Occlusal Radiographs in a Turkish Pediatric Subpopulation.

Objectives: Dental radiographs are a useful diagnostic aid in the oral health care and dental treatment of children. The most commonly used radiographs are periapical and panoramic radiographs. Occlusal radiographs are preferred in more specific cases. The aim of this study was to retrospectively evaluate the reasons for obtaining occlusal radiographs in pediatric patients. Material and methods: Occlusal radiographs of patients aged 1-13 years who attended the Pediatric Dentistry Clinic of Ondokuz Mayis University Faculty of Dentistry between 01 August 2015 and 01 August 2020 were retrospectively evaluated. Patients with syndromes and diseases that could cause cleft lip and palate and dental anomalies were not included in the study. The medical history of the 354 patients who were included in the study was provided by the automated system. Results: A total of 359 occlusal radiographs from these patients were analysed. The number of male patients included in the study was 208 and the number of female patients was 146. Occlusal radiographs of the maxilla of 312 patients were taken, of the mandible of 37 patients, and both the upper and lower jaws of 5 patients. It was found that occlusal radiographs were taken mostly for dental trauma in the permanent dentition (156), injuries in the primary dentition (68) and for the diagnosis of dental anomalies (57). Conclusions: Occlusal radiographs are taken for specific situations in pediatric dentistry and are particularly useful in the detection and diagnosis of primary and permanent tooth injuries.

Contrast arthrography of the equine temporomandibular joint.

Background: Disorders of the equine temporomandibular joint (TMJ) cause clinical problems and detailed investigations of this joint are becoming more common. Specialist radiographic projections have the potential to highlight osseous abnormalities; however, the ability to assess the intra-articular soft tissue structures is currently limited to computed tomography (with, or without contrast enhancement) or magnetic resonance imaging. Both modalities are expensive and not readily accessible. Objective: To develop a technique of contrast arthrography of both compartments of the equine TMJ in cadavers and then perform the refined technique in three living horses as a proof-of-principle. Study design: A descriptive, experimental, study. Methods: Contrast arthrography of the discomandibular and discotemporal joint compartments of both TMJs was performed in 12 cadaveric equine heads using needles placed in the caudal pouches of the respective joint compartments. Radiographs were taken using previously published techniques, repeated with the mouth open and after air had been injected into the joints, to perform a double-contrast study. The TMJs of three healthy horses were subsequently examined to determine the validity of the procedure in live animals. Results: Single and double-contrast arthrography allowed delineation of the dorsal and ventral surfaces of the intra-articular disc in addition to filling the rostral and caudal joint pouches of the independent joint compartments. Contrast extravasation was common, and in two instances iatrogenic disc penetration resulted in the false diagnosis of pathologic disc perforation. The techniques were well tolerated in all three live horses. Main limitations: Low number of horses. Conclusion: Contrast arthrography allows interpretation of intra-articular soft tissue structures, but caution is advised in diagnosing intra-articular disc perforation. Even with experience, accessing the discomandibular joint can be challenging.

Comparison of the diagnostic and prognostic abilities of flexible laryngoscopy and dynamic digital radiography for vocal cord paralysis: A prospective observational study.

BACKGROUND: Although flexible laryngoscopy (FL) is the reference modality for diagnosing vocal cord paralysis (VCP), FL involves patient discomfort and insertion intolerance. Dynamic digital radiography (DDR) with high spatial and temporal resolution is easier to use and less invasive when evaluating VCP. METHODS: Seventy-eight patients underwent FL and DDR before and after neck surgery. Qualitative and quantitative vocal cord movement (VCM) evaluations were conducted. Patients with postoperative VCP were followed-up regularly. RESULTS: DDR exhibited diagnostic performance with 67% sensitivity and 100% specificity. The cutoff for VCM was 2.4 mm, with DDR exhibiting 100% sensitivity and 78% specificity. All cords with transient VCP had positive VCM at both 3 weeks and 2 months. Additionally, 50% and 75% of cords with permanent VCP had negative VCM at 3 weeks and 2 months, respectively. CONCLUSIONS: DDR is promising for the diagnosis of postoperative VCP and early prediction of permanent postoperative VCP.

An atypical case involving real, ghost, and pseudo-ghost images on a panoramic radiograph.

Purpose: This report presents a unique case featuring real, ghost, and pseudo-ghost images on the panoramic radiograph of a patient wearing earrings. It also explains the formation of these images in an easy-to-understand manner. Material and Methods: One real image and two ghost images appeared on each side of a panoramic radiograph of a patient wearing earrings on both sides. Of the two ghost images on each side, one was considered a typical ghost image and the other was considered a ghost-like real image (pseudo-ghost image). The formation zones of the real, double, and ghost images were examined based on the path and angles of the X-ray beam from the Planmeca ProMax. To simulate the pseudo-ghost and typical ghost images on panoramic radiography, a radiopaque marker was affixed to the right mandibular condyle of a dry mandible, and the position of the mandible was adjusted accordingly. Results: The center of rotation of the Planmeca ProMax extended beyond the jaw area, and the area of double image formation also reached beyond the jaw. The radiopaque-marked mandibular condyle, situated in the outwardly extending area of double image formation, exhibited triple images consisting of real, double (pseudo-ghost), and ghost images. These findings helped to explain the image formation associated with the patient's earrings observed in the panoramic radiograph. Conclusion: Dentists must understand the characteristics and principles of the panoramic equipment they use and apply this understanding to taking and interpreting panoramic radiographs.

Deep learning-based automatic segmentation of the mandibular canal on panoramic radiographs: A multi-device study.

Purpose: The objective of this study was to propose a deep-learning model for the detection of the mandibular canal on dental panoramic radiographs. Materials and Methods: A total of 2,100 panoramic radiographs (PANs) were collected from 3 different machines: RAYSCAN Alpha (n=700, PAN A), OP-100 (n=700, PAN B), and CS8100 (n=700, PAN C). Initially, an oral and maxillofacial radiologist coarsely annotated the mandibular canals. For deep learning analysis, convolutional neural networks (CNNs) utilizing U-Net architecture were employed for automated canal segmentation. Seven independent networks were trained using training sets representing all possible combinations of the 3 groups. These networks were then assessed using a hold-out test dataset. Results: Among the 7 networks evaluated, the network trained with all 3 available groups achieved an average precision of 90.6%, a recall of 87.4%, and a Dice similarity coefficient (DSC) of 88.9%. The 3 networks trained using each of the 3 possible 2-group combinations also demonstrated reliable performance for mandibular canal segmentation, as follows: 1) PAN A and B exhibited a mean DSC of 87.9%, 2) PAN A and C displayed a mean DSC of 87.8%, and 3) PAN B and C demonstrated a mean DSC of 88.4%. Conclusion: This multi-device study indicated that the examined CNN-based deep learning approach can achieve excellent canal segmentation performance, with a DSC exceeding 88%. Furthermore, the study highlighted the importance of considering the characteristics of panoramic radiographs when developing a robust deep-learning network, rather than depending solely on the size of the dataset.

Deep learning system for distinguishing between nasopalatine duct cysts and radicular cysts arising in the midline region of the anterior maxilla on panoramic radiographs.

Purpose: The aims of this study were to create a deep learning model to distinguish between nasopalatine duct cysts (NDCs), radicular cysts, and no-lesions (normal) in the midline region of the anterior maxilla on panoramic radiographs and to compare its performance with that of dental residents. Materials and Methods: One hundred patients with a confirmed diagnosis of NDC (53 men, 47 women; average age, 44.6±16.5 years), 100 with radicular cysts (49 men, 51 women; average age, 47.5±16.4 years), and 100 with normal groups (56 men, 44 women; average age, 34.4±14.6 years) were enrolled in this study. Cases were randomly assigned to the training datasets (80%) and the test dataset (20%). Then, 20% of the training data were randomly assigned as validation data. A learning model was created using a customized DetectNet built in Digits version 5.0 (NVIDIA, Santa Clara, USA). The performance of the deep learning system was assessed and compared with that of two dental residents. Results: The performance of the deep learning system was superior to that of the dental residents except for the recall of radicular cysts. The areas under the curve (AUCs) for NDCs and radicular cysts in the deep learning system were significantly higher than those of the dental residents. The results for the dental residents revealed a significant difference in AUC between NDCs and normal groups. Conclusion: This study showed superior performance in detecting NDCs and radicular cysts and in distinguishing between these lesions and normal groups.

Impact of dental imaging on pregnant women and recommendations for fetal radiation safety: A systematic review.

Purpose: This study was conducted to investigate the safety of dental imaging in pregnant women with respect to fetal health. Materials and Methods: Searches were conducted of the PubMed, Scopus, and Web of Science databases in May 2023. The inclusion criteria encompassed cross-sectional and longitudinal studies that focused on the analysis of diagnostic dental imaging in pregnant women, as well as studies utilizing phantoms to simulate imaging examinations. The exclusion criteria consisted of reviews, letters to the editor, book chapters, and abstracts from scientific conferences and seminars. Results: A total of 3,913 articles were identified. Based on a review of the titles and abstracts, 3,892 articles were excluded, leaving 21 articles remaining for full-text review. Of these, 18 were excluded, and 4 additional articles were included as cross-references. Ultimately, 7 articles underwent quantitative-qualitative analysis. Three retrospective studies were focused on pregnant women who underwent dental imaging procedures. The remaining 4 studies utilized female phantoms to simulate imaging examinations and represent the radiation doses absorbed by the uterus or thyroid. Conclusion: Few dental radiology studies have been conducted to determine the safe radiation threshold for pregnant women. Additionally, the reviewed articles did not provide numbers of dental examinations, by type, corresponding to this dose. Dental imaging examinations of pregnant women should not be restricted if clinically indicated. Ultimately, practitioners must be able to justify the examination and should adhere to the "as low as diagnostically acceptable, being indication-oriented and patient-specific" (ALADAIP) principle of radioprotection.

Eustachian tube calcification as an unusual finding on a panoramic radiograph.

The author herein presents an unusual case of eustachian tube calcification masquerading as loose radiopacities in the temporomandibular joints on a panoramic image, creating a diagnostic challenge. The patient, a 72-year-old woman, presented to the dental service for implant treatment to improve her masticatory function. A cone-beam computed tomography scan was performed and reviewed by a board-certified oral and maxillofacial radiologist. The scan showed no evidence of calcifications in the temporomandibular joints; however, it revealed nodular calcifications within the cartilaginous portion of the eustachian tube bilaterally. Additionally, this report briefly reviews the differential diagnosis of calcified loose bodies in the temporomandibular joint and provides information that needs to be reinforced periodically.

Differences in the panoramic appearance of cleft alveolus patients with or without a cleft palate.

Purpose: The purpose of this study was to clarify the panoramic image differences of cleft alveolus patients with or without a cleft palate, with emphases on the visibility of the line formed by the junction between the nasal septum and nasal floor (the upper line) and the appearances of the maxillary lateral incisor. Materials and Methods: Panoramic radiographs of 238 patients with cleft alveolus were analyzed for the visibility of the upper line, including clear, obscure or invisible, and the appearances of the maxillary lateral incisor, regarding congenital absence, incomplete growth, delayed eruption and medial inclination. Differences in the distribution ratio of these visibility and appearances were verified between the patients with and without a cleft palate using the chi-square test. Results: There was a significant difference in the visibility distribution of the upper line between the patients with and without a cleft palate (p<0.05). In most of the patients with a cleft palate, the upper line was not observed. In the unilateral cleft alveolus patients, the medial inclination of the maxillary lateral incisor was more frequently observed in patients with a cleft palate than in patients without a cleft palate. Conclusion: Two differences were identified in panoramic appearances. The first was the disappearance (invisible appearance) of the upper line in patients with a cleft palate, and the second was a change in the medial inclination on the affected side maxillary lateral incisor in unilateral cleft alveolus patients with a cleft palate.

Pediatric mandibular chronic nonbacterial osteomyelitis: A case report with 12 years of radiologic follow-up.

Chronic nonbacterial osteomyelitis (CNO) is histologically characterized by nonspecific osteitis. This inflammatory disorder, which lacks an infectious origin, typically presents with chronic pain and swelling at the affected site that can persist for months or even years. However, it is rare for CNO to affect the mandible. A 10-year-old girl presented with a primary complaint of pain in her left mandible. She had no significant medical or dental history. On examination, swelling was visible on the left buccal side, and imaging revealed radiolucent bone deterioration within the left mandible. This case report presents the radiological changes observed over a 12-year follow-up period. Variations in radiopacity, radiolucency, and periosteal reactions were noted periodically. This case highlights the radiological characteristics and findings that are crucial for the diagnosis of CNO, a condition for which no clear diagnostic criteria are currently available.

A Review on Cone-Beam Computed Tomography and its Application in Dentistry.

Cone-beam computed tomography (CBCT), which has benefits over traditional radiography in this age of cutting-edge technology, has become increasingly popular in oral radiology. The utilization of CBCT is experiencing significant growth in several dental specialties, mainly for diagnostic purposes and treatment planning. Image acquisition and 3D imaging have helped the clinical use of cone-beam technology. The equipment has a user-friendly interface, minimum image distortion, and images compatible with many planning and simulation software applications. The present literature review aims to discuss CBCT and its various applications in dentistry.

Evaluating the Role of Nanoparticles in Enhancing Bone Regeneration in Dental Implantology.

Background: Dental implantology has witnessed substantial progress in recent years, driven by a growing emphasis on optimizing bone regeneration around dental implants. Nanoparticles have emerged as a potential tool for enhancing osseointegration and bone tissue regeneration. Materials and Methods: This human clinical trial enrolled 60 adult participants requiring dental implants. Patients were randomly assigned to one of two groups: a control group receiving conventional dental implants, and an experimental group receiving dental implants with nanoparticle-coated surfaces. Radiographic imaging, histological analysis of bone biopsies, and implant stability assessments were conducted at three and six months post-implantation. Results: Histological examination of bone biopsies revealed a statistically significant increase in new bone formation in the experimental group compared to the control group at both three and six months (P < 0.05). Radiographic assessment demonstrated a 25% higher bone density around nanoparticle-coated implants (P < 0.01) at the six-month mark. Implant stability quotient (ISQ) measurements indicated a 20% greater stability in the experimental group (P < 0.05) at the same time point. Conclusion: This human clinical trial provides strong evidence that the incorporation of nanoparticles on dental implant surfaces enhances bone regeneration and osseointegration in a human population.

Accuracy of CBCT in Preoperative Assessment of Impacted Canines vs. Panoramic Radiography.

Background: Accurate assessment of impacted canines is crucial for successful treatment planning. Radiographic techniques like Cone Beam Computed Tomography (CBCT) and Panoramic Radiography are commonly used, but their comparative accuracy remains under scrutiny. Materials and Methods: In this study, 50 patients diagnosed with impacted canines were enrolled. Both CBCT and Panoramic Radiography images were obtained for each patient using standard protocols. Two experienced dentists independently analyzed the images to determine the position of impacted canines and their relationship with neighboring structures. Results: The findings of this study revealed that CBCT provided superior accuracy in assessing the position of impacted canines compared to Panoramic Radiography. Specifically, CBCT demonstrated a mean accuracy rate of 89.5%, while Panoramic Radiography showed a mean accuracy rate of 72.3%. Moreover, CBCT allowed for better visualization of impacted canine angulation, depth, and spatial orientation. Panoramic Radiography, on the other hand, displayed limitations in precisely identifying the impacted canine's position. Conclusion: The study's outcomes underscore the higher accuracy of CBCT over Panoramic Radiography in the preoperative assessment of impacted canines. CBCT's detailed imaging provides valuable insights for treatment planning, potentially leading to improved surgical outcomes. Although CBCT entails greater radiation exposure and cost, its benefits in accurate diagnosis and treatment planning justify its use in cases of impacted canines.

Routine 6-Week Outpatient Radiography and Visit in Patients with Conservatively Treated Multiple Rib Fractures: Valuable or a Waste of Resources?

Background: This study investigated the incidence and clinical consequences of abnormal radiological and clinical findings during routinely performed 6-week outpatient visits in patients treated conservatively for multiple (3 or more) rib fractures. Methods: A retrospective analysis was conducted among patients with multiple rib fractures treated conservatively between 2018 and 2021 (Opvent database). The primary outcome was the incidence of abnormalities on chest X-ray (CXR) and their clinical consequences, which were categorized as requiring intervention or additional clinical/radiological examination. The secondary focus was the incidence of deviation from standard treatment in response to the findings (clinical or radiological) at the routine 6-week outpatient visit. Results: In total, 364 patients were included, of whom 246 had a 6-week visit with CXR. The median age was 57 years (interquartile range, 46-70 years) and the median Injury Severity Score was 17 (interquartile range, 13-22). Forty-six abnormalities (18.7%) were found on CXR. These abnormalities resulted in additional outpatient visits in 4 patients (1.5%) and in chest drain insertion in 2 (0.8%). Only 2 patients (0.8%) with an abnormality on CXR presented without symptoms. None of the 118 patients who had visits without CXR experienced problems. Conclusion: Routine 6-week outpatient visits for patients with conservatively treated multiple rib fractures infrequently revealed abnormalities requiring treatment modifications. It may be questioned whether the 6-week outpatient visit is even necessary. Instead, a more targeted approach could be adopted, providing follow-up to high-risk or high-demand patients only, or offering guidance on recognizing warning signs and providing aftercare through a smartphone application.

A novel method of assessing intraoperative surgical margins in patients with dermatofibrosarcoma protuberans: A specimen radiography system.

Background Dermatofibrosarcoma protuberans (DFSP) is one of the most challenging cutaneous cancers in surgical clinic practice. Excision with negative margins is essential for effective disease control. However, wide surgical margins and maximal tissue conservation are mutually exclusive. Mohs micrographic surgery conserves tissue but is time-consuming. Thus, we developed a novel specimen radiography system that can be used intraoperatively. Aims To introduce a specimen radiography system for evaluating intraoperative surgical margins in patients with dermatofibrosarcoma protuberans. Methods Since September 2017, we have treated seven biopsy-proven cases of local DFSPs via local excision with surgical margins of 2-4 cm. During operations, the operative specimens were screened using the specimen radiography system. All surgical specimens were pathologically examined intraoperatively. Results Five patients were men and two were women, of median age 36 years. The mean radiographic screening time was 9.7 ± 2.3 min. Radiographically negative margins were confirmed intraoperatively. The minimal margin width ranged from 5.0 to 35.4 mm (mean width 16.9 ± 10.4 mm). The intraoperatively negative radiographic margins were consistent with those revealed by postoperative pathology. The minimal pathological margin width ranged from 4.0 to 34.5 mm (mean 16.6 ± 10.1 mm) and was not significantly different from the intraoperative data. Limitations The sample size was small and positive or negative predictive values were not calculated. Conclusions We introduce a novel method of intraoperative surgical margin assessment for DFSP patients. It may find broad clinical and research applications during oncoplastic surgery.

"Rhin sling," A Novel Type of Shoulder Sling in Post-Stroke Shoulder Subluxation: A Case Report.

This case report introduces a novel type of shoulder prosthesis in 2 patients with hemiplegic shoulder subluxation. A unique reel traction device was incorporated to allow easy traction and accurate correction of joint subluxation. X-ray images taken before and after application showed immediate correction effects that were maintained up to 2 hours after application with no change of sling position. These 2 cases support the idea that this new type of shoulder sling could be applied for therapeutic and corrective purposes in hemiplegic stroke patients with shoulder subluxation.

Current updates in MSK infection imaging: A narrative review.

This article presents a comprehensive overview of the diagnostic utility of existing imaging techniques including radiography, computed tomography, ultrasonography, magnetic resonance imaging (MRI), and radionuclide imaging in the context of the most common orthopaedic or musculoskeletal infections. It also includes illustrative images showcasing significant findings in various musculoskeletal infections including osteomyelitis, cellulitis, septic arthritis, necrotising infections and peri-prosthetic joint infections and their associated complications.

Comparative evaluation and patient satisfaction with an electrical impedance-based device versus digital radiography in the estimation of remaining dentin thickness in carious posterior permanent teeth: (Diagnostic accuracy study).

BACKGROUND: Accurate assessment of remaining dentin thickness (RDT) is paramount for restorative decisions and treatment planning of vital teeth to avoid any pulpal injury. This diagnostic accuracy study compared the validity and patient satisfaction of an electrical impedance based device Prepometer™ (Hager & Werken, Duisburg, Germany) versus intraoral digital radiography for the estimation of remaining dentin thickness in carious posterior permanent teeth. METHODS: Seventy patients aged 12-25 years with carious occlusal or proximal permanent vital posterior teeth were recruited. Tooth preparation was performed to receive an adhesive restoration. Pre- and post-excavation RDT were measured radiographically by two calibrated raters using the paralleling periapical technique. Prepometer™ measurements were performed by the operator. Patients rated their satisfaction level with each tool on a 4-point Likert scale and 100 mm visual analog scale (VAS). Inter and intragroup comparisons were analyzed using signed rank test, while agreement between devices and observations was tested using weight kappa (WK) coefficient. RESULTS: the intergroup comparisons showed that, before and after excavation, there was a significant difference between measurements made by both techniques (p < 0.001). After excavation, there was a weak agreement between measurements (WK = 0.2, p < 0.001), whereas before excavation, the agreement was not statistically significant (p = 0.407). Patients were significantly more satisfied with Prepometer™ based on scales and VAS (p < 0.001). CONCLUSION: Prepometer™ could be a viable clinical tool for determining RDT with high patient satisfaction, while radiographs tended to overestimate RDT in relation to the Prepometer™.

Target sign in COVID-19, radiological interpretation and diagnostic contribution of digital thoracic tomosynthesis.

INTRODUCTION: Our objectives are: To describe the radiological semiology, clinical-analytical features and prognosis related to the target sign (TS) in COVID-19. To determine whether digital thoracic tomosynthesis (DTT) improves the diagnostic ability of radiography. MATERIAL AND METHODS: Retrospective, descriptive, single-centre, case series study, accepted by our ethical committee. Radiological, clinical, analytical and follow-up characteristics of patients with COVID-19 and TS on radiography and DTT between November 2020 and January 2021 were analysed. RESULTS: Eleven TS were collected in 7 patients, median age 35 years, 57% male. All TS presented with a central nodule and a peripheral ring, and in at least 82%, the lung in between was of normal density. All TS were located in peripheral, basal regions and 91% in posterior regions. TS were multiple in 43%. Contiguous TS shared the peripheral ring. Other findings related to pneumonia were associated in 86% of patients. DTT detected 82% more TS than radiography. Only one patient underwent a CT angiography of the pulmonary arteries, positive for acute pulmonary thromboembolism. Seventy-one per cent presented with pleuritic pain. No distinctive laboratory findings or prognostic worsening were detected. CONCLUSIONS: TS in COVID-19 predominates in peripheral and declining regions and can be multiple. Pulmonary thromboembolism was detected in one case. It occurs in young people, frequently with pleuritic pain and does not worsen the prognosis. DTT detects more than 80 % of TS than radiography.