Combination of Autofluorescence imaging and salivary protoporphyrin in Oral precancerous and cancerous lesions: non-invasive tools

Background: Normal and cancerous tissues have distinct auto-fluorescence properties because of differences in their biophysical and biochemical agents. Scientific evidences related to diagnostic fluorescence imaging for detection of oral precancerous and cancerous lesions are very limited. Objectives: The aim of this study was to find out potential relationships between serum, salivary and tissue protoporphyrin IX ( PX) levels in subjects with or without oral precancerous and cancerous lesions. Also, to find out diagnostic value of fluorescence imaging (VELscope® system, LED Dental Inc., White Rock, B.C.) and salivary protoporphyrin IX (PX) in oral precancerous and cancerous lesions. Furthermore this study attempts to find out diagnostic value of the combination of approaches of fluorescence imaging and salivary protoporphyrin for detection of oral precancerous and cancerous lesions. Material and Methods: The study sample comprised 3 test groups, with biopsy confirmed precancerous (leukoplakia and lichen planus) and cancerous lesions (squamous cell carcinoma) and one control group of 25 healthy individuals. To find out sensitivity and specificity, another 100 patients presenting for routine dental care were selected and clinical examinations were followed by fluorescence imaging and normal photography, which were finally confirmed by biopsy. The clinical and histopathogical examinations were done in conjunction with photography of the oral cavity using digital camera and fluorescence imaging. Serum, tissue and salivary protoporphyrin (PX) levels were measured. Results: Using fluorescence imaging, oral cancerous and precancerous lesions showed deep purple to deep brown and dark green colour respectively, while normal tissues showed pale green colour in contrast. The PX levels in serum, salivary and tissues were significantly higher in precancerous and cancerous lesions as compared to normal healthy tissues. Salivary and serum PX levels were highly correlated in all groups. The sensitivity and specificity to the discrimination of precancerous and cancerous lesions from the healthy tissues were higher by combination approaches of salivary protoporphyrin X and VELscope® system as compared individual approach. Conclusions: Combination approach of salivary protoporphyrin X and VELscope® system are more sensitive and specific to discriminate precancerous and cancerous lesions from the healthy tissues as compared to individual approach. Further studies are required on large samples of oral precancerous and cancerous lesions to test sensitivity and specificity and thus validate the clinical applicability of fluorescence imaging in (pre)cancerous diagnostics

Salivary apoptotic cells in oral (pre-) cancer as a potential diagnostic means

Background: Apoptosis is a genetically programmed form of cell death which is indispensable for development and homeostasis of multi-cellular organism. Objectives: The aim of this study was to find out the salivary apoptotic cells in oral precancerous and cancerous patients and furthermore to observe the potential diagnostic value of salivary apoptotic cells in detection of oral pre-cancer and cancer. Materials and Methods: Unsimulated saliva was collected from a group of 103 subjects diagnosed with oral (pre-) cancer and a control group of 30 healthy age- and gender-matched individuals. The test group diagnosed with (pre-) cancer was further subdivided in 4 lesion groups oral squamous cell carcinoma (OSCC), oral lichen planus lesions (n=26), oral leukoplakia (n=25), oral sub-mucous fibrosis (n=24) Apoptotic cells were morphologically studied using fluorescence microscopy (TUNEL technique). Results: While the morphology of apoptotic cells in oral pre-cancer and cancer are morphological similar to the typical epithelial cells of oral cavity mucosa, the number of apoptotic cells was significantly less in OSCC as compared to precancerous and normal healthy tissues. Conclusions: It could therefore be concluded that salivary apoptotic epithelial cells might be used in early detection and diagnosis of oral pre-cancer and cance

Spiral Computed Tomography Based Maxillary Sinus Imaging in Relation to Tooth Loss, Implant Placement and Potential Grafting Procedure

Objectives: The purpose of the present study was to explore the maxillary sinus anatomy, its variations and volume in patients with a need for maxillary implant placement.Materials and Methods: Maxillary sinus data of 101 consecutive patients who underwent spiral computed tomography (CT) scans for preoperative implant planning in the maxilla at the Department of Periodontology, University Hospital, Catholic University of Leuven, Leuven, Belgium were retrospectively evaluated. The alveolar bone height was measured on serial cross-sectional images between alveolar crest and sinus floor, parallel to the tooth axis. In order to describe the size of the maxillary sinus anteroposterior (AP) and mediolateral (ML) diameters of the sinus were measured.Results: The results indicated that the alveolar bone height was significantly higher in the premolar regions in comparison to the molar region (n = 46, P < 0.01). The age showed negative relation to bone dimension (r = - 0.32, P = 0.04).Anterior and posterior border of the maxillary sinuses were mostly located in the first premolar (49%) and second molar (84%) regions, respectively. Maxillary sinus septa were indentified in 47% of the maxillary antra. Almost 2/3 (66%) of the patients showed major (> 4 mm) mucosal thickening mostly at the level of the sinus floor. The present sample did not allow revealing any significant difference (P > 0.05) in maxillary sinus dimensions for partially dentate and edentulous subjects.Conclusions: Cross-sectional imaging can be used in order to obtain more accurate information on the morphology, variation, and the amount of maxillary bone adjacent to the maxillary sinus

Endodontics Program Directors’, Residents’, and Endodontists’ Considerations About CBCT‐Related Graduate Education

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153548/1/jddjde018098.pd

Accuracy of linear measurements using three imaging modalities: two lateral cephalograms and one 3D model from CBCT data

SummaryBackground: The aim of this study was to evaluate the accuracy of linear measurements on three imaging modalities: lateral cephalograms from a cephalometric machine with a 3 m source-to-mid-sagittal-plane distance (SMD), from a machine with 1.5 m SMD and 3D models from cone-beam computed tomography (CBCT) data. Methods: Twenty-one dry human skulls were used. Lateral cephalograms were taken, using two cephalometric devices: one with a 3 m SMD and one with a 1.5 m SMD. CBCT scans were taken by 3D Accuitomo® 170, and 3D surface models were created in Maxilim® software. Thirteen linear measurements were completed twice by two observers with a 4 week interval. Direct physical measurements by a digital calliper were defined as the gold standard. Statistical analysis was performed. Results: Nasion-Point A was significantly different from the gold standard in all methods. More statistically significant differences were found on the measurements of the 3 m SMD cephalograms in comparison to the other methods. Intra- and inter-observer agreement based on 3D measurements was slightly better than others. Limitations: Dry human skulls without soft tissues were used. Therefore, the results have to be interpreted with caution, as they do not fully represent clinical conditions. Conclusions: 3D measurements resulted in a better observer agreement. The accuracy of the measurements based on CBCT and 1.5 m SMD cephalogram was better than a 3 m SMD cephalogram. These findings demonstrated the linear measurements accuracy and reliability of 3D measurements based on CBCT data when compared to 2D techniques. Future studies should focus on the implementation of 3D cephalometry in clinical practic

Influence of scanning and reconstruction parameters on quality of three-dimensional surface models of the dental arches from cone beam computed tomography

The study aim is to investigate the influence of scan field, mouth opening, voxel size, and segmentation threshold selections on the quality of the three-dimensional (3D) surface models of the dental arches from cone beam computed tomography (CBCT). 3D models of 25 patients scanned with one image intensifier CBCT system (NewTom 3G, QR SLR, Verona, Italy) using three field sizes in open- and closed-mouth positions were created at different voxel size resolutions. Two observers assessed the quality of the models independently on a five-point scale using specified criteria. The results indicate that large-field selection reduced the visibility of the teeth and the interproximal space. Also, large voxel size reduced the visibility of the occlusal surfaces and bone in the anterior region in both maxilla and mandible. Segmentation threshold was more variable in the maxilla than in the mandible. Closed-mouth scan complicated separating the jaws and reduced teeth surfaces visibility. The preliminary results from this image-intensifier system indicate that the use of medium or small scan fields in an open-mouth position with a small voxel is recommended to optimize quality of the 3D surface model reconstructions of the dental arches from CBCT. More research is needed to validate the results with other flat-panel detector-based CBCT systems

Pre-surgical radiographic and clinical features as predictors for temporomandibular joint discectomy prognosis

Objectives This study aimed to identify potential clinical and radiological predictors associated with the outcome of discectomies. Methods In this retrospective observational study, the material comprised preoperative CBCT images and medical records of 62 patients with disc derangement disorders, who had undergone discectomy because of disc displacement with reduction (DDwR), disc displacement without reduction (DDwoR), systemic arthritis (SA), or joint hypermobility. Clinical and radiographic variables were analysed in relation to success rate determined by subjective, objective and combined outcomes. Results The success odds ratio was 11 times higher in patients with painful DDwR versus that of SA (p = 0.03), and even 25.9 times higher when considering solely objective outcome (p = 0.03). In the absence of subchondral pseudocyst, there were 5.2 times higher odds to have a successful subjective outcome (p = 0.04). Extensive bone apposition on the temporal joint component indicated a 9.3 times higher likelihood of a failed objective outcome (p = 0.04). Conclusions There is a significant higher risk for combined outcome failure for the diagnosis SA involving the TMJ compared with DDwR. Predictors of importance based on CBCT findings related to the objective outcome failure were extensive bone apposition on the temporal joint component and condylar subchondral pseudocysts for the subjective outcome failure.publishedVersio

Clinical and pathological differences between the pyogenic granuloma and lobular capillary hemangioma in the oral cavity : a scoping review

Since initially described, the terms “pyogenic granuloma” (PG) and “lobular capillary hemangioma” (LCH) have undergone a significant change in meaning, which leads to a confusion in the literature. In this study, we attempted to investigate if there are any clinical and pathological differences between the pyogenic granuloma and lobular capillary hemangioma through a scoping review of the available literature. A Medline search has identified 342 articles from 2001 to 2018, from which English papers, case series, retrospective studies, and cross-sectional studies were selected. Data from the articles was charted using appropriate subheadings for the clinical question (e.g., number of patients, clinical features, histology, pathogenesis, differential diagnosis, treatment). Compared to LCH, PG seems to occur more in the middle-aged range, has a clearer predilection for (pregnant) females, and has more frequently a known triggering factor in the history. Histologically, PGs appear as radially organized capillaries (while LCHs have a lobular pattern), have a mixed inflammatory infiltrate (compared to the occasional lymphocytic infiltrate in LCHs), and can undergo fibrosing transformation when chronic, which is not seen in LCHs. Finally, besides basic excision, several other treatment options have been described for both lesions. Since the pyogenic granuloma and lobular capillary hemangioma show clinical and pathological differences, we propose them to be considered as distinct lesions, which makes interpreting the literature much easier.https://www.termedia.pl/Journal/Journal_of_Stomatology-137am2021Oral Pathology and Oral Biolog

A systematic review on diagnostic test accuracy of magnetic resonance neurography versus clinical neurosensory assessment for post-traumatic trigeminal neuropathy in patients reporting neurosensory disturbance

Objectives: To perform a systematic review of published studies on diagnostic accuracy of magnetic resonance neurography (MRN) vs clinical neurosensory testing (NST) for post-traumatic trigeminal neuropathy (PTTN) in patients reporting neurosensory disturbances (NSD). Methods: Human studies except case reports, reviews, systematic reviews and meta-analyses were included. PubMed, Embase, Web of Science and Cochrane Library were consulted. Risk of bias assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Predetermined data extraction parameters were noted and summarized. Results: 8 studies met eligibility criteria of which 7 were retrospective, representing 444 subjects. Most studies were at high risk of bias with low applicability concerns. Populations and objectives were divergent with a large variation in timing (3 days-17 years post injury) and parameters (multiple coil designs, fat suppression techniques, additional contrast agent) of MRI acquisition. T-2 weighted 3 T imaging with short echo times (2.2-100 ms) and fat suppression was applied in seven studies, techniques varied. Determination of sensitivity and specificity could not be performed due to the methodological variation between studies and lacking comparative data between index and reference tests. Based on limited data, PTTN correlated reasonably well between clinical assessment, intraoperative findings and MRN abnormalities (k = 0.57). Increased signal intensity correlated with persistency of neurosensory disturbances in one study. Intra- (ICC 0.914-0.927) and interobserver (k = 0.70-0.891) MRN variability was considered good to excellent. One retrospective study showed substantial impact of MRN on clinical decision making in one-third of patients. Conclusion: Currently, there is insufficient scientific knowledge to support or refute the use of MRN. Based on limited data, MRN seems promising and reliable in detection and grading of PTTN. Methodological issues underline the importance for prospective blinded studies with standardization of signal intensity calculation and rigorous reporting of MRI acquisition parameters