Flávia Maria de Moraes Ramos-Perez

Ossifying fibroma misdiagnosed as chronic apical periodontitis.

INTRODUCTION Ossifying fibroma mimicking chronic apical periodontitis is extremely rare. This report describes a case of ossifying fibroma located in the periapical region of the mandibular right canine that was misdiagnosed as chronic apical periodontitis. METHODS A 40-year-old woman complained of slight pain in the right anterior mandibular region without mucosal abnormalities or swelling. Radiographically, a well-circumscribed, unilocular, radiolucent lesion was observed that was located in the periapical region of the mandibular right canine, which presented an endodontically treated root canal. Under local anesthesia, the lesion was fully excised. RESULTS Microscopically, there was fibrocellular connective tissue associated with a mineralized component, which consisted of lamellar or trabecular and woven bone, compatible with the diagnosis of ossifying fibroma. CONCLUSIONS Although it is very rare, ossifying fibroma should be considered in the differential diagnosis of unusual or persistent apical radiolucencies.

Assessment of the anterior loop of the mandibular canal: A study using cone-beam computed tomography

Purpose Sufficient area in the interforaminal region is required for dental implant placement, and the anterior loop of the mandibular canal is located within the limits of this area. The aim of this study was to evaluate the prevalence and extent of the anterior loop in a Brazilian sample population using cone-beam computed tomography (CBCT). Materials and Methods CBCT images from 250 patients (500 hemimandibles) obtained for various clinical indications were randomly selected and evaluated to determine the presence and length of the anterior loop. The length of the anterior loop was then compared based on gender, age, and the side of the mandible. The data were analyzed using the Pearson chi-square test and linear regression analysis. Results An anterior loop was identified in 41.6% of the cases, and its length ranged from 0.25 mm to 4.00 mm (mean, 1.1±0.8 mm). The loop had a greater mean length and was significantly more prevalent in males (p=0.014). No significant differences were found between the right and left sides regarding length (p=0.696) or prevalence (p=0.650). Conclusion In this study, a high prevalence of the anterior loop of the mandibular canal was found, and although its length varied greatly, in most cases it was less than 1 mm long. Although this is a prevalent anatomical variation, safety limits for the placement of implants in this region cannot be established before an accurate evaluation using imaging techniques in order to identify and preserve the neurovascular bundles.

Lateral periodontal cyst: report of case and review of the literature

BackgroundAs the lateral periodontal cyst (LPC) is an unusual odontogenic cyst, most papers are single case reports or series with a limited number of cases, with few large series. The aim of this study is to report an additional case of LPC, emphasizing the clinical, radiographic, and histopathological features, differential diagnosis, and review of 264 cases reported in the English-language literature.Case reportA 51-year-old male patient presented with a well-delimited, radiolucent, mandibular lesion, located between the roots of the right lower lateral incisor and canine and evidenced during routine radiographic examination. A surgical excision was performed. Microscopically, there was a cystic cavity lined by simple squamous epithelium, compatible with LPC.DiscussionLPC is an unusual odontogenic cyst and presents a marked predilection for occurring in the mandible between the roots of canines and premolars. Accurate clinical and imaging exams should be performed for a correct approach and diagnosis.

Radioprotective effect of sodium selenite on bone repair in the tibia of ovariectomized rats

This study evaluated protection by selenium (Se) in the bone repair process in ovariectomized rats after irradiation. For such purpose, 80 ovariectomized female Wistar rats were randomly divided into 4 experimental groups: ovariectomized (Ov), Ov/Se, Ov/irradiated (Irr) and Ov/ Se/Irr. A bone defect was created on the tibia of all animals 40 days after ovariectomy. Two days after surgery, only the Ov/Se and Ov/Se/Irr rats received 0.8 mg Se/kg. Three days after surgery, only the Ov/Irr and Ov/Se/Irr rats received 10 Gy of x-rays on the lower limb region. The animals were euthanized at 7, 14, 21 and 28 days after surgery to assess the repair process, which was evaluated by analysis of trabecular bone number (Masson Trichrome) and birefringence analysis (Picrosirius). It was possible to observe a delay in the bone repair process in the ovariectomized/irradiated group and similarity between the ovariectomized, Ov/Se and Ov/Se/Irr groups. In conclusion, sodium selenite exerted a radioprotective effect in the bone repair of tibia of ovariectomized rats without toxicity.

Human identification study by means of frontal sinus imaginological aspects.

The objective of this study was to evaluate the applicability of human identification parameters, established by Tatlisumak et al. (2007), by means of cone-beam computed tomography and extraoral radiographs of the frontal sinus region. From a total of 58 dry skulls, 26 were selected. Posteroanterior, profile cephalometric radiographs and cone-beam computed tomography images were acquired, adopting a specific method for reproducibility purposes. The images were evaluated by two examiners, previously calibrated, in a darkened environment and at two distinct sessions, with a minimum of 15 days between them. The characteristics of the frontal sinus were analyzed using the Cohens kappa test, for categorical variables, and Lins concordance correlation coefficient (CCC) for continuous variables. Acceptable values of inter method variability for the categorical variables were found, while same cannot be told for continuous variables. The parameters evaluated for the frontal sinus on extraoral radiographs and cone-beam computed tomographs were mostly concordant, with the exception of three. Categorical and discrete variables showed an intra- and interexaminer concordance ranging from good to perfect, and the quantitative continuous variables showed concordance ranging from moderate to excellent. The parameters examined are applicable and reproducible using multiplanar reconstructions of cone-beam computed tomography and extraoral radiographs of the frontal sinus.

Radioprotective Effect of Vitamin E in Parotid Glands: a Morphometric Analysis in Rats

The aim of this study was to evaluate the radioprotective effect of vitamin E on rat parotid glands by morphometric analysis. Sixty male rats were divided into 5 groups (n=6): control, in which animals received olive oil solution; olive oil/irradiated, in which animals received olive oil and were irradiated with a dose of 15 Gy of gamma radiation; irradiated, in which animals were irradiated with a dose of 15 Gy gamma radiation; vitamin E, which received α-tocopherol acetate solution; vitamin E/irradiated, which received α-tocopherol acetate solution before irradiation with a dose of 15 Gy gamma rays. Half of the animals were euthanized at 8 h, and the remaining at 30 days after irradiation. Both parotid glands were surgically removed and morphometric analysis of acinar cells was performed. Data were subjected to two-way ANOVA and Tukeys test (α=0.05). Morphometric analysis showed a significant reduction in the number of parotid acinar cells at 30 days in olive oil/irradiated and irradiated groups. In groups evaluated over time a significant reduction was shown at 30 days in olive oil/irradiated and irradiated groups, indicating that ionizing radiation caused tissue damage. The vitamin E/irradiated group presented more acinar cells than the irradiated group, but no statistically significant difference was observed (p>0.05). In conclusion, vitamin E seems to have failed as a radioprotective agent on acinar cells in rat parotid glands.

Ossifying Fibroma of the Jaws: A Clinicopathological Case Series Study

The aim of this study was to assess the clinical, radiographic and microscopic features of a case series of ossifying fibroma (OF) of the jaws. For the study, all cases with OF diagnosis from the files of the Oral Pathology Laboratory, University of Ribeirão Preto, Ribeirão Preto, SP, Brazil, were reviewed. Clinical data were obtained from the patient files and the radiographic features were evaluated in each case. All cases were reviewed microscopically to confirm the diagnosis. Eight cases were identified, 5 in females and 3 in males. The mean age of the patients was 33.7 years and most lesions (7 cases) occurred in the mandible. Radiographically, all lesions appeared as unilocular images and most of them (5 cases) were of mixed type. The mean size of the tumor was 3.1 cm and 3 cases caused displacement of the involved teeth. Microscopically, all cases showed several bone-like mineralized areas, immersed in the cellular connective tissue. From the 8 cases, 5 underwent surgical excision and 1 patient refused treatment. In the remaining 2 cases, this information was not available. In conclusion, OF occurs more commonly in women in the fourth decade of life, frequently as a mixed radiographic image in the mandible. Coherent differential diagnoses are important to guide the most adequate clinical approach. A correlation between clinical, imaginological and histopathological features is the key to establish the correct diagnosis.

Human identification by FSS system adapted to cephalometric radiographs

The aim of this study was to verify the applicability and reproducibility of the FSS system [8] adapted for frontal and lateral cephalometric radiographs of the frontal sinus for human identification purposes. Eighty lateral and frontal digital cephalometric radiographs from a private Dental Radiology services database were evaluated. Evaluations were performed in a dimmed lighting room, using a 4.200 lux lightbox with mask, ultrafan paper and pencil with a 0.5 diameter tip. The sheet of paper was superimposed on the radiograph to obtain the outlines of the frontal sinus and two examiners made the drawings independently at two different times, with a minimum period interval between evaluations. To obtain the linear physical measurements of the frontal sinus, a digital pachymeter was used. Later, all the discrete variables were codded for the statistical analysis. All variables were tested by means of the Cohens Kappa test. The intraexaminer agreement ranged from good to perfect (p<0.001), while the interexaminer agreement ranged from regular to perfect (p<0.001). The use of frontal and lateral cephalometric radiographs was found to be reproducible and reliable for human identification by an adaptation of FSS system.

Effects of treatment with fluoxetine on mandibular development: A morphological study in rats.

AIM To verify whether the use of fluoxetine during gestation and lactation interferes in mandibular bone formation in rats. METHODS Twenty-four Wistar rat pups were used and distributed into four groups: CG - control of gestation; CL - control of gestation and lactation; FG - treated with fluoxetine during gestation and FL - treated with fluoxetine during gestation and lactation. At 25 days of life, after anesthesia, perfusion and decapitation, the mandibles were removed. Radiographic, histologic, histometric and polarizing microscopy analyses were performed. Statistical analysis was used considering a level of 5% significance. RESULT The FL group compared with its control (CL) was shown to differ statistically from the other groups as regards histometry and radiopacity, revealing a reduction in the inferior cortical thickness, reduction in number of osteocytes, with consequent reduction in radiographic bone density. There was also reduction in the number of osteoblasts in FG. CONCLUSION The long-term use of fluoxetine via oral route by pregnant and lactating rats modifies the mandibular bone mass.

Radicular dens invaginatus in a mandibular premolar: cone-beam computed tomography findings of a rare anomaly

Dens invaginatus is a rare developmental anomaly and its etiology remains controversial. Radicular dens invaginatus is an unusual dental anomaly. The aims of this paper are to report the radiographic and tomographic findings of a case of radicular dens invaginatus and to discuss the relevant features associated with this dental anomaly. A 16-year-old female was referred to a private oral radiology clinic for orthodontic evaluation. Radiographically, a morphological alteration to the root portion of the right mandibular first premolar and the presence of a discrete radiolucent periapical lesion were observed. The diagnosis was only elucidated after cone-beam computed tomography (CBCT). The CBCT images revealed enlargement of the root, and a dilated invagination with limited enamel that had its open site along the lateral portion of the root without evidence of buccal and lingual expansion. The diagnosis of radicular dens invaginatus was then established.