Ultrasound in differential diagnosis of periapical radiolucencies: A radiohistopathological study.

OBJECTIVES: To evaluate the efficacy of ultrasound in differential diagnosis of periapical radiolucencies. MATERIALS AND METHODS: Ten patients aged between 19 years and 40 years with periapical lesions associated with anterior maxillary or mandibular teeth were selected and consented for the study. Pre-operative periapical radiographs were obtained. Measurements and provisional diagnoses of the apical areas were made by two specialist observers on two separate occasions. Preoperative ultrasound examinations with Doppler flowmetry were then performed and the images assessed by two specialist observers for the size, contents, vascular supply and a provisional diagnosis made as to whether the lesion was a cyst or granuloma. Endodontic surgery was performed including curettage of the apical tissues to enable histopathological investigation, which provided the gold standard diagnosis. All measurements and findings were compared and statistically analyzed. RESULTS: Total 10 lesions were identified in 10 patients. On periapical radiographs, lesions were readily identified but observers were unable to differentiate granuloma from cyst using either modality. Where sufficient buccal cortical bone had been resorbed, ultrasound imaging was simple but underestimated the size of the lesions compared with periapical radiographs. In all cases, the ultrasound diagnosis agreed with the histopathological gold standard. CONCLUSION: Ultrasonography (USG) can provide accurate information about the nature of intraosseous lesions of the jaws before any surgical procedure. It is proposed that USG with Doppler flowmetry can provide an additional diagnostic tool without invasive surgery, where treatment option is nonsurgical.

Peripheral ossifying fibroma: Series of five cases.

Peripheral ossifying fibroma (POF) is a reactive lesion of the gingival tissues that predominantly affects women and is usually located in the maxilla anterior to the molars. It originates from the cells of the periodontal ligament. The definitive diagnosis is established by histological examination, which reveals the presence of cellular connective tissue with focal calcifications. Surgical excision is the treatment of choice, though the recurrence has been reported. We present a clinical, radiological and histological review of five cases of POF diagnosed and treated at our institute.

Expression of tumor necrosis factor α and its correlation with severity of oral submucous fibrosis: a case-control study.

OBJECTIVE: The objective of this case-control study was to evaluate the plasma tumor necrosis factor α (TNF-α) levels in patients with oral submucous fibrosis and to determine the relation of plasma TNF-α levels with the severity of oral submucous fibrosis. STUDY DESIGN: Blood samples were collected from 25 patients who were diagnosed with oral submucous fibrosis and from 25 age- and sex-matched control participants. The plasma was isolated by centrifugation of blood samples. The levels of plasma TNF-α were estimated using enzyme-linked immunosorbent assay. RESULTS: A total of 19 out of 25 patients had detectable plasma TNF-α levels ranging from 0.1 to 106.4 pg/mL (mean, 23.46 pg/mL), whereas only 12 out of 25 control participants had detectable plasma TNF-α levels ranging from 0.1 to 33.3 pg/mL (mean, 6.93 pg/mL). The difference between the TNF-α levels of patients and controls was statistically significant (P = .015) according to the Mann-Whitney test. CONCLUSIONS: Patients with oral submucous fibrosis had significantly increased TNF-α levels compared with controls.

Reliability of digital panoramic radiographs in detecting calcified carotid artery atheromatous plaques: a clinical study.

OBJECTIVES: The objective of this study was to determine whether digital panoramic radiography is a reliable method to detect calcified carotid artery atheromatous plaques (CCAAP) as compared with ultrasonography. STUDY DESIGN: Digital panoramic radiographs were obtained from 50 patients who also underwent carotid ultrasound examination. The images were interpreted by trained maxillofacial radiologist for the presence or absence of calcified atheromatous plaques. The extent of carotid calcification on carotid ultrasonography was determined by a trained Sonologist, which was considered as the gold standard assessment. RESULTS: Digital panoramic radiographs had a sensitivity of 76% and specificity of 98.66% in determining CCAAP. There was a high level of agreement between diagnoses, with a kappa value of 0.8. CONCLUSION: To conclude, digital panoramic radiographs had good sensitivity and high specificity in detecting CCAAP. If properly trained, dentists can detect such plaques and can refer patients to physician for timely medical treatment.

Working length changes in curved canals after coronal flaring by using rotary files and hand file: An in vitro study.

AIM: This in vitro investigation examined the effect of early coronal flaring (CF) and late CF on the working length (WL) in curved root canals. BACKGROUND: The objective of this study was to determine if canal length is altered as a result of CF in curved canals of molar roots. STUDY DESIGN: The conditions compared were combinations of (a) stainless steel hand files using Gates Glidden (G. G.) drills (SS) versus nickel-titanium rotary files (Ni-Ti); and (b) early CF (flaring completed before WL determination) versus late CF (flaring completed after WL determination). Selected were 90 canals of extracted maxillary or mandibular first molars (mesial root of mandibular molars and the mesiobuccal root of the maxillary molars) from three groups. CF was accomplished for the SS group using G. G. drills and for the Ni-Ti group using rotary ProTaper and Hero Shaper files. WL was determined by a digital vernier caliper before CF, immediately after CF, and again after canal preparation. STATISTICAL ANALYSIS: A repeated measures analysis of variance (ANOVA) test and a Tukey's multiple prosthoc test were used for this study. RESULTS: Results indicated that WL decreased for all canals as a result of canal preparation. The mean decrease in WL was significantly greater for the SS group (-0.77 ± 0.42 mm) than for the Ni-Ti groups (-0.33 mm ± 0.44). Less change in WL occurred in all groups when initial WL was determined after CF. CONCLUSION: WL in curved canals consistently decreases during the course of instrumentation. Clinician should keep this in mind for better treatment outcome.

Use of extraoral periapical radiography in Indian population: technique and case reports.

Performing intraoral radiography in certain patients is difficult as these patients are unable to tolerate intraoral film placement. To assist such patients a new technique has been innovated using extraoral film placement. Use of this technique has been documented in Caucasian and Taiwanese populations. In this paper we report use of this technique for Indian population. We have done about 40 cases using this technique and have found the average angulation for maxillary (-25+/-5 degrees) and mandibular (-15+/-5 degrees) teeth for Indian population. We recommend use of this technique in the personal dental clinics where panoramic radiographic machines are not readily available. Here we report the technique and cases where diagnostic imaging was performed in patients using the extraoral periapical technique.

Successful immediate autotransplantation of tooth with incomplete root formation: case report.

This case report presents successful immediate mandibular third molar autotransplantation to replace the nonrestorable mandibular first molar. In this case, after the extraction of the nonrestorable tooth, the donor molar with incomplete root formation was autotransplanted into the recipient site after the atraumatic extraction. A long-term follow-up of 2 years revealed that the tooth was fixed in its socket without residual inflammation, masticatory function was satisfactory and without discomfort; the tooth was not mobile, no pathologic condition was apparent radiographically, the lamina dura appeared normal and the tooth showed radiographic evidence of root growth, and pulpal regeneration and the depth of the pocket, gingival contour, and gingival color were all normal. The purpose of this case report is to demonstrate the clinical application of autotransplantation as a future option of permanent restoration without implants, orthodontic space closure, or partial denture.

Achondroplasia with oligodontia: Report of a rare case.

Achondroplasia is considered as a form of skeletal dysplasia/dwarfism that manifests with stunted stature and disproportionate limb shortening. Achondroplasia is of special interest in the field of dentistry because of its characteristic craniofacial features. It has been considered as the most common short-limbed dwarfism syndrome. Very few authors have reported the presence of oligodontia in achondroplastic patients. The present paper reports a rare case of oligodontia in a young, female, achondroplastic patient.

Dentigerous cyst associated with an impacted mesiodens: report of 2 cases.

Dentigerous cysts are the most common developmental cysts of the jaws, most frequently associated with impacted mandibular third molar teeth. Dentigerous cysts around supernumerary teeth, however, account for 5% of all dentigerous cysts, with most developing around a mesiodens in the anterior maxilla. This report describes two cases of a dentigerous cyst associated with an impacted mesiodens. Both of the patients complained of swelling in the maxillary anterior region. Radiographic examination revealed an impacted mesiodens surrounded by a large corticated radiolucency in both cases. A provisional diagnosis of infected odontogenic cyst was made. The cysts were enucleated with the removal of the mesiodens in the two cases. Histopathological examination confirmed the diagnosis of infected dentigerous cyst associated with an impacted mesiodens in both cases. The patients remained asymptomatic, and no complications were noted.

Evaluation of carotid artery atheromatous plaques using digital panoramic radiographs with Doppler sonography as the ground truth.

OBJECTIVES: The objective of the study was to determine whether digital panoramic radiography is a reliable method to detect calcified carotid artery atheromatous plaques (CCAAP) as compared to ultrasonography. STUDY DESIGN: Digital panoramic radiographs were obtained from 50 patients who also underwent carotid ultrasound examination. The images were interpreted by trained maxillofacial radiologist for the presence or absence of calcified atheromatous plaques. The extent of carotid calcification on carotid ultrasonography was determined by a trained sonologist which was considered as gold standard assessment. RESULTS: Digital panoramic radiographs had sensitivity of 76% and specificity of 98.66% in determining calcified carotid artery atheromatous plaques. There was a high level of agreement between diagnoses, with a kappa value of 0.8. CONCLUSION: To conclude, digital panoramic radiographs had good sensitivity and high specificity in detecting calcified carotid artery atheromatous plaques. If properly trained, dentists can detect such plaques and can refer patients to physician for timely medical treatment.

Genetics and presence of non-syndromic supernumerary teeth: A mystery case report and review of literature.

Presence of supernumerary teeth is well-recognized clinical phenomenon. However, it is uncommon to find multiple supernumeraries in individuals with no other associated disease or syndrome. Presence of multiple supernumerary teeth is thought to have genetic component. We report a rare case where multiple supernumerary teeth were seen without presence of any other syndrome in 3 generations; father, son, and two grandsons. We also present a review of similar cases published in literature till date. The role of genetics in development of supernumerary teeth is highlighted.

Interventional radiography in management of high-flow arteriovenous malformation of maxilla: report of a case.

Arteriovenous malformations are extremely rare conditions in that can result from abnormalities in the structure of blood vessels, which may be potentially fatal. A 30-year-old female patient visited our hospital with a complaint of swelling on the right maxillary posterior gingiva along with the large port-wine stain on right side of face. On clinical examination, the swelling was compressible and pulsatile. Radiographic examination revealed a lytic lesion of maxilla. Diagnostic angiography revealed a high-flow arteriovenous malformation of maxilla which was treated by selective transarterial embolization of maxillary artery using polyvinyl alcohol particles.

Extraoral periapical radiography: an alternative approach to intraoral periapical radiography.

It is difficult to take intraoral radiographs in some patients who are intolerable to place the film in their mouth. For these patients, Newman and Friedman recommended a new technique of extraoral film placement. Here we report various cases that diagnostic imaging was performed in patients using the extraoral periapical technique. This technique was used to obtain the radiographs for the patients with severe gag reflex, pediatric dental patients, and patients with restricted mouth opening. This technique can be recommended as an alternative to conventional intraoral periapical technique in cases where intraoral film placement is difficult to achieve.