Rare and Multiple Hypodontia in Van der Woude Syndrome: Case Report.

Van der Woude syndrome (VWS) is a rare syndrome of genetic etiology, commonly occasioned by mutations in the IRF6 gene and that causes disorders in craniofacial development. VWS is characterized by the presence of paramedian fistulas in the lower lip and cleft lip and / or cleft palate. Although some dental phenotypes have been reported in this syndrome, multiple and rare hypodontias were not described. Through this case report, we present a case of Van der Woude Syndrome (VWS) with rare and multiple hypodontia in which clinical data and radiographic exams were evaluated. The patient presented hypodontia of eight permanent teeth (lateral incisors, second premolars and second molars). So, when the dentist recognizes multiple and/or rare hypodontias, for an accurate diagnosis, detailed examination of the lower lip is indicated, as well as a survey of the family history and referral for genetic counseling, since the syndrome presents high penetrance. The patient is expected to be rehabilitated to have a good quality of life. Rehabilitation in these cases requires alveolar bone graft, orthodontics and prosthesis to replace missing teeth.

Implications of anatomical variation of the sphenoid sinus for orthognathic surgery: a case report in cone beam computed tomography / Implicações da variação anatômica do seio esfenoidal para cirurgia ortognática: um relato de caso em tomografia computadorizada de feixe cônico

ABSTRACT The Sphenoid Sinus is considered the paranasal sinus with more variation to the degree of pneumatization. Thus, this work aimed report to the first case on the interference of this anatomical variation for orthognathic surgery. A 18- year-old woman, with isolated cleft palate repaired, was submitted to orthognathic surgery to correct the maxillomandibular skeletal discrepancy. The cone beam computed tomography (CBCT) exam performed for preoperative planning showed a great extension for the adjacent structures, with proximity to the posterior wall of the maxillary sinus and pterygomaxillary fissure bilaterally. The postoperative CBCT image evidenced the compromise of the sinus floor due to the factors related to the transoperative period. This case, along with literature review, highlighted the importance of identifying sphenoid sinus variation in CBCT exams prior to orthognathic surgery, in order to avoid serious complications for the patient, such as sinus infections; hemorrhages; mucocele formation or intracranial involvement.

RESUMO O Seio Esfenoidal é considerado o seio paranasal com maior variação quanto ao grau de pneumatização. Assim, este trabalho objetivou relatar o primeiro caso sobre a interferência dessa variação anatômica para a cirurgia ortognática. Mulher,18 anos, com fissura de palato isolada reparada, foi submetida à cirurgia ortognática para correção da discrepância esquelética maxilomandibular. O exame de tomografia computadorizada de feixe cônico (TCFC), realizado para planejamento pré-operatório, mostrou grande extensão para as estruturas adjacentes, e com proximidade da parede posterior do seio maxilar e fissura pterigomaxilar bilateralmente. A imagem de TCFC pós-operatória evidenciou o comprometimento do assoalho do seio devido aos fatores relacionados ao transoperatório. Este caso, juntamente com a revisão da literatura, destacou a importância de identificar a variação do seio esfenoidal nos exames de TCFC prévios à cirurgia ortognática, a fim de evitar complicações graves para o paciente, tais como sinusite, hemorragias, formação de mucoceles ou, até mesmo, envolvimento intracraniano.

Radiographic characteristics of the maxillomandibular complex in neufibromatosis: short communication and literature review.

OBJECTIVE: To report radiographic characteristics of a case of a patient with neurofibromatosis involving the maxillomandibular complex and to point out other dental radiographic characteristics that are found in the scientific literature to help the dentist when faced with a case of neurofibromatosis. SHORT COMMUNICATION: Male, 31 years old, referred for radiographic examination. During anamnesis and physical examination, lesions were noted, which were papules and café-au-lait patches larger than 1 cm on the trunk and upper limbs, further to Lisch nodules (brown spots on the iris) and axillary and inguinal ephelides. When investigating the history of the disease, the patient reported the presence of such skin atlterations since birth and mentioned that his mother had been diagnosed with neurofibromatosis. During radiographic evaluation, a significant increase in the caliber of the mandibular canal and mental foramen was observed, bilaterally. CONCLUSION: Completing the combination of skin characteristics present in the patient, anamnesis data and current history of the disease with interpretation of radiographic alterations, it was possible to arrive at the diagnostic hypothesis of Neurofibromatosis type 1 and correct clinical management. Therefore, it is extremely important for the dentist to be aware of the clinical, physical and radiographic characteristics that this condition presents for the correct management and success of dental treatment.

Novel dental phenotype in non-syndromic Pierre Robin Sequence: A retrospective study.

OBJECTIVE: The objective was to investigate dental phenotypes in individuals with non-syndromic Pierre Robin Sequence (ns-PRS) and compare the prevalence of these phenotypes with subjects with non-syndromic cleft palate (ns-CP) and a control group with subjects without any craniofacial anomalies. METHODS: A total of 760 panoramic radiographs of 330 individuals (110 with ns-PRS; 110 with ns-CP and 110 without any malformations) were digitized and evaluated regarding the diagnosis of taurodontism, tooth agenesis, root dilaceration and tooth transposition. Chi-square test was applied to compare the occurrence of dental phenotypes between groups. A P value of less than 0.05 was considered statistically significant. RESULTS: Total prevalence of dental phenotypes was 94.5% of ns-PRS; 54.5% of ns-CP and 59.1% of the control group subjects with a statistically significant difference for the ns-PRS when compared to the other two groups. Two dental phenotypes, taurodontism and dental agenesis were identified with statistically significant higher prevalences in subjects with ns-PRS when compared with the ns-CP group and the control group (p < 0.001). Taurodontism was the most prevalent dental phenotype, with 92.73% in the ns-PRS group, 40.91% for ns-CP and 44.55% in the control group. Tooth agenesis had a prevalence of 22.7% for ns-PRS, 4.5% for ns-CP and no case in the control group. For the prevalence of root dilaceration and tooth transposition, no statistically significant differences were observed between the three groups. CONCLUSIONS: Due to the high frequency of taurodontism in individuals with ns-PRS, we suggested that this novel phenotype would be important in the phenotypic screening of ns-PRS and could be considered as a phenotype associated with ns-PRS.

Prevalencia de alteraciones en el complejo estilohioideo y tonsilolitos en la tomografía computarizada de haz cónico realizada en individuos con fisura labiopalatina / Cleft lip and palate subjects prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography

Introducción y objetivos: Los tonsilolitos y alteraciones en el complejo estilohioideo pueden presentar similar sintomatología a otras de diferente etiología. Los individuos con fisura labiopalatina describen similares síntomas en razón de las repercusiones anatómicas propias de esta anomalía. El objetivo de este estudio fue determinar la prevalencia de alteraciones del complejo estilohioideo y tonsilolitos en exámenes de tomografía computarizada de haz cónico en individuos con fisura labiopalatina. Métodos: Según criterios de inclusión y exclusión fueron analizadas 66 tomografías de 2.794 tomografías, en el software i- Cat visión ® con índice Kappa 0,8 intraexaminador. Resultados: La prevalencia total de osificación del complejo estilohioideo incompleto en individuos con fisura labiopalatina fue de 66,6%, la prevalencia de estos hallazgos en el género femenino fue de 75% y 61,9% en el género masculino. La prevalencia total de tonsilolitos fue de 7,5%. Conclusión: Es de relevancia constatar en el informe radiológico la presencia de la calcificación del complejo estilo-hioideo y tonsilolitos. Debido a la proximidad anatómica y similar sintomatología clínica con otras alteraciones orofaciales presentes en los individuos con fisura labiopalatina, haciendo énfasis en individuos con fisura labiopalatina del género femenino, pacientes con fisura tipo transformen incisivo y posforamen incisivo por presentar mayor prevalencia. Conocer más sobre la morfometría anatómica de individuos con fisura labiopalatina coadyuva relevantemente en la elección de conductas clínicas y calidad de vida de estos pacientes, teniendo presente que la fisura labiopalatina es una de las anomalías más comunes (AU)

Introduction and objectives: Tonsilloliths and abnormal stylohyoid complex may have similar symptoms to others of different aetiology. Individuals with cleft lip and palate describe similar symptoms because of the anatomical implications that are peculiar to this anomaly. The aim of this study was to determine the prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography in individuals with cleft lip and palate. Methods: According to the inclusion and exclusion criteria, 66 CT scans out of of 2,794 were analysed, on i- Cat ® vision software with 0.8 index Kappa intra-examiner. Results: The total prevalence of ossification of the incomplete stylohyoid complex in individuals with cleft lip and palate was 66.6%; the prevalence of these findings in females was 75% and 61.9% in males. The total prevalence of tonsilloliths was 7.5%. Conclusion: It is important to ascertain calcification of the stylohyoid complex and tonsilloliths in the radiological report, due to the anatomical proximity and similarsymptomatology to other orofacial impairments inindividuals with cleft lip and palate, focusing on females with oral cleft formation, patients with incisive trans foramen cleft and incisive post foramen cleft because they are more prevalent. Greater knowledge of the anatomical morphometry of individuals with cleft lip and palate greatly contributes towards the selection of clinical behaviours and the quality of life of these patients, since cleft lip and palateis one of the most common anomalies (AU)

Cleft lip and palate subjects prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography. / Prevalencia de alteraciones en el complejo estilohioideo y tonsilolitos en la tomografía computarizada de haz cónico realizada en individuos con fisura labiopalatina.

INTRODUCTION AND OBJECTIVES: Tonsilloliths and abnormal stylohyoid complex may have similar symptoms to others of different aetiology. Individuals with cleft lip and palate describe similar symptoms because of the anatomical implications that are peculiar to this anomaly. The aim of this study was to determine the prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography in individuals with cleft lip and palate. METHODS: According to the inclusion and exclusion criteria, 66 CT scans out of of 2,794 were analysed, on i- Cat ® vision software with 0.8 index Kappa intra-examiner. RESULTS: The total prevalence of ossification of the incomplete stylohyoid complex in individuals with cleft lip and palate was 66.6%; the prevalence of these findings in females was 75% and 61.9% in males. The total prevalence of tonsilloliths was 7.5%. CONCLUSION: It is important to ascertain calcification of the stylohyoid complex and tonsilloliths in the radiological report, due to the anatomical proximity and similarsymptomatology to other orofacial impairments inindividuals with cleft lip and palate, focusing on females with oral cleft formation, patients with incisive trans foramen cleft and incisive post foramen cleft because they are more prevalent. Greater knowledge of the anatomical morphometry of individuals with cleft lip and palate greatly contributes towards the selection of clinical behaviours and the quality of life of these patients, since cleft lip and palateis one of the most common anomalies.

Verruciform xanthoma in the hard palate: a case report and literature review.

Oral verruciform xanthoma (OVX) is an uncommon lesion that appears on the oral mucosa. The aim of this paper was to discuss the probable etiopathogenesis of OVX in the hard palate, reinforcing the importance of including this lesion in the differential diagnosis of verrucous lesions. A 43-year-old male smoker presented with a painless lesion with a verrucous surface and erythematous spots on the hard palate. Excisional biopsy revealed oral mucosa consisting of hyperkeratosis, acanthosis, and elongated rete pegs. Subjacent connective tissue showed numerous foam cells with clear cytoplasm and pyknotic nucleus, negative on periodic acid-Schiff staining. Immunohistochemical analysis revealed foam cells positive for anti-CD68 antibody, while anti-KI-67 antibody was restricted to the basal layer of the oral epithelium. A final diagnosis of OVX was established. The patient showed no signs of recurrence after seven months of follow-up. Physical trauma and smoking habits can be directly related to the etiology of verruciform xanthoma because the lesion is chronic and inflammatory with slow growth, and sites if high trauma are more often affected by such a lesion. The hard palate is the second most commonly affected site, and local trauma caused by smoking can be a cause of this type of lesion.

Taurodontism, Root Dilaceration, and Tooth Transposition: A Radiographic Study of a Population With Nonsyndromic Cleft Lip and/or Palate.

OBJECTIVES: In an effort to contribute to proper dental planning and define possible dental phenotypes of nonsyndromic cleft lip and/or palate (CL/P), this study aimed to investigate the occurrence of taurodontism, root dilaceration, and tooth transposition in persons with nonsyndromic CL/P, specifically analyzing the differences among gender, cleft types, and the most affected teeth. DESIGN: This retrospective study analyzed 974 panoramic x-rays from nonsyndromic Brazilians older than 16 years and categorized into the following four groups: group 1, 250 persons with unilateral cleft lip and palate; group 2, 250 persons with unilateral cleft lip; group 3, 224 persons with cleft palate; and a control group of 250 persons without clefts. Radiographs were digitalized with a scanner and analyzed. RESULTS: In the Brazilian population studied, the prevalence of taurodontism was 60.4% in group 1, 62.4% in group 2, 67.0% in group 3, and 42.8% in the control group. Root dilacerations had a prevalence of 31.2% in group 1, 29.6% in group 2, 26.3% in group 3, and 27.2% in the control group. The teeth most affected by taurodontism were 17 and 27; whereas root dilacerations were most common in teeth 38 and 48. No tooth transpositions were found in any radiograph analyzed. CONCLUSIONS: Taurodontism is significantly more prevalent in Brazilians with nonsyndromic CL/P than in persons without clefts; whereas the prevalence of root dilaceration no different from that in the control group. However, root dilacerations in anterior teeth were increased in groups 1 and 2 when compared to the control group.

Analysis of linear measurements on 3D surface models using CBCT data segmentation obtained by automatic standard pre-set thresholds in two segmentation software programs: an in vitro study.

OBJECTIVE: The aim of this in vitro study was to evaluate the reliability and accuracy of linear measurements on three-dimensional (3D) surface models obtained by standard pre-set thresholds in two segmentation software programs. MATERIALS AND METHODS: Ten mandibles with 17 silica markers were scanned for 0.3-mm voxels in the i-CAT Classic (Imaging Sciences International, Hatfield, PA, USA). Twenty linear measurements were carried out by two observers two times on the 3D surface models: the Dolphin Imaging 11.5 (Dolphin Imaging & Management Solutions, Chatsworth, CA, USA), using two filters(Translucent and Solid-1), and in the InVesalius 3.0.0 (Centre for Information Technology Renato Archer, Campinas, SP, Brazil). The physical measurements were made by another observer two times using a digital caliper on the dry mandibles. RESULTS: Excellent intra- and inter-observer reliability for the markers, physical measurements, and 3D surface models were found (intra-class correlation coefficient (ICC) and Pearson's r ≥ 0.91). The linear measurements on 3D surface models by Dolphin and InVesalius software programs were accurate (Dolphin Solid-1 > InVesalius > Dolphin Translucent). The highest absolute and percentage errors were obtained for the variable R1-R1 (1.37 mm) and MF-AC (2.53 %) in the Dolphin Translucent and InVesalius software, respectively. CONCLUSION: Linear measurements on 3D surface models obtained by standard pre-set thresholds in the Dolphin and InVesalius software programs are reliable and accurate compared with physical measurements. CLINICAL RELEVANCE: Studies that evaluate the reliability and accuracy of the 3D models are necessary to ensure error predictability and to establish diagnosis, treatment plan, and prognosis in a more realistic way.

Avaliação da relação entre as raízes dos dentes posteriores e o assoalho do seio maxilar em pessoas sem e com fissura labiopalatina / Relationship evaluation between the posterior teeth roots and the maxillary sinus floor in patients with and without cleft lip and palate

O seio maxilar apresenta formato distinto e volume variável entre as pessoas e seu assoalho pode ser encontrado em íntimo contato com as raízes dos dentes posteriores, podendo haver protrusão dessas raízes em seu interior. Tal proximidade é de grande relevância frente aos casos de comunicação bucossinusal em potencial ou pela possibilidade de desenvolvimento de um quadro infeccioso de origem odontogênica, em que esse pode vir a se estender para o interior do seio maxilar. Existe uma ausência de trabalhos na literatura acerca da relação estabelecida entre dentes posteriores e o seio maxilar em pessoas com fissura labiopalatina. O objetivo do presente estudo foi identificar e comparar a relação entre o assoalho do seio maxilar e os ápices radiculares dos dentes posteriores em imagens de tomografia computadorizada de feixe cônico em pessoas sem fissura labiopalatina e com fissura transforame incisivo unilateral e bilateral. Foram avaliados 100 indivíduos sem anomalias craniofaciais e 112 com fissura transforame incisivo unilateral ou bilateral, não sindrômicos, utilizando o programa i-CAT® Vision, onde a relação estabelecida pelas estruturas foi convencionada sendo, tipo 0 ou ausência de contato entre as estruturas, tipo 1 ou relação de íntimo contato entre as estruturas sem protrusão radicular no interior do seio maxilar e tipo 2 ou relação de íntimo contato entre as estruturas com protrusão radicular no interior do seio maxilar. Foi utilizado o teste do qui-quadrado para comparar os achados entre os grupos estudados, considerando valor estatisticamente significante quando p≤ 0,05. Foi avaliada a relação do assoalho do seio maxilar com 1679 dentes, totalizando 3664 raízes onde 1883 (51,3%) foram classificadas como tipo 0, 1456 (39,7%) tipo 1 e 325 (8,8%) do tipo 2. Houve diferença estatisticamente significante para a raiz palatina do dente 18 entre os grupos com fissura unilateral e bilateral (p = 0,011), para a raiz mesiovestibular do dente 18...

The maxillary sinus has a remarkable feature and a variable volume among people where the inferior wall may be found in an intimate relation with the posterior teeth roots protruding or not inside the antrum. This proximity is of great relevance considering a potential oroantral communication or the spreading of an odontogenic infection into the maxillary sinus. There is a lack of evidence into the literature regarding the relationship between posterior teeth roots and the maxillary sinus in non-syndromic complete cleft lip and palate patients. This study aimed to evaluate and compare cone beam computed tomography images regarding the relationship between the posterior teeth roots and the maxillary sinus floor in non-cleft lip and palate patients and non-syndromic complete unilateral and bilateral cleft lip and palate patients. Images were interpreted using the i-CAT® Vision software including 100 noncleft patients and 112 presenting non-syndromic complete unilateral and bilateral cleft lip and palate. The relationship between teeth roots and the maxillary sinus floor was established as type 0 or no contact between these structures, type 1 or close contact without root protrusion into the sinus and type 2 or close contact with root protrusion into the sinus. The chi-square test, considering a statistically significant value where p≤0,05, was used to compare data between different groups. The sample included 1679 teeth and 3664 roots where 1883 (51,3%) were classified as type 0, 1456 (39,7%) as type 1 and 325 (8,8%) as type 2. There were statistically significant differences for tooth 18 palatine root between both complete cleft lip and palate groups (p = 0,011), for tooth 18 mesiobuccal root between noncleft and the bilateral groups (p = 0,046) and between both complete cleft lip and palate groups (p = 0,016) and for tooth 24 buccal root between non-cleft and the bilateral group (p = 0,001). Complete unilateral and bilateral cleft lip and palate...

Dezessete anos de acompanhamento imaginológico de pseudocistos recorrentes do seio maxilar em paciente com fissura palatina / Seventeen years imaging follow-up of recurrent pseudocysts of the maxillary sinus in a cleft patient

Relata-se um caso de paciente portador de fissura palatina apresentandopseudocistos em seios maxilares. As lesões foram diagnosticadas em radiografias panorâmicas obtidas com finalidade odontológica por um período de 17 anos, ora no lado direito, ora no lado esquerdo. Em algumas imagens as lesões não eram vistas. O presente relato demonstra a natureza silenciosa dos pseudocistos, além da possibilidade de resolução espontânea e reaparecimento.

It is reported a case of pseudocysts in maxillary sinuses in a cleft patient. The lesions were diagnosed on random panoramic radiographs for a period of 17 years, either in the right or left maxillary sinus. In some images the lesions were not seen. This report demonstrates the silent nature of pseudocysts,besides the possibility of spontaneous resolution and recurrence.

The importance of a proper selection area to be biopsied in nodular leukoplakia: a case report.

Nodular leukoplakia is a non-homogeneous type of oral leukoplakia presenting a white surface with verrucous, nodular, ulcerated or erythematous features with a greater risk of malignant transformation when compared to the homogeneous type. Common sites of involvement include lip commissures, buccal mucosa and soft palate. It is often associated with epithelial dysplasia or carcinoma and requires detailed microscopic assessment and regular follow-up. The importance of a proper selection of the area to be biopsied and the close teamwork between a dentist and oral pathologist is the basis of providing an accurate final diagnosis.

Panorâmica versus TCFC para interpretação de ateromas calcificados da carótida / Panoramic versus CBCT exams to suggest carotid artery calcifications

Objetivo: o objetivo deste estudo foi avaliar a prevalência das calcificações na artéria carótida – CACs – em imagens digitais panorâmicas (PD) e de tomografia computadorizada de feixe cônico (TCFC) dos mesmos pacientes. A CAC é uma doença vascular que acomete os pacientes acima dos 50 anos, coincidindo com uma grande maioria de pacientes que procura reabilitação por implantes. Assim sendo, é importante que o implantodontista esteja atento à interpretação da CAC, uma vez que detectada requer encaminhamento do paciente a um cardiologista para confirmação do diagnóstico. Material e métodos: foram avaliadas 100 imagens (200 lados) de panorâmicas digitais (idade média de 48 anos) e a imagem TCFC dos mesmos pacientes. O re-exame das imagens panorâmicas foi realizado com o objetivo de identificar os CACs falso-positivos e falso-negativos em relação à TCFC. Resultados: considerando 200 lados analisadas, 3,5% (n=7/200) foram interpretadas como CACs em radiografias panorâmicas, e 2,5% (n=5/200) em imagens de TCFC. Dos sete casos CACs positivos em radiografias panorâmicas, três foram falso-positivos quando comparados à correspondente TCFC. Quanto aos cinco casos CACs positivos em TCFC, um era falso-negativo, comparado à imagem panorâmica respectiva. Conclusão: calcificações artéria carótida – CACs – podem ser vistas nas imagens panorâmicas e/ou TCFC, no entanto, a panorâmica tendeu a mostrar casos falso-positivos da CAC. A CAC surge como um achado incidental nos exames de panorâmica e de TCFC, mas ainda assim o dentista tem como obrigação encaminhar o paciente para um cardiologista para a confirmação do diagnóstico, uma vez detectada a sua suposta presença.

Uncommon trajectory variations of the mandibular canal and of the mandibular incisive canal: case report.

PURPOSE: This paper aims to report and discuss a case in which unusual anatomical variations were observed in the mandibular canal (MC) and the mandibular incisive canal (MIC) in a same patient. MATERIALS AND METHODS: A 49-year-old healthy female was referred for mandibular dental implant placement. Panoramic radiography and cone beam computed tomography (CBCT) were performed. Cross-sections, axial, coronal, panoramic reconstructions and volume rendering were obtained. RESULTS: The panoramic radiograph did not show any evidence of abnormality. CBCT showed a bifid MC on the right side. It extended to the buccal cortex, exteriorized for 6 mm and returned to its conventional trajectory to reach the mental foramen. On the left side, the MIC initially followed its normal trajectory for 4 mm but, in the canine region, it also extended to the buccal cortex and exteriorized. CONCLUSION: The advent of CBCT in Dentistry allowed a greater accuracy in the diagnosis of anatomical variations in the jaws, preventing injury to the neurovascular bundle and enabling an adequate surgical planning in the region.

Maxillary sinus and posterior teeth: accessing close relationship by cone-beam computed tomographic scanning in a Brazilian population.

INTRODUCTION: This study aimed to evaluate the close proximity established between the maxillary sinus floor and posterior teeth roots apices by using cone-beam computed tomographic scanning. METHODS: The relationship of maxillary sinuses and posterior teeth roots, which were divided into 2 groups, was analyzed using i-CAT Vision software (Imaging Sciences, Hatfield, PA). Group 1 included all root apices found in close contact with the maxillary sinus floor without sinus floor elevation, whereas group 2 included all root apices that were protruded within the sinus producing an elevation of the bony cortical. RESULTS: A total of 100 maxillary sinuses and 601 roots apices were evaluated. Group 1 presented 130 of 601 (21.6%) roots and group 2 presented 86 of 601 (14.3%) roots. CONCLUSIONS: The second molar mesiobuccal root apex is frequently found in close proximity with the sinus floor, and the relation between these anatomic structures should be considered in order to prevent an iatrogenic procedure and minimize the risks from an infectious disease within the sinus.

Lesão traumática na papila incisiva: relato de caso / Traumatic lesion in the incisive papilla: case report

A papila incisiva, localizada abaixo do forame incisivo, é uma estrutura anatômica propensa a traumas que podem vir a apresentar sinais de infl amação, gerando confusão e erros de diagnóstico, caso não seja realizado um exame clínico detalhado, levando, assim, o paciente a uma terapia inadequada. Dessa forma, por meio da apresentação de um relato de caso, os autores buscam salientar a importância do exame clínico detalhado, além da avaliação e do conhecimento das imagens clínicas e radiográfi cas para a realização de um diagnóstico diferencial adequado. Abordam, mais precisamente, o diagnóstico diferencial entre traumatismo físico e cisto do ducto nasopalatino, discutindo, ainda, como a falta de anamnese e o exame físico criterioso levaram a um erro de diagnóstico e tratamento incorreto do paciente.

The incisive papilla, located beneath the incisive foramen, is an anatomical structure that, when it is exposed to trauma, shows signs of infl ammation, leading the problem to a misdiagnosis an inadequate therapy due to a mistake and confusion during the clinical examination. Thus, by a case report, the authors highlight the importance of a detailed clinical examination besides the evaluation and knowledge of clinical and radiographic images for an appropriated diff erential diagnosis. That can address, more precisely, the diff erential diagnosis between physical trauma and the nasopalatine duct cyst, beyond discuss how the lack of anamnesis and accurate physical examination led to a misdiagnosis and a wrong treatment.

Variações anatômicas do canal mandibular detectadas em imagens de tomografia computadorizada de feixe cônico / Anatomic variations of mandibular canal detected in cone beam computed tomography images

O canal mandibular é uma estrutura anatômica de extrema importância na Implantodontia. Presenças de variações anatômicas no trajeto do canal podem determinar modificação no planejamento cirúrgico. O exame de tomografia computadorizada de feixe cônico (TCFC) permite a avaliação tridimensional da região de interesse, sendo uma técnica superior aos exames bidimensionais na detecção de variações anatômicas. O objetivo deste artigo foi apresentar as principais variações anatômicas do canal mandibular, que podem ser detectadas em exames de TCFC, e suas implicações clínicas. Foram utilizados 60 exames de TCFC pertencentes ao banco de imagens do Departamento de Estomatologia da Faculdade de Odontologia de Bauru. Os exames tinham o protocolo de escaneamento com campo de visão (FOV) de 6 cm, 8 cm ou 13 cm, e tamanho de voxel de 0,3 mm, tendo sido avaliados no software i-CAT Vision. Os critérios considerados durante a análise foram: presença de deiscências nas corticais ósseas e de ramificações. Observou-se quatro deiscências linguais do lado direito e oito do lado esquerdo, seis ramificações do lado esquerdo e três do lado direito. Ou seja, a presença de deiscências e ramificações no canal mandibular pode ser observada em aproximadamente 10% dos casos, em média, com uso de TCFC. As variações anatômicas no canal mandibular devem ser cuidadosamente avaliadas no volume total capturado pela TCFC, propiciando a realização de um adequado planejamento cirúrgico.

The mandibular canal is an anatomic structure of extreme importance in implantology. The presence of anatomical variations can determine changes in the surgical planning. The cone beam computed tomography (CBCT) exams enable three-dimensional evaluation of the interest region and it is a superior technique in comparison with two-dimensional images for the detection of anatomical variations. The aim of this paper is to present the main anatomical variations of the mandibular canal that can be detected in CBCT exams and its clinical implications. For this, 60 CBCT scans from the database of Department of Stomatology, Bauru Denta School, were used. The exams were obtained using 6 cm, 8 cm or 13 cm field of view (FOV) and 0.3 mm voxel size, evaluated with i-CAT Vision software. The criteria considered during the analysis were dehiscence of the cortical bone and ramifications. We observed four lingual dehiscences in the right side and eight in the left side, six ramifications in the left side and three in the right, which indicates that the ramifications and dehiscences of the mandibular canal can be observed in approximately 10% of cases, in average, using CBCT. The implantodontist should evaluate the entire CBCT image volume to search for anatomical variations in the mandibular canal for appropriate surgical planning.

Periodontal manifestations and ambulatorial management in a patient with Sturge-Weber syndrome.

Sturge-Weber syndrome is a nonhereditary congenital condition characterized by leptomeningeal and facial skin angiomatous malformation following the trigeminal nerve path. The intraoral angiomatosis are presented in 40% of cases and results in an important periodontal alteration, increasing the risk of bleeding during dental procedures. A 43-year-old male patient presented with port wine stain on the right side of the face, the entire hard and soft palates, the alveolar ridge, and buccal mucosa, and had an excessive accumulation of calcified masses in both supragingival and subgingival sites, with swelling and generalized inflammation throughout the gingiva and alveolar mucosa. He reported not having sanitized the area for years for fear of bleeding. Periodontal management, to remove calculus and to control gingivitis initiated in the supragingival region and gradually reaching the subgingival region to control oral microbiota, was performed with mild bleeding. The redness of the staining greatly diminished with time and the extreme halitosis of the patient also improved sharply leading to a dramatic improvement in quality of life. Ambulatory care is a feasible alternative for periodontal management that within safety limits for bleeding risks reduces the operational cost.

Avaliação do seio maxilar por meio de tomografia computadorizada de feixe cônico / Maxillary sinus evaluation through cone beam computed tomography

O cirurgião-dentista necessita muitas vezes visualizar imagens associadas a estruturas importantes onde um bom conhecimento da anatomia crânio facial e dentomaxilar é imprescindível na elaboração de um diagnóstico correto. O seio maxilar é uma estrutura anatômica localizada no terço médio da face, sendo de extrema importância por estar localizado muito próximo às estruturas dentárias posteriores, devendo fazer parte do conhecimento dos cirurgiões-dentistas, nas diversas especialidades. Nesse estudo foram avaliados 50 exames de Tomografia Computadorizada de Feixe Cônico (TCFC) onde os seios maxilares podiam ser visualizados, resultando em um total de 78 extensões para diferentes regiões foram encontradas, 17 indivíduos apresentavam espessamento da membrana sinusal, 14 mostravam imagens compatíveis com cistos de retenção de muco e 6 apresentavam velamento do seio maxilar, variando entre total e parcial. Um total de 64 septos foram identificados no interior da cavidade sinusal, 86 cúpulas alveolares localizadas nas raízes dos diferentes dentes, 126 raízes foram encontradas em íntimo contato com o assoalho sinusal. Os resultados foram estatisticamente significantes para a relação entre cúpulas alveolares e extensões alveolares para a raiz palatina do dente 26, a presença de septos no teto dos seios maxilares de mulheres e da relação da média da região desdentada do dente 26 para os homens, com os valores de p < 0,05. Diversos fatores relacionados à morfologia do osso maxilar, a ausência de dentes e a própria conformação da cavidade sinusal podem resultar em diferentes formatos entre indivíduos e variações até no mesmo indivíduo. O exame por Tomografia Computadorizada de Feixe Cônico (TCFC) dos seios maxilares permite uma avaliação tridimensional e sua relação com as estruturas adjacentes, ou seja, uma perfeita reprodução da região dentomaxilofacial, auxiliando de maneira precisa os profissionais que irão intervir junto ou próximo a essa estrutura anatômica.

Dentistry professionals are required to analyze, in many cases, images associated to important structures where a great knowledge of the dentomaxillofacial anatomy is vital for an accurate diagnostic. The maxillary sinus is an anatomical structure that occupies the upper 2/3s of the maxillary bone and it is very important because the proximity with the posterior dental structures, it must be well known by dentists in the several specialties. In this study, 50 Cone Beam Computed Tomography (CBCT) exams in which the maxillary sinus could be evaluated, showed a total of 78 extension toward different regions were achieved, 17 subjects displayed a mucosal thickening, 14 evidenced a compatible imaging of mucous retention cysts and 6 presented a partially or completely filled maxillary sinus. A total of 64 maxillary sinus septa were identified, 86 different roots were localized inside de sinus, 126 roots were found to be in proximity with the sinus floor. The results were statistically significant to the relation made between these roots, which were inside the sinus and the alveolar extensions to the palatine root of the tooth 26, the presence of maxillary sinus septa located in the roof of the women maxillary sinus and the relation made between the median value for men in the edentulous region of the tooth 26, with a p value < 0,05. Its anatomy is one of the most varied, and many factors related to the maxillary bone morphology like edentulousness and the sinus conformation can result on different shapes, even in the same person. The Cone Beam Computed Tomography (CBCT) of the maxillary sinus provides a three-dimensional evaluation and its relationship with the boundary structures. It is a precise reproduction of the dentomaxillofacial region, providing valuable support to the professional who will work on or next to this anatomical structure.

Lesão periférica de células gigantes: relato de caso / Peripheral lesion in giant cells

A lesão periférica de células gigantes é um processo proliferativo não neoplásico. Considerada uma lesão reacional, parece ter origem no periósteo ou ligamento periodontal, relacionada a trauma, irritação local e mais recentemente aos implantes dentais. Neste trabalho apresentamos as principais características clínicas, radiográficas e microscópicas da lesão fundamentados em recente revisão de literatura.

Peripheral giant cell granuloma is a non-neoplasic tumorous proliferationthat occurs in all age groups, and this condition can be more aggressive in child. The etiological factors it is not exactly known, althogh local irritating factors, trauma, and actually dentalimplants are related. There is a high predilection for the mandible anda slight one for women. After surgical treatment the tissue must besubmitted for histopathological evaluation to a correct diagnosis.