Diagnosing everyday problems from everyday radiographs [invited keynote presentation]

Dental radiographs (including CBCT) have been a valuable diagnostic tool in the dentist's armamentarium and are commonly being used in various dental practices across Australia. Successful interpretation of dental radiographs depends on thorough understanding of the normal anatomy of head and neck and therefore, a systematic approach is highly recommended for the interpretation of any radiograph per se. Dental radiographs are very useful in evaluating the pathologies affecting the teeth, developmental disorders of jaws, foreign bodies, trauma, cysts and tumours etc. Calcifications of various structures located in the head and neck region are relatively common and are detected on routine panoramic radiographs. Dental practitioners should be aware of all the above pathologies, especially those associated with systemic illnesses so that they can timely refer the patients to the respective specialists. Knowledge acquired through experience and keeping abreast of the literature is helpful when arriving at an accurate diagnosis. Clinicians are responsible for reviewing the entire image, and when anomalies are detected, must determine the appropriate course of action. Advanced radiological or other examinations can be performed for comparison, periodic follow up, management and research purposes. This presentation highlights variety of oral and dental pathologies (which are illustrated by classic examples, are exclusively Radiology related, many of which are brain teasing) that general dentists in Australia encounter. It also outlines the basic steps the clinicians must consider to continually refine their diagnostic skills and knowledge of anatomy in order to formulate a differential diagnosis

Radiographic Evaluation of Osteoporosis Through Detection of Jaw Bone Changes: a Simplified Early Osteoporosis Detection Effort

Osteoporosis has become a worldwide problem and has been known as a silence disease. Nowadays, there are a lot of diagnostic tools for detecting osteoporosis. Eighty eight postmenopausal were included and underwent digital panoramic, digital periapical, and conventional radiography. Ultrasound bone densitometry of os calcis used as gold standard. Correlation between stiffness index (SI) with a digital dental, digital panoramic and conventional dental radiography are 0.170 (p = 0.11), -0382 (p = 0.001) and 0.246 (p = 0.021) respectively. Significant relationship was found between the SI only with digital panoramic and conventional dental. The highest correlation was found between SI values with mandibular Inferior Cortex on digital panoramic (-0.382, Pearson Correlation Tests). Correlation between digital panoramic radiographs and the SI values was the highest of the three radiographic modalities in this study. This indicates that evaluation of cortical bone is more accurate than cancellous bone. Bone quality evaluation in patients at high risk for osteoporosis using panoramic and dental conventional radiograph by dentist, contributes in preventing further occurrence of osteoporosis which in turn could reduce mortality and morbidity of osteoporosis in Indonesia

Relationship between bridging and dimensions of sella turcica with classification of craniofacial skeleton

Purpose: In orthodontics, it is essential to determine the craniofacial skeleton pattern (class I, II, III) for planning treatment. Sella turcica bridging that is seen on lateral cephalometric radiographs is considered as a normal finding. This study aimed to compare sella turcica bridging and its dimensions in patients with various craniofacial patterns. Material and methods: A total of 105 lateral cephalometric radiographs (53 men and 52 women), aged 14-26 years, were randomly and equally assigned to three groups of class I, II, and III, respectively. The length, diameter, and depth of the sella turcica as well as sella turcica bridging were determined on radiographs. The chi-squared test was used for assessing the relationship between sella turcica bridging and craniofacial skeleton classification. ANOVA was used for assessing the relationship between the dimensions of the sella turcica and craniofacial skeleton classification. The Pearson's correlation coefficient was used for assessing the relationship between age and the dimensions of the sella turcica. Results: The sella turcica had a normal shape in 64.76% of patients, whereas 35.33% of patients had sella turcica bridging. In total, 11.42% of patients belonged to class I, 34.28% to class II, and 66.62% to class III. The diameter of the sella turcica had a significant relationship with age; the diameter of the sella turcica increased with age (p < 0.001). Conclusions: There is a significant relationship between craniofacial skeleton patterns and sella turcica bridging, i.e., the incidence of sella turcica bridging is higher in class III patients. The sella turcica had a greater diameter in older patients

Treatment Rate Of Second Mesio-Buccal Canals In Maxillary Molars In A Musod Endodontic Resident Patient Population

Purpose: The primary reason for non-surgical root canal treatment (NSRCT) failure in an upper molar is inadequate cleaning, shaping and filling of the second mesio-buccal root canal (MB2). Failure to locate and treat a present MB2 will lead to a worsened long-term prognosis. This retrospective study investigated the treatment rate of MB2s in a sample of patients who were treated in Marquette University School of Dentistry\u27s (MUSOD) advanced dental education program in Endodontics. Materials and Methods: The study protocol was approved by Marquette\u27s IRB. Data were gathered from records of 447 patients who received endodontic treatment between 2008 and 2012 and include; presence of an MB2 (dependent variable), tooth number, patient age (years), and gender (independent variables). Personal identifiers subject to HIPAA regulations were not collected. Presence of an MB2 was determined from clinical notes and verified radiographically. Frequencies of present or absent MB2s were tabulated as a function of various independent variables and statistically analyzed using chi-square tests. Results: Overall, 50.3% of all patients presented with an MB2. Male and female patients had MB2s in 60.6% and 43.8%, respectively. MB2s were found in 53.1% (172 out of 324) and 43.1% (53 out of 123) of maxillary first and second molars, respectively. The mean age of the sample was 42.4 years. Below the mean age, MB2 canals were found in 56.0%, while above the mean age, they were present in 43.2%. There was no statistically significant difference in side distribution (left side of maxillary arch compared to right side). Respective frequencies were 49.3% and 51.4%. Conclusion: MB2 treatment rates may serve as a guide for practicing endodontists because they were achieved with the most current treatment techniques, advanced visualization, adequate time, and clinical expertise

The assessment of maxillofacial soft tissue and intracranial calcifications via cone-beam computed tomography

Abstract: Background: Cone-beam Computed Tomography (CBCT) scans obtained with larger field of view let us see various incidental findings, anatomical variations and pathologies, like intracranial and soft tissue calcifications. Objective: The purpose of this retrospective study was to determine the prevalence of intracranial and soft tissue calcifications via CBCT. Methods: Full volume (maxillofacial region) scans of 290 patients achieved for various reasons were investigated by blinded two dentomaxillofacial radiologists. Demographic data of the patients were saved. The findings were categorized and statistically analyzed with descriptive statistics, crosstabs and chi-square tests. Results: Totally 290 patients aged between 24 and 81 years old (mean age ± standard deviation: 49±14) consisting of 155 females (53.4%) and 135 males (46.6%) were examined in the study. The most common calcifications were pineal gland calcification (64.5%), followed by tonsillolith (34.1%), petroclinoid ligament calcification (33.4%), Intracranial Internal Carotid Artery Calcifications (IICAC) (18.3%), Extracranial Internal Carotid Artery Calcifications (EICAC) (8.3%) and the others (1.7%, equally sialolith, antrolith and choroid plexus calcification), respectively. Conclusion: Tonsillolith, EICAC and IICAC showed an increase with age. EICAC was seen more in females, conversely petroclinoid ligament calcification was seen more in males. There was a statistically significant correlation between EICAC and IICAC

The association between Ponticulus Posticus and Dental Agenesis: a retrospective study

OBJECTIVE: Neural tube defects may increase the risk of an abnormal development of skull, vertebral column and teeth formation, including dental agenesis in non syndromic patients. The association between the presence of a congenital Dental Agenesis (DA) and the Atlantooccipital Ligament (AOL) calcification, known as "Ponticulus Posticus" (PP), as possible links can be investigated. DESIGN: After a systematic review of the scientific literature on this topic, two independent examiners assessed the AOL calcification in lateral cephalograms of 350 non syndromic patients(7-21 years old). The results were compared with a control group (non syndromic patients, without congenital missing teeth). RESULTS: The 16.3% of the population studied by cephalometric analysis revealed a prevalence rate of PP (both complete and partial) with a slight male predominance is seen, not statistically significant (χ square test = 0.09; p= 0.76). In both sexes complete PP is more observed. In the patients affected by DA the frequency of PP is the 66.6% (both complete than partial). The χ square test with Yates correction showed a significative difference(χ= 66.20; p value= 0.00) between PP in patients with DA compared to not affected by DA. CONCLUSIONS: PP is not an uncommon anomaly. Since orofacial pain like migraine and other symptoms are often associated to PP, during routine radiographic examination, if detected, it should be documented in patients' health record and with symptoms, further investigation should be sought for. These findings encourage to think there's an association between DA in non syndromic patients and neuro-crestal cells defects

An evaluation of mesiodentes: A retrospective study with cone-beam computed tomography

Background: The mesiodens, located in the palatal midline between the two maxillary central incisors, is the most common type of supernumerary tooth. The aim of this study was to evaluate the distribution of mesiodentes according to shape, position, and complications using cone-beam computed tomography (CBCT) images. Methods: This study was carried out retrospectively on the CBCT images of cases. The following data were recorded: age, gender, number, shape (conical, incisor, tuberculate, round), size (less than 8 mm, 8-16 mm, and over 16 mm), direction (vertical, semi-vertical, horizontal, inverted), position (impacted or erupted) of the mesiodens, any pathologies or complications (delayed eruption of adjacent tooth, root resorption, cystic formation, diastema, displacement of adjacent tooth) and relation with neighboring anatomical structures (nasal cavity, nasopalatine canal). Results: The age distribution of the patients ranged from 7 to 61 years; mean 16.8±14.2 years. In total, 65 mesiodens were seen in 50 patients. The results showed that; mesiodentes were observed in the form of an incisor tooth (38.5%) mostly, followed conical shape (33.8%). A majority of the mesiodentes were in vertical direction (38.5%) and impacted (92.3%) in the CBCT images. Thirty-six patients (72%) had one mesiodens, 13 patients (26%) had two, and one patient (2%) had three mesiodentes. The most common complication was delayed eruption (29.2%). No complications were found in 49.2% of the cases. Sixteen cases (24.1%) were associated with the nasal cavity, while 43 cases (66.1%) were associated with the nasopalatine canal. Conclusion: Radiographic examination, especially with CBCT images, is important for an exact diagnosis, evaluation, and management of mesiodens

The Reliability Of Facial Soft Tissue Landmarks With Photogrammetry

Introduction:With attention being given to the deleterious effects of radiation exposure from dental radiographs and inaccuracies in cephalometric soft tissue measurements, an alternative method of facial analysis with sufficiently reliable soft tissue landmarks should be developed. The goals of this study were threefold: (1) to define a new, low-cost method for capturing standardized frontal and sagittal facial images, (2) to determine on which photographic view that landmarks can be more reliably located, and (3) to determine which landmarks are appropriate for quantitative facial analysis. Materials and Methods:Simultaneous frontal and right sagittal facial images of 10 male and 10 female dental student subjects were captured using high-definition webcams as part of a low-cost set-up. Seventeen identical predefined facial soft tissue landmarks were located by 5 examiners on both types of images and were recorded as coordinate values. These coordinate values were used to calculate the best estimate of the true value for each landmark, mean deviation from this best estimate, and reliability in the X- and Y-axes using the Shrout-Fleiss intraclass correlation coefficient with corresponding 95% confidence intervals. Two examiners repeated the landmark location to evaluate intra-examiner reliability. Results:With a 95% confidence interval range of \u3e0.950, nose and mouth landmarks were among the most reliable landmarks on frontal and sagittal facial images. Converselyright soft tissue gonionwas one of the least reliable landmarks located in this study. In general, landmarks located by a single examiner showed greater reliability than when there were multiple examiners. Conclusions:This low-cost method yielded frontal and sagittal images sufficient for landmark identification. The magnitude of error varies between landmarks, is largest for poorly demarcated landmarks, and most had a non-circular envelope of error. Certain landmarks were more reliable on sagittal images and others were more reliable on frontal images. All landmarks had greater reliability and less mean deviation when located by a single examiner