The effect of the dental follicle volume of palatally impacted canines on the relative position of the adjacent teeth.

OBJECTIVE: To assess if the dental follicle volume of palatally impacted canines (PICs) affects the relative root position of the adjacent lateral incisors (LIs) and first premolars (FPs). MATERIALS AND METHODS: A retrospective cross-sectional study of 49 patients with unilaterally PICs with dental follicles who had CBCT imaging previously taken. Four orthodontic centers in different countries provided the sample. A mean difference of 5° between the angular measurements (mesiodistal tip, buccolingual inclination, or mesiodistal rotation) of the LI and FP adjacent to the PIC and the controls was considered clinically relevant. A value of 0.05 was set for significance level and a power of 80%. The minimum sample size was determined to be 26 patients. These patients were further assigned to an LI sample (n = 49) and an FP sample (n = 23), dependent on the direct contact of the dental follicle to that adjacent tooth. A manual segmentation technique was used to obtain the volumetric measurements of the dental follicle. Angular measurements of adjacent teeth were then compared to the contralateral nonimpacted side, which acted as the control. A multivariant regression analysis was performed using IBM SPSS software, and statistical significance was set at α = 0.05. RESULTS: Adequate intra-rater reliability was accomplished. The multivariant regression analysis implied that there is no difference in the mean change in the tip, torque, and rotation of the LI and FP between the impacted and control sides when dental follicle volumes are considered (P = .509 for the LI sample and P = .804 for the FP sample). LIMITATIONS: CBCT imaging of dental follicle border delimitations, partial volume effect, and scattering are limitations. This is a convenience sample where the FP subsample is small. CONCLUSION: The dental follicle volume of the PICs does not seem to influence the relative position of the adjacent LI and FP mesiodistal tip, buccolingual inclination, and mesiodistal rotation. Early intervention could have been suggested to avoid certain malocclusion traits if significant displacements were demonstrated.

Orthodontists' criteria for prescribing cone-beam computed tomography-a multi-country survey.

OBJECTIVES: This study aimed to describe and compare CBCT imaging prescription in clinical practice among orthodontists from five countries in Europe and America. Additionally, it investigated factors associated with the prescribing and the use of guidelines for CBCT imaging. MATERIALS AND METHODS: A cross-sectional survey was carried out using an online questionnaire sent to all registered orthodontists in Belgium, Brazil, Canada, Romania, and the United States of America (USA). The data were analyzed by descriptive statistics, bivariate tests, and Poisson regression. RESULTS: The final sample consisted of 1284 participants. CBCT was prescribed by 84.4% of the participants for selected cases (84.9%), mainly for impacted teeth (92.4%), presurgical planning (54.1%), and root resorption (51.9%). High cost was most frequently the limiting factor for CBCT prescription (55.4%). Only 45.2% of those who were using CBCT imaging reported adhering to guidelines. CBCT imaging prescription was associated with the orthodontists' countries (p < .009, except for Belgium, p = .068), while the use of guidelines was associated with the respondents' country and additional training on CBCT imaging (p < .001). CONCLUSIONS: Orthodontists refer patients for CBCT for selected indications (impacted teeth, root resorption, presurgical planning, dentofacial deformities, as suggested by the international guidelines, and also for upper airway and temporomandibular joint evaluation). Many do not adhere to specific guidelines. There are substantial variations between the countries about the orthodontists' referral for CBCT and guideline usage, irrespective of gender. CBCT prescription may be limited by financial barriers, adhering to specific guidelines and prior CBCT training. CLINICAL RELEVANCE: CBCT prescription among orthodontists must be based on prescription criteria and current guidelines. It is advised to improve CBCT education and training to enhance CBCT selection, referral, analysis, and interpretation in orthodontic practice.

Comparison of Adjusted Fluoride Concentrations Between Water Treatment Facilities and Endpoints in Alberta, Canada.

OBJECTIVES: This investigation aimed to determine whether fluoride concentration in water at the user endpoint remains the same as at the adjusted source, i.e., water treatment facilities. METHODS: Daycares in Alberta, Canada, were used as the endpoint to measure fluoride concentration. They were randomly selected from a list of 400 licensed daycares provided by the Ministry of Children's Services. All water samples collected from the daycares were sent to the accredited Alberta Centre for Toxicology (ACFT) for analysis within 7 days of collection. ACFT used ion chromatography to determine fluoride concentration levels. Statistics analyses were conducted using the software SPSS 25. RESULTS: Water samples were collected from 141 daycares in 35 municipalities. In municipalities that adjust fluoride content, public water is supplied by 8 Alberta Environment & Parks regulated water systems. Fluoride concentration in water samples examined at the endpoint ranged from 0.58 mg/L to 0.79 mg/L. The differences between fluoride concentration at the water treatment facilities and the daycares ranged from -0.03 to 0.22 mg/L. CONCLUSIONS: This study confirms that the concentration of fluoride adjusted at water treatment facilities in Alberta is maintained at endpoints at the approximate optimal level of 0.7 mg/L.

Oropharyngeal 3-dimensional changes after maxillary expansion with 2 different orthodontic approaches.

INTRODUCTION: The objective of this research was to compare the oropharyngeal volume and minimal cross-sectional area (MCA) changes after maxillary expansion using either the Damon system or Hyrax appliances as assessed through cone-beam computed tomography (CBCT) imaging. METHODS: Patients aged between 11 and 17 years with skeletal maxillary transverse discrepancy in need of maxillary expansion were included and allocated randomly into 1 of the 2 treatment groups, Damon or Hyrax. Patients underwent CBCT imaging at 2 time points: T1, after initial clinical evaluation before treatment, and T2, after completion of full orthodontic treatment. The CBCT data were assessed using Dolphin software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). In addition, a qualitative assessment of breathing function was done using the modified Nasal Obstruction and Septoplasty Effectiveness Scale questionnaire. RESULTS: A statistically significant increase in the oropharyngeal volume (2.23 mL; P = 0.005) and MCA (29.72 mm2; P = 0.007) after the completion of treatment (T2 - T1) for the Hyrax group was suggested. No statistically significant difference was found in the Damon group for volume (1 mL; P = 0.311) and for MCA (7.32 mm2; P = 0.643). In addition, no statistically significant difference was found in the breathing function in both treatment groups (P >0.05). CONCLUSIONS: Hyrax expansion followed by fixed appliances produced more dimensional upper airway changes at the oropharyngeal level than the Damon system approach. No breathing functional changes were noted in either samples.

Intraoral Imaging in Dental Private Practice - A Rectangular Collimator Study.

OBJECTIVE: To gain a better understanding of the extent to which rectangular collimation is being used in private practice and the barriers to adoption by practitioners. METHODS: Licensed dentists in private practice were asked to answer a survey composed of 17 multiple-choice questions and 1 open-ended question regarding demographics, radiation safety, image receptor type, intraoral imaging techniques and use of rectangular collimation. RESULTS: Among all participants (n = 82), 86.6% used digital systems (n = 71) and 13.4% conventional film (n = 11). Most (74.0%, n = 60) were aware of the benefits of using rectangular collimation, with 5.5% reporting not knowing of the existence of this device (n = 3). Only 12.9% of the dentists reported using rectangular collimation routinely (n = 10). The youngest and oldest age groups had the lowest compliance rates, 5.6% and 0%, respectively. CONCLUSION: Although 74.0%, (n = 60) of private practitioners were aware of the benefits of using rectangular collimation to reduce radiation dose, only 12.2% (n = 10) used it routinely for intraoral imaging. Barriers to implementing rectangular collimation in private practice settings included challenges in training support staff and fear of an increase in the occurrence of technical errors that would result in re-exposure of patients.

Dental imaging of trabecular bone structure for systemic disorder screening: A systematic review.

The purpose of this systematic review was to evaluate the potential use of dental imaging assessment of trabecular bone structure in the maxillomandibular complex as an adjuvant screening tool to identify systemic disorders. Five electronic databases and grey literature were searched. Studies were included if they investigated subjects with altered trabecular bone determined by dental radiographs. The QUADAS-2 assessed the risk of bias (RoB) among the studies, while the GRADE determined the strength of evidence. A total of 14 studies that included 1,466 individuals were considered eligible for the qualitative analysis. All studies presented an overall low RoB and low concern regarding applicability. Systemic disorders such as osteoporosis, osteogenesis imperfecta, diabetes, and primary hyperparathyroidism, with their respective control groups, were analyzed among the included studies. Osteoporosis was the condition presenting the most significant results, and 72% of the studies detected changes in the maxillomandibular trabecular bone structure. Studies exploring diabetic edentulous patients found less dense trabecular bone pattern (p < 0.05). In summary, periapical and panoramic radiographs, computed tomography, and cone beam computed tomography imaging could be considered useful for the assessment of the mandibular trabecular bone structure of patients affected by osteoporosis and patients with diabetes.

Assessing students' confidence in interpreting dental radiographs following a blended learning module.

OBJECTIVE: This study assessed senior dental hygiene (DH) students' self-reported confidence in interpreting dental radiographs following the introduction of a blended learning (BL) module for radiology interpretation. The assessment of students was conducted five months prior to graduation. METHODS: A BL oral radiology module was designed. In order to capture the context, descriptions and differences of students' experience and confidence, a qualitative research approach was selected. Data were captured using a semi-structured interview process and analysed using phenomenographic methods. RESULTS: Sixteen students were interviewed. Blinded transcripts were analysed, and the main themes relating to confidence were extracted and arranged into categories. The categories were coded as to how confident (low, medium or high) each of the students felt specific to varying contexts and complexities of radiographic interpretation. CONCLUSION: Predominately, the BL model had a positive impact on DH students' confidence in the interpretation of radiographic findings. However, when asked about their level of overall confidence in interpreting dental radiographs, students still did not describe themselves as confident for all potential findings on radiographs at this point in their education. The students highlighted the importance of having patient history details and clinical assessment findings included in the interpretation exercises and expressed a desire to collaborate with other professionals when interpreting radiographs.

Patient satisfaction and quality of life status after 2 treatment modalities: Invisalign and conventional fixed appliances.

INTRODUCTION: Our objectives were to assess patient satisfaction and quality of life among adults via 2 validated comprehensive questionnaires and to compare patient satisfaction and status in oral health-related quality of life immediately after orthodontic treatment in patients treated with Invisalign (Align Technology, San Jose, Calif) and those who received standard bracket-based treatment. METHODS: Adult patients (n = 145) treated with bracket-based or Invisalign therapy were recruited from several private practices and a university clinic. The survey comprised a combination of the Dental Impacts on Daily Living index and the Patient Satisfaction Questionnaire. This 94-question assessment focused on various dimensions of satisfaction and quality of life. Multivariate analysis of variance and the bootstrap test were applied. A reliability analysis was used to assess responses at a 6-month follow-up for a small sample of patients. RESULTS: Finally, 122 patients were assessed. The multivariate analysis of variance analysis showed that the eating and chewing dimension was significantly different between the 2 groups (Invisalign, 49%; bracket based, 24%; P = 0.047). No significant difference in any other satisfaction factors (all, P > 0.05) was identified. The follow-up assessment was only possible in a small sample of the bracket group; it showed adequate reliability values on the categories of oral comfort (intraclass correlation coefficient [ICC], 0.71), general performance (ICC, 0.755), situational (ICC, 0.80), and doctor-patient relationship (ICC, 0.75). CONCLUSIONS: Of the patients surveyed to assess their satisfaction and oral health-related quality of life immediately after completion of their orthodontic treatment, both the bracket-based and Invisalign treated patients had statistically similar satisfaction outcomes across all dimensions analyzed, except for eating and chewing: the Invisalign group reported more satisfaction. Patient satisfaction remained relatively similar 6 months later for the bracket-type treatment.

Patient satisfaction and quality of life changes after Invisalign treatment.

INTRODUCTION: Our objective was to assess patient satisfaction and changes in oral health-related quality of life immediately after orthodontic treatment using the Invisalign system (Align Technology, Santa Clara, Calif). METHODS: Adult patients were recruited from private practices in Canada and surveyed using a combination of 2 validated questionnaires: Dental Impact of Daily Living and Patient Satisfaction Questionnaire. This 94-question assessment focused on various dimensions of satisfaction and changes in quality of life. Multivariate analysis of variance, regression analysis, and canonical correlation analysis were applied in the data analysis. RESULTS: A total of 81 patients, 29.6% men and 70.4% women, exclusively treated with the Invisalign system participated. The most significant improvements were seen in the appearance and eating and chewing categories, with patients responding positively to more than 70% of the questions in those categories. Food packing between teeth, affecting 24% of the participants, and pain affecting 16% were the most common sources of dissatisfaction. However, these negative experiences were not strong enough to reduce the overall positive experience that patients reported. Appearance and dentofacial improvement were strongly correlated. Canonical correlation of the Patient Satisfaction Questionnaire factors showed that doctor-patient relationship had a significant correlation with situational aspects, dentofacial improvement, and the residual category. Phrases from the doctor-patient relationship category such as "the orthodontist treated me with respect" and "carefully explained what treatment would be like" were associated with higher patient satisfaction. CONCLUSIONS: Although positive changes in appearance and eating categories were linked with patient satisfaction, doctor-patient relationship was the factor that correlated better with multiple aspects of patient satisfaction.

Correlation and reliability of cone-beam computed tomography nasopharyngeal volumetric and area measurements as determined by commercial software against nasopharyngoscopy-supported diagnosis of adenoid hypertrophy.

INTRODUCTION: The aim of this study was to evaluate the diagnostic correlation and reliability of Dolphin Imaging fully automated segmentation (Dolphin Imaging and Management Solutions, Chatsworth, Calif) for assessing adenoid hypertrophy. This was investigated through 3 modes: (1) intraobserver and interobserver agreement of repeated airway auto-segmentation procedures, (2) correlation between auto-segmentation measures of volume and minimal cross-sectional airway against nasopharyngoscopy, and (3) optimum diagnostic cutoff thresholds for volume and minimal cross-sectional airway identified and tested with sensitivity and specificity analyses. METHODS: Cone-beam computed tomography scans of 38 patients with suspected upper airway obstruction were analyzed. Two calibrated evaluators applied a previously validated method to quantify nasopharyngeal minimal cross-sectional airway and volume using Dolphin Imaging. Assessments were compared against grades of obstruction provided by otolaryngologists' diagnoses. RESULTS: The reliability between the 2 assessments by the same evaluator on the Dolphin automatic segmentation function for volume (ICC, 0.97; 95% CI, 0.95, 0.98) and minimal cross-sectional airway (ICC, 0.84; 95% CI, 0.69, 0.91) was excellent. The interoperator reliability for volume was also excellent (ICC, 0.97; 95% CI, 0.95, 0.98), but only good (ICC, 0.701; 95% CI, 0.44, 0.85) for minimal cross-sectional airway. In contrast, the Spearman rank correlation test demonstrated weak associations between the values of the automatic measurements for both volume (4.9%; ρ = -0.22) and minimal cross-sectional airway (3.7%; ρ = 0.19). Assessments of accuracy via Receiver Operating characteristic analysis, sensitivity, specificity, negative predictive values, positive predictive values, and likelihood ratios demonstrated the poor clinical applicability of volume and minimal cross-sectional airway numbers provided by Dolphin Imaging. CONCLUSIONS: The evaluators were reliable at manipulating the selected software, achieving consistent volume and minimal cross-sectional airway measurements, However, Dolphin Imaging volumetric and minimal cross-sectional airway measurements did not correlate well with the nasopharyngoscopy-supported reference standard for adenoid hypertrophy assessment. Under these study conditions, volume and minimal cross-sectional airway used to assess localized adenoid hypertrophy with cone-beam computed tomography imaging based on automated measurements may not yield high-quality clinically relevant information about upper airway constriction related to adenoid hypertrophy.

Gingival condition associated with two types of orthodontic fixed retainers: a meta-analysis.

BACKGROUND: The maintenance of gingival health around orthodontic fixed retainers (FRs) is difficult and different designs have been proposed. OBJECTIVE: The goal of this systematic review was to analyse whether FR designs that allow unobstructed interproximal flossing, compared with the ones that do not, improve gingival parameters. SEARCH METHODS: Detailed individual database search strategies for Cochrane Library, 'Latin' American and 'Caribbean' Health Sciences Literature, PubMed, Scopus, and Web of Science were developed. Grey literature was also considered. SELECTION CRITERIA: Clinical trials and cross-sectional studies that compared two types of FRs (plain and waved) were included and evaluated. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, and risk of bias (RoB) assessment were performed individually and in duplicate. The methodology quality was assessed using the MAStARI RoB tool. RESULTS: Four studies met the inclusion criteria, and all presented moderate RoB. While two of those studies found a statistically significant difference in gingival parameters, the other two did not report differences. A meta-analysis was conducted based on two of the selected studies, which performed evaluations of plaque index (PI) and calculus index (CI). The results revealed no differences on PI between wave FR and plain FR of 0.46 (0.24 to 0.69) and no differences on CI of 0.12 (-0.10 to 0.33). Regarding comfort, no clear differences were identified. CONCLUSIONS: There is not enough scientific evidence to support or not an association between FR design and gingival health, flossing frequency, or patient comfort. REGISTRATION: PROSPERO - CRD42016030059.

Oral manifestations in patients with familial adenomatous polyposis: A systematic review and meta-analysis.

BACKGROUND AND AIM: The oral manifestations of familial adenomatous polyposis (FAP) have been reported in the recent literature. Therefore, there has been growing interest in the characterization of the dento-osseous anomalies because they may precede colorectal cancer and may be used as a diagnostic marker. This systematic review and meta-analysis was performed to evaluate the published evidence for what are the oral manifestations of FAP and their frequency in affected individuals. METHODS: The search was performed at Cochrane Library, EMBASE, LILACS, PubMed, Scopus, and Web of Science for articles published up to March 2015. A grey literature search was conducted through Google Scholar. Reference lists of the included articles and additional studies identified by expert were screened for potential relevant studies. The methodology of selected studies was evaluated using the risk of bias checklist of the Agency for Healthcare Research and Quality. RESULTS: Twenty observational studies totalizing 1635 individuals affected by FAP met the inclusion criteria. Osseous, dental, and oral mucosa alterations were observed in FAP patients. The meta-analysis showed the frequency of osseous jaw lesions, and the dental anomalies were 65.35% and 30.48%, respectively, and two studies suggested that oral mucosa vascular density is a phenotypic manifestation in patients with FAP. Most of the studies were evaluated as moderate risk of bias. CONCLUSION: The most frequent oral manifestation on FAP patients is osseous jaw alterations. In the future, well-designed studies are necessary to classify osseous and dental anomalies in order to demonstrate the true prevalence of each alteration separately.

Accuracy and reliability of orthodontists using cone-beam computerized tomography for assessment of adenoid hypertrophy.

INTRODUCTION: Our objectives were to evaluate the reliability of agreement between orthodontists, with various degrees of cone-beam computed tomography (CBCT) imaging manipulation comfort, in classifying adenoid hypertrophy through CBCT generated images and also to determine how accurate orthodontists are compared with the gold standard diagnosis, nasopharyngoscopy. METHODS: This was a cross-sectional study in which a randomized list of board-certified orthodontists evaluated different degrees of adenoid hypertrophy of a stratified sampling of 10 scans. The available pool of CBCT images was from a multidisciplinary airway clinic in which children and adolescents had a CBCT scan and a nasopharyngoscopy (reference standard) by an otolaryngologist (head and neck surgeon) on the same day. The participating orthodontists used the same viewer software and computer, and had access to a previously published visual guideline for evaluating adenoid size. RESULTS: Fourteen orthodontists evaluated 10 CBCT reconstructions. Interoperator reliability was excellent (intraclass correlation coefficient [ICC], 0.941; 95% confidence interval, 0.882-0.984). However, the orthodontists' evaluations against the reference standard demonstrated poor accuracy, (ICC mean, 0.39; ICC range, 0.0-0.74). Dichotomous data representing healthy and unhealthy patients were analyzed individually, and the orthodontists' evaluations and the nasopharyngoscopy results (accuracy) showed, on average, poor kappa values (mean, 0.44; range, 0.20-0.80). CONCLUSIONS: Different levels of CBCT expertise impacted the assessment accuracy. The participating orthodontists showed excellent consistency among themselves; however, poor agreement between their CBCT assessments compared with nasopharyngoscopy demonstrated that this sample of clinical orthodontists had poor diagnostic accuracy. Together, these findings suggest that orthodontists may make consistent and systematic errors in this type of evaluations.

Patient compliance and periodontal outcomes.

DATA SOURCES: PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) were searched until 2014. Reference lists from the articles were examinedStudy selectionTwo authors independently searched for randomised and non-randomised controlled trials and prospective and retrospective cohorts with a mean follow up period of at least five years. DATA EXTRACTION AND SYNTHESIS: Quality of the studies was assessed using the Newcastle-Ottawa scale (NOS) and the data were extracted on a specially designed form. The primary outcome was calculated as risk ratio of tooth loss (RRTL). Risk difference of tooth loss (RDTL) and weighted mean difference of tooth loss rate (WDTLR) were also calculated. RESULTS: One prospective and seven retrospective cohort studies including 1409 participants were included. The pooled RRTL was calculated as 0.56 (CI: 0.38,0.82) P<0.01, while the pooled RDTL was calculated as -0.05 (CI: -0.08, -0.01) p<0.01. Based on the risk difference, the NNT was calculated as 20. CONCLUSIONS: Tooth loss rate was significantly lower in the regular compliance group over the five years. To prevent one extraction, 20 teeth have to be maintained with regular compliance for more than five years.

Factors associated with patient and parent satisfaction after orthodontic treatment: a systematic review.

INTRODUCTION: Our objective was to identify factors associated with orthodontic treatment satisfaction of patients and their caregivers, when applicable. METHODS: MEDLINE via Ovid, PubMed, EBM Reviews and EMBASE via OVIDSP, LILACS, Web of Science, and Google Scholar were searched electronically. Reference lists of included articles were also screened for potential relevant studies missed during the electronic searches. Studies evaluating the satisfaction levels of patients or caregivers after orthodontic treatment were considered. Methodologic quality of the included studies was assessed using a modified Newcastle-Ottawa scale. RESULTS: Eighteen studies satisfied the inclusion criteria, representing 2891 patients and 464 parents. The risk of bias was moderate in 13 and low in 4 of the included articles. The studies used different questionnaires and timings to assess postorthodontic treatment satisfaction. Based on the available limited evidence, satisfaction was associated with perceived esthetic outcomes, psychological benefits, and quality of care. The latter was specifically linked to dentist-staff-patient interactions. Dissatisfaction was associated with treatment duration, pain levels and discomfort, and the use of retention appliances. When both assessments were available, the patient's and the parent's satisfaction levels were strongly correlated. CONCLUSIONS: Based on the limited available evidence with moderate risk of bias, we identified factors that appear to be more commonly associated with a high or low level of satisfaction. Consideration of these factors could be important for practitioners attempting to set realistic expectations of their patients and caregivers regarding orthodontic treatment outcomes.

Temporomandibular Joint Disorders and Pain Confounders: An Awareness Study.

OBJECTIVES: Temporomandibular disorders (TMD) are the most common nonodontogenic cause of orofacial pain, leading to morbidity and impairment. TMD presents a diagnostic challenge due to many aetiologies that exhibit comparable symptoms and refer pain to the temporomandibular joint (TMJ) region. Patients may be referred to dental specialists without accounting for all pain sources. This study aims to identify radiographic confounders (RCs) that can be mistaken for TMD in patients undergoing TMJ assessment using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A review of 369 CBCT oral maxillofacial radiology reports of the TMJ acquired between July 2020 and June 2023 was completed. Pertinent RCs were classified as endodontic lesions, impacted dentition, sinus pathologies, root fractures, soft tissue calcifications, and others. The chi-squared test assessed the significance of the relationship between RCs and patient variables. RESULTS: A total of 283 RCs were identified in 202 of the 369 cases (54.7%). The most frequent findings included sinus abnormalities (32.5%), endodontic lesions (15.2%), impacted dentition (12.7%), and elongated/calcified stylohyoid process (9.2%). Significant associations were found between sinus pathologies with TMD signs (P = .009) and gender (P = .001). CONCLUSION: Our results indicate that RCs that mimic TMD-related symptoms are prevalent in patients referred for TMJ CBCT imaging. CLINICAL RELEVANCE: Clinicians should be aware of these RCs when diagnosing complaints related to the TMJ. We recommend clinicians first obtain dental clearance and investigate all other potential sources of a patient's complaint before initiating referrals to avoid unnecessary costs and delays in patient care.

Uncovering the Hidden: A Study on Incidental Findings on CBCT Scans Leading to External Referrals.

OBJECTIVES: This project aims to determine the prevalence of cone-beam computed tomography (CBCT) findings requiring referral. Additionally, the goal is to establish a reference standard protocol for incidental findings, outlining indications for further investigation and management protocol. METHODS: Patients records from the Advanced Imaging Centre at the School of Dentistry, University of Alberta, underwent systematic examination to identify CBCT incidental findings. Radiographic findings requiring referral were categorised into 8 anatomic zones. Analysis assessed prevalence and a management protocol was developed for significant findings. Inferential analyses were conducted to determine the frequency and prevalence of specific findings requiring further investigation. RESULTS: A total of 1260 CBCT interpretive reports were analysed. The most prevalent radiographic findings outside the areas of interest were found in the cervical vertebrae (18%), followed by the sinuses (15%), temporomandibular joints (8%), jaw lesions (7%), airway (5%), teeth (5%), soft tissue calcifications (5%), and other (1%). CONCLUSIONS: Findings most commonly requiring external referral included carotid atheroma (2.7%), cervical vertebrae osteoarthritis (0.97%), jaw lesions (0.86%), adenoid and/or tonsillar hypertrophy (0.86%), and paranasal sinus pathology (0.73%). Increased medicolegal awareness and practitioner knowledge contribute to the rising number of CBCT-identified radiographic findings outside the area of concern. The study addresses the debate on reporting all CBCT/radiographic findings by exploring their prevalence and providing protocols. These guidelines assist dentists in identification, decision-making, and referral processes.

The use of panoramic radiographs to address the oral health needs of vulnerable Canadian populations.

Background: The high demand for oral health care services among vulnerable individuals combined with limited available resources requires a rethinking of the provision of oral health services. This study aimed to determine the usefulness of the dental panoramic radiograph (DPR) as an imaging tool to assess oral health and prioritize dental interventions in vulnerable patients. Methods: This observational and retrospective study evaluated charts of patients who attended Public Health Dental Clinics (PHDC), Alberta Health Services (AHS), in Calgary, Canada, between January 2018 and December 2019. Data collected included sex and age at the time of image acquisition. The following radiographic findings were gathered: the number of missing, present, decayed, restored, and impacted teeth; periapical lesions; retained root; periodontal bone loss; odontogenic and non-odontogenic lesions in the jaws; carotid calcification; and incidental radiographic findings with clinical relevance. Results: Of the 526 DPRs evaluated, 57.4% were from male patients and 42.6% were from female patients, with a mean age of 38.5 years. The average number of present teeth in females and males was 23.7 and 22.6, respectively. The most prevalent dental-related finding was periodontal bone loss (81.5%), followed by periapical lesions (59.6%) and impacted teeth (27%). Among non-dental findings, osseous lesions of the jaws were found in 10.4% of the patients, and carotid atheroma had a frequency of 3.2%. Conclusion: The DPR is a useful adjunct to the clinical exam in this specific population. It provides an opportunistic overview of their oral health and necessary support to establish priorities in oral health care in a public health setting.

Contexte : La forte demande de services de santé buccodentaire chez les personnes vulnérables, combinée aux ressources limitées disponibles, nécessite de repenser la prestation des services de santé buccodentaire. Cette étude vise à déterminer l'utilité de la radiographie panoramique comme outil d'imagerie pour évaluer la santé buccodentaire et prioriser les interventions dentaires chez les patients vulnérables. Méthodes : Cette étude observationnelle et rétrospective a évalué les dossiers des patients qui ont fréquenté les cliniques dentaires de santé publique d'Alberta Health Services (AHS) à Calgary, au Canada, entre janvier 2018 et décembre 2019. Les données recueillies comprenaient le sexe et l'âge au moment de l'acquisition de l'image. Les résultats radiographiques suivants ont été recueillis : nombre de dents manquantes, présentes, cariées, réparées et incluses; lésions périapicales; racine résiduelle; perte osseuse parodontale; lésions odontogéniques et non odontogéniques dans les mâchoires; calcification carotidienne; et résultats radiographiques accessoires pertinents sur le plan clinique. Résultats : Parmi les 526 radiographies panoramiques évaluées, 57,4 % provenaient d'hommes et 42,6 % de femmes, avec un âge moyen de 38,5 ans. Le nombre moyen de dents présentes chez les femmes et les hommes était de 23,7 et 22,6, respectivement. La découverte la plus courante liée aux soins dentaires était la perte osseuse parodontale (81,5 %), suivie des lésions périapicales (59,6 %) et des dents incluses (27 %). En ce qui concerne les résultats non liés aux soins dentaires, des lésions osseuses des mâchoires ont été repérées chez 10,4 % des patients, et l'athérome carotidien avait une fréquence de 3,2 %. Conclusion : La radiographie panoramique est un complément utile à l'examen clinique dans cette population particulière. Elle donne un aperçu de leur santé buccodentaire et le soutien nécessaire pour établir les priorités en matière de soins buccodentaires dans un contexte de santé publique.

A comparison of panoramic radiographic findings in patients with familial adenomatous polyposis and the general population: a multicenter study.

OBJECTIVES: Familial adenomatous polyposis (FAP) is a hereditable disorder characterized by early and unremitting development of intestinal polyps and extraintestinal manifestations requiring multidisciplinary surveillance. Herein we describe a multicenter cross-sectional analysis of the dento-osseous radiographic findings of patients with FAP from North and South America. STUDY DESIGN: Groups I and II included individuals with FAP diagnosed by standard clinical criteria. Patients were paired with age- and sex-matched participants without FAP. Panoramic radiograph of both cohorts, including children and adults, were analyzed. RESULTS: Of 114 panoramic radiographs, 38 were from patients with FAP, composed of group I (n = 22) and group II (n = 16), and 76 were from matched control participants. Evaluators had excellent agreement on key findings (intraclass correlation coefficient = 0.89). The prevalence of osseous anomalies was higher in adults (75%) than in children (65.4%). Dental anomalies were also higher in children with FAP with a prevalence of 15.4%. CONCLUSIONS: We describe important and significant differences in the prevalence of dento-osseous anomalies in children compared with adult patients with FAP. These findings warrant careful consideration and may influence multidisciplinary management of the condition. Conversely, the presence of these abnormalities in pediatric dental patients even if not diagnosed with FAP should be borne in mind as possibly indicating de novo or unrecognized disease.

Can gray values be converted to Hounsfield units? A systematic review.

OBJECTIVES: The purpose of this systematic review was to answer the focus question: "Could the gray values (GVs) from CBCT (cone beam computed tomography) be converted to Hounsfield units (HUs) in multidetector computed tomography (MDCT)?" METHODS: The included studies try to answer the research question according to the PICO strategy. Studies were gathered by searching several electronic databases and partial grey literature up to January 2021 without language or time restrictions. The methodological assessment of the studies was performed using The Oral Health Assessment Tool (OHAT) for in vitro studies and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) for in vivo studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE system) instrument was applied to assess the level of evidence across the studies. RESULTS: 2710 articles were obtained in Phase 1, and 623 citations remained after removing duplicates. Only three studies were included in this review using a two-phase selection process and after applying the eligibility criteria. All studies were methodologically acceptable, although in general terms with low risks of bias. There are some included studies with quite low and limited evidence estimations and recommendation forces; evidencing the need for clinical studies with diagnostic capacity to support its use. CONCLUSIONS: This systematic review demonstrated that the GVs from CBCT cannot be converted to HUs due to the lack of clinical studies with diagnostic capacity to support its use. However, it is evidenced that three conversion steps (equipment calibration, prediction equation models, and a standard formula (converting GVs to HUs)) are needed to obtain pseudo Hounsfield values instead of only obtaining them from a regression or directly from the software.