Effect of composite radiopacity and margin location of the restoration on the diagnosis of secondary caries.

This research aimed to evaluate the effect of the radiopacity of a Bulk-Fill composite (X-TraFil, VOCO, Germany) and a Conventional composite (P60, 3M ESPE, USA) and assessment of the margin location in the enamel and dentin on the diagnosis of secondary caries. 76 intact premolars with MOD preparation were divided into two equal groups and filled with the conventional and bulk-fill composite. Four regions were considered to simulate carious lesions (two regions in enamel and two regions in dentin). In each group, half of the regions in the dentin and half in the enamel were randomly selected for secondary caries simulation and filled with a wax-plaster combination while the remaining regions stayed intact. Bitewing imaging was done using the PSP digital sensor. Five examiners reviewed the images, and lesions were recorded. Caries diagnosis indicators and paired-sample t-test were used for statistical analysis. The reproducibility and accuracy of the examiners' responses were evaluated using the kappa and agreement coefficient (α=0.05). The sensitivity, specificity, and accuracy of diagnosing secondary carious lesions in enamel were significantly better under conventional than bulk-fill composite. Similarly, the sensitivity and accuracy of diagnosing secondary caries in dentin were significantly higher under conventional composite than bulk-fill composite (p<0.05). No significant differences were found in the agreement and kappa coefficient between conventional and bulk-fill composites in the enamel and dentin (p>0.05). The diagnostic accuracy of carious lesions was higher under conventional composite than bulk-fill composite. However, the location of the secondary was ineffective in caries diagnosis.

Effect of composite radiopacity and margin location of the restoration on the diagnosis of secondary caries

Abstract This research aimed to evaluate the effect of the radiopacity of a Bulk-Fill composite (X-TraFil, VOCO, Germany) and a Conventional composite (P60, 3M ESPE, USA) and assessment of the margin location in the enamel and dentin on the diagnosis of secondary caries. 76 intact premolars with MOD preparation were divided into two equal groups and filled with the conventional and bulk-fill composite. Four regions were considered to simulate carious lesions (two regions in enamel and two regions in dentin). In each group, half of the regions in the dentin and half in the enamel were randomly selected for secondary caries simulation and filled with a wax-plaster combination while the remaining regions stayed intact. Bitewing imaging was done using the PSP digital sensor. Five examiners reviewed the images, and lesions were recorded. Caries diagnosis indicators and paired-sample t-test were used for statistical analysis. The reproducibility and accuracy of the examiners' responses were evaluated using the kappa and agreement coefficient (α=0.05). The sensitivity, specificity, and accuracy of diagnosing secondary carious lesions in enamel were significantly better under conventional than bulk-fill composite. Similarly, the sensitivity and accuracy of diagnosing secondary caries in dentin were significantly higher under conventional composite than bulk-fill composite (p<0.05). No significant differences were found in the agreement and kappa coefficient between conventional and bulk-fill composites in the enamel and dentin (p>0.05). The diagnostic accuracy of carious lesions was higher under conventional composite than bulk-fill composite. However, the location of the secondary was ineffective in caries diagnosis.

Resumo Essa pesquisa teve como objetivo avaliar o efeito da radiopacidade de resina composta Bulk-Fill (X-TraFil, VOCO, Alemanha) e de resina composta convencional (P60, 3M ESPE, EUA) e a avaliação da localização da margem no esmalte e na dentina no diagnóstico de cárie secundária. 76 pré-molares intactos com preparo MOD foram divididos em dois grupos iguais e restaurados de acordo com o grupo experimental. Quatro regiões foram consideradas para simular lesões de cárie (duas regiões no esmalte e duas regiões na dentina). Em cada grupo, metade das regiões na dentina e metade no esmalte foram selecionadas aleatoriamente para a simulação de cárie secundária e preenchidas com uma combinação de cera e gesso, enquanto as regiões restantes permaneceram intactas. As imagens de bitewing foram feitas usando o sensor digital PSP. Cinco examinadores analisaram as imagens, e as lesões foram registradas. Os indicadores de diagnóstico de cárie e o teste t de amostra pareada foram usados para análise estatística. A reprodutibilidade e a precisão das respostas dos examinadores foram avaliadas usando o kappa e o coeficiente de concordância (α=0,05). A sensibilidade, a especificidade e a precisão do diagnóstico de lesões cariosas secundárias no esmalte foram significativamente melhores com a resina composta convencional do que com a resina composta bulk-fill. Da mesma forma, a sensibilidade e a precisão do diagnóstico de cáries secundárias na dentina foram significativamente maiores com a resina convencional do que com a resina bulk-fill (p<0,05). Não foram encontradas diferenças significativas na concordância e no coeficiente kappa entre as resinas convencionais e bulk-fill no esmalte e na dentina (p>0,05). A precisão do diagnóstico de lesões cariosas foi maior com a resina composta convencional do que com a resina composta bulk-fill. Entretanto, a localização do secundário foi ineficaz no diagnóstico de cárie.

Adenoid 'ameloblastoma': Clinicopathological description of 4 additional BRAF-negative cases.

OBJECTIVE: Adenoid ameloblastoma (AA) is an epithelial odontogenic tumor that was recognized as a separate entity in the last odontogenic classification of WHO in 2022. The etiology is unknown, and the pathogenesis remains controversial. The objective of this study is to contribute the clinicopathological features of 4 additional BRAF-negative cases to the existing literature, aiming to enhance the molecular understanding of this unique tumor in the forthcoming classification. MATERIALS AND METHODS: This study consists of a case series of four patients diagnosed with AA. The patients' demographic and clinical information were collected from the universities' medical achieves. Histopathologically, all cases were reexamined according to the latest update of the WHO odontogenic tumor classification. In addition to H&E and immunohistochemical stains, cytogenetics was also evaluated. RESULTS: Well-defined unilocular radiolucent lesions were observed in all cases. Ameloblastoma-like components exhibited reserved nuclear polarity, suprabasal stellate reticulum-like epithelium, duct-like structure, whorls/morules, and cribriform architecture were common features. Variable immunoreactivity to CK7, CK19, CK14, p63, and p40 were determined, and proliferative activity was greater than 15%. The BRAF molecular study revealed no mutations. CONCLUSIONS: When diagnosing AA, the essential histopathological characteristics must be rigorously applied, and a significant portion of the lesion should contain these features. Additionally, despite limited molecular data, since the BRAF mutation commonly observed in ameloblastomas is not present in the majority of AA cases, we propose changing the term "ameloblastoma" to "ameloblastic" and referring to it as "adenoid ameloblastic tumor" in the forthcoming classification.

Evaluation of diagnostic accuracy of CBCT and intraoral radiography for proximal caries detection in the presence of different dental restoration materials.

PURPOSE: This study aimed to assess the diagnostic accuracy of cone-beam computed tomography (CBCT) and digital intraoral radiography for the detection of proximal caries adjacent to amalgam, e.max porcelain, and metal-ceramic restorations (MCRs). MATERIALS AND METHODS: Parallel intraoral radiographs were obtained from 40 posterior teeth using PSP sensors. To obtain CBCT scans, the teeth were first radiographed alone, and were then positioned next to a tooth with an amalgam restoration, MCR, and e.max porcelain crown, and radiographed again. Two blinded observers scored radiographs using a four-point scale (0: absence of proximal caries, 1: enamel caries, 2: carious lesion extending to the outer half of dentin, 3: carious lesion extending to the inner half of dentin). Tooth sections were made, and the grade of caries was determined under a light microscope at x12 magnification. The sensitivity, specificity, and accuracy of CBCT and intraoral radiographs were then calculated. RESULTS: Artifact-free CBCT scans and intraoral radiographs had the highest diagnostic accuracy (0.826 and 0.657, respectively) while CBCT images of the teeth next to the amalgam restorations (0.526) had the lowest accuracy. The diagnostic accuracy of CBCT images of the teeth next to the porcelain crowns and MCRs was 0.613 and 0.601, respectively. CONCLUSION: Artifact-free CBCT images had higher diagnostic accuracy than intraoral radiography for the detection of all grades of proximal caries. The diagnostic accuracy of CBCT images of teeth adjacent to amalgam, porcelain, and MCRs was lower compared to intraoral radiographs and artifact-free CBCT images.

Evaluation of Dimension and Bridging of Sella Turcica and Presence of Ponticulus Posticus in Individuals With and Without Cleft: A Comparative Study.

OBJECTIVE: Sella turcica abnormalities such as sella turcica bridging (STB) have been observed frequently among patients with craniofacial anomalies. Ponticulus posticus (PP) is an important structure and its presence causes complications during surgeries. Due to the importance of these structures, this study aimed to evaluate the prevalence of STB, PP, and dimensions of the sella turcica in individuals with and without cleft. DESIGN: A cross-sectional study. SETTING: Orthodontic and Radiology Departments in a public dental school, Tehran, Iran. PATIENTS: Eighty-three lateral cephalograms of individuals with cleft and ninety-two cephalograms of class I individuals without cleft. MAIN OUTCOME MEASURES: Length, depth, and maximum anterior-posterior diameter (APD) of sella turcica, presence of STB (classified as types 1, 2, and 3), and PP. RESULTS: In the group with cleft, 19.3% of individuals had type I, 65.1%, type II, and 15.7%, type III STB. In the group without cleft, 15.2% had type I, 73.9%, type II, and 10.9%, type III STB. In the group with cleft, 65.1% of individuals had no PP, 24.1%, incomplete, and 10.8%, complete PP while in the group without cleft, 56.5% had no PP, 29 31.5%, incomplete, and 12%, complete PP. CONCLUSION: The sella turcica dimensions, STB, and PP prevalence were not significantly different between individuals with and without cleft. The sella turcica length and prevalence of STB and PP were not affected by age, sex, and cleft type. However, the depth and the APD were affected by age.

Cytotoxicity, genotoxicity, and immunohistochemical expression of p53 in the oral mucosal epithelium of adults following cone-beam computed tomography.

This study sought to assess the cytotoxicity, genotoxicity, and immunohistochemical (IHC) expression of p53 in the oral mucosal epithelium of adults following cone-beam computed tomography (CBCT). This before-and-after observational study evaluated 30 patients (15 males and 15 females); mean age 35 years, who required CBCT. Exfoliating epithelial cells of the buccal mucosa were collected with a cotton swab immediately before and 10 days after CBCT. Following Papanicolaou staining, genotoxicity was evaluated by the micronucleus assay. The frequencies of pyknosis, karyorrhexis, karyolysis, budding and binucleation as cytotoxicity factors were also recorded. Expression of p53 was evaluated by IHC staining. Data were analyzed by paired samples t-test. Micronucleated cells, pyknosis, karyorrhexis, karyolysis, budding, cytotoxicity, and expression of p53 increased significantly after CBCT. CBCT exerts genotoxic and cytotoxic effects and leads to overexpression of p53 protein in the oral buccal mucosal cells.

Ameloblastic Carcinoma with Calcification: A Rare Case Report in the Mandible and Literature Review.

Ameloblastic carcinoma (AC) is a scarce malignant tumor which is more prevalent in the mandible than the maxilla. It occurs in a wide range of age groups, and there is a sex predilection in males. AC shows specific microscopic features and requires more aggressive surgical treatment plans in comparison with conventional ameloblastoma. Radiographically, AC resembles ameloblastoma except that it rarely represents focal mineralized materials, seemingly reflecting dystrophic calcification. This characteristic is uncommon in typical ameloblastomas, and only few cases reported with such opacities and mineralized materials. Due to this rare radiographic and microscopic presentation, an accurate diagnosis could be challenging, and pathologists should consider a combination of benign and malignant odontogenic tumors occurring in jaws.

Desmoplastic Fibroma of the Jaws: A Case Series and Review of Literature.

Desmoplastic fibroma (DF) is a benign, locally aggressive neoplasm that rarely occurs in the facial skeleton. It usually presents during the first three decades of life. Due to its aggressiveness and high recurrence rate, early diagnosis is imperative, and complete surgical removal of the lesion is the treatment of choice. Herein, we present three cases of DF namely a 2 year-old girl with a mandibular DF, a 9 year-old boy with a maxillary lesion and a 1.5-year old boy with a mandibular DF. Complete clinicopathological information, treatment plan and long-term follow-up of patients are discussed. Histopathologic features of 3 cases revealed non-capsulated spindle cell tumor with fascicular or swirling patterns in incisional biopsy. Immunohistochemical staining was performed to make a definitive diagnosis. Strongly positive nuclear immunoreactivity for ß-catenin confirmed the diagnosis of desmoplastic fibroma in 3 cases. Segmental mandibulectomy, partial maxillectomy and hemimandibulectomy were done for the cases. There was no recurrence in our reported cases after 8 and 11 months and 3 years follow up, respectively. It is noteworthy that despite the aggressive nature of DF, young patients often respond well to wide resection treatment.

Metastatic papillary thyroid carcinoma of the mandible: Case report and literature review.

The oral cavity is not a usual site for metastasis including about one percent of all oral tumors. Metastatic papillary thyroid carcinoma (PTC) is uncommon and usually occurs in regional lymph nodes of neck, so mandibular metastasis is a rare event. We present a case with swelling in the right mandible that has been diagnosed metastatic tumor of PTC. The clinical features, radiographic aspect and treatment plan are discussed. Furthermore, a thorough review of literature revealed 77 published cases of metastatic thyroid carcinoma to the oral cavity with their summarized features.

Thickness of Buccal and Lingual Alveolar Bone Plates according to the Position of Impacted Mandibular Third Molars on Cone-Beam Computed Tomography Scans.

OBJECTIVES: This study sought to assess the thickness of buccal and lingual alveolar bone plates according to the position of impacted mandibular third molars on cone-beam computed tomography (CBCT) scans. MATERIALS AND METHODS: Eighty-four CBCT scans of impacted mandibular third molars were evaluated in this retrospective study. All images had been obtained by ProMax 3D CBCT system with the exposure settings of 78 kVp, 12 mA, 16 s time, 0.2 mm voxel size and 10 × 9 cm field of view. The impaction angle of teeth and the thickness of buccal and lingual cortical plates were determined on images by drawing lines in the anterior, middle, posterior, superior, central and inferior regions. Thickness of bone plates was analyzed according to the position of impacted molars relative to the buccal and lingual plates using the Student t-test and relative to the second molars using one-way ANOVA and Tukey's test. RESULTS: In the buccolingual direction, the buccal plate thickness was maximum in lingual position followed by central position, and minimum in buccal position of the teeth. The lingual plate thickness was minimum in horizontal and distoangular positions and maximum in the mesioangular position of impacted teeth. CONCLUSION: Risk of lingual plate preformation is higher in surgical removal of impacted third molars with distoangular and horizontal positions. Thus, further attention must be paid by the surgeons to such cases.

An Extrafollicular Adenomatoid Odontogenic Tumor Mimicking a Periapical Cyst.

Adenomatoid odontogenic tumor (AOT) is a rare noninvasive odontogenic tumor that occurs mostly in the second decade of life. Based on its tooth association, AOT can be classified into three categories of follicular, extrafollicular, and peripheral types; the follicular classification is considered as the most common type of AOT. This study reported a large extrafollicular case of AOT in a 40-year-old female. She was asymptomatic and tumor was detected accidentally by her dental practitioner. Since the panoramic radiograph showed a well-defined unilocular radiolucent lesion, we observed radiopaque spots within the lesion by using cone beam computed tomography. The extrafollicular type can mimic a periapical radiolucent lesion.

Effects of artifact removal on cone-beam computed tomography images.

BACKGROUND: Dental implants and metal fillings may cause artifacts in cone-beam computed tomography (CBCT) images and reduce image quality and anatomic accuracy. The purposes of this study are a subjective evaluation of anatomic landmarks and linear bone measurements after applying artifact removal (low-medium) option on CBCT images. MATERIALS AND METHODS: In this cross-sectional study, thirty CBCT images from thirty qualified patients were selected in a private radiology center. Low and medium artifact removal was applied to images. Three radiologists assessed the visibility of the mandibular canal, mental foramen, and lamina dura in images. Crestal width and bone length were also measured in three groups of images and was compared by exact McNemar test. ICC test (two-way random model, absolute agreement types) was calculated for comparison of linear bone measurements in three images groups. P ≤ 0.05 was considered statistically significant. RESULTS: Percent agreement of determining mental foramen (outline and location), mandibular canal (outline and location), and lamina dura between three groups of images were 100%, 100%, 83.3%, 96.7%, and 56.6%, respectively. The results of exact McNemar test revealed that medium artifact removal group had a statistical difference in lamina dura observation with none and low artifact removal groups (P < 0.001). Intraclass correlation coefficient showed no statistical differences in crestal width and bone length between groups (P < 0.001). CONCLUSION: Applying artifact removal does not affect the visibility of large anatomical structures and linear bone measurements, but delicate structures such as lamina dura may become less clear after artifact removal.

Central cementifying fibroma of maxilla.

Central cementifying fibroma is a bony tumor, which is believed to be derived from the cells of the periodontal ligament. Central cemento-ossifying fibroma behaves like, a benign bone neoplasm. This bone tumor consists of highly cellular, fibrous tissue that contains varying amounts of calcified tissue resembling bone, cementum, or both. Central cemento-ossifying fibromas of the mandible are common; however, they are rare in the maxilla region. This tumor is most frequent between 35 and 40 years of ages. In this report we have described a 37-year-old male with cemento-ossifying fibroma of the maxilla region with the mass that had been appeared 2-3 months prior to his first referral. Radiologic imaging such as intra-oral, panoramic, and Cone Beam CT had been performed. Histological analysis was done and finally diagnosis of central cementifying fibroma was made. The postoperative follow up at 12 months revealed no recurrence.

Assessing the anatomical variations of lingual foramen and its bony canals with CBCT taken from 102 patients in Isfahan.

BACKGROUND: Some studies have been performed on assessing the anatomical variations of lingual foramen and its bony canals, in many different countries but no study has been performed in Iran yet. The purpose of this study is to assess the anatomical variations of lingual foramen and its bony canals with cone-beam computed tomography (CBCT) imaging in Isfahan. MATERIALS AND METHODS: This was a cross-sectional study in which CBCT images taken from 102 patients referred to the Radiology Department of Head and Neck in Esfahan (Iran) University between 2010 and 2011. The presence of the lingual foramen and its bony canals, the locations, sizes, and length were assessed. The distances between the terminal end of lingual canal at the buccal and lingual side from the inferior border of the mandible and alveolar crest were measured. We also evaluated the effect of patient age and gender on the dimensional measurements of the anatomical landmark mentioned above t test, analysis of variance (ANOVA), and pearson's correlation were used for statistical analysis and P value lower than 0.05 was considered significant. RESULT: All of the CBCT images taken showed the presence of lingual foramen. Of all the participants, 52% of them had two foramens in their images. The mean diameters of the upper and lower lingual foramen were 1.12 and 0.9 mm, respectively. CONCLUSION: These anatomical landmarks in Isfahan population vary from previous studies. All of the images had at least one lingual foramen which demonstrates high prevalence of this anatomy among Isfehanian population. Therefore, it is recommended to use CBCT imaging for preoperative evaluation prior to installing dental implants.

Prevalence of zygomatic air cell defect: Panoramic radiographic study of a selected Esfehanian population.

BACKGROUND: The mastoid pneumatization begins on the 33(rd) week of embryonic life, and continuous up to 8-9 years of age. This air cells is important for surgical perspective. Inadvertent penetration through this anatomical feature during surgical procedures can be disastrous. Aim of this study is to determine the prevalence of zygomatic air cell defect (ZACD) in the Esfehanian population. MATERIALS AND METHODS: This was a cross-sectional study. 2600 panoramic radiographs of patients aged between 3 and 90 years were evaluated retrospectively to establish dominant laterality, type and grade amongst these patients. The SPSS 11.5 program was used for the statistical analysis. Mean and standard deviation were used for statistical methods in this study. RESULTS: ZACD was found in 94 cases, representing a prevalence of 3.6%. 59 cases occurred in females (62.8%) and 35 cases occurred in males (37.2%). Most cases were in their twenties. Unilateral ZACD was found in 70 patients (74.5%) with the half occurring on the right side. In 24 cases (25.5%) was bilateral. 70 of the cases (59.3%) were multilocular type, while 45 (38.1) and 3 (2.6%) were unilocular and trabecular type, respectively. 59 cases were grade 2 (62.8%) and 35 were grade 3 (37.2%). CONCLUSIONS: The frequency of ZACD amongst Iranian population was more than previous studies. In addition younger population was involved in this group. So it is important for clinicians who are planning to perform temporomandibular joint surgery to assess radiographic imaging thoroughly before the surgery to avoid intraoperative complications.

Plunging ranula of the submandibular area.

The term "ranula" is used to describe a diffuse swelling in the floor of the mouth caused by either a mucous extravasation or, less commonly, a mucous retention cyst derived from the major sublingual or submandibular salivary glands. The most common presentation of ranula is a painless, slow-growing, soft, and movable mass located in the floor of the mouth. Ranula may be simple or plunging. Simple ranula often present as masses in the floor of the mouth, limited to the mucous membranes. Diving ranulas extend through the facial plans, usually posterior to the mylohyoid muscle into the neck, and present as cervical masses. Thyroglossal duct cyst, branchial cleft cyst, cystic hygroma, submandibular sialadenitis, intramuscular hemangioma, cystic or neoplastic thyroid disease might be included in differential diagnosis. A variety of surgical procedures have been quoted in the literature ranging from marsupialization, excision of the ranula, sclerotherapy, and excision of the sublingual gland. The recurrence rate varies according to the procedure performed.