Evaluation of the efficacy of pharmacological treatment in patients with temporomandibular joint dysfunctions using ultrasonography.

STATEMENT OF PROBLEM: Temporomandibular joint dysfunctions (TMDs) are complex problems affecting the temporomandibular joints (TMJs), masticatory muscles, or both. TMDs are considered muscle pain caused by contraction and ischemia in the masticatory muscles, but evaluation of the efficacy of pharmacological treatment is lacking. PURPOSE: The purpose of this clinical study was to evaluate the changes in masticatory muscles, joint space, and main arteries supplying the TMJs after pharmacological therapy in patients with TMDs using ultrasonography (USG). MATERIAL AND METHODS: The TMJ space, masseter and temporal muscles, temporal superficial artery (TSA), and facial artery (FA) were examined using USG in 30 participants with acute TMD pain before and after 10 days of symptomatic treatment with analgesic and myorelaxant. The bilateral masseter and temporal muscle thicknesses, joint space, and end-diastolic minimum velocity (Ved), minimum end-diastolic minimum velocity (Vmin), peak systolic maximum velocity (Vmax), pulsatility index (PI), and resistance index (RI) values of the TSA and FA were measured and compared before and after pharmacological treatment. The relationship between the masseter muscle thickness and the Ved and Vmin values of the TSA and FA before and after pharmacological treatment was analyzed using the paired sample t test; the relationship between the temporal muscle thickness, TMJ spaces, and Vmax, PI, and RI values of the TSA and FA was analyzed using the Wilcoxon signed-rank test (α=.05). RESULTS: A significant difference was found between the right temporal muscle thickness before and after medication (P=.01), whereas no statistically significant difference was found in the left temporal muscle thickness (P>.05). A significant difference was found between pretreatment and posttreatment bilateral masseter thicknesses at rest (right P=.014; left P=.004). No statistically significant difference was found in the bilateral joint space or Vmax, Vmin, Ved, PI, and RI values of the TSA and FA before and after treatment (P>.05). CONCLUSIONS: Pharmacological treatment in participants with acute TMD led to a reduction in masseter and temporal muscle thickness but did not significantly affect joint space and local blood flow. USG is a useful diagnostic tool in the diagnosis and follow-up of TMDs.

An Anatomorphometric Study of Occipital Spurs and Their Association With Dental Occlusion.

Background and objective The occipital spur (OS) can be described as an abnormal elongation of the external occipital protuberance (EOP); its etiology is multifactorial and may involve biomechanical, immunological, and/or genetic factors. This study aimed to determine the frequency and characteristics of elongated EOP or OS as well as the relationship of OS with occlusion in a group of Turkish dental patients. Materials and methods Lateral cephalometric radiographs of 1925 patients taken in 2022 were retrospectively analyzed. The frequency, types, and dimensions of OS were determined based on gender and age groups. Molar occlusion and incisal bite were also evaluated. Results Of the 1925 patients, 679 were males and 1246 were females. The mean age of the cohort was 18.17 ±5.03 years (range: 4-61). OS was detected in 483 (25.1%) patients and was more common in males (p<0.001); 133 (27.5%) of the OSs were flat, 247 (51.1%) crest, and 103 (21.3%) spin type. The incidence of OS increased depending on age groups (p<0.001). There was no statistically significant association between OS presence and molar occlusion (p>0.05). However, a statistically significant association was observed between anterior incisal bite (p=0.001) and OS presence. There was a statistically significant difference in terms of OS sizes in males and females; the sizes of OS were larger in males than in females (length: p<0.05, base and thickness: p<0.001). Conclusions The frequency of OS was quite high in our cohort; it was more common and of larger size in males and older age groups. The most common type was the crest type. While there was no statistically significant association between OS frequency and molar occlusion, there was a significant relationship with incisal bite. The frequency of OS was highest in people with anterior crossbite.

Evaluation of submandibular gland and submandibular fossa: a combined cone beam computed tomography and ultrasound study.

Purpose: The purpose of this study was to use Cone Beam Computed Tomography (CBCT) to evaluate the submandibular fossa (SF) morphometrically and ultrasonography (USG) to evaluate the submandibular gland (SG). Materials and methods: Radiological evaluation was performed on 40 SFs and SGs from 20 patients. The depth and width of the SF were measured on axial CBCT sections, while the anteroposterior, medio-lateral, and supero-inferior lengths and volumes of the SGs were measured by USG. Statistical analysis was performed to evaluate CBCT and USG measurements. Results: The study found a statistically significant positive correlation between SF depth and SG medio-lateral dimension (p = 0.023), SF width and SG antero-posterior dimension (p = 0.021), and SF width and SG volume (p = 0.000). However, there was no significant correlation between SF depth and SG volume (p=0.146). Conclusion: The SF is an important area in surgical procedures planned in the mandibular posterior region, especially in implant applications. The dimensions of the SF are closely related to the dimensions of the SG. USG can be used to examine the SG without the risk of ionizing radiation.

Sonographic features of various dental materials and foreign bodies.

OBJECTIVE: To reveal the sonographic characteristics of various foreign bodies and dental materials to aid diagnosis. METHODS AND MATERIALS: 24 objects consisting of various dental materials and foreign bodies were included in the study. Objects were embedded in bovine gelatin. Images of the objects were obtained by conventional radiography and ultrasonography (USG). Opacities were evaluated by conventional radiography. Their visibility and posterior acoustic behaviors were examined by USG. In addition, the actual sizes of the objects and their dimensions measured by USG were compared. RESULTS: All objects included in the study, including non-opaque ones, could be visualized by USG. When the posterior acoustic behavior of objects was examined, 15 of the objects (62.5%) caused posterior acoustic shadowing on USG. While 6 of the objects (25%) did not have any USG artifacts, 2 of them (8,3%) had comet tail artifact and 1 of them (4,2%) had reverberation artifact. There was no statistically significant difference between the actual dimensions of the objects and their dimensions measured by USG (p > 0,05). CONCLUSION: USG is a very useful technique for imaging foreign bodies and dental materials, it can even show objects that cannot be seen in X-rays on in-vitro environment.

Examination of oral hemangiomas by intraoral ultrasonography.

OBJECTIVES: Oral hemangioma is a benign vascular tumor characterized by the presence of numerous blood vessels. We aimed to examine the clinical and ultrasonographic findings of patients diagnosed with oral hemangioma in our ultrasonography (USG) archive, retrospectively. METHODS: This study was conducted by examining 20 patients diagnosed with oral hemangioma and underwent USG examination in the Department of Oral and Maxillofacial Radiology of Atatürk University Faculty of Dentistry from 2016 to 2020. All patients had intraoral and radiographic examinations. Patients pre-diagnosed clinically oral hemangioma were evaluated as intraoral with USG. The intraoral USG examinations were performed using both the B-mode and the color Doppler mode. RESULTS: The mean age of the patients was 42.4 ± 19.14 years; 16 patients were female and four were male. The lesions were mostly observed on the alveolar mucosa (30%), followed by the buccal mucosa (25%), the lower lip (15%), the mouth floor (15%), the tongue (15%). In intraoral USG examinations of all oral hemangiomas, we detected submucosal located, well-defined, lobulated, non-capsule, hypo-isoechoic, heterogeneous lesion areas. Additionally, while we detected only peripheral blood flow in 6 (30%) of 20 patients, we detected both internal and peripheral blood flow in 14 (70%). CONCLUSIONS: In our study, the examination of the oral hemangiomas with the intraoral probe and the color Doppler mode was very helpful in the differential diagnosis. Although histopathology has an important place in definitive diagnosis, particularly intraoral USG can provide sufficient information for the diagnosis of oral hemangiomas.

The efficacy and limitations of USI for diagnosing TMJ internal derangements.

INTRODUCTION: This study was conducted to determine the effectiveness of ultrasonographic imaging for diagnosing temporomandibular joint internal derangements. MATERIALS AND METHODS: Ultrasonographic and magnetic resonance imaging scans of temporomandibular joints were obtained bilaterally in 55 patients who had temporomandibular joint disorders and who were diagnosed with temporomandibular joint internal derangements following a clinical examination. Diagnostic accuracy of ultrasonographic imaging was assessed considering magnetic resonance imaging as the gold standard method. RESULTS: When the results of ultrasonographic imaging and magnetic resonance imaging were compared, the diagnostic accuracy of ultrasonographic imaging was 0.81 for detecting TMJ disc displacement. The diagnostic accuracy of ultrasonographic imaging in detecting TMJ disc position was 0.81 in the closed-mouth position and 0.93 in the open-mouth position. CONCLUSION: As a noninvasive and reproducible imaging method acquiring dynamic images, ultrasonographic imaging is a successful method in the evaluation of temporomandibular joint disc displacement.

Imaging of masseter muscle spasms by ultrasonography: a preliminary study.

OBJECTIVES: The aim of this study was to determine the effectiveness of ultrasonography (USG) in locating spasm points in the masseter muscle. METHODS: Fifteen patients with TMJ dysfunction and five healthy controls were included in the study. First clinical examination of TMJ and palpation of masticatory muscles were done. Then, the masseter muscles were examined by USG. A total of 40 masseter muscles were examined within the study. RESULTS: Spasm points were observed as limited isoechogenic areas within normal heterogeneous muscle tissue. Within the 30 masseter muscles of patients with TMJ dysfunction, a total of 14 spasm points were detected clinically and 18 spasm points were detected ultrasonographically. No clinic or sonographic spasm point was detected in the masseter muscles of healthy controls. CONCLUSION: USG demonstrated in detail the internal structure of the masseter muscle in all patients and provided precise localization of the spasm points on the muscle. This is a preliminary study, showing that changes in muscle internal structure can be visualized with USG.

Is ultrasonography sufficient for evaluation of mental foramen?

METHODS:: The measurements were established on 60 MFs of 30 patients (16 males, 14 females) with a mean age of 30.70 ± 9,23 years. The vertical and the horizontal diameters, distance to the alveolar crest of the MF was measured by both CBCT and USG. Results obtained with CBCT and USG were statistically compared. And also the blood flow of the MF determined by Doppler USG. RESULTS:: All of the MFs could be detected by CBCT and USG. The vertical and the horizontal diameter measurements were compatible with each other by CBCT and USG. However, the distance to the alveolar crest was lower in USG than CBCT (p < 0.0001). The blood flow could be detected in all patients by Doppler USG that was weak in 8 MFs and strong in 52 MFs. Also there was no statistically significant association between the blood flow and age or gender. Furthermore, the blood flow was related with the horizontal diameter of the MF; however, it was not related with the vertical diameter and the distance to the alveolar crest. CONCLUSIONS:: USG is quite effective in showing the shape, size, and the location of the MF easily and rapidly. However, it is not as accurate as CBCT in measuring the distance from the MF to alveolar crest. And also it allows to examine the flow rate of mental artery with its Doppler modes.

Garre's Osteomyelitis of the Mandible Caused by Infected Tooth.

AIM: Garre's osteomyelitis is a local thickening of the periosteum caused by a slight irritation or infection. We aimed to present the extraoral, intraoral, and radiographic findings and postoperative pursuits of two patients diagnosed with Garre's osteomyelitis. In this case report, although clinical findings indicate infection source, these clinical findings are strongly supported by cone-beam computed tomography images. In addition, it can be seen that when we have followed the case I, we have chosen the right path in treatment. CASE REPORTS: Two patients presented to our clinic due to severe swelling and facial asymmetry in the right and left mandibular region. As a result of the clinical and radiological examinations, the patients were diagnosed with Garre's osteomyelitis. Infected teeth that were responsible for the formation of Garre's osteomyelitis were extracted under antibiotic treatment in both cases. A complete improvement in postoperative control was observed in case I. On the other hand, the other case could not be followed up postoperatively. CONCLUSION: In Garre's osteomyelitis, new bone formation can occur in many pathological conditions. Therefore, it should be distinguished from other pathologies that cause new bone formation, such as Ewing's sarcoma, Caffey disease, and fibrous dysplasia.

Correction to: Cone beam computed tomography and ultrasonography imaging of benign intraosseous jaw lesion: a prospective radiopathological study.

In the original version of this article, '123 lytic intraosseous jaw lesions diagnosed in 112 patients' was incorrectly presented as '123 lytic intraosseous jaw lesions diagnosed in 121 patients' and 'an average age of 31.7 ± 15.4 (range, 6-72)' was incorrectly presented as 'average age of 15.4 ± 31.7 (range, 6-72)'.

Cone beam computed tomography and ultrasonography imaging of benign intraosseous jaw lesion: a prospective radiopathological study.

OBJECTIVE: We assessed whether ultrasonography (US) can be used in combination with cone beam computed tomography (CBCT) to image intraosseous jaw lesions. MATERIAL AND METHODS: Using CBCT and US, we evaluated 123 lytic intraosseous jaw lesions diagnosed in 121 patients with guidance from the CBCT findings. The lesions were classified into two groups based on histopathological evaluation: (1) cysts and (2) tumors and tumor-like lesions. US and histopathological findings on the lesions of the two groups and their relationships with each other were also assessed. Results are reported as means ± standard errors, and p < 0.001 was accepted as indicating statistical significance. RESULT: In total, 123 lesions were evaluated; 74 (60.2%) were cysts and 49 (39.8%) were tumors or tumor-like lesions. The CBCT and US findings were compatible as far as dimensional measurements of the lesions in the three planes (p < 0.001). The US and histopathological findings on the content of the lesions correlated (p < 0.001). CONCLUSION: CBCT provides useful information for diagnosing intraosseous jaw lesions. Because it offers no valid Hounsfield unit (HU) value, it does not differentiate between solid and cystic masses. Thus, US can be used with CBCT to image intraosseous jaw lesions caused by buccal cortical thinning or perforation. CLINICAL RELEVANCE: US provides useful information about intraosseous jaw lesions and can be used with CBCT to image such lesions caused by buccal cortical thinning or perforation. Clinicians can take this information into consideration when evaluating intraosseous jaw pathology.

Comparison of radiopacity of different composite resins.

BACKGROUND: The radiopacity of composite resins has been considered as an important requirement, improving the radiographic diagnosis. AIM: The present study aimed to compare the radiopacity of eight different composite materials using an aluminum step wedge. MATERIALS AND METHODS: Eight different composite resins were used in this study. The samples were prepared using a stainless steel mold (2 × 8), and a 2-mm-thickness horizontal section was obtained from the freshly extracted molar tooth. Three different radiographs were taken by establishing standard conditions. Mean gray values were obtained by taking three measurements from each step of both the tooth and the aluminum step wedge, and the aluminum thickness equivalents were calculated. Statistical analysis was performed using one-way variance analysis and Tukey's test (P < 0.05). RESULTS: All aluminum thickness equivalents were found to be higher than those of the enamel and dentin, except Clearfil Majesty Esthetic (2.23 mm ± 0.52 mm) and Filtek Silorane (3.67 mm ± 0.15 mm) (P < 0.05). The Clearfil Majesty Posterior (8.50 mm ± 0.10 mm) and Arabesk Top (8.17 mm ± 0.06 mm) were found to be the most radiopaque composites. CONCLUSION: All composite resin materials tested in this study were confirmed to the International Standards Organization 4049 standards. However, since radiopacity is not the only criterion for clinical use, it is a better approach to take all other properties of the materials into consideration.

Changes in jawbones of male patients with chronic renal failure on digital panoramic radiographs.

OBJECTIVE: To compare the existence of gonial cortical bone thickness, antegonial index, mandibular canal bone resorption and gonial angle values and pathologies like ground-glass appearance in jawbones and brown tumor in male patients undergoing dialysis due to chronic renal failure and men from the healthy control group on panoramic radiographs. MATERIALS AND METHODS: Panoramic radiographs were taken from 80 male individuals in total (40 normal and 40 dialysis patients). Values obtained from the right and left sides of the mandible were summed and their means were calculated. Gonial cortical thickness, antegonial index and gonial angle values were assessed with the Student's t-test, mandibular canal wall resorption with the Chi-square test, and pathologies such as ground-glass appearance and Brown tumor as "available" or "not available." RESULTS: Statistically significant differences were observed among the antegonial index (P < 0.001), gonial cortical bone thickness (P < 0.001), and gonial angle (P < 0.001) values of study and control groups. Besides, mandibular canal wall resorption (P < 0.001) was also statistically significant. In the study group, pathologies with ground-glass appearance were encountered in mandible, but no radiographic findings were observed similar to brown tumor. CONCLUSIONS: Compared to the control group, decreases were found in gonial cortical bone thicknesses, antegonial index values, mandibular canal wall resorption, and gonial angle values of the patients receiving dialysis treatment due to chronic renal failure. Although it is not statistically significant, pathology with ground-glass appearance was detected in a patient, but no pathologies like brown tumor were observed. These findings from patients with chronic renal failure must be evaluated in panoramic radiography.

Morphometric and morphologic evaluation of the mental foramen in relation to age and sex: an anatomic cone beam computed tomography study.

OBJECTIVE: The aim of this study was to assess the vertical and horizontal position, angle, and diameter of the mental foramen (MF) according to sex and age by cone beam computed tomography in a Turkish patient population. METHODS: Cone beam computed tomography records of 192 consecutive patients consisting of 106 women and 86 men were examined, retrospectively. The vertical and horizontal positions of MF, angle and diameter of MF, and distance from MF to the alveolar crest and the base of the mandible were evaluated with respect to sex and age groups. RESULTS: There were statistically significant differences in the distance of MF to the alveolar crest according to age groups. When we compared the right and left sides, we have only found out statistically significant differences in the angles of MF and that it was higher in the left side. CONCLUSIONS: From our results, the detection of the position of MF can provide detailed information for preoperative treatment planning (for surgery and dental implant surgery procedures), especially in the mandibular premolar region.

Are all soft tissue calcifications detected by cone-beam computed tomography in the submandibular region sialoliths?

Heterotrophic soft tissue calcification occurs with the deposit of calcium salts in soft tissue rather than bone. The aim of this report is to describe cone-beam computed tomographic (CBCT) and ultrasonographic (US) findings of 2 cases of soft tissue calcifications that were initially diagnosed as submandibular or parotid sialolithiasis. Multiple soft tissue calcifications were evaluated by panoramic radiography, CBCT imaging, and US imaging in a 50-year-old male patient and a 30-year-old male patient. Calcifications were detected in the soft tissue of the submandibular area at axial, coronal, and multiplanar reformatted examinations and were prediagnosed as sialolithiasis. US examination was conducted to determine the complete relation between the soft tissues and the calcifications. In conclusion, high-resolution dental volumetric tomography with a low radiation dose is the optimal diagnostic tool to analyze the skeletal structure of the maxillofacial region in 3 dimensions. However, it is not sufficient to examine the soft tissues. US imaging is a useful diagnostic tool to evaluate the relation between the soft tissues and the calcifications in the submandibular area.

Incidental findings in the maxillofacial region detected by cone beam CT.

PURPOSE: The purpose of this study was to determine the location, nature, and occurrence of incidental maxillofacial findings on cone beam computed tomography (CBCT) scans performed for maxillofacial diagnostic purposes. MATERIALS AND METHODS: CBCT images of 207 consecutive patients (129 females and 78 males) were examined. The sample consisted of 85 temporomandibular joint (TMJ) disorder patients, 45 paranasal sinusitis patients, 30 obstructive sleep apnea syndrome patients, 15 implant patients, and 32 others. RESULTS: The overall rate of incidental findings was 92.8%. The highest rate of incidental findings was in the airway area (51.8%), followed by impacted teeth (21.7%), TMJ findings (11.1%), endodontic lesions (4.3%), condensing osteitis (1%), and others (2.9%). The airway incidental findings included mucosal thickening (21.3%), deviation of the nasal septum (12.6%), conchal hypertrophy (11.1%), bullous concha (3.9%), and retention cysts (2.9%). The impacted teeth consisted of third molars (18.8%) and canines (2.9%). The incidental findings for the TMJ patients were erosion of the condyle (4.8%), osteophytes (3.4%), and bifid condyle (2.9%). CONCLUSION: Oral radiologists should be aware of possible incidental findings and should be vigilant about comprehensively evaluating possible underlying diseases.

Median rhomboid glossitis: a clinical and microbiological study.

OBJECTIVES: The purpose of this study was to investigate the relationship between median rhomboid glossitis (MRG) and Candida and bacteria species, prevalence and possible association with age, gender, smoking, denture wearing, and diabetes mellitus. METHODS: Tongue examinations were performed on 4244 consecutive patients. Of all the examined patients, 30 diagnosed with MRG were selected as the study group and another 30 patients were selected as the control group, and these 2 groups were compared in terms of age and gender. Tongue cultures from these 60 patients were subjected to bacterial and mycological examinations. RESULTS: MRG frequency was detected to be 0.7%. In mycological examination, Candida species were determined in 90.0% of the MRG patients and in 46.6% of the control group. This difference was statistically significant. Multivariate logistic regression indicated that diabetes mellitus and 20-39 years of age were significantly related to MRG. However, the association between MRG, gender, smoking, and 40-69 years of age was not statistically significant. CONCLUSIONS: It was determined that although there was a significant association between MRG, Candida and diabetes mellitus, the possible risk factors such as gender, smoking, and denture wearing for oral candidiasis were invalid for MRG.

The prevalence of root dilacerations in a Turkish population.

OBJECTIVES: The aim of this study was to determine the prevalence of root dilaceration in a Turkish dental patient population, considering factors such as dental localization and the relationship between the sexes in this anomaly. STUDY DESIGN: A retrospective study was performed using periapical radiography of 2,124 patients, who ranged in age from 15 to 65 years old. All data (age, sex and systemic disease or syndrome) were obtained from the patient files and analyzed for root dilaceration. Descriptive characteristics of sexes, jaws, and dental localization were recorded. The Pearson chi-squared test was used. RESULTS: Of the 2,251 patients, 214 (9.5%) were found to have root dilaceration. Root dilacerations were determined in 276 (4.3%) of 6386 teeth, belonging to a total of 2251 patients. Anomalies were found in 9.8% of males, compared with 9.3% of females, a difference that was not statistically significant (p>0.05). Root dilacerations were distributed fairly evenly between the maxilla and mandible. The most frequently root dilacerated teeth were found to be mandibular third molars (12.8%), followed by maxillary third molars (7.4%), and maxillary first molars (6.7%). Root dilaceration was not detected in maxillary central incisors, mandibular central incisors or mandibular lateral incisors. CONCLUSION: root dilaceration is an uncommon developmental anomaly which occurs mostly in the posterior teeth, which are not prone to suffer trauma. The radiographic diagnosis of this anomaly is important before surgery, and especially before endodontic treatment or orthodontic treatment.

Correlation between oral health-related quality of life (OHQoL) and oral disorders in a Turkish patient population.

OBJECTIVES: The purpose of the present study is to determine the nature of the complaints that bring patients to our clinic and to what degree these complaints affect their quality of life (QoL). We also aimed to determine any associations between gender, education or harmful habits and each patient's oral health-related quality of life (OHQoL). METHODS: A total of 1090 patients, consisting of 651 females (59.7 %) and 439 males (40.3 %), were included in this study. Of these patients, 220 constituted healthy controls. Two patient-centered outcome measures, the 14 item OHIP-14 and the 16 item OHQoL-UK measures were used. RESULTS: Most of the patients presented with toothache and caries (50.1 %), 11.2 % had suffered tooth loss and had denture needs, 9.2 % had periodontal problems, 1.8 % had temporomandibular joint (TMJ) disorders, 3.8 % had buried third molars, 2.4 % had orthodontic and aesthetic disorders, 1.3 % had suffered injury due to trauma, and 20.2 % came only for control checkups. OHQoL was best in the control group and the worst in patients who had suffered trauma. In addition, we noted correlations between gender, education and harmful habits, and that of the patient's oral health-related quality of life. CONCLUSION: According to our results, OHQoL is associated with the oral complaints of patients. Furthermore, OHQoL may not only be associated with the oral health status of patients, but factors such as gender, education and harmful habits may also play a role.

Pre-eruptive coronal resorption and congenitally missing teeth in a patient with amelogenesis imperfecta: a case report.

This clinical report describes a male with autosomal recessive generalized hypoplastic amelogenesis imperfecta. This case is unusual in coronal resorptions prior to tooth eruption. This finding has been reported in some cases of autosomal recessive, autosomal dominant and X linked amelogenesis imperfecta (AI). In reported cases, the defects were usually small and occurred in a maximum of 2 teeth per person. In our case, pre-eruptive coronal resorptions affected three second molar teeth from both jaws. On the other hand; congenitally missing teeth and malocclusion were present in this case. Recall evaluations at 3 month intervals occurred for a period of 2 years and then prosthodontic management began.