Radiographic Characteristics of Soft Tissue Calcification on Digital Panoramic Images

Abstract Objective: To assess the prevalence of soft tissue calcifications and their panoramic radiographic characteristics. Material and Methods: This descriptive retrospective study evaluated 2027 panoramic radiographs. The type and location of calcifications and the age and gender of patients were evaluated by two radiologists. Data were analyzed via SPSS and the Chi-square, Fisher's exact and Kappa tests were used to compare the categorical demographic variables among the groups. The confidence interval was set to 95% and p<0.05 was considered statistically significant. Results: The prevalence of calcified stylohyoid ligament was 11.24%. This value was 3.99% for tonsillolith, 1.33% for calcified carotid plaque, 0.69% for antrolith, 0.39% for calcified lymph node, 0.29% for phleboliths, and 0.19% for sialoliths. The prevalence of these conditions had no significant association with gender or age (p=0.102). The prevalence of bilateral calcified stylohyoid ligament, tonsillolith, and a calcified carotid plaque was significantly higher (p<0.001). The most prevalent type of calcified stylohyoid ligament, according to O'Carroll's classification, belonged to types 1, 4, 3 and 2 (p<0.001). The most commonly observed radiographic pattern was multiple, well-defined tonsilloliths (75.3%, p<0.001). Conclusion: The prevalence of soft tissue calcifications on panoramic radiographs was relatively low in this Iranian population. The most calcifications were respectively calcified stylohyoid ligament, tonsillolith, calcified carotid plaque, antrolith, calcified lymph node, phleboliths and sialoliths. Calcified stylohyoid ligament, tonsillolith and calcified carotid plaque were more bilaterally. Thereby panoramic imaging can help in primary assessment, epidemiologic and screening evaluation of these calcifications.

Dental age estimation using the pulp-to-tooth ratio in canines by neural networks.

PURPOSE: It has been proposed that using new prediction methods, such as neural networks based on dental data, could improve age estimation. This study aimed to assess the possibility of exploiting neural networks for estimating age by means of the pulp-to-tooth ratio in canines as a non-destructive, non-expensive, and accurate method. In addition, the predictive performance of neural networks was compared with that of a linear regression model. MATERIALS AND METHODS: Three hundred subjects whose age ranged from 14 to 60 years and were well distributed among various age groups were included in the study. Two statistical software programs, SPSS 21 (IBM Corp., Armonk, NY, USA) and R, were used for statistical analyses. RESULTS: The results indicated that the neural network model generally performed better than the regression model for estimation of age with pulp-to-tooth ratio data. The prediction errors of the developed neural network model were acceptable, with a root mean square error (RMSE) of 4.40 years and a mean absolute error (MAE) of 4.12 years for the unseen dataset. The prediction errors of the regression model were higher than those of the neural network, with an RMSE of 10.26 years and a MAE of 8.17 years for the test dataset. CONCLUSION: The neural network method showed relatively acceptable performance, with an MAE of 4.12 years. The application of neural networks creates new opportunities to obtain more accurate estimations of age in forensic research.

Evaluation of the efficacy of the metal artifact reduction algorithm in the detection of a vertical root fracture in endodontically treated teeth in cone-beam computed tomography images: An in vitro study.

BACKGROUND: Three-dimensional (3D) cone-beam computed tomography (CBCT) scans play an important role in dental diagnostics and treatment planning, especially in detecting vertical root fractures (VRFs). However, artifacts caused by high-density dental materials can negatively affect the quality of CBCT images by decreasing contrast and masking structures. OBJECTIVES: The aim of this study was to assess the efficacy of artifact removal software in detecting VRFs in endodontically treated teeth on CBCT scans. MATERIAL AND METHODS: This study evaluated 70 endodontically treated single-rooted teeth. Half of the teeth were cracked by introducing a wedge into the canal and tapping gently with a hammer; the rest remained untouched as a control group. The teeth were then mounted in a bovine rib bone. Soft tissue was simulated using red dental wax. Cone-beam computed tomography scans were taken using the NewTom® 3G, ProMax® 3D and Cranex® 3D CBCT systems, and the MATLAB software was applied. The images were evaluated by 2 oral and maxillofacial radiologists, and the results were recorded in a checklist. The data was analyzed using the κ coefficient, McNemar's test and the receiver operating characteristic (ROC) curves. RESULTS: A significant inter-observer agreement was noted between the 2 observers in detecting VRFs using all CBCT systems. In all systems, the use of the MATLAB software improved the detection of VRFs, but the difference was not significant in the NewTom 3G (p = 0.119) and ProMax 3D (p = 0.455) systems. However, the difference was significant in the Cranex 3D system (p = 0.039). CONCLUSIONS: The MATLAB artifact removal software can enhance the detection of VRFs on CBCT scans to some extent.

Diagnostic Accuracy of Three Cone Beam Computed Tomography Systems and Periapical Radiography for Detection of Fenestration Around Dental Implants.

CONTEXT: Early detection of peri-implant bone defects is highly important to prevent further bone loss and implant failure. AIMS: This study aimed to assess the diagnostic accuracy of three cone-beam computed tomography (CBCT) systems and periapical radiography for detection of fenestration around dental implants. METHODS: Thirty-one titanium implants were placed in the bovine ribs, in which peri-implant fenestration were simulated. Using a round fissure bur, fenestration defects were created in the apical-third region of implants. CBCT and PA radiographs were obtained before and after creating the defects. The results were analyzed using Chi-square test; kappa coefficient; Cochran's Q-test; McNemar's test; and sensitivity, specificity, positive predictive value, and negative predictive value; and receiver operating characteristic curve. RESULTS: A significant agreement was noted between the two observers in the detection of defect-free samples in all imaging systems (P < 0.05). In detection of samples with defects, a significant agreement was observed between the two observers in use of Cranex three-dimensional and NewTom 3G systems (P < 0.05), but the agreement was not significant for detection of defects in use of Promax 3D (P > 0.05). The results showed no significant difference among the four imaging systems in detection of defect-free samples while the difference was significant among the four groups for detection of defects (P < 0.05). NewTom had the highest sensitivity (75.81%) and specificity (100%) for detection of fenestration. CONCLUSIONS: Within the limitations of CBCT systems different kVp used by different systems, artifacts and noises that influences image quality, difference in diagnostic value of different CBCT systems is due to the differences in type of detector and voxel size. In terms of the type of detector, our results showed that NewTom 3G, which has a higher (kVP) than other systems and the highest accuracy for detection of fenestration.

Root Morphology and Number of Canals in Mandibular Central and Lateral Incisors Using Cone Beam Computed Tomography.

Most failures in endodontic treatment of mandibular incisors are due to the presence of a missed canal specifically the lingual. This investigation aimed to examine the root morphology and number of canals in mandibular incisors using cone beam computed tomography (CBCT). Two hundred and seven patients were assessed in terms of their mandibular central and lateral incisors of CBCT. The inclusion criteria were absence of root resorption, coronal restoration or root filling and clarity and optimal resolution of images. According to the Vertucci's classification, number of roots and canals and type of canal were evaluated by two oral and maxillofacial radiologists. In order to data analysis SPSS version 16 and descriptive statistics were implemented. All mandibular incisors had one root. Most central (84.5%) and lateral (78.2%) incisors had a single canal (p= 0.065). The majority of central (54.5%) and lateral (56.5%) incisors were Vertucci's type I (p= 0.102). Prevalence of one canal in males: central (84.8%), lateral (77.9%) and in females: central (84.2%), lateral (78.5%) (p= 0.518). Prevalence of Vertucci's type I in males: central (52.3%), lateral (45.3%) and in females: central (56.1%), lateral (64.4%) (p=0.188). The prevalence of two canals was 15.5% (central) and 21.8% (lateral) in mandibular incisors. The Vertucci's type I was the most typical kinds of mandibular incisors. Considering the limitations of periapical radiography in determining canal morphology, CBCT can be helpful in case of any concern regarding root canal morphology.

Root morphology and number of canals in mandibular central and lateral incisors using cone beam computed tomography

Abstract Most failures in endodontic treatment of mandibular incisors are due to the presence of a missed canal specifically the lingual. This investigation aimed to examine the root morphology and number of canals in mandibular incisors using cone beam computed tomography (CBCT). Two hundred and seven patients were assessed in terms of their mandibular central and lateral incisors of CBCT. The inclusion criteria were absence of root resorption, coronal restoration or root filling and clarity and optimal resolution of images. According to the Vertucci's classification, number of roots and canals and type of canal were evaluated by two oral and maxillofacial radiologists. In order to data analysis SPSS version 16 and descriptive statistics were implemented. All mandibular incisors had one root. Most central (84.5%) and lateral (78.2%) incisors had a single canal (p= 0.065). The majority of central (54.5%) and lateral (56.5%) incisors were Vertucci's type I (p= 0.102). Prevalence of one canal in males: central (84.8%), lateral (77.9%) and in females: central (84.2%), lateral (78.5%) (p= 0.518). Prevalence of Vertucci's type I in males: central (52.3%), lateral (45.3%) and in females: central (56.1%), lateral (64.4%) (p=0.188). The prevalence of two canals was 15.5% (central) and 21.8% (lateral) in mandibular incisors. The Vertucci's type I was the most typical kinds of mandibular incisors. Considering the limitations of periapical radiography in determining canal morphology, CBCT can be helpful in case of any concern regarding root canal morphology.

Resumo A maioria das falhas no tratamento endodôntico dos incisivos mandibulares é devida à presença de um canal perdido, especificamente do lingual. Esta investigação teve como objetivo analisar a morfologia radicular e o número de canais nos incisivos inferiores utilizando a tomografia computadorizada de feixe cônico (TCFC). Duzentos e sete pacientes foram avaliados em termos de seus incisivos centrais e laterais mandibulares de TCFC. Os critérios de inclusão foram ausência de reabsorção radicular, restauração coronária ou preenchimento radicular e clareza e resolução ótima das imagens. De acordo com a classificação de Vertucci, o número de raízes e canais e o tipo de canal foram avaliados por dois radiologistas orais e maxilo-faciais. Para análise dos dados, o SPSS versão 16 e análise estatística descritiva foram implementados. Todos os incisivos inferiores tinham uma raiz. A maioria dos incisivos centrais (84,5%) e laterais (78,2%) apresentava um único canal (valor de P: 0,065). A maioria dos incisivos centrais (54,5%) e laterais (56,5%) eram do tipo I de Vertucci (valor de P: 0,102). Prevalência de um canal no sexo masculino: central (84,8%), lateral (77,9%) e no feminino: central (84,2%), lateral (78,5%) (valor de P: 0,518). Prevalência de Vertucci tipo I em homens: central (52,3%), lateral (45,3%) e feminina: central (56,1%), lateral (64,4%) (valor de P: 0,188). A prevalência de dois canais foi de 15,5% (central) e 21,8% (lateral) nos incisivos inferiores. O tipo I de Vertucci era dos tipos mais comuns de incisivos inferiores. Considerando as limitações da radiografia periapical na determinação da morfologia do canal, a TCFC pode ser útil em caso de qualquer preocupação com relação à morfologia do canal radicular.

Comparison of Cone Beam Computed Tomography and Multi Slice Computed Tomography Image Quality of Human Dried Mandible using 10 Anatomical Landmarks.

INTRODUCTION: Cone Beam Computed Tomography (CBCT) has gained a broad acceptance in dentomaxillofacial imaging. Computed Tomography (CT) is another imaging modality for diagnosis and preoperative assessments of the head and neck region. AIM: Considering the increased radiation exposure and high cost of CT, this study sought to subjectively assess the image quality of CBCT and Multi Slice CT (MSCT). MATERIALS AND METHODS: A dry human mandible was scanned by five CBCT systems (New Tom 3G, Scanora, CRANEX 3D, Promax and Galileos) and one MSCT system. Three independent oral and maxillofacial radiologists reviewed the CBCT and MSCT scans for the quality of 10 landmarks namely mental foramen, trabecular bone, Periodontal Ligament (PDL), dentin, incisive canal, mandibular canal, dental pulp, enamel, lamina dura and cortical bone using a five-point scale. RESULTS: Significant differences were found between MSCT and CBCT and among the five CBCT systems (p<0.05) in visualization of different anatomical structures. A fine structure such as the incisive canal was significantly less visible and more variable among the systems in comparison with other anatomical landmarks such as the mental foramen, mandibular canal, cortical bone, dental pulp, enamel and dentin (p<0.05). The Cranex 3D and Promax systems were superior to MSCT and all other CBCT systems in visualizing anatomical structures. CONCLUSION: The CBCT image quality was superior to that of MSCT even though some variability existed among different CBCT systems in visualizing fine structures. Considering the low radiation dose and high resolution, CBCT may be beneficial for dentomaxillofacial imaging.

A comparative study of the conventional and digital intraoral radiography methods for root canal length measurement / Comparação entre Radiografia intraoral convencional e digital para medição de comprimento do canal radicular: estudo in vitro

Objective: Measurement of root canal length is one of the most important stages of endodentic treatment, and any error at this stage can lead to the failure. This study aimed to compare conventional and digital intraoral radiography in measurement of root canal length. Material and Methods: In this study, 35 single-canal maxillary teeth were collected. Access cavities were prepared. An endodontic number 10#K- file was introduced into the canal, until the tip was visible at the apical foramen and the actual canal length (gold standard) was determined. After acquisition conventional radiographs using E-Ektaspeed and F-Insight film (Eastman-Kodak Co. Rochester, NY, USA) and digital radiographs using Photostimulable Phosphor Plates(PSP) (Soredex, Helsinki, Finland) and Charge Coupled Devices (CCD)(RVG, Trophy,NY,USA). they were examined separately with a two-week interval by two oral and maxillofacial radiologists. The data were analyzed with ANOVA and Tukey’s tests using SPSS-19 software (SPSS Inc., Chicago, IL, USA). Result: No statistically significant difference was observed between different radiographies, and different observers (P > 0.05). Nevertheless, in comparison with the gold standard, in all cases, the F-speed conventional radiography and the digital CCD radiography showed the highest and the lowest accuracy, respectively. Also, the PSP and the E-speed conventional radiography were in the second and third order of accuracy, respectively. Conclusion: The use of digital radiography does not improve the accuracy of the root canal length measurement,but the digital technique has advantages,such as the reduced patient exposure, eliminating the time consuming processing stages, and producing fast images...

Objetivo: A medição do comprimento do canal radicular é uma das etapas mais importantes de tratamento endodôntico, e qualquer erro nesta fase pode levar ao fracasso. Este estudo teve como objetivo comparar a radiografia intra-oral convencional e digital na medida do comprimento do canal radicular.Material e Métodos: Neste estudo, 35 dentes superiores com canal único foram coletados. Cavidades de acesso foram preparadas. Uma lima endodôntica tipo K, número 10 foi introduzida no canal, até que a ponta era visível no forame apical e o comprimento do canal real (padrão ouro) foi determinada. Após a aquisição de radiografias convencionais, utilizando os filmes E-Ektaspeed e F- Insight (Eastman Kodak Co.,Rochester, NY, EUA) e radiografias digitais utilizando placas foto estimuláveis de fósforo (PSP) (Soredex, Helsinki, Finlândia) e dispositivos de acoplamento (CCD) (RVG, Troféu, NY, EUA), as mesmas foram examinadas separadamente com um intervalo de duas semanas, por dois radiologistas oral maxilofaciais. Os dados foram analisados pelos Testes de ANOVA e Tukey utilizando o software SPSS-19 (SPSS Inc., Chicago, IL, EUA). Resultados: Não houve diferença estatisticamente significativa entre as diferentes radiografias, e observadores diferentes (P > 0,05). No entanto, em comparação com o padrão-ouro, em todos os casos, a radiografia convencional e a radiografia digital CCD apresentaram o maior e a menor precisão, respectivamente. Além disso, a PSP e a radiografia convencional estavam na segunda e terceira ordem de precisão, respectivamente. Conclusão: O uso da radiografia digital não melhora a precisão da medição do comprimento de canal, mas a técnica digital tem vantagens, tais como a exposição do paciente reduzida, eliminando o demorado estágio de processamento, produzindo assim, imagens mais rápidas...

Two huge maxillofacial osteoma cases evaluated by computed tomography.

Osteomas are benign osteogenic neoplasms or hamartomas with a very slow growth rate. Osteoma is the most common mesenchymal neoplasm of the paranasal sinuses. In the jaws, the mandible is more commonly involved than the maxilla. Osteomas may occur at any age, but most frequently are found in individuals older than 40 years. Although most osteomas are small, some may become large enough to cause severe damage, especially those that develop in the frontoethmoid region. Osteomas composed solely of compact bone are uniformly radiopaque and those containing cancellous bone show evidence of internal trabecular structure. To determine and evaluate the exact extension and internal structure of these lesions, computed tomography (CT) is a more useful imaging modality in comparison to conventional radiography. Hereby, we discuss clinical and imaging features of two osteomas (one in the ethmoid sinus and the other in the mandible) along with the main differential diagnoses and pathologic features.