Idiopathic Osteosclerosis and Condensing Osteitis in a Sample of the Lebanese Population: A Digital Panoramic Based Study.

Background: Idiopathic osteosclerosis (IO) is an area of enlarged bone production in the jaw that usually appears radiopaque and round, elliptical, or irregular in shape. Condensing osteitis (CO) is a focalized osseous reaction leading to periapical sclerotic bone growth. Objective: The aim of this study was to investigate the prevalence, localization, shape, and dental relationship of IO and CO in a group of Lebanese patients and to correlate these findings to age and gender. Methods: 520 digital panoramic radiographs of patients (215 men and 305 women) ranging in age from 18 to 77 (mean age 40.89 years) who visited the Faculty of Dental Medicine, Lebanese University, for dental treatment were included in this study and assessed for IO and CO. The prevalence of the two lesions according to gender and age, as well as their localization, and dental relationship, were recorded and saved in an Excel sheet. Results: Among the 520 radiographs, 47 (9%) showed IO, and 30 (5.8%) showed CO. Both lesions are more frequent among females in their third decade and are essentially found in the mandible, mainly in relation to the root apices. Conclusion: Within the limits of this study, we concluded that in our sample of the Lebanese population, the prevalence of IO and CO is low and supports the theory that IO can be defined as developmental variations of normal bony architecture unrelated to a local stimulant, and CO could be considered reactive bone formations related to pulpitis, deep restoration, or caries.

Bone Apposition in the Mandibular Angle in Adult Patients Diagnosed with Bruxism: a Digital Panoramic Based Study.

Background: Bruxism is defined as a movement disorder of the masticatory system leading to serious problem in the integrity of the oral dentition; it is characterized by teeth grinding and clenching and has been typically classified into three types: a) bruxism occurring during sleep, b) awake-related bruxism, and c) mixed sleep/awake-related bruxism. Objective: The aim of this study was to assess any bone apposition in the mandibular angle in a group of adult patients diagnosed with bruxism using digital panoramic radiographs. Methods: In the sample of 150 digital panoramic radiographs of 66 women and 84 men with an age range of 24-78 years and diagnosed with bruxism were evaluated. Results: Among the 300 mandibular angles evaluated, 156 (52%) showed bone apposition against 144 (48%) who did not. Conclusion: The changes in the mandibular angle, especially bone apposition, can help diagnosing long term bruxism on panoramic radiographs.

Mandibular Metastasis of a Recurrent Poorly Differentiated Urothelial Bladder Carcinoma.

Metastatic lesions to the oral cavity are uncommon; they represent between 1 and 3% of all malignant oral neoplasms. In this article, we report a rare case of metastatic urothelial bladder carcinoma in the mandible detected on oral radiographic images and confirmed with multiple imaging modalities. A 67-year-old woman presented to our clinic suffering from pain in the right side of the mandible with a mild swelling. Panoramic radiograph revealed an ill-defined relatively radiolucent lesion in the right mandibular premolar-canine region presenting with permeative changes. Cone-beam computed tomography showed a relatively hypodense lesion with demineralization, interruption of the buccal cortices, and slight thickening and sclerosis of the buccal cortical bone. The patient was referred for further evaluation including additional advanced imaging radiographic techniques (MRI and PET scan) and clinical and histopathological examinations that lead to a final diagnosis of metastatic lesion from an underlying urothelial bladder carcinoma.

Correlating Radiographic Fractal Analysis at Implant Recipient Sites with Primary Implant Stability: An In Vivo Preliminary Study.

Objectives The aim of this study was to demonstrate a possible correlation between radiographic trabecular bone quantified with fractal dimensions analysis and values of primary implant stability deliberated using the Osstell® monitor (Integration Diagnostics AB, Goteborgsvagen, Sweden) with the density of bone specimens harvested from the implant recipient sites and calculated using the mass and volume of the bone bloc specimens. Material and methods Fifty implants of the same brand, diameter, and length were inserted with the same surgical procedures; 25 implants in the molar premolar region of the maxilla and 25 implants in the mandibular posterior region of only healthy male patients between 20 and 50 years of age. Prior to the placement of the implants, biopsies were taken from the selected site for density calculation using a calibrated trephine. Two photostimulable phosphor digital periapical radiographs were obtained for each patient and two regions of interest were selected for a fractal dimension analysis: one site before implantation and the same site immediately postoperatively adjacent to the implant. Results There were correlations between the fractal dimensions and implant stability quotient as well as between fractal dimensions and bone density. No significant difference was found between the fractal dimensions of pre- and postoperative periapical radiographs for the same region of interest and between implant stability quotient values of the maxillae and mandible sites. Conclusion All executed analyses were helpful in assessing the bone density in the recipient site of implant placement using fractal dimensions, offering complementary information about predictable bone density assessed on a periapical radiograph.

Mapping Maxillary Sinus Septa in a Lebanese Sample: a Radio-anatomical Study.

INTRODUCTION: Sinus septa are bony processes that develop in a variable fashion. Such structures present a challenge for surgical procedures of the maxillary sinuses. AIM: This study aims to evaluate the prevalence and patterns of maxillary sinus septa in a sample from the Lebanese population. METHODS: A retrospective cross-sectional study was conducted on a series of 568 Cone Beam Computed Tomography scans (CBCT) belonging to patients that presented to the Maxillofacial Radiology division of the Faculty of Dental Medicine in the Lebanese University. None of the included patients had sinus pathologies. Age ranged from 18 to 80 years with 332 females and 236 males yielding a total of 1136 maxillary sinus. Sinuses were inspected for septa, specifying their location in multiple dimensions, angulations and number. RESULTS: 36.27% of studied patients presented at least one septum (27.46% of all sinuses). No predilection towards age or sex was found. A higher number of septa were located in the middle region anteroposteriorly (38.14%), and most were localized in the inferior third coronally (81.16%). Multiple angulations are also reported. CONCLUSION: Our results suggest a common prevalence of maxillary sinus septa in our Lebanese sample and suggest similar distribution and patterns to that of reported literature.

Image-based Bone Density Classification Using Fractal Dimensions and Histological Analysis of Implant Recipient Site.

BACKGROUND: Success of dental implants is affected by the quality and density of the alveolar bone. These parameters are essential for implant stability and influence its load-bearing capacity. Their assessment is usually based on preoperative radiographs used as a tool prior to implant procedures. OBJECTIVE: The aim of the study was to compare the bone density of surgically harvested bone specimens at implant recipient sites in the maxillary and mandibular posterior region using histological analysis to the radiographic bone density using fractal dimension for reliability and determining an image based classification of bone density prior surgery. METHODS: Fifty implants were placed in the posterior region of male patients, (twenty five implants in the maxilla and twenty five in the mandible). The edentulous regions were presurgically assessed using Photo Stimulable Phosphor Plate (PSP) intra-oral radiographs and the fractal dimension box counting of region of interest was calculated at the implant recipient site. During surgery, bone core specimens were trephined, and bone densities and minerals parameters were evaluated based on histological analysis using SEM (Scanning Electron Microscopy), and atomic absorption spectrometry. RESULTS: Fractal dimensions (FD) values for the same region of interest (ROI) selected on the radiographs of bone blocks and edentulous sites were different but showed a proportional variation in molar and premolar region of the maxilla and mandible. Bone density results, calculated by the ratio of bone mass (BM) to the bone volume (BV) of the bone core specimen (D=M/V), increased in the mandibular bone blocks, and decreased in the maxilla specimens. Moreover, fractal dimension values of preoperative radiographs at implant recipient sites and bone density of trephined showed a statistically similar distribution. However, no significant difference was shown in the percentage of minerals contents and mass of calcium phosphate of each bone specimen between maxilla and mandible based on scanning electron microscopy analysis. Four types of bone densities were classified according to the distribution of FD values based on preoperative radiographs and on the densities of bone cores calculations. CONCLUSION: Radiographic estimation of bone quality calculated with fractal dimension could be a useful, non-invasive tool when using preoperative intra-oral radiographs to predict bone density at implant recipient sites with caution and limits concerning the kind of digital radiographs and size of region of interest, especially when these results were based with bone specimens harvested from implant site as an absolute reference.

Location of Posterosuperior Alveolar Artery and Correlation with Maxillary Sinus Anatomy.

The blood supply to both the lateral wall of the maxillary sinus and the overlying membrane originates from the posterosuperior alveolar artery (PSAA) and the infraorbital artery. The purpose of the present study was to evaluate the anatomic characteristics of the PSAA in a large number of subjects of the Lebanese population. Images of 696 sinuses were analyzed using cone beam computed tomography (CT). Coronal, axial, and sagittal CT images were evaluated for the presence of an osseous canal in the lateral wall of the sinus, and the prevalence, position, and location of the canal were studied and presented.

Number of basis images effect on detection of root fractures in endodontically treated teeth using a cone beam computed tomography machine: an in vitro study.

OBJECTIVES: The objective of this study was to compare the accuracy of root fracture detection in endodontically treated teeth using scans acquired with a 180° rotation motion compared with a 360° after which the patient exposure and number of basis images are doubled. METHODS: Sixty-six roots were collected and decoronated. All were treated endodontically. One-half of the roots were fractured, resulting in 2 root fragments which were then glued together. The roots were placed randomly in 8 prepared beef rib fragments. Five reviewers independently reviewed the scans twice, at different times. RESULTS: The specificity of the 360° scan was significantly higher than the 180° scan; doubling the basis images leads to a significant decrease in false-positive rates. Accuracy and sensitivity were not significantly different. CONCLUSIONS: Only the specificity is improved by the increased rotation and doubling of images. The accuracy and sensitivity are not improved.