Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe complication of mainly antiresorptive drugs. We evaluated the frequency of dentoalveolar pathologies in patients scheduled for antiresorptive therapy in a 'real-world' setting, also including patients with poor oral health potentially requiring tooth extractions and/or other dentoalveolar surgery. This approach is in contrast to the setting of recent randomized trials with restrictive exclusion criteria. Patients & methods: We prospectively included patients suffering from solid tumors with osseous metastases or multiple myeloma. Screening for dentoalveolar pathologies was done prior to initiation of antiresorptive therapy at the specialized MRONJ clinic of the University Hospital for Cranio-Maxillofacial and Oral Surgery, Innsbruck, Austria. Results: 119 subjects could be included. In 76 patients (63.9%), a dental focus was revealed including deep caries (24.4% of patients), chronic apical periodontitis (26.9%), periodontal disease (45.8%), root remnants (16%), jaw cysts (2.5%), partially impacted teeth (5.0%) and peri-implantitis (5.0%). Conclusion: Considering the high number of dentoalveolar pathologies (63.9%), systematic dental focus screening prior to initiation of antiresorptive therapy is of utmost importance to lower the risk for MRONJ.

Brightness and contrast adjustments influence the radiographic detection of soft tissue calcification.

OBJECTIVE: To assess the influence of subjective enhancement of brightness and contrast of digital panoramic radiographs on the detection of soft tissue calcifications. MATERIALS AND METHODS: In this observational study, 500 digital panoramic radiographs were evaluated by two examiners in consensus, who scored the images for the presence of calcifications for each right and left side of the image. After 30 days, all images were revaluated under subjective manipulation of digital brightness and contrast. Calcifications were classified based on the diagnostic hypothesis: sialolith, tonsillolith, calcified atheroma, phlebolith, rhinolith, maxillary sinus antrolith, synovial chondromatosis, lymph node calcification, stylohyoid ligament, triticeous cartilage, or/and upper horn of thyroid cartilage calcification. For intra-examiner agreement, 20% of the sample was reevaluated. The Kappa test and McNemar test were used (α = 0.05). RESULTS: In original images, calcifications were observed in 44.2% of the patients, and in enhanced images, this number was 70.8%. Many calcifications were detected only in enhanced images, mainly in the diagnostic hypotheses of calcified atheroma and stylohyoid ligament. Intra-examiner agreement was excellent for the detection of soft tissue calcifications (0.82) and for the classification (0.81). CONCLUSION: Subjective enhancement of brightness and contrast alters the detection of soft tissue calcifications in digital panoramic radiograph.

[Panoramic radiographs in dental diagnostics]. / Panoramische röntgenopnamen in de tandheelkundige diagnostiek.

Panoramic radiographs are frequently used in dental practice in addition to bitewing radiographs and periapical radiographs. The way a panoramic photograph is created is different from that of a projection image, such as bitewing and periapical radiographs. As a result, the sharpness of detail is much less, and overlap of structures occurs in different areas of the image. Consequently the diagnostic utility is limited to the recognition of anomalies for which small details play a lesser role. The advantage of a panoramic radiograph is that structures over a large area are shown in their relative location. Because of the lower resolution and the higher dose of radiation to the patient compared with a series of intraoral images, the panoramic radiograph is not indicated during a periodic check-up. If clinical inspection indicates a need for it and as a supplement to an intraoral radiograph, a panoramic radiograph can, however, be appropriate in cases of abnormalities that extend over a larger area, such as tumours and developmental disorders.

Digital panoramic radiography for diagnosis of the temporomandibular joint: CBCT as the gold standard

Three-dimensional imaging modalities have been reported to be more accurate than panoramic radiographs (PR) for the assessment of bone components of the temporomandibular joint (TMJ). No exact prior information is available that demonstrates which specific limitations occur in terms of TMJ diagnosis when using PR for this purpose. This study aimed to assess the clinical validity of digital panoramic radiography (DPR) when diagnosing morphological disorders of the TMJ using cone-beam computed tomography (CBCT) images as the gold standard. A sample composed of TMJ images (N = 848), including 212 DPR and 212 CBCT images obtained from the same patient, was used to assess any morphological changes in the TMJ. Four appraisers diagnosed all of the DPR images, whereas the CBCT images were used to establish the gold standard. The reliability of each appraiser’s response pattern was analyzed using the Kappa test (κ), and diagnostic tests were performed to assess each appraiser’s performance using a significance level setting of 5% (α = 0.05). Reliability of each appraiser’s response pattern compared to the gold standard ranged from a slight-to-moderate agreement (0.18 ≤ κ ≤ 0.45); and among the different appraisers, the response pattern showed a fair agreement (0.22 ≤ κ ≤ 0.39). Diagnostic tests showed a wide range among the different possible morphological changes diagnosed. DPR does not have validity when diagnosing morphological changes in the TMJ; it underestimates the radiological findings with higher prevalence, and thus, it cannot be used effectively as a diagnostic tool for bone components within this region.

Diagnóstico ortodôntico sem as radiografias periapicais de todos os dentes: cuidado, você pode se surpreender / Orthodontic diagnosis without periapical radiograph of all teeth: be careful, you might be surprised

Objetivo: a proposta do presente artigo foi relatar um caso clínico onde, ao serem analisados os detalhes anatômicos na radiografia panorâmica de um paciente previamente ao início do tratamento ortodôntico, não foi detectada a presença de dente extranumerário na região apical do primeiro molar superior esquerdo. Resultado: apesar da presença desse elemento extra, não houve a necessidade de removê-lo para a realização do tratamento ortodôntico, entretanto, poderia em uma outra situação clínica comprometer o bom andamento e sucesso do tratamento. Conclusão: dessa forma, conclui-se com a descrição desse caso clínico que a radiografia panorâmica não substitui o exame periapical no planejamento ortodôntico pois são complementares. Radiografias periapicais apenas dos dentes anteriores poderiam ser insuficientes para o diagnóstico e prevenção dos riscos da terapia ortodôntica.

Value of cone-beam computed tomography in the process of diagnosis and management of disorders of the temporomandibular joint.

The objective of this study was to assess the value of cone-beam computed tomographic (CT) images in the primary diagnosis and management of 128 outpatients with disorders of the temporomandibular joint (TMJ). Before a diagnosis was made and treatment planned, the history was taken, physical examination made, and the orthopantomogram studied. After assessment of the cone-beam CT, the oral and maxillofacial surgeon (specialist or resident) was allowed to revise the provisional primary diagnosis and management. The degree of certainty was rated by the clinician before and after the cone-beam CT had been assessed. The primary diagnosis was changed in 32 patients (25%), additional diagnostic procedures were changed in 57 (45%), and the treatment was changed in 15 (12%) (in 4 the treatment was changed to a (minimally) invasive procedure). A total of 74 patients (58%) had their diagnosis and management changed after the cone-beam CT had been assessed. Changes in diagnosis and management were clinically relevant in 9/32 and 9/61 patients, respectively. The clinician's certainty about the primary diagnosis increased after the cone-beam CT had been assessed in 57 patients. Logistic regression analysis showed that the odds in favour of changes in primary diagnosis and management increased when limited mandibular function was a primary symptom, the patient was taking medication for pain, and the articular eminence could not be assessed on OPT. Assessment of cone-beam CT led to changes in primary diagnosis and management in more than half the patients with disorders of the TMJ.

Radiation protection in dental X-ray surgeries--still rooms for improvement.

AIM: To illustrate the authors' experience in the provision of radiation protection adviser (RPA)/medical physics expert (MPE) services and critical examination/radiation quality assurance (QA) testing, to demonstrate any continuing variability of the compliance of X-ray sets with existing guidance and of compliance of dental practices with existing legislation. METHOD: Data was collected from a series of critical examination and routine three-yearly radiation QA tests on 915 intra-oral X-ray sets and 124 panoramic sets. Data are the result of direct measurements on the sets, made using a traceably calibrated Unfors Xi meter. The testing covered the measurement of peak kilovoltage (kVp); filtration; timer accuracy and consistency; X-ray beam size; and radiation output, measured as the entrance surface dose in milliGray (mGy) for intra-oral sets and dose-area product (DAP), measured in mGy.cm(2) for panoramic sets. Physical checks, including mechanical stability, were also included as part of the testing process. RESULTS: The Health and Safety Executive has expressed concern about the poor standards of compliance with the regulations during inspections at dental practices. Thirty-five percent of intra-oral sets exceeded the UK adult diagnostic reference level on at least one setting, as did 61% of those with child dose settings. There is a clear advantage of digital radiography and rectangular collimation in dose terms, with the mean dose from digital sets 59% that of film-based sets and a rectangular collimator 76% that of circular collimators. The data shows the unrealised potential for dose saving in many digital sets and also marked differences in dose between sets. CONCLUSION: Provision of radiation protection advice to over 150 general dental practitioners raised a number of issues on the design of surgeries with X-ray equipment and critical examination testing. There is also considerable variation in advice given on the need (or lack of need) for room shielding. Where no radiation protection adviser (RPA) or medical physics expert (MPE) appointment has been made, there is often a very low level of compliance with legislative requirements. The active involvement of an RPA/MPE and continuing education on radiation protection issues has the potential to reduce radiation doses significantly further in many dental practices.

Evaluation of common operator errors in panoramic radiography in Trinidad and Tobago: a comparison of formally vs informally trained operators / La evaluación de los errores comunes de los operadores de radiografía panorámica en Trinidad y Tobago comparación de los operadores adiestrados formalmente frente a los adiestrados informalmente

AIM: To evaluate and compare the frequency of common operator errors seen on panoramic radiographs in dental private practices and in the dental hospital (taken by informally and formally trained operators, respectively) in Trinidad and Tobago. METHOD: One thousand panoramic radiographs of patients over the age of 10 years were included in this study. These comprised 500 from the dental hospital and 500 from dental private practices. The radiographs were reviewed using standardized criteria to identify the most common operator errors. RESULTS: There were only 21 (4.2%) error free radiographs in the dental private practice sample and 29 (5.8%) in the dental hospital sample. Frequencies of specific errors were significantly higher in the dental private practice sample in each category except for "Chin tipped too low" (Chi-square p < 0.05) CONCLUSION: This study supports the need for the introduction of statutory guidelines with respect to the use of ionizing radiation in dentistry in Trinidad and Tobago and in particular, the implementation of formally assessed dedicated dental radiography training for all operators of dental X-ray equipment.

OBJETIVO: Evaluar y comparar la frecuencia de los errores comunes de los operadores, observados en las radiografías panorámicas en las clínicas dentales privadas y en el hospital de odontología (tomadas por operadores adiestrados formalmente e informalmente, de forma respectiva) en Trinidad y Tobago. MÉTODO: Mil radiografías panorámicas de pacientes de más de 10 años de edad, fueron incluidas en este estudio. Las mismas comprendían 500 provenientes del hospital odontológico y 500 provenían de las prácticas privadas de dentistas. Las radiografías fueron examinadas a partir de criterios estandarizados, a fin de identificar los errores más comunes de los operadores. RESULTADOS: Hubo sólo 21 (4.2%) radiografías sin errores en la muestra de la clínica dental privada, y 29 (5.8%) en la muestra del hospital de odontología. Las frecuencias de errores específicos fueron significativamente más altas en la muestra de la clínica dental privada en cada categoría, salvo el caso del "mentón inclinado excesivamente hacia abajo" (Chi-cuadrado p < 0.05) CONCLUSIÓN: Este estudio subraya la necesidad de introducir pautas reglamentarias con respecto al uso de la radiación ionizante en la cirugía dental en Trinidad y Tobago, particularmente en lo que concierne al adiestramiento especializado en radiografía dental, formalmente evaluado, para todos los operadores de equipos de rayos x para el trabajo dental.

Detection of crestal radiolucencies around dental implants: an in vitro experimental study.

PURPOSE: The aim of this study was to compare the diagnostic potentials and practical advantages of different imaging modalities in detecting bone defects around dental implants. MATERIALS AND METHODS: Crestal bone defects with sequentially larger diameters were randomly prepared around 100 implants that were inserted in bovine bone blocks. Conventional periapical radiography (PR), direct digital radiography (DDR), panoramic radiography (PANO), cone-beam computed tomography (CBCT), and multislice computed tomography (MSCT) were performed for all specimens. The diagnostic accuracies of the devices, confidence of the answers, subjective image quality, defect visibility in planar orientations, and duration of diagnosis were analyzed based on the interpretations of 7 calibrated observers. RESULTS: The agreement levels of intra- and interobserver scores were rated good. PR, DDR, and CBCT were mostly more accurate than PANO and MSCT (P < .05). Confidence levels were positively correlated with the defect size (ρ = 0.20, P < .01), and that of DDR was the highest (P < .05). The subjective image quality of PR and DDR was higher than that of CBCT, PANO, and MSCT (P < .05 for all comparisons). Axial-coronal-sagittal visibilities of the defects were higher for CBCT compared with MSCT (P < .05). The diagnostic time was shorter for DDR (P < .05) and longer for the tomographic systems (P < .05) than for the other devices. CONCLUSIONS: DDR may provide a faster and more confident diagnostic option that is as accurate as PR in detecting peri-implant radiolucencies. CBCT has a comparable potential to these intraoral systems but with slower decision making and lower image quality, whereas PANO and MSCT become more reliable when bone defects have a diameter that is at least 1.5 mm larger than that of the implant.

Frequency of errors and pathology in panoramic images of young orthodontic patients.

The aims of this study were to evaluate the frequency of errors in panoramic radiographs in young orthodontic patients, to register pathologic and abnormal conditions, and to compare these findings with the patient's record. A total of 1287 panoramic radiographs of children and adolescents (530 boys and 757 girls; mean age 14.2 years) were analyzed. The radiographs were obtained of patients referred for orthodontic treatment during a 1 year period. Four observers evaluated the radiographs for 10 common errors, pathologies, and/or anomalies. Cohen's kappa was used for the calculations of inter- and intraobserver variability. Five of the errors were divided into clinically relevant or not clinically relevant errors, i.e. errors influencing diagnosis. Only those pathological findings with a possible influence on orthodontic treatment were compared with the patient's record. Of the 1287 radiographs, 96 per cent had errors. The number of errors in each image varied between 1 and 5, and in 24 per cent of these images, the errors could be of importance for clinical decision making. The most common error was that the tongue was not in contact with the hard palate. Pathologies or anomalies were found in 558 patients and a total of 1221 findings were recorded. Findings of possible relevance for orthodontic treatment were 63, and 12 of those were registered in the patient records. Pathological findings outside the dental arches were low and could be an argument for minimizing the radiation field.

A comparative diagnostic assessment of anterior tooth and bone status using panoramic and periapical radiography.

AIMS: The aim of the present study was to compare diagnostic assessments of anterior tooth and bone status in a randomised cohort of pre-orthodontic patients using panoramic and periapical radiographs. METHOD: Four hundred and forty-four cases with matched periapical and panoramic radiographs were examined by three observers. Two were final-year postgraduate endodontic students and the other, a final-year Honours degree dental student. Multi-rater Kappa values were used to assess the reliability of the observers, with a value of 1 equating to complete agreement. RESULTS: With the exception of endodontic Class 1 and 2 palatal invaginations, reliability exceeded 0.95 for all three observers. An assessment of the graduate endodontic students revealed only a marginal increase in the kappa values. Statistical analysis (p < 0.05) determined that developmental anomalies or tooth/bone pathoses were more reliably detected by observers using periapical radiographs compared with panoramic films. This finding has relevance given the likelihood of anterior dental trauma among young children. CONCLUSION: While there have been considerable improvements in the quality of dental panoramic radiography, the present study indicated that a reliable pre-orthodontic or post-trauma diagnostic assessment should include both panoramic and intra-oral radiographs.

Accuracy of linear measurements before and after digitizing periapical and panoramic radiography images

The aim of this study was to evaluate the accuracy of linear measurements made on conventional and digitized periapical and panoramic radiographic images of dry human hemi-mandibles. Images from the posterior region of 22 dry human hemi-mandibles were obtained by conventional panoramic and periapical radiography technique. Using a digital caliper, 3 vertical measurements were marked directly on the dry hemi-mandibles (reference measurements) as well as on the tracing from the conventional radiographic images of the specimens made onto acetate paper sheet: Distance 1: between the upper limit of the alveolar ridge and the lower limit at the mandible base; Distance 2: between the upper limit of the alveolar ridge and the upper limit of the mandibular canal; Distance 3: between the lower limit of the mandibular canal and the lower limit of the mandible base. Next, the radiographs were digitized and the three measurements were made on the digital images using UTHSCSA Image Tool software. Data were analyzed statistically by one-way ANOVA (α=0.05). There was no statistically significant differences (p>0.05) between periapical and panoramic radiographs or between the measurements recorded using the digital caliper and UTHSCSA software compared with dry mandible specimens for Distances 1 (p=0.783), 2 (p=0.986) and 3 (p=0.129). In conclusion, the radiographic techniques evaluated in this study are reliable for vertical bone measurements on selected areas and the UTHSCA Image Tool software is an appropriate measurement method.

O objetivo deste estudo foi avaliar a acurácia de medidas lineares realizadas em radiografias panorâmicas e periapicais convencionais e digitalizadas de hemimandíbulas humanas secas. Imagens da região posterior de 22 hemimandíbulas humanas secas foram obtidas pelas técnicas panorâmica e periapical convencionais. Com o paquímetro eletrônico digital, foram realizadas três medições verticais diretamente sobre as hemimandíbulas (medidas referenciais), bem como sobre o decalque das imagens convencionais, em papel de acetato: Distância 1: Distância entre o limite superior do rebordo alveolar e o limite inferior da base da mandíbula; Distância 2: Distância entre o limite superior do rebordo alveolar e o limite superior do canal mandibular e Distância 3: Distância entre o limite inferior do canal mandibular e o limite inferior da base da mandíbula. Posteriormente, as radiografias foram digitalizadas e as três medidas foram realizadas nas imagens digitais utilizando o programa UTHSCSA Image Tool. Os dados foram analisados estatisticamente pelo teste ANOVA a um critério (α=0,05). Não houve diferenças estatisticamente significantes (p>0,05) entre as radiografias panorâmicas e periapicais, assim como para as medidas obtidas com o paquímetro e pelo programa UTHSCSA Image Tool, quando comparados aos espécimes mandibulares, avaliando as distâncias 1 (p=0,783), 2 (p=0,986) e 3 (p=0,129). Em conclusão, as técnicas radiográficas avaliadas neste estudo mostraram-se confiáveis para mensurações ósseas verticais na área selecionada e o programa de digitalização de imagens UTHSCSA Image Tool é um método adequado de aferição.

Construction of a copper stepwedge with aluminum equivalent mean gray values.

OBJECTIVES: To produce a copper (Cu) stepwedge with aluminum (Al) equivalent mean gray values (MGV). MATERIAL AND METHODS: The thicknesses of Cu steps that were equivalent to those of the Al were formulated using the X-ray attenuation properties of the materials. The Al and fabricated Cu stepwedges were radiographed, but the MGVs of the Cu stepwedge were mismatching to those of the Al. Using a mathematical function to adjust the pixel MGV of Cu stepwedge to those of the Al, new Cu stepwedges were created. In vitro iterations were performed until best approximation to Al was reached. RESULTS: The MGV of the Cu stepwedges fabricated by formularization were different than those of Al (p=0.001). Iteration method led to MGV similar to those of the Al stepwedge (p=0.207). CONCLUSIONS: Construction of a Cu stepwedge according to the basic rules of radiophysic failed to result in a stepwedge with similar radiodensity values to those of Al stepwedge. Further studies may use the formularization method only for prototype Cu wedge production, but consecutive iterations shall be compassed to obtain the best approximation to Al MGV.

Construction of a copper stepwedge with aluminum equivalent mean gray values

OBJECTIVES: To produce a copper (Cu) stepwedge with aluminum (Al) equivalent mean gray values (MGV). MATERIAL AND METHODS: The thicknesses of Cu steps that were equivalent to those of the Al were formulated using the X-ray attenuation properties of the materials. The Al and fabricated Cu stepwedges were radiographed, but the MGVs of the Cu stepwedge were mismatching to those of the Al. Using a mathematical function to adjust the pixel MGV of Cu stepwedge to those of the Al, new Cu stepwedges were created. In vitro iterations were performed until best approximation to Al was reached. RESULTS: The MGV of the Cu stepwedges fabricated by formularization were different than those of Al (p=0.001). Iteration method led to MGV similar to those of the Al stepwedge (p=0.207). CONCLUSIONS: Construction of a Cu stepwedge according to the basic rules of radiophysic failed to result in a stepwedge with similar radiodensity values to those of Al stepwedge. Further studies may use the formularization method only for prototype Cu wedge production, but consecutive iterations shall be compassed to obtain the best approximation to Al MGV.

Correlations between seven panoramic radiomorphometric indices and bone mineral density in postmenopausal women.

OBJECTIVES: The aim was to test for correlations of 7 panoramic radiomorphometric indices with lumbar spine and hip bone mineral densities (BMDs) and to test the accuracy of these indices for predicting osteoporosis and a T-score < or =-2.0. STUDY DESIGN: Mandibular cortical indices, simple visual estimations of cortical widths, mental and antegonial indices, antegonial depth, gonial and antegonial angles, and BMD were measured in 351 postmenopausal women. RESULTS: Associations were demonstrated between BMDs, qualitative indices, and cortical measurements. In the case of severely eroded mandibular cortices, the odds ratio (OR) for osteoporosis (according to the World Health Organization criteria) was 4.82 and the OR for a T-score < or =-2.0, the threshold to begin treatment, was 10.87. In the case of very thin mandibular cortices, the ORs were 8.02 and 5.46 for osteoporosis and a T-score < or =-2.0, respectively. The mental index cutoff for osteoporosis was 3.15 mm. CONCLUSIONS: Antegonial indices and gonial angles cannot be used as osteoporosis predictors. The most accurate indices were the mental index, mandibular cortical index, and visual estimation of cortical width.

Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis.

OBJECTIVE: As part of the Multisite Research Diagnostic Criteria For Temporomandibular Disorders (RDC/TMD) Validation Project, comprehensive temporomandibular joint diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computerized tomography (CT). STUDY DESIGN: Interexaminer reliability was estimated using the kappa (kappa) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. Computerized tomography was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA). RESULTS: For the radiologic diagnosis of OA, reliability of the 3 examiners was poor for panoramic radiography (kappa = 0.16), fair for MRI (kappa = 0.46), and close to the threshold for excellent for CT (kappa = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (kappa = 0.78) and for DD without reduction (kappa = 0.94) and good for effusion (kappa = 0.64). Overall percent agreement for pairwise ratings was >or=82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and of effusion was 81%. Negative percent agreement was >or=88% for all conditions. Compared with CT, panoramic radiography and MRI had poor and marginal sensitivity, respectively, but excellent specificity in detecting OA. CONCLUSION: Comprehensive image analysis criteria for the RDC/TMD Validation Project were developed, which can reliably be used for assessing OA using CT and for disc position and effusion using MRI.

Comparação da morfologia de terceiros molares superiores por meio de radiografia panorâmica e pós-exodontia / Comparasion of the morphology of upper third molars through panoramic radiography and after extraction

O uso de radiografias panorâmicas é cada vez mais aceito e rotineiro no dia a dia do cirurgião dentista. Esta também vem sendo muito usada para o planejamento cirúrgico de exodontias de terceiros molares. Porém, alguns trabalhos colocaram em discussão a fidelidade deste exame em detectar pequenas alterações anatômicas e a possibilidade de distorção de imagem do exame. Neste trabalho analisamos 27 dentes extraídos com seus respectivos exames radiográficos panorâmicos prévios à exodontia. Foi detectado que houve diferença significativa no que tange ao critério de número de raízes avaliado no exame radiográfico e no elemento extraído e também no que diz respeito à dilaceração radicular verificada neste exame e no dente.

Panoramic radiography is actually one of the most used imaginologic exams in clinical dentistry. It is also very used for surgical planning of third molars extraction. However, some papers raise some discussion about the accuracy of this exam in detecting small anatomic changes and the possibility of distortion of the image. In this paper, 27 dental elements (all upper third molars) that were extracted were analyzed, and comparison between the real aspect of the root morphology of the teeth that were extracted and the number of roots with the respective image on the panoramic radiography were performed. Significant differences were detected between these two observations in the number of roots and root dilaceration.

Estudo comparativo em radiografias panorâmicas do grau de inclinação dos terceiros molares inferiores segundo os traçados de Altonen, Haavikko & Mattila, e de Puricelli / Comparative study of the degree of inclination of third molars based on Altonen, Haavikko, Mattila?s and Puricelli?s tracings on panoramic radiographs

A presente pesquisa teve por objetivo realizar uma avaliação comparativa entre os resultados das medidas obtidas segundo dois traçados (Altonen, Haavikko e Mattila × Puricelli), efetuados sobre radiografias panorâmicas em dois momentos de formação radicular, verificando-se a presença ou ausência de compatibilidade entre os mesmos quanto ao grau de inclinação dos terceiros molares inferiores em relação aos segundos molares. Desta forma, as seguintes medidas foram comparadas: ângulo Beta de Altonen, Haavikko e Mattila correspondente ao gama de Puricelli, o qual indicou o relacionamento dos terceiros molares inferiores em relação aos segundos molares. Baseando-se nos resultados obtidos, apresentados e discutidos no presente trabalho e de acordo com a metodologia estudada, pode-se concluir que os traçados diferem entre si. Entretanto, apresentam uma correlação positiva.

The aim of the present investigation was to compare the measurements obtained based on two tracings (Altonen, Haavikko and Mattila versus Puricelli) conducted on panoramic radiographs at two moments of root formation, as to their compatibility with the degree of inclination the lower third molars in relation to the second molars. Thus, the following measurements were compared: the beta angle of Altonen, Haavikko and Mattila with the corresponding gamma angle of Puricelli, parameters that indicate the relationship of the lower third molars to the second molars. Based on the results presented and discussed in the present study, and based on the method employed, it is concluded that tracings differ but also show a positive correlation.

Considerações sobre radiografias panorâmicas: implicações clínicas resultantes da distorção inerente à técnica / Considerations on panoramic radiographs: clinical of distortion inherent to the technique

O objetivo deste trabalho é, através de uma revisão da literatura, estabelecer a importância e as indicações da radiografia panorâmica no exercício da Clínica Odontológica. Além disso, revisar os fatores que influenciam a obtenção da imagem e que contribuem para a magnificação e distorção inerentes à técnica quanto às aferições horizontais, verticais e angulares obtidas através das respectivas radiografias.

Achados radiográficos em pacientes infantis triados para atendimento odontológico / Radiographic findings in children screened for dental treatment

Apesar da radiografia panorâmica permitir avaliação abrangente de toda a região maxilo-mandibular, mostrando-se como importante ferramenta diagnóstica, seu uso rotineiro ainda é discutido. O Objetivo deste estudo foi avaliar a importância deste exame complementar em pacientes infantis. Foram analisadas mil radiografias panorâmicas de pacientes com idade de 3 a 12 anos, que procuraram atendimento odontológico na FO de Piracicaba - Universidade Estadual de Campinas. Os achados radiográficos mais comuns foram agenesias dentárias, anomalias dentárias de forma ou tamanho de dentes supranumerários. Em menor frequência foram observadas algumas imagens sugestivas de cisto dentígeno e odontoma. Pudemos concluir que embora as alterações radiográficas não sejam comuns nesta faixa etária, o uso da radiografia panorâmica contribui para o melhor planejamento odontológico.