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Objetivo: La enfermedad de Caffey o hiperostosis cor- tical infantil es una enfermedad rara que afecta uno o más huesos en los primeros meses de vida y debido a su baja inci- dencia está subdiagnosticada, y por tanto se aplican procedi- mientos invasivos innecesarios en su estudio y tratamiento. Se presenta un caso clínico atípico de enfermedad de Caffey en una paciente mayor de 1 año de edad y su resolución. Caso clínico: El servicio de Cirugía Maxilofacial del Hospital Provincial Pediátrico Eduardo Agramonte Piña de Camagüey, Cuba, atiende a una niña de 1 año y 10 meses que se encontraba hospitalizada por presentar una inflamación alarmante en la región facial y cervical precedida de un cua- dro febril y dificultad para alimentarse. Se indicaron los estu- dios apropiados, cuyos resultados, junto a las características clínicas, permitieron diagnosticar la enfermedad de Caffey. Aunque sea una enfermedad rara, es importante estudiarla para realizar un correcto análisis de cada caso y diferenciarla de otras enfermedades que requieren de conductas terapéuti- cas agresivas (AU)
Aim: Caffey's disease or infantile cortical hyperostosis is a rare disease that affects one or more bones in the first months of life and due to its low incidence, it is underdiag- nosed, and therefore unnecessary invasive procedures are applied in its study and treatment. An atypical clinical case of Caffey's disease in a patient older than 1 year and its reso- lution is presented. Case report: The Maxillofacial Surgery service of the Eduardo Agramonte Piña Provincial Pediatric Hospital in Camagüey, Cuba, takes the case of a 1 year and 10-month-old female patient who was hospitalized for an alarming inflam- mation in the facial and cervical region, preceded by a fever and difficulty to eat. The appropriate studies were indicated, which results, together with the clinical characteristics, al- lowed the diagnosis of Caffey's disease. Although it is a rare entity, it is important to study it to carry out a correct analysis of each case and differentiate it from other diseases that re- quire aggressive therapeutic behaviors (AU)
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Humanos , Masculino , Lactente , Hiperostose Cortical Congênita/etiologia , Assistência Odontológica para Crianças/métodos , Sinais e Sintomas , Diagnóstico Clínico , Cuba , Unidade Hospitalar de Odontologia/métodosRESUMO
Abstract The objective of this study was to analyze the influence of insertion torque, bone type, and peri-implant bone loss on implant stability quotient (ISQ) of cylindrical external hexagon (EH) and Morse Taper (MT) implants. Forty-four single implants were placed in the edentulous areas of 20 patients who met the inclusion and exclusion criteria. Immediately after implant placement (t1) and after osseointegration (four and six months for mandible and maxilla, respectively) (t2), insertion torque, resonance frequency, and peri-implant bone loss were measured using probing depths and digital periapical radiography. A significant difference was noted in the ISQ values between t1 and t2 in type III bone for EH and MT implants. No significant difference in bone loss values was observed when comparing bone types for EH or MT in all evaluated sites. Based on marginal bone loss assessed using radiography, there was no significant difference between the MT and EH groups. A positive correlation between torque and ISQ t1 value was observed for MT (correlation: 0.439; p = 0.041) and EH (correlation: 0.461; p = 0.031) implants. For EH and MT implants, the greater the insertion torque, the greater was the ISQ value (moderately positive correlation). A weak negative correlation was found between bone type and ISQ t1 for MT implants. Contrarily, no correlation was observed between bone type and ISQ t1 for EH implants. In all cases, bone loss around the implants was clinically normal.
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The objectives of the present study were to assess Fractal Dimension (FD) values in the mandible cortical bone obtained from digital periapical radiographs (DPR), high-resolution microtomography (µCT), and cone-beam computed tomography (CBCT), by two processing methods: binarization (FD.b) and grayscale-based method (FD.f) and, finally, to identify the correlation among these values with other micro-architectural parameters. For this, a prospective study was conducted on 18 healthy individuals (mean age 23 ± 2.4 years old) who underwent third molar extraction. Pre-operative CBCT scans were conducted, bone fragments were removed from the retro-molar region, and DPR and µCT were performed on those bone samples. FD.b and FD.f values were calculated using three parasagittal sections for CBCT, one image for DPR, and three sections for µCT. The 3D bone microarchitecture was analyzed in µCT (voxel size: 19 µm). As a result, FD.b mean values of 1.55 ± 0.02 and 1.80 ± 0.01 were obtained for CBCT and µCT, respectively. Furthermore, FD.f mean values of 1.22 ± 0.12 for DPR, 0.99 ± 0.04 for CBCT, and 1.30 ± 0.07 for µCT were obtained. Both FD.b and FD.f values showed a good agreement. FD.f was negatively correlated with the standard deviation of the mean gray value (p = 0.003) for DPR and intra-cortical bone surface (p = 0.02) for µCT. In conclusion, image processing with or without binarization revealed different values for FD, although showing agreement. The grayscale-based method retrieved FD values correlated with the gray levels and the cortical porous network, which means that FD can be a valuable index for mandibular cortical bone evaluation. FD is associated with mineralization and microarchitecture. Nevertheless, there was no correlation between FD values obtained from low- (DPR) and high-resolution (µCT) X-ray modalities with FD obtained from the in vivo CBCT.
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Tomografia Computadorizada de Feixe Cônico , Fractais , Humanos , Adulto Jovem , Adulto , Microtomografia por Raio-X/métodos , Estudos Prospectivos , Osso Cortical , MandíbulaRESUMO
Ð clinical case of non-union in a cat after open fracture repair by intramedullary ostheosynthesis of the radius was described. The patient was presented with non-weight bearing lameness, fistulas with purulent discharge, swelling and severe pain. During the surgical revision, after bone sequestrum removal, the bone defect was filled with cancellous and cortical bone autografts. Osteosynthesis with a modified external bone fixator, made of Duracryl® Plus - a rapidly self-curing metacrylate polymer - and 6 Kirschner wires passing perpendicularly through both radial cortices was performed. The post-operative period was smooth, and after 23 weeks the external fixator was removed. Radiography showed very good bone healing, with excellent clinical result. The use of the ulna as a donor bone was very convenient because it allowed collecting a cortical graft of larger size. The extremely light model of external bone fixator provided adequate strength of fixation elements and proved to be an efficient and not expensive technique for osteosynthesis in cat with non-union fractures of the distal radius and ulna.
Um caso clínico de correção de uma não união de uma fratura exposta em um gato após por osteossíntese intramedular do rádio foi descrito. O paciente apresentou claudicação, fístulas com secreção purulenta, edema e dor intensa. Durante a revisão cirúrgica, após a remoção do sequestro ósseo, o defeito ósseo foi preenchido com autoenxertos de osso esponjoso e cortical. Foi realizada osteossíntese com fixador ósseo externo modificado, confeccionado em Duracryl® Plus polímero metacrilato de rápida autopolimerização e 6 fios de Kirschner passando perpendicularmente por ambas as corticais radiais. O pós-operatório foi tranquilo e após 23 semanas o fixador externo foi removido. A radiografia mostrou boa consolidação óssea, com excelente resultado clínico. A utilização da ulna como osso doador foi muito conveniente, pois permitiu a coleta de um enxerto cortical de maior tamanho. O modelo extremamente leve de fixador ósseo externo proporcionou resistência adequada dos elementos de fixação e mostrou-se uma técnica eficiente e de baixo custo para osteossíntese em gatos com fraturas não consolidadas do rádio distal e ulna.
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SUMMARY OBJECTIVE: To reduce surgical exposure and improve accuracy, this study evaluated the anatomical distance parameter D (including D1, D2, and D3) of the lumbar isthmus for cortical bone screw insertion. METHODS: A total of 25 structurally complete lumbar dry specimens were used for lumbar anatomy measurements. The six cadaver specimens were divided into upper and lower parts on the plane of the T11-T12 vertebrae, and we use the lower parts. Therefore, six lumbar wet specimens and another four complete lumbar dry specimens were selected. The lumbar isthmus tangent point was considered a coordinate origin, and the insertion point was determined through translating the distance of D1 value to the midline of the vertebral body horizontally and then vertically moved toward inferior board of the transverse process with the distance of D3 value. RESULTS: In four dry and six wet intact lumbar specimens, cortical bone screws were placed according to the average value of the isthmus parameter D. A total of 100 trajectories were verified in specimens by X-ray and computed topography scan to evaluate the safety, accuracy, and feasibility of the surgical use of isthmus parameter D. Using this parameter, the rates of excellent screw placement were 95% (38/40) in four dry specimens and 88.7% (53/60) in six wet specimens. CONCLUSION: The isthmus parameter D is easier to use by the operator, which can improve surgical accuracy and reduce operation time. LEVEL OF EVIDENCE: Level IV, prospective study.
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Bone biopsy is still the gold standard tool to evaluate either trabecular or cortical bone, though the quantitative computed tomography of the vertebrae (QCT), a non-invasive technique, could be useful to evaluate bone structure in patients with chronic kidney disease (CKD). Cortical bone microstructure derangements have been associated with poor outcomes in the general population. An association between trabecular bone density, assessed by QCT, and bone volume and microarchitecture by histomorphometry, has been previously documented. This relationship has not yet been fully evaluated in cortical bone in the CKD scenario. The aim of this study was to evaluate the relationship among vertebrae density measured by QCT, structural histomorphometric parameters of cortical bone and biochemical and hormonal data in 50 CKD stage 2-5ND patients. This was a post hoc analysis of a cross-sectional study where cortical porosity and cortical thickness were analyzed in undecalcified bone samples from the iliac crest. The cortical bone density was obtained by QCT from the thoracic vertebrae. The patients were 52 ± 10 years, 68% men, 30% diabetes and the estimated glomerular filtration rate 34 ± 16 mL/min/1.73 m2. Cortical porosity was 4.6% (3.6; 6.6) and cortical thickness was 578.4 ± 151.8 µm, while cortical bone density was 149.2 ± 58.3 HU. Cortical density correlated with cortical thickness (p = 0.001) but not with cortical porosity (p = 0.30). Higher porosity was associated with older age (p = 0.02), higher levels of PTH (p = 0.04) and lower renal function (p = 0.03), while smaller thickness was associated with higher levels of PTH (p = 0.02). Lower density was associated with older age (p = 0.02) and higher levels of PTH (p = 0.01). In conclusion, cortical bone density measured by QCT was able to mirror the cortical thickness of bone biopsy in pre-dialysis CKD patients. In addition, PTH action on cortical bone can be already seen in this population.
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BACKGROUND: The aim of this study was to evaluate the microarchitecture, composition and mechanical properties of cortical bone of rats with type I diabetes mellitus (TIDM) and submitted to insulin therapy (IT). METHODS: Thirty rats were divided into three groups (n=10): non-diabetic, diabetic and diabetic+insulin. TIDM was induced by intravenous injection of streptozotocin. In diabetic+insulin group, 4IU insulin was administered twice per day (1I U at 7 am and 3I U at 7 pm). The animals were euthanized five weeks after TIDM induction; the tibiae were removed and submitted to microcomputed tomography (micro-CT, 8 µm), fourier transform infrared spectroscopy (FTIR) and dynamic microhardness indentation. RESULTS: Micro-CT analysis showed that diabetic group had lower bone surface/tissue volume ratio (BS/BV) (p=0.018), cortical thickness (Ct.Th) (p<0.001) and degree of anisotropy (Ct.DA) (p=0.034) values compared to non-diabetic group. The diabetic group showed lower Ct.Th than diabetic + insulin group (p=0.018). The non-diabetic group had lower fractal dimension (Ct.FD) values compared to diabetic groups (p<0.001). The ATR-FTIR analyses showed lower values for all measured parameters in the diabetic group than the non-diabetic group (amide I ratio: p=0.046; crystallinity index: p=0.038; matrix:mineral ratios - M:MI: p=0.006; M:MIII: p=0.028). The diabetic+ insulin group showed a lower crystallinity index (p=0.022) and M:MI ratio (p=0.002) than nondiabetic and diabetic groups, respectively. The diabetic group showed lower Vickers hardness values than non-diabetic (p<0.001) and diabetic+insulin (p=0.003) groups. CONCLUSION: TIDM negatively affects bone microarchitecture, collagen maturation, mineralization and bone microhardness. Moreover, insulin minimized the effect of TIDM on cortical thickness and organic/mineral matrix.
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Diabetes Mellitus Tipo 1 , Insulina , Animais , Osso Cortical , Diabetes Mellitus Tipo 1/tratamento farmacológico , Humanos , Insulina/farmacologia , Insulina/uso terapêutico , Minerais , Ratos , Microtomografia por Raio-XRESUMO
We analyzed the effect of naringin (NAR), a flavonoid from citric fruits, on bone quality and biomechanical properties, as well as the redox state of bone marrow in rats fed a fructose-rich diet (FRD), an experimental model to mimic human metabolic syndrome. NAR blocked the increase in the number of osteoclasts and adipocytes and the decrease in the number of osteocytes and osteocalcin (+) cells caused by FRD. Trabecular number was significantly higher in the FRD+NAR group. FRD induced a decrease in the femoral trabecular and cortical bone mineral density, which was blocked by NAR. The fracture and ultimate loads were also decreased in the FRD and FRD+NAR groups. NAR increased the number of nodes to terminal trabecula, the number of nodes to node trabecula, the number of nodes, and the number of nodes with 2 terminals and decreased the Dist (mean size of branches) value. FRD decreased bone marrow catalase activity, an effect that was prevented by NAR. In conclusion, FRD has detrimental effects on the long bones, which are associated with oxidative stress in the bone marrow. Most of these changes are prevented by NAR through its antioxidant properties and promotion of bone formation. Novelty: Fructose-rich diets have detrimental effects on long bones, which are associated with oxidative stress in the bone marrow. Most of these changes are prevented by naringin through its antioxidant properties and promotion of bone formation.
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Frutose , Síndrome Metabólica , Animais , Dieta , Flavanonas , Frutose/efeitos adversos , Síndrome Metabólica/prevenção & controle , Ratos , Ratos WistarRESUMO
ABSTRACT Introduction: This study aims to evaluate the safety of using the cortical path screw with transfixation of the second cortical bone in relation to the vascular structures. Methods: This retrospective observational study (level of evidence: III, study of non-consecutive patients) analyzed data from the medical records of patients who underwent computed angiotomography scans of the abdomen at Hospital Mater Dei, measuring, in millimeters, the distance between the point of the lumbar vertebra considered the anatomical reference for the transfixation of the second cortical bone and the vascular structures adjacent to the spine (abdominal aorta, inferior vena cava, iliac vessels, segmental lumbar arteries). Results: Forty-eight patients were evaluated, with a mean age of 60 years (±8 years, 41-75), of whom 52% were male and 48% female. The measurements obtained between the pre-vertebral vessels and the possible screw exit points did not demonstrate contact in any of the vertebrae studied. Conclusions: The measurements obtained suggest the safety of using the cortical path screw transfixing the second cortical bone. Knowing the position of the vessels is essential to reduce intra- and postoperative complications related to spinal instrumentation. Level of evidence III; Study of non-consecutive patients.
RESUMO Introdução: Este trabalho objetiva avaliar a segurança do uso do parafuso de trajeto cortical com transfixação da segunda cortical óssea com relação às estruturas vasculares. Métodos: Estudo observacional retrospectivo (nível de evidência: III, estudo de pacientes não consecutivos) analisou dados de prontuários de pacientes submetidos ao exame de angiotomografia computadorizada do abdome no Hospital Mater Dei, realizando a medida, em milímetros, entre o ponto da vértebra lombar considerado a referência anatômica para a transfixação da segunda cortical óssea e as estruturas vasculares adjacentes à coluna (aorta abdominal, veia cava inferior, vasos ilíacos, artérias lombares segmentares). Resultados: Foram avaliados 48 pacientes, com média de idade de 60 anos (±8 anos, 41-75), sendo 52% do sexo masculino e 48% do feminino. As medidas obtidas entre os vasos pré-vertebrais e os pontos possíveis de saída do parafuso não demonstraram contato, em todas as vértebras estudadas. Conclusões: As medidas obtidas sugerem a segurança do uso do parafuso de trajeto cortical transfixando a segunda cortical óssea. Conhecer a posição dos vasos é essencial para reduzir as complicações intra e pós-operatórias relacionadas à instrumentação da coluna vertebral. Nível de evidência III; Estudo de pacientes não consecutivos.
RESUMEN Introducción: Este estudio tiene como objetivo evaluar la seguridad del uso del tornillo de trayectoria cortical con transfijación de la segunda cortical ósea con respecto a las estructuras vasculares. Métodos: Estudio observacional retrospectivo (nivel de evidencia: III, estudio de pacientes no consecutivos) que analizó datos de registros médicos de pacientes sometidos a examen de angiografía por tomografía computarizada de abdomen en el Hospital Mater Dei, realizando la medición, en milímetros, entre el punto de la vértebra lumbar considerado la referencia anatómica para la transfijación de la segunda cortical ósea y las estructuras vasculares adyacentes a la columna (aorta abdominal, vena cava inferior, vasos ilíacos, arterias lumbares segmentarias). Resultados: Se evaluaron 48 pacientes, con una edad promedio de 60 años (±8 años, 41-75); 52% eran hombres y 48% mujeres. Las medidas obtenidas entre los vasos prevertebrales y los posibles puntos de salida del tornillo no demostraron contacto en todas las vértebras estudiadas. Conclusiones: Las medidas obtenidas sugieren la seguridad de utilizar el tornillo de trayectoria cortical transfijando la segunda cortical ósea. Conocer la posición de los vasos es fundamental para reducir las complicaciones intra y postoperatorias relacionadas con la instrumentación espinal. Nivel de evidencia III; Estudio de pacientes no consecutivos.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Fusão Vertebral , Procedimentos Ortopédicos , Circulação SanguíneaRESUMO
The quantitative ultrasound technique was used to evaluate bone-mimicking phantoms; however, these phantoms do not mimic the intermediate stages of cortical bone healing. We propose using windshield glass as an original material to produce phantoms that mimic the characteristics of three different stages of cortical bone healing. This material was processed via a route that included breaking, grinding, compacting, drying, and sintering in four temperature groups: 625 °C, 645 °C, 657 °C, and 663 °C. The parameters evaluated were the ultrasonic longitudinal phase velocity (cL), corrected (αc) ultrasonic attenuation coefficient, and bulk density (ρs). The results showed that the mean values ofcL,αc,andρsvaried from 2, 398 to 4, 406 m·s-1, 3 to 10 dB·cm-1, and 1, 563 to 2, 089 kg·m-3, respectively. The phantoms exhibited properties comparable with the three stages of cortical bone healing and can be employed in diagnostic and therapeutic studies using ultrasound.
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Ultrassom , Osso Cortical/diagnóstico por imagem , Imagens de Fantasmas , UltrassonografiaRESUMO
BACKGROUND: The effects of swimming training associated with insulin treatment on the cortical bone health in young rats with severe type 1 diabetes remain unclear, although there is evidence of such effects on the cancellous bone. This study examined the effects of swimming training combined with insulin therapy on the femoral midshaft structural and mechanical properties in growing rats with type 1 diabetes. METHODS: Male Wistar rats were divided into six groups (n = 10): control sedentary, control exercise, diabetic sedentary, diabetic exercise, diabetic sedentary plus insulin and diabetic exercise plus insulin. Diabetic rats received an injection (60 mg/kg body weight) of streptozotocin (STZ). Exercised animals underwent a swimming program for eight weeks. RESULTS: Diabetes induced by STZ decreased the bone mineral content (BMC) and density (BMD), and cortical thickness and maximum load and tenacity in the femoral midshaft. Insulin treatment partially counteracted the damages induced by diabetes on BMC, BMD and cortical thickness and tenacity. Swimming training did not affect the femoral structural and mechanical properties in diabetic rats. The combination of treatments did not potentiate the insulin effects. In conclusion, swimming training does not affect the benefits of insulin treatment on the femoral midshaft structural and mechanical properties in growing rats with severe type 1 diabetes.
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Abstract Aiming to evaluate cortical bone microarchitecture and osteonal morphology after irradiation, twelve male New Zealand rabbits were used. The animals were divided: control group (no radiation-NIr); and 3 irradiated groups, sacrificed after: 7 (Ir7d); 14 (Ir14d) and 21 (Ir21d) days. A single radiation dose of 30 Gy was used. Computed microtomography analyzed the cortical microarchitecture: cortical thickness (CtTh), bone volume (BV), total porosity (Ct.Po), intracortical porosity (CtPo-cl), channel/pore number (Po.N), fractal dimension (FD) and degree of anisotropy (Ct.DA). After scan, osteonal morphology was histologically assessed by means: area and perimeter of the osteons (O.Ar; O.p) and of the Haversian canals (C.Ar; C.p). Microtomographic analysis were performed by ANOVA, followed by Tukey and Dunnet tests. Osteon morphology analyses were performed by Kruskal-Wallis, and test Dunn's. Cortical thickness was significant difference (p<0.010) between the NIr and irradiated groups, with thicker cortex at Ir7d (1.15±0.09). The intracortical porosity revealed significant difference (p<0.001) between irradiated groups and NIr, with lower value for Ir7d (0.29±0.09). Bone volume was lower in Ir14d compared to control. Area and perimeter of the osteons were statistically different (p<0.0001) between NIr and Ir7d. Haversian canals also revealed lower values (p<0.0001) in Ir7d (80.57±9.3; 31.63±6.5) compared to NIr and irradiated groups. Cortical microarchitecture was affected by radiation, and the effects appear to be time-dependent, mostly regarding the osteons morphology at the initial days. Cortex structure in Ir21d revealed similarities to control suggesting that microarchitecture resembles normal condition after a period.
Resumo Com o objetivo de avaliar a microarquitetura óssea cortical e a morfologia dos osteons após irradiação, foram utilizados doze coelhos machos da Nova Zelândia. Os animais foram divididos: grupo controle (sem radiação-NIr); e 3 grupos irradiados, sacrificados após: 7 (Ir7d); 14 (Ir14d) e 21 (Ir21d) dias. Foi utilizada uma dose única de radiação de 30 Gy. A microtomografia computadorizada analisou a microarquitetura cortical: espessura cortical (CtTh), volume ósseo (BV), porosidade total (Ct.Po), porosidade intracortical (CtPo-cl), número de canal/ poro (Po.N), dimensão fractal (DF) e grau de anisotropia (Ct.DA). Após a varredura, a morfologia dos osteosn foi avaliada histologicamente por meio de: Área e perímetro do osteon (O.Ar; O.p) e dos canais de Havers (C.Ar; C.p). A análise microtomográfica foi realizada por ANOVA, seguida pelos testes de Tukey e Dunnet. As análises morfológicas do osteon foram realizadas por Kruskal-Wallis e testadas por Dunn. A espessura cortical foi diferente (p<0,010) entre os grupos controle e irradiados, com córtex mais espesso no Ir7d (1,15±0,09). A porosidade intracortical revelou diferenças significativas (p<0,001) entre os grupos irradiados e o controle, com menor valor para Ir7d (0,29±0,09). O volume ósseo foi menor no Ir14d em relação ao controle. Área e perímetro do osteon foi diferente (p<0,0001) entre o controle e Ir7d. Os canais haversianos também revelaram valores mais baixos (p<0,0001) em Ir7d (80.57±9.3; 31.63±6.5) em relação ao controle e demais grupos irradiados. A microarquitetura cortical é afetada pela radiação e os efeitos parecem ser dependentes do tempo, principalmente em relação à morfologia dos osteons nos dias iniciais. A estrutura cortical em Ir21d revelou semelhanças com o controle, sugerindo que a microarquitetura se assemelha à condição normal após um período.
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Animais , Masculino , Coelhos , Osso Cortical/diagnóstico por imagem , Ósteon , Osso e Ossos , Porosidade , FractaisRESUMO
Introduction: Distal clavicle fractures represent 12%-26% of all clavicle fractures. For unstable cases, surgical fixation is the preferred method of treatment. To date, there is still controversy regarding the best fixation method with a high reoperation and complication rate reported. The purpose of this article is to describe a minimally invasive method for reduction and stabilization of displaced distal clavicle fractures, using cortical buttons. Surgical technique: After standard preoperative preparation, a 3-cm incision is made at the coracoclavicular area. Using both coracoid and clavicle tunnels, fracture reduction and fixation is obtained using a cortical fixation button. Standard postoperative care is given. Results: A total of 21 patients (19 men) with a mean age of 34.7 years were treated using this technique. The follow-up was between 6 and 41 months, with an average of 23.4 months. The mean simple shoulder test score was 79.4 (range 66-91.7), and the QuickDASH score was 11 (range 6.8-15.9). Consolidation of the fracture was confirmed at the 12-week follow-up radiography, with no cases of nonunion or malunion identified. No patients presented infection or complications at the surgical site. Implant removal was not needed in this series. All the patients returned to work. Conclusion: Minimally invasive button fixation of unstable distal clavicle fractures is a safe and reliable alternative treatment. The initial outcome report is promising with excellent clinical and radiological results and no complications or implant removals.
RESUMO
A Osteogênese Imperfeita (OI) é uma doença genética rara, caracterizada por ossos frágeis com fraturas recorrentes. Na maioria dos casos a OI, é causada por mutações nos genes COL1A1 ou COL1A2 os quais codificam o colágeno tipo I. Mutações em novos genes envolvidos na via do metabolismo ósseo têm sido descobertas. A OI está associada a alterações dentárias e craniofaciais, sendo as mais prevalentes a dentinogênese imperfeita e a má oclusão. A literatura tem mostrado que é possível predizer o risco de fratura óssea ao analisarmos índices radiomorfométricos e dimensão fractal (DF) da mandíbula em radiografias panorâmicas. O objetivo desta pesquisa foi verificar se há diferenças no padrão de oclusão, na cortical e no trabeculado ósseo mandibular de indivíduos com OI quando comparados com indivíduos sem OI. Desse modo, a tese conta com a apresentação de dois artigos científicos. O primeiro artigo objetivou analisar dois índices radiomorfométricos, o índice cortical mandibular (ICM) e o índice mentual (IM), e a DF do trabeculado ósseo mandibular de indivíduos com OI e comparar com indivíduos sem OI. Foi realizado um estudo transversal, pareado por idade e sexo, com 20 indivíduos com OI e 40 sem OI. Os dados foram obtidos por meio de radiografias panorâmicas de pacientes com OI e sem OI atendidos na Faculdade de Odontologia da Universidade Federal de Minas Gerais. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG (protocolo 02470518.3.0000.5149). O teste t pareado (p <0,05) foi usado para comparar os valores de IM e DF. O teste do qui-quadrado (p <0,05) comparou o ICM entre os grupos. A média de idade de ambos os grupos foi 13,10 anos (± 6,57). O valor médio do IM foi de 2.08 (±0.79) no grupo de indivíduos com OI e 2.91 (±0.60) para indivíduos sem OI (p<0,001). O valor médio de DF do grupo OI [0.3248 (±0.7240)] foi inferior ao do grupo sem OI [0.3814 (±0.5587)] no côndilo mandibular (p=0,002). O grau C3 do ICM foi mais frequente entre os indivíduos com OI (p <0,001). Indivíduos com OI apresentaram valores menores nos IM e DF, além de pior morfologia da cortical mandibular. O segundo artigo, uma revisão sistemática e meta-análise (já publicada), objetivou avaliar se indivíduos com OI são mais afetados por má oclusão do que indivíduos normotípicos. Foi realizada uma busca nas principais bases. A avaliação do risco de viés e a análise da força de evidência foram conduzidas. Em comparação com indivíduos sem OI, o grupo com OI teve 19,69 vezes mais chance de apresentar má oclusão de Classe III de Angle (OR = 19,69, IC: 9,0043,09) e apresentar maior mordida cruzada anterior (MD = 6,08, CI: 2,409,77). Indivíduos sem OI tiveram um ângulo ANB (MD= 3,88, IC: 1,156,61) e ângulo SNA (MD = 2,11, IC: 0,243,98) significativamente maiores em comparação com indivíduos com OI. Nenhuma diferença entre os grupos foi encontrada para SNB (MD = −0,50, IC: −2,21 a 1,21) e mordida aberta (MD = 0,98, IC: −0,29 a 2,25). A maioria dos estudos incluídos teve qualidade metodológica moderada. A força da evidência foi baixa ou muito baixa. A ocorrência de má oclusão Classe III de Angle e mordida cruzada anterior foi maior entre os indivíduos com OI em comparação com aqueles sem OI.
Osteogenesis Imperfecta (OI) is a rare genetic disease characterized by fragile bones with recurrent fractures. In most cases, OI is caused by mutations in the COL1A1 or COL1A2 genes which encode type I collagen. Mutations in new genes involved in the bone metabolism pathway have been discovered. OI is associated with dental and craniofacial alterations, the most prevalent being dentinogenesis imperfecta and malocclusion. The literature has shown that it is possible to predict the risk of bone fracture when analyzing radiomorphometric indices and fractal dimension (FD) of the mandible in panoramic radiographs. The objective of this research was to verify if there are differences in the occlusion pattern, in the cortical and in the mandibular bone trabeculate of individuals with OI when compared to individuals without OI. Thus, the thesis has the presentation of two scientific articles. The first article aimed to analyze two radiomorphometric indices, the mandibular cortical index (MCI) and the mentual index (MI), and the FD of the mandibular bone trabeculate of individuals with OI and compare with individuals without OI. A cross-sectional study, matched by age and sex, was carried out with 20 individuals with OI and 40 without OI. Data were obtained through panoramic radiographs of patients with OI and without OI treated at the Faculty of Dentistry of the Federal University of Minas Gerais. The study was approved by the Research Ethics Committee at UFMG (protocol 02470518.3.0000.5149). Paired t-test (p < 0.05) was used to compare MI and DF values. The chi-square test (p < 0.05) compared the ICM between groups. The mean age of both groups was 13.10 years (± 6.57). The mean value of MI was 2.08 (±0.79) in the group of individuals with OI and 2.91 (±0.60) for individuals without OI (p<0.001). The mean FD value of the OI group [0.3248 (±0.7240)] was lower than that of the group without OI [0.3814 (±0.5587)] in the mandibular condyle (p=0.002). ICM grade C3 was more frequent among individuals with OI (p<0.001). Individuals with OI had lower MI and DF values, in addition to worse mandibular cortical morphology. The second article, a systematic review and meta-analysis (already published), aimed to assess whether individuals with OI are more affected by malocclusion than normotypic individuals. A search was carried out in the main bases. Risk of bias assessment and strength of evidence analysis were conducted. Compared with individuals without OI, the group with OI was 19.69 times more likely to have Angle Class III malocclusion (OR = 19.69, CI: 9.00 43.09) and to have greater anterior crossbite (MD = 6.08, CI: 2.409.77). Subjects without OI had a significantly greater ANB angle (MD= 3.88, CI: 1.156.61) and SNA angle (MD= 2.11, CI: 0.243.98) compared to subjects with hi. No difference between groups was found for SNB (MD = −0.50, CI: −2.21 to 1.21) and open bite (MD = 0.98, CI: −0.29 to 2.25). Most of the included studies were of moderate methodological quality. The strength of the evidence was low or very low. The occurrence of Angle Class III malocclusion and anterior crossbite was higher among individuals with OI compared to those without OI.
Assuntos
Osteogênese Imperfeita , Radiografia Panorâmica , Osso Esponjoso , Osso Cortical , Má OclusãoRESUMO
Os inibidores de aromatase (IAs) são medicamentos mais comumente utilizados para tratamento para pacientes com câncer de mama. Os IAs atuam inibindo a enzima aromatase, que é responsável pela conversão de hormônios esteroidais. Vários estudos mostram a importância do estrógeno para a formação óssea. Acredita-se que a privação do estrógeno possa ter um efeito deletério no osso causando o aumento da reabsorção óssea, diminuição da densidade mineral óssea (DMO) e com isso o aumento do risco de osteoporose e fraturas. A osteoporose é uma doença sistêmica multifatorial caracterizada pela redução da massa óssea e desorganização estrutural do tecido ósseo. O diagnóstico da osteoporose é baseado em critérios densitométricos da Organização Mundial de Saúde (OMS) com referência na classificação do T-score, realizada pela técnica de absorciometria de energia dupla de raios X (DXA), cujo valor avalia a DMO. Por se tratar de uma doença sistêmica, a osteoporose também afeta os ossos maxilares. Desta forma, o trabalho tem como objetivo avaliar parâmetros imaginológicos em pacientes mulheres que fazem tratamento com; IAs e encaminhadas para investigação de perda de massa óssea em um hospital de referência no tratamento dessas pacientes. Foram avaliadas 40 mulheres sob terapia com IAs. Foram avaliados índices radiomorfométricos (IR) de tomografia computadorizada de feixe cônico (TCFC) e análise fractal (AF) para algumas regiões de interesse (RI), espessura da cortical mandibular (ECM) e índice cortical mandibular (ICM) em radiografias panorâmicas digitais (RPD). Todas as pacientes foram submetidas ao exame DXA para avaliar a condição de DMO e divididas nos grupos: normal e baixa DMO. Para cada IR e para as RI da dimensão fractal, foram estabelecidas a curva característica de operação do receptor (ROC), a área sob a curva (AUC), a sensibilidade e a especificidade com seus receptivos intervalos de confiança. Os valores de AUC para os índices de RPD variaram de 52,6%-75,8%. O índice com a maior AUC foi a ECM, apresentando sensibilidade de 38,1%-100,0% e especificidade de 36,8%-84,2%. Para a AF, a RI do trabeculado total teve a maior sensibilidade, enquanto a RI anterior ao forame mentual teve a maior especificidade. Na análise da TCFC, os valores de AUC variaram de 51,8%-62,0%. Os índices com a AUC mais elevada foram o índice molar (M), com sensibilidade 18,1%-61,6% e especificidade de 66,9%-98,7% e o índice anterior (A) com sensibidade de 25,7%- 70,2% e especificidade de 48,8%-90,9%. O índice da sínfise (S) apresentou a maior sensibilidade e o índice posterior (P) apreentou a maior especificidade. Os índices de tomografia computadorizada inferior (ITC I) apresentou sensibilidade e especificidade razoáveis. Assim a ECM, a AF das RI do ângulo da mandíbula e do trabeculado total da RPD, bem como os índices ITC (I), M, P e A na TCFC mostraram-se úteis para identificar mulheres na pós-menopausa que usavam AI com baixa DMO.
Aromatase inhibitors (AIs) are the most commonly used drugs to treat breast cancer patients. AIs work by inhibiting the aromatase enzyme, which is responsible for converting steroid hormones. Several studies show the importance of estrogen for bone formation. It is believed that estrogen deprivation can have a deleterious effect on bone, causing increased bone resorption, decreased bone mineral density (BMD) and thus an increased risk of osteoporosis and fractures. Osteoporosis is a multifactorial systemic disease characterized by reduced bone mass and structural disorganization of bone tissue. The diagnosis of osteoporosis is based on densitometric criteria of the World Health Organization (WHO) with reference to the T- score classification, performed by the dual energy X-ray absorptiometry (DXA) technique, whose value assesses the BMD. As it is a systemic disease, osteoporosis also affects the maxillary bones. Thus, the study aims to evaluate imaging parameters in female patients undergoing treatment with AIs and referred for investigation of bone mass loss in a reference hospital in the treatment of these patients. Forty women undergoing therapy with AIs were evaluated. Radiomorphometric indices (RI) of cone beam computed tomography (CBCT) and fractal dimension (FD) were evaluated for some regions of interest (ROI), mandibular cortical width (MCW) and mandibular cortical index (MCI) in digital panoramic radiographs (DPR). All patients underwent the DXA exam to assess the status of BMD and divided into groups: normal and low BMD. The AUC values for the DPR indices ranged from 52.6%-75.8%. The index with the highest AUC was the mandibular cortical width ([MCW]; sensitivity: 38.1%-100.0%; specificity: 36.8%-84.2%). For FD, the total trabecular index had the greatest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT analysis, the values of AUC ranged from 51.8%-62.0%. The indices with the highest AUC were the molar index (M, sensitivity: 18.1%-61.6% and specificity: 66.9%-98.7%) and anterior (A, sensitivity: 25.7%-70.2% and specificity 48.8%-90.9%). The symphysis (S) index had the highest sensitivity, and the posterior (P) index presented the highest specificity. Sensitivity and specificity reasonable were obtained to computed tomography index (Inferior) [CTI (I)]. The MCW, FD of ROI of the mandible angle and total mandibular in the DPR, as well as the CTI (I), M, P, and A indices in the CBCT are useful to identify postmenopausal women who were using AI with low BMD.
Assuntos
Osteogênese , Osteoporose , Densidade Óssea , Inibidores da Aromatase , Estrogênios , Radiografia Panorâmica , Tomografia Computadorizada de Feixe Cônico , Osso Esponjoso , Osso CorticalRESUMO
OBJECTIVE: The purpose of this study was to analyze the morphometric effects of mechanical vibration with a duration of 4 or 8 weeks on the femur of oophorectomized Wistar rats. METHODS: Sixty-four female rats were submitted to oophorectomy or a sham operation, and each of those 2 groups were randomized into 4 groups: untreated and euthanized at week 12, untreated and euthanized at week 16, treated for 4 weeks and euthanized at week 12, and treated for 8 weeks and euthanized at week 16. The vibration treatment was performed for 10 min/d, with a frequency of 60 Hz, 3 d/wk. The rats were then euthanized and the right femur dissected. Subsequently, histomorphometric analysis was performed on the proximal epiphysis and diaphysis of the spongy and cortical bone, respectively. RESULTS: As expected, the oophorectomy groups presented reduction of spongy and cortical bone tissue. Further, the vibration therapy of 4 and 8 weeks' duration in the oophorectomized groups led to increased bone mass, observed as an increased percentage of spongy tissue, and increased thickness and percentage of cortical tissue. However, the variables of femoral neck diameter, mean area of the shaft, and number of osteocytes were not altered by oophorectomy and vibration. CONCLUSION: The mechanical vibration was effective in increasing the bone mass of the femur of oophorectomized Wistar rats, observed by increasing the percentage of spongy bone and increasing the percentage and thickness of cortical bone.
Assuntos
Fenômenos Biomecânicos/fisiologia , Osso e Ossos/fisiologia , Exercício Físico/fisiologia , Osteoporose Pós-Menopausa/prevenção & controle , Vibração/uso terapêutico , Animais , Densidade Óssea , Feminino , Fêmur/fisiologia , Humanos , Distribuição Aleatória , Ratos , Ratos WistarRESUMO
Flame retardants (FRs) are used in a variety of common items from furniture to carpet to electronics to reduce flammability and combustion, but the potential toxicity of these compounds is raising health concerns globally. Organophosphate FRs (OPFRs) are becoming more prevalent as older, brominated FRs are phased out, but the toxicity of these compounds, and the FR mixtures that contain them, is poorly understood. Work in a variety of in vitro model systems has suggested that FRs may induce metabolic reprogramming such that bone density is compromised at the expense of increasing adiposity. To address this hypothesis, the present studies maternally exposed Wistar rat dams orally across gestation and lactation to 1000 µg daily of the FR mixture Firemaster 550 (FM 550) which contains a mixture of brominated FRs and OPFRs. At six months of age, the offspring of both sexes were examined for evidence of compromised bone composition. Bone density, composition, and marrow were all significantly affected, but only in males. The fact that the phenotype was observed months after exposure suggests that FM 550 altered some fundamental aspect of mesenchymal stem cell reprogramming. The severity of the phenotype and the human-relevance of the dose employed, affirm this is an adverse outcome meriting further exploration.
Assuntos
Osso e Ossos/efeitos dos fármacos , Retardadores de Chama/efeitos adversos , Organofosfatos/efeitos adversos , Bifenil Polibromatos/efeitos adversos , Animais , Reprogramação Celular/efeitos dos fármacos , Poeira/análise , Monitoramento Ambiental/métodos , Feminino , Halogenação/efeitos dos fármacos , Lactação/efeitos dos fármacos , Masculino , Células-Tronco Mesenquimais/efeitos dos fármacos , Ratos , Ratos WistarRESUMO
BACKGROUND: Vascular calcification progression has been associated with the loss of trabecular bone in chronic kidney disease (CKD) patients. There are few data evaluating the relationship between cortical bone loss and vascular calcification in this population. The aim of this study was to prospectively evaluate the association between changes in cortical bone density and coronary artery calcification (CAC) progression in non-dialyzed CKD patients. METHODS: Changes of cortical and trabecular bone, and changes of calcium score, were analyzed using vertebral tomographic images from a prospective study. Automatic delineation of the cortical bone layer was performed by Image J software, and trabecular bone was determined by selecting a region of interest using Vitrea 2® software. Cortical and trabecular bone density (BD) were expressed in Hounsfield Units (HU), and coronary artery calcium score in Agatston Units (AU). RESULTS: Seventy asymptomatic patients [57.8 ± 10.2 years, 63% males, 20% diabetic, estimated glomerular filtration rate (eGFR) = 37.3 (24.8-51.3) mL/min/1.73m2] were followed for 24 months. The mean cortical and trabecular BD did not change over time. While 49 patients lost either bone, 29 (41%) patients lost cortical [- 4.4%/year (ranging from - 7.15 to - 0.5)] and 39 (56%) lost trabecular bone [- 3.15%/year (- 13.7 to - 0.25)]. There was no association between cortical and trabecular BD changes (p = 0.12). CAC was observed in 33 (46%) patients at baseline, and 30 (91%) of them showed CAC progression. While an inverse correlation between trabecular bone and calcium score changes was observed (p = 0.001), there was no correlation between cortical bone and calcium score changes (p = 0.34). CONCLUSION: CKD patients experience either cortical or trabecular bone loss over time, but these changes do not take place simultaneously in all patients. Cortical, unlike trabecular bone loss, is not associated with vascular calcification progression in these patients.
Assuntos
Desmineralização Patológica Óssea , Osso Esponjoso , Insuficiência Renal Crônica/complicações , Calcificação Vascular/diagnóstico , Doenças Assintomáticas , Desmineralização Patológica Óssea/diagnóstico , Desmineralização Patológica Óssea/etiologia , Densidade Óssea , Brasil/epidemiologia , Osso Esponjoso/irrigação sanguínea , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/patologia , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/metabolismo , Tomografia Computadorizada por Raios X/métodos , Calcificação Vascular/epidemiologiaRESUMO
OBJECTIVES: To describe the effects of cemento-osseous dysplasia (COD) on anatomical structures. METHODS: CBCT scans were retrospectively selected from a database of individuals who attended an Oral Medicine service. Cases with a confirmed diagnosis of periapical, focal, or florid COD were included. Two oral and maxillofacial radiologists assessed the scans. Frequencies of the variables were described according to COD case, lesion areas, and teeth. RESULTS: Sixty COD cases affected 244 areas and 426 teeth. Florid COD was the most common (n = 48). Cortical bone (buccal, lingual, palatine, or mandibular) (n = 42) and the maxillary sinus (n = 13) were the structures most frequently affected by displacement or perforation. Thinning (n = 80), expansion (n = 62), and perforation (n = 60) of the cortical bone were common effects. The median size of the lesions was 12 mm in the mesiodistal direction, 8 mm in the buccal-lingual/palatal direction, and 9 mm in the superior-inferior direction. Root resorption was observed in 18.1% of all teeth, while tooth displacement was uncommon (0.6%). All teeth affected by COD had a discontinuous lamina dura and non-uniformly visible periodontal ligament space. CONCLUSIONS: CBCT images revealed that cortical bone, lamina dura, and periodontal ligament space were the structures most affected by COD and the effects of COD on anatomical structures were more frequent than previously described. CLINICAL RELEVANCE: CODs are fibro-osseous lesions common in the clinical practice, and relationship with anatomical structures is poorly described. CBCT is an appropriate method for the diagnosis and follow-up of patients with COD.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Tumores Odontogênicos , Brasil , Diagnóstico Diferencial , Humanos , Tumores Odontogênicos/diagnóstico por imagem , Estudos RetrospectivosRESUMO
OBJECTIVES: To assess the prevalence of dental implant-related perforations of relevant anatomical structures and inadequate spacing between the implant and the adjacent tooth or implant, and their association with anatomical location, implant dimension, thread exposure, and presence of graft, using cone beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT scans of patients with implants were retrospectively assessed regarding the presence of implant-related perforation of adjacent anatomical structures, and inadequate mesial and distal spacing between the implant and the adjacent tooth/implant (i.e., < 1 mm or < 3 mm, respectively). Implants were classified according to anatomical location, dimensions, thread exposure, and the presence of graft (i.e., bone graft or bone substitutes). Prevalence of perforations and inadequate spacing was compared among the different implant classifications (Chi-squared test). Significance level was set at 5%. RESULTS: A total of 1109 implants were assessed, out of which 369 (33.3%) presented perforation of adjacent structures. Prevalence of perforations in the maxilla (43.5%) was higher than in the mandible (11.3%). Inadequate spacing was found in 18.2% of the mesial and distal measurements, which was more prevalent in the maxilla (p < 0.001). Implants perforating adjacent structures or placed with inadequate spacing presented higher prevalence of thread exposure (p < 0.001). No significant difference was found between the presence of perforations or inadequate spacing and presence of graft (p > 0.05). CONCLUSIONS: Implant-related perforations of relevant anatomical structures and inadequate spacing between the implant and the adjacent tooth/implant are relatively prevalent and more common in the maxilla. Both are associated with threads exposure. CLINICAL RELEVANCE: Information on dental implant-related perforations and inadequate spacing can assist dental surgeons in pre-surgical planning.