Changes in dimension of neurovascular canals in the mandible and maxilla : a radiographic finding in patients diagnosed with MRONJ

The aim of this retrospective study was to compare the morphological features of neurovascular canals and foramina of patients with medication-related osteonecrosis of the jaws (MRONJ) and healthy individuals by using cone beam computed tomography (CBCT). The CBCT images of 58 patients under bisphosphonate therapy diagnosed with MRONJ and age gender- matched controls were retrospectively evaluated. The diameter of mandibular and nasopalatine canal and mandibular, mental and lingual foramina were measured on several sections of CBCT. The value of mental index (MI) and panoramic mandibular index (PMI) were also assessed. The mean value of diametric measurements for all neurovascular canals and foramina in MRONJ patients were narrower than controls. Left mandibular foramen was the most affected area (p<0.001). There were significantly difference in all measurements of mental foramen, lingual foramen and mandibular incisive canal between two groups (p<0.05). PMI of MRONJ subjects were also significantly differences in both sides (p<0.05). In MRONJ patient, neurovascular canals and foramina are affected due to the alterations in bone remodeling. Therefore, the diametric measurement of neurovascular canals and assessment of MI and PMI on CBCT, is a potentially useful method for detection of early changes associated with bisphosphonate therapy and for predict areas where new necrosis may occur

Cone beam computed tomographic analysis of maxillary premolars and m olars to detect the relationship between periapical and marginal bone loss and mucosal thickness of maxillary sinus

Background: This study assessed the relationship between mucosal thickness (MT) of the maxillary sinus and periodontal bone loss (PBL) and periapical condition of related teeth. We also aimed to identify the association between root apices and the inferior wall of the maxillary sinus using Cone beam computed tomography (CBCT). Material and Methods: In this study, CBCT images of 205 patients with 410 maxillary sinuses were examined, retrospectively. A total of 582 maxillary molars and 587 premolars were observed. The relationship of each root with maxillary sinus and apical lesions of these roots were classified, PBL was examined and the situations of adjacent teeth were estimated. The effect of these conditions on sinus mucosal thickness (MT) was evaluated. Results: There was a significant correlation between MT of maxillary sinus and both PBL and age (r = 0.52, p =0.000 and r = 0.111, p = 0.002, respectively). The frequency of MT increased as the severity of apical lesion enlarged. A positive correlation was found between MT and degree of PBL and periapical lesions. To reveal the association between MT and pulpoperiapical condition bivariate correlation was done and a significant relationship between the pulpoperiapical condition and MT was found (r = 0.17, p =0.000). Conclusions: This retrospective study showed that MT of the maxillary sinus was common among patients with PBL and MT was significantly associated with PBL and apical lesions. The relationship of maxillary sinus to adjacent teeth had also positive correlation with MT. CBCT imaging enabled better evaluation of maxillary sinus, posterior teeth and surrounding structures compared to other imaging tool

Ultrasonographic evaluation of jaw elevator muscles in young adults with bruxism and with and without attrition-type tooth wear: A pilot study

Objective This pilot study was planned to analyze masticatory activation in bruxism patients with and without attrition by ultrasonographic evaluation of mandibular adductor muscles. Methods Sixty bruxism patients (group 1: 30 without attrition, group 2: 30 with attrition) and an age-sex matched control of 30 (group 3) were clinically examined. The thickness of bilateral temporalis and masseter muscles during clench and rest was measured by ultrasonography. Results The mean muscle thicknesses were higher in bruxing patients than in controls. In group 2, the clench/rest ratio (C/R) of the right and left masseter and temporal muscles were higher than the control group (p = 0.03,p = 0.01,p = 0.04,p = 0.03, respectively). Conclusion The thickness of chewing muscles increases with bruxism. The occlusal forces in the teeth increase, and therefore, the tooth wear increases. Ultrasonographic muscle thickness can be used to determine muscle activity in bruxism patients

Aberrant Anatomical Variation of Maxillary Sinus Mimicking Periapical Cyst: A Report of Two Cases and Role of CBCT in Diagnosis

Most periapical lesions are associated with microorganisms from infected root canal systems. Maxillary sinus can pose a diagnostic dilemma radiographically because of its anatomical variation which can mimic a periapical pathosis. The aim of this study was to describe two cases of aberrant anatomical variation of the maxillary sinus that presented radiographic similarities to a periapical cyst in order to call the attention of clinicians to the fact that several different diseases are able to mimic endodontic periapical lesions. An accurate assessment of this morphology was made with the help of cone-beam computed tomography (CBCT)