The differences in panoramic mandibular indices and fractal dimension between patients with and without spinal osteoporosis

OBJECTIVES: The aims of this study were to evaluate the relationship between osteoporosis, oral signs, body mass index and age; and to assess the possibility of using these parameters as an indicator of post-menopausal osteoporosis. The oral signs were panoramic-based mandibular indices, such as cortical width, cortical index, panoramic mandibular index and mandibular crest resorption degree; the number of teeth and fractal dimension analysis. METHODS: Forty-eight post-menopausal women between the ages of 40 years and 64 years were evaluated. Mandibular indices and the number of mandibular teeth were measured and evaluated from panoramic radiographs and fractal dimension was calculated from the direct digital periapical radiographs of the mandibular premolar-molar region in box-counting method. Weight, height, menopausal status and age of the patients were recorded by questionnaire. Bone mineral densities of the patients were measured with dual energy X-ray absorptiometry. RESULTS: In this study there were no statistically significant differences between the osteoporotic and non-osteoporotic patients for cortical width, panoramic mandibular index, alveolar crest resorption degree, fractal dimension and the number of mandibular teeth, but there was a difference for cortical index. Binary logistic regression analyses demonstrated that age (P = 0.015) was an important risk factor for osteoporosis. CONCLUSION: The results of this study demonstrated that osteoporotic patients were more likely to have altered inferior cortex morphology than non-osteoporotic patients and age is an important risk factor for osteoporosis.     

Individualized periapical radiography determined by clinical and panoramic examination.

The efficiency of panoramic radiography compared with full-mouth periapical examination is an unresolved problem. The diagnostic yield of periapical lesions when the clinical signs and symptoms and the findings from a panoramic radiograph served as the basis for an individualized periapical radiographic examination was studied. Two hundred patients were examined clinically and radiographically. The periapical status was assessed step by step with access to increasing numbers of radiographs. For the clinical examination, the sensitivity was 0.24, the positive predictive value 0.62, the specificity 0.98, the negative predictive value 0.90 and the likelihood ratio for the positive test result 12. For radiographs indicated by the clinical examination plus the panoramic radiograph and selected periapical radiographs, both the sensitivity and the positive predictive value were 0.91, the specificity and the negative predictive value 0.99 each and the likelihood ratio was 91. False findings were twice as frequent in the upper as in the lower arch and particularly found in the incisor and premolar regions. In 30% of the patients no periapical radiograph was needed to supplement the panoramic radiograph. In the other patients, two supplementary periapical radiographs were needed on average. We conclude that the information obtained from the clinical and panoramic examinations supplemented with no more than two periapical radiographs will result in a high diagnostic yield on the periapical status.     

Marginal bone in periodontal disease: an evaluation of image quality in panoramic and intra-oral radiography

Five observers assessed the panoramic and full-mouth (14 periapical and four posterior bitewing) radiographs of 20 patients each for the ability to interpret and measure the marginal bone level. The image quality of each site was classified as excellent, acceptable or unacceptable. Depiction errors affecting interpretability and measurability were also noted. In the upper arch, the frequency of uninterpretable and non-measurable sites was almost equal for panoramic and periapical radiography. Image quality was better with periapical radiography in the lower arch. In the posterior regions of both arches, more sites could not be measured from panoramic compared with bitewing radiographs. Due to overlapping the distal surface of the maxillary canine and the mesial surface of the first maxillary premolar could often not be interpreted in either panoramic or periapical radiographs, but infrequently in the bitewings. In the lower arch, the most frequent depiction error was inadequate density in the incisor region of panoramic radiographs. On the basis of these results, we proposed that in clinical practice the panoramic radiograph can be supplemented with individually selected periapicals. In epidemiological studies, the panoramic radiograph should be combined with a premolar bitewing radiograph.     

Survey of radiographic practices for periodontal disease in UK and Irish dental teaching hospitals

OBJECTIVES: To assess current radiographic practices in dental teaching hospitals for the management of patients with periodontal diseases. METHODS: All 17 dental teaching hospitals in UK and Ireland were sent a questionnaire on radiographic equipment and radiograph selection currently used for assessment of patients with destructive periodontal diseases. Opinions were recorded for advantages and disadvantages of the most frequently used radiographic views. RESULTS: A 100% response rate was achieved. All hospitals used panoramic and specific periapical radiographs as one of their radiographic regimes for patients with periodontal disease. Fifty-three per cent of respondents most frequently took panoramic and selected periapical radiographs. Twenty-four per cent took full mouth periapical radiographs (FMPAs) most frequently and 18% took a panoramic radiograph alone. Twenty-four per cent of hospitals operated a protocol for selection of radiographs for periodontal patients. CONCLUSIONS: The most commonly used views taken to assess periodontal status are panoramic radiographs with selected periapicals. Few hospitals operate a protocol for prescribing radiographs.     

Osteochondromas of the mandibular condyle: variance in radiographic appearance on panoramic radiographs

OBJECTIVES: Osteochondromas are frequently found in the general skeleton, but are rare in the mandibular condyle. Radiographically, most reports describe osteochondromas as a mushroom-shaped bony enlargement capped with cartilage on the condylar surface. However, the radiographic appearance of this lesion on the panoramic radiograph has rarely been studied. The purpose of this article is to increase the radiographic knowledge of mandibular condylar osteochondroma and facilitate making an exact diagnosis through observing the lesional appearance on panoramic radiograph. METHODS: The panoramic radiographs of 12 cases of mandibular condylar osteochondromas were reviewed. All cases were obtained from the Department of Oral Radiology, West China College of Stomatology, Sichuan University, between 1988 and 2006. The final diagnoses of all cases were based on pathology. RESULTS: Osteochondromas may arise on different areas around the mandibular condyle and present diverse appearances on panoramic radiograph. CONCLUSIONS: The mandibular condylar osteochondromas may show different growth positions encircling the condyle and exhibit varying shapes on panoramic radiograph. These features will help us to increase cognition of the lesion and make an exact diagnosis.     

A retrospective study evaluating the use of the panoramic radiograph in endodontics

Patients are referred to the endodontist to have root canal therapy performed to treat pulpal and periradicular diseases. Routinely, the only radiograph to accompany the patient is the periapical radiograph. This radiograph is inadequate in the detection of asymptomatic pathosis that may be present in other areas of the maxilla and mandible. The military's readiness mission requires that a panoramic radiograph be part of the patient's dental record. In addition to its use for personal identification purposes, the panoramic radiograph is an excellent diagnostic tool that can give the clinician an overall view of the dentoalveolar structures. This retrospective study evaluated randomly selected panoramic radiographs and recorded the presence of radiolucent and radiopaque areas not evident on a referral periapical radiograph. The results of this study found a 4.2% occurrence of undiagnosed pathosis following additional radiographs and clinical examinations.     

Fractal analysis of the trabecular bone pattern in the presence/absence of metal artifact–producing objects: Comparison of cone-beam computed tomography with panoramic and periapical radiography

Objectives:The effect of metallic objects on the fractal dimension (FD), bone area fraction (BAF) and gray scale values (GSVs) of cone-beam CT (CBCT) images was assessed. Also, FD, BAF and GSV were compared among CBCT, digital periapical and panoramic radiographies.Methods:Digital periapical and panoramic radiographs were acquired from six blocks of bovine rib. Additionally, different arrangements of titanium implants and intracanal metallic posts were created in the bone blocks and CBCT scans were taken from the different implant-root arrangements. The three radiographical modalities were compared by analysis of variance. Pairwise comparisons between the modalities were performed by the Tukey test (significance level set at 0.05).Results:Different root-implant arrangements in the CBCT images revealed no significant differences in the FD (p = 0.920), BAF and GSV values (p = 0.623). FD differed significantly among the three modalities (p < 0.001). Significant differences were found between CBCT and each of the periapical and panoramic techniques (p < 0.001), while no remarkable differences were observed in the FD of the periapical and panoramic images (p = 0.294). BAF and GSV showed significantly different results among the three radiographical techniques (p < 0.001). The difference was remarkable between CBCT and periapical (p < 0.001), CBCT and panoramic (p < 0.001) and periapical and panoramic (p = 0.008).Conclusion:Presence of titanium implants and intracanal posts does not produce different results in the fractal analysis (FA) of the CBCT images. The trabecular bone pattern is best assessed by FA of the periapical radiographs followed by the panoramic and CBCT techniques, respectively.     

Clinical evaluation of the effects of radiographic distortion on the position and classification of mandibular third molars

OBJECTIVE: Panoramic radiographs are routinely employed for surgical planning of unerupted third molars. The objective of this study was to evaluate distortions in the position of mandibular third molars on panoramic radiographs. MATERIALS AND METHODS: Panoramic radiographs of 14 patients with indication for extraction of the mandibular third molars were used. Transurgical impressions of the crowns of the teeth to be extracted and adjacent second molars (n=19) were achieved with addition silicone and poured with type IV plaster for comparison of the inclinations of the third molars on the radiographs and study casts. RESULTS: There was a mean difference of -5.37 degrees between the position of the third molar on the panoramic radiograph and on the study cast (standard deviation 1.46, P<0.05, Student's t-test). CONCLUSION: There is distortion in the position of teeth on the panoramic radiograph, which may influence the surgical planning; however, this does not invalidate it as the main tool for diagnosis and surgical planning of mandibular third molars.     

Assessment of mandibular bone mineral density in patients with type 2 diabetes mellitus

OBJECTIVES: To assess mandibular bone mineral density in patients with type 2 diabetes mellitus using panoramic radiographs. METHODS: Nineteen patients with type 2 diabetes mellitus and 17 control subjects participated in the study. Bone mineral density measurements were performed on the panoramic radiographs with the help of a five-step copper stepwedge phantom, attached to each film cassette, which was calibrated before hand by dual energy X-ray absorptiometry (DXA). The analysis was performed on digitized images by dedicated software (Scion Image). The accuracy of the measurement technique was also evaluated by cross-calibration with a DXA phantom. RESULTS: Mean mandibular bone mineral density (g cm(-2)) was 1.53+/-0.27 in women and 1.52+/-0.29 in men with type 2 diabetes. In age and gender matched control subjects the values were 1.56+/-0.28 and 1.46+/-0.23 in women and in men, respectively. No statistically significant difference was observed between groups in mandibular bone mineral density. CONCLUSIONS: The present study showed that bone mineral density of the mandible does not seem to be affected in patients with type 2 diabetes mellitus. We also observed that a panoramic radiograph could serve for accurate mandibular bone density determination, when calibrated well with the DXA method.     

Observer performance in the assessment of periapical pathology: a comparison of panoramic with periapical radiography.

Observer performance in the assessment of the periapical pathology from panoramic and periapical radiography was examined. Five endodontists, five general practitioners and five oral radiologists were asked to assess the periapical status of 117 teeth. The observers assessed the panoramic and periapical radiographs of the teeth, which were evenly distributed throughout the jaws with a 50% probability that either an osteolytic or sclerotic lesion was present. The results of the comparison between panoramic and periapical radiography were influenced by the selection of observers. When the oral radiologists acted as observers, the mean P(A) value for periapical radiography was higher than for panoramic radiography (P less than 0.001), resulting in periapical radiography presenting a higher overall diagnostic accuracy than panoramic radiography for all 15 observers (P less than 0.01). There was, however, no difference between panoramic and periapical radiography when the two groups of endodontists and general practitioners acted as observers. The comparison of the three groups of observers showed no difference between their diagnostic accuracy when assessing panoramic radiographs. With periapical radiography, the oral radiologists demonstrated a higher diagnostic accuracy than the endodontists (P less than 0.05). The observers in each group with the highest diagnostic accuracy also had the highest intra-observer agreement. The mean intra-observer agreement of the five general practitioners was higher than those of the other two groups of observers for panoramic radiography. For periapical radiography, the mean agreement rates of the groups were comparable.     

Radiological features of osteogenic sarcoma of the jaws. A comparative study of different radiographic modalities

OBJECTION: To evaluate the clinical and radiological features of osteogenic sarcoma of the jaws with particular reference to the effectiveness of the radiographic modalities used. MATERIAL AND METHODS: A total of 66 cases (57 from the English-language literature and nine new cases) were critically evaluated for the features depicted with intra-oral and panoramic radiography and CT. RESULTS: The mean age of the patients was 36 years (median 31.5 years). There were no differences in gender distribution. A ratio of 1:1.6 between the maxilla and the mandible was found. Lesions had diffuse borders in 78% of cases and defined but not corticated borders in 22%. Twenty-nine per cent were radiolucent, 29% radiopaque and 41% mixed density. Widening of the periodontal ligament space (PDL) was seen in 14 of the 47 (28%) lesions associated with teeth and structural changes in the mandibular canal in 34% of the mandibular lesions. There was a periosteal reaction in 48% and soft tissue involvement in 33% of the lesions. CONCLUSIONS: Widening of the PDL space was best demonstrated on periapical radiographs. Structural changes in the mandibular canal were shown mainly with panoramic radiographs. Periosteal reaction was best demonstrated by occlusal radiographs and soft tissue involvement by CT. Thorough radiological examination using periapical, occlusal and panoramic radiography, and recognition of the radiological features of osteogenic sarcoma should lead to earlier diagnosis.     

Comparison between panoramic and periapical radiography in the diagnosis of periodontal bone loss

Panoramic and periapical radiography was performed on 100 patients. Five observers each registered the scores for marginal bone level, presence of bone defects and furcation involvement in the radiographs of 20 patients and the results were compared. The overall concordance in scoring the marginal bone level was high when panoramic and periapical radiography was compared. In the upper arch, 66% of the sites showed concordant scores, 31% deviated by one and 3% by two score-points. In the lower arch, 74% of sites had concordant scores, 25% deviated by one and 1% by two score-points. The panoramic radiographs more often indicated a more severe bone loss than the periapical radiographs. The concordance was related to the degree of bone loss. In sites with no bone loss the concordance was high whereas it was lower in those with severe bone loss. The concordance of the two radiographic methods for the mandibular canine, premolars and first molar was equally as high as the intra-observer overall agreement, but lowest for the mandibular central incisors and the maxillary molars. Bone defects were more easily identified by periapical radiography.     

The prevalence of bifid mandibular condyle detected in a Brazilian population

OBJECTIVES: To determine the prevalence of bifid mandibular condyle (BMC) detected on panoramic radiographs in a Brazilian population. METHODS: The panoramic radiographs of 50 080 radiographs taken from 1999 to 2006 were retrospectively reviewed in order to identify BMC cases. RESULTS: 9 (0.018%) of the 50 080 patients, 2 men and 7 women, with age ranging from 20 years to 74 years, had BMC. These conditions were unilateral in 7 (78%) subjects and bilateral in 2 (22%) subjects. All patients denied a history of any previous trauma or fracture of the mandible, pain, or trismus. CONCLUSIONS: BMC is an uncommon finding in a group of Brazilian subjects and, although it is rare, dentists should be aware of this condition on routine panoramic radiographs and its implications for function and appropriate treatment modalities.     

Horizontally root fractured teeth with pulpal vitality - two case reports

This case study reports the successful outcome of horizontal root fractures of two different patients, which took place in permanent incisors. Report 1 describes a case of a 29-year-old patient who suffered a mandibular trauma affecting mainly the lower central incisors, caused by a car accident. A panoramic radiograph was taken right after the accident and showed a horizontal root fracture in the middle third of tooth 42, which went untreated. Report 2 illustrates a case of a 17-year-old male patient who searched for orthodontic therapy and the periapical radiograph showed horizontal root fracture in tooth 11 caused by a previous trauma, which went untreated as well. There was healing through the reestablishment of pulp activity and dental coloration without professional intervention.     

Radiomorphometric indices of the mandible in a British female population

OBJECTIVES: To examine the radiomorphometric indices of the mandible on panoramic radiographs in a population of British female patients, to identify their normal ranges and to investigate their relationships with age, detentition and social class. METHODS: Five indices, cortical width at the gonion (GI) and below the mental foramen (MI), the panoramic mandibular index (PMI), the mandibular cortical index (MCI) and one new index (measurement of cortical width at the antegonion; AI), were measured bilaterally on 500 panoramic radiographs of females by one trained observer. The measurements were analysed for ease of application, repeatability, relationships with age, dentition and social class and interrelationships between the variables. RESULTS: All quantitative indices (GI, MI, PMI, AI), showed a significant, negative correlation with age. MCI showed an age-related distribution. Mandibular dentition exerted a significant influence on some indices, but social class had no influence. Intra-observer repeatability of MI, PMI and AI was fair (precision < 20%) but that for GI was poor. Intra-observer agreement in MCI assessments was excellent. CONCLUSIONS: The age-related changes in mandibular radiomorphometric indices and their variation within each age band lend support to their potential use in identification of skeletal osteopenia. However, problems with repeatability and measurement precision identified in the pilot study, notably with GI, may be a considerable obstacle to their use in general practice.     

Digital orthopantomograms in osteoporosis detection: mandibular density and mandibular radiographic indices as skeletal BMD predictors

Objectives:

To determine the correlation of skeletal bone mineral density (BMD) with mandibular density and mandibular radiographic indices estimated on digital panoramic radiographs.

Methods:

Study comprised 112 female subjects older than 45 years. Digital panoramic radiographs were taken, and patients were referred to densitometric measuring (dual energy X-ray absorptiometry) of BMD in the hip bones and lumbar spine regions (L1–L4). On the radiographs, mandibular bone density was estimated and the following indices were measured by the DIGORA^® software (Soredex, Tuusula, Finland): mental index (MI), gonial index (GI), antegonial index (AI), panoramic mandibular index (PMI) and alveolar crest resorption degree (M/M). Mandibular cortical index (MCI) was visually estimated.

Results:

Mandibular density and visual index MCI are significant predictors of hip and spine BMD. Mandibular density was marked by a significant square trend: it decreased until the age of 54 years and remained constant until the age of 64 years when it started to increase. Significant correlations were found between MI, AI and PMI values and BMD in the hip but not in the lumbar spine region. The GI and M/M values did not show statistically significant correlations with BMD of either region.

Conclusions:

Mandibular bone density and mandibular radiographic indices are useful in detecting patients with decreased BMD. The applicability of orthopantomograms in diagnosing osteoporosis/osteopenia should be recognized as the potential greatest benefit of this everyday diagnostic method in dental practice.     

Worth syndrome as a diagnosis for mandibular osteosclerosis

This case report presents an unusual incidental radiographic finding on a dental panoramic radiograph that caused diagnostic confusion. A 46-year-old female presented with symmetrical sclerotic cortical thickening of the anterior mandible visible on radiograph, with no other major clinical examination findings. The patient subsequently showed no change in radiographic appearance over a 6 year period. Based on this evidence, and the benign nature of the history, we propose a diagnosis of Worth syndrome. This report aims to clarify the difference in terminology and presentation of two conditions known to produce mandibular osteosclerosis: Worth syndrome and Van Buchem disease, both of which are often quoted synonymously in the literature.     

The prevalence and correlation of carotid artery calcification on panoramic radiographs and peripheral arterial disease in a population from the Republic of Korea: the Dong-gu study

Objectives:

The aim of this study was to determine the prevalence of carotid artery calcification (CAC) detected on panoramic radiographs and peripheral arterial disease (PAD), and to evaluate the difference in the prevalence of PAD between patients with CAC and patients without CAC detectable by panoramic radiograph.

Methods:

The surveyed population consisted of 4078 subjects aged 50 years and older (1410 males and 2668 females) who underwent medical and dental examination in Gwangju city, South Korea. Two oral and maxillofacial radiologists interpreted the panoramic radiographs for the presence of carotid artery calcification. A trained research technician measured the ankle–brachial index (ABI). An ABI <0.9 in either leg was considered evidence of PAD.

Results:

The prevalence of CAC on panoramic radiographs was 6.2% and that of PAD was 2.6%. Subjects with CAC had a significantly higher prevalence of PAD than those without CAC (5.5% vs 2.4%, respectively). The presence of CAC on panoramic radiographs was associated with PAD (odds ratio 1.84; 95% confidence interval 1.01–3.36) after adjusting for potential confounders.

Conclusion:

CACs detected on panoramic radiographs were positively associated with PAD in middle-aged and older Korean adults.     

The effect of periapical rarefying osteitis on cortical and cancellous bone. A study comparing conventional radiographs with computed tomography.

OBJECTIVE: To determine whether erosion of the cortical plate is necessary for successful radiographic identification of periapical rarefying osteitis. METHODS: Forty-two periapical osteitic lesions were diagnosed from periapical radiographs of 26 patients who were subsequently examined by cross-sectional computed tomography (CT). The relation of the lesions to the buccal and lingual cortical plates was determined and their size measured. RESULTS: The 42 lesions varied in size from 2 - 10 mm. Thirty one (74%) lesions diagnosed on the periapical radiographs were limited on CT to the cancellous bone with no erosion of the cortical plates. The 11 lesions with cortical erosion were randomly located throughout the jaws. Erosion was due to either the eccentric buccal or lingual location of the tooth apex, large size (>6 mm) of the lesion or narrowness of the jaw. CONCLUSIONS: Periapical lesions can be diagnosed from periapical radiographs while they are limited to the cancellous bone and before they have eroded the cortices.