Utility of Panoramic Radiographs in the Screening of Individuals with Edentulous Arches: A Need-Analysis Study

Abstract Objective: To evaluate the utility of panoramic radiographs in pre-prosthetic screening of edentulous arches. Material and Methods: Panoramic radiographs taken for three years were retrospectively analyzed. Observations from the radiographs shall be categorized and classified into either of the two categories, namely: 'findings with minimal impact on denture fabrication' and 'findings which affect denture fabrication and require further evaluation.' Anatomic variations, jaw pathologies, and residual ridge resorption patterns were assessed. Results: This study included the initial screening of 23,020 panoramic radiographs, out of which 505 (showing either one or both edentulous arches) were included for the study purpose. The age range of the subjects was from 21 to 94 years. 52.6% of the radiographs showed positive findings. More than half of the radiographs belonged to the males (52.5%). Hyperpneumatization of the maxillary sinus, crestal position of the mental foramen, and retained root fragments were the most common entities noted in the radiographs. Changes in the mental foramen were significantly higher in males than females (p=0.002). Conclusion: Observations from this study showed that panoramic radiographs have high utility for screening edentulous arches, and they should be used in routine clinical practice before denture fabrication.

Aspectos descriptivos imagenológicos del osteoma de los maxilares: Revisión de la literatura / Descriptive imagenological aspects of osteoma in the jaws: review of the literature

El osteoma es una lesión osteogénica benigna, derivado de hueso compacto o esponjoso. Se caracteriza por ser de crecimiento lento y aparece con más frecuencia entre los 20 y los 50 años de vida, con una prevalencia mayor en hombres con respecto a las mujeres. Clínicamente asintomáticos, los podemos encontrar en la región craneofacial, particularmente en los senos paranasales y la mandíbula, y pueden presentarse de tres formas: central, periférica y extraósea, siendo más comunes los solitarios, a diferencia de los múltiples que están relacionados con el síndrome de Gardner. El tratamiento de los osteomas es quirúrgico cuando causan complicaciones. Los estudios por imágenes, como la radiografía panorámica y la TCHC, son las modalidades de mayor uso para determinar la ubicación, la extensión y las relaciones anatómicas de la lesión. Las características imagenológicas pueden presentarse como una excrecencia ósea de hueso compacto, esponjoso o mixto. El conocimiento de esta lesión nos permitirá tener mejores propuestas diagnósticas. (AU)

Osteomas are benign osteogenic lesions derived from compact or spongy bone. They are characterized by their slow growth and appear more frequently between 20 and 50 years of age, with a higher prevalence in men than in women. These lesions are clinically asymptomatic and can be found in the craniofacial region, particularly in the paranasal sinuses and the mandible, and may have a central, peripheral or extraosseous presentation. Multiple osteomas are related to Gardner's Syndrome. Treatment of osteoma is surgical when complications develop. Imaging studies such as panoramic radiography and cone beam computed tomography are the modalities most widely used to determine the location, extent, and anatomical relationships of the lesion. Imaging features may present as a bony excretion of compact, spongy, or mixed bone. Adequate knowledge of these lesions allows adequate diagnosis and better treatment planning. (AU)

Can Denture Wearing Increase the Nutritional Status in Pre-Elderly and Elderly Patients?

Abstract Objective: To investigate the relationships among tooth loss, denture wearing, nutrition intake, and nutritional status. Material and Methods: This observational cohort study was conducted on 26 patients (≥ 45 years old) at the Faculty of Dentistry, Universitas Indonesia. Tooth loss was classified according to the Eichner Index. The Semi-quantitative Food Frequency Questionnaire was used to measure nutritional intake (kcal). Mini Nutritional Assessment Short Form (MNA-SF) and Handgrip Strength (HGS) assessments were employed to measure the nutritional status at baseline (before denture insertion), 1, 2, 3, 6, 9, and 12 months after denture use. Results: Significant differences in nutritional intake (p<0.05) between the Eichner B and C groups were noted at 3, 6, 9, and 12 months after using dentures. Significant increases in nutritional intake were noted after wearing the dentures (p<0.05) when compared with the baseline values. The nutritional status was considered normal in 65.4% of the patients at 12 months and 38.5% at baseline. Furthermore, the nutritional status 1, 2, 3, 6, 9, and 12 months after wearing denture was significantly improved compared with the baseline values (p<0.05). Significant differences in HGS (p<0.05) were observed between the Eichner B and C groups at 6, 9, and 12 months after using the denture. However, no significant differences in HGS were noted before and after wearing the denture (p<0.05). Conclusion: Denture wearing can improve the nutritional intake and status of pre-elderly and elderly patients.

Sex Recognition of Skulls in Chinese Uygur / 法医学杂志

Objective Logistic regression method was used to establish a multiple regression sex discriminant function to discriminate the complete skull model and the incomplete skull model without frontal bone, occipital bone and mandible of Uygur adults in Turpan, Xinjiang. Methods A total of 117 （60 male and 57 female） three-dimensional skull models were collected by CT. Sixteen cranial measurement indexes were measured and calculated by computer software. The multivariate regression sex discriminant function was established with Logistic regression method and retrospectively tested. Results Among the 16 measurement indexes, except for nose width （x7） and maximum frontal breadth （x13）, the remaining 14 indexes had statistical significance of differences between male and female （P<0.05）. For the discriminant function of complete skull established by eyebrow arch convexity （x4）, mastoid width （x6）, maximum cranial length （x12）, cranial base length （x15）, cranial circumference （x16）, the male and female discrimination accuracy was 90.0% and 94.7%, respectively. For the sex discriminant function of incomplete skull without frontal bone established by mandibular angle width （x10）, mandibular height （x11） and cranial circumference （x16）, the discrimination accuracy of male and female was 85.0% and 84.2%, respectively. For the sex discriminant function of incomplete skull without occipital bone established by the index of eyebrow arch convexity （x4）, the discrimination accuracy of male and female was 80.0% and 73.7%, respectively. For the sex discriminant function of incomplete skull without mandible established by frontal chord （x5） and occipital protrusion angle （x9）, the discrimination accuracy of male and female was 85.0% and 78.9%, respectively. Conclusion The computer software and system developed in our study can achieve sex discrimination of complete skulls and incomplete skulls without frontal bone, occipital bone or mandible.

Evaluation of Damon system effects in alveolar bone support by cone-beam computed tomography (CBCT) / Avaliação dos efeitos do sistema Damon no suporte ósseo dentário por meio da tomografia computadorizada de feixe cônico (TCFC)

Introduction: The aim of this study was to assess changes in buccal bone thickness, buccolingual inclinations and transversal width of teeth during treatment with the Damon System. Material and Methods: Twenty-one patients of both sexes, with a mean initial age of 14.99 ± 1.27 years, with complete permanent dentition up to second molars, treated with no extractions and minimum initial crowding of 4mm (maxillary: - 6.71mm (SD 2.99), mandibular: -5.12 mm (SD 2.03)) were taken to CBCT scan before (T1) and after (T2) orthodontic treatment with the Damon System. In the maxilla, buccal bone thickness was measured at 4mm and 6mm from the cementoenamel junction of the right first molar in the apical direction. For the mandible, the same protocol was used, but the axial sections were performed at 4mm and 8mm. Buccolingual inclinations were verified using CBCT-panoramic cross-sectionals based on the image that presented the most appropriate view of buccal face of the clinical crown. Transversal width measurements were performed in intermolar, intersecond premolar, interfirst premolar and intercanine distances by 3D multiplanar reconstruction in the two-time periods. Distribution of the variables was verified by Shapiro-Wilk test. Changes in all variables from T1 to T2 were compared using paired t-test. The correlation between changes in bone thickness, buccolingual inclinations and transversal width was assessed by Pearson correlation coefficient. Results: At 4mm height, treatment with Damon System produced a statistically significant decrease in buccal bone thickness, mainly in the posterior teeth of the maxillary and mandibular arches. At 8mm, there was a statistically significant decrease in buccal bone thickness only in mandibular molar and premolar teeth. Regarding buccolingual inclinations, a statistically significant increase was observed in the maxillary arch, mainly in the incisors and premolars teeth. In the mandibular arch, all teeth showed a statistically significant increase of buccal inclination, except for the left canine and first molar. Concerning transversal width, there was a statistically significant increase in maxillary and mandibular transversal width at the end of treatment, exception of the maxillary canines. Conclusion: In general, orthodontic treatment with the Damon self-ligating brackets system showed an expansion of the dental arches followed by a decrease in buccal bone thickness, caused by buccal inclination of dental crowns in both arches.(AU)

Introdução: O objetivo do presente estudo foi avaliar as alterações nas espessuras das tábuas ósseas vestibulares, nas inclinações dentárias e nas dimensões transversais dos arcos durante o tratamento com o Sistema Damon de braquetes autoligáveis. Materiais e Métodos: Vinte e um adolescentes de ambos os gêneros com idade média de 14,99 ± 1,27 anos, dentadura permanente completa até os segundos molares, tratados sem extrações e apinhamento inicial mínimo de 4mm (superior: -6,71mm (DP 2,99), inferior: -5,12mm (DP 2,03) foram submetidos a exames de Tomografia Computadorizada de Feixe Cônico (TCFC) antes (T1) e após (T2) o tratamento ortodôntico com o Sistema Damon. A espessura da tábua óssea vestibular da maxila foi determinada por cortes axiais nas distâncias de 4mm e 6mm localizados apicalmente à junção amelocementária do primeiro molar superior direito. Para a mandíbula, foi realizado o mesmo protocolo, porém os cortes axiais selecionados foram realizados nas distâncias de 4mm e 8mm apicalmente à junção amelocementária do primeiro molar inferior direito. Para mensuração das inclinações dentárias, foram utilizados cortes parassagitais gerados a partir da imagem panorâmica da TCFC. As medidas foram realizadas a partir do ângulo formado pela linha vestibular da coroa clínica (LVCC) e a borda superior ou inferior da imagem selecionada. As dimensões transversais dos arcos (6-6/5-5/4-4/3-3) foram mensuradas por meio de cortes axiais das reconstruções 3D. As variáveis foram submetidas ao teste de Shapiro-Wilk para testar sua distribuição. As alterações de todas as variáveis de T1 para T2 foram comparadas por meio dos testes t-pareado. A correlação entre as alterações das espessuras ósseas com as alterações nas inclinações dentárias e dimensões transversais dos arcos foi verificada pelo coeficiente de correlação de Pearson. Resultados: o tratamento com o Sistema Damon produziu uma diminuição estatisticamente significante na espessura da tábua óssea vestibular predominantemente na região posterior dos arcos superior e inferior no corte realizado a 4mm. Nos cortes realizados a 8mm, houve uma diminuição estatisticamente significante na espessura óssea vestibular somente na região de molares e premolares inferiores. Em relação as inclinações vestibulolinguais dos dentes, um aumento estatisticamente significante foi observado no arco superior, com predomínio nos incisivos e premolares. No arco inferior, todos os dentes mostraram um aumento estatisticamente significante da inclinação para vestibular, com exceção do canino e primeiro molar esquerdos. As dimensões transversais dos arcos superiores e inferiores sofreram um aumento estatisticamente significante ao final do tratamento com o Sistema Damon, com exceção dos caninos superiores. Conclusão: De maneira geral, o tratamento ortodôntico com o Sistema Damon de braquetes autoligáveis produziu um aumento nas dimensões transversais seguida por uma redução da espessura óssea na parede vestibular dos dentes, ocasionada pela inclinação vestibular das coroas dentárias em ambos os arcos.(AU)

Cherubism - A case report with long term follow up.

Cherubism is a rare non-neoplastic disease of the bone characterized by bilateral painless enlargement of the jaws giving a cherubic appearance to the patient. It is an autosomal dominant disorder but may occur sporadically. In this paper, we have tried to explain about the clinical, radiological and histopathologic features of cherubism by presenting a case study. A case study of a 7 year old male patient, who first presented with mandibular bilateral swellings to our department in 1998, has been presented. In-depth clinical, radiological and histopathologic examination was done. An extensive long-term follow-up till 11 years was maintained. When presented for the first time, radiological investigation showed characteristic multilocular lytic lesions of the mandible bilaterally. Histopathological examination of the biopsy specimen showed proliferating fibrous connective tissue interspersed by multinucleated giant cells. It was diagnosed as a case nonfamilial cherubism. Follow-up after 5 years showed involvement of the maxilla as well, which was then corrected by surgical methods. Upon follow up 11 years after the first presentation, it was seen that the lesion was regressing by itself and there was improvement in facial contour. The natural course of Cherubism through its progression, stabilization and involution of the disease after puberty, has been highlighted in this case. More, in-depth studies to understand the nature and the pathogenesis of this condition better are required.

Radiological frequency of idiopathic osteosclerosis in patients referred to Qazvin Dental School [2009]

Idiopathic osteosclerosis is a common radioopaque lesion of the jaw. This lesion is asymptomatic and usually discovered on different radiographs quite by accident. The aim of this study was to investigate the radiographic characteristics of idiopathic osteosclerosis in jaw bones in patients referred to Department of Radiology at Qazvin Dental School. This was a descriptive study performed on 820 panoramic radiographs of 325 male and 465 female patients referred to radiology department for variety of reasons. The radiographs, prepared by different methods, were examined for detecting idiopathic osteosclerosis. Information regarding each radiograph such as the location, number, structure, kind of relation to adjacent teeth, and density [trabecular-cortical] as well as the information on patients' sex and age were registered. Using SPSS version 16, the desired frequency was calculated. Due to the descriptive nature of the study, no special statistical test was used. Of total radiographs, in 87 patients [10/61%], there were 97 idiopathic osteosclerosis lesions at different sites and shapes with demarcated border [50.52%] and trabecular density [54.52%]. Of patients, 58.63% were females and 41.37% males. Most lesions were in the lower jaw especially in first [30.93%] and second molars region [24.75%] and frequently not associated with the adjacent teeth [35.05%]. These lesions were more common in patients at their fourth and fifth decades of life. Based on our results it was revealed that the idiopathic osteosclerosis lesions are more frequent in lower jaw especially in molar areas and it is more common in women compared to men

Fijación de radioyodo en huesos maxilares simulando metástasis en pacientes con Carcinoma Diferenciado de Tiroides (CDT): False- Positive images in patients with Differentiated Thyroid Carcinoma. (DTC) / Uptake of 131-I in maxillary bones mimicking salivary glands

En estudios centellográficos con 131I (CCT) para seguimiento, postablación o tratamiento de pacientes portadores de carcinoma diferenciado de tiroides (CDT) se observan frecuentemente en tiempos precoces áreas de captación del radiotrazador en macizo facial. Estas áreas corresponden, generalmente, a glándulas salivares y extremo anterior de mucosa nasal y se mantienen durante las primeras 48 horas y no son observadas generalmente a las 72 horas. Pero con menor frecuencia se presentan otras que persisten durante varias semanas; estas áreas fueron consideradas como posibles retención en glándulas salivares, en tejido tiroideo ectópico en piso de boca, o proteínas yodas entre otras causas. En 1996 Valdivieso y col. (Cong. Arg. Biol. Med. Nuclear, Mar del Plata) y Gutiérrez y col. (SLAT, Chile) consideraron además de las mencionadas posibilidades, que la fijación se podría realizar en hueso maxilar en relación con procesos dentales y esta idea se vio favorecida por dos presentaciones sobre pocos casos que coincidían con la idea sobre el lugar de fijación del radioelemento con producción de imágenes falsas-positivas de enfermedad metastática. Con el propósito de determinar la frecuencia de observación de estas imágenes se procedió a la revisión de 636 CCT efectuados entre el 1 de enero de 2002 y el 31 de diciembre de 2007 en 502 pacientes. En el 31,5 % de los pacientes se observaron áreas activas en maxilares que persistían por varias semanas; la intensidad de concentración fue del 0,3 al 1,2 % de la actividad administrada. En 10 pacientes se efectuaron áreas de interés sobre las zonas activas que se controlaron durante 3 semanas, determinándose el T ½ efectivo registrándose valores promedio de 6,87 ± 0,94 días muy próximos al T ½ físico del 131I, indicando fuerte unión del compuesto radiactivo formado. La intensidad de concentración del radioyodo es variable dependiendo de la intensidad de la lesión dental, (caries, prótesis, pulpitis, granulomas periapicales) y en especial se incrementa en pacientes provenientes del interior que habitaban en zonas con aguas con contenido de flúor o arsénico. Seis pacientes tratados con actividades altas de radioyodo de entre 5,55 y 11,1 MBQ (150 a 300 mCi) mostraron lesiones actínicas en mucosa bucal y lingual. En 5 pacientes se efectuaron inmediatamente después del CCT con radioyodo, estudios panorámicos de Rx maxilar y de centellograma óseo coincidiendo las imágenes maxilares positivas de ambos estudios con las áreas positivas con radioyodo, confirmándose la localización de las mismas. En 13 pacientes que se sometieron a intensos tratamientos odontológicos, en estudios de CCT posteriores se apreció la disminución de intensidad de las imágenes o su desaparición. Ninguno de los pacientes presentó metástasis de CDA en las áreas activas maxilares. Estos hallazgos confirman la concentración del radioyodo en hueso maxilar en relación con alteraciones, dentales debiendo efectuarse investigaciones más profundas sobre la naturaleza de la molécula formada y los mecanismo de fijación de la misma. Deberá tenerse en cuenta el estado de salud dentario del pacientes antes de someterlo a tratamiento de metástasis o ablaciones, en especial cuando las actividades de radioyodo a utilizar sean mayores de 3,7 GBq (100 mCi) y aún indicar tratamiento de las lesiones dentales en forma previa.

In the whole body scans (WBS) with 131I in the follow-up or treatment of patients bearing DTC it is observed frequently fixation areas of the tracer apparently in relation with salivary glands. These areas generally belong to the salivary glands and are present during the first 48/72 hours, but others are kept during more than 3 weeks. These latter ones were considered as possible uptake in ectopic thyroid cells in the mouth floor, iodized proteins, retention of salivary glands and other assertions. Valdivieso et al (Cong. Arg. Biol. Med. Nuclear, 1996) and Gutiérrez et al (SLAT,Chile, 1997) considered that the fixation took place also in maxillary bones probably in areas in relation with dental illness (inflammation, pulpitis, dental caries, perionditis, periapical granuloma, periapical cyst and resorption of surrounding bone seen radiologically as periapical radiolucency). This presumption was sustained for two publications (Clin. Nucl. Med. 1998;23. 747-749, and Clin. Nucl. Med. 2000; 23; 314-315). This end the review of 638 131I WBS carried out between January 1st, 2002 and December 31st of 2007 in 502 patients that were studied for ablation, treatment of metastasis or relapses or follow up. In 31,5% of the patients were observed areas of activity in maxilla. The intensity of concentration of the tracer was 0.3 to 1.2 % of the activity administered. In 10 patients was determinate the effective T ½ and in 5 a panoramic Rx of the maxilla and a bone scintigraphy with 99mTc-MDP; there were correlation between both images, the 131I one an the 99mTc-MDP with radiology. The effective T½ mean value was 6,87 days ± 0,94 (S.D.) very close to the physical T ½ of the radioiodine tracer indicating a strongly labeled molecule. In 6 patients treated with high activities of radioiodine (5,55 to 11,1 MBq - 150 to 300 mCi) actinic lesions were observed in mouth and lingual mucous membrane, including ulcers. The intensity of the images and of the lesions correlate with the intensity of the administered activity of radioiodine, the previous condition of dental integrity and in patients living in the interior of our country in zones of "bad" water containing tracers of arsenic and fluorine. In 13 patients submitted to intense treatment of dental problems posterior WBS showed a decrease of the positive maxilla areas or they were not found. The presence of metastasis in the active maxilla area was in all cases negative. Our observations confirm that radioiodine is deposited in maxillary bone in relation of dental lesions and that this 131I move in a very slow place. This mechanism of fixation has to be determined. We fully recommended taking into account the existence of dental illness or incomplete dental treatments when the administration of higher activities than 3.7 GBq (150 mCi).

Study on the indexes of forensic identification by the occlusal-facial digital radiology / 法医学杂志

OBJECTIVE@#To discuss the coding of full dentition with 32 locations and measure the characteristics of some bony indexes in occlusal-facial digital radiology (DR).@*METHODS@#To select randomly three hundred DR orthopantomogram and code the full dentition, then analyze the diversity of dental patterns. To select randomly one hundred DR lateral cephalogram and measure six indexes (N-S,N-Me,Cd-Gn,Cd-Go,NP-SN,MP-SN) separately by one odontologist and one trained forensic graduate student, then calculate the coefficient variation (CV) of every index and take a correlation analysis for the consistency between two measurements.@*RESULTS@#(1) The total diversity of 300 dental patterns was 75%.It was a very high value. (2)All six quantitative variables had comparatively high CV value.(3) After the linear correlation analysis between two measurements, all six coefficient correlations were close to 1. This indicated that the measurements were stable and consistent.@*CONCLUSION@#The method of coding full dentition in DR orthopantomogram and measuring six bony indexes in DR lateral cephalogram can be used to forensic identification.

Intraosseous Nerve Sheath Tumors in the Jaws

Although the head and neck region is recognized as the most common location for peripheral nerve sheath tumors, central involvement, particularly in the jaw bones, is quite unusual. Neurofibroma is one of the most common nerve sheath tumors occurring in the soft tissue and generally appears in neurofibromatosis 1 (NF1 or von Recklinghausen's disease). Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon sarcomas that almost always arise in the soft tissue. Here, we report four cases of intraosseous peripheral nerve sheath tumors occurring in the jaw bones and compare the clinical, radiologic, and pathologic findings in order to make a differential diagnosis.