Avaliação de medidas lineares por meio de radiografia convencional e digitalizada no tratamento endodôntico

A radiologia digital tem sido amplamente difundida na odontologia, especialmente na endodontia. O sucesso do tratamento endodôntico depende das medidas lineares obtidas a partir de radiografias tomadas durante a odontometria, e do seguimento do comprimento de trabalho determinado até a obturação final. Este trabalho objetivou comparar a precisão das medidas lineares obtidas em radiografias convencionais com as imagens digitais indiretas avaliadas pelo programa Digora 1.5, durante as diferentes fases do tratamento endodôntico, bem como avaliar as ferramentas disponíveis neste programa. Foram analisadas 160 radiografias de dentes unirradiculares, dos arquivos da disciplina de Radiologia do departamento de estomatologia, da Faculdade de Odontologia de Bauru - USP, divididos em 4 grupos referentes a odontometria, prova do cone, comprobatória e obturação final. As análises das radiografias convencionais e das imagens digitalizadas foram realizadas por cinco examinadores previamente calibrados. Constatou-se um alto índice de concordância inter e intra-examinadores, respectivamente, por meio do coeficiente de concordância geral de Kendall e pelo índice de correlação. Os resultados relacionados às medidas lineares, submetidos à Análise de Variância a dois critérios e ao teste de Tukey, revelaram: quanto ao método, uma diminuição estatisticamente significante das medidas obtidas pelo método digital em relação à convencional (p < 0,05); e houve diferença estatisticamente significante entre a Fase 1 (odontometria) e a Fase 4 (obturação final) do tratamento endodôntico. Para a interpretação da imagem digitalizada, houve uma preferência estatísticamente significativa pela ferramenta de ajuste de Brilho e Contraste do programa Digora 1.5, analisado pelo teste de Friedman. Os resultados obtidos nesse estudo demonstraram que a imagem digitalizada proporcionou medidas lineares menores do que as realizados pelo método convencional, contudo não está ainda determinado se essa diminuição, corresponderia a uma maior acurácia do sistema, e, portanto, se traria maiores benefícios clínicos.INTRODUCTION: A successful endodontic therapy depends on the linear measurements obtained by means of radiographs taken during odontometry and also on the application of the established working length up to the final obturation. OBJECTIVE: The aim of this study was to compare the precision of the linear measurement obtained by means of conventional radiographs and indirect digital images evaluated by the Digora 1.5 software during the different stages of endodontic treatment, as well as to evaluate the tools available on this software. METHODS: A total of 160 radiographs of single-rooted teeth were obtained from files, which were analysed and divided in 4 groups comprising odontometry, cone fit, condensation and the final obturation. Analyses of the conventional radiographs and digitized images were performed by five previuosly calibrated examiners. RESULTS: A high level of inter and intra-examiner agreement was observed through application of the Kendall coefficient and the correlation index, respectively. In relation to the results of linear measurement, the two-way variance analyses and the Tukey test revealed that, concerning the method, a statistically significant decrease was observed on the measurement obtained through the digital method when compared to the conventional radiograph (

Avaliação de ruído em imagens radiográficas digitalizadas por meio do histograma

OBJETIVOS: Avaliar três equipamentos digitais em relação ao ruído agregado as imagens radiográficas digitalizadas contendo diferentes densidades ópticas. MATERIAL AND MÉTODO: Uma imagem radiográfica foi digitalizada seqüencialmente dez vezes usando dois escaneres (HP 4c/T and HP 5370C) e uma câmera digital (Nikon 990). Por meio do histograma foram medidos os valores de pixels e os desvios-padrões da região de interesse de cada imagem. Ambos valores foram utilizados para o cálculo do ruído nas diferentes densidades ópticas. RESULTADOS: Os valores encontrados para o ruído foram diferentes para cada equipamento e para cada densidade óptica. Houve uma diferença estatística significante entre os valores de ruído encontrados para o escaner HP 4c/T e a câmera digital (pTo evaluate the performance of three digital devices regarding the noise added to digital radiographic images containing different optical densities. METHODS: A radiographic image was digitized repeatedly ten times using two scanners (HP 4c/T and HP 5370C) and a digital camera (Nikon 990). A histogram tool measured a mean pixel value and the standard deviation of the region of interest in each image. Both values were used to calculate the image noise at the different optical densities. RESULTS: The noise values found were different for all devices and optical densities. There was a statistically significant difference (

Segmental resection vs. partial resection on treating solid multicystic ameloblastomas of the jaws – recurrence rates: a systematic review and meta-analysis

The aim of the present study was to compare the recurrence rates of solid multicystic ameloblastomas after segmental resection or marginal resection.PubMed, ScienceDirect, Web of Science, Scopus, Embase were searched for studies published up to July 2022. The gray literature was also searched. Meta-analysis was performed using OpenMeta Software, p< 0.05 considered significant.Among the search, 8 studies met all eligibility criteria. The group that underwent marginal resection was 1.1 times more likely to present recurrence of the lesion compared to the group that underwent segmental resection. There was no statistically significant difference between the two groups (segmental resection and marginal resection) in all eight studies regarding reducing ND (95% Confidence interval, 0.339 – 3.705; heterogeneity: Q value= 3.105; I2= 0%).The results showed that there was no statistically significant difference between segmental and marginal resection for the treatment of solid multicystic ameloblastomas; however, prospective studies with more rigorous methodological procedures are needed to better compare the surgical techniques

Assessment of spontaneous resolution of idiopathic bone cavity

Idiopathic Bone Cavity (IBC) or Simple Bone Cyst (SBC) is a non- epithelialized bone cavity with serosanguinous fluid content or empty. There is a literature debate regarding its pathogenesis that remains unclear. The main treatment option is the surgical exploration, although there are successful cases described in the literature in which just a follow-up with clinical and radiographic evaluation was performed. Objective: This study aimed to assess the spontaneous resolution of idiopathic bone cavity untreated by surgery. Material and Methods: Twenty-one patients diagnosed with surgically untreated IBC were submitted to a follow-up protocol modified from Damante, Guerra, and Ferreira5 (2002). A clinical and radiographic evaluation was performed in 13 patients (13/21), while eight patients (8/21) were only radiographically evaluated. Three observers evaluated the panoramic radiographs of 21 patients and the Kappa test was performed by intra and inter-examiners. Inductive and descriptive statistics were applied to the results. Results: Only one patient had a positive response to palpation and percussion of the teeth in the cyst area. Most of the cysts evaluated were rated as 3 (lesion “in involution”), 4 (lesion “almost completely resolved”), or 5 (“completely resolved”). Conclusions: We observed progressive spontaneous resolution of IBC. Most cysts were found in the recovery process in different follow-up periods. Patient's follow-up, without surgery, may be considered after the diagnosis based on epidemiological, clinical, and radiographic features of the lesion

Tomographic study of Jaw bone changes in patients with bisphosphonate-related osteonecrosis

Bisphosphonates (BP) are synthetic pyrophosphate-like substances with antiresorptive properties and specifically affect osteoclastic activity. In 2007, the American Association of Oral and Maxillofacial Surgeons (AAOMS) defined diagnostic criteria for Osteonecrosis of the Jaws Associated with Bisphosponates (BRONJ). BRONJ is mainly diagnosed by clinical features, but the detection of early bone changes by imaging may help prevent and better understand the disease. The objective of this study was to evaluate maxillary changes in CBCT in patients using BP. All included patients were diagnosed with osteonecrosis and received bisphosphonate drugs in the last ten years. All imaging examinations were obtained by I-CAT and 3D Accuitomo. The multiplanar reconstructions were analyzed by an examiner without knowledge of the clinical aspects and location of the lesions. The study sample consisted of 21 patients, the majority of the sample represented patients with cancer (76.2%), the other patients had osteoporosis (23.8%). Only four patients (19.04%) received alendronate, while intravenous bisphosphonates, such as zoledronate and pamidronate, represented the treatment of most of our sample. Most of our patients presented stage 1 and 2 MRONJ (85.7%), whose lesions were mainly observed in the mandible (52.4%). Fifty-seven percent of the patients had at least one bone change. In BRONJ, bone changes vary between exposed and non-exposed areas and one aspect of the study was: persistent extraction cavities in the BRONJ lesion region and high frequency of periodontal ligament space widening in areas that are not involved in BRONJ lesions. This reflects the very important role of dental and periodontal diseases in the pathophysiology of BRONJ. Thus, preventive measures should be prioritized for patients exposed to anti-resorptive drugs

Visibility of the mandibular canal on CBCT crosssectional images

The identification of the mandibular canal (MC) is an important prerequisite for surgical procedures involving the posterior mandible. Cone beam computed tomography (CBCT) represents an advance in imaging technology, but distinguishing the MC from surrounding structures may remain a delicate task. OBJECTIVES: The aim of this study was to assess the visibility of the MC in different regions on CBCT cross-sectional images. MATERIAL AND METHODS: CBCT cross-sectional images of 58 patients (116 hemi-mandibles) were analyzed, and the visibility of the MC in different regions was assessed. RESULTS: The MC was clearly visible in 53% of the hemi-mandibles. Difficult and very difficult visualizations were registered in 25% and 22% of the hemi-mandibles, respectively. The visibility of the MC on distal regions was superior when compared to regions closer to the mental foramen. No differences were found between edentulous and tooth-bearing areas. CONCLUSIONS: The MC presents an overall satisfactory visibility on CBCT cross-sectional images in most cases. However, the discrimination of the canal from its surrounds becomes less obvious towards the mental foramen region when cross-sectional images are individually analyzed

Visibility of the mandibular canal on CBCT crosssectional images

The identification of the mandibular canal (MC) is an important prerequisite for surgical procedures involving the posterior mandible. Cone beam computed tomography (CBCT) represents an advance in imaging technology, but distinguishing the MC from surrounding structures may remain a delicate task. OBJECTIVES: The aim of this study was to assess the visibility of the MC in different regions on CBCT cross-sectional images. MATERIAL AND METHODS: CBCT cross-sectional images of 58 patients (116 hemi-mandibles) were analyzed, and the visibility of the MC in different regions was assessed. RESULTS: The MC was clearly visible in 53% of the hemi-mandibles. Difficult and very difficult visualizations were registered in 25% and 22% of the hemi-mandibles, respectively. The visibility of the MC on distal regions was superior when compared to regions closer to the mental foramen. No differences were found between edentulous and tooth-bearing areas. CONCLUSIONS: The MC presents an overall satisfactory visibility on CBCT cross-sectional images in most cases. However, the discrimination of the canal from its surrounds becomes less obvious towards the mental foramen region when cross-sectional images are individually analyzed

Contribuição da radiografia panorâmica no diagnóstico de calcificação de ateroma de carótida: relato de caso e revisão da literatura

ResumoAs calcificações vasculares são comuns em pacientes com lesões ateroscleróticas avançadas, ocorrendo mais em indivíduos de idade avançada, reduzindo a distensão e luz dos vasos sanguíneos, gerando hipertensão. Ateromas podem levar a cardiopatia, a qual está diretamente associada à ocorrência de acidente vascular cerebral. Calcificações nos ateromas de carótida podem ser detectadas incidentalmente nas radiografias panorâmicas odontológicas, porém a associação entre a presença das imagens e o diagnóstico ainda representa um desafio. Neste artigo relatamos o achado incidental de ateromas de carótida na radiografia panorâmica de um paciente masculino de 73 anos. A radiografia apresentava imagem radiopaca com grande dimensão e localização atípica de ateroma de carótida, representando um desafio para o diagnóstico. A despeito dos achados radiográficos exuberantes o paciente apresentou estenose inferior a 50% no exame ultrassonográfico. Assim, revisamos a literatura sobre a precisão da radiografia panorâmica no diagnóstico e a necessidade de encaminhamento do paciente para investigações adicionais.AbstractVascular calcifications are common in patients with advanced atherosclerotic lesions. Most frequent in older adults, they reduce distension and decrease the lumen of blood vessels causing hypertension. Atheroma can lead to heart disease and is directly associated with the occurrence of cerebral vascular accident. Calcifications of the carotid atheroma can be detected as incidental findings on panoramic radiographs for evaluation, but the association between the presence of the images and the diagnosis is still a challenge for the clinician. We report the incidental finding of carotid atheroma on panoramic radiography of a 73 year‐old male. The radiography showed a radiopaque image with large and atypical location of carotid atheroma, representing a challenge to diagnose. Despite the significant radiographic findings, the stenosis observed on ultrasonography was smaller than 50%. Hence, we review the literature about the accuracy of panoramic radiography in the diagnosis and the need for further investigation

Os exames de imagem mais frequentemente solicitados no tratamento do quisto ósseo aneurismático e a sua relação com o resultado: uma atualização

El objetivo de este estudio fue revisar cuáles son los exámenes de imagen más requeridos, sus características y si la elección principal es suficiente para el manejo de la lesión. Se realizaron búsquedas en las bases de datos PubMed, Web of Science y Scopus. Los artículos incluidos eran informes de casos o series de casos de quistes óseos aneurismáticos en la mandíbula o el maxilar que tenían toda la información sobre el caso, desde el diagnóstico hasta el seguimiento. Los 32 artículos incluidos mostraron que el primer examen de imagen requerido es el examen radiográfico panorámico de los casos, y solo unos pocos eligen la tomografía computarizada como primera opción. El tratamiento elegido suele ser el curetaje, y 9 casos presentaron recidivas, aunque 17 no informaron del seguimiento. Los exámenes de imagen 2D fueron el tipo más requerido a la hora de diagnosticar un quiste óseo aneurismático, pero los exámenes 3D fueron necesarios en muchos casos para una mejor evaluación y para proporcionar más detalles. &nbsp; &nbsp;This study aimed to review the most required imaging tests, their characteristics, and whether the primary choice is sufficient for lesion management. PubMed, Web of Science, and Scopus databases were searched. The included articles were case reports or series of aneurysmal bone cysts in the mandible or maxilla that had all the information about the case, from diagnosis to follow-up. The 32 included articles showed that the first imaging test required is a panoramic radiographic examination of the cases, with only a few choosing computed tomography as the first option. The treatment of choice is usually curettage, and 9 cases had recurrences, although 17 did not report follow-up. 2D imaging examinations were the most required type when diagnosing an aneurysmal bone cyst, but 3D examinations were necessary in many cases for better evaluation and to provide more details. &nbsp;O objetivo deste estudo foi analisar quais os exames imagiológicos mais frequentemente solicitados, as suas características e se a escolha principal é suficiente para a gestão da lesão. Foram pesquisadas as bases de dados PubMed, Web of Science e Scopus. Os artigos incluídos eram relatos de casos ou séries de casos de cistos ósseos aneurismáticos na mandíbula ou maxila que continham todas as informações sobre o caso, desde o diagnóstico até o acompanhamento. Os 32 artigos incluídos mostraram que o primeiro exame de imagem solicitado é o exame radiográfico panorâmico dos casos, sendo que apenas alguns escolheram a tomografia computadorizada como primeira opção. O tratamento de escolha é geralmente a curetagem, e 9 casos tiveram recidivas, embora 17 não tenham relatado o acompanhamento. Os exames de imagem 2D foram os mais solicitados para o diagnóstico de cisto ósseo aneurismático, mas os exames 3D foram necessários em muitos casos para uma melhor avaliação e para fornecer mais detalhes

CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus : importance to sagittal split osteotomy

Mandibular Sagittal Split Osteotomy (MSSO) is a popular technique in orthognathic surgery used both to advance and to retreat the mandible. However, MSSO may incur in important complications, such as bad splits and sensorineural injuries. Knowing the location of the fusion between the buccal and lingual cortical (FBLC) in the mandibular ramus and the bone thickness in the region where osteotomies will be performed is determinant in MSSO planning to avoid complications. The aim of this study was to document and evaluate possible differences between sexes regarding the location of the FBLC in relation to the superior cortical of mandibular foramen (MF) and bone thickness in the region of interest for MSSO in a Brazilian population. Eighty five cone-beam Computed Tomography (CBCT) scans were used to perform linear measurements to determine the location of the FBLC. Bone thickness from the mandibular canal (MC) to the cortical external surfaces and the diameter of the MC were measured at three different points: mandibular ramus (A), mandibular angle (B) and mesial of the second molar (C). The FBLC was located at a mean distance of 8.3 mm from the superior cortical of the MF in males and 8.1 mm in females. There was no difference between males and females regarding the mean bone thickness from the MC to the buccal external surface at all the points investigated (p >>0.05). Bone thickness from the lingual external surface to the MC was bigger among females than males in regions B and C (p<0.05). The diameter of the MC was bigger among males in regions B and C. Sexual dimorphism regarding mandibular bone thickness but not regarding the location of FBLC was present. This fundamental knowledge may assist to the panning of MSSO