Evaluation of renal osteodystrophy in the dental clinic by assessment of mandibular and phalangeal cortical indices.

OBJECTIVES: Secondary hyperparathyroidism (SHPT) is a disease that affects patients with chronic kidney disease, and is characterized by mineral disturbance and bone loss, known as renal osteodystrophy. The aim of this study was to assess the validity of using intraoral phosphor storage plates to take radiographs of the middle phalanges to evaluate bone loss resulting from SHPT during follow-up of these patients. METHODS: The sample consisted of 24 patients with chronic kidney disease, 12 with parathyroid hormone (PTH) levels ≥500 pg/ml, and 12 with PTH levels <500 pg/ml, who underwent hemodialysis weekly. For each patient, a panoramic radiograph and digital radiographs of the ring, index, and middle fingers of both hands were taken. The Mandibular Cortical Index (MCI) and the Trabecular Bone Pattern Index (TBP) were applied to the panoramic radiographs, while the Phalangeal Cortical Index (PCI) was applied to the digital radiographs of the phalanges. Three evaluators performed all analyses. RESULTS: Significant correlations were found between the PTH levels and the MCI (p = 0.023), the PCI (p = 0.039) and the TBP index (p = 0.032). These parameters were also significantly interrelated (MCI × PCI = 0.001; MCI × TBP = 0.004 and PCI × TBP = 0.009). The PCI was shown to have the highest correlation with PTH levels. CONCLUSION: In patients with chronic renal disease, it is clinically relevant to use panoramic and digital radiographs using intraoral storage plates to assess a number of quantitative parameters that can be linked to PTH levels.

Quantitative evaluation of posterior mandibular region by cone beam computerized tomography as a donor site for autogenous bone grafts / Avaliação quantitativa da região posterior de mandíbula por meio da tomografia computadorizada cone beam como área doadora para enxertos ósseos autógenos

Knowledge of the craniofacial anatomic structures is fundamental for successful autogenous bone grafting surgeries in implant dentistry. In view of the limitations of panoramic radiography, as a bidimensional image, Cone Beam Computerized Tomography (CBCT) has become necessary, as it makes possible to observe potential segments of autogenous bone grafting for implant placement in edentulous regions. The aim of this paper was quantify the bone thickness using CBCT to measure the thickness of the vestibular cortical-medullary bone in the mandibular retromolar and molar regions, as donor segments for the patients. The scans were obtained from a Newtom QVT 9000 3G Aperio ® Tomograph. They were taken from mandibles of 50 patients. We obtained statistically significant differences between measurements of molar areas of men and retromolar area of women (p<0.05). The results of this research broaden the dentist's knowledge about evaluating potential donor areas in the posterior region of the mandible, as regards the requirement of predictability. In conclusion, greater thickness of donor area was observed in both the male and female gender bilaterally, in the mandibular retromolar and third molar regions. Furthermore, upper segment region presented greater cortical thickness in all the studied regions.

O conhecimento das estruturas anatômicas craniofaciais é fundamental para o sucesso de cirurgias de enxerto ósseo autógeno em implantodontia. Tendo em vista as limitações da radiografia panorâmica, como uma imagem bidimensional, a tomografia computadorizada Cone Beam (TCCB) tornou-se necessária, uma vez que torna possível observar segmentos ósseos com potencial para serem utilizados como enxertos autógenos para a colocação de implante em regiões desdentados. O objetivo deste estudo foi quantificar a espessura de osso usando TCCB para medir a espessura óssea cortical-medular vestibular nas regiões retromolar e molar inferior, como segmentos de doadores para os pacientes. Os exames foram obtidos a partir de um Newtom QVT 9000 3G Aperio ® Tomograph. Estes foram retirados de mandíbulas de 50 pacientes. Observamos diferenças estatisticamente significativas entre as medidas de áreas molares de homens e área retromolar das mulheres (p <0,05). Os resultados desta pesquisa ampliam o conhecimento do cirurgião-dentista sobre a avaliação de áreas doadoras potenciais na região posterior da mandíbula, no que diz respeito à exigência de previsibilidade. Em suma, observamos uma maior espessura da área doadora, tanto no sexo masculino quanto no feminino, na retromolar mandibular e na região de terceiros molares. A região do segmento superior apresentou maior espessura cortical em todas as regiões estudadas.

Severe secondary hyperparathyroidism and panoramic radiography parameters.

OBJECTIVES: Renal osteodystrophy (RO) are skeletal abnormalities seen in patients with secondary hyperparathyroidism (SHPT). This study aims to evaluate the effects of RO using panoramic radiography parameters. Furthermore, the correlation between these parameters and parathyroid hormone (PTH) levels was tested. MATERIALS AND METHODS: Qualitative (mandibular cortical index/trabecular bone pattern) and quantitative parameters (mental index/calcification and resorption foci) were applied from panoramic radiographs of chronic kidney disease (CKD) patients and controls. Frequency distribution and descriptive analysis were used to compare the results of both groups. Spearman's correlation coefficient evaluated the correlation between serum PTH levels of CKD patients and the radiographic parameters. Intra- and interobserver agreement was tested using the intraclass correlation coefficient and kappa index. RESULTS: Intra- and interobserver agreement was respectively excellent (0.81-1.00) and good (0.61-0.80). Qualitative parameters demonstrate significant difference compared with the control group. Mean mental index was lower in patients with CKD (3.17 ± 1.35 mm), but the difference was not significant. Calcification/resorption foci (3.63 ± 2.07) of CKD patients were significantly more present than in the control group (p = 0.0001). PTH levels were correlated with mental index, mandibular cortical index and trabecular bone pattern (respectively, 0.0034, 0.0315, and 0.0370). CONCLUSIONS: RO presented a number of characteristic bone metabolic effects in the jaws that could be observed on panoramic radiographs. Radiographs of CKD patients demonstrate significantly more calcification and resorption. CLINICAL RELEVANCE: The mental index, mandibular cortical index, and trabecular bone pattern are good parameters for evaluating the effects of RO on severe secondary hyperparathyroidism.

Correlation between hand/wrist and panoramic radiographs in severe secondary hyperparathyroidism.

OBJECTIVES: Hand/wrist and dental radiographs are important for osteoporosis analysis in secondary hyperparathyroidism (SHPT). This study evaluated whether a correlation exists between the effects of the disease on the hands and jaws, and investigated the association between osteoporosis progression in the hands and parathyroid hormone (PTH) levels in chronic kidney disease (CKD) patients. MATERIALS AND METHODS: Four panoramic radiographic parameters (mental index, mandibular cortical index, trabecular bone pattern, and calcification/resorption) and four corresponding hand/wrist radiographic parameters (metacarpal cortical thickness, phalangeal cortical index, trabecular bone pattern, and calcification/resorption) were applied to investigate possible correlation between the effects of SHPT on the jaws and hands/wrists, by Spearman's correlation coefficient. PTH levels and the hand/wrist radiographic parameters were also tested by spearman's correlation coefficient (p < 0.05). The presence of brown tumors, vascular calcifications, and acroosteolysis on the hands was also evaluated. RESULTS: Mandibular cortical index was strongly correlated with the phalangeal cortical index (p = 0.000). Phalangeal cortical index and trabecular bone pattern of hand/wrist correlated with PTH levels (0.002 and 0.000, respectively). Brown tumors occurred in four CKD patients, while both vascular calcifications and acroosteolysis were observed in 19 patients. CONCLUSION: There is a significant correlation between the morphological changes caused by secondary hyperparathyroidism in hand and jaw bones. The morphological status can be assessed using the mandibular cortical index, besides the phalangeal cortical index. The latter correlates well with parathyroid hormone levels of advanced chronic kidney disease. CLINICAL RELEVANCE: Panoramic images reveal morphological changes in the jaw bone, indicating likewise changes in the hand/wrist in severe secondary hyperparathyroidism. The severity of the bone changes may be a reflection of the parathyroid hormone levels in advanced chronic kidney disease.

Avaliação volumétrica por meio da tomografia computadorizada de feixe cônico, dos leitos ósseos potencialmente doadores na região de ramo e mento / Volumetric evaluation by cone beam computed tomography, about the potentially donors bone grafts in ramus and chin

As tomografias computadorizadas (TCs) tridimensionais (3D) solucionaram em grande parte as inconveniências da sobreposição de estruturas anatômicas comuns aos exames radiográficos convencionais (2D). O propósito neste trabalho foi avaliar por meio da Tomografia computadorizada de feixe cônico (TCFC) qual região oferece maior volume ósseo, se a região de mento ou aregião de ramo da mandíbula. Foram selecionados 100 exames de TCFC, de indivíduos com idade de 18 a 89 anos do sexo masculino (50) e do feminino(50) com necessidade de realizar cirurgia para enxertia óssea autógena. Os exames foram avaliados por dois radiologistas treinados, para quantificar o volume ósseo das regiões potencialmente doadoras, que foram avaliadas por diferentes orientações para delimitação do volume potencial do leito doador, utilizando um software para avaliação. Sendo posteriormente avaliados pela análise estatística t de Student, teste de Tukey, correlacionando as diferenças estatísticamente significantes (p < 0,05) entre a avaliação das região mensuradas, por métodos diferentes. Verificou-se o maior potencial doador encontrado na região mentual, chegando a atingir o volume médio de 1,59cm 3contra 1,07cm3 a região de ramo. Concluímos que a região mentual, entre os dentes caninos inferiores, proporciona maior volume ósseo e assim como na revisão da literatura, encontramos maior volume ósseo para a região mentual quando comparada as outras regiões doadoras intraorais, avaliadas neste trabalho. E que a seleção do leito doador de enxerto ósseo autógeno intraoral deve ser principalmente julgada de acordo com o conhecimento anatômico da região eletiva e o domínio técnico/prático cirúrgico do Cirurgião.

Computed tomography (CT) three-dimensional largely solved the inconvenience of over lapping anatomical accidents common to conventional radiographic. The purpose of this study was to evaluate by cone beam computed tomography (CBCT) the region that offers larger bone volume, the ramus or chin region. Were selected according to the criteria of inclusion and non inclusion, 100 CBCT scans of individuals aged 18-89 years old males (50) and female (50) with need for surgery for autogenous grafting, belonging to a particular clinical CT. The studies were evaluated by two trained radiologists in the program OsiriX ® 4.1.2V to quantify bone volume of potential donor regions, which were evaluated by different guidelines, defining the potential volume of the donor site. Further evaluated by statistical analysis Student's t and Tukey's test, that comproove statistically significant differences (p < 0,05) between the evaluations of the same region by different methods. With the largest potential donor found in the chin region, reaching an volume average of 1,59 cm3 against 1,07 cm3 the ramus region.

Avaliação volumétrica por meio da tomografia computadorizada de feixe cônico, dos leitos ósseos potencialmente doadores na região de ramo e mento / Volumetric evaluation by cone beam computed tomography, about the potentially donors bone grafts in ramus and chin

As tomografias computadorizadas (TCs) tridimensionais (3D) solucionaram em grande parte as inconveniências da sobreposição de estruturas anatômicas comuns aos exames radiográficos convencionais (2D). O propósito neste trabalho foi avaliar por meio da Tomografia computadorizada de feixe cônico (TCFC) qual região oferece maior volume ósseo, se a região de mento ou aregião de ramo da mandíbula. Foram selecionados 100 exames de TCFC, de indivíduos com idade de 18 a 89 anos do sexo masculino (50) e do feminino(50) com necessidade de realizar cirurgia para enxertia óssea autógena. Os exames foram avaliados por dois radiologistas treinados, para quantificar o volume ósseo das regiões potencialmente doadoras, que foram avaliadas por diferentes orientações para delimitação do volume potencial do leito doador, utilizando um software para avaliação. Sendo posteriormente avaliados pela análise estatística t de Student, teste de Tukey, correlacionando as diferenças estatísticamente significantes (p < 0,05) entre a avaliação das região mensuradas, por métodos diferentes. Verificou-se o maior potencial doador encontrado na região mentual, chegando a atingir o volume médio de 1,59cm 3contra 1,07cm3 a região de ramo. Concluímos que a região mentual, entre os dentes caninos inferiores, proporciona maior volume ósseo e assim como na revisão da literatura, encontramos maior volume ósseo para a região mentual quando comparada as outras regiões doadoras intraorais, avaliadas neste trabalho. E que a seleção do leito doador de enxerto ósseo autógeno intraoral deve ser principalmente julgada de acordo com o conhecimento anatômico da região eletiva e o domínio técnico/prático cirúrgico do Cirurgião

Computed tomography (CT) three-dimensional largely solved the inconvenience of over lapping anatomical accidents common to conventional radiographic. The purpose of this study was to evaluate by cone beam computed tomography (CBCT) the region that offers larger bone volume, the ramus or chin region. Were selected according to the criteria of inclusion and non inclusion, 100 CBCT scans of individuals aged 18-89 years old males (50) and female (50) with need for surgery for autogenous grafting, belonging to a particular clinical CT. The studies were evaluated by two trained radiologists in the program OsiriX ® 4.1.2V to quantify bone volume of potential donor regions, which were evaluated by different guidelines, defining the potential volume of the donor site. Further evaluated by statistical analysis Student's t and Tukey's test, that comproove statistically significant differences (p < 0,05) between the evaluations of the same region by different methods. With the largest potential donor found in the chin region, reaching an volume average of 1,59 cm3 against 1,07 cm3 the ramus region

O uso da tomografia computadorizada 3D cone beam no diagnóstico e na localização de caninos impactados / The use of computer tomography 3D cone beam to diagnosis and location of impacted canines

O diagnóstico e a localização de dentes caninos impactados superiores sempre foi um desafio para os ortodontistas. Métodos tradicionais radiográficos em duas dimensões vêm nos auxiliando na detecção dos dentes e possíveis problemas associados. Seguindo a evolução das tomografias computadorizadas o método definido como Cone Beam ou feixe cônico permite agora exames detalhados e com menor índice de radiação sobre as estruturas crânio-faciais, sendo de grande utilidade principalmente para a odontologia. O presente trabalho tem como objetivo apresentar as vantagens do uso da tomografia computadorizada na localização de dentes caninos superiores ectópicos, assim como detalhar o diagnóstico de três casos clínicos relacionados ao tema.

The diagnosis and location of impacted upper canine teeth has always been a challenge for orthodontists. Traditional radiographic methods in two dimensions have been assisting in the detection of dental problems and possible associates. Following the evolution of computed tomography the method defined as "Cone Beam" permits detailed examinations and with the lowest level of radiation on the skull-facial structures, and a very useful mainly for dentistry. This paper aims to present the advantages of using the CT scan in locate higher ectopic canine teeth, and detailing the diagnosis of three cases as well.