HIV patients presenting chronic periodontitis [at least eight sites presenting a probing depth (PD) >4 mm and bleeding] were included in this study. Patients received full mouth periodontal treatment with an ultrasonic device and supragingival plaque control. Medical (CD4 cell counts and HIV load) as well as periodontal clinical parameters [probing pocket depth (PPD), clinical attachment level (CAL)] were assessed at baseline and 3 and 6 months after treatment. ANOVA/Tukey and Pearson's correlation tests were used for statistical analysis (α=5%). The results showed that PPD reduction and CAL gain were statistically significant at 3 and 6 months after periodontal therapy (p<0.05). At 6 months, CAL gain was 0.6±0.5 mm and PPD reduction was 0.7±0.5 mm. At the same time, a statistically significant increase in CD4 cell counts could be seen after the third month (p<0.05) and sixth month (p<0.05). Moreover, at 6 months, the relationship between the improvement in clinical parameters, i.e., PPD reduction, and the number of TCD4 lymphocytes could be highlighted. This was shown as the greater the PPD reduction, the greater the increase in TCD4 cells (r=0.68, p=0.02). These data suggest that periodontitis treatment could be associated with an improvement in medical conditions in HIV subjects.