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INTRODUCTION: The study aims as a pilot study to evaluate the effect of different treatment regimen and different types of endodontic sealers on pain and periapical radiographic changes was studied. MATERIALS AND METHODS: Forty patients in need of an endodontic root canal treatment on anterior teeth were selected and divided into two groups (20 patients each), according to the endodontic treatment protocol (single or multiple visits). Then, each group was subdivided into two subgroups according to sealer used 10 each (AH Plus Jet resin sealer, Total Fill Bioceramic Sealer). To record pain intensity of the patients at different intervals: 1, 2, 3, 7 days, a visual analog scale was used. Furthermore, patients were recalled after 1, 3, 6, 9 months to evaluate periapical radiographic changes. RESULTS: Showed that as regard pain assessment both tested endodontic sealers, as well as single or multiple visits have no statistically significant difference between pain values of patients during all the observation period from immediately post-operative, after 4, 12, 24, 48, 72 h as well as after 7 days (p > 0.05). As regard lamina dura thickness, results showed that with both tested endodontic sealers as well as single or multiple visits, there was no statistically significant difference between lamina dura thickness of patients after 1 month, 3, 6 as well as after 9 months. CONCLUSIONS: Neither number of visits of endodontic treatment nor type of sealer used for obturation affects post-operative pain and thickness of lamina dura.

Objectives. The dental alveolus is lined by a thin cortical layer (“bundle bone”, “alveolar bone proper”, “cribriform plate”, “lamina dura”), that can impede access to the bone marrow and its vasculature. During unassisted socket healing, the alveolar bundle bone is gradually resorbed allowing tissue resources from the bone marrow to enter into the socket space. An optimized wound healing process, either during unassisted socket healing or during ridge preservation procedures, with autogenous bone and/or any bone/collagen substitute material, depends at least partly on an adequate vascularization of the socket space. This ensures sufficient recruitment of osteoblast and osteoclast precursor cells and facilitates fast bone regeneration and/or uneventful integration of the augmentation material. Methods. The present technical note describes an easy treatment step after tooth extraction aiming to improve socket healing with or without any ridge preservation procedure, by facilitating an increased blood inflow into the dental alveolus. Specifically, after tooth extraction the alveolar bundle bone is perforated several times – mainly in a palatally/lingually – by a small round bur (diameter < 1 mm) extending into the trabecular bone. Results and conclusions. By means of this relatively simple treatment step, an increased blood inflow into the alveolus is achieved after tooth extraction, which might enhance socket healing and corticalization of the entrance, and in turn result in a lower complication rate (e.g., dry socket), in an enhanced graft incorporation, and/or in a reduced loss of alveolar ridge volume.

Background Sagittal fractures of equine cheek teeth are commonly observed during oral examination. There are few reports on the apical and endodontic pathology associated with such fractures seen during computed tomographic (CT) examination. Objectives This study aimed to document the prevalence of CT changes indicative of apical disease in equine cheek teeth, which have suffered a sagittal fracture involving the clinical ± reserve crown. Study design This study is a retrospective case series. Methods CT examinations of equine heads with sagittal fractures of cheek teeth present were reviewed: 81 teeth from 49 horses were identified to have a sagittal cheek tooth fracture. The images were evaluated for apical pathology including gas (in the endodontic system and periapically), widened periodontal space, periapical sclerosis, apical clubbing, cementoma/hypercementosis, lamina dura loss, associated sinusitis and sinus mucosal swelling. An apical infection grading system was created to give each tooth a score. Hounsfield units were used to measure the density of the endodontic, apical and periapical regions. The fracture length ratio was recorded. Statistical analysis was performed using a generalised estimating equation to evaluate predictors of apical infection and associations between clinical signs and CT abnormalities. Results Eighty-seven sagittal fractures (56 buccal, 17 palatal/lingual and 14 midline) from 81 teeth were recorded (74 maxillary and 7 mandibular). Apical infection was diagnosed in 73% (37/51, P = .05) of buccal, 55% (6/11, P = .07) of palatal/lingual, 100% (13/13) of midline, 100% (6/6) of multiple fractures and 96% (23/24, P = .008) of fractures involving infundibula. There was no significant relationship between apical infection and the presence of clinical signs associated with dental pathology (P = .4). There was no significant association between fracture length ratio and apical infection (P = 1.0). Midline sagittal fractures were significantly associated with sinusitis when compared with all other maxillary fractures (odds ratio [OR] 5.92, 95% confidence interval [CI] 1.67-20.83, P = .006). Loss of the lamina dura was not significantly associated with apical infection (P = .5). Main limitations There is a maxillary cheek tooth bias in the data set and the subjective grading system. Conclusions A large proportion of fractured cheek teeth have evidence of apical infection on CT examination and therefore warrant treatment.

Dens invaginatus is a developmental deformation with varying anatomical features, caused by the envelopment of the enamel organ and/or the Hertwig’s epithelial root sheath within the tooth before calcification completes, increasing the vulnerability of pulpal and periodontal inflammation, posing challenges to treatment, and adequate healing. Cell rest of Malassez, remnants of enamel organ or root sheet may cause cystic lesion formations, also hinder the normal healing process and form a fibrous scar. Intraosseous fibrous scar is a result of incomplete wound healing after periradicular surgery which mimics an asymptomatic residual cyst clinically and radiographically. We herein report a case of a surgically managed an immature maxillary lateral incisor affected with Type II dens invaginatus associated with incomplete periradicular healing presented as intraosseous fibrous scar with a persistent well-defined radiolucency between the healthy trabecular bone. The regular clinical and radiographic follow-up records the asymptomatic endodontically treated dens invaginatus with an intact lamina dura and regular healing trabecular bone pattern. Its 4 years of post-operative evaluation has been presented. Features of this case, causes of such incomplete healing, diagnosis, treatment line, prognosis, and the dilemma of the clinician are discussed together with its probable implications.

Medication-related osteonecrosis of the jaws (MRONJ) is a rare and serious adverse effect of anti-resorptive and/or antiangiogenic therapy that can cause necrotic bone exposure in the oral cavity, which affects patients’ quality of life. The present study aimed to review literature regarding MRONJ with special focus on diagnostic and treatment. The databases PubMed, Scielo and Google Scholar were searched for reports regarding diagnostic and treatment of MRONJ. Even though this disorder shows poor response to treatment, there is an increase in cure rates when early diagnosed and treated. In this way, systematic dental follow-up of patients under anti-resorptive and/or antiangiogenic therapy is essential for the identification of signs and symptoms suggestive of MRONJ like pain, swelling or dental mobility. Radiographic and tomographic features like increase of bone density, bone sclerosis or osteolysis, persisting alveolar socket, periosteal neoformation, lamina dura widening and mandibular canal widening may indicate bone necrosis. Since there is no universally accepted treatment to cure MRONJ, the management involves symptom palliation and control of associated infection, and surgical excision of necrotic bone is recommended for more severe cases. Each case must be individually evaluated by a multidisciplinary team, allowing dental and medical discussion. The prevention of MRONJ by patients education, elimination of risk factors and oral health maintenance is still the most important measure in the management of these patients. A osteonecrose maxilar relacionada a medicamentos (MRONJ) é um raro e grave efeito adverso de terapia antirreabsortiva e/ou antiangiogênica que pode causar exposição de osso necrótico em cavidade bucal, o que implica na qualidade de vida dos pacientes. O presente trabalho teve por objetivo revisar a literatura sobre MRONJ enfatizando os critérios de diagnóstico e tratamento. As bases de dados PubMed, Scielo e Google scholar foram consultadas em busca de artigos que abordassem o tema. Embora apresente baixa resposta ao tratamento, o diagnóstico e tratamento precoce aumentam a chance de cura. Dessa forma, o acompanhamento odontológico sistemático de pacientes que estejam em terapia antirreabsortiva e/ou antiangiogênica é fundamental para a identificação de sinais ou sintomas sugestivos de MRONJ como dor, tumefação ou mobilidade dentária. Alterações radiográficas ou tomográficas como aumento da densidade óssea, esclerose óssea ou osteólise, persistência de alvéolo dentário, neoformação periosteal, espessamento da lâmina dura e estreitamento do canal mandibular podem ser indicativos da presença de necrose óssea. Como ainda não existe um tratamento universalmente aceito capaz de curar a MRONJ, a abordagem envolve paliação de sintomas e controle da infecção associada, reservando-se a remoção cirúrgica da área necrótica para casos mais graves. Salienta-se que cada caso deve ser avaliado individualmente por uma equipe multidisciplinar que permita a discussão entre a equipe de saúde bucal e equipe médica. A prevenção da MRONJ por meio da educação dos pacientes, eliminação dos fatores de risco e manutenção da saúde bucal constitui ainda a medida mais importante no manejo desses indivíduos.

Cribriform adenocarcinoma of minor salivary gland (CAMSG) is currently classified as a subtype of polymorphous adenocarcinoma. CAMSG differs from polymorphous adenocarcinoma in that it has a distinct histopathologic appearance and clinically CAMSG has higher rate of lymph node metastasis at initial presentation. Panoramic radiograph shows an ill-defined radiolucent lesion in the right maxilla that extends from the distal of maxillary right canine to the mesial of maxillary second molar. The lesion has invasive borders and causes destruction and loss of the lamina dura and periodontal ligament space in the mesial of the second molar and distal of the canine. The lesion has also invaded into the right maxillary sinus destroying the floor of sinus. CBCT images show a low attenuation lesion involving the right maxillary alveolar bone at the premolars and first molar area. This report describes the radiographic appearance of a case of CAMSG on panoramic radiograph, cone-beam computed tomography (CBCT), multi-detector computed tomography (MDCT) and on magnetic resonance imaging (MRI).

The central giant cell granuloma (CGCG) presents as a benign, painless, slow-growing swelling of the jaw. These lesions are reported more frequently in females and most often occur in the mandible. Radiographically, it presents as a distinct delineated bony pathology with a loss of lamina dura around teeth. There can be frequent signs of displacement of teeth and tooth germs. Currently, the usually followed surgical treatment of the CGCG ranges from simple curettage to en -bloc resection. The extensive resection of aggressive and larger lesions inevitably results in the loss of teeth and tooth germs, especially in younger patients. Since, calcitonin has a direct inhibiting effect on osteoclasts and is efficient in controlling diseases with increased osteoclast activity, such as Paget’s disease, and osteoclastic bone metastases, hence serve as a promising alternative. This paper presents the effectiveness and safety of Calcitonin nasal spray, in the management of a CGCG of the jaw, in an 8-year-old patient who was given calcitonin as first-line therapy. Keywords: Bony pathology, Calcitonin nasal spray, Central giant cell granuloma (CGCG), Enbloc resection, Management, Swellings of jaws.

Background/Purpose Due to the rarity of oral lymphoma (OL), we aimed to evaluate the clinical features of OL and discuss these findings in light of the literature. Methods English language literature (1980–2019) related to OL was searched in two electronic databases. Patients (2000–2019) diagnosed with OL were also selected from the database of the Oral Pathology Department in our institution. The clinical features, radiographic appearance, and histopathological diagnosis in these selected cases from publications and our institution were then analyzed. Results 607 cases of OL (15 in our institution and 592 from literature) in patients aged between 0 and 92 years (average, 51.8 years) with a male to female ratio of 1.6:1 were included. The most common diagnosis was diffuse large B-cell lymphoma (n = 205), followed by Burkitt lymphoma (n = 72) and T-cell lymphoma (n = 37). The most frequent site was the gingiva, followed by palate, maxilla, mandible, tongue and buccal mucosa. The most frequent symptoms were swelling, ulceration, paresthesia, mobile tooth and pain. Radiographic findings included ill-defined osteolytic lesion, thickening of the periodontal ligament, loss of lamina dura and tooth displacement. Conclusion Despite the rarity of extranodal lymphomas in oral cavity, their occurrence may be part of disseminated disease. Detailed history-taking, clinical and imaging examination and awareness of the patient's signs and symptoms are important for early diagnosis and an improved prognosis. The current data form a useful basis for clinical investigation and teaching regarding lymphoma occurring in the oral cavity.

Objective: this study aims to assess the rate of agreement between panoramic radiography (PR) and CBCT in evaluating the radiographic features of intraosseous lesions and detecting whether these differences had a significant impact on the accuracy of differential diagnoses. Methods: Twenty four (24) intraosseous biopsy-proven lesions were reviewed using PR and CBCT images by two oral and maxillofacial radiologists. Both observers answered eighteen questions for each case describing the lesions` radiographic criteria and listed two possible differential diagnoses for each case. Results: McNemar’s test was used for comparing the two modalities and for calculating the inter-observer agreement. The intra-observer agreement showed that questions 18 (cortical destruction) and 10 (expansion in the anatomical landmarks) had the lowest percentage of agreement between both observers. Furthermore, there was no statistically significant difference between the two modalities in terms of the agreement between differential diagnosis and final diagnosis (P > 0.05). Conclusions: Both PR and CBCT provide similar agreement in describing the lesion location, epicenter, internal structure. Moreover, similar agreement was also observed regarding the effect of the lesion on the teeth including resorption, impaction and displacement, root resorption, lamina dura, and periodontal membrane space of the teeth. The main disagreement between the two modalities was found in the expansion of the normal surrounding anatomic boundaries, and cortical destruction.

The management of an immature permanent tooth protocol aims to eliminate pulpal pathology, disinfection, and if possible, redevelopment of the root. The paper aimed to present a case report that a successful survival history of a seemingly inadequate mineral trioxide aggregate plug and its 8-year follow-up. In the presented case, all treatment goals such as the elimination of clinical symptoms/signs of infection, apical periodontitis healing, healthy lamina dura, and further root maturation were achieved; however, a formation was observed in an 8-year recall similar to regeneration-associated intracanal calcification. There was no way to clinically understand how the healing process occurred in the area histologically, but the follow-up showed that the relevant tooth met the healing criteria.

Panoramic imaging is the most widely requested radiographic technique in dentistry. In orthodontics, the clinical and radiographic examinations are routinely carried out along with dental and skeletal photographs as a part of diagnosis and treatment planning. The evaluation of radiographs of patients after orthodontic treatment is important in understanding the possible changes that tend to occur post-treatment. This study aims to analyze the incidental findings present in the radiographs of patients who previously underwent orthodontic treatment. A total of 30 patients (18 females; 12 male) were randomly selected from the Orthodontic clinic at the Department of Orthodontics, Saveetha Dental College and Hospital, Chennai. Two independent examiners analyzed the panoramic radiographs for anomalies and pathologies. The result showed the most common finding, which was periodontal pathology (Generalised bone loss, widening of periodontal ligament space, or both, loss of lamina dura) with a prevalence of 36.7%. All the patients taken into the study had at least one anomaly. In conclusion, the relevant findings were observed in all the radiographs & special care should be taken while evaluating them to diagnose alterations that may require other dental treatments.

Periapical lesion is the most common sequelae of pulp necrosis due to either carious involvement or trauma. Treatment options to manage periapical lesion with open apex ranges from non-surgical root canal treatment and/or apical surgery to extraction. Objective: clinicall and radiogrphicall evaluation of the effect of MTA and bioceramic root canal sealer to manage immature permenant teeth with open apex. Methodology: The study was composed of sixty teeth from 54 children with age ranged from seven to ten years old age. Children were divided in to two equal groups: 1-Group A:Teeth were received apexification with MTA 2-Group B:Teeth were received apexification with bioceramic root canal sealer. All patients were followed clinically and radiographically immediate postoperatively, 3 and 6 months. Results: The success rate in both bioceramic and MTA was 93.3% and 90% respectively with no statistical significant difference. After 6 months, all teeth shows normal lamina dura among both bio ceramic and MTA groups. While, reduced radiolucences and obvious healing of bone detected among 93.3% and 90% of tooth among bio ceramic and MTA groups respectively. Conclusions: Both MTA and bioceramic sealer show good results

The main aim is to identify, by means of different imaging modalities, the early bone changes in patients “at risk” and in stage 0 MRONJ. A search of the literature was performed on PubMed, Embase, Web of Science, and Cochrane Library databases, until June 9, 2020. No language or year restrictions were applied. Screening of the articles, data collection, and qualitative analysis was done. The Newcastle-Ottawa Scale (NOS) was used for observational studies, and the Systematic Review Centre for Laboratory Animal Experimentation’s (SYRCLE) risk of bias tool for the animal studies. A total of 1188 articles were found, from which 47 were considered eligible, whereas 42 were suitable for the qualitative analysis. They correspond to 39 human studies and 8 animal studies. Radiographic findings such as bone sclerosis, osteolytic areas, thickening of lamina dura, persisting alveolar socket, periapical radiolucency, thicker mandibular cortex, widening of the periodontal ligament space, periodontal bone loss, and enhancement of the mandibular canal were identified as early bone changes due to antiresorptive therapy. All those findings were also reported later in Stage 0 patients. The main limitations of these results are the lack of prospective data and comparisons groups; therefore, careful interpretation should be made. It is a fact that radiographic findings are present in antiresorptive-treated patients, but the precise timepoint of occurrence, their relation to the posology, and potential risk to develop MRONJ are not clear. The importance of a baseline radiographic diagnosis for antiresorptive-treated patients.

Lateral periodontal cysts (LPCs) are odontogenic cysts with rare occurrence and developmental origin. A 46-year old female patient, chronic smoker with non-contributory medical history presented with dull pain/pressure in the left mandibular premolar region and the associated teeth were vital on pulp testing. Periapical radiograph revealed a well- circumscribed, radiolucent region measuring

Aim: Ludwig's angina is a rare aggressive infection, often of dental origin, characterized by a rapid spread of cellulitis in the submandibular and sublingual spaces. Ludwig's angina is potentially fatal, if it obstructs the airways and if it is not treated with appropriate antibiotic therapy. Summary: The case report describes the diagnosis and the management of a Ludwig's angina caused by an endodontic infection in a 16 years-old female patient. The infection has been caused by a decay of the second lower right molar. After hospitalization and systemic antibiotic therapy, in accordance with the patient and the parents endodontic and restorative treatments of the tooth were performed. After 3 and 5 years, the radiological examination revealed no periapical lesions around right lower second molar and the presence of lamina dura. Key learning points: This aggressive infection may often be undervalued and this may cause dangerous consequences to the patient's life. The infection can be prevented by periodic dental care and interventions, which can avoid odontogenic infections. In the case of Ludwig's angina, early diagnosis is fundamental to save the patient's life. After the initial antibiotic therapy and once the life of the patient is no longer at risk, an appropriate endodontic therapy can be considered a valid therapy for this disease. Riassunto: Obiettivi: L’angina di Ludwig è un’infezione aggressiva, spesso di origine odontogena, caratterizzata da una raccolta cellulitica a rapida evoluzione che coinvolge gli spazi sotto-mandibolare e sotto-linguale. Essa può ostruire le vie respiratorie ed essere potenzialmente fatale se non tempestivamente trattata con cure antibiotiche appropriate. Riassunto: In questo articolo viene descritto un caso di diagnosi e trattamento di un’angina di Ludwig causata da un’infezione odontogena in una ragazza di 16 anni. L’infezione é stata causata da una carie a carico del secondo molare inferiore di destra. Dopo il ricovero ospedaliero ed una terapia antibiotica sistemica parenterale, con il consenso dei genitori abbiamo è stata eseguita una terapia endodontica e la successiva ricostruzione con materiali adesivi dell’elemento dentario in questione. Dopo 3 e 5 anni gli esami radiografici mostrano assenza di lesioni periapicali e la presenza della lamina dura. Punti chiave di apprendimento: Questa infezione aggressiva è spesso sottovalutata e ciò può causare conseguenze gravi per la vita del paziente. Tali infezioni possono essere prevenute con controlli periodici del cavo orale. In caso di angina di Ludwig una diagnosi tempestiva è fondamentale per salvare la vita del paziente. Dopo l’iniziale terapia antibiotica ed aver messo in sicurezza la salute generale del paziente, la terapia endodontica può essere considerata una valida alternativa per questa patologia. Keywords: Ludwig's angina, Endodontic therapy, Endodontic infection, CBCT, Management infection, Parole chiave: Angina di Ludwig, Terapia endodontica, Infezione endodontica, CBCT, Gestione dell’infezione

Purpose Chitosan has been shown to promote wound healing and induce bone formation. The aim of this split-mouth study was to evaluate the effectiveness of chitosan based dressing in wound healing after lower third molar extraction. Method Asymptomatic symmetrical mandibular third molars were extracted simultaneously in 27 patients and Chitosan dressing was placed into the extraction socket in the test side. Pain scores were recorded on VAS using a 0 to 10 pain score. Wound healing was compared between right and left side. Radiographic findings were evaluated by observing lamina dura and density of extraction socket. Results Test group had more pain than control at all time intervals and unerupted tooth sites showed mean pain score significantly more than erupted tooth sites. Test group was superior to control in event of wound healing. Healing was significantly better in erupted tooth than unerupted tooth. At second week 12 sites showed better radiographic findings in chitosan treated group compared to 3 sites in the control group. At third month, 14 sites showed improved bone formation in chitosan treated group compared to 4 in control group. None of the unerupted teeth group showed better radiographic finding in test side at 2 week and 3 month compared to erupted teeth group. Conclusion Chitosan is effective in promoting wound healing and early osteogenesis in erupted tooth socket after extraction. We recommend that chitosan dressing should be used in the sockets of erupted tooth after extraction but should be avoided in unerupted or impacted teeth cases.

Objective: To analyze the relationship between age, body mass index (BMI), bone mineral density (BMD), and alveolar bone resorption with menopause duration in postmenopausal women. Material and Methods: A cross-sectional study was developed involving 59 subjects, aged 45 to 80 years and categorized the duration of menopause as ≤5 years and >5 years. Body mass index measurement and menopause duration were collected. Bone loss seen on radiography was measured by drawing a vertical line from the cementoenamel in the distal part of the 36 teeth and the mesial portion of 46 teeth to the base of the bone marked by the lamina dura intact. Categorical determinations of age, BMI, BMD, and alveolar bone resorption were based on receiver operating characteristic (ROC) curves. Were used Pearson correlation and Spearman correlation tests with the significance level set at 5%. Results: The majority of subjects (54.2%) with menopause duration >5 years were aged >54.5 years, most had BMI >24.2 kg/m2 (39%), had bone resorption >2.95 mm (52.5%), and had bone density ≤73.89 (49.2%). Pearson and Spearman correlation tests showed no significant correlation between age, BMI, bone density, and alveolar bone resorption (p>0.05). Conclusion: The longer the duration of menopause showed a tendency for lower bone density and higher age, BMI, and bone resorption.

Introduction The endodontic treatment of apical periodontitis (AP) without surgical intervention presents a unique clinical challenge. This case series aimed to test the changes in size of periapical lesion scale and healing in post-treatment of AP by cone beam computed tomography (CBCT) using Waveobe Gold reciprocating file with single cone treatment approach. Presentation of cases A total of 20 patients with 20 teeth (9 M, six premolars, one canine, and four incisors) with AP underwent CBCT scanning before and after non-surgical root canal treatment (NSRCT) or non-surgical retreatment (NSReTx). Standardized root canal chemo-debridement and instrumentation with WaveOne Gold (WOG) reciprocating files was used. The canals were obturated using epoxy-based sealer (AH Plus) with a single WaveOne Gold conform fit gutta-percha cone technique. After one year, assessment with CBCT images showed that the success and healing rate using (AH Plus) with single cone technique was very high. Discussion Apical periodontitis is an inflammatory disease at the root end of teeth. Following NSRCT or NSReTx, evaluation of lesion size by radiograph has been essential to the evaluation of lesions post-operatively. In addition to the absence of symptoms, complete restitution of the lamina dura and periodontal ligament (PDL) space on post-operative radiograph has been considered the optimal outcome success. Conclusions Within the limitations of this study, NSRCT or NSReTx using reciprocating WaveOne Gold and single cone with AH plus sealer resulted in healing of AP as assessed by CBCT., Highlights • This case series report consider the first clinical trial assessing the outcome of Non-surgical root canal treatment on healing of apical periodontitis by CBCT in different tooth types with primary apical periodontitis without endodontic treatment and post apical periodontitis with inadequate apical filling. • Within the limitations of this study, NSRCT or NSReTx using reciprocating WaveOne Gold files and single cone with AH plus sealer resulted in healing of AP as assessed by CBCT.

Background: Osteonecrosis of the Jaw (ONJ) - related to Bisphosphonates (BPs), denosumab, and other drugs - is a bone disease, that should be evaluated not only on base of clinical features (bone exposure and other signs or symptoms) but also by imaging tools, mostly Computed Tomography (CT) or Cone Beam Computed Tomography (CBCT). An Italian proposal of definition and staging is based on extension of bone alterations at CT scan study. Some scarce literature suggests that ONJ cases observed after denosumab might have different characteristics at CT scan. Methods: We reviewed CT relevant images at ONJ sites of patients developing ONJ after denosumab treatment only, looking for presence of radiological alteration signs. “Early signs” included: cortical disruption; markedly thickened and sclerotic lamina dura; trabecular thickening; focal bone marrow sclerosis; persisting alveolar socket; sequestra formation; widening of periodontal ligament space. “Late signs” included: oro-antral fistula; pathologic fracture; prominence of the inferior alveolar nerve canal; osteolysis extending to the sinus floor; diffuse osteosclerosis; osteosclerosis of adjacent bones (zygoma; hard palate); periosteal reaction; sinusitis. Cases of patients receiving BPs and shifted to denosumab were excluded. The results were compared with similar data collected by CT scans of ONJ patients treated with zoledronic acid only. The ONJ stage according to Italian staging system (stage 1, focal ONJ; stage 2, diffuse ONJ; stage 3, complicated ONJ) was adopted in both the groups. Results: We evaluated CT scans of patients treated with denosumab, developing ONJ. After exclusion of patients shifted to denosumab after biphosphonates, 8 patients were found as receiving denosumab only and their CT scan findings were compared with those of 10 ONJ cases observed after zoledronic acid treatment, randomly selected in a database of 103 ONJ cases. Tha stage resulted more advanced in cases after zoledronic acid treatment. Preliminary analysis indicate that frequency of the single characteristics might be slightly different in the two patient populations; particularly diffuse osteosclerosis was less frequent in this little sample of patients receiving denosumab (2 out of 8 cases) in comparison with those ones receiving zoledronic acid (7 out of 10 cases). Conclusions: A large multicentre retrospective and prospective study is warranted and hopeful, aimed to clarify the differences on CT alterations in denosumab-related and BP-related ONJ cases.

Background. This study aimed to assess the prevalence of missed canals in endodontically treated teeth and their association with apical periodontitis in a Saudi Arabian population using CBCT. Materials and Methods. A total of 208 CBCT radiographs were investigated. For each tooth, radiographs of axial, coronal, and sagittal segments were acquired to appraise the external as well as the internal structure of the root canal system and apical area. In root canal-treated teeth, unfilled canals appearing from the cementoenamel junction to the apex were defined as missed untreated canals; and a periapical lesion was considered when disruption of the lamina dura was detected, and the low-density area associated with the radiographic apex was at least twice the width of the periodontal ligament space. The data were presented as frequencies and percentages. The Z-test was used to analyze the differences in proportions with the significance level set at P value

Objective Hypercalcemia is determined as an increase in the serum calcium level (above 10.5 mg/dL or ionized calcium is above 1.5 mmol/L). It was aimed to evaluate the effect of the increased serum calcium levels in dental panoramic radiographs with oral pathologies. Materials & Methods The final sample number of the present study was determined as 143. 61 patients with hypercalcemic calcium levels were grouped in Hypercalcemia Group (HPEG) whereas 82 patients were grouped in Normal Group. (NG) Measurements were performed only on the panoramic radiographs. The evaluated parameters were cyst-tumor or granuloma existence, sinus pneumatization, stylohyoid ligament calcifications, lamina dura loss, bone loss existence, etc. Statistical tests were carried out at p Results The cyst-tumor formation (p = 0.03) and stylohyoid ligament calcification (p = 0.009) and increased radiopacity (p = 0.03) were significantly more common in NG than the HPEG group. Alveolar bone loss (p = 0.001) and periodontal defects (p = 0.01) were significantly more common in HPEG than the NG group. There was no significant relationship between other examined parameters. (p > 0.05) Conclusion The serum calcium level revealed statistically significant outcomes and a close relationship with the pathologies occurring in the alveolar bone in the oral and maxillofacial region. However, it is highly recommended to include more patients in the newly planned studies and another bone-related biomarker should be evaluated simultaneously.

Internal root resorption is characterised by progressive loss of tooth substance initiating at the root canal wall as a result of clastic activity. This report describes a case of a perforating internal root resorption on a maxillary central incisor in a 25-year-old patient. The perforating internal root resorption was firstly diagnosed with periapical radiographs and assessed with full detail with the aid of CBCT, allowing determination of the extension and areas involved in the resorption lesion, as well as the treatment planning. According to these findings, a MTA barrier was performed on the root, -coronally to the resorption lesion, leaving the root apically to the resorption lesion untouched. Clinical findings and periapical radiographs indicated complete resolution of the radiolucency associated with the resorptive defect, with reestablishment of lamina dura along the root and occlusion of the lumen of the root canal in the apical segment, after a 5-year follow-up.

A simple bone cyst (SBC) is an intrabone cavity without epithelial lining, which occasionally occur with fibrous-osseous lesions. The imaging finding of the scalloped border and conserving the lamina dura, periodontal ligament spaces, or follicular spaces are considered radiographically pathognomonic of SBC. SBC has been reported to occur with fibrous-osseous lesions, including cemento-osseous dysplasia (COD). Computed tomography (CT) imaging findings are sparse, and there are no reports of magnetic resonance imaging (MRI) findings, including apparent diffusion coefficient (ADC) value calculated by diffusion-weighted MRI for the florid COD-associated SBC. We report a case of a 39-year-old woman who was referred to our hospital because a panoramic radiograph of her right mandible showed asymptomatic radiolucency in the apical molar area. CT images showed a low-density lesion in the periapical areas of the right mandible, which accompanied a well-defined, high-density lesion, and a mixed low/high-density lesion with an unusual marked irregular border in the left mandible. The MRI showed cyst-like extremely hyperintense signals on fat-suppressed T2-weighted images at the right mandibular low-density and the left mandibular mixed low/high-density areas. ADC map showed high values (over 2.5×10−3 mm2/s) at the cystic areas in the bilateral mandible. We performed incisional biopsies of the bilateral mandibular lesions and resections of the bilateral maxillary lesions. Surgical and histopathological findings established a diagnosis of florid COD in the bilateral mandible and maxilla, simultaneously complicated by multiple SBCs in the bilateral mandible. The ADC value of cystic component is useful for the diagnosis, if the COD-associated SBC exhibits solitary, nonspecific, or rare imaging findings.

Introduction: Teeth frequently fail to erupt and situations arise that prevent the canines from reaching the occlusal plane. Objective: Discourse about the three situations in which the canine does not reach the occlusal plane, and remains unerupted; and at the same time, point how to make a safe diagnosis of alveolodental ankylosis - one of the three causes -, based on tomography. Conclusions: Ankylosis occurs in impacted teeth by atrophy of the periodontal ligament, including the epithelial rests of Malassez. The tomographic signs of alveolodental ankylosis in unerupted canines are the interruption of hypodense periodontal space, discontinuity of the lamina dura and its continuity with the root surface, which gradually loses its regular shape. RESUMO Introdução: Muitas vezes, a erupção falha, e ocorrem situações que impedem que os caninos cheguem até o plano oclusal. Objetivos: Discorrer sobre quais as três situações nas quais o canino não chega até o plano oclusal, permanecendo não irrompido e, ao mesmo tempo, destacar como se diagnosticar com segurança uma dessas três causas, a anquilose alveolodentária, a partir da tomografia. Conclusões: A anquilose em dentes não irrompidos ocorre pela atrofia do ligamento periodontal, incluindo os Restos Epiteliais de Malassez. Os sinais tomográficos de uma anquilose alveolodentária em caninos não irrompidos são a interrupção do espaço periodontal hipodenso, a descontinuidade da lâmina dura e a sua continuidade com a superfície radicular, que, gradativamente, perde sua regularidade.

Chronic pulpal inflammation and infection are the main predisposing factors for internal and external root resorption (IRR & ERR); however, merging of IRR and ERR is a rare lesion which rigorously alters the anatomy of root canals. This study reports a case of merged IRR and ERR in an asymptomatic maxillary left central incisor in a 33-year old Caucasian woman that was managed by one-visit root canal therapy (RCT) using calcium-enriched mixture (CEM) cement. Radiographic examination showed a short root with under-filled root canal obturation associated with ERR/IRR and an apical lesion. After thorough chemo-mechanical preparation, the root canal was obturated with CEM cement; one week later, the access cavity was permanently restored. Clinical/radiographic examinations at 1-year follow-up revealed uneventful healing, reestablishment of lamina dura and stabilization of the resorptive defects. The treatment outcome demonstrates that one-visit RCT using CEM cement may be a viable treatment option in cases with merged external/internal root resorption. Further clinical trials with a larger number of cases are suggested to document a higher level of evidence.

BACKGROUND: The hyperparathyroidism (HPT) is a condition in which the parathyroid hormone (PTH) levels in the blood are increased. HPT is categorised into primary, secondary and tertiary. A rare entity that occurs in the lower jaw in association with HPT is the so-called brown tumour, which an osteolytic lesion is predominantly occurring in the lower jaw. It is usually a manifestation of the late stage of the disease. Osteosclerotic changes in other bones are almost always associated with renal osteodystrophy in secondary HPT and are extremely rare in primary HPT. This article reports a rare case of a brown tumour in the mandible as the first sign of a severe primary HPT, associated with osteosclerotic changes on the skull.CASE REPORT: A brown tumour in the mandible was diagnosed in 60 - year old female patient with no previous history of systemic disease. The x - rays showed radiolucent osteolytic lesion in the frontal area of the mandible affecting the lamina dura of the frontal teeth, and skull osteosclerosis in the form of salt and pepper sign. The blood analyses revealed increased values of PTH, calcitonin and β – cross-laps, indicating a primary HPT. The scintigraphy of the parathyroid glands showed a presence of adenoma in the left lower lobe. The tumour lesion was surgically removed together with the lower frontal teeth, and this was followed by total parathyroidectomy. The follow - up of one year did not reveal any signs of recurrence.CONCLUSION: It is critical to ensure that every osteolytic lesion in the maxillofacial region is examined thoroughly. Moreover, a proper and detailed systemic investigation should be performed. Patients should undergo regular check-ups to prevent late complications of HPT.

Lesions of non-endodontic origin may mimic periapical abscess. Osteosarcoma is a rare malignant lesion. Case report The present report describes a case of chondroblastic osteosarcoma in the periapical region of teeth #29, #30, and #31 of an 18-year-old male. Clinical history showed self-reported discomfort in the right posterior gingiva for over a month. Physical examination showed a small expansion and redness of the right mandibular buccal and lingual cortical plates, but no signs of pain or inflammation were observed. All the teeth responded positively to pulp sensibility. Periapical and panoramic radiographs showed slight periapical radiolucency in the roots of teeth #29 and #30, clear periodontal ligament space widening, and evident loss of lamina dura. Incisional biopsy was performed, and based on microscopic findings the diagnosis of chondroblastic osteosarcoma was confirmed. Conclusions Non-endodontic diseases associated with tooth root apex, such as chondroblastic osteosarcoma, should be included in differential diagnosis of jaw lesions that resemble periapical abscess.

AIM: To study the Prevalence of Apical Periodontitis in Type 2 Diabetic Patients METHODOLOGY: Total of 112 controlled type 2 diabetic patients were selected for the study. The age of patients was 50 to 65 years. Out of 112 patients, 60 patients were males and 52 patients were female. All patients underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. Periapical areas including periapical bone, periodontal ligament space and lamina dura, were examined in all individuals excluding 3rd molar. RESULTS: Out of 112 type 2 diabetic patients 87 patients were diagnosed with apical periodontitis. Out of 2800 examined teeth, 188 teeth were diagnosed with apical periodontitis and 2612 teeth were found to be not associated with apical periodontitis. Out of 2800 examined teeth, 6.71% teeth were found to be associted with apical periodontitis. CONCLUSION: Prevalence of apical periodontitis in type 2 diabetic patients is 77.68%.

Introduction: Root canal infection is a common consequence of dental caries which can cause premature loss in primary dentition. The exposure of pulp tissue to the oral environment allow oral microorganisms to access into the pulp chamber and lead to pulp necrosis without treatment. To identify bacteria associated with root canal infection would be beneficial and lead to providing more effective treatment. Aims: To quantify Lactobacilli and Enterococcus faecalis levels in infectious root canal of primary teeth between irreversible pulpitis and pulp necrosis groups, and to analyze the association between these bacteria and clinical signs and symptoms. Materials and methods: Total subjects were 170 Thai children aged 2-10 years old. All subjects were selected from patients who came to the pediatric dental clinic, Pediatric Department, Faculty of Dentistry, Mahidol University, Thailand and needed a pulpectomy treatment. DNA extraction and quantitative real-time PCR was performed. Results: Mean age of the children was 5 ± 1.3 years old. One hundred and ten samples were diagnosed with irreversible pulpitis and 60 with pulp necrosis. One hundred and seven subjects (63%) had a history of pain. One hundred and twenty subjects (71%) had clinical signs and symptoms. One hundred and thirty-four radiographs (79%) showed radiographic pathology. The detection of total bacteria, Lactobacillus and E. faecalis was 100%, 100% and 84% (142/170), respectively. The ratio of Lactobacillus and E. faecalis to total bacteria levels was 20% and 9%, respectively. When compared between irreversible pulpitis and pulp necrosis groups, the quantities of total bacteria (p=0.000), Lactobacillus (p=0.000) and E. faecalis (p=0.001) in pulp necrosis group were higher than those of the irreversible pulpitis group. The ratio of Lactobacillus to total bacteria in the pulp necrosis group was higher than in the irreversible pulpitis group (p=0.004), whereas the ratio of E. faecalis to total bacteria was not different between the two groups. Only Lactobacillus was associated with a history of pain (p=0.013). Gingival swelling was correlated with Lactobacillus quantities (p=0.01). When analyzed within each group, E. faecalis quantity was correlated with clinical pain (p=0.01) in pulp necrosis group. In the irreversible pulpitis group, the data showed pathologic finding of lamina dura (p=0.000) and furcation involvement (p=0.016) which correlated with E. faecalis quantities. Conclusion: The bacterial levels of total bacteria, Lactobacillus and E. faecalis in pulp necrosis group were higher than the irreversible pulpitis group. Levels of Lactobacillus and E. faecalis were associated with a history of pain, pathologic finding of lamina dura and furcation involvement. Gingival swelling was correlated with Lactobacillus quantities.

Aim Today, thanks to modern technologies as operative microscope, ultrasonic tips, devices to activate irrigation and tridimensional obturation performed with thermo plasticized gutta-percha, excellent results could be obtained. Materials and methods In this study, we present 5 patients with the presence of periapical lesions in molars and incisors with history of pain. Modern endodontic technologies were used. The rationale of using these technologies was to obtain a chemo-mechanical cleansing and obturation of the entire endodontic system and to gain the lesion resolution with a non-surgical approach. Results A success rate of 100% was obtained. Radiographs and clinical examinations were done until 10 years. All the cases highlighted the success achieved in the short and long term through the complete resolution of the lesions and therefore the reconstitution of the lamina dura. Conclusions The positive results highlighted by these clinical cases demonstrate how the use of modern technologies is essential to avoid iatrogenic damage and to gain safe and reproducible results.

Rheumatoid arthritis (RA), an autoimmune inflammatory disorder, results in persistent synovitis with severe bone and cartilage destruction. Bisphosphonates (BPs) are often utilized in RA patients to reduce bone destruction and manage osteoporosis. However, BPs, especially at high doses, are associated with osteonecrosis of the jaw (ONJ). Here, utilizing previously published ONJ animal models, we are exploring interactions between RA and ONJ incidence and severity. DBA1/J mice were divided into four groups: control, zoledronic acid (ZA), collagen-induced arthritis (CIA), and CIA-ZA. Animals were pretreated with vehicle or ZA. Bovine collagen II emulsified in Freund's adjuvant was injected to induce arthritis (CIA) and the mandibular molar crowns were drilled to induce periapical disease. Vehicle or ZA treatment continued for 8 weeks. ONJ indices were measured by micro-CT (µCT) and histological examination of maxillae and mandibles. Arthritis development was assessed by visual scoring of paw swelling, and by µCT and histology of interphalangeal and knee joints. Maxillae and mandibles of control and CIA mice showed bone loss, periodontal ligament (PDL) space widening, lamina dura loss, and cortex thinning. ZA prevented these changes in both ZA and CIA-ZA groups. Epithelial to alveolar crest distance was increased in the control and CIA mice. This distance was preserved in ZA and CIA-ZA animals. Empty osteocytic lacunae and areas of osteonecrosis were present in ZA and CIA-ZA but more extensively in CIA-ZA animals, indicating more severe ONJ. CIA and CIA-ZA groups developed severe arthritis in the paws and knees. Interphalangeal and knee joints of CIA mice showed advanced bone destruction with cortical erosions and trabecular bone loss, and ZA treatment reduced these effects. Importantly, no osteonecrosis was noted adjacent to areas of articular inflammation in CIA-ZA mice. Our data suggest that ONJ burden was more pronounced in ZA treated CIA mice and that RA could be a risk factor for ONJ development. © 2016 American Society for Bone and Mineral Research.

Introducción: la enfermedad periodontal afecta más de la mitad de la población en Colombia siendo estimada una de las primeras causas de morbilidad oral. Las ayudas diagnósticas que permitan la evaluación de su extensión y severidad resultan de importancia puesto que así se tendrán herramientas confiables para cuantificar la gravedad del problema. Objetivo: determinar la concordancia interexaminador para la detección de hallazgos radiográficos en pacientes con periodontitis crónica localizada empleando radiografía periapical convencional. Métodos: estudio de pruebas diagnósticas incluyendo pacientes con periodontitis crónica localizada, sobre el diente con peor nivel de inserción clínico y a través de una sola radiografía convencional por órgano dentario empleando técnica de paralelismo. Las valoraciones radiográficas fueron realizadas por dos evaluadores independientes y cegados para los hallazgos: lámina dura, defectos óseos y tipo de defecto. El acuerdo obtenido se estimó a través de Kappa de Cohen. Resultados: se tomaron en total 125 radiografías. La edad promedio fue 38,8±9,9 años, y 61,6% eran mujeres. La concordancia para lámina dura fue 0,08 (IC 95 %: -0,04 - 0,21), defectos óseos 1,00 (IC 95 %: 1,00 - 1,00); tipo de defecto presente 0,31 (IC 95 %: 0,29 - 0,38). Conclusiones: la concordancia se evaluó como nula, casi perfecta y aceptable para los hallazgos lámina dura, presencia de defectos óseos y tipo de defecto respectivamente. Para algunos hallazgos y dada la importancia de los procesos diagnósticos y terapéuticos se necesitan valoraciones más exactas que se traduzcan en un mayor grado de acuerdo.

The purpose of the present study was to evaluate the longitudinal survival rate of the treatment of teeth affected with periodontally hopeless prognosis and secondary occlusal traumatism (SOT) using intentional replantation (IR) and periodontal prosthesis. We collected data from 17 individuals who received IR and participated in the study during 1995 to 2014. Of the 17 teeth affected by periodontally extreme conditions with deep angular bone defects, severe alveolar bone loss extending to or beyond the apex, and SOT, was recognized as having hopeless prognosis. Those teeth were treated sequentially using procedures that included basic periodontal therapy, therapeutic provisional prosthesis, IR, fixed dental prosthesis, crown and sleeve‐coping telescopic dentures (CSCTDs), or fixed prosthesis and CSCTD combined. Longitudinal assessments of clinical parameters and radiographic bone change before and after IR were evaluated. Clinical results showed that the overall cumulative survival rate of assayed teeth after IR therapy (5–12 years) was 88.2%. The mean (±SD) estimated radiographic alveolar bone loss was 12.7 ± 2.1 mm (88.5% ± 13.3%) of the root length, initially, and estimated radiographic alveolar bone gain was 4.0 ± 2.2 mm ultimately, in 17 replanted teeth with SOT. Only one tooth (5.9%) exhibited root resorption. Ankylosis was not observed during the study. Periapical radiographs demonstrated that satisfactory periodontal healing of lamina dura and bone fills occurred in all replanted teeth with SOT. Generally, tooth mobility and SOT were significantly improved after therapy. Most treated teeth functioned well and remained stable clinically throughout the periods of study. The present study documented a promising outcome for autogenous IR and periprosthetic therapy of 17 periodontally hopeless teeth for 5–12 years. The present study revealed good bone gain and elimination of SOT and prominent occlusal function. We concluded that the application of IR, minocycline‐HCL and periodontal prosthetic procedures later elevated the prognosis of these otherwise hopeless teeth with SOT, which are valuable options for retaining teeth with periodontally extreme situations.

Made available in DSpace on 2018-12-11T17:09:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-11-01 Context: A better understanding of the relation between traumatic dental occlusion and periodontal changes is needed. Aims: This study aimed to evaluate the pattern of osteoclastic activity in the periodontal bone in front of the traumatic dental occlusion in rat molars. Patients and Methods: Traumatic dental occlusion (TO) was induced in twenty rats, which were sacrificed after periods of 2, 5, 7, and 14 days. Transversal histological sections of both jaws were stained with tartrate-resistant acid phosphatase and hematoxylin and eosin. Mann-Whitney U-Test was used for group comparison, and Pearson's correlation test was applied for the number of osteoclasts and bone area (BA). Results: Traumatic dental occlusion caused an increase in the number of osteoclasts in the bone of the upper and lower right first molar from days 2-5 to 2-14, respectively. In the TO groups, the number of osteoclasts on the lamina dura and in the center of the alveolar bone septum, respectively, increased almost 4-fold and 9-fold in the lower jaw; and 3-fold and 5-fold in the upper jaw, during all periods. In the TO groups, the BA of the alveolar bone septum was substantially reduced. There was a negative correlation between the number of osteoclasts and BA in both jaws during all experimental periods. Conclusions: Traumatic dental occlusion increases osteoclast activity in the alveolar lamina dura and in the center of alveolar bone and stimulates a higher degradation in the center of the alveolar bone septum. Department of Surgery and Integrated Clinic Dentistry School of Araçatuba São Paulo State University (UNESP) Department of Physiology and Morphology Dentistry School of Araçatuba São Paulo State University (UNESP) Department of Oral Cell Biology Academic Centre for Dentistry Amsterdam Amsterdam University of Amsterdam and VU University Amsterdam Department of Surgery and Integrated Clinic Dentistry School of Araçatuba São Paulo State University (UNESP) Department of Physiology and Morphology Dentistry School of Araçatuba São Paulo State University (UNESP)

Flare-up following endodontic treatment is an undesirable complication. In this case report, the patient presented with severe pain and swelling in the mandibular left quadrant, related to teeth # 35 and # 36. Clinical evaluation revealed an intraoral palpable bluish swelling. Past dental history showed that tooth # 36 was endodontically treated four years ago. The tooth was asymptomatic until the lingual cusp was fractured. A general practitioner replaced the coronal restoration, prepared the tooth, and took final impression. Immediately after, the patient developed symptoms and received antibiotic and analgesic therapy for three weeks. Following comprehensive clinical assessment, tooth # 35 was excluded as a culprit, and tooth # 36 remained under investigation. Clinical and radiographic examination of tooth # 36 showed a less than-optimal root canal filling, furcation involvement, narrow zone of attached gingiva, and history of replacement of the coronal filling with post and core, which might have had an impact on the ecology of the tooth; all were suggestive of endodontic disease. On the other hand, perplexing signs such as lack of tenderness to percussion and continuity of the lamina dura, suggested otherwise. The case was diagnosed as a previous root canal treatment with normal periapical tissue, and accordingly, endodontic retreatment was instigated. In addition, exploratory surgery was performed and blue pieces of elastomeric impression material were found, which might have been the cause of all the signs and symptoms. In this case, foreign body reaction is a probable diagnosis. The purpose of this report is to forewarn dentists of the risks associated with impression material in case of periodontal disease and to emphasize the importance of prioritizing the patient data to avoid the pitfalls of misdiagnosis and unnecessary treatment.

Carbonic anhydrase II (CA II) is involved with the acid-base homeostasis of tissue. This study aims to evaluate the effect of traumatic dental occlusion (TDO) by means of CA II expression in osteoclasts and osteocytes (near the lamina dura and in the centre of alveolar bone septum), in the periodontal ligament (PDL) and in lining cells (periosteum). For this study, 50 male Wistar rats aged seven weeks were divided into 2 groups: Loaded and Unloaded group. The study periods were 2, 5, 7, 14 and 21 days. The Mann-Whitney U test for quantitative, and the Chi-square test for semi-quantitative analyses were used for group comparison, along with Bonferroni’s post-hoc test. Statistically significant differences between the groups were observed in the number of osteoclasts in the lamina dura (days 5, 7 and 21); the alveolar bone septum (days 2 and 7); osteocytes near the lamina dura (days 2, 5, 7 and 14); and in the centre of the alveolar bone septum (days 2, 5, 7 and 14). There were also differences between-group in CA II expression in the lining cells on days 7 and 14. TDO increases CA II expression in osteoclasts, osteocytes, the PDL and lining cells of the periosteum. Clinical Relevance: Traumatic dental occlusion stimulates higher cells activity of the alveolar bone at short (lamina dura) and long (centre of alveolar bone and periosteum) distances. La anhidrasa carbónica II (AC II) participa en la homeostasis ácido-base del tejido. Este estudio tiene como objetivo evaluar el efecto de la oclusión dental traumática (ODT) mediante la expresión de CA II en osteoclastos y osteocitos (cerca de la lámina dura y en el centro del tabique del hueso alveolar), en el ligamento periodontal (LP) y en las células de revestimiento. (periostio). Para este estudio, 50 ratas Wistar macho de siete semanas se dividieron en 2 grupos: un grupo cargado y un grupo descargado. Los periodos de estudio fueron 2, 5, 7, 14 y 21 días. La prueba U de Mann-Whitney para análisis cuantitativos y la prueba de Chi-cuadrado para análisis semicuantitativos se utilizaron para la comparación de grupos, junto con la prueba post-hoc de Bonferroni. Se observaron diferencias estadísticamente significativas entre los grupos en el número de osteoclastos en la lámina dura (días 5, 7 y 21); el tabique del hueso alveolar (días 2 y 7); osteocitos cerca de la lámina dura (días 2, 5, 7 y 14); y en el centro del tabique del hueso alveolar (días 2, 5, 7 y 14). También hubo diferencias entre los grupos en la expresión de AC II en las células de revestimiento los días 7 y 14. La ODT aumenta la expresión de AC II en los osteoclastos, osteocitos, el LP y las células de revestimiento del periostio. Relevancia clínica: la oclusión dental traumática estimula una mayor actividad de las células del hueso alveolar a distancias cortas (lámina dura) y largas (centro del hueso alveolar y periostio). A anidrase carbônica II (AC II) participa da homeostase ácido-básica do tecido. Este estudo tem como objetivo avaliar o efeito da oclusão dentária traumática (ODT) através da expressão de AC II em osteoclastos e osteócitos (próximo à lâmina dura e no centro do septo do osso alveolar), no ligamento periodontal (LP) e nas células de revestimento. (periósteo). Para este estudo, 50 ratos Wistar machos com sete semanas de idade foram divididos em 2 grupos: um grupo com carga e um grupo sem carga. Os períodos de estudo foram de 2, 5, 7, 14 e 21 dias. O teste U de Mann-Whitney para análise quantitativa e o teste Qui-quadrado para análise semiquantitativa foram usados ​​para a comparação dos grupos, juntamente com o teste post-hoc de Bonferroni. Diferenças estatisticamente significativas foram observadas entre os grupos no número de osteoclastos na lâmina dura (dias 5, 7 e 21); o septo do osso alveolar (dias 2 e 7); osteócitos próximos à lâmina dura (dias 2, 5, 7 e 14); e no centro do septo do osso alveolar (dias 2, 5, 7 e 14). Também houve diferenças de grupo na expressão de AC II em células de revestimento nos dias 7 e 14. ODT aumenta a expressão de AC II em osteoclastos, osteócitos, LP e células de revestimento periosteal. Relevância clínica: a oclusão dentária traumática estimula o aumento da atividade das células ósseas alveolares em distâncias curtas (lâmina dura) e longas (centro do osso alveolar e periósteo).

This review presents an overview of some diagnostic imaging-related issues regarding medication-related osteonecrosis of the jaws (MRONJ), including imaging signs that can predict MRONJ in patients taking antiresorptive drugs, the early imaging features of MRONJ, the relationship between the presence or absence of bone exposure and imaging features, and differences in imaging features by stage, between advanced MRONJ and conventional osteomyelitis, between oncologic and osteoporotic patients with MRONJ, and depending on the type of medication, method of administration, and duration of medication. The early diagnosis of MRONJ can be made by the presence of subtle imaging changes such as thickening of the lamina dura or cortical bone, not by the presence of bone exposure. Most of the imaging features are relatively non-specific, and each patient's clinical findings and history should be referenced. Oral and maxillofacial radiologists and dentists should closely monitor plain radiographs of patients taking antiresorptive/antiangiogenic drugs.

This report describes the oral manifestations of renal tubular acidosis (RTA) associated with secondary rickets and discusses the biological plausibility of these findings. The characteristic electrolyte changes during RTA or genetic mutations that trigger RTA may be responsible for impaired amelogenesis, dental malocclusion, impacted teeth, and absent lamina dura. This report reinforces the possibility of an association between RTA and the oral manifestations described. RESUMO Este relato de caso descreve as manifestações bucais da acidose tubular renal (ATR) associada ao raquitismo secundário e discute a plausibilidade biológica desses achados. As alterações eletrolíticas características da ATR ou as mutações genéticas que a desencadeiam podem ser responsáveis pela amelogênese imperfeita, maloclusão dentária, dentes impactados e ausência de lâmina dura. Este relato reforça a possibilidade de uma associação entre ATR e as manifestações bucais descritas.

Fibrous dysplasia is a rare bone disorder characterized by the replacement of normal bone by abnormal fibrous tissue. Here we present a 16-year-old female with a fibrous dysplasia in the maxilla and obliteration of the sinus in the same side. Cone beam computed tomography scan revealed a mixed radiopacity that extended from the alveolar crest of the right posterior teeth to the right orbital floor in the superior-inferior direction. The radiopaque areas had homogenous ground glass appearance. There is a loss of bone trabeculation, thinning of the cortical boundaries but still intact, and a loss of the lamina dura around the right posterior permanent teeth. The radiographical features of the lesion were indicative of fibrous dysplasia in the maxilla.

Metastatic disease to the oral cavity is relatively rare and constitutes approximately 1% of all oral cavity malignancies. Skeletal involvement predominates over soft tissue presentations and the posterior region of the mandible is frequently affected. Pain, swelling and sensory alterations have been reported and may mimic periodontal or periapical disease or osteomyelitis. We present a case of a 63-year-old female with a complaint of progressive dysthesia for three months. Panoral and 3D imaging revealed widening of the PDL and loss of lamina dura affecting most of the mandibular teeth, which all tested vital. The patient's medical history was significant for osteoporosis, but there was no history of anti-resorptive drug use. Upon examination, a gingival alveolar swelling was noted. Biopsy revealed high-grade adenocarcinoma, with immunohistochemical features most consistent with a breast primary. Subsequently, it was learned that the patient had a history of breast cancer, treated by total mastectomy of the left breast over three years previously with no previous evidence of metastases. The rarity of metastatic lesions to the jaw makes diagnosis particularly challenging. This case emphasizes the importance of assembling a thorough medical history as part of a complete patient work-up, especially in the presence of atypical symptoms or radiographic findings