Potencial del uso de la radiografía panorámica como ayuda diagnóstica en derechohabientes de una institución de seguridad social / Potential for the use of panoramic radiography as a diagnostic aid in beneficiaries of a social security institution

Introducción: A pesar de que actualmente la radiografía panorámica es un instrumento auxiliar de diagnóstico de uso común, desafortunadamente sus beneficios no se aprovechan en su totalidad y su empleo se limita al uso en determinadas áreas de la odontología y en ocasiones se omiten hallazgos que pueden tener un significado clínico importante. Material y métodos: Estudio transversal y descriptivo de una muestra aleatoria de 500 estudios de imagen (radiografías panorámicas) durante el periodo de enero a mayo de 2018 analizadas por expertos estandarizados y empleando estadística descriptiva básica mediante el paquete estadístico Excel. Resultados: Se incluyeron 500 estudios, 67% correspondió a mujeres en un rango de cinco a 91 años de edad con una mediana de 43 años, 48% presentó alteraciones siendo las más frecuentas pérdida del proceso alveolar 45%, alteraciones en articulación temporomandibular 34%, y calcificación del ligamento estilohioideo 31%. Conclusión: Se reportaron hallazgos clínico-radiográficos significativos, resaltando la necesidad de un análisis cuidadoso de los métodos auxiliares de diagnóstico que permitan visualizar de manera contextual el tratamiento odontológico de los pacientes y/o reportar al especialista correspondiente otro tipo de hallazgos (AU))

Introduction: Although panoramic radiography is currently a commonly used diagnostic auxiliary instrument, unfortunately its benefits are not fully exploited and its use is limited to use in certain areas of Dentistry and eventually findings that may have important clinical significance are omitted. Material and methods: Crosssectional and descriptive study of a random sample of 500 imaging studies (panoramic radiographs) during the period from January to May 2018, analyzed by standardized experts and using basic descriptive statistics using the Excel statistical package. Results: 500 studies were included corresponding to 67% women and an age range from five to 91 years of age with a median of 43 years, 48% presented alterations, the most frequent being loss of the alveolar process 45%, alterations in the temporomandibular joint 34%, and calcification of the hyoid ligament 31%. Conclusion: In this study significant clinical-radiographic findings are reported, highlighting the need for a careful analysis of auxiliary diagnostic methods that allow visualize the dental treatment of the patients and / or report other findings to the corresponding specialist (AU)

Evaluation of SPECT/CT in the assessment of inflammatory jaw pathologies.

PURPOSE: Since accurate diagnosis of inflammatory jaw diseases is still challenging, this study investigated the performance of three phase bone scintigraphy including SPECT/CT in the assessment of correct diagnosis and size of the affected bone tissue. METHOD: This retrospective study contained 31 patients with suspected jaw-related osteoradionecrosis, osteomyelitis or medication-related osteonecrosis of the jaw, which underwent 3-phase bone scintigraphy including SPECT/CT. Results were reviewed by two nuclear medicine physicians. Positive cases received surgery; negative ones were followed-up for six months. Both served as reference standard. Inflamed bone length was measured in the SPECT/CT images and postoperatively by a pathologist. RESULTS: 19 out of 20 positive cases and 10 out of 11 negative ones were classified correctly by SPECT/CT (sensitivity 95 %, specificity 91 %, accuracy 94 %, positive predictive value 95 %, negative predictive value 91 %). Regarding the length of affected bone, no significant difference (p = 0.23) could be observed between SPECT/CT and postoperative obtained values. Both correlated significantly (r = 0.86, p = 0.0001). CONCLUSION: SPECT/CT can safely detect different kinds of inflammatory jaw pathologies compared to other conventional imaging modalities. Lack of specificity of conventional scintigraphy ranging from 17 % to 71 % in earlier studies could be improved by adding CT-analysis. Additionally, SPECT/CT assists the surgeon in determining the expansion of the process (with focus on the length) preoperatively and thereby optimizing surgery planning.

Radiologic assessment and frequency of idiopathic osteosclerosis of jawbones: an interpopulation comparison.

BACKGROUND: Idiopathic osteosclerosis is a localized growth of compact bone with an unknown cause. This asymptomatic lesion is an insignificant finding and as such requires no treatment. It should be distinguished from other types of osteosclerosis created by inflammatory processes and systemic diseases. PURPOSE: To determine the prevalence and distribution of idiopathic osteosclerosis in the jawbones in Iran and to compare this prevalence and distribution with other populations. MATERIAL AND METHODS: This cross-sectional descriptive study was performed in the Dental School of Shahid Beheshti University of Medical Sciences, Tehran, between 2010 and 2011. Data were collected from the files of patients who underwent panoramic radiography for dental treatment. Location, shape, and relation between idiopathic osteosclerosis and the tooth as well as the resorption of the tooth involved were evaluated. Lesion distribution regarding age, gender, localization, shape, dental relationship, and root resorption was assessed using the chi-squared test. RESULTS: In total, 787 panoramic radiographs of 456 women and 331 men were assessed. Idiopathic osteosclerosis was detected in 75 (9.5%) patients. The prevalence of idiopathic osteosclerosis was significantly higher in the women (11.8% vs. 6.3%; P < 0.01). The mean age of the patients with idiopathic osteosclerosis was 31.9 ± 17.9 years and 30.8 ± 13.3 years in the patients without idiopathic osteosclerosis. The distribution of idiopathic osteosclerosis in the mandible (97.3%), mostly in the premolar region, was significantly higher than that in the maxilla (2.7%). CONCLUSION: Our results showed high frequencies of idiopathic osteosclerosis in Iran in comparison to some other countries.

A comparative study of three imaging modalities currently used in the assessment of patients for maxillofacial surgery.

UNLABELLED: Diagnostic imaging is pivotal in clinical maxillofacial evaluation. This study evaluated and compared the use of conventional radiographs (CR) with two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) in patients requiring maxillofacial surgery. Pre-surgical records of sixty five patients who had undergone routine CR, 2D CT and 3D CT were selected and classified into the categories of traumatic injury, pathology and deformities. The accuracy of image analysis, diagnosis and treatment planning were scored and the data statistically analysed. 2D CT scanning was more effective diagnostically and is preferred for cases of traumatic injury (44%, SD=0.54, p>0.05) and pathology (34%, SD=0.47, p>0.05) whilst 3D CT imaging was indicated for the deformity category (22%, SD=0.58, p>0.05). Linear comparisons between radiographic modalities within each clinical group revealed significant differences (p<0.05). Multiplanar reformatted (MPR) 2D cross sectional CT views offered additional imaging information. CONCLUSION: 2D CT scanning is an excellent imaging modality for the majority of craniomaxillofacial surgical cases. 3D CT scanning is also recommended for cases of trauma and pathology. Both 2D CT and 3D CT scanning are vital in craniomaxillofacial deformities and reconstructive surgery.

Noninvasive assessment of human jawbone using ultrasonic guided waves.

The problem of detecting defects in jawbones is an important problem. Existing methods based on Xrays are invasive and constrain the achievable image quality. They also may carry known risks of cancer generation or may be limited in accurate diagnosis scope. This work is motivated by the lack of current imaging modalities to accurately predict the mechanical properties and defects in jawbone. Ultrasonic guided waves are sensitive to changes in microstructural properties and thus have been widely used for noninvasive material characterization. Using these waves may provide means for early diagnosis of marrow ischemic disorders via detecting focal osteoporotic marrow defect, chronic nonsuppurative osteomyelitis, and cavitations in the mandible (jawbone). Guided waves propagating along the mandibles may exhibit dispersion behavior that depends on material properties, geometry, and embedded cavities. In this work, we present the first study in the theoretical and experimental analysis of guided wave propagation in jawbone. Semianalytical, finite-element (SAFE) method is used to analyze dispersion behavior of guided waves propagating in human mandibles. The geometry of the cross section is obtained by segmenting the computed tomography (CT) images of the jawbone. The cross section of the mandible is divided in two regions representing the cortical and trabecular bones. Each region is modeled as a linear Hookean material. The material properties for both regions are adopted from the literature. The experimental setup for the guided waves experiment is described. The results from both numerical analysis and guided waves experiment exhibit variations in the group velocity of the first arrival signal and in the dispersion behavior of healthy and defected mandibles. These results shall provide a means to noninvasively characterize the jawbone and accurately assess the bone mechanical properties. Our study is not aimed at characterizing the bone density in human mandibles. Rather, it is aimed to assess bone mechanical properties and defects that cannot be diagnosed by X-ray or other imaging modalities. This work may pave the way to the development of inexpensive noninvasive devices to detect small defects in human mandibles.

Three-dimensional imaging for virtual assessment and treatment simulation in orthognathic surgery.

Conventional two-dimensional imaging for assessing and treatment planning orthognathic surgery has limitations. Three-dimensional imaging offers the ability to more accurately portray maxillofacial anatomy. Three-dimensional CT-based models can be generated for assessment of the dentofacial deformity. Interactive software can simulate surgical moves and algorithms can predict the three-dimensional soft tissue changes that will occur. This will inevitably effect diagnosis and treatment planning for orthognathic surgery in the future.

Incidence, risk factors and management of osteonecrosis of the jaw in patients with multiple myeloma: a single-centre experience in 303 patients.

The incidence, characteristics and risk factors for the development of osteonecrosis of the jaw (ONJ) were evaluated among 303 myeloma patients. Only patients who received bisphosphonates developed ONJ (28/254; 11%). Zoledronic acid produced 9.5-fold greater risk for developing ONJ than pamidronate alone (P = 0.042) and 4.5-fold greater risk than subsequent use of pamidronate + zoledronic acid (P = 0.018). Use of thalidomide and number of bisphosphonate infusions also increased the risk for ONJ by 2.4-fold (P = 0.043), and 4.9-fold respectively (P = 0.012). ONJ developed earlier among patients receiving zoledronic acid. Our data indicates that administration of zoledronic acid for more than 2 years or in combination with thalidomide requires caution in myeloma.

Preoperative application of limited cone beam computerized tomography as an assessment tool before minor oral surgery.

We describe the preoperative application of limited cone beam computerized tomography (CT) using a Dental three-dimensional (3D)-CT as an assessment tool before minor oral surgery. The Dental 3D-CT provided 42.7 mm-high and 30 mm-wide rectangular solid images. This size covered the height of the mandible with standing teeth. Dental 3D-CT clearly demonstrated lesions in the maxillary and mandibular bone. Resorption of the bone due to disease expansion was depicted more clearly on the Dental 3D-CT than on conventional radiographs. Information about lesion location and the relationship between the lesions and their adjacent anatomical structures, such as the mandibular canal and maxillary antrum, was useful for minor oral surgery. Due to its high resolution and low radiation dose, Dental 3D-CT was useful for preoperative examination prior to minor oral surgery.

Radiographic assessment of peri-implant vertical bone loss: DICRG Interim Report No. 9.

Vertical bone loss is being assessed radiographically as part of the Dental Implant Clinical Research Group studies through direct measurements on study radiographs taken longitudinally at surgery and recall appointments. Preliminary results and trends for the period between implant placement and 6 months after implant uncovering show more bone loss in implants that are 1) not coated with hydroxyapatite; 2) placed in the maxilla; 3) placed in anterior regions of the jaws; 4) in completely edentulous cases; and 5) placed in bone scored as having lower quality. Confounding relationships between predictor variables will require controlled statistical analyses when data collection is completed.

Longitudinal radiographic assessment of dense bone islands of the jaws.

OBJECTIVES: This study assessed dense bone island (DBI) inception and growth in jaws. STUDY DESIGN: A population of 2991 patients (age range 5 to 35 years) was studied with at least two panoramic radiographs taken 1 to 10 years apart for each patient. Lesions were digitized and measured with computer measuring software. The size of the earliest DBI was compared with subsequent DBI measurements after the latter measurement was normalized with reference to the size of the nearest tooth. RESULTS: Sixty-nine patients with DBIs were identified. A total of 3.1% of the patients with DBI were found in the 5- to 10-year age range, with the first patient in the DBI group found at 9.4 years. A significantly higher proportion (p = 0.002) of the unaffected patients (26%) was found in the same 5-to 10-year age range. The proportions of patients in the DBI and unaffected groups in older age ranges were similar. Assessment of DBI size changes showed that 43% of the 53 DBIs detected between 9.4 and 19 years enlarged (mean change, 212%), and 17% diminished (mean change, 49%). In comparison, 29.4% of 17 DBIs detected between 20 and 35 years enlarged (mean change, 153%), and 5.9% diminished (mean change, 60%). CONCLUSION: Our results indicate that DBIs are labile lesions, develop during early adolescence, and retain a potential for enlargement, or to a lesser extent shrinkage, into adulthood.

Panoramic radiography in dental diagnostics.

Panoramic radiography was studied with the aim to answer some questions about technical and diagnostic properties regarding dental diagnostics. A unit with an intraoral X-ray tube was studied regarding radiation beam area, absorbed doses, and image quality for various screen-film combinations. The beam area for lateral views was wider than optimal and the contact dose high. Modifications of shielding cylinders would reduce both radiation beam and contact dose. One screen-film combination was most sensitive and produced radiographs with best subjectively perceived image quality. Agreement between panoramic (rotational and intraoral X-ray tube techniques) and intraoral radiography in diagnosis of periapical pathology, assessment of marginal bone height, and caries diagnosis was evaluated in 400 patients. Average agreement between panoramic and intraoral radiographs in periapical diagnosis was 55% for the rotational and 46% for the intraoral tube technique. Agreement in marginal bone height was 55% and 49%, respectively and in caries diagnosis 34% and 46%. Radiographs from 40 patients were used to evaluate a procedure starting with rotational panoramic radiography followed by intraoral radiographs considered necessary to achieve a comprehensive examination of teeth and surrounding bone. The number of intraoral radiographs, information loss, and monetary costs with this procedure were evaluated. Mean number of adjunct intraoral radiographs was 5.1 per patient whilst 8.5 should have been chosen to satisfy a "gold standard" used. Monetary costs were similar for an optimal combination of panoramic and intraoral radiography as for a survey with 20 intraoral images Sensitivity for a combination of radiographs was 80-96% in periapical diagnosis and marginal bone loss assessment, and 42-96% in caries diagnosis. Specificity was 95-97% for periapical and caries diagnosis and 50-92% for marginal bone loss. Radiographs from six conventional units and two programs ("dental" and "jaw" panorama) of a new multi-modal unit were compared in diagnostic quality of periapical and crestal bone areas. Number of adjunct intraoral radiographs to achieve a comprehensive evaluation of periapical and marginal bone was estimated. Quality of the "dental" panorama was significantly better than that of other machines/programs. There were no significant differences between images obtained with conventional units and the "jaw" panorama. Number of adjunct intraoral radiographs was lowest for the "dental" panorama. Quality obtained with an old unit was similar to that from modern machines. Rotational and intraoral X-ray tube panoramic radiography perform equally well. Agreement between panoramic and intraoral radiography is not sufficient for panoramic radiography to be used alone to diagnose periapical lesions, marginal bone loss and caries. It is possible to perform a full-mouth survey with a combination of panoramic and intraoral radiography but when limited regions need to be examined intraoral radiography is the method of choice.

Method for radiographic assessment of alveolar bone level at endosseous implants and abutment teeth.

A radiographic method expressing the alveolar bone level in absolute figures is presented. By means of a calibrated measuring radiographic film fixed to a magnifying viewer, alveolar bone levels were determined directly on intraoral periodic "identical" radiographs. A polyether impression was made for fixation of the filmholder in order to obtain reproducible radiographs. The method was applied to assess changes in the alveolar bone level at endosseous implants and abutment teeth. Radiographs of 23 endosseous implants and 21 abutment teeth from nine patients were examined and measurements of the alveolar bone level were performed. The mean difference between double observations on the same exposure as well as on repeated exposures was about 0.2 mm (s.d. 0.17-0.32 mm). The uncertainty of the present radiographic method was mainly due to the measurement procedure, as the radiographic technique showed a high degree of reproducibility. The method is a simple and reliable technique for longitudinal investigations of changes in the alveolar bone level at endosseous implant and tooth abutments.