In vitro comparison between the image obtained using PSP plates and Kodak E-speed films.

OBJECTIVES: The aim of this study was to compare the intra-oral radiographic images obtained by a PSP digital radiography system ("Orex", Israel) with that obtained using Kodak Ultra speed films in terms of image quality, radiation dosage and diagnostic value. METHODS: The physical measurement of image quality was conducted with an aluminum step-wedge. Radiation dosage was measured with a dosimeter. Fog and base levels were measured by developing unexposed films and scanning unexposed PSP plates. The in vitro model included preparation and radiographic evaluation of approximal artificial lesions in premolars and molars in depths ranging from 0.25 mm to 1.00 mm. Radiographs were evaluated for the existence of a lesion and its size by 8 experienced clinicians. RESULTS: Relative contrast was similar in both methods. The resolving power of the digital system was lower than that of the E-speed film. As for the subjective evaluation of artificial lesions, there was no significant difference between the two methods excluding those tooth images without lesions, where the analog method was found to be more accurate. CONCLUSIONS: The PSP system ("Orex") provides good image quality and diagnostic information with reduced exposure when compared with E-speed film.

[Distribution of patients' complaints presented to the law court of the Israel Dental Association according to themes, dental area profession and the results].

The purpose of this study was to review the distribution of patients' complains presented to the law court of the Israel Dental Association in Tel Aviv district, according to their topics, dental areas and results. 260 complaint cases filed between 2000 and July 2008 were reviewed. only 186 cases, to which an arbitration proceeding conducted full appeal only, were taken into account . Dentists, who encountered many complaints, were classified according to their country of graduation, as specialists or general dentists. The complaints were classified according to their specific dental field, year of complaint, to the number of arbitrations each year, to the number of appeals each year, to the entity who submitted the appeal, to the difference between the verdict in the District compared to the national ruling, to the distribution of complaints by gender and to the frequency of complaints by anonymous doctors. The distribution of complaints in accordance with topics was as follows: 30% in oral rehabilitation 13.5% in Dental prosthesis, 12.4% in implants, in endodontics 5.3%, 3.7% in maxillofacial surgery, 3.2% on ethics, 2.7% in orthodontics, 1.1% in periodontology 0.5 % in pedodontics and 28% in combined dental domains. 92.5% of complaints filed against dentists who were not experts. 7.5% of the complaints were filed against s specialists. Specialists in the field of oral rehabilitation encountered the largest number of complaints, i.c. 30%. Approximately 35.2% of complaints filed against dentists who have completed their studies in Eastern European countries and 24.9% against the Israeli graduates. 63% of referrals to the Court from Tel Aviv district for which a full arbitration procedure / appeals were presented by women whereas only 37% were presented by men. An analysis of the findings in the difference between the verdicts in the District compared to the national ruling it showed a tendency to aggravation of punishment. (P = 0.003) The Greatest number of appeals was filed in 2001, mostly by patients. In 2004, the greatest number of appeals were filed mostly by dentists. Most appeals have been filed over the years by patients. Against a small number of doctors several complaints were filed. The majority of complaints that were filed in a specific period against one doctor was 6.

Critical evaluation of the radiological and clinical features of adenomatoid odontogenic tumour.

OBJECTIVES: The aim of this study was to evaluate the radiological and clinical features of adenomatoid odontogenic tumours (AOTs). METHODS: A total of 272 cases (267 from the English-language literature and 5 new cases) were analysed with special emphasis on their radiological features. RESULTS: The patients' ages at time of diagnosis ranged from 3 years to 82 years (mean 18.4 years). The maxilla-to-mandible ratio was 1.7:1. Mandibular lesions were significantly more frequent among patients older than 16 years (p = 0.032). Expansion of the cortex was significantly more prominent among patients older than 16 years (p = 0.045). There was a positive correlation between the size of the lesion and the age of the patient at the time of diagnosis (p = 0.016). The size was also associated with increased root resorption (p < 0.001), ill-defined borders (p < 0.001), expansion (p < 0.001) and perforation of the cortex (p < 0.001). Small opacities were present in 77% of lesions and were associated with expansion of the cortex (p = 0.043). The significant radiological features in patients aged 30 years and above were root resorption (p = 0.013) and lesions crossing the midline (p = 0.019). CONCLUSIONS: The size of an AOT is influenced by the patient's age. It is also associated with root resorption, ill-defined borders, expansion and perforation of the cortex, but it cannot be ruled out that those changes reflect a longer duration of the lesion.

Classifying degenerative joint disease by the RDC/TMD and by panoramic imaging: a retrospective analysis.

The purposes of the study were to evaluate the utility of diagnosing degenerative joint disease (DJD) by the clinical finding of coarse crepitus alone, without supporting imaging studies, as defined by the RDC/TMD, and to evaluate the contribution of panoramic radiography as an aid in the diagnosis of DJD. A retrospective analysis of 372 consecutive patients with TMD was conducted. Their panoramic radiographs were evaluated for the extent of their contribution to the final diagnosis. Panoramic radiography was of no diagnostic value in 94.4% of the cases when the group was considered as a whole. When patients diagnosed with DJD were considered separately, panoramic radiography was completely sufficient for reaching the final diagnosis in 20.0% of the cases. In almost 90% of these patients, however, the clinical examination did not support the diagnosis of DJD (no coarse crepitus was found). This raises some doubts about the effectiveness of the clinical examination according to the RDC/TMD and about the utility of panoramic radiography in the definitive diagnosis of DJD, because both techniques have low accuracy (11.1% and 20%, respectively). The present study supports the current recommendations that panoramic radiography should not be ordered routinely to assess DJD, but still it is first choice when any dental problem is suspected. Further additional imaging (computerized tomography, magnetic resonance imaging) should be considered only if there is reason to expect that the findings might affect diagnosis and management. This study adds to recent criticisms of the clinical validity of the RDC/TMD, with regard to DJD.

Digital images obtained with a digital camera are not associated with a loss of critical information--a preliminary study.

AIM: To investigate whether digital images obtained by a digital camera are deficient compared to the original radiographs. MATERIALS AND METHODS: Twenty pairs of bitewing radiographs of children and 40 anterior periapical radiographs were photographed using a digital camera. Images were saved as JPEG files and loaded onto a laptop. Film radiographs and digital images as scanned and after adjustments were evaluated for proximal caries and for periapical pathologies. RESULTS: A not statistically significant higher number of proximal lesions were observed on plain-film and enhanced digital images than on unenhanced images. Enhanced digital images resulted in significantly more diagnoses of external root resorption compared with conventional radiographs. Pulp canals appeared significantly more abnormal (obliterated or enlarged) in digital images compared with film radiographs. CONCLUSIONS: Storing existing radiographs in a digital medium for space saving purposes using a digital camera does not loose critical information.Clinical implication Clinicians can use digital cameras to digitise and store radiographic images without losing important diagnostic information.

Quantitative measurements obtained by micro-computed tomography and confocal laser scanning microscopy.

OBJECTIVES: To compare measurements obtained by micro-CT with those obtained by confocal laser scanning microscope in simulative internal resorption cavities. METHODS: An extracted human maxillary central incisor tooth was divided into two in the coronal plane. Four artificial internal resorption cavities were prepared with standardized burs on each section, and diameters and volumes were measured using a laser scanning electron confocal microscope and a desktop cone beam micro-CT-40. Differences between means of quantitative measurements for both methods were tested using the paired t-test; the correlation between quantitative measurements was tested by regression analysis. RESULTS: Mean diameter and volume differences between the two methods were 0.061 mm and 0.004 mm(3), respectively. Average diameter and volume calculations obtained by micro-CT were significantly lower (P < 0.001 for diameter and P < 0.01 for volume). A significantly strong relationship was found in the average diameters (R(2) = 92.9%) and calculated volumes (R(2) = 91%), (P < 0.001). CONCLUSIONS: Although a strong correlation between both methods was found, micro-CT significantly underestimated the diameters and volumes.

[Vertical root fractures in endodontically treated teeth--Part II: Etiology and prevention].

The etiologic factors for vertical fractures in endodontically treated teeth are predisposing factors, such as loss of tooth material, anatomy of the susceptible teeth, moisture loss, previous dentinal cracks, and loss of bone support; and iatrogenic factors, such as excessive removal of radicular dentin as a result of endodontic and prosthetic procedures and improper selection of dowels. Identification of susceptible teeth and roots, proper selection and cementation of dowels, and avoidance of excessive force during condensation of gutta percha and in removal of tooth structure during endodontic and prosthetic procedures, are all measures that can be taken to prevent root fractures.

[Vertical root fractures in endodontically treated teeth part I: clinical and radiographic diagnosis].

A correct and quick diagnosis of endodontically treated vertically fractured teeth is important for two main reasons: (1) the differential diagnosis between the clinical and radiographic appearance of periodontal disease and endodontic failures, and (2) the delay in making the correct diagnosis will result in rapid loss of supporting bone, especially on the buccal side. Typical clinical signs in the maxillary and mandibular premolars and mesial root of the mandibular molars, which are the most susceptible roots and teeth, for fracture are a highly located sinus tract and a deep bony defect along the root facing the fracture line. In the maxillary and mandibular premolars and the mesial root of mandibular molars, typical bony radiolucencies are the halo, vertical and periodontal types. Radiolucency in the bifurcation was typical in vertical root fractures of mandibular molars.

Radiological features of central haemangioma of the jaws.

OBJECTIVES: The aim of this study was to evaluate the radiological and clinical features of central haemangioma of the jaws. METHODS: A total of 86 cases (84 from the English-language literature and two new cases) were studied and critically evaluated with emphasis on the radiological features. RESULTS: Age at time of initial diagnosis ranged from 0 to 74 years (mean 23 years, median 17 years). There was approximately equal distribution between females and males. The ratio between the mandible and maxilla was 3.3:1. Of the lesions, 69% were located in the posterior region of the jaws. Lesions were radiolucent in 96% of cases. Of the lesions, 66% were multilocular, 33% unilocular, and 1% not loculated. Borders were described in 41 cases, as well defined in 32% and diffuse in 68%. Tooth resorption was described in 23% of the lesions and tooth displacement in 16%, both more common in the mandible. The inferior alveolar nerve canal was involved in 15% of the mandibular lesions and the sinus in 35% of the maxillary lesions. CONCLUSIONS: Central haemangioma has a marked variability in its radiological appearance and should be considered in the differential diagnosis of many unilocular or multilocular radiolucent lesions of the jaws, especially in the mandible. Some radiographic patterns, such as the spoke-like and sunray appearance frequently described in the literature, are actually extremely rare.

Radiological and clinical features of calcifying epithelial odontogenic tumour.

OBJECTIVES: To analyse systematically the radiographic features of the calcifying epithelial odontogenic tumour (CEOT). METHOD: Clinical and radiological features of 67 cases of CEOT (four new and 63 from the literature) were analysed. RESULTS: There were 27 (41%) males and 39 (59%) females with a male-to-female ratio of 1 : 1.5. Age ranged from 13 - 77 years (mean 43.5 years), with a peak in the fourth and fifth decades. The mandible was involved in 74% of the cases and 69% of all lesions were in the posterior area. The mixed radiolucent-radiopaque pattern was the most frequent (65%), with 32% radiolucent and 3% radiopaque. Coronal clustering of the radiopaque material was found in 12% and in one case, a 'driven snow' pattern of the radiopaque material was clearly recognizable. Lesions were unilocular in 58%, multilocular in 27% and not loculated in 15%. The unilocular type was more frequent in the maxilla than in the mandible. Borders were well defined and corticated in 20%, defined but not corticated in 59% and diffuse in 21%. Sixty per cent were associated with impacted teeth. Lesions larger than 3 cm tended to be more frequent in the mandible, mixed radiolucent-radiopaque and to have a higher proportion of diffuse borders than the smaller lesions. CONCLUSION: Radiographic features which have been considered characteristic of CEOT, coronal clustering and 'driven snow' patterns, are seen in only a small percentage of cases.

Anatomic and radiologic course of the mandibular incisive canal.

The purpose of this article was to define the anatomic and radiographic courses of the incisive mandibular canal and discuss its clinical significance. The study group comprised of 46 hemimandibles fixed in formalin. After radiographic examination, the buccal cortical plate of the mandible was removed leaving the bony frame of the incisive bundle intact. The morphology of the bony walls of the canal was evaluated, as having complete, partial, or no cortical walls. The course of the intraosseous pathway of the canal and its diameter in four different locations were recorded. An incisive bundle was anatomically found in all hemimandibles, travelling within a canal with complete (n = 10), partial (n = 27), or no (n = 9) bony cortical borders. The diameter of the canal ranged from 0.48 mm to 2.9 mm. Radiographically, the canal was either well defined (n = 11, 24%), poorly defined (n = 15, 32%), or undetectable (n = 20, 44%). A statistically significant correlation was found between the anatomic structure of the incisive canal bony borders and its radiographic detectability (p = 0.043). No correlation was found between the anatomic and radiological width of the incisive canal diameter. An incisive canal with a large diameter could have an important role in successful osteointegration and prevention of postoperative sensory disturbances. According to the present study, the ability to interpret the incisive canal from conventional radiographs is limited. Therefore, it is recommended to use conventional tomographs or computerised tomographic dental scans for better imaging of the intermental foraminal area.

Anterior loop of the mental canal: an anatomical-radiologic study.

This study sought to characterize the anatomical dimensions of the anterior mental loop and to determine the accuracy of conventional radiographs in identifying its presence and dimensions. The study group consisted of 46 hemimandibles fixed in formalin. Radiographs of the area between the mental foramen and the midline were obtained and evaluated for each hemimandible, followed by dissection and physical examination of the same area. Anatomically, an anterior loop of the mental nerve was observed in only 13 hemimandibles (28%). The anterior extension of the loop ranged from 0.4 to 2.19 mm. No correlation was found between the radiographic image and the anatomical shape of the loop. Of the radiographically diagnosed loops, 40% were not seen in anatomical examination. In cases with a false radiologic loop, a correlation was found between the diameter of the origin of the incisive canal and the radiologic interpretation of the loop. The radiologic appearance or diagnosis of the anterior mental loop in cadaver mandibles does not disclose the true ramification of the inferior alveolar nerve to the mental and incisive nerve.

Radiographic features of vertically fractured, endodontically treated maxillary premolars.

OBJECTIVE: The purpose of this study was to evaluate the most frequent radiographic appearance of bony lesions associated with vertically fractured roots of endodontically treated maxillary premolars. STUDY DESIGN: The radiographic features of 102 endodontically treated teeth and their periradicular areas (51 with and 51 without vertically fractured roots) were evaluated and compared. RESULTS: The predominant appearance of the periradicular area in the teeth with vertically fractured roots was the "halo" lesion (57%); by contrast, in the non-vertically fractured roots group, a "periapical" radiolucent lesion was most frequently found (55%). Angular bone loss (14%) and periodontal radiolucency (14%) were also typical radiolucent lesions in the vertically fractured teeth. CONCLUSIONS: "Halo" lesion, perilateral radiolucency, and angular resorption of the crestal bone, combined with diffuse or defined but not corticated borders, indicated a high probability of vertical root fracture in maxillary premolars.

Radiological and clinical features of aneurysmal bone cyst of the jaws.

PURPOSE: To evaluate the clinical and radiological features of aneurysmal bone cyst (ABC) of the jaws. MATERIALS AND METHODS: A total of 64 cases (60 from the English-language literature and four new cases) were studied and critically evaluated with emphasis on the radiological features. RESULTS: Age at time of initial diagnosis ranged from 4-78 years, with a mean age of 21.5 years and median age of 17 years. There were no differences in gender distribution. The ratio between the mandible and maxilla was 2.4:1. Ninety-two per cent of the lesions were located in the posterior region of the jaws. Lesions were radiolucent in 87% of cases, radiopaque in 2% and mixed in 11%. Fifty-three per cent were multilocular, 43% unilocular and 3% not loculated. The border of the lesions was defined but not corticated in 39%, well defined in 33% and diffuse in 28%. CONCLUSIONS: ABC has a variable radiological appearance and should be considered in the differential diagnosis of any unilocular or multilocular radiolucent lesion of the jaws as well as any mixed radiolucent-radiopaque lesion.

Radiological features of primary intra-osseous carcinoma of the jaws. Analysis of the literature and report of a new case.

OBJECTIVES: To analyse the clinical and radiological features of primary intra-osseous carcinoma of the jaws (PIOC). MATERIAL AND METHODS: Twenty-four cases (23 from the literature and one new case) of PIOC were reviewed. RESULTS: Patient's age at time of diagnosis ranged from 4-76 years, (mean 50 years). Male to female ratio was 1.7:1. Most lesions (79%) were in the mandible and of these, 95% were in the posterior area, approximately 70% of the maxillary lesions were in the anterior region and crossed the midline. In 87% of the cases PIOC was radiolucent; the remainder were mixed radiolucent-radiopaque lesions. The radiological borders were defined but none corticated in 57% of the cases and diffuse in 43%. The lesion was unilocular in 61% and not loculated in 35%. CONCLUSIONS: The variable radiological features of PIOC and its deceptive resemblance to odontogenic cysts and other tumours of the jaws suggests that despite its rarity, PIOC should be considered in the differential diagnosis of radiolucent lesions in the jaws.

Characteristics of the aging rat mandible.

The study evaluates the effect of age and sex on the physical characteristics of rat mandible. Wistar derived rats were divided into four groups; young male (4-6 months old), old male (23-25 months old), young female (4-6 months old) and old female (23-25 months old). Mandibles were removed and cleaned of soft tissue, placed on a dental X-ray film and exposed together with an aluminium stepwedge 0.5-3.0 mm. Body weight, and weight, volume, length, base, height, area, density of the mandible were recorded. Also the optical density of the coronoid process, condylar process and mandibular gonion area were measured using a digital densitometer and related to equivalent density of aluminium. Body weight and mandible weight showed age and sex related changes. In most morphometric data there was age but no sex differences. No densitometric differences were found between young or old male or female in the coronoid process, condylar process or gonion. Male rats have greater body weight and mandible weight associated with more food consumption which eventually increased masticatory muscle activity. No missing teeth were noted among male or female aged rats. The results presented here suggest that age-related changes in rat mandible are not general phenomena, but rather specific and limited to some morphometric parameters but not to densitometric parameters. The integrity of the dentition and normal masticatory system activity during aging may be the underlying mechanism.

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

OBJECTIVE: 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.

Clinical and radiological features of odontogenic myxoma of the jaws.

OBJECTIVES: To analyse critically the clinical and radiological features of odontogenic myxoma. METHODS: The clinical features of 164 cases of odontogenic myxoma (two new and 162 from the literature) and the radiological features of 96 cases (two new and 94 from the literature) were analysed. RESULTS: Most of the tumors (75%) were diagnosed in the 2nd to 4th decades. The male to female ratio was 1:1.5. Tumors were located in the mandible in two-thirds and in the maxilla one-third of cases. A multilocular appearance was observed in 55% and unilocular in 36%; 9% were not loculated. There was a statistically significant correlation (P < 0.000) between the size of the lesion and its locularity with the larger lesions more likely to be multilocular. Only 5% of the tumors were associated with an unerupted tooth. CONCLUSIONS: Odontogenic myxoma has a variable clinical and radiological appearance and it should be considered in the differential diagnosis of radiolucent and mixed radiolucent-radiopaque lesions of both jaws in all age groups.

Interpretation of bitewing radiographs. Part 1. Evaluation of the presence of approximal lesions.

OBJECTIVE: Bitewing radiographs are the main tool for approximal caries detection. However, interpretation of findings is affected by numerous factors, such as beam angulation, exposure conditions, morphologic variations, etc. The objective of the present study was to compare the ability to detect virtually identical, artificial lesions in different tooth surfaces. METHODS: The in vitro model included preparation and radiologic evaluation of approximal artificial lesions in premolars and molars in depths ranging from 0.00 mm to 1.50 mm. RESULTS: Significant differences were found in the prospect of a lesion detection between the different lesion depths (p < 0.0000) and between the different surfaces examined (p < 0.05). The interaction between lesion depth and tooth surface was significant at the 0.0001 level (ANOVA with repeated measures). CONCLUSIONS: The results indicate that initial approximal lesions of uniform size are more readily detected in premolars than in molars and that the chance of an incipient lesion to remain undetected is twice as high in molars than in premolars.

Interpretation of bitewing radiographs. Part 2. Evaluation of the size of approximal lesions and need for treatment.

OBJECTIVE: The decision to treat initial approximal carious lesions is based mainly on interpretation of bitewing radiographs. In a previous report, it was shown that artificial approximal lesions of uniform size are more readily detected on radiographs in premolars than in molars. The objective of the present study was to compare the ability to evaluate the depth of similar size artificial lesions on radiographs and reach decisions concerning treatment, in premolars and molars. METHOD: Clinicians were asked to evaluate on radiographs, the size of in vitro prepared artificial lesions, and decide at which point they would perform a restoration. RESULTS: Significant differences were found in the evaluation of lesion depth between different tooth surfaces. The interaction between lesion depth and tooth surface originated from the examiners' trend to score same size lesions as penetrating deeper into the tooth in premolars than in molars. The probability of the examiners to decide on restorative treatment in shallow lesions (0.25 mm, 0.50 mm) was higher in premolars than in molars. CONCLUSIONS: The findings suggest that clinicians evaluate initial lesions as being deeper and more prone to treatment in premolars than in molars.