Evaluation of the effect of sickle cell disease on the mandibular bone of children and adolescents by image texture and radiomorphometric analysis.

OBJECTIVES: Sickle cell disease (SCD) can cause osteoporotic changes in the jaw bones. In this study, it was aimed to evaluate possible bone changes using fractal analysis (FA) and morphometric analyses in dental panoramic radiographs of children and adolescents diagnosed with both homozygous and heterozygous forms of SCD. METHODS: Sixty-five individuals (33 SCD, 32 controls) aged 6-17 years were included in the study. Four separate areas of interest (ROI) were selected for the right and left sides of all panoramic radiographs, and the FA value of the ROIs was calculated. Mandibular cortical width (MCW), panoramic mandibular index (PMI) and mandibular cortical index (MCI) and were evaluated. Data were statistically analyzed and p < 0.05 was accepted for statistical significance. RESULTS: Fractal values of right and left ROI1 (the center of the mandibular angle.) and ROI4 (the cortical bone), and right ROI2 (the middle of the mandibular ramus) were statistically lower in the case group (p < 0.05). Right ROI2 and ROI4 fractal values of individuals in the case group were lower than those on the left side (p < 0.05). While MCI categories did not differ from the case-control group (p > 0.05), PMI and MCW values were lower in the case group (p < 0.05). All evaluated parameters did not differ according to age and gender (p > 0.05). CONCLUSION: The results of this study showed that SCD affects the mandible. FA, MCW and PMI parameters can be used to detect early osteoporotic changes in the disease.

Assessment of the Prevalence of Radix Entomolaris and Distolingual Canal in Mandibular First Molars in 15 Countries: A Multinational Cross-sectional Study with Meta-analysis.

AIM: The aim of this study was two-folded: i) to assess the prevalence of Distolingual Canal (DLC) and Radix Entomolaris (RE) in Mandibular First Molars (M1Ms), using Cone Beam Computed Tomography (CBCT) images and ii) to assess the impact of sociodemographic factors on the prevalence of these conditions worldwide. METHODS: CBCT images were scanned retrospectively and the ones including bilateral M1Ms were included in the study. The evaluation was performed by 1 researcher in each country, trained with CBCT technology. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating axial sections from coronal to apical. The presence of DLC and RE in M1Ms (yes/no) was identified and recorded. RESULTS: Six thousand three hundred four CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries regarding the prevalence of both RE and DLC (P < .05). The prevalence of DLC ranged from 3% to 50%, and the overall prevalence was 22% (95% CI: 15%-29%). RE prevalence ranged from 0% to 12%, and the overall prevalence was 3% (95% CI: 2%-5%). There were no significant differences between left and right M1Ms or between genders for either DLC or RE (P > .05). CONCLUSION: The overall prevalence of RE and DLC in M1Ms was 3% and 22%. Additionally, both RE and DLC showed substantial bilaterally. These variations should be considered by endodontic clinicians during endodontic procedures in order to avoid potential complications.

A retrospective comparative fractal and radiomorphometric analysis of the effect of 3 generations of anti-epileptic drugs on the mandible.

OBJECTIVE: The present study investigated the possible impacts of anti-epileptic drugs (AEDs) on trabecular and cortical bone in the mandible. STUDY DESIGN: Fractal dimension (FD) and the radiomorphometric parameters of mandibular cortical width (MCW), panoramic mandibular index (PMI), and mandibular cortical index (MCI) were assessed on 497 dental panoramic radiographs (DPRs) of patients in the case group and controls. AEDs were compared according to 3 generations, duration of use, and patient age and sex. RESULTS: FD of the angle and body of the mandible and MCW were significantly lower in the case group than in the control group (P < .001). FD values in the ramus and angle were lower in first-generation and third-generation AEDs than in second-generation drugs (P ≤ .011). FD in the mandibular body was lower in first-generation and second-generation AED users than in third-generation drugs (P = .017). Drug use for at least 1 year resulted in significantly lower values for all FDs and MCW values and more class 3 MCI assessments than short-duration use, but PMI was higher with more than 1 year of AED use (P ≤ .020). Age and sex had no significant effects. CONCLUSIONS: AEDs caused significant changes in bone compared with controls in some FD values, MCW, and MCI. The effect of drug generation is pronounced in trabecular bone. Anti-epileptic drug use for more than 1 year had a greater effect than short-term use.

Effect of Maxillary Sinus Anatomy on Bone Gain After Lateral Window Sinus Floor Elevation: A Case-Control Study.

Purpose: To evaluate the effect of maxillary sinus anatomy on sinus floor elevation (SFE) operations performed with the lateral window approach. Materials and Methods: CBCT and digital panoramic radiographs were evaluated before and at least 6 months after maxillary sinus floor elevation (SFE) operations performed in 33 maxillary sinus regions in 26 patients. Maxillary sinus volume, grafted volume (GV), sinus width (SW), residual bone height (RBH), and vertical graft resorption (VGR) were calculated. The effects of RBH and SW on GV and VGR were evaluated statistically. Results: The mean GV values in the maxillary sinuses classified as narrow, average, and wide were 2.60 ± 0.57, 3.44 ± 0.65, and 3.70 ± 0.64 cm3, respectively. The mean VGR was 2.12 ± 1.67 mm, and in the sites classified as narrow, average, and wide, the mean VGR values were 1.50 ± 0.79, 1.58 ± 1.28, and 3.46 ± 2.06 mm, respectively. A statistically significant difference in GV and VGR was found between the SW groups. The mean posterior maxillary RBH was 2.30 ± 1.05 mm, and 17 and 16 sinuses were classified as ≤ 2 and > 2 mm, respectively. There was no statistically significant difference in the effect of RBH on GV or VGR. Conclusion: Although posterior maxillary RBH did not affect new bone formation in the sinuses grafted only with hydroxyapatite-derived inorganic bovine bone, with increasing SW, the GV decreased and the VGR increased.

Assessment of the Prevalence of Middle Mesial Canal in Mandibular First Molar: A Multinational Cross-sectional Study with Meta-analysis.

BACKGROUND: An additional canal found in the mandibular first molar (M1M) is the middle mesial canal (MMC), which is often missed during root canal treatment. In this study, the prevalence of MMC in M1M on cone-beam computed tomography (CBCT) images was evaluated in 15 countries, along with the effect of some demographic factors on its prevalence. METHODS: Deidentified CBCT images were scanned retrospectively, and the ones including bilateral M1Ms were included in the study. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating three planes (coronal, sagittal, and axial) after a 3-dimensional alignment of the long axis of the root(s). The presence of an MMC in M1Ms (yes/no) was identified and recorded. RESULTS: In total, 6304 CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries (P < .05). MMC prevalence ranged from 1% to 23%, and the overall prevalence was 7% (95% confidence interval [CI]: 5%-9%). No significant differences were found between the left and right M1M (odds ratio = 1.09, 95% CI: 0.93, 1.27; P > .05) or between genders (odds ratio= 1.07, 95% CI: 0.91, 1.27; P > .05). As for the age groups, no significant differences were found (P > .05). CONCLUSIONS: The prevalence of MMC varies by ethnicity, but it is generally estimated at 7% worldwide. Physicians must pay close attention to the presence of MMC in M1M, especially for opposite M1Ms, due to the prevalence of MMC being significantly bilateral.

Are morphological and morphometric characteristics of maxillary anterior region and nasopalatine canal related to each other?

OBJECTIVES: The main purpose of this article was to clarify the relationship of anterior bone and tooth morphology with NPC. The anatomical features of the NPC region in three dimensions from coronal, axial, and sagittal directions were analyzed using CBCT and the effects of age, gender, sagittal root positions (SRPs) of central teeth, anterior overbite depth (AOD), central incisor (CI)/palatal plane (PP) angle, NPC/PP angle, and collum angles (CA) on NPC were evaluated in a group of the Turkish population. MATERIALS AND METHODS: In this retrospective study, CBCTs of a total of 330 individuals between the ages of 17 and 82 were evaluated. The effects of SRP, AOD, CI/PP angle, NPC/PP angle and CA on the anatomical features of NPC were examined on the basis of age and gender. Descriptive statistics, Kolmogorov-Smirnov, Chi-square, Wilcoxon, Mann-Whitney-U, Kruskal-Wallis, and Spearman correlation tests were used. p values of < 0.05 were accepted as statistically significant. RESULTS: While the SRPs, CI/PP angle, NPC/PP angle, CA, and age did not differ statistically according to NPC shape (p > 0.05), NPC shape varied according to gender and AOD (p < 0.05). It was found that cylindrical NPC (32.8%) was more common in females, while conical-shaped NPC (30.7%) was more common in males (p < 0.01). While most conical NPC was detected in individuals with Class I overbite depth, cylindrical NPCs were found in Class II and III individuals (p < 0.01). CONCLUSIONS: The results showed that gender and AOD are influential factors on NPC shape. While conical-shaped NPC is more common in individuals with bite depth incisal, cylindrical-shaped NPC is more likely to be seen in individuals with middle and cervical thirds.

Assessment of maturation stages and the accuracy of age estimation methods in a Turkish population: A comparative study.

Purpose: This study assessed the associations between chronological age, dental maturation (DM), cervical vertebrae maturation (CVM), and hand-wrist maturation (HWM) in individuals aged 9-19 years. In addition, this study aimed to derive practical methods to evaluate the skeletal age using DM, CVM, or HWM for orthodontic, medical, and forensic purposes and to compare which of these 3 developmental parameters is more accurate for estimating the age of individuals in a Turkish population. Materials and Methods: Panoramic, lateral cephalometric, and hand-wrist radiographs of 284 patients aged 9-19 years were used in this study. The DM, CVM, and HWM stages were determined. The Kolmogorov-Smirnov, kappa, Wilcoxon, Kruskal-Wallis, chi-square, and Spearman correlation tests and simple linear regression analysis were used for statistical analysis. The significance level was 0.05. Results: Statistically significant differences were found between chronological age and DM, chronological age and CVM, and chronological age and HWM in both sexes (P<0.05). DM did not show statistically significant differences according to sex (P>0.05), but CVM and HWM were statistically different between males and females (P<0.05). The DM-estimated age yielded more accurate values than the other methods. Conclusion: All correlations between skeletal and dental stages were statistically significant. Our results showed that there was no statistically significant difference between chronological age and DM-estimated age. Therefore, it can be concluded that DM stages have the potential to be used for legal purposes.

Comparison of cone-beam computed tomography and digital panoramic radiography for detecting peri-implant alveolar bone changes using trabecular micro-structure analysis.

OBJECTIVES: We compared changes in fractal dimension (FD) and grayscale value (GSV) of peri-implant alveolar bone on digital panoramic radiography (DPR) and cone-beam computed tomography (CBCT) immediately after implant surgery and 12 months postoperative. MATERIALS AND METHODS: In this retrospective study, 16 patients who received posterior mandibular area dental implants with CBCT scans taken about 2 weeks after implantation and one year after implantation were analyzed. A region of interest was selected for each patient. FDs and GSVs were evaluated immediately after implant surgery and at 12-month follow-up to examine the functional loading of the implants. RESULTS: There were no significant differences between DPR and CBCT measurements of FD values (P>0.05). No significant differences were observed between FD values and GSVs calculated after implant surgery and at the 12-month follow-up (P>0.05). GSVs were not correlated with FD values (P>0.05). CONCLUSION: The DPR and reconstructed panoramic CBCT images exhibit similar image quality for the assessment of FD. There were no changes in FD values or GSVs of the peri-implant trabecular bone structure at the 12-month postoperative evaluation of the functional loading of the implant in comparison to values immediately after implantation. GSVs representing bone mass do not align with FD values that predict bone microstructural parameters. Therefore, GSVs and FDs should be considered different parameters for assessing bone quality.

Radiomorphometric analysis of edentulous posterior mandibular ridges in the first molar region: a cone-beam computed tomography study.

PURPOSE: The aim of our study was to determine the prevalence and degree of lingual concavities in the first molar region of the mandible to reduce the risk of perforating the lingual cortical bone during dental implant insertion. METHODS: A total of 163 suitable cross-sectional cone-beam computed tomography images of edentulous mandibular first molar regions were evaluated. The mandibular morphology was classified as a U-configuration (undercut), a P-configuration (parallel), or a C-configuration (convex), depending on the shape of the alveolar ridge. The characteristics of lingual concavities, including their depth, angle, vertical location, and additional parameters, were measured. RESULTS: Lingual undercuts had a prevalence of 32.5% in the first molar region. The mean concavity angle was 63.34°±8.26°, and the mean linear concavity depth (LCD) was 3.03±0.99 mm. The mean vertical distances of point P from the alveolar crest (Vc) and from the inferior mandibular border were 9.39±3.39 and 16.25±2.44, respectively. Men displayed a larger vertical height from the alveolar crest to 2 mm coronal to the inferior alveolar nerve (Vcb) and a wider LCD than women (P<0.05). Negative correlations were found between age and buccolingual width at 2 mm apical to the alveolar crest, between age and Vcb, between age and Vc, and between age and LCD (P<0.05). CONCLUSIONS: The prevalence of lingual concavities was 32.5% in this study. Age and gender had statistically significant effects on the lingual morphology. The risk of lingual perforation was higher in young men than in the other groups analyzed.

Is the maxillary sinus volume affected by concha bullosa, nasal septal deviation, and impacted teeth? A CBCT study.

PURPOSE: Various mechanisms play an important role in the growth of maxillary sinus cavities. The purpose of this study was to investigate the correlations of maxillary sinus volume (MSV) with nasal septal deviation (NSD), concha bullosa (CB) and impacted teeth using cone-beam computed tomography (CBCT) images. METHODS: From 55 patients, a total of 110 maxillary sinus images were obtained and examined. Data including age, gender, impacted third molar, canine teeth, NSD, and CB were examined. MSV was measured using the MIMICS software (Materialise HQ Technologielaan, Leuven, Belgium). All statistical analyses were performed using the SPSS (Statistical Package for Social Sciences, version 21) software and p values < 0.05 were considered to indicate statistical significance. RESULTS: Mean volume of the right maxillary sinus was 13.566 cm3, while the left was 13.882 cm3. The rate of patients with right and left impacted third molar teeth was 49.1% and 47.3%, respectively. The rate of right and left impacted canines was 1.8% and 5.5%, respectively. NSD was found in 56.4% of CBCT examinations and right and left CB were observed in 30.9% and 32.7% of the patients' examinations, respectively. Males had a significantly higher mean sinus volume than females for both sides (p < 0.05). There were no significant correlations between MSV and age (p > 0.05). No significant differences were found between MSV and impacted teeth, NSD and CB (p > 0.05). CONCLUSION: NSD, CB, impacted teeth, and age were not found to be related to MSV. Gender had an effect on MSV and males had higher mean sinus volume than females.

Evaluation of morphometric features of fossa navicularis using cone-beam computed tomography in a Turkish subpopulation.

PURPOSE: Fossa navicularis is a bone defect in the clivus. Familiarity with this anatomical variant is important because it is close to vital anatomical structures in the base of the skull. The aim of this study was to determine the prevalence and morphometric properties of fossa navicularis within the clivus in a Turkish subpopulation using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A total of 168 CBCT scans (female: 96, male: 71) were evaluated. High-quality CBCT images of patients without a syndromic condition or a history of neurological disease or surgery were included in the study. The prevalence, depth, length, and width of the fossa navicularis were performed. RESULTS: The prevalence of fossa navicularis was 27.5% (n=46 patients). Sex was not associated with the depth, length, or width of the fossa navicularis (P>0.05). A significant positive correlation was found between age and length of the fossa navicularis (P>0.05). CONCLUSION: Fossa navicularis was found to be rare (27.5%). Anatomical variants of the skull base can also be clearly identified on CBCT images. The results of this study may be useful to radiologists, anatomists, and surgeons interested in the skull base.

Metastatic breast cancer to bilateral mandibular ramus regions.

Metastatic carcinomas to the jaw bones are uncommon and comprise to about 1% of all malignant oral neoplasms. The purpose of this report is to present a rare case of metastatic breast carcinoma to bilateral mandibular ramus regions. The present case report is about a 40-year-old female patient with the complaints of a paresthesia in the right mandibular area of the last month duration. She was referred to our department by her oncologist with the differential diagnosis of osteonecrosis or metastasis. She had undergone modified radical mastectomy for invasive lobular carcinoma of the left breast. Oral cavity examination did not reveal the existence of any ulcer or fistula. Panoramic, cone-beam computed tomography (CBCT), and positron-emission tomography (PET) were used for diagnosing the lesions. In panoramic radiography and CBCT images, there were lytic lesions on the both of right and left coronoid, condyle, and ramus of the mandible. PET results showed us fluoro-2-deoxy-D-glucose uptake in the mandible and vertebrae. On the basis of the patient's medical history and paresthesia of the lower lip and chin, the metastatic disease was highly suspected. The patient was referred to her oncologist for further treatment since it was not amenable to the surgical management. The general dentist or dental specialist should maintain a high level of suspicion while evaluating patients with a history of cancer. Paresthesias of the lower lip and the chin should be considered ominous signs of metastatic disease.

Gender and Age Estimation Using the Morphometric Analysis of Odontoid Process: Is There a Relationship With Dental Maturation?

OBJECTIVE: The purposes of this study were to show that differences in odontoid process related to age and gender using cone beam volumetric tomography, develop regression formulae based on metric data for gender and age estimation in a Turkish population and investigate whether there is a relationship between the odontoid process and dental maturation for usefulness in forensic and bioarchaeological studies. MATERIAL AND METHOD: The study sample included a total of 77 subjects in the age group of 8-22 years. The anterior-posterior and transverse diameters of the odontoid process were measured. Regression formulae were performed for age and gender estimation. The dental maturation levels were determined according to Demirjian's method. RESULT: The mean values of anterior-posterior diameters were significantly larger than those of transverse diameters (P < 0.05). Those values were statistically higher for men than for women (P < 0.05). The lowest correlations were observed for the all measurements of the odontoid process in all cases. There were no significant correlations between the dental maturation levels and all measurements of the odontoid process. CONCLUSION: The findings of the present study state that measurements of the odontoid process can be utilized for age and gender estimation in the Turkish population.

Evaluation of trabecular pattern of mandible using fractal dimension, bone area fraction, and gray scale value: comparison of cone-beam computed tomography and panoramic radiography.

OBJECTIVE: This study was performed to compare the fractal dimension (FD), bone area fraction (BAF), and gray scale value (GSV) on digital panoramic radiography (DPR) and cross-sectional cone-beam computed tomography (CBCT) using image analysis and to determine whether a relationship exists among parameters associated with bone quality. METHODS: Thirty edentulous human hemimandibles were scanned by DPR and CBCT. Ninety regions of interest (ROIs) were evaluated on DPR and CBCT images to calculate the FD and BAF. The GSV of the ROI on CBCT was also calculated. RESULTS: Statistically significant differences were observed in the FD values of the ROIs between DPR and CBCT (p = 0.002) and in the BAF values of ROIs between DPR and CBCT (p = 0.017). The Spearman's correlation test revealed a statistically significant high correlation between the FD and BAF values of the ROIs on DPR and between the FD and BAF values of the ROIs on CBCT (p < 0.01). No significant correlations were observed between the GSVs of ROIs on CBCT and the FD values of ROIs on DPR, the BAF values of ROIs on DPR, the FD values of ROIs on CBCT, and the BAF values of ROIs on CBCT (p > 0.05). CONCLUSIONS: The GSV did not support the FD and BAF. Additionally, DPR and CBCT did not have similar image quality for assessing the FD, BAF, and GSV. In evaluating the trabecular structure, the use of panoramic radiographs should be continued because the image resolution of CBCT is lower and its generalized dose is higher than that of panoramic radiography. These results may serve as a reference for clinical practitioners using dental CBCT to analyze the trabecular structures of alveolar bones.

A comparative study of cone-beam computed tomography and digital panoramic radiography for detecting pulp stones.

PURPOSE: The aim of this study was to compare cone-beam computed tomography (CBCT) and digital panoramic radiography (DPR) for the detection of pulp stones. MATERIALS AND METHODS: DPR and CBCT images of 202 patients were randomly selected from the database of our department. All teeth were evaluated in sagittal, axial, and coronal sections in CBCT images. The systemic condition of patients, the presence of pulp stones, the location of the tooth, the group of teeth, and the presence and depth of caries and restorations were recorded. The presence of pulp stones in molar teeth was compared between DPR and CBCT images. RESULTS: Pulp stones were identified in 105 (52.0%) of the 202 subjects and in 434 (7.7%) of the 5,656 teeth examined. The prevalence of pulp stones was similar between the sexes and across various tooth locations and groups of teeth (P>.05). A positive correlation was observed between age and the number of pulp stones (ρ=0.277, P<.01). Pulp stones were found significantly more often in restored or carious teeth (P<.001). CBCT and DPR showed a significant difference in the detection of pulp stones (P<.001), which were seen more often on DPR than on CBCT. CONCLUSION: DPR, as a 2D imaging system, has inherent limitations leading to the misinterpretation of pulp stones. Restored and carious teeth should be carefully examined for the presence of pulp stones. CBCT imaging is recommended for a definitive assessment in cases where there is a suspicion of a pulp stone on DPR.

Evaluation of styloid process morphology and calcification types in both genders with different ages and dental status.

PURPOSE: The purpose of this study was to investigate the morphology and calcification pattern of the styloid process (SP) and to determine their relations with subjects' age, gender, and dental status. MATERIALS AND METHODS: 910 panoramic radiographs were stratified by age, dental status and gender. The distance between the points where SP leaves the tympanic plate of the temporal bone and the bony tip of SP was measured. Calcification patterns were classified as : (A) Region 1, tympanohyal alone (B) Region 2, stylohyal alone (C) Region 1 and 2, separate (D) Regions 1 and 2, continuous (E) Regions 1, 2, and 3, continuous (F) Regions 1, 2, and 3, separate (G) Regions 1 and 2, continuous, but separate from 3 (H) Regions 2 and 3, separate (I) Regions 2 and 3, continuous, but separate from 1 (J) Region 3 alone (K) Region 3 and 4, continuous (may include calcification in one other region) (L) No styloid process visible. RESULTS: The right SPs were found to be longer than the left (p<0.05). Types D (right 42.9%, left 42%) and E (right 33.3%, left 30.8%) were the most common morphological calcifications on both sides. No statistical difference was found for bilateral SP length between gender, age, and dental status groups. A significant difference was found only for right SP morphological calcification types as to age groups in both genders (p<0.05). No significant difference was found for SP morphological calcification types according to gender and dental status. CONCLUSION: The morphological types are formed at their present area. Even though SP calcification type was determined according to the length of SP, age was not an effective factor on the length, but the morphological calcification type of SP. Therefore, factors other than age may have a role in the development of morphological calcification types. Structural characteristics of SP are not associated with age, gender and dental status.

Efficacy of Twisted File Adaptive, Reciproc and ProTaper Universal Retreatment instruments for root-canal-filling removal: A cone-beam computed tomography study.

The aim of this study was to evaluate the efficacy of Twisted File (TF) Adaptive, Reciproc, and ProTaper Universal Retreatment (UR) System instruments for removing root-canal-filling. Sixty single rooted teeth were decoronated, instrumented and obturated. Preoperative CBCT scans were taken and the teeth were retreated with TF Adaptive, Reciproc, ProTaper UR, or hand files (n=15). Then, the teeth were rescanned, and the percentage volume of the residual root-canal-filling material was established. The total time for retreatment was recorded, and the data was statistically analyzed. The statistical ranking of the residual filling material volume was as follows: hand file=TF Adaptive>ProTaper UR=Reciproc. The ProTaper UR and Reciproc systems required shorter periods of time for retreatment. Root canal filling was more efficiently removed by using Reciproc and ProTaper UR instruments than TF Adaptive instruments and hand files. The TF Adaptive system was advantageous over hand files with regard to operating time.