Ectopic teeth with disparate migration: A literature review and new case series.

Purpose: Ectopic eruption can be defined as the emergence of a tooth in an abnormal location, where the tooth does not follow its typical eruption pathway. While ectopic eruption within the dentate region is well-documented in the literature, ectopic eruption in non-dentate regions is relatively rare. This study aimed to report 6 cases of ectopic teeth and present a systematic review of the English-language literature on ectopic teeth, emphasizing demographic characteristics, radiographic features, potential complications, and treatment options. Materials and Methods: A literature search was conducted using the PubMed, Medline, Web of Science, and Cochrane databases. The demographic data and radiographic findings of patients presenting with ectopic teeth were recorded. Results: The literature review yielded 61 cases of ectopic teeth, with patients ranging in age from 3 to 74 years. The findings from these previously reported cases demonstrated that the most common location for ectopic teeth was the maxillary sinus, which is consistent with this case series. The Pearson chi-square test was performed to evaluate the correlation between age and location of ectopic teeth, and the results were found to be statistically significant (P<0.05). However, no statistically significant relationship was observed between sex and the location of ectopic teeth. Conclusion: The distinct features of these cases warrant reporting. This study presents the first case of supernumerary teeth in the condyle without any associated pathosis. Another notable characteristic is the pre-eruptive resorption of 2 inverted supernumerary teeth ectopically located in the palate, which predisposes to sinus opacification.

Maxillary mucormycosis and concurrent osteomyelitis in a post-COVID-19 patient with new onset diabetes mellitus.

The occurrence of invasive fungal respiratory superinfections in patients with COVID-19 has gained much attention in the post-COVID era. The elucidation of invasive fungal sinusitis with osteomyelitis as a rare aggressive infection that requires prompt diagnosis and treatment to prevent fatal consequences has been noteworthy. Cone-beam computed tomography findings in those patients are central to early diagnosis and management. Here we report a case of post-COVID mucormycosis with osteomyelitis of the maxilla in a 72-year-old woman with a history of recently diagnosed diabetes mellitus.

Assessment of alveolar bone changes in response to minimally invasive periodontal surgery: A cone-beam computed tomographic evaluation.

Purpose: The aim of this study was to evaluate 3-dimensional cone-beam computed tomography (CBCT) images of alveolar bone changes in patients who underwent minimally invasive periodontal surgery-namely, the pinhole surgical technique (PST). Materials and Methods: Alveolar bone height was measured and compared on CBCT images of 254 teeth from 23 consecutive patients with Miller class I, II, or III recession who had undergone PST. No patient with active periodontal disease was selected for surgery. Two different methods were used to assess the alveolar bone changes postoperatively. In both methods, the distance between the apex of the tooth and the mid-buccal alveolar crestal bone on pre- and post-surgical CBCT studies was measured. Results: An average alveolar bone gain >0.5 mm following PST was identified using CBCT (P=0.05). None of the demographic variables, including sex, age, and time since surgery, had any significant effect on bone gain during follow-up, which ranged from 8 months to 3 years. Conclusion: PST appears to be a promising treatment modality for recession that results in stable clinical outcomes and may lead to some level of resolution on the bone level. More long-term studies must be done to evaluate the impact of this novel technique on bone remodeling and to assess sustained bone levels within a larger study population.

Cone-beam computed tomographic imaging of central giant cell granuloma: A comprehensive review.

Purpose: The aim of this study was to characterize the cone-beam computed tomographic (CBCT) imaging features of central giant cell granuloma (CGCG) of the jawbone. Materials and Methods: This study retrospectively reviewed 26 CBCT studies of histologically proven cases of CGCG during a period of 20 years, from 1999 to 2019. Patients' demographic data were recorded, and radiographic features were assessed (location, border, cortication, appearance of the internal structure, locularity, septation, expansion, cortical perforation, effects on surrounding tissue, whether the lesion crossed the midline, and lesion volume). Results: In this study, CGCGs were seen almost twice as often in the mandible than in the maxilla, and 64.7% of mandibular lesions involved the anterior region. Only 26.9% of lesions crossed the midline, a feature that was considered characteristic of CGCG. Furthermore, 65.4% of lesions were unilocular and 34.6% were multilocular. The correlation between a lesion's size and its locularity was statistically significant, and larger lesions showed a multilocular appearance. The mean volume of multilocular lesions was greater than that of unilocular lesions. Conclusion: CGCGs showed variable radiographic features on CBCT, and this imaging modality is highly effective at demonstrating the radiographic spectrum and lesional extent of CGCGs in the jawbone.

Accuracy of a patient 3-dimensional virtual representation obtained from the superimposition of facial and intraoral scans guided by extraoral and intraoral scan body systems.

STATEMENT OF PROBLEM: A patient 3-dimensional virtual representation aims to facilitate the integration of facial references into treatment planning or prosthesis design procedures, but the accuracy of the virtual patient representation remains unclear. PURPOSE: The purpose of the present observational clinical study was to determine and compare the accuracy (trueness and precision) of a virtual patient obtained from the superimposition procedures of facial and intraoral digital scans guided by 2 scan body systems. MATERIAL AND METHODS: Ten participants were recruited. An intraoral digital scan was completed (TRIOS 4). Four fiduciary markers were placed in the glabella (Gb), left (IOL) and right infraorbital canal (IOR), and tip of the nose (TN). Two digitizing procedures were completed: cone beam computed tomography (CBCT) (i-CAT FLX V-Series) and facial scans (Face Camera Pro Bellus) with 2 different scan body systems: AFT (ScanBodyFace) and Sat 3D (Sat 3D). For the AFT system, a reference facial scan was obtained, followed by a facial scan with the participant in the same position as when capturing the CBCT scan. For the Sat 3D system, a reference facial scan was recorded, followed by a facial scan with the patient in the same position as when capturing the CBCT scan. The patient 3-dimensional representation for each scan body system was obtained by using a computer program (Matera 2.4). A total of 14 interlandmark distances were measured in the CBCT scan and both 3-dimensional patient representations. The discrepancies between the CBCT scan (considered the standard) and each 3-dimensional representation of each patient were used to analyze the data. The Kolmogorov-Smirnov test revealed that trueness and precision values were not normally distributed (P<.05). A log10 transformation was performed with 1-way repeated-measures MANOVA (α=.05). RESULTS: The accuracy of the virtual 3-dimensional patient representations obtained by using AFT and Sat 3D systems showed a trueness ranging from 0.50 to 1.64 mm and a precision ranging from 0.04 to 0.14 mm. The Wilks lambda detected an overall significant difference in the accuracy values between the AFT and Sat 3D systems (F=3628.041, df=14, P<.001). A significant difference was found in 12 of the 14 interlandmark measurements (P<.05). The AFT system presented significantly higher discrepancy values in Gb-IOL, TN-IOR, IOL-IOR, and TN-6 (P<.05) than in the Sat 3D system. The Sat 3D system had a significantly higher discrepancy in Gb-TN, TN-IOL, IOL-3, IOL-6, TN-8, TN-9, TN-11, IOR-11, and IOR-14 (P<.05) than in the AFT system. The Wilcoxon signed-rank test did not detect any significant difference in the precision values between the AFT and Sat 3D systems (Z=-0.838, P=.402). CONCLUSIONS: The accuracy of the patient 3-dimensional virtual representations obtained using AFT and Sat 3D systems showed trueness values ranging from 0.50 to 1.64 mm and precision values ranging from 0.04 to 0.14 mm. The AFT system obtained higher trueness than the Sat 3D system, but both systems showed similar precision values.

Large airway-obstructing retropharyngeal lipoma in an asymptomatic patient: a case report.

BACKGROUND: Lipomas are common benign mesenchymal tumors that appear in the head and neck region in approximately 25% of cases where they are noted. Lipomas of the airway region are exceedingly rare, accounting for less than 1% of airway obstruction tumors. Correlation of radiographic findings from cone beam computed tomography (CBCT), multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI) of a rare retropharyngeal lipoma has not been previously reported. CBCT studies acquired for implant and/or other diagnostic purposes may be the first line of detection as an incidental finding. CASE PRESENTATION: A 66-year-old female presented for a pre-implant CBCT with no history of other complaints or signs/symptoms. CBCT imaging depicts a large, well-defined, low-attenuation/soft tissue density lesion with an undulating appearance extending from the posterior left pharyngeal wall and occluding two-thirds of the airway from C2 to C4. The lesion extends laterally into the left parapharyngeal space and inferiorly beyond the field of view of the study. Evidence of faint internal septations was noted. The patient was immediately referred for an ENT consult. Laryngoscopy, MRI, and contrast-enhanced MDCT imaging were conducted to determine the full extent and nature of the lesion, as well as to potentially plan for biopsy and/or surgical resection. Removal of the lesion was successful, and histopathologic evaluation confirmed lipoma. Periodic follow-up was recommended to monitor for possible recurrence. DISCUSSION: The slower growth pattern of some benign lesions may obscure any symptoms as changes the patient may normally notice take place over an extended period. Furthermore, soft tissue lesions and especially those in the posterior midline, such as in this case, may not be easily visible on routine panoramic imaging or clinical exam, allowing for substantially large growth before detection. While the soft tissue contrast of the CBCT volume is poor, enough information was present to establish an initial differential diagnosis and the need for more advanced imaging modalities. With the growing popularity and adoption of CBCT in maxillofacial imaging, a thorough understanding of the appearance of hard and soft tissue lesions, as well as a strong understanding of the baseline appearance of normal anatomy, is important to ensure no incidental pathoses go undiagnosed.

Cone-beam computed tomographic imaging of silent sinus syndrome: A case series and a literature review.

While silent sinus syndrome (SSS) is familiar to otolaryngologists and ophthalmologists, it is a rare clinical entity in dentistry and is likely to be underdiagnosed due to dentists' lack of awareness of this condition. SSS presents a diagnostic challenge to dentists, as patients typically have no history of trauma or sinusitis. The characteristic feature of SSS is a gradual retreat of the maxillary sinus walls, resulting in enophthalmos and hypoglobus. Multidetector (multislice) computed tomography is the imaging modality of choice for SSS and other paranasal sinus diseases. Cone-beam computed tomography promises to be an alternative low-dose imaging modality. This report describes 3 cases of SSS in adults, who had no identified clinical symptoms except diminutive and opacified maxillary sinuses, as well as the inward bowing of the sinus walls as noted on cone-beam computed tomographic imaging.

Radiographic manifestations of fibroblastic osteosarcoma: A diagnostic challenge.

Osteosarcoma is the most common primary bone tumor after plasma cell neoplasms. Osteosarcoma has diverse histological features and is characterized by the presence of malignant spindle cells and pluripotent neoplastic mesenchymal cells that produce immature bone, cartilage, and fibrous tissue. Osteosarcoma most frequently develops in the extremities of long bones, but can occur in the jaw in rare cases. The clinical and biological behavior of osteosarcoma of the jaw slightly differs from that of long-bone osteosarcoma. The incidence of jaw osteosarcoma is greater in the third to fourth decades of life, whereas long-bone osteosarcoma mostly occurs in the second decade of life. Osteosarcoma of the jaw has a lower tendency to metastasize and a better prognosis than long-bone osteosarcoma. Radiographically, osteosarcoma can present as a poorly-defined lytic, sclerotic, or mixed-density lesion with periosteal bone reaction response. Multi-detector computed tomography is useful for identifying the extent of bone destruction, as well as soft tissue involvement of the lesion. The current case report presents a fibroblastic osteosarcoma involving the left hemimandible with very unusual radiographic features.

A Novel Prefabricated Grid for Guided Endodontic Microsurgery.

INTRODUCTION: This study aimed to introduce a novel method using cone-beam computed tomographic (CBCT) imaging and prefabricated grids to guide apical access during endodontic microsurgery and to compare its accuracy with that of the nonguided method. METHODS: Forty-two roots from human cadaver jaws were selected. Twenty-one were randomly assigned to the experimental group (grid based) and their contralateral counterparts to the control group (nonguided). Preoperative CBCT images were used to design a drill path that intended to reach the palatal/lingual aspect of the roots without attempting to complete the osteotomy or to resect the entire root end. In the experimental group, prefabricated metal grids used during imaging and surgery acted as a reference in the design and drilling. Postoperative CBCT volumes were superimposed on the preoperative volumes, and the distances between the actual drill paths and the target points were measured. A dichotomized outcome of success versus failure was also recorded and compared. Statistical analysis was performed using the paired t test and Fisher exact test. RESULTS: The mean deviation of the drill paths from the target points was 0.66 mm ± 0.54 mm (mean ± standard deviation) for grid-based drilling and 1.92 mm ± 1.05 mm (mean ± standard deviation) for nonguided drilling (P < .001). Grid-based drilling was on average 1.27 mm (95% confidence interval, 0.81-1.72 mm) closer to the target point than nonguided drilling. The probability of successful drilling was also significantly higher with grids than without grids (P = .02). CONCLUSIONS: The proposed method of guided osteotomy and root-end resection using prefabricated grids was more accurate than the nonguided method.

Goldenhar syndrome (oculo-auriculo-vertebral spectrum): Findings on cone beam computed tomography-3 case reports.

BACKGROUND: Goldenhar syndrome, also known as oculo-auriculo-vertebral spectrum, is a variant of hemifacial microsomia, a congenital condition affecting primarily aural, oral, and mandibular development, with vertebral anomalies, ocular abnormalities, and epibulbar dermoids. As a complex and heterogeneous condition, this disorder varies from mild to severe, and involvement is unilateral in many cases, but bilateral involvement is also known to occur. It presents several complex problems in treatment, requiring an integrated, multidisciplinary approach. CLINICAL AND RADIOGRAPHIC FINDINGS: Oculo-auriculo-vertebral spectrum has a wide range of clinical manifestations. This report describes radiographic features of the syndrome in 3 patients, as visualized on maxillofacial cone beam computed tomography. Pertinent radiographic findings include multiple substantial unilateral anomalies affecting the skull, cervical vertebrae, orbits, ears, maxilla, mandible, and teeth. DEFINITIVE INTERPRETATION: Radiographic features are consistent with those previously reported in the literature for oculo-auriculo-vertebral spectrum. CONCLUSIONS: It is important to emphasize the relevance of diagnostic imaging and characterization of the syndrome as well as the significance of coordinated diagnosis and management approaches among oral and maxillofacial radiologists and medical/dental specialists to allow for planning and implementation of interdisciplinary intervention at an early stage.

Prevalence of Middle Mesial Canals and Isthmi in the Mesial Root of Mandibular Molars: An In Vivo Cone-beam Computed Tomographic Study.

INTRODUCTION: Many studies have investigated the morphology of the mandibular molar, but the prevalence of the middle mesial (MM) canal in the mesial root of the mandibular molar is still the subject of controversy. In addition, in previous literature, a true MM canal has not been clearly distinguished from an isthmus between the mesiobuccal and mesiolingual canals. Therefore, the objectives of this study were 2-fold: METHODS: Ninety limited field of view cone-beam computed tomographic scans were observed. One hundred twenty-two mature mandibular first and second molars with no previous root canal treatment, no root resorption, and intact crowns were retrospectively evaluated. Data regarding the sex, age, presence of MM canals, and number of root canals in the mesial root were recorded. RESULT: Of the 122 teeth, 20 (16.4%) had true MM canals. The prevalence of MM canals was 26% in first molars and 8% in second molars (P < .05). The frequency of isthmi in the mesial roots was 64.7%. The frequency of isthmi was higher in second molars, but the difference was not statistically significant (P > .05). CONCLUSIONS: This study showed a high prevalence of mandibular molars with MM canals or isthmi. The detection and biomechanical cleaning of these areas during nonsurgical or surgical root canal treatment are critical.

Radiographic features of plasma cell leukemia in the maxilla: A case report.

Plasma cell leukemia (PCL) is an aggressive form of multiple myeloma where there is hematogenous spread of abnormal plasma cells into the periphery. This is opposed to multiple myeloma, where the abnormal plasma cells stay in the bone marrow. PCL is more common in males than females, and is also more common in African-Americans than Caucasians. Signs and symptoms of PCL include, but are not limited to, renal insufficiency, hypercalcemia, anemia, lytic bone lesions, thrombocytopenia, hepatomegaly, and splenomegaly. Here, we discussed a case of a 71-year-old Caucasian female recently diagnosed with primary PCL with radiographic features of this disease throughout the body, with an emphasis on the maxillofacial skeleton and relevance from a dental standpoint.

Long-standing chin-augmenting costochondral graft creating a diagnostic challenge: A case report and literature review.

To our knowledge, the imaging features of costochondral grafts (CCGs) on cone-beam computed tomography (CBCT) have not been documented in the literature. We present the case of a CCG in the facial soft tissue to the anterior mandible, with changes mimicking a cartilaginous neoplasm. This is the first report to describe the CBCT imaging features of a long-standing graft in the anterior mandible. Implants or grafts may be incidental findings on radiographic images made for unrelated purposes. Although most are well-defined and radiographically homogeneous, being of relatively inert non-biological material, immune reactions to some grafts may stimulate alterations in the appearance of surrounding tissues. Biological implants may undergo growth and differentiation, causing their appearance to mimic neoplastic lesions. We present the case of a cosmetic autogenous CCG that posed a diagnostic challenge both radiographically and histopathologically.

Incidental Findings on Cone Beam Computed Tomography Studies outside of the Maxillofacial Skeleton.

Objective. To define the presence and prevalence of incidental findings in and around the base of skull from large field-of-view CBCT of the maxillofacial region and to determine their clinical importance. Methods. Four hundred consecutive large fields of view CBCT scans viewed from January 1, 2007, to January 1, 2014, were retrospectively evaluated for incidental findings of the cervical vertebrae and surrounding structures. Findings were categorized into cervical vertebrae, intracranial, soft tissue, airway, carotid artery, lymph node, and skull base findings. Results. A total of 653 incidental findings were identified in 309 of the 400 CBCT scans. The most prevalent incidental findings were soft tissue calcifications (29.71%), followed by intracranial calcifications (27.11%), cervical vertebrae (20.06%), airway (11.49%), external carotid artery calcification (10.41%), lymph node calcification (0.77%), subcutaneous tissue calcification and calcified tendonitis of the longus colli muscle (0.3%), and skull base finding (0.15%). A significant portion of the incidental findings (31.24%) required referral, 17.76% required monitoring, and 51% did not require either. Conclusion. A comprehensive review of the CBCT images beyond the region of interest, especially incidental findings in the base of skull, cervical vertebrae, pharyngeal airway, and soft tissue, is necessary to avoid overlooking clinically significant lesions.

Advances in endodontics: Potential applications in clinical practice.

Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) endodontic imaging, (2) root canal preparation, (3) root canal disinfection, (4) root canal filling, and (4) regenerative endodontic procedures (REPs). Jointly, these advances are aimed at improving the state of the art and science of root canal treatment.

Radiographic manifestations of Mönckeberg arteriosclerosis in the head and neck region.

Mönckeberg sclerosis is a disease of unknown etiology, characterized by dystrophic calcification within the arterial tunica media of the lower extremities leading to reduced arterial compliance. Medial calcinosis does not obstruct the lumina of the arteries, and therefore does not lead to symptoms or signs of limb or organ ischemia. Mönckeberg sclerosis most commonly occurs in aged and diabetic individuals and in patients on dialysis. Mönckeberg arteriosclerosis is frequently observed in the visceral arteries, and it can occur in the head and neck region as well. This report describes a remarkable case of Mönckeberg arteriosclerosis in the head and neck region as detected on dental imaging studies. To the best of our knowledge, this is the first case that has been reported in which this condition presented in the facial vasculature. The aim of this report was to define the radiographic characteristics of Mönckeberg arteriosclerosis in an effort to assist health care providers in diagnosing and managing this condition.

Incidental findings of skull-base abnormalities in cone-beam computed tomography scans with consultation by maxillofacial radiologists.

INTRODUCTION: Cone-beam computed tomography (CBCT) gives orthodontists and other dental clinicians 3-dimensional information for planning treatment in the craniofacial region. Often overlooked are incidental findings outside the treatment region of interest. METHODS: Two patients with incidental findings of skull-base abnormalities are presented. The orthodontic patient was tentatively diagnosed with a notochordal remnant in the clivus; the implant patient exhibited an empty sella turcica. RESULTS: For the clivus lesion in the orthodontic patient, an artifact was ruled out after a second CBCT image and further distinguished from a fat-containing tumor after magnetic resonance imaging. The impression after magnetic resonance imaging was a notochordal remnant, although chordoma was also included in the differential, warranting a 6-month follow-up magnetic resonance image to confirm the diagnosis. The CBCT study for the implant patient demonstrated an enlarged sella turcica. The impression after the magnetic resonance imaging was an enlarged and partially empty sella with no evidence of a pituitary mass. CONCLUSIONS: Orthodontists and implant surgeons may come across incidental findings outside their area of expertise on CBCT scans, highlighting the importance of appropriate consultation with maxillofacial radiologists. Notochordal remnants may present as nonexpansile intraosseous low-density areas. The challenge in distinguishing these lesions radiographically with chordomas warrants follow-up to confirm a diagnosis. An empty sella is a noteworthy finding because of its potential for endocrine and neuro-ophthalmological disorders despite an asymptomatic presentation.

Arrested Pneumatization of the Sphenoid Sinus on Large Field-of-View Cone Beam Computed Tomography Studies.

Arrested pneumatization of the sphenoid sinus is a normal anatomical variant. The aim of this report is to define cone beam computed tomography (CBCT) characteristics of arrested pneumatization of sphenoid sinus in an effort to help differentiate it from invasive or lytic skull base lesions. Two cases are presented with incidental findings. Both studies, acquired for other diagnostic purposes, demonstrated unique osseous patterns that were eventually deemed to be anatomic variations in the absence of clinical signs and symptoms although the pattern of bone loss and remodeling was diagnosed as pneumatization of the sphenoid sinus by a panel of medical and maxillofacial radiologists following contrasted advanced imaging. It is important to differentiate arrested pneumatization of the sphenoid sinus from lesions, such as arachnoid granulations, acoustic neuroma, glioma, metastatic lesions, meningioma, or chordoma, to prevent unnecessary biopsies or exploratory surgeries that would consequently reduce treatment costs and alleviate anxiety in patients.

Multiple myeloma in bisphosphonate-affected jaws--a diagnostic challenge: case report.

OBJECTIVE: To discuss the challenges in diagnosis and appropriate management of critical underlying pathoses if a patient presents with signs and symptoms indicative of different conditions that may coexist. SUMMARY: This case features clinical and radiographic challenges in reaching a diagnosis in a middle- aged man undergoing bisphosphonate therapy for multiple myeloma. The patient had history of bisphosphonaterelated osteonecrosis of the jaw (BRONJ) in the mandible. The patient presented with pain and swelling in the anterior maxilla, associated with paresthesia of upper lip. The radiographic features were suggestive of BRONJ and invasive fungal sinusitis. MRI appearance was suggestive of malignant involvement by plasmacytoma or lymphoma. Although biopsy is usually not advocated in bisphosphonate-affected jaws, it was advised in this case and was positive for multiple myeloma. Vigilance is required to correlate clinical and radiologic findings and further investigations must be considered if malignancy is suspected.