Placas estabilizadoras: avaliação de sua eficácia no tratamento das disfunções temporomandibulares

A placa estabilizadora é o mais difundido método de tratamento das disfunções têmporo-mandibulares. A Ressonância Magnética (RM) é o exame mais indicado para a visualização dos componentes da Articulação têmporo-mandibular (ATM). Quarenta pacientes com sinais e sintomas de disfunções têmporo-mandibulares foram tratados com as placas estabilizadoras por um período médio de 12 meses, com controles periódicos quinzenais. Após a estabilização do quadro clínico foram realizados ajustes oclusais e a avaliação por meio da RM. Concluímos que os melhores resultados dessa modalidade de tratamento são relacionados à melhora total (70%) ou parcial (22,5%) da sintomatologia dolorosa e ao restabelecimento da função do complexo crânio-mandibular. A RM permitiu avaliar e concluir que as placas possibilitam condições para que o organismo possa criar meios resistentes às disfunções da articulação têmporo-mandibular por meio da eliminação de vários fatores etiológicos. E que após o tratamento, os pacientes podem conviver com os deslocamentos do disco, alguns com maior, outros com menor tolerância.Occlusal stabilization appliances or splints are the most widely employed method for treatment of temporomandibular disorders (TMD). Magnetic Resonance Imaging (MRI) is the most indicated imaging modality to evaluate the components of the temporomandibular joint (TMJ). Forty patients with signs and symptoms of temporomandibular disorders were treated with splints for a mean period of 12 months, comprising regular semimonthly follow-ups. After stabilization of the clinical status, occlusal adjustments and MRI evaluation were performed. It was concluded that the success of this kind of treatment are related to the total (70%) or partial improvement (22.5%) of painful symptomatology and to the functional reestablishment of the craniomandibular complex. The MRI allowed evaluation and also the conclusion that the splints provide conditions for the organism to develop means to resist to the temporomandibular disorders by means of elimination of several etiologic factors. Moreover, after treatment the patients are able to cope with disc displacements with larger or smaller tolerance

Palatal bone defect mimicking a chronic periapical lesion: a case report emphasizing the importance of the use of a three-dimensional radiographic examination

Lesão periapical crônica é uma das patologias ósseas mais comuns em dentes humanos, e é detectada primariamente por radiografia simples, como a panorâmica ou periapical. Radiografias simples são amplamente utilizadas em odontologia; no entanto, elas são limitadas por questões inerentes à técnica em si, tais como a sobreposição de estruturas anatômicas e a falta de informação sobre a extensão da lesão. Portanto, métodos radiográficos tridimensionais, como a tomografia computadorizada de feixe cônico, são valiosos para avaliar com precisão as lesões periapicais. Dessa forma, este relato clínico descreve um caso em que as características radiográficas de osso levaram a um diagnóstico primário de lesão periapical crônica nos incisivos superiores, no entanto, era um defeito palatino. A radiolucência resultante foi causada pelo defeito palatino sobreposto ao osso maxilar, imitando, assim, uma lesão periapical. Além disso, no mesmo caso, demonstramos uma lesão periapical crônica verdadeira em outra área. Essa lesão apareceu como uma radiolucência sutil na radiografia periapical, mas foi maior que o esperado quando avaliada por tomografia computadorizada de feixe cônico.Chronic periapical lesion is among the most usual bone pathology observed in human teeth, and it is often first detected by plain radiographs, such as panoramic or periapical radiography. Plain radiographs are widely used in dentistry; however, they have limitations inherent to the technique itself, such as anatomic structures overlapping and lack of information on the extension of the lesion. Therefore, three-dimensional radiographic methods, such as cone beam computed tomography are valuable to accurately assess periapical lesions. Thus, this clinical report describes a case in which the bone radiographic features led to a primary diagnosis of chronic periapical lesion in superior incisors, however, it was a defect in the palatal bone. The resulting radiolucency created by the palatal bone defect overlapped the maxillary bone, mimicking a periapical lesion. Additionally, in the same case, we demonstrate a true chronic periapical lesion in another area that presented as a subtle radiolucency in periapical radiography, however, it was larger than expected when evaluated in Cone Beam Computed Tomography

Stafne bone defects radiographic features in panoramic radiographs : assessment of 91 cases

To evaluate 91 cases of Stafne bone defect (SBD) in panoramic radiographs (PR) to determine the prevalence of different SBD variants, considering age, gender, and side. Additionally, to assess the most frequent imaging features of SBD. Participant data were collected from 91 SBD cases with PR imaging. First, SBDs were classified according to their location, as anterior, posterior, or ramus variant. SBD imaging features were classified according to radiographic imaging findings, assessing margins, degree of internal radiolucency, shape, topographic relationship between the defect and mandibular border, location of the defect according to mandibular teeth, and locularity. The topographic relationship between the SBD and the mandibular canal was described for the inferior variant only. Mean sizes were also described. A total of 92 SBD cases were evaluated from 91 radiographs. One case presented multiple defects. Mean patient age was 60.80 years. Men were more affected than women. The most frequent SBD variant was the posterior variant, and the least frequent was the ramus variant. The most observed radiographic features were thick sclerotic bone margin in the entire contour of the defect, partially radiolucent internal content, oval shape, continuity with mandible base without discontinuity of mandible border, third molar region location, and unilocular shape. With the posterior variant only, the most common topographic relationship between the defect and the upper wall of the mandibular canal was the defect located below the upper wall and continuous with the inferior wall of the mandibular canal. The knowledge of common SBD radiographic imaging features in PR can help dental practitioners with the differential diagnosis of SBD

Comparative spectrophotometric study of the color stability of three dental porcelains after repeated fi rings

O objetivo deste estudo foi avaliar a estabilidade de cor de três marcas comerciais de porcelanas dentais aluminizadas durante seu processo de queima. Essas porcelanas são utilizadas para a conconfecção de dentes de prótese fixa. Para o experimento foram confeccionados 30 corpos-de-prova em forma de disco com 2 mm de espessura e 10 mm de circunferência, sendo 10 da marca AllCeram, 10 da marca Noritake Cerabien CZR e 10 da marca Vita VM7. As amostras foram queimadas 10 vezes. As leituras de cor foram feitas em espectrofotômetro de reflexão nos seguintes intervalos: após a 1a queima, após a 3a queima, após a 5a queima e após a 10a queima. As curvas de reflexão foram convertidas em valores LAB e a diferença de cor foi medida por meio do método CIELAB (ΔE). Os resultados obtidos demonstraram que existe variação de cor e que essa variação depende do número de queimas realizadas e da marca comercial utilizada.The purpose of this investigation was to quantify the color differences in CIE ΔE units produced by multiple fi rings of three all-ceramic systems used in the fabrication of prosthodontic teeth. Thirty samples of the following brands were fabricated: AllCeram, Noritake Cerabien CZR and Vita VM7. A spectrophotometer was used for refl ectance measurement of color after 1 fi ring, 3 fi rings, 5 fi rings and 10 fi rings. The results were converted into CIELAB units. Color differences (ΔE) were calculated in the CIE color space. The color differences resulting from multiple fi rings proved to be dependent on the number of fi rings and on the porcelain brand tested

Relationship between stylohyoid ligament calcification and systemic osteoporosis by CBCT and panoramic radiography

The purpose of this study was to use panoramic radiography and cone beam computed tomography images to investigate (1) the accuracy of these methods concerning osteopenia and osteoporosis diagnosis, and (2) the correlation between presence of stylohyoid ligament calcification and osteopenia and osteoporosis. A hundred seventy-one images from digital archive were enrolled in this study. All panoramic radiography and cone beam computed tomography images were obtained using the Veraviewepocs 3D system and observed at i-VIEW-3DX software. For osteopenia and osteoporosis diagnosis, the mandibular cortex was assessed.  Presence of stylohyoid ligament calcification was also assessed and mineralization in all parts of the stylohyoid complex was considered. All recorded data were referred to statistical analysis and the significance level was set at 5%. There is an agreement between the imaging modalities for osteopenia and osteoporosis diagnosis, since the rate of disagreement is 21.6%. The results confirmed the osteoporosis diagnosis in elderly women and the correlation between osteopenia and osteoporosis diagnosis and the presence of stylohyoid ligament calcification (p 0.06). The present study suggests that (1) panoramic radiography and computed tomography images are accurate enough for osteopenia and osteoporosis diagnosis with low disagreement rate between methods and (2) there is a significant correlation between presence of stylohyoid ligament calcification and osteopenia and osteoporosis diagnosis in elderly women

Mucocele com reabsorção da parede do seio maxilar: relato de caso

Mucoceles are locally-expansive, slow-growing benign lesions that are generated from obstructed seromucous glands in the sinonasal mucosa. It has a cystic aspect and leads to sinus opacification. Patients usually present non-specific opacification and, in rare cases, enlarged mucoceles can lead to bone destruction through the compression of sinus surrounding bone walls. This report shows the case of a female patient without any clinical complaints who presented an evident opacification in her left maxillary sinus eroding the sinus wall, which was noticeable by means of panoramic radiograph, aside from maxillary sinus wall thinning and destruction, demonstrated through cone beam computed tomography examinations. The main diagnosis hypothesis was mucocele, as confirmed by the patient’s otolaryngologist. As the presence of any inflammatory disease in the maxillary sinus contraindicates sinus augmentation, the patient was referred to otorhinolaryngy treatment before implant rehabilitation.As mucoceles são lesões benignas localmente expansivas, de crescimento lento, que se desenvolvem a partir de glândulas seromucosas obstruídas na mucosa nasossinusal. Os pacientes geralmente apresentam radiograficamente opacificação inespecífica de aspecto cístico e, em casos raros, mucoceles de grandes proporções podem levar à destruição óssea, por meio da compressão do seio ao redor das paredes ósseas. Neste relato, é demonstrado um caso de uma paciente do gênero feminino, sem queixas clínicas, que apresentava evidente opacificação em seu seio maxilar esquerdo, erodindo a parede sinusal, observada inicialmente em radiografia panorâmica. Por meio da tomografia computadorizada de feixe cônico, notou-se afinamento e erosão da parede do seio maxilar. A principal hipótese diagnóstica foi mucocele, confirmada posteriormente pelo otorrinolaringologista da paciente. Como a presença de qualquer doença inflamatória no seio maxilar é uma contraindicação a cirurgias em soalho de seio maxilar, a paciente foi encaminhada para tratamento otorrinolaringológico antes da reabilitação com implantes

Thermography in dentistry: a bibliometric review / Termografia em odontologia: uma revisão bibliométrica

Infrared thermography is an imaging exam present in the scope of diagnosis, evolutionary monitoring, and prognosis in the health area. Over the years, thermography has been studied in medicine, and it is a technique recently used in Dentistry. In this sense, the objective of this work was to carry out a literature review with a bibliometric approach to the use of thermal images for the diagnosis/monitoring of dental treatments. Studies that relate thermography to dental specialties were analyzed, considering the use of thermography as a diagnostic aid and monitoring of dental treatments in its wide range of activities. Searches were performed in the following databases: PubMed, Web of Science, Embase, Scopus, Scielo, from 1985 to 2020, with a search phrase including thermography and Dentistry specialties. The results show the trends in publications relating thermographic images to dental specialties by year of publication, journals, country, type of study, manufacturer of cameras used, resolution, and ambient temperature, totaling 119 publications in 83 journals. Temporomandibular Dysfunction and Orofacial Pain was the specialty with the highest concentration of publications relating thermography to Dentistry (27 articles). Endodontics was the second specialty (23 articles), Restorative Dentistry was the third specialty (18 articles) followed by Surgery (17 articles). It can be concluded that thermography is indicated as an auxiliary diagnostic method in Dentistry specialties. The main indications for thermography in Dentistry are in the context of diagnosis of Orofacial Pain (dysfunctions temporomandibular disorders of the muscular and articular types, noninflammatory odontalgias and neuropathies), Endodontics (inflammatory odontalgias), Implantology (osseointegration), and follow-up evolution of the postoperative surgeries

Fragile X syndrome: panoramic radiographic evaluation of dental anomalies, dental mineralization stage, and mandibular angle

Fragile X syndrome (FXS) is a disorder linked to the chromosome X long arm (Xq27.3), which is identified by a constriction named fragile site. It determines various changes, such as behavioral or emotional problems, learning difficulties, and intellectual disabilities. Craniofacial abnormalities such as elongated and narrow face, prominent forehead, broad nose, large and prominent ear pavilions, strabismus, and myopia are frequent characteristics. Regarding the oral aspects, deep and high-arched palate, mandibular prognathism, and malocclusion are also observed. Objective: The purpose of this study was to evaluate the dental radiographic characteristics as described in 40 records of patients with panoramic radiography. Material and Methods: The patients were in the range of 6–17 years old, and were divided into two groups (20 subjects who were compatible with the normality standard and 20 individuals diagnosed with the FXS), which were matched for gender and age. Analysis of the panoramic radiographic examination involved the evaluation of dental mineralization stage, mandibular angle size, and presence of dental anomalies in both deciduous and permanent dentitions. Results: The results of radiographic evaluation demonstrated that the chronology of tooth eruption of all third and second lower molars is anticipated in individuals with FXS (

Utilização exames de tomografia computadorizada da maxila e mandíbula e sua correlação com as vértebras cervicais objetivando o rastreamento de pacientes com risco de osteoporose

Objetivos: avaliar a correlação da densidade mineral óssea (DMO) da maxila e mandíbula com as vértebras cervicais, utilizando unidades de Hounsfield (HU), utilizando tomografia computadorizada (TC) multislice, para verificar se a TC pode ser útil como ferramenta de rastreamento da osteoporose. Métodos: 79 exames de tomografia computadorizada multislice de pacientes que foram submetidos a CTs de maxila, mandíbula e vértebras cervicais simultaneamente foram incluídos. As seguintes regiões anatômicas esquerda e direita foram avaliadas: ramo da mandíbula; cabeça mandibular; a área abaixo do primeiro molar inferior e a área abaixo das cúspides superiores. HU foram medidos em cada área usando uma região de interesse (ROI) de 0.1cm posicionada no centro do corte tomográfico. Resultados: Foi encontrada uma correlação significativa entre a coluna cervical e a região posterior da mandíbula, bem como uma correlação significativa entre a região anterior da maxila e a coluna cervical. No entanto, nenhuma correlação foi encontrada entre a coluna cervical e outros locais da mandíbula, como o ramo mandibular e a cabeça. Conclusões: Como os valores de HU do osso anterior e posterior da mandíbula se correlacionam com os valores de HU do osso cervical, este exame pode ser aplicado a ferramentas de rastreio da osteoporose.Objectives: to evaluate the correlation of the bone mineral density (BMD) from maxilla and mandible with that of the cervical vertebrae, using Hounsfield units (HU) and multislice computed tomography (CT) to verify whether CT could be a useful osteoporosis screening tool. Methods: 79 multislice CT examinations from patients who underwent CT examinations of maxilla, mandible and cervical vertebrae simultaneously were included. The following left and right anatomical regions were assessed: mandible ramus; mandible head; the area below the inferior first molar and the area below the upper cuspids. HU were measured in each area using a 0.1 cm region of interest (ROI) positioned in the center of the slice. Results: a significant correlation between the cervical spine and the posterior region of the mandible was found, as well as a significant correlation between the anterior maxilla and the cervical spine. However, no correlation was found between the cervical spine and other parts of the mandible, such as ramus and head of mandible. Conclusions: As anterior maxillary bone and posterior mandible bone HU values correlate with cervical bone HU values, this examination may be applied as osteoporosis screening tool

Relação entre alterações ósseas detectadas na panorâmica e osteoporose

Objectives: Since the screening for low systemic bone mineral density (BMD) can be performed using panoramic radiography (PR), the use of other detectable signs in PR that could increase the rate of patients correctly indicated for dual bone densitometry (DXA) is still needed. Hence, this study aims to correlate low BMD with Body Mass Index (BMI) and visible changes on PR: elongated styloid process, mandibular cortical index (MCI), and number of teeth. Material and methods: PRs of 23 patients who had a DXA exam were used. Each patient was classified by three examiners with different levels of expertise (beginner, experienced, and expert) according to the MCI; the styloid process, as normal or elongated; the number of teeth; and the BMI. Results: A significant correlation was observed between the MCI and the DXA only for the expert observer (r=−0.47). For the other variables (elongated styloid process, number of teeth, and BMI) no significant correlations were observed. The inter-examiner agreement was 0.50 for the expert observer and the beginner, 0.27 for the experienced and the expert, and 0.58 for the experienced and beginner. The intra-examiner correlation was 0.77 for the expert, 0.48 for the beginner, and 0.28 for the experienced observer. Conclusion: The MCI showed a significant correlation with low bone mineral density; however, no evidence was found of a relationship between low bone mineral density and other detectable signs in RP.Objetivos: Como o rastreio da baixa densidade mineral óssea (DMO) sistêmica pode ser realizado por meio da radiografia panorâmica (RP), a procura por outros sinais detectáveis na RP que possam aumentar a taxa de pacientes indicados corretamente para o exame de densitometria óssea (DXA) ainda é necessária. Este estudo tem como objetivo correlacionar a baixa densidade DMO com o Índice de Massa Corpórea (IMC) e as alterações visíveis na RP: processo estiloide alongado, índice cortical mandibular (ICM) e número de dentes. Material e métodos:    Foram utilizadas RPs de 23 pacientes que possuíam exame de DXA, para cada um, três examinadores com níveis diferentes de expertise (iniciante, experiente e expert) os classificaram de acordo com o ICM; o processo estiloide, como normal ou alongado; o número de dentes; e o IMC.Resultados: Foi observada correlação significante entre o ICM e o DXA apenas para o observador expert (r=-0,47). Para as outras variáveis (processo estiloide alongado, número de dentes e IMC) não houve correlações significantes. A concordância inter examinador foi de 0,50 para o observador expert e iniciante, 0,27 para experiente e expert e de 0,58 entre experiente e iniciante. A correlação intraexaminador foi de 0,77 para o expert, 0,48 para o iniciante e de 0,28 para o observador experiente. Conclusão: O ICM apresentou correlação significante com a baixa densidade mineral óssea, porém não foram encontradas evidências da relação de baixa densidade óssea com outros sinais detectáveis na RP