Can CBCT change the level of confidence of oral maxillofacial surgeons in mandibular third molar management?

This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.

Can the method of cbct interpretation influence endodontic diagnosis? / O método de interpretação da tcfc pode influenciar o diagnóstico endodôntico?

Objetivo: Este estudo avaliou a influência do método de visualização e análise do exame de tomografia computa-dorizada de feixe cônico (TCFC) no diagnóstico de afecções endodônticas. Materiais e métodos: Vinte casos clínicos contendo doze diferentes afecções endodônticas foram ana-lisados por dois especialistas em radiologia odontológica e um especialista em endodontia. Inicialmente, os avaliadores visualizaram os casos em Portable Document Format (PDF) contendo uma seleção de imagens digitais e, por consenso, descreveram suas hipóteses diagnósticas para cada caso. Após uma semana, os avaliadores reavaliaram os casos, desta vez utilizando reconstrução multiplanar em um visualizador de imagens no formato Digital Imaging and Communications in Medicine (DICOM). Novamente, por consenso, eles indicaram suas hipóteses diagnósticas. Resultados: Em 10% dos casos, houve discrepância entre os diagnósticos realizados utili-zando as seleções de imagens digitais em PDF e utilizando a reconstrução multiplanar. A visualização das imagens em PDF obteve sensibilidade de 0.714, especificidade de 0.966, e acurácia de 90%. Discussão: Na maioria destes casos, as afecções endodônticas identificadas utilizando o visuali-zador de imagens DICOM (reconstrução multiplanar) não foram detectadas quando visualizados os PDF de imagens pré-selecionadas. Conclusão: Embora mais estudos sejam necessários, os autores reiteram que a utilização de recons-truções multiplanares sempre são preferíveis comparadas à outras formas de análise da TCFC, para que se atinja o máximo potencial diagnóstico do exame de imagem.

Aim: This study evaluated the influence of the method used for visualization and analysis of cone-beam com-puted tomography (CBCT) on the diagnosis of endodontic conditions. Materials and methods: Twenty clinical cases containing twelve different endodontic conditions were analyzed by two specialists in dental radiology and one specialist in endodontics. Initially, the evaluators viewed the cases in Portable Document Format (PDF) containing a selection of digital images and, by consensus, described their diagnostic hypotheses for each case. One week la-ter, the evaluators reassessed the cases, this time using multiplanar reconstructions with a Digital Imaging and Communications in Medicine (DICOM) format image viewer. Once more, by consensus, they recorded their diagnostic hypotheses. Results: In 10% of the cases there was a discrepancy between the diagnoses made using preselected digital images in PDFs and by viewing multiplanar reconstructions. The visualization of the PDF images obtained a sensitivity of 0.714, specificity of 0.966, and 90% accuracy. Discussion: In the majority of these cases, endodontic conditions identified using the DICOM image viewer (multiplanar reconstruction) were not detected using the PDFs of preselected images. Conclusion: Although more studies are needed, the au-thors reiterate that using multiplanar reconstructions should always be preferred to other forms of analysis for CBCT, so that the maximum diagnostic potential of the imaging exam can be achieved.

Can CBCT change the level of confidence of oral maxillofacial surgeons in mandibular third molar management?

Abstract This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.

Association between internal carotid artery calcifications detected as incidental findings and clinical characteristics associated with atherosclerosis: A dental volumetric tomography study.

PURPOSE: To evaluate the presence of calcifications in the internal carotid artery (ICA) in cone-beam computed tomography (CBCT), and to verify the association of these findings with sex, age, dental condition, and risk factors associated with vascular disorders. METHODS: The CBCT scans used in this study were obtained from the database of a private dental clinic requested for the planning of rehabilitation with dental implants. The selection criteria were patients aged 40 years and above. Out of a pool of 1176 CBCT examinations, a total of 284 scans of adult patients were evaluated by two blinded observers. Data were collected from patients' medical records. RESULTS: ICA calcifications were present in 63.0% of the examinations. Most calcifications were in the intracranial pathway (166). Despite being present in a smaller number 57 (C1), extracranial calcifications were more severe. Spearman's ρ coefficients (rS) indicated that the number of missing teeth was directly associated with the presence of calcifications (p = 0.042) and severity (p = 0.020). The age variable also had a direct relationship with the presence of calcifications (p ≤ 0.0001), increasing its frequency and severity over the years. In addition, hypertension (p = 0.036) and use of antihypertensive drugs (p = 0.015) were directly associated. CONCLUSIONS: There is a high occurrence of ICA calcifications in CBCT as incidental findings in adult patients, and it is directly associated with age, number of missing teeth and hypertension.

Bilateral Sinonasal Inverted Papilloma: Report of an Uncommon Case Involving Sinuses of the Face and Orbital Cavity.

BACKGROUND Nasosinusal papilloma is a benign aggressive tumor. It usually occurs unilaterally in the nasal cavity and can extend to the sinuses. The diagnosis is made by the correlation of findings observed in tomographic and histopathological exams. The recommended treatment is surgical excision with clinical monitoring. Orbital involvement occurs in about 9% of cases of advanced SIP. However, there is no report of cases of a benign tumor that invaded the adjacent soft tissues. Therefore, our objective is to report an unusual case of SIP that bilaterally involved the nasal cavity and maxillary sinuses, and extended to involve the ethmoidal cells and sphenoid and frontal sinuses. CASE REPORT In this article, we report an unusual presentation of sinonasal inverted papilloma (SIP) in a 60-year-old man. The tumor bilaterally involved the nasal cavity and maxillary sinuses and extended to involve the ethmoidal cells and the sphenoid and frontal sinuses, as well as the orbital cavity on the right side. An open surgical procedure was performed for complete removal of the lesion and follow-up with imaging exams. CONCLUSIONS The involvement of these structures is uncommon in SIP. This highlights the importance of this case report. Diagnosis and surgical treatment must be carefully planned. In this work, we describe all the steps that helped guide the choice of the best surgical technique to be performed and offer the best clinical follow-up.

Therapeutic effects of andiroba (Carapa guianensis Aubl) oil, compared to low power laser, on oral mucositis in children underwent chemotherapy: A clinical study.

ETHNO-PHARMACOLOGICAL RELEVANCE: The Carapa guianensis Aubl, popularly known as andiroba, is a large tree of the Meliaceae family, commonly found in the Amazon region. The oil extracted from its seeds is recognized in traditional medicine and has high anti-inflammatory and analgesic potential, which are the basic prerequisites for a therapeutic agent that can be used in the treatment of oral mucositis (OM). Moreover, the aforementioned oil has antimicrobial, antiallergic, and parasiticidal actions and is effective in the management of cutaneous and muscular dysfunctions. AIM OF THE STUDY: To evaluate the therapeutic effects of andiroba gel (Carapa guianensis Aubl) on the symptomatology and evolution of OM in children with leukemia who underwent chemotherapy and to compare it to the effects of low power laser. MATERIALS AND METHODS: This randomized, double-blind clinical trial involved 60 patients of both genders with leukemia, with age ranging from six to twelve years. The patients were divided into two study groups: the andiroba group (n = 30) and the laser group (n = 30). The level of pain experienced by the patients was assessed using the Wong-Baker visual analog scale and the degree of severity of OM was assessed using a table, recommended by the World Health Organization, that depicts the degrees of severity of OM. The data obtained were analyzed using the Mann-Whitney test, with statistical significance indicated by a P value less than or equal to 0.05. RESULTS: A statistically significant reduction in the degree of OM was observed on the fourth, fifth, and sixth days and in the pain scores on the second, third, and fourth days in the andiroba group after the manifestation of OM, compared to the laser group. CONCLUSIONS: The use of andiroba oil effectively reduced the severity of OM and relieved pain, which resulted in a decrease in the severity of signs and symptoms in the patients in the andiroba group, compared to the laser group.

Sex estimation using paranasal sinus discriminant analysis: a new approach via cone beam computerized tomography volume analysis.

Sex estimation is an important step for subject identification in forensic medicine, to which paranasal sinuses may contribute, as they remain intact even upon severe damage to the skull and other bones. Cone beam computerized tomography (CBCT) is an excellent tool in the examination of these structures. The present study aimed to evaluate the maxillary, frontal and sphenoidal sinuses through a discriminant analysis to determine the sex correlations with foramen magnum measurements were also assessed. Two-hundred cranial CBCT scans were analysed. The volume of the maxillary, frontal and sphenoidal sinuses were measured using the ITK-SNAP software (4.0.2). Student's t test and the Mann-Whitney test were applied for the descriptive analysis of independent samples, and data were subjected to discriminant analysis. The volumes of the maxillary, frontal and sphenoidal sinuses of female subjects were smaller than those of male subjects (p < 0.001). Upon summing up the volumes of the evaluated paranasal sinuses, the chances to correctly determine an individual's gender are 96.2% and 92.7% for males and females, respectively. When correlating said values with foramen magnum measurements, sex identification chances increase to 100%. Thus, adult paranasal sinus volumes analysed by CBCT may be useful for sex identification when summed together and correlated with foramen magnum measurements.

Central Cemento-Ossifying Fibroma: Clinical Imaging and Histopathological Diagnosis / Fibroma Cemento-Osificante Central: Diagnóstico Clínico, Imagenológico e Histológico

ABSTRACT: Central ossifying fibroma is a lesion in which diagnosis has proved intriguing and unclear for presenting clinical, radiographic, and even histopathological similarities to other types of lesions such as the fibrous dysplasia of bone and cement-bone dysplasia. It is a benign neoplasm of uncertain etiology and slow development in which the mandible is affected more frequently than the maxilla. We described a case of central cemento-ossifying fibroma involving the right mandible of a thirty-five-female patient by presenting its clinical, radiographic, and histological characteristic sand discussing some differential diagnoses.

RESUMEN: El fibroma cemento-osificante central es una lesión que requiere un diagnóstico diferencial ya que muestran similitud clínica, histológica y radiológica con la displasia fibrosa y con la displasia cemento-ósea. Esta lesión es un tumor benigno de etiología incierta, presenta crecimiento lento y afecta principalmente la mandíbula más que el maxilar. Se reporta un caso de un paciente de sexo femenino de 35 años, diagnosticada con fibroma cementoosificante central que le afectó el lado derecho de la mandíbula. Se describen las características clínicas, histológicas y radiológicas de la paciente y se discuten los diversos diagnósticos diferenciales.

Therapeutic effect of andiroba oil (Carapa guianensis Aubl.) against oral mucositis: an experimental study in golden Syrian hamsters.

OBJECTIVES: The aim of this study was to investigate the healing activity of andiroba (Carapa guianensis Aubl.) against oral mucositis (OM) induced by 5-fluorouracil in golden Syrian hamsters. MATERIALS AND METHODS: A total of 122 animals were randomized and divided into six groups: andiroba oil 100%, andiroba oil 10%, andiroba oil 10% refined, no treatment group, all n = 28; and negative control (NC) and cyclophosphamide (CPA) groups, both n = 5. OM was induced by intraperitoneal administration of 60 mg/kg 5-FU on days 0, 5 and 10 followed by mechanical trauma on the oral mucosa on days 1 and 2. From day 1 to day 15, the animals of the andiroba group were treated three times a day. On days 4, 8, 12 and 15, the mucosa was photographed and removed for clinical and histopathological analysis. The bone marrow of the femur was removed and the micronucleus test was performed to evaluate the cytotoxicity and genotoxicity. The data were subjected to analysis of variance, followed by the Tukey and Bonferroni test. RESULTS: Treatment with 100% andiroba oil reduced the degree of OM compared to that reported in the other groups (p < 0.05). Andiroba oil at both concentrations was not cytotoxic, but treatment with 100% andiroba oil showed a genotoxic potential (p < 0.001). CONCLUSIONS: Frequent administration of andiroba oil accelerated the healing process in an experimental model of 5-fluorouracil-induced OM. However, the genotoxicity of andiroba in other cell systems and under other conditions are being tested. CLINICAL RELEVANCE: The use of andiroba in topical form may be associated with reduced intensity of OM. Seek therapeutic alternatives to minimize the pain and suffering that these side effects cause cancer patients is an important scientific step.

Anatomical relation between nasal septum deviation and oropharynx volume in different facial patterns evaluated through cone beam computed tomography.

INTRODUCTION: The objective of this study was to establish the anatomical relation between nasal septum deviation (NSD) and oropharynx volume in different facial patterns using cone beam computed tomography (CBCT). METHODS: Ninety CBCT examinations were analyzed. InVivoDental software was used to evaluate cephalometric image reconstructions in terms of facial type, determined from cephalometric measurements indicative of growth direction; the presence of NSD was also evaluated. ITK-SNAP software was employed for delimitation of the oropharynx. Intra-examiner error methods were recorded. The results were subjected to parametric and non-parametric tests using Bioestat 5.0. RESULTS: A comparison of facial types revealed a significantly lower prevalence of NSD in the dolichofacial group compared with the brachyfacial and mesofacial groups (P = 0.0101 and 0.0149, respectively). In the total sample, there was a very strong positive relation between the presence of NSD and oropharynx space volume (P = 0.0162). The oropharynx volume was larger in all facial patterns in the presence of NSD. CONCLUSION: The presence of NSD was not associated with facial type, although the oropharynx volume in patients with NSD increased. Therefore, deviation of the septum influences oropharynx volume.

Cone-Beam Computed Tomography Findings in the Early Diagnosis of Calcified Atheromas.

PURPOSE: Computed tomograms of the mandibles of 285 patients with indications for dental implants were evaluated at a private clinic. MATERIALS AND METHODS: This study involved the evaluation of 285 cone-beam computed tomograms of patients 50 to 75 years of age who were referred to the clinic for the evaluation for implant placement images with visible C3 and C5 vertebrae that were obtained using the same I-Cat tomographic device (Imaging Sciences-Kavo, Hatfield, PA). Atheromas in the carotid space were visualized using paraxial images. RESULTS: Data were analyzed using Student t and χ2 tests, with a significance level of a P value less than or equal to .05. Atheromas in the carotid space were observed in 17.89% of patients; a significant difference in the incidence of atheromas was observed between men (24.27%) and women (14.29%; P = .034). However, no significant correlation was found between the frequency of occurrence of atheromas and the affected side of the carotid bifurcation (right or left) in women (P = .431) or men (P = .558). CONCLUSION: Based on these results, cone-beam computed tomography could be a useful tool for the diagnosis of atheroma.

Análise dos softwares gratuitos para tomografia computadorizada de feixe cônico de interesse aos cirurgiões-dentistas / Analysis of free software for computed tomograp hy cone beam of interest to dentists

O objetivo deste artigo foi avaliar programas de imagens odontológicas disponíveis gratuitamente na internet como ferramentas para prática do cirurgião-dentista e que funcionam em computadores pessoais. Foi realizada uma pesquisa no Medline entre os anos de 2005 a 2014, com enfoque em software utilizado para visualizar imagens tomográficas na Odontologia. Para a pesquisa dos softwares foi realizado busca no site Google e em sites especializados por programas gratuitos disponíveis para windows. Foram utilizados as palavras chaves "free dicom viewer" e "dental software". De acordo com os critérios de inclusão e exclusão três softwares foram analisados. Conhecer a existência de softwares gratuitos e que dão um grande suporte para os profissionais é de extrema importância para a Odontologia atual.

The aim of this study was to review the dental imaging programs available for free on the Internet as tools to practice DDS and running on personal computers. A survey was conducted in Medline from 2005 to 2014, with focus on the software used to view tomographic images in dentistry. A research about the software was done at Google search site and specialized sites for free programs available for Windows. Key words were used "free dicom viewer" and "dental software." According to the criteria of inclusion and exclusion 3 softwares were analyzed. Knowing the existence of free softwares which are able to support professionals improve their jobs is a matter of great importance for the current dentistry.

Anatomical study of the canalis sinuosus in 100 cone beam computed tomography examinations.

OBJECTIVE: To identify and describe the morphology and location of the canalis sinuosus (CS) and make correlations with gender, age, and distance of this canal to important adjacent structures on the region, thus mapping the anatomy of this structure. METHODOLOGY: A total of 100 cone beam computed tomography (CBCT) examinations were collected from the files of a dental clinic in the Municipality of Belém, Pará, Brazil, and analyzed to identify the site of bifurcation, the diameter of CS right after such bifurcation and in its terminal portion as well as the direction of its course and the distance to the alveolar bone crest region. The anatomical views were evaluated using InVivoDental software on sagittal, axial, and coronal sections, and the results were submitted to Fisher's exact test, Kendall correlation coefficients, Mann-Whitney tests, and T tests. RESULTS: CS was present in 88 % of the sample. There were no statistically significant changes in the presence of CS regarding gender, age and direction of course. A strong positive correlation between CS's diameter on its initial and terminal portions was observed (p < 0.0001). There was a statistically significant change in the distance to alveolar bone crest related to gender, which is higher in men (p = 0.0303). CONCLUSION: In the sample, CS was frequent and similar in both genders, with course distance to the alveolar bone crest and termination in different locations that ought to be analyzed on CBCT prior to surgical procedures.

Sedação com óxido nitroso como adjuvante em procedimentos odontológicos / Sedation with nitrous oxide as an adjuvant in dental procedures

Objetivo: descrever a importância da sedação com óxido nitroso como adjuvante em procedimentos odontológicos. Método: a literatura foi revisada nas bases de dados MEDLINE, LILACS, SCIELO, SCOPUS, utilizando como estratégia de busca os termos ?óxido nitroso?, ?odontologia?, ?sedação consciente?. Considerações finais: a sedação com óxido nitroso é muito valido dentro do consultório odontológico, em razão do seu potencial ansiolítico e relaxante, desde que seja utilizado por um profissional habilitado.

Objective: to describe the importance of sedation with nitrous oxide as an adjunct in dental procedures. Method: the literature was reviewed in MEDLINE, LILACS, SCIELO, SCOPUS, using as search strategy terms "nitrous oxide", "dentistry", "conscious sedation". Final Thoughts: the sedation with nitrous oxide is very valid in the dental office, because of its potential anxiolytic and relaxing, since it is used by a qualified professional.