Does a final rinse to remove smear layer interfere on dentin permeability of root canals?

Objective. The objective of this study was to assess the influence of different final irrigating solutions on dentin permeability and smear layer removal using the same specimens and relate the results obtained. Study design. Forty anterior human teeth were instrumented and divided into 4 groups (n = 10) at the final rinse step, according to the irrigant used: G I (control) - 1% NaOCl; G II - 17% EDTA; G III - 17% EDTAT; and G IV - Biopure MTAD. The canals were filled with 0.5% methylene blue and maintained in bottles for 48 hours. The roots were transversally split in coronal, middle, and apical fragments. The specimens were photographed and analyzed regarding dye penetration. The fragments were then axially split and prepared for SEM. The photomicrographs were analyzed and qualified by scores. Results. Only the EDTA-T group exhibited statistical difference in which the apical third had less dentin permeability (P < .05). When a decalcifying agent was used, smear layer was removed, which did not happen in the NaOCl group. Regarding smear layer removal, differences were found only in the EDTA group in which the apical third presented more smear layer (P < .05). No correlation was found for both studies (r = 0.4207). Conclusions. There was not an even relationship between the results from both studies, which inferes that higher or lower dentinal permeability does not necessarily correspond to a higher or lower amount of smear layer. The analysis of dentin permeability and smear layer removal was shown to be a feasible procedure using the same specimens. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: e47-e51)

Influence of different volumes of EDTA for final rinse on smear layer removal

Objective. The aim of this study was to analyze the influence of different volumes of 17% EDTA for final rinse on smear layer removal on the different areas of the root canal. Study design. Forty single-rooted teeth were instrumented using rotary instruments. The teeth were divided into 3 test groups according to the EDTA volume for final rinse (5 mL, 10 mL, 15 mL) and 1 control group (10 mL of 1% sodium hypochlorite). The roots were axially split into halves, and the smear layer removal from the canals was determined under scanning electron microscope. The data were analyzed using Kruskal Wallis and Dunn tests. Results. The 3 experimental groups showed no statistical difference (P > .05); however, when the test groups were compared to the control group statistically significant differences were found (P < .01). The root canal wall surfaces of teeth in the control group showed the presence of heavy smear layer through the entire length of the root canals. The other groups showed mainly smear layer-free surfaces or a small amount of debris. When coronal, middle and apical thirds were compared, there was no statistically significant difference (P > .05). Conclusions. Based on the results, it appears that a final rinse with 5 mL of EDTA per canal provides good smear layer removal, with root canal walls free of debris and mostly open dentinal tubules in all areas. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:e40-e43)

Cystic hygroma: characterization by computerized tomography

Lymphangiomas are benign nonencapsulated lesions composed of sequestered noncommunicating lymphoid tissue lined by lymphatic endothelium and are thought to be caused by congenital obstruction of lymphatic drainage. They are subclassified by vessel size, such as the capillary, which is rare and located in subcutaneous tissue, cavernous (located about the mouth and tongue), and cystic (cystic hygromas). The cystic hygromas show a predilection for the neck (75%) and maxilla (20%), and the remaining 5% arise in rare locations such as the mediastinum, retroperitoneum, bone, kidney, colon, liver, spleen and scrotum. Only 3%-10% of neck lesions extend into the mediastinum. In this paper, we report a rare case of cystic hygroma with a huge dimension discussing the use of computed tomography scanning for diagnosis.

SAPHO syndrome with temporomandibular joint ankylosis: clinical, radiological, histopathological, and therapeutical correlations

The SAPHO syndrome is characterized by specific clinical manifestations of synovitis, acne pustulosis, hyperostosis, and osteitis. It is a rare disease with a combination of osseous and articular manifestations associated with skin lesions. We describe a patient with SAPHO syndrome of the mandible and involvement of the temporomandibular joint (TMJ ankylosis). The findings from orthopantomography, computed tomography (CT), and clinical and histopathological examinations are compared and analyzed to improve the final diagnosis. Our patient was submitted to a bilateral high condylectomy and coronoidectomy to correct the open mouth limitation. No previous report of SAPHO syndrome associated with secondary TMJ ankylosis was found in the literature.

The immunohistochemical profile of oral inflammatory myofibroblastic tumors

Objective. The aim of this study was to demonstrate the immunohistochemical profile of oral inflammatory myofibroblastic tumors (IMTs) along with morphologic analysis. Study design. Three cases diagnosed as oral IMTs were selected to compile an immunohistochemical panel constituted by calponin, caldesmon, Bcl-2, desmin, fibronectin, CD68, Ki-67, S100, anaplastic lymphoma kinase (ALK), alpha-smooth muscle actin, cytokeratins AE1/AE3, muscle-specific actin, CD34, and vimentin. An oral squamous cell carcinoma with a focal area of desmoplastic stroma was used as control for the stained myofibroblastic cells. Results. All oral IMTs were positive for calponin, revealing a strong and diffuse expression in the spindle-shaped cells. The lesions were also positive for vimentin (3/3), fibronectin (3/3), alpha-smooth muscle actin (3/3), and muscle-specific actin (1/3) and negative for h-caldesmon, Bcl-2, desmin, CD68, Ki-67, S100, ALK, cytokeratins AE1/AE3, and CD34. Conclusions. Within the results encountered, the present panel should be of great assistance in the diagnosis of oral IMTs. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 111: 749-756)

Detection of TGIF1 homeobox gene in oral squamous cell carcinoma according to histologic grading

Objective. TGIF1 homeobox gene involvement in oral cancer has not yet been investigated. This study analyzed the expression of TGIF1 transcripts and protein in oral squamous cell carcinoma (OSCC). Study design. Snap-frozen samples from 16 patients were taken from both OSCC and nontumoral adjacent epithelium (NT) for in situ hybridization (ISH). Forty-six paraffin-embedded samples of OSCC were submitted to immunohistochemistry (IHC). A descriptive analysis of the transcript signal detection was accomplished, and TGIF1 immunoexpression was carried out considering protein levels, localization, and cellular differentiation. Results. ISH reactions showed TGIF1 transcripts with a signal that was frequently intense in NT, and generally weak in OSCC, and that had stronger transcript signal in well-differentiated areas of OSCC when compared with poorly differentiated ones. IHC reactions had poorly differentiated cases associated with TGIF1 protein expression in both the nucleus and cytoplasm (P = .05, Fisher test). Conclusions. TGIF1 gain or loss of function might possibly play a role in oral cancer cell differentiation. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 111: 218-224)

Evaluation of the lateral pterygoid muscle using magnetic resonance imaging

Objectives: The aims of this study were to evaluate the visibility of the lateral pterygoid muscle (LPM) in temporomandibular joint (TMJ) images obtained by MRI, using different projections and to compare image findings with clinical symptoms of patients with and without temporomandibular disorders (TMD). Methods: In this study, LPM images of 50 participants with and without TMDs were investigated by MRI. The images of the LPM in different projections of 100 TMJs from 35 participants (70 TMJs) with and 15 participants (30 TMJs) without clinical signs and symptoms of TMD were visible and analysed. Results: The oblique sagittal and axial images of the TMJ clearly showed the LPM. Hypertrophy (1.45%), atrophy (2.85%) and contracture (2.85%) were the abnormalities found in the LPM. TMD signs, such as hypermobility (11.4%), hypomobility (12.9%) and disc displacement (20.0%), could be seen in TMJ images. Related clinical symptoms, such as pain (71.4%), articular sounds (30.4%), bruxism (25.7%) and headache (22.9%), were observed. Conclusions: Patients with TMD can present with alterations in the LPM thickness. Patients without TMD also showed alterations, such as atrophy and contracture, in TMJ images. Recognition of alterations in the LPM will improve our understanding of clinical symptoms and pathophysiology of TMD, and may lead to a more specific diagnosis of these disorders. Dentomaxillofacial Radiology (2010) 39, 494-500. doi: 10.1259/dmfr/80928433

Cigarette smoke inhalation modulates gene expression in sites of bone healing: a study in rats

Objective. The aim of this study was to assess the effect of cigarette smoke inhalation (CSI) on gene expression in alveolar bone healing sites. Study design. Wistar rats were randomly assigned to the groups: control [animals not exposed to CSI (n = 20)] and test [animals exposed to CSI, starting 3 days before teeth extraction and maintained until killing them (n = 20)]. First mandibular molars were bilaterally extracted, and the expression of alkaline phosphatase, bone morphogenetic protein (BMP) 2 and 7, receptor activator of nuclear factor kappa B ligand, osteoprotegerin, and d2 isoform of vacuolar adenosine triphosphatase V(o) domain were assessed by quantitative polymerase chain reaction in the newly formed tissue in the sockets. Results. Overall, data analysis demonstrated that CSI significantly affected the expression pattern of all of the studied genes except BMP-7. Conclusion. The expression of key genes for bone healing may be affected by CSI in tooth extraction sites. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:447-452)

Accuracy of direct digital radiography for detecting occlusal caries in primary teeth compared with conventional radiography and visual inspection: an in vitro study

Objectives: The diagnosis of caries lesions is still a matter of concern in dentistry. The diagnosis of dental caries by digital radiography has a number of advantages over conventional radiography; however, this method has not been explored fully in the field of paediatric dentistry. This in vitro research evaluated the accuracy of direct digital radiography compared with visual inspection and conventional radiography in the diagnosis of occlusal caries lesions in primary molars. Methods: 50 molars were selected and evaluated under standardized conditions by 2 previously calibrated examiners according to 3 diagnostic methods (visual inspection, conventional radiography and direct digital radiography). Direct digital radiographs were obtained with the Dixi3 system (Planmeca, Helsinki, Finland) and the conventional radiographs with InSight film (Kodak Eastman Co., Rochester, NY). The images were scored and a reference standard was obtained histologically. The interexaminer reliability was calculated using Cohen`s kappa test and the specificity, sensitivity and accuracy of the methods were calculated. Results: Examiner reliability was good. For lesions limited to the enamel, visual inspection showed significantly higher sensitivity and accuracy than both radiographic methods, but no significant difference was found in specificity. For teeth with dentinal caries, no significant differences were found for any parameter when comparing visual and radiographic evaluation. Conclusions: Although less accurate than the visual method for detecting caries lesions confined to the enamel, the direct digital radiographic method is as effective as conventional radiographic examination and visual inspection of primary teeth with occlusal caries when the dentine is involved. Dentomaxillofacial Radiology (2010) 39, 362-367. doi: 10.1259/dmfr/22865872

Comparison between computed tomography and clinical evaluation in tumour/node stage and follow-up of oral cavity and oropharyngeal cancer

Objectives: The aim was to verify the concordance of CT evaluation among four radiologists (two oral and maxillofacial and two medical radiologists) at the TN (tumour/node) stage and in the follow-up of oral cavity and oropharyngeal cancer patients. The study also compared differences between clinical and CT examinations in determining the TN stage. Methods: The following clinical and tomographic findings of 15 non-treated oral cavity and oropharyngeal cancer patients were compared: tumour size, bone invasion and lymph node metastases. In another 15 patients, who had previously been treated, a clinical and tomographic analysis comparison for the presence of tumoural recurrence, post-therapeutic changes in muscles and lymph node metastases was performed. The concordances of tomographic evaluation between the radiologists were analysed using the kappa index. Results: Significant agreement was verified between all radiologists for the T stage, but not for the N stage. In the group of treated patients, CT disclosed post-therapeutic changes in muscles, tumour recurrence and lymph node metastases, but no concordance for the detection of lymph node metastases was found between radiologists. In the first group, for all radiologists, no concordance was demonstrated between clinical and tomographic staging. CT was effective for delimitating advanced lesions and for detecting lymph node involvement in N0 stage patients. CT revealed two cases of bone invasion not clinically detected. Conclusions: Interprofessional relationships must be stimulated to improve diagnoses, and to promote a multidisciplinary approach to oral cavity and oropharyngeal cancer. Although CT was important in the diagnosis and follow-up of cancer patients, differences between medical and dental analyses should be acknowledged. Dentomaxillofacial Radiology (2010) 39, 140-148. doi: 10.1259/dmfr/69910245

Assessment of linear and angular measurements on three-dimensional cone-beam computed tomographic images

Objective. The purpose of this research was to provide further evidence to demonstrate the precision and accuracy of maxillofacial linear and angular measurements obtained by cone-beam computed tomography (CBCT) images. Study design. The study population consisted of 15 dry human skulls that were submitted to CBCT, and 3-dimensional (3D) images were generated. Linear and angular measurements based on conventional craniometric anatomical landmarks, and were identified in 3D-CBCT images by 2 radiologists twice each independently. Subsequently, physical measurements were made by a third examiner using a digital caliper and a digital goniometer. Results. The results demonstrated no statistically significant difference between inter-and intra-examiner analysis. Regarding accuracy test, no statistically significant differences were found of the comparison between the physical and CBCT-based linear and angular measurements for both examiners (P = .968 and .915, P = .844 and .700, respectively). Conclusions. 3D-CBCT images can be used to obtain dimensionally accurate linear and angular measurements from bony maxillofacial structures and landmarks. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 430-436)

Recurrent bilateral gingival peripheral calcifying epithelial odontogenic tumor (Pindborg tumor): A case report

Calcifying epithelial odontogenic tumor (CEOT) is an extremely rare, benign neoplasm, accounting for approximately 1% of all odontogenic tumors. Peripheral CEOTs commonly resemble oral hyperplastic or reactive lesions and are histologically similar to their intraosseous counterparts. We report an unusual case of multifocal peripheral CEOT. A 40-year-old female presented with bilateral soft, painful, erythematous, gingival swellings localized in premolar areas of the mandibular gingiva. The presumptive diagnosis was bilateral pyogenic granuloma. The masses were surgically excised under local anesthesia without bone curettage and both recurred 12 months later. Morphologic features, and histochemical and immunohistochemical tests revealed bilateral peripheral calcifying odontogenic epithelial tumor. There is no clinical or radiographic evidence of recurrence 3.5 years after excision. This multifocal phenomenon has been reported previously only for intraosseous CEOT. Gingival masses must be carefully evaluated for clinical and histologic evidence of neoplasia. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: e66-e71)

Nasopharyngeal angiofibroma. surgical approach using a transoral Le Fort I osteotomy following embolization: a case report

Nasopharyngeal angiofibroma (NA) is a rare vascular benign nonencapsulated neoplasm, characterized by local aggressiveness and destructive potential, typically diagnosed in adolescent males. We report a case of NA affecting a 15-year-old male that presented with a persistent nasal obstruction and epistaxis with 1 year of evolution. Clinical and radiological patterns pointed out a differential diagnosis of NA. Arteriography demonstrates the vascular support of the tumor and evinces the embolization of the internal maxillary artery. The surgical approach was procedure by Le Fort I osteotomy exposing the tumor and promoting easy access for posterior removal. The surgery was carried out without hemorrhagic problems. The maxilla was fixed in the original position with 4 L-shape plaques. Histopathological findings supported the diagnosis of NA. The patient presented after 8 months of postoperative follow-up, without clinical signs of recurrence or residual tumor and without palatal or maxillary teeth paresthesia.

Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate

The aim of this study was to determine the applicability of multislice and cone-beam computerized tomography (CT) in the assessment of bone defects in patients with oral clefts. Bone defects were produced in 9 dry skulls to mimic oral clefts. All defects were modeled with wax. The skulls were submitted to multislice and cone-beam CT. Subsequently, physical measurements were obtained by the Archimedes principle of water displacement of wax models. The results demonstrated that multislice and cone-beam CT showed a high efficiency rate and were considered to be effective for volumetric assessment of bone defects. It was also observed that both CT modalities showed excellent results with high reliability in the study of the volume of bone defects, with no difference in performance between them. The clinical applicability of our research has shown these CT modalities to be immediate and direct, and they is important for the diagnosis and therapeutic process of patients with oral cleft. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112: 249-257)

Complex odontoma associated with dentigerous cyst in maxillary sinus: case report and computed tomography features

Tumoural and cystic lesions are common findings in the daily practice of dental professionals and maxillofacial radiologists. However, simultaneous lesions are rare and represent a diagnostic challenge to overcome. Among tumoural pathologies, odontomas are the most common odontogenic tumour of the jaws. Cystic transformation or development from the tumoural capsule are well recognized in situations such as ameloblastomas originated from a dentigerous cyst. Otherwise, despite literature reports, dentigerous cysts arising from odontomas are very rare and could lead to misdiagnosis. Here, we report a case of a complex odontoma associated with a dentigerous cyst in the maxillary sinus, focussing on the tomographic features and a differential imaging approach to the diagnosis of these lesions.