Cone-beam computed tomography and anatomical observations of normal variants in the mandible: variant dentists should recognize.

Many types of cone-beam computed tomography (CBCT) have recently been developed and are being used in many dental clinics. CBCT has significantly changed imaging diagnosis in dentistry by showing detailed structures in multiple dimensions with high spatial resolution. This allows dentists to confirm what cannot be recognized with conventional two-dimensional images, such as small neurovascular canals, the buccolingual location of structures/lesions, and the three-dimensional shapes of hard tissue structures. The aim of this study was to review the normal variants of detailed anatomical structures in relation with the mandibular canal by comparing the previous reports and anatomical evaluations. These structures are likely to be observed on CBCT images by dental practitioners prior to dental procedures involving the mandibular teeth and bone. Understanding the relationship of these structures is useful for dental practitioners and oral surgeons to reduce the possibility of causing damage and patient discomfort during dental procedures.

Histological and radiographic study of human edentulous and dentulous maxilla.

Data on the bone trabecular structure and density of the edentulous regions of the first upper molars are important for designing successful dental treatments, especially dental implants. However, no detailed defined morphometric properties on the human maxilla are available at the immunohistochemical and radiographic levels. Cone-beam computed tomography analysis and immunohistochemical observation were applied to the maxillary first molar region of 91 cadavers (46 males and 45 females). The edentulous maxilla can be classified into the following three forms: fully edentulous (FE), partially edentulous (PE), and immediately edentulous (IE). Compared with the first molar dentulous (FMD) specimens, significant differences in cortical bone structure and bone density exist among IE, PE, and FE in maxilla (P < 0.001). According to histochemical observations, the positive CD31 reaction clearly described a large vessel of the PE and small vessels of FMD and IE in maxillary sinus connective tissue. These structural issues were clearly related to tooth extraction. These morphological and radiographic data describing the edentulous region of the maxillary first molar might be useful for improving dental treatments.

Observation of the temporal crest canal in the mandibular ramus by cone beam computed tomography and macroscopic study.

PURPOSE: The mandibular ramus is regarded as a relatively safe zone for a sagittal splitting osteotomy or for harvesting bone during implant treatment. The only important anatomical structure is the mandibular canal. The mandible has some anatomical variants that need to be recognized, such as a bifid mandibular canal, a retromolar canal, and rarely a temporal crest canal (TCC). In this study, cadaver mandibles were used to evaluate the TCC in the mandibular ramus using cone beam computed tomography (CBCT). METHODS: Altogether, 90 sites on 48 mandibles from Japanese cadavers were examined in this study. The CBCT volumetric images were acquired for areas of 79 mm[Formula: see text] 71 mm. Three-dimensional observation of the images was undertaken to estimate the frequency, position of the orifices, and canal continuity. The cadaver mandibles in which the TCCs were observed were dissected from the inner surface to confirm the contents. RESULTS: Five TCCs (5.6 %) were observed in 90 observation areas. At least one TCC was confirmed in four (8.3 %) of 48 mandibles. Two types of TCC were recognized. Dissection revealed that they contained neurovascular bundles. CONCLUSION: Three-dimensional diagnosis is essential prior to surgical procedures in the mandibular ramus because unexpected blood vessels may be present that may cause bleeding or complications during the surgery.

Differences in the morphology of the maxillary sinus and roots of teeth between Macaca fuscata and Macaca fuscata yakui determined using cone beam computed tomography.

The Japanese macaque is an endemic species consisting of two subspecies: Macaca fuscata fuscata (MFF) and Macaca fuscata yakui (MFY). The MFY is indigenous to Yakushima Island and represents a subspecies of MFF that lives from Honshu to Shikoku and Kyushu, Japan. However, the differences in the skulls of the MFY and MFF are unknown, despite these subspecies having different skull sizes. The maxillary sinus (MS) indicates that the features of the frontal view reflect the transversal growth of the maxilla of the skull. In this study, we show the MS structures of the MFF (n = 9, 18 sides) and MFY (n = 10, 20 sides) using a cone-beam computed tomography instrument. Base on three-dimensional (3D) reconstructed images the MS and nasal cavity were found to present almost to no significant differences between MFF and MFY. However, we designated three classifications of the sinus floor based on the 3D MS images of these Japanese macaques: a round-like shape (type a, MFF = 66.7% (12/18), MFY = 45% (9/20)), a flat-like shape (type b, MFF = 22.2% (4/18), MFY = 35% (7/20)), and an irregular shape (type c, MFF = 11.1% (2/18), MFY = 20.0% (4/20)). The sinus floor shapes of the MFF were mostly type a, while those of the MFY were mostly type b. The prevalence of a root contacting the cortical bone is higher in the canine (26.7%, (8/30)) and second premolar (20%, (6/30) of the MFY at the nasal cavity, moreover, this value is higher in the third molar (42.9%, (9/21)) of the MS in the MFY. These results suggest that the features of the floor of the MS are related to the differences in maxillary root apices teeth between MMF and MMF.

Observing the bony canal structure of the human maxillary sinus in Japanese cadavers using cone beam CT.

We observed the location of the posterior superior alveolar artery (PSAA) and nerve at the macroscopic level between the maxillary sinus (MS) and surrounding bone of the anterior region of the maxilla. This study was completed using cone beam computed tomography (CBCT) imaging of 19 human cadavers with 38 sides of Japanese origin (ranging in age from 59-94 years, mean 77.7 +/- 9.8 years) that were prepared for this study. The bony canal structure of the inner surface of the maxilla was clearly apparent in our results, and the bony canals were classified into three types according to the structure along the course of the PSAA: canal-like, ditch-shaped tunnel and fragmented, and the lest sides were undefined. Calcitonin gene-related peptide (CGRP)-positive fibers were identified along the PSAA in the bony canal of the maxilla by immunohistochemistry. The presence of the bony structure and CGRP-positive nerve fibers along the PSAA suggests that there is risk to the PSAA during surgery involving graft implant in the floor of the maxillary sinus.

Evaluation of the blood and nerve supply patterns in the molar region of the maxillary sinus in Japanese cadavers.

The maxillary sinus (MS) in the maxilla bone is located near the orbit, the nasal cavity and the oral cavity; however, the positioning of the constituent bones is complex. The posterior superior alveolar branches of the maxillary artery and nerve are distributed in the lateral wall of the MS. The courses of these blood vessels and nerves are restricted by the morphology of the craniofacial bones, and the landmarks used in dental implant treatment of these courses mainly run along the lateral wall of the MS. In this study, 19 human cadavers with 34 sides of Japanese origin (ranging in age from 59-94 years, mean 77.7 +/- 9.8 years) were prepared for measurement of the MS, the superior alveolar artery and the infraorbital artery using cone beam computed tomography (CBCT). The posterior superior alveolar artery (PSAA) of the lateral wall of the MS can be classified into one of three groups based on the supply pattern. In the greatest number of cadavers, the PSAA ran mainly to the lateral surface of the zone between the superior border of the alveolar foramen and the inferior border of the MS (53.0%, 18/34). In others, the PSAA ran to the zone between the infraorbital foramen and the superior border of the alveolar foramen (17.6%, 6/34); in a third group, the PSAA ran to the zone between the inferior border of the MS and the greater palatine foramen (23.5%, 8/34). The lest of two sides are spread out in this area (5.9%, 2/34). CBCT is the most accurate tool to evaluate important anatomical parameters, such as the distance of the blood supply, for the implant of grafts in the floor of the MS during surgical procedures.

Understanding the formation of maxillary sinus in Japanese human foetuses using cone beam CT.

The formation of the maxillary sinus (MS) is tied to the maturation of the craniofacial bones during development. The MS and surrounding bone matrices in Japanese foetal specimens were inspected using cone beam computed tomography relative to the nasal cavity (NC) and the surrounding bones, including the palatine bone, maxillary process, inferior nasal concha and lacrimal bone. The human foetuses analysed were 223.2 ± 25.9 mm in crown-rump length (CRL) and ranged in estimated age from 20 to 30 weeks of gestation. The amount of bone in the maxilla surrounding the MS increased gradually between 20 and 30 weeks of gestation. Various calcified structures that formed the bone matrix were found in the cortical bone of the maxilla, and these calcified structures specifically surrounded the deciduous tooth germs. By 30 weeks of gestation, the uncinate process of the ethmoid bone formed a border with the maxilla. The distance from the midline to the maximum lateral surface border of the MS combined with the width from the midline to the maximum lateral surface border of the inferior nasal concha showed a high positive correlation with CRL in Japanese foetuses. There appears to be a complex correlation between the MS and NC formation during development in the Japanese foetus. Examination of the surrounding bone indicated that MS formation influences maturation of the maxilla and the uncinate process of the ethmoid bone during craniofacial bone development.

Effects of amifostine administration prior to irradiation to the submandibular gland in mice: autoradiographic study using 3H-leucine.

We histochemically investigated the radioprotection of organelle in acinus on the submandibular gland using amifostine. Mice were divided into those without amifostine administration or irradiation (group A), with amifostine administration and without irradiation (group B), without amifostine and with 5 Gy of irradiation (group C), and with amifostine and 5 Gy of irradiation (group D). In groups B and D were given 100 mg/kg of amifostine at 30 minutes prior to irradiation to the area equivalent to the submandibular gland. HE staining revealed that group D showed atrophy of the acinar cells, though the change was milder than that seen in group C. In AZAN-Mallory staining, fibrogenesis were found more often in group C as compared to the other groups. In Light Microscopic Autoradiography findings, the ratio of reduced silver particles in the acinar cells was lower in group C than in the other groups at 30 minutes after RI administration. Microstructure findings showed the findings were very similar to those of group A. In Electron microscopic Autoradiography, the ratio among the secretory granules was lower in group C at 120 minutes after RI administration. Our results indicate that amifostine can alleviate xerostomia caused by late effect from radiation.

Measurement of anterior loop length for the mandibular canal and diameter of the mandibular incisive canal to avoid nerve damage when installing endosseous implants in the interforaminal region: a second attempt introducing cone beam computed tomography.

PURPOSE: To measure and compare the anterior loop length (ALL) for the mandibular canal and the mandibular incisive canal diameter (ICD) at its origin in cadavers using anatomy and cone beam computed tomography (CBCT) to safely install endosseous implants in the most distal area of the interforaminal region. MATERIALS AND METHODS: The ALL and ICD were measured using CBCT in 4 cadavers, and using anatomy in 71 cadavers. RESULTS: The ranges and mean +/- SD for the anatomic measurements were: ALL, 0.0 to 9.0 mm and 1.9 +/- 1.7 mm; ICD, 1.0 to 6.6 mm and 2.8 +/- 1.0 mm. The average discrepancies between CBCT and anatomic measurements were 0.06 mm or less for both the ALL and the ICD, which were less than the resolution of CBCT. CONCLUSIONS: Because large variations in measurements were observed, both for ALL and ICD, no fixed distance mesially from the mental foramen should be considered safe. The ALL and the ICD can be estimated from the CBCT measurement. The preoperative CBCT measurement yields important information for each case.

Classifications of tunnel-like structure of human petrotympanic fissure by cone beam CT.

The discomallear ligament (DML) runs through a narrow space of bony petrotympanic fissure, which joins the articular disc of the temporomandibular joint (TMJ) and the malleus in the tympanic cavity. Previous report suggest that an anatomical feature gives rise to TMJ pain and dysfunction. Recently, the movement of the malleus caused by hypertension on the discomallear ligament is important to the function of the TMJ. The purpose of this study is to define its morphological features using the cone beam CT (CBCT) and anatomical dissection of Japanese cadavers. Petrotympanic fissure and DML were observed in 14 cadavers (eight males and six females). It is revealed that a wide tunnel-like structure was found on CBCT images in the middle region of the petrotympanic fissure to the malleus in the tympanic cavity consisting of mainly three types: a wide tunnel-shaped structure (29.2%, 7/24, type 1), a tunnel-shaped structure widely open in the entrance of the petrotympanic fissure to the mandibular fossa and gradually thinning out in the tympanic cavity (20.8%, 5/24, type 2), and a tunnel-shaped structure widely open in the entrance of the mandibular fossa, middle region with flat-shaped tunnel structure and narrow exit in the tympanic cavity (41.7%, 10/24, type 3). These structures between the entrance of the petrotympanic fissure and the exit at the tympanic cavity are important to define the limited movement of the malleus. Therefore, morphological feature of the ligaments in malleus may relate to TMJ pain, dysfunction and hearing function.

Anastomosis between the inferior alveolar artery branches and submental artery in human mandible.

The mental artery displays several branches internal to the anterior region of the mandible as confirmed by macroscopic observation and computed tomography. The inferior alveolar artery formed complex branches and divided into mental and incisive branches, which were found in the right internal side of the mandible of one male cadaver (88 years old). The branches of these two arteries ran through the bony lingual canal to the lingual foramen between the canine and premolar region of the inner surface of the mandible body, where they emerged to enter the mylohyoid and anterior belly of the digastric muscles and communicate with the submental artery. The observation of the anastomotic artery is considered important for surgical placement of dental implants in the mandibular region.

The appearance of foramen in the internal aspect of the mental region of mandible from Japanese cadavers and dry skulls under macroscopic observation and three-dimensional CT images.

The lingual canal with foramen displays different appearances on the internal surfaces of mandible as confirmed by macroscopic observation and computerized tomography (CT). The lingual canal was observed in the inside of mental region run to the outside of lingual foramen, which is extend internally from mandibular canal in right and left sides of the mandible in cadavers (13 sides out of 88 sides) and in dry skulls (43 out of 94 sides) examined. The spinal foramen connected with mental canal occurred at the midline of mandible in 6 cases (6 out of 47 cases) in dry skulls. In this small foramen, the inferior alveolar artery give some branches to the inside of mental region at the anterior mandible and which may be run pass through the lingual canal to the lingual foramen, where they emerge to enter the mylohyoid or anterior belly of digastric muscles. The observations of these are important considerations for surgical placement of dental implants in the region in the mandible.

Rare courses of the mandibular canal in the molar regions of the human mandible: a cadaveric study.

The inferior alveolar artery, vein and nerve send some branches to the molar teeth via the mandibular canal to the mental foramen. The present study attempted to define the presence and course of the mandibular canal in the mandible with the alveolar process by macroscopic cadaveric dissection and computerized tomography (CT) in order to provide information that might prevent injuries to vessels and nerves at risk during root canal treatment. We identified the position of the mandibular canal within a 30% ratio of the distance from inferior border of mandible to the apices of the root for 39 out of 131 sides (mesial root of first molar, 20%; distal root of first molar, 22.6%; mesial root of second molar, 27.8% and distal root of second molar, 47%) on panoramic X-ray observation. In one cadaver (male, 64 years old), the root apex of the second molar was in close proximity to the upper bony mandibular canal. Macroscopic dissection and computerized tomography showed that the main trunks of the inferior alveolar artery, vein, and nerve were in tight contact with the apex of the second molar. These observations of the anatomic course of the mandibular canal will be important to consider during root canal treatment of mandibular teeth.

Radioprotection of the murine submandibular gland by isoproterenol: autoradiography study with 3H-leucine.

Irradiation of the salivary glands results in the generation of free radicals from metal ions present in the secretory granules of acinar cells, a process that is believed to exacerbate radiation damage to the salivary glands. We therefore conducted a comparative investigation of radiation damage to the acinar cells of murine submaxillary glands in which granule secretion had been induced, and used autoradiography to visualize the pathological changes. Male BALB/c mice, at 8 weeks of age, were divided into four groups: a no-isoproterenol (IPR) and no-irradiation group (group I), a no-IPR, irradiated group (group II), an IPR, no-irradiation group (group III), and an IPR, irradiated group (group IV). Intraperitoneal injections of IPR were used, and 3 h later, the submaxillary region was irradiated with X-rays at a dose of 10 Gy. Three days after the irradiation, 3H-leucine was administered, and submaxillary glands were removed at predetermined times. Thin sections were prepared, and light- and electron-microscope autoradiography was performed. The number of reduced silver particles per unit acinar cell area was determined by light-microscopic autoradiography, and the proportion of reduced silver particles in the rough endoplasmic reticulum, the Golgi apparatus, and secretion granules was determined by electron-microscopic autoradiography. The result indicated that the effects of the radiation on the secretory potential of the submaxillary glands were diminished in acinar cells with a higher secretory granule content.

Experimental study on wound healing of alveolar bone sockets in the rat maxilla after X-ray irradiation.

The purpose of this study was to examine the effects of radiation on the healing process of tooth extraction wounds. X-ray doses of 10 Gy were delivered once to the maxillofacial area of Wistar strain rats, and the maxillary first molar was extracted 7 days later. Animals were killed 3, 7, and 14 days after odontectomy, and thin sections of the maxilla were prepared. The specimens were stained with hematoxylin and eosin, azan, alkaline phosphatase and tartrate-resistant acid phosphatase (TRAP) stains for microscopic observation. The ratio of the area of the bone tissue to the area of the alveolar socket (BS/TS) and the numbers of TRAP-positive cells were evaluated. Seven days after odontectomy, BS/TS was significantly lower in the irradiated group than in the nonirradiated group. Alkaline phosphatase staining was observed along the rim of the bone 7 and 14 days after odontectomy in both groups, but it was milder in the irradiated group than in the nonirradiated group. TRAP-positive cells were present on the floor of the postextraction socket and the margins of the septal alveolar bone, and, 3 days after odontectomy, the number of TRAP-positive cells was significantly greater in the irradiation group than in the nonirradiation group.