ABSTRACT Objective: The present study aimed to evaluate cone beam computed tomography image segmentation as a tool for measuring the volume of external inflammatory root resorption in human permanent teeth. Methods: A total of 40 cone beam computed tomography images of permanent maxillary and mandibular anterior teeth diagnosed with external inflammatory root resorption. The images were exported in the DICOM format to the Materialise MIMICS software program (version 10.01; Materialise NV, Belgium) for segmentation and characterisation of resorption cavities in terms of location, number of reabsorption sites, relationship to resorption sites, and nominal and percentage volumetric beside assessment of root resorption cavities and remaining root volume. All measurements were performed in duplicate and blindly by a trained radiologist at an interval of 30 days to analyse the intraclass correlation coefficients. Results: The nominal volumetric measures of root resorption cavities ranged from 0.6 mm3 to 114.4 mm3 (median, 13.2 mm3). The percentage volume of root resorption cavities ranged from 0.37% to 39.44% (median, 4.73%). The nominal of remaining root volume ranged from 88 mm3 to 401.3 mm3 (median, 212.4 mm3). The percentage of remaining root volume ranged from 60.34% to 99.63% (median, 95.37%). Conclusions: The results of this preliminary study suggest that segmentation is an effective and reproducible tool for measuring the volumetric size of external inflammatory root resorption cavities. Further longitudinal studies are needed to explore the usefulness of cone beam computed tomography image segmentation in improving external inflammatory root resorption diagnosis and supporting decision making for the treatment of such conditions. Objective Methods 4 version 10.01 1001 10 01 NV Belgium location sites 3 coefficients Results 06 0 6 0. mm 1144 114 114. median, median (median 132 13 2 13. mm3. . mm3) 037 37 0.37 3944 39 44 39.44 4.73%. 473 4.73% 73 4.73%) 8 4013 401 401. 2124 212 212. 6034 60 34 60.34 9963 99 63 99.63 95.37%. 9537 95.37% 95 95.37%) Conclusions conditions 10.0 100 1 11 03 0.3 394 39.4 47 4.73 7 21 603 60.3 996 9 99.6 953 95.37 10. 39. 4.7 60. 99. 95.3 4. 95.

RESUMO Objetivo: O presente estudo teve como objetivo avaliar a segmentação de imagens de tomografia computadorizada de feixe cônico como ferramenta para medir o volume de reabsorção radicular inflamatória externa em dentes permanentes humanos. Métodos: Um total de 40 imagens de tomografia computadorizada de dentes anteriores permanentes superiores e inferiores com diagnóstico de reabsorção radicular inflamatória externa. As imagens foram exportadas no formato DICOM para o software Materialize MIMICS (versão 10.01; Materialize NV, Bélgica) para segmentação e caracterização das cavidades de reabsorção em termos de localização, quantidade de sitios de reabsorção, relação com locais de reabsorção e avaliação volumétrica nominal e percentual da raiz. Além da avaliação das cavidades de reabsorção radicular e do volume radicular remanescente. Todas as medidas foram realizadas em duplicata e às cegas por um radiologista treinado com intervalo de 30 dias para análise dos coeficientes de correlação intraclasse. Resultados: As medidas volumétricas nominais das cavidades de reabsorção radicular variaram de 0,6 mm3 a 114,4 mm3 (mediana de 13,2 mm3). O volume percentual de cavidades de reabsorção radicular variou de 0,37% a 39,44% (mediana, 4,73%). O volume nominal de volume radicular remanescente variou de 88 mm3 a 401,3 mm3 (mediana 212,4 mm3). O volume percentual de volume radicular remanescente variou de 60,34% a 99,63% (mediana, 95,37%). Conclusões: Os resultados deste estudo preliminar sugerem que a segmentação é uma ferramenta eficaz e reprodutível para medir o tamanho volumétrico das cavidades com reabsorção radicular inflamatória externa. Mais estudos longitudinais são necessários para explorar a utilidade da segmentação de imagens de tomografia computadorizada de feixe cônico na melhoria do diagnóstico de reabsorção radicular inflamatória externa e no apoio à tomada de decisões para o tratamento de tais condições. Objetivo humanos Métodos 4 versão 10.01 1001 10 01 NV Bélgica localização raiz 3 intraclasse Resultados 06 0 6 0, mm 1144 114 114, mediana 132 13 2 13, mm3. . mm3) 037 37 0,37 3944 39 44 39,44 mediana, 4,73%. 473 4,73% 73 4,73%) 8 4013 401 401, 2124 212 212, 6034 60 34 60,34 9963 99 63 99,63 95,37%. 9537 95,37% 95 95,37%) Conclusões condições 10.0 100 1 11 03 0,3 394 39,4 47 4,73 7 21 603 60,3 996 9 99,6 953 95,37 10. 39, 4,7 60, 99, 95,3 4, 95,

RESUMO Exostoses ou hiperostoses são crescimentos ósseos benignos originados da cortical óssea e dependem de sua localização para uma denominação mais precisa. Os tipos mais comuns encontrados na cavidade oral são o Tórus Palatino e o Tórus Mandibular. Exostoses bucais e palatais acometem a face vestibular do processo alveolar na maxila e/ou na mandíbula (comumente na região de molares e pré-molares) e a superfície do processo alveolar posterior (usualmente na área da tuberosidade maxilar), respectivamente. A etiologia das exostoses ainda não foi esclarecida, mas acredita-se em uma interação entre fatores ambientais e genéticos. São usualmente assintomáticas, a não ser que a mucosa se torne ulcerada. A frequência aumenta com a idade, tendo sua maior prevalência a partir de 60 anos de idade, sendo mais comuns em homens e sofrendo influências étnicas. É importante uma avaliação minuciosa para o correto diagnóstico, visto que outras lesões, como os osteomas, possuem características clínicas semelhantes às das exostoses. A maior parte das exostoses é diagnosticada clinicamente em conjunto com interpretações radiográficas, tornando a biópsia dispensável e o tratamento é usualmente desnecessário. O objetivo deste artigo foi relatar um caso clínico de exostose maxilar bilateral, incomum, em uma paciente do sexo feminino. Se uma quantidade excessiva de osso está presente, as exostoses podem mostrar uma relativa radiopacidade nas radiografias dentárias. Inicialmente foram realizadas radiografias periapicais e radiografia panorâmica para avaliar as alterações. Devido ao tamanho das exostoses, realizou-se uma Tomografia Computadorizada de Feixe Cônico, para confirmação do diagnóstico. A paciente encontra-se em acompanhamento.

ABSTRACT Exostoses or hyperostoses are benign bony outgrowths originating from the cortical bone and depend on their location for a more precise designation. The most common types found in the oral cavity are the torus palatinus and the torus mandibularis. Buccal and palatal exostoses are located along the buccal aspect of the maxilla and/or the mandible (commonly in the premolar and molar areas) and on the palatal aspect of the maxilla (usually in the tuberosity area), respectively. The etiology of exostoses still hasn’t been enlightened but an interaction between environmental and genetic factors is accredited. They are usually asymptomatic, unless the mucosa becomes ulcerated. The frequency of exostoses increases with age, having their biggest prevalence from 60 years old, being more common in men and suffering ethnic influences. A thorough evaluation is important for the correct diagnosis since other lesions have similar clinical characteristics to the exostoses such as osteomas. The majority of exostoses are diagnosed clinically along with radiographic interpretations, making the biopsy dispensable and the treatment is usually unnecessary. The aim of this article was to describe a case report of bilateral maxillary exostosis, unusual, in a female patient. If an excessive amount of bone is present the exostoses may exhibit a relative radiopacity on dental radiographs. Initially, periapical and panoramic radiographs were performed to evaluate the alterations. Due to the size of the exostoses a concomitant Cone Beam Computed Tomography was performed to confirm the diagnosis. The patient is in follow-up.

Abstract Inflammatory external root resorption (IERR) is a pathological process defined by the progressive loss of dental hard tissue, dentin, and cementum, resulting from the combination of the loss of external root protective apparatus and root canal infection. It has been suggested that healing patterns after tooth replantation may be influenced by the genetic and immunological profiles of the patients. The purpose of the present investigation was to evaluate the DNA methylation patterns of 22 immune response-related genes in extracted human teeth presenting with IERR. Methylation assays were performed on samples of root fragments showing IERR and compared with healthy bone tissue collected during the surgical extraction of impacted teeth. The methylation patterns were quantified using EpiTect Methyl II Signature Human Cytokine Production PCR Array. The results revealed significantly higher hypermethylation of the FOXP3 gene promoter in IERR (65.95%) than in the bone group (23.43%) (p < 0.001). The ELANE gene was also highly methylated in the pooled IERR sample, although the difference was not statistically significant (p= 0.054). Our study suggests that the differential methylation patterns of immune response-related genes, such as FOXP3 and ELANE, may be involved in IERR modulation, and this could be related to the presence of root canal infection. However, further studies are needed to corroborate these findings to determine the functional relevance of these alterations and their role in the pathogenesis of IERR.

Abstract The present study aimed to evaluate the performance of cone beam computed tomography (CBCT) and digital periapical radiographs (PR) in diagnosing external root resorption (ERR) in human permanent teeth replanted after traumatic avulsion. The samples comprised 39 permanent maxillary incisors replanted after traumatic avulsion. Digital PR and CBCT images were taken from each tooth and independently examined by 2 calibrated examiners to assess the ERR activity regarding type and extension. The degrees of agreement between both imaging examinations were determined by the mean global agreement index using SPSS software. The two imaging examinations diverged greatly in the diagnosis of the type of ERR since CBCT identified more cases as inflammatory ERR and PR as replacement ERR. A discordance level of 69.2% was observed between the two methods in the diagnosis of the type of ERR when CBCT for mesial and distal (MD) surfaces was considered and 61.5% when CBCT for mesial, distal, buccal and lingual (MD/BL) was considered. Likewise, CBCT and PR differed regarding the ERR index. PR examinations classified most cases as moderate or severe (69.2%), while CBCT examinations classified more cases as mild either in the MD surfaces analysis (41.4%) or in the analysis of the MD-BL surfaces (51.3%). In conclusion, the present results highlight a discrepancy between CBCT and digital PR performance in the diagnosis of different types and extent of ERR in replanted teeth.

Abstract: Pulp canal obliteration (PCO) is a frequent finding associated with pulpal revascularization after luxation injuries of young permanent teeth. The underlying mechanisms of PCO are still unclear, and no experimental scientific evidence is available, except the results of a single histopathological study. The lack of sound knowledge concerning this process gives rise to controversies, including the most suitable denomination. More than a mere semantic question, the denomination is an important issue, because it reflects the nature of this process, and directly impacts the treatment plan decision. The hypothesis that accelerated dentin deposition is related to the loss of neural control over odontoblastic secretory activity is well accepted, but demands further supportive studies. PCO is seen radiographically as a rapid narrowing of pulp canal space, whereas common clinical features are yellow crown discoloration and a lower or non-response to sensibility tests. Late development of pulp necrosis and periapical disease are rare complications after PCO, rendering prophylactic endodontic intervention useless. Indeed, yellowish or gray crown discoloration may pose a challenge to clinicians, and may demand endodontic intervention to help restore aesthetics. This literature review was conducted to discuss currently available information concerning PCO after traumatic dental injuries (TDI), and was gathered according to three topics: I) physiopathology of PCO after TDI; II) frequency and predictors of pulpal healing induced by PCO; and III) clinical findings related to PCO. Review articles, original studies and case reports were included aiming to support clinical decisions during the follow-up of teeth with PCO, and highlight future research strategies.