Proximity of healthy posterior teeth to the maxillary sinus floor in relation to mucosal thickening: a CBCT study.

OBJECTIVES: To evaluate the relationship between proximity of the root apices of healthy maxillary posterior teeth to the maxillary sinus floor (MSF) and mucosal thickening (MT) of the MSF using cone beam computed tomography (CBCT). METHODS: Eighty-four CBCT images obtained from the patients, aged between 20 and 70 years with healthy and fully dentate maxillary posterior sextants, were included. The anatomical relationship between root apices of maxillary posterior teeth and MSF, was evaluated: (Type 1: no contact, Type 2: at least one root apex in contact, Type 3: at least one root apex protruding into MSF). Besides, MT of the MSF was measured from the thickest region. The patients were categorized into two groups based on the absence (≤ 2 mm) or the presence (2 < mm) of MT. Statistical significance was accepted at p < 0.05. RESULTS: Intraexaminer consistency demonstrated an excellent agreement (p < 0.05). The prevalence of Type 1, 2, and 3 proximity were found as 26 (15.5%), 61 (36.3%), and 81 (48.2%); respectively. Overall, 62 (36.9%) maxillary sinuses demonstrated MT (2 < mm, mean: 8.6 ± 7.5 mm). The prevalence and mean values of MT (2 < mm) were not found to be statistically significantly different in terms of sex and proximity types (p > 0.05). Logistic regression analysis results were not found to be statistically significant (p > 0.05). CONCLUSION: The proximity of healthy maxillary posterior teeth to the MSF was not found to be a contributing factor for the MT of the MSF. Further studies with larger samples, taking the other factors causing MT into consideration, are needed.

Perceived sources and levels of stress, general self-efficacy and coping strategies in clinical dental students.

The aims of this study were to identify sources of stress among clinical students and to evaluate the students' perceived levels of stress, general self-efficacy and effective coping strategies in a private dental school environment. The study group consisted of 130 undergraduate clinical dental students in a Turkish private dental school, during the academic year 2014-2015. The students were surveyed using modified version of the dental environment stress (DES) survey, the perceived stress scale, the general self-efficacy scale (G-SES) and the brief coping scale. Age, sex, year of study, history of psychiatric treatment and factors that affected the choice of dentistry were also recorded. Final year and female clinical dental students, who were found to be the most stressful students, had moderate to high perceived stress scores. Total and 'Faculty and administration' related DES scores increased with the year of study. Stressors related to 'Workload' and 'Clinical training' affected females more than males. G-SES scores were higher in male students and students, who had no history of psychiatric treatment. The most and the least common coping strategies were 'Planning' and 'Substance abuse', respectively. 'Religion' was found to be one of the main coping strategies. Stress factors affecting Turkish clinical dental students studying at private dental school differed from the previously reported stress factors affecting students studying at a governmental dental school. Advanced year and female students experienced more stress than the other students.

Evaluation of morphology of the nasopalatine canal using cone-beam computed tomography in a subgroup of Turkish adult population.

PURPOSE: The aim of the study was to evaluate the anatomy and morphology of the nasopalatine canal (NPC) using cone-beam computed tomography (CBCT) and to determine variations of the NPC in relation to age, gender, and status of edentulism of anterior maxilla. METHODS: Patients scheduled for CBCT imaging for further radiographic evaluation of the maxilla with various reasons were consecutively enrolled in this study. Reformatted sagittal and coronal slices were analyzed with regard to dimensions and anatomic characteristics of the NPC. The correlation of age, gender, and status of edentulism of anterior maxilla with all the variables were evaluated. RESULTS: The study comprised 157 subjects with a mean age of 49.64 years. The analysis of the diameter of the incisive foramen revealed a mean of 4.48 mm whereas the diameter of the palatine foramen revealed a mean of 2.88 mm. The mean length of NPC was 10.87 mm and found significantly longer in males and patients with anterior teeth. In terms of incisive foramen and palatine foramen diameter, there was not any significant difference between males and females and between patients with and without anterior teeth (p > 0.05). CONCLUSION: There was relationship between the gender of the patients and the length of the NPC, with significantly lower mean values in females. This result suggests that careful analysis of anatomical structures by taking into consideration some variables would aid the clinician in performing a safer surgical intervention and prevent possible complications. CNCT scanning prior to implant surgery specifically in edentulous patients with severely atrophic maxillae might be a good diagnostic tool to guide the clinician for a safer and predictable procedure.

Ethical decision making in dental education: a preliminary study.

BACKGROUND: In terms of ethical decision making, every clinical case, when seen as an ethical problem, may be analyzed by means of four topics: medical indications, patient preferences, quality of life, contextual features. The aim of this study was to compare the performance of 4th year dental students on Ethical Decision Making before and after a course on ethics. METHODS: Fourth year dental students (n = 37) from academic year 2013-2014 participated in the study. A 3-h lecture, which was about four topics approach to clinical ethical case analysis, was given to the students. The lecture was based on case scenarios related with dental ethics. After the completion of lectures,a case scenario was presented to the students to assess their ethical decision making abilities. At the end of the exam, four topics and ethical judgment were evaluated. Their performances on this examination were evaluated before and after lectures. Statistical evaluation was performed with the significance level set at p < 0.05. RESULTS: A statistically significant difference was found between the means of four topics (p < 0.05). There was no statistically significant difference between the mean scores of judgment of ethical decision (p > 0.05). The mean total score of the students after the course was significantly higher than before course (67.5 and 54.4, respectively; p < 0.05). CONCLUSION: More lectures should be implemented to the curriculum to increase the student awareness of ethical issues and to reach the ultimate goals of dental education.

Evaluation of pneumatization in the articular eminence and roof of the glenoid fossa with cone-beam computed tomography.

BACKGROUND: Detection of air cavities, so called pneumatizations, nearby to the temporomandibular joint (TMJ) area is important, as they represent sites of minimal resistance and facilitate the spread of various pathologies into the joint as inflammation, tumor or fractures and serve as a possible complicating factor in TMJ surgery. AIMS: To determine the prevalence of pneumatization of the articular eminence (PAT) and roof of the glenoid fossa (PRGF) using cone-beam computed tomography (CBCT). STUDY DESIGN: Cross-sectional study. METHODS: Acquired images of 111 patients (222 TMJs) were evaluated. The presence of pneumatization was recorded at the articular eminence and roof of the glenoid fossa. Age and gender were recorded for all patients and type (unilocular or multilocular) and laterality were noted for the cases of pneumatization. RESULTS: The mean age of the study group was 48.86±18.31 years. Among all the patients, 73 (65.8%) had PAT, while 13 (11.7%) had PRGF. Forty-two (37.8%) of the patients had PAT bilaterally; whereas 3 of them (2.7%) presented PRGF bilaterally. The percentage of PAT was higher for females (73.6%) than males (51.3%) (p<0.05). CONCLUSION: CBCT images are an accurate and reliable means of detection of the exact size and type of pneumatization and the relationship of pneumatization to the adjacent tissues. This is especially significant before a surgical intervention is planned in this region, in order to make a sound diagnosis.

Comparison of case-based and lecture-based learning in dental education using the SOLO taxonomy.

The aim of this study was to compare the impact of case-based learning (CBL) and lecture-based learning (LBL) on fourth-year dental students' clinical decision making by using the Structure of Observed Learning Outcome (SOLO) taxonomy. Participants in the study were fourth-year dental students (n=55) in academic year 2012-13 taught in a large-group LBL context and fourth-year dental students (n=54) in academic year 2013-14 taught with the CBL methodology; both took place in the oral diseases course at Yeditepe University Faculty of Dentistry, Istanbul, Turkey. All eligible students participated, for a 100 percent response rate. A real case was presented to the students in both groups to assess their clinical decision making on the topic of oral diseases. Their performance was evaluated with the SOLO taxonomy. Student t-test was used for statistical evaluation, and significance was set at the p<0.05 level. A statistically significant difference was found between the mean scores of the relational and extended abstract categories of the CBL and LBL groups (p<0.05). Students who were taught with CBL had higher scores at the top two levels of the SOLO taxonomy than students taught with LBL. These findings suggest that an integrated case-based curriculum may be effective in promoting students' deep learning and it holds promise for better integration of clinical cases likely to be encountered during independent practice.

Articular eminence inclination, height, and condyle morphology on cone beam computed tomography.

AIM: The aim of the present study was to examine the relationship between articular eminence inclination, height, and thickness of the roof of the glenoid fossa (RGF) according to age and gender and to assess condyle morphology including incidental findings of osseous characteristics associated with osteoarthritis (OA) of the temporomandibular joint (TMJ) using cone beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT images of 105 patients were evaluated retrospectively. For articular eminence inclination and height, axial views on which the condylar processes were seen with their widest mediolateral extent being used as a reference view for secondary reconstruction. Condyle morphology was categorized both in the sagittal and coronal plane. RESULTS: The mean values of eminence inclination and height of males were higher than those of females (P < 0.05). There were significant differences in the RGF thickness in relation to sagittal condyle morphology. Among the group of OA, the mean value of the RGF thickness for "OA-osteophyte" group was the highest (1.59 mm), whereas the lowest RGF values were seen in the "OA-flattening." CONCLUSION: The sagittal osteoarthritic changes may have an effect on RGF thickness by mechanical stimulation and changed stress distribution. Gender has a significant effect on eminence height (Eh) and inclination.

In Vitro Detection of Dental Root Fractures with Cone Beam Computed Tomography (CBCT).

BACKGROUND: Since the diagnosis of non-displaced longitudinal fractures present difficulties for the dentist, three-dimensional evaluation is necessary. OBJECTIVES: The aim of this study is to demonstrate the accuracy of cone beam computed tomography (CBCT) in detecting dental root fractures in vitro. MATERIALS AND METHODS: An in vitro model consisting of 210 recently extracted human mandibular teeth was used. Root fractures were created by mechanical force. The teeth were placed randomly in the empty dental alveoli of a dry human mandible and 15 different dental arcs were created. Images were taken with a unit Iluma ultra cone-beam CT scanner (Imtec Corporation, Germany). Three dental radiologists separately evaluated the images. RESULTS: According to the fracture types and fracture presence, there was an overall statistically significant agreement between the key and readings. Kappa values for intra observer agreement ranged between 0.705 and 0.804 indicating that each observer gave acceptable ratings for the type and presence of fractures. CONCLUSIONS: Detailed information about root fractures may be obtained using CBCT.

Three cases of elongated mandibular coronoid process with different presentations.

Abnormal elongation of the mandibular coronoid process is rare and its etiology is not yet elucidated. The aim of this report is to demonstrate and discuss the relationship between elongated mandibular coronoid process and limitation of mouth opening with cone beam computed tomography. Although the clinical characteristic of elongation of the coronoid process is mandibular limitation, in this report, one case had problem with mouth opening. Axial scans revealed that the distance between the coronoid process and the inner face of the frontal part of the zygomatic bone may cause limitation in mouth opening. In conclusion, instead of the length, the distance between the coronoid process and the inner face of the frontal part of the zygomatic bone may be the actual reason for limitation of mouth opening. This may prevent misdiagnosis.

Measurements of the foramen magnum and mandible in relation to sex using CBCT.

The purpose of this study was to evaluate pre-existing CBCT images of a large sample of adult females and males to provide data on foramen magnum and mandibular measures of sexual dimorphism for use as a reference sample in cases of establishing identity in unknown fragmentary skulls. The study group consisted of 161 adult patients. 3D images of the patients were assessed retrospectively. FM measurements were obtained from reformatted axial sections. Six mandibular measurements were taken. According to the results, the study identified four mandibular measurements as final predictors of sex which are as follows: the gonial angle (G-angle) and ramus length (Ramus-L), gonion-gnathion length (G-G-L) and bigonial breadth (BG-Br). It was found that the cross-validated grouped overall predictive accuracy was 83.2% for FM and mandible measurements. It could correctly identify males in 77.3% and females in 87.4% of the cases. To assess sexual dimorphism, the gonial angle and ramus, gonion-gnathion lengths, and bigonial breadth of the mandible and sagittal diameter of the FM may be used on CBCT images.

Evaluation of the posterior superior alveolar artery and the maxillary sinus with CBCT.

Assessment of the maxillary sinus anatomy before sinus augmentation is important for avoiding surgical complications, because of the close anatomical relationship between the posterior maxillary teeth and the maxillary sinus. The posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and overlying membrane. We evaluated the location of the PSAA and its relationship to the alveolar ridge and maxillary sinus using cone beam computed tomography (CBCT). The study group consisted of 135 CBCT scans (270 sinuses) obtained from the archive of the dentomaxillofacial radiology department at Yeditepe University Faculty of Dentistry, Istanbul, Turkey. The distance between the lower border of the artery and the alveolar crest, bone height from the sinus floor to the ridge crest, distance from the artery to the medial sinus wall, and the diameter and location of the artery were determined. The occurrence of septa and pathology were recorded from CBCT scans. The PSAA was observed in 89.3% of sinuses, and 71.1% of arteries were intraosseous with diameters mostly < 1 mm (68.9%). The prevalence of sinus septa was 55.2%, and that of sinus pathology was 57.4%. The mean age was 43.07 ± 17.55 years. There was a statistically significant difference between the location of the artery and gender (p < 0.05). The prevalence of sinus membrane thickening was 57.4%. Detailed knowledge about the location of the PSAA and sinus morphology may be obtained with CBCT before maxillary sinus surgery.

Evaluation of the posterior superior alveolar artery and the maxillary sinus with CBCT

Assessment of the maxillary sinus anatomy before sinus augmentation is important for avoiding surgical complications, because of the close anatomical relationship between the posterior maxillary teeth and the maxillary sinus. The posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and overlying membrane. We evaluated the location of the PSAA and its relationship to the alveolar ridge and maxillary sinus using cone beam computed tomography (CBCT). The study group consisted of 135 CBCT scans (270 sinuses) obtained from the archive of the dentomaxillofacial radiology department at Yeditepe University Faculty of Dentistry, Istanbul, Turkey. The distance between the lower border of the artery and the alveolar crest, bone height from the sinus floor to the ridge crest, distance from the artery to the medial sinus wall, and the diameter and location of the artery were determined. The occurrence of septa and pathology were recorded from CBCT scans. The PSAA was observed in 89.3% of sinuses, and 71.1% of arteries were intraosseous with diameters mostly < 1 mm (68.9%). The prevalence of sinus septa was 55.2%, and that of sinus pathology was 57.4%. The mean age was 43.07 ± 17.55 years. There was a statistically significant difference between the location of the artery and gender (p < 0.05). The prevalence of sinus membrane thickening was 57.4%. Detailed knowledge about the location of the PSAA and sinus morphology may be obtained with CBCT before maxillary sinus surgery.

Assessment of root canal treatment outcomes performed by Turkish dental students: results after two years.

The aim of this study was to evaluate radiographically the periapical status and technical standard of root canal therapies performed by a group of undergraduate dental students in Turkey two years following completion of the treatments. A random sample of 264 patients who received root canal treatment from undergraduate students at the Yeditepe University Faculty of Dentistry in 2009 were recalled after two years. The study sample consisted of 319 root-filled teeth in 158 dental patients (females=97, males=61) who presented to the student clinics during that time frame. For each root-filled tooth, two periapical radiographs were examined to identify the periapical status, one showing pre-treatment and the other showing post-treatment status. The quality of endodontic treatment was examined according to the distance between the end of root filling and radiographic apex and the density of the obturation according to presence of voids within the root filling material. This examination found that 54.2 percent of roots had fillings of acceptable length, while 37.3 percent were short, 7.8 percent were overfilled, and 0.6 percent was unfilled; 2.5 percent of the teeth were observed with broken root canal instruments. After two years, PAI scores of teeth with acceptable length of root canal filling (0-2 mm from the radiographic apex) were found to be lower than those of the overfilling and short filling cases (>2mm) (p<0.01). Moreover, voids were detected in the root canal fillings of 52.7 percent of endodontically treated teeth. The PAI scores of root fillings with inadequate density were significantly higher than adequate ones (p<0.01). Although endodontic treatments performed by undergraduate students do not appear to be unqualified compared to those performed by general practitioners, more emphasis must be placed on the technical quality of endodontic treatment to obtain better results.

Demographic profile and future expectations of students enrolled in a Turkish private dental school.

The purposes of this study were to obtain information about the social and demographic profile of students enrolled in the first private Turkish dental school, to gather information regarding the reasons for their preferences, and to obtain data about their career expectations. Questionnaires were distributed to 278 students; 229 returned the survey for an overall response rate of 82 percent. Of the respondents, 145 (65.5 percent) were females and seventy-five (34.5 percent) were males; they had an average age of 21.62±1.58. First degree relative (mother, father, sibling) had the greatest influence on the students in choosing dentistry as a career. Fathers and mothers had similar impact on the students' choice of dental profession (45.9 percent and 46.6 percent, respectively). Humanistic feelings, desire to serve others, and reasonable working hours were the predominant reasons that motivated females to become a dentist (p<0.05). Also, academic interest and interest in a medical field were significantly influencing factors for female students (p<0.05 and p=0.001, respectively). One-hundred and ninety-seven students (86 percent) expressed a goal of specializing in a specific branch of dentistry; orthodontics and oral and maxillofacial surgery were the top-ranked specialties. Although only 41 percent of the students were of Istanbul origin, 82.5 percent reported that they wish to practice in Istanbul.

Assessment of the stylohyoid complex with cone beam computed tomography.

BACKGROUND: Orientation of the stylohyoid complex (SHC) may be important for evaluation of the patient with orofacial pain or dysphagia. OBJECTIVES: Our purpose was to assess the length and angulations of SHC using cone beam computed tomography (CBCT). PATIENTS AND METHODS: In this study, 3D images provided by CBCT of 69 patients (36 females, 33 males, age range 15-77 years) were retrospectively evaluated. All CBCT images were performed because of other indications. None of the patients had symptoms of ossified SHC. The length and the thickness of SHC ossification, the anteroposterior angle (APA) and the mediolateral angle (MLA) were measured by maxillofacial radiologists on the anteroposterior, right lateral and left lateral views of CBCT. Student's t test, Pearson's correlation and Chi-square test tests were used for statistical analysis. RESULTS: According to the results, the mean length of SHC was 25.3 ± 11.3 mm and the mean thickness of SHC was 4.8 ± 1.8 mm in the study group. The mean APA value of SHCs was 25.6° ± 5.4° and the mean MLA value was 66.4° ± 6.7°. A positive correlation coefficient was found between age and APA (r = 0.335; P < 0.01); between thickness and APA (r = 0.448; P < 0.01) and also between length and thickness was found (r=0.236). CONCLUSION: The size and morphology of the SHC can be easily assessed by 3D views provided by CBCT. In CBCT evaluation of the head and neck region, the radiologist should consider SHC according to these variations, which may have clinical importance.

Diagnosis of jaw and dentoalveolar fractures in a traumatized patient with cone beam computed tomography.

The purpose of this case report is to discuss and illustrate the clinical usage of Cone Beam Computed Tomography (CBCT) for the diagnosis of maxillofacial fractures in a traumatized patient. In this presentation, a 30-year-old male patient who was referred to Oral Diagnosis and Radiology Department with a limitation of mouth opening was reported. The history of the patient revealed a traumatic injury on his face because of a fall. The patient was initially examined by a medical practitioner in the emergency department of a public hospital. According to 2D cephalometric analysis, no fracture existed. Panoramic radiograph and postero-anterior reverse-town showed bilateral condyle fractures. In addition, a fracture in the left mandibular incisor region could clearly be detected on the panoramic radiograph. For further diagnosis, digital images were taken with CBCT. Cross-sectional views showed two vertical fracture lines on the alveolar bone between teeth numbers 17, 18 and 14, 15. A palatal root fracture was observed associated with tooth number 18. A fracture line in the left mandibular incisor region as well as bilateral condyle fractures could be seen clearly on CBCT views. CBCT is becoming a popular tool in modern dental practise. In the diagnosis of dentoalveolar fractures, CBCT has made it possible for the practitioner to get more detailed information.

Detection of artificial occlusal caries in a phosphor imaging plate system with two types of LCD monitors versus three different films.

The aim of this study was to determine diagnostic performance of a storage phosphor plate system Digora Optime (Soredex, Helsinki, Finland) with two types of LCD monitor in the detection of artificial caries when compared to Ultraspeed (D), Ektaspeed Plus (E), and Insight (F) radiographic films. Seventy extracted human molars-with artificial caries-were radiographed under identical standardized conditions using (1) a storage phosphor plate system Digora (Soredex, Helsinki, Finland), (2) Insight, (3) Ektaspeed Plus, and (4) Ultraspeed (Carestream Health Inc, Rochester, NY). All digital images and radiographs were examined by three observers for the presence or absence of artificial caries using a five-point confidence scale. Digital images were evaluated both on a LCD computer monitor (Philips 170S, Holland) and medical monitor-3 megapixel monochrome display (Me355i2, Totoku, Tokyo)-with brightness and contrast enhancement. Observer responses were evaluated using ROC analysis and other measurements for diagnostic accuracy. Storage phosphor images with medical monitor demonstrated higher mean A (z) values (0.70 +/- 0.08) than digital images with computer monitor and conventional films. Storage phosphor images with medical monitor presented the highest score, 0.97, 0.90, 0.94, for each observer, respectively. Also, true positive observations (0.82) and positive likelihood ratios (2.71) were higher in enhanced storage phosphor images with medical monitor. Caries detection of mechanically created lesions by experienced radiologists is roughly comparable when examining D-speed film images and Digora images on both the computer and medical LCD monitors, and appears to be poorer on E- and F-speed film images.

Dental lesions in adult diabetic patients.

The aim of this study was to investigate the number of existing teeth, prevalence of endodontically treated teeth, periapical lesions, caries and restorations in diabetic patients by taking periapical radiographs. Forty-six patients with Type I diabetes and 40 patients with Type II diabetes participated in the study. The control group consisted of 50 patients. There were significant differences between patients with Type I and Type II diabetes in the mean number of missing teeth surfaces and existing teeth.

Prevalence of the patients with history of hepatitis in a dental facility.

OBJECTIVES: The aim of the study is to investigate the prevalence of the dental patients who had a history of hepatitis. STUDY DESIGN: A total of 13.527 records of patients who were examined between October 1, 2002 and October 1, 2004 were reviewed retrospectively. The medical histories of patients were taken before routine clinical and radiographic examination. A dental software program was used for the collection of data. The chi-square test was utilized to evaluate correlations between different parameters. RESULTS: The percentage of the patients who had a medical history of hepatitis was 7.9% (n=1065). Within the total patients; history of hepatitis A was found as 3.2% (n=438), hepatitis B was 2.3% (n=308), hepatitis C was 0.1% (n=16). The frequency of the patients who were hepatitis B carriers was 0.8% (n=113) and 17% (n=181) of patients did not know which type of hepatitis they had suffered from. CONCLUSIONS: Because dentists are particularly at risk for contacting hepatitis, a strict sterilization procedure is mandatory to prevent the transmission.