Introduction: The purpose of the study was to evaluate the effects of maxillomandibular advancement (MMA) surgery with counterclockwise rotation on soft tissue oral and nasal structures. Materials and Methods: This retrospective study included 34 subjects diagnosed with OSA who underwent MMA at the Stanford Sleep Clinic. Initial (T1) and Final (T2) CBCTs were evaluated and compared for 10 hard tissue and 15 soft tissue measurements. Additionally, the external nasal valve surface area was measured and compared between the two time points. A 3D superimposition was performed and used to evaluate the relative hard and soft tissue movements. Results: There was a linear correlation in the advancement of the maxilla to the sagittal movement of the upper lip of 75%, while the mandibular soft tissue moved 91-93% of the mandibular sagittal position. The interalar width and mouth width increased significantly following surgery while the lower vermillion border length decreased significantly. There was a clinically significant increase in the average surface area of the external nasal valve by 28%. No correlations were found between maxillary impaction and soft tissue oral or nasal measurements. Conclusion: MMA with CCW results in significant changes to the soft tissue nose and oral region. Soft tissue planning must be considered to maintain desirable esthetics following surgery.

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INTRODUCTION: Many studies have used different diagnostic methods to detect and measure the mental loop. Due to different criteria used and dissimilar diagnostic techniques diverse results were found in these studies. Understanding anatomical structures are crucial for planning and placing dental implants. Implant surgeons should be familiar with anatomical variations that they may encounter. METHODS: CBCTs of twenty male and twenty female patients were selected and categorized into four groups; male and female groups aged (18-44) and male and female groups aged (45-65). SIMPLANT Pro 17.01 software was used to determine the shape and the extension of the mental loop. Data was collected and analyzed for statistical significance to determine the association between CBCT findings and the patient's gender and age. RESULTS: The extension of the anterior loop of the metal nerve in this study ranged between 0 – 3.17mm. The mean of the loop was 1.25mm. The mental loops mean extension in males was 1.25mm. The mental loops mean extension in females was 1.23mm. The mental loops mean extension in elders was 1.19mm. The mental loops mean extension in younger group was 1.28mm. Subjects tend to have more curved mental loops compared to straight loops regardless the gender and/ or age group. CONCLUSION: In this study no association found between the shape and the extension of the mental loop with subjects age and gender. Measuring the extension of the mental loop should be mandatory for each individual to avoid injuries during implant placement in the interforaminal region.

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Bakgrund: Under en ortodontisk behandling med fast apparatur finns det en risk för att tänderna drabbas av rotresorption. Rotresorptioner kan mätas med hjälp av Cone Beam Computed Tomography (CBCT). Mätresultatet kan dock variera mellan olika observatörer och mätfel kan uppstå vilket påverkar metodens tillförlitlighet.Syfte: Att beräkna det mätfel som uppstår vid mätning av rotresorptioner som uppstår till följd av en ortodontisk behandling i CBCT-bilder och utvärdera mätmetodens tillförlitlighet. Metod: Tio ungdomar som genomgick ortodontisk behandling undersöktes med hjälp av CBCT-röntgen av båda käkar (tand 16-26 samt 36-46). Fem observatörer mätte tändernas rotlängd i utvalda CBCT-snitt. Studien omfattade 100 rötter från totalt 90 tänder. Mätningen upprepades av samma observatörer vid ett senare tillfälle. Tillförlitlighet utvärderades med intraklass-korrelationskoefficient (ICC 2.1) med 95% konfidensintervall. Mätfelet beräknades med Dahlbergs formel och standard moment of measure variance estimator (MME)-formel. Resultat: Tillförlitligheten mellan observatörer uppmättes till ICC = 0,88 under den första mätningen och ICC = 0,87 vid den upprepade mätningen. Inom observatörerna uppmättes tillförlitligheten till ICC = 0,84-0,92. Mätfelet uppmätt med Dahlbergs formel var 0,44-0,64 mm för samtliga tänder och observatörer. Det största mätfelet uppstod vid mätning av kuspider, 0,4-1,15 mm. Det minsta mätfelet uppstod vid mätning av molarer, 0,42-0,53 mm. Mätfelet vid mätning av premolarer och incisiver var 0,42-0,70 respektive 0,43-0,66 mm. När mätfelet beräknades med MME-formeln erhölls liknande resultat. Konklusion: Mätning av rotlängd i CBCT-bilder uppvisar hög reliabilitet inom och mellan olika observatörer. Precisionen varierar mellan olika tandgrupper och observatörer, men vid mätning av allvarliga rotresorptioner (>2 mm) är metoden pålitlig. CBCT anses vara en pålitlig metod för mätning av rotresorptioner som uppstått till följd av ortodontisk behandling. Vid studier där en mätning utförs bör reliabilitet och precision tas i beaktande. / Background: An orthodontic treatment may cause root resorption of varying extent on the involved teeth. The resulting root resorption can be measured in cone beam computed tomography (CBCT) images. However, measurement results may vary among different raters because of measurement errors, affecting the reliability of the method of measurement. Objectives: To evaluate reliability and precision of measurement of root length following orthodontic treatment in CBCT images. Methods: Ten adolescents participating in a trial of orthodontic treatment were examined with CBCT of both jaws. Five raters measured root length in preselected CBCT images of 100 roots from 90 teeth. The measurements were later repeated by the same raters. Reliability was expressed as intra-class correlation coefficient (ICC 2.1). Measurement error was calculated with Dahlberg’s formula and standard moment of measure variance estimator (MME)formula. Results: The inter-rater reliability for all raters had an ICC-value of 0,88 for the first measurement and an ICC-value of 0,87 for the second measurement. The intra-rater reliability for all raters had an ICC-value between 0,84-0,92. Measurement error calculated with the Dahlberg's formula ranged between 0,44-0,64 mm for all teeth for all raters. The largest difference of measurement error between raters was observed in canines, 0,44-1,15 mm. The smallest measurement error was observed in molars, 0,42-0,53 mm. Measurement errors calculated by the MME formula showed similar results. Conclusion: Root length measurements in CBCT-images show high intra- and inter rater reliability. The precision varies between raters and tooth groups but measurements of severe root resorptions (>2 mm) are reliable with this method. The reliability and precision of a method should always be considered when conducting measurement studies. CBCT could be considered a reliable method for measurement of root resorption following orthodontic treatment with different orthodontic appliances.

A cárie dentária continua sendo um grande desafio para os Cirurgiões-Dentistas pela dificuldade de diagnóstico, sobretudo em superfícies proximais. Muitos equipamentos se destinam a facilitar o exame do paciente, tendo como principal objetivo o diagnóstico de cáries incipientes. Dentre os exames mais utilizados está a radiografia interproximal associada ao exame clínico. O Sistema Internacional de Avaliação e Detecção de Cáries (ICDAS) vem sendo bem aceito tanto para o uso clínico como para pesquisas in vitro e in vivo, apresentando ótimos resultados. Além da técnica interproximal, a tomografia cone beam (CBCT) vem entrando no cotidiano da Odontologia, mas pouco se sabe sobre o seu desempenho para avaliação de cáries iniciais em superfícies proximais. A microtomografia (CT) é um novo método de avaliação destinado a pequenos espécimes e se assemelha a uma versão em miniatura da tomografia axial computadorizada, gerando imagens na ordem de micrômetros. Este método vem sendo utilização em pesquisas para se avaliar tecidos mineralizados, devido à sua habilidade de aferir com precisão o coeficiente de atenuação linear. O método padrão ouro que define com maior precisão os estágios da cárie é o histológico. Contudo, para sua avaliação é necessário destruir os espécimes. Este trabalho teve por objetivo avaliar o desempenho do método ICDAS, de radiografias digitais pela técnica interproximal, da CBCT e da CT para lesões precoces de cárie, com relação à histologia. Houve correlação entre os dados obtidos com o sistema ICDAS para superfícies proximais e as imagens da CT, no que diz respeito à classificação quanto à profundidade das lesões. A CT tem correlação positiva com a histologia tanto na classificação das lesões como na profundidade, contudo esta relação poderia ser maior se uma melhor resolução fosse conseguida. As radiografias digitais pela técnica interproximal tiveram o melhor desempenho com relação à CT e à histologia, sendo este desempenho muito semelhante ao método clínico ICDAS. A CBCT obteve o pior desempenho, contudo ainda assim houve correlação positiva com a histologia e com a CT. A associação do método clínico ICDAS e as radiografias interproximais digitais tiveram o melhor desempenho com relação à histologia. A grande vantagem da microtomografia quando comparada a outros métodos de avaliação da doença cárie, é a manutenção da integridade dos espécimes, a informação tridimensional e isotrópica, possibilitando o uso dos espécimes em outro momento, sem a perda de eventuais características presentes nos mesmos. / Dental caries is still a great challenge to dentists, manly in proximal surfaces due to its difficult diagnosis. Many types of equipment have been designed to minimize this problem, specially aiming early caries detection. Among all, one of the most used by clinicians is the interproximal radiograph. The International Caries Assessment System (ICDAS) is a clinical evaluation method that is well accepted and used having a good performance not only for in vivo but also for in vitro studies. Cone beam CT (CBCT) is also being assessed in the overall Dentistry, but its performance on early caries detection has not extensively being evaluated. Microtomography (CT) is a new assessment method which is addressed to small specimens and is similar to a miniature version of axial computed tomography, producing images with micrometrical definition. CT is being assessed in dental research to evaluate mineral content of hard tissues, due to its ability to measure precisely the linear attenuation coefficient. The gold standard method to measure early caries lesions is histological method. However, to perform it, its necessary to cut the specimen. This study had the aim to evaluate the ICDAS, digital X-rays with the interproximal technique, CBCT and CT performance for early caries lesions, when compared to histology. ICDAS for proximal surfaces and CT had a positive correlation through the lesions depth. CT had a positive correlation with histology when analyzing lesions depth and the classification relating to the severity of the lesion, although this relation could be better if a better resolution could be achieved. Digital bite-wing radiographs had the best performance among all exams when comparing to CT and histology, similar to what we notice with the ICDAS results. CBCT had the worst results when comparing to CT and histology, but it was still considered a good relation. The best performance was achieved with the association of ICDAS and digital bite-wing radiographs when comparing to histology. The great advantage of CT when compared to other validating methods to evaluate dental caries is that it doesnt destroy the specimens, it gives tridimensional and isotropic information, making possible to use the specimens again, without losing inner properties.

O seio esfenoidal humano, embora sua morfologia seja mais regular quando comparada à dos demais seios paranasais, apresenta numerosas variações anatômicas que afetam sua relação com estruturas vizinhas. Diversos autores mostram a importância do conhecimento dessas variações anatômicas, baseadas tanto na forma quanto na sua presença, para uma correta e segura abordagem cirúrgica nos procedimentos via endoscópica transesfenoidais. Devido a isso, o frequente estudo deste segmento anatômico se torna preponderante e para isso a tomografia computadorizada helicoidal, mais recentemente com o desenvolvimento da aquisição multislice, é de grande importância para o conhecimento tridimensional dos seus aspectos anatômicos e suas estruturas vizinhas, sendo hoje o exame indicado. A tomografia computadorizada por feixe cônico, devido ao baixo custo dos equipamentos e principalmente a baixa dose de radiação, aliada à qualidade e fidelidade de suas imagens, têm ocupado um espaço importante no diagnóstico por imagem nas diferentes especialidades da Odontologia e mostra-se também relevante sua ampliação em outras áreas em função das vantagens já citadas. O objetivo desse estudo, a partir da análise das imagens de 300 pacientes, obtidas em equipamento de tomografia computadorizada por feixe cônico, é mostrar a viabilidade da obtenção das mesmas para a avaliação das variações anatômicas do seio esfenoidal humano, no que se refere à presença e o tipo de expansão basilar e de septos, em um tomógrafo que une qualidade e fidelidade de imagens com baixa dose de radiação. Os resultados mostraram ser viável a observação, por meio da tomografia computadorizada por feixe cônico, tanto da presença de expansão basilar quanto de septos no seio esfenoidal humano, onde 69% dos exames analisados apresentaram expansão basilar e 60% septos. A presença de expansões mostrou ser independente em relação ao gênero e a idade e 81% delas apresentaram-se como críticas. A presença de septos mostrou ser também independente em relação ao gênero, porém associada a pacientes acima de 40 anos, sendo que 36% apresentaram somente o septo principal, 6% septos acessórios e 18% ambos. / The human sinus, although their morphology is more regular when compared to the other paranasal sinuses, has numerous anatomical variations that affect their relationship with neighboring structures. Several authors show the importance of anatomical variations knowledge, based on its shape and occurrence, for a correct and safe surgical approach in the endoscopic transsphenoidal procedures. Due to this, the frequent anatomic study becomes important and the helical CT, most recently with the development of multislice acquisition, is of great importance to the knowledge of their three-dimensional anatomy and its neighboring structures, being nowadays the main indicated survey. The cone beam computed tomography due to the its low cost of equipment and especially the low dose of radiation, combined with quality and fidelity of images, have occupied an important position in diagnostic imaging in the different specialties of Dentistry and shows to be also relevant in others areas according to the advantages already mentioned. This study, based on the analysis of obtained images from 300 patients in cone beam computed tomography equipment, intents the viability of obtaining the evaluation of anatomic variations of sphenoid sinus, in regard to the presence and type of basilar expansion and internal septa, in a CT scanner that combines quality and fidelity of images with low radiation dose. By means of cone-beam computed tomography the results showed the observation to be viable. The presence of basilar sinus expansion and septa in human sphenoid sinus were found. 69% of the analyzed cases showed basilar expansion and 60% the presence of septa. The presence of expansion was independent when considered the gender and age and 81% presented themselves as critical. The presence of septa was independent of gender and associated with patients over 40 years, and 36% had only primary septum, 6% accessories septa and 18% both.