Supplementary role of panoramic radiographs in the medical surveillance of a patient at risk for stroke

Panoramic radiography is commonly used by dentists as a diagnostic tool. The known prevalence range of positive incidental carotid artery calcifications in the general dental population is 2% to 5%, with a population older than 55 representing the higher end of the range. Dentists are expected to identify medical conditions while providing dental care and to refer patients for follow-up medical care. In this case report, incidental carotid artery calcifications were identified on routine panoramic radiographs obtained for oral health reasons. A 69-year-old white man who was under surveillance for carotid stenosis and risk for stroke had a routine panoramic radiograph made for oral health reasons. Positive carotid calcification findings on a panoramic radiograph were found to be in accord with a subsequent duplex ultrasound examination.     

Bilateral parotid glands aplasia: a case report and literature review

Objectives

Bilateral parotid gland aplasia is a rare congenital anomaly that almost consistently leads to xerostomia and caries. It is often associated with other congenital craniofacial abnormalities. The objective was to describe a case with asymptomatic bilateral parotid gland aplasia and to review previously reported cases.

Methods

Panoramic radiograph, computed tomography and magnetic resonance imaging were obtained and an in-depth assessment of patient’s dental status and sequence analysis of FGF10, FGFR2 and FGFR3 genes were performed. Previous reports of bilateral parotid gland aplasia were assessed.

Results

In a 64-year-old woman with extensive basal cell carcinoma of nasal skin an incidental bilateral parotid gland aplasia was noted during radiotherapy treatment planning. Dental status revealed surprisingly numerous (n?=?15) teeth without active caries lesions. No other craniofacial abnormalities were identified. To rule out most probable syndromes associated with parotid gland aplasia, sequence analysis of FGF10, FGFR2 and FGFR3 genes was performed showing no pathogenic variants. With a literature review, we identified 148 cases of salivary gland aplasia in which median age at diagnosis was 21 years and one third were asymptomatic. In only 10 of these cases, the patients presented with bilateral aplasia of parotid glands without other craniofacial abnormalities.

Conclusions

Absence of salivary glands can have a debilitating effect on oral health and is often accompanied by other craniofacial abnormalities. However, relatively frequent asymptomatic course suggests that this rare malformation is probably underdiagnosed. Therefore, we propose systematic reporting of salivary gland aplasia to assess its true prevalence in general population.

     

A comparison of the use of cone-beam computed tomography and panoramic radiography in the assessment of pre-eruptive intracoronal resorption

Objective: This study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PIR) using cone beam computed tomography (CBCT) and panoramic radiography and to compare the findings of these imaging techniques.

Methods: This retrospective study consisted of 733 patients who had at least one unerupted tooth and had undergoneimaging with both three-dimensional (3D) CBCT and two-dimensional (2D) panoramic radiography. In all the images, the number of teeth with intracoronal resorption, affected tooth type and number, and size and location of the PIR defects were recorded. The McNemar test was used to compare the prevalence of PIR in the CBCT and panoramic images.

Results: Fewer PIR defects were detected in the panoramic images (3.1% of the patients) than in the CBCT images (9.5% of the patients) (pConclusions: CBCT detected more cases of PIR than panoramic radiography. The mandibular third permanent molar was the most commonly affected tooth.     

Incidental findings of carotid artery stenosis detected by calcifications on panoramic radiographs: report of three cases

Atherosclerosis, a progressive inflammatory disorder, may lead to coronary artery disease or stroke. The prevalence of atherosclerosis associated with mortality and morbidity is very high in developed countries, and is the underlying cause of approximately 50% of all deaths in Western societies. Panoramic radiographs (PRs) are an indispensable diagnostic tool used by dental practitioners. In the general dental population, the prevalence of positive incidental carotid artery calcifications (CACs) is reported to range from 2 to 5%. Therefore, incidental findings of CAC on PRs taken during routine dental evaluation may be useful for detecting asymptomatic patients at risk of stroke and could provide life-saving information. In this case report, we present radiological findings and follow-up of three patients with severe atherosclerosis that was incidentally detected on PRs, and discuss the role and importance of PRs in the detection of CACs.     

Diagnostic accuracy of panoramic radiography,stereo-scanography and cone beam CT for assessment of mandibular third molars before surgery

Abstract

Objective. To compare the diagnostic accuracy of panoramic imaging, stereo-scanography and cone beam computed tomography (CBCT) for assessment of mandibular third molars. Material and methods. One hundred and twelve patients (147 third molars) underwent radiographic examination by panoramic imaging, stereo-scanography and CBCT. Tooth angulation, root morphology, number of roots and relation to the mandibular canal were assessed. The same variables were assessed intra- and post-operatively and served as reference for the radiographic assessments. The diagnostic accuracy for each variable was compared between the three modalities and accuracy was further expressed as sensitivity and specificity and tested between the modalities for identifying the relation to the mandibular canal. Results. There were no significant differences between the modalities regarding tooth angulation, root morphology and number of roots. However, CBCT was more accurate than stereo-scanography for determining root bending in the bucco-lingual plane (p = 0.02). Moreover, sensitivity for direct contact to the mandibular canal (panoramic imaging: 0.29, stereo-scanography: 0.57, CBCT: 0.67) was higher for CBCT than for panoramic images (p = 0.05) and specificity for no direct contact to the mandibular canal (panoramic imaging: 0.78, stereo-scanography: 0.53, CBCT: 0.68) was higher for panoramic images and CBCT than for scanograms (p < 0.001). Conclusion. Panoramic imaging, stereo-scanography and CBCT seem equally valuable for examination of tooth angulation, number and morphology of roots of mandibular third molars. However, CBCT was more accurate for assessment of root bending in the bucco-lingual plane and more accurate than panoramic images to identify direct contact to the mandibular canal.     

Anatomical Variations of the Bifid Mandibular Canal on Panoramic Radiographs in Citizens from Zagreb,Croatia

BackgroundThe bifid mandibular canal (BMC) is an anatomical variation with reported prevalence ranging from 0.08 to 65%. Identifying anatomical variations of mandibular canal is very important in order to prevent possible complications during oral surgical and other dental procedures.ObjectivesThe aim of this study was to determine the prevalence and to classify the morphology of BMCs using digital panoramic radiographs.Material and methodsA retrospective study was conducted that included 1008 digital panoramic radiographs (412 female and 596 male) used to identify the type of BMC. Panoramic radiographs were analyzed by three oral surgeons and one dentist, and BMCs were classified into six different types, 4 types according to Langlais et al. (types 1-4), and two new types (types 5 and 6) described by authors.ResultsThe prevalence of BMC was 4.66% (n=47), with no significant differences in gender between BMC types (P=0.947; χ²=0.74). The prevalence of type 1 BMC was 0.79% (n=8), type 2 2.08% (n=21), type 3 0.30% (n=3), type 4 0% (n=0), type 5 0.89% (n=9) and type 6 0.60% (n=6).ConclusionThis study revealed a relatively high prevalence of BMCs among Zagreb citizens. Furthermore, two new types of BMCs were described. These results stress the importance of a careful and thorough radiographic analysis prior to each invasive procedure in the mandible.     

Tooth loss and craniofacial factors associated with changes in mandibular condylar morphology

Objective: To investigate the association between tooth loss and craniofacial factors with changes in mandibular condylar morphology.

Methods: A total of 123 patients participated in this cross-sectional study. The mandibular condylar morphology was evaluated using digital panoramic radiography. The exposure variables included gender, age group, molar relationship, facial growth pattern, facial asymmetry, dental midline, posterior crossbite, presence of fixed dental prosthesis, and tooth loss.

Results: Unilateral and bilateral mandibular condyle structural alterations were found in 20.3% and 28.5% of the sample, respectively. After the adjustment analysis, posterior crossbite (adjusted OR = 3.34, 95% CI = 1.23–9.06) and tooth loss (adjusted OR = 4.08, 95% CI = 1.72–9.64) were associated with the outcome. The tooth type associated with mandibular condyle structural alterations were premolars and upper molars.

Conclusion: The findings suggest that posterior crossbite and tooth loss are associated with mandibular condyle structural alterations.     

Dentists’ use of digital radiographic techniques: Part II – extraoral radiography: a questionnaire study of Swedish dentists

Objective: The present study aims to gain knowledge about the dentist’s use and choice of digital extraoral imaging methods, panoramic radiography and cone beam computed tomography (CBCT).

Materials and Methods: A questionnaire sent to 2481 dentists within the Swedish Dental Society contained questions about the panoramic technique and CBCT technique used, education, clinic size and type of service. The response rate was 53%.

Results: The study showed that 61% of the Swedish dentists had access to panoramic techniques and that 84% used a direct digital sensor, while 6% used storage phosphor plate techniques. Around 8% of the Swedish dentists had access to CBCT. It was also observed that group practices had two times higher odds of having panoramic equipment compared with solo practices. Approximately 40% of the dentists had undergone postgraduate education in oral radiology during the last 5 years. Dental nurses and dental hygienists exposed 92% of the panoramic radiographs and 75% of the CBCTs. Thirty per cent of those clinics with access to a panoramic unit exposed >30 panoramic radiographs per month and 56% of the clinics having access to CBCT did more than 75 examinations per year.

Conclusions: Today 61% of Swedish dentists have access to panoramic radiography and 8% have access to CBCT. There is a greater likelihood of having access if the dentist works in the public dental health service or in a group practice and if the dentist has undergone any postgraduate course in oral radiology.     

Assessment of Carotid Artery Calcifications on Digital Panoramic Radiographs and Their Relationship With Periodontal Condition and Cardiovascular Risk Factors

ObjectiveThe main purpose of this study is to determine the presence of carotid artery calcification (CAC) detected on digital panoramic radiographs (DPRs) retrospectively and correlate the findings with cardiovascular risk factors including gender, age, smoking status, hypertension, diabetes, and hyperlipidemia, along with atherosclerotic cardiovascular disease and periodontal status.MethodsThis clinical study is registered at ClinicalTrials.gov as NCT04017078. DPRs, periodontal status and cardiovascular risk factors of 1,101 patients (576 males, 525 females) were evaluated. The patients were grouped based on whether CAC was detected in dental DPRs [CAC (+)] or not [CAC (–)]. Periodontal status was categorised as gingivitis, periodontitis, and gingivitis with reduced periodontium (periodontally stable patient).ResultsOut of 1,101 patients, whose mean age was 42.1 ± 15.5 years and 525 (47.7%) were female, 34 (3.1%) were diagnosed with CAC on DPRs. No significant difference was observed between groups considering gender, hypertension, diabetes, hyperlipidemia, smoking, and periodontal status. Patients aged 40–55 years (n = 398, 36.15%) and patients older than 55 years (n = 222, 20.16%) were associated with CAC (odds ratio = 4.49, 95% confidence interval = 1.65–12.17, P = 0.003; odds ratio = 4.41, 95% confidence interval = 1.33–14.61, P = 0.015, respectively).ConclusionAmong all parameters, only age exhibited significant correlation with an increased risk of carotid calcification. Further studies with prospective designs and larger study populations are needed.     

Diagnostic validity (sensitivity and specificity) of panoramic X-rays in osteoarthrosis of the temporomandibular joint

Objective:

To establish the diagnostic validity of panoramic X-rays (PRx) in temporomandibular osteoarthrosis (OA) using the clinical and imaging criteria (magnetic resonance imaging, MRI) of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) as gold standards.

Methods:

Eighty-four patients with full clinical records (RDC/TMD), PRx, and MRI scans were selected. Two stomatologists evaluated the PRx for OA. The MRI findings were derived from the radiologist report. Intra/inter-examiner concordance was established. The diagnostic concordance between clinical signs and MRI was determined. Both were used as gold standards to calculate the validity of PRx in OA.

Results:

The diagnostic validity of PRx with MRI as gold standard was sensitivity?=?69·0% and specificity?=?67·9%. The diagnostic validity of PRx with clinical criteria as gold standard was sensitivity?=?61·6% and specificity =?57·9%.

Discussion:

Panoramic X-rays have scant diagnostic validity in temporomandibular osteoarthrosis when taking MRI or clinical criteria of RDC/TMD as gold standards.     

Prevalence of maxillary lateral incisor agenesis and associated skeletal characteristics in an orthodontic patient population

Objectives: This study was aimed to investigate the prevalence of maxillary lateral incisor agenesis and associated skeletal characteristics in an orthodontic patient population.

Materials and methods: The records of the 1066 patients seeking orthodontic treatment were screened for maxillary lateral incisor agenesis (MLIA). The following data were recorded for each subject: age; gender; unilateral or bilateral agenesis of MLI and side. The lateral cephalogram of each subject with MLIA was digitally traced. The data were compared to age-matched control orthodontic patients with skeletal Class I.

Results: The prevalence of maxillary lateral incisor agenesis was 4.9% (52 patients) in which 63.5% were females. There was a significant difference between MLIA patients and controls in sagittal relationships (ANB, Wits, AB plane, angle of convexity and Co-A/Co-Gn differential analyses) p?Conclusions: Patients with maxillary lateral incisor agenesis showed a significant tendency for skeletal Class III compared with the Class I control. This could be attributed to maxillary hypoplasia/retrognathia.     

Dental and periodontal health in Finnish adults in 2000 and 2011

Objective: We assessed dental and periodontal health in adults aged ≥30 years living in southern and northern Finland as part of the Health 2000/2011 Surveys (BRIF8901).

Material and methods: Clinical findings in 2000 (n?=?2967) and 2011 (n?=?1496) included the presence of teeth and number of teeth with caries, fillings, fractures or periodontal pockets.

Results: Edentulousness decreased in all age groups. The prevalence of those with no caries increased from 67% to 69% in men and from 80% to 85% in women, and of those with no periodontal pocketing from 26% to 30% in men and from 39% to 42% in women. In 2011, the mean number of decayed teeth was 0.8 in men and 0.3 in women, and the corresponding mean numbers of teeth with deepened periodontal pockets 5.6 and 3.7. The gender difference had levelled concerning edentulousness, number of teeth and DMF teeth, but still existed in the occurrence of caries and periodontal pocketing.

Conclusion: The findings were in line with other population-based reports in the 2000s. However, periodontal health in Finland seems not to be as good as in many European countries and in the USA.     

Linear measurement accuracy of CBCT panoramic reconstructions: experimental study with dry human mandibles

Introduction

Studies on software accuracy of reformatted panoramic computed tomography (CT) images are scarce.

Objectives

The aim of this study was to evaluate the software accuracy of reformatted panoramic views from cone-beam computed tomography (CBCT).

Methods

Ten dry mandibles were scanned using CBCT with different voxel sizes. Following the reconstruction of panoramic views with three different software, horizontal and vertical linear measurements were performed using the electronic rules of each software. Measurements of the corresponding dry mandibles were taken with a digital caliper and defined as the gold standard.

Results

There were no statistically significant differences in linear distances among the dry mandibles and reformatted panoramic CT views. The relative error ranged from 1.3 to 8.0%, depending on the software and voxel size.

Conclusions

The linear measurements on reformatted panoramic views are reliable.

     

Dental pain and oral health-related quality of life in individuals with severe dental anxiety

Objectives: To analyze the prevalence and level of dental pain among adult individuals with severe dental anxiety (DA), and the association between dental pain and oral health-related quality of life (OHRQoL).

Methods: The study was based on 170 adult individuals with DA referred to a specialized DA clinic. All patients answered a questionnaire including questions on DA (DAS, DFS), OHRQoL (OIDP) and dental pain. An adapted clinical examination and a panoramic radiograph revealed the present oral status.

Results: The prevalence of dental pain was high (77.6%) and among those reporting pain the intensity was high (49.0–61.0 on a VAS). One or more problems during the last 6 months with the mouth or teeth affecting the individual’s daily activities were reported in 85.3% of the participants. Individuals who reported dental pain had lower OHRQoL compared with those who did not report dental pain (p?p?p?=?.008).

Conclusion: This study revealed a high prevalence and a high level of dental pain among adult individuals with severe DA. Having dental pain was associated with poor OHRQoL.     

Prevalence and incidence of oromandibular dystonia: an oral and maxillofacial surgery service–based study

Objectives

Oromandibular dystonia is a focal dystonia characterized by sustained or intermittent contractions of the masticatory and/or tongue muscles. This epidemiological study aimed to estimate the prevalence and incidence of oromandibular dystonia in Kyoto (population: 1,465,701).

Materials and methods

The population sample was citizens of Kyoto who visited our department between 2015 and 2019 and were differentially diagnosed by an oromandibular dystonia specialist having idiopathic (primary) and acquired (secondary) oromandibular dystonia. A total of 144 patients (100 women and 44 men; mean age, 57.5 years) were analyzed for clinical features, and the prevalence (prevalence date, January 1, 2020) and annual incidence were estimated.

Results

The male-to-female ratio was 1:2.3 (p<0.001). Age at onset was significantly (p<0.01) earlier in men (47.5 years) than that in women (56.9 years). The crude prevalence of oromandibular dystonia was estimated at 9.8 per 100,000 persons (95% confidence interval: 8.3–11.6) (idiopathic dystonia, 5.7 [4.6–7.1]; tardive dystonia, 3.4 [2.5–4.5]) and incidence at 2.0 (1.3–2.8) per 100,000 person-years (idiopathic dystonia, 1.2 [0.68–1.9], tardive dystonia, 0.68 [0.32–1.3]). The prevalence was 13.0 (10.5–15.8) in women and 6.3 (4.6–8.5) in men. All age groups showed female predominance. The highest prevalence was 23.6 (14.4–36.5) in women aged 60–69 years.

Conclusions

As this is an oral and maxillofacial surgery service–based study, the actual prevalence of oromandibular dystonia may be even higher.

Clinical relevance

It was suggested that oromandibular dystonia might be more common than cervical dystonia or blepharospasm.

     

Taurodontism: A minor diagnostic criterion in Laurence-Moon/Bardet-Biedl syndromes

Abstract

Objective. The objective of the study was to present the prevalence of taurodontism in the permanent dentition in individuals with Laurence-Moon/Bardet-Biedl syndromes (LM/BBS). Methods and participants. Thirty-nine individuals were studied, which comprises the whole population of known LM/BBS patients in Norway. Data were collected retrospectively. Panoramic radiographs (OPG) were evaluated to document taurodontism. Results. Taurodontism was found in 82.9% of the individuals with LM/BBS. The second mandibular molars had the highest (72.3%) prevalence of taurodontism and the first mandibular molars the lowest (58.2%). Conclusion. This study suggests that taurodontism should be included as a minor diagnostic criterion for the Laurence-Moon/Bardet-Biedl syndromes (LM/BBS).     

Diagnostic reproducibility of the elongated styloid process

The aim of this study was to estimate the reproducibility related to the presence and to the measurements of elongated styloid process (ESP), based on panoramic radiographs and the prevalence of ESP. Experimental design: one hundred sixty six panoramic radiographs were used, from edentulous patients from the Radiology Clinic files, at Araraquara Dental School, Unesp, during a four-year period. One hundred and twenty one were female and 45 were male. Two calibrated observers evaluated the radiographs. A caliper was used to measure, in mm, the ESP from the base of the temporal bone to the tip of the structure. The ESP was considered present when the measurements were 30mm or more. Kappa statistics (k ) and intra-class correlation coefficient (r ), were applied to estimate the reproducibility. The results showed that related to the presence of ESP, the interobserver agreement was k =0.85. Related to the measurements of ESP, the interobserver agreement was r =0.52. The prevalence of ESP was estimated in 12.6%. ESP distribution in females was similar to that for males. In conclusion, we found a greater level of agreement when observers evaluated the presence of ESP than when they did the measurement of ESP. The prevalence of ESP was 12.6%.     

Prevalence and Characteristics of Root Resorption Identified in Cone-Beam Computed Tomography Scans

IntroductionRoot resorption is a destructive process that compromises tooth structure and can result in tooth loss. Often it remains asymptomatic and is an incidental finding on radiographic examinations. The purpose of this study was to determine prevalence and characteristics of root resorption in patients referred for cone-beam computed tomography (CBCT) imaging for a variety of indications.MethodsThe study included CBCT scans of 1086 consecutive patients referred for CBCT imaging over an 18-month period. A total of 1148 scans were acquired. Data were abstracted from radiology reports, and prevalence estimates of resorption were computed for the aggregate sample and also across specific indications.ResultsResorption was identified in 171 patients (15.7%, 95% CI: 13.6%–17.9%) and in 249 teeth with a prevalence range of 2.6%–92.3% across specific indications. An 18.7% of the patients had 2 resorption sites whereas 8.8% had 3 or more resorption sites. The majority of affected teeth were anteriors (43.8%), followed by molars (40.6%) and premolars (14.5%). The most prevalent resorption types were external (29.3%), cervical (22.5%), infection-induced apical resorption (13.7%), internal (9.6%), and impacted tooth induced (8.8%). The majority of teeth with resorption did not have prior endodontic treatment (73.9%) and had radiographically normal periapex (69.5%). Of 249 teeth with resorption, 31% presented as incidental finding. The prevalence of incidental findings of resorption increased with age, P < .05, and was significantly lower for anterior teeth (20.2%) as compared to premolars (41.7%) and molars (36.6%), (P < .05).ConclusionThe high proportion of incidental findings of resorption detected by CBCT suggests that resorption is not recognized/detected by conventional radiography and therefore remains underdiagnosed.     

C-shaped canals in mandibular molars of a Brazilian subpopulation: prevalence and root canal configuration using cone-beam computed tomography

Objectives

To assess C-shaped root canal configuration by identifying its prevalence and each configuration type proportion, according to tooth (mandibular first or second molar) and demographic characteristics in a Brazilian population, using cone-beam computed tomography (CBCT). Moreover, it was verified if there is a relationship between root canal configuration observed in two-dimensional reconstructions of CBCT and presence of C-shape.

Methods

Mandibular jaw CBCT scans (184 males and 220 females, aged 15 to 80 years), which presented 1464 mandibular molars (710 first molars and 754 second molars), were assessed. Teeth were evaluated for the presence and type of C-shaped root canals by observing the roots at five levels in CBCT axial reconstructions. Root canal configuration was assessed in panoramic reconstructions. Data were statistically analyzed at a significance level of 5%.

Results

Of the 1464 mandibular molars, 125 (8.5%) were classified as C-shaped. This variation was more prevalent in females (n = 107, 85.6%) and in second molars (n = 108, 86.4%). C1 (uninterrupted C-shaped canal) was the most prevalent type of C-shaped configuration (41.76%), while C5 (no canal lumen) was the least prevalent type (0.96%). Single root with single canal in panoramic reconstructions was the most predominant configuration for C-shaped teeth (n = 54, 43.2%). Fused roots presented 17.2 higher odds of being associated with C-shaped root canals than non-fused roots.

Conclusions

C-shaped root canals were more prevalent in mandibular second molars and in females. Additionally, clinicians should bear in mind the greater possibility of C-shaped configuration in mandibular molars with fused roots.

Clinical relevance

Mandibular molars with C-shaped canals present a clinical challenge. A higher C-shaped proportion was noted in radiographic fused root types, which had 17.2 higher odds of presenting such anatomy when compared to radiographic non-fused roots. Root radiographic features may help in diagnosis of complex C-shaped morphologies.

     

Dental anomaly patterns associated with tooth agenesis

Objective: The objective of this study is to evaluate the relationship between tooth agenesis and the occurrence of other dental anomalies in children and adolescents.

Material and methods: Panoramic radiographs of 195 subjects with tooth agenesis, except for the third molar, were retrospectively examined and compared with a non-agenesis control group of 600 subjects. Their ages ranged from 7 to 15 years. Panoramic and periapical radiographs were used to analyze the presence of other associated dental anomalies. The occurrences of these anomalies were compared with those in the non-agenesis group.

Results: Subjects with tooth agenesis showed a significantly higher prevalence of a small maxillary lateral incisor (17.7%), distoangulation of the mandibular second premolar (6.5%), delayed development of a permanent tooth (10.8%), and hypo-occlusion of a primary molar (11.8%). In contrast, the prevalence of a supernumerary tooth was higher in the control group, and no difference was observed in the prevalence of ectopic eruption of a first molar. According to the agenesis area, microdontia of the maxillary lateral incisors occurred more often in patients with anterior or premolar agenesis than in the molar agenesis groups. Distoangulation of the mandibular second premolars, delayed tooth development, and hypo-occlusion of the primary molars were associated with premolar tooth agenesis.

Conclusions: A small maxillary lateral incisor, distoangulation of the mandibular second premolar, delayed development of a permanent tooth, and hypo-occlusion of a primary molar were frequently associated with tooth agenesis, providing additional evidence of a genetic interrelationship in the causes of these dental anomalies.