Ultrasonographic Evaluation of Calcifying Cystic Odontogenic Tumor: A Case Report

The Calcifying Cystic Odontogenic Tumor(CCOT) is an uncommon lesion that demonstrates considerable histopathologic diversity and variable clinical behavior. A CCOT is rarely found in everyday practice. According to Kramer and Pindborg as well as majority of other authors’ classification, since 1992 the World Health Organization favored the use of the term calcifying cystic odontogenic tumor, described it as a cystic or neoplastic-like odontogenic pathological lesion of the jaw, and classified it as a benign odontogenic tumor. Ultrasonography(USG) is an inexpensive, non-invasive, and almost an available technique that is well tolerated by patient. In recent years many investigations focused on the use of ultrasonography in maxillofacial region as well as in intra osseous lesions of the jaws. This paper describes a 34 year old female with a painless mild swelling in the left anterior maxillary region associated with an impacted lateral incisor. The Panoramic, lateral occlusal and periapical view findings showed well-defined corticated unilocular mixed lesion with cluster of small pebbles calcifications. USG examination, using linear probe transducer, and also evaluation of location, size, internal echoe and boundary of the tumor were performed and documented. The main USG features of the tumor appeared as anechoic pattern cystic like lesion with some calcifying contents. Pathologic diagnosis was obtained by examining the surgical specimen. Therefore, ultrasonography may be used as an effective supplementary diagnostic tool for maxillofacial lesions

SURVEY OF AWARENESS LEVELS OF DENTISTS ABOUT CORRECT USAGE OF VARIOUS RADIOGRAPHIES IN DENTISTRY

Introduction: With the increasing usage of X rays, professional responsibility entails dentists to have sufficient and correct knowledge about prescription of radiographies in order to correctly diagnose and minimally expose patients to radiation. The aim of this study was to assess the awareness levels of dentists in Yazd in term of correct prescription of radiographies. Method: In this descriptive, cross sectional study, specially formatted questionnaires were filled by 134 dentists. Their knowledge in 10 various fields for correct prescription of radiographies was evaluated and compared in each field on the basis of gender and educational status.(General, specialists) Results: According to the results, knowledge levels about correct prescription of panoramic, periapical radiographies, CT and MRI was good, while that for occlussal radiographies, patients prone to caries, patients with periodontal diseases, evaluation of growth condition and dental crypts was moderate. In addition, it was weak for bitewing radiographies and in patients not prone to caries. There was no significant difference in awareness levels according to gender. The awareness level of specialists was much higher than that of general dentists except in cases of patients prone to caries where the difference was not significant. Conclusion: One of the most effective means for reducing probable risks of radiation is abstention from prescription of unnecessary radiographies

Comparing Eruption Space of the Lower Third Molar in Unerupted and Erupted Teeth via Digital Anoramic Radiography in Patients Referring to Yazd Dental College during 2011-13

Introduction: The aim of this study is to determine and compare the eruption space of unerupted and erupted third molars by the means of digital panoramic radiography in patients referring to Yazd dental college during 2011-2013. Methods: In this cross-sectional descriptive study, 150 archived digital panoramic radiographies in radiology department were evaluated with Romexis software under the standard circumstances. The radiographic pictures belonged to 73 men and 77 women with the average age of 21.18±1.67 years. In patients with erupted third molars as well as unerupted third molars (mesio-angular and vertical), several parameters were examined including: angle of the tooth axis of second and third molar, Gonial angle, the width of third molar, retro-molar space and its ratio to the width of third molar, the development stage of third molar root as well as the distance between the center of ramus and the most distal point of second molar. The data related to age, sex and the eruption situation of lower third molar- unerupted or erupted- were extracted from the patient’s log. The data were analyzed by SPSS (ver.17) via applying descriptive tests and T-test. Results: A statistically significant difference was observed between the two groups in regard with the average angle between second and third molar, the mean space of retro-molar and its ratio to the width of third molar as well as the mean distance between centers of ramus and second molar (P=0.0001). Moreover, no significant difference was observed in Gonial angle mean (P=0.213) and the width of third molar (P.value=0.348). Conclusion: Increasing the angle between second and third molar as well as inadequate space of retro-molar can lead to impaction of lower third molar, but the width of third molar and the Gonial angle size did not reveal any significant role in determination of impaction or eruption of third molar

A Comparison of Panoramic, Periapical and Bite Wing Radiographies in Evaluation of Alveolar Bone Loss in Periodiontitis

Introduction: The height of the alveolar bone, is normally maintained by equilibrium between bone formation and bone resorption, but in periodontal disease more destruction or lack of bone formation will reduce the alveolar bone height. However the radiography is important in diagnosis, treatment plan and detection of quality and quantity of the alveolar bone; although the type of radiography is more important. The purpose of this study is the comparison between panaromic, P.A (Parallel), Bite Wing radiographs in diagnosis of periodontitis. Methods: This study was descriptive cross-Sectional study Periapical (PA), Bitewing (B.W) & Panoramic radiographic images in 32 pationent 13 male and 19 female with moderate to advanced periodontitis (mean age 38 year) were taken before surgical treatment. Actual hight of defect were measured by a William's probe during surgery, the distance between cemento enamel junction (CEJ) and alveolar crest were measured on radiographs using a digital vernie scale as will as. Actual measurements were compared with values taken from panoramic PA, B.W radiographs. For Data analysis Paired t test was used. Results: A total of 314 linear distances from the panoramic PA , B.W, and CEJ/BL were measured. The mean difference between panoramic and actual Measurements (0.115 and 0.28) P=(0.24-0.07), were not satistically significant (P> 0.05). The mean difference between P.A and actual measurements (0.279-0.498) P=(0.0001-0.004) showed a satistically significant difference (P< 0.05). The mean deference between BW and actual Measurements (0.576-0.613) P=(0.24-0.07) were satistically significant (P<0.05). Conclusion: Although, all forms of radiographic images showed agreement in detection of periodontal bone loss, the accuracy of panoramic radiographs was more than PA & BW radiographs'. Specially when the magnification was adjusted in panoramic radiography

Comparison of the accuracy of digital and conventional radiography in evaluation of curved canals lengths.

Background and Aim: Proper shaping and cleaning of the root canal system is one of the most important aspects of endodontic treatment. To estimate the canal length before instrumentation in endodontic treatment, traditionally, conventional radiographic techniques and recently Direct Digital Radiography (DDR) are applied. The application of computer technology to radiography has allowed less exposure time, image acquisition, manipulation, storage, retrieval, and transmission to remote sites in a digital format, elimination of wet processing and considerable reduction in the time lapse between image acquisition and display. The purpose of this study was to compare the accuracy of DDR versus conventional radiography in estimating endodontic file lengths of curved canals in first mandibular molars. Materials and Methods: In this test evaluation study, fourty extracted human first mandibular molars with root curvature were selected. Samples were divided into two groups: With root curvature less than 25&amp;#61616; and more than 25&amp;#61616;. Samples were mounted in plaster blocks and canal lengths were estimated by using DDR and conventional radiographs. Regression analysis and correlation coefficient were used to calculate statistical differences between the groups with P&lt;0.05 as the limit of significance. Results: Conventional radiography was more precise in canals with less than 25 degrees curvature (P=0.160). While, DDR was more precise for canals with curvature more than 25 degrees (P=0.605). However, these differences were not statistically significant. Conclusion: The image quality of DDR system has improved to the point that it can now be used for estimating canal lengths, even for curved canals, with accuracy comparable to that of conventional radiography

Determining the Relationship between Dental Caries and Periodontal Disease on the Panoramic Radiographies

Introduction: Dental caries and periodontal disease are probably the most common oral chronic diseases in worldwide, and their prevalence is progressively increasing from day to day. Therefore, this study was conducted to investigate the relationship between caries and periodontal disease. Methods: In this cross sectional study, 237 panoramic radiographies of patients aged 10 to 65 years (110males and 127 females) were selected utilizing convenience sampling. In order to measure the variables, a graduate caliper with 0/2 mm accuracy and Negatoscope with optimum light were used. Moreover, in order to diagnose the caries and minimize the errors, “calibration” method was selected. Results: There was no significant relationship between crown caries and mean of alveolar bone loss. (p=0/19). As the age increased in patients, the mean of alveolar bone loss also increased and a significant association was detected between the severity of caries, alveolar bone loss and male gender. Conclusion: Generally, no relationship was observed between dental caries and periodontal disease in this study

Investigating Frequency of Reasons for Referring to CBCT in a Private Imaging Center in Yazd from 2010 to 2012

Introduction: A CBCT system (Cone Beam Computed Tomography) is a new method in the application of radiography in dental science that provides three-dimensional data of the hard and soft tissue, without magnification or distotion. Information obtained via this diagnostic imaging can be utilized in treatment planning. Methods: In this retrospective descriptive study, the CBCT prescription of all dentists (DDS & Expert) were investigated in a private Center of Oral and Maxillofacial Radiology (426 patients) in Yazd from Oct 2010 to Dec 2012 (26 months) and the following information was extracted: age, sex, years of prescription, reason of prescription, academic level of prescriber. Moreover, data was analyzed utilizing SPSS Version 16. Results: The study results revealed that 64.8% of patients aged between 30 to 60 years. Prevalence of male and female patients was approximately equal. Most CBCT prescriptions were by general dentists (44%) and then it belonged to Oral and Maxillofacial Surgeons (32.2%). CBCT was requested most for implant (88%). Number of CBCT requests in 2010 was 18.5%; in 2011 was 29.3% and in 2012 was 52.1%. Conclusion: Patients referred for evaluation before implant involve one of the main reasons for the CBCT request. However, it seems that the using CBCT was not limited to implant and will be developed in oral and maxillofacial surgery, orthodontics, root canals therapy and other dental treatments

Evaluation the Effect of two Classes of antihypertensive drugs on bone Mineral Density of the Jaws in Males over 50 Years Old in Yazd Using Cone–Beam–Computed Tomography in 2015

Introduction: Aging increases the probability of the concurrent incidence of osteoporosis and hypertension. It is demonstrated that antihypertensive drugs can affect bone metabolism. The object of this study was to evaluate the effects of antihypertensive medication on bone mineral density of maxilla and mandible in males over 50 years old using CBCT. Methods: In this analytical cross-sectional study, 174 CBCT images belong to males over 50 years old were selected according to inclusion and exclusion criteria. According to the history of using antihypertensive drugs by the patients, these images set into three groups: control group who did not have any history of hypertension, beta blocker users group (at least 5 years) and calcium-channel blocker users group (at least 5 years). Bone mineral density in each jaw was obtained in four regions using CBCT and the mean of these four values in each jaw was taken as the mean mineral density of that jaw. One-way ANOVA analysis and Tukey post hoc test were used to compare the mean values. Results: In beta blocker group, the mean of mineral density of all regions of maxilla except for incisor region was significantly greater than that for the control group. The difference between these two groups in mandible was statistically significant only at the mean of lower jaw. There was no statistically significant difference between the control group and the calcium-channel blocker group at all regions of maxilla and mandible. Conclusion: It may be preferred to use beta blockers instead of calcium channel blockers to control hypertension in the patients at risk for osteoporosis

A Review on Anatomical Variations of Mental Foramen (Number, Location, Shape, Symmetry, Direction and Size)

Mental foramen is located on the anterior aspect of the mandible that permits the terminal branch of the inferior alveolar nerve and blood vessels to exit. The anatomical variations of mental foramen are of considerable importance in local anesthesia, treatment of the fractures in the parasymphysis area, orthognatic surgeries, implant placement, etc. Regarding the importance of mental foramen in dentistry (from local anesthesia to invasive surgical procedures), this study intends to review the anatomical variations of mental foramen in this study. Absence of mental foramen is rare. On the other hand, prevalence of accessory mental foramen has been estimated lower than 15% in the most studies. The position of mental foramen is normally between first and second premolar teeth or under second premolar tooth in different ethnic groups and bilateral symmetry exists in regard with location in most cases. In most studies, the ratio of distance from mental foramen to symphysis to distance from symphysis to posterior border of ramus has been reported about 1/3.5 to 1/3. Mental foramen is oval or circular in shape and its most common direction is usually posterosuperior. Its size in different studies has been estimated about 2 to 5 millimeters and asymmetry in size is possible on both sides of mandible. Due to variations of mental foramen between various ethnic groups and even different individuals in the same ethnic group, using advanced imaging techniques such as CBCT is recommended in order to gain detailed knowledge of anatomy and morphology of mental foramen before applying invasive surgeries

Analysis of Anatomy of Mesio-Buccal Root Canal in Maxillary First Permanent Molars Using CBCT Technique

Introduction: To conduct a successful endodontic treatment, one needs to identify, clean and completely obturate the whole root canals.One important reason of reduction in success of endodontic treatment in maxillary molars is failure in identification and treatment of second mesiobuccal canal. Therefore, the present study intended to analyze the anatomy of mesiobuccal root of first maxillary molar in terms of the presence or absence of second mesiobuccal canal by using CBCT (Cone Beam Computed Tomography) technique. Methods: In this analytical study, 30 extracted maxillary first permanent molars were collected and placed in a solution of 5/25% sodium hypochlorite for 24 hours. Then each tooth was individually mounted in plastic cylinder using modeling wax. The cylinders were divided into 6 groups of 5 samples. The samples of each group were placed in CBCT machine in the form of a U to operate the imaging procedure. The images were analysed by an experienced observer (oral and maxillofacial radiologist). Percentage analysis was done for this study. Results: Assessment by CBCT revealed presence of second mesiobuccal canal in 60% of samples, out of which in 55.55% the second mesiobuccal canal was in coronal 3rd, in 33.33% in middle 3rd and in 11.11% was in apical 3rd. Conclusion: According to this study, it can be concluded that in more than half of mesiobuccal roots of maxillary first molars, there are two canals and CBCT scans could be helpful in finding additional canals in maxillary first molars, and thus could contribute to higher successes in endodontic treatment