Benign cementoblastoma in a primary lower molar, a rarity.

An asymptomatic radiopacity surrounded by a radiolucent line was observed from a panoramic radiograph of an 11-year-old girl. The lesion was associated with the mesial root of the lower right second primary molar. The radiographic appearance of the lesion suggested a benign cementoblastoma. Histological diagnosis after surgical excision of the tumour and extraction of the tooth confirmed the radiographic diagnosis. Benign cementoblastomas associated with primary teeth are extremely rare lesions. To our knowledge, only eight cases have been reported in the literature.

Radiographic periodontal attachment loss as an indicator of death risk in the elderly.

OBJECTIVES: Oral infections have been associated with serious systemic diseases and an increased risk of death. Our aims were to investigate whether radiographically-observed apical periodontitis lesions, carious teeth, periodontal attachment loss (horizontal bone loss, furcation lesions, number of teeth with infrabony periodontal pockets, the extent of infrabony periodontal pockets) and the sum of all these findings have any relationships with all-cause mortality within 4-year follow-up. MATERIAL AND METHODS: 292 community-dwelling elderly persons aged 76, 81 and 86 years. The number of deaths within 4 years was 54 (18.5%). In the dentate 169 subjects, of whom 32 (18.9%) deceased within 4 years, the mean number of teeth was 15.5 in men and 13.2 in women. The imaging method used was panoramic radiography supplemented by intraoral radiographs. RESULTS: 51% of the dentate subjects had infrabony pockets (mean 1.5, s.d. 2.2), and 40% had periapical periodontitis lesions (mean 1.0, s.d. 1.6). After controlling for age and gender, vertical bone loss judged as advanced infrabony pockets was associated with 4-year all-cause mortality (Odds ratio 2.2,1.0-4.7). Other associations were statistically insignificant. CONCLUSION: Periodontal attachment loss may indicate an increased risk of death in the elderly.

Radiographic periodontal findings in an elderly Finnish population.

By means of panoramic radiography and additional intraoral radiographs, the occurrence of calculus, the extent of horizontal bone loss, the depth and number of infrabony pockets, the number of furcation lesions, and the number of interproximal restoration overhangs were studied in 169 dentate 76-, 81-, and 86-year-old subjects (54 male and 115 females) living at home. Alveolar bone loss (horizontal or vertical) among the participants was common, and in only 8 subjects (5%) was it judged non-existent. It was slight in 30 subjects (18%), moderate in 53 (31%), and advanced in 78 (46%). Infrabony pockets were found in 51% of the subjects and furcation lesions in 28%. The presence of calculus did not correlate with the other parameters. The number of interproximal overhangs was associated with the number of infrabony pockets and of furcation lesions (R=0.3, p<0.001 and p<0.0001) and the number of infrabony pockets with the number of furcation lesions (R=0.4, p<0.0001). Our study shows that periodontal findings are common in the dentate elderly, and associations recently found between periodontal infections and several serious diseases make radiographic examination an integral part of the oral examination of the elderly patient.

Height of mandibular basal bone in dentate and edentulous subjects.

Age-related differences in the height of the mandibular basal bone were compared between young and old dentate subjects and between dentate and old edentulous subjects by means of panoramic radiographs. The distances of the mental foramen and mandibular canal from the lower border of the mandible, when measured, showed the mandibular basal bones in old dentate and in old edentulous men to be higher than those of young dentate men in the molar region (P < 0.05). The height of the basal bone below the mental foramen was smaller in old edentulous women than in young and old dentate women (P < 0.05). A slight bone deposition along the lower border of the mandible in the molar region seems to take place with increasing age. The mental foramina of edentulous women move toward the lower border of the mandible as a result of alveolar bone resorption.

Radiographic condylar findings and occlusal imbalance in old people.

The radiographic condylar findings of 293 old people (76, 81 and 86 years old) were investigated using panoramic radiography. One hundred and twenty four subjects were clinically edentulous, and 169 had at least one natural tooth left. Condylar findings were observed in 16% of the edentulous subjects, and in 25% of the dentate subjects. Over 95% of the findings were radiographic signs often associated with osteoarthrosis. Condylar findings were more common in edentulous women (18%) than in edentulous men (9%) (P < 0.05). Imbalanced occlusion was assessed using the Eichner index. This index describes the existing occlusal support zones, dividing the dentition into three main classes. When natural dentition and fixed constructions were included 70% of the population had no occlusal contacts. With removable dentures included, class A (contacts in four support zones) represented 74% and class C (no occlusal contacts) 4% of the subjects. Three per cent of the men and 0.5% of the women had no occlusal contacts even then. Imbalanced occlusion showed no association with condylar findings; neither were there any significant differences in the condylar findings between the sexes in the dentate subjects, between the age groups, or between the dentate and edentulous groups.

Height of the residual ridge and radiographic appearance of bony structure in the jaws of clinically edentulous elderly people.

Alveolar atrophy and its relation to osteopenia of the mandible were studied in 124 edentulous 76-, and 81- and 86-year-old subjects (32 males and 92 females). Both variables were assessed visually from panoramic radiographs. Mandibular alveolar atrophy was found to be more severe in women (P < 0.001). No statistically significant differences were found between the three age-groups in mandibular alveolar atrophy, nor between the sexes or age-groups in maxillary alveolar atrophy. The structure of the mandibular bone was osteopenic in 38 patients (30.7%), a situation that was more frequent in women (P < 0.001). The relationship between the observed osteopenia and the severity of the mandibular alveolar atrophy in women was statistically significant (P < 0.05).

Effect of head positioning in panoramic radiography on vertical measurements: an in vitro study.

OBJECTIVE: To assess whether it is possible to make accurate vertical measurements of the jaws from panoramic radiographs. METHODS: Five dry skulls were shifted 5 mm forwards and backwards and tilted 5 degrees up and down in the sagittal plane. Panoramic radiographs of each skull were obtained in nine different positions. In the maxilla, three reference lines were used and vertical measurements were made at the distal surfaces of the first premolar and first molar and in the midline. In the mandible, measurements were made at the distal surfaces of the first premolar and first molar, and at the mental foramen on both sides, and in the midline. The points and lines were marked manually and the radiographs were digitized, magnified and measured. RESULTS: Sagittal shifting and tilting had only a slight effect on measurements in the mandible. Sagittal tilting of the head had the greatest effect on all the measurements made from the line between the articular eminences to the alveolar crest, as well as measurements in the maxillary midline. CONCLUSIONS: The line between the articular eminences is unsuitable as a reference line for measurements of the tooth-bearing areas. A slight misalignment of the head does not significantly affect the vertical measurements in the mandible or of the posterior maxilla if the reference lines are in the same vertical plane as the teeth.

Changes in the position of the mental foramen as a result of alveolar atrophy.

The location of the mental foramen has often been claimed to be unaffected by alveolar atrophy. In the present study, the distances of the mental foramen and the mandibular canal from the lower cortex of the mandible were compared in a radiographed series of 40 edentulous elderly women with advanced alveolar atrophy and 40 elderly women who had 10 or more lower teeth left. The mental foramen was situated on average 3.8 mm lower in dentulous jaws than in dentulous jaws (P < 0.0001). The mandibular canal was also situated lower in edentulous jaws, but the difference was not statistically significant. The results confirm the finding that the mental foramen seems to descend as a result of alveolar atrophy.

Radiographic maxillary sinus findings in the elderly.

The prevalence of radiographic maxillary sinus findings in 293 elderly subjects (76, 81, and 86 years old) were investigated with the use of panoramic radiography: 124 subjects were edentulous in both jaws, 167 had an edentulous maxilla, and 169 had at least one natural tooth left. Mucous cysts or diffuse mucosal thickenings were found in 12% of the subjects. Of the mucosal thickenings, 70% were found in subjects with a dentate upper jaw (p < 0.05), suggesting an odontogenic origin for that proportion (40%) exceeding the prevalence in subjects edentulous in the maxilla. That the prevalence of mucous cysts was 5% both in subjects with a dentate upper jaw and in those with a edentulous upper jaw suggests nonodontogenic causes.

Tortuosity of the lingual artery and coronary atherosclerosis.

In a series of 69 human cadavers (age range 18-95 years), the tortuosity of the lingual artery and its association to age, sex, death of cardiovascular disease and general atherosclerotic state as assessed at necropsy were studied. The tortuosity increased significantly with age, but there were no sex differences. Within the three age groups there were no significant associations between arterial tortuosity and death from cardiovascular disease or general atherosclerotic state.

Endodontically treated teeth and periapical findings in the elderly.

The radiographic quality of root-canal fillings, the prevalence of periapical findings and their associations with gender and age were investigated in 133 dentate old people living at home (45 males and 88 females, aged 76, 81, and 86 years and who had endodontically treated teeth or periapical lesions. Sixteen per cent of the endodontically treated teeth (n=507) exhibited periapical lesions, compared with 4% for the teeth not endodontically treated (P<0.0001) (chi-square test). Lesions were least prevalent in association with radiographically adequate root canal fillings (10%), and most prevalent in teeth with root canal post perforation (100%). Overfilled root canals and multi-rooted teeth with one or more unfilled roots also showed a high percentage of lesions (19% and 22%, respectively). Men had more periapical lesions than women in endodontically treated teeth (P<0.001, Mann-Whitney U-test), a finding contrary to previous studies in younger subjects. There were no other statistically significant differences between the sexes or age groups, although the percentage of root-filled teeth increased with age.

Radiographic findings in the jaws of clinically edentulous old people living at home in Helsinki, Finland.

In the present survey the radiographic findings in the jaws of 124 clinically edentulous old people living at home in Helsinki, Finland, were studied, using panoramic radiography supplemented by intraoral radiographs. Only 9% of the subjects had root remains. Impacted teeth were found in 4%, radiolucent lesions in 3%, and radiopaque findings in 13%. Deviations from normal condylar structure were found in 17% and mucosal thickenings in the maxillary sinuses in 7%. The mental foramen was situated at the top of the residual ridge in 42% of the subjects. Topically situated mental foramen and condylar changes were commoner in women. The radiographic oral health status of the population studied was good.

Dental radiographic findings in the elderly in Helsinki, Finland.

A total of 169 dentate persons, aged 76, 81, and 86 years, living at home in Helsinki, Finland, were examined by means of panoramic radiography supplemented by intraoral radiographs. The older the age group, the fewer teeth remained. Altogether 75% of the subjects had radiographically detectable caries. A high proportion of the carious teeth (62%) was found in a relatively small number (24%) of subjects. The number of carious teeth and their percentage of the total number of teeth were greater in the older age groups. The proportion of endodontically treated teeth was 19% in the 76-year-olds and 26% in the 86-year-olds. Of the subjects 41% had periapical periodontitis, which was commoner in root-filled teeth (18%) than in other teeth (4%). Caries and periapical radiolucent and radiopaque findings were commoner in men. Vertical bone pockets (3 mm or deeper) were found in 51% and furcation lesions in 28% of the subjects. Compared with earlier Finnish studies, the results indicate an improving oral health status among elderly Finns.

Three main arteries of the face and their tortuosity.

The anatomy of the facial, transverse facial and infraorbital arteries and their tortuosity was studied in 69 human cadavers (age range 18-95 years). The types of facial vascularisation were divided into four categories according to the gradually diminishing relative dominance of the facial artery. Type A, in which the facial artery was dominant, comprised 22% of the cases; type B 49%; type C 20%; and the variant of the hypoplastic facial artery, type D, 9% of the cases. The type of vascularisation was not dependent on age or sex. The tortuosity of all three arteries showed a statistically significant increase with age. A weak correlation was found between the relative dominance and the tortuosity of the facial artery.

Clinical and panoramic assessment of marginal bone loss. A cadaver study.

The purpose of this study was to investigate the reliability of panoramic tomography for the assessment of marginal alveolar bone loss. The study was conducted with 20 human cadavers, in relation to 123 of their teeth. Panoramic tomograms of the cadaver dentitions were taken using a Zonarc radiographic apparatus. Root lengths and bone losses were measured mesially and distally from the panoramic tomograms. Bone loss was also measured by surgical exposure of the marginal bone. Root length was also measured after extraction of the tooth. After allowing for the vertical magnification, radiographic bone loss values were found to be about 0.8 mm (27%) less than clinical values. This difference was statistically significant only in the incisor area. It was almost significant in the premolar region. It is therefore concluded that panoramic tomography is sufficiently reliable for clinical assessment of alveolar bone loss but that the bottom of periodontal pockets always tends to be somewhat deeper than the radiographically visible defect.