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To evaluate the efficiency of photobiomodulation therapy (PBMT) in the midpalatal suture (MPS) and pain sensation in patients undergoing rapid palatal expansion (RPE). Thirty-four individuals with the diagnosis of skeletal maxillary hypoplasia were divided in two groups: laser (n = 18) and control (n = 16). Treatment plan consisted of the use of the Hyrax expander in all patients. Subjects in the laser group were irradiated with diode laser (980 nm, 0.3 W) in six spots bilaterally distributed along the MPS for 10 s during the active phase of treatment and after overcorrection (passive phase of RPE). Control group received sham irradiations with the laser in standby mode to characterize the placebo effect. Digital occlusal radiographs were performed at different time-points for bone formation evaluation in both groups. The effects of laser irradiation on pain were assessed by the visual analog scale (Wong-Baker Faces Pain Scale). Bone formation between groups was not significantly different (p = 0.2273). At 3 months, bone formation was not yet complete in both groups. Pain sensation was similar between groups (p = 0.3940). However, pain was significantly higher for the first 7 days of treatment compared with the 14th day. PBMT did not accelerate bone regeneration in the MPS and pain sensation was similar.
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Terapia com Luz de Baixa Intensidade , Osteogênese/efeitos da radiação , Técnica de Expansão Palatina , Palato/fisiologia , Palato/efeitos da radiação , Suturas , Regeneração Óssea/efeitos da radiação , Humanos , MasculinoRESUMO
OBJECTIVES: This study investigated whether professional experience and type of image examination (panoramic radiography (PAN) or cone beam computed tomography (CBCT)) could influence the pre-surgical planning for dental implant treatment. MATERIALS AND METHODS: Six dentists, from two different levels of experience (senior (Sr) and junior (Jr)) performed simulated pre-surgical planning by using PANs and after 1 month, by using CBCTs, considering implant length (IL), implant width (IW), need for bone graft (BG), and other surgical procedures (OP). Bland-Altman test and Kappa coefficient were used to identify agreements. RESULTS: Bland-Altman test showed good agreement in the plans for inter-professional (i.e., Sr vs Jr) comparisons. Bland-Altman plots displayed intra-observer agreement (i.e., differences between PAN and CBCT), showing discrepancy between imaging modalities for IL and a tendency towards selecting larger dental implant options when using PAN and smaller options with CBCT. Kappa showed almost perfect (0.81-1.0) agreement between Jr and Sr for OP (PAN and CBCT). For BG, agreement was substantial (0.61-0.80) when planning was done with PAN and CBCT. Descriptive statistics showed evidence that when Jrs used CBCT, they no longer indicated the BG they had planned when they used PAN. CONCLUSION: There were differences in the pre-surgical planning for treatment with dental implants depending on the professional experience and the type of imaging examination used. CLINICAL RELEVANCE: Variation in dental implant planning can affect treatment time, cost, and morbidity in patients.
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Competência Clínica , Tomografia Computadorizada de Feixe Cônico/métodos , Implantação Dentária Endóssea , Planejamento de Assistência ao Paciente/normas , Radiografia Panorâmica/métodos , Adulto , Feminino , Humanos , Imageamento Tridimensional , MasculinoRESUMO
OBJECTIVE: To assess the detection of simulated periapical lesions in digital intraoral radiography with different levels of brightness and contrast combinations, and to investigate the observers' preference of image quality for this diagnostic task. METHODS: Digital radiographs were acquired prior to periapical lesion simulation and after each one of four defects enlargement. Original images were adjusted in 4 brightness and contrast combinations. Five observers evaluated the images according to the presence of periapical lesion on a 5-point scale. In a second moment, the observers ordinated the images subjectively, according to quality, from the best to the worst to detect the bone defect. The area under the receiver operating characteristic curve was calculated for the diagnostic values and compared by two-way ANOVA. The significance level was set at 5% (P<0.05). RESULTS: No differences were found between the diagnostic values of the five combinations of brightness and contrast (P>0.05). The overall results showed low values of area under the Receiver Operating Characteristic (ROC) curve and sensitivity of the periapical radiography in the detection of periapical lesions of sizes from 1 to 3, which rose substantially in size 4. For image quality, combinations with the lowest brightness and highest contrast were preferred by the observers in 58% of the cases. CONCLUSION: Brightness and contrast adjustments do not influence the detection of simulated periapical lesions in digital intraoral radiography. Lower brightness and higher contrast images were preferred for this diagnostic task.
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OBJECTIVES: To evaluate the impact of audience response systems (ARS) on student participation (SP) during Oral and Maxillofacial Radiology (OMR) undergraduate lectures and on final examination scores (FES). Furthermore, an analysis of unanimity assessed the influence of ARS on students' responses. Students' perceptions were also assessed. METHODS: A controlled crossover study was designed. Four lectures covering topics of OMR were each taught with ARS and without ARS (i.e. hand-raising method). SP and FES were compared between ARS and HR groups. Unanimity of answers was analyzed for both groups. Questionnaires assessed students' impressions about ARS. RESULTS: Mean SP of ARS and HR groups were 97.6% and 47.3%, respectively, and this difference was statistically significant (P<.05). Mean FES for the ARS group (77%) was slightly higher than HR group (75.1%), however, not statistically significant. There was positive correlation between SP and FES. With ARS, only 5.7% of the questions were unanimous, whilst 51.4% were unanimous with HR method. Most students reported that the use of ARS had positive influence on their attention (92%), participation (96%), classmates' participation (82.7%), interest (74.7%), and learning (86.7%). For the five-point scale ratings of the relevance of ARS features, anonymity had an average 3.6, whilst other items received an average 4.6 or higher. CONCLUSIONS: ARS significantly increased participation in OMR lectures; however, an increase in FES could not be associated with ARS by itself. Not taking into consideration which method was used to answer questions posed during lectures, higher participation correlated with higher scores. ARS is well-accepted and students believe that these devices positively influence their performance. Among the recognized advantages of ARS, anonymity was considered the least relevant.
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Comportamento , Educação em Odontologia/métodos , Radiologia/educação , Estudantes de Odontologia/psicologia , Estudos Cross-Over , Humanos , Boca/diagnóstico por imagemRESUMO
INTRODUCTION: There is no consensus about the accuracy of cone-beam computed tomography (CBCT) for detecting vertical root fractures (VRFs), nor is there certainty about the isolated effect of different tube current parameters on the diagnosis of VRF through CBCT scans. This study aimed to evaluate how tube current affects the detection of VRF on CBCT examinations in the absence of intracanal materials and in the presence of gutta-percha (GP) and metal (MP) or fiberglass (FP) intracanal posts. METHODS: The sample consisted of 320 CBCT scans of tooth roots with and without VRF divided into 8 groups: no fracture/no intracanal material; no fracture + GP; no fracture + MP; no fracture + FP; fracture/no intracanal material; fracture + GP; fracture + MP; fracture + FP. The scans were acquired with an OP300 unit using 4 different milliamperes (4 mA, 8 mA, 10 mA, 13 mA). Five oral radiologists analyzed the images. The area under the receiver operating characteristic curve (Az), sensitivity, specificity, positive and negative predictive values, and interobserver agreement were calculated. RESULTS: Diagnostic performance for the different milliamperes tested was similar for teeth without root filling materials or with FP. Teeth with GP and MP showed the highest Az values for 8 mA and 10 mA, respectively. For teeth with MP, specificity was significantly higher when 10 mA was used. CONCLUSIONS: For teeth without root filling materials or with FP, the use of a reduced milliampere does not seem to influence the detection of VRF in a significant manner. For teeth with GP and MP, an increased milliampere may lead to increased diagnostic performance.
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Tomografia Computadorizada de Feixe Cônico/métodos , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/lesões , Guta-Percha , Humanos , Curva ROC , Materiais Restauradores do Canal Radicular , Obturação do Canal Radicular , Sensibilidade e Especificidade , Raiz Dentária/diagnóstico por imagemRESUMO
OBJECTIVE: This preliminary study aimed to evaluate the antimicrobial activity, flow and radiopacity of endodontic sealers with nanostructured silver vanadate decorated with silver nanoparticles (AgVO3). METHODS: The minimum inhibitory concentration (MIC) of AgVO3 was evaluated against Enterococcus faecalis, Pseudomonas aeruginosa and Escherichia coli. Specimens were prepared from the following endodontic sealers: AH Plus (DENTSPLY DeTrey GmbH, Konstanz, Germany), Sealapex (Sybron Endo, Orange, CA, USA), Sealer 26 (DENTSPLY, Petrópolis, Brazil) and Endofill (DENTSPLY, Petrópolis, Brazil), with concentrations of 0%, 2.5%, 5% and 10% of AgVO3. Agar diffusion was used to evaluate the materials after 48 hours and 7 days (n=6). Flow (n=6) and radiopacity (n=9) were evaluated. The data were analysed by analysis of variance (ANOVA) and the Tukey honestly significant difference (HSD) (α=0.05). RESULTS: The MIC of AgVO3 was 500 µg/mL for E. faecalis and 31.25 µg/mL for P. aeruginosa and E. coli. The AgVO3 did not influence the antimicrobial activity of AH Plus against E. faecalis (P>0.05) but did promote this activity for Sealapex (P<0.01). Moreover, this activity increased for Endofill from 2.5% and for Sealer 26 from 5% (P<0.05). Against P. aeruginosa, only AH Plus and Endofill 10% inhibited zone formation (P<0.01). The antimicrobial activity of Endofill increased from 2.5% against E. coli (P<0.01). Sealapex 5% and 10% (P<0.01), Sealer 26 10% and AH Plus promoted antimicrobial activity against E. coli. An increase in the zone of inhibition occurred between 48 hours and 7 days in the Sealapex 10% and Endofill 5% groups against E. coli. The flow of AH Plus and Endofill decreased with the increase of AgVO3 (P<0.05), and the flow of Sealer 26 and Sealapex was not affected (P>0.05). The radiopacity of AH Plus increased with AgVO3 (P<0.05). Endofill 5% and 10% did not differ from the control Endofill (P>0.05). The incorporation of AgVO3 did not influence the radiopacity of Sealer 26 (P>0.05). The incorporation of 2.5% and 5% AgVO3 reduced the radiopacity of Sealapex (P<0.05). CONCLUSION: Adding AgVO3 may increase the antimicrobial effect of endodontic sealers without major changes in their physicochemical properties.
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[This corrects the article on p. 159 in vol. 46, PMID: 27672611.].
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PURPOSE: The purpose of this study was to detect the anterior loop of the mental nerve and the mandibular incisive canal in panoramic radiographs (PAN) and cone-beam computed tomography (CBCT) images, as well as to determine the anterior/mesial extension of these structures in panoramic and cross-sectional reconstructions using PAN and CBCT images. MATERIALS AND METHODS: Images (both PAN and CBCT) from 90 patients were evaluated by 2 independent observers. Detection of the anterior loop and the incisive canal were compared between PAN and CBCT. The anterior/mesial extension of these structures was compared between PAN and both cross-sectional and panoramic CBCT reconstructions. RESULTS: In CBCT, the anterior loop and the incisive canal were observed in 7.7% and 24.4% of the hemimandibles, respectively. In PAN, the anterior loop and the incisive canal were detected in 15% and 5.5% of cases, respectively. PAN presented more difficulties in the visualization of structures. The anterior/mesial extensions ranged from 0.0 mm to 19.0 mm on CBCT. PAN underestimated the measurements by approximately 2.0 mm. CONCLUSION: CBCT appears to be a more reliable imaging modality than PAN for preoperative workups of the anterior mandible. Individual variations in the anterior/mesial extensions of the anterior loop of the mental nerve and the mandibular incisive canal mean that is not prudent to rely on a general safe zone for implant placement or bone surgery in the interforaminal region.
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Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.
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Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico por imagem , Falanges dos Dedos da Mão/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/patologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/fisiopatologia , Densidade Óssea , Remodelação Óssea/fisiologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Falanges dos Dedos da Mão/patologia , Falanges dos Dedos da Mão/fisiopatologia , Mãos/diagnóstico por imagem , Humanos , Arcada Osseodentária/diagnóstico por imagem , Arcada Osseodentária/patologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/patologia , Osteoporose/induzido quimicamente , Reprodutibilidade dos Testes , Fatores de Risco , Fatores de Tempo , UltrassonografiaRESUMO
OBJECTIVE: To investigate the presentation of accessory mental foramina (AMF) on cone-beam computed tomography (CBCT) and digital panoramic examinations (PAN). STUDY DESIGN: Imaging examinations (i.e., CBCT and PAN) of 100 patients (200 hemi-mandibles) were assessed. AMF prevalence, diameter, and location related to adjacent teeth and to the mental foramen (MF) were analyzed. RESULTS: On CBCT images, the AMF was observed in 3% of the patients: two unilateral cases and one bilateral case, with mean diameter of 0.93 mm (±0.3); no AMF was identified on PAN. Most AMF were located between the premolars, either superiorly (two cases) or mesially (two cases) to the MF. The mean horizontal distance to the corresponding MF was 2.3 mm (±1.0) and the mean vertical distance was 4.0 mm (±0.7). CONCLUSIONS: The results of this study suggest that CBCT is an effective tool for presurgical tridimensional assessment of the neurovascular structures, such as MF and its variations; On the other hand, PAN examinations were not able to show the AMF cases assessed on CBCT.
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Tomografia Computadorizada de Feixe Cônico , Mandíbula/diagnóstico por imagem , Radiografia Panorâmica , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Mandíbula/irrigação sanguínea , Mandíbula/inervação , Pessoa de Meia-Idade , PrevalênciaRESUMO
OBJECTIVE: This study aimed to assess the presence of additional foramina and canals in the anterior palate region, through cone beam computed tomography (CBCT) images, describing their location, direction, and diameter. MATERIALS & METHODS: CBCT exams of 178 subjects displaying the anterior maxilla were included and the following parameters were registered: gender; age group; presence of additional foramina in the anterior palate (AFP) with at least 1 mm in diameter; location and diameter of AFP; and direction of bony canals associated with AFP. RESULTS: Twenty-eight patients (15.7%) presented AFP and in total 34 additional foramina were registered. No statistical differences between patients with or without AFP were found for gender or age. The average diameter of AFP was 1.4 mm (range from 1 to 1.9 mm). Their location was variable, with most of the cases occurring in the alveolar process near the incisors or canines (n = 27). In 18 cases, AFP was associated with bony canals with upward or oblique direction toward the anterior nasal cavity floor. In 14 cases, the canal presented as a direct extension of the canalis sinuosus, in an upward direction laterally to the nasal cavity aperture. In two cases, the canal was observed adjacent to the incisive and joined the nasopalatine canal superiorly. DISCUSSION: CBCT images have a crucial role in the recognition of anatomical variations by allowing detailed tridimensional evaluations. Additional foramina and canals in the anterior region of the upper jaw are relatively frequent. Practitioners should be aware and trained to identify these variations. CONCLUSIONS: Over 15% of the population studied had additional foramina in the anterior palate, between 1 mm and 1.9 mm wide, with variable locations. In most cases the canals associated with these foramina either presented as a direct extension of the canalis sinuosus, or coursed towards the nasal cavity floor.
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Tomografia Computadorizada de Feixe Cônico , Palato Duro/irrigação sanguínea , Palato Duro/inervação , Adulto , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Palato Duro/diagnóstico por imagemRESUMO
BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory disease with multiple articular and para-articular involvement that has a predilection for the axial skeleton. In spite of its high prevalence, ankylosis secondary to AS is a rare condition. CASE REPORT: A 31-year-old male diagnosed with AS was referred for computed tomography (CT) of the temporomandibular joint (TMJ) due to severe mouth opening limitation. The patient had a 16-year medical history of AS and sought assistance due to TMJ pain and incapacity to open his mouth. RESULTS: Previous bony scintigraphy revealed involvement of the spine, sacroiliac joints, right knee, and left TMJ. Magnetic resonance imaging revealed erosion of the left condyle and posterior slope of the articular eminence, and a mass of heterogeneous signal intensity between these structures. The left condyle also presented sclerosis/edema of the bone marrow and the disk could not be identified. Sagittal and coronal CT images showed moderate alterations of the TMJ on the right side. On the left side, the images displayed markedly eroded condyle and mandibular fossa, and a bony mass resulting in ankylosis of the osseous components of the joint. CONCLUSION: TMJ ankylosis in AS patients is rare and very few reports have presented imaging features of the condition through advanced diagnostic techniques.