Mandibular canal bifurcation and trifurcation: case report from a finding obtained through cone beam computed tomography / Bifurcação e trifurcação do canal mandibular: relato de caso a partir de um achado em tomografia computadorizada de feixe de cone

Aim: This case report aims to demonstrate a rare mandibular canal (MC) variation, presenting right trifurcation and left bifurcation through Cone-Beam Computed Tomography (CBCT). Case report: A 26-year-old female patient with no systemic disorders was referred for surgical removal of the lower third molars due to the presence of painful symptoms. CBCT was requested to evaluate the relationship between third molars and the mandibular canal and to guide the surgical planning. Tomographic volume was analyzed through the Sidexis software (Sirona Dental Systems, Bernsheim, Germany). During the analysis of tomographic sections, it was possible to observe the presence of bilateral MC variations. Bifurcation of the right MC and trifurcation of the left MC were observed. Conclusion: The present report highlighted the importance of CBCT for the diagnosis of anatomical changes, such as MC trifurcation.

Objetivo: Este relato tem por objetivo descrever uma rara variação do canal mandibular (CM) apresentando trifurcação direita e bifurcação esquerda, por meio da Tomografia Computadorizada de Feixe Cônico (TCFC). Relato do caso: Paciente do sexo feminino, 26 anos de idade, sem comprometimento sistêmico, foi encaminhada para remoção cirúrgica dos terceiros molares inferiores devido a presença de sintomatologia dolorosa. Foi solicitada uma TCFC para avaliar a relação entre terceiros molares e o canal mandibular, para orientar o planejamento cirúrgico. O volume tomográfico foi analisado por meio do software Sidexis (Sirona Dental Systems, Bernsheim, Alemanha). Durante a análise dos cortes tomográficos, foi possível observar a presença de variações do CM bilateralmente. Observou-se bifurcação do CM direito e trifurcação do CM esquerdo. Conclusão: O presente relato destacou a importância da TCFC para o diagnóstico das alterações anatômicas, como a trifurcação do canal mandibular.

Mandibular incisive canal-related prevalence, morphometric parameters, and implant placement implications: a multicenter study of 847 CBCT scans

BACKGROUND: This study evaluated the epidemiological and morphological features of the mandibular incisive canal (MIC) using cone beam computed tomography (CBCT) in a significant sample of subjects in Brazil. MATERIAL AND METHODS: This retrospective, multicenter study assessed 847 CBCT scans performed at four oral imaging centers. The sample comprised CBCT images acquired from dentate individuals who presented at least from tooth 35 to tooth 45 in the anterior mandible region. Data regarding patient sex and age, and MIC linear measurements (length and diameter in mm), anatomical distances (to the alveolar, buccal and lingual cortexes, inferior border of the mandible, and adjacent teeth apexes), and location were obtained. RESULTS: The MIC was more prevalent in women (76.3% [p < 0.001]) between the fourth and sixth decades of life (p < 0.001). It was present bilaterally (p < 0.001) and exhibited a mean length of 7.7 mm (standard deviation [SD]=3.7 mm). Spearman correlation and logistic regression analysis revealed collinearity between age and linear measurements (p < 0.05). The mean distances varied from the initial to the final portion of the MIC, respectively, in relation to the buccal cortex (mean = 2.6 mm, SD = 1.27; mean=3.96 mm; SD =1 .43), to lingual cortex (mean=5.13 mm; SD=1.7; mean = 4.61 mm, SD = 1.65), and to the inferior mandibular border (mean = 9.32 mm, SD = 1.92; mean=8.76 mm, SD = 2.07 mm). The difference in the proximity of the MIC to the apex of the inferior lateral incisor was statistically significant (p < 0.05). CONCLUSIONS: Results of this study revealed a high prevalence of MIC with a bilateral pattern in women who were between the fourth and sixth decades of life. Both the distance between the MIC and the lingual cortex of the mandibular alveolar bone, and the diameter of the MIC, decreased as its trajectory assumed a more anterior position

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Effect of different exposure times on caries detection and pixel value in a wireless digital system.

OBJECTIVES: : The aim of this study was to assess, using the CDR Wireless®, the effect of different exposure times on caries detection and pixel intensity values. MATERIALS AND METHODS: Forty teeth were x-rayed using a Schick CDR Wireless sensor at eight different exposure times - 0.06, 0.10, 0.13, 0.16, 0.20, 0.25, 0.30, and 0.32 s. Four observers evaluated the images for presence of carious lesions scoring proximal surfaces of each tooth on a 5-point scale. Scores were compared to histological sections of the teeth. Accuracy was evaluated by means of ROC curve analysis. Radiographs of an aluminum step wedge were obtained using the same eight exposure times. Pixel intensity measurements were obtained, and mean pixel values were statistically analyzed using linear regression. RESULTS: The Az for each exposure time varied from 0.53 to 0.62. Two-way analysis of variance and Tukey test demonstrated that the exposure time of 0.25 s presented the best result and was significantly higher than 0.30 s and 0.35 s. In regard to mean pixel values, two different behaviors were observed, and the exposure time of 0.20 s presented mean pixel values in both phases. CONCLUSION: The performance of the exposure times from 0.06 s to 0.25 s was satisfactory for proximal caries detection, and 0.25 s is the best as indicated for this finality. CLINICAL RELEVANCE: Considering that a reduction of exposure time represents a reduction of patient exposure dose, and this reduction cannot neglect image quality, the behavior of any digital system must be carefully evaluated.

Termografia infravermelha na odontologia / Infrared thermography in dentistry

A termografia infravermelha consiste em um exame de imagem complementar aplicada na avaliação da temperatura corporal com base na emissão de radiação infravermelha através da pele, podendo auxiliar no diagnóstico ou monitoramento das intervenções terapêuticas. Trata-se de uma técnica não ionizante e não invasiva que capta e registra a distribuição térmica da superfície cutânea avaliada por meio das alterações na microcirculação dos pacientes frente a diferentes condições patológicas. Dentre as aplicações na Odontologia, a termografia pode complementar o exame físico anatômico, visto que apresenta em tempo real condições fisiológicas, de acordo com a temperatura. Esta técnica pode auxiliar no diagnóstico e planejamento do tratamento de alterações orofaciais, como processos inflamatórios e infecciosos na região orofacial, acompanhamento pós-cirúrgico e na avaliação de pacientes com desordens temporomandibulares (DTM). A termografia ainda é pouco utilizada na Odontologia, e protocolos para avaliação de alterações na região de cabeça e pescoço ainda devem ser testados e estabelecidos. Porém, já mostra ser um exame complementar de boa performance na detecção de pontos gatilho da dor, acompanhamento de pacientes de forma não invasiva e como documentação médico-legal.

Infrared thermography consists of a complementary imaging test applied to the assessment of body temperature based on the emission of infrared radiation through the skin, which may aid in the diagnosis or monitoring of therapeutic interventions. It is a non-ionizing and non-invasive technique that captures and records the thermal distribution of the cutaneous surface evaluated by means of the changes in the patients' microcirculation in face of different pathological conditions. Among the applications in Dentistry, thermography can complement the anatomical physical examination, since it presents in real time physiological conditions according to temperature. This technique can help in the diagnosis and planning of the treatment of orofacial alterations, such as inflammatory and infectious processes in the orofacial region, post-surgical follow-up and in the routine evaluation of patients with temporomandibular disorders (TMD). Thermography is still poorly used in Dentistry and protocols for the evaluation of head and neck disorders have yet to be tested and established. However, it already shows up as a good complementary examination for the detection of pain trigger points, follow-up of patients in a non-invasive way, and as medical-legal documentation.

Decrease in Mandibular Cortical in Patients With Type 1 Diabetes Mellitus Combined with Poor Glycemic Control.

In this study we analyzed the mandibular cortical bone of patients with type 1 diabetes mellitus (T1DM) and non-diabetic. Fifty patients with T1DM and 100 non-diabetic ones paired by age and gender were analyzed. Two double-blinded observers evaluated 150 digital panoramic images of both groups. The mandibular cortical bone was analyzed using the Mandibular Cortical Index (MCI), Mental Index (MI), Gonial Index (GI), Antegonial Index (AI) and Upper and Lower Panoramic Mandibular Indexes (UPMI and LPMI), with the aid of RADIOIMP® software. Influence of T1DM in the morphology of the mandibular cortical bone was studied based on obtaining data related to T1DM diagnosis time, blood glucose level, T1DM control and the presence of chronic complications. Collected data were submitted to descriptive (mean and standard deviation) and inferential analyzes (Pearson's chi-squared test and Fisher's exact test) (p≤0.05). According to the MCI, individuals with T1DM had higher frequencies of mandibular cortical alterations, in both sexes and all age groups (p<0.01). For quantitative indexes, MI, GI, AI, UPMI and LPMI, female patients showed statistically significant differences for GI and AI, while male patients had statistically significant differences for all indexes (p<0.05), presenting the individuals with TDM1 inferior measures. Individuals with poor T1DM control showed significantly higher frequency of mandibular cortical alteration (92.3%), with lower means for MI, GI, AI and LPMI (p≤0.05). In conclusion, patients with T1DM showed decrease in the mandibular cortical bone when compared to non-diabetic ones, indicating that poor disease control is associated with these alterations.

The effect of different exposure parameters on proximal caries detection using the Kodak 9000 3D CBCT system / Efeito de diferentes parâmetros de exposição na detecção de cáries proximais usando o sistema Kodak 9000 3D TCFC

ABSTRACT Objective: The objective of study was to evaluate the diagnostic quality of CBCT images for caries lesions detection using different exposure parameters. Methods: Sixty extracted human teeth were selected and scanned using Kodak 9000 3D CBCT system, with the following exposure parameters combinations: 74 kV, 10mA; 74 kV, 12mA; 74 kV, 8 mA; 70 kV, 10 mA; 70kV, 12 mA; 70 kV e 8 mA; 70 kV, 6.3 mA. Two observers evaluated the images for caries presence using CS 3D Imaging Software. Each observer scored the proximal surfaces of each tooth on a 5-point scale. The scores were compared to histological sections used as gold standard. Accuracy for caries lesion detection was assessed for each exposure parameter combination and evaluated by means of ROC curve analysis. Results: The mean values for the areas under the ROC curves for each exposure parameter combination varied from 0.35 to 0.60. There was no statistical significant difference among protocols 1, 2, 4, 6 and 7. However, protocols 3 and 5 differed from all protocols. Conclusion: Although the highest dose protocol was the most efficient for proximal caries detection, the lowest dose protocol should be chosen based on the ALADA principle.

RESUMO Objetivo: Avaliar a qualidade de diagnóstico de imagens de TCFC para detecção de lesões de cárie utilizando parâmetros de exposição diferentes. Métodos: Sessenta dentes humanos extraídos foram selecionados e digitalizados usando o sistema Kodak 9000 3D TCFC, com as seguintes combinações de parâmetros de exposição: 74 kV, 10 mA; 74 kV, 12 mA; 74 kV, 8 mA70 kV, 10 mA; 70 kV, 12 mA; 70 kV e 8 mA; 70 kV, 6,3 mA. Dois observadores avaliaram as imagens para a presença de cárie utilizando o CS 3D Imaging Software. Cada observador pontuou as superfícies proximais de cada dente em uma escala de 5 pontos. Os escores foram comparados com cortes histológicos, utilizados como padrão-ouro. A precisão para detecção de lesões de cárie foi analisada para cada combinação de parâmetros de exposição e avaliada por meio de análise da curva ROC. Resultados: Os valores médios para as áreas sob as curvas ROC para cada combinação de parâmetro de exposição variou de 0,35-0,60. Não houve diferença estatística significativa entre os protocolos 1, 2, 4, 6 e 7. No entanto, os protocolos 3 e 5 diferem de todos os protocolos. Conclusão: Embora o protocolo de dose mais elevada foi o mais eficiente para a detecção da cárie proximal, o protocolo de dose mais baixa deverá ser escolhido com base no princípio ALADA.

Decrease in Mandibular Cortical in Patients With Type 1 Diabetes Mellitus Combined with Poor Glycemic Control

Abstract In this study we analyzed the mandibular cortical bone of patients with type 1 diabetes mellitus (T1DM) and non-diabetic. Fifty patients with T1DM and 100 non-diabetic ones paired by age and gender were analyzed. Two double-blinded observers evaluated 150 digital panoramic images of both groups. The mandibular cortical bone was analyzed using the Mandibular Cortical Index (MCI), Mental Index (MI), Gonial Index (GI), Antegonial Index (AI) and Upper and Lower Panoramic Mandibular Indexes (UPMI and LPMI), with the aid of RADIOIMP® software. Influence of T1DM in the morphology of the mandibular cortical bone was studied based on obtaining data related to T1DM diagnosis time, blood glucose level, T1DM control and the presence of chronic complications. Collected data were submitted to descriptive (mean and standard deviation) and inferential analyzes (Pearson's chi-squared test and Fisher's exact test) (p≤0.05). According to the MCI, individuals with T1DM had higher frequencies of mandibular cortical alterations, in both sexes and all age groups (p<0.01). For quantitative indexes, MI, GI, AI, UPMI and LPMI, female patients showed statistically significant differences for GI and AI, while male patients had statistically significant differences for all indexes (p<0.05), presenting the individuals with TDM1 inferior measures. Individuals with poor T1DM control showed significantly higher frequency of mandibular cortical alteration (92.3%), with lower means for MI, GI, AI and LPMI (p≤0.05). In conclusion, patients with T1DM showed decrease in the mandibular cortical bone when compared to non-diabetic ones, indicating that poor disease control is associated with these alterations.

Resumo Neste estudo, nós analisamos a cortical óssea mandibular de pacientes com Diabetes Mellitus tipo 1 (DM1) e não diabéticos. Foram analisados ​​50 pacientes com DM1 e 100 não diabéticos, pareados por idade e sexo. Dois observadores com duplo-mascaramento avaliaram 150 imagens panorâmicas digitais de ambos os grupos. A cortical óssea mandibular foi analisada por meio do Índice Cortical Mandibular (ICM), Índice Mental (IM), Índice Goníaco (IG), Índice Antegoníaco (IA) e os Índices Panorâmicos Mandibulares Superior (IPMS) e Inferior (IPMI), com o auxílio do software RADIOIMP®. A influência do DM1 na morfologia da cortical óssea mandibular foi analisada com base na obtenção de dados relacionados ao tempo de diagnóstico do DM1, nível de glicemia, controle do DM1 e presença de complicações crônicas. Os dados coletados foram submetidos a análises descritivas (média e desvio-padrão) e inferenciais (teste de Qui-quadrado de Pearson e teste exato de Fisher) (p ≤0,05). De acordo com o ICM, indivíduos com DM1 apresentaram maiores frequências de alterações corticais mandibulares, em ambos os sexos e todas faixas etárias (p <0,01). Para os índices quantitativos, IM, IG, IA, IPMS e IPMI, pacientes do sexo feminino apresentaram diferença estatisticamente significativa para os IG e IA, enquanto os pacientes do sexo masculino mostraram diferenças estatisticamente significativas para todos os índices (p <0,05), tendo os indivíduos com DM1 medidas inferiores. Indivíduos com controle ruim do DM1 apresentaram frequência de alteração na cortical mandibular significativamente maior (92,3%), com menores médias para o IM, IG, IA e IPMI (p ≤0,05). Em conclusão, pacientes com DM1 apresentaram diminuição na cortical óssea mandibular quando comparados aos não diabéticos, indicando que o controle ruim da doença está associado a essas alterações.

Relationship between articular eminence inclination and alterations of the mandibular condyle: a CBCT study.

This study aimed at verifying the correlation among angulation of the articular eminence (AE), shape of the condyle and its degenerative bone diseases (DBDs), according to age and sex, through Cone Beam Computed Tomography (CBCT). Five hundred and twenty-eight temporomandibular joints (TMJ) were evaluated. The condyles were classified as: flat, convex, angled and rounded, and the AE angulation was measured. The DBDs evaluated were osteophytes, flattening, erosion, subcortical cysts and spinal sclerosis. There was no difference in the mean angulations in relation to age group (p>0.05). In age groups of 60-69 years (p=0.003) and 70 years or over (p=0.021), the angulation was higher in males. There was an association between DBD and sex (p=0.047), in that the prevalence was higher in females. Differences in AE angles were not observed in condyles with one or no DBDs (p>0.05). However, the presence of two or more DBDs led to a decrease in the angle (p<0.05). Angled condyles showed higher AE angulations than the flat and convex types (p<0.01). In conclusion, the AE inclination is influenced by DBD and condyle shape; an association of two or more bone diseases in the condyle, or its flat or convex anatomy, results in a decrease in the angulation.

Condyle Excursion Angle, Articular Eminence Inclination, and Temporomandibular Joint Morphologic Relations With Disc Displacement.

PURPOSE: The aim of this study was to evaluate the relations of the condyle excursion angle (CEA) and the morphology and morphometry of the articular eminence to disc displacement (DD) using magnetic resonance imaging (MRI) of symptomatic patients. MATERIALS AND METHODS: MRIs of 199 temporomandibular joints (TMJs) were evaluated. Qualitative and quantitative morphologic analyses were performed with tools available in PACS 11.0 (Carestream Health, Inc, Rochester, NY). The articular eminence inclination (AEI), eminence height (EH), CEA, and articular eminence morphologic shape were evaluated. Statistical analyses were used to evaluate any possible association of the variables with DD in the closed- and open-mouth positions, age, and gender. The significance level was set at .05. RESULTS: Elderly women (>60 yr) presented higher prevalence values (43.26%). There was no statistical correlation between DD and gender (P = .4290). Higher mean values of the AEI and EH were associated with box-shaped eminences. The EH, AEI, and CEA were not related to the presence or absence of DD and the different types of DD. The AEI (P = .002) and CEA (P < .001) values were higher for TMJs with disc reduction in the open-mouth position. CONCLUSION: Disc position in the closed- and open-mouth positions is not influenced by articular eminence morphology; however, the AEI and CEA have an influence on disc reduction.

Relationship between articular eminence inclination and alterations of the mandibular condyle: a CBCT study

Abstract This study aimed at verifying the correlation among angulation of the articular eminence (AE), shape of the condyle and its degenerative bone diseases (DBDs), according to age and sex, through Cone Beam Computed Tomography (CBCT). Five hundred and twenty-eight temporomandibular joints (TMJ) were evaluated. The condyles were classified as: flat, convex, angled and rounded, and the AE angulation was measured. The DBDs evaluated were osteophytes, flattening, erosion, subcortical cysts and spinal sclerosis. There was no difference in the mean angulations in relation to age group (p>0.05). In age groups of 60-69 years (p=0.003) and 70 years or over (p=0.021), the angulation was higher in males. There was an association between DBD and sex (p=0.047), in that the prevalence was higher in females. Differences in AE angles were not observed in condyles with one or no DBDs (p>0.05). However, the presence of two or more DBDs led to a decrease in the angle (p<0.05). Angled condyles showed higher AE angulations than the flat and convex types (p<0.01). In conclusion, the AE inclination is influenced by DBD and condyle shape; an association of two or more bone diseases in the condyle, or its flat or convex anatomy, results in a decrease in the angulation.

Digital panoramic radiography versus cone beam computed tomography in the delineation of maxillomandibular tumors.

This research aimed to compare the efficacy of digital panoramic radiography (DPR) with that of cone beam computed tomography (CBCT) for delineation of odontogenic and nonodontogenic tumors. From November 2009 through March 2011, 23 tumors in the maxillomandibular complex were diagnosed by histopathological examination. All DPRs and CBCTs were obtained and analyzed by a single previously calibrated radiologist, who considered the following radiographic aspects: clarity of the lesion edges, relation with dental elements, involvement of adjacent anatomical structures, cortical bone expansion and disruption, and, if present, type of involved anatomical structures and site of bone expansion and disruption. Of 23 patients, 15 (65.2%) were male and 8 (34.8%) were female. The tumor was classified as odontogenic in 73.9% of patients and nonodontogenic in 26.1% of patients. Analysis revealed that 56.5% of the tumors were located in the mandible, 34.8% in the maxilla, and 8.7% in both arches. For all analyzed variables, CBCTs offered more accurate details than did DPRs. Panoramic radiography should not be the examination of choice to visualize lesions in the maxillomandibular complex.

Temporomandibular joint disk adhesion: evidence from magnetic resonance images / Adesão do disco da articulação temporomandibular: evidências em ressonância magnética

This case report has the aim to present an adhesion of the temporomadibular disc to the articular eminence, diagnosed on magnetic resonance imaging images. A 37-year-old female patient with TMJ (temporomandibular joint) disk adhesion on the left side and complaining of bilateral otalgia over the last 2 years is reported in the present article. The patient did not complain of articular pain or clicking, or any other noises of any nature. Clinical observation showed that the patient had restricted jaw opening, with mandibular deviation the left side without correction during mandibular movement. Our diagnostic impression was of partial anterior disk displacement with reduction of the right side disc; and partial anterior disk displacement with reduction and disc disk adhesion with hypo-mobility of the condyle, on the left temporomandibular joint. The peculiarity of this reported case is the fact that besides the bilateral partial anterior disc displacement, there was also found an adhesion of the disc on the left side. In conclusion, the magnetic resonance imaging exam of the temporomandibular joint can be considered an exam of choice for the evaluation of disc positioning and its morphological alterations.

Este trabalho tem como objetivo apresentar um caso clínico de adesão do disco da articulação temporomandibular à eminência articular, diagnosticada através da ressonância magnética. Paciente de 37 anos de idade, sexo feminino, com queixa de crises ocasionais de otalgia bilateral, ao longo dos últimos 2 anos. A paciente não referia dor ou ruídos articulares de qualquer natureza. Clinicamente, apresentava limitação de abertura de boca, com desvio à esquerda sem correção da trajetória ao final do movimento mandibular. A impressão diagnóstica foi de deslocamento anterior parcial, com redução, do disco articular direito; e, para o lado esquerdo, deslocamento anterior parcial, com redução, e adesão do disco articular ao componente temporal, com hipomobilidade do côndilo. A particularidade do caso descrito está justamente no fato de que além do deslocamento parcial anterior, bilateral, existia, também, uma adesão do disco no lado esquerdo. Conclui-se que o exame de ressonância magnética da articulação temporomandibular pode ser considerado o método de escolha para avaliação do posicionamento do disco articular e suas alterações morfológicas.

Radiographic evaluation of the dental condition of elderly people treated at a Brazilian public university

AIM: To assess the dental status of elderly patients examined in the clinical dentistry course of a Brazilian public university. METHODS: An observational and descriptive study based on the analysis of panoramic radiographs. The sample consisted of 60 elderly patients who met the inclusion criteria. Two observers who had been trained in appropriate conditions performed the radiographic analysis. Data were stored in a specific form, recorded in a database and analyzed using descriptive statistics (measures of central tendency and variability) and inferential statistics (Mann-Whitney U test, Kruskal-Wallis test, Chi-square analysis and calculation of the Cramer's V coefficient). RESULTS: Most patients had at least one tooth in the oral cavity (71.7%), while 28.3% were totally edentulous, an average of 10.5 teeth per individual. The average number of teeth was 11.36 in males and 9.89 in females. The number of healthy teeth was 328 (5.47 per patient). In this study, 88.3% of the subjects had periodontal bone loss, with prevalence of moderate (35.0%) and severe (28.3%) bone loss. CONCLUSIONS: Given the high incidence of edentulous individuals, the high number of restored teeth and poor periodontal conditions, it is concluded that the overall oral health status of the evaluated elderly subjects is poor.

Computed tomography findings of periostitis ossificans

Periostitis ossificans (PO) is a type of chronic osteomyelitis, an inflammation of cortical and cancellous bone. In the maxillo facial region, the mandible is most frequently affected. The cause of inflammatory subperiosteal bone production in PO is spread of infection from a bacterial focus (e.g.: odontogenic disease, pulpal or periodontal infection, and extraction wounds). This pathology is most commonin younger people (mean age of 13 years). Conventional radiographs are one of the most usefultools for diagnosis, but in some cases computed tomography (CT) has a key role in both diagnosis and identification of the tissues involved. This paper reports two cases of PO in which CT help edestablishing the suspicious etiology: a 12-year-old boy with PO of pulpal origin and a 14-year-old boy with PO of periodontal origin.

Morfologia incomun das raízes e canais do primeiro molar inferior: relato de caso / Unusual roots and canals morphology of a mandibular first molar: case report

O conhecimento da anatomia da raiz e dos canais radiculares, suas variações anatômicas e características próprias tem grande importância no correto diagnóstico e no sucesso do tratamento endodôntico. Numerosos estudos tem sido realizados sobre o sistema de canais radiculares dos primeiros molares inferiores. Primeiros molares inferiores normalmente apresentam duas raízes; distal e mesial; com dois canais radiculares em cada. Estudos in vivo e in vitro tem mostrado que os primeiros molares inferiores podem ter 2 ou 3 raízes com 3 ou 4 canais radiculares. Este artigo relata um caso incomun de primeiro molar inferior apresentando quatro raízes e descreve seu tratamento

Temporomandibular juint: uncommon adhesion to the condyle of a posteriory displaced disk / Articulação temporomandibular: adesão incomum ao côndilo de um disco deslocado para posterior

The case of a 41-year-old female patient who did not complain of articular pain or clicking (even past clicks) is herein presented. History of relevant diseases, local trauma, or temporomandibular joint surgery were not reported. Clinically, the patient presented jaw opening limitation with deflection of the mandible to the right side without correction of the trajectory at the end of the jaw opening movement. The imaging features led to the diagnosis of partial posterior displacement and adhesion of the disk to the condyle on both sides; as well as condylar hypomobility and apparent adhesion of the disk to the temporal component on the right side. This particular case is probably the first case of bilateral TMJ posterior disk displacement and adhesion to the condyle reported in literature.

Osteocondrite dissecante da articulação temporomandibular: imagem em radiografia panorâmica / Osteochondritis dissecans of the temporomandibular joint: panoramic radiography features

Relatamos um caso de um paciente de 62 anos, do sexo masculino, apresentando osteocondrite dissecante (OD), estádio 4, na articulação temporomandibular (ATM) do lado esquerdo. Também salientamos a importância da radiografia panorâmica no diagnóstico da OD nos seus estádios 3 e 4, e recomendamos sua inclusão no protocolo de abordagem por imagem para casos de OD.

Mapeamento radiográfico da junção do palato duro com o assoalho da fossa nasal em imagens panorâmicas digitais / The radiographic mapping of the hard palate and nasal fossa floor junction on digital panoramic images

O objetivo deste trabalho foi mapear a imagem da junção do palato duro com o assoalho da fossa nasal na radiografia panorâmica digital, procurando identificar as estruturas que participam na formação desta imagem. Foram utilizados um crânio inteiro e um hemicrânio de humanos, ambos macerados. No palato duro, na região da sutura intermaxilar, foi posicionada uma esfera metálica no forame incisivo sendo realizada uma primeira radiografia. Em seguida, a esfera foi posicionada 5mm após o forame incisivo, deslocada em direção à espinha nasal posterior, sendo novamente radiografada. Este processo foi repetido dez vezes até que a última imagem representasse a esfera posicionada na espinha nasal posterior. Todas as imagens foram interpretadas por dois radiologistas. Concluiu-se que na imagem panorâmica digital, produzida pelo aparelho Instrumentarium, a mais superior representa uma imagem fantasma das estruturas localizadas na porção posterior do palato duro/assoalho de fossa nasal. A esfera quando posicionada mais para posterior forma imagem tripla e o conjunto dessas imagens – imagem dupla real e imagem fantasma – corresponde ao que é considerado como imagem dupla da estrutura anatômica palato duro/assoalho de fossa nasal. A linha inferior corresponde à junção da imagem única das estruturas anteriores com as imagens reais duplas das estruturas posteriores.

Adhesión del disco de la ATM - reporte de un caso / TMJ disk adhesion: a case report

Presentamos un caso de adhesión unilateral del disco de la articulación temporo-mandibular en un paciente de 51 años, sexo femenino, con queja de otalgia bilateral ocasional, de intensidad moderada, a lo largo de los últimos 10 años. La paciente no refirió dolor o ruidos articulares de ninguna naturaleza. Clínicamente, presentaba limitación de apertura bucal, con desvío hacia la izquierda sin corrección de la trayectoria al final del movimiento mandibular. La impresión diagnóstica clínica e imagenológica fue de desplazamiento anterior parcial con reducción del disco articular derecho; y aparente desplazamiento anterior parcial, adhesión del disco articular (“anchored disc phenomenon” - ADP) e hipomovilidad del cóndilo izquierdo

It is reported on a case of a 51-year-old female patient presenting TMJ (temporomandibular joint) disk adhesion on the left side and complaining of otalgia over the last 10 years. The patient did not complain of articular pain or clicking. Clinically, the patient presented jaw opening limitation, with deflection of the mandible to the left side without correction of the trajectory at the end of the jaw opening movement. Our diagnostic impression was partial anterior disk displacement with reduction, for the right side; and elusive partial anterior disk displacement, disk adhesion (“anchored disc phenomenon” - ADP), and hipomobility of the condyle, for the left side

Avaliação da qualidade das radiografias panorâmicas de um serviço de radiologia odontológica / Evaluation of panoramic dental radiograph quality taken in a radiological dental practice

Neste trabalho o objetivo foi demonstrar a importância da garantia da qualidade das radiografias panorâmicas realizadas por alunos ingressantes do mestrado e de especialização em Radiologia Odontológica de uma instituição. Foram avaliadas radiografias panorâmicas realizadas no período entre outubro de 2003 e agosto de 2004...