Characteristics of an oral and maxillofacial radiology department. Report of the ad hoc Department Characteristics Committee of the American Academy of Oral and Maxillofacial Radiology.

Oral and maxillofacial radiology is a dynamic and multifaceted discipline that plays a critical role in patient care, the education of general dentists and dental specialists, and the academic health of the dental school. Diagnostic and treatment advances in temporomandibular joint disorders (TMD), implants trauma and orthognathic surgery, and craniofacial abnormalities depend heavily on conventional and advanced imaging techniques. Oral and maxillofacial radiology contributes to the education of pre- and post-doctoral dental students with respect to biomedical and clinical knowledge, cognitive and psychomotor skills, and the professional and ethical values necessary to properly prescribe, obtain, and interpret radiographs. The development of an active and successful oral and maxillofacial radiology department, division, or section requires the committment of institutional resources. This document may serve as a guide to dental schools committed to excellence in oral and maxillofacial radiology.

Identification of condylar anatomy affects the evaluation of mandibular growth: guidelines for accurate reporting and research.

Mandibular length is measured on cephalographs to depict changes during growth and after orthodontic treatment, and is often defined between condylion (Co, most posterior superior point on the condylar outline) and pogonion (Pog, most anterior point on the chin). The aim of this study was to assess the accuracy of identifying condylar anatomy, thus the validity of using Co-Pog to evaluate mandibular growth. The sample included 34 children from a prospective study on the early treatment of distoclusions. Two lateral head films were taken of each child, the first with the mouth closed (MC), the second with the mouth open (MO). Three examiners, two orthodontists (U.H. and K.H.) and a dental radiologist (R.B.), rated the condyle as identifiable, nonidentifiable, and interpreted. The rating was applied to the left (L) and right (R) condyles, or to only one outline (O) when the R and L structures appeared superimposed and were not distinguished separately. Besides Co-Pog, the orthodontists traced sella-nasion (SN) and incisor tip-menton (I-Me) to evaluate variability in measurements that do not include Co. One operator (J.G.) measured all distances. Agreement among the three examiners was best in rating the MO radiographs (50%): 4.1% identifiable, 5.9% nonidentifiable or interpreted; in the MC films, they agreed in 32.3% of the cases, but only one of the ratings was identifiable (2.9%). The highest agreement was in identifying the left condyle on the MO film (35.3%). Intraclass correlation coefficients for CO-Pog ranged from r = 0.73 (L side) to r = 0.92 (O) for one orthodontist, and for the other from r = 0.76 (O) to r = 0.85 (L). Both orthodontists had high correlations for SN and I-Me between MC and MO (0.94 < r < 0.98). The variability between examiners in recognizing condylar anatomy, particularly on radiographs taken with the mouth closed, suggests that the identification of condylar anatomy must be rated in studies of mandibular growth. Researchers measuring mandibular length in investigations of mandibular growth after orthodontic therapy should differentiate between cases where the condyle is readily identified, and those where condylar anatomy is interpreted.

A follow-up study of a third-party radiographic evaluation system.

A follow-up study was conducted to evaluate the performance of the rating system for third-party carriers which was developed and instituted in 1976. Further, the technical quality of radiographs submitted under the system was evaluated. The conditions and parameters of the second study were identical to those of the original work. Statistical comparison of the data from both studies shows a significant decrease in the frequency of error occurrences over the 3-year span between the studies.

A bitewing radiographic study of a population of diabetic and nondiabetic rhesus monkeys.

A population of 7 diabetic and 13 nondiabetic rhesus monkeys (Macacca mulatta) were examined radiographically using bitewing imaging techniques. Each subject was scored radiographically for bone levels, periodontal ligament (PDL) widening, radiographic calculus, and carious lesions. Prior to examinations blood samples were obtained for fasting blood glucose levels. Results indicated that all clinical variables were generally greater for the diabetic group, with bone loss being the only statistically significant parameter. Calculus levels, however, were found to be greater radiographically in the nondiabetic group. In viewing the study population as a single group of 20 monkeys, decreased bone levels were found to be positively correlated with PDL widening and blood glucose levels suggesting an association of hyperglycemic states with possible decreased resistance to infection. It was concluded that carbohydrate intolerance with hyperglycemia in diabetes mellitus may be associated with the radiographic variable of increased bone resorption using an objective system of measurement for evaluation and scoring. Without a quantitative system of measurement such as devised in this study, other radiographic variables such as PDL widening, calculus deposits, and carious lesions may not be accurately tested against one another or correlated with other experimental clinical parameters.

The use of image intensification in sialography.

The application of image intensification to sialography is presented. The advantages of better visualization of noncalcified or poorly calcified pathologic conditions, more accurate localization of strictures and soft-tissue tumors, and determination of gland function are discussed. These advantages over the conventional static sialographic technqiue would appear to outweigh the disadvantage of some increased exposure of patient and operator to radiation. In the authors' experience image intensification is the technique of choice in the majority of cases.

A study to develop a rating system and evaluate dental radiographs submitted to a third party carrier.

An easy, efficient system for rating radiographs was developed and applied to 1,000 preauthorization case submissions. The films were evaluated and the frequency distribution of errors determined. Results showed the majority of the examined full-mouth and partial-mouth radiograph series submitted to Pennsylvania Blue Shield were substandard. Recommendations for screening radiographs to upgrade their technical quality are offered.