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OBJECTIVE: The aim of this study was to determine the influence of periapical radiographs, cone beam computed tomography (CBCT) sections, and cone beam volumetric data on the determination of periapical bone destruction in endodontically treated distal root canals of premolar canine teeth. Nontreated mesial roots were used as controls. STUDY DESIGN: Enterococcus faecalis strain (ATCC 29212) was inoculated into 30 root canals of 2 mongrel dogs to induce apical periodontitis. After 60 days, the root canals of the distal roots of the 11 mandibular and 4 maxillary premolars were endodontically treated (n = 15). The mesial root canals were used as controls (no treatment). The bone destruction was evaluated after 6 months by 5 evaluators using periapical radiographs and by CBCT (coronal and sagittal sections). After the experimental period, the area of the lesions in periapical radiographs and CBCT sections were measured in mm(2) using the ImageTool software. A single evaluator measured the volumetric data using the OsiriX software. The comparison between the diagnosis methods in treated root canals and controls was performed using parametric and nonparametric criteria. The Pearson correlation coefficient was computed between radiographic values and CBCT volumetric data in treated root canals and controls. RESULTS: The results showed the presence of chronic apical periodontitis in every inoculated tooth. After 6 months, periapical radiographs, coronal CBCT sections, and volumetric data showed lower bone destruction in endodontically treated teeth in comparison with the control group (P < .05). The 5 evaluators found no differences between the apical periodontitis area of treated teeth and controls when CBCT sagittal sections were used (P > .05). No correlation was found between x-ray and CBCT volumetric values in treated root canals. CONCLUSIONS: Although selected CBCT sagittal sections showed similar values of bone destruction in endodontically and nontreated root canals, volumetric CBCT data showed that periapical lesions of endodontically treated root canals had half of the volume of periapical lesions in nontreated root canals. No relationship could be found between the periapical values of bone destruction and volumetric data found in CBCT of treated rood canals. [ABSTRACT FROM AUTHOR]

Background: To evaluate the impact of oral health on the quality of life (QOL) of individuals undergoing cancer treatment at the time of diagnosis of medication-related osteonecrosis of the jaw (MRONJ)., Material and Methods: The present cross-sectional study analyzed patients with MRONJ from 2013 to 2019. The collected data included demographic data, base disease, medications associated with MRONJ, route of administration and time of use, signs, symptoms, and tomographic features of acute MRONJ, staging according to American Association of Oral and maxillofacial Surgeons position paper 2014 (AAOMS), type of dental treatment performed, outcome, and the responses to the Oral Health Impact Profile questionnaire (OHIP-14). Statistical analysis was performed using the Tukey test to study the association between oral condition and the QOL. A p-value of less than 0.05 was considered statistically significant., Results: The sample consisted of 16 medical records of patients with MRONJ. Psychological discomfort showed alarmingly significant results ( p < 0.001) with strong negative impact on the QOL of the patients. Functional limitation was the least affected dimension ( p = 0.747). The other dimensions did not show statistically significant results., Conclusions: MRONJ compromises oral health and negatively impacts the QOL, especially with respect to the psychological discomfort (worry and stress). The OHIP-14 questionnaire proved to be an effective tool in the assessment of this impact. Key words: Medication-related osteonecrosis of the jaw, quality of life, oral health, OHIP-14., Competing Interests: Conflicts of interest No competing financial interests exist., (Copyright: © 2020 Medicina Oral S.L.)

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.

Objectives: 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., Methods: 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., Results: 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., Conclusions: 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.

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 aim of this study was to identify the shape and route of the bony canal of the posterior superior alveolar artery (PSAA) and posterior superior alveolar nerve (PSAN) using different identification methods, including computed tomography (CT), panoramic radiograph, and macroscopic evaluation (corpse and dry skull). Twenty-four patients were analyzed by CT and panoramic and posterior anterior (PA) radiographs; additionally, 90 dry skulls and 21 dissected anatomical specimens were examined. Three-dimensional-CT revealed that the lateral wall of the maxillary sinus resembled a tunnel format in 60% of the treated patients. Out of all 24 patients, the panoramic radiograph identified the bony canal in only one patient; whereas the PA radiograph identified it in 80% of the patients. The dry skulls showed tunnellike routes of the PSAA and PSAN in 65% of the cases. Moreover, the pathway was also visibly observed in the dissected anatomical specimens as a straight shape in 85% of the cases. Thus, our results demonstrated that the most common shape of the bony canal of the PSAA and PSAN is the tunnel format with a straight route by 3D-CT, posterior anterior radiography, and macroscopic evaluation. However, in the panoramic radiographs, it was difficult to identify this canal.

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.

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.

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.

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., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

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 < 0.05). The analyses without the guideline showed that the observer tended to diagnoses more false-positive SCO., Conclusion: Based on the results, we can suggest that CBCT images are more suitable to differentiate tonsilloliths and SCO than panoramic images. The guideline was more important to diagnosis SCO than tonsilloliths. SCO was misclassified in 34% without the guideline., (© 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to determine the prevalence of apical periodontitis (AP) detected in cone beam CT (CBCT) images from a database., Methods: CBCT images of 300 Brazilian patients were assessed. AP images were measured in three dimensions. Age, gender, number and location of total teeth in each patient were considered. AP location was considered according to tooth groups. The extent of AP was determined by the largest diameter in any of the three dimensions. Percentages and the χ(2) test were used for statistical analysis., Results: AP was found in 51.4% of the patients and in 3.4% of the teeth. Higher prevalence of AP was found in 60- to 69-year-olds (73.1%) and in mandibular molars (5.9%) (p < 0.05). Inadequate endodontic treatment presented higher prevalence of AP (78.1%)., Conclusions: AP can be frequently found in CBCT examinations. The presence of AP has a significant association with patients' age, and tooth type and condition. CBCT databases are useful for cross-sectional studies about AP prevalence in a population.

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.

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<0.05) were observed in the coronal portion of fillings performed with both radiopaque sealers. Specificity values for Acroseal® were significantly higher (p<0.05) in the coronal and apical portions of fillings., Conclusions: The type of root canal sealer can affect the observers' ability to detect root canal filling voids during radiographic analysis of upper single-rooted teeth.

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., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

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.

Objective: 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., Method: 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., Results: 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)., Conclusion: 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.

Unlabelled: The identification of the mandibular canal (MC) is an important prerequisite for surgical procedures involving the posterior mandible. Cone beam computed tomography (CBCT) represents an advance in imaging technology, but distinguishing the MC from surrounding structures may remain a delicate task., Objectives: The aim of this study was to assess the visibility of the MC in different regions on CBCT cross-sectional images., Material and Methods: CBCT cross-sectional images of 58 patients (116 hemi-mandibles) were analyzed, and the visibility of the MC in different regions was assessed., Results: The MC was clearly visible in 53% of the hemi-mandibles. Difficult and very difficult visualizations were registered in 25% and 22% of the hemi-mandibles, respectively. The visibility of the MC on distal regions was superior when compared to regions closer to the mental foramen. No differences were found between edentulous and tooth-bearing areas., Conclusions: The MC presents an overall satisfactory visibility on CBCT cross-sectional images in most cases. However, the discrimination of the canal from its surrounds becomes less obvious towards the mental foramen region when cross-sectional images are individually analyzed.

Schwannoma is a benign tumor arising from nerve-sheath Schwann cells. When it affects the mouth, the lips are rarely involved. A MEDLINE search in the English literature from 1969 to 2009 revealed only 17 documented cases of schwannomas of the lip. This report describes the unusual case of a 52-year-old man who developed a schwannoma of the lower lip. Histopathologic examination and immunohistochemical staining studies were performed. Although rare, schwannoma should be considered in the differential diagnosis of any nodule or mass in the oral mucosa.

The aim of this ex vivo was to investigate if two radiopaque root canal sealers with different formulations would influence the radiographic perception of root canal fillings. The root canals of 48 extracted maxillary canines were prepared and randomly assigned to 3 groups of 16 specimens each. In each group, the root canals were filled by lateral condensation of gutta-percha and one of the tested sealers: Endométhasone, Sealer 26, or a non-radiopaque sealer. A through-and-through void was simulated in half of the specimens from each group (n=8). The buccolingual radiographic images obtained were randomly interpreted for voids existence by a radiologist and an endodontist. The differences in sensitivity and specificity between groups and examiners were compared using, respectively, Fisher's Exact and McNemar tests at 5% significance level. Both radiopaque sealers caused a significant decrease in sensitivity at the coronal part of fillings. The use of Endométhasone increased specificity values for both coronal and apical portions of the root canal fillings. In conclusion, the tested sealers influenced the radiographic perceptions of laterally condensed root canal fillings in a different way.

This article presents a case report in which a systemic disease was first suspected by viewing a panoramic radiograph. A 49-year-old man sought prosthetic rehabilitation with implants. Panoramic radiography revealed an osteolysis of poorly defined limits in the apical region of teeth No. 26 to 28. The patient's medical history included the recent removal of a giant cell lesion from the left tibia. During palpation of the neck, a fixed nodule was detected on the superior portion of the left thyroid gland. Biochemical tests showed elevated levels of serum alkaline osphatase, serum calcium, and parathyroid hormone. As the serum phosphate was low, the final diagnosis was primary hyperparathyroidism. A CT scan showed a hypodense lesion involving teeth No. 26 to 28, with preserved cortical bone. A whole-body bone scintigraphy showed lesions in the mandible and other long bones. A high radiopharmaceutical capitation was present in the left parathyroid gland. The patient was referred to a head and neck surgeon, who removed the left thyroid lobule and the parathyroid gland. The microscopic diagnosis was parathyroid carcinoma. After eight months of follow-up, the mandibular lesion disappeared.

Fibrous dysplasia is a benign fibro-osseous disease that affects one or more bones. Although its etiology has been defined, the mechanism of spontaneous resolution is still unclear. There is strong evidence indicating the occurrence of stabilization when bone maturation is completed. Deformities that lead to esthetic and functional disorders are observed in almost all cases. Plastic surgery is often recommended when the maxilla and mandible are involved. In the case of mild deformities, careful follow-up during skeletal growth is recommended. We describe here the 23-year follow-up of a patient with monostotic fibrous dysplasia whose disease had stabilized by 13 years of follow-up.

The purpose of this study was to evaluate morphological characteristics of teeth with hypercementosis that are relevant to endodontic practice. Twenty-eight extracted teeth with hypercementosis had their root apexes analyzed by scanning electron microscopy (SEM). The teeth were divided according to tooth groups and type of hypercementosis. The following aspects were examined under SEM: the contour and regularity of the root surface; presence of resorption; presence and number of apical foramina, and the diameter of the main foramen. The progression of club shape hypercementosis was directly associated with the presence of foramina and apical foramen obstruction. Cases of focal hypercementosis presented foramina on the surface, even when sidelong located in the root. Circular cementum hyperplasia form was present in 2 out of 3 residual roots, which was the highest proportion among the tooth types. The detection of a large number of foramina in the apical third of teeth with hypercementosis or even the possible existence of apical foramen obliteration contributes to understand the difficulties faced during endodontic treatment of these cases.

Isotretinoin (13-cis-retinoic acid) is a retinoid that has been used for the past 20 years to treat a variety of dermatologic conditions. It is beneficial in many skin conditions, although its side effects and toxicity require careful monitoring by physicians and other health professionals, among them, dentists, who should be prepared to manage an adverse occurrence. In this paper, the oral side effects of isotretinoin are described; and some of them are illustrated.

Ehlers-Danlos syndrome (EDS) is a hereditary disorder of the connective tissue related to collagen metabolism. Deficiency or alteration of the collagen present in the tissues results in some classic signs such as skin hyperelasticity, articular hypermobility, and vascular fragility, among others. In addition, EDS oral manifestations are rarely cited in the literature. The aim of this article is to report a rare case of a young female patient with EDS who presented supernumerary teeth and an odontogenic keratocyst. There is no report in the literature of the simultaneous occurrence of these alterations. The article further highlights the importance of EDS diagnosis in patients who need dental treatment and the due care for their assistance.

Techniques were developed to obtain standardised intra- and extra-oral radiographs in minipigs for use in medical-dental research. Twelve male minipigs (BR-1 Minipigs) were chosen at random. Two animals each at 3, 5, 7, 9, 12 and 15 months of age were anaesthetised and subjected to radiographic examinations to assess six techniques. Three intra-oral and three extra-oral techniques, standardised for humans, were used with variations of the angle of incidence of the X-ray beams, focus-film distance and exposure time. Two film positioners were developed for the intra-oral techniques. Two examiners then chose the radiographs with the least image distortion, greatest clarity and least superimposition of images. For each technique, the suitable angle of incidence of the X-ray beams, the focus-film distance and exposure time that produced the highest quality radiographs were standardised.

This study was designed to characterize the development of oral structures in the BR-1 minipig and to compare these data with literature reports on domestic swine and other minipig lineages. Twelve male minipigs were anesthetized and given physical and radiographic examinations. The presence and chronology of tooth eruption from 3 to 15 months of age were assessed, and the radiographic results were interpreted by two certified researchers, who obtained a high index of agreement (kappa>0.81). The eruption chronology was similar to that reported for domestic swine and other minipig lineages. The results indicate that it is possible to use the BR-1 minipig in dental research.

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.

Objective: Panoramic radiographs are routinely employed for surgical planning of unerupted third molars. The objective of this study was to evaluate distortions in the position of mandibular third molars on panoramic radiographs., Materials and Methods: Panoramic radiographs of 14 patients with indication for extraction of the mandibular third molars were used. Transurgical impressions of the crowns of the teeth to be extracted and adjacent second molars (n=19) were achieved with addition silicone and poured with type IV plaster for comparison of the inclinations of the third molars on the radiographs and study casts., Results: There was a mean difference of -5.37 degrees between the position of the third molar on the panoramic radiograph and on the study cast (standard deviation 1.46, P<0.05, Student's t-test)., Conclusion: There is distortion in the position of teeth on the panoramic radiograph, which may influence the surgical planning; however, this does not invalidate it as the main tool for diagnosis and surgical planning of mandibular third molars.

Benign osteoblastoma is a bone tumour that seldom occurs in the facial bones. The objective of this article is to add one more case of this rare lesion to the academic literature and to provide a systematic review of previously published cases. A new case of benign osteoblastoma is presented and clinical, radiographic and microscopic aspects, as well as differential diagnosis, treatment and follow-up are discussed. The importance of the correct diagnosis of this type of lesion is stressed, since it presents a clinical, radiographic and microscopic similarity to other bone lesions, including malignant tumours, which may lead the professional into conducting the case in an improper manner.

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.

The films were compared through their characteristic curves obtained in experimental conditions and processed in Sillib's developers. Radiographies of a phanton, obtained in standard conditions of exposure and development, were analysed by dentists and technicians for judgement. It was possible to conclude that as long as the recommendations of films and developers manufactures are followed, the results are acceptable for dental clinical work, when these films were processed in Sillib's solution (20 degrees C/2 min). The judges preferred those which received two times the recommended exposure.