Diagnostic agreement between panoramic radiographs and color doppler images of carotid atheroma

The aim of this study was to investigate the agreement between diagnoses of calcified atheroma seen on panoramic radiographs and color Doppler images. Our interest stems from the fact that panoramic images can show the presence of atheroma regardless of the level of obstruction detected by color Doppler images. Panoramic and color Doppler images of 16 patients obtained from the archives of the Health Department of the city of Valença, RJ, Brazil, were analyzed in this study. Both sides of each patient were observed on the images, with a total of 32 analyzed cervical regions. The level of agreement between diagnoses was analyzed using the Kappa statistics. There was a high level of agreement, with a Kappa value of 0.78. In conclusion, panoramic radiographs can help detecting calcifications in the cervical region of patients susceptible to vascular diseases predisposing to myocardial infarction and cerebrovascular accidents. If properly trained and informed, dentists can refer their patients to a physician for a cardiovascular evaluation in order to receive proper and timely medical treatment.

Validity and reliability of a computer method to estimate vertebral axial rotation from digital radiographs

Axial vertebral rotation, an important parameter in the assessment of scoliosis may be identified on X-ray images. In line with the advances in the field of digital radiography, hospitals have been increasingly using this technique. The objective of the present study was to evaluate the reliability of computer-processed rotation measurements obtained from digital radiographs. A software program was therefore developed, which is able to digitally reproduce the methods of Perdriolle and Raimondi and to calculate semi-automatically the rotation degree of vertebra on digital radiographs. Three independent observers estimated vertebral rotation employing both the digital and the traditional manual methods. Compared to the traditional method, the digital assessment showed a 43% smaller error and a stronger correlation. In conclusion, the digital method seems to be reliable and enhance the accuracy and precision of vertebral rotation measurements.

Influência da largura do septo inter-radicular sobre a estabilidade dos mini-implantes

OBJETIVO: este estudo teve como objetivo avaliar a influência da largura do septo inter-radicular no local de inserção de mini-implantes autoperfurantes sobre o grau de estabilidade desses dispositivos de ancoragem. MÉTODOS: a amostra consistiu de 40 mini-implantes inseridos entre as raízes do primeiro molar e segundo pré-molar superiores de 21 pacientes, com o intuito de fornecer ancoragem para retração anterior. A largura do septo no local de inserção (LSI) foi mensurada nas radiografias pós-cirúrgicas e, sob esse aspecto, os mini-implantes foram divididos em dois grupos: grupo 1 (áreas críticas, LSI<3mm) e grupo 2 (áreas não críticas, LSI>3mm). A estabilidade dos mini-implantes foi avaliada mensalmente pela quantificação do grau de mobilidade e a partir dessa variável foi calculada a proporção de sucesso. Avaliou-se também: a quantidade de placa, altura de inserção, grau de sensibilidade e período de observação. RESULTADOS: os resultados obtidos demonstraram que não houve diferença estatisticamente significativa para o grau de mobilidade e proporção de sucesso entre os mini-implantes inseridos em septos de largura mesiodistal crítica e não crítica. A proporção de sucesso total encontrada foi de 90% e nenhuma variável demonstrou estar relacionada ao insucesso dos mini-implantes. No entanto, observou-se maior sensibilidade nos pacientes cujos mini-implantes apresentavam mobilidade, e que a falha desses dispositivos de ancoragem ocorria logo após sua inserção. CONCLUSÃO: a largura do septo inter-radicular no local de inserção não interferiu na estabilidade dos mini-implantes autoperfurantes avaliados neste estudo.

Digital subtraction radiographic analysis of the combination of bioabsorbable membrane and bovine morphogenetic protein pool in human periodontal infrabony defects

OBJECTIVES: This study assessed the bone density gain and its relationship with the periodontal clinical parameters in a case series of a regenerative therapy procedure. MATERIAL AND METHODS: Using a split-mouth study design, 10 pairs of infrabony defects from 15 patients were treated with a pool of bovine bone morphogenetic proteins associated with collagen membrane (test sites) or collagen membrane only (control sites). The periodontal healing was clinically and radiographically monitored for six months. Standardized pre-surgical and 6-month postoperative radiographs were digitized for digital subtraction analysis, which showed relative bone density gain in both groups of 0.034 ± 0.423 and 0.105 ± 0.423 in the test and control group, respectively (p>0.05). RESULTS: As regards the area size of bone density change, the influence of the therapy was detected in 2.5 mm² in the test group and 2 mm² in the control group (p>0.05). Additionally, no correlation was observed between the favorable clinical results and the bone density gain measured by digital subtraction radiography (p>0.05). CONCLUSIONS: The findings of this study suggest that the clinical benefit of the regenerative therapy observed did not come with significant bone density gains. Long-term evaluation may lead to a different conclusions.

Dimensões nasofaringeanas e faciais em diferentes padrões morfológicos

OBJETIVO: o presente estudo propõe-se a comparar as dimensões da nasofaringe e as características esqueléticas avaliadas por exame cefalométrico, em indivíduos com padrões morfológicos distintos. MÉTODOS: foram utilizadas 90 telerradiografias de pacientes de ambos os gêneros, de 12 a 16 anos de idade, as quais foram igualmente divididas em três grupos distintos, referentes aos padrões morfológicos - braquifacial, mesofacial e dolicofacial. Foram realizadas medições específicas da região nasofaringeana (ad1-Ptm, ad2-Ptm, ad1-Ba, ad2-S0, (ad1-ad2-S0-Ba-ad1/Ptm-S 0-Ba-Ptm) X 100, e Ptm-Ba) e relativas ao padrão esquelético da face. RESULTADOS: observou-se que os pacientes dolicofaciais apresentaram menor profundidade sagital óssea (Ptm-Ba) e da via aérea da nasofaringe (ad1-Ptm e ad2-Ptm). Sugere-se que essas diferenças estejam relacionadas a um posicionamento relativamente mais posterior da maxila, comum a esses pacientes. Todavia, não foram detectadas diferenças quanto à espessura de tecido mole na parede posterior nasofaringeana (ad1-Ba e ad2-S0), ou à sua proporção em relação a toda a área delimitada para a nasofaringe [(ad1-ad2-S0-Ba-ad1/Ptm-S 0-Ba-Ptm) X 100]. CONCLUSÃO: sugere-se, portanto, que as características faciais de excesso vertical encontradas em pacientes dolicofaciais podem ocorrer, dentre outros fatores, em virtude da obstrução da via aérea nasofaringeana, uma vez que tais dimensões se apresentaram menores para os dolicofaciais.

Skeletal alterations associated with the use of bonded rapid maxillary expansion appliance

Bonded maxillary expansion appliances have been suggested to control increases in the vertical dimension of the face after rapid maxillary expansion (RME). However, there is still no consensus in the literature about its real skeletal effects. The purpose of this prospective study was to evaluate, longitudinally, the vertical and sagittal cephalometric alterations after RME performed with bonded maxillary expansion appliance. The sample consisted of 26 children, with a mean age of 8.7 years (range: 6.9-10.9 years), with posterior skeletal crossbite and indication for RME. After maxillary expansion, the bonded appliance was used as a fixed retention for 3.4 months, being replaced by a removable retention subsequently. The cephalometric study was performed onto lateral radiographs, taken before treatment was started, and again 6.3 months after removing the bonded appliance. Intra-group comparison was made using paired t test. The results showed that there were no significant sagittal skeletal changes at the end of treatment. There was a small vertical skeletal increase in five of the eleven evaluated cephalometric measures. The maxilla displaced downward, but it did not modify the facial growth patterns or the direction of the mandible growth. Under the specific conditions of this research, it may be concluded that RME with acrylic bonded maxillary expansion appliance did promote signifciant vertical or sagittal cephalometric alterations. The vertical changes found with the use of the bonded appliance were small and probably transitory, similar to those occurred with the use of banded expansion appliances.

Quantitative radiographic evaluation of periapical bone resorption in dog's teeth contaminated with bacterial endotoxin (LPS) associated or not with calcium hydroxide

The aim of this study was to quantify radiographically the periapical bone resorption in dogs' teeth contaminated with bacterial endotoxin (LPS), associated or not with calcium hydroxide. After pulp tissue removal, 60 premolars were randomly assigned to 4 groups and were either filled with LPS (group 1), filled with LPS plus calcium hydroxide (group 2) or filled with saline (group 3) for a period of 30 days. In group 4, periapical lesion formation was induced with no canal treatment. Standardized radiographs were taken at the beginning of the treatment and after 30 days and the Image J Program was used for measurement of periapical lesion size. Periapical lesions were observed in groups 1 (average of 8.44 mm2) and 4 (average of 3.02 mm2). The lamina dura was intact and there were no areas of periapical bone resorption in groups 2 and 3. It may be concluded that calcium hydroxide was effective in inactivating LPS, as demonstrated by the absence of apical periodontitis in the roots that were filled with bacterial endotoxin plus calcium hydroxide.

Diagnosis and root canal treatment in a mandibular premolar with three canals

This paper presents a case report of a left mandibular second premolar with three canals and three different apical foramina. A 39-year-old male patient presented to our clinic with pain in the mandibular left second premolar. Initially, pain was caused by cold stimulus and later was spontaneously. The intraoral clinical examination revealed a fractured amalgam restoration with occlusal caries. Percussion and cold (Endo-Frost) tests were positive. The radiographic examination showed the presence of two roots. The probable diagnosis was an acute pulpitis. After access cavity, it was observed remaining roof of the pulp chamber and mild bleeding in the tooth lingual area, indicating the possible presence of a third canal. The endodontic treatment was completed in a single session using Root ZX apex locator and K3 NiTi rotary system with surgical diameter corresponding to a .02/45 file in the three canals and irrigation with 1% sodium hypochlorite. The canals were obtured with gutta-percha cones and Sealer 26 using the lateral condensation technique. After 1 year of follow-up, the tooth was asymptomatic and periapical repair was observed radiographically. Internal alterations should be considered during the endodontic treatment of mandibular second premolars. The correct diagnosis of these alterations by the analysis of preoperative radiographs can help the location of two or more canals, thereby avoiding root therapy failure.

Influence of intracanal post on apical periodontitis identified by cone-beam computed tomography

The determination of the success of endodontic treatment has been often discussed based on outcome obtained by periapical radiography. The aim of this study was to verify the influence of intracanal post on apical periodontitis detected by cone-beam computed tomography (CBCT). A consecutive sample of 1020 images (periapical radiographs and CBCT scans) taken from 619 patients (245 men; mean age, 50.1 years) between February 2008 and September 2009 were used in this study. Presence and intracanal post length (short, medium and long) were associated with apical periodontitis (AP). Chi-square test was used for statistical analyses. Significance level was set at p<0.01. The kappa value was used to assess examiner variability. From a total of 591 intracanal posts, AP was observed in 15.06%, 18.78% and 7.95% using periapical radiographs, into the different lengths, short, medium and long, respectively (p=0.466). Considering the same posts length it was verified AP in 24.20%, 26.40% and 11.84% observed by CBCT scans, respectively (p=0.154). From a total of 1,020 teeth used in this study, AP was detected in 397 (38.92%) by periapical radiography and in 614 (60.19%) by CBCT scans (p<0.001). The distribution of intracanal posts in different dental groups showed higher prevalence in maxillary anterior teeth (54.79%). Intracanal posts lengths did not influenced AP. AP was detected more frequently when CBCT method was used.

Method for determination of root curvature radius using cone-beam computed tomography images

This article describes and discusses a method to determine root curvature radius by using cone-beam computed tomography (CBCT). The severity of root canal curvature is essential to select instrument and instrumentation technique. The diagnosis and planning of root canal treatment have traditionally been made based on periapical radiography. However, the higher accuracy of CBCT images to identify anatomic and pathologic alterations compared to panoramic and periapical radiographs has been shown to reduce the incidence of false-negative results. In high-resolution images, the measurement of root curvature radius can be obtained by circumcenter. Based on 3 mathematical points determined with the working tools of Planimp® software, it is possible to calculate root curvature radius in both apical and coronal directions. The CBCT-aided method for determination of root curvature radius presented in this article is easy to perform, reproducible and allows a more reliable and predictable endodontic planning, which reflects directly on a more efficacious preparation of curved root canals.

Prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults

The aim of this study was to assess the prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults. A total of 1,372 periapical radiographs of endodontically treated teeth were analyzed based on the quality of root filling, status of coronal restoration and presence of posts associated with apical periodontitis (AP). Data were analyzed statistically using odds ratio, confidence intervals and chi-square test. The prevalence of AP with adequate endodontic treatment was low (16.5%). This percentage dropped to 12.1% in cases with adequate root filling and adequate coronal restoration. Teeth with adequate endodontic treatment and poor coronal restoration had an AP prevalence of 27.9%. AP increased to 71.7% in teeth with poor endodontic treatment associated with poor coronal restoration. When poor endodontic treatment was combined with adequate coronal restoration, AP prevalence was 61.8%. The prevalence of AP was low when associated with high technical quality of root canal treatment. Poor coronal restoration increased the risk of AP even when endodontic treatment was adequate (OR=2.80; 95%CI=1.87-4.22). The presence of intracanal posts had no influence on AP prevalence.

Effects of detachment and repositioning of the medial pterygoid muscle on the growth of the maxilla and mandible of young rats

PURPOSE: To analyze the effects of detachment and repositioning of the medial pterygoid muscle on the growth of the maxilla and mandible of young rats through cephalometry. METHODS: Thirty one-month-old Wistar rats were used, distributed into three groups: experimental, sham-operated and control. In the experimental group, unilateral detachment and repositioning of the medial pterygoid muscle was performed. The sham-operated group only underwent surgical access, and the control group did not undergo any procedure. The animals were sacrificed at the age of three months. Their soft tissues were removed and the mandible was disarticulated. Radiographs of the skull in axial projection and the hemimandibles in lateral projection were obtained, and cephalometry was performed. The values obtained were subjected to statistical analyses among the groups and between the sides in each group. RESULTS: There were significant differences in the length of the mandible relative to the angular process in the experimental group and in the height of the mandibular body in the sham-operated group. CONCLUSION: The experimental detachment and repositioning of the medial pterygoid muscle during the growth period in rats affected the growth of the angle region, resulting in asymmetry of the mandible.

Juvenile idiopathic arthritis with involvement of the temporomandibular joint: the role of image examinations

PURPOSE: Juvenile idiopathic arthritis (JIA) has unknown etiology, and the involvement of the temporomandibular joint (TMJ) is rare in the early phase of the disease. The present article describes the use of computed tomography (CT) and magnetic resonance (MRI) images for the diagnosis of affected TMJ in JIA. CASE DESCRIPTION: A 12-year-old, female, Caucasian patient, with systemic rheumathoid arthritis and involvement of multiple joints was referred to the Imaging Center for TMJ assessment. The patient reported TMJ pain and limited opening of the mouth. The helical CT examination of the TMJ region showed asymmetric mandibular condyles, erosion of the right condyle and osteophyte-like formation. The MRI examination showed erosion of the right mandibular condyle, osteophytes, displacement without reduction and disruption of the articular disc. CONCLUSION: The disorders of the TMJ as a consequence of JIA must be carefully assessed by modern imaging methods such as CT and MRI. CT is very useful for the evaluation of discrete bone changes, which are not identified by conventional radiographs in the early phase of JIA. MRI allows the evaluation of soft tissues, the identification of acute articular inflammation and the differentiation between pannus and synovial hypertrophy.

Effectiveness of sealing active proximal caries lesions with an adhesive system: 1-year clinical evaluation

The objective of this study was to evaluate the effectiveness of a therapeutic sealant to arrest non-cavitated proximal carious lesion progression. The study population comprised 44 adolescents who had bitewing radiographs taken for caries diagnosis. Non-cavitated lesions extending up to half of dentin thickness were included in the sample. In the experimental group (n = 33), the proximal caries-lesion surfaces were sealed with an adhesive (OptiBond Solo, Kerr) after tooth separation. The control group (n = 11) received no treatment, except for oral hygiene instructions including use of dental floss. Follow-up radiographs were taken after one year and were analyzed in comparison with baseline radiographs. In a blind study setting, visual readings were performed by two examiners, blinded to whether the examined radiograph was baseline or follow-up, and whether it concerned a test or control lesion. The efficacy of sealing treatment was evaluated by the McNemar test (0.05). About 22% of the sealed lesions showed reduction, 61% showed no change and 16% showed progression. For the control lesions, the corresponding values were 27%, 36% and 36% respectively. The number of lesions that showed reduction and no changes were merged and therefore 83.3% of the sealed lesions and 63.6% of the control lesions were considered clinically successful. No statistical significance was detected (p > 0.05). In the course of 1 year, sealing proximal caries lesions was not shown to be superior to lesion monitoring.

Influência da proporção entre as alturas do ramo mandibular e dentoalveolar posterior na inclinação do plano mandibular

OBJETIVO: avaliar a existência de correlação entre a proporção da altura do ramo mandibular (AR) com a altura dentoalveolar posterior total (ADAPT) e a inclinação do plano mandibular (PM). MÉTODOS: dois examinadores avaliaram 81 telerradiografias laterais de pacientes, com idades a partir de 18 anos, do arquivo do curso de especialização em Ortodontia e Ortopedia Facial da Faculdade de Odontologia da UFBA. As radiografias foram digitalizadas, os pontos marcados e as medidas obtidas através do programa Radiocef 1.0. Mediu-se a inclinação do plano mandibular para caracterizar o padrão vertical da face e dividir as radiografias em três grupos: grupo de face normal (GN), de 22º a 28º, de face curta (GC), menor que 22º, e de face longa (GL), maior que 28º. A inclinação do plano palatino serviu como critério de exclusão, sendo que valores abaixo de -2,5° ou acima de 3,5º foram excluídos. Desta forma, 46 telerradiografias laterais totalizaram a amostra. RESULTADOS: a AR diferiu entre GC e GL, porém não houve diferença estatisticamente significante para as alturas dentoalveolares posteriores. Houve baixa correlação entre a AR e a ADAPT nos grupos, no entanto, a correlação da proporção entre essas alturas com a inclinação do PM mostrou-se estatisticamente significante e negativa. CONCLUSÃO: este é um fator a ser levado em consideração na avaliação do PM, quando do diagnóstico e tratamento das displasias verticais dentofaciais.