Consecutive Panoramic Radiographs Research Articles

A study on calcification, variability of the stylo-mandibular ligament, or styloid process with regard to clinical parameters among United Arab Emirates population

Aim: The styloid process (SP) is often considered elongated when it is longer than 33 mm. The aim of this study is to assess the prevalence of the elongated styloid process (ESP) among dental patients and the role of dental pathology as a possible etiological factor. Materials and Methods: In total, 2000 consecutive panoramic radiographs of normal people were retrieved from the College of Dentistry, Ajman University, Ajman, UAE, during the 2-year study period. Two calibrated observers evaluated the radiographs to minimize interobserver bias and error. A caliper was used to measure the length (in millimeters of the ESPs directly on the radiographs from the caudal margin of the tympanic plate to the tip of the SP). The ESP was considered present when the measurements were ≥30 mm. Results: This study indicates that the prevalence of the ESP was about 6.9% among the patients who attended the dental school clinic. Of the 2000 panoramic radiographs reviewed, ESP could be measured in 100 cases at least on one side. There was a significant difference between distributions on the left and right sides. The distribution also depends significantly on age and gender. The incidence of related symptoms was higher than that reported in previous studies. Conclusions: The incidence of ESP among dental patients was estimated to be 6.9%, more prevalent among the elderly compared to the young people and bilateral. Odds ratio (OR) in favor of developing ESP in males is 2.378 times more than that in females. In contrast, the OR in favor of having unilateral ESP in males is less than that in females by 0.284.

Stafne bone defect of the molar region of the mandible

Background/purposeThe classic Stafne bone defect (SBD) is a rare small well-demarcated radiolucent lesion in the molar region of the mandible near the mandibular angle. This study reported a series of 5 SBD cases.Materials and methodsThis study reviewed 4000 consecutive panoramic radiographs from February 2017 to May 2017 and found 5 classic SBD cases. The clinical and radiographic findings of these 5 SBD cases were reported.ResultsWe found 5 SBD cases presenting as small, well-defined, and radiolucent lesions at the typical first molar to third molar region of the mandible near the mandibular angle and below the mandibular canal. The mean age of the 5 patients at the time of diagnosis was 53.4 years (range, 45–69 years). All the 5 SBD cases occurred in male patients, 3 were on the right side and 2 were on the left side of the mandible. The mean greatest dimension of the 5 SBDs was 1.5 cm (range, 1.2–1.9 cm). All the 5 SBD cases were found incidentally on the panoramic radiographs and two of them were confirmed by cone-beam computed tomography. No surgical intervention was performed for these 5 SBD cases.ConclusionThe classic SBDs occur most frequently in male patients in the age group between 40 years and 60 years. For the SBDs at the typical site of the molar region of the mandible near the mandibular angle and below the mandibular canal, these lesions can be monitored by panoramic radiography once per one or two years.

Predicting pathology in impacted mandibular third molars

Introduction: The rising incidence of the impacted mandibular third molars and their association with pathologies is now considered a public health problem. Aims and Objectives: The objective of this study was to assess the position of impacted mandibular third molars that are prone to developing pathologies and to determine the frequency and type of pathological conditions associated with these impacted teeth to facilitate planning for their prophylactic removal. Materials and Methods: Consecutive panoramic radiographs and clinical examination of 300 patients with impacted mandibular third molars were collected. They were segregated according to Pell and Gregory’s classification, Winter’s classification, and according to their state of eruption. These were correlated with associated pathologies based on clinical and radiological criteria. Statistical Analysis Used: Descriptive statistics included computation of percentages, mean, and standard deviations. The statistical test applied for the analysis was Pearson’s Chi-square test (χ2). For this test, confidence interval and P value were set at 93% and ≤0.03, respectively. Results: The pathology most commonly associated with impacted third molars was pericoronitis, which had the highest frequency of occurrence in partially erupted, distoangular, and IA positioned (as per Pell and Gregory classification) impacted teeth. Impacted mandibular third molars, which were in IA position, placed mesially, and partially erupted, were prone to develop pathologies such as dental caries and periodontitis. Conclusion: The clinical and radiographical features of impacted third molar may be correlated to the development of their pathological complications. The partially impacted mandibular third molars with mesioangularly aligned in IA position have the highest potential to cause pathological complications.

Dimensional Changes Following Lateral Wall Sinus Augmentation Without Concomitant Implant Placement Using a Composite Bone Graft.

To evaluate changes in sinus dimensions immediately postoperatively and 1 year later using a composite of bovine-derived xenograft and autogenous bone for lateral bone augmentation of the maxillary sinus. Patients who underwent lateral wall sinus augmentation procedures without concomitant implant placement were considered for this retrospective analysis if they had three consecutive panoramic radiographs: pretreatment (T0), immediately after lateral wall sinus augmentation (T1), and approximately 1 year postoperatively (T2). Eighteen subjects aged 47 to 69 years were included. The surgical protocol included grafting with a composite of bovine-derived xenograft and autogenous bone (9:1 ratio). Digital panoramic radiographs were transferred into measurement software, and the following measurements were performed: (1) vertical distance from the alveolar crest to the height of the augmented material, (2) sagittal area of the grafted area, and (3) vertical distance from the alveolar crest to the roof of the maxillary sinus. All measurements were performed by one examiner. Double measurements were performed in nine patients at T2, and the calculated Cronbach's alpha statistic was very high (.9658 to .9882). The mean overall sinus sagittal area was 1,330 ± 481 mm2 prior to the grafting procedure, when it decreased to 858.2 ± 436 mm2 (range, 380.7 to 2,134 mm2) immediately postoperatively (P = .0035) and remained stable at 1 year (mean, 882.2 ± 384 mm2, P > .05). Similarly, the overall area of the grafted material at the time of surgery was 468.3 ± 208 mm2 and was only slightly reduced at 1 year (422.2 ± 193 mm2). The midsagittal graft height at T1 (mean, 20.67 ± 4.5 mm) was insignificantly and minimally reduced at 1 year (mean, 19.35 ± 4.9 mm). The linear dimensions of composite bone-derived xenograft/autogenous bone grafts following lateral wall sinus augmentation exhibited minimal changes during the 8- to 12-month healing period.

Bifid Mandibular Canals: Prevalence and Implications

Bifid mandibular canals (BMCs) are variations of the normal anatomy, with a reported prevalence ranging from 0.08 to 65%. Aberrations of the mandibular canal can have important clinical implications. We therefore sought to assess the prevalence of BMCs and discuss several surgical implications that may be associated with this variation. A retrospective chart study of available digital panoramic images from our file archives from 2011 to 2013 was performed to search for the prevalence of BMCs; to this end, 5,000 consecutive panoramic radiographs of patients aged 18 to 80 years were studied. Detection of BMCs was based on visualization of 2 radiolucent lines and at least 3 radiopaque borders on the monitor and confirmed by 2 oral and maxillofacial surgeons and 2 dentists. The types of bifidity also were assessed and recorded. Data analysis was performed using the χ(2) test. BMCs were observed in 61, or 1.2%, of 5,000 digital panoramic images. There were no statistically significant correlations found regarding age or gender. The most frequently encountered type of bifid canal was type 2 (82%). The prevalence of BMCs seen on panoramic images in this study was 1.2% and was not correlated with age or gender.

Lingual Cortical Mandibular Bone Depression: Frequency and Clinical-Radiological Features in a Brazilian Population

The aim of this study was to report the frequency and clinical-radiological features of cases of lingual cortical mandibular bone depressions (LCMBD) diagnosed in consecutive panoramic radiographs and cone-beam computed tomography (CBCT) scans from a Brazilian population. The methods included a retrospective analysis of consecutive panoramic radiographs, charts from the Oral Medicine clinic and consecutive CBCT scans. All cases diagnosed as LCMBD were selected and clinical-radiological data were retrieved from the clinical charts and by the analysis of the image exams. Twenty LCMBD cases diagnosed in 18 patients were found, including 2 from 3,000 consecutive panoramic radiographs (0.07%), 6 from 2,421 Oral Medicine patients (0.25%) and 10 from 1,684 CBCT scans (0.59%). The 18 patients had a mean age of 51.5 years and 13 were males. Two patients presented bilateral lesions. Fourteen images (70%) were classified as well-defined. Eighteen affected the posterior area of the mandible and two affected the anterior mandible. Size of the lesions was larger in younger patients. In conclusion, there seemed to be a considerable radiological heterogeneity when comparing the LCMBD cases and it seemed that the images decreased in size with the increase of patient's age.

Factors affecting changes in sinus graft height between and above the placed implants

The aim of this study was to compare the radiographic dimensional changes of sinus graft height above and between placed implants, and evaluate the factors effecting these changes with 2 different grafting materials and both combination. The study group comprised 42 patients (50 sinus augmentation procedures). Four consecutive panoramic radiographs were evaluated for changes in sinus graft height between and above the placed implants. Factors that may influence graft height reduction were evaluated. The mean percentage of autogenous bone height reduction was 23% between implants and 13% above the implants. Bovine xenograft showed a mean of 6.5% graft height reduction between implants and 0% above implants. The only 2 parameters that correlated with reduction of graft height above and between the implants were time elapsed from surgery and the type of bone graft. Autogenous bone graft presented significantly more reduction (P = .022), whereas anorganic bovine bone graft had only minor or no changes in height. The most important factor influencing reduction in vertical bone height on the time axis, following sinus augmentation is the grafting material, followed by the presence of a functional implant. Anorganic bovine bone was found superior in graft height maintenance in an up to 10 years of follow-up.

The incidence of canine transmigration and tooth impaction in a Turkish subpopulation

The purpose of this study was to determine the incidence of transmigrated maxillary and mandibular canine teeth and also of the other impacted teeth in a Turkish subpopulation. Five thousand consecutive panoramic radiographs taken of patients who attended the Department of Oral Diagnosis and Radiology, Selcuk University, for routine examination between 2005 and 2007 were examined to identify incidences of transmigrated and impacted teeth. Demographic information of all patients was also recorded. Transmigrations were categorized according to the classification of Mupparapu. The effect of age, gender, and sidedness (left or right side) on the recorded abnormality was evaluated using a t-test. The incidence of transmigrated upper and lower canine teeth was found to be 0.34 per cent [17 patients, 12 females/5 males, with a mean age of 34 years (range 16-76 years)] and 0.14 per cent [7 patients, 4 females/3 males, with a mean age of 37.1 years (range 17-62 years)]. The incidence of tooth impaction was 2.94 per cent [147 patients, 101 females/46 males, with a mean age of 29.7 years (range 15-80 years)]. The most frequently impacted tooth was the upper canine followed by the lower canine, lower second premolar, and upper second premolar. No incidence of maxillary first molar impaction was found. Gender and sidedness did not show a statistical significance on the recorded abnormality (P = 0.22 and P = 0.48, respectively). However, in the 15-29 year age group, this was statistically different (P < 0.05). The incidence of transmigration of impacted mandibular canine teeth was greater than other teeth. With the increased use of panoramic radiographs, it is inevitable that diagnosis of such anomalies will increase.

Incidence of canine impaction and transmigration in a patient population.

In this study, 4500 consecutive panoramic radiographs were prospectively reviewed. The incidence of canine impaction was found to be 3.58% and the incidence of canine transmigration was 0.31%. There were six maxillary and eight mandibular transmigrant canines. The incidence of impacted canine teeth and transmigration of maxillary and mandibular canines may be more frequent than was previously thought, at least in some populations.

Screening radiographs for new adult patients

Objectives To measure the radiological diagnostic yield on screening panoramic radiographs taken of new adult patients and to identify selection criteria for panoramic radiography of new adult patients. Design Survey of 1,817 consecutive panoramic radiographs taken as 'routine' on new patients with statistical analysis of clinical and radiological findings. Setting All radiographs were obtained from 41 general dental practitioners (GDPs). The GDPs provided the clinical information about the patient obtained by history and examination. Collection of material occurred in 1998/1999. Materials and methods Two dental radiologists recorded the radiological findings on each of 1,817 panoramic radiographs by consensus. Those findings that would have been identified from bilateral posterior bitewing radiographs of each patient were then excluded to give modified figures for radiological findings. Indices of diagnostic yield were devised and calculated for each radiograph from the data on radiological findings. Total diagnostic yield (DY) and modified diagnostic yield (MDY), after exclusion of findings identifiable on bitewing radiographs, were both calculated. Clinical indicators of a high MDY were identified using stepwise multiple regression analysis. Results MDY was 0 for 17% of the radiographs (all patients) and 23% of the radiographs when the asymptomatic group were considered. The clinical variables for which the significance was high (p<0.001) were: increasing number of teeth with clinical suspicion of periapical pathology, partially erupted teeth, increasing number of clinically evident carious lesions, partially dentate status and crowns. Conclusion Taking posterior bitewing radiographs of new adult patients would reduce the diagnostic yield identified solely by panoramic radiography. Using clinical factors derived from the history and examination as radiographic selection criteria modestly improves the odds of achieving a high diagnostic yield from panoramic radiography.

Screening panoramic radiography of new adult patients: diagnostic yield when combined with bitewing radiography and identification of selection criteria.

To measure the radiological diagnostic yield on screening panoramic radiographs taken of new adult patients and to identify selection criteria for panoramic radiography of new adult patients. Survey of 1,817 consecutive panoramic radiographs taken as 'routine' on new patients with statistical analysis of clinical and radiological findings. All radiographs were obtained from 41 general dental practitioners (GDPs). The GDPs provided the clinical information about the patient obtained by history and examination. Collection of material occurred in 1998/1999. Two dental radiologists recorded the radiological findings on each of 1,817 panoramic radiographs by consensus. Those findings that would have been identified from bilateral posterior bitewing radiographs of each patient were then excluded to give modified figures for radiological findings. Indices of diagnostic yield were devised and calculated for each radiograph from the data on radiological findings. Total diagnostic yield (DY) and modified diagnostic yield (MDY), after exclusion of findings identifiable on bitewing radiographs, were both calculated. Clinical indicators of a high MDY were identified using stepwise multiple regression analysis. MDY was 0 for 17% of the radiographs (all patients) and 23% of the radiographs when the asymptomatic group were considered. The clinical variables for which the significance was high (p < 0.001) were: increasing number of teeth with clinical suspicion of periapical pathology, presence of partially erupted teeth, increasing number of clinically evident carious lesions, partially dentate status and presence of crowns. Taking posterior bitewing radiographs of new adult patients would reduce the diagnostic yield identified solely by panoramic radiography. Using clinical factors derived from the history and examination as radiographic selection criteria modestly improves the odds of achieving a high diagnostic yield from panoramic radiography.

A critical evaluation of panoramic radiography as a screening procedure in dental practice

One thousand consecutive panoramic radiographs were assessed to determine the risk/benefit relationship involved when this technique is used to screen patients for previously undiagnosed pathologic processes. The results of the investigation do not support the use of this technique as a routine procedure in general dental patient assessment.