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A metastatic giant cell–rich osteosarcoma (GCRO) to the jaws is an exceedingly rare neoplasm. To date, fewer than 10 cases have been reported in the English language literature. In this article, we describe an additional case of a metastatic GCRO that presented the diagnostic challenge of a painless mass in the posterior mandible of a 19-year-old girl who exhibited rapid and aggressive local growth. The lesion was confirmed radiologically as an ill-defined expansive osteolytic mass showing cortical perforation. Microscopically, the presence of osteoclast-like giant cells permeated with atypical oval and rounded mesenchymal cells in a fibrovascular stroma, cellular atypia, and scarce osteoid formation were observed. Immunohistochemistry revealed the Ki-67 proliferative index in 50% of positive cells, positivity for vimentin and CD68, as well as scarce positivity for CDK4. The patient's medical history involved a GCRO in the proximal ulna. This report highlights the aggressive behavior of GCRO and its high capacity for metastasis to different parts of the body. Clinicians, pathologists, and surgeons should be aware of the giant cell–rich variant of osteosarcoma of the jaws, an imminent “wolf in a sheep's skin”, because its indolent but unrelenting growth and dissemination, with radiographic and histologic characteristics that may represent a diagnostic pitfall regarding aggressive central giant cell lesions of the jaws.

Introduction Surgically assisted rapid maxillary expansion is a widely used surgical procedure for resolving transverse maxillary occlusal changes in patients with bone maturity. However, few studies about the postoperative morphologic alterations in the nasal cavity in its inferior portion and the nasal septum positioning exist. Methods The linear nasal septum measurements of 26 adult patients treated with surgically assisted rapid maxillary expansion from 2009 to 2013 were assessed through a retrospective analysis of cone-beam computed tomographies, in Digital Imaging and Communications in Medicine files, through the Dolphin Imaging program (Dolphin Imaging and Management Solutions, Chatsworth, Calif), aimed to identify significant changes during 3 time periods of the treatment: preoperative, immediately after the palatal expansion device locking (immediate postoperative), and 6-months postoperative (late postoperative). The analyses were performed in the inferior third of the nasal septum, from 4 equidistant points in anteroposterior position and height, using fixed cranial references for lateral measures of displacement. Results No significant difference was found between preoperative, immediate postoperative, and late postoperative measurements in the 4 fixed nasal septum measurements, applying the analysis of variance test with a significance level of 5%. Comparing the surgical times alone, we found no statistically significant difference between the right and left sides applying the Student t test, which also showed symmetry in the nasal septum. Conclusions The measurements of the nasal septum did not change in the different surgical times throughout their inferior extension, and they remained symmetrical throughout patients’ follow-up period.

Radiographic examinations combined with clinical and histological tests play an important role in diagnosing changes in the craniofacial region. Considering that X-radiation is a form of ionizing energy capable of damaging the DNA of individuals, it has been the object of studies since its introduction. The micronucleus test is used to quantify this damage, assessing whether or not chromosomal breakage occurs. Objective: To evaluate, through a systematic review (SR) with meta-analysis, the occurrence of genotoxic effects in the oral epithelium after the exposure of patients to panoramic radiographs. Methods: An SR was performed with the PICOS (Population, Intervention, Comparison, Outcome, and Study design) strategy, aiming to answer the following question: “Can panoramic radiographs induce genotoxic effects on the oral epithelium?” The study was registered in the PROSPERO (International prospective register of systematic reviews) platform. A systematic search was performed in the following electronic databases: PubMed (including MedLine), Scopus, Embase, LILACS, Medline EbscoHost, and Google Scholar. Treatment effects were defined as standardized mean difference (SMD), and 95% confidence intervals (CI) were established. The Joanna Briggs Institute questionnaire for observational studies was applied to assess the risk of bias. The GRADE tool was used to assess the quality of evidence of the SR. Results: A total of 251 potentially relevant studies were selected through the search strategy. After screening titles and abstracts, 11 full-text manuscripts were assessed for eligibility and nine observational studies were included in the meta-analysis. The present study showed an increase in micronuclei after the exposure (SMD = 0.21, 95% CI, 0.03 to 0.28, p = 0.02), with a Tau2index = 0.00, Chi2 = 2.35, and p-value = 0.97. Therefore, the articles selected were considered homogeneous and the I² of 0% indicated low heterogeneity. Conclusion: According to the studies analysed, although the quality of evidence was considered low, panoramic radiographs can cause genotoxic damage in the oral epithelium but with a small effect size.

This clinical note describes a case report where the patient notices that one of the symptoms suffered during COVID-19 infection is a mononeuropathy of the branches of the maxillary nerve, reviewing in the literature the findings of the affinity of the coronavirus to nerve fibers.

Objective: To assess the reliability of CEFBOT, an artificial intelligence (AI)-based cephalometry software, for cephalometric landmark annotation and linear and angular measurements according to Arnett’s analysis. Methods: Thirty lateral cephalometric radiographs acquired with a Carestream CS 9000 3D unit (Carestream Health Inc., Rochester/NY) were used in this study. The 66 landmarks and the 10 selected linear and angular measurements of Arnett’s analysis were identified on each radiograph by a trained human examiner (control) and by CEFBOT (RadioMemory Ltd., Belo Horizonte, Brazil). For both methods, landmark annotations and measurements were duplicated with an interval of 15 days between measurements and the intraclass correlation coefficient (ICC) was calculated to determine reliability. The numerical values obtained with the two methods were compared by a t-test for independent variables. Results: CEFBOT was able to perform all but one of the 10 measurements. ICC values > 0.94 were found for the remaining eight measurements, while the Frankfurt horizontal plane - true horizontal line (THL) angular measurement showed the lowest reproducibility (human, ICC = 0.876; CEFBOT, ICC = 0.768). Measurements performed by the human examiner and by CEFBOT were not statistically different. Conclusion: Within the limitations of our methodology, we concluded that the AI contained in the CEFBOT software can be considered a promising tool for enhancing the capacities of human radiologists.

The purpose of this article is to assist dental clinicians to identify neurofibromatosis type 1 and its variants. We present a rare case of a 68-year-old man affected since his childhood by the presence of generalized nodules throughout the body, causing aesthetic deformations. Interestingly, the impact in the oral cavity was not significant, presenting nodes only in the gingiva, an unusual area of manifestation. Panoramic radiograph showed a discrete enlargement of the mandibular canal. After 1 year of follow-up, the patient died due to cardiovascular complications caused by the syndrome.

The occurrence of calcifying odontogenic cyst (COC) in the posterior maxillary region is uncommon, with few cases described in literature. We report a case of a 13-year-old female patient presenting a large lesion in the left maxilla (> 7.5 cm). Panoramic radiograph showed a well-delimited radiolucent unilocular lesion extending from the posterior left maxilla to the maxillary sinus. The patient was submitted to decompression followed by conservative surgical removal of the lesion. Histological analysis of the surgical specimen confirmed the diagnosis of COC. After one year, no local recurrence has been observed and the patient remains under follow-up on a regular basis.

Resumo Introdução A interface implante-pilar protético e a formação dos seus microgaps são aspectos relevantes na transferência das cargas e na resposta biológica, estando ligadas ao sucesso da reabilitação. Objetivo Avaliar microgaps na interface entre a conexão interna do implante do tipo Cone Morse e a superfície do componente protético por meio da microscopia eletrônica de varredura (MEV). Material e método Foram utilizados 20 implantes dentários de tamanho 3,75 × 11,0mm do tipo Cone Morse com seus respectivos pilares protéticos da Singular® (Singular Implants, RN, Brasil). Os munhões retos foram acoplados aos implantes com torque de 32N/cm2 e o conjunto resultante foi emergido em base de Resina Epóxi ES260, para permitir secção longitudinal da amostra. As amostras foram analisadas e os microgaps mensurados no MEV (JEOL JCM-5700, MA, USA), e posteriormente os dados foram analisados. Resultado A média e o desvio padrão dos maiores microgaps foram observados na parte apical do implante nos lados direito e esquerdo, sendo 1,44±2,68 e 1,16±1,49 μm, respectivamente. Os menores microgaps foram na parte superior do implante nos lados direito e esquerdo, sendo 0,60±0,73 e 0,66±0,67 μm, respectivamente. Contudo, no teste de Kruskal-Wallis, não houve diferença estatisticamente significativa entre as regiões dos implantes, tanto para o lado esquerdo (p=0,692) como para o direito (p=0,865). No teste de Mann-Whitney, não houve diferenças estatisticamente significativas entre os lados para as diferentes regiões dos implantes. Conclusão Mesmo com a presença de microgaps na interface implante-pilar protético, estes apresentam tamanho inferior ao que causaria problemas biológicos e mecânicos. As amostras analisadas quanto à sua compatibilidade de encaixe foram satisfatórias. Abstract Introduction The implant-prosthetic abutment interface and the formation of its microgaps are relevant aspects in load transfer and biological response and are linked to the success of the rehabilitation. Objective To evaluate microgaps at the internal connection interface of the Cone Morse implant and the prosthetic component surface by means of scanning electron microscopy (SEM). Material and method Twenty 3.75 x 11.0 mm Cone Morse dental implants with their respective Singular® prosthetic abutments were used (Singular Implants, RN, Brazil). The straight trunnions were attached to the implants with a 32N/cm2 torque and the ES260 Epoxy Resin-based set emerged to allow longitudinal sectioning of the sample. The samples were analyzed and the microgaps measured in SEM (JEOL JCM-5700, MA, USA), and later the data were analyzed. Result The mean and standard deviation of the largest microgaps were observed in the apical part of the right and left side 1.44±2.68 and 1.16±1.49 μm, respectively. The smallest microgaps were on the upper implant right and left sides 0.60±0.73 and 0.66±0.67 μm, respectively. However, in the Kruskal-Wallis test there was no statistically significant difference between the implant regions, both for the left side (p=0.692) and right side (p=0.865). The Mann-Whitney test, there were no statistically significant differences between the sides for the different regions of the implants. Conclusion Even with the presence of microgaps in the implant-post interface, it presents a smaller size than the one presenting biological and mechanical problems. The samples analyzed for their fitting compatibility were satisfactory.

Background Clinicians often use calcium hydroxide liners during stepwise treatment of advanced caries. In this randomized clinical trial, the authors compared the short-term outcome of stepwise caries removal with and without use of a calcium hydroxide liner in conjunction with provisional resin-modified glass ionomer (RMGI) restorations. Methods The authors included in the trial 98 patients aged 15 to 30 years who had a deep carious lesion in a posterior tooth. The authors measured the dentin thickness radiographically and recorded its color, consistency, and moisture, as well as the bacterial count of the lesions. After partial caries removal, the authors assigned patients randomly to have their caries provisionally restored using RMGI with (control group) or without (test group) a calcium hydroxide liner. The primary outcome measure was tooth vitality after 90 days. Secondary outcomes included changes in dentinal, radiographic, and microbiological characteristics of the lesions. Results The authors found no statistically significant difference between the test and control groups in tooth vitality after 90 days. Irrespective of calcium hydroxide liner use, the authors observed darker, harder, drier, and less contaminated dentin after the provisional restorations, but dentin thickness remained unchanged. Conclusions On the basis of this 3-month clinical trial's results, the use of a calcium hydroxide liner during stepwise caries excavation and provisional restoration did not provide any additional benefit. Practical Implications After 3 months, using a calcium hydroxide liner does not appear to offer any additional benefit when clinicians use RMGI provisional restorations during stepwise caries removal. Longer studies are needed to confirm these results.

The adenomatoid odontogenic tumor (AOT) has a prevalence of 3% to 7% among odontogenic tumors and 3 described variants: Follicular, extrafollicular, and peripheral (or gingival). We reported a case of extrafollicular AOT in a 31-year-old melanoderm woman. An increase in volume was observed in the lower left third of the face associated with bulging of the buccal and lingual cortices in the region of elements 34 to 32. The imaging revealed a well-defined unilocular radiolucent area with sclerotic margin, involving periapices of elements 34, 33, and 32, rupture of the vestibular bone cortex in the region, and mild root resorption of units 33 and 32. Histopathologic examination revealed presence of fibrovascular capsule and epithelial cells forming structures such as ductus and solid patter. The treatment was an excisional biopsy. Follow-up of 7 and 15 days with satisfactory postoperative period was performed. Provision will be made every 6 months.

Introduction: The use of the mobile device is based on radiofrequency waves, a type of electromagnetic wave, formed by a magnetic and electric field. This technology uses radio transmitters and receivers, operating in the microwave range, and therefore, ends up being an emitter and receiver of nonionizing energy. Objective: To evaluate whether the nonionizing radiation emitted by smartphones cause genotoxic and/or cytotoxic effects on the cells present in the oral mucosa, and to compare the different brands. Study design: A total of 30 adults were divided into 2 groups according to 2 mobile phone brands. The material was collected by smearing the jugal mucosa bilaterally with a spatula, and it was evaluated by means of the micronucleus test. This test analyzed the shape, borders, changes within the cytoplasm, and the chromatin structure, color, and texture. Statistical analysis was performed using the Wilcoxon test, with a significance level of 5%. Results: For micronuclei, there was no statistically significant difference between exposed and nonexposed sides (P = .251); however, for the other alterations, there was a statistically significant difference (P = .024). Regarding the comparison between the marks, there was no statistically significant difference (P = .47). Conclusion: The different brands of smartphones do not appear to offer risks of inducing genotoxicity. However, both brands showed cytotoxicity. Funding: CNPq.

OBJECTIVE To assess the temporomandibular joint (TMJ) osseous components morphology and the condyle position in patients with different sagittal skeletal relationships, sex, and age, using cone-beam computed tomography (CBCT). METHODS The CBCT images of 180 asymptomatic patients (60 class I, 60 class II, and 60 class III) were assessed retrospectively. Groups were also divided according to age (

The aim of this study was to evaluate the morphological surface and the microtensile bond strength (μTBS) of the immediate dentin sealing (IDS) submitted to four different methods for removing temporary cement. Molar teeth received IDS with adhesive system (Adper Scotchbond Multipurpose, 3 M ESPE). Temporary restorations were made with eugenol-free temporary cement (RelyX Temp NE, 3 M ESPE). After the storage (7 days; 37 °C), the samples were submitted to four methods for removing temporary cement: periodontal curette (PC); sodium bicarbonate sandblasting (SB); aluminum oxide sandblasting (AO); and abrasion with diamond bur (DB). The control group (C) received no treatment. The morphological surface analysis (n = 2) and IDS thickness (n = 3) were analyzed using scanning electron microscopy (SEM). Resin composite blocks (Filtek Z250, 3 M ESPE) were produced and cut into sticks (~1 mm2) for μTBS (n = 9). Fracture patterns were analyzed on stereomicroscope and classified as adhesive, mixed, cohesive-dentin or cohesive-resin. Data were submitted to Shapiro-Wilk test and one-way ANOVA followed by Tukey's post hoc test (α = 0.05). PC and SB groups showed the lowest and the highest μTBS values, respectively (ρ

O trabalho tem como objetivo discutir acerca do carcinoma epidermoide de palato mole, suas principais características clínicas, histológicas e prevalência, critérios fundamentais para auxiliar no diagnóstico e tratamento dessa patologia. O carcinoma epidermoide é o tumor maligno mais comumente encontrado na cavidade oral, acomete principalmente a borda posterior da língua, tendo predileção por indivíduos tabagistas e/ou etilistas crônicos devido maior probabilidade de desenvolver o câncer bucal associado ao fator irritativo crônico. Sua manifestação ocorre em diferentes graus de malignidade tendo como características predominantes anaplasia, destruição do tecido local, crescimento rápido e capacidade de metástase. O diagnóstico do carcinoma epidermoide geralmente é tardio, seja pelo desconhecimento da patologia pelo profissional ou mesmo percepção das alterações na mucosa pelo próprio paciente que evitam buscar atendimento por temer o diagnóstico. Trata-se de uma revisão narrativa, de natureza qualitativa e exploratória, a qual objetiva elencar e evidenciar os critérios diagnósticos para o carcinoma epidermoide de palato mole, pautados em critérios clínicos, histológicos, tratamento e sua etiologia. Foi realizada uma busca ativa nas seguintes bases de dados eletrônicas: PUBMED, Medline, Google Scholar, Diadorim, Portal Periódicos CAPES, utilizando-se de descritores, Descriptors in Health Science (DeCS) e Medical Subject Headings (MeSH). Com o estudo, conclui-se que o conhecimento sobre lesões tumorais é de suma importância por parte dos profissionais da saúde, auxiliando assim em um diagnóstico precoce, tornando-se menos negativo e elevando as taxas de sobrevida do paciente.

The use of the mobile device is based on radiofrequency waves, an electromagnetic wave type. To verify if cellular damage occurs, the micronucleus test was developed, aiming to identify an increase in the frequency of mutations in cells that are exposed to a varied range of agents. Objective: This study aims to answer the following question: "Could the nonionizing radiation emitted by mobile telephone devices cause genotoxic and/or cytotoxic effects in the cells present in the oral mucosa, from microscopic observation by the micronucleus test?" Study Design: Three stages were followed: defining the objective, tracing the search method (PICO), selecting articles, and extracting data. The databases consulted were: MEDLINE, PubMed (AllDatabases, MeSH), Scopus, LILACS, Google academic, PROSPERO, and COCHRANE using the Boolean operators Persons, Smartphone, Mutagenicity Tests, and Mouth, based on MeSH terms. Results: A total of 396 articles were found, 323 abstracts were analyzed, 312 abstracts were excluded, and w6 full texts and 6 studies were included, according to the table of scientific evidence (grade 5). Conclusion: Our study revealed that there is no occurrence of genotoxic effects; nonetheless, there is a suggestion of occurrence of cytotoxic effects caused by exposure to electromagnetic fields of radiofrequency emitted by mobile phones, especially in case of prolonged exposure.

Objective: To develop and evaluate a smartphone application with web application tool, content management, that enables the study of radiographic anatomy. Study Design: Face-to-face meetings and design thinking activities were carried out to better understand the proposed problem by the research group. The application, completed in the beta version, provided satisfaction and usability questionnaires to 51 students of the dentistry course. Results: A total of 50% of students use the Android operating system; 100% of the students feel that applications can aid in the teaching of radiology, 93.20% prefer to study by photos, and 86.40% study with the cell phone connected. Regarding the satisfaction questionnaire, with the APPOLO app (app of learning on line), Cronbach alpha coefficient was applied, obtaining values above 0.7; therefore, the questionnaire is reliable. In addition, 98.04% affirmed that it the content that is made available is certainly important. A total of 64.69% of the students considered the quantity of the images satisfactory. The majority, 68.62%, feel very motivated to complement their study with this type of methodology. As for the usability of the application, 66.66% found its handling very easy. Conclusion: The APPOLO application proved to be practical and easy to understand, navigate, and use; further, it can assist in the teaching support of students of dental radiology.

Objectives: The odontogenic adenomatoid tumor (AOT) has a prevalence of 3% to 7% among odontogenic tumors. There are 3 variants of AOT: follicular, extrafollicular, and peripheral. The present study aims to trace the clinical and epidemiologic profile of extrafollicular AOT, based on a review of case reports. Study Design: Using the adenomatoid and extrafollicular descriptors, a search was performed in the PubMed database. Fifty-one articles were obtained as a result. The following exclusion criteria were adopted: by title, by case report, by the summary, and by the series of cases. At the end, 10 articles were used as sources for the present study. Results: Ten cases were published between 2009 and 2019, with the following most prevalent characteristics: Asian ethnicity (90%), no gender preference, and mandible location (60%). Imaging presentation included well-defined borders (80%); root displacement (50%); presence of cortical perforation (30%); and root resorption (30%). The mean time of the cases was 4 months, with a maximum of 2 years, and no recurrence was observed in any of the cases. Conclusion: Extrafollicular odontogenic adenomatoid tumor is uncommon. It does not present a predominant profile, exhibiting a diversity of clinical manifestations, with slow to fast and locally aggressive growth.

Cleidocranial dysostosis (CCD) is an inherited autosomal dominant syndrome due to the heterozygous mutation of the RUNX2 gene, which is often the same in men and women. The diagnosis is based on clinical and radiographic features, which include images of the skull, thorax, pelvis, and hands. The present study aims to present a case report of CCD in a 29-year-old feoderm woman. During intraoral examination permanent nonerupted teeth, deep palate, prominent mandible, maxillary hypoplasia, and vertical occlusion dimension were observed. Panoramic radiographs and computed tomography scan of the conical bundle showed several nonerupted teeth and multiple supernumerary teeth. Wormian bones and persistent open sutures were observed on the lateral radiograph of the head. The shoulder radiograph shows the absence of right and left clavicles. In view of the complexity of the treatment an interdisciplinary discussion is necessary, taking into account age and economic condition.

Fibrous dysplasia (FD) is a benign fibro-osseous lesion that accounts for 2.5% of bone lesions. Herein, we present an 11-year-old female patient presented to examination with an increase in volume on the right side of the face with indeterminate evolution time. Intraoral clinical examination revealed a hardened region, with no alteration in the mucosa, that suggests a bone etiology lesion. Radiographic examination showed a mixed, circumscribed lesion with a pediculated and poorly delimited aspect in relation to healthy bone tissue, extending from the right coronary process to the lateral region of the ipsilateral jaw. Histopathologically the presence of trabeculae of immature bone tissue dispersed in a cellular fibrous stroma and absence of cellular atypia was observed. The diagnosis was FD. The treatment was the total exeresis of the lesion, performed to avoid relapses and due to aesthetic and functional impairment. The patient has been in follow-up for 9 months without recurrence.

Pain due to administration of local anesthetics is the primary reason for patients' fear and anxiety, and various methods are used to minimize it. This study aimed to measure the degree of pain during administration of anesthesia and determine the latency time and duration of pulpal anesthesia using two anesthetic methods in the maxilla. Materials and Methods: A randomized, single-blind, split-mouth clinical trial was conducted with 41 volunteers who required class I restorations in the maxillary first molars. Local anesthesia was administered with a needleless jet injection system (experimental group) or with a carpule syringe (control) using a 30-gauge short needle. The method of anesthesia and laterality of the maxilla were randomized. A pulp electric tester measured the latency time and duration of anesthesia in the second molar. Visual analogue scale (VAS) was used to measure the degree of pain during the anesthetic method. Data were tabulated and then analyzed by a statistician. The t-test was used to analyze the differences between the groups for basal electrical stimulation. Duration of anesthesia and degree of pain were compared using the Mann-Whitney test. A 5% significance level was considered. Results: There was no statistical difference in the basal electrical stimulation threshold (mA) and degree of pain between the two methods of anesthesia (p>0.05). Latency time was 2 minutes for all subjects. The duration of pulpal anesthesia showed no statistical difference (minutes) between the two methods (p

Aim: The aim of this study is to assess the accuracy of images acquired with cone-beam computed tomography (CBCT) in the identification of three different root alterations. Materials and Methods: Forty human premolars were allocated to four experimental groups (n = 10): sound teeth (control), vertical root fracture (VRF), external root resorption (ERR), and root perforation (RP). After the root alterations had been produced, four teeth were randomly assembled into 10 macerated mandibles and submitted to CBCT. Images were acquired with five voxel sizes (0.125, 0.200, 0.250, 0.300, and 0.400 mm) and assessed by three experienced dental radiologists. Sensitivity, specificity, positive and negative predictive values, and the areas under the receiver operating characteristic curve (accuracy) were calculated. The accuracy of imaging in different voxel sizes was compared with Tukey exact binomial test (α=5%). Results: Accuracy with voxel sizes 0.125, 0.200, and 0.250 mm was significantly higher in the detection of ERRs and VRFs than voxel sizes 0.300 and 0.400 mm. No statistical difference was found in terms of accuracy among any of the studied voxel sizes in the identification of RPs. Conclusions: Voxel size 0.125 mm produced images with the best resolution without increasing radiation levels to the patient when compared to voxel sizes 0.200 and 0.250 mm. Voxel sizes 0.300 and 0.400 mm should be avoided in the identification of root alterations.

Introduction The golden proportion has been used in dentistry in an attempt to improve facial function and, possibly, esthetics by simplifying the diagnosis of facial and dental disharmony. The aim of this study is to analyze pre- and postoperative cephalometric tracings of lateral cephalograms of patients with class II and III deformities submitted to orthognathic surgery, and verify if the 13 dental–skeletal patterns (ratios), as defined by Ricketts, moved closer to or further away from the golden proportion. Materials and methods A total of 110 lateral cephalometric radiographs, 55 obtained preoperatively and 55 postoperatively, were analyzed using Dolphin Imaging software. Results Radiographs analysis demonstrated that ratios 1, 3, 4, 5, 7, 8, 9, 10, and 13 remained statistically different from the golden proportion postoperatively. Ratio 12 was the only one to move closer to the golden number, while the opposite happened with ratio 6, which moved further away after the surgery. Ratios 2 and 11 kept statistically similar to the golden proportion both pre and postoperatively. Conclusion It may be concluded that orthognathic surgery had little effect on the proportions studied, and that the golden proportion was not present in the majority of the ratios analyzed neither before nor after surgery. Clinical significance Determine whether the facial patterns approach the golden ratio after surgical correction. Also determine whether the golden ratio may be a standard to guide the surgical treatment of patients with skeletal patterns of type II and III. How to cite this article Bragatto FP, Chicarelli M, Kasuya AVB, Takeshita WM, Iwaki-Filho L, Iwaki LCV. Golden Proportion Analysis of Dental–Skeletal Patterns of Class II and III Patients Pre and Post Orthodontic-orthognathic Treatment. J Contemp Dent Pract 2016;17(9):728-733.

Context: Some radicular changes are challenging for clinicians to diagnose, such as of root perforations, external root resorption (ERR), and vertical root fractures (VRFs). This study aims to facilitate it by comparing the diagnostic accuracy of cone-beam computed tomography (CBCT), orthopantomography, and conventional and digital periapical radiography (DPR) in the diagnosis of such problems. Is it worth doing CBCT despite the radiation dose? Aims: To evaluate and compare the diagnostic accuracy of CBCT, panoramic radiography, and conventional and DPR in the diagnosis of root perforation (RP), ERR, and VRF. Materials and Methods: The sample consisted of 40 extracted human teeth and 10 macerated human mandibles. RPs were performed using diamond burs, ERRs using spherical carbide burs, and RFs using a universal machine EMIC-DL 1000. The images were evaluated by 6 dentomaxillofacial radiologists. Results: Receiver operating characteristic (ROC) revealed that CBCT showed the highest area under the ROC curve (Az) values for RP, ERR, and VRF (0.903, 0.950, and 0.849, respectively). The worst Az values for RP, ERR, and VRF (0.718, 0.494, and 0.611, respectively) were for panoramic radiography. Conclusions: CBCT showed the best results in the diagnosis of ERR and VRF. The diagnosis of ERR was the least accurate, panoramic radiography being not appropriate for its diagnosis. CBCT and conventional periapical radiography obtained similar results for the evaluation of RP. So for, RP indicate the conventional periapical radiography because CBCT has a higher radiation dose.

In this manuscript, we present a rare case report of giant complex odontoma in the maxillary sinus, where the applied therapy included complete excision of the lesion with a conservative approach. Odontomas are also called benign growth abnormalities or hamartomas. They represent a more common type of odontogenic tumor and are related to various disorders such as bad dental placements, expansion, increased volumetric bone, and no eruption of permanent teeth. Usually they have an asymptomatic evolutionary course. The etiologic factors, although obscure, are related to local trauma, infection, and genetic factor. The structural composition of an odontoma consists of mature dental tissues. Odontomas can be differentiated according to their anatomical presentations: Compound odontoma-clusters of several denticles and complex odontoma-well defined tumefaction mass. The diagnosis can be performed by radiographic examination.

BackgroundSecondary or recurrent caries are located around restoration margins or under these lesions, and can lead to tooth loss. The interproximal or bite wing radiograph is the technique of choice to assist diagnosis of secondary caries.ObjectiveTo evaluate diagnostic accuracy of secondary caries in pulpal walls artificially created in extracted human premolars, observed in digital bitewing radiographs using variations in horizontal X-ray beam angle of incidence and application of enhancement filters.Materials and methodsThe sample consisted of 20 healthy premolars, in which secondary caries lesions were simulated by means of subjecting the pulpal wall of the cavity to wear with spherical carbide drill half, fitted to a high speed handpiece, under constant cooling, focused perpendicular to the tooth surface. The orifices were filled with wax and all teeth were restored with composite resin Filtek Z350 XT®. Later teeth were radiographed with a digital sensor complementary metal-oxidesemiconductor (CMOS) varying the horizontal angle at intervals of 2°, covering a range of −10 to +10°.ResultsThe results showed that in the diagnosis of secondary caries, there was no statistically significant difference between the 2 pseudocolor filters, and negative and direct digital radiography. The pseudocolor filter no. 1 showed statistically significant differences, except at a horizontal angle of 0°, thus indicating lower efficiency in the diagnosis of secondary caries.ConclusionSecondary caries with esthetic pulp wall restoration can be diagnosed irrespective of variation in the horizontal angle of incidence of the X-ray beam. The use of different radiographic enhancement filters did not result in improved diagnosis of secondary caries.How to cite this articleDeprá LC, Iwaki LCV, Chicarelli M, Takeshita WM. Influence of Image Filters and Variation in Horizontal Angle of Incidence of X-ray Beam in Digital Interproximal Radiographs for Diagnosis of Secondary Caries in Esthetic Restorations. J Contemp Dent Pract 2015;16(10): 805-812.

To assess cytological evidence of genotoxicity and cytotoxicity of X-rays in oral exfoliated cells of adults subjected to partial and total cone beam CT (CBCT) (stitching module) by means of micronuclei frequency, associated with counting of degenerative nuclear alterations (pyknosis, karyolysis, karyorrhexis, buds and broken eggs), besides comparing the partial and total CBCT (stitching module) in search of possible differences in the nature and/or intensity of the effects.29 adults who were referred to total or partial CBCT were selected. All CBCT were performed with a Carestream CS 9000 3D scanner (Carestream Health Inc., Rochester, NY). Material collection was done immediately before CBCT and 10 days later, by scraping the left and right cheek mucosa with a plastic spatula. Statistical analysis was performed using the Wilcoxon test (paired data), at a significance level of 5%.The statistically significant difference was noted in the frequency of micronucleated cells for both partial and total acquisition (p = 0.008 and p0.001, respectively). Regarding to cytotoxicity, there was a statistically significant difference for both partial and total acquisition (p0.001 and p0.001, respectively).The partial and total CBCT seems to offer risks of inducing genetic damage. In addition both forms of CBCT acquisition have promoted the induction of cytotoxic nuclear alterations.

This study evaluated the microhardness of two resin cements and a low-viscosity resin composite when light-cured under different ceramic thicknesses. A total of 20 samples (10.0 × 1.0 mm) of each material were polymerized by means of a LED light source with an intensity of 1,100 mW/cm2 for 20 seconds. For each experimental group, different ceramic thicknesses (0.5 mm, 1.0 mm, and 1.5 mm) were applied to each sample. For the control group, the samples were polymerized without the presence of ceramics. Each material was then stored in dry vials that inhibited the passage of light for a period of 24 hours. After that time, each sample underwent Vickers hardness test (HMV, Shimadzu: 25 g/10 seconds). The data were collected and analyzed using analysis of variance and Tukey test (P < .05). For the control group, RelyX Veneer (3M ESPE), Filtek Flow Z350XT (3M ESPE), and Allcem Veneer (FGM) showed mean microhardness values and standard deviations of 44.42 ± 4.9, 44.25 ± 2.4, and 31.71 ± 2.4, respectively. The lowest microhardness value (24.13) was found when the greatest ceramic thickness (1.5 mm) was used on the Allcem Veneer cement (P < .01). The microhardness of resin-based materials was affected when the 1.5-mm-thick ceramic material was interposed during photoactivation.

Background Cone beam computed tomography (CBCT) has become an important diagnostic tool in dentistry but has the disadvantage of exposing the patient to ionizing radiation, which may induce base damage, single- and double-strand breaks, and DNA protein crosslinks. Objective The aim of this study was to assess cytologic evidence of genotoxicity and cytotoxicity of x-rays in the oral exfoliated cells of adults subjected to partial and total (stitching module) CBCT by determining micronuclei frequency, associated with counting of degenerative nuclear alterations (pyknosis, karyolysis, karyorrhexis, buds, and broken eggs), and comparing partial and total (stitching module) CBCT in search of possible differences in the nature and/or intensity of the effects. Methods Thirty adults who were referred for total or partial CBCT were selected. Material collection was performed immediately before scanning and 10 days later, by scraping the vestibular mucosa with a plastic spatula. Statistical analysis was performed by using the paired t test for intragroup analysis and Student's t test for the intergroup data, with a significance level of 5%. Results No statistically significant difference was noted in the mean frequency of micronucleated cells before and after partial CBCT (P = .403). However, there was a significant difference in micronucleus frequency before and after total CBCT (P = .003). With regard to cytotoxicity, there was a statistically significant difference between partial and total acquisitions (P = .007 and P Discussion/Conclusions Only total CBCT seems to have a risk of inducing genetic damage, although both forms of CT scanning have promoted the induction of cytotoxic nuclear alterations.

The use of short dental implants represents one way to overcome this limitation, in association with bone grafting procedures. Tricalcium phosphate-based grafts are among those widely used. The purpose of this study was to assess the biocompatibility of this biomaterial in the coverage of bone defects around short dental implants. Ten New Zealandrabbits were used in this study, each animal received 4 implants, two were placed in the right tibia region (control group) and two in the left tibia region (test group). Forty implants were used, with 4mm diameter and 6mm length. For the control group, holes 6 mmdeep were made, and the implants were then inserted at the level of bone tissue. In the control group, the implants of 6 mmin length were inserted to its full length, while in the test group, the same implant was inserted up to 4 mmand left exposed 2 mm. These 2 mmexposed were coated with a bone substitute of tricalcium phosphate and a collagen membrane. After three months, the animals were prepared for histomorphometric analysis, which showed that the control group had a higher number of osteoblasts per μm 2 than the test group (p < 0.001). It was concluded that under these experimental conditions, tricalcium phosphate showed tissue biocompatibility and osteoconductive potential.

The aim of this study was to evaluate the optical density of the zirconia granules used as a graft in a rat calvarium model. Forty animals (Rattus Novergicus, albinus, Wistar) were divided into control and experimental groups and submitted to bone detects in the cranial cap using a trephine type burr 6 mmin diameter. The control group had the defect filled with blood coagulum, and the experimental group was filled with zirconia granules of 300 to 850 µm. The animals were sacrificed at intervals of 7, 14, 30, and 60 days. Digital images were obtained from the bone defect region, and optical density of the zirconia granules was measured using the Image Tool ® 3.0. software (UTHSCSA,San Antonio, EUA). The histological analysis of the specimens was also evaluated. The values obtained were analyzed by statistical methods: Analysis of Variance, Welch’s Anova, and F Test. It was verified that the mean optical density of the bone repair process differs in all analyzed regions, irrespective of time (p < 0.0001). In the region with the zirconia graft, the mean density was always higher than the other regions analyzed, and the control group showed the same behavior of the experimental groups, but for the region with zirconia graft, the average density is always greater.

PURPOSE: To develop an experimental model to study and radiologically monitor displacement of skin flaps in the pericranium of rats subjected to traction and surgical fixation using suture anchored in a skull bone tunnel or with N-butyl-2-cyanoacrylate (Histoacryl TM) surgical adhesive. METHODS: Radiological markers were placed in the subcutis of Wistar rats undergoing subperiosteal detachment of the pericranium with pulling and fixation of the flap. We performed radiography on postoperative days 3, 7, 14, 21, and 45. A p-value of

The purpose of this article was to compare the mean value of optical density of four porcelains commonly used for fabrication of inlay/onlay prostheses using direct digital radiograph. The sample consisted of 20 2-mm thick porcelain specimens (measured by digital pachymeter): Empress (Ivoclair), Simbios (Degussa), Vita Omega 900 and Vitadur Alpha (Vita Zahnfabrik). The values of optical density of the specimens were expressed in millimeters aluminum equivalent (mm eq Al). The samples were X-rayed using two charge coupled devices (CCD) - RVG (Trophy) - Visualix (Gendex) and a phosphor plate system - Digora (Soredex). The optical density reading was performed with Image Tool 1.28 in a total of 110 measurements. Statistical analysis showed that there were statistically significant differences in all materials studied (p < 0.05) regardless of the radiographic system used. The highest optical density value was found for Omega 900 (1.8988 mmeqAl - Visualix - Gendex) and the lowest for Vitadur Alpha (0.8647 - Visualix - Gendex). Thus, the material presenting the highest degree of optical density was Omega 900, Empress and Simbios presented intermediate optical density values, Vitadur Alpha presented the lowest value, and the optical density of porcelains was not influenced by the digital radiography systems. Objetivo desse trabalho é comparar valores médios de densidade óptica de quatro porcelanas comumente utilizadas para confecção de inlay/onlay por meio da densidade óptica usando radiografia digital. A amostra constou de 20 corpos de prova com espessura de 2mm (mensurados em paquímetro digital) das porcelanas: Empress (Ivoclair), Simbios (Degussa), Vita Omega 900 e Vitadur Alpha (Vita Zahnfabrik). Os valores de densidade óptica das amostras foram expressos em milímetros equivalente em alumínio (mm eq Al). Os espécimes foram radiografados, utilizando dois sistemas de dispositivo de carga acoplada (CCD) - RVG (Trophy) - Visualix (Gendex) e um sistema de placa de fósforo - Digora (Soredex). A leitura da densidade óptica foi realizada no programa Image Tool 1.28 totalizando 110 medições. As leituras de densidade ópticas foram feitas no programa Image Tool 1.28 totalizando 110 mensurações. A análise estatística demonstrou que houve diferença estatisticamente significante entre a densidade óptica das porcelanas estudadas independentemente do sistema de radiografia empregado (p < 0,05). A porcelana Omega 900 obteve 1,8988mmeqAl - Visualix - Gendex e Vitadur Alpha 0,8647mmeqAl - Visualix - Gendex. Conclui-se que a porcelana Omega 900 apresentou os maiores valores de densidade óptica, enquanto que Empress e Simbios obtiveram valores intermiediários, Vitadur Alpha apresentou os menores valores de densidade óptica e a densidade óptica das porcelanas não foram influenciadas pelo sistema de radiografia digital.

Introduction: The present pilot study aims to compare the condylar translation between patients with hyperdivergent and hypodivergent facial pattern. Methods: after analysis of photographs and cephalometric data, sample obtained was divided into two groups: hyperdivergent (n = 12) and hypodivergent (n = 12). For evaluation of condylar translation, temporomandibular joint planigraphys with maximum mouth opening and maximum intercuspal were performed. Subsequently, the tracing of maximum mouth opening in the articulation of each planigraphy was carried out. Metric values were obtained from the measurement of the distance between the point in the lower region of the articular eminence and the point in the most anterior superior mandibular condyle. Results: no statistically significant differences were found between the groups compared. However, the values obtained for horizontal translation performed by the right mandibular condyle were 6.00 mm for the hyperdivergent group, and 3.25 mm in the hypodivergent group. For condyle on the opposite side the horizontal translation averages were 5.66 mm for the hyperdivergent group, and of 4.50 mm for the hypodivergent group. Conclusions: the divergence between the means suggests that hyperdivergent patients show higher condylar translation in both condyles when compared with hypodivergent patients. Further studies should be conducted aiming to elucidate the relationship among facial pattern, cortical thickness condylar and condylar translation.

To present further information about SBCs based on a retrospective study of 12 cases, by describing their clinical and radiographic characteristics, and comparing them with recent findings. The study examined SBCs from the Projeto Lesoes Bucais ‘treatment and epidemiology of diseases of the oral cavity’, run at State University of Maringa, Parana State, Brazil, between 1995 and 2014. Twelve cases were found among the records of 2.424 patients who had been submitted to different types of biopsy. All cases occurred in the mandible, predominantly in patients in the second decade of life, in the region posterior to canines, and among women. All lesions were solitary, 75% of them unilocular. Helicoidal CT showed expansion and rupture of the cortical bone in one case. Differential diagnosis was confirmed by means of histopathological examination. Treatment consisted of surgical exploration in all cases. Most SBCs are usually asymptomatic and diagnosed by chance on routine X-ray examination. However, SBC can cause bone expansion or bone rupture, only visible with more sophisticated imaging systems. This study showed that the diagnosis of SBC benefits with the use of conventional radiography and CT, associated with careful clinical examinations.

The aim of this study was to verify the radiopacity of four microhibridas composed resin: Filmagic – Vigodent, Herculite – Kerr, TPH – Dentsply, W3D – Wilcos in the color A3 and compares them with the dental enamel using direct digital radiography system. Acrylic Plates of 20mm for 30mm had been used, in the thickness 1mm, 2mm and 3mm, contend four cavities which had been filled with resins composed, it was used three human teeth in the same thickness, 36 samples was confected. The specimens were stored at 37 ± 1oC and immersed in distillate water. The specimens and the human tooth had been radiographed with the Dentsply – Gendex 765DC® from a distance of 40cm and to capture the images, a charge-coupled-device system for digital radiography (Visualix® Dentsply-Gendex) and a software DIGORA® for Windows®. The results submitted to statistical analysis (Tukey´s test a variance analyze ANOVA) showed that there was statistical difference among the optical density of the dental enamel and composite resins, being that the composite resin TPH presented 220,76 (1mm), 239,32 (2mm) e 244,09 (3mm), followed by Herculite 192,87 (1mm), 211,67 (2mm) e 225,16 (3mm); W3D 179,90 (1mm), 205,07 (2mm) e 220,95 (3mm) e Fill Magic 174,59 (1mm), 190,90 (2mm) e 212,01 (3mm) e enamel 113,66 (1mm), 119,97 (2mm) e 143,13 (3mm). The composite resins in the thicknesses studied had presented optical density values higher than enamel so they had been satisfied to be used in dental restorations.

Orthognathic surgery is widely used in the treatment of dento-maxillofacial deformities, which changes both the facial appearance and the pharyngeal airway space. The aim of this study was to evaluate cephalometric changes in the pharyngeal airway space before and after orthognathic surgery in patients with Class II and Class III malocclusions. The sample consisted of 38 lateral cephalograms, 17 of patients with Class II who had undergone mandibular advancement, and 21 of patients with Class III who had undergone mandibular setback. Cephalometric analysis of Arnett-Gunson FAB Surgery using Dolphin Imaging 11.5 evaluated point B’ and Pog’. Statistical analysis used Paired t-test at 5% significance level. The increase in the means of point B’ and Pog’ after mandibular advancement was not statistical. Similarly, the means of point B’ and Pog’ did not differ after mandibular setback. Thus, the pharyngeal airway space at the level of B’ and Pog’ kept constant pre and post orthognathic surgery for both Class II and Class III.

Background: To evaluate the diagnostic accuracy of different radiographic methods in the assessment of proximal alveolar bone loss (ABL). Materials and Methods: ABL, the distance between cement-enamel junction and alveolar bone crest, was measured in 70 mandibular human teeth - directly on the mandibles (control), using conventional periapical radiography with film holders (Rinn XCP and Han-Shin), digital periapical radiography with complementary metal-oxide semiconductor sensor, conventional panoramic, and cone-beam computed tomography (CBCT). Three programs were used to measure ABL on the images: Image tool 3.0 (University of Texas Health Sciences Center, San Antonio, Texas, USA), Kodak Imaging 6.1 (Kodak Dental Imaging 6.1, Carestream Health ® , Rochester, NY, USA), and i-CAT vision 1.6.20. Statistical analysis used ANOVA and Tukey′s test at 5% significance level. Results: The tomographic images showed the highest means, whereas the lowest were found for periapical with Han-Shin. Controls differed from periapical with Han-Shin (P < 0.0001). CBCT differed from panoramic (P = 0.0130), periapical with Rinn XCP (P = 0.0066), periapical with Han-Shin (P < 0.0001), and digital periapical (P = 0.0027). Conventional periapicals with film holders differed from each other (P = 0.0007). Digital periapical differed from conventional periapical with Han-Shin (P = 0.0004). Conclusions: Conventional periapical with Han-Shin film holder was the only method that differed from the controls. CBCT had the closest means to the controls.

Context: The pulse oximeter is a device that noninvasively provides continuous information about the peripheral oxygen saturation (SpO2) rate. This device is utilized in the detection of hypoxemia, due to its able to sense changes in hemoglobin oxygen saturation. Aims: The objective of this study was to verify the accuracy of the Choice® Medical MD300C3 Fingertip Pulse Oximeter, as compared to that of a hospital oximeter coupled with a Dräger® Infinity Delta monitor, with the purpose of using this first methodology in dental procedures to monitor the peripheral oxygen saturation (SpO2) of patients submitted to dental treatments. Materials and Methods: Fifty-five adult patients, both genders, were selected in the Santa Casa Hospital of Maringa, Brazil. The volunteers did not present cardiac problems, prosthetic cardiac valves, pacemakers, or pulmonary diseases, and were not pregnant or children. Each patient received a portable fingertip pulse oximeter (PPO) on the middle finger of the left hand and the hospital oximeter (control device) on the forefinger of the same hand. A total of six measurements were developed. The Pearson correlation coefficient and the Bland and Altman method was used to calculate the statistical analysis. Results: No statistically significant difference was found between the measurements taken by the utilized devices. The average of comparative analysis presented by the devices was 0.2337 ± 0.4355 (mean ± SD), suggesting a strong correlation between the obtained results. Conclusion: According to the methodology of the research, the PPO has similar accuracy to the conventional hospital oximeter with digital sensor. The PPO can be used in dental treatments.