Detection and characteristics of the gubernacular tract in supernumerary teeth on cone beam computed tomography.

OBJECTIVES: The aim of this study was to evaluate the prevalence and visualization of supernumerary teeth (ST) and imaging characteristics of their gubernacular tract (GT) using cone beam computed tomography (CBCT). METHODS: Presence and visualization of ST were retrospectively evaluated using 960 CBCT images. The imaging characteristics of GT were analyzed to determine various presentations of GT according to type, shape, and orientation of ST. RESULTS: ST were radiographically detected in 93 patients, for a prevalence of 9.7%. Premolar shaped ST were more common (p = 0.003). GT was detected in 104 (77.2%) of impacted ST and mostly found straight in shape (49.0%). It was most frequently observed in peridens (n = 51, 49.0%) followed by mesiodens (n = 41, 39.4%) and more frequently seen in premolar-like ST (n = 44, 42.3%). The mean length of the GT in mandible was 2.8 mm, the mean length of the GT in maxilla was 1.0 mm (p < 0.001). The mean angle of the GT in mandible was 17.0, and the mean angle of the GT in maxilla was 43.0 (p = 0.004). CONCLUSIONS: CBCT can be used for evaluations in dental practice to provide comprehensive information about ST and their GT characteristics. Clinicians should be able to identify the characteristics of GTs on CBCT for dental treatments, especially traction and extraction of ST.

Imaging characteristics of enamel pearls on CBCT and their co-relation with supernumerary tooth.

OBJECTIVES: Enamel pearl (EP) is an ectopic growth of enamel that is generally round and white and it firmly adheres to the external root surface of tooth. The aim of this study was to assess the prevalence and imaging features of enamel pearls (EPs) and to investigate the potential relationship between EP and supernumerary tooth. METHODS: Cone beam computed tomography (CBCT) images of 1003 patients were evaluated for the presence of EP. Descriptive characteristics of gender and age of patients and imaging features of EPs and presence of supernumerary tooth were recorded. RESULTS: In this study, 72 EPs were radiographically detected in 63 molars in 43 patients, with a person prevalence of 4.29% and tooth prevalence of 0.71%. Most of the EPs (95.83%) were detected in maxillary molars especially in third (n = 42, 58.33%) and second molars (n = 18, 25%). They were more frequently located at mesial (n: = 21; 29.16%); distal (n = 16; 22.22%) proximal surface of roots and the furcation between the disto-buccal and the palatal roots (n = 12; 16.67%) respectively. CBCT images of 109 (10.87%) patients showed supernumerary tooth/teeth and 13 of these also presented EP. A statistical significant relationship between supernumerary tooth and EP was found (p = 0.001). Additionally, CBCT images of four EPs showed corticated hypodens tracts similar to gubernaculum dentis (GD). CONCLUSIONS: Clinicians and radiologists should be aware that EPs are most frequently observed in maxilla especially in third and second molars. Presence of supernumerary tooth might be associated with higher presence of EPs.

Evaluation of the pharyngeal recess with cone-beam computed tomography.

PURPOSE: To evaluate the radiological anatomy of the pharyngeal recess (PR) by gender and age. METHODS: Images of patients who underwent cone-beam computed tomography (CBCT) were analyzed retrospectively. A total of 600 PRs (140 male, 160 female) were examined. PR depths, distances between the posterior nasal spine (PNS) and the posterior wall of the pharynx, right and left torus levatorius lengths, and distances between the right and left torus levatorius were measured on the axial plane passing through the PNS-basion point. RESULTS: PR depths differed significantly between age groups (right p = 0.030, left p = 0.047). The PR depths of individuals under 35 years of age were significantly higher than those of individuals aged 35 and over. Further, the distances between the PNS and the posterior wall of the pharynx differed significantly between age groups and between gender groups. The distances between the PNS and the posterior wall of the pharynx were shorter in patients under 35 years of age (p = 0.000). In terms of gender, these distances were significantly longer in males (p = 0.014). The distances between the right and left torus levatorius were also significantly longer in males (p = 0.029). CONCLUSION: The PR is the region in which nasopharyngeal carcinoma originates most frequently and is very important for early diagnosis. The present results indicated that this region can be examined with CBCT.

Evaluation of simulated periodontal defects via various radiographic methods.

OBJECTIVES: The aim of this study was to compare the diagnostic accuracy of conventional films and direct digital radiographs (DDR), in the determination of the depth and type of simulated periodontal intrabony defects. MATERIALS AND METHODS: Three types of periodontal intrabony defects (one, two, and three walled) were artificially created in dry mandibles. Standard radiographic images were taken with Ultraspeed, Ektaspeed, Insight films, and DDR. The radiographic images were evaluated by three oral radiologists to identify the type and depth of these defects on the radiographs. RESULTS: The average measured depth of the defects on the dry mandibles was 7.85 mm. The average depth of the type 1 defect on the radiographs was 7.19 mm, type 2 was 7.18 mm, and type 3 was 7.15 mm. The average depth of the defects via the Ultraspeed film was 7.15 mm, Ektaspeed film was 7.17 mm, Insight film was 7.19 mm, and DDR was 7.20 mm. Type 1, type 2, and type 3 defect depth measurements showed 8.9, 9.7, and 16.3% understated, respectively (p < 0.01). The accurate estimation rates of type 1, type 2, and type 3 defects were 93.8, 53, and 25.4%, respectively. CONCLUSIONS: Both radiographic techniques have the same diagnostic value and display the minor destructive changes in the bone. As the number of osseous walls increases, it becomes difficult to determine the defect type and morphology. Further research is needed to monitor the intrabony defects, with less radiation exposure. CLINICAL RELEVANCE: The accurate identification of defect type and depth depends on the number of walls, not the imaging methods.

Expansive focal cemento-osseous dysplasia.

AIM: To present a case of expansive focal cemento-osseous dysplasia and emphasize the importance of differential diagnosis. BACKGROUND: Cemento-osseous dysplasia is categorized into three subtypes on the basis of the clinical and radiographic features: Periapical, focal and florid. The focal type exhibits a single site of involvement in any tooth-bearing or edentulous area of the jaws. These lesions are usually asymptomatic; therefore, they are frequently diagnosed incidentally during routine radiographic examinations. Lesions are usually benign, show limited growth, and do not require further surgical intervention, but periodic follow-up is recommended because occasionally, this type of dysplasia progresses into florid osseous dysplasia and simple bone cysts are formed. CASE REPORT: A 24-year-old female patient was referred to our clinic for swelling in the left edentulous mandibular premolarmolar region and felt discomfort when she wore her prosthetics. She had no pain, tenderness or paresthesia. Clinical examination showed that the swelling in the posterior mandible that was firm, nonfluctuant and covered by normal mucosa. On panoramic radiography and computed tomography, a well defined lesion of approximately 1.5 cm in diameter of mixed density was observed. The swelling increased slightly in size over 2 years making it difficult to use prosthetics and, therefore, the lesion was totally excised under local anesthesia, and surgical specimens were submitted for histopathological examination. The histopathological diagnosis was focal cemento-osseous dysplasia. CONCLUSION: In the present case, because of the increasing size of the swelling making it difficult to use prosthetics, young age of the patient and localization of the lesion, in the initial examination, cemento-ossifying fibroma was suspected, and the lesion was excised surgically; the histopathological diagnosis confirmed it as focal cemento-osseous dysplasia. CLINICAL SIGNIFICANCE: We present a case of expansive focal cemento-osseous dysplasia. Differential diagnosis is essential because ossifying fibroma is a real neoplastic entity.