Effect of minor amendments of patient's position on the accuracy of linear measurements yielded from cone beam computed tomography

Statement of Problem: Image distortion in intra and extra-oral radiographs are an unavoidable phenomenon. Patient's positional changes from the routine alignments is an important issue for this unwanted alteration, Therefore the accuracy of the dimensional measurements will be affected

Purpose: Our purpose is to find out the effect of minor changes [possibly happening in the clinic] in the position of a human dry skull on the accuracy of the measurements acquired by Cone Beam Computed Tomography [CBCT]

Materials and Method: In this study, 3 locations on the skull were pointed with radioopaque markers. Imaging process with Kodak 9000 CBCT was performed in standard and 10 analytically miss- oriented positions. Then 2 distances were measured between the centers of markers. Later, these measurements were compared with the standard position values

Results: There was not any imperative difference in the measurements of the 10 altered positions yielded in this study with standard position values

Conclusion: According to our results, apparently, the accuracy of linear measurements in CBCT images is endorsed by unintentional small changes in the patient's position during the projections

Follicular ameloblastoma presenting as a sinonasal tumor

A case of follicular ameloblastoma of the left maxilla in a 74-year-old man is reported. The tumor was presented as a radiographically solid mass filling the left sinonasal cavity and invaded maxillary alveola. After radical surgery, the patient has pursued a non-aggressive clinical course after 4 years of follow-up. The radio-pathological features of this tumor were reviewed and the possibility of its sinonasal epithelium origin was discussed

[Effect of magnesium supplementation on calorie intake and weight loss of overweight or obese insomniac elderly subjects: a double-blind randomized clinical trial]

There is evidence suggesting an association between insomnia and obesity and probable beneficial effects of magnesium supplementation on insomnia. The objective of this study was to determine the effects of dietary magnesium supplementation on the energy intake and weight reduction of insomniac overweight or obese elderly subjects. A double-blind randomized clinical trial was conducted on 46 overweight or obese subjects randomly allocated into the magnesium or the placebo group, receiving, daily for 8 weeks, either 500 mg magnesium or a placebo, respectively. Using appropriate questionnaires, data were collected on insomnia [insomnia severity index = ISI], physical activity, and sleep-log at baseline and at the end of the intervention period. In addition, information was obtained on anthropometric confounding factors and daily intakes of magnesium, calcium, potassium, caffeine, energy form carbohydrates, fat and protein, and total daily energy intake using the 24-hr dietary recall questionnaire for 3 days. The N4 and SPSS software version 16 were used for data analysis, the level of significance being a p-value < 0.05. No significant differences were observed in the assessed variables between the two groups at baseline. As compared to the placebo group, in the experimental group diatery magnesium supplementation brought about statistically significant increases in sleep duration and sleep efficiency, as well as significant decreases in the total energy intake and energy from carbohydrate and fat. The total length of time in bed, morning awakening time, energy from protein, serum magnesium concentration, or body weight were not different between the experimental and the placebo groups. In this study diatery magnesium supplementation resulted in improvements in sleep indices and a decrease in energy intake in elderly subjects. However, it had no beneficial effect on their body weight

Chronic multifocal inflammation of the alveolar bone mimicking malignancy: a case report

Chronic inflammation of the alveolar bone is a great clinical and radiologic mimic, which merits recognition by the clinician and pathologist. The patient can thus be reassured of the proper early treatment and a favorable prognosis. Occasionally, it is difficult to differentiate inflammatory lesions from malignant tumors. The aim of this report is to present a case with an inflammatory lesion mimicking malignant condition. We report a 19-year-old male complaining of rapid onset gingival swelling of the right side of both jaws and looseness of the right upper molar teeth in 20 days. Based on the acute onset of the gingival hyperplasia, severe looseness of the affected teeth especially in the maxilla, and the patient's age, multifocal rapid growing malignant condition was not ruled out. The lesion was misdiagnosed as a malignant condition by clinical and radiographic examination. The whole body bone scan showed no significant increased uptake in the right oral cavity compatible with no active bony pathology. The surgical pathology findings of the lesion showed severe chronic inflammation with surface epithelial hyperplasia. The initial diagnosis of the lesion was malignant condition but it was ruled out by bone scan and histological appearance

Bilateral cystic lesions associated to maxillary erupted dilated odontomas: a case report

The term 'Dilated Odontoma' is a malformation which most frequently occurs in the deciduous, permanent or supernumerary teeth. It can be diagnosed with deep invagination of the enamel inside the crown or root. In other words, the most extreme form of dens in the dente is known as "dilated odontoma". Although dilated odontomas are usually asymptomatic, their eruption into the mouth can give rise to pain, inflammation, and infection. This report is an attempt to describe the case of a 22-year-old female presenting with bilateral cystic lesions associated with erupted dilated odontomas of the maxilla. The patient had no history of pain but she complained about a recurrent swelling which she was suffering from for about two years. Conventional radiographs showed bilateral cystic lesions associated with dilated odontomas. The findings were also confirmed by Dent Scan. The treatment plan consisted of surgical removal of the lesions, followed by histopathologic study in order to confirm the initial diagnosis

[Comparison of second molar eruption patterns in skeletal class I and class II malocclusions]

The timing and pattern of eruption of second molars are clinically important factors and might be related to different types of craniofacial skeletal morphology and malocclusion.In this cross sectional study the eruptive positions of the second molars in Class I and Class II malocclusion were studied and compared. Pretreatment records including clinical examinations, and radiographs of 99 orthodontic patients, [56 girls and 43 boys with the mean age of 10.2 years] were evaluated. Approximately 25.3% of the patients had skeletal Class I, 35.3% had skeletal maxillary Class II, and 39.3% had skeletal mandibular Class II malocclusions. The eruptive position in relation to a reference line, as well as, the developmental stages of the patients' second molars, and the dental ages were recorded using theirs panoramic radiographs. Data were analyzed using ANOVA and Chi- square tests. The mean values of dental and chronologic ages of the subjects were similar. The distribution of various developmental stages in each malocclusion group was similar. There was an association between the type of skeletal malocclusion and dental developmental stage of the second molars [p <0.0001]. The eruptive position of second molars was more occlusal in the maxilla of patients with maxillary Class II and more apical in the mandible of patients with mandibular Class II [p <0.0001] According to the present study, the maxillary second molars erupt earlier in maxillary Class II malocclusion patients, and the mandibular second molars erupt later in mandibular Class II malocclusion compared to other malocclusions

[Bifid mandibular nerve canal: a literature review and report of two cases]

Bifid mandibular canal is almost a rare anatomical variation and can be of considerable interest for the dentists. This condition can lead to complication in performing mandibular anesthesia, surgery of the lower third molar, orthognatic or reconstructive mandibular surgery, placement of dental implants and prosthesis, bleeding, and traumatic neuroma. Therefore, paying attention to this condition seems necessary. In this article, two cases of bilateral bifid mandibular canal are reproted

[ effect of prenatal care group education on pregnant mothers' knowledge, attitude and practice]

Effective prenatal education may play an important role in decreasing diseases and morbidity and therefore promoting mother's health. The aim of this study was to examine the effect of group education [by a standard teaching model] on knowledge, attitude and practice of pregnant mothers. This study was a field trial which was performed on 60 pregnant women in their 6[th] to 8[th] gesta-tional age. Samples were divided into two groups randomly. The experiment group was instructed using the standard protocol developed by maternal health unit of Isfahan Provincial Health Center and the control group received the routine prenatal instructions. In the standard protocol, the educational needs during the first, second and third trimesters of pregnancy were determined and 14 training sessions with prepared lesson plans were designed. The data were gathered by a questionnaire. Mother's knowledge in second and third trimester was significantly higher in intervention group compared to the control group. Also, it was almost significant in the first trimester. But, the educational program had no effect on mothers' attitude and no difference between the attitude of the two groups of intervention and control was observed. In contrast, the education had a positive effect on mothers' practice and a significant difference was revealed between the practices of the two groups. Considering the special features of this educational model, implementing this program as a continuous intervention in all health care centers could improve the quality of prenatal care

[Mandibular incisive canal in panoramic view]

One of the anatomic structures in mental interforaminal area is mandibular incisive canal [MIC]. Due to the lack of sufficient emphasis in anatomic texts and limited ability of conventional radiographies to depict it, this structure is not fully recognized or considered by dentists in planning treatment. Ignorance of this canal can lead to post-surgical complications in this region. The aim of this study was the assessment of radiographic appearance of mandibular incisive canal in panoramic view. In this cross-sectional study, 2324 panoramic views of patients [1117 males, 1207 females] with the mean age of 18 to 70 years were inspected for presence of MIC. Digital photographies were obtained from those radiographic views containing MIC. Then panoramic views with good visible MIC were selected in the study. A data sheet containing age, sex, visibility, extension of the canal in each side, and distance between MIC and inferior border of mandible was completed. An approximate course of MIC was determined and drawn. Chi-square test and SPSS- 11.5 software were used to analyze the data. In 883 cases [38%] of panoramic radiographies, MIC was visible, and 277 of them [11.9%] displayed MIC with good visibility. In 19% of cases MIC was detected in right side, and in 14% of cases it was detected in left side. In rest of the cases [67%] canals were visible on both sides. Based on Chi-square test, good visibility of the canals in men was significantly more than in women. Because less than 50% of panoramic views with good quality and standard protocol could depict incisive canal of the lower jaw, use of other more reliable methods such as C.T or tomography should be recommended in case of necessity

Effect of standardizing prenatal care protocol on pregnancy outcome

The new maternal health care program has been designed in order to improve the quality of the current national program. Standard protocol along with the methods of physicians' and midwives' intervention clearly defined in this program. This study was carried out to examine the effectiveness of this program in terms of improving child birth, pregnancy indicators and solving related problems. The historical cohort study started in Ardestan since 2003 and continued until the midyear of 2005. Mothers who labored were randomly selected and categorized in two groups who received care based on the new program and who didn't receive care. A checklist was prepared for each subject using health files and hospital records. The collected data were analyzed by SPSS software. The results showed that the frequency of caesarian section in two groups was the same. The frequency of L.B.W in group who received new care services was lower than the other group. Pregnancy age indicator at the time of delivery to determine the frequency of full term birth was promoted in first group. In case of stillbirth indicator, some improvements were seen in group who received new cares. Preterm labor is one of the most prevalent problems in society resulted in immaturity and low weighted infants and high costs for families and government. Presenting compiled cares and providing appropriate services using the new guidelines can be effective to improve child birth indicators especially in reducing the number of preterm and still births

[Radiographic and CT scan evaluation of root resorption of permanent incisors maxillary impacted carises]

Resorptions of permanent incisors are a rare complication of ectopically erupting maxillary canines but when they occur they may lead to extraction, orthodontic treatment or both. The purpose of this study was to assess the incisor root resorption adjacent to impacted maxillary canines using conventional radiographs and CT scan. Fourteen patients [13-20 years] with 18 impacted canines were studied. Upper alveolar bone CT scans of the patients and their periapical and panoramic images were analyzed for detecting incisor root resorption caused by impacted canines. Degree of root resorption was assessed on CT scans on the basis of the self-designed classification. Buccolingual, mesiodistal and superioinferior location of resorption of incisors' roots and their longitudinal extension were assessed using CT scans in regard to the number of CT cuts showing the resorption. All of the teeth adjacent to impacted maxillary canines showed resorption. The most prevalent resorption site [84.6%] was detected in lateral incisors. 61.5% of involved teeth in CT scan did not show any resorption in the conventional radiographs and the others [38.5%] were questionable. In 77% of cases, resorption of palatal and distopalatal surfaces of involved roots were not detectable in conventional radiographs. Assessment of canine eruption angle in panoramic radiography revealed that this angle did not have any significant role in developing root resorption of adjacent teeth. Conventional radiographs are not able to detect root resorption of the incisors adjacent to impacted canines. Therefore, in cases which intensity and extension of root resorption has an effect on treatment plan and prognosis, CT scan is strongly recommended

[Malignancy after renal transplantation: a case series study from Isfahan University]

Long term use of immunosuppressive therapy in transplant recipients in order to prevent acute and chronic rejection increases the long term risk of cancer. This study evaluates the incidence of different organs cancer after renal transplantation and immunosuppressive therapy. This is a retrospective analysis of malignant tumors in renal graft recipients with more than one year graft survival. Patients were assessed according to their age, sex, diagnosis of cancer, immunosuppressive drugs, donors and period of dialysis before transplantation. Evaluating all existing files in selected private clinics in Isfahan 350 patients were reviewed and 289 of them had entrance criteria. A total of 186 men and 103 women [mean age: 42.17 +/- 13.09 years] were included. They were followed up over a mean period of 52.46 +/- 33.24 months. A total of six cases [2.1%] of cancer were diagnosed in six recipients: All patients with cancer were male with a mean age of 51.17 +/- 14.7 years [range: 26-68 years]. Tumor presented at a mean time of 51 months [rang: 15-82 months] after transplantation. There were two patients with BCC, two patients with SCC and two patients with lymphoma. Two patients died of progressive malignant disease. Age, period of dialysis before transplantation, and using immunosuppressive and anti-rejection drugs had no significant impact on development of post transplant malignancy. The frequency of tumors in these patients is lower than what reported by other centers, probably due to short period of follow up and low incidence of cancer in our general population. The risk of malignancy was 28 fold higher among transplant recipients than in general population. High risk of cancer in this group, confirms the necessity of routine examination for organ transplant recipients both before and after transplantation

[ vitro comparison of sensitivity and specificity of photo stimulable phosphor [PSP] receptor and FILM-F for detection of non-vertical root fracture]

Root fracture of permanent teeth caused by injury are relatively rare, occurred in 0/5-7 percent of dental injuries cases. Generally, final diagnosis is based on the radiographic fitures of a fracture line/ lines, and mobility of the coronal segments of the teeth. In the recent years, digital radiography with different types of receptors has become available. These receptors have some advantages, in which the greatest is dose reduction. The aim of this study was to compare the detectional accuracy of PSP receptor with dental film F in the diagnosis of root facture. In this in-vitro study 162 extracted human teeth were selected and parallel periapical radiographs of teeth were taken with two different receptors [film-F, PSP] under a standard condition. The presence or absence of root fracture was evaluated by two observers according to 2 points confidence scale. The actual status of each root of the tooth was determined by sable-seek staining. Sensitivity and specificity of the imaging modalities were calculated and the observer responses were analyzed with Mc-Nemar and kappa test. The sensitivity value of F-speed film and PSP receptor were 80 and 77.5% respectively, while the specificity values were 83.5 and 87% respectively. The difference in detecting root fracture between the test groups was not statistically significant. Although, there is no statistically significant differences between evaluated imaging modalities in root fracture detection, because of reduced exposure in digital radiography relative to conventional film, it seems logical if the conventional radiographic films will be replaced by digital system in root fracture detection

[Evaluation of the "false positive internal joint derangement" in sonography by using MRI]

Today, the most precise method for TMJ soft tissue imaging is MRI. But, due to high cost and complexities of this procedure, its application to all patients is neither possible, nor logical. So, many physicians are forced to treat their involved patients in TMJ dysfunction, without complete information about disc situation, based only on the results of clinical exams and evidences of conventional radiography of TMJ hard tissues. The aim of this study is to evaluate the accuracy of the high resolution-Ultra sonography [HRUS] in TMJ disc displacement detection. This is done via the evaluation of the "false positive internal joint derangement" in sonography by using MRI. MRI imaging of 16 TMJs of 10 patients, which in clinical exams were diagnosed as ADD [Anterior Disc Displacement] cases, was confirmed by sonography. The results of sonography compared with those of MRI were tabulated [table 1]. The final results presented descriptively. In this study, all cases of ADD diagnosed in sonography, were confirmed by MRI too. HR-US can be used in TMJ diagnosis and treatment planning as a reliable technique for imaging of disc in this joint

[Evaluation of degree of agreement between cervical vertebrae maturation indicators in lateral cephalometry and hand wrist radiographs]

Evaluation of skeletal growth which is necessary in growth modification and orthognathic surgery is usually done by using skeletal maturity indicators of hand and wrist radiographs. The use of growth stages of cervical vertebrae seen in lateral cephalometrics films currently has been suggested to avoid over exposure. The purpose of the present study was to investigate the degree of agreement between hand and wrist bones developmental stages and cervical vertebral maturation stages. The subjects of this cross-sectional study consisted 58 females and 61 males ranging from 8 to 17 years old divided into 10 groups. A total of 119 hand, wrist and lateral cephalometry radiographs were obtained and analyzed. The hand and wrist radiographs were evaluated according to the Fishman system, which uses four stages of bone maturation found at six sites located on thumb, third finger, fifth finger and radius. Cervical vertebral maturation was determined from lateral cephalometry radiographs based on a system developed by Hassel and Farman. In all age groups, the skeletal maturity stage in the hand and wrist bones and cervical vertebrae of female subjects were ahead of male subjects. The Kappa test revealed a high degree of agreement between skeletal maturation indicator in hand and wrist bones and cervical vertebrae in all of the samples [d. of a.=0.846, p<0.001], females [d. of a.=0.791, p<0.001] and male [d. of a.=0.892, p<0.0001]. The chronological conformity between 2 methods showed a high degree of agreement in all age groups except in 8 and 17 years old ages. The highest chronological agreement was seen in 15 years old age group, although the degree of agreement in 8 years old age group was low and in 17 years old age group was moderate. According to the results of this study, hand and wrist radiographs can be easily replaced by cervical vertebral maturation analysis for evaluation of skeletal developmental stage

[Effect of standard prenatal care protocol on the pregnancy outcome]

The new maternal health care program has been designed in order to improve the numerous weaknesses of the current national program. Standard protocol along with the methods of physicians' and midwifes' intervention is clearly defined in this programs. This pilot project has started in Ardestan district since 2003 and will continue until the midyear of 2005. This study was conducted to examine the efficacy and effectiveness of this program in terms of improving child birth and pregnancy indicators and solving related problems. This is an analytic [Hystorical cohort] study. Two groups of mothers who gave birth to their children after starting the program entered the study. Mothers who received current care and those who received care based on the new program were randomly selected. A checklist was complated for each subject using health files and hospital records. The aim was to examine the birth outcomes and relevant indicators. The collected date were analyed by SPSS software. The results of this study show that the frequencies of Caesarian section in two groups are th same. The frequency of L.B.W in the group who received new care services is lower than the other group. An improvement in the full term pregnancy indicator indicator in the first group was also observed. In case of stillbirth indicator, about one percent improvement was seen in the group who received new care. High preterm birth indicator is one of the most common problms in Iran. It shows the number of preterm and full term births with low birth weight imposing high costs to the families and the government. It seems that providing appropriate services using the new guidelines can be effective on improving child birth indicators specially in form of reducing the number of preterm child birth and stillbirth cases

Bifid mandibular canal [a case report]

Bifid mandibular canal is a rare condition that has been reported by researchers in different countries. According to the present data, comprehensive evaluation of such cases has not been yet performed in Iran. It seems that examination of patient with bifid mandibular canal has its own scientific importance. This is a case of a 35 years old man who referred to Shiraz Dental School for routine dental treatment. Panoramic radiograph of the patient showed a bilateral ascending accessory manibular canal. According to the complications of such an anomaly like inadequate anesthesia in the affected side, infringing of wisdom teeth in the accessory canal, bleeding, traumatic nuroma, etc and due to rarity of such cases this case was selected to be reported as a case-report

Response rate to hepatitis B vaccination in patients with chronic renal failure and End-stage-renal-disease: Influence of diabetes mellitus

Hepatitis B vaccination is recommended for all individuals with renal failure. Nevertheless, the response rate for this vaccine in hemodialysis patients is low. This study was designed to determine the response rate to hepatitis B vaccination in chronic renal failure [CRF] and end stage renal disease [ESRD] patients and those factors that influence it. We evaluated antiHBs level after primary vaccination in 32 predialysis and 93 dialysis patients. HBsAg positive patients were excluded. AntiHBs titers were determined in the period of 1 to 6 months after completion of vaccination. Seroconversion [antiHBs >/= 10mIU/ml] was found in 100 patients [80%], but an excellent response [titer>100 mIU/ml] was observed only in 74 [59.2%]. Response rate were 71.9 and 82.8 in predialysis CRF and ESRD patients, respectively, but this difference was not significant [

[ in vitro evaluation of Kodak insight, ekta speed plus film and radiovisiography in detecting natural proximal caries]

Statement of Problem: Dental caries is the most common chronic infectious diseases involving about 95% of population and still is a major cause of loss of teeth. Dental caries diagnosis is a challenging task for dental practitioners. In spite of developing different diagnostic methods for better evaluation of dental caries, conventional intraoral films continues to be the most widely used radiographic modality for the diagnosis of dental caries

Purpose: The aim of this study was to evaluate the efficiency of Ekta speed plus, insight radiographic films, and RVG ui 100 in detecting proximal caries lesions

Materials and Methods: Seventy two surfaces of 36 extracted human premolars were evaluated. Radiographs of teeth blocks were taken with two different films and RVG, under standard conditions. The presence or absence of approximal caries was evaluated by six observers according to 3 points confidence scale. The actual status of each surface of the tooth was histologicaly determined from the teeth sections. Sensitivity and specificity of the imaging modalities were calculated and the observer responses were assessed with Fissure Exact Test

Results: The sensitivity values of Ekta speed plus, Insight and RVG were 24.3%, 18% and 46% respectively, while the specificity values were 86.4%, 87.1% and 78% respectively. The difference in detecting approximal carious lesions between the systems was not statistically significant

Conclusion: This study suggests that there is no significant difference between the three imagining modalities in detecting approximal caries. So, Insight film and RVG ui sensor merit considerations as the new standard of care

[ reliability and comparison of linear measurements of intraosseous periodontal lesions by conventional periapical and digitized radiographs]

Statement of Problem: Intraoral radiographs are the most common diagnostic tool used to assess alveolar bone loss with periodontal origin. However, radiographic assessment tends to underestimate the amount of bone loss. Digital processing and manipulation of radiographic images may enhance diagnostic interpretation of radiographs

Purpose: The aim of the present study was to evaluate the validity of linear measurement of intraosseous periodontal lesions by conventional periapical [PA] and digitized radiographs in comparison with clinical measurements

Materials and Methods: In this practical study, 35 standard conventional PA radiographs [Parallel technique] were obtained from 50 vertical periodontal osseous lesions. During mucoperiosteal full thickness flap surgery, the distances between the depth of periodontal osseous lesions and the crest of interproxiaml bones were measured and compared with liner measurements of the lesions by conventional PA radiographs and digitized radiographs manipulated by gamma adjustment Photoshop 7.0 software for statistical evaluation. The results of the two radiographic measurements were compared with intrasurgical measurement by Dunnett test

Results: Conventional PA radiographs underestimated the depth of lesion in comparison with clinical measurements. Linear measurements by the two observers did not show any significant difference between digitized radiographs and clinical dimensions, but measurements by the third observer underestimated the depth of the lesion in digitized radiographs in comparison with clinical measurements. However, the amount of underestimation was less than that of measured by conventional PA radiographs

Conclusion: In this study, the validity of digitized radiographs was more than that of the conventional PA radiographs in comparison with clinical measurements [Gold standard]