Does sleep bruxism affect masticatory muscles volume and occlusal force distribution in young subjects? A preliminary study.

Objective To compare the differences in masticatory muscle volume and occlusal force distribution between patients with sleep bruxism (SB) and healthy individuals. Methods The study was performed on 14 SB patients and 12 controls aged between 20 and 27 years. Magnetic resonance images from a previous clinical trial were used for volumetric measurements of masticatory muscles. Distribution of bite forces was recorded using T-Scan® II. T-tests were used for data comparison. Results The mean age of the subjects was 23 ± 1.85 years. The mean muscle volumes of patients with SB and healthy subjects were 177.3 and 185.9 cm3, respectively. The mean occlusal force areas were 72.4 pixels and 89.8 pixels for patients with SB and healthy subjects, respectively. There was no significant difference in measurements between groups (p > 0.05). Conclusion There was no significant difference in the distribution of masticatory muscles and occlusal force between young patients with SB and healthy subjects.

Oral rehabilitation with implant-supported fixed dental prostheses of a patient with cleidocranial dysplasia.

This clinical report describes the oral rehabilitation with implant-supported fixed dental prostheses in the maxilla and mandible of a patient with cleidocranial dysplasia. Cone-beam computed tomography and a tilted implant protocol in the mandible helped to establish a conservative approach for bone preservation, prevent surgical complications, enable proper implant positioning to avoid anatomic structures, and support the fixed dental prostheses.

Differential Diagnosis of Parotid Lipoma in a Breast Ca Patient.

Lipomas are common benign tumors usually detected on the torso, neck, upper thighs, and upper arms. However, they are rarely found in the parotid gland region. Because of their rarity at this site, they are not often considered in the differential diagnosis of parotid tumors. This report describes a rare case of a lipoma in the superficial lobe of parotid gland. A 71-year-old female patient admitted to our department complaining about swelling and pain in the posterior area of the left mandibular region since one month. Her medical history included mastectomy after breast CA fifteen years ago. Clinical examination revealed a smooth-surfaced, soft, and painful mass, with well-defined margins in the left mandibular region. Differential diagnosis of metastasis, inflammatory neck swellings, and benign salivary gland tumors were considered for the patient. Advanced imaging methods such as ultrasonography and contrast tomography revealed that the lesion was a lipoma of parotid gland. A surgical intervention under general anesthesia was planned for the removal of the mass; however patient refused the surgical treatment. Patient was placed on six-month periodic recall. This article reviews the radiographic appearance and differential diagnoses of lipoma in this rare location.

Temporomandibular joint involvement in psoriatic arthritis.

Psoriasis is a chronic, papulosquamous, and an inflammatory skin disease. It has been found that between 5% and 24% of patients develop psoriatic arthritis (PA) at the same time after or even prior to skin findings. The involvement of temporomandibular joint (TMJ) is a rare condition. In this report, a-46-year-old male patient was referred to our clinic with the complaint of pain in the bilateral TMJs, and a limited jaw movement. Medical anamnesis revealed he had psoriasis for the last 21 years, and developed a seronegative polyarthritis with destructive changes for 8 years. On extra-oral examination, crepitation at TMJs and limitation of jaw movements was detected. The radiographic examination with cone-beam CT revealed the bilaterally decreased joint spaces, erosion, and the loss of cortical edge of the joint on the condylar heads. The definitive diagnosis of PA was made with the help of patient's history and radiological findings. The uses of non-steroidal anti-inflammatory drugs and occlusal splint have been suggested for conservative treatment.

Correlation of upper airway radiographic measurements with risk status for obstructive sleep apnea syndrome in young dental patients.

OBJECTIVE: The aim of the present study is to compare radiographic measurements of the upper airway (UA) in young adult patients with different levels of risk status for obstructive sleep apnea syndrome. STUDY DESIGN: The study included 50 patients between 18 and 30 years of age who were referred for dental examination and evaluation of impacted third molars. Case record forms, including habit history, along with the Berlin Questionnaire and the Epworth Sleepiness Scale, were completed by the patients and their relatives. According to the answers, 25 low-risk patients and 25 high-risk patients were selected. Cephalometric radiographs and cone beam computed radiography images were obtained for radiographic analysis when the patients were admitted into the study. RESULTS: There were significant differences in body mass index, neck circumference measurements, Epworth score, and smoking status between risk groups. There were significant differences for UA measurements on radiographic evaluation. Body mass index (BMI) was found to be correlated positively with neck circumference and Epworth scores and negatively with UA measurements for all patients. Velopharyngeal measurements showed the highest correlation with Epworth scores, BMI, and neck circumference. CONCLUSIONS: The radiographic findings correlated with the survey results. Our data suggest that radiographic measurements of UA may be used as a predictor of risk for obstructive sleep apnea syndrome in a young population.

Prevalence of ponticulus posticus among patients with different dental malocclusions by digital lateral cephalogram: a comparative study.

PURPOSE: The aim of the present study was to investigate the prevalence of ponticulus posticus among patients with dental Angle class I, II, and III malocclusions in Middle Anatolian population. METHODS: A total of 1246 cephalometric radiographs were examined in a 6 months period. Each patient was assigned an identification number, and demographic information, absence/presence of PP, if present, type of PP and type of dental malocclusion were recorded by two observers. In cases where there was any disagreement, a third observer was consulted. Distributions of obtained values were analysed using Pearson's Chi-square test. RESULTS: The mean age of subjects was 20.98 ± 6.95 years (range 10-39). In the analysed sample, PP had a prevalence of 18.8 % (complete form 9.6 %, incomplete form 9.2 %). There was a significant difference between genders (p = 0.002) (more prevalent in male patients: 119/522; 23 %). No significant difference was found between age groups (p > 0.05). PP was most frequently detected in Angle class III patients (78/351; 22.2 %) but there was no significant difference between malocclusion groups (p > 0.05). CONCLUSION: In the present study, PP is found to be a relatively common anomaly in patients with dental malocclusions. Although Angle class III patients showed a higher frequency of PP, statistically no significant difference was found among dental malocclusion groups.

Spontaneous Healing of Mandibular Noncontinuous Defect Caused by Medication-Related Osteonecrosis of the Jaw.

BACKGROUND: Bisphosphonates are used throughout supportive cancer therapies for the treatment of osteoporosis and metastatic bone diseases, but they invariably induce medication-related osteonecrosis of the jaw (MRONJ). This medicational modality may induce consequential losses that can lead to spontaneous or surgical therapy related bone fractures or defects. MRONJ stages and treatment alternatives are described in the current procedures. Accordingly, treatments for stages 0 and 1 are conservative whereas the treatment for stage 3 is surgical resection of the necrotic bone. Stage III MRONJ therapy is still controversial within the scope of conceivable bone fractures or defects. When the development of MRONJ is refractory to conventional treatment modalities, surgical management can be suggested. The aim of this study was to evaluate the results of the surgical treatment of MRONJ as part of a medical patient. METHODS: A 72-year-old man was referred to our department for extensive pain of the left mandibular region that occurred after tooth extraction. It was identified in his medical history that he had received a nitrogen-containing intravenous bisphosphonate (Zometa; Novartis, East Hanover, NJ) therapy for prostate cancer. He had been administered 4 mg. IV Zolenat 9 times during the first year of therapy, followed by 2 doses of the same amount of Zolenat in the second year. RESULTS: The treatment started with a therapy that combined antibiotics and antibacterial mouth rinse with chlorhexidine for maintaining oral hygiene. After the maturity of the sequestrum was identified through radiographic examination, the patient was treated by the segmental resection of the extensive necrotic bone, resulting in discontinuity of the mandibular corpus. Two years later, spontaneous bone healing occurred along the residual defect on the mandible. CONCLUSION: Treatment options for the defects resulting from MRONJ are still under debate, and no evidence-based guidelines are available. However, due to the results displayed in this patient; it may be a sound approach to closely follow up and observe MRONJ-related bone to prevent additional complications.

Assessment of Third Molar Impaction Pattern and Associated Clinical Symptoms in a Central Anatolian Turkish Population.

OBJECTIVES: The purpose of this study was to assess the pattern of third molar impaction and associated symptoms in a Central Anatolian Turkish population. MATERIAL AND METHODS: A total of 2,133 impacted third molar teeth of 705 panoramic radiographs were reviewed. The positions of impacted third molar teeth on the panoramic radiographs were documented according to the classifications of Pell and Gregory and of Winter. The presence of related symptoms including pain, pericoronitis, lymphadenopathy and trismus was noted for every patient. Distributions of obtained values were compared using the Pearson χ2 test. Nonparametric values were analyzed using the Mann-Whitney U test and Kruskal-Wallis test. RESULTS: The mean age of the subjects was 30.58 ± 11.98 years (range: 19-73); in a review of the 2,133 impacted third molar teeth, the most common angulation of impaction in both maxillaries was vertical (1,177; 55%). Level B impaction was the most common in the maxilla (425/1,037; 39%), while level C impaction was the most common in the mandible (635/1,096; 61%). Pain (272/705; 39%) and pericoronitis (188/705; 27%) were found to be the most common complications of impaction. Among 705 patients (335 males, 370 females), pericoronitis was more prevalent in males (101; 30%) and usually related to lower third molars (236; 22%). The retromolar space was significantly smaller in females (p < 0.05). Moreover, there was a significant difference in retromolar space for the area of jaw (maxillary: 11.3 mm; mandibular: 14.2 mm) and impaction level (A: 14.7 mm; B: 11.1 mm; C: 10.3 mm; p < 0.05). CONCLUSION: The pattern of third molar impaction in a Central Anatolian Turkish population was characterized by a high prevalence rate of level C impaction with vertical position. Pain and pericoronitis were the most common symptoms usually associated with level A impaction and vertical position.

Stafne Bone Cavity Complicated By Periapical Infection.

Stafne bone cavity (SBC) is an uncommon lesion of the mandible; and generally found incidentally on routine radiographic examinations. The radiographic differential diagnosis of SBC includes a variety of lesions including odontogenic cysts, benign tumors, or bone metastases. In the present case, a 22-year female patient was admitted with chief complaint of pain in the right mandibular molar area. On panoramic radiographic examination, a non-specific large radiolucent lesion related to mandibular molar teeth was detected and extra-oral surgical intervention was planned. However, on examination with cone-beam CT(CBCT), a SBC was suspected due to lack of lingual cortical plate; and intraoral surgical exploration confirmed the diagnosis showing a cavity with small inflamed salivary gland tissue. Examination with CBCTon suspicious jaw lesions helps avoid unnecessary extraoral surgical interventions.

Evaluation of volumetric measurements on CBCT images using stafne bone cavities as an example

BACKGROUND: The aim of the present study is to evaluate the efficacy of CBCT in volume measuring using Stafne Bone Cavities (SBC) as an example. MATERIAL AND METHODS: The study was conducted with 14 subjects with SBC detected on panoramic radiographs. In order to evaluate lesions volumetric dimensions, CBCT images for each patient were captured. Files in Digital Imaging and Communications in Medicine (DICOM) format were transferred into a medical image processing program (ITK-SNAP 2.4.0) and volume in mm3 of the cavities were measured using semi-automatic segmentation procedure by 2 observers blinded to each other over a one-month period. Inter-reliability of volumetric measurements between observers was compared. SBCs relation to mandibular canal was also examined and three types of relation were observed; type 1: mandibular canal is separated from the SBC, type 2: mandibular canal is in contact with SBC, type 3: mandibular canal goes through the SBC. RESULTS: There were 12 males and 2 females who had SBC in this study (age range: 37-73, mean age: 55.3 years). The total volume of SBC in patients ranged from 160 mm3 to 520 mm3 (mean: 361.7 mm3 ). There was no significant difference between observers for volume measurements (p > 0.05). According to relationship of SBC with mandibular canal, most SBCs were Type 1 (64.3 %) followed by type 3 (21.4 %) and type 2 (14.3 %). Pearson correlation coefficient shows a positive correlation between lesions volumetric size and relation with mandibular canal (pearson correlation = 0.54, sig < 0.05). CONCLUSIONS: Based on the results of this preliminary study, CBCT was considered to be an effective radiographic technic for measuring volumetric sizes of SBCs. However further studies with larger sample sizes are needed to prove the usefulness of CBCT in volume measurements

Evaluation of volumetric measurements on CBCT images using stafne bone cavities as an example.

BACKGROUND: The aim of the present study is to evaluate the efficacy of CBCT in volume measuring using Stafne Bone Cavities (SBC) as an example. MATERIAL AND METHODS: The study was conducted with 14 subjects with SBC detected on panoramic radiographs. In order to evaluate lesions volumetric dimensions, CBCT images for each patient were captured. Files in Digital Imaging and Communications in Medicine (DICOM) format were transferred into a medical image processing program (ITK-SNAP 2.4.0) and volume in mm3 of the cavities were measured using semi-automatic segmentation procedure by 2 observers blinded to each other over a one-month period. Inter-reliability of volumetric measurements between observers was compared. SBCs relation to mandibular canal was also examined and three types of relation were observed; type 1: mandibular canal is separated from the SBC, type 2: mandibular canal is in contact with SBC, type 3: mandibular canal goes through the SBC. RESULTS: There were 12 males and 2 females who had SBC in this study (age range: 37-73, mean age: 55.3 years). The total volume of SBC in patients ranged from 160 mm3 to 520 mm3 (mean: 361.7 mm3). There was no significant difference between observers for volume measurements (p>0.05). According to relationship of SBC with mandibular canal, most SBCs were Type 1 (64.3 %) followed by type 3 (21.4 %) and type 2 (14.3 %). Pearson correlation coefficient shows a positive correlation between lesions volumetric size and relation with mandibular canal (pearson correlation = 0.54, sig < 0.05). CONCLUSIONS: Based on the results of this preliminary study, CBCT was considered to be an effective radiographic technic for measuring volumetric sizes of SBCs. However further studies with larger sample sizes are needed to prove the usefulness of CBCT in volume measurements.

Radiographic diagnosis of osteochondritis dissecans of the temporomandibular joint: two cases.

OBJECTIVE: To present two cases of osteochondritis dissecans (OCD) in temporomandibular joints (TMJs) evaluated by panoramic radiography and cone-beam computed tomography (CBCT). CLINICAL PRESENTATION AND INTERVENTION: Two patients were referred to the Oral and Maxillofacial Radiology Clinic with pain, preauricular tenderness on the TMJ region and limitation of mandibular movements. An earlier panoramic radiograph revealed radiopaque lesions adjacent to the condyles. CBCT images were obtained from patients to assess the radiopacities. The CBCT scan detected irregular-type radiopaque lesions on anterior and superior aspects of the right condyle as well as degenerative osseous changes on both TMJs. CONCLUSION: The CBCT images revealed degenerative osseous changes and loose bodies on TMJs. The lesions were diagnosed as OCD with the help of trauma history, as well as clinical and radiographic findings.

A Diagnosis of Maxillary Sinus Fracture with Cone-Beam CT: Case Report and Literature Review.

The purpose of this article is to present the case of maxillofacial trauma patient with maxillary sinus fracture diagnosed with cone-beam computed tomography (CBCT) and to explore the applications of this technique in evaluating the maxillofacial region. A 23-year-old male patient attempted to our clinic who had an injury at midface with complaints of swelling, numbness. The patient was examined before in emergency center but any diagnosis was made about the maxillofacial trauma. The patient re-examined clinically and radiographically. A fracture on the frontal wall of maxillary sinus is determined with the aid of CBCT. The patient consulted with the department of maxillofacial surgery and it is decided that any surgical treatment was not necessary. The emerging technique CBCT would not be the primary choice of imaging maxillofacial trauma. Nevertheless, when advantages considered this imaging procedure could be the modality of choice according to the case.

A possible association of idiopathic osteosclerosis with excessive occlusal forces.

OBJECTIVES: The aim of the study was to determine the relationship between idiopathic osteosclerotic lesions and occlusal forces using the T-Scan II computerized occlusal analysis device, and to test the sensitivity of the system in occlusal analysis. METHOD AND MATERIALS: The study was conducted with 21 volunteers with idiopathic osteosclerosis (IO; 14 women, 7 men) aged between 17 and 62 years (mean 29.95). For every patient, seven or eight recordings were made with the T-Scan II occlusal analysis device in maximum intercuspation, and the last two (excluding any with technical problems) were chosen for evaluation. For each lesion-related area, the distribution of high occlusal forces from two different movies was analyzed. RESULTS: In 18 patients (85.71%), lesions were observed in an area of high occlusal force, and in 13 patients (61.9%), the lesions were located at the first area subjected to high occlusal forces. The percentage distribution of high forces at a lesion related area ranged from 0% to 88%. On average, the high forces at an osteosclerotic lesion area accounted for 20% of the maximum total force. No statistical differences were observed between the measurements of the two selected recordings (P > .05). CONCLUSION: The findings of this study suggest a possible relationship between IO and occlusal forces and primary contacts. T-Scan II was found to be a successful diagnostic device for detecting primary contacts and excessive occlusal forces.

Bilateral and pseudobilateral tonsilloliths: Three dimensional imaging with cone-beam computed tomography.

PURPOSE: Tonsilloliths are calcifications found in the crypts of the palatal tonsils and can be detected on routine panoramic examinations. This study was performed to highlight the benefits of cone-beam computed tomography (CBCT) in the diagnosis of tonsilloliths appearing bilaterally on panoramic radiographs. MATERIALS AND METHODS: The sample group consisted of 7 patients who had bilateral radiopaque lesions at the area of the ascending ramus on panoramic radiographs. CBCT images for every patient were obtained from both sides of the jaw to determine the exact locations of the lesions and to rule out other calcifications. The calcifications were evaluated on the CBCT images using Ez3D2009 software. Additionally, the obtained images in DICOM format were transferred to ITK SNAP 2.4.0 pc software for semiautomatic segmentation. Segmentation was performed using contrast differences between the soft tissues and calcifications on grayscale images, and the volume in mm(3) of the segmented three dimensional models were obtained. RESULTS: CBCT scans revealed that what appeared on panoramic radiographs as bilateral images were in fact unilateral lesions in 2 cases. The total volume of the calcifications ranged from 7.92 to 302.5mm(3). The patients with bilaterally multiple and large calcifications were found to be symptomatic. CONCLUSION: The cases provided the evidence that tonsilloliths should be considered in the differential diagnosis of radiopaque masses involving the mandibular ramus, and they highlight the need for a CBCT scan to differentiate pseudo- or ghost images from true bilateral pathologies.