Pixel intensity and fractal analyses: detecting osteoporosis in perimenopausal and postmenopausal women by using digital panoramic images

Objective. Pixel intensity values (PI) and fractal dimensions (FD) were compared in selected mandibular regions on digital panoramic images of normal, osteopenic, and osteoporotic perimenopausal and postmenopausal women to evaluate their relative efficacies in detecting osteoporotic-associated bone density changes.Study design. Standardized mandibular angle, body, and canine/premolar (C/PM) regions on 54 charge-coupied device (CCD) digital panoramic images of normal and potentially osteoporotic postmenopausal women were analyzed for PI and FD. Lumbar spine and femoral neck dual-energy x-ray absorptiometry QXA) on each patient served as the reference standard examination. Pearson correlation coefficients and analysis of variance (ANOVA) were performed.Results. There was significant correlation among PI measurements (P < 0.01), and no significant correlation between FD. C/PM had significantly lower PI than control C/PM (P = 0.049).Conclusions. Osteoporotic changes in mandibular C/PM cancellous bone were detected in our study population on CCD digital panoramic images by using a robust image analysis paradigm. Future automated application of such image analysis could enable widespread, cost effective screening for osteoporosis in dental settings.

Use of BioGran and Calcitite in bone defects: Histologic study in monkeys (Cebus apella)

The present study compares the biologic behavior of BioGran and Calcitite as fillers for surgical cavities in the mandibles of 4 adult monkeys (Cebus apella). The surgical cavities were prepared through both mandibular cortices, with a diameter of 5 mm, in the angle region. Two cavities were prepared on the right side and 1 on the left and divided into 3 groups: R-1 sites were filled with bioglass (BioGran), R, sites were not filled, and L sites were filled with hydroxyapatite (Calcitite). After 180 days the animals were sacrificed and the specimens were removed for histologic processing. Results showed no bone formation in group R, (empty cavities). BioGran-treated sites showed bone formation and total repair of the bone defect, and the bioglass particles were almost totally resorbed and substituted by bone. The few remaining crystals were in intimate contact with newly formed bone. Calcitite did not allow bone formation, and granules inside the cavities were involved by connective tissue. Based upon those results, the authors concluded that bioglass resulted in total obliteration of the surgical cavity with bone and hydroxyapatite was present in a large amount and involved by connective tissue, without bone formation.

Analysis of failed commercially pure titanium dental implants: A scanning electron microscopy and energy-dispersive spectrometer X-ray study

Background: the failure of osseointegration in oral rehabilitation has gained importance in current literature and in clinical practice. The integration of titanium dental implants in alveolar bone has been partly ascribed to the biocompatibility of the implant surface oxide layer. The aim of this investigation was to analyze the surface topography and composition of failed titanium dental implants in order to determine possible causes of failure.Methods: Twenty-one commercially pure titanium (cpTi) implants were retrieved from 16 patients (mean age of 50.33 +/- 11.81 years). Fourteen implants were retrieved before loading (early failures), six after loading (late failures), and one because of mandibular canal damage. The failure criterion was lack of osseointegration characterized as dental implant mobility. Two unused implants were used as a control group. All implant surfaces were examined by scanning electron microscopy (SEM) and energy-dispersive spectrometer x-ray (EDS) to element analysis. Evaluations were performed on several locations of the same implant.Results: SEM showed that the surface of all retrieved implants consisted of different degrees of organic residues, appearing mainly as dark stains. The surface topography presented as grooves and ridges along the machined surface similar to control group. Overall, foreign elements such as carbon, oxygen, sodium, calcium, silicon, and aluminum were detected in failed implants. The implants from control group presented no macroscopic contamination and clear signs of titanium.Conclusion: These preliminary results do not suggest any material-related cause for implant failures, although different element composition was assessed between failed implants and control implants.

The influence of loss of bone mass on induced periodontal disease: A radiographic and densitometric study of female rats

Background: Changes in mineral density in the mandibular and femoral bones (BMD) after estrogen deficiency caused by ovariectomy (OVX) and the influence of these changes on induced periodontal disease were evaluated in female rats.Methods: Forty-eight female Holtzman rats (90 days old) were randomly divided into five groups: 0: control (N = 9); 1: SHAM without induced periodontal disease (N = 11); 2: SHAM with induced disease (N = 10); 3: OVX without induced disease (N = 9); and 4: OVX with induced disease (N = 9). In groups 2 and 4, the first lower molars were tied with ligatures for 30 days 120 days after surgery. After 5 months the animals were sacrificed to measure global mineral density (BMD) and that of the sub-regions of the mandible and femur by dual energy x-ray absorptiometry (DXA). The extent of vertical bone loss was evaluated with digital radiography by measuring the distance from the bone crest to the cemento-enamel junction at the mesial of the first lower molar.Results: Results of the femur (Kruskal-Wallis test) showed a significant difference (P < 0.001) between the groups SHAM and OVX in bone density values for all regions. Comparison between the groups in relation to the BMD of the mandible, both in the sub-regions and global revealed no differences (P < 0.05). The vertical bone loss measured for the groups with induced disease was similar (P= 0.713).Conclusions: Differences between the groups were found in the bone mineral density BMD of the femur but not of the mandible. OVX had no influence on induced periodontal disease.

Treatment of gingival fibromatosis associated with Zimmermann-Laband syndrome

Background: Gingival fibromatosis is a rare condition characterized by a generalized enlargement of the buccal and lingual aspects of the attached and marginal gingiva.Methods: This case report describes the periodontal management of a 13-year-old female patient with gingival fibromatosis associated with Zimmermann-Laband syndrome. The patient presented with gingival enlargement involving the maxillary and the mandibular arches, anterior open bite, and non-erupted teeth. Periodontal treatment included gingivectomy in all four quadrants.Results: Histopathologic evaluation of the excised tissue supported the diagnosis of gingival flbromatosis. A significant improvement in esthetic appearance and eruption of the non-erupted teeth were obtained. The patient was referred for appropriate orthodontic treatment and has been closely followed for the earliest signs of recurrence of gingival enlargement.Conclusions: the successful therapy for gingival fibromatosis depends on correctly identifying the etiological factors and improving the impaired function and esthetic appearance through surgical intervention and adjunctive orthodontics. Maintaining treatment results depends on preservation of periodontal health.

Avaliação da alteração do plano oclusal em cirurgias ortognáticas combinadas com utilização de fixação interna rígida em pacientes com padrão facial de Classe II

OBJETIVO: avaliar a estabilidade de cirurgias bimaxilares com fixação interna rígida, na qual promoveu-se uma rotação anti-horária da mandíbula e conseqüente redução do ângulo do plano oclusal. METODOLOGIA: foram estudados 15 pacientes com padrão facial de Classe II e deficiência mandibular. Os movimentos cirúrgicos foram avaliados por meio de medidas lineares e angulares realizadas no programa CefX, obtidas de telerradiografias cefalométricas em norma lateral em três diferentes tempos: (T0) pré-operatório, (T1) pós-operatório imediato e (T2) pós-operatório de no mínimo 6 meses. RESULTADOS E CONCLUSÕES: os resultados demonstraram que a cirurgia bimaxilar promove mudanças faciais significativas e, principalmente, que a rotação anti-horária da mandíbula com redução do ângulo do plano oclusal mostrou-se estatisticamente estável, sendo uma opção confiável em cirurgias de pacientes com padrão facial de Classe II com deficiência mandibular.

Detection of the Vandibular Canal and the Mental Foramen in Panoramic Radiographs: Intraexaminer Agreement

The aim of this study was to evaluate the intraexaminer agreement in the detection of the mandibular canal roof (MCR) and mental foramen (MF) in panoramic radiographs. Forty panoramic radiographs of edentulous patients were used. Two calibrated examiners (A and B) read the images 2 times, for both sides independently, under blind conditions. The interval between the readings was 10 days. The intraexaminer agreement in the interpretation of MCR and MF was performed by kappa statistics with linear weighting (x). The intraexaminer agreement for the detection of MCR, in the left side, was good for both examiners (A: kappa = 0.67; B: kappa = 0.71). Related to the right side, it was found to be kappa = 0.47 and kappa = 0.62, respectively to A and B. The intraexaminer agreement for the detection of MF was good for both examiners interpreting the left side (A: kappa = 0.61; B: kappa = 0.63), and in relation to the right side, it was moderate (A: kappa = 0.51) and fair (B: kappa = 0.38). The intraexaminer agreement in the detection of MCR was good and from good to fair in the detection of MF.

Recursive hierarchic segmentation analysis of bone mineral density changes on digital panoramic images

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

In vitro comparison of 1.5 mm vs. 2.0 mm screws for fixation in the sagittal split osteotomy

Purpose: Numerous "in vitro" investigations have been conducted to evaluate the role of screw size and pattern in determining optimal resistance to deformation, often these have been controversial. The aim of this study was to evaluate the effect of screw size and insertion technique on the stability of sagittal split osteotomies.Materials and methods: This study used twenty polyurethane replicas of human hemimandibles with a prefabricated sagittal split ramus osteotomy (SSRO). The hemimandibles were stabilized with 1.5 mm and 2.0 mm titanium screws inserted in an inverted L configuration. All specimens were tested to determine the strength and stability of the fixation.Results: In all cases there was failure of the synthetic bone before there was any evidence of screw failure. There were no significant differences in the load necessary to make the construct fail between the 1.5 or 2.0 mm screw sizes.Conclusion: There was no statistically significant difference between the strengths achieved with screws of 1.5 and 2.0 mm diameters for fixation of SSRO performed in synthetic mandibles. There was no fracture of the 1.5 mm or 2.0 mm diameter screws in any of the tests. 1.5 mm diameter screws in an inverted L pattern have as much stability and mechanical resistance as a 2.0 mm screw, may be safely used for this procedure. (C) 2010 European Association for Cranio-Maxillo-Facial Surgery.

Prospective study of soft tissue contour changes following chin bone graft harvesting

This study sought to evaluate changes in the soft tissue contour after chin bone graft harvesting. Thirty selected patients underwent chin bone graft harvesting and evaluations were made using lateral cephalograms preoperatively and postoperatively at 30 and 180 days. Fixed points and lines were established on cephalometric tracings and used to measure the selected vertical and sagittal parameters. Results showed statistically significant alterations to the vertical position values of the vermilion (V-VPV) which increased from 9.70 to 11.01 and the exposure of lower incisors (V-ELI) which increased from 1.85 to 3.5, showing an increase in their distance from the plane of reference and a lowering of their position, the clinical equivalent of a labial ptosis condition. None of the sagittal parameters analysed showed any statistically significant variation in the final evaluation. The study concluded that the alterations to patients' soft tissue contours resulted mainly from failure to ensure precise reattachment of the mentalis muscles and identified the need for further investigation of that aspect.

Treatment of experimental periodontal disease with antimicrobial photodynamic therapy in nicotine-modified rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Scanning electron microscopy evaluation of the hard tissue barrier after pulp capping with calcium hydroxide, mineral trioxide aggregate (MTA) or ProRoot MTA

The aim of this study was to investigate the morphology and localisation of calcium hydroxide- and mineral trioxide aggregate (MTA)-induced hard tissue barriers after pulpotomy in dogs' teeth. Pulpotomies were performed on maxillary and mandibular premolars of five dogs. The teeth were assigned into three groups according to the pulp-capping agent used. The pulpal wounds were capped with calcium hydroxide (Ca(OH)(2) - control), MTA or ProRoot MTA, and the cavities were restored with amalgam. After a 90-day follow-up period, the dogs were euthanised and the teeth were examined under scanning electron microscopy (SEM). An image-processing and analysis software was used to delimit the perimeters of the root canal area and the hard tissue barrier to determine the percentage of root canal obliteration. SEM data were used to assess the morphology, localisation and extension of the reparative hard tissue barriers. ProRoot MTA was statistically different from MTA and Ca(OH)(2) (P < 0.05) regarding tissue barrier morphology. Localisation data showed that ProRoot MTA was significantly different from Ca(OH)(2) (P < 0.05) and similar to MTA (P > 0.01; P > 0.05). No statistically significant difference (P > 0.01; P > 0.05) was observed between MTA and Ca(OH)(2). A larger number of complete (centroperipheral) hard tissue barriers with predominance of dentinal tubules was observed to the ProRoot MTA when compared with the Ca(OH)(2) group.

Comparative Histopathological Analysis of Human Pulps after Class I Cavity Preparation with a High-Speed Air-Turbine Handpiece or Er:YAG Laser

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A cross-over randomised clinical trial of eccentric occlusion in complete dentures

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Accuracy of impression and pouring techniques for an implant-supported prosthesis

Purpose: The purpose of this in vitro study was to compare the dimensional accuracy of a stone index and of 3 impression techniques (tapered impression copings, squared impression copings, and squared impression copings splinted with acrylic resin) associated with 3 pouring techniques (conventional, pouring using latex tubes fitted onto analogs, and pouring after joining the analogs with acrylic resin) for implant-supported prostheses. Materials and Methods: A mandibular brass cast with 4 stainless steel implant-abutment analogs, a framework, and 2 aluminum custom trays were fabricated. Polyether impression material was used for all impressions. Ten groups were formed (a control group and 9 test groups formed by combining each pouring technique and impression technique). Five casts were made per group for a total of 50 casts and 200 gap values (1 gap value for each implant-abutment analog). Results: The mean gap value with the index technique was 27.07 mu m. With the conventional pouring technique, the mean gap values were 116.97 mu m for the tapered group, 5784 mu m for the squared group, and 73.17 mu m for the squared splinted group. With pouring using latex tubes, the mean gap values were 65.69 mu m for the tapered group, 38.03 mu m for the squared group, and 82.47 mu m for the squared splinted group. With pouring after joining the analogs with acrylic resin, the mean gap values were 141.12 jum for the tapered group, 74.19 mu m for the squared group, and 104.67 mu m for the squared splinted group. No significant difference was detected among Index, squarellatex techniques, and master cast (P > .05). Conclusions: The most accurate impression technique utilized squared copings. The most accurate pouring technique for making the impression with tapered or squared copings utilized latex tubes. The pouring did not influence the accuracy of the stone casts when using splinted squared impression copings. Either the index technique or the use of squared coping combined with the latex-tube pouring technique are preferred methods for making implant-supported fixed restorations with dimensional accuracy.