Dentomaxillofacial Radiology Research Articles

Exploring the age and gender-based distribution of paranasal sinus osteomas using cone beam computed tomography: A retrospective cross-sectional study

ObjectiveThe objective of this study is to explore the prevalence, size, location and radiographic features of osteomas in the paranasal sinuses using cone beam computed tomography imaging. Study designThis study was planned as retrospective cross-sectional. 499 consecutive cone beam computed tomography scans obtained in a dentomaxillofacial radiology department for various dental indications. Statistical analysis of all data was done with SPSS version 22. Descriptive statistics and chi-square tests were used to determine the prevalence of categorical parameters. ResultsOsteoma was detected in 7 % (n = 35) of the 499 images analyzed. The age of the patients ranged from 6 to 96 years (mean 42.03 ± 18.70). No significant difference was found between the genders (p = 0.77). In terms of localization, it was significantly more common in the ethmoid sinuses (p < 0.01). Cortical type osteoma was observed the most frequently in the analyzed images (p < 0.01). The incidence of osteoma was not significant depending on age (p = 0.50). ConclusionOsteomas in the paranasal sinuses show a 7 % prevalence in CBCT images, with the ethmoid sinus being the most common site. The average size of osteomas was 3.43 ± 1.78 mm, predominantly cortical in type. These findings highlight the necessity for thorough examination of CBCT images by dentomaxillofacial radiologists to avoid overlooking osteomas.

Magnetic Resonance Imaging in Digital Dentistry: The Start of a New Era

In June 2024, at the European Congress of Dentomaxillofacial Radiology (ECDMFR) in Germany, the first-ever magnetic resonance imaging (MRI) system dedicated to dentistry was introduced [...]

Radiation safety of dentomaxillofacial radiology in Finland: Reported abnormal irradiation-related incidents during 2012–2022

IntroductionThis study evaluates adverse events (AEs) in dentomaxillofacial radiology (DMFR) in Finland, including their quantity, nature, and outcomes. It also compares reporting activity between public and private healthcare organizations, as they share same legal obligations to report AEs. Two-thirds of dental images are taken in public, the rest in private healthcare. MethodsIn Finland, radiation-related AEs are reported to the Radiation and Nuclear Safety Authority (STUK). We categorized DMFR-related AEs by nature, outcome, and imaging modality. We also submitted a questionnaire to STUK to gather information on their observations and remarks made during inspections of establishments providing dental imaging services. ResultsDuring 2012–2022, STUK received reports of 1343 DMFR-related AEs, mostly causing patient harm (92.9%) leading almost always to excessive radiation doses (99.7%). Private healthcare reported most AEs (65.2%), with municipal institutions reporting the remainder (34.8%). Intraoral-related AEs (20.0%) slightly outnumbered panoramic-related ones (18.7%), but the majority (56.7%) didn't specify the imaging modality. CBCT-related incidents were least reported (4.5%). During STUK's inspections, remarks mostly concerned deficiencies in practical quality assurance (31.3%) or technical quality assurance (32.9%). ConclusionDMFR-related AEs may be underreported despite legal obligations, with most stemming from human error, highlighting the need to enhance patient safety culture. There's a notable reporting gap between private and public healthcare providers relative to the number of dental radiographs conducted. Organizational deficiencies in practical and technical quality assurance underscore the importance of ongoing education, as well as monitoring by STUK. Implications for practiceEnhancing patient safety culture in dentistry, including dentomaxillofacial radiology, demands customized multiprofessional development, as unaltered patient safety procedures from medicine and secondary care may not align with dentistry's requirements.

Retrospective evaluation of condylar morphology using panoramic radiography in a sample of Turkish population.

The temporomandibular joint is one of the most complex anatomic structures. It takes a great role in masticatory system and helps to make possible some functions such as speaking, chewing and swallowing. Clinicians should have sufficient anatomical knowledge to assess relationships of the hard and soft tissues, including the mandibular condyle, glenoid fossa, articular eminence of the temporal bone, the articular disc and its attachments. The aim of this study was to evaluate the frequency of different types of mandibular condyles and its distribution according to the age and gender. It was also evaluated whether the condyle types were bilaterally symmetrical or not. A total of 1315 digital panoramic images which obtained from the patients suffering from the dental problems were assessed. Demographic data, condylar morphology were noted. All obtained data were analysed by using descriptive statistics. Morphology of mandibular condyles were classified into four shapes as identified in other studies, namely: type I - oval shape, type II - diamond shape, type III - bird beak shape, type IV - crooked finger shape. Two independent examiners, who have 19 and 7 years of experience in oral and dentomaxillofacial radiology, made a consensus and evaluated all images. A total of 1315 digital panoramic images were assessed. Seven hundred sixty-seven [58.3%] the patients were female and 548 [41.6%] were male. The age range of patients was from 18 to 84 years. Right-left condyle types were found to be symmetrical in the range of 67% of the subpopulation examined in the study. For the consensus, 'oval' condyle was common on both the right and left, while 'crooked finger' condyle was the rarest. The temporomandibular joint is the most important structure for all jaw functions such as speech, swallowing. In order for all these functions to continue in a healthy way, the anatomical structure should be known very well down to the finest detail. Identification of anatomical structures and their variations can play an important role in implant dentistry. Clinicians commonly prefer conventional radiologic methods to evaluate dentomaxillofacial region. Although the most of the variations are asymptomatic and require no treatment,correct identification of these findings will reduce unnecessary further diagnostic assessments and will provide more appropriate treatment plans.

Evaluation of ChatGPT's Real-Life Implementation in Undergraduate Dental Education: Mixed Methods Study.

The recent artificial intelligence tool ChatGPT seems to offer a range of benefits in academic education while also raising concerns. Relevant literature encompasses issues of plagiarism and academic dishonesty, as well as pedagogy and educational affordances; yet, no real-life implementation of ChatGPT in the educational process has been reported to our knowledge so far. This mixed methods study aimed to evaluate the implementation of ChatGPT in the educational process, both quantitatively and qualitatively. In March 2023, a total of 77 second-year dental students of the European University Cyprus were divided into 2 groups and asked to compose a learning assignment on "Radiation Biology and Radiation Protection in the Dental Office," working collaboratively in small subgroups, as part of the educational semester program of the Dentomaxillofacial Radiology module. Careful planning ensured a seamless integration of ChatGPT, addressing potential challenges. One group searched the internet for scientific resources to perform the task and the other group used ChatGPT for this purpose. Both groups developed a PowerPoint (Microsoft Corp) presentation based on their research and presented it in class. The ChatGPT group students additionally registered all interactions with the language model during the prompting process and evaluated the final outcome; they also answered an open-ended evaluation questionnaire, including questions on their learning experience. Finally, all students undertook a knowledge examination on the topic, and the grades between the 2 groups were compared statistically, whereas the free-text comments of the questionnaires were thematically analyzed. Out of the 77 students, 39 were assigned to the ChatGPT group and 38 to the literature research group. Seventy students undertook the multiple choice question knowledge examination, and examination grades ranged from 5 to 10 on the 0-10 grading scale. The Mann-Whitney U test showed that students of the ChatGPT group performed significantly better (P=.045) than students of the literature research group. The evaluation questionnaires revealed the benefits (human-like interface, immediate response, and wide knowledge base), the limitations (need for rephrasing the prompts to get a relevant answer, general content, false citations, and incapability to provide images or videos), and the prospects (in education, clinical practice, continuing education, and research) of ChatGPT. Students using ChatGPT for their learning assignments performed significantly better in the knowledge examination than their fellow students who used the literature research methodology. Students adapted quickly to the technological environment of the language model, recognized its opportunities and limitations, and used it creatively and efficiently. Implications for practice: the study underscores the adaptability of students to technological innovations including ChatGPT and its potential to enhance educational outcomes. Educators should consider integrating ChatGPT into curriculum design; awareness programs are warranted to educate both students and educators about the limitations of ChatGPT, encouraging critical engagement and responsible use.

A large radiolucent lesion with impacted teeth: was it an ameloblastoma or a dentigerous cyst? a case report

Objectives: This case report aims to describe a large radiolucent lesion associated with an impacted tooth from CBCT radiographs. Case Report: A 19-year-old woman was referred to have a CBCT examination in the dentomaxillofacial radiology unit in Dental Hospital Universitas Padjadjaran with swelling on the palatal side of the face and a lump on the gum at the upper right unerupted canine and premolar. The CBCT examination results showed impacted teeth 13 and 14 with a large radiolucent lesion with a well-defined and corticated border surrounding teeth 13 and 14, expanding into the maxillary sinus and nasal cavity. Oral hygiene was in good condition. The facial profile looked asymmetrical. Conclusion: Based on the CBCT result in terms of location and radiographic feature, this extensive radiolucent lesion led to a suspect radiodiagnosis of the ameloblastoma. Histology examinations are required to establish a definitive diagnosis. A cyst wall lined with odontogenic squamous epithelium was confirmed in the histology result examination.

Soft tissue simulant materials in X-ray-based imaging in dentomaxillofacial radiology: a scoping review.

In in-vitro dental radiographic research, simulation of soft tissue is required to replicate the clinical condition as close as possible. This study aimed to find out which soft tissue simulation material have been studied to use in dentomaxillofacial radiology and showed similarity in radiodensity to the soft tissues of the maxillofacial region. In this scoping review, Web of Science, Embase, Scopus, Google scholar and PubMed databases were searched on April 9, 2023, considering the following PICOS: Population: soft tissue simulants, Intervention: X-ray-based imaging, Comparison: -, Outcome: properties of the soft tissue simulants, Study design: in-vitro studies. Screening, study selection, and data extraction were performed by two independent researchers. A third team member was consulted in the case of disagreement. Quality assessment of the included studies was made using Quality Assessment Tool For In-Vitro Studies (QUIN Tool). Of the initial 1172 articles retrieved in the database search, 13 studies were included in the review. Seven studies had a low risk of bias. In 8 studies, computed tomography (CT) or cone beam computed tomography (CBCT), in 4 studies intraoral radiography, and in 2 studies panoramic radiography was used (one study has used CT/CBCT and panoramic radiography). The studies varied in the radiographic modality, acquisition parameters, selected outcomes, and gold standard. In the majority of the studies (n = 10, 77%), acrylic resin derivatives were used in the soft tissue simulant formula alone or as a major component. Wax was used in the simulant material in 8 studies (62%). In addition, in 3 studies (23%) ice/water was used as the main simulant. Ballistic gelatin, expanded 2-cm thick polystyrene with or without 1-cm utility wax, and 0.5cm of acrylic resin were shown to have a radiographic density similar to soft tissue in standardized studies employing CBCT scanning. For intraoral radiographs, using self-polymerizing acrylic resin, utility wax, and wood, as well as a polymethylmethacrylate box filled with water in thicknesses ranging from 4 to 45mm, provides suitable radiographic contrast. However, for 4 and 8mm of wax and 4mm of water, the radiographic contrast is not appropriate. In addition, 13-17mm wax and 14.5mm acrylic resin showed acceptable soft tissue densities in intraoral radiography. Further studies using different imaging modalities with standardized conditions and objective metrics are required to confirm the most appropriate soft tissue simulant material for in-vitro dental radiographic research.

Computed tomography-based assessment of sphenoid sinus and sella turcica pneumatization analysis: a retrospective study.

A preoperative three-dimensional examination of the sphenoid sinus anatomy, its pneumatization pattern, and its relevance to neighboring neurovascular constructions is crucial to preventing possible complications. In this study, the aim was to evaluate the relationship between sphenoid sinus pneumatization types and the sella turcica using computed tomography (CT). CT data from 420 patients referred to the Department of Dentomaxillofacial Radiology were evaluated retrospectively. Sella pneumatization types were classified as conchal, presellar, incomplete sellar, and complete sellar, and they were evaluated. Obtained data were evaluated using the IBM SPSS 25.0 (Armonk, New York, USA) package program. CT images of 420 individuals, including 174 women and 246 men with a mean age of 43.87 ± 17.58 years, were included in the study. When the sella turcica morphologies were evaluated, the most widespread morphological type was irregularity in the posterior part of the dorsum sella, in 51.2% of cases. In addition, a statistically significant correlation was found between the pneumatization of the sphenoid sinus and the morphological types of sella (p < 0.05). In this research endeavor, the predominant observation comprised the complete sellar sphenoid sinus pneumatization type, exhibiting irregularity in the posterior aspect of the dorsum sella, representing one of the sellar types. Notwithstanding, it is imperative to conduct additional investigations to establish the generalizability of the present study's findings.

Dental-dedicated MRI, a novel approach for dentomaxillofacial diagnostic imaging: technical specifications and feasibility.

MRI is a noninvasive, ionizing radiation-free imaging modality that has become an indispensable medical diagnostic method. The literature suggests MRI as a potential diagnostic modality in dentomaxillofacial radiology. However, current MRI equipment is designed for medical imaging (eg, brain and body imaging), with general-purpose use in radiology. Hence, it appears expensive for dentists to purchase and maintain, besides being complex to operate. In recent years, MRI has entered some areas of dentistry and has reached a point in which it can be provided following a tailored approach. This technical report introduces a dental-dedicated MRI (ddMRI) system, describing how MRI can be adapted to fit dentomaxillofacial radiology through the appropriate choice of field strength, dental radiofrequency surface coil, and pulse sequences. Also, this technical report illustrates the possible application and feasibility of the suggested ddMRI system in some relevant diagnostic tasks in dentistry. Based on the presented cases, it is fair to consider the suggested ddMRI system as a feasible approach to introducing MRI to dentists and dentomaxillofacial radiology specialists. Further studies are needed to clarify the diagnostic accuracy of ddMRI considering the various diagnostic tasks relevant to the practice of dentistry.

Sydney Blackman (1898-1971): a pioneer in dental radiology and radiography.

Sydney Blackman, was a consultant radiologist at the Royal Dental Hospital of London between 1931 and 1967. He contributed much to the advance of dento-maxillofacial radiology. His development of the 'rotograph' as the first commercially available dental panoramic machine established dental radiology on a level with medical radiology. Sydney was a major contributor to the establishment of the British Society of Dental and Maxillofacial Radiology.

Variations and thicknesses of anterior belly of the digastric muscle: an ultrasonographic study.

This study aims to evaluate the anatomy and anatomical variations of the anterior belly of the digastric muscle. Hundred and fifty one ultrasonographic images of the digastric muscle pairs were evaluated in Near East University Faculty of Dentistry Department of Dentomaxillofacial Radiology. Morphological variations were recorded using the classification of the digastric muscle into 12 types by Kim et al. For the analysis, the Mann-Whitney U test and Chi-square test were used, and for the correlational analysis, Spearman's rho test was applied. P < 0.05 was considered statistically significant in all tests. Seventy female and 81 male patients aged 19-60years were evaluated. Type 1 digastric muscle was observed in 145 of 151 patients, Type 2 in 3 patients, and Type 7 in 3 patients. The thicknesses of the right and left digastric muscles were measured, and a statistically significant difference was observed between the groups when the genders were compared. It was observed that both right and left digastric muscle thicknesses were higher in males than females. There was a statistically significant positive high correlation between right and left digastric muscle thicknesses (p = 0.000; r = 0.736). No statistically significant difference was found between genders (p = 0.596) in terms of anatomical variations. Considering that the variations of the digastric muscle may have a clinical significance role, the normal anatomy and variations of this muscle should be well known by maxillofacial surgeons and radiologists.

News from the European Journal of Therapeutics: A new issue and a new editorial board

News from the European Journal of Therapeutics: A new issue and a new editorial board

Evaluation of Stylohyoid Ligament Calcifications in the Central Anatolian Region

This study aims to determine the prevalence of the elongated styloid process (ESP) on panoramic radiographs in a Turkish subpopulation and to investigate the relationship between SP lengths and the age and gender of individuals. Digital panoramic radiographs of 1000 patients who applied to Necmettin Erbakan University, Faculty of Dentistry, Dentomaxillofacial Radiology Clinic for the first examination between January 2020 and January 2022 were obtained from the database and examined. Individuals were evaluated by dividing them into three groups according to their age SP lengths were measured on both sides, and those greater than 30 mm were contemplated elongated. The data were evaluated in the SPSS V.21 program. In 1000 evaluated patients, ESP of &gt;30 mm was detected in 304 individuals. It was determined that SP length did not differ according to age groups, gender, and systemic disease (p&lt;0.05). Panoramic radiographs are useful, economical, and easily reachable diagnostic equipment in the diagnosis of symptomatic or asymptomatic ESP. Furthermore, it would be more useful to evaluate the prevalence of ESP with larger sample groups and advanced imaging methods.

Norman John David Smith (1931-2010): radiologist, master mariner and instigator of dental distance-learning courses.

David Smith was a major influence on the world of dental radiology, helping to found the European Academy of Dental Radiology. He was a president of both the British Society of Dental Radiology and the British Society of Dental and Maxillofacial Radiology, and an honourary life member of the European Academy of Dentomaxillofacial Radiology. David was also a master mariner, politician and fighter for the introduction of distance-learning programmes in dental education.

A suspect of large dentigerous cyst associated with impacted canine evaluated by CBCT: a case report in a young patient

Objectives: This case report aims to describe a large radiolucent lesion associated with an impacted canine in a young patient from CBCT radiographs.&#x0D; Case Report: A 12-year-old boy was referred for CBCT examination to the Dentomaxillofacial Radiology unit at the Universitas Padjadjaran Dental Hospital with swelling on the right side of the face and a gingival lump on the upper right region suspected as an unerupted canine. The CBCT examination results showed an ectopic impacted tooth 13 and a large hypodense/radiolucent lesion with a well-defined and corticated border located on the coronal of tooth 13, expanding into the maxillary sinus and nasal cavity.&#x0D; Conclusion: Based on the CBCT result in terms of location and radiographic features, this extensive radiolucent lesion led to a suspect radiodiagnosis of the dentigerous cyst within a young patient. However, histology examination is still required to establish a definitive diagnosis.

Automatic Segmentation of Teeth, Crown–Bridge Restorations, Dental Implants, Restorative Fillings, Dental Caries, Residual Roots, and Root Canal Fillings on Orthopantomographs: Convenience and Pitfalls

The aim of our study is to provide successful automatic segmentation of various objects on orthopantomographs (OPGs). 8138 OPGs obtained from the archives of the Department of Dentomaxillofacial Radiology were included. OPGs were converted into PNGs and transferred to the segmentation tool's database. All teeth, crown-bridge restorations, dental implants, composite-amalgam fillings, dental caries, residual roots, and root canal fillings were manually segmented by two experts with the manual drawing semantic segmentation technique. The intra-class correlation coefficient (ICC) for both inter- and intra-observers for manual segmentation was excellent (ICC > 0.75). The intra-observer ICC was found to be 0.994, while the inter-observer reliability was 0.989. No significant difference was detected amongst observers (p = 0.947). The calculated DSC and accuracy values across all OPGs were 0.85 and 0.95 for the tooth segmentation, 0.88 and 0.99 for dental caries, 0.87 and 0.99 for dental restorations, 0.93 and 0.99 for crown-bridge restorations, 0.94 and 0.99 for dental implants, 0.78 and 0.99 for root canal fillings, and 0.78 and 0.99 for residual roots, respectively. Thanks to faster and automated diagnoses on 2D as well as 3D dental images, dentists will have higher diagnosis rates in a shorter time even without excluding cases.

Evaluation of dental students’ feedbacks on clinical education practices during the COVID-19 pandemic

Introduction: The aim of this study was to examine the impact of COVID-19 pandemic on dental education and investigate the dental students’ contentment and comment about the oral diagnosis and dentomaxillofacial radiology (ODR) clinical courses after the reopening.&#x0D; Materials and Methods: All fourth grade-year and fifth grade-year dental students who completed their ODR clinical skill training course were invited to fill out an online questionnaire.&#x0D; Results: Seventy-nine students responded the survey, 34 (43%) of students have satisfied with post-pandemic clinical courses and there was a statistically significant relation between the satisfaction and supporting by teaching staff (p=0.001). Students stated that number of clinical works were inadequate and there was a statistically significant relation between the number of patients examined and having adequate skill at patient examination and treatment planning (p=0.001). 33 (41.8%) dental students found online clinical courses satisfactory but 69 (87.3%) students preferred clinical skill training courses instead of online. &#x0D; Conclusion: During the COVID-19 pandemic dental schools must plan their clinical courses and make arrangements to allow the students to care as many as patients possible and education staff should be in close contact with students at each step of the clinical courses.

The use of protection measures in dento-maxillofacial radiology in Europe: a survey among experts

Patient contact shielding to reduce radiation exposure to radiosensitive organs of patients is known to be used inconsistently in the field of dento-maxillofacial radiology (DMFR). There is an ongoing discussion if its use is still justified with regard to recent technical enhancements in the field. Thus, the aim of this study was to investigate the recommended and applied safety standards regarding dose protection measures in dental radiology within European countries. With an online questionnaire the use of safety measures, especially lead protection and collimation, in different patient groups (adults, children, pregnant women) was interrogated including leading experts in the field of DMFR. Among the 24 participants from 13 different countries, there was a tendency towards lead protection for intraoral radiography and towards collimation for extraoral radiography. Participants based their decision mainly on law and societal guidelines. Overall, the application of radiation protection measures varies within Europe. It seems safe to say that lead protection as a measure of radiation dose limitation is still recommendable even though collimation and technical advancements have led to great dose reductions. Collimation should be used more broadly and a standardization of protection measures and an update of radiation protection guidelines in Europe is desirable. Accepted for publication: September 12, 2022 Published online: September 13, 2022

The use of protection measures in dento-maxillofacial radiology in Europe: a survey among experts.

Patient contact shielding to reduce radiation exposure to radiosensitive organs of patients is known to be used inconsistently in the field of dento-maxillofacial radiology (DMFR). There is an ongoing discussion if its use is still justified with regard to recent technical enhancements in the field. Thus, the aim of this study was to investigate the recommended and applied safety standards regarding dose protection measures in dental radiology within European countries. With an online questionnaire the use of safety measures, especially lead protection and collimation, in different patient groups (adults, children, pregnant women) was interrogated including leading experts in the field of DMFR. Among the 24 participants from 13 different countries, there was a tendency towards lead protection for intraoral radiography and towards collimation for extraoral radiography. Participants based their decision mainly on law and societal guidelines. Overall, the application of radiation protection measures varies within Europe. It seems safe to say that lead protection as a measure of radiation dose limitation is still recommendable even though collimation and technical advancements have led to great dose reductions. Collimation should be used more broadly and a standardization of protection measures and an update of radiation protection guidelines in Europe is desirable.

Imaging analysis 3D cone-beam computed tomography of a suspected infected radicular cyst in the mandible

Objectives: This article is aimed to report the use of cone-beam computed tomography (CBCT) imaging analysis on a radiolucent lesion case.&#x0D; Case Report: A 24-year-old female patient was referred to dentomaxillofacial radiology installation, at Universitas Padjadjaran Dental Hospital for a CBCT examination of a lower jaw lesion. The CBCT result demonstrated a large radiolucent lesion at the periapical of tooth 37 with a mostly diffuse border that extended posteriorly to the ramus. There was a cortical thinning on the lingual side alveolar bone. Density analysis revealed an average density of –22,9 grayscale.&#x0D; Conclusion: CBCT 3D could analyze lesions from qualitative and quantitative approaches. Based on these approaches, the lesion of this case led to a suspect of infected radicular cyst.