Assessment of the knowledge of canalis sinuosus amongst dentists and dental students: An online-based cross-sectional study.

INTRODUCTION: Canalis sinuosus (CS) is a neurovascular canal that corresponds to a small branch of the infraorbital canal. This study aimed at assessing the knowledge and detection performance of CS amongst dentists and dental students. MATERIALS AND METHODS: Four-hundred and five dentists and dental students answered a questionnaire with three parts: 1. Socio-demographical; 2. Clinical cases with cone- beam computed tomography (CBCT) sections showing CS and 3. Previous knowledge about CS. The chi-squared test and Spearman's correlation test were used to compare results as appropriate. p-values below .05 were considered statistically significant. RESULTS: Most participants did not identify CS in any CBCT. There was an association between the number of correct answers and dental specialties. Most individuals had not learned about CS previously. There was an association between past knowledge of CS and gender, highest academic degree, working environment, dental specialty and number of correct answers but not with age or experience in Dentistry. CONCLUSION: This study suggests that most dentists are not aware about CS and do not know how to diagnose it. Previous knowledge about CS positively influenced its identification in CBCT.

Radiographic examination in the diagnosis of a curious case associating odontoma to agenesis and supernumerary teeth / O exame radiográfico no diagnóstico de um caso curioso associando odontoma à agenesia e dente supranumerário

ABSTRACT Developmental disorders of human dentition may result in various abnormalities according to etiologic agents and the developmental period involved. The size, shape and number of teeth may be affected. Dental abnormalities can occur singly or in multiples in an individual and may or may not be associated with syndromes. Complementary radiographic examinations are valuable for diagnosis, especially in lesions that are asymptomatic and detected only through examination. The present study is intended to report a case of an incidental finding in panoramic radiography of an odontoma, a supernumerary tooth and permanent tooth agenesis in the same non-syndromic individual. According to the literature, the association of hypodontia and hyperdontia (called concomitant hypo-hyperdontia) is most common. The association of hyperdontia and odontoma is uncommon but still reported. However, regarding the association of hypodontia and odontoma no reports were found, as well as the association of the three pathologies.

RESUMO Os distúrbios de desenvolvimento da dentição humana podem resultar em diferentes anomalias dependendo do agente etiológico e do período do desenvolvimento acometido. O tamanho, a forma e o número dos dentes, dentre outros, podem ser afetados. Podem ocorrer isoladamente ou em conjunto num mesmo indivíduo, bem como estarem ou não associados a síndromes. Os exames radiográficos complementares são valiosos para o diagnóstico, sobretudo quando as lesões são assintomáticas e detectadas incidentalmente no exame. O presente trabalho relata o caso de achado incidental, em radiografia panorâmica, de odontoma, dente supranumerário e agenesia de dente permanente num mesmo indivíduo não sindrômico. Segundo relatos da literatura, a associação de hipodontia e hiperdontia, denominada hipo-hiperdontia concomitante, é a mais comumente encontrada. A associação de hiperdontia e odontoma é incomum, mas ainda é relatada. No entanto, a respeito da associação de hipodontia e odontoma não foram encontrados relatos, bem como da associação das três patologias.

Canalis sinuosus: An Anatomic Repair that May Prevent Success of Dental Implants in Anterior Maxilla.

Canalis sinuosus (CS) is a neurovascular canal that corresponds to a small branch of the infraorbital canal. It contains the anterior superior alveolar nerve and vessels, supplying the anterior maxilla. Despite having been described 81 years ago, CS is not recognized by many dental practitioners and may be the cause of unintended injuries during dental procedures. The aims of this study are to report a case of a patient who suffered pain due to exposure of the CS, to provide a comprehensive review of other CS cases that were challenging to diagnose, and to propose guidelines for preoperative examination of patients undergoing surgical procedures in the anterior maxilla. The review of the literature revealed six cases, in addition to the one presented here, of unintended or potential damage to CS. Five out of seven cases were related to dental implant placement and resulted in postoperative pain and/or paresthesia. The dental implant was removed in 4 out of the 5 cases. This study reinforces the importance of awareness of CS by dental practitioners and provides a protocol for the preoperative examination of the patient to prevent avoidable injuries to CS.

Study Between Panoramic Radiography and Cone Beam-Computed Tomography in the Diagnosis of Ameloblastoma, Odontogenic Keratocyst, and Dentigerous Cyst.

OBJECTIVE: To determine how the diagnosis may or may not be influenced by cone-beam computed tomography (CBCT), comparing the diagnostic hypotheses obtained using images of panoramic radiographs and CBCT in cases of ameloblastoma, odontogenic keratocyst, and dentigerous cyst. STUDY DESIGN: Five cases were selected for each lesion. Panoramic radiographs and CBCT scans were analyzed by 15 dentists for the formulation of the diagnostic hypotheses. Two observers performed the analyses and measurement of qualitative and quantitative features of the lesions evaluated in the CBCT. RESULTS: There was no statistically significant difference in correct diagnostic average between panoramic radiography and CBCT, but there was a significant difference in correct diagnostic average in the diagnosis of ameloblastoma using CBCT compared to panoramic radiography. Master's and PhD-level observers had greater correct diagnostic average in the diagnosis of odontogenic keratocyst using panoramic radiograph compared to specialists, with a significant difference. CONCLUSION: Cone-beam computed tomography images revealed that the ameloblastomas were greater in size and expansion compared to the odontogenic keratocyst and the dentigerous cysts. Ameloblastomas showed a higher incidence of multiloculated aspects compared to odontogenic keratocyst and dentigerous cysts. There were no differences between quantitative and qualitative features of odontogenic keratocyst and dentigerous cysts.

Sclerotherapy as an esthetic indication in oral vascular malformations: a case series.

BACKGROUND: The use of monoethanolamine oleate 5% is effective for the treatment of vascular malformations with low blood flow. OBJECTIVES: To report a case series of vascular malformations in the mouth and oral cavity treated with monoethanolamine oleate 5%. METHODS: A retrospective descriptive study was performed in electronic patient charts covering seven years. Patient demographics, diagnostic resources, lesion site, size, and number of applications of monoethanolamine oleate 5% were collected. RESULTS: A total of 21 vascular malformations were recorded, located mostly on the lower lip (52.3%) and resolved in a single application in 14 patients. The authors found 19 patients treated with sclerotherapy. Thirteen were women and six were men, with a mean age of 61 years. STUDY LIMITATION: Small sample size. CONCLUSIONS: Sclerotherapy is an effective treatment for vascular malformations of the lips and oral cavity, with resolution after only one or two applications (n=16).

Sclerotherapy as an esthetic indication in oral vascular malformations: a case series

Abstract Background The use of monoethanolamine oleate 5% is effective for the treatment of vascular malformations with low blood flow. Objectives To report a case series of vascular malformations in the mouth and oral cavity treated with monoethanolamine oleate 5%. Methods A retrospective descriptive study was performed in electronic patient charts covering seven years. Patient demographics, diagnostic resources, lesion site, size, and number of applications of monoethanolamine oleate 5% were collected. Results A total of 21 vascular malformations were recorded, located mostly on the lower lip (52.3%) and resolved in a single application in 14 patients. The authors found 19 patients treated with sclerotherapy. Thirteen were women and six were men, with a mean age of 61 years. Study limitation Small sample size. Conclusions Sclerotherapy is an effective treatment for vascular malformations of the lips and oral cavity, with resolution after only one or two applications (n = 16).

Foraminas acessórias da região anterior da maxila em tomografia computadorizada de feixe cônico / Additional foraminas in anterior maxilla through cone beam computed tomography

Por meio do exame tridimensional de Tomografia computadorizada de feixe cônico (TCFC) é possível avaliar a área de interesse previamente aos procedimentos com maior precisão. As variações anatômicas são estruturas que devem ser consideradas para a realização de cirurgias, como a foramina acessória da região anterior da maxila (FARAM). O objetivo principal do presente estudo foi avaliar a FARAM, em 150 exames de TCFC, obtidas no aparelho ICat Classic®. Por meio do programa ICat Vision® foram mensuradas o diâmetro, a distância da FARAM ao forame incisivo (FARAM-FI), da FARAM ao rebordo alveolar vestibular (FARAM-RAV) e da FARAM a sutura intermaxilar (FARAM-SI). Também foi avaliada a trajetória dos canais ósseos formados a partir da FARAM. Nos pacientes dentados, foram localizados por meio da área dos dentes: incisivo central, incisivo lateral e caninos. Foi realizada a correlação entre a presença da FARAM e o gênero e a idade. Dos 150 exames, a FARAM estava presente em 21 exames (14%). Destes, dez pacientes eram edêntulos na região de interesse de estudo e não foi possível localizar a foramina em relação aos dentes. Nenhum exame apresentou a FARAM relacionada ao incisivo central, em sete estavam relacionadas ao incisivo lateral e em quatro estavam relacionadas ao canino. Nenhum exame apresentou a FARAM bilateralmente, sendo que treze foram localizadas no lado direito e oito do lado esquerdo. O diâmetro médio da FARAM foi de 1,57 ± 0,38 mm. As médias das distâncias de FARAM-RAV foi de 11,65 ± 3,34 mm, FARAM-FI foi de 8,86 ± 2,72 mm e FARAM-SI, foi de 6,37 ± 2,9 mm. A trajetória do canal ósseo mais comum foi ascendente/oblíqua em direção a região anterior do assoalho da cavidade nasal. A correlação entre a presença da FARAM e o gênero foi estaticamente significante para os homens (p=0,055) no teste do qui-quadrado. No entanto, não foi estatisticamente significante para a idade.(AU)

Through cone beam computed tomography (CBCT) is possible to evaluate the region of interest before surgical procedures in tridimensional view. Anatomical variations should be considered for performing surgeries, as the additional foraminas in anterior maxilla (AFAM). The main aim of the present study is evaluate AFAM in 150 CBCT exams, obtained through ICat Classic® device. In ICat Vision® software, the diameter, the distance from the AFAM to the incisive foramen (AFAM-IF), AFAM to the vestibular alveolar ridge (AFAM-VAR) and AFAM intermaxillary suture (AFAM-IS) were measured. It was also evaluated the trajectory of the bony canals related to AFAM. In dentate patients, AFAM was located through the teeth area: central incisor, lateral incisor and canines. The correlation between the presence of FARAM and gender and age was investigated. The AFAM was presented in 21 exams (14%). In the positive exams, 10 patients were edentulous in the region of study interest and it was not possible to locate the foramen in relation to the teeth. Any exam presented the AFAM related to the central incisor, in seven were related to the lateral incisor and in four were related to the canine. Any exam presented the AFAM bilaterally, of which thirteen were located on the right side and eight on the left side. The mean diameter of the AFAM was 1.57 ± 0.38 mm. The distance of the AFAM-VAR 11.65 ± 3.34 mm, AFAMIF was 8.86 ± 2.72 mm and AFAM-IS was 6.37 ± 2.9 mm. The most common bone canal trajectory was upward/ oblique to the anterior region of the floor of the nasal cavity. The correlation between the presence of AFAM and the gender was statically significant for males (p=0.055) in the chi-square test. However, it was not statistically significant for age.(AU)

Tuberous Sclerosis: A Case Report with Oral Manifestation / Esclerosis Tuberosa: Caso Clínico con Manifestaciones Orales

Tuberous sclerosis is an autosomal dominant neurocutaneous syndrome, which may involve multiple organ systems and shows highly variable clinical manifestations. Oral manifestations, including lesions on hard tissues, enamel hypoplasia and gingival hyperplasia have been previously described. We report a case of 25-year-old woman with this syndrome presenting multiple fibrous nodules on the buccal mucosa and lips. Awareness of the different oral manifestations of tuberous sclerosis is important to ensure appropriate diagnosis and treatment.

La esclerosis tuberosa es un síndrome autosómico dominante neurocutáneo, que puede afectar varias partes del cuerpo y las manifestaciones clínicas son variables. Manifestaciones orales que incluyen lesiones en tejidos duros, hipoplasia del esmalte e hiperplasia gingival se han descrito previamente. Este artículo presenta un caso de una mujer de 25 años con esclerosis tuberosa presentando múltiples nódulos fibrosos en la mucosa bucal y los labios. El conocimiento de las diferentes manifestaciones orales de la esclerosis tuberosa es importante para asegurar el diagnóstico y tratamiento adecuados.

Forâmen lingual lateral – relato de dois casos clínicos através da tomografia computadorizada de feixe cônico / Lateral lingual foramina (LLF) – two case reports with the use of cone beam computed tomography (CBCT)

O reconhecimento do forâmen lingual lateral (FLL) e muito importante, especialmente na implantodontia. Assim, a tomografia computadorizada feixe cônico (TCFC) permite a visualização de estruturas anatômicas nao detectadas na radiografia convencional, com o FLL. Este artigo relata dois casos de FLL ambos no lado direito em dois pacientes distintos. Ambos os exames foram obtidos pelo I-Cat e avaliados no programa I-Cat Vision. A injúria aos vasos que atravessam a FLL pode causar hematoma no assoalho bucal e, em situações mais graves, a obstrução das vias aéreas superiores

Lateral lingual foramen (LLF) recognition is very important, especially to dental implant practitioners. In this way, cone-beam computed tomography (CBCT) allows visualization of anatomic structures not detected in conventional radiography, such as LLF. This paper reports two LLF cases both at the right side in two different patients. Both exams were obtained through I-CAT Classic device and evaluated with the I-CAT Vision software. Injuries to LLF contained vascular bundles might cause hematoma at the floor of the mouth and, in worst cases, subsequent upper airway obstruction.

Foraminas acessórias mandibulares em tomografia computadorizada de feixe cônico / Accessory mandibular foramina in cone-beam computed tomography

Com o surgimento da Tomografia Computadorizada de Feixe Cônico (TCFC) foi possível observar estruturas anatômicas que antes não eram visualizadas em radiografias convencionais, como a foramina lingual lateral (FLL). A FLL é um orifício localizado na região posterior lingual da mandíbula que se comunica com o canal mandibular (CM). O objetivo do estudo foi avaliar a presença da FLL em 100 exames de TCFC obtidas pelo aparelho i-CAT Classic®. A presença da FLL foi comparada entre gênero e idade. As FLL foram localizadas em pacientes dentados através de 5 áreas: primeiro pré-molar inferior (A), segundo pré-molar inferior (B), primeiro molar inferior (C), segundo molar inferior (D) e terceiro molar inferior (E). Foram realizadas as medidas de diâmetro axial (DA), diâmetro coronal (DC) e a distância de FLL ao forame mentual (FLL-FM), e FLL à borda inferior da mandíbula (FLL-BI). A FLL estava presente em 39% (39/100) dos exames e foram encontradas 52 FLL (26 exames unilaterais e 13, bilaterais). O lado direito apresentou 29 FLL, enquanto o lado esquerdo 23. A região onde mais foi encontrada FLL foi a região B. 21 foraminas foram encontradas na posição lingual ao FM. O valor médio do DA foi de 1,26±0,57 mm e do DC de 1,82±1,12 mm. Os valores médios da distância de FLLFM e FLL-BI foram 12,74±7,7 e 5,82±2,78 mm, respectivamente. Não houve diferença estatisticamente significante da presença da FLL entre a idade ou o sexo. A medida FLL-FM foi maior em homens tanto do lado direito como do lado esquerdo, mostrando uma diferença estatisticamente significante (p=0,032).

Cone-beam Computed Tomography (CBCT) allowed viewing some anatomical structures that were not noted in bi-dimensional images, such as lateral lingual foramina (LLF). LLF is an aperture located in posterior lingual mandible area, linked with mandibular canal (MC). The present study evaluated the LLF presence through 100 CBCT images, obtained by i-CAT Classic®. Presence or absence of LLF was compared between sex and age. The LLF was located in dentate patients through 5 areas: first lower pre-molar (A), second lower pre-molar (B), first lower molar (C), second lower molar (D) and third lower molar (E). Was measured axial diameter (AD) and coronal diameter (DC), and, the distance from LLF to mentual foramen (LLF-MF) and from LLF to lower mandible border (LLF-LMB). These measures were also compared between gender. LLF was observed in 39% of the exams (39/100). Fiftytwo LLF were found (26 unilateral and 26 bilateral). Right and left sides presented 29 LLF and 23 LLF respectively. The most prevalent area of LLF occurrence was B area. 21 LLF was located in lingual position of MF. The mean average of AD was 1,26±0,57 mm, and CD was 1,82±1,12 mm. The mean average values of LLF-MF and LLF-BI distances were 12,74±7,7 and 5.82±2,78 mm, respectively. There was no statistical difference of gender or age correlated with LLF presence. Men have LLFMF distance greater than woman, showing no statistically significant difference (p=0,032).

Position of the greater palatine foramen: an anatomical study through cone beam computed tomography images.

PURPOSE: The block anesthesia of the greater palatine foramen (GPF) is largely used in minor oral surgeries, periodontics and general dentistry. Furthermore, the area of the GPF serves as a donor of soft tissue graft. So, the aim of this study was to evaluate the position and characteristics of the GPF in Brazilian patients using cone beam computed tomography (CBCT) providing anatomical information for the greater palatine nerve block anesthesia and indicate site to collect palatal donor tissue. METHODS: Fifty CBCT exams of Brazilian patients with a mean age of 35.8 years (27 male/23 female) were evaluated. All patients had erupted first, second and third upper molars. A total of 100 GPF were evaluated bilaterally. The GPFs were assessed regarding position, diameter and distances to the midline maxillary suture (MMS) and to alveolar ridge (AR). Guidelines were drawn in the CBCT axial image depicting all molar interproximal surfaces, bilaterally. The guidelines were located between first, second and third molar and in the center of the second and third, performing five guidelines in each side. These guidelines and the molars were landmarks to assess the GPF anatomic position. RESULTS: From the 100 GPF analyzed, 92 were located in the third molar region (24 male/22 female). The 92 GPF were distributed as 47 in the left side and 45 in the right side. The average GPF diameter and the distance to both the AR and the MMS were 3.1 mm; 7.9 and 15.3 mm, respectively. CONCLUSIONS: Within the limits of this study, we concluded that the in Brazilian patients studied, the GPF location was more closely related to third molar. Therefore, whenever the third molar is erupted, it could be used as landmark for successful GPN block anesthesia. Moreover, harvesting palatal mucosa graft around the third molar should be done cautiously to prevent damage to the GPF vascular-nerve complex.

Lipoma oral: considerações gerais e relato de caso com características atípicas / Oral lipoma: general considerations and case report with atypical cha racteristics

Olipoma é um tumor benigno mesenquimal raro na boca, que se desenvolve em qualquer área onde há tecido adiposo. Classicamente, a lesão é amarelada e, quando removida por biópsia excisional, emerge no fixado r, dado este importante no diagnóstico. O objetivo deste trabalho é relatar um caso de lipoma oral, assim como abordar as principais características da lesão e a importância de cada etapa no diagnóstico das lesões orais.

Lipoma is arare mesenchymal benign neoplasm in the oral cavity, which develops in anysite where there is fat tissue. Classicall, the lesion is yellwish, and when it is removed by an excisional biopsy it emerges in a solution of formaldehyde, this being an important finding at diagnosis. The aim of this work is to report a case of orallipoma, as well as the main characteristics of this lesion and the value of each step in the diagnosis of oral injuries.