Metastatic breast cancer to bilateral mandibular ramus regions.

Metastatic carcinomas to the jaw bones are uncommon and comprise to about 1% of all malignant oral neoplasms. The purpose of this report is to present a rare case of metastatic breast carcinoma to bilateral mandibular ramus regions. The present case report is about a 40-year-old female patient with the complaints of a paresthesia in the right mandibular area of the last month duration. She was referred to our department by her oncologist with the differential diagnosis of osteonecrosis or metastasis. She had undergone modified radical mastectomy for invasive lobular carcinoma of the left breast. Oral cavity examination did not reveal the existence of any ulcer or fistula. Panoramic, cone-beam computed tomography (CBCT), and positron-emission tomography (PET) were used for diagnosing the lesions. In panoramic radiography and CBCT images, there were lytic lesions on the both of right and left coronoid, condyle, and ramus of the mandible. PET results showed us fluoro-2-deoxy-D-glucose uptake in the mandible and vertebrae. On the basis of the patient's medical history and paresthesia of the lower lip and chin, the metastatic disease was highly suspected. The patient was referred to her oncologist for further treatment since it was not amenable to the surgical management. The general dentist or dental specialist should maintain a high level of suspicion while evaluating patients with a history of cancer. Paresthesias of the lower lip and the chin should be considered ominous signs of metastatic disease.

Evaluation of trabecular pattern of mandible using fractal dimension, bone area fraction, and gray scale value: comparison of cone-beam computed tomography and panoramic radiography.

OBJECTIVE: This study was performed to compare the fractal dimension (FD), bone area fraction (BAF), and gray scale value (GSV) on digital panoramic radiography (DPR) and cross-sectional cone-beam computed tomography (CBCT) using image analysis and to determine whether a relationship exists among parameters associated with bone quality. METHODS: Thirty edentulous human hemimandibles were scanned by DPR and CBCT. Ninety regions of interest (ROIs) were evaluated on DPR and CBCT images to calculate the FD and BAF. The GSV of the ROI on CBCT was also calculated. RESULTS: Statistically significant differences were observed in the FD values of the ROIs between DPR and CBCT (p = 0.002) and in the BAF values of ROIs between DPR and CBCT (p = 0.017). The Spearman's correlation test revealed a statistically significant high correlation between the FD and BAF values of the ROIs on DPR and between the FD and BAF values of the ROIs on CBCT (p < 0.01). No significant correlations were observed between the GSVs of ROIs on CBCT and the FD values of ROIs on DPR, the BAF values of ROIs on DPR, the FD values of ROIs on CBCT, and the BAF values of ROIs on CBCT (p > 0.05). CONCLUSIONS: The GSV did not support the FD and BAF. Additionally, DPR and CBCT did not have similar image quality for assessing the FD, BAF, and GSV. In evaluating the trabecular structure, the use of panoramic radiographs should be continued because the image resolution of CBCT is lower and its generalized dose is higher than that of panoramic radiography. These results may serve as a reference for clinical practitioners using dental CBCT to analyze the trabecular structures of alveolar bones.

Comparison of cone-beam computed tomography with bitewing radiography for detection of periodontal bone loss and assessment of effects of different voxel resolutions: an in vitro study.

OBJECTIVE: The aim of the study was to compare intraoral radiographs and CBCT images for detection of horizontal periodontal bone loss, and to investigate the diagnostic effect of different voxel resolutions in CBCT imaging. METHODS: A total of 240 sites with horizontal bone loss were measured on the buccal, lingual, mesial, and distal surfaces of 60 posterior teeth in four maxillary and six mandibular bones obtained from cadavers (dry skulls). Direct measurements on the dry skulls were accepted as the gold standard values. Measurements on CBCT images at two different voxel resolutions (0.250 and 0.160 mm3) and intraoral bitewing radiographs were compared with one another and with the gold standard values. RESULTS: The measurements on the CBCT images at two voxel resolutions and bitewing radiographs did not differ significantly (p > 0.05) from the direct measurements on the dry skulls. No significant difference was found between the bitewing radiographs and CBCT images for measurements in the mesial and distal regions (p > 0.05). There was no significant difference between the measurements on the buccal and lingual surfaces at the two different voxel resolutions (p > 0.05). CONCLUSIONS: CBCT scans are recommended for evaluation of buccal and lingual bone loss to avoid intraoral radiographs that exceed routine examination of interproximal alveolar bone loss. Furthermore, instead of basing the voxel size on the required CBCT scans, it is recommended to select the smallest possible field of view to reduce the dose of radiation.

Is There a Possible Association between Skeletal Face Types and Third Molar Impaction? A Retrospective Radiographic Study.

OBJECTIVE: Third molar impaction is seen much more than impaction of any other tooth as they are the last teeth to erupt. Inadequate retromolar space and the direction of eruption may be contributing factors. The aim of this study was to investigate the relationship between third molar impaction and different skeletal face types. SUBJECTS AND METHODS: Panoramic and lateral cephalometric radiographs of 158 orthodontic patients (aged 19-25 years) were retrieved from the archived records of the Necmettin Erbakan University Faculty of Dentistry, Konya, Turkey. Third molar impaction was classified on the basis of Winter's classification. The skeletal facial type was determined by a measure of the angle created by the lines Ba-Na and Pt-Gn. The mean was 90 ± 2 and this value was regarded as mesofacial. An angle of > 93° was regarded as brachyfacial and an angle of < 87° as dolichofacial. RESULTS: The overall presence of mandibular and maxillary third molar impactions was 65.2 and 38.6%, respectively. Although there was a statistically significant difference between different skeletal facial types and mandibular third molar impaction (p < 0.05), no statistically significant differences were observed between different skeletal facial types and maxillary third molar impaction (p > 0.05). Brachyfacials demonstrated a lower prevalence of third molar impaction than dolichofacials. CONCLUSIONS: Different skeletal face types were associated with mandibular third molar impaction. Brachyfacials, who have a greater horizontal facial growth pattern than dolichofacials, showed a lower prevalence of impacted mandibular third molars.

A comparative study of cone-beam computed tomography and digital panoramic radiography for detecting pulp stones.

PURPOSE: The aim of this study was to compare cone-beam computed tomography (CBCT) and digital panoramic radiography (DPR) for the detection of pulp stones. MATERIALS AND METHODS: DPR and CBCT images of 202 patients were randomly selected from the database of our department. All teeth were evaluated in sagittal, axial, and coronal sections in CBCT images. The systemic condition of patients, the presence of pulp stones, the location of the tooth, the group of teeth, and the presence and depth of caries and restorations were recorded. The presence of pulp stones in molar teeth was compared between DPR and CBCT images. RESULTS: Pulp stones were identified in 105 (52.0%) of the 202 subjects and in 434 (7.7%) of the 5,656 teeth examined. The prevalence of pulp stones was similar between the sexes and across various tooth locations and groups of teeth (P>.05). A positive correlation was observed between age and the number of pulp stones (ρ=0.277, P<.01). Pulp stones were found significantly more often in restored or carious teeth (P<.001). CBCT and DPR showed a significant difference in the detection of pulp stones (P<.001), which were seen more often on DPR than on CBCT. CONCLUSION: DPR, as a 2D imaging system, has inherent limitations leading to the misinterpretation of pulp stones. Restored and carious teeth should be carefully examined for the presence of pulp stones. CBCT imaging is recommended for a definitive assessment in cases where there is a suspicion of a pulp stone on DPR.

Investigation of the prevalence of retromolar canals: a cone beam CT study / Investigación de la prevalencia de los canales retromolares: estudio de tomografía computarizada de haz cónico

SUMMARY: The retromolar canal (RMC) is a collateral branch of the mandibular canal. This branch seems to be involved in the innervation of the third molar, retromolar trigon and part of the buccal mucosa and fibres of the buccinator and temporalis muscles. The prevalence of RMC in osseous and CBCT studies was reported between 1.7 %-72 %. This study aims to investigate the prevalence of RMCs in a Turkish population using cone beam CT. 340 CBCT images of hemimandibles of 170 patients, with a mean age of 37 (range, 16-80), that clearly identified the course of the mandibular canal in the posterior mandible were selected retrospectively from the archived records of our Oral and Maxillofacial Radiology Department. The sagittal, coronal, axial and pseudopanoramic images were used for assessing the RMCs. This variant was found in 19 out of 170 patients (11 %). Of the 340 CBCT examinations in 170 patients, 20 showed the presence of a RMC (5 %). It was present unilaterally in 18 patients (95 %) and bilaterally in one patient (5 %). There was no difference in the presence of RMCs with regard to sex and sides of the mandible (p>0.05). Clinicans should be aware of RMC and this anatomical variance should be taken into consideration while planning surgery around this region. When there is any suspicion of the RMC presence CBCT is the best imaging modality to visualize the three-dimensional structure of this variant.

RESUMEN: El canal retromolar (CRM) es una rama colateral del canal mandibular. Esta rama parece estar comprometida en la inervación del tercer molar, el trígono retromolar parte de la mucosa oral y de las fibras de los músculos buccinador y temporal. La prevalencia de CRM se ha reportado entre el 1,7 % -72 % en estudios óseos y de tomografía computarizada. Este estudio tuvo como objetivo investigar la prevalencia de CRM en una población turca utilizando tomografía de haz de cono. Se seleccionaron 340 imágenes TCHC de los registros de nuestro Departamento de Radiología Oral y Maxilofacial, de mandíbulas de 170 pacientes con una edad media de 37 años (rango, 16-80), las que identificaban el trayecto del conducto mandibular en la parte posterior de la mandíbula. Se utilizaron las imágenes sagital, coronal, axial y pseudo panorámica para evaluar los CRM. La variante se encontró en 19 de los 170 pacientes (11 %). De los 340 exámenes realizados con TCHC en 170 pacientes, en 20 de éstos se observó la presencia de un CRM (5 %); se observó unilateralmente en 18 pacientes (95 %) y bilateralmente en un paciente (5 %). No hubo diferencias en la presencia de CRM con respecto al sexo y los lados de la mandíbula (p> 0,05). Los clínicos deben considerar el CRM y tener en cuenta esta variación anatómica al planificar la cirugía en esta región. Cuando existe alguna sospecha de la presencia CRM, la TCHC es la mejor modalidad para visualizar la estructura tridimensional de esta variante.

Treatment of post-orthodontic white spot lesions with CPP-ACP paste: A three year follow up study.

To determine the efficacy of topical applications of 10% casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste in reverting white spot lesions (WSLs) after fixed orthodontic treatment. Forty one participants were randomly assigned to either the test group (CPP-ACP) or the control group (only fluoride toothpaste). All patients used regular fluoride-containing toothpaste. CPPACP paste or fluoridated toothpaste was applied on to tooth surfaces with WSLs twice a day during 36-month after de-bonding. The labial/buccal surfaces of teeth were assessed by use of DIAGNOdent pen (DD), Gorelick Index and ICDAS II criteria at baseline (T1) and 36-month (T2) follow-up visits. The total counts of Streptococcus mutans and Lactobacillus were obtained at T1 and T2. DMFT, DMFS, stimulated flow rate and buffer capacity were calculated in two appointments. Daily usage of CPP-ACP paste was not better than normal care for improving the appearance of WSLs after 36 months.

Efficacy of Twisted File Adaptive, Reciproc and ProTaper Universal Retreatment instruments for root-canal-filling removal: A cone-beam computed tomography study.

The aim of this study was to evaluate the efficacy of Twisted File (TF) Adaptive, Reciproc, and ProTaper Universal Retreatment (UR) System instruments for removing root-canal-filling. Sixty single rooted teeth were decoronated, instrumented and obturated. Preoperative CBCT scans were taken and the teeth were retreated with TF Adaptive, Reciproc, ProTaper UR, or hand files (n=15). Then, the teeth were rescanned, and the percentage volume of the residual root-canal-filling material was established. The total time for retreatment was recorded, and the data was statistically analyzed. The statistical ranking of the residual filling material volume was as follows: hand file=TF Adaptive>ProTaper UR=Reciproc. The ProTaper UR and Reciproc systems required shorter periods of time for retreatment. Root canal filling was more efficiently removed by using Reciproc and ProTaper UR instruments than TF Adaptive instruments and hand files. The TF Adaptive system was advantageous over hand files with regard to operating time.

Bilateral geminated teeth with talon cusps: A case report.

Talon cusps and gemination are rare dental anomalies that can cause significant aesthetic and clinical problems. Bilateral talon cusps on geminated teeth have not been reported so far. The case of gemination with talon cusps on both maxillary central incisors was presented in this report. The main complaints of the patient were tongue irritation and aesthetic problems. The talon cusps were gradually reduced at 2 consecutive sittings and the exposed surface was treated with a fluoride gel. The aesthetical appearance was improved using a composite resin. Fixed orthodontic treatment was initiated for repositioning the left maxillary lateral incisor. A long term, multidisciplinary approach is necessary for the treatment of gemination with talon cusps.

Self-reported data on sleep quality and psychologic characteristics in patients with myofascial pain and disc displacement versus asymptomatic controls.

PURPOSE: The aim of this research was to compare the differences between patients with myofascial pain and disc displacement and asymptomatic individuals based on aspects of psychologic status and sleep quality. MATERIALS AND METHODS: One hundred thirty patients (81 women, 49 men; mean ages: 30.0 and 31.0 years, respectively) with temporomandibular disorder were selected, and 64 control subjects (32 women, 32 men; mean ages: 27.2 and 27.5 years, respectively) were included in the investigation over a period of 1 year. Clinical diagnosis of 65 patients with myofascial pain and 65 patients with disc displacement with or without limitation and joint pain was determined according to the Research Diagnostic Criteria for Temporomandibular Disorders. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Psychologic status was assessed using Symptom Checklist-90-Revised (SCL-90-R). Chi-square, Kolmogorov-Smirnov, one-way analysis of variance, and Tukey Honestly Significant Difference post hoc multiple comparison or Tamhane T2 tests were used for statistical analysis. RESULTS: There was a significant difference between patients with myofascial pain and disc displacement regarding somatization and paranoid ideation. No statistically significant difference was found between patients with disc displacements and controls in all dimensions of the SCL-90-R. Total score for the PSQI was statistically significantly different between patients with myofascial pain and controls; no significant differences were found between patients with disc displacement and those with myofascial pain or controls regarding the PSQI. CONCLUSION: To manage patients with myofascial pain, psychologic assessments including sleep quality should be considered.

Sociodemographic comparison in patients with subjective and objective clinical findings of temporomandibular dysfunctions.

OBJECTIVES: To investigate the differences in healthy persons and patients with myofacial pain without limitation, objective signs of temporomandibular dysfunctions (TMDs), and both subjective and objective features with respect to age, gender, effects of TMDs on daily life, economic condition, smoking habit, marital status, and education. METHODS: Sociodemographic information of 296 persons (212 females and 84 males) was evaluated. Subjects were categorized into 4 groups according to clinical findings: no TMD symptoms (control, C); myofacial pain without limitation (MP); objective signs (PWOS); or both subjective and objective features (MP/PWOS). RESULTS: The C, MP, PWOS, and MP/PWOS groups comprised 64 (22%), 66 (22%), 68 (23%), and 98 (33%) subjects. PWOS and MP/PWOS differed significantly between the 15-30 and 30-45 year age groups. Although patients with PWOS were significantly higher in the 15-30 year age group, patients with MP/PWOS were significantly higher in the 30-45 year age group. A significant difference was observed with respect to gender in all groups except the control group. The effects of TMD symptoms on daily life differed statistically among the groups. CONCLUSIONS: Female gender is a risk factor for TMDs. Females are more vulnerable to subjective and objective signs than males. During general dental examinations, females should be checked for TMD symptoms. PWOS manifest before MP. Moreover, mechanical derangements can cause myofacial pain. MP can mostly affect daily life, but PWOS tend to be prohibitive.

Correlation between the Condyle Position and Intra-Extraarticular Clinical Findings of Temporomandibular Dysfunction.

OBJECTIVES: To investigate the relationship between different clinical findings and condyle position. METHODS: Tenderness on masseter (MM), temporal (TM), lateral pyterigoid (LPM), medial pyterigoid (MPM) and posterior cervical (PSM) muscles, limitation, deviation and deflection in opening of mouth, clicking, crepitating, tenderness on lateral palpation of temporomandibular joint (TMJ) area for each side of 85 patients were evaluated. Each side of patients was categorized into the clinical findings: no sign and/or symptom of temporomandibular dysfunctions (TMDs), only extraarticular findings and only intraarticular findings, extra and intraarticular findings. Condyle positions of 170 TMJs were determined the narrowest anterior (a) and posterior interarticular distance (p) on mid-sagittal MRIs of condyles and expressed as p/a ratio and these ratio were transformed into logarithmic base e. Spearman's Correlation was used to investigate the relationship between the condyle position and the clinical findings. The difference between the condyle positions of different groups was tested by T test. Reliability statistic was used to determine intra-observer concordance of two measurements of condylar position. RESULTS: A significant relationship was found between the condyle position and tenderness of PSM. There was no significant difference between the groups in aspect of the condyle position. Occlusion and condyle position correlated with significantly. CONCLUSIONS: The inclination of the upper cervical spine and craniocervical angulations can cause the signs and symptoms of TMD and condyle position is not main cause of TMDs alone but it may be effective together with other possible etiological factors synergistically.

An in vitro comparison of different diagnostic methods in detection of residual dentinal caries.

The aim of this study was to investigate the efficiency of different diagnostic methods in detection of residual dentinal caries in excavated cavities. Fifty extracted molar with deep dentinal carious lesions were excavated using a slow-speed handpiece. All cavities were assessed by laser fluorescence(LF) device, electronic caries monitor(ECM), and caries detector dye(CDD) by three independent observers blindly. The measurements were repeated after two weeks. Specimens containing dentin slices 150 mum in thickness were prepared for histological analyses. The existence and absence of carious dentin was determined using a lightmicroscope. The average intraobserver accuracy was 1.00 (perfect agreement) for CDD, 0.86 (excellent agreement) for ECM, and 0.50 (good agreement) for LF. The average interobserver accuracy values were 0.92 (excellent agreement), (0.36 marginal agreement) and 0.48 (good agreement), for CDD, ECM, and LF, respectively. The average specificity was 0.60 for CDD, 73% for ECM, and 0.50 for LF. The average sensitivity was 0.55 for CDD, 0.85 for LF, and 0.47 for ECM. The average accuracy values were 0.53, 0.51, and 0.81 for CDD, ECM, and LF, respectively. LF had the greatest sensitivity and accuracy values of any of the methods tested. As a conclusion, LF device is appeared to most reliable method in detection of remain caries in cavity. However, because of its technical sensitivity it may susceptible to variations in measurements. To pay attention to the rule of usage and repeated measurements can minimize such variations in clinical practice. It was concluded that LF is an improvement on the currently available aids for residual caries detection.

Calcifications of the pulp chamber: prevalence and implicated factors.

The objectives of this study were to describe the prevalence of pulp chamber calcifications in a sample of Turkish dental patients and to report associations between presence of pulp chamber calcifications and dental status, gender, age, and cardiovascular diseases (CVDs). Data were collected through radiographic examination of periapical and bitewing radiographs of 15,326 teeth from 536 dental patients, comprising 270 male and 266 female patients aged between 13 and 65 years. Definite radiopaque focuses inside the radiolucent pulp chamber were defined as pulp chamber calcifications. When the pulp chamber was completely radiolucent, that tooth was scored as tooth without pulp chamber calcification. The dental status was scored as intact, carious, restored, or restored + carious. Pulp chamber calcifications were identified in 204 (38%) patients examined. Of the 15,326 teeth, 747 (4.8%) had pulp chamber calcifications. Gender and dental status were found to be correlated with the presence of pulp chamber calcifications. The high prevalence of pulp chamber calcifications in carious, restored, and restored + carious teeth support the view that the occurrence of pulp chamber calcifications can be a response to long-standing irritants. However, to report any associations between occurrence of pulp chamber calcifications and different dental or clinical status, further studies are still needed.

Osteosarcoma: a case report.

Although osteosarcoma of the head and neck is a relatively rare disease, it is a highly malignant bone tumor. Diagnosis of the tumor is important especially in early stages for improving prognosis. The patients with orofacial pain firstly prefer to go to dentists. Such kind of pain may be associated with an oral or maxillofacial cancer. The dentists must be careful for evaluating the clinical and radiologic clues. These clues determine the biopsy necessity, type and management plan. The aim of this case presentation is to emphasize the importance of dentists on diagnosis and prognosis of oral malignancies.

Correlation of different MRI characteristics of anterior disc displacement with reduction and without reduction.

The aim of this study was to evaluate the correlations between magnetic resonance imaging (MRI) findings in anterior displacement with reduction (ADDR) and anterior displacement without reduction (ADDWR). Two hundred patients with temporomandibular disorder (TMD) symptoms were examined clinically by a clinician experienced with this disorder. There were 130 joints with ADDR and 45 joints with ADDWR; 88 patients were identified according to the clinical and MRI diagnoses of both observers. The MRI characteristics such as position, signal intensity, morphology of disc, degenerative changes, effusion, scar tissue, avascular necrosis, and condylar hypermobility were evaluated in the individual with ADDR and ADDWR. The Chi-square test was used to determine the correlation between MRI characteristics in the ADDR and the ADDWR. There were significant relationships between degenerative changes and increased signal intensity, degenerative changes and side-way displacement, effusion and the deformation of the disc, effusion and subluxation, increased signal intensity and subluxation, elongation deformation and increased signal intensity, and elongation deformation and side-way displacement in ADDR. There were significant relationships between degenerative changes and effusion, degenerative changes and decreased signal intensity, scar tissue and avascular necrosis, deformation of disc and increased signal intensity, as well as deformation of disc and decreased signal intensity in ADDWR. These MRI findings also correlated with the clinical findings, however, this correlation appears to be a synergistic pattern rather than a set of clear-cut relationships. The correlations between these MRIs and different clinical findings such as pain and dysfunction also must be evaluated. Existing correlations must be considered in the diagnosis and treatment planning of TMD, and signs and symptoms of TMD should be monitored after treatment.