Utility of CBCT for the measurement of palatal bone thickness.

INTRODUCTION: The palate is an alternative anchoring site for orthodontic implants. Adequate bone at mini-implant placement site can influence the success or failure of anchorage. Hence, it is imperative to measure the thickness of the palatal bone. MATERIALS AND METHODS: CBCT scans of 30 subjects in the age range of 12 to 28 years were retrospectively analyzed with the objective of measuring the palatal bone thickness. Thirty sites were identified on each CBCT scan with incisive foramen as a landmark and measurements were obtained anteroposteriorly as well as mediolaterally, using Carestream 3D imaging software. The data collected was analyzed using one-way ANOVA. RESULTS: Statistical analysis revealed higher palatal bone thickness at the median and paramedian regions of anterior palate, 4mm and 8mm distal to incisive foramen. CONCLUSION: CBCT is an ideal modality for measuring palatal bone thickness and can be utilized for locating the ideal site for placement of orthodontic mini-implants.

Prevalence of temporal bone pneumatization in relation to temporomandibular joint - A computed tomographic study.

BACKGROUND: Pneumatic spaces represent sites of minimal resistance, facilitating the spread of various pathological processes into the joint such as tumors, infection or fractures or vice versa. Considering the clinical importance of temporomandibular joint, prevalence of pneumatic spaces of the temporal bone in relation to TMJ in the roof of the TMJ fossa; articular eminence; zygomatic process and peritubal area was determined using Computed tomography. Laterality and gender wise prevalence of pneumatic spaces around the TMJ was also assessed. MATERIALS AND METHODS: A total of 100 high-resolution CT images of adult patients subjected to CT scan for the base of skull/temporal bone were utilized. Axial, reformatted coronal and sagittal images were analyzed on a DICOM viewer for the presence and distribution of pneumatic spaces of the temporal bone around TMJ in the roof of TMJ fossa, articular eminence, zygomatic process and peritubal area. RESULTS: The extent of pneumatization of the temporal bone varied considerably. The prevalence of pneumatization of the roof of the TMJ fossa was 52%, articular eminence (12%), the root of the zygomatic process (5%) and peritubal area was 56%. Higher frequency of bilateral pneumatization was seen. No statistically significant correlation was seen in gender wise distribution of pneumatization. CONCLUSION: The present study revealed higher prevalence of pneumatization of temporal bone around TMJ. The knowledge of these air spaces is helpful for the interpretation of imaging studies and to understand the spread of pathological processes into the joint.

Morphological variations of median maxillary labial frenum: A clinical study.

BACKGROUND: Median maxillary labial frenum (MMLF) appears as a fold of mucous membrane extending from the lining of the mucous membrane of the lips towards the crest of the alveolar ridge on the labial surface. MMLF can demonstrate certain variations in their shape, size and position, both among individuals and within the same individual at different ages. Many clinicians, not being aware of the normal variations of median maxillary labial frenum misinterpret them as pathological entities. OBJECTIVES: The objectives of the study were to determine the prevalence of morphologic variations of MMLF, to classify the morphological variations of MMLF on the basis of their location on the frenum and to compare the morphological variations of MMLF among different age groups and genders. MATERIALS AND METHODS: The study was conducted on 700 males and 700 females of age 5 to 74 yrs, chosen randomly. They were equally divided on the basis of age into 7 groups, each group having equal gender distribution. The morphological variations of MMLF were classified according to Sewerin's classification and the attachments on the freni were further sub-classified. RESULTS: The commonest type of frenum was found to be the simple type, whereas bifid frenum was not found at all. Statistically significant difference was found in proportion of types of frenum among the different age groups and also in proportion of types of frenum among the different sites of presence of frenal attachments. No statistically significant difference was found in proportion of types of frenum in male and female subjects. CONCLUSION: This study shows that MMLF presents with an array of morphological variations. These morphological variations may sometimes pose a complicating factor in maintaining oral hygiene, speech, mastication, esthetics, denture construction, etc. Hence, appropriate recognition of frenal variations and subsequent modification of treatment procedures are essential for a successful outcome of therapy.

Efficacy of oral brush cytology in the evaluation of the oral premalignant and malignant lesions.

OBJECTIVE: In the present study, oral brush cytology of premalignant and malignant lesions was performed using tooth brush. The cytopathological diagnosis of brush cytology was compared with that of punch biopsy. The reliability of oral brush cytology using tooth brush was assessed in terms of sensitivity and specificity. MATERIALS AND METHODS: A total of 67 patients, 32 premalignant lesions and other 35 frank oral carcinomas, were included in the study. All patients underwent oral brush cytology using a toothbrush followed by punch biopsy. Sensitivity, specificity, positive and negative predictive values were calculated. Cytopathology and histopathology of premalignant and malignant lesions were compared using Mann-Whitney U test. Inter- and intra-examiner reliability was calculated using Rank-correlation coefficient. RESULTS: Two in premalignant group and five in malignant group were marked insufficient. 18% of cases were false negatives. The sensitivity, specificity, positive predictive value and negative predictive value were 77%, 100%, 100% and 38%, respectively. Statistical analysis showed P>0.05, suggesting that there is no significant difference between histopathology and brush cytology in assessing both premalignant and malignant lesions. Inter- and intra-examiner reliability were 99.22% and 99.77%, respectively. CONCLUSION: Brush cytology using a tooth brush is reliable and can be easily performed with less cost and discomfort to the patient. It is useful in those situations when a patient refuses to have a biopsy performed or when medically compromised patients would be exposed to unnecessary surgical risks. It can be used for screening for suspicious oral lesions, and may have applications in resource-challenged areas.

Familial hypophosphatemic rickets.

Rickets is the failure of mineralization of osteoid and newly formed bones in a child skeleton. It is commonly associated with vitamin D deficiency; however, it can be because of a decrease in the serum phosphate levels leading to inadequate mineralization of cartilage and bone, consequent skeletal deformities, and growth retardation. The hypophosphatemic conditions that interfere in bone mineralization comprise many hereditary or acquired diseases. One of the hereditary types of hypophosphatemic rickets is the familial hypophosphatemic rickets. This rare variety was diagnosed in a 9-year-old patient who had come with a chief complaint of a missing tooth. In the present case, radiographic aspects of oral and systemic manifestations of familial hypophosphatemic rickets are highlighted.