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A odontodisplasia regional é uma anomalia dentária, pouco comum, não hereditária e com uma etiologia ainda desconhecida. Os tecidos afetados são o esmalte e a dentina, são acometidos nos dentes decíduos e, as vezes na dentição permanente de um mesmo indivíduo. Esta lesão pode ser confundida com outras lesões como por exemplo o odontoma ou dentes com outro tipo de anomalia. O objetivo é relatar um caso de odontodisplasia regional na dentição decídua e permanente de uma criança, assim como apresentar as diferentes ferramentas diagnósticas. Os dentes acometidos mostravam-se ao exame clínico, como dentes hipoplásicos com coloração amarelo amarronzado. Uma radiografia panorâmica e radiografias periapicais, assim como uma biopsia excisional, foram essenciais para obter um diagnóstico correto, e assim poder oferecer uma adequada conduta para a preservação e previsibilidade dos diferentes tipos de tratamentos reabilitadores odontológicos que essa criança poderia ter nos próximos anos até a idade adulta.

Objetivo: Relatar dois casos de Sinusite Maxilar Odontogênica (SMO), diagnosticados exclusivamente por Tomografia Computadorizada de Feixe Cônico (TCFC). Relato de Caso 1: Mulher, 48 anos de idade, referiu dor difusa em face e primeiro molar superior esquerdo (PMSE) com lesão cariosa. A radiografia panorâmica mostrou uma lesão periapical bem delimitada na região do PMSE e opacificação do seio maxilar esquerdo (OSME). Apenas na TCFC houve relação entre a lesão periapical do PMSE e o seio maxilar através da ruptura cortical do assoalho do seio maxilar, espessando a mucosa do seio maxilar (EMSM). A SMO foi diagnosticada como um cisto periapical envolvendo o PMSE. Ela foi encaminhada para tratamento endodôntico. Relato de Caso 2: Homem de 33 anos referiu dor difusa na face e no primeiro molar superior direito (PMSD). A radiografia panorâmica mostrou uma rarefação óssea sem limites e perda óssea vertical ao redor das raízes da PMSD. A TCFC mostrou as mesmas características do Caso 1. Devido o grande EMSM, foi feito um diagnóstico diferencial entre a doença periodontal e o tumor do seio maxilar. O diagnóstico de SMO e doença periodontal foi feito. O seio maxilar foi a cirurgia explorada através da comunicação oral da extração dentária e da comunicação remanescente. Conclusão: A TCFC proporcionou detalhes do foco infeccioso odontogênico, comprometimento do osso alveolar e seio maxilar, assim como uma melhor visualização anatômica entre os dentes afetados e o seio maxilar, os quais não foram observados nas imagens radiográficas 2D.

Objetivo: avaliar a eficácia do levantamento do seio maxilar atraumático sem enxerto ósseo e a taxa de sobrevivência da instalação de implantes imediatos. Material e métodos: realizou-se uma estratégia de buscanas bases de dados Pubmed, Web of Science e Science Direct, obtendo 103 artigos, sendo selecionados 07estudos publicados entre 2008 até 2019. Resultados: foram registrados 576 pacientes com idades entre 19e 85 anos de idade, de ambos os sexos e 1,113 implantes instalados. Verificou-se uma taxa de sucesso esobrevivência dos implantes de 96,6%, após um seguimento de 1 a 3 anos e houve um ganho ósseo de aproximadamente 3mm. Considerações finais: o levantamento de seio maxilar atraumático sem enxerto ósseo é eficaz para reabilitação de áreas edêntulas e mostra um bom resultado ao longo do tempo, com uma taxa média de sobrevivência dos implantes de 96,3%. Ainda faltam estudos para determinar qual tipo de implante é melhor para este tipo de técnica.

Florid osseous dysplasia (FOD) is an extensive form of osseous dysplasia where normal trabecular bone is substituted by fibrous connective tissue and amorphous mineralized tissue. Usually, the lesions are mainly asymptomatic and the patients should be followed with clinical and imaging examination, requiring no intervention. Nevertheless, due to the poor vascularization of the lesion and local trauma, secondary infections and osteomyelitis may occur. Patients may present with pain, mucosal ulceration, and lesion exposure in the oral cavity, fistula and swelling. In such cases, correct diagnosis and management of the lesion is decisive to reestablish patient’s health and quality of life. The aim of this article is to present a case of complicating secondary chronic osteomyelitis treated successfully with conservative intervention. A 68-year-old black female patient reported a “swelling of the gums” that was present for eleven years, with episodes of periodic pain and swelling. On physical examination, a papule with suppuration in the alveolar mucosa in the right side of the mandible was observed. Panoramic radiography and CBCT showed a mixed lesion surrounded by sclerotic bone. The patient was diagnosed with chronic osteomyelitis in association with FOD and treated with antibiotic therapy together with surgical curettage. The incidence, etiophatology, differential diagnosis, treatment and prevention of secondary osteomyelitis associated with FOD are discussed in the light of literature. This information might assist the dentists while choosing the best treatment options for similar cases.

Objective To identify and compare the morphology and dimensions of the nasopalatine canal (NPC) of individuals with and without cleft lip and palate using Conical Beam Computed Tomography (CBCT) images and to relate the results to the type of cleft and tooth absences in the region. Setting This is a cross-sectional, analytical study with a retrospective sample. Patients, Participants 100 CBCT exams from patients with cleft lip and palate and 100 CBCT exams from patients without cleft lip and palate were used. Interventions The NPC was evaluated for its morphology and measurements in the coronal, sagittal, and axial reformatting of CBCT exams. Results It was obtained as a result that in the group of patients with a cleft, the shapes of funnel, banana, and needle of the NPC were more frequent than in the control group. Patients with cleft lip and palate had significantly a larger nasopalatine foramen and a larger NPC diameter, besides a significantly shorter NPC, compared to controls. In both groups, edentulous patients had less anterior maxillary bone thickness, when compared to patients with maxillary anterior teeth. Patients with clefts had a bone thickness buccal to the NPC less than in the control group. Conclusions This study confirms the anatomical variability of NPC in patients with cleft lip and palate. This finding reinforces the need for thorough surgical planning of the anterior region of the maxilla, in CBCT exams, by the dentist.

Objective To determine how the diagnosis may or may not be influenced by cone-beam computed tomography (CBCT), comparing the diagnostic hypotheses obtained using images of panoramic radiographs and CBCT in cases of ameloblastoma, odontogenic keratocyst, and dentigerous cyst. Study design Five cases were selected for each lesion. Panoramic radiographs and CBCT scans were analyzed by 15 dentists for the formulation of the diagnostic hypotheses. Two observers performed the analyses and measurement of qualitative and quantitative features of the lesions evaluated in the CBCT. Results There was no statistically significant difference in correct diagnostic average between panoramic radiography and CBCT, but there was a significant difference in correct diagnostic average in the diagnosis of ameloblastoma using CBCT compared to panoramic radiography. Master's and PhD-level observers had greater correct diagnostic average in the diagnosis of odontogenic keratocyst using panoramic radiograph compared to specialists, with a significant difference. Conclusion Cone-beam computed tomography images revealed that the ameloblastomas were greater in size and expansion compared to the odontogenic keratocyst and the dentigerous cysts. Ameloblastomas showed a higher incidence of multiloculated aspects compared to odontogenic keratocyst and dentigerous cysts. There were no differences between quantitative and qualitative features of odontogenic keratocyst and dentigerous cysts.

A 60-year-old woman with leukoderma, retired, presented with a main complaint of “ball in the roof of the mouth,” evolution of 10 years, without change of size, and she had used a partial removable prosthesis for 20 years. However, in the last month she began to feel pain. She was a smoker for 10 years (1 pack/d). Clinical examination showed a nodule on the palate, normocorate, in the tooth region 24/25, 1 cm in diameter, hard to palpation, smooth surface, with defined and regular borders. An excisional biopsy was performed, which revealed gingival mucosa with hyperplastic parakeratinized squamous epithelium, and submucosa with fascicular arrangements of young fibroblast cells in dense bundles of collagen fibers. In the depth connective tissue, salivary glands with acinar atrophy and mononuclear inflammatory infiltrate and ductal dilation were noted. The diagnosis was fibroma, benign neoplasm uncommon in the oral mucosa. In the postoperative period, good healing was observed without recurrences.

A 55-year-old male with leukoderma, retired, had a main complaint of having a white spot on the tongue, unknown evolution time. The patient had no systemic history and was an ex-smoker (35 years). Clinically, he had a white plaque on the right lateral border of the tongue, asymptomatic, 5.0 × 1.5 cm in diameter, resilient, smooth surface, homogeneous, and well delimited. In addition, he had whitish plaques in the eyes. Incisional biopsy revealed oral mucosa consisting of hyperplastic stratified squamous epithelium, with areas of acanthosis, and cells of the middle and superficial layers were vacuolized with clear cytoplasm (basket weave aspect). Underlying, fibrous connective tissue with an extensive area of skeletal muscle fibers interspersed with adipose cells was noted. Due to clinical and histopathologic findings, the diagnosis was hereditary benign intraepithelial dyskeratosis. The patient reported not knowing if anyone in the family showed the same lesion. The conduct was clinical preservation and periodic controls.

A 4-year-old leucoderm girl had a chief complaint reported by the mother of absent teeth and a gingival enlargement. The patient could not eat well, and pacifier use presented pain of the left ear and nasal discharge. Facial asymmetry and infarcted submandibular lymph node were observed on the facial left side. Intraoral examination presented a bone enlargement on the left side of the maxilla, teeth 63 and 64 partially erupted, and tooth 65 not erupted. Cone beam computed tomography showed asymmetric maxillary sinuses, showed agenesis of the teeth 23, 25, and 45, and confirmed bone maxilla augmentation. The diagnosis was segmental odontomaxillary dysplasia. The patient referred to the otorhinolaryngologist and returned after 3 months without sinusitis signals. The conducted was clinical preservation every 3 months to verify the teeth eruption. The child is under pediatric follow-up. In this case, anamnesis and clinical and imaging examination were essential for a correct diagnosis.

The aim of this study was to evaluate dental abnormalities and dental maturity (DM) in the permanent dentition of childhood cancer survivors (CCSs) in comparison with that of healthy individuals.A retrospective, case-control study, with convenience sampling, evaluated 111 panoramic radiographs (PRs) of CCSs compared with 111 PRs of healthy individuals matched for age and gender. Dental anomalies (DAs) were associated with age of cancer diagnosis and type of antineoplastic treatment. DM was assessed by using the Demirjian method.A higher prevalence of microdontia, hypodontia, and dental root anomalies were present in CCSs compared with healthy individuals (P.05). CCSs were the only individuals with 10 or greater DAs compared with healthy individuals. Microdontia was the only DA associated with age of cancer diagnosis less than 71 months (P.05). Impacted teeth were associated with multimodal cancer treatment (P.001). DM did not present a significant statistical difference between CCSs and healthy individuals (P.05).CCSs had a higher prevalence of DAs without DM alteration compared with healthy individuals. Age of cancer diagnosis and type of treatment can influence the prevalence of some dental abnormalities.

Quando interpretamos imagens, devemos conhecer os diferentes grupos de lesoes radiopacas, radiolucida e mistas. Dentre as imagens radiopacas mais comuns, que podem ser vistas nas radiografias panorâmicas, podemos citar a osteoesclerose. O objetivo deste estudo foi avaliar a presenca de osteosclerose em radiografias panorâmicas, classificando-as conforme genero e localizacao. E caracterizada como areas de trabeculado osseo denso, devido, de etiologia variada que inclui maior demanda funcional de uma determinada regiao. De formato variado a imagem pode ser oval, eliptica ou irregular, localizadas no apice radicular, entre as raizes ou em areas distantes das raizes dentarias, majoritariamente na regiao de pre-molares e molares. Neste estudo interpretamos 550 imagens panorâmicas pertencentes ao Departamento de Estomatologia (Disciplina de Radiologia) da Faculdade de Odontologia de Bauru FOB - USP, com melhor qualidade de imagem. Encontramos 57 (10,4%) imagens compativeis com osteoesclerose. Das 57 imagens, 54 (94,7%), eram unilaterais, e apenas 3 apresentavam lesoes bilaterais, localizadas na mandibula. Todas as areas de osteoesclerose foram encontradas na mandibula e a ocorrencia maior na regiao de molares (54,4%), sendo 20 na regiao apical, 16 na area interradicular e 21 em area edentula. Na regiao de incisivos e caninos (10,5%) e na regiao de pre-molares (35%). Foi possivel constatar que e mais frequente em mulheres e estava presente principalmente em radiografas de pacientes com media de idade de 28,8 anos.

ResumoAs calcificações vasculares são comuns em pacientes com lesões ateroscleróticas avançadas, ocorrendo mais em indivíduos de idade avançada, reduzindo a distensão e luz dos vasos sanguíneos, gerando hipertensão. Ateromas podem levar a cardiopatia, a qual está diretamente associada à ocorrência de acidente vascular cerebral. Calcificações nos ateromas de carótida podem ser detectadas incidentalmente nas radiografias panorâmicas odontológicas, porém a associação entre a presença das imagens e o diagnóstico ainda representa um desafio. Neste artigo relatamos o achado incidental de ateromas de carótida na radiografia panorâmica de um paciente masculino de 73 anos. A radiografia apresentava imagem radiopaca com grande dimensão e localização atípica de ateroma de carótida, representando um desafio para o diagnóstico. A despeito dos achados radiográficos exuberantes o paciente apresentou estenose inferior a 50% no exame ultrassonográfico. Assim, revisamos a literatura sobre a precisão da radiografia panorâmica no diagnóstico e a necessidade de encaminhamento do paciente para investigações adicionais.AbstractVascular calcifications are common in patients with advanced atherosclerotic lesions. Most frequent in older adults, they reduce distension and decrease the lumen of blood vessels causing hypertension. Atheroma can lead to heart disease and is directly associated with the occurrence of cerebral vascular accident. Calcifications of the carotid atheroma can be detected as incidental findings on panoramic radiographs for evaluation, but the association between the presence of the images and the diagnosis is still a challenge for the clinician. We report the incidental finding of carotid atheroma on panoramic radiography of a 73 year‐old male. The radiography showed a radiopaque image with large and atypical location of carotid atheroma, representing a challenge to diagnose. Despite the significant radiographic findings, the stenosis observed on ultrasonography was smaller than 50%. Hence, we review the literature about the accuracy of panoramic radiography in the diagnosis and the need for further investigation.

Panoramic radiographs are the most requested imaging exams in dentistry and an essential part of the documentation used by orthodontists in treatment planning Alterations that modify bone density and the trabecular bone pattern can be finding in panoramic radiographs before and after the orthodontic treatment Furthermore the transition between the mixed to the permanent dentition is a complex process that can incur in fails and odontogenic anomalies The identification of incidental findings that may demand specific dental or medical treatment is important to provide satisfactory dental care Material and methods The aim of this study was to evaluate panoramic radiographs obtained before and after the orthodontic treatment in order to identify the most prevalent incidental findings Five hundred panoramic radiographs pretreatment and post treatment from patients between eleven and eighteen years old obtained between and were selected from the archives of the Department of Orthodontics Bauru School of Dentistry University of S atilde o Paulo The image analysis was performed by one single examiner Results The incidence of impacted teeth and supernumerary teeth was significant higher in the pretreatment group p lt The incidence of root dilacerations osteosclerosis and the presence of orthodontic retainers was significant higher in the post treatment group p lt Apical remodeling in the incisors was observed in patients in the post treatment group Conclusion In conclusion clinical relevant incidental findings were observed in both groups Special care should be taken while evaluating post treatment radiographs to diagnosis alterations that may require intervention or interfere in other dental treatments

Transverse maxillary deficiency is characterized by posterior uni or bilateral crossbite, crowded and rotated teeth, as well as high palate. Its treatment in adult individuals is surgically assisted rapid palatal expansion. The aim of this study was to verify the occurrence of dimensional alterations in the mandibular condyles of patients with TMD submitted to surgically assisted maxillary expansion. Measurements of the mandibular condyles using the DISTANCE tool in cone beam computed tomography iCat software were performed. The values obtained were submitted to statistical analysis by the paired t-test and the results showed statistically significant dimensional reduction in the axial posterior-anterior lateral (-0.74mm), axial posterior-anterior lateral left (-0.90mm) and coronal medium right (-1.24mm) dimensions. The coronal inferior (1.13mm), coronal inferior left (1.78mm) and coronal superior-inferior right (0.76mm) measurements showed statistically significant dimensional increase. The results allowed us to conclude that dimensional alterations occurred in the mandibular condyles in individuals with maxillary transversal deficiency that underwent surgically assisted rapid palatal expansion (SAPE), which can be understood by remodeling, since they are characterized by dimensional increase or reduction, depending on the location where the measurement was performed.

This study evaluated the image quality and the diagnosis of root fractures when using the Zoom Reconstruction tool (J Morita, Kyoto, Japan).A utility wax phantom with a metal sample inside was used for objective evaluation, and a mandible with 27 single-rooted teeth (with and without obturation and with and without vertical or horizontal fractures) was used for diagnostic evaluation. The images were acquired in 3 protocols: protocol 1, field of view (FOV) of 4 × 4 cm and a voxel size of 0.08 mm; protocol 2, FOV of 10 × 10 cm and a voxel size of 0.2 mm; and protocol 3, Zoom Reconstruction of images from protocol 2 (FOV of 4 × 4 cm and a voxel size of 0.08 mm). The objective evaluation was achieved by measuring the image noise, and the diagnosis of fractures was performed by 3 evaluators. The area under the receiver operating characteristic curve was used to calculate accuracy, and analysis of variance compared the accuracy and image quality of the protocols.Regarding quality, protocol 1 was superior to protocol 2 (P .0001) and Zoom Reconstruction (P .0001). Additionally, images of protocol 2 presented less noise than the Zoom Reconstruction image (P .0001); however, for diagnosis, Zoom Reconstruction was superior in relation to protocol 2 (P = .011) and did not differ from protocol 1 (P = .228) for the diagnosis of a vertical root fracture in filled teeth.The Zoom Reconstruction tool allows better accuracy for vertical root fracture detection in filled teeth, making it possible to obtain a higher-resolution image from a lower-resolution examination without having to expose the patient to more radiation.

Objectives: This study investigated the association of congenital cervical vertebrae anomalies (CVA) with the prevalence of cleft lip and palate (CLP) specifying the most frequent associations. Methods: A meta-analysis was based on the Preferred Reporting Items of Systematic reviews and Meta-Analyses guideline. A search of the PubMed, Embase, Web of Science, Science Direct, Scopus and Lilacs database was performed until March 2018. Clinical studies that evaluated CVA in individuals with CLP (experimental group) and without CLP (control group) was included. For the statistical analysis, the software Comprehensive Meta-Analysis (Biostat; Englewood, NJ) was used, with a p-value < 0.05 considered significant. Results: A total of 10 articles were included, for a total of 2566 individuals with CLP and 2301 individuals without CLP. The meta-analysis indicated statistically significant differences and the group of individuals with CLP had an increased number of CVA when compared to the group of individuals without CLP (p < 0.05; 95% confidence interval, 2.41–6.11; heterogeneity: Q-value 32.8, I2 72.6%). Conclusions: This study indicated that CVA are associated with the presence of CLP. Among the patients with CVA the most frequent anomalies were the deficiency of the posterior arch, followed by the fusion of cervical vertebrae. Individuals with cleft palate and those with unilateral cleft lip and palateCLP had an increased prevalence of CVA.

OBJECTIVE: To evaluate the influence of rotation degree and field of view (FOV) size on the amount of artefacts produced in cone beam CT (CBCT) images. METHODS: A cylindrical wax utility phantom, with a metallic sample in its interior, was scanned with two FOV sizes (100 x 100 and 40 x 40 mm) and in full (360°) and partial (~180°) rotations. After the acquisitions, images were objectively assessed in the ImageJ software, obtaining the standard deviation in areas around the metal sample. The influence of artefacts produced by the several FOVs and rotation degrees was compared by two-way analysis of variance (α = 0.05). RESULTS: The images obtained with a large FOV presented a higher amount of noise compared to a restricted FOV, both for partial (p = 0.0037) and full (p = 0.0023) rotation degrees. For images obtained with a restricted FOV, full rotation resulted in images with less noise (p = 0.0259). For images obtained with large FOV, there was no statistically significant difference (p = 0.1494) in noise for both rotation protocols. CONCLUSIONS: As there were no significant differences in the amount of artefacts in rotation protocols for large FOVs, the partial rotation can be indicated due to its lower exposure to radiation. For acquiring images with restricted FOVs, the full rotation is recommended.

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.

Purpose To evaluate the lateral lingual foramen (LLF), an aperture located in the posterior lingual mandible area, through cone beam computed tomography (CBCT) images. Materials and methods To evaluate the LLF presence through 100 CBCT images. Presence of LLF was compared between sex and age. Width and height were determined and the distance from the LLF to the mental foramen (LLF-MF) and that of the LLF to the lower mandible border (LLF-LBM) were obtained. Results LLF was observed in 39% of the examinations and 52 LLF were found and the most prevalent area of occurrence was at the second premolar area. The mean width was 1.26 ± 0.57 mm and the mean height was 1.82 ± 1.12 mm. The mean values of LLF-MF and LLF-LBM distances were 12.74 ± 7.7 and 5.82 ± 2.78 mm, respectively. Conclusions LLF are asymmetrical structures with bilateral or unilateral distribution, located in the second premolar region close to the LBM.

Purpose: Genial tubercles (GTs) are bony protuberances on the lingual aspect of the mandible symphysis, where genioglossus and geniohyoid muscles are inserted. In the literature, few papers report their real dimensions. Cleft lip and palate are craniofacial anomalies involving the maxilla, but the anatomical structures of the mandible can be altered when these have associated with the cleft, some syndrome. This study aimed to evaluate the GTs of 30 individuals and to make their measurements in cone beam computed tomography examinations. Methods: A sample of 30 individuals, 19 of them with cleft lip and palate, 6 individuals with Treacher Collins syndrome (TCS), and 5 individuals with Pierre Robin sequence, was used. The GTs were evaluated about the amount and the following measurements were performed: A—distance from the apex of the central incisors to GT, B—mandibular thickness in the region of GT, C—GT height, D—GT width, and E—distance from inferior border of mandible to GT. Results: The individuals presented since the absence of GTs to 3. The TCS group had the highest average of the measurements A, D, and E with statistical difference (P = 0.006) (P = 0.011) and (P = 0.017), respectively. The Pierre Robin sequence group had the highest average measurement of B and C, but there was no statistical difference. Conclusions: The difference in the measurements can be explained perhaps because individuals with TCS have glossoptosis and changes on retrognathic mandible, which would affect the position of the GT.

The mental foramen (MF) is an important anatomic landmark of the mandible, through which the mental nerve and blood vessels emerge. The importance of MF in dental practice is especially related to dental implants placement and other surgical procedures in the region. It is fundamental to be careful in order to avoid nerve and vessels injury during procedures. Anatomic variations of the MF can be found, such as occurrence of multiple foramina and unusual location. In very rare occasions, the absence of MF can be detected. The observation of this variation is not always possible using only conventional radiographs. The modern imaging resource cone beam computed tomography (CBCT) allows an accurate three-dimensional assessment of MF, as well as the identification of its variations. The aim of this article is to report MF absence and hypoplasia detected in CBCT images of a 27-year-old daughter and her 63-year-old mother, both from Brazil. Despite the MF anatomic variations, they presented no sensorial disturbance in the regions supplied by the mental nerve.

INTRODUÇÃO: a deficiência transversal da maxila é caracterizada pela atresia maxilar, palato ogival, apinhamento e rotação dos dentes, além da mordida cruzada posterior (uni ou bilateral). O tratamento dos pacientes com esta deficiência consiste no alargamento das bases ósseas maxilares. Nos pacientes com maturidade esquelética, a expansão da maxila é obtida através de procedimentos ortocirúrgicos (conhecidos como expansão de maxila cirurgicamente assistida - EMCA) que podem gerar efeitos sobre a cavidade e sobre o septo nasal. OBJETIVO: avaliar o comportamento do septo nasal frente aos procedimentos de EMCA. METODOLOGIA: foram avaliadas radiografias cefalométricas em norma póstero-anterior e radiografias oclusais totais de maxila, obtidas pela técnica convencional e posteriormente digitalizadas, de 16 pacientes submetidos à EMCA pela técnica de osteotomia Le Fort I subtotal. As radiografias foram obtidas no período pré-operatório (inicial) e pós-operatório mediato ou ao final da expansão e foram digitalizadas e mensuradas utilizando o programa DIGORA. Foram medidas, ainda, as distâncias entre os dentes (caninos, primeiro pré-molares, segundo pré-molares, primeiros molares e segundos molares). RESULTADOS: após a análise estatística pode-se constatar o aumento das distâncias interdentárias e intermaxilares, além do aumento da largura da porção basal da abertura piriforme e das distâncias entre a parede lateral da porção basal da abertura piriforme e o septo nasal. CONCLUSÃO: a EMCA é um procedimento eficaz, capaz de alargar a porção basal da abertura piriforme, que parece não influenciar no posicionamento do septo nasal. INTRODUCTION: Maxillary transversal deficiency is characterized by constricted maxillary arch, dental crowding and rotation, along with posterior uni or bilateral crossbite. The treatment of this deficiency is based on the widening of maxillary bone. In skeletal mature patients the maxillary expansion is achieved by means of surgical-orthodontic procedures (known as surgically assisted maxillary expansion - SAME) that can cause some effects on the nasal cavity and septum. AIM: To evaluate the behavior of the nasal septum after the procedures of SAME. METHODS: Post-anterior cephalometric and maxillary occlusal radiographs, taken by conventional technique and therefore digitalized, were analyzed from 16 patients undergone SAME. For all patients, the SAME technique consisted of subtotal Le Fort I osteotomy. The radiographs were taken before the surgical procedure, right after (mediate post-operatory time) or after the expansion, and thereafter digitalized and measured using DIGORA program. Also, the distances between teeth (canines, first premolars, second premolars, first molars and second molars) were registered. RESULTS: The statistical treatment showed an increase in interdental and intermaxillary distances, along with an increase in the width of the base of piriform aperture and in the distances between the base of lateral wall of the piriform aperture and nasal septum. CONCLUSION: SAME is an efficient procedure that seems not to influence the septum position.

The primary aim of this paper is to present clinical and radiographic aspects of odontogenic myxomas diagnosed at the Stomatology Clinic of Bauru School of Dentistry, University of São Paulo, Brazil and to compare them with data reported in a series published in the literature. A second objective is to report a clinical case of odontogenic myxoma in a 9-year-old patient in whom the lesion involved the anterior region of the maxilla. Dental records between 1975 and 2000 were reviewed and seven cases diagnosed as odontogenic myxoma were found in individuals aged from nine to 60 years. Of these, four occurred in women and three in men. The mandible was affected in five cases and the maxilla in two. All patients presented with asymptomatic swelling in the affected area. A mixed radiographic result was observed in five patients, while in two patients the lesion was completely radiolucent. The borders of the lesion were well-defined in six patients. In four cases there was dental displacement, although root resorption was not observed in any of these. The treatment of choice was surgical excision. Four cases did not recur during the period of follow-up, which varied from nine months to 19 years. It was concluded the clinico-radiographic study of odontogenic myxomas should be continually refined with the aim of offering the patient an appropriate treatment, since the lesion presents a high potential for recurrence. Citation Dezotti MSG, Azevedo LR, Fontão FNGK, Capelozza ALA, Sant'ana E. Odontogenic Myxoma – A Case Report and Clinico-Radiographic Study of Seven Tumors. J Contemp Dent Pract 2006 February;(7) 1:117-124.

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.

The aim of this study was to evaluate the reproducibility of the gray values and noise of a direct digital radiography system (Visualix eHD) for various exposure times and analyzed regions. To obtain radiographic images in a standardized manner, the digital sensor of the system and a stepwedge were positioned in a phantom at a focus-film distance of 30 cm in a dental device at 70 kV, 7 mA and 2.2 mm filtration. Ten consecutive repetitions of X-ray imaging were performed at each exposure time (0.05, 0.07, 0.09 and 0.13 s). Gray values were analyzed using ImageJ software in five regions of interest (ROIs): alveolar bone (AB), soft tissue (ST) and three steps of the stepwedge (S1, S2 and S3). The results showed that both the variability of the gray values and the noise were statistically greater (p < 0.05) in the most radiolucent region (ST). Only the noise was affected by the exposure time. In conclusion, the reproducibility of the gray values and the noise of the Visualix eHD system can vary in specific areas with different radiolucency.

An evaluation of a patient's general health before dental treatment is necessary to identify any systemic conditions, which may influence treatment and allow the dentist to evaluate risks, and reduce possible complications. Of the 860 dentists contacted by mail, 112 provided health questionnaires used in their offices. The authors evaluated the information in these questionnaires by describing content and rating them according to the importance of each topic. Questions were divided into categories and compared against a standard list of health-related topics. The authors also assessed the questionnaires based on dentists' area of specialization and length of clinical experience. It was not possible to establish a statistically significant correlation between the quality of a health questionnaire and dentists' specialty or length of experience; however, the questionnaires used by periodontists were rated as more comprehensive than those adopted by pedodontists (p < 0. 05). Overall, the topics asked about most frequently were allergies, diabetes, and patient drug use.

Entende-se por anomalia uma variação ou desvio de uma característica ou estrutura anatômica, relativamente à normalidade. Pelo tratamento antineoplásico, sobreviventes de câncer infantil estão em risco de adquirir anomalias dentárias como efeito tardio. Esses efeitos podem ser observados pela radiografia panorâmica. Para resultados confiáveis e reprodutíveis é necessário que os examinadores passem por um treinamento prévio. Este pode ser medido por meio de testes de concordância como o teste de Kappa. O objetivo do presente trabalho foi apresentar a importância da calibragem dos examinadores para avaliação radiográfica de anomalias dentárias de pacientes com câncer, a fim de obter informações com alta confiabilidade. Foram selecionadas aleatoriamente 40 radiografias panorâmicas digitais, sendo 20 do grupo controle e 20 do grupo experimental. Os examinadores foram considerados calibrados quando os valores do teste de Kappa estavam entre 0,61-1,0. A calibração intraexaminador teve como mínimo um valor de concordância substancial (0,61-0,80) e um máximo de concordância perfeita (0,81 -1,0) para os dois examinadores. Em relação à calibração interexaminador observou-se como resultado mínimo de Kappa uma concordância moderada (0,41 – 0,60) na primeira etapa, sendo que na segunda etapa chegou-se a uma concordância substancial (0,61-0,80) demostrando que as examinadoras se encontravam calibradas. Para a avaliação de anomalias dentárias em radiografias panorâmicas é necessária uma calibração cautelosa e minuciosa que favoreça a emissão de informações confiáveis e reproduzíveis para evidência científica.

We report two cases in which cone beam computed tomography (CBCT) was essential for the establishment of the diagnosis of periapical lesions. CBCT allows a three-dimensional assessment of a specific region with no superimposition of structures. Therefore, its use is recommended when radiographic images are not sufficient for the diagnosis.

The aim of this study was to determine the efficacy of pixel value analysis using images generated by the Digora™ and Visualix™ systems for the early detection of external root resorption (ERR). Thirty extracted human lower incisors were radiographed using the Digora and Visualix systems; then, ERR was induced by immersing the teeth in 6 mol L-1 of hydrochloric acid for different periods of time (10, 30 and 60 minutes). ERR was confirmed by calcium quantification with an atomic absorption spectrophotometer. One digital image was acquired per time period at 70 kVp, 7 mA, 2.2 mm filtration, focus-film distance of 30 cm, and with exposure times of 0.09 s in the Digora system and 0.05 s in Visualix system. The region of interest was defined using ImageJ software. Statistical analysis was performed using ANOVA and Pearson’s correlation (p < 0.05). There was no statistically significant difference between the time for ERR induction and the pixel values with either system. A positive correlation between the time of ERR induction and the calcium concentration was observed (r = 0.8892; p < 0.001). In conclusion, independent of the site of ERR induction and the digital system, pixel value analysis was not effective for ERR detection.

Purpose. The aim of this paper is to report a case in which the cone beam computed tomography (CBCT) was important for the confirmation of the presence of maxillary sinus septum and, therefore, the absence of a suspected pathologic process.Case Description. A 27-year-old male patient was referred for the assessment of a panoramic radiograph displaying a radiolucent area with radiopaque border located in the apical region of the left upper premolars. The provisional diagnosis was either anatomical variation of the maxillary sinuses or a bony lesion.Conclusion. The CBCT was important for an accurate assessment and further confirmation of the presence of maxillary septum, avoiding unnecessary surgical explorations.

Introduction The purpose of this study was to compare the accuracy of digital periapical (PA) radiography and 3 cone-beam computed tomographic (CBCT) scanners in the identification of various internal anatomic patterns in mandibular incisors. Methods Forty mandibular incisors were scanned using micro–computed tomographic imaging as the gold standard to establish the internal anatomic pattern. The number of root canals and internal patterns were classified into type I (single canal, n = 12), type Ia (single oval canal, n = 12), and type III (2 canals, n = 16). The teeth were placed in a human mandible, and digital PA radiography and 3 CBCT scans (Kodak 9000 3D [Carestream Health, Rochester, NY], Veraviewepocs 3De [J Morita MFG Corp, Kyoto, Japan], NewTom 5G [QR Srl, Verona, Italy]) were performed. Two blinded examiners classified each tooth's anatomic pattern, which were then compared with the micro–computed tomographic determinations. Results Considering type I and type Ia, which both presented with 1 root canal, there was a high degree of accuracy for all methods used ( P > .05). The same result was found for type III. When identifying the shape of single canals (type I), CBCT imaging was more accurate compared with PA radiography. Concerning oval canals (type Ia), there was a significant difference between PA radiography and NewTom CBCT (PA radiography = 44%, NewTom = 88%). However, there were no significant differences between the 3 CBCT units. Conclusions Double-exposure digital PA radiography for mandibular incisors is sufficient for the identification of the number of root canals. All CBCT devices showed improved accuracy in the identification of single root canal anatomy when a narrow canal was present. However, the identification of oval canals was improved only with the NewTom CBCT device.

The aim of this study was to identify the type and frequency of incidental findings (IFs) in the maxillofacial region of CBCT scans with different sizes of field of view (FOV), and the clinical relevance of the findings was classified as requirement or not of monitoring, treatment or referral to a specialist.We analyzed 150 CBCT examinations, divided according to the size of the FOV into 3 groups: 6-cm maxilla, 6-cm mandible and 13-cm maxilla/mandible. The IFs were categorized into six areas: airway, temporomandibular joint (TMJ), bone, lesions of the jaws, teeth and soft-tissue calcifications.The results showed 560 IFs that were found in 92% of the samples studied. A total of 225 IFs were found in examinations of the maxilla group, 99 findings in the mandible group and 236 findings in the maxilla/mandible group. The IFs were most frequent in the tooth zone (27.32%), followed by airways, soft-tissue calcifications, TMJ, bone, lesions of the jaw and other findings. We also found that 43.46% of the IFs did not need treatment or referral to another professional, 28.97% findings required the acquisition of new images for monitoring and 27.55% findings needed treatment or referral.The present study confirmed the high frequency of IFs in CBCT scans. It was concluded that it is necessary to interpret and report the total volume obtained in CBCT examinations and not only the purpose of the examination region.

Objetivo: realizar uma reflexão sobre a aplicação dos princípios bioéticos na atuação do cirurgião-dentista em âmbito hospitalar. Material e Métodos: uma revisão crítica da literatura foi realizada acessando-se as bases de dados PubMed, Scielo e Biblioteca Virtual em Saúde, utilizando-se os descritores “Bioética”, “Equipe Hospitalar de Odontologia”, “Ética Odontológica” e “Ética Institucional”. Resultados: não foram encontrados estudos específicos sobre o tema proposto. Há escassez de trabalhos na literatura científica específicos sobre a aplicação dos princípios bioéticos ao dia a dia dos profissionais de Odontologia em âmbito hospitalar. Conclusão: a observância e o respeito aos pilares bioéticos da autonomia, justiça, beneficência e não maleficência devem estar incluídos nas atitudes do cirurgião-dentista e da equipe multiprofissional, minimizando os desconfortos ocasionados por problemas de ordem geral e bucal.

OBJECTIVE: This study compared the influence of three epoxy resin-based sealers with distinct radiopacities on the observers' ability to detect root canal filling voids during radiographic analysis. MATERIAL AND METHODS: The root canals of 48 extracted maxillary canines were prepared and divided into three groups. Each group was laterally condensed with one sealer (AH Plus®, Acroseal® or a non-radiopaque sealer), and a longitudinal void was simulated in half of the specimens from each group (n=8). Buccolingual radiographs were obtained and randomly interpreted for voids by a radiologist and an endodontist in a blinded fashion. Teeth were cut and inspected under a microscope to confirm the position of void. Differences in sensitivity and specificity between groups and examiners were compared using the Fisher's Exact and McNemar tests, respectively (α=0.05). RESULTS: Significantly lower sensitivity levels (p

Objective The aim of this study was to establish an anatomical guideline in cone beam computed tomography (CBCT) images to discriminate soft-tissue calcifications, specifically, tonsilloliths, and styloid chain ossification (SCO) in the multiplanar reconstruction screen of the i-CAT Vision. Materials and Methods We analyzed 100 pairs of CBCT images and panoramic digital radiographies regarding the presence or absence of tonsilloliths and SCO. The intraobserver agreement varied from excellent to good. The statistical analyses included Mann–Whitney test, chi-square test, Spearman test, Student's t-test, and Wilcoxon test. The analyses were repeated without the guideline to verify its effectiveness. Results A total of 25 tonsilloliths were found in panoramic images while CBCT images revealed 60. Panoramic and CBCT images showed 42% and 63% of patients positive to SCO, respectively. We found a statistically significant difference when comparing the presence of tonsilloliths and SCO between panoramic and CBCT images (Wilcoxon test P

The aim of this study was to evaluate the performances of observers in diagnosing proximal caries in digital images obtained from digital bitewing radiographs using two scanners and four digital cameras in Joint Photographic Experts Group (JPEG) and tagged image file format (TIFF) files, and comparing them with the original conventional radiographs.In total, 56 extracted teeth were radiographed with Kodak Insight film (Eastman Kodak, Rochester, NY) in a Kaycor Yoshida X-ray device (Kaycor X-707; Yoshida Dental Manufacturing Co., Tokyo, Japan) operating at 70 kV and 7 mA with an exposure time of 0.40 s. The radiographs were obtained and scanned by CanonScan D646U (Canon USA Inc., Newport News, VA) and Genius ColorPage HR7X (KYE Systems Corp. America, Doral, FL) scanners, and by Canon Powershot G2 (Canon USA Inc.), Canon RebelXT (Canon USA Inc.), Nikon Coolpix 8700 (Nikon Inc., Melville, NY), and Nikon D70s (Nikon Inc.) digital cameras in JPEG and TIFF formats. Three observers evaluated the images. The teeth were then observed under the microscope in polarized light for the verification of the presence and depth of the carious lesions.The probability of no diagnosis ranged from 1.34% (Insight film) to 52.83% (CanonScan/JPEG). The sensitivity ranged from 0.24 (Canon RebelXT/JPEG) to 0.53 (Insight film), the specificity ranged from 0.93 (Nikon Coolpix/JPEG, Canon Powershot/TIFF, Canon RebelXT/JPEG and TIFF) to 0.97 (CanonScan/TIFF and JPEG) and the accuracy ranged from 0.82 (Canon RebelXT/JPEG) to 0.91 (CanonScan/JPEG).The carious lesion diagnosis did not change in either of the file formats (JPEG and TIFF) in which the images were saved for any of the equipment used. Only the CanonScan scanner did not have adequate performance in radiography digitalization for caries diagnosis and it is not recommended for this purpose.

Forensic age estimation is an important element of anthropological research, as it produces one of the primary sources of data that researchers use to establish the identity of a person living or the identity of unknown bodily remains. The aim of this study was to determine if the chronology of third molar mineralization could be an accurate indicator of estimated age in a sample Brazilian population. If so, mineralization could determine the probability of an individual being 18 years or older. The study evaluated 407 panoramic radiographs of males and females from the past 5 years in order to assess the mineralization status of the mandibular third molars. The evaluation was carried out using an adaptation of Demirjian's system. The results indicated a strong correlation between chronological age and the mineralization of the mandibular third molars. The results indicated that modern Brazilian generation tends to demonstrate an earlier mandibular third molar mineralization than older Brazilian generation and people of other nationalities. Males reached developmental stages slightly earlier than females, but statistically significant differences between the sex were not found. The probability that an individual with third molar mineralization stage H had reached an age of 18 years or older was 96.8-98.6% for males and females, respectively.