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.

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.

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.

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.

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.