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OBJECTIVE: To assess the accuracy of cone-beam computed tomography (CBCT) for determining gingival thickness. MATERIAL AND METHODS: Searches were undertaken in PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO, and gray literature (Google Scholar and ProQuest) for studies considered eligible according to the following criteria: cross-sectional observational studies, which compared CBCT accuracy with that of transgingival probing when determining gingival thickness, in adult patients with good periodontal health. No language or time restrictions were applied in this systematic review. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for analytical cross-sectional studies. RESULTS: Six articles were included for qualitative synthesis, involving a pooled sample of 132 patients with a mean age of 29 years (18-51 years). Of these 6 studies, 5 were eligible for quantitative analysis. The meta-analysis showed no statistically significant difference between CBCT and transgingival probing measures of gingival tissue (mean difference of 0.10 (95% CI-0.17-0.38). No significant level of heterogeneity was detected (Tau2-P = 0.0662; I2 = 0%; H2-P = 1.000; Q-P = 1.134). According to the GRADE criterion, confidence in the cumulative evidence was considered low. CONCLUSIONS: CBCT is an accurate method for determining gingival tissue thickness, comparable to the reference standard (transgingival probing). CLINICAL RELEVANCE: CBCT could be considered for gingival thickness measurement when bone thickness is also needed, and thereby aid in the assessment of gingival biotype without the discomfort and anesthesia needed in transgingival probing. TRIAL REGISTRATION: This protocol was registered at the PROSPERO database (International Prospective Register of Systematic Review) under registration number CRD42022326970. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022326970 .

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OBJECTIVES: To evaluate the influence of image acquisition parameters (voxel, FOV, kVp, mA) on the accuracy of cone-beam computed tomography (CBCT) in detecting vertical root fracture (VRF). MATERIAL AND METHODS: Searches were performed in 6 main databases and the gray literature, without restrictions of language or date. Observational clinical studies (OCS) and in vitro-extracted teeth (IV) studies were considered eligible for inclusion when investigating the accuracy (sensitivity, specificity) of CBCT in detecting VRF in human teeth. The risk of bias was assessed using QUADAS-2, and a meta-analysis was performed using Review Manager v5.4 software and Jamovi software v1.6. RESULTS: A total of 60 out of 132 articles was included after fulfilling the eligibility criteria. Of these, 54 were IV studies while 6 were OCS. In the IV studies, it was seen that smaller FOV sizes tended to present higher accuracy values. The meta-analysis of the 6 OCS showed that the overall sensitivity and specificity values for 0.08 mm and 0.1 mm voxels were greater (0.84 and 0.79, respectively) than the sensitivity and specificity values for 0.125 mm and 0.2 mm voxels (0.70 and 0.55, respectively). CONCLUSIONS: Despite the uncertain risk of bias found for the IV and OCS studies, smaller voxel and FOV sizes seem to provide more accurate VRF detection values when using CBCT. CLINICAL RELEVANCE: This information is crucial for supporting the clinician when prescribing CBCT in cases of a clinical suspicion of VRF, and contributes to the personalization of the CBCT prescription, thereby ensuring greater accuracy in the VRF diagnosis. Registration This protocol was registered at the PROSPERO database (International Prospective Register of Systematic Review) under registration number CRD42020210118.

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OBJECTIVE: To undertake a joint analysis of the influence of fracture width, dental thickness and distance of the fracture from the cortical bone on the radiographic diagnosis of vertical root fractures. METHODS: Thirty-six uniradicular bovine teeth were endodontically treated and distributed into three groups according to the remaining root dentine thickness: 1.2 mm, 1.5 mm and 1.8 mm. Each group comprised 12 teeth, six with vertical root fracture and six without. Scanning electron microscopy (SEM) images of the fractured tooth groups were obtained and the fracture lines were measured. All specimens were inserted into bone defects created in bovine ribs, at different distances from the external cortical bone. Digital periapical radiographs were randomly evaluated by three blinded examiners (presence or absence of fractures). RESULTS: The specificity for periapical radiography was found to be 89% and the accuracy rate was 57.4%. The mixed-model regression using the generalised estimating equation (GEE) model showed that the width of the fracture line and the thickness of the dental remnant play an important role in radiographic detection of vertical root fractures. There is a lower chance of correct diagnosis with fracture line widths < 0.2 mm (odds ratio [OR] 0.294, 95% confidence interval [CI] 0.103 to 0.836; P = 0.022) and tooth thicknesses < 1.2 mm (OR 0.342, 95% CI 0.157 to 0.747; P = 0.007). CONCLUSION: Fracture line widths < 0.2 mm and smaller root thicknesses lead to a less accurate diagnosis of vertical root fractures on periapical radiographs.

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OBJECTIVES: The aim of this systematic review was to examine the evidence of the binary histologic grading system capacity for predicting malignant transformation and to compare it with that of the WHO systems. MATERIAL AND METHODS: A systematic review was conducted, using PubMed, EMBASE, LILACS, Web of Science, Scopus, and LIVIVO databases without any language or timeframe restrictions. Studies were included if they compared the binary and the WHO histologic grading systems in the prediction of malignant transformation of oral epithelial dysplasia (OED). RESULTS: The capacity of the WHO and binary grading systems to predict malignant transformation ranged from 16 to 80% and from 5 to 80%, respectively. The pooled malignant transformation rate of lesions classified as severe dysplasia or carcinoma in situ by the WHO grading was 40% (95% confidence interval (CI), 0.02-0.87; I2 = 92%; P = 0.00), while the corresponding value for lesions classified as high-risk by the binary grading system was 31% (95% CI, 0.00-0.84; I2 = 97%; P = 0.00). Overall, there was no significant difference in prognostication accuracy between the WHO and the binary systems (odds ratio = 2.02; 95% CI, 0.88-4.64). CONCLUSIONS: Although some studies suggest that the binary system is associated with lower inter-rater variability when grading OED, the evidence remains inconclusive on whether this system is superior to that of the WHO at predicting malignant transformation. CLINICAL RELEVANCE: The reproducibility of the binary system has the potential to be better for prognostic purposes. However, there is no high-quality evidence to confirm if this advantage may assist clinicians in decision-making.

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OBJECTIVES: To present an image processing framework to improve the detection of vertical root fractures (VRFs) in digital periapical radiography. MATERIALS AND METHODS: Thirty endodontically treated human teeth (15 of them fractured with a metal post inserted into them, and 15 for the control) were enclosed in a dry mandible and radiographed individually. The proposed framework was applied to the raw data, as a preprocessing step, and was composed of four stages: geometric adjustment and negative, denoising, adaptive contrast enhancement, and gamma correction. The contrast-to-noise ratio (CNR) and sharpness of the image's VRF region were used for the objective evaluation of the method. In addition, five examiners evaluated the original and enhanced images, using a 5-point scale to assess confidence. RESULTS: The objective results showed that the proposed framework increased the CNR of the VRF region by 173% compared to the standard preprocessing method provided by the detector's manufacturer. The results found by the human observers indicated that the area under the curve (AUC) and sensitivity of the diagnosis of VRF significantly increased by 4% and 17% (p ≤ 0.05), respectively, when the examiners evaluated the image with the proposed method concomitantly with the image available in the commercial software. However, the specificity was reduced. CONCLUSIONS: The proposed image processing framework can be used as an additional tool to that provided by the manufacturer to increase the sensitivity and AUC of the diagnosis of VRF. CLINICAL RELEVANCE: The proposed method can be easily used in clinical practice to aid VRF detection, since it does not incur high computational costs and does not increase the radiation dose applied to the patient.

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OBJECTIVES: This study evaluated factors associated with vertical root fracture in endodontically treated teeth, using a cone-beam computed tomography (CBCT) image database. MATERIALS AND METHODS: The sample for this case-control study consisted of 81 CBCT scans of teeth with vertical root fracture (VRF) and 81 CBCT scans of non-fractured teeth, matched by age, sex, and tooth position. The analyzed variables included dentin thickness, an intraradicular post, an adjacent implant, and a missing adjacent tooth. Student's t test test was used to compare the quantitative variables. The chi-square test was used to compare the categorical variables. Logistic regression was performed to evaluate the association between the presence of VRF and the independent factors assessed. RESULTS: The mean dentin thickness of fractured teeth was 1.3 mm, whereas that of non-fractured ones was 1.5 mm (p < 0.001). There was no difference between the fractured and non-fractured groups, regarding implant frequency or missing adjacent tooth (p > 0.05). There were a significantly larger number of teeth with posts in the fractured versus non-fractured group (p = 0.007). However, dentin thickness ≤ 1.3 mm was the only factor associated with VRF in the multiple regression model (OR = 3.60, 95%CI = 1.76-7.37). CONCLUSIONS: Dentin thickness may influence the development of VRF. Dentin thickness ≤ 1.3 mm is associated with a greater likelihood of fracture than ≥ 1.4 mm. CLINICAL RELEVANCE: This study suggests there may be a minimum amount of safe dentin thickness that should be preserved after endodontic instrumentation.

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BACKGROUND: The purpose of this experimental study was to compare the immunohistochemical expression of SOX2 and BCL-2 in Odontogenic Keratocyst (OKC) and Ameloblastoma (AB) specimens, and to identify a possible correlation in their expression.MATERIAL AND METHODS: Immunohistochemical analysis was performed to evaluate SOX2 and BCL-2 expression in OKC (n = 20) and AB (n = 20). The immunoexpression was analyzed by a quantitative and qualitative scoring system. The comparison between the immunoexpression of SOX 2 and BCL-2 was assessed by the Mann-Whitney U-test. Spearman's correlation coefficient evaluated the correlation between SOX2 and BCL-2 expressions.RESULTS: SOX2 and BCL-2 expression was observed in all specimens of OKC in the full thickness of the epithelium lining. SOX2 immunostaining was higher in OKC, in comparison with AB samples (P<0.05). BCL-2 immunostaining between OKC and AB was not statistically significant. There was no significant correlation between SOX2 and BCL-2 in OKC and AB specimens.CONCLUSIONS: SOX2 and BCL-2 expressions in OKC may suggest their relationship with the biological behavior of this lesion, and the higher expression of SOX2 might be an upstream influence on the Hh signaling pathway

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A 39-year-old woman sought specialized treatment complaining of a large, painful oral ulcer in the right buccal vestibule after receiving emergency endodontic treatment 3 days earlier. The patient reported that the tooth, the mandibular right first premolar, was not isolated with a rubber dam and that she felt the extrusion of a liquid in the buccal tissues. Clinically, a necrotic area with raised erythematous borders was observed in the mandibular right side. The clinical diagnosis was a chemically induced ulcer caused by a sodium hypochlorite accident. Dexamethasone and amoxicillin were prescribed to control pain and prevent secondary infection. The large size of the lesion was an indication for application of low-level laser therapy (LLLT), which was delivered at a wavelength of 685 nm (output power, 30 mW; power density, 0.5 mW/cm2 ; energy density, 6 J/cm2 ) every 2 days for a total of 6 sessions. The LLLT was applied to the necrotic area with a punctual mode (2 points) for 12 seconds per point. The patient reported a substantial reduction in pain after the second application, and the wound was completely healed after 6 sessions. The results observed in this patient suggest that LLLT could aid patients in recovering from NaOCl-related lesions.

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Objective: The aim of this report is present a rare case of oral Mucous Membrane Pemphigoid (MMP) in a 9-year-old-boy successfully treated with low doses of systemic corticosteroid. Case description: A 9-year-old boy was referred to our service with the complaint of painful gingiva and generalized burning mouth sensation over 1 year. Intraoral examination revealed desquamative lesions affecting the entire attached gingiva of both the maxilla and the mandible. After the incisional biopsy the MMP diagnosis was confirmed, and the patient was initially treated with dexamethasone 0,1mg/Ml mouth rinse twice daily for 24 weeks. Due the difficulty in eating and the presence of persistent large oral lesions, systemic prednisone 20 mg (1 mg/Kg) was prescribed for 4 weeks with a 5 mg gradual reduction per week over 3 weeks. After initiating the systemic corticosteroid therapy, the patient showed total regression of the lesions, and no indication of recurrence has been observed in the past 6 months. Conclusion: There is no cure for MMP; however, treatment can provide complete and long-lasting remission. Based on this premise, it is plausible to consider not only topical but also low doses of systemic corticosteroids in resistant cases of oral MMP, even in children. These measures could improve the quality of life of these patients by reducing pain and, consequently, improving the child's eating behavior.

Objetivo: O objetivo deste relato é apresentar um caso raro de Penfigóide Benigno das Membranas Mucosas (PBMM) em um menino de 9 anos de idade tratado com sucesso com baixas doses de corticosteróide sistémico. Relato de caso: Um menino de 9 anos de idade foi encaminhado ao nosso serviço com a queixa de gengiva dolorida e sensação de queimação na boca há aproximadamente 1 ano. Ao exame físico intraoral constatou-se a presença de lesões descamativas que afetavam toda a gengiva inserida, tanto na maxila quanto na mandíbula. Após a realização de uma biópsia incisional o diagnóstico de PBMM foi confirmado, e o paciente foi inicialmente tratado com elixir de dexametasona 0,1mg / ml duas vezes por dia durante 24 semanas. Devido a dificuldade em comer e a presença de grandes lesões orais persistentes, foi prescrito prednisona sistêmica 20 mg (1 mg / Kg) por 4 semanas com uma redução gradual de 5 mg por semana durante 3 semanas. Depois de iniciar a corticoterapia sistêmica, o paciente apresentou regressão total das lesões, e nenhum sinal de recorrência tem sido observado nos últimos 6 meses. Conclusão: Não há cura para o PBMM; no entanto, o tratamento pode proporcionar a remissão completa e de longa duração. Com base nesta premissa, é plausível considerar a terapia tópica, mas também a utilização de corticosteroides sistêmicos em casos resistentes de PBMM oral, mesmo em crianças. Estas medidas poderiam melhorar a qualidade de vida desses pacientes, reduzindo a dor e, consequentemente, melhorando a alimentação da criança.

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Objetivo: O presente trabalho avaliou o padrão de crescimento, o índice de proliferação celular e morfologia de pré-osteoblastos humanos cultivados com Bio-Oss® e GenOx®. Material e Método: Pré-osteoblastos humanos MC3T3-E1 foram cultivados em contato com os biomateriais por 1, 24 e 72horas para avaliação da proliferação celular, medido com o teste colorimétrico MTS. Para a avaliação do padrão de crescimento e da morfologia celular, as células foram cultivadas por 24 e 72 horas, respectivamente e avaliadas sob microscopia de contraste de fase e microscopia eletrônica de varredura (MEV). Para verificação de diferenças no crescimento celular entre os grupos foi utilizado o teste one-way de ANOVA, sendo considerados significantes valores de p<0,05. Resultados: A proliferação celular foi maior na primeira hora nas amostras em contato com os biomateriais em comparação ao grupo controle. Nos períodos de 24 e 72 horas de cultivo celular, a curva de crescimento não mostrou diferença estatisticamente significante entre os grupos (p>0.05). Na microscopia de contraste de fase observou-se que as células cresceram em proximidade aos biomateriais, iniciando a formação da monocamada de maneira semelhante. Quando analisadas no MEV, as células cultivadas sobre os biomateriais apresentaram-se com formato fusiforme e núcleo arredado. Conclusão: Com a comparação do comportamento biológico de Bio-Oss® e GenOx®, realizada in vitro neste estudo, pôde-se observar que apesar das diferenças físico-químicas, o padrão, índice de crescimento e morfologia celular de Bio-Oss® e GenOx® se mostraram semelhantes, e que ambos materiais são biocompatíveis e representam uma boa opção como substitutos ósseos.

Objective: The present study aimed to evaluate the growth pattern, cell proliferation index and morphology of human preosteoblasts cultured with Bio-Oss® and GenOx®. Material and Methods: MC3T3-E1 human pre-osteoblasts were cultured in contact with biomaterials for 1, 24 and 72 hours for the cell proliferation assay with the colorimetric test MTS. For the growth pattern and cell morphology analysis, the cells were cultured for 24 and 72 hours, respectively, and evaluated under phase contrast microscopy and scanning electron microscopy. To verify differences in cell growth among the groups, the one-way ANOVA test was used (p <0.05). Results: In the first hour of cell culture the cell proliferation was pronounced in samples in contact with the biomaterials. At 24 and 72 hours of cell culture, no significant differences between the groups was observed in respect of cell proliferation. In phase contrast microscopy it was noted that the cells grew in proximity to the biomaterials, initiating the formation of a monolayer. When analyzed in the scanning electron microscopy, the cells cultured on the biomaterials presented a fusiform morphology and a round nucleus. Conclusion: Despite the physico-chemical differences between Bio- Oss® and GenOx®, these two biomaterials presented a similar growth index and cell morphology analysis, showing that both biomaterials are biocompatible and represent a good choice as bone substitutes.