Initial Radiographic Examination Research Articles

Dento-alveolar trauma rehabilitation using fixed prosthesis: clinical case report

Dental trauma is an unexpected, accidental event and requires immediate emergency attention. There are several etiological factors and almost any collision between the face and an object can result in a dental trauma. Objective: The objective of this study is to report a case of dento-alveolar trauma and its dental management, promoting the patient's well-being, restoring health, function and aesthetics. Case report: A 20-year-old male patient came to the dental clinic of CEUNI - FAMETRO complaining of dissatisfaction with his broken tooth after a sports collision. Intraoral clinical examination revealed a large coronary loss below the gingival level in element 15, leaving only the buccal and lingual faces. In the initial radiographic examination, it was verified the presence of an endodontic treatment already performed, but endodontic retreatment was necessary, due to exposure and contamination of the filling material. The treatment plan proposed to the patient consisted of rehabilitation with an intraradicular retainer and then the cementation of a ceramic crown. Conclusion: The study concluded that the rehabilitation with the use of an intraradicular retainer, the fiberglass pin and the metal-free ceramic crown also obtained good results. Thus, it was observed that these materials were able to return the functionality of the tooth, oral health and aesthetics with a natural aspect to the element, the patient reported that he was very satisfied with the final result of his treatment.

Maksillofasial Bölgede Yer Alan Yabanci Cisimlerin Analizi: Retrospektif Çalişma

Aim: Retained foreign bodies in the maxillofacial region are caused by trauma, therapeutic procedures, or previous surgeries in which the broken instruments were left behind. They can usually be asymptomatic, but can also cause infections, be swallowed, or block the airway, leading to vital problems. Despite the complications they can cause, one-third of foreign bodies are overlooked during initial clinical and radiographic examinations. Therefore, the presence of foreign bodies and the symptoms they cause will be studied in patients examined during a specific time period.
 Material and Methods: From December 2020 to August 2022, 6 624 radiological data were collected and retrospectively analysed. The number, characteristics, location of foreign bodies, age, and sex of patients were recorded.
 Results: Radiologic data from 6624 patients who presented to the oral and maxillofacial clinic between the dates included in the study were reviewed, and 48 patients were found to have retained foreign bodies at a frequency of 0.77%. Of these patients, 22 were male and 26 were female. It was found that most of the retained foreign bodies were located in the mandible (80.85%). The foreign bodies detected were filling materials, canal sealers, drills, bein elevator pieces, buckshots, and dental forceps pieces, with filling materials being found significantly more often than other detected retained foreign bodies (p

A rare case of pulmonary artery to left atrium fistula

BackgroundThe first description of right pulmonary artery-to left atrium communication was done by Friedlich and coauthors in 1950. The right pulmonary artery and left atrium are directly connected by the right pulmonary artery to left atrial fistula through a thin-walled aneurysm. Here, we describe a female adult patient who underwent investigation for dyspnea and had Type 1 right pulmonary artery to left atrium connection.Case presentationTwenty-two-year-old female presented with history of breathlessness (New York Heart association classification grade III) for 3 years. On initial examination, her saturation was 60% with no clinical evidence of cyanosis. Initial radiographic examination and CT pulmonary angiogram revealed a dilated communication between the right inferior pulmonary artery and left atrium. The patient was then referred for cardiac MRI. The MR imaging showed the following findings: Dilated right ventricle and atrium with Ostium secundum type of atrial septal defect. Large focal outpouching was noted arising from the right inferior pulmonary artery whose inferomedial portion appeared to communicate with left atrium. The final diagnosis was right pulmonary artery to left atrial fistula-Type I with ostium secundum type atrial septal defect. Midline sternotomy was performed for ligation of this fistula with septal correction. Post surgery, patient began to improve clinically and her saturation in room air increased to 92%ConclusionsRight pulmonary artery to left atrial fistula is different from the pulmonary AV fistula and its rarity directs the need for imaging to diagnose the condition and for management selection. The fistulous connection, which most frequently originates from the posterior wall of the descending branch of RPA and inserts into the LA, is readily seen on CT/catheter angiography. Due to the rarity of this entity and much fewer evidences in imaging, we have reported a type 1 right pulmonary artery to left atrium connection.

Acquired scoliosis of the cervical spine secondary to vertebral neoplasia in an aged pony gelding

SummaryA 20‐year‐old New Forest pony gelding presented for investigation of a firm swelling on the right side of the neck and a variably sized patch of sweating on the right side of the cranial neck. Clinical examination revealed moderate scoliosis with right side convexity centred on the mid‐caudal cervical spine. Initial radiographic examination of the cervical spine showed very subtle heterogeneously increased opacity of the vertebral body of the fifth cervical vertebra (C5). Further investigations were declined by the owner. The pony’s clinical condition deteriorated over the following 6 weeks; at this stage, the pony showed proprioceptive deficits of both fore‐ and hindlimbs (grade 1/5 and 3/5 respectively) and difficulty lowering his head to eat from the ground. Repeat radiographs showed mildly increased opacity of the vertebral body of C5 with a small amount of new bone formation ventrally. Neoplasia of the fifth cervical vertebra was suspected. In view of the clinical deterioration and the likely very poor prognosis, the pony was subjected to euthanasia. Post‐mortem computed tomographic examination showed heterogeneously increased attenuation surrounding small, poorly defined regions of reduced attenuation in the trabecular bone of the vertebral body and right transverse process of C5. There was also moderate, irregular periosteal new bone formation on the fifth and sixth cervical vertebrae with a poorly defined mildly hyperattenuating soft tissue structure adjacent to the right pedicle of C5 and extending into the right side of the vertebral canal, compressing the spinal cord to the left side. Post‐mortem examination revealed tan‐coloured tissue running along the right side of the C5 vertebral body, into the right side of the vertebral canal, compressing the spinal cord to the left side and invading adjacent epaxial muscles. Histopathological examination of this tissue was consistent with an undifferentiated sarcoma. To the authors’ knowledge this is the first report of acquired scoliosis secondary to cervical neoplasia in a horse or pony.

Utility of lateral scapular radiographs in initial evaluation of nontraumatic shoulder conditions

Lateral scapular radiographs have been routinely included in the initial radiographic examination of both traumatic and nontraumatic shoulder conditions. With the advance of modern imaging modalities, the clinical utility of the lateral scapular view has become questionable. The purpose of the study was to assess the utilization of the lateral scapular view among the members of the American Shoulder and Elbow Surgeons (ASES) and to determine the clinical utility of the lateral scapular view in the initial evaluation of nontraumatic shoulder conditions. The study consisted of two parts. The first part involved an online survey of ASES members, which asked them 3 questions regarding their preference for radiographic evaluation of new patients with nontraumatic shoulder pain. The second part involved a clinical vignette-based survey, where 4 shoulder surgeons at our institution were given 50 clinical vignettes and asked to independently answer 4 questions regarding the most probable diagnosis, abnormal radiographic findings, further imaging studies, and treatment plan for each case. The survey was repeated twice; the first was given without a lateral scapular view, and the second given 4 weeks later with a lateral scapular view included. We obtained diagnostic accuracy and percent agreement of each surgeon over two surveys and intraobserver and interobserver reliability on each variable. Of a total of 235 ASES members who responded to the online survey, 193 (82.1%) indicated their routine use of a lateral scapular view. The most common reason for obtaining the view was better characterization of acromion morphology (75.4%). The clinical vignette-based survey showed substantial intrarater reliability (κ > 0.6) of the 4 surgeons between the two surveys for the most probable diagnosis, abnormal x-ray findings, and further imaging studies, while the intrarater reliability for treatment plan was moderate (κ= 0.548). The mean diagnostic accuracy of the 4 surgeons was almost equal (74% vs. 75%) between the surveys. Overall, each surgeon's percent agreement across the 2 surveys was over 70%. None of the 4 surgeons recommended a lateral scapular view for further imaging during the first survey; each wanted either advanced imaging (computed tomography, magnetic resonance imaging) or none. The addition of a lateral scapular radiograph in the presence of other orthogonal views does not appear to improve surgeons' diagnostic accuracy or affect their decision-making on the treatment plan in nontraumatic shoulder conditions. The clinical utility of the lateral scapular view may need to be reassessed in this setting.

Avaliação da adaptação marginal das restaurações classe II realizadas em uma Faculdade no Estado do Espírito Santo

Abstract Introduction composite resins are materials widely used for Class II restorations, to restore the anatomization of the dental element. However, there are several factors that can interfere with the quality of a good restoration. Objective the objective of the present study is to carry out a retrospective evaluation of the clinical performance of Class II restorations performed by undergraduate students of Dentistry at the Escola São Francisco de Assis (ESFA), and to identify the main errors. Material and method we selected the medical records of patients treated in the disciplines of Dentistry II, Integrated I and II in the Dentistry clinic at ESFA, which presented detailed information on the Class II procedure, as well as initial radiographic examinations, using the FDI method. The sample consisted of 33 medical records that included 72 teeth. Result it was observed that more than 80% of the restorations were classified as acceptable. And, only 19.44% of the restorations were unacceptable, failing due to functional and biological properties. Conclusion it was found that undergraduate students in Dentistry at ESFA, who are guided by professors to perform treatments following pre-established clinical protocols, are capable of carrying out quality restorative procedures.

Radiographic characterization of acute scaphoid fractures in children under 11years of age.

Delayed diagnosis of scaphoid fractures can lead to long-term morbidity. While radiography is the preferred screening examination, there is a relative paucity of literature that examines fracture visibility in younger children, who have smaller ossification centers, an abundance of unossified cartilage and fractures that preferentially involve the distal scaphoid. To characterize acute scaphoid fractures in younger children on radiographs with observer agreement and with respect to fracture location. This institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant cross-sectional study included children (≤10years of age) with acute scaphoid fractures (≤7days), who underwent radiographic examinations at a tertiary children's hospital between December 2008 and June 2019. Three readers (two pediatric radiologists and one orthopedic surgeon) reviewed each examination to determine fracture visibility on each radiographic view and fracture location. Kruskal-Wallis, Fisher exact and Cochran-Armitage tests were used to compare fracture visibility and location, and Kappa tests were used to calculate observer agreement. Twenty-eight children (15 boys, 13 girls; mean age: 9.5±0.6years) with 10 (36%) distal corner, 11 (39%) distal body and 7 (25%) mid-body fractures, underwent 7 (25%) 4-view, 18 (64%) 3-view and 3 (11%) 2-view examinations. Twenty-six (93%) fractures were visible on at least one view with six (21%) fractures visible on all available views. No significant association was found between fracture visibility and fracture location (P=0.32). Observer agreement was substantial to almost perfect. Only 7% of these acute scaphoid fractures in younger children are inconspicuous on the initial radiographic examination.

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

Concurrent Ipsilateral Tibial Shaft and Distal Tibial Fractures in Pediatric Patients: Risk Factors, Frequency, and Risk of Missed Diagnosis.

The purpose of this study was to determine the frequency of concurrent ipsilateral distal tibial fractures with tibial shaft fractures in the pediatric population; to identify patient and fracture characteristics that increase the likelihood of a concurrent fracture; and determine if any of these concurrent distal tibial fractures were missed on initial radiographic examination. Retrospective chart review was done to identify patients 5 to 17 years old who were treated for a tibial shaft fracture at a large, Level 1 free-standing children's hospital and an outpatient orthopaedic practice between 2008 and 2016. Patient and fracture characteristics were recorded. Of 517 fractures (515 patients), 22 (4.3%) had concurrent ipsilateral distal tibial fractures: 11 triplane, 5 medial malleolar, 3 bimalleolar, and 2 Tillaux (Salter-Harris III) ankle fractures, and 1 Salter-Harris II distal tibial fracture. Age was the only patient characteristic significantly associated with a second, more distal fracture: patients with both fractures were older (12.7 y) than those with an isolated tibial shaft fracture (11 y). There was no difference in the rate of distal tibial fractures between high-energy and low-energy mechanisms of injury and no differences in the rate of open injuries or the presence of a fibular fracture. Patients with a tibial shaft fracture at the junction of the middle and distal thirds were significantly more likely to have a concurrent distal tibial fracture; oblique and spiral fracture patterns were more frequent in the group with concurrent distal tibial fractures than in the isolated tibial shaft fracture group. In our series, 36% of the concurrent distal tibial fractures were not diagnosed until chart review for this study, which suggests the need for ankle-specific imaging in certain patients. We recommend ankle-specific imaging when an oblique or spiral tibial shaft fracture is located at the junction of the middle and distal thirds of the tibia or in patients in whom a distal tibial fracture is suspected because of pain, swelling, or bruising. Level III-retrospective comparative study.

Posttraumatic Subfibular Ossicle Formation in Children: Experience in a Single Primary Care Unit.

Although subfibular ossicles have been linked to various clinical problems, whether its origin is congenital or traumatic remains unclear. The objectives of this study were to determine the incidence of subfibular ossicle formation after ankle inversion in children. Among 896 pediatric patients who visited a single primary care unit after foot and ankle trauma, 593 patients sustaining ankle inversion injury were included in this study. For each pediatric patient, physical examination and radiographic examination were performed. The incidence of subfibular ossicle was evaluated based on initial radiographic examination. To analyze the incidence of unprecedented subfibular ossicle formation after ankle inversion injury, radiographs of 188 patients who were followed up for >6 months were evaluated according to the grade of initial injury. At initial visit, 1.0% of examined ankles (12 from 1186 ankles) showed well-corticated subfibular ossicle not related to initial injuries. Overall incidence of subfibular ossicle at final follow-up after ankle inversion injury was 39.4% (74/188). Incidence of subfibular ossicle at final follow-up was associated with initial injury grade. As for the morphology of ossicle, 93.2% (55/59) of cases with wafer bone fragment at the time of initial injury became oval or round-shaped subfibular ossicle at final radiograph. The chance of ossicle formation after ankle inversion injury was substantially high in pediatric population. On the basis of the findings of our study, we carefully suggest that majority, if not all, of subfibular ossicles would be posttraumatic in pediatric period. Level IV-case series.

Clinical Implication of Os subfibulare

Category: Ankle, Sports, Trauma Introduction/Purpose: Os subfibulare, defined as a separated ossicle of the distal fibular, has been linked to various clinical problems such as subfibulare pain and chronic lateral ankle instability. However, whether os subfibulare is congenital or traumatic remains unclear. The objectives of this study were: 1) to determine the incidence of os subfibulare development after ankle sprain in children and adolescents in a single primary care orthopedic clinic, and 2) to evaluate clinical implication of os subfibulare associated with ankle sprain in children and adolescents Methods: Among 896 pediatric patients (age ranging from 3 to 16 years) who visited a single primary care unit after sustaining ankle inversion injury, 627 patients who were followed up for over 2 weeks were included in this study. For each pediatric patient, physical examination and radiographic examination (anteroposterior, lateral, and mortise view of the bilateral ankle) were performed. The incidence of os subfibulare was evaluated based on initial radiographic examination. To analyze the incidence of new os subfibulare formation after ankle inversion injury, radiographs of 193 patients who were followed up for more than 6 months were evaluated according to the grade of injury. Results: At initial visit, 1% of examined ankles (13 from 1,254 ankles of 627 patients) showed well corticated ossicle not related to initial injuries. We cannot recognize the existence of accessory ossification center of the fibula in our study population. Overall incidence of os subfibulare at final follow up after ankle inversion injury was 23.9% (150/627). Os subfibulare at final follow up was correlated with initial injury grade (OR: 8.0, p = 0.001). In patients with initial avulsion fragment, 64.9% (61/94 cases) had residual ossicle at the final radiograph after being followed up for more than 6 months. As for the morphology of ossicle, 54 cases with wafer bone fragment at the time of initial injury showed oval or round shape ossicles at final radiograph. Conclusion: The incidence of os subfibulare at the initial radiograph was about 1%. The chance of ossicle formation after ankle inversion injury was substantially high in pediatric population. Based on the findings of our study, we carefully suggest that majority, if not all, of os subfibulare would be posttraumatic in pediatric period. Therefore, ankle inversion injury in children should be managed more actively to reduce the chance of posttraumatic os subfibulare formation.

Haemorrhagic myelomalacia in a cat with extradural T-cell lymphoma

Myelomalacia is a term used to indicate the softening of the spinal cord, which results from ischaemic or haemorrhagic necrosis that can occur as a sequel to acute spinal cord injury. A 10-month-old, female, mixed breed domestic cat exhibiting neurological symptoms was referred for evaluation. Neurological examination revealed symptoms consistent with thoracolumbar syndrome. Initial radiographic examination detected no changes of the thoracolumbar spine. The cat received a palliative treatment of and prednisolone. The patient did not respond to the treatment and one month later presented with worsening of symptoms that progressed to non-ambulatory paraplegia. Radiographic examination was performed a second time and revealed a mass inside the spinal canal at the L1 and L3 vertebral levels. The animal died and was sent for post-mortem examination. The necropsy revealed a greyish-white epidural mass inside the spinal canal that was compressing the spinal cord at the L1 and L3 vertebral levels. The spinal cord between T2 and L3 was reddish and friable. The pancreaticoduodenal lymph node was enlarged. Histologically, the spinal cord mass and pancreaticoduodenal lymph node presented neoplastic lymphocyte proliferation, and haemorrhagic myelomalacia was observed in the spinal cord from T2 to L3. Immunohistochemistry revealed that the neoplastic lymphocytes were positive for CD3 antibody (T-cell lymphoma), and the lymphoid organs showed immunostaining for feline leukaemia virus (FeLV). Haemorrhagic myelomalacia due to extradural lymphoma should be considered as a differential diagnosis in cats with spinal neurological signs.

A Rare Case of Radicular Dens in Dente diagnosed by Clinical, Radiographic, Tomographic, and Histopathological Examinations

ABSTRACT Dens invaginatus is a dental anomaly caused by an invagination of enamel that affects in most of the cases the crown of the tooth. The treatment depends on the degree of invagination and morphological involvement. This report describes a dental anomaly affecting the permanent lower lateral incisor of a 13-year-old patient, which resulted in swelling, pain, and dental impaction. The initial radiographic examination suggested a gemination, a fusion with a supernumerary tooth or a dens invaginatus extending to the root. For more accurate diagnosis and treatment plan of this anomaly, computed tomography scan was performed, which revealed the presence of enamel in the root. Due to pain and the impossibility of performing an orthodontic traction, the treatment of choice in this case was dental extraction. The final diagnosis was confirmed by histopathological examination and revealed the rare occurrence of a radicular dens invaginatus. How to cite this article Moreno APD, de Carvalho FK, de Queiroz AM, León JE, Zanella EP, De Rossi A. A Rare Case of Radicular Dens in Dente diagnosed by Clinical, Radiographic, Tomographic, and Histopathological Examinations. Int J Experiment Dent Sci 2017;6(1):39-43.

Osteoblastoma of the temporal articular tubercle misdiagnosed as a temporomandibular joint disorder

The case of a 17-year-old female with a benign osteoblastoma in the temporomandibular joint (TMJ) is reported. The patient had a 2.5-year history of reduced mouth opening accompanied by tenderness and swelling in the left TMJ. Initial treatment included stabilization of the occlusion with a splint, jaw exercises, and analgesics. At first the patient's symptoms decreased, but they then increased 18 months later, prompting a cone beam computed tomography (CBCT) evaluation of the joint. The radiographic findings showed a somewhat ill-defined, radiolucent, expansile lesion containing small scattered calcifications located in the temporal articular tubercle. The lesion was removed under general anaesthesia and sent for histopathological examination. At the 12-month follow-up, the patient had normal TMJ function without clinical symptoms. CBCT examination showed a small recurrence of 3mm. Another 12 months later, CBCT showed a 1-mm increase in the recurrence. Her function was normal, with slight tenderness lateral to the left TMJ. The decision from a multidisciplinary meeting was further annual follow-up. The present case illustrates the importance of initial radiographic examination together with clinical examination in patients with TMJ dysfunction.

Reabilitação multidisciplinar em caso de reabsorção dental interna/externa

As reabsorções dentais são situações raras na Odontologia. Neste caso clínico, um paciente leucoderma, gênero feminino, apresentou-se na clínica odontológica do Cecom, para tratamento endodôntico do elemento 22. Ao exame radiográfico inicial, constatou-se a presença de reabsorção interna e externa do 21, que apresentava-se assintomático. A paciente não se recordava de ter sofrido trauma na referida região. A única queixa com relação a este elemento era a presença ocasional de uma fístula em gengiva marginal, da qual saia um exsudato. A paciente submeteu-se ao tratamento endodôntico e restaurador do 22, e a seguir ao tratamento multidisciplinar do 21 (endodontia, periodontia e dentística). Inicialmente o tratamento endodôntico do 21 foi realizado por um endodontista, obturando-se o terço apical da raiz com guta – percha + sealer 26, e o restante do conduto com MTA. Após 01 semana a paciente retornou para complementação estética do vedamento da reabsorção externa. Foi realizado um retalho em mucosa, por uma periodontista, o qual foi elevado, sendo a raiz debridada em seguida. Áreas vedadas com MTA, após a presa, ficam enegrecidas, daí a necessidade de substituição desta parte por um material mais estético. A partir daqui uma especialista em estética realizou a remoção desta parte do MTA, realizando em seguida uma restauração transcirúrgica com resina fotopolimerizável. Feita a restauração, a periodontista reposicionou o retalho e realizou as suturas. O caso está em acompanhamento há 18 meses, sem sinais de reativação das reabsorções e sem comprometimento periodontal.

Isolated Fracture of the Trapezoid. A Rare Injury.

Dear Sir, Trauma to the wrist can result in carpal bone fractures that are not always apparent on initial radiographic examination. Fractures of the trapezoid bone are the rarest of carpal fractures, with only a few reported cases in the published literature. We present a case of isolated fracture of the trapezoid that was managed conservatively and had a full functional recovery. A 20 year old male presented to the Emergency Department reporting having a car door accidentally close against the back of his wrist a few hours prior. The patient presented with localized edema and tenderness proximal to the base of the 2nd metacarpal. Radiographic evaluation was normal. Nonetheless some suspicion remained that an occult fracture of either a carpal bone or the base of the 2nd metacarpal was present. A CT scan of the wrist was obtained, which revealed a minimally displaced fracture of the trapezoid extending in the axial plane (Fig. 1). The patient was placed in a short arm splint for 6 weeks. At the follow – up visit, the pain had subsided and the edema had completely resolved, albeit some wrist stiffness was present. A new CT scan was obtained at that time, which demonstrated near complete union of the fractured parts. After a 2 week self-exercise program for the stiffness the patient was completely symptom free. At 1 year, he remains symptom free and reports being entirely satisfied with the outcome. Fig. 1 Axial thin slice (1 mm) CT demonstrating the fracture line through the trapezoid bone The trapezoid is the least commonly fractured carpal bone, with the literature containing only a few case reports and case series. These fractures can occur in isolation or in combination with other injuries to the carpus or metacarpals. Most authors describe the mechanism of injury to be either an axial loading or bending force through the 2nd metacarpal [1, 2] or a direct blow to the wrist [2]. The presentation is typically that of pain and tenderness at the base of the 2nd metacarpal. Initial radiography is invariably normal, and diagnosis was made through the use of CT [1, 2], MRI [3] or even technetium bone scan [3]. The ease and availability of CT scans and other advanced imaging modalities is probably the reason that these injuries are identified more frequently in recent years. The limited number of published cases prevents the recommendations regarding treatment of trapezoid fractures from carrying much power or weight. Nonetheless, the literature thus far suggests that for isolated fractures with minimal displacement, cast immobilization results in satisfactory outcomes [1]. Surgical treatment was performed for displaced fractures or for complex injuries [3]. Still, there are differences regarding type of casting (whether short -arm cast or thumb spica), length of time of immobilization, and so forth. Similarly, operative treatments were individualized based on the pattern and complexity of osseo –ligamentous injuries. Not much is known about the long –term outcomes of trapezoid fractures. Adverse outcomes of other carpal bone fractures, especially the scaphoid, such as non- union, avascular necrosis and development of arthritis are well known. In some of the cases reported in the literature so far, delayed union and non-union resulted in persistent pain [3, 4] and diminished grasp power [4]. Thus, a missed fracture could very well result in loss of function and diminished quality of life. It is only proper that in any patient with trauma to the base of the 2nd metacarpal, the appropriate mechanism of injury, or persistent pain after a period of rest and splinting that this fracture be suspected and sought after.

Randomized in vivo evaluation of photodynamic antimicrobial chemotherapy on deciduous carious dentin.

The aim of this randomized in vivo study was to compare antimicrobial chemotherapies in primary carious dentin. Thirty-two participants ages 5 to 7 years underwent partial caries removal from deep carious dentin lesions in primary molars and were subsequently divided into three groups: control [chlorhexidine and resin-modified glass ionomer cement (RMGIC)], LEDTB [photodynamic antimicrobial chemotherapy (PACT) with light-emitting diode associated with toluidine blue solution and RMGIC], and LMB [PACT with laser associated with methylene blue solution and RMGIC]. The participants were submitted to initial clinical and radiographic examinations. Demographic features and biofilm, gingival, and DMFT/DMFS indexes were evaluated, in addition to clinical and radiographic followups at 6 and 12 months after treatments. Carious dentin was collected before and after each treatment, and the number of Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Fusobacterium nucleatum, Atopobium rimae, and total bacteria was established by quantitative polymerase chain reaction. No signs of pain or restoration failure were observed. All therapies were effective in reducing the number of microorganisms, except for S. sobrinus. No statistical differences were observed among the protocols used. All therapies may be considered as effective modern approaches to minimal intervention for the management of deep primary caries treatment.

Rhinomaxillary mucormycosis in an immunocompetent individual: Importance of early diagnosis

Rhinomaxillary mucormycosis presents with a characteristic destruction and necrosis most commonly affecting immunocompromised patients, especially diabetics. The present reported case was extremely unusual that the characteristic clinical feature of ulceration or necrosis was absent and the patient was apparently healthy (immunocompetent) with mere findings of generalized periodontal pockets, mobility of maxillary teeth, and a diffuse mild swelling in the anterior region of the hard palate on initial (clinical and radiographic) examination. This emphasized the need to include this fatal opportunistic infection in the differential diagnosis of maxillary swellings in otherwise healthy patients showing minimal clinical signs which could camouflage its presence.

Radiographically Occult and Subtle Fractures: A Pictorial Review

Radiographically occult and subtle fractures are a diagnostic challenge. They may be divided into (1) “high energy trauma fracture,” (2) “fatigue fracture” from cyclical and sustained mechanical stress, and (3) “insufficiency fracture” occurring in weakened bone (e.g., in osteoporosis and postradiotherapy). Independently of the cause, the initial radiographic examination can be negative either because the findings seem normal or are too subtle. Early detection of these fractures is crucial to explain the patient's symptoms and prevent further complications. Advanced imaging tools such as computed tomography, magnetic resonance imaging, and scintigraphy are highly valuable in this context. Our aim is to raise the awareness of radiologists and clinicians in these cases by presenting illustrative cases and a discussion of the relevant literature.

Outcome of surgical endodontic treatment in dogs: 15 cases (1995–2011)

To document the short- and long-term outcomes of surgical endodontic treatment in dogs in a clinical setting. Retrospective case series. 15 dogs that underwent surgical endodontic treatment. Medical records of dogs that underwent surgical endodontic treatment at 3 institutions from January 1995 to December 2011 were reviewed. Information extracted included signalment, history, initial clinical signs, physical and radiographic examination findings, treatment, and outcome. Outcome was determined through evaluation of the pre- and postoperative radiographs as well as clinical and radiographic findings at follow-up evaluations. On the basis of radiographic findings, treatment was considered successful if the periapical lesion and bone defect created by surgery had completely healed and no new root resorption was detected; a treatment was considered to have no evidence of failure if the periapical lesion remained the same or had not completely resolved and root resorption was static. 15 dogs were treated by means of apicoectomy and retrograde filling following a failed or complicated orthograde root canal treatment. The mean long-term follow-up time was 15.2 months (range, 3 to 50 months). On radiographic evaluation, 10 of 15 dogs had successful resolution of the periapical disease; 5 dogs had no radiographic evidence of failure of endodontic treatment. All dogs were considered to have a successful clinical outcome. Surgical endodontic treatment was an effective option for salvaging endodontically diseased but periodontally healthy teeth of dogs in which orthograde treatment was unsuccessful and nonsurgical retreatment was unlikely to succeed.