RESUMO Objetivo: Analisar se a avaliação dinâmica de volumes de tomografia computadorizada de feixe cônico (TCFC) influencia a percepção de ortodontistas quanto à determinação da posição e do prognóstico de mini-implantes (MIs) inter-radiculares. Material e Métodos: Foram selecionados 30 volumes de TCFC, nos quais foram simuladas três formas de instalação de MIs: 1) MI a 1 mm de distância da lâmina dura (LD); 2) MI tocando a LD; e 3) MI sobreposto à LD. As imagens foram examinadas por 35 ortodontistas na forma de reconstruções panorâmicas, reconstruções sagitais e uma sequência de reconstruções axiais. Os examinadores avaliaram a relação entre o MI e a LD, e indicaram o prognóstico dos MIs instalados, usando uma escala de 4 pontos (quanto maior o escore, mais favorável o prognóstico). Os dados foram submetidos à análise estatística, por meio dos testes de Kappa, Friedman e Nemenyi. Resultados: Houve associação significativa entre o prognóstico, os tipos de imagem e as três formas de inserção dos MIs (p<0,05). A visualização dinâmica dos volumes de TCFC (reconstruções axiais) foi associada a maiores escores para o prognóstico e a avaliações mais confiáveis da posição dos MIs. Escores mais inconsistentes e discordantes foram mais associados às reconstruções panorâmicas e sagitais. Conclusão: A análise do volume tomográfico em reconstruções axiais pode melhorar a avaliação do ortodontista quanto à posição dos MIs inter-radiculares, apresentando impacto significativo na determinação do prognóstico do caso.

ABSTRACT Objective: To investigate the influence of dynamic visualization of cone beam computed tomography (CBCT) scans on orthodontist’s assessment of positioning status and prognosis of interradicular mini-implants (MI). Methods: Three MI positions were virtually simulated in thirty CBCT volumes: (1) MI 1 mm from the lamina dura (LD), (2) MI touching the LD and (3) MI overlapping the LD. Each position was exposed to orthodontists (n = 35) as panoramic reconstruction, sagittal reconstruction and a sequence of axial slices. Each orthodontist evaluated the MI position (relationship with the LD) and scored the prognosis using a four-point scale (the higher the score, the better the prognosis). Kappa, Friedman and Nemenyi statistics were used. Results: Statistically significant associations were detected between the prognosis scores and the type of image visualized (p<0.05). The dynamic visualization of the CBCT volume (axial slices) was associated with higher scores for prognosis and more reliable evaluation of MI positioning. Inconsistent outcomes were more frequently associated with panoramic and sagittal reconstructions. Conclusion: The dynamic visualization of axial slices allowed orthodontists to perform better assessment of MI position and considerably affected prognosis judgment.

ABSTRACT: Florid osseous dysplasia (FOD) is an extensive form of osseous dysplasia where normal trabecular bone is substituted by fibrous connective tissue and amorphous mineralized tissue. Usually, the lesions are mainly asymptomatic and the patients should be followed with clinical and imaging examination, requiring no intervention. Nevertheless, due to the poor vascularization of the lesion and local trauma, secondary infections and osteomyelitis may occur. Patients may present with pain, mucosal ulceration, and lesion exposure in the oral cavity, fistula and swelling. In such cases, correct diagnosis and management of the lesion is decisive to reestablish patient’s health and quality of life. The aim of this article is to present a case of complicating secondary chronic osteomyelitis treated successfully with conservative intervention. A 68-year-old black female patient reported a “swelling of the gums” that was present for eleven years, with episodes of periodic pain and swelling. On physical examination, a papule with suppuration in the alveolar mucosa in the right side of the mandible was observed. Panoramic radiography and CBCT showed a mixed lesion surrounded by sclerotic bone. The patient was diagnosed with chronic osteomyelitis in association with FOD and treated with antibiotic therapy together with surgical curettage. The incidence, etiophatology, differential diagnosis, treatment and prevention of secondary osteomyelitis associated with FOD are discussed in the light of literature. This information might assist the dentists while choosing the best treatment options for similar cases.

RESUMEN: La displasia ósea florida (DOF) es una forma de displasia del tejido óseo donde el hueso trabecular normal es sustituido por tejido conectivo fibroso y por tejido mineralizado amorfo. En general, las lesiones son de origen asintomático y los pacientes deben ser controlados con exámenes clínicos. Sin embargo, debido a la vascularización deficiente de la lesión y el trauma local, pueden ocurrir lesiones secundarias y osteomielitis. Los pacientes pueden presentar dolor, ulceración de la mucosa, lesión expuesta en la cavidad oral, fístula y edema. En estos casos, el diagnóstico adecuado y el tratamiento de la lesión es decisivo para estabilizar la salud y la calidad de la vida. El objetivo de este artículo fue presentar un caso de complicación secundaria crónica de la osteomielitis tratada con tratamiento conservador. Una paciente de 68 años de edad, negra, informa de "hinchazón de las encías" que presentaba durante once años, con episodios de dolor. En el examen intra-oral se observó una pápula con supuración en la mucosa alveolar del lado derecho de la mandíbula. Además de la radiografía panorámica y tomografía computarizada de haz cónico (TCHC) se tomaron muestras de la lesión debido a observación de hueso esclerótico. El paciente fue diagnosticado con una infección por osteomielitis en asociación con DOF y fue tratada con antibióticos, además de una cirugía curativa. En este artículo se presentaron la incidencia, el diagnóstico diferencial, el tratamiento y la prevención de los efectos secundarios de osteomielitis asociados con el DOF. La información de este trabajo podría ayudar a los dentistas en la aplicación del tratamiento indicado en casos similares.

Abstract Idiopathic Bone Cavity (IBC) or Simple Bone Cyst (SBC) is a non- epithelialized bone cavity with serosanguinous fluid content or empty. There is a literature debate regarding its pathogenesis that remains unclear. The main treatment option is the surgical exploration, although there are successful cases described in the literature in which just a follow-up with clinical and radiographic evaluation was performed. Objective This study aimed to assess the spontaneous resolution of idiopathic bone cavity untreated by surgery. Material and Methods Twenty-one patients diagnosed with surgically untreated IBC were submitted to a follow-up protocol modified from Damante, Guerra, and Ferreira5 (2002). A clinical and radiographic evaluation was performed in 13 patients (13/21), while eight patients (8/21) were only radiographically evaluated. Three observers evaluated the panoramic radiographs of 21 patients and the Kappa test was performed by intra and inter-examiners. Inductive and descriptive statistics were applied to the results. Results Only one patient had a positive response to palpation and percussion of the teeth in the cyst area. Most of the cysts evaluated were rated as 3 (lesion “in involution”), 4 (lesion “almost completely resolved”), or 5 (“completely resolved”). Conclusions We observed progressive spontaneous resolution of IBC. Most cysts were found in the recovery process in different follow-up periods. Patient's follow-up, without surgery, may be considered after the diagnosis based on epidemiological, clinical, and radiographic features of the lesion.