Síndrome de Apert: características clínicas e radiográficas e relato de caso

PURPOSE: Apert syndrome is a rare type I acrocephalosyndactyly syndrome characterized by craniosynostosis, severe syndactyly of the hands and feet, and dysmorphic facial features. Presents autosomal dominant inheritance assigned to mutations in the fibroblast growth factor receptors gene. The oral cavity of Apert patients includes a reduction in the size of the maxilla, tooth crowding, anterior open-bite of the maxilla, impacted teeth, delayed eruption, ectopic eruption, supernumerary teeth, and thick gingiva. The mandible usually is within normal size and shape, and simulates a pseudoprognathism. CASE DESCRIPTION: A female patient, 13 years old, with diagnosis of Apert syndrome, attended a dental radiology clinic. The clinical signs were occular anomalies, dysmorphic facial features, syndactyly and oral features observed clinically and radiographically. The patient was referred to a specialized center of clinical care for patients with special needs. CONCLUSION: Because of the multiple alterations in patients with Apert syndrome, a multidisciplinary approach, including dentists and neurosurgeons, plastic surgeons, ophthalmologists and geneticists, is essential for a successful planning and treatment.OBJETIVO: A síndrome de Apert é um tipo raro de acrocefalossindactilia do tipo I caracterizada por cranioestenose, sindactilia severa das mãos e dos pés, e características faciais dismórficas. Apresenta herança autossômica dominante atribuída a mutações no gene referente aos receptores do fator de crescimento de fibroblastos. A cavidade oral de pacientes de Apert apresenta uma redução no tamanho da maxila, apinhamento dentário, mordida aberta anterior da mandíbula superior, dentes retidos, erupção atrasada, erupção ectópica, dentes supranumerários, gengival e espessura. A mandíbula é no tamanho e forma normais, e simula um pseudoprognatismo. Um caso de síndrome de Apert é apresentado. DESCRIÇÃO DO CASO: Paciente do sexo feminino, 13 anos de idade, com diagnóstico de síndrome de Apert, foi atendida em um serviço de radiologia odontológica. A paciente apresentava anomalias oculares, características faciais dismórficas e sindactilia, aos exames clínico e radiográfico. A paciente foi encaminhada a um centro especializado para atenção a pessoas com necessidades especiais. CONCLUSÃO: Uma abordagem multidisciplinar, incluindo cirurgiões-dentistas e neurocirurgiões, cirurgiões plásticos, oftalmologistas e geneticistas, é essencial para um planejamento bem sucedido e tratamento de casos de síndrome de Apert devido às múltiplas alterações nesses pacientes

Thalassemia: essential radiographic and clinical features of interest to dentistry

Thalassemia is a type of hereditary anemia that predominantly affects individuals born in or descendents of countries bathed by the Mediterranean Sea, such as Italy and Greece. Also known as Cooley’s anemia and Mediterranean anemia, the disease causes alterations in hemoglobin formation and malformations of the cranium, long bones, maxilla and mandible. It presents two distinct clinical conditions: one severe, called “major” thalassemia, and the other mild, denominated “minor” thassalemia. Hematologic exam diagnoses the two forms of the disease. Its clinical and radiographic manifestations include hepatosplenomegalia, lymphadenopathy, augmented mandible, increase in medullary spaces, thick bone trabeculae and in lower quantity, resembling a “spider web”, displacement of the mandibular canal, with loss of detail of its superior and inferior corticals and a radiographic aspect of “hair standing on end” at the surface of the cranium. Some of these manifestations are so characteristic and capable of being observed in radiographs that they form part of the dentist’s routine. This case report discusses the alterations observed in the panoramic radiograph of a patient with thalassemia diagnosed by means of hematologic exam

Vertical and horizontal location of the mental foramen in relation to the mandibular second premolar by the radiograph method

Objective: Measure the distance in millimeters, between the apex and the long axis of the mandibular second premolar and the mental foramen. Methods: One hundred and four panoramic radiographs of adults with teeth were selected. Measurement was performed by digitizing the radiographs. The “Image Tool 1.28” program was used to identify the distances. The data of 67 radiographs out of the total, whose visualization of the foramen on the right and left sides was considered good, were submitted to the Student’s-t test and Wilcoxon Sign Test Sinais de Postos de Wilcoxon with a=5%. Results: Analyzing the distance from the long axis to the foramen in the 104 radiographs, it was found located at the medial, 73.34% on the right and 69.04% on the left, being the highest percentages. In the distance between the apex and the foramen, the two sides wererelated, t(t=1.07; gl=66; p=0.288), on the right being (median; mean±standard deviation: 4.73; 4.88±3.46) and on the left (5.45;5.23±3.68) and from the long axis to the foramen, relating the sides, parametric (t=1.98; gl=66; p=0.051) and non-parametric (p=0.081), indicating on the right (median; mean±standard deviation: 4.02; 3.81±4.03) and on the left (3.79; 2.78±4.15). The results indicated that the mental foramen was presented medially to the 2nd premolar, being correspondent to the sides, both to a mean of, right, 4.88mm from the apex and 3.81 mm in the mesial direction; and left, 5.23mm from the apex and 2.78mm in the mesial direction. Conclusion: It could be concluded that both the distance from the apex and from the long axis did not differ statistically toward the right and left

Comparison of radiographic densities from different dental intraoral x-ray films by computed analysis into aluminium-equivalent values

RESUMO O objetivo deste estudo foi obter as densidades radiográficas de diferentes filmes periapicais por meio de um programa computadorizado que utiliza a imagem equivalente em alumínio (alumínio-equivalente). Avaliaram-se os filmes Agfa Dentus M2 Comfort", Kodak InSight, Kodak Ektaspeed Plus, Kodak Ultra-speed e Kodak D. Todos foram expostos aos raios X juntamente com um escalímetro de Alumínio, variando-se o tempo de exposição (0,1 a 1 segundo). Após a leitura das densidades radiográficas construiu-se um gráfico para compararmos as propriedades sensitométricas dos filmes. O filmes mais sensíveis foram o Agfa Dentus M2 Comfort" e o Kodak InSight, e os menos sensíveis o Kodak Ultra-speed e o Kodak D. Os filmes Agfa Dentus M2 Comfort" e Kodak InSight apresentaram os maiores contrastes. Os resultados obtidos por este método indicam que deve-se utilizar os filmes Agfa Dentus M2 Comfort" e Kodak InSight para reduzir a dose de radiação recebida pelo paciente.ABSTRACT The aim of this study was to obtain radiographic densities from different dental intraoral x-ray films through a software using aluminium-equivalent image. The densities had been measured in order to compare dental x-ray films in terms of speed, base plus fog, and contrast. Agfa Dentus M2 Comfort", Kodak InSight, Kodak Ektaspeed Plus, Kodak Ultra-speed and Kodak D-speed films were evaluated. All films were exposed together with aluminium wedge, at times ranging from 0,1-1 second. By plotting a graphic of density against exposure, sensitometric properties were compared. Agfa Dentus M2 Comfort" and Kodak InSight films obtained the highest film speed; Kodak Ultra-speed and Kodak D-speed films exhibited the lowest sensitivity. Agfa Dentus M2 Comfort" and Kodak InSight films had presented valuesm to contrast superior to other films. Therefore, Agfa Dentus M2 Comfort" and Kodak InSight films must be recommended to minimize the radiation dose to the patient