Does Fractal Analysis Have a Role in Diagnosis of Langerhans Cell Histiocytosis?

PURPOSE: Langerhans cell histiocytosis (LCH) of the jaws is a rare disease and is often diagnosed at an advanced stage. This study aims to assess the trabecular pattern of jaws via fractal analysis (FA) on initial panoramic radiographs (OPG) of the patients with LCH to facilitate interpretation of the radiographic changes. METHODS: A case-control study investigated LCH cases with jaw involvement retrieved from the databases of Istanbul and Kocaeli Universities between 2010 and 2021. Initial OPGs of LCH cases and OPGs of healthy sex- and age-matched controls were investigated with FA. All images were assessed using ImageJ software. On each OPG, a total of 6 regions of interest (ROIs) located on the mandible were investigated bilaterally. The independent variables were the trabecular patterns of jaws of LCH cases and their control matches. The outcome variables were the fractal dimension (FD) values obtained from the ROIs on OPGs. Data were analyzed using the Mann-Whitney U test and Student's t test. RESULTS: Fifteen LCH-control pairs were investigated. In one ROI located in the supracortical area above the left mandibular angle, FD values of LCH cases (1.273 ± 112.8) were significantly lower than controls (1.308 ± 85.3; P < .05). Lower FD values were also calculated for some of the remaining ROIs, but there was no significant difference between groups (P > .05). CONCLUSIONS: Regarding our results, FA was not a useful parameter to discern radiographical trabecular changes between LCH cases and controls. Multicenter studies with larger populations are needed to investigate the potential of FA in the identification of this rare disease.

High levels of heavy metal accumulation in dental calculus of smokers: a pilot inductively coupled plasma mass spectrometry study.

BACKGROUND AND OBJECTIVE: Various trace elements, including toxic heavy metals, may exist in dental calculus. However, the effect of environmental factors on heavy metal composition of dental calculus is unknown. Smoking is a major environmental source for chronic toxic heavy metal exposition. The aim of this study is to compare toxic heavy metal accumulation levels in supragingival dental calculus of smokers and non-smokers. MATERIAL AND METHODS: A total of 29 supragingival dental calculus samples were obtained from non-smoker (n = 14) and smoker (n = 15) individuals. Subjects with a probability of occupational exposure were excluded from the study. Samples were analyzed by inductively coupled plasma mass spectrometry in terms of 26 metals and metalloids, including toxic heavy metals. RESULTS: Toxic heavy metals, arsenic (p < 0.05), cadmium (p < 0.05), lead (p < 0.01), manganese (p < 0.01) and vanadium (p < 0.01) levels were significantly higher in smokers than non-smokers. The levels of other examined elements were similar in both groups (p > 0.05). CONCLUSION: Within the limitations of this study, it can be concluded that the elementary composition of dental calculus may be affected by environmental factors such as tobacco smoke. Therefore, dental calculus may be utilized as a non-invasive diagnostic biological material for monitoring chronic oral heavy metal exposition. However, further studies are required to evaluate its diagnostic potential.

The extrusion of root canal cement containing paraformaldehyde into the inferior alveolar nerve canal resulting in infection and numbness.

AIM: To describe the impact of extruded paraformaldehyde-containing root canal cement into the inferior alveolar nerve canal following a delay in removal and the subsequent management of the case. SUMMARY: A 30-year-old man was referred for management of prolonged anaesthesia in the right mandibular region following root canal treatment. Panoramic and cone beam computed tomography findings revealed that overextruded root canal cement had penetrated into the inferior alveolar nerve canal beyond the distal root of the mandibular right second molar (tooth 47). The root canal cement contained paraformaldehyde. Initially, the patient refused surgical removal of the cement. However, after 3.5 months, the patient returned with an acute infection in the same region. After resolution of the acute abscess and root canal retreatment, surgical treatment was performed under general anaesthesia. Granulation tissue and necrotic bone were found associated with the cement.

Use of cone-beam computed tomography to evaluate C-shaped root canal systems in mandibular second molars in a Turkish subpopulation: a retrospective study.

AIM: To use cone-beam computed tomography (CBCT) to evaluate the prevalence and anatomical features of C-shaped canals in permanent mandibular second molars amongst members of a Turkish population. METHODOLOGY: An endodontist and oral radiologist examined CBCT images of 271 Turkish mandibular second molars to determine the presence of C-shaped canals and their anatomical features. Root canal configurations at five different levels were categorized using the classification of Fan et al. (Journal of Endodontics, 30, 2004a,b, 899-903; 904-8). Bilateral or unilateral occurrence of C-shaped canals and their relationships with gender, age and tooth position were examined and statistically analysed using the chi-squared test. RESULTS: Of the 271 mandibular second molars examined, 24 (8.9%) molars from 17 patients had a C-shaped root canal system. The prevalence of bilateral C-shaped canals was 6.3% amongst 111 patients with bilateral mandibular second molars. There were no significant differences in the distribution of C-shaped canals with respect to gender or age. Only one tooth had the same canal configuration from the orifice to the apex. In the remainder of the teeth, the cross-sectional canal configuration changed at different levels of the root. CONCLUSIONS: The configuration of C-shaped canals varied along the length of the root. The prevalence of C-shaped canals in mandibular second molars in this Turkish population was lower than in other Asian populations.

A detailed radiomorphometric analysis of the mandibular foramen, lingula and anti-lingula with a special emphasis on mandibular prognathism.

INTRODUCTION: The aim of this study was to evaluate radiomorphometric differences of mandibular foramen (MF), lingula (Li), and anti-lingula (AL) between prognathic and non-prognathic patients, using cone-beam computed tomography (CBCT). METHODS: A total of 228 3D CBCT images of 57 prognathic and 57 non-prognathic patients were retrospectively evaluated. The distances between MF or Li to occlusal plane (OP), anterior border of ramus (AR), posterior border of ramus (PR), sigmoid notch (SN), gonion (Go) and distances Li to MF were measured. The presence of AL, and the distances to Li were also assessed in both groups. RESULTS: In prognathic patients the mean distances of MF-AR and Li-PR were lesser, and Li-OP was greater (p < 0.05). However, distances from MF or Li to the other ramal landmarks were similar in both groups (p > 0.05). Presence of AL was found at 53 sides in prognathic and 20 sides in non-prognathic groups (p < 0.05). The horizontal distance of Li-MF was greater in prognathic patients (p < 0.05). On the other hand, there was no difference between groups regarding the horizontal distance of Li-Al, and the vertical distances of Li-MF and Li-AL (p > 0.05). CONCLUSION: The present study provided valuable data regarding morphological differences of MF-AR, Li-MF and Li-OP, which should be considered in the preoperative assessment of patients with mandibular prognathism. Presence of AL was more common in prognathic patients and mainly located above Li. 3D CBCT applications facilitated assessment of AL and its relationship with Li.

A clinicopathologic analysis of 135 cases of cemento-osseous dysplasia: To operate or not to operate?

PURPOSE: The aim of this retrospective study was to investigate the characteristics of cemento-osseous dysplasia (COD) lesions for devising a clinical algorithm to help management decisions, specifically discussing the need for a possible surgical intervention versus solely follow-up. MATERIALS AND METHODS: One hundred thirty-five subjects were thus identified having previously diagnosed and treated for COD from the archives of the pathology in between 2005-2015. These were then re-evaluated. Demographic features, radiographic and histopathologic findings were assessed. RESULTS: The most frequent variant was the focal type (n=83), and the mandible (n=131) was predominantly affected jaw bone. Female predilection was evident for all subtypes. Almost half of the lesions (n=72) presented with mixed radiolucent and radiopaque appearances in radiography at the time of the biopsy. Cementicles/psammoma body-like calcifications and trabecular pattern were the most common hard tissue appearances. CONCLUSION: COD lesions are non-neoplastic fibro-osseous lesions which can exhibit similar histopathologic and radiologic features with other bone lesions. Ideally, these lesions should be clinically identified and followed-up. Considering the possible complications, a thorough knowledge of these lesions and their differentials is essential in order to avoid unnecessary surgical interventions.

Case of osseous dysplasia with an unusual concentric, circular, radiological appearance.

Osseous dysplasia is an idiopathic process that is characterised by the replacement of normal bone with fibrous tissue and metaplastic bone. On radiographic images it may be predominantly radiolucent, predominantly radio-opaque, or mixed. We present a focal osseous dysplastic lesion with an unusual concentric, circular, radiographic appearance.

Peripheral ameloblastoma: a case report.

Peripheral ameloblastoma, a rare and unusual variant of odontogenic tumour, comprises about 1% of all ameloblastomas. The extraosseous location is the peculiar feature of this type of tumour, which is otherwise similar to the classical ameloblastoma. An additional case of this infrequent tumour is described on the lingual alveolar mucosa of the right mandibular premolar region in a 60-year-old man. Clinical evidence, microscopic findings, CT imaging and recurrence for this tumour are discussed.