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.     

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.     

Narrowing of the inferior dental canal in relation to the lower third molars

OBJECTIVES: To assess narrowing of the inferior dental canal in the lower third molar regions using computed tomography (CT) and to determine the value of radiographic markers on rotational panoramic radiographs in assessing the true relationships of the inferior dental canal. METHODS: Patients referred for CT assessment of impacted lower third molars were used in this study. The lower third molars were assessed using CT to determine the position and morphology of the inferior dental canal relative to the roots and the cortical plates. The radiographic markers on rotational panoramic radiographs were correlated with the CT findings when rotational panoramic radiographs were available. RESULTS: The patients referred had 202 lower third molars. Inferior positioning of the inferior dental canal was the most common location on CT. Narrowing of the inferior dental canal was found in relation to the lower third molars in 66.8% of cases. The chance of narrowing of the inferior dental canal as shown using CT increased when at least one of the radiographic markers, superimposition, narrowing, deviation or reduction in density was present on the rotational panoramic radiograph. Deviation of the inferior dental canal on rotational panoramic radiographs was found to be the most significant predictor of narrowing of the inferior dental canal and a close relationship to the roots, as shown in CT. CONCLUSIONS: Narrowing of the inferior dental canal is a common finding when impacted lower third molars are assessed using CT. On rotational panoramic radiographs deviation of the inferior dental canal is the best predictor of narrowing of the inferior dental canal and a close relationship to the roots.     

Comparing the accuracy of panoramic and intraoral radiography in the diagnosis of proximal caries

OBJECTIVES: The purpose of this study was to compare the diagnostic accuracy of panoramic and intraoral radiographic surveys in the diagnosis of proximal caries according to the different dental regions (maxillary and mandibular incisor, canine, premolar and molar). METHODS: In this study, full mouth series and panoramic radiographs of 79 patients were used. The radiographs were evaluated for proximal caries by three observers. The diagnostic accuracy of radiographic surveys for each dental region was assessed by means of receiver operating characteristic (ROC) curve analysis. RESULTS: Full mouth series was the most efficient method in the diagnosis of caries for incisor and canine teeth. However, full mouth series and combination of panoramic plus bitewings had similar diagnostic accuracy for premolar and molar teeth. CONCLUSIONS: Panoramic survey alone was not sufficient for the diagnosis of proximal caries for the entire dentition. The combination of panoramic plus bitewing plus anterior periapical survey exhibited a diagnostic accuracy for proximal caries that was comparable with full mouth series.     

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.     

Fractal dimension on dental radiographs

OBJECTIVES: (1) To compare fractal dimension (FD) from periapical radiographs with FD from panoramic radiographs; (2) to correlate FD with cortical thickness and morphology; and (3) to correlate FD with a reported history of osteoporotic fractures. METHODS: Information on fracture and smoking history was obtained by a telephone interview with 281 elderly (>60 years of age) patients who had periapical and panoramic radiographs exposed on the same date. FD was measured in several locations on both types of radiograph. Mandibular cortical thickness and morphology were obtained from the panoramic radiograph. RESULTS: FD measured in the mandible was lower than FD in the maxilla. Same-jaw measurements had a higher correlation than same-side measurements. FD measured on panoramic radiographs was lower than FD from periapical radiographs. There was a negative correlation between cortical thickness and FD. FD was higher in subjects with more mandibular cortical porosities and resorption. The mean panoramic FD from subjects with a history of osteoporotic fractures was significantly higher, after adjusting for smoking, gender, age, height and weight. CONCLUSIONS: FD measured on panoramic radiographs is lower than FD measured on periapical radiographs. FD is higher in both types of radiograph in subjects with a thinner, severely eroded mandibular cortex and a history of osteoporotic fractures. This study confirms other reports that FD increases when bone mass decreases. In addition, it suggests that panoramic radiographs can be used as a possible alternative for the measurement of FD to periapical radiographs.     

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.     

End-user survey for digital sensor characteristics: a pilot questionnaire study

OBJECTIVE: To survey end-user opinions on dental digital sensor characteristics for the design of a new X-ray imaging sensor. MATERIALS AND METHODS: 100 questionnaires were sent out to dentists and dental radiologists. The questionnaire consisted of six parts related to dental sensors. A: Details about the respondent; B: Prioritization of most important aspects of digital sensors; C: Rating advantages and D: disadvantages of digital sensors; F: Dental features that need to be enhanced by digital sensors; G: End-user comments. RESULTS: Fifty-six questionnaires were returned. Contrast resolution and imaging time were assessed as the most and the least important aspects, respectively. Aspects considered as advantages by approximately 80% of respondents were: optimal contrast resolution, increased specificity, increased discrimination between diseased and healthy tissue, increased sensitivity, lower dose to the patient by more than 20%; as a disadvantage, increased patient dose was given. Dental features considered important by over 80% of the respondents were for intraoral radiographs: the visibility of caries, periapical, periodontal, and bone lesions; for panoramic radiographs: reduction of ghost images, image sharpness and bone. Bone and soft tissues on cephalograms and bone on temporomandibular joint (TMJ) tomograms were mentioned by over 70%. CONCLUSION: The most desired characteristic for a new sensor is contrast resolution. Dose saving is not considered as important unless it is more than 20%. Examination time is not a major issue. Caries, periapical and periodontal, and bone lesions for intraoral radiographs, reduction of ghost images, image sharpness and bone for panoramic radiographs were the most frequently mentioned dental features that should be enhanced by digital sensors.     

Recognizing invariant geometric structure in dental radiographs.

The dental radiograph is a non-invasive tool that is used to view internal structures for the diagnosis of caries, periapical lesions and periodontal disease. The requirement for a standardized image is most prominent in periodontal disease since the diagnosis is best done with a difference radiograph. The difficulty is that exact registration for subtraction requires exact reproduction of imaging geometry. A new model of imaging geometry, based on the correspondence of 3D structures, to describe the radiograph formation process is presented. The experimental results show that 3D measurements can be made in dental radiographs (P < 0.01) with up to 16-mm translation errors and angulation errors of up to 32 degrees.     

Cemento-osseous dysplasia,a radiological mimic of periapical dental abscess

In the imaging evaluation of Emergency Department patients presenting with facial pain, there is a condition that can mimic the radiographic appearance of a periapical dental abscess. This condition, cemento-osseous dysplasia, may appear similar on dental X-rays, panoramic radiographs, and computed tomography examinations to and must be distinguished from the more common periapical abscess in order to avoid inappropriate intervention. This review highlights the easy confusion of these two entities based on radiographic appearance and the clinical implications of such a mistake and suggests some approaches to avoid this error.     

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.     

Validity of using a panoramic radiograph for initial dental classification of Army recruits

OBJECTIVE: The objective of this study was to examine the validity of classifying Initial Entry Training (IET) soldiers into dental fitness classification 2 or 3 based solely on examining panoramic radiographs. MATERIALS AND METHODS: The dental readiness classification, derived from a clinical screening examination versus a panoramic radiological examination, was compared for 1,050 Fort Sill Basic Training recruits during a 1-month period. The dentist who reviewed the panoramic radiograph and determined a dental classification was blinded to the earlier dental classification from the clinical examination. The Spearman's rank order correlation test was used to determine if a statistically significant correlation existed between classifications based on the clinical examination versus classification by review of the panoramic radiograph alone. RESULTS: The project identified that 18% (n = 186) and 23.7% (n = 249) of the sample population had at least one class 3 condition identified from the clinical screening examination and the panoramic radiograph review, respectively. Of the 186 dental fitness category 3 conditions identified from the routine dental screening, 81.7% (152) of them were also identified from the review of the panoramic radiograph. Spearman's rank order correlation test statistic was 0.633 for a p < 0.001, indicating a statistically significant correlation in the identification of IET soldiers with class 3 conditions using a screening examination with a review of the panoramic radiograph. CONCLUSIONS: The findings of this study suggest that panoramic radiograph review can identify IET soldiers with dental fitness category 3 conditions and implies that a policy change may be prudent to allow this type of initial classification.     

Pre-operative diagnostic radiograph interpretation by general dental practitioners for root canal treatment

Objectives

The aim of this study was to evaluate which radicular radiographic features general dentists want to interpret, determine which of the radicular radiographic features general dentists interpret and which ones they miss in a diagnostic radiograph and correlate how accurately general dentists are able to interpret radiographic features.

Methods

20 general dental practitioners were selected and given 2 sets of questionnaires. The first set asked them to fill out the findings they would elucidate in a diagnostic radiograph while the second set consisted of 30 randomly selected intraoral radiographs to interpret.

Results

In the first set of questionnaires, more than 50% of dentists said they would interpret periapical changes, calcification, root curvature and the number of root canals. Less than 50% said they would interpret canal morphology, open apex, resorption, fracture, number of roots and lamina dura. In the second set of questionnaires, more than 90% missed grade 1 or 2 periapical changes (according to periapical index scoring), resorption and canal calcification. More than 80% of dentists missed extra roots and root curvature buccally while no dentists were able to interpret the periodontal ligament width changes, lamina dura and canal variation (C-shape). Using a paired t-test, there was significant variation in answers between the first set and second set of questionnaires.

Conclusion

It is concluded from this study that general dental practitioners are able to detect radiographic changes when they are extensive but they miss periodontal ligament width and lamina dura changes.     

Development of a prediction tool for low bone mass based on clinical data and periapical radiography

Objectives

This study aimed to develop and test a tool for low bone mass pre-screening by combining periapical radiographs with clinical risk factors.

Methods

The study sample consisted of 60 post-menopausal women over 40 years of age who were referred for dental radiographs. These patients also had their bone mineral density measured at the lumbar spine and proximal femur using dual-energy X-ray absorptiometry. Radiographic density measurements and 14 morphological features were obtained from each dental radiograph using digital image processing software. The clinical variables considered were age and bone mass index. Classification and regression tree analysis (CART) was used to test the predictive power of clinical and radiographic risk factors for classifying individuals.

Results

CART indicated that the most important variables for classifying patients were age, number of terminal points/periphery, periphery/trabecular area, radiographic density and bone mass index.

Conclusion

A combination of clinical and radiographic factors can be used to identify individuals with low bone mineral density, with higher accuracy than any one of these factors taken individually.     

Digital panoramic radiography: a clinical survey

The application of digital panoramic radiography with photostimulable phosphors to dental diagnosis was evaluated in 500 patients. Comparative intraoral films of selected groups of teeth and electronic magnifications of the same portion of the arches were obtained in 63 cases. Digital images improved the quality of dental examinations compared with film radiographs. The possibility of contrast modulation was helpful to compensate for the different radiographic densities of the arches and to improve the visibility of gingival soft tissues. In addition, digital radiography reduced the radiation dose administered to the patient. The use of digital panoramic radiography is proposed as a substitute for film studies in all hospitals where a central unit for digital radiology is available. Correspondence to: R. Nessi     

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.     

Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery

OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy of the panoramic radiograph in the detection of carotid artery calcification using CT as the gold standard. METHODS: 110 dental patients (average age 65.2 years, range 50-82 years) with both panoramic radiographs and CT scans available were selected for the evaluation of carotid artery calcification. Two oral and maxillofacial radiologists interpreted the panoramic radiographs for the presence of carotid artery calcification. CT scans were independently interpreted by a neuroradiologist. RESULTS: The accuracy of panoramic radiographs in the detection of carotid artery calcification was 62.3%. The sensitivity and the specificity were 22.2% and 90.0%, respectively. CONCLUSIONS: Panoramic radiography has a moderate diagnostic accuracy in the detection of carotid artery calcification, but the sensitivity is low.