Efficacy of panoramic radiographs in the preoperative planning of posterior mandibular implants: a prospective clinical study of 1527 consecutively treated patients

OBJECTIVES: Various imaging techniques, including conventional radiography and computed tomography, are proposed to localize the mandibular canal prior to implant surgery. The aim of this study is to determine the incidence of altered mental nerve sensation after implant placement in the posterior segment of the mandible when a panoramic radiograph is the only preoperative imaging technique used. MATERIAL AND METHODS: The study included 1527 partially and totally edentulous patients who had consecutively received 2584 implants in the posterior segment of the mandible. Preoperative bone height was evaluated from the top of the alveolar crest to the superior border of the mandibular canal on a standard panoramic radiograph. A graduated implant scale from the implant manufacturer was used and 2 mm were subtracted as a safety margin to determine the length of the implant to be inserted. RESULTS: No permanent sensory disturbances of the inferior alveolar nerve were observed. There were two cases of postoperative paresthesia, representing 2/2584 (0.08%) of implants inserted in the posterior segment of the mandible or 2/1527 (0.13%) of patients. These sensory disturbances were minor, lasted for 3 and 6 weeks and resolved spontaneously. CONCLUSIONS: Panoramic examination can be considered a safe preoperative evaluation procedure for routine posterior mandibular implant placement. Panoramic radiography is a quick, simple, low-cost and low-dose presurgical diagnostic tool. When a safety margin of at least 2 mm above the mandibular canal is respected, panoramic radiography appears to be sufficient to evaluate available bone height prior to insertion of posterior mandibular implants; cross-sectional imaging techniques may not be necessary.

Evaluation of the maxillary sinus in panoramic radiography—a comparative study

Background: The aim of this study was to evaluate the validity and the inter- and intra-examiner reliability of panoramic-radiograph-driven findings of different maxillary sinus anatomic variations and pathologies, which had initially been prediagnosed by cone beam computed tomography (CBCT). Methods: After pairs of two-dimensional (2D) panoramic and three-dimensional (3D) CBCT images of patients having received treatment at the outpatient department had been screened, the predefinition of 54 selected maxillary sinus conditions was initially performed on CBCT images by two blinded consultants individually using a questionnaire that defined ten different clinically relevant findings. Using the identic questionnaire, these consultants performed the evaluation of the panoramic radiographs at a later time point. The results were analyzed for inter-imaging differences in the evaluation of the maxillary sinus between 2D and 3D imaging methods. Additionally, two resident groups (first year and last year of training) performed two diagnostic runs of the panoramic radiographs and results were analyzed for inter- and intra-observer reliability. Results: There is a moderate risk for false diagnosis of findings of the maxillary sinus if only panoramic radiography is used. Based on the ten predefined conditions, solely maxillary bone cysts penetrating into the sinus were frequently detected differently comparing 2D to 3D diagnostics. Additionally, on panoramic radiographs, the inter-observer comparison demonstrated that basal septa were significantly often rated differently and the intra-observer comparison showed a significant lack in reliability in detecting maxillary bone cysts penetrating into the sinus. Conclusions: Panoramic radiography provides the most information on the maxillary sinus, and it may be an adequate imaging method. However, particular findings of the maxillary sinus in panoramic imaging may be based on a rather examiner-dependent assessment. Therefore, a persistent and precise evaluation of specific conditions of the maxillary sinus may only be possible using CBCT because it provides additional information compared to panoramic radiography. This might be relevant for consecutive surgical procedures; consequently, we recommend CBCT if a precise preoperative evaluation is mandatory. However, higher radiation dose and costs of 3D imaging need to be considered. Keywords: Panoramic radiography; Cone beam computed tomography; Maxillary sinus; Inter-imaging method differences; Inter-examiner reliability; Intra-examiner reliability

Computed tomography and scintigraphy exams for diagnosis and treatment planning of the condylar osteochondroma: a case report

PURPOSE: To report an uncommon case of osteochondroma affecting the mandibular condyle of a young patient and to illustrate the important contributions of different imaging resources to the diagnosis and treatment planning of this lesion. CASE DESCRIPTION: A 24-year-old female patient with the chief complaint of an increasing facial asymmetry and pain in the left pre-auricular region, revealing a reduced mouth opening, mandibular deviation and posterior cross-bite over a period of 18 months. Panoramic radiography revealed an enlargement of the left condyle, whereas computed tomography (CT) sections and three-dimensional CT showed a well-defined bone growth arising from condylar neck. The scintigraphy exam showed an abnormal osteogenic activity in the left temporomandibular joint. The condyle was surgically removed and after 18 months follow-up the panoramic radiography and CT scans showed no signs of recurrence. CONCLUSION: Although osteochondroma is a benign bone tumor that rarely arises in cranial and maxillofacial region, it should be considered in the differential diagnosis of slow-growing masses of the temporomandibular area and the use of different imaging exams significantly contribute to the correct diagnosis and treatment planning of this pathological condition.

A Statistical Study of the Association of Seven Dental Anomalies in the Brazilian Population

The objective of this study was to show the association patterns among seven types of dental anomalies (second pre-molar agenesis, upper side incisive reduced in size, lower first molar infra-ochlesis, enamel hypoplasia, first molar ectopic eruption, supra numerous teeth and upper canine ectopic eruption) in a population sample without dental treatment ranging in age from 7 to 14. A total of 172 patients were attended and underwent the clinical examination at the Clinica Infantil da Fundacao Educacional de Barretos. Eleven patients from this total were selected according to a first dental anomaly diagnosis and submitted to panoramic radiography. A significant association (p < 0.05) was detected among six pairs of anomalies (second pre-molar agenesis x first pre-molar ectopic eruption; second pre-molar agenesis x lower first molar infra-ochlesis; second pre-molar agenesis x upper side incisive reduced in size; supra numerous teeth x reduced size upper side incisive; first pre-molar ectopic eruption x enamel hypoplasia; lower first molar infra-ochlesis x upper side incisive reduced in size) suggesting a common genetic origin for these conditions. The association was not significant in only one case where there was anomaly sharing by the patients. The existence of an anomaly is clinically relevant for early diagnosis of a possible association and an anomaly can indicate an increased risk of other anomalies.

Absence and hypoplasia of the mental foramen detected in CBCT images: a case report

The mental foramen (MF) is an important anatomic landmark of the mandible, through which the mental nerve and blood vessels emerge. The importance of MF in dental practice is especially related to dental implants placement and other surgical procedures in the region. It is fundamental to be careful in order to avoid nerve and vessels injury during procedures. Anatomic variations of the MF can be found, such as occurrence of multiple foramina and unusual location. In very rare occasions, the absence of MF can be detected. The observation of this variation is not always possible using only conventional radiographs. The modern imaging resource cone beam computed tomography (CBCT) allows an accurate three-dimensional assessment of MF, as well as the identification of its variations. The aim of this article is to report MF absence and hypoplasia detected in CBCT images of a 27-year-old daughter and her 63-year-old mother, both from Brazil. Despite the MF anatomic variations, they presented no sensorial disturbance in the regions supplied by the mental nerve.

Impacted Lower Third Molar Fused with a Supernumerary Tooth - Diagnosis and Treatment Planning Using Cone-Beam Computed Tomography

Osny Ferreira-Junior, Luciana Dorigatti de Avila, Marcelo Bonifacio da Silva Sampieri, Eduardo Dias-Ribeiro, Weiliang Chen, Song Fan. Impacted Lower Third Molar Fused with a Supernumerary Tooth-Diagnosis and Treatment Planning Using Cone-Beam Computed Tomography. International Journal of Oral Science, 1(4): 224-228, 2009 This paper reported a case of fusion between an impacted third molar and a supernumerary tooth, in which a surgical intervention was carried out, with the objective of removing the dental elements. The panoramic radiography was complemented by the Donovan`s radiographic technique; but because of the proximity of the dental element to the mandibular ramus, it was not possible to have a final fusion diagnosis. Hence, the Cone-Beam Computed Tomography-which provides precise three-dimensional information-was used to determinate the fusion diagnosis and also to help in the surgical planning. In this case report we observed that the periapical, occlusal and panoramic were not able to show details which could only be examined through the cone-beam computed tomography.

Quantificação da eficiência da proteção da tiróide no exame de ortopantomografia

Mestrado em Radiações Aplicadas às Tecnologias da Saúde - Área de especialização: Proteção Contra Radiações

Interceptive Approach to Treatment of Impacted Maxillary Canines

Impaction of maxillary canines can be prevented by early intervention in the mixed dentition phase after the correct diagnosis of malocclusion, reducing the complexity of the treatment. This article reports the case of a 10-year-old patient who possessed impacted maxillary canines and, after early extraction of primary canines, had reestablished favorable permanent successors' eruption axis. This 5-year radiographic follow-up study with panoramic radiography shows that this can be used in practice and that an effective control strategy ensures the accuracy in the inclination of the impacted canines. Treatment success is related to early diagnosis and strategic interceptive treatment choice.

A survey of radiographic prescription in dental implant assessment

Objectives: To survey the current radiographic prescriptions in dental implant assessment amongst dentists in Brazil.Methods: Sixty-nine dentists were interviewed during a dental implant meeting by two calibrated graduate students, using a 19-question questionnaire, considering imaging modality options both for pre-operative implant site assessment and for follow-up, particularly with respect to cost, patient radiation dose, and broad coverage of facial bones and teeth. Epi-Info 6.04 software was used to analyse the database file.Results: Approximately 63.8% of the dentists prescribed only panoramic radiography for dental implant assessment and 28.9% ordered panoramic radiography plus periapical radiography and/or conventional tomography and/or computed tomography (CT). Only 7.2% of the dentists ordered conventional tomography or CT as a single examination, although 10.1% ordered it in combination with other imaging modalities. The main reasons given for prescribing panoramic radiography were broad coverage and cost (86.4%).Conclusions: This study has shown that most of the dentists in this study prescribe panoramic radiographs in dental implant assessment based on broad coverage and cost. They are not following the American Academy of Oral and Maxillofacial Radiology recommendations regarding cross-sectional imaging.

Estudio radiográfico do desenvolvimento da dentição permanente de crianças brasileiras com idade cronológica variando entre 84 e 131 meses.

With the help of orthopantomograms we analyse the tooth development beside body weight and height from Brazilian healthy boys and girls. So, their dental age were compared to their chronological age. The results of this investigation, according to the methodology employed, indicated that: 1. girls showed accelerated formation of permanent teeth and mean values of dental age higher than boys; 2. the mean values of dental age in girls were higher than their chronological age in all groups; 3. the teeth development stages were appropriate in assessment of the degree of physiological maturity of a growing child.

Cleidocranial dysplasia: importance of radiographic images in diagnosis of the condition.

Cleidocranial dysplasia (CCD) is a rare syndrome usually caused by an autosomal dominant gene, although 40% of cases of CCD appear spontaneously with no apparent genetic cause. This condition is characterized by several cranial malformations and underdevelopment, absence of the clavicles, and multiple supernumerary and impacted permanent teeth. The diagnosis of this condition is usually based on the presence of the main features (supernumerary teeth, partial or total absence of one or both the clavicles, and bony malformations) and on clinical and familial evidence. The bony and dental features of CCD may be visualized on radiographic images of the face and skull. Here, we present a familial case of CCD and discuss the importance of dental radiographs in diagnosis of the condition.

A survey of radiographic measurement estimation in assessment of dental implant length.

The aim of this study is to survey radiographic measurement estimation in the assessment of dental implant length according to dentists' confidence. A 19-point questionnaire with closed-ended questions was used by two graduate students to interview 69 dentists during a dental implant meeting. Included were 12 questions related to over- and underestimation in three radiographic modalities: panoramic (P), conventional tomography (T), and computerized tomography (CT). The database was analyzed by Epi-Info 6.04 software and the values from two radiographic modalities, P and T, were compared using a chi2 test. The results showed that 38.24% of the dentists' confidence was in the overestimation of measurements in P, 30.56% in T, and 0% in CT. On the other hand, considering the underestimated measurements, the percentages were 47.06% in P, 33.33% in T, and 1.92% in CT. The frequency of under- and overestimation were statistically significant (chi2 = 6.32; P = .0425) between P and T. CT was the radiographic modality with higher measurement precision according to dentists' confidence. In conclusion, the interviewed dentists felt that CT was the best radiographic modality when considering the measurement estimation precision in preoperative dental implant assessment.

Dental age in patients with Down syndrome

The aim of this research was to evaluate dental age in 102 patients with Down Syndrome, using panoramic radiographs. A software program developed by the Discipline of Radiology, School of Dentistry of São José dos Campos, São Paulo State University (UNESP), was used. A table of mineralization chronology of permanent teeth among Brazilians conceived by Nicodemo, Moraes and Medici Filho was used within the software. Statistical analysis of the results showed that 70.91% of the males land 61.21% of the females presented advanced dental age. Only 32.09% of the males and 39.79% of the females presented delayed dental age. Regarding the differences between the dental and chronological ages, two thirds of the males and females presented dental age with differences of up to 12 months, which means that they can be considered to be within normal standards, whereas only 18.87% of the males and 10.21% of the females presented dental age outside normal standards, with differences of over 24 months. In conclusion, the majority of the patients with Down Syndrome were considered to be within the normal standards of mineralization chronology.

Incontinentia pigmenti presenting as hypodontia in a 3-year-old girl: A case report

Introduction. Incontinentia pigmenti or Bloch-Sulzberger syndrome is a rare X-linked dominant disease that mainly affects the skin, eyes, hair, central nervous system and teeth. The disease is predominant among women. Although dermatologic manifestations are among the most important aspects for the diagnosis of the syndrome, they are less damaging to the patient and do not require treatment. However, oral involvement characterized by hypodontia of deciduous and permanent teeth is important for the diagnosis and treatment of the patient. Case presentation. We report the case of a 3-year-old girl with ophthalmologic and neurologic disturbances, cutaneous manifestations and hypodontia. Since the patient did not present more damaging manifestations such as neurologic and/or ophthalmologic problems, her most severe complications were related to dental anomalies. The importance of integrated dental treatment, which combines pediatric dentistry, orthodontics and conventional prosthesis, is emphasized. Conclusion. Hypodontia is a frequent finding in incontinentia pigmenti, and dentists should be aware of this condition in order to help with the diagnosis. © 2009 Kitakawa et al; licensee BioMed Central Ltd.

Imprint cytology of osteosarcoma of the jaw: A case report

Introduction. Osteosarcomas are highly malignant bone-forming neoplasms that account for about 20% of all sarcomas. In light of their aggressive behavior, early diagnosis is crucial for determining adequate treatment. Dental professionals may be the first to detect jaw osteosarcomas in their initial stages. The aim of this case report is to draw attention to the possibility of diagnosing this tumor based on clinical, radiographical and cytological characteristics before confirmation by histology. Case presentation. A 24-year-old Afro-Brazilian man presented with swelling and pain on the left side of the mandible in the region of the third molar (tooth 38). Radiography showed a poorly delimited intraosseous lesion with radiolucent and radiopaque areas. The cytological aspects were consistent with the diagnosis of osteosarcoma, which was confirmed by biopsy. Conclusion. Imprint cytology was found to be a reliable, rapid and easy complementary examination. An early diagnosis of osteosarcoma of the jaw is fundamental to the early determination of an adequate treatment. © 2009 Cabral et al; licensee BioMed Central Ltd.