Three-dimensional evaluation of mandibular condyle and coronoid process according to sex, age, and skeletal deformities.

OBJECTIVE: To correlate the volume of the mandibular condyle (MC) and the coronoid process (CP) with sex, age, and skeletal deformities. METHODS: The structures were visualized through semi-automatic segmentation of the 3D model and complemented with manual segmentation, using the ITK-SNAP 3.0 software. Mann-Whitney, Kruskal-Wallis, and the Dunn test were performed (p < 0.05). RESULTS: The MC volume showed statistical differences between sex and skeletal deformities. Men and Class III patients showed higher values. CP volume was not influenced by age or skeletal deformities. However, statistical differences were found between sex, with higher values for men. CONCLUSION: MC volume was influenced by sex and skeletal deformities, while CP was influenced only by sex. Women have smaller volumes for these structures. Age is not correlated with the volume of MC and CP. The highest and lowest values of condylar volume were found for Class III and II individuals, respectively.

Oral manifestations of systemic fungal infections: 25-year experience in an endemic region

Some mycoses are endemic. They develop through hematogenous spread, causing a generalized infection, usually with secondary mucosal involvement.The aim of this observational and retrospective study was to report the prevalence and characteristics of oral lesions in patients diagnosed with systemic fungal infections (SFI) over a 25-year period in southern Brazil. Demographic (age, sex, ethnicity, occupation) and clinical (anatomical location, symptoms,histopathological diagnosis and management) data from the medical records of patients with SFI were collected from 1995 to 2019. 34 cases of SFI were found, of which 31 (91.18%) were diagnosed as paracoccidioidomycosis (PCM) and 3 (8.82%) as histoplasmosis. Men were much more affected (n = 31; 91.18%), with an average age of 46.9 years. Most patients (n = 18; 58.06%) were Caucasian; 48% (n = 15) were farm/rural workers and the most affected region was the jugal mucosa (n = 13; 25.49%) followed by the alveolar ridge (n = 12; 23.52%). All patients with histoplasmosis were immunocompetent men (mean age: 52.67 years), and the palate was the most affected. All patients underwent incisional biopsy and were referred to an infectologist. The dentist has an essential role in the recognition of SFI, whose oral manifestations may be the first sign. SFI should be included in differential diagnosis in patients from endemic areas. In addition, the inevitable human mobility and globalization make knowledge of these mycosesnecessary worldwide, especially since advanced cases in immunocompromised patients can be fatal.

Correlation between the presence of the median perforating canal in adults with sex, age and skeletal facial patterns: A cross-sectional study.

INTRODUCTION: The aim of the present study was to evaluate the presence of the median perforating canal (MPC) and its morphometric measurements in Cone Beam CT (CBCT) scans of adult patients, correlating the findings with sex, age and skeletal facial patterns. MATERIAL AND METHODS: 717 CBCT scans were selected from a Brazilian population and the presence of the MPC was recorded. MPC diameter was measured in three points: lingual, medial and buccal. To determine the correlation between MPC presence and sex, age and ANB angle classifications the Chi-square test was performed. MPC diameters were related to sex, age and skeletal discrepancies using Mann-Whitney U and Kruskal-Wallis tests. The level of significance adopted was 5%. RESULTS: Of the 717 CBCT scans analyzed, the MPC was present in 181 patients (25.24%), 279 (38.91%) men and 438 (61.09%) women. The mean age was 37.91 (±14.46) years old, ranging from 18 to 88 years old. There were no differences in the presence of MPC between women and men (p = 0.85), between skeletal discrepancies (p = 0.09) and age groups (p = 0.94). Regarding the MPC diameter, statistical difference was found only for the medial diameter between sexes (p = 0.04), with the highest values in men. CONCLUSION: The MPC was detected in 25.24% of the studied population, with significant differences only for its medial diameter in men.

Accuracy of three-dimensional soft tissue profile prediction in orthognathic surgery.

PURPOSE: To evaluate the accuracy of three-dimensional (3D) soft tissue prediction in bimaxillary orthognathic surgery. METHODS: Cone-beam computed tomographs of 88 patients with class II (n = 46) and class III (n = 42) malocclusions, who underwent bimaxillary orthognathic surgery, were included in this retrospective study. 3D soft tissue prediction and postoperative outcome were compared by using ten landmarks of facial soft tissues. Patients' sex and age were also assessed. Results were analyzed using a mixed model methodology (p < 0.05). RESULTS: The success criterion adopted was a mean discrepancy of < 2 mm. Most mandibular landmarks indicated a tendency for underprediction with a downward direction in class II patients, with some values > 2 mm. In class III, there was overprediction with a downward direction for the mandibular landmarks, with values < 2 mm. More accurate results were found in female and older patients. CONCLUSIONS: 3D surgical planning showed clinically acceptable results for predicting soft tissues in patients undergoing bimaxillary orthognathic surgery, with more accurate results for class III patients. Although some differences were found when age and sex were interacted, a consistent association between these variables could not be stated. These results support the clinician, as accuracy can provide a strong guide to the surgeon when planning surgical orthodontic treatment.

Evaluation of ortogonblender software bone movement tools in bimaxillary orthognatic surgeries performed in dolphin software.

The aim of this observational, longitudinal and retrospective study was to evaluate the fidelity of virtual surgical planning (VSP) performed on Dolphin Imaging & Management Solutions® 11.95 software on hard tissues, using the tools of the open-source software OrtogOnBlender - Blender3D. For this, linear, angular and 7-point anatomical measurements of the skeletal profile were used, and the discrepancies between the VSP and the result after bimaxillary orthognathic surgery were calculated. Pre- and postoperative cone beam CT (CBCT) scans of 43 consecutive patients with class II and III skeletal deformities were evaluated and the results of the VSP were compared to the 1-month postoperative results. All overlapping points presented values within the range considered clinically irrelevant (< 2 mm and < 4°) and differences were not significant (p > 0.05). The comparison of anatomical points showed lower values (≤ 2.11 mm) in point A of class II. For hard tissues, the comparison between VSP and 1-month postoperative tomography demonstrated the faithful results of virtual planning using this software.

Differential diagnosis for an unusual calcification in the maxillary sinus: case report / Diagnóstico diferencial para calcificação incomum em seio maxilar: relato de caso

ABSTRACT The aim of this study was to report a rare case of an asymptomatic calcification of unusual size and shape, inside the maxillary sinus identified on a cone beam computed tomography exam and to discuss the importance of knowledge of the anatomy of maxillary sinus and its changes carefully evaluating the entire volume of the images, regardless of the region of interest. An 83-year-old female patient underwent a cone beam computed tomography exam for other diagnostic purposes in the maxillofacial region. When analyzing the entire volume, an image of unusual limits, hyperdense and calcified was found in the right maxillary sinus, close to the anterior and medial wall, with a rounded and homogeneous shape, occupying approximately one third of the maxillary sinus. There was no lytic or erosive lesions on the maxillary sinus wall. The main diagnostic hypotheses raised were giant anthrolith, mucous retention phenomenon and osteoma. Due to the anatomical complexity of the maxillary sinus, diagnosis in this region becomes a challenge. Considering the limitations of 2D exams, the cone beam computed tomography exam can be used to evaluate these structures. Knowledge of differential hypotheses is extremely important for the case to be conducted correctly, but it does not replace biopsy and histopathological examination.

RESUMO O objetivo desse estudo foi relatar um caso raro de uma calcificação assintomática de tamanho e formato incomum, no interior do seio maxilar, diagnosticado em um exame de tomografia computadorizada de feixe cônico, além de discutir a importância do conhecimento da anatomia do seio maxilar e suas alterações, avaliando cuidadosamente todo o volume das imagens, independentemente da região de interesse. Paciente do sexo feminino, 83 anos de idade, realizou uma tomografia computadorizada de feixe cônico para outros fins de diagnóstico na região bucomaxilofacial. Ao analisar todo volume da tomografia encontrou-se uma imagem de limites incomuns, hiperdensa e calcificada, no seio maxilar direito, próximo a parede anterior e medial, com formato arredondado e homogêneo, ocupando aproximadamente um terço do seio maxilar, com as suas paredes intactas e sem nenhuma lesão lítica ou erosiva. As principais hipóteses diagnosticas levantadas foram antrólito gigante, fenômeno de retenção mucoso e osteoma. Devido a complexidade anatômica do seio maxilar, o diagnóstico nessa região se torna um desafio. Considerando as limitações dos exames 2D, a tomografia computadorizada de feixe cônico pode ser empregada para a avaliação dessas estruturas. O conhecimento do raciocínio diagnóstico e das hipóteses diferenciais são de extrema importância para o que o caso seja conduzido corretamente, porém não substituem a biópsia e o exame histopatológico.

Evaluation of a Protocol For Topical Application of Capsaicine Gel 0.025 % in the Management of Burning Mouth Syndrome Correlating its Impact on Quality of Life

ABSTRACT: The aim of this study is to report the results obtained with a protocol of topical application of capsaicin gel 0.025 % in the management of burning mouth syndrome (BMS) to evaluate the influence of the disease and treatment on their quality of life (QOL) using the OHIP-14 questionnaire (Oral Health Impact Profile). After clinical examination and diagnosis of BMS, 10 patients reported the intensity of the burning by means of a subjective score ranging from 0 to 10 and also answered the OHIP-14. Then, a topical application protocol of capsaicin gel 0.025 % was initiated, with weaning from medication and complete withdrawal within 180 days. At each reassessment consultation (30, 60, 90 and 180 days), the patients answered the OHIP-14 and subjective burning scores were collected again. Overall, the capsaicin gel showed gradual reduction or elimination of symptoms of BMS, as well as an improvement in the QOL of patients throughout treatment. At 180 days, after medication withdrawal, 6 patients (60 %) reported total absence of burning and in four patients (40 %) the score remained or decreased. In one patient (10 %) the score increased, although it remained below the initial score. The results showed an improvement in the QOL of all patients who completed the protocol and the impact of BMS on the QOL decreased in relation to the initial score in all patients. The topical use of 0.025 % capsaicin gel was effective in reducing or remitting symptoms of BMS. The OHIP-14 questionnaire showed the negative impact of BMS on patients' QOL and the role of treatment in its improvement.

RESUMEN: El objetivo de este estudio fue reportar los resultados obtenidos con un protocolo de aplicación tópica de gel de capsaicina al 0,025 % en el manejo del síndrome de boca ardiente (SBA), para evaluar la influencia de la enfermedad y el tratamiento en su calidad de vida (CV) mediante el cuestionario OHIP-14. Tras el examen clínico y diagnóstico de SBA, 10 pacientes refirieron la intensidad del ardor mediante una puntuación subjetiva de 0 a 10 y también respondieron la OHIP-14. Luego, se inició un protocolo de aplicación tópica de gel de capsaicina al 0,025%, con destete de la medicación y retiro completo en 180 días. En cada consulta de reevaluación (30, 60, 90 y 180 días), los pacientes respondieron el OHIP-14 y se recogieron nuevamente las puntuaciones subjetivas de quemado. En general, el gel de capsaicina mostró una reducción o eliminación gradual de los síntomas del SBA, así como una mejora en la calidad de vida de los pacientes durante todo el tratamiento. A los 180 días, después de la retirada de la medicación, 6 pacientes (60 %) informaron ausencia total de ardor y en cuatro pacientes (40%) la puntuación se mantuvo o disminuyó. En un paciente (10 %) la puntuación aumentó, aunque se mantuvo por debajo de la puntuación inicial. Los resultados mostraron una mejora en la CV de todos los pacientes que completaron el protocolo y el impacto de SBA en la CV disminuyó en relación con la puntuación inicial en todos los pacientes. El uso tópico de gel de capsaicina al 0,025 % fue efectivo para reducir o remitir los síntomas del SBA. El cuestionario OHIP-14 mostró el impacto negativo de SBA en la CV de los pacientes y el papel del tratamiento en su mejora.

Comparison of limited- and large-volume cone-beam computed tomography using a small voxel size for detecting isthmuses in mandibular molars.

PURPOSE: This study was performed to compare the ability of limited- and large-volume cone-beam computed tomography (CBCT) to display isthmuses in the apical root canals of mandibular molars. MATERIALS AND METHODS: Forty human mandibular first molars with isthmuses in the apical 3 mm of mesial roots were scanned by micro-computed tomography (micro-CT), and their thickness, area, and length were recorded. The samples were examined using 2 CBCT systems, using the smallest voxels and field of view available for each device. The Mann-Whitney, Friedman, and Dunn multiple comparison tests were performed (α=0.05). RESULTS: The 3D Accuitomo 170 and i-Cat devices detected 77.5% and 75.0% of isthmuses, respectively (P>0.05). For length measurements, there were significant differences between micro-CT and both 3D Accuitomo 170 and i-Cat (P<0.05). CONCLUSION: Both CBCT systems performed similarly and did not detect isthmuses in the apical third in some cases. CBCT still does not equal the performance of micro-CT in isthmus detection, but it is nonetheless a valuable tool in endodontic practice.

What has Changed in the Daily Practice of the Dental Imaging Center During the COVID-19 Pandemic?

ABSTRACT: A new type of RNA coronavirus (SARS-CoV-2) related to acute respiratory syndrome (SARS) and responsible for COVID-19 disease has spread around the world, resulting in an unprecedented pandemic. COVID-19 has become an international public health emergency and countless people and sectors have been affected. In this context, individual and collective protection measures were taken, mainly in health care. Dentistry, considered a high risk area, had to undergo changes in relation to biosecurity, including in radiological clinical practice. Thus, this letter aims to comment on these changes during visits to dental imaging centers.

RESUMEN: Un nuevo tipo de coronavirus de ARN (SARS-CoV-2) relacionado con el síndrome respiratorio agudo (SARS) responsable de la enfermedad COVID-19 se ha extendido por todo el mundo y ha provocado una pandemia sin precedentes. COVID-19 se ha convertido en una emergencia de salud pública internacional y un sinnúmero de personas y sectores se han visto afectados. En este contexto, se tomaron medidas de protección individual y colectiva, principalmente en el ámbito de la salud. La atención dental, considerada de alto riesgo, tuvo que sufrir cambios en relación con la bioseguridad, incluida la práctica clínica radiológica. Así, esta carta tiene como objetivo comentar estos cambios durante los atendimientos a los centros de imagenología dental.

Biosecurity Perspectives in Oral and Maxillofacial Radiology in Times of Coronavirus disease (COVID-19): a Literature Review

ABSTRACT: The aim of this work was to report biosecurity measures in the Oral and Maxillofacial Radiology (OMR) clinic in the current context of COVID-19, based on a literature review. An electronic search for scientific papers was perform ed using PubMed, Embase, Web of Science, and Scopus database. Although the literature related to care in the OMR clinic regarding COVID-19 is still scarce, this unprecedented scenario created by the pandemic generated an urgent need for measures to prevent the transmission of the virus. Dentists are at maximum risk of contagion and, although the practice of OMR generally does not produce aerosols, radiologists and technicians are continually in contact with body fluids, such as saliva. In additio n, imaging exams are often indispensable for emergency or elective dental diagnosis and treatment. Training in infection control practices during major outbreaks of infectious diseases should be quickly reinforced and dental settings have unique characteristics that warrant specific infection control considerations. Some recommendations have been proposed and were discussed, which cover patient flow, equipment handling and environment, radiographic technique and processing, personal protective equipment and preparation and issuance of radiological reports and access to exam results. Due to the COVID-19 pandemic, biosecurity measures in the routine of the OMR clinic are indispensable to enable emergency dental care and the perspectives of returning to elective treatment. Biosecurity measures and staff training at the OMR clinic should be instituted immediately, since imaging exams are an important and often indispensable part of dental diagnosis and treatment.

RESUMEN: El objetivo de este trabajo fue reportar las medidas de bioseguridad en la clínica de Radiología Oral y Maxilofacial (OMR) en el contexto actual del COVID-19, a partir de una revisión de la literatura. Se realizó una búsqueda electrónica de artículos científicos utilizando PubMed, Embase, Web of Science y la base de datos Scopus. Si bien la literatura relacionada con la atención en la clínica OMR respecto al COVID- 19 aún es escasa, este escenario inédito creado por la pandemia generó una urgente necesidad de medidas para prevenir la transmisión del virus. Los dentistas tienen el máximo riesgo de contagio y, aunque la práctica en la OMR generalmente no produce aerosoles, los radiólogos y técnicos están continuamente en contacto con fluidos corporales, como la saliva. Además, los exámenes por imágenes a menudo son indispensables para el diagnóstico y el tratamiento dental de emergencia o electivo. La capacitación en prácticas de control de infecciones durante brotes importantes de enfermedades infecciosas debe reforzarse rápidamente y los entornos dentales tienen características únicas que justifican consideraciones específicas de control de infecciones. Se han propuesto y discutido algunas recomendaciones que cubren el flujo de pacientes, el manejo y el entorno del equipo, la técnica y el procesamiento radiográfico, el equipo de protección personal y la preparación y emisión de informes radiológicos y el acceso a los resultados de los exámenes. Debido a la pandemia de COVID-19, las medidas de bioseguridad en la rutina de la clínica OMR son indispensables para posibilitar la atención dental de emergencia y las perspectivas de volver al tratamiento electivo. Las medidas de bioseguridad y la capacitación del personal en la clínica OMR deben instituirse de inmediato, ya que los exámenes por imágenes son una parte importante y, a menudo, indispensable del diagnóstico y tratamiento dental.

Accuracy of cone-beam CT in detecting vertical root fractures in teeth with post-endodontic restorations: an in vitro study

The aim of this study was to evaluate the accuracy of cone-beam CT (CBCT) for the detection of artificially created vertical root fractures (VRF) in extracted teeth restored with metallic (MP) and fiberglass (FGP) posts. After root canal obturation, 60 extracted human premolars were scanned by using the highest-resolution settings of a CBCT unit. Theprepared roots were randomly divided into three groups: group C (control group): non-restored and non-endodontically treated teeth (n = 20); group MP (n = 20); group FGP (n = 20). In all groups, 10 teeth were artificially fractured. Two external and independent observers blindly recorded the presence or absence of VRF. Sensitivity, specificity, accuracy, intra-and interobserver agreement were calculated. Kappa value for inter-and intraobserver agreement was 0.82 and 0.84 respectively, demonstrating goodagreement. The highest values for sensitivity (0.80 -0.90), specificity (1.00) and accuracy (0.90 -0.95) were found in the control group. The teeth with FGP restoration presented the lowest sensitivity (0.30 -0.50) and accuracy (0.60 -0.65) values. Both examiners had a good performance in the diagnosis of fractures in teeth with MP, with accuracy ranging between 0.85 -0.90. The presence of MP did not influence accuracy; however, the presence of FGP reduced the diagnostic capacity of CBCT.

Influence of mandibular positioning on the accuracy and reliability of linear measurements on cone beam CT using different voxels and two software programs / Influência do posicionamento mandibular na acurácia e confiabilidade de medidas lineares em tomografia computadorizada de feixe cônico utilizando diferentes voxels e dois softwares

Objetivo: este estudo avaliou a acurácia e confiabilidadedas medidas lineares em exames detomografia computadorizada de feixe cônico(TCFC), em dois softwares, utilizando diferentesvoxels e variando o posicionamento da mandíbula.Material e Métodos: 10 imagens de TCFC demandíbulas humanas com 25 pontos foram obtidas,usando diferentes protocolos de aquisição(0.250, 0.300, 0.400-mm voxels) e orientações damandíbula (centralizada, rotacionada 10° lateralmentepara direita e esquerda, inclinada 10° para cima e para baixo); 14 medidas foram realizadasnas reconstruções multiplanares nos softwares XoranCate OsiriX. Os achados foram comparadoscom as medidas físicas através de um paquímetrodigital. O teste ANOVA e o coeficiente de correlaçãoforam utilizados com p < 0,05. Resultados:não houve diferença estatisticamente significantequando as medidas foram comparadas em aquisiçõescom diferentes tamanhos de voxels emambos os softwares. A posição da mandíbula nãoinfluenciou nas medidas. Nenhuma diferença foiencontrada quando os valores foram comparadosentre os softwares e o paquímetro digital. Conclusão:as medidas lineares em ambos os softwaresforam confiáveis e acurados comparados a mensuraçãofísica em todos os protocolos. A acuráciae a confiabilidade das mensurações não influenciaramde acordo com as variações de posicionamentoda mandíbula.(AU)

Objective: this study evaluated the accuracy and reliability of linear measurements on cone beam CT (CBCT) scans in two software programs, using different voxels and varying mandible positioning. Material and methods: CBCT images of 10 human mandibles with 25 markers were obtained using different acquisition protocols (0.250, 0.300, 0.400-mm voxels) and mandible orientations (centered, rotated 10° laterally to right and left, tilted 10 up and down); fourteen measurements were carried out on the multiplanar reconstructions in XoranCat and OsiriX Lite software programs. The findings were compared to physical measurements using a digital caliper. ANOVA and correlation coefficient tests were used, at α = 0.05. Results: there was no statistically significant difference when the measurements were compared in acquisitions with different voxel sizes analysed in both software programs. Mandibular positioning changes did not influence the measurements. No differences were found when the values were compared between the software programs and the digital caliper. Conclusion: linear measurements in both programs were reliable and accurate compared with physical measurements when using all acquisition protocols. The accuracy and reliability of the measurements were not influenced by variations in the mandible positioning.(AU)

Inflammatory and developmental odontogenic cysts: 23-year observational and retrospective study / Cistos odontogênicos inflamatórios e de desenvolvimento: estudo observacional e retrospectivo de 23 anos

Objective: This observational and retrospective study evaluated the prevalence and characteristics of odontogenic cysts, outlining the epidemiological profile of these lesions. Material and methods: The following data were collected from the medical records of patients with a diagnosis confirmed by microscopy: age, sex, ethnicity, anatomical location, histopathological diagnosis and treatment, between 1995 and 2018. Results: Of the 70 cysts, 75.7% were inflammatory and 24.2% development. The inflammatory periapical cyst was the most prevalent (62.8%) followed by the dentigerous cyst (71.0%). The lateral radicular cysts and odontogenic keratocysts obtained the same percentage (5.7%), followed by the residual cyst (4.3%), paradental (2.8%) and the orthokeratinized variable (1.5%). Women were slightly more affected (1.12: 1) with greater involvement of leucodermas (80%). Age and anatomical location differed according to each lesion, although the anterior maxilla region was more affected. Enucleation was the most used treatment (75.7%), except for odontogenic keratocysts, in which marsupialization was performed in 75% of the cases. Conclusion: Epidemiological data provide an important insight into the prevalence, extent and severity of these lesions, allowing early diagnosis and prevention, in order to guarantee the reduction of cases and improve the quality of life of the population.

Objetivo: Avaliar a prevalência e características dos cistos odontogênicos de forma observacional e retrospectiva, delineando o perfil epidemiológico destas lesões. Material e Métodos: Foram coletados os seguintes dados dos prontuários de pacientes com diagnóstico confirmado microscopicamente: idade, sexo, etnia, localização anatômica, diagnóstico histopatológico e tratamento, entre os anos de 1995 a 2018. Resultados: Dos 70 cistos, 75,7% eram inflamatórios e 24,2% de desenvolvimento. O cisto periapical inflamatório foi o mais prevalente (62,8%) seguido pelo cisto dentígero (71,0%). O cisto radicular lateral e queratocisto odontogênico obtiveram o mesmo percentual (5,7%), seguidos do cisto residual (4,3%), paradentário (2,8%) e a variável ortoqueratinizada (1,5%). As mulheres foram ligeiramente mais afetadas (1,12:1) com maior acometimento de leucodermas (80%). Idade e localização anatômica diferiram de acordo com cada lesão, embora a região anterior de maxila tenha sido mais afetada. A enucleação foi o tratamento mais utilizado (75,7%), exceto para o queratocisto odontogênico, no qual a marsupialização foi realizada em 75% dos casos. Conclusão: Os dados epidemiológicos fornecem uma visão importante para o entendimento da prevalência, extensão e gravidade dessas lesões, viabilizando o diagnóstico precoce e medidas preventivas, a fim de garantir a redução dos casos e melhorar a qualidade de vida da população.

Cone-beam computed tomographic study of the persistent foramen tympanicum according to age, sex, and skeletal patterns.

This cross-sectional study evaluated the influence of prevalence, laterality and diameter of persistent foramen tympanicum (PFT) in cone beam computed tomographic (CBCT) scans of adult patients with different sagittal skeletal patterns, sex and age. CBCT of 510 patients were assessed for the presence of PFT. Skeletal pattern, age and sex of the affected patients were recorded, as well as laterality and diameter of PFT. Differences were tested using the one-way ANOVA, chi squared and paired-t tests, at α=5%. A total of 49 (9.7%) patients presented with PFT; 36 (73.5%) were women (p<0.01) aging from 31-50 years (p>0.05), with Class III skeletal pattern (p>0.05). The unilateral/bilateral ratio was 3.9:1 (p<0.01). No correlation was found between the PFT diameters with sex and age, but differences were found between the classes, with the largest diameters in Class II individuals (p=0.046). The prevalence of PFT in CBCT scans was 9.7%, with women being more affected, with unilateral defects in most cases. Skeletal patterns did not have significant effects on PFT prevalence, although PFT diameter varied among classes, with higher measures in Class II individuals.

Limitation of diagnostic value of cone-beam CT in detecting apical root isthmuses.

INTRODUCTION: Isthmuses are reported as common anatomic complexities in teeth often associated with failures in endodontic treatment. They should be considered before starting treatment and a preoperative computed tomography scan (CT) may demonstrate these complexities. OBJECTIVE: To assess the diagnostic value of the highest resolution settings of a cone-beam CT (CBCT) system in identifying and measuring apical isthmuses, using micro-CT as reference. METHODOLOGY: After micro-CT scanning, 40 humans' lower first molars with isthmuses in the apical-3 mm of mesial roots were scanned by the highest resolution settings of the New Generation i-Cat ® CBCT equipment. Two blinded observers recorded the detection of isthmuses in CBCT scans. The lengths of isthmuses were compared between micro-CT and CBCT to assess the diagnostic value of CBCT. Quantitative data for sensitivity were represented as percentages (95% confidence interval). The Bland-Altman method was used to assess differences between gold standard lengths (micro-CT) and CBCT lengths. RESULTS: BCT demonstrated 30 positive findings, representing sensitivity for isthmus identification of 75% (95% CI=0.4114-1.1364). Differences between the lengths in micro-CT (1.99±0.40 mm) and CBCT (1.53±0.41 mm) were significant (p<0.0001). CONCLUSION: The CBCT device used presented limited diagnostic value in the identification and measurement of apical isthmuses in the mesial roots of lower molars. In some cases, the actual anatomy of the apical root canal may not be completely delineated in this type of CBCT system, even using the highest resolution settings.

Monoethanolamine oleate sclerotherapy for the treatment of intraoral vascular anomalies: retrospective study and suggestion for a clinical guideline.

Vascular anomalies are common in the head and neck, and oral lesions are most commonly found on the lips, tongue, mucosa, and palate. Monoethanolamine oleate sclerotherapy (MOS) is an option for treatment, although we know of no established protocols yet. We report the prevalence and characteristics of intraoral vascular anomalies (IVA) and the results achieved with the use of 5% MOS, and suggest a clinical guideline. Data from the medical records of patients with IVA were collected (age, sex, ethnicity, site, size, duration, and treatment). Cases treated with MOS were detailed, and data about number of applications, interval between them, dose, adverse effects, and results were recorded. A total of 65 cases of IVA were found. White-skinned women aged from 61 to 70 years (n=21) were most likely to be affected, and the lower lip (n=25) was the most common site. Twenty-seven were treated with MOS using a mean of 1-2 applications with a seven-day interval. The mean dose applied was 0.3ml/section, which was diluted in local anaesthetic in 38 cases. Twenty-two resolved completely. In summary, we found a prevalence of 4.8% of IVA and European women aged 61 to 70 years were most affected. MOS 5% was effective and safe in the treatment of IVA more than 3cm in size, with minimal morbidity and adverse effects. We therefore suggest a sclerotherapy protocol of 0.3ml of the drug (undiluted with anaesthetic) for each 1cm lesion (maximum 3cm), with weekly revaluations and further applications when necessary within a 14-day period.

Accuracy of 3D virtual surgical planning for maxillary positioning and orientation in orthognathic surgery.

OBJECTIVE: This retrospective and observational study evaluated the accuracy of a 3D virtual surgical planning (VSP) for the maxillary positioning and orientation in patients undergoing bimaxillary orthognathic surgery, comparing the planned and postoperative outcomes. SETTING AND SAMPLE POPULATION: Seventy consecutive patients of both sexes, who were submitted to bimaxillary orthognathic surgery between 2015 and 2019 were included in our study. MATERIAL AND METHODS: The patients were evaluated by fusing preoperative planning and postoperative outcome using cone-beam computed tomography scan evaluation. Three-dimensional VSP and postoperative outcomes were compared by using three linear and three angular measurements. The main outcome interest was the difference between the VSP movement, and the surgical movement obtained. The success criterion adopted was a mean linear difference of <2 mm and a mean angular difference of <4°. RESULTS: Results were analysed using a linear mixed model with fixed and random effects, at α = .05. No significant statistical differences were found for linear and angular measurements between the planned and postsurgical outcomes (P > .05). All overlapping points presented values within the range considered clinically irrelevant (<2 mm; <1°). CONCLUSIONS: Three-dimensional VSP was executed with a high degree of accuracy. When comparing the planned and postsurgical outcomes, all overlapping points presented values within the range considered clinically irrelevant.

Unusual intraoral cancer with unexpected outcome in a patient with xeroderma pigmentosum: An alert for antineoplastic treatment.

Xeroderma pigmentosum (XP) is a rare autosomal disorder characterized by extreme sensitivity to ultraviolet radiation. DNA repair mechanisms are impaired, and minimal sun exposure can lead to the development of cutaneous neoplasms in very young patients. Intraoral carcinomas are uncommon and, when present, are located mainly at the tongue tip. We report an unprecedented case of squamous cell carcinoma (SCC) in the floor of mouth of a 23-year-old woman with XP. The patient was referred to the oncologist, and 2 months after surgical resection, she underwent a single session of chemotherapy plus radiotherapy. However, she died 73 hours after undergoing her first chemotherapy session. Considering the unexpected outcome of this case, we also investigated possible exacerbated adverse effects of antineoplastic treatments (especially cisplatin-based chemotherapy) in patients with XP and reviewed the main characteristics of the disease, especially cases with oral manifestations reported in the literature.

Limitation of diagnostic value of cone-beam CT in detecting apical root isthmuses

Abstract Isthmuses are reported as common anatomic complexities in teeth often associated with failures in endodontic treatment. They should be considered before starting treatment and a preoperative computed tomography scan (CT) may demonstrate these complexities. Objective To assess the diagnostic value of the highest resolution settings of a cone-beam CT (CBCT) system in identifying and measuring apical isthmuses, using micro-CT as reference. Methodology After micro-CT scanning, 40 humans' lower first molars with isthmuses in the apical-3 mm of mesial roots were scanned by the highest resolution settings of the New Generation i-Cat ® CBCT equipment. Two blinded observers recorded the detection of isthmuses in CBCT scans. The lengths of isthmuses were compared between micro-CT and CBCT to assess the diagnostic value of CBCT. Quantitative data for sensitivity were represented as percentages (95% confidence interval). The Bland-Altman method was used to assess differences between gold standard lengths (micro-CT) and CBCT lengths. Results BCT demonstrated 30 positive findings, representing sensitivity for isthmus identification of 75% (95% CI=0.4114-1.1364). Differences between the lengths in micro-CT (1.99±0.40 mm) and CBCT (1.53±0.41 mm) were significant (p<0.0001). Conclusion The CBCT device used presented limited diagnostic value in the identification and measurement of apical isthmuses in the mesial roots of lower molars. In some cases, the actual anatomy of the apical root canal may not be completely delineated in this type of CBCT system, even using the highest resolution settings.