Best clinical practice guidance for prescribing dental radiographs in children and adolescents: an EAPD policy document.

BACKGROUND: The European Academy of Paediatric Dentistry (EAPD) proposes this best clinical practice guidance to help practitioners decide when and how to prescribe dental radiographs in children and adolescents. METHODS: Four expert working groups conducted each a systematic review of the literature. The main subjects were radiation protection, intraoral dental radiography (bitewing and periapical radiographs), panoramic radiography (PR) and cone-beam computed tomography (CBCT). In addition, three workshops were held during the corresponding EAPD Interim Seminar in Chania (Crete, Greece) in 2019. On the basis of the identified evidence, all invited experts presented their findings and during the workshops aspects of clinical relevance were discussed. RESULTS: Several clinical-based recommendations and statements were agreed upon. CONCLUSION: There is no or low-grade evidence about the efficacy of dental radiographic examinations in young populations. The given recommendations and rationales should be understood as best clinical practice guidance. It is essential to respect the radiological principles of an individualized and patient-specific justification. When a dental radiograph is required, its application needs to be optimized, aiming at limiting the patient's exposure to ionising radiation according to the ALADAIP principle (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific).

A systematic review of relative indications and contra-indications for prescribing panoramic radiographs in dental paediatric patients.

PURPOSE: To systematically review the evidence of the diagnostic efficacy of panoramic radiographs (PRs) in the following six clinical situations: caries, acute dental infections, dental trauma, dental anomalies, Developmental disorders and pathological conditions in children. The research question posed by the EAPD was: "In which clinical situations and age groups is it indicated/contra-indicated to prescribe PRs in relation to these six clinical situations, in children". METHODS: An electronic search of the following databases was conducted: MEDLINE via OVID, EMBASE via OVID, The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE) and the Cochrane Health Technology Assessment (HTA), to identify relevant studies published from 1990 to 2018. The systematic review was performed according to the PRISMA guidelines. Study screening, data extraction and risk of bias assessment of included studies was carried out independently and in duplicate using the QUADAS 2 tool. RESULTS: The search resulted in 3420 potentially relevant studies, and following screening 175 full texts were obtained, of which 16 were finally included in the review. Meta-analysis was not possible for any of the aforementioned clinical situations, therefore the included studies were tabulated in terms of qualitative descriptive hierarchy of evidence for diagnostic. CONCLUSION: Based on currently available evidence there is a need for high quality diagnostic accuracy efficacy studies to address important diagnostic tasks in these six clinical situations in children, as there is a lack of scientific evidence concerning PRs in children, as there would support the production of guidelines for prescribing PRs in children along with their relative indications and contra-indications.

Application of nano-hydroxyapatite/chitosan scaffolds on rat calvarial critical-sized defects: A pilot study.

BACKGROUND: The purpose of this pilot study was to evaluate for the first time the effect of 75/25 w/w nano-Hydroxyapatite/Chitosan (nHAp/CS) scaffolds on Guided Bone Regeneration (GBR) in rat calvarial critical-sized defects (CSDs). MATERIAL AND METHODS: Six adult Sprague Dawley rats, 3 males and 3 females, were used. Two CSDs, full thickness and 5mm in diameter, were trephined in both sides of the parietal bone. The right CSD was filled with nHAp/CS scaffold, while the left CSD remained empty, as the control group. The wound was sutured in layers. Rats were euthanized with diethyl ether inhalation at 2, 4 and 8 weeks after surgical procedure. Histological and histomorphometric analysis was performed within distinct regions of interest (ROI): the lateral area inward of the middle sagittal seam; the lateral area outward of the middle sagittal seam and the central area. RESULTS: The mean surface of newly formed bone (in µm2) in the lateral area inward of the middle sagittal seam of all rats was significantly higher (P=0.039) in the experimental group (91733.00±38855.60) than the control group (46762.17±25507.97). The NOex-c, defined as total number of osteocytes (OST) in newly formed bone surface in experimental group [experimental OST] minus the total number of osteocytes in newly formed bone surface in control group [control OST], was significantly greater (P=0.029) at 4th week post-surgery. Within the experimental group, a statistically significant increase (P=0.042) in the surface of newly formed bone was noticed in rats euthanized in 4th week compared with rats euthanized in 2nd week after surgery in the lateral area inward of the middle sagittal seam. CONCLUSIONS: The results of this study suggest that 75/25 w/w nHAp/CS scaffolds should be considered as a suitable biomaterial for GBR.

Establishment of diagnostic reference levels for dental panoramic radiography in Greece.

The purpose of the present study was to present the national diagnostic reference levels (DRL) established for panoramic dental examinations in Greece. The establishment of DRL, as a tool for the optimisation of radiological procedures, is a requirement of national regulations. Measurements performed by the Greek Atomic Energy Commission on 90 panoramic systems have been used for the derivation of DRL values. DRL values have been proposed for exposure settings of different patient types (child, small adult and standard adult), both for film and digital imaging. The DRLs for different patient types are grouped in three categories: children, small adults (corresponding to female) and average adults (corresponding to male). Proposed DRLs for these groups are 2.2, 3.3 and 4.1 mGy, respectively. In order to investigate the correlation of DRLs with the available imaging modalities (CR, DR and film), this parameter was taken into account. DR imaging DRL is the lowest at 3.5 mGy, CR imaging the highest at 4.2 mGy and film imaging at 3.7 mGy. In order to facilitate comparison with other studies, kerma-width product values were calculated from Ki, air and field size.

Association between extra- and intracranial calcifications of the internal carotid artery: a CBCT imaging study.

OBJECTIVES: This study aimed to evaluate the association between the extracranial and intracranial calcification depiction of the internal carotid artery (ICA), incidentally found in CBCT examinations in adults, and to discuss the conspicuous clinical implications. METHODS: Out of a series of 1085 CBCT examinations, 705 CBCT scans were selected according to pre-defined criteria. The extra- and intracranial calcifications depicted along the course of the ICA were documented according to a comprehensive set of descriptive criteria. RESULTS: In total, 799 findings were detected, 60.1% (n = 480) were intracranially and 39.9% (n = 319) were extracranially allocated. The χ(2) test showed associations between all variables (p < 0.001). Also, most of the combinations of variables showed statistically significant results in the McNemar's test (p < 0.001). CONCLUSIONS: We found that a significant correlation exists between extra- and intracranial calcifications of the ICA. It is clear that in cases of the presence of a calcification in the ICA extracranially, the artery's intracranial portion has an increased risk of showing the same findings. CBCT imaging is widely used as a diagnostic tool, thus, our results contribute to the identification of a subgroup of patients who should undergo further medical evaluation of the atherosclerosis of the ICAs.

Cervical dentin hypersensitivity: a cross-sectional investigation in Athens, Greece.

The purpose of this study was to identify the prevalence of cervical dentin hypersensitivity in a cross-sectional investigation of Greek adults. Seven hundred and sixty-seven subjects were examined. Participants were patients processed for first examination in the Clinic of Oral Diagnosis and Radiology at the Faculty of Dentistry, University of Athens. The evaluation of hypersensitivity was performed using two methods: for each tooth, the response to a) tactile stimulus and b) air-blast stimulus was measured. Additional factors such as smoking habits, oral health behaviour, consumption of acidic foods, type of toothbrush, daily use of fluoride solution and of desensitising toothpaste, gingival recession and non-carious cervical lesions were recorded and evaluated as causative factors. Descriptive statistics on the demographics of the study sample, of oral health behaviour characteristics and of oral examination findings were performed. Comparisons of these characteristics in the presence or absence of hypersensitivity were conducted with the chi-square test. Data were further analysed using multiple logistic regression modelling. Among study participants, 21·3% had at least one cervical dentin hypersensitivity reaction to the tactile stimulus, and 38·6%, to the air-blast stimulus. Multivariate analysis detected association of the hypersensitivity in tactile or air-blast stimulus with the non-carious lesions and with the gingival recessions. Additionally, a relation between hypersensitivity and air-blast stimulus with gender (female) was found. There was no association between the hypersensitivity in both of the stimuli and the level of education, smoking, consumption of acidic foods, type of toothbrush and daily use of fluoride solution or desensitising toothpaste. The overall prevalence of cervical dentin hypersensitivity in the adult population in Athens ranged from 21·3% to 38·6% depending on the type of stimuli. Cervical non-carious lesions and gingival recessions were determined as significant predictors of dentin hypersensitivity.

Establishment of diagnostic reference levels for dental intraoral radiography.

Diagnostic reference levels (DRLs) is a tool for the optimisation of radiological procedures. Establishment of a DRL is a requirement of national regulations. Measurements performed by the Greek Atomic Energy Commission on 529 dental intraoral radiographic facilities have been used in order to define DRLs for digital and film imaging modalities, taking into account the region of the mouth to be imaged. Thus, different DRL values have been proposed for minimum (usually incisors), maximum (usually maxillary molars) and average exposure settings, both for film and digital imaging. The results have been compared with similar studies performed in Europe and the USA and are in line with the most recent ones.

Continuing professional development systems and requirements for graduate dentists in the EU: survey results from the DentCPD project.

INTRODUCTION: By maintaining skills and keeping dentists up-to-date, continuing professional development (CPD) supports safe clinical practice. However, CPD for dentists across Europe is not harmonised. AIM: One aim of the 'DentCPD' project (www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. As part of the process, data were collected on existing approaches to CPD for EU dentists. This paper reports those findings. METHODS: Informed by a review of the literature and internet search, the CPD for Graduate Dentists questionnaire gathered data from dental educators on CPD systems, requirements, provision and accreditation in Europe. It sought opinion on mandatory CPD and e-learning. RESULTS: Responses were received from 143 individuals from 30 EU countries. About half the countries had a compulsory CPD system which typically included mandatory core topics. Elsewhere CPD was optional or based on recommended hours. University dental schools and professional dental associations were the most common CPD providers. National regulatory bodies were the most common accrediting body. Only 41% of respondents thought they knew the criteria for successful accreditation of CPD. Eighty-one percent agreed that 'CPD should be obligatory for all dentists'. CONCLUSION: These results present an overview of the status of CPD for EU dentists. Despite a notable trend towards regulated CPD systems, current requirements for dentists to engage in CPD show variation. The harmonisation of requirements would enhance both dentist mobility and safe clinical practice.

The development of an exemplar e-module for the continuing professional development of European dentists.

AIM: To present the development of an exemplar e-module for dental continuing professional development (CPD) provided by dental schools and other dental educational providers. MATERIALS AND METHODS: The exemplar e-module covered the topic of 'Sterilisation and cross-infection control in the dental practice' as this is one of the most recommended topics for dental CPD in Europe. It was developed by a group of topic experts, adult learning and distance learning experts and a technical developer. Major concerns were pedagogy, interoperability, usability and cost reduction. Open-source material was used to reduce the cost of development. RESULTS: The e-module was pre-piloted in dental practitioners for usability and then evaluated by experts in the field and dental academics through an electronic questionnaire and an online presentation and discussion at the ADEE 2012 Special Interest Group on DentCPD-Lifelong learning. This facilitated refinement before final production. A Creative Commons License was implemented to ensure the developers' rights and facilitate wider distribution and access to CPD providers. DISCUSSION AND CONCLUSIONS: The e-module was developed according to well-defined pedagogical and technical guidelines for developing e-learning material for adult learners. It was structured to promote self-study by directing learners through their study, promoting interaction with the material, offering explanation and providing feedback. Content validity was ensured by extensive review by experts. The next step would be to expand the evaluation to practising dentists in various countries after relevant translations, and adaptations to local policies have been made.

Recommendations for the development of e-modules for the continuing professional development of European dentists.

AIMS: To provide evidence-based and peer-reviewed recommendations for the development of dental continuing professional development (CPD) learning e-modules. METHODS: The present recommendations are consensus recommendations of the DentCPD project team and were informed by a literature research, consultations from e-learning and IT expert, discussions amongst the participants attending a special interest group during the 2012 ADEE meeting, and feedback from the evaluation procedures of the exemplar e-module (as described in a companion paper within this Supplement). The main focus of these recommendations is on the courses and modules organised and offered by dental schools. RESULTS AND DISCUSSION: E-modules for dental CPD, as well as for other health professionals' continuing education, have been implemented and evaluated for a number of years. Research shows that the development of e-modules is a team process, undertaken by academics, subject experts, pedagogists, IT and web designers, learning technologists and librarians. The e-module must have clear learning objectives (outcomes), addressing the learners' individual needs, and must be visually attractive, relevant, interactive, promoting critical thinking and providing feedback. The text, graphics and animations must support the objectives and enable the learning process by creating an attractive, easy to navigate and interactive electronic environment. Technology is usually a concern for learners and tutors; therefore, it must be kept simple and interoperable within different systems and software. The pedagogical and technological proficiency of educators is of paramount importance, yet remains a challenge in many instances. CONCLUSIONS: The development of e-courses and modules for dental CPD is an endeavour undertaken by a group of professionals. It must be underpinned by sound pedagogical and e-learning principles and must incorporate elements for effective visual learning and visual design and a simple, consistent technology.

Continuing professional development systems and requirements for graduate dentists in the EU: survey results from the DentCPD project.

INTRODUCTION: By maintaining skills and keeping dentists up-to-date, continuing professional development (CPD) supports safe clinical practice. However, CPD for dentists across Europe is not harmonised. AIM: One aim of the 'DentCPD' project (www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. As part of the process, data were collected on existing approaches to CPD for EU dentists. This paper reports those findings. METHODS: Informed by a review of the literature and internet search, the CPD for Graduate Dentists questionnaire gathered data from dental educators on CPD systems, requirements, provision and accreditation in Europe. It sought opinion on mandatory CPD and e-learning. RESULTS: Responses were received from 143 individuals from 30 EU countries. About half the countries had a compulsory CPD system which typically included mandatory core topics. Elsewhere CPD was optional or based on recommended hours. University dental schools and professional dental associations were the most common CPD providers. National regulatory bodies were the most common accrediting body. Only 41% of respondents thought they knew the criteria for successful accreditation of CPD. Eighty-one percent agreed that 'CPD should be obligatory for all dentists'. CONCLUSION: These results present an overview of the status of CPD for EU dentists. Despite a notable trend towards regulated CPD systems, current requirements for dentists to engage in CPD show variation. The harmonisation of requirements would enhance both dentist mobility and safe clinical practice.

Variability of dental cone beam CT grey values for density estimations.

OBJECTIVE: The aim of this study was to investigate the use of dental cone beam CT (CBCT) grey values for density estimations by calculating the correlation with multislice CT (MSCT) values and the grey value error after recalibration. METHODS: A polymethyl methacrylate (PMMA) phantom was developed containing inserts of different density: air, PMMA, hydroxyapatite (HA) 50 mg cm(-3), HA 100, HA 200 and aluminium. The phantom was scanned on 13 CBCT devices and 1 MSCT device. Correlation between CBCT grey values and CT numbers was calculated, and the average error of the CBCT values was estimated in the medium-density range after recalibration. RESULTS: Pearson correlation coefficients ranged between 0.7014 and 0.9996 in the full-density range and between 0.5620 and 0.9991 in the medium-density range. The average error of CBCT voxel values in the medium-density range was between 35 and 1562. CONCLUSION: Even though most CBCT devices showed a good overall correlation with CT numbers, large errors can be seen when using the grey values in a quantitative way. Although it could be possible to obtain pseudo-Hounsfield units from certain CBCTs, alternative methods of assessing bone tissue should be further investigated. ADVANCES IN KNOWLEDGE: The suitability of dental CBCT for density estimations was assessed, involving a large number of devices and protocols. The possibility for grey value calibration was thoroughly investigated.

Evaluation of a blended learning course for teaching oral radiology to undergraduate dental students.

AIMS: The purpose of this study was to develop and implement a blended course (a combined face-to-face and online instruction) on undergraduate oral radiology and evaluate it by comparing its educational effectiveness (derived from students' performance and answers to questionnaires) to a conventional course's. Students' attitudes concerning the blended methodology were also registered. METHODOLOGY: An original course was developed and implemented, and its electronic version was uploaded to an e-learning educational platform. The course was attended by two groups of final-year students, who were taught by either the conventional face-to-face methodology or the blended learning methodology. Students answered a series of questionnaires, before and after following the course, regarding their perceptions, attitudes and evaluation of the course. Additionally, they completed knowledge assessment tests and their grades (before and after the course) were compared. Educational effectiveness of the course was determined by analysing the results of the questionnaires and the tests. RESULTS: Students in the blended group performed significantly better than their colleagues of the conventional group in the post-course knowledge test, and female students of the blended group performed better than male students. Students evaluated high the course content, organisation, educational material, and the blended group students additionally appreciated the course design and clarity of instructions. Students' attitudes towards elements of blended learning (effectiveness, motivation and active engagement) were very positive. Most of the blended group students, who attended the face-to-face meeting (approx. 91%), evaluated it as helpful for summarising the subject and clarifying difficult issues. CONCLUSIONS: Blended learning is effective and well evaluated by dental students and can be implemented in undergraduate curriculum for teaching oral radiology.

The relationship between osteoporosis and periodontitis in women aged 45-70 years.

OBJECTIVE: To explore the possible relationship between the osteoporotic condition and the severity of periodontitis in women aged 45-70 years. MATERIALS AND METHODS: Ninety women with generalized chronic periodontitis, aged 45-70 years, were studied. Areal bone mineral density (BMDa) was assessed using standardized dual energy X-ray absorptiometry (normal: T-score ≥ -1, osteopenic: -2.5 ≤ T-score <-1, osteoporotic: T-score < -2.5). Gingival index (GI), bleeding on probing, clinical attachment loss (CAL), probing pocket depth and gingival recession (GR) were recorded. Periodontitis severity was represented by CAL. Menopausal condition and smoking were documented. RESULTS: Mean GI, bleeding on probing, CAL and GR were significantly greater for osteoporotic women than women with normal BMDa (P = 0.002, P = 0.01, P = 0.04, respectively). Osteopenic women and women with normal BMDa significantly differed in mean GI (P = 0.02). The associations found between osteoporotic women and women with normal BMDa and the associations found between osteopenic women and women with normal BMDa existed even after adjusting for smoking and menopausal status. CONCLUSION: Subjects with osteoporosis (OPR) presented with greater CAL than the subjects with normal BMDa, which suggests a greater severity of periodontitis. Subjects with OPR had greater GR than the subjects with normal BMDa. Subjects with osteopenia and subjects with normal BMDa did not differ in CAL, which might suggest that the early diagnosis of reduced BMDa, prior to the establishment of a significant negative impact on the periodontal tissues, might be important. Smoking and menopausal status did not alter these associations.

Basic principles for use of dental cone beam computed tomography: consensus guidelines of the European Academy of Dental and Maxillofacial Radiology.

OBJECTIVES: To develop "basic principles" on the use of dental cone beam CT by consensus of the membership of the European Academy of Dental and Maxillofacial Radiology. METHODS: A guideline development panel was formed to develop a set of draft statements using existing European directives and guidelines on radiation protection. These statements were revised after an open debate of attendees at a European Academy of Dental and Maxillofacial Radiology (EADMFR) Congress in June 2008. A modified Delphi procedure was used to present the revised statements to the EADMFR membership, utilising an online survey in October/November 2008. RESULTS: Of the 339 EADMFR members, 282 had valid e-mail addresses and could be alerted to the online survey. A response rate of 71.3% of those contacted by e-mail was achieved. Consensus of EADMFR members, indicated by high level of agreement for all statements, was achieved without a need for further rounds of the Delphi process. CONCLUSIONS: A set of 20 basic principles on the use of dental cone beam CT has been devised. They will act as core standards for EADMFR and, it is hoped, will be of value in national standard-setting within Europe.

Evaluation of the severity of temporomandibular joint osteoarthritic changes related to age using cone beam computed tomography.

OBJECTIVES: The aim of this study is to evaluate and correlate with age the severity of temporomandibular joint (TMJ) osteoarthritic changes using cone beam CT (CBCT). METHODS: The images of 71 patients with findings of degenerative arthritis were retrieved from the computer data base. All patients had been examined with CBCT (NewTom 9000 QR-DVT). Left and right TMJs were evaluated independently for each patient. TMJ evaluation included: (a) bony changes of the condyle (flattening, erosion, sclerosis, osteophytes, resorption); (b) joint space (normal, increased, reduced, bony contact between the condyle and the mandibular fossa); and (c) bony changes of mandibular fossa (normal, sclerosis, erosion, resorption). The radiographic findings were statistically analysed. RESULTS: Significant differences in the mean age were found: (a) between absent and moderate erosion (P = 0.019), as well as between absent and extensive erosion (P = 0.048); (b) between absent and extensive formation of osteophyte (P = 0.003), as well as between slight and extensive formation of osteophyte (P = 0.025); (c) between normal joint space and bony contact (P = 0.0002), as well as between reduced joint space and bony contact (P = 0.001). CONCLUSIONS: Degenerative arthritis is an age-related disease. The progression and severity of osseous changes in the condylar head and mandibular fossa are increased with age. In older age groups, patients are expected to have more frequent and severe progressive degenerative bony changes due to the development of TMJ osteoarthritis than patients in younger age groups.

The subjective image quality of conventional and digital panoramic radiography among 6 to 10 year old children.

OBJECTIVES: To compare the diagnostic quality of orthopantomographs made with the conventional unit Orthophos Siemens and the direct digital unit Planmeca 2000 cc Proline among children 6-10 years old and to investigate possible diferences on image interpretation between oral radiologists and pediatric dentists. METHODS: Study material included two independent groups of panoramic images (50 in each group) made with different panoramic modalities (digital conventional). Eight observers (four pediatric dentists and four oral radiologists) evaluated all images for diagnostic quality in 12 pre-determined areas using a 4-point rating scale. RESULTS: Digital and conventional panoramic radiography performed almost similarly as far as it concerns the specific diagnostic tasks rated with the exception of the interproximal contacts of mandibular molars where digital panoramic radiography was scored significantly higher and the periapical region of anterior mandible and anterior mandibular tooth germs where conventional panoramic radiography was found to be significantly better. Both oral radiologists and pediatric dentists graded similarly digital and conventional radiographs for a variety of diagnostic tasks. CONCLUSIONS: It can be concluded that diagnostic image quality obtained with the digital orthopantomograph unit Planmeca 2000 cc Proline was generally equal to image quality obtained with the conventional orthopantomograph unit Orthophos Plus CD. Image interpretation between oral radiologists and pediatric dentists was not substantially different

Psychophysical properties of a new F-speed intraoral film.

OBJECTIVES: To compare the psychophysical properties of the new Kodak InSight F-speed intraoral dental film with those for the E-speed Ektaspeed Plus film by means of the perceptibility curve (PC) test. METHODS: A specially designed test object was used. The test object was made of aluminium and was 10 mm thick. It contained ten holes, contrast details, with the same diameter of 1.5 mm but with different depths. The depths ranged from 0.03 mm to 0.30 mm in steps of 0.03 mm. The holes were placed randomly within a square area with a total of 16 possible positions. Radiographs of the test object were obtained over the full exposure ranges of the two films. A Combex DX-907 dental X-ray unit was used operating at 10 mA and two tube potentials, 70 kVp and 90 kVp. The focus-to-object distance was 50 cm. Ten observers evaluated the radiographs under uniform artificial lighting using a view box and stated the number of perceptible representations of contrast details. In order to construct perceptibility curves, absolute values of the reciprocal of the minimum perceptible logarithmic exposure differences, 1/(DeltalogE)min, were plotted as functions of the logarithm of exposures, logE, registered by the tested films. Comparisons between the two films were made separately for the two tube potentials, 70 kVp and 90 kVp. RESULTS: The results are presented graphically. PCs for the InSight film had higher peaks than those for the Ektaspeed Plus film. This indicates that the viewers were able to perceive smaller exposure differences in the former compared with the latter. PCs for the InSight film were shifted towards the left along the exposure axis relative to the PCs for the Ektaspeed Plus film indicating that the former film is more sensitive than the latter. The integrals of the PCs for InSight film were larger than those for Ektaspeed film indicating superior psychophysical properties of the InSight film. CONCLUSIONS: From the point of view of perception, the new InSight film has such psychophysical properties in comparison with Ektaspeed Plus film that it will be the more favourable of the two in clinical radiographic practice.

Radiographic examination of the temporomandibular joint using cone beam computed tomography.

Cone beam CT (CBCT) is a new technique for maxillofacial imaging. We describe a reconstruction technique for radiographic examination of the temporomandibular joint (TMJ) using CBCT, and we further present four cases where the technique was employed. The technique provides a complete radiographic investigation of the bony components of the TMJ. The reconstructed images are of high diagnostic quality. The examination time is shorter and the patient dose is lower than that with conventional CT. It may therefore be considered as the imaging technique of choice when investigation of bony changes of the TMJ is the task at hand.

Clinical and radiographic findings following application of enamel matrix derivative in the treatment of intrabony defects. A series of case reports.

AIM: The purpose of this case report study was to evaluate the clinical and radiographic findings following application of enamel matrix derivative (EMD) in the treatment of 2- or 3-wall intrabony defects in a private periodontal practice one year after surgery. METHOD: 15 consecutive patients (age range 38 67 years, 9 females, 6 males, 3 smokers) with 25 intrabony defects were included in the study. The decision to use reconstructive surgery was taken at least 3 months after termination of the presurgical treatment phase. Inclusion criteria were: presence of an interproximal area with residual probing depth (PD) > or =6 mm, probing attachment level (PAL) > or =6 mm and an associated intrabony defect > or =4 mm deep and > or =2 mm wide as measured during surgery (defects were not associated with adjacent furcation lesions). Open-flap surgery was performed to expose the defects and the EMD gel was applied after proper debridement. The patients were instructed to rinse 2x daily for 6 weeks with a 0.12% solution of chlorhexidine. RESULTS: At 12 months, mean PD decreased from 8.4 mm to 4.0 mm and PAL from 10.2 mm to 6.6 mm, while recession increased from 1.8 mm to 2.6 mm. Residual PD greater than 4 mm was observed only in 7 sites. 14 sites demonstrated a PAL gain of 2-3 mm, 9 sites a gain of 4-5 mm and 2 sites a gain of 6 mm. Radiographic assessment indicated a mean crestal bone resorption of 20.7% and a mean improvement in the distance between the CEJ and the base of the defect of 22.9%. The combination of defect fill from the bottom of the defect and crestal resorption resulted in a mean defect resolution of 61%. CONCLUSION: Within the limits of this study, the application of EMD gel in 2- or 3-wall intrabony defects resulted in clinically significant gain of PAL and radiographic bone. Further controlled clinical studies are required to confirm the effectiveness of the EMD gel in the treatment of various osseous defects.