COMPUTED TOMOGRAPHY IMAGING STRATEGIES AND PERSPECTIVES IN ORBITAL FRACTURES

Objective:

The objective of this study was to demonstrate the sensitivity and specificity of multislice computed tomography (CT) for diagnosis of orbital fractures following different protocols, using an independent workstation.

Materials and methods:

CT images of 36 patients with maxillofacial fractures (symptomatic to orbit region) who were submitted to multislice CT scanning were analyzed, retrospectively. The images were interpreted based on 5 protocols, using an independent workstation: 1) axial (original images); 2) multiplanar reconstruction (MPR); 3) 3D images; 4) association of axial/MPR/3D images and 5) coronal images. The evaluated anatomical sites were divided according to the orbital walls: lateral (with or without zygomatic frontal process fracture); medial; superior (roof) and inferior (anterior, medial). The collected data were analyzed statistically using a validity test (Youden''s J index; p<0.05). The clinical and/or surgical findings (medical records) were considered as the gold standard to corroborate the diagnosis of the anatomical localization of the orbital fracture.

Results:

3D-CT scanning presented sensitivity of 78.9%, which was not superior to that of MPR (84.0%), axial/MPR/3D (90.5%) and coronal images (86.1%). On the other hand, the diagnostic value of axial images was considered limited for orbital fractures region, with sensitivity of 44.2%.

Conclusions:

Except for the axial images, which presented a low sensitivity, all methods evaluated in this study showed high specificity and sensitivity for the diagnosis of orbital fractures according to the proposed methodology. This protocol can add valuable information to the diagnosis of fractures using the association of axial/MPR/3D with multislice CT.     

Maxillary lesion presenting as a first sign of multiple myeloma: case report

Plasma cell neoplasia is a lymphoid neoplastic proliferation of B cells. This denomination encloses multiple myeloma (MM), solitary bone plasmacytoma and extramedullary plasmacytoma. MM consists of a clonal proliferation of plasma cells based in the bone marrow, with various degrees of differentiation. Neoplastic cells usually produce great amounts of monoclonal light or heavy chains of immunoglobulin that can be detected in serum or urine. The disease is more frequently in men and the average age at diagnosis is about 60 years. The diagnosis is established by blood and urine exams and medullary biopsy. Patients may present renal failure, bone pain, fatigue, recurrent infections and nervous system dysfunction. Oral manifestations may be the first sign of MM, highlighting the importance of the dentist in the early diagnosis of the disease. Treatment involves mainly irradiation and chemotherapy and the prognosis is generally poor. This paper reports a case of a 65 years old black female who had a complaint of a painful mass in the maxilla that prompted a MM diagnosis.     

Brazilian gutta-percha points. Part II: thermal properties

This study was undertaken to explore the effect of heating on gutta-percha, analyzing the occurrence of endothermic peaks corresponding to the transformation that occurs in the crystalline structure of the polymer during thermal manipulation. This study also sought to determine the temperature at which these peaks occur, causing a transformation from the beta- to the alpha-form, and from the alpha- to the amorphous phase. Eight nonstandardized gutta-percha points commercially available in Brazil (Konne, Tanari, Endopoint, Odous, Dentsply 0.04, Dentsply 0.06, Dentsply TP, Dentsply FM) and pure gutta-percha (control) were analysed using differential scanning calorimetry (DSC) and thermogravimetry analysis (TGA). The transition temperatures were determined and analysed. With the exception of Dentsply 0.04 and Dentsply 0.06, the majority of the products showed thermal behaviour typical of beta-gutta-percha, with two endothermic peaks, exhibiting two crystalline transformations upon heating from ambient temperature to 130 degrees. Upon cooling and reheating, few samples presented two endothermic peaks. It was concluded that heating dental gutta-percha to 130 degrees C causes changes to its chemical structure which permanently alter its physical properties.     

Microscopic qualitative evaluation of fixation time and decalcification media in rat maxillary periodontium

The rat model is widely used in periodontal research and the quality of histological sections is essential. The purpose of this study was to evaluate the histological characteristics of periodontal tissues in Wistar rat maxillae, with different times of fixation and decalcified by nitric acid or formic acid (Anna Morse Solution). Fifteen rats were used. Fixation was performed for 24, 48 and 72 hours. The maxillae were hemi-sectioned and each part was decalcified either in nitric acid for 7 days or in Anna Morse solution for 35 days. Two trained and blinded examiners performed the evaluation. Fourty eight hours of fixation and decalcification with Anna Morse solution showed more clear characteristics of the epithelium-connective tissue interface and of the periodontal structures. Mean measurements between the cementum-enamel junction and the bone crest varied in the different experimental times from 176.5 (+/- 60.45) to 210.94 (+/- 39.33) pixels on the buccal aspect, and from 199.69 (+/- 38.33) to 298.55 (+/-70.81) pixels on the palatal aspect, with no statistically significant differences (ANOVA, p > 0.05). In the same fixation period, decalcification with nitric acid or Anna Morse solution did not display any statistically significant differences. It may be concluded that for a qualitative histological analysis, fixation should preferably be for 48 hours and the demineralization should be made by Anna Morse solution. For a histomorphometric analysis, the decalcification solution does not interfere in the results.     

Use of radiographs for periodontal diagnosis in private practice

The aim of the present study was to determine the percentage of dentists who use radiographic examination on the initial appointment, and establish the relation between the use of periodontal probe and graduation year. Dentists were interviewed in their private offices in three cities in Rio Grande do Sul. They were asked about the routine use of radiographic examination and, if applicable, what technique was applied and what clinical instrument was used at the first appointment. Opened and closed questions were included in the interview and for some of them more than one answer was possible. A significant number of dentists (62.9%) reported some kind of radiographic examination at the initial appointment. Among the radiographic techniques, the periapical was the most cited (74.3%), followed by the panoramic (36.2%) and bite-wing (32.9%) techniques. There was an association between the use of periodontal probe and the use of radiographic examination at the initial appointment. Dentists who used periodontal probe used radiographic examination more frequently (p=0.010). More recently graduated dentists (1991-2005) used radiographic examination more than the others (p=0.022). In conclusion, a large number of dentists reported the use of radiographic examination at the initial appointment. There was an association between the use of this examination technique and the use of the periodontal probe; recently graduated dentists used radiographic examinations more frequently than the others.     

Simple bone cyst: possible misdiagnosis in periapical pathology

Simple bone cysts are non-neoplastic bone lesions, classified as intraosseous pseudocysts without epithelial lining, that can be empty or filled by fluid and display uncommon clinical and radiographic features. This article presents an unusual case of a simple bone cyst with clinical and radiographic features similar to chronic apical periodontitis. A general dentist referred an 18-year-old man for endodontic treatment after the patient complained of pain in the mandibular right second molar, which displayed a significant bony radiolucency. Chronic periapical lesion was excluded after detailed clinical and radiographic examinations. During surgical exploration, an empty bone cavity was observed and curetted before wound closure. One year later, complete healing was observed.     

Composite depth of cure obtained with QTH and LED units assessed by microhardness and micro-Raman spectroscopy

This study analyzed the depth of cure of a composite assessed by microhardness and the degree of conversion as a function of the light cure unit (LCU) used. Two light cure units, one LED (Ultraled-Dabi Atlante) and one quartz-tungsten-halogen (QTH, Optilux 401-Demetron) unit were used to cure 4.0 x 4.0 mm and 5.0 mm deep composite specimens (Filtek Z250, 3M ESPE). After 24 hours storage at 37 degrees C, Knoop microhardness and degree of conversion were measured on the irradiated surface and at each millimeter of the sample's depth. The degree of conversion was determined by using micro-Raman spectroscopy. The specimens cured with the QTH unit presented uniform decay in microhardness up to 4 mm in depth. Beyond 4 mm, the drop was abrupt. With LED photoactivation, uniform decay was observed only up to 2 mm. At higher depths, the decay in microhardness increased rapidly, especially beyond 3 mm. Depth of cure assessed by micro-Raman revealed that the degree of conversion behaved similarly to microhardness for both LCUs. A strong linear regression between microhardness and the degree of conversion, including both LCUs, was established with R2 = 0.980.     

The importance of dentin collagen fibrils on the marginal sealing of adhesive restorations

This study evaluated the importance of the union between dentin collagen and three different adhesive materials. Sixty Class V restorations were prepared on the buccal and lingual surfaces of 30 recently extracted human premolars, with the cervical margins in dentin and the occlusal margins in enamel. These restorations were distributed to three groups of 20 cavities each based on the employed adhesive system used: Group A: Single Bond; Group B: Prime&Bond NT; Group C: One Coat Bond. Each group was subdivided according to dentin treatment: (1) manufacturers' adhesive protocol and (2) removal of the collagens fibers (total etch + sodium hypochlorite 5% for two minutes) + adhesive protocol. After the restorations were completed, the teeth were stored in saline solution (24 hours/37 degrees C), subjected to thermal cycling, washing and scoring according to dye penetration. Dye penetration was evaluated, with the numbers ranging from 0 (no infiltration) to 3 (greatest infiltration). When the dentin microleakage scores were compared in subgroups A1XA2, B1XB2 and C1XC2, the Mann-Whitney Test revealed significant differences between groups B and C (p < 5%). The better results were shown in subgroups B2 (p = 0.0345) and C2 (p = 0.0029). The results showed that the collagen fibrils were not necessary for adhesion, and their removal positively influenced the marginal sealing of Prime&Bond NT and One Coat Bond.     

The influence of C-factor, flexural modulus and viscous flow on gap formation in resin composite restorations

This study analyzed the influence of C-factor, flexural modulus and viscous flow on gap formation in resin composite restorations. Two resin composites, a mini-filled hybrid (P 60) and a nanofilled (Supreme), were used. The flexural modulus was obtained from bar-shaped specimens submitted to three-point bending. Viscous flow was obtained from the difference between the initial and final diameter of resin composite disks submitted to a load of 10 N for 120 seconds. Gap analysis was conducted in three types of cylindrical cavities (C-factor of 1.8, 2.6 and 3.4) that were prepared on the occlusal surfaces of human molars. The gap width at the dentin-resin composite interface was measured using a 3D scanning system (Talyscan 150). The data were analyzed by ANOVA and Student-Newman-Keuls' test, t-test and linear regression analysis (alpha = 0.05). The cavities with C-factor 3.4 presented the highest Gap formation (p < 0.0001). The lowest Gap formation was found in cavities restored with Supreme resin composite (p < 0.0001). P 60 presented significantly higher flexural modulus and lower viscous flow than Supreme (p < 0.0001). Regression analyses detected a significant influence of flexural modulus and viscous flow on gap formation (p < 0.05).