Short-term changes of condylar position after sagittal split osteotomy for mandibular advancement.

OBJECTIVE: The goal of this study was to quantify condylar position changes after mandibular advancement surgery with rigid fixation (screws). Radiographic changes in condylar position were determined in all planes (X, Y, and Z). Computed tomography with image reconstruction was used. STUDY DESIGN: A consecutive population of patients who elected to have rigid fixation for surgical stabilization method were studied (n = 21). Computed tomography data were acquired in the axial plane through use of abutting 1.5-mm-thick slices. Data acquisition occurred 1 week preoperatively and 8 weeks postoperatively. Measurements were made from 2-dimensional reconstructions. RESULTS: The averages were as follows: lateral displacement from midline, 1.2 mm (55% of patients); medial displacement from midline, 1.5 mm (45% of patients; range, 3.2 mm); condyle angle increase from coronal plane, 3.5 degrees (60% of patients); condyle angle decrease from coronal, 4.3 degrees (40% of patients; range, 8.5 degrees); superior rotation of proximal segment, 3.2 degrees (39% of patients); inferior rotation of proximal segment, 8.6 degrees (61% of patients; range, 15.6 degrees); superior displacement, 1.2 mm (60% of patients); inferior displacement, 1.0 mm (40% of patients; range, 2.5 mm); anterior displacement, 1.6 mm (33% of patients); posterior displacement, 1.6 mm (67% of patients; range, 2.8 mm). CONCLUSIONS: Changes occurred in all planes, but the most common postoperative condyle position was more lateral; with increased angle, the coronoid process was higher and the condyle was more superior and posterior in the fossa.

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.

Advanced imaging methods.

Recent developments in imaging sciences have enabled dental researchers to visualize structural and biophysical changes effectively. New approaches for intra-oral radiography allow investigators to conduct densitometric assessments of dento-alveolar structures. Longitudinal changes in alveolar bone can be studied by computer-assisted image analysis programs. These techniques have been applied to dimensional analysis of the alveolar crest, detection of gain or loss of alveolar bone density, peri-implant bone healing, and caries detection. Dental applications of computed tomography (CT) include the detailed radiologic anatomy of alveolar processes, orofacial soft tissues and air spaces, and developmental defects. Image analysis software permits bone mass mineralization to be quantified by means of CT data. CT has also been used to study salivary gland disease, injuries of the facial skeleton, and dental implant treatment planning. Magnetic resonance imaging (MRI) has been used extensively in retrospective and prospective studies of internal derangements of the temporomandibular joint. Assessments based on MRI imaging of the salivary glands, paranasal sinuses, and cerebrovascular disease have also been reported. Magnetic resonance spectroscopy (MRS) has been applied to the study of skeletal muscle, tumors, and to monitor the healing of grafts. Nuclear imaging provides a sensitive technique for early detection of physiological changes in soft tissue and bone. It has been used in studies of periodontitis, osteomyelitis, oral and maxillofacial tumors, stress fractures, bone healing, temporomandibular joint, and blood flow. This article includes brief descriptions of the technical principles of each imaging modality, reviews their previous uses in oral biology research, and discusses potential future applications in research protocols.

Video-based teleradiology for intraosseous lesions. A receiver operating characteristic analysis.

Immediate access to off-site expert diagnostic consultants regarding unusual radiographic findings or radiographic quality assurance issues could be a current problem for private dental practitioners. Teleradiology, a system for transmitting radiographic images, offers a potential solution to this problem. Although much research has been done to evaluate feasibility and utilization of teleradiology systems in medical imaging, little research on dental applications has been performed. In this investigation 47 panoramic films with an equal distribution of images with intraosseous jaw lesions and no disease were viewed by a panel of observers with teleradiology and conventional viewing methods. The teleradiology system consisted of an analog video-based system simulating remote radiographic consultation between a general dentist and a dental imaging specialist. Conventional viewing consisted of traditional viewbox methods. Observers were asked to identify the presence or absence of 24 intraosseous lesions and to determine their locations. No statistically significant differences in modalities or observers were identified between methods at the 0.05 level. The results indicate that viewing intraosseous lesions of video-based panoramic images is equal to conventional light box viewing.

Clinical usefulness of two-dimensional reformatted and three-dimensionally rendered computerized tomographic images: literature review and a survey of surgeons' opinions.

PURPOSE: This study compares the usefulness of axial computed tomography (CT) with two-dimensional (2D) reformats and three-dimensionally (3D) rendered CT data in the treatment planning and management of patients. PATIENTS AND METHODS: Twenty-nine patients who had been studied with CT were grouped into the following four clinical problems: 1) temporomandibular joint assessment (n = 8), 2) growth and development assessment (n = 4), 3) posttrauma and postoperative assessment (n = 13), 4) "other" (n = 4). The clinicians who treated these patients were surveyed for their opinions of the usefulness of CT with and without 2D/3D reformatting. RESULTS: In a majority of the cases within each of the four clinical groups, the clinicians believed that 2D and/or 3D reformatting of the CT data provided additional useful information for patient management. In most of the cases, 3D imaging provided information in addition to that provided by the axial or reformatted 2D images. CONCLUSION: 2D and 3D CT images can be useful to the clinician in diagnosis and treatment planning. These methods enhance the accuracy of diagnostic decisions and the establishment of appropriate treatment plans.

Positional changes of the mandibular condyle assessed by three-dimensional computed tomography.

This investigation was designed to test the validity and reliability of three-dimensional computed tomography (3-D CT) for quantification of positional changes of the condyle in a laboratory model. The model consisted of a mounted dried human skull and a mandibular condyle attached to a micromanipulator. Controlled changes in condylar position were made and the condyle/fossa was imaged. Positional changes were measured by triangulation methods based on specific 3-D CT landmarks. The data were analyzed using descriptive statistics, analyses of variance to evaluate the sources of variability, and linear contrasts to evaluate the differences between observed and expected values. The results indicated that selection of appropriate anatomic landmarks for assessment of movement influences technique accuracy. The data also indicate that 3-D CT is most accurate in detecting inferior condylar movements. Lateral and posterior movements were assessed with less accuracy than the inferior positional changes. The clinical significance of these differences has yet to be determined.

Digital subtraction radiography in artificial recurrent caries detection.

The diagnostic accuracy of digital subtraction radiography in detection of artificial recurrent caries lesions was assessed in this project. The use of digital subtraction radiography has been shown to markedly increase the accuracy of the detection of destruction in the periodontal bone, but the method has not been evaluated in secondary caries detection. Defects of three different sizes, simulating recurrent caries, were sequentially prepared in the interproximal cavity preparation margins of 28 teeth. Two composite restorative materials with different radiographic densities were used as posterior restorations, and a radiograph was obtained of each defect size and restorative material. The radiographs were digitized and subtracted from the reference images, and the conventional radiographs and the subtraction images were evaluated by seven observers. The data were analysed with ROC statistics. Subtraction radiography was found to be superior to conventional radiography in recurrent caries detection, mainly by reducing the false-positive diagnoses. The radiopacity of the restorative material had a significant effect on accuracy with conventional but not with subtraction radiography.

Quantitative and subjective analysis of temporomandibular joint radiographs.

The lateral oblique transcranial radiograph of the temporomandibular joint is commonly used in dentistry. Changes in horizontal angulation of the x-ray beam can produce changes in radiographic condylar position. This study used quantitative and subjective methods to assess and rank changes in radiographic condylar position as a function of known horizontal x-ray beam changes. Six dry skulls were positioned in a craniostat device where known angulations could be measured. Nine sequential transcranial temporomandibular joint radiographs were made of each joint and five of these 12 sets were randomly selected for analyses. The quantitative method involved film digitization, computer calculations, and expressed condylar position as a ratio between posterior and anterior joint space distributions. Eight observers viewed the same films and ranked radiographic condylar position from anterior to posterior. The two methods agreed with known rankings 81.8% of the time. Subjective rankings were more variable than quantitative rankings. Intraobserver differences were insignificant and the observers were consistent among themselves as a group.

A method for three-dimensional image reformation for quantitative cephalometric analysis.

Recognition and treatment of craniofacial deformities require an understanding of complex skeletal structures in three planes of space. Traditional imaging techniques rely on biplanar radiographs which provide only two-dimensional data. The introduction of three-dimensional image display (3DIR) has provided a method of object analysis in three planes of space, obviating the need for mental reconstruction, and yielding more spatial information than was previously available. This study was undertaken to investigate the quantitative value of three-dimensional images compared with cephalometric techniques in assessing a craniofacial deformity. Metallic marker references were placed on a deformed skull. Measurements taken from cephalograms and three-dimensional images were compared with corresponding digitized and manual measurements taken from the skull. Three-dimensional image reformation provided a more accurate representation of the deformity than the cephalometric methods. Because all structural relationships are preserved in the CT data matrix, measurements are inherently accurate and reproducible. 3DIR offers dynamic advantages over cephalometric methods because data can be manipulated interactively. Further investigation is needed to study the importance of head position and to develop patient selection criteria, scan protocols, and surgical treatment planning algorithms.

The effect of lesion size, restorative material, and film speed on the detection of recurrent caries.

The purpose of this investigation was to study the effect of the size of carious lesions, radiographic density of composite and amalgam restorative materials, and film speed on the radiographic detection of simulated recurrent caries. Radiographs were made of extracted premolars with either large or small recurrent carious lesions simulated adjacent to Class II amalgam or composite restorations with both E-speed and D-speed intraoral film. For each restorative material, teeth that had no simulated caries were compared with teeth that had small and large simulated caries. Recurrent caries is detected best when the lesion is adjacent to radiopaque composite restorations, and detection is poorest when the lesion is next to radiolucent composite restorations. Large carious lesions are identified correctly more often than small lesions, although many lesions are not detected at all, especially those adjacent to radiolucent composite materials. There is no difference between E-speed and D-speed film for the detection of recurrent carious lesions.

Impact of a continuing education programme for teachers of dental radiology.

Continuing professional education is recognized as an important mission of contemporary dental schools. Research has shown that innovative methods of course delivery result in increased impact of continuing education efforts as measured by change in behaviour of the participants in their own workplaces. A case study is reported which describes the Carolina Institute of Dental Radiology Education. This 2-week intensive course for dental radiology instructors is offered by the University of North Carolina School of Dentistry. A survey of participants indicated that significant improvements in the radiology programmes supervised by the participants occurred following their attendance at the Institute.

Clinical evaluation of a samarium/aluminum compound filter.

Rare earth compound filters, which offer reduced patient exposure during intraoral radiography, have not been clinically evaluated for their effect on diagnostic yield. This clinical study was conducted to compare the diagnostic yield of bitewing radiographs exposed with a conventional aluminum filter with matched bitewing radiographs exposed with a samarium/aluminum compound filter. One hundred sixty-three pairs of bitewing radiographs were read independently by two reviewers for absence or presence and depth of proximal carious lesions. Degree of agreement between films was assessed by means of the kappa statistic. Results showed good agreement between the radiographs exposed with each filter type. Thus, x-ray machines modified with a samarium/aluminum rare earth compound filter produce bitewing radiographs of comparable diagnostic yield and lower dose when compared with radiographs exposed with a conventional aluminum filter.

Exposure reduction in cephalometric radiology: a comprehensive approach.

Various methods have been proposed and investigated for the purpose of reducing radiation exposures in cephalometric radiography. The purpose of this investigation was to use various dose-reducing methods from four major categories--(1) rare-earth intensifying screens, (2) rare-earth filtration, (3) prepatient soft-tissue enhancement methods, and (4) films varying in speed and latitude--to determine optimal combinations on the basis of exposure reduction and image quality achieved. In laboratory tests and clinical trials, radiation doses were compared along with various tests of image quality for the standard system currently used at this institution and for experimental systems. Image quality was assessed by standard panel-of-expert methods and more quantitative methods involving optical densitometry, contrast indices, and landmark envelopes of error. Results demonstrated that significant exposure reductions were achievable, often with improved image quality. The degree of exposure reduction was dependent largely upon the type of intensifying screen and to a lesser extent on beam filtration or film types. The greatest reduction in exposures were achieved with techniques using rare-earth beam filtration. Image quality was highest with a new wide-latitude type film. Because such significant reduction in radiation exposure for cephalometrics is possible with new techniques, we conclude that a change from the previous standard should occur. In establishing a new technique, orthodontists should consider adopting rare-earth screens and beam filters, flat-grained films, prepatient soft-tissue enhancement methods, and the elimination of grids.