Cone Beam Computed Tomography Findings Research Articles

Determination of Bone Biotypes in the Region of Maxillary Teeth in Adult Men Using Cone Beam Computed Tomography

Background: Bone density has prognostic significance in planning the surgical phase with implant-supported fixed prostheses and affects the surgical success and choice of implant design and shape.Objective: To determine bone biotypes in a region of maxillary teeth in adult men.Materials and methods: We studied cone beam computed tomography findings of 38 patients aged 20 to 53 years and conducted bone densitometry in a region of each tooth. The obtained values were converted to bone biotypes according to Misch bone density classification. We used statistical methods to identify the most common bone biotypes in each tooth region in men.Results and discussion: Based on the statistical analysis results, in more than half of the adult men D2 and D3 bones were observed in the region of maxillary premolars and molars, while D2 and D1 were found in the region of maxillary incisors and canines.Conclusions: We found that D2 and D3 are the most common bone biotypes in the region of maxillary teeth. These findings can be used as one of prognostic criteria in planning the surgical phase with implant-supported fixed prostheses.

Evaluation of diagnostic accuracy of cone beam computed tomography and multi-detector computed tomography for detection of anatomical variations in rhinoplasty

BackgroundDifferent imaging techniques, such as multi-detector computed tomography (MDCT) scan and cone beam computed tomography(CBCT), are used to check the structure of the nose before rhinoplasty. This study aimed to evaluate the accuracy of two imaging techniques, MDCT scan, and CBCT, in diagnosing structural Variations in rhinoplasty for the first time.MethodsThis diagnostic accuracy study was conducted on 64 rhinoplasty candidates who complained of snoring and sleep apnea or had a positive result in the examination with Cottle’s maneuver or modified Cottle technique between February 2021 and October 2022 at 15- Khordad Hospital affiliated to Beheshti University of Medical Sciences. Before rhinoplasty, patients were randomly assigned to one of the CT and CBCT techniques with an equal ratio. Scans were assessed for the presence of Nasal septum deviation (NSD), Mucocele, Concha bullosa, and nasal septal spur by two independent radiologists. The findings of the two methods were evaluated with the results during rhinoplasty as the gold standard.ResultsNSD was the most common anatomical variation based on both imaging techniques. The accuracy of CBCT for diagnosing Nasal Septum Deviation and Mucocele was 80% and 75%, respectively. The sensitivity, specificity, and accuracy of CBCT in detecting Concha bullosa were 81.3% and 83.3%, respectively. The Kappa coefficient between CBCT and intraoperative findings for diagnosing NSD and Concha Bullosa was 0.76 and 0.73, respectively (p < 0.05).ConclusionCBCT can be considered a suitable method with high accuracy and quality to evaluate the anatomical variations before rhinoplasty.

Cone-Beam Computed Tomographic Evaluation of the Posterior Wall of the Nasopharynx in Turkish Population

Aim: This study aims to evaluate the radio-morphometry of important anatomical structures such as Rosenmüller fossa (RF), pharyngeal bursa (PB), and Eustachian tube (ET) in the posterior wall of the nasopharynx by cone beam computed tomography (CBCT).&#x0D; Material and Methods: The posterior wall of the nasopharynx was analyzed retrospectively in CBCT images of 110 patients. The depth and width of the Rosenmüller fossa (RF), pharyngeal bursa (PB), and Eustachian tube (ET), their distances to the posterior nasal spina (PNS) and mid-sagittal plane, and the angles between them were measured. RF was categorized into three types. The relationship between the measured values and gender, age groups, and RF types was investigated. The obtained variables were analyzed statistically.&#x0D; Results: The mean right RF depth was 8.2 and left RF was 8.6 mm. RF widths differed significantly by gender (right p=0.013, left p=0.004). There was a statistically significant positive correlation between RF-PNS distances and age (left r=0.314, p=0.001; right r=0.240, p=0.011). The prevalence of RF types was 31.8%, 19.5%, and 48.6% for type A, type B, and type C, respectively. In individuals with RF Type C, both RF and ET were located more lateral to the midline. The prevalence of PB was 45.5%.&#x0D; Conclusion: Nasopharyngeal carcinoma (NPC) most commonly occurs in the RF. A good knowledge of the anatomy and variations of the nasopharyngeal region is important in the early diagnosis of NPC. Oral and maxillofacial radiologists must know the anatomy of the nasopharynx to understand and interpret incidental findings in CBCT.

Diagnostic Study of Mandibular Cortical Index Classification Using Dental Cone-Beam Computed Tomography Findings: A Preliminary Cross-Sectional Study

The prevalence of osteoporosis is high, reportedly affecting 200 million people worldwide. A major problem associated with osteoporosis is that femoral fractures cause a decline in general function and loss of independence, greatly reducing patients’ quality of life. Notably, osteoporosis is an asymptomatic chronic metabolic disease, and its detection is thus often delayed. Interestingly, mandibular cortical index (MCI) classification using dental panoramic radiography is reportedly useful for early detection of osteoporosis. However, this visual classification method can lead to differences in diagnoses among surgeons. The aim of this preliminary study was to analyze cone-beam computed tomography (CBCT) data and examine an objective MCI classification using the findings obtained. MCI classification (classified as C1, C2, or C3) was performed by three examiners on 70 women (91 sites) aged ≥20 years. The mandibular cortical width of all sites was measured using CBCT images. The results showed that the mandibular cortical width was not particularly correlated with age or number of present teeth, and no significant quantitative differences were found between C1 and C2. However, coronal CBCT images of C2 revealed multiple characteristic trabecular bone structures. These structures may be an important finding affecting the classification of two-dimensional dental panoramic radiography images.

Utility of intra-procedural cone-beam computed tomography imaging for the determination of the artery of Adamkiewicz suspected by angiography during transarterial embolization for hemoptysis.

To evaluate the role of cone-beam computed tomography (CT) performed for the determination of the artery of Adamkiewicz (AKA) suspected by angiography during trans-catheter bronchial artery embolization for hemoptysis. In this retrospective study, 17 patients with hemoptysis who underwent cone-beam CT for evaluation of the AKA prior to arterial embolization from December 2014 to March 2022 were included. During the angiographic session, two interventional radiologists selected the possible AKAs that were defined as obscured hairpin-curved vessels arising from the dorsal branch of the intercostal arteries and running towards the midline in the arterially enhanced phase. Contrast-enhanced cone-beam CT was performed as an adjunct to angiography to determine whether the indefinite AKA was a real AKA based on whether it was found to connect to the anterior spinal artery. Selective cone-beam CT was performed at 17 possible AKAs detected by selective arteriogram of the intercostal artery (ICA). Cone-beam CT allowed for the determination of AKAs in 16 cases (94.1%). As a result of cone-beam CT findings, 9 of 16 study arteries (56.3%) were judged as definite AKAs, and the remaining 7 (43.7%) were judged as definitely not AKAs but as the musculocutaneous branching from the dorsal branch of the ICA. In 1 of 17 cases (5.9%), cone-beam CT could not determine the AKA because of poor image quality caused by inadequate breath holding. An additional anterior radiculomedullary artery arising from the dorsal branch of the lower ICA because of the inflow of the contrast medium through the anastomosis was detected in one case by conebeam CT but not by angiography. Intraprocedural enhanced cone-beam CT performed as an adjunctive technique to angiography is sufficient for confident determination of the AKA, which is essential for the operators to perform accurate and safe arterial embolization for hemoptysis.

Contribution of cone beam computed tomography to suggest a hypothesis of odontogenic keratocyst in the diagnosis of a bone lesion: a case report

In the literature, several studies have investigated cone beam computed tomography (CBCT) findings of microscopically confirmed odontogenic keratocysts (OK). Such data can be useful on clinical routine in the diagnosis of bone lesions to define a hypothesis of OK before surgical resection. Objective: To report a clinical case of an extensive bone lesion in the mandible, which tomographic and clinical findings suggested OK as the first hypothesis. Case report: A 14-year-old male underwent a CBCT scan of the mandible for investigating an asymptomatic radiolucent bone lesion detected in a panoramic radiography. Clinically no swelling was evident and the adjacent teeth presented positive response to pulpal sensitivity test. CBCT images revealed a hypodense and unilocular lesion extending from mandibular left central incisor region to mandibular left first molar site; from jaw base to periapical region of the adjacent teeth; from buccal to lingual bone cortical. At the site of the lesion, there was erosion of the buccal and lingual bone cortical, which presented a mild expansion. Additionally, sectional images showed scalloped edges of the lesion, slight external root resorption at the apex of mandibular left second premolar, subtle incomplete septa and mandibular canal involvement by the lesion. Conclusion: The relevant CBCT findings contributed to suggest a probable hypothesis of OK in the diagnosis of a mandibular bone lesion. However, final diagnosis depends on microscopic examination.

TMJ degenerative joint disease: relationships between CBCT findings, clinical symptoms, and signs

Objectives The relationships between cone-beam computed tomography (CBCT) findings, Temporomandibular disorder (TMD) symptoms, and signs were investigated in patients with TMJ degenerative joint disease (DJD). Material and Methods Adult patients with Diagnostic Criteria for TMDs (DC/TMD)-defined intra-articular conditions were enrolled and subjected to CBCT assessment. The participants were organized into three groups, namely no (NT), early (ET), and late (LT) TMJ DJD based on radiographic findings. TMD symptoms/signs were appraised using the DC/TMD methodology. Statistical analyses were performed using Chi-square/non-parametric tests and Kappa statistics (α = 0.05). Results The mean age of the participants (n = 877) was 30.60 ± 11.50 years (86.6% women). NT, ET, and LT were observed in 39.7%, 17.0%, and 43.3% of the study sample. Significant differences in the prevalence of TMD symptoms (TMD pain, TMJ sounds, opening, and closing difficulty) and signs (TMD/TMJ pain, TMJ clicking/crepitus, and opening limitation) were discerned among the three groups (p ≤ .001). TMD/TMJ pain and opening difficulty/limitation were more prevalent in early rather than late degenerative changes. While moderate agreements between symptoms and signs were observed for TMD pain/opening limitation, the concurrence for TMJ sounds was fair. Conclusions Young adults with TMJ sounds and pain should be examined with CBCT to establish the extent/progress of osseous changes.

Accuracy verification of dental cone-beam computed tomography of mandibular incisor root canals and assessment of its morphology and aging-related changes.

The root canal morphology undergoes aging-related changes, and relevant quantitative analyses have not yet been reported. We compared the cone beam computed tomography (CBCT) and micro-computed tomography (micro-CT) scans of extracted mandibular incisors to check the accuracy of morphological measurements. Thereafter, the root canal morphology and aging-related changes in the mandibular incisors of Japanese individuals were assessed using CBCT. Six extracted teeth were fixed in a phantom head and imaged using CBCT and micro-CT. The correlation between the findings of the two imaging modalities was examined. Further, CBCT reconstructed images of the mandibular incisors of 81 individuals were observed. Age-related changes of the root canals were compared between participants aged <30 years and those aged ≥30 years. The CBCT and micro-CT findings regarding the root canals of the extracted teeth coincided in 94.4% of the cases. Mandibular incisors exhibiting two root canals in either cross-section accounted for 9.9% of central incisors and 12.4% of lateral incisors. Mandibular central incisors with two root canals were observed in two (6.3%) individuals aged <30 years and six (12.2%) aged ≥30 years. Mandibular lateral incisors with two root canals were observed in one (3.1%) individual aged <30 years and nine (18.4%) aged ≥30 years. CBCT allows accurate evaluation of complex root canal morphologies and is useful for endodontic preoperative assessment. Mandibular incisors have more frequent occurrence of two root canals with aging.

CBCT Imaging of a Rare Case of Radix Entomolaris in Mandibular Second Molar

The presence of an additional supernumerary distolingual root in the mandibular molar is termed Radix Entomolaris (RE). It is common in the mandibular first molar, but its occurrence in the mandibular second molar is scarcely reported in the literature. Two-dimensional imaging can diagnose anatomical root canal variations when taken with different horizontal angulations. With the recent innovations in three-dimensional diagnostic imaging, cone beam computed tomography (CBCT) can aid in unfolding the complexities of the root canal system. Accurate diagnosis by CBCT leads to the success of endodontic treatment. A rare case of radix entomolaris in the mandibular second molar in an Indian female is reported here with three of its CBCT findings. Imaging in all three dimensions, oblique sections and volume rendering by CBCT proved to be of additional help to understand the complex anatomy and root canal morphology of the tooth.

A study to evaluate the change in management plan of chronic otitis media (mucosal) after cone beam computed tomography

: Imaging of temporal bone helps the Otologists in preoperative surgical planning in ear surgery. Cone Beam Computed Tomography (CBCT) has much higher spatial resolution and clarity as compared to conventional X-Ray and much lower radiation exposure as compared to HRCT Temporal Bones. : To evaluate the change in management plan of Chronic Otitis Media (Mucosal) after CBCT. Also to determine the sensitivity and specificity of the CBCT findings by comparing with intra operative findings in the study participants. We conducted an observational descriptive study in the ENT Department of an academic Tertiary care hospital from October 2017 to October 2019. We included 95 patients whose management plan before CBCT was compared with the plan after CBCT and the percentage of cases undergoing a change in the management after CBCT was determined. The correlation of CBCT findings and intra operative findings in terms of specificity and sensitivity was also statistically calculated. : Subsequent to imaging, the management plan was changed in only 4 patients which was statistically non-significant. CBCT showed a 100% sensitivity, specificity, positive predictive value and negative predictive value to detect pneumatisation of the Mastoid, high jugular bulb and low-lying dura. The sensitivity to detect ossicular erosion was 98.9%. : Thorough clinical examination is the most important factor in decision making in patients with Chronic Otitis Media (Mucosal) and management plan remains unchanged after imaging. Though thorough clinical examination remains the gold standard in making a management plan of patients with Chronic Otitis Media (Mucosal), CBCT with its available details and minimal radiation helped to minimise intraoperative inadvertent injuries which might result due to normal anatomic variations like low lying dura, forward lying sinus, contracted mastoid cavity etc.

RELATIONSHIP BETWEEN THE POSITION OF HEADS OF TEMPOROMANDIBULAR JOINT AND UPPER RESPIRATORY TRACT IN MALOCCLUSION CLASS I AND II

The respiratory organs and the maxillofacial apparatus are quite closely related to each other. Reducing the size of the upper respiratory tract is a factor that contributes to the development and formation of bite pathology and even dysfunction of the temporomandibular joint (TMJ). In recent years, there has been an increase in the prevalence of maxillofacial anomalies among children. The aim of the study Is to determine and to compare the position of the TMJ heads and the anatomical dimensions (anterior-posterior dimensions) of the upper respiratory tract in patients with malocclusion class I and II bite based on cone beam computed tomography findings. The analysis of 39 cone-beam computer tomograms of patients was carried out. According to the ANB angle, all patients were divided into two groups based on the type of malocclusion: group I included patients with malocclusion class I, and group II included patients with malocclusion class II. Measurement and interpretation of cone-beam computer tomography was carried out according to the method of N.A. Rabukhina and the McNamara’s method. The dimensions of the joint space of the temporomandibular joint in three sections (front, top and back both on the right and on the left) had no statistically significant differences. The average value of the joint space on the left and right in the patients of the first group in the front section was 2.5±0.27mm, in the patients of the second group – 3.01±0.35. In the upper part these indicators in patients of the first group were 2.76±0.37 mm, in the second group - 2.65±0.32 mm. In the posterior part the average value of the joint’s gap was 3.06±0.01 mm in patients of the first group and 2.28±0.27 mm in the second group. Measurements of the oropharyngeal area on cone-beam computed tomography were (according to the McNamara’s method): the width of the upper part of the pharynx in the first group - 17.41±0.44 mm, and in the second group averaged 15.82±0.61 mm with statistical significance (р˂0.05). In patients with bite pathology of both classed, according to the McNamara’s method, the lower part of the pharynx is narrowed compared to the norm. The study demonstrated the patients of the II group have a statistically significant difference in the reduction of the pharyngeal upper part width compared to I group and the displacement of the TMJ heads upwards and backwards.

Advanced intraoperative imaging guidance for inside-out central venous recanalization using a novel catheter access system

BackgroundThe novel Surfacer Inside-Out recanalization technique facilitates right-sided central venous access in occluded vessels but carries a risk of arterial and pleural injuries. This article demonstrates how an advanced intraoperative imaging protocol can help to avoid these potential complications. MethodsThis retrospective review included patients undergoing the Surfacer Inside-Out central venous recanalization procedure between December 2017 and October 2021. The study sample comprised patients included in the SAVE-US trial at our site as well as patients treated after US Food and Drug Administration approval of the device. All procedures were performed using intraoperative cone-beam computed tomography (CBCT) angiography to map out the trajectory of the device through the mediastinum and supraclavicular space with fusion imaging for guidance. Procedures were aborted if CBCT findings predicted injury to arterial or respiratory structures. The intraoperative coronal and sagittal orientation of the device was compared to preoperatively predicted trajectory. ResultsA total of 17 procedures were performed in 16 patients with end-stage renal disease and a mean age of 61 ± 11 years. Most patients presented a type 3 central venous occlusion (9/15). Successful recanalization was achieved in 14 of the 17 cases (82.4%) with no intraoperative complications. The procedure had to be aborted in 3 of the 17 cases based on intraoperative CBCT findings, which projected the device to perforate the right pleural space in one patient, the trachea and right subclavian artery in another, and the innominate artery in the third patient. The total radiation dose per procedure was 753 ± 346 mGy and the mean procedural time was 101.6 ± 29.7 minutes. A median of 2 (range, 1-5) intraoperative CBCT scans were performed per patient and accounted for 70% of the total radiation dose. Statistical analysis showed intraoperative CBCT findings to differ significantly from preoperative predicted values. ConclusionsThe nonsteerable and penetrating nature of the Surfacer device may lead to serious complications when performed under fluoroscopic guidance alone. Intraoperative CBCT with fusion overlay enhances the safety and effective use of this device and inside out crossing technique.

Observation of mandibular second molar roots and root canal morphology using dental cone-beam computed tomography.

The mandibular second molars show various morphological features in the roots and root canal, and a gutter-shaped root (GSR) caused by fusion of the mesial and distal roots is frequently encountered. In this study the number of the roots associated with mandibular second molars were observed using dental cone-beam computed tomography (CBCT). For those with a GSR, determination of root morphology and root canal classification were performed. CBCT image data from 173 Japanese mandibular second molars were obtained. Using sliced images, the number of the roots and root morphology were determined. In cases with a GSR, the ratio for the fused roots was determined and root canal morphology features were classified. A GSR was found in 61 (35.3%), with greater prevalence in females. In addition, the overall ratio of the fused part to root thickness in those with a GSR was 48.7%, with no significant difference related to sex. Furthermore, a C-shaped root canal morphology was commonly observed in both males and females with a GSR. In the present cohort examined in Japanese, most of the mandibular second molar were found to have two roots, with a GSR noted in 35.5%. While a GSR was more often observed in females, a C-shaped root canal was the most common root canal morphology in both sexs. It is considered that assessment using CBCT findings is helpful for precise determination of root canal morphology and presence of a GSR in mandibular second molars.

Skeletal Muscle Mass Measurement Using Cone-Beam Computed Tomography in Patients With Head and Neck Cancer.

Background and purposeHead and neck cancer (HNC) patients usually present with malnutrition during radiotherapy, leading to loss of skeletal muscle mass (SMM) and poor clinical outcomes. CT has been used in clinical practice for measuring SMM in cancer patients. However, its clinical application for monitoring SMM is limited by the expensive price and high radiation exposure. This study aimed to investigate the feasibility of cone-beam computed tomography (CBCT) for assessing SMM and its changes in HNC patients undergoing radiotherapy.Materials and methodsThis study was divided into two parts. In part 1 (n = 32), the cross-sectional of skeletal muscle area (SMA) at the third cervical vertebra (C3) based on CBCT and computed tomography (CT) was assessed. In part 2 (n = 30), CT and CBCT were performed, and patients’ weight was measured before and at four different time points during radiotherapy. SMAs at C3 were independently identified by three senior radiation oncologists. The interobserver agreement of SMA on CBCT (SMACBCT) findings was analyzed using the intraclass correlation coefficient (ICC). One-way analysis of variance was used to evaluate the interobserver variability and statistical significance for SMA measurements. CBCT and CT measurement differences and correlations were analyzed using paired sample t-test and Pearson correlation analysis, respectively. The Krouwer variant of the Bland–Altman plot was used to analyze the agreement of SMA measurements between CBCT and CT. A simple linear regression model was used to analyze the relationship of SMA measurements between the two imaging techniques, and the equation was established. A repeated-measures ANOVA was performed to evaluate the effects and interactions between weight loss, SMA loss, and time.ResultsSMACBCT demonstrated excellent interobserver reliability; no significant difference between SMACBCT and SMA on CT (SMACT) at C3 was observed in all patients. The SMACBCT and SMACT were highly correlated (r = 0.966; 95% confidence interval = 0.955–0.975; p < 0.001). Bland–Altman analysis revealed that SMACBCT was generally higher than SMACT. The predicted SMA value at C3 on CT using CBCT was similar to the actual value. Moreover, significant differences between SMA and weight loss (F =10.99, p = 0.002), groups (weight loss and SMA loss) and times (4 time points) (F = 3.93, p = 0.013), and mean percent loss over time (F = 7.618, p < 0.001) were noted.ConclusionCBCT may be used as an alternative for CT to measure SMA in HNC patients during radiotherapy.

Dental and Maxillofacial Cone Beam CT-High Number of Incidental Findings and Their Impact on Follow-Up and Therapy Management.

Cone beam computed tomography (CBCT) is increasingly used for dental and maxillofacial imaging. The occurrence of incidental findings has been reported, but clinical implications of these findings remain unclear. The study’s aim was to identify the frequency and clinical impact of incidental findings in CBCT. A total of 374 consecutive CBCT examinations of a 3 year period were retrospectively evaluated for the presence, kind, and clinical relevance of incidental findings. In a subgroup of 54 patients, therapeutic consequences of CBCT incidental findings were queried from the referring physicians. A total of 974 incidental findings were detected, involving 78.6% of all CBCT, hence 2.6 incidental findings per CBCT. Of these, 38.6% were classified to require treatment, with an additional 25.2% requiring follow-up. Incidental findings included dental pathologies in 55.3%, pathologies of the paranasal sinuses and airways in 29.2%, osseous pathologies in 14.9% of all CBCT, and findings in the soft tissue or TMJ in few cases. Clinically relevant dental incidental findings were detected significantly more frequently in CBCT for implant planning compared to other indications (60.7% vs. 43.2%, p < 0.01), and in CBCT with an FOV ≥ 100 mm compared to an FOV < 100 mm (54.7% vs. 40.0%, p < 0.01). Similar results were obtained for paranasal incidental findings. In a subgroup analysis, 29 of 54 patients showed incidental findings which were previously unknown, and the findings changed therapeutical management in 19 patients (35%). The results of our study highlighted the importance of a meticulous analysis of the entire FOV of CBCT for incidental findings, which showed clinical relevance in more than one in three patients. Due to a high number of clinically relevant incidental findings especially in CBCT for implant planning, an FOV of 100 × 100 mm covering both the mandible and the maxilla was concluded to be recommendable for this indication.

Correlation between clinical symptoms and cone beam computed tomography finding in temporomandibular disorders patients

Background: Abnormalities of temporomandibular joint, masticatory muscles, and/or related structural abnormalities are known as temporomandibular disorders. The use of cone beam computed tomography for temporomandibular imaging is becoming more prevalent. Aim: This study was carried out to analyse correlation between clinical symptoms and cone beam computed tomography finding in temporomandibular disorders patients. Methods and materials: This study looked at cone beam computed tomography pictures and clinical records of 40 patients with temporomandibular joint issues who sought treatment in Sangli district of Maharashtra between 2016 and 2018. The type of condylar bony change was classified based on the cone beam computed tomography images using both Koyama et al's classification and Ahmad et al's image analysis criteria. An orofacial pain specialist took a complete history and did a clinical assessment on all of the participants. The average pain intensity level self-reported in the previous week was graded on a 0 to 10 verbal rating scale, with "0" indicating no pain and "10" indicating the worst pain possible. Results: The greatest condyle bony change and verbal pain rating had a poor association. There was no statistically significant link between maximum condyle alteration and maximum openness.

Mucormycosis: A case report of black fungus as COVID-19 complication

We report a case of post-COVID-19 mucormycosis infection caused by Rhizopus oryzae. The patient was diagnosed with COVID-19 and treated according to the existing protocols. Following recovery, the patient developed swelling and pain in the right upper region of the face. A diagnosis of mucormycosis was established after cone-beam computed tomography findings. The patient was referred to a government hospital where she was treated according to the COVID protocol. Generally, mucormycosis develops in patients who are immunocompromised or suffering from debilitating disease which was COVID infection and uncontrolled diabetes in this case. The mold usually gains entry through the respiratory tract involving the nose and sinuses, which can further progress to intracranial structures. Early diagnosis and intervention are the keys to good prognosis and decreasing morbidity. Judicious use of drugs is required in COVID-19 patients, especially in immunocompromised patients as research is still in progress. Opportunistic fungal coinfections are one of the complications which are needed to be taken care of. Prophylactic treatment protocols need to be established, along with rational use of corticosteroids.

Frequency of Recommending Cone Beam Computed Tomography in Comparison to Panoramic Radiograph, While Diagnosing a Pathology/Status of Vital Structures Around Mandibular Impacted Third Molar

Objective: This study assesses the quantity and quality of reliability of both conventional and cone-beam computed tomography (CBCT) in evaluating external root resorption (ERR) and proximity of inferior alveolar canal (IAC) around impacted mandibular third molars and also the practicability to advise CBCT as the first radiographic examination in every patient with above pathology. Methodology: A prospective cross-sectional study was conducted with a sample of 73 individuals, aged between 18 and 40 years, irrespective of their sex. Digital panoramic radiograph (PAN) and CBCT were carried out for individuals with mandibular impacted third molars, which were evaluated by three observers independently for ERR and relation of impacted teeth with inferior alveolar nerve (IAN) canal (resorption of IAN cortical plate, impingement, and approximation). The data was analyzed by Kappa test and the PAN and CBCT findings were compared using Wilcoxon signed-rank test. Results: Out of 73 subjects, 13 subjects showed resorption of the IAN cortical plate in CBCT, among which only five were confirmed in PAN. Forty-three cases showed impingement of the third molar on the IAN in PAN, which was completely absent in CBCT. Among 14 subjects who presented contact or approximation of the third molar with the canal in PAN, only seven were confirmed in CBCT. Twenty-five cases actually showed ERR in CBCT, whereas PAN confirmed only eight cases. Pathologies seen on PAN were considerably very less in comparison with CBCT. Conclusion: Thus, we conclude that two-dimensional (2D) radiographs are the first choice of diagnostic radiographs, even though the CBCT is accurate in displaying the pathology; however, the decision to advise CBCT image should depend on whether the information from CBCT changes the surgeon's diagnosis and treatment planning.

Reliability of radiographic findings in large FOV CBCTs of mandibular third molars as basis for pre-operative patient information

Objective The aim of this study was to assess the relation between radiographic findings in large field of view (FOV) cone beam computed tomography (CBCT) exams and clinical findings of mandibular third molars in relation to the pre-operative patient information. Material and Methods Two hundred and nine mandibular third molars in 134 orthognathic patients examined with CBCT were removed. Three observers assessed tooth- and mandibular canal-related variables in CBCT images, and the findings were correlated to clinical findings during surgery for all observers: tooth angulation, number and morphology of roots and close relationship between the tooth and the mandibular canal. Moreover, positive (PPV) and negative (NPV) predictive values and positive (LR+) and negative (LR-) likelihood ratios were calculated for the canal-related variables. Inter- and intra-observer reproducibility was expressed as percentage accordance and kappa-statistics. Results Generally, there was high correlation between radiographic and clinical tooth-related variables. The opposite was true for the canal-related variables, since the PPV and LR + were low. The highest PPV and LR + were found when the mandibular canal was positioned between the roots of the third molar. Conclusions Tooth-related findings in CBCT are reliable, whereas mandibular canal-related findings should not affect the information provided to the patient pre-operatively.

In children and adolescents with temporomandibular disorder assembled with juvenile idiopathic arthritis - no association were found between pain and TMJ deformities using CBCT

BackgroundChildren and adolescents with juvenile idiopathic arthritis (JIA) may suffer from temporomandibular disorder (TMD). Due to this, imaging diagnosis is crucial in JIA with non-symptomatic TM joint (TMJ) involvement. The aim of the study was to examine the association between clinical TMD signs/symptoms and cone-beam computed tomography (CBCT) findings of TMJ structural deformities in children and adolescents with JIA.MethodsThis cross-sectional study is part of a longitudinal prospective multi-centre study performed from 2015–2020, including 228 children and adolescents aged 4–16 years diagnosed with JIA, according to the International League of Associations for Rheumatology (ILAR). For this sub-study, we included the Bergen cohort of 72 patients (32 female, median age 13.1 years, median duration of JIA 4.5 years). Clinical TMD signs/symptoms were registered as pain on palpation, pain on jaw movement, and combined pain of those two. The severity of TMJ deformity was classified as sound (no deformity), mild, or moderate/severe according to the radiographic findings of CBCT.ResultsOf 72 patients, 21 (29.2%) had pain on palpation at and around the lateral pole, while 41 (56.9%) had TMJ pain upon jaw movement and 26 (36.1%) had pain from both. Of 141 TMJs, 18.4% had mild and 14.2% had moderate/severe structural deformities visible on CBCT. CBCT findings were not significantly associated with either the pain on palpation or the pain on jaw movement. A significant difference was found between structural deformities in CBCT and the combined pain outcome (pain at both palpation and movement) for both TMJs for the persistent oligoarticular subtype (p = 0.031).ConclusionsThere was no association between painful TMD and CBCT imaging features of the TMJ in patients with JIA, but the oligoarticular subtype of JIA, there was a significant difference associated with TMJ pain and structural CBCT deformities.