Determinação do sexo por meio de medidas dentais em tomografia computadorizada de feixe cônico / Sex determination through dental measurements in cone beam computed tomography

Introdução: Os dentes são as estruturas mais duras do corpo humano e suportam a altas temperaturas sem desintegração, por isso são utilizados na odontologia forense para identificação humana. O dente canino, em especial, normalmente é o menos afetado por doenças bucais, quando comparados a outros dentes, e é mais propenso a resistir em casos de traumatismos. Objetivo: Identificar o dimorfismo sexual da população da Grande Vitória-ES, por meio de medidas dentais lineares em dentes caninos permanentes nos exames de tomografia computadorizada de feixe cônico (TCFC). Materiais e métodos: Foram realizadas medidas da maior largura e altura da coroa dos caninos superiores e inferiores, direitos e esquerdos e a distância entre as cúspides dos caninos superiores e inferiores em uma amostra de 100 exames (47 do sexo masculino e 53 do sexo feminino) de TCFC. Resultados: Foi encontrada uma diferença estatisticamente significante nas medidas intercanina superior e cervicoincisal do elemento 23. Conclusão: Existe uma diferença sexual, apresentando na população feminina, com dimensões maiores que as encontradas no sexo masculino, na população estudada, na medida intercanina superior e na medida cervicoincisal do canino superior esquerdo. Por meio de medidas dentais em exames de TCFC, foi possível concluir que essas medidas podem identificar o sexo, porém não deve ser utilizada de forma isolada, deve ser feita concomitante com outras formas periciais.

Estimativa de idade por meio do volume das câmaras pulpares em imagens de tomografia computadorizada de feixe cônico ­ revisão de literatura / Estimation of age using the volume of the pulp chambers in cone beam computed tomography images ­a review

Introdução: A estimativa de idade é uma das formas de identificação na área forense que visa obter a idade mais próxima da idade cronológica em indivíduos vivos ou mortos. A análise por meio dos dentes é um dos métodos mais confiáveis, pois estes são considerados como os tecidos mais duros e resistentes do corpo humano. A idade em adultos pode ser estimada por meio da formação de dentina secundária com consequente redução do tamanho da câmara pulpar. O exame de tomografia computadorizada de feixe cônico (TCFC) é o único que contempla o volume pulpar e desta forma resulta em informações confiáveis e podem ser tomadas como um guia para predição de idade em adultos. Objetivo: revisar a literatura sobre o uso da TCFC como método de imagem para estimar a idade dental por meio do volume da polpa em dentes unirradiculares e multirradiculares. Resultados: A TCFC é o exame ideal para avaliar o volume da câmara pulpar, pois permite mensurar a distância vestíbulo-lingual e mésio-distal. Os dentes incisivos superiores se mostraram como ideais nesta avaliação pelo fato de serem unirradiculares. Considerações finais: A ciência forense pode usufruir desta tecnologia de imagem para estimar a idade nos casos periciais em indivíduos vivos ou mortos.

The relationship of articular eminence and mandibular fossa morphology to facial profile and gender determined by cone beam computed tomography.

OBJECTIVE: The aim of this study was to evaluate the relationship of the morphology of the articular eminence and mandibular fossa to facial profile and sex by using cone beam computed tomography (CBCT) images. STUDY DESIGN: CBCT examinations of 76 patients were conducted, and the patients were classified according to facial profile as dolichocephalic, mesocephalic, or brachycephalic. The inclination and height of the articular eminence and the inclination of the mandibular fossa of 152 temporomandibular joints were measured. Comparisons between these measurements and facial profile and gender were performed by 2-way analysis of variance with Tukey's post hoc test. Significance was established at α = 0.05. RESULTS: Males with brachycephaly presented significantly greater values of eminence inclination compared with those with other facial types and greater values than patients with dolichocephaly for the measurements of eminence height and inclination of the fossa posterior wall (P ≤ .05). Females with brachycephaly presented significantly greater eminence height values compared with those with other facial profiles (P ≤ .05). No significant differences were observed between males and females. CONCLUSIONS: The morphology of the articular eminence and the mandibular fossa is associated with facial profile, with males with brachycephaly showing greater inclination of the eminence and mandibular fossa. Articular eminence height in brachycephaly was greater in both sexes.

Double mandibular canal and triple mental foramina: detection of multiple anatomical variations in a single patient.

Having complete information about a patient's mandibular canal and mental foramen is fundamental to performing safer procedures and avoiding intraoperative and postoperative complications. Cone beam computed tomography (CBCT) produces accurate images for the analysis of maxillomandibular bone structures and is widely used in dentistry. The aim of this study is to report a case of mandibular bifid canal associated with triple mental foramina that was revealed with CBCT images. A 45-year-old woman was referred for a CBCT scan of remaining bone quantity to assist in preoperative implant planning. The patient had reported problems related to anesthesia during extraction of the mandibular right second and third molars. Examination showed bilateral bifurcation of the mandibular canal, from the mandibular foramen to the gonial angle. In addition, exteriorization of the mandibular canal was noticed in 3 regions; that is, there were 3 distinct mental foramina. Clinicians must be aware of these anatomical variations in the mandibular region during dental procedures to avoid complications such as difficulty in obtaining anesthesia or postoperative sensory dysfunction.

Influence of cone beam CT volume orientation on alveolar bone measurements in patients with different facial profiles.

OBJECTIVES: To evaluate the influence of cone beam CT (CBCT) volume orientation on alveolar bone measurements for dental implant planning using CBCT in patients with different facial profiles. METHODS: 74 CBCT volumes were selected from a database and classified according to the facial profile of the patient. Height and width measurements of the alveolar bone were carried out with the volume of the mandible in two different orientations: occlusal plane and mandibular base parallel to the horizontal plane. The data were subjected to the mixed model methodology for repeated measures, through the PROC MIXED procedure. Multiple comparisons were performed by Tukey Kramer test (α = 0.05). RESULTS: Alveolar bone width was significantly greater when the CBCT volume was oriented with the mandibular base parallel to the horizontal plane, for all facial profiles (p ≤ 0.05). Alveolar bone height was significantly higher (p ≤ 0.05) for dolichofacial individuals when compared to that of mesofacial and brachyfacial individuals, who did not differ significantly between each other (p > 0.05), regardless of the CBCT volume orientations used in this study. CONCLUSIONS: CBCT-based alveolar bone width is increased when the image volume is oriented with the mandibular base parallel to the horizontal plane and dolichofacial individuals present greater alveolar bone height.

Morphological Evaluation of the Nasopalatine Canal in Patients With Different Facial Profiles and Ages.

PURPOSE: To evaluate the influence of facial profile and age on the morphology of the nasopalatine canal. MATERIALS AND METHODS: One hundred thirty-two cone-beam computed tomograms were classified according to facial profile-mesofacial, brachyfacial, and dolichofacial-and divided into the following age groups: 21 to 30, 31 to 40, 41 to 50, and 51 to 60 years. Measurements were obtained for openings of the incisive and nasopalatine foramina, alveolar bone thickness, and the full length, most constricted region, and volume of the nasopalatine canal. Intra- and inter-examiner agreements were calculated using the intraclass correlation coefficient. After exploratory and descriptive analysis, data were subjected to 2-way analysis of variance and Tukey test for comparisons between facial profiles and age groups. The significance level was 5% (α = 0.05). RESULTS: Intra- and inter-examiner reproducibilities were excellent for all measurements. Patients older than 50 years presented a significantly larger nasopalatine canal than patients 21 to 30 years old for all facial profiles (P ≤ .05). Linear measurements obtained from the nasopalatine canal showed no significant difference between facial profiles and age groups (P > .05). CONCLUSIONS: The nasopalatine canal was not influenced by facial profile but did exhibit an increased volume with aging, particularly after 50 years of age.

Diagnosis of ethmoid sinolith by cone-beam computed tomography: case report and literature review.

INTRODUCTION: The aim of this study was to report the first case of diagnosis of a rare ethmoid sinolith by cone-beam computed tomography (CBCT) and discuss the importance of carefully assessing the entire volume of the images regardless of the region of interest. CASE PRESENTATION: A 22-year-old woman underwent CBCT examination to assess the upper permanent canine teeth. Analysis of the entire volume of CBCT revealed an oval-shaped hyperdense, homogeneous, expansive formation with defined boundaries located in the ethmoid bone. The differential diagnosis of a sinolith in the ethmoid sinus was confirmed after removal of the lesion by nasoendoscopy and histopathological examination. CONCLUSION: The diagnosis of lesions in the ethmoid sinus is challenging because of the complex anatomy of this region. Considering the limitations of two-dimensional X-ray examination, CBCT examination has become an important imaging modality for the diagnosis of these calcifications. In addition, the ability of the dental surgeon to assess the entire volume of the CBCT images and the knowledge of imaging features of these calcifications allows for recognition of incidental findings, facilitating early diagnosis and appropriate treatment.

Clinical implications, diagnosis, and treatment of a giant frontoethmoid osteoma.

Osteomas are benign, asymptomatic fibro-osseous tumors that are most commonly observed in the paranasal sinuses and sometimes are found in imaging examinations that were taken for other reasons. Giant osteomas are rarely found in the frontal and ethmoid sinuses but, when they are, they may cause intracranial and orbital complications. The aims of this case report are to describe a frontoethmoid osteoma in a 40-year-old woman, discuss the characteristics of this lesion through cone beam computed tomography (CBCT) imaging, and review the options for treatment. A CBCT examination performed for the purpose of orthodontic diagnosis revealed the presence of a large, well-defined, lobular, hyperdense mass that occupied a sizeable area of the frontal sinus and extended to the ethmoid sinus. The patient did not report any pain. Based on the physical and imaging characteristics of the mass, the location and size of the lesion, and the patient's age, the diagnosis was a giant frontoethmoid osteoma. Due to its enhanced field of view, CBCT may enable earlier diagnosis of lesions that affect the maxillofacial region.

Correlation between midline deviation and condylar position in patients with Class II malocclusion: A cone-beam computed tomography evaluation.

INTRODUCTION: Midline deviation of the mandible and maxilla can affect craniofacial growth and occlusion and cause consequences to the temporomandibular joint. The aim of this study was to evaluate the lateral displacement of the skeletal and dental midlines in relation to the condyle head position in Class II patients with cone-beam computed tomography. METHODS: We used 82 cone-beam computed tomography images. The lateral displacement of the skeletal and dental midlines considering the 3-dimensional reference plane was analyzed with points in the maxillary and mandibular central incisors, anterior nasal spine, and menton. The condyle-fossa relationship, concentric position of the condyles, and dimensional and positional symmetries between the right and left condyles were evaluated. RESULTS: There was a statistically significant difference regarding anterior nasal spine with maxillary central incisor, menton, and mandibular central incisor points for both sides, and also for maxillary central incisor-menton for the displacement of the left side. We found differences in the temporomandibular joint for inclination and diameter measurements of the condylar process. Strong correlations were observed between the maxilla and the condylar process diameter (right side) and the distance between the geometric centers (left side), in addition to a strong correlation between the sagittal midline displacement and the geometric center differences on the right and left sides. CONCLUSIONS: In patients with Class II malocclusion, lateral displacement of skeletal and dental midlines in relation to the condyle head position has a significant correlation with the anteroposterior difference between the geometric center of the right and left condylar processes.

Foreign bodies in the interior of the maxillary sinus: diagnosis by cone beam computed tomography.

To avoid complications, the intimate relation between the maxillary sinus and dental roots deserves attention during surgical procedures. Accidental introduction of foreign bodies, such as dental implants, may irritate the maxillary sinus mucosa, causing sinusitis. Cone beam computed tomography (CBCT) has been proven to be suitable for diagnosis in these cases by providing the exact location of the foreign body. The present article reports 3 cases of foreign bodies inside the maxillary sinus associated with inflammatory processes. Imaging examinations, such as CBCT, are an important tool to assist dentists in diagnosing the presence of foreign bodies in the interior of the maxillary sinus.

Simple bone cyst: rare incidental finding in the mandibular condyle by cone beam computed tomography.

The simple bone cyst (SBC) is a benign intraosseous lesion that is considered to be a pseudocyst because the cystic cavity does not present an epithelial lining. The most accepted theory regarding its etiology is that the SBC develops when the blood clot fails to organize subsequent to bleeding caused by trauma. The SBC is asymptomatic, and therefore the diagnosis is made through routine imaging examinations. In imaging examinations, the lesion is characterized by a radiolucent, unilocular, well-delimited appearance and an irregular or scalloped contour with or without a sclerotic halo. This case report describes an SBC in the mandibular condyle region, discovered incidentally on imaging examinations.

Ankylosis of Permanent First Molar: Diagnosis by Cone Beam Computed Tomography / Anquilosis del Primer Molar Permanente: Diagnóstico por Tomografía Computarizada con Haz Cónico

ABSTRACT: Ankylosis is an anomaly of tooth eruption characterized by the fusion of cementum and alveolar bone, and may affect from small regions to the entire root surface. Clinical assessment combined with imaging exams can aid diagnosis. Radiographic testing enables assessing only proximal regions of possibly affected roots. Whereas cone beam computed tomography (CBCT) allows a three-dimensional assessment of axial, coronal, and sagittal planes of all dental extension, eliminating thus overlapping images and helping to confirm the correct diagnosis. The present study contains a case report of a male patient with ankylosis in tooth 16 diagnosed by CBCT, aiming at providing information for dentists about this anomaly, its characteristics and situations in which CBCT should be indicated.

RESUMEN: La anquilosis es una anomalía de la erupción del diente caracterizada por la fusión de cemento y hueso alveolar, y puede afectar desde pequeñas regiones hasta toda la superficie de la raíz. La evaluación clínica combinada con los exámenes de imagen puede ayudar a diagnosticar esta anomalía. Las pruebas radiográficas permiten evaluar sólo las regiones proximales de las raíces posiblemente afectadas. La tomografía computarizada de haz de cono (CBCT) permite una evaluación tridimensional de los planos axial, coronal y sagital de toda la extensión dental, eliminando así las imágenes superpuestas y ayudando a confirmar el diagnóstico correcto. En el presente estudio se presenta un reporte de caso de un paciente con anquilosis en el diente 16 diagnosticado por CBCT, con el objetivo de proporcionar información para los dentistas sobre esta anomalía, sus características y situaciones en las que debe indicarse la CBCT.

Monostotic fibrous dysplasia: a case report with cone-beam computed tomography findings / Displasia fibrosa monostótica: relato de caso por meio de achados de tomografia computadorizada de feixe cônico

ABSTRACT Fibrous dysplasia is a benign fibrous-osseous lesion in which normal bone is replaced by fibrous connective tissue and immature bone, affecting only one (monostotic) or several bones (polyostotic) and mainly occurring in children and young adults. When present in facial bones, the maxilla is more frequently involved than the mandible, which can cause facial asymmetry in addition to dental complications. In the image exams, the main characteristic of fibrous dysplasia is its unpolished glass appearance. Computed tomography is the ideal method for evaluating this lesion and its relationship with adjacent structures. The use of conventional radiography, due to the overlapping of anatomical structures, makes it difficult to delineate the extension of the lesion. The present study is aimed at guiding dentist-surgeons on the main imaging characteristics of fibrous dysplasia by describing a case of a female 10-year-old patient presenting with this lesion in the maxilla.

RESUMO A displasia fibrosa é uma lesão fibro-óssea benigna em que o osso normal é substituído por tecido conjuntivo fibroso e osso imaturo, podendo afetar um único osso (monostótica) ou vários ossos (poliostótica), ocorrendo principalmente em crianças e adultos jovens. Quando presente nos ossos faciais, a maxila é envolvida com mais frequência que a mandíbula, podendo causar assimetria facial, além de complicações odontológicas. Nos exames por imagem a característica principal da displasia fibrosa é a aparência de vidro despolido. A tomografia computadorizada é o método ideal para avaliação dessa lesão e relação com estruturas adjacentes. A radiografia convencional, devido a sobreposição de estruturas anatômicas, torna difícil a delimitação da extensão da lesão. O presente estudo teve como objetivo apresentar o relato de caso de um paciente do sexo feminino, 10 anos de idade, com presença de displasia fibrosa na maxila, objetivando orientar os cirurgiões-dentistas com relação às principais características imaginológicas dessa lesão.

Cone beam computed tomography in the diagnosis of dens invaginatus: case report / Tomografía computarizada de haz cónico en el diagnóstico de diente invaginado: presentación de un caso

The aim of this report is to present a case of dens invaginatus asymptomatic discovered after exam cone beam computed tomography. A 20-year-old patient attended the clinic Radiology to perform tomography to fracture research at the root of the tooth 15. However, the examination was observed the presence of a conoid supernumerary tooth between the tooth located roots 11 and 12, which had a hyperdense line to the apex of the root, representing the invagination of the enamel, dens invaginatus feature. It was also observed extensive hypodense image in the periapical region, with areas of external resorption both in supernumerary tooth as we ll as the roots of teeth 11 and 12. The treatment consisted of surgery for dens invaginatus extraction. The dentists should be aware of the imaginological characteristics of the anomalies that can affect the teeth/jaws, which can be discovered in tests for routine imaging and proper conduct for the treatment of patients.

El objetivo de este trabajo fue presentar un caso dedens invaginatusasintomático descubierto en una tomografía computarizada de haz cónico. Un paciente de 20 años de edad acudió a la clínica radiológica para realizarse una tomografía producto una fractura radicular del diente 15. Sin embargo, en el exámen se observó la presencia de un diente supernumerario cónico localizado entre las raíces de los dientes 11 y 12, observando además una línea hiperdensa hacia el ápice de la raíz, que representa la invaginación del esmalte, característica propia de undens invaginatus.También se observó un área hipodensa en la región periapical, con áreas de reabsorción externa tanto en el diente supernumerario como en las raíces de los dientes 11 y 12. El tratamiento consistió en cirugía de extracción deldens invaginatus. Los dentistas deben conocer las características imagenológicas de las anomalías que pueden afectar a los dientes, las cuales pueden ser descubiertas en exámenes de rutina y también el protocolo adecuado de tratamiento de éstas.

Efficacy of a cone beam computed tomography metal artifact reduction algorithm for the detection of peri-implant fenestrations and dehiscences.

OBJECTIVE: To determine whether the use of a metal artifact reduction (MAR) algorithm improves the detection of peri-implant fenestrations and dehiscences on cone beam computed tomography scans. STUDY DESIGN: One hundred titanium fixtures were implanted into bovine ribs after the creation of defects simulating fenestrations and dehiscences. Images were acquired using four different protocols, namely, A2 (MAR on, voxel 0.2 mm), A3 (MAR on, voxel 0.3 mm), B2 (MAR off, voxel 0.2 mm), and B3 (MAR off, voxel 0.3 mm). For all protocols, receiver operating characteristic (ROC) curves were determined. Values for the areas under the ROC curves (Az) were subjected to analysis of variance. RESULTS: Az values were not statistically different among protocols regardless of the defect type (P > .05). CONCLUSIONS: The MAR algorithm tested by us did not improve the diagnosis of peri-implant fenestrations and dehiscences with use of either the 0.2 mm or the 0.3 mm voxel sizes.

Erros cometidos por estudantes de Odontologia de uma universidade pública brasileira na realização de radiografias periapicais / Technical errors in periapical radiographs taken by dental students of a Brazilian public university

A proposta do estudo foi identificar e quantificar os erros mais cometidos por estudantes de Odontologia da UFES na execução de radiografias periapicais. Foi um estudo observacional com delineamento transversal cuja amostra constou de 352 radiografias contidas em prontuários de pacientes atendidos no curso nos últimos 5 anos. Os dados foram quantificados de acordo com tipo de erro e período do curso e submetidos ao teste de Qui-quadrado com nível de significância adotado em 5%. Constatou-se grande frequência de erros (84,37%), sendo o 9º período o que apresentou a maior frequência (92,30%) e o 8º período, a menor (70,00%) (p < 0,05). O erro mais observado foi o armazenamento incorreto (15,60%), até então não quantificado em ambiente acadêmico. Os outros dois erros mais frequentes foram a falta de enquadramento (14,60%) e imagens com baixa densidade (10,80%). Concluiu-se que o índice de erros é alto na amostra estudada e que se deve atentar para o armazenamento de radiografias periapicais no âmbito universitário (AU).

We aimed to identify and quantify the errors that dental students of UFES mostly commit when taking periapical radiographs. A total of 352 periapical radiographs was evaluated in this cross-sectional study. The radiographs were collected in the records of patients attended in the University in the last five years. Type of error and academic semester of the course were considered and data were submitted to the Chi-squared test at a significance level of 5%. The results demonstrated a high frequency of errors (84.37%) where the students in the 9th academic semester showed the highest frequency (92.30%) while those in the 8th academic semester had the lowest (70.00%) (p < 0.05). Improper storage (15.60%) was the most frequent error in the sample and it has not been quantified for academic environment in the literature to the best of our science. The other two most frequent errors were: inadequate positioning of the film (14.60%) and low radiographic density (10.60%). We concluded that most of the periapical radiographs taken by the dental students of UFES have errors. Attention should be given to the storage of film-based periapical radiographs in universities (AU).

A relação entre disfunção temporomandibular e disfunção tubária em pacientes com fissura palatina / Temporomandibular joint dysfunction and its correlation with auditory tube in cleft palate patients

OBJETIVO: investigar, em indivíduos com fissura palatina, a existência de disfunções temporomandibulares, tendo como fator predisponente a disfunção tubária. MÉTODO: foram avaliados 10 indivíduos (20 articulações temporomandibulares), operados de fissura de palato, que estavam em tratamento no Centro Clínico de Fonoaudiologia da PUC Minas, com idade variando entre 8 e 18 anos, de ambos os sexos, e que apresentavam história de otite média na primeira infância. Esses foram submetidos à meatoscopia, imitanciometria, pesquisa da função tubária, exame de palpação da musculatura orofacial e exames de imagem (radiografias transcraniana em seis posições e Ap de Town). RESULTADOS: foi observado que a maioria da amostra apresentava disfunção da tuba auditiva, correspondendo a 80% do total. Em relação à articulação temporomandibular nove indivíduos (90%) não apresentaram disfunção, em apenas um indivíduo (10%) foi verificado presença de desordem temporomandibular. CONCLUSÃO: ao analisar a relação entre a disfunção tubária e disfunção temporomandibular, não foram observados resultados significantes de acordo com o Teste Exato de Fisher, evidenciando que a articulação temporomandibular dos fissurados de palato, não sofre alterações provenientes do funcionamento ineficiente da tuba auditiva.

PURPOSE: investigate the existence of dysfunctional temporomandibular disorders, and as a predisposing factor to investigate tubal dysfunction in patients with cleft palate. METHOD: 10 individuals (20 temporomandibular joints), operated of cleft palate had been evaluated, that were in treatment in the Clinical Center of Fonoaudiologia of the PUC-MG, with age varying between 8 and 18 years, of both gender, and that they presented history of middle otitis in first infancy. The same ones had been submitted to the meatoscopia, imitanciometria, research of the tube function, examination of feel of the face muscle and examinations of image (x-rays transcraniana in 6 positions and AP of Town). Being compared for the Accurate Test of Fisher (p<0,05). RESULTS: it was observed that the majority of the sample presented of auditory tube dysfunction, when analyzed for the test of the tube function corresponding 80% of the total. In relation to the joint to temporomandibular nine individuals (90%) they had not presented dysfunction and only one individual (10%) got, observed in the examinations of image, presence at the back of condyle process of the left side. CONCLUSIONS: as preliminary data, when analyzing the temporomandibular joint dysfunction and its correlation with auditory tube, the Accurate Test of Fisher did not find resulted significant, evidencing that the joint to temporomandibular of the cleft palate patients, does not suffer alterations proceeding from the inefficient functioning from auditory tube.