Marginal bone loss in the second molar related to impacted mandibular third molars: comparison between panoramic images and cone beam computed tomography

BACKGROUND: Deciding whether or not to extract third molars remains a controversial situation in dental practice. Image exams support this decision by enabling a close view of the third molar, its adjacent bone and its relationship with the second molar. This study aimed to assess and compare second molar bone loss adjacent to impacted mandibular third molar in panoramic radiographs (PAN) and cone beam computed tomography (CBCT) scans. MATERIAL AND METHODS: A sample of 70 patients was selected (n=124 teeth). Each patient had a set of a panoramic radiograph and CBCT scans consecutively taken for dental treatment purposes. In PAN and CBCT, mandibular third molars were classified based on their position and bone loss of the adjacent second molar. Agreement between PAN and CBCT scans was assessed and quantified. RESULTS: Outcomes of bone loss assessment were different between PAN and CBCT scans (p < 0.05). Bone loss was found in 62.9% of the PAN, while in CBCT scans it was found in 80%. In particular, nearly 29% (n=27) of the teeth that were classified without bone loss in PAN were classified with bone loss in CBCT scans. Mesioangular and horizontal third molars had a statistically significant association with bone loss of the adjacent second molars (p < 0.05). In general, PAN underestimated the severity of bone loss compared to CBCT scans (p < 0.05). CONCLUSIONS: Diagnosing second molar bone loss due to impaction of adjacent third molar in PAN may be challenging because of false negatives. Impacted third molars justify preoperative CBCT scans if second molar bone loss needs to be precisely assessed for a more detailed and reliable treatment plan

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Diagnostic sequence for early diagnosis of neurofibromatosis type 1 using NIH criteria.

Early diagnosis of neurofibromatosis is significant to start the multidisciplinary approach of this type of patient. This syndrome may be first identified in pediatric dental care. This study is about a 9-year-old patient who was diagnosed with neurofibromatosis type 1 from a plexiform neurofibroma displayed in the left hemi-maxilla. From the microscopic diagnosis of the lesion the investigation of other related injuries began, according to the diagnostic criteria of the National Institute of Health (NIH), leading to the diagnosis of systemic alterations. The parental awareness about the condition and the establishment of multidisciplinary care are important for the treatment to be more conservative and the patient has fewer complications with better quality of life. The use of the diagnostic criteria in this case shows how methodization is important for reaching more accurate and reliable diagnoses.

A new case of the pilomatrixoma rare in the preauricular region and review of series of cases.

Pilomatrixoma is considered a rare benign tumor arising from the hair follicle, most common in the head and neck region, but it is rarely diagnosed on a clinical basis. This report describes a new case of giant pilomatrixoma in a 36-year-old female patient. The nodule was localized in the preauricular area on the right side, appearing as a slow-growing, fixed, painless, with a hardened consistency, unusual giant (4.5 cm). A cone-beam computed tomography (CBCT) examination showed a slightly hyperdense lesion, and fine-needle aspiration cytology (FNAC) revealed peripheral blood and mononucleated inflammatory cells. After enucleation of lesion, a diagnosis of pilomatrixoma was confirmed. The differential diagnosis of pilomatrixoma is broad, because its characteristics also can be found in other lesions common to the head and neck. Thus, a lesion in the head and neck, adherent to the skin, and well demarcated, mainly in the young and in females, should be suspected as pilomatrixoma.

Diagnosis, treatment, and rehabilitation of a patient with inflammatory pseudotumor.

Inflammatory pseudotumors are a group of lesions of unknown etiology that mimic clinically and radiographically neoplasms. In the maxilla, inflammatory pseudotumors are presented with bone alterations of erosion, remodeling, and sclerosis. The diagnosis is of exclusion, where multiple biopsies are required. The present study aims to report the case of a male patient who presented with increased volume in the left maxillary region, with diagnosis after total left maxillectomy being inflammatory pseudotumor. The patient did not present recurrences with 3 years of preservation and underwent by multidisciplinary treatment with esthetic and functional rehabilitation with the preparation of a bucomaxilo prosthesis. Despite presenting some suggestive clinical features, the inflammatory pseudotumor has a difficult and of exclusion diagnosis, where multiple biopsies are required. They are lesions that simulate clinically and radiographically neoplasms. If it is surgically accessible, the treatment of choice is complete surgical resection.

Influência dos antiinflamatórios Valdecoxib (Bextra) e Rofecoxib (Vioxx) no processo de reparo em feridas de extração dental: estudo microscópico em ratos / Effect of the antiinflammatory Valdecoxib (Bextra) and Rofecoxib (Vioxx) in the process of alveolar healing in rats: microscopy study

Foi avaliado o efeito dos antiinflamatórios Valdecoxib e Rofecoxib no processo de reparo em feridas de extração de ratos. Para tanto, foram utilizados 48 ratos (Rattus novergicus, albinus, Wistar), machos, com peso entre 280 e 320 gramas, divididos em 3 grupos com 16 animais. No Grupo I (controle), os animais foram submetidos apenas à exodontia. No Grupo II, os animais receberam, por via intraperitoneal, doses específicas de Valdecoxib no pós-operatório imediato e nos 2 dias subseqüentes. No Grupo III, os animais receberam doses específicas de Rofecoxib no pós-operatório imediato e nos 2 dias subseqüentes. Os animais, em número de 4 para cada grupo, foram sacrificados aos 3, 7, 15 e 24 dias pós-operatórios. A seguir, a maxila direita foi removida, fixada em formalina, desmineralizada em EDTA e incluídas em parafina. Os cortes com 6 micrometros de espessura foram corados pela hematoxilina e eosina para análise microscópica. Dentro das condições estabelecidas no presente trabalho, foi possível concluir que: 1) a regeneração do epitélio da mucosa gengival foi semelhante nos Grupos I, II e III; 2) a reparação do alvéolo dental dos animais dos Grupos II e III mostrou-se mais retardada quando comparada ao Grupo I (controle)

The present study evaluated the effect of the non-steroidal antiinflammatory Valdecoxib (Bextra) and Rofecoxib (Vioxx) in the alveolar healing process in rats. Forty eight male rats (Rattus novergicus, albinos, Wistar) weighting around 280 and 320g, were divided into three groups containing 16 animals each, and the following procedures performed: group I was used as control group, being parameter for the others, were the extraction was did. In group II, the animals received Valdecoxib after post-operatory and 2 days after period. In group III, the animals were received Rofecoxib after post-operatory and 2 days after period. At 3, 7, 15 and 24 post-operatory days, four animals from each group were sacrificed by overdose anesthetic; the upper jaw was removed, fixed in formaline solution, demineralized in EDTA and embedded in paraffin. Six micrometer slices were stained with HE, to be analyzed under light microscopy. From the results, it was concluded that: 1) the soft tissue repair in groups II and III was the same compared to group I and II; 2) bone repair in groups II and III was delay compared to group I, beginning on 7 days after surgery