Evaluation of renal osteodystrophy in the dental clinic by assessment of mandibular and phalangeal cortical indices

Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)Objectives Secondary perparathyroidism (SHPT) is a disease that affects patients with chronic kidney disease, and is characterized by mineral disturbance and bone loss, known as renal osteodystrophy. The aim of this study was to assess the validity of using intraoral phosphor storage plates to take radiographs of the middle phalanges to evaluate bone loss resulting from SHPT during follow-up of these patients. Methods The sample consisted of 24 patients with chronic kidney disease, 12 with parathyroid hormone (PTH) levels >= 500 pg/ml, and 12 with PTH levels < 500 pg/ml, who underwent hemodialysis weekly. For each patient, a panoramic radiograph and digital radiographs of the ring, index, and middle fingers of both hands were taken. The Mandibular Cortical Index (MCI) and the Trabecular Bone Pattern Index (TBP) were applied to the panoramic radiographs, while the Phalangeal Cortical Index (PCI) was applied to the digital radiographs of the phalanges. Three evaluators performed all analyses. Results Significant correlations were found between the PTH levels and the MCI (p = 0.023), the PCI (p = 0.039) and the TBP index (p = 0.032). These parameters were also significantly interrelated (MCI x PCI = 0.001; MCI x TBP = 0.004 and PCI x TBP = 0.009). The PCI was shown to have the highest correlation with PTH levels. Conclusion In patients with chronic renal disease, it is clinically relevant to use panoramic and digital radiographs using intraoral storage plates to assess a number of quantitative parameters that can be linked to PTH levels

Aspectos radiológicos e epidemiológicos do granuloma central de células gigantes Radiological and epidemiological aspects of central giant cell granuloma

OBJETIVO: Este estudo teve como objetivo avaliar os principais aspectos radiográficos e epidemiológicos das lesões de células gigantes (granulomas centrais de células gigantes e tumores marrons do hiperparatireoidismo). MATERIAIS E MÉTODOS: A amostra consistiu de 26 lesões de células gigantes diagnosticadas em 22 pacientes divididos em dois grupos, um deles composto por 17 pacientes que não tinham hiperparatireoidismo (grupo A) e o outro formado por cinco pacientes portadores de tal distúrbio (grupo B). RESULTADOS: O sexo feminino (72,7%) foi o mais acometido. As lesões ocorreram mais freqüentemente na segunda década de vida, com média de idade de 27 anos. A mandíbula (61,5%) foi o arco mais envolvido. Radiograficamente, 57,7% das lesões eram multiloculares e 42,3% eram uniloculares com limites definidos. Todas as 26 lesões provocaram expansão óssea, 15,4% produziram reabsorção radicular, 50% causaram deslocamento dentário e 11,5% produziram dor. Na mandíbula, 18,7% das lesões cruzavam a linha média. O grupo A apresentou 66,7% das lesões na mandíbula e o grupo B mostrou igualdade na distribuição das lesões entre os arcos. O grupo A apresentou 66,7% das lesões multiloculares e 33,3%, uniloculares. O grupo B apresentou 62,5% das lesões uniloculares e 37,5%, multiloculares. CONCLUSÃO: As lesões de células gigantes podem manifestar-se, radiograficamente, com um amplo espectro, desde pequenas lesões uniloculares de crescimento lento até extensas lesões multiloculares. Elas apresentam características de benignidade, embora algumas lesões possam demonstrar um comportamento localmente agressivo.<br>OBJECTIVE: The present study was aimed at evaluating main radiological and epidemiological aspects of giant cell lesions (central giant cell granuloma and brown tumors of hyperparathyroidism). MATERIALS AND METHODS: The sample consisted of 26 giant cell lesions diagnosed in 22 patients divided into two groups, one of them including 17 patients who were not affected by hyperparathyroidism (group A) and another including five patients with such a disorder (group B). RESULTS: Prevalence was higher in female patients (72.7%). Most frequently, lesions occurred more in the second decade of life (mean age, 27 years). The mandible arc was most frequently involved (61.5%). Radiographically, 57.7% of lesions were multilocular and 42.3% were unilocular with defined limits. All of the 26 lesions caused expansion of bone, 15.4% radicular resorption, 50% dental displacement, and 11.5% produced pain. In the mandible 18.7% of the lesions crossed the midline. Group A showed 66.7% of lesions in the mandible and group B showed an even distribution of lesions between arches. In group A 66.7% of lesions were multilocular, and 33.3% unilocular; in group B 62.5% were unilocular, and 37.5% multilocular. CONCLUSION: Giant cells lesions may present themselves with a wide spectrum, from small, slow-growing unilocular lesions to extensive multilocular lesions. They present features of benignity, though some lesions may demonstrate a locally aggressive behavior