A Hiperplasia Coronoide (HC) e um aumento nao-neoplasico e relativamente raro do processo coronoide que pode limitar o movimento mandibular, como consequencia da intima relacao entre o processo coronoide hiperplasico e a regiao anterior do osso zigomatico. A tomografia computadorizada (TC) e extremamente util para a observacao dessa relacao, desempenhando assim um papel importante no diagnostico e planejamento do tratamento cirurgico. Uma vez que a TC e realizada, os dados podem ser vistos em muitos arranjos diferentes, incluindo o multiplanar (MPR) e a reconstrucao em 3D, no entanto, a resolucao desta ultima pode nao ser tao boa quanto a primeira. Nosso objetivo e analisar a importancia e a preferencia por reconstrucoes de imagens multiplanares (MPR) e 3D para diagnosticar e interpretar a Hiperplasia Coronoide (HC), comparando cirurgioes buco-maxilo-faciais com radiologistas orais. Ambas as articulacoes temporomandibulares (ATM) de 20 pacientes foram analisadas pelos 2 grupos. Tres imagens de cada ATM compreenderam o conjunto de exames (MPR, reconstrucoes 3D em maxima intercuspidacao e reconstrucoes 3D com abertura maxima da boca). Apos cada analise, os grupos responderam a um questionario sobre a utilidade de cada exame e classificou a relacao entre a cabeca da mandibula e da fossa mandibular. A Hipomobilidade esteve presente em 55,2%. Ambos os grupos afirmaram que tanto MPR e as reconstrucoes em 3D, especialmente a ultima, foram fundamentais para diagnosticar CH e as requisitariam para interpretar a HC corretamente. Foi encontrada uma diferenca significativa entre os examinadores sobre a MPR; apenas o grupo de radiologistas considerou que este exame nao e tao elucidativo para o diagnostico da CH.

Coronoid Hyperplasia (CH) is a non-neoplastic and relatively rare enlargement of the coronoid process that may limit mandibular movement as a consequence of the close association between the hyperplastic coronoid process and the anterior region of the zygomatic bone. Computed tomography (CT) is extremely useful for the observation of this association and plays an important role in diagnosing and planning surgical treatment. Once the CT scan is performed, the data can be viewed in many different arrangements, including multiplanar (MPR) and 3D rendering, although the resolution of the latter may not be as good as that of the former. Our aim is to analyze the importance of and preference for multiplanar and 3D reconstruction images for diagnosing and interpreting Coronoid Hyperplasia (CH), by comparing the opinions of oral surgeons and oral radiologists who analyzed both temporomandibular joints (TMJ) in 20 patients. Three images of each TMJ comprised the set of scans (MPR, 3D reconstructions with maximum intercuspation and 3D reconstructions with maximum mouth opening). After each analysis, the members of the two groups answered a questionnaire about the usefulness of each examination and classified the association between the head of mandible and mandibular fossa. Hypomotility was present in 55.2%. Both groups stated that both MPR and 3D reconstructions, particularly the latter, were fundamental for diagnosing CH and that they would request them in order to interpret CH correctly. The examiners were found to differ significantly regarding their opinion of MPR; only radiologists considered MPR to be less elucidative for the diagnosis of CH.

There are many studies that compare the accuracy of multislice (MSCT) and cone beam (CBCT) computed tomography for evaluations in the maxillofacial region. However, further studies comparing both acquisition techniques for the evaluation of simulated mandibular bone lesions are needed. The aim of this study was to compare the accuracy of MSCT and CBCT in the diagnosis of simulated mandibular bone lesions by means of cross sectional images and axial/MPR slices. Lesions with different dimensions, shape and locularity were produced in 15 dry mandibles. The images were obtained following the cross sectional and axial/MPR (Multiplanar Reconstruction) imaging protocols and were interpreted independently. CBCT and MSCT showed similar results in depicting the percentage of cortical bone involvement, with great sensitivity and specificity (p < 0.005). There were no significant intra- or inter-examiner differences between axial/MPR images and cross sectional images with regard to sensitivity and specificity. CBCT showed results similar to those of MSCT for the identification of the number of simulated bone lesions. Cross sectional slices and axial/MPR images presented high accuracy, proving useful for bone lesion diagnosis.

OBJECTIVE: This study evaluated the influence of metallic dental artifacts on the accuracy of simulated mandibular lesion detection by using multislice technology. MATERIAL AND METHODS: Fifteen macerated mandibles were used. Perforations were done simulating bone lesions and the mandibles were subjected to axial 16 rows multislice CT images using 0.5 mm of slice thickness with 0.3 mm interval of reconstruction. Metallic dental restorations were done and the mandibles were subjected again to CT in the same protocol. The images were analyzed to detect simulated lesions in the mandibles, verifying the loci number and if there was any cortical perforation exposing medullar bone. The analysis was performed by two independent examiners using e-film software. RESULTS: The samples without artifacts presented better results compared to the gold standard (dried mandible with perforations). In the samples without artifacts, all cortical perforation were identified and 46 loci were detected (of 51) in loci number analysis. Among the samples with artifacts, 12 lesions out of 14 were recognized regarding medullar invasion, and 40 out of 51 concerning loci number. The sensitivity in samples without artifacts was 90% and 100% regarding loci number and medullar invasion, respectively. In samples with artifacts, these values dropped to 78% and 86%, respectively. The presence of metallic restorations affected the sensitivity values of the method, but the difference was not significant (p>0.05). CONCLUSIONS: Although there were differences in the results of samples with and without artifacts, the presence of metallic restoration did not lead to misinterpretation of the final diagnosis. However, the validity of multislice CT imaging in this study was established for detection of simulated mandibular bone lesions.

OBJECTIVE: The aims of this study were to establish parameters in panoramic radiography for interpretation of unilocular radiolucent lesions, and to compare the accuracy of diagnoses given by examiners before and after using these parameters. MATERIAL AND METHODS: In Part I, 12 specialists analyzed 24 images and the diagnostic criteria used by each examiner to make correct diagnoses were used to build a list of basic radiographic parameters for each pathology (ameloblastoma, keratocystic odontogenic tumor, dentigerous cyst, and idiopathic bone cavity). In Part II, this list was used by 6 undergraduate students (Un), 8 recently graduated dentists (D), 3 oral pathologists, 3 stomatologists, 3 oral radiologists, and 3 oral surgeons to diagnose the corresponding pathologies in the other set of 24 panoramic radiographs (T2). The same analysis occurred without using this list (T1). The method of generalized estimating equations (GEE) was used in order to estimate the probability of making a correct diagnosis depending on the specialty of the examiner, type of lesion, and moment of the evaluation, T1 or T2 (before or after they had access to the list of parameters, respectively). RESULTS: Higher values were obtained for the probability (GEE) of making a correct diagnosis on T2; the group Un presented the highest improvement (14.6 %); no differences between the probabilities were observed either between Un and D, or among the different groups of specialists. CONCLUSIONS: The use of panoramic radiographic parameters did allow improving the diagnostic accuracy for all groups of examiners.

O objetivo deste estudo foi identificar as principais caracteristicas radiograficas para a diferenciacao de lesoes radiolucidas uniloculares mandibulares, por meio dos criterios utilizados por diferentes grupos de especialistas durante o processo de interpretacao radiografica para a obtencao dos diagnosticos corretos das lesoes. Vinte e quatro radiografias panoramicas foram selecionadas exibindo as seguintes lesoes: ameloblastoma, tumor odontogenico queratocistico, cisto dentigero e cisto osseo simples. Seis casos de cada entidade patologica foram analisados por 3 especialistas de 4 areas diretamente relacionadas a diagnostico (patologistas, estomatologistas, radiologistas e cirurgioes buco-maxilo-faciais). Inumeras caracteristicas importantes tanto para a correta distincao quanto para a ocorrencia de confusao entre as lesoes, foram levantadas pelos especialistas durante a analise. O metodo de equacoes de estimacao generalizada (EEG) foi utilizado para estimar a probabilidade do acerto do diagnostico segundo a especialidade do examinador e o tipo de lesao, nao sendo encontrada relacao significativa (p>0.05 para todas as variaveis). A porcentagem geral de diagnostico correto entre os especialistas ficou em torno de 56%, o que mostra que estas lesoes sao de dificil diagnostico radiografico. Embora a especialidade dos examinadores nao tenha influenciado os resultados, isto e, os 4 tipos de especialistas mostraram a mesma capacidade diagnostica, os criterios utilizados para a interpretacao das mesmas lesoes foram frequentemente diferentes entre os especialistas. A compilacao desses criterios possibilitou a identificacao e selecao de algumas caracteristicas radiograficas distintivas uteis na formulacao de hipoteses diagnosticas de lesoes radiolucidas uniloculares. O diagnostico radiografico das lesoes radiolucidas uniloculares mandibulares e particularmente dificil e a analise histopatologica e essencial para a obtencao do diagnostico definitivo.

The main goal of this study was to identify the main distinctive radiographic characteristics of different unilocular radiolucent mandibular lesions based on the criteria used by different groups of specialists during the process of radiograph interpretation to arrive at a correct diagnosis. A total of 24 panoramic radiographs were selected exhibiting the following lesions: ameloblastoma, keratocystic odontogenic tumor, dentigerous cyst and simple bone cyst. Six cases of each pathology were analyzed by 3 specialists from 4 related areas (pathologists, stomatologists, radiologists and oral surgeons). A number of important distinctive features and confounding characteristics that are liable to misinterpretation were pointed out by the specialists during the analysis. The method of generalized estimating equations (GEE) was used to estimate the probability of correct diagnosis according to the specialization of the examiner and the type of lesion and no significant relation was found (p>0.05 for all variables). The overall percentage of correct diagnosis among the specialists was around 56%, which shows that these lesions are of difficult radiographic diagnosis. Although the specialty of the examiners did not influence the results, i.e., the 4 different kinds of specialists showed the same diagnostic capacity, the criteria used for interpreting the same lesions were often different among the specialists. The compilation of these criteria enabled the identification and selection of some useful distinctive radiographic characteristics to formulate diagnostic hypothesis of unilocular radiolucent lesions. The radiographic diagnosis of the unilocular radilucent mandibular lesions is particularly difficult and the histopathological examination is essential to make the definitive diagnosis.

The aim of this study was to investigate the agreement between diagnoses of calcified atheroma seen on panoramic radiographs and color Doppler images. Our interest stems from the fact that panoramic images can show the presence of atheroma regardless of the level of obstruction detected by color Doppler images. Panoramic and color Doppler images of 16 patients obtained from the archives of the Health Department of the city of Valença, RJ, Brazil, were analyzed in this study. Both sides of each patient were observed on the images, with a total of 32 analyzed cervical regions. The level of agreement between diagnoses was analyzed using the Kappa statistics. There was a high level of agreement, with a Kappa value of 0.78. In conclusion, panoramic radiographs can help detecting calcifications in the cervical region of patients susceptible to vascular diseases predisposing to myocardial infarction and cerebrovascular accidents. If properly trained and informed, dentists can refer their patients to a physician for a cardiovascular evaluation in order to receive proper and timely medical treatment.

Radiografias periapicais e panorâmicas, com aparelho elipsopantomográfico, são comparadas na avaliação do tratamento endodôntico. Com este objetivo, radiografias realizadas nestas duas técnicas, num mesmo paciente, com pelo menos um dente com tratamento endodôntico, foram analisadas por três examinadores, levando-se em consideração as condições apicais (lesões periapicais), a obturação do canal radicular (tipo de material, preenchimento e limite apical), a restauração do dente e o preenchimento da câmara pulpar. Os resultados mostram que a radiografia periapical define melhor a presença de rarefação óssea periapical difusa, obturação do canal radicular com guta-percha, tratamento endodôntico inadequado, justaposição do material restaurador inadequada para a região anterior e a presença de restauração metálica fundida na região posterior. Para os demais itens avaliados, os resultados da análise estatística não são significantes. A concordância de diagnósticos entre examinadores se mostra superior nas radiografias periapicais.

Periapical and panoramic radiography with a ellipsopantomograph device, are compared in the evaluation of endodontic treatment. With this objective, radiographies carried out under both techniques with the same patient having at least one tooth endodontically treated, were analysed by three observers, taking into consideration the apical conditions (periapical lesions), the root canal filling (material type, filling and apical level), tooth restoration and filling of the pulpar camera. The results demonstrated that periapical radiography is a better way to define the appearance of difuse periapical bone rarefaction, root canal filling with gutta-percha, insatisfactory endodontic treatment, an inadequate juxtaposition of the restoration material to the anterior region, and the presence of metallic casted restorations in the posterior region. Other result evaluations were not significant. The diagnostic agreement among the observers is higher in periapical radiography.

Neste estudo, apresentamos uma avaliação dos alunos do curso de Odontologia, iniciantes na execução das técnicas radiográficas periapicais, da bissetriz e do paralelismo, conforme duas estratégias de ensino. A performance foi diferente em ambas as situações. Os melhores resultados da técnica da bissetriz foram encontrados quando utilizamos inicialmente o ensino da técnica do paralelismo.

The present study evaluates dental students, which are beginners in executing radiographic periapical techniques, both paralleling and bisecting-angle, according to two teaching strategies. Performance levels were found to be different according to the utilized strategy. The best results regarding the bisecting-angle technique were found when the paralleling technique was taught first.