Radiographic Orofacial Findings of Systemic Diseases.

This article discusses the orofacial clinicoradiographic features of systemic diseases that manifest in the orofacial region. The systemic diseases discussed are grouped into the following: autoimmune diseases, endocrine diseases, bone diseases, hematologic diseases, syndromes, and malignancies. The radiographic manifestation ranges from radiolucent bony destruction, increased bone density, calcification, thinning of cortical plate, loss of trabeculation, missing teeth, and supernumerary teeth. It is imperative for clinicians to be cognizant of these findings, as they may be the first manifestation of these systemic diseases.

Guidelines for oral and maxillofacial imaging: COVID-19 considerations.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing the current coronavirus disease 2019 (COVID-19) pandemic, is not only highly infectious but can induce serious outcomes in vulnerable individuals including dental patients and dental health care personnel (DHCPs). Responses to COVID-19 have been published by the Centers for Disease Control and Prevention and the American Dental Association, but a more specific response is required for the safe practice of oral and maxillofacial radiology. We aim to review the current knowledge of how the disease threatens patients and DHCPs and how to determine which patients are likely to be SARS-CoV-2 infected; consider how the use of personal protective equipment and infection control measures based on current best practices and science can reduce the risk of disease transmission during radiologic procedures; and examine how intraoral radiography, with its potentially greater risk of spreading the disease, might be replaced by extraoral radiographic techniques for certain diagnostic tasks. This is complemented by a flowchart that can be displayed in all dental offices.

Mastoid osteoma: A rare incidental finding in an orthodontic patient.

Mastoid osteomas of the temporal bone are rare, benign, and usually asymptomatic tumors. However, depending on their size and extension, mastoid osteomas may cause facial palsy, a sensation of ear fullness, pressure-related pain, hearing loss, recurrent external ear infections, and chronic discharge. The etiology of mastoid osteomas is still unknown, but congenital, infectious, and traumatic factors have been proposed. Surgical treatment may be performed with minimal postoperative morbidity. In this article, the authors report a case of a 48-year-old woman seeking orthodontic treatment with an unusual retroauricular protruding mass, including the diagnostic process and differential diagnosis. This case supports the essential role of cone-beam computed tomography to analyze and identify the lesion as a mastoid osteoma.

Invasion of the canalis sinuosus by dental implants: A report of 3 cases.

The canalis sinuosus (CS) and its accessory canals (ACs) are anatomical structures in the anterior maxilla. These structures are often neglected when planning implant surgery because their clinical significance is still not well-defined. After a retrospective evaluation of 194 patients rehabilitated with dental implants in the anterior maxilla, 3 patients were identified who presented unexpected chronic neurosensory disturbances without any clinical signs supportive of implant failure. Tomographic assessment using cone-beam computed tomography (CBCT) revealed the invasion of the CS and ACs by dental implants, which appeared to explain the patients' symptoms. The purpose of this report was to familiarize practicing dentists and specialists with the CS and its ACs. Unanticipated neurosensory symptoms after implant placement in the anterior maxilla justify the use of CBCT to rule out an injury to this neurovascular bundle.

Radiographic patterns of multiple myeloma in the jawbones of patients treated with intravenous bisphosphonates.

BACKGROUND: The purpose of this study was to evaluate whether intravenous (IV) bisphosphonate (BP) therapy can change the radiographic patterns of multiple myeloma (MM) in the jawbones. METHODS: The authors evaluated panoramic radiographs obtained from 188 patients with MM for the presence of solitary osteolytic lesions, multiple osteolytic lesions, diffuse osteoporosis, diffuse sclerosis, lamina dura abnormalities, nonhealing alveolar sockets, and bone sequestration. The authors compared results obtained from patients treated with IV BPs with those obtained from patients who had never been exposed to BPs. RESULTS: Multiple osteolytic lesions (P = .001), diffuse osteoporosis (P = .001), and diffuse sclerosis (P = .0036) occurred more often in the mandible in both groups. Solitary osteolytic lesions occurred less frequently in the BP group (P = .0078). Lamina dura abnormalities (P = .0006) and nonhealing alveolar sockets (P = .0021) were associated with BP treatment. CONCLUSIONS: IV BP therapy changes the radiographic patterns of MM in the jawbones. PRACTICAL IMPLICATIONS: The effect of BPs in the maxillofacial area is a matter of concern for health practitioners because this type of medication causes several alterations of the jawbones in patients with cancer.

Panoramic and skull imaging may aid in the identification of multiple myeloma lesions

Background: The purpose of this study was to investigate the presence of punched-out lesions in craniofacial bones using three different radiographic protocols in a large cohort of patients. Material and Methods: One hundred fifty-five MM patients were evaluated using panoramic and skull (frontal and lateral) radiographs, which were performed in all patients at the time of MM diagnosis. The diagnostic potential for detecting punched-out lesions was compared among the radiographic techniques. Results: MM punched-out lesions were identified in 135 (87%) panoramic radiographs, 141 (91%) frontal and 144 (93%) lateral skull radiographs. Punched out-lesions were synchronously present in skull and jawbones in 129 (83.23 %) cases. The lesions were detected exclusively in skull in 18 (11.61%) cases and exclusively in jawbones in 6 (3.87%) cases. Punched out-lesion mainly affected the skull and the jawbones in a synchronous way (p<0.001) rather than separately Conclusions: All investigated radiographic techniques (panoramic, frontal and lateral skull approaches) demonstrated high detection rates for MM punched-out lesions in craniofacial bones. Panoramic radiography may aid to the radiographic protocols to identify multiple myeloma bone lesions (AU)

No disponible

Comparison of mandibular cortical thickness and QCT-derived bone mineral density (BMD) in survivors of childhood acute lymphoblastic leukemia: a retrospective study.

OBJECTIVE: To examine whether panoramic radiograph-determined mandibular cortical thickness correlated with quantitative computed tomography-derived bone mineral density (BMD) in survivors of childhood acute lymphoblastic leukemia (ALL). METHODS: We identified patients treated for ALL at St. Jude Children's Research Hospital, seen in the After Completion of Therapy (ACT) Clinic between January of 2006 and January of 2014 who had QCT-derived BMD and panoramic radiographs obtained within 1 month of each other. Panoramic radiographs were independently scored by a pediatric radiologist, two pediatric dentists, and a general dentist using the Klemetti technique. We used the Spearman's rank correlation test and the multivariate regression model to investigate the effect of evaluator experience on results. RESULTS: The study cohort comprised 181 patients with 320 paired studies: 112 (62%) male, 112 (71%) were white. Median age at ALL diagnosis was 6.4 (range, 0-18.8) years. Median age at study was 11.9 (range, 3.3 to 29.4) years. The median average BMD was 154.6 (range, 0.73-256) mg/cc; median QCT Z-score (age and gender adjusted) was -0.875 (range, -5.04 to 3.2). We found very weak association between panoramic radiograph score and both QCT-BMD average (P = 0.53) and QCT Z-score (P = 0.39). Results were not influenced by level of reader experience. CONCLUSIONS: The Klemetti technique of estimating BMD does not predict BMD deficits in children and young adult survivors of ALL, regardless of reviewer expertise. Alternative methods are needed whereby dental healthcare providers can identify and refer patients at risk for BMD deficits for detailed assessment and intervention.

Development of tools for the oral health and panoramic radiograph evaluation of head and neck cancer patients: a methodological study.

PURPOSE: Describe the methodology used to construct tools for standardized data collection of head and neck cancer patients (HNCP). METHODS: We constructed the Oral Health Evaluation Tool (OHET) and Panoramic Radiograph Evaluation Tool (PRET) for systematic collection of long-term oral clinical/radiographical complications, prevalence, and severity. Tools were pilot-tested in 50 chemoradiation-treated HNCP >6 months post-therapy. RESULTS: Tools allowed for collection of extensive clinical and radiographical data. A medium of 1.9 years had elapsed since chemoradiation completion. Patients had a median of 6 missing teeth, 32.7% had no decay and a medium of 30% had filled surfaces; 42.9% had moderate-to-severe decay. Reduced/thickened saliva was noted in 85.4% and dry mucosa in 93.9%. Gingival bleeding was present in 75.5% HNCP and attachment loss in 86%. Four patients had trismus. CONCLUSIONS: Tools were user friendly and provided comprehensive, reproducible, and inexpensive means to evaluate post-therapy oral health of HNCP. Validation testing is ongoing.

Can dental students be taught to use dental radiographs for osteoporosis screening?

This study investigated the possibility of teaching dental students to detect radiographic changes suggestive of osteoporosis. Twenty-five panoramic radiographs from dental school patients with a history of osteoporosis and radiographic changes suggestive of the disease and twenty-five normal panoramic radiographs were selected by a clinician from the database of the College of Dentistry, University of Tennessee Health Science Center. Twenty students were taught to use the mandibular cortical index (MCI) and detect changes suggestive of osteoporosis. Students also used a five-point scale to determine the diagnostic accuracy of panoramic images for osteoporosis. Intraclass Correlation Coefficient (ICCC) and Cronbach's alpha internal coefficiency statistical tests were used to evaluate interrater reliability among the twenty students and between the students and the radiologist. To test for differences in diagnosis between the gold standard (dental clinician) and the oral radiologist, we performed a McNemar's chi-square test for matched data. The interrater consistency was excellent for both the students (α=0.902) and between the students and the radiologist (α=0.909). The diagnostic accuracy of panoramic images was moderate (Az=0.81). No statistically significant difference between radiographic and clinical evaluations (McNemar's chi-square=3.063; p=0.0801) was observed. Teaching dental students to recognize radiographic changes suggestive of osteoporosis in routine panoramic radiographs should be emphasized to improve their awareness and identification of this disease.

Comparison between intraoral indirect and conventional film-based imaging for the detection of dental root fractures: an ex vivo study.

Digital intraoral radiographic systems have been rapidly replacing conventional dental X-ray films for diagnosis of dental diseases. Current scientific literature supports the use of these digital systems for the detection of dental caries, periodontal bone loss, and periapical pathologies. However, relatively few studies have been published addressing the detection of dental root fractures. The purpose of this study was to compare the intraoral F-speed film (Insight) with two photostimulable phosphor (PSP) indirect digital systems (ScanX and Digora Optime) for the detection of simulated dental root fractures. Ten raters evaluated images acquired from 10 dry human cadaver mandibles under optimal viewing conditions. These data were analyzed by a 5-point receiver operating characteristic curve analysis for statistical differences. Sensitivity and specificity of these systems were also assessed. Since statistically significant difference between the systems was not observed, the results of this study agreeably support indirect digital PSP plates as an alternative to the evaluated conventional film for the detection of dental root fractures.

Diagnostic considerations of calcified lymph nodes.

Dentists are responsible for the diagnosis of abnormalities involving both hard and soft tissues in and around the oral cavity. In addition to a clinical examination, the radiographic evaluation will often highlight abnormalities within the radiographic field. A relatively uncommon radiographic abnormality is calcification of lymph nodes, which may be associated with a number of pathologic processes, both local and systemic. We present and discuss lymph node calcifications and the diagnostic considerations associated with them in order to assist practitioners in managing their patients appropriately.

Three-dimensional location of the retaining screw axis for a cemented single tooth implant restoration.

Retrievability is a major concern with cemented versus screw-retained implant restorations. This article describes the use of cone beam radiography to help target and create a precise screw access opening for a loosened implant-supported single crown retained by cement to its abutment.

Evaluation of interproximal caries using the IPad 2 and a liquid crystal display monitor.

OBJECTIVE: The objective of this study was to compare the detection of interproximal caries in digital intraoral images presented in a 24-inch liquid crystal display (LCD) monitor and the IPad 2. STUDY DESIGN: Twenty-seven digital bitewing radiographs of 102 adult teeth were generated by a charge-coupled device sensor and presented to 4 dentists in 2 sessions. The dentists were asked to rate the presence or absence of carious lesions using a 5-point scale. Differences in sensitivity, specificity, and accuracy were weighted using the Wilcoxon test, and the z test for the receiver operating characteristic curves. RESULTS: For the IPad 2 and LCD monitor, A(z) values were 0.87 and 0.86, respectively. For the tablet, the mean values of sensitivity, specificity, and accuracy were 0.75, 0.86, and 0.83, respectively. For the LCD monitor, these values were 0.77, 0.82, and 0.80, respectively.

Effect of JPEG compression on the diagnostic accuracy of periapical images in the detection of root fracture.

The ability of a periapical radiograph to exhibit the fracture depends on many factors including, but not limited to, the resolution of the image. The quality can be reduced by the image compression. The purpose of this study is to evaluate the effect of Joint Photographic Experts Group (JPEG) compressions on the diagnostic capability of periapical images in the detection of root fractures. Ten dry human mandibles containing 151 teeth were used in this study. Mandibles were radiographed with direct digital imaging sensor using the paralleling technique. Four observers detected root fracture on the images saved in one uncompressed and two compressed formats. Receiver operating characteristic (ROC) and anova analyses were performed to compare the performance of the three different systems and evaluate the effect of the compression on the accuracy of root fracture detection. Results did not show any statistically significant difference between the original, large images presented in tagged image file format (TIFF) and the two compressed images (JPEG medium file and JPEG small file images) in the detection of root fractures. The intra-rater comparison showed a significant consistency in the detection of the fracture. The compression reduced the file size considerably (from 1.77 MB to 453 and 95 Kb), but it did not affect the accuracy of root fracture detection. The file size reduction, on the other hand, is very beneficial for image electronic storage and mainly in teleradiology.

Imaging modalities to access bony tumors and hyperplasic reactions of the temporomandibular joint.

Benign and malignant tumors in the temporomandibular joint (TMJ) are rare. However, when a patient presents with clinical findings such as altered occlusion or facial asymmetry, a morphologic alteration in the condyle should be ruled out. The differential diagnosis for benign hyperplastic bony lesions in the TMJ should include condylar hyperplasia, osteochondroma, osteoma, chondroma, and osteoblastoma. If malignant features are present, chondrosarcoma and osteosarcoma should be considered. For the differential diagnosis, imaging is the most noninvasive method to evaluate the integrity of the TMJ. Imaging can be classified as morphologic or functional according to the information provided. The current scientific data have shown that panoramic images have 97% sensitivity and 45% specificity for identifying hyperplastic conditions in the TMJ. The sensitivity and specificity of medical computed tomography (CT) and cone-beam CT is 70% and 100%, and 80% and 100%, respectively, for the detection of bony abnormalities. To differentiate benign and malignant bony tumors, magnetic resonance imaging has a sensitivity and specificity of 44% and 95%, respectively. The corresponding percentages for single positron emission CT are 91% and 94%, for single positron emission CT/CT are 100% and 100%, for positron emission tomography are 88% and 72%, and for positron emission tomography/CT are 100% and 97%. The combination of morphologic and functional (single positron emission CT and positron emission tomography) modalities appears to improve the sensitivity and specificity to assess a hyperplastic condyle, facilitating treatment planning and providing a better prognosis for the patient.

Applications of cone-beam computed tomography in fractures of the maxillofacial complex.

Imaging plays an essential role in the evaluation of maxillofacial fractures both pre- and postoperatively. Several studies support the use of conventional two-dimensional imaging for traumas involving mainly the mandible, but for more complex situations advanced imaging modalities such as computed tomography (CT) and magnetic resonance imaging have higher indication. Nowadays, besides CT, cone-beam computed tomography (CBCT) has appeared as a reasonable and reliable alternative considering radiation dosage, image quality and comfort for the patient. The purpose of this study was to review the fracture patterns involving the maxillofacial complex, provide a technical and practical comparison between CT and CBCT, and finally present the potential applications of CBCT illustrated with clinical examples.

Application of advanced imaging modalities for the diagnosis of metastatic adenocarcinoma of the lungs in the temporomandibular joint.

Several pathologies, including malignant diseases, may mimic temporomandibular disorders (TMD). Correct diagnosis is important to avoid treatment delay. Several new imaging diagnostic modalities are available and should be used accordingly. This is a case report of a 71-year-old woman with functional limitation and painful symptoms in the preauricular region. She was initially diagnosed and treated as TMD, however with no improvement of the symptoms. Advanced imaging studies were requested. Computerized tomography and magnetic resonance imaging findings were consistent with soft tissue tumor with nonhomogeneous content in the left temporomandibular joint region. Positron emission tomography showed significant radiotracer uptake in the site of the lesion as well as in the lungs, lumbar spine, and bladder, suggesting tumoral metastases. This report emphasizes the importance of imaging in the assessment and establishment of accurate differential diagnosis. Thorough knowledge of the available modalities and their indications is essential to avoid delay in treatment and improve outcomes.

Correlation between retroglossal airway size and body mass index in OSA and non-OSA patients using cone beam CT imaging.

Most obstructive sleep apnea (OSA) patients are overweight, and OSA is substantially more common in obese individuals. In morbidly obese patients, at least 70% suffer from OSA. However, the exact mechanism by which obesity causes OSA is unclear. The aim of this study is to evaluate the retroglossal airway configuration quantitatively and to make clear the relationship between Body mass index (BMI) and airway configuration. This retrospective study included 15 OSA patients (male = 11; female = 4) and 14 normal controls (male = 8; female = 6). We studied the airway configuration on an axial slice at the level of the anterior-inferior corner of the second cervical vertebra. Maximum anterior-posterior diameter (AP) and lateral width (LW) of the airway were measured, and the square area (SA) was calculated. The airway cross-section area (AWA) was also measured, and then the AWA/SA ratio was calculated. AP, LW, and AWA were not statistically significantly different between controls and OSA patients. On the other hand, the AWA/SA ratio in OSA patients was 8.8% statistically significantly smaller than in controls after adjusting for sex, age, and BMI. In this sample, there was a negative correlation between age and the AWA/SA ratio but only in the OSA group. The AWA/SA ratio was significantly negatively correlated with OSA status (R = -0.5; p = 0.008) after adjusting for BMI and age. In this present study, we could evaluate the retroglossal airway configuration quantitatively. The AWA/SA ratio was correlated with OSA status after adjusting for BMI and age.

Evaluation of cross-section airway configuration of obstructive sleep apnea.

Upper airway imaging techniques can be useful to identify the exact location and nature of the obstruction in obstructive sleep apnea (OSA) patients. Ten OSA patients and 10 non-OSA control subjects were imaged using cone-beam computed tomography (NewTom QR-DVT9000) to compare their upper airway structure. The OSA subjects presented higher BMI (OSA: 29.5 +/- 9.05 kg/m(2); non-OSA: 23.1 +/- 3.05 kg/m(2) [P = .034]), lower total volume (mm(3)) of the airway (OSA: 4868.4 +/- 1863.9; non-OSA: 6051.7 +/- 1756.4 [P = .054]), statistically significantly smaller anterior-posterior dimension (mm) of the minimum cross-section segment (OSA: 4.6 +/- 1.2; non-OSA: 7.8 +/- 3.31 [P = .009]), and smaller minimum cross-section area (OSA: 45.8+/-17.5 mm(2); non-OSA: 146.9 +/- 111.7 mm(2) [P = .011]) positioned below the occlusal plane in 70% of the cases (OSA:7 out of 10; non-OSA: 5 out of 10 [P = .030]). The OSA group presented a concave or elliptic shaped airway and the non-OSA group presented a concave, round, or square shaped airway.