Digital Panoramic System Research Articles

Assessment of variations in upper and lower gonial angle in children with mouth breathing habit

Background: Mouth breathing is one of the most common deleterious oral habits in children. The habitual position of muscles inside and outside the mouth will affect dental development. Mouth breathing influences skeletal growth and thereby affects the cephalometric parameters. The present study aimed to assess if there is any variation in upper and lower gonial angles in children with mouth breathing habit. Methods: The 33 patients in the age group of 8 to 12 years reporting to the Department of Pediatric and Preventive Dentistry with chief complaint of mouth breathing was selected for the study based on inclusion and exclusion criteria. Lateral cephalograms of these children were taken with a digital panoramic system under standard exposure factors, as recommended by the manufacturer. Upper and lower gonial angles were determined on the lateral cephalograms. The values obtained were tabulated and subjected to statistical evaluation. Results: The mean upper and lower gonial angles were seen to increase from the normal in children with mouth breathing habit. However, independent sample t test showed no statistically significant difference in upper and lower gonial angles with a p value of 0.598 in upper gonial angle and 0.714 in lower gonial angle. Contusions: Early detection of the changes in the upper and lower gonial angles can help a pediatric dentist in effectively framing a treatment plan in children with mouth breathing habit, to prevent further deterioration in the dental and skeletal structures and be able to correct the already occurred unfavourable changes in them.

Evaluation of mandibular trabecular and cortical structure by fractal analysis in hyperlipidemia and hypertension patients

IntroductionThis study aimed to evaluate the mandibular trabecular and cortical changes in patients with hyperlipidemia (HL) and/or hypertension (HT) using fractal dimension (FD) analysis, mandibular cortical width (MCW), panoramic mandibular index (PMI) and mandibular cortical index (MCI). Materials and methodsPanoramic radiographs of 100 patients were evaluated. FD measurement of three region of interest (ROI) including the angulus, corpus and interdental bone area were made. MCW, PMI and MCI were also measured and noted. ResultsAngulus, corpus and interdental FD values were significantly lower in three disease groups than the control group. Angulus, corpus, and interdental FD values were significantly lower in the HL+HT group than in the HL group and HT group. MCW value was significantly lower in the HL group, HT group, and HL+HT group than the control group. The cortical index C1 was more common in the control group while C2 was more common in the HT, HL and HL+HT group. ConclusionThe fact that FD was significantly lower in the HL+HT group compared to the HL and HT groups indicates the positive effect of their association on bone loss and quality. FD measurements on images obtained using a direct digital panoramic system can be used for treatment planning and follow-up of patients with HL and/or HT.

An epidemiological study of elongation of styloid process in the saurashtra population: A retrospective radiographic digital orthopantomographic study

Introduction: The styloid process (SP) is a cylindrical bony structure emerging from the lower surface of the petrous temporal bone, its normal length is from 20 mm to 30 mm and those with more than 30 mm length are considered elongated. Calcification in stylohyoid ligament or calcification of SP is termed Eagle's syndrome. The aim of this study is to conduct an epidemiological survey of SP on digital orthopantomogram (OPG) in the Saurashtra population with an age range of 5–90 years. Materials and Methods: This is a retrospective study of 1088 OPG radiographs randomly selected from the database of 2019–2020 from the oral medicine and radiology department of our institute, which was taken on the OPG model CS 8100 Carestream digital panoramic system. Measurements of SP were done from the temporal bone to the tip. Those with more than 30 mm in length were considered to be elongated. The study sample was divided into four different age groups and was compared according to gender and sides. The Chi-square test and t-test were performed. Results: Elongated SP was noted in 354 (32.53%) out of 1088 subjects. Among age groups, subjects of more than 50 years showed a maximum number of elongated SPs. Conclusion: Subjects showing elongated SP and their mean length are increased with age, which indicates chronic development of calcification. No statistical significance was found in the elongation of SP in correlation with the cohort's gender and sides (bilateral or unilateral).

Transfer Deep Learning for Dental and Maxillofacial Imaging Modality Classification: A Preliminary Study.

To apply the technique of transfer deep learning on a small data set for automatic classification of X-ray modalities in dentistry. For solving the problem of classification, the convolution neural networks based on VGG16, NASNetLarge and Xception architectures were used, which received pre-training on ImageNet subset. In this research, we used an in-house dataset created within the School of Dental Medicine, Tel Aviv University. The training dataset contained anonymized 496 digital Panoramic and Cephalometric X-ray images for orthodontic examinations from CS 8100 Digital Panoramic System (Carestream Dental LLC, Atlanta, USA). The models were trained using NVIDIA GeForce GTX 1080 Ti GPU. The study was approved by the ethical committee of Tel Aviv University. The test dataset contained 124 X-ray images from 2 different devices: CS 8100 Digital Panoramic System and Planmeca ProMax 2D (Planmeca, Helsinki, Finland). X-ray images in the test database were not pre-processed. The accuracy of all neural network architectures was 100%. Following a result of almost absolute accuracy, the other statistical metrics were not relevant. In this study, good results have been obtained for the automatic classification of different modalities of X-ray images used in dentistry. The most promising direction for the development of this kind of application is the transfer deep learning. Further studies on automatic classification of modalities, as well as sub-modalities, can maximally reduce occasional difficulties arising in this field in the daily practice of the dentist and, eventually, improve the quality of diagnosis and treatment.

A cross-sectional survey of dentists' use of digital radiographic techniques in Riyadh, Saudi Arabia

Introduction: Undergraduate oral and maxillofacial radiology curricula are currently undergoing a reform process that is moving toward digital-based radiology that requires dedicated resources to train dental students to the field experience. It is not known if the time is appropriate to totally shift from training students on conventional analog film-based radiology to training them on digital images and the choice of digital system in intraoral and extraoral radiography. Aim: The aim of this study is to assess availability and utilization of the digital radiographic techniques by dental clinics in Riyadh, Saudi Arabia, using a cross-sectional descriptive, epidemiological survey. Materials and Methods: The study included dental departments of nine main governmental hospitals, six dental schools in Riyadh and a representative selected sample of the private dental clinics in Riyadh that included 40 dental clinics. A self-administered e-survey regarding the use of analog or digital radiographic intraoral and extraoral techniques was made. Descriptive statistics are reported in forms of means and range. Results and Discussion: For intraoral radiographic examinations, most clinics (90.9%) used digital systems. Solid-state detectors such as charge-coupled device (CCD) and complementary metal oxide semiconductor sensors were the most popular type digital intraoral sensors (94%) and only 13 locations (26%) used digital photostimulable phosphors plates. For panoramic radiography, almost all (98.1%) used digital systems. Again, the solid-state detectors were the most common digital panoramic system (96.4%). Most respondents had a digital information system to store, retrieve, and display digital radiographs (92.7%), whereas only four locations (5.9%) used hard-copy films or paper prints. Conclusion: Digital imagining is more common than film-based imaging in intraoral radiography in and panoramic radiography in the different dental care delivery sites in Riyadh, Saudi Arabia.

Evaluation of Significant Radiographic Findings and Their Impact on the Oral Health-Related Quality of Life of Patients with Complete Dentures.

The aim of this study was to assess the frequency and location of positive radiographic findings in edentulous patients and to evaluate the oral health-related quality of life (OHRQoL) and complacency of patients with positive radiologic findings. A total of 1,349 asymptomatic edentulous patients were retrospectively evaluated using a digital panoramic system for the presence of retained root fragments, impacted teeth, foreign bodies, radiolucencies, radiopacities, mental foramen at or near the alveolar crest, and maxillary sinus pneumatization. The patients with positive findings were called for a follow-up to take a new panoramic radiograph. The functional status and symptoms of participants were measured with the Oral Health Impact Profile (OHIP-14). At least one or more of the radiographic findings were observed in 35.21% of the evaluated radiographs. The most frequent finding was sinus pneumatization (20.9%). The mean total OHIP score was 9.74 ± 8.34. There was no statistically significant difference observed for gender, age, education levels, marital status, or having surgical interventions for total OHIP-14 scores (P > .05). The results of this study suggest that routine radiographic examination of edentulous patients may not be crucial before rehabilitation, and using a total percentage of positive radiographic findings may result in the exaggeration of the disease risk in edentulous patients.

Skin entrance dose with and without lead apron in digital panoramic radiography for selected sensitive body regions.

The aim of this study was to compare the dose at skin level at five significant anatomical regions for panoramic radiography devices with and without lead apron by means of a highly sensitive dosimeter. A female RANDO-phantom was exposed in five different digital panoramic radiography systems, and the dose at skin level was assessed tenfold for each measurement region by means of a highly sensitive solid-state-dosimeter. The five measurement regions selected were the thyroid, both female breasts, the gonads, and a central region in the back of the phantom. For each panoramic machine, the measurements were performed in two modes: with and without a commercial lead apron specifically designed for panoramic radiography. Reproducibility of the measurements was expressed by absolute differences and the coefficient of variation. Values between shielded and unshielded doses were pooled for each region and compared by means of the paired Wilcoxon tests (p≤0.05). Reproducibility as represented by the mean CV was 22±52% (median 2.3%) with larger variations for small dose values. Doses at skin level ranged between 0.00μGy at the gonads and 85.39μGy at the unshielded thyroid (mean±SD 15±24μGy). Except for the gonads, the dose in all the other regions was significantly lower (p<0.001) when a lead apron was applied. Unshielded doses were between 1.02-fold (thyroid) and 112-fold (at the right breast) higher than those with lead apron shielding (mean: 14-fold±18-fold). Although the doses were entirely very low, we observed a significant increase in dose in the radiation-sensitive female breast region when no lead apron was used. Future discussions on shielding requirements for panoramic radiography should focus on these differences in the light of the linear non-threshold (LNT) theory which is generally adopted in medical imaging.

Assessment of panoral radiograph quality in a dental treatment center

Purpose The quality of orthopantogram (OPG) images is primarily a function of patient positioning during image capture. The purpose of the investigation was to evaluate the quality of digital panoral radiographic images obtained by using the same imaging device in a large dental treatment center on the basis of the radiography technician operator securing the image. Materials and Methods Three hundred OPGs radiographs taken on a Kodak 8000C Digital Panoramic and Cephalometric System device in a large dental treatment center comprised the sample. The most recent OPGs beginning at May 2010 through 2007 were selected for three radiography technicians until subgroups of 100 OPGs per technician were obtained. Each panoral was evaluated by two investigators for 21 OPG image errors. Results Mean panoral total score was 14.71 and mean grade was 2.41 for the entire sample indicating a “good” quality. Significant differences were found among technicians for 3 of 21 panoral fault variables. The relative contribution to inferior OPG quality was greatest for the following positioning faults in rank order: Gazebo effect (11.3%), condyles pushed out (11.0%), unclear nasal structures (10.0%), airspace over U6s (9.5%), and condyles image top (9.0%). Conclusions There were no significant differences among technicians for overall quality indicators (total score and grade). However, statistically significant differences among the three technicians were found for image error wide anterior teeth, Gazebo effect, and unclear nasal structures.

Reliability of panoramic radiography in assessing gonial angle compared to lateral cephalogram in adult patients with Class I malocclusion

Introduction: Gonial angle is an important angle of the craniofacial complex. Lateral cephalogram and orthopantomogram (OPG) can be used to determine this angle. Objectives: To investigate whether OPGs can be used as an alternative to lateral cephalogram for measuring the gonial angle. Study Design: A total of 100 radiographs were collected from patients with Angle's Class I malocclusion (50 males and 50 females) with age ranging from 15 to 30 years, with a mean age of 18.24 years. Materials and Methods: The radiographs were taken with digital panoramic system (Kodak 8000C) under standard exposure factors, as recommended by the manufacturer. Gonial angle was determined by the tangent of the inferior border of the mandible and the most distal aspect of the ascending ramus and condyle on both panoramic and cephalometric radiographs. Statistical Analysis: Mean values were evaluated using z test. The statistical analysis was performed by using the Statistical Package for the Social Sciences (version 11.5). Results: The mean gonial angle was 121.13° and 122.22° on panoramic and cephalometric radiographs, respectively. There was no statistical significant difference between the measured gonial angles on panoramic and cephalometric radiographs (P > 0.005). Conclusion: Panoramic radiography can be used to determine the gonial angle as accurately as lateral cephalogram. In addition, we can determine the right and left gonial angles of a patient in an OPG without interferences due to superimposed images of anatomical structures in lateral cephalogram.

Evaluation of styloid process in Bareilly population on digital panoramic radiographs

Introduction: The styloid process is a long slender and pointed bony process projecting downwards, forwards and slightly medially from the temporal bone. Elongated styloid process is being more often seen in panoramic radiographs which are commonly used in dental practice. Aim: To assess the styloid process on digital panoramic radiographs. Materials and Methods: It is a cross-sectional study based on the panoramic radiographs of 2000 patients who reported to the department. The panoramic radiographs were available in the archives of our department as soft copies. These panoramic radiographs were obtained using Orthoralix DDE (GENDEX, USA) digital panoramic system. The length of the styloid process was measured radiographically on both sides of the maxillofacial region using the measurement toolbars on the accompanying analysis software. For statistical analysis, we used the unpaired t-test, Chi-square test, and one-way analysis of variance test, as necessary. Results: The average length of the right and left styloid process in males was 26.96 ± 8.748 and 26.76 ± 8.33 in females; right and left average length were 26.02 ± 5.86 and 26.59 ± 7.00 in males and females, respectively. The length of the styloid process on both sides increased with age; males had longer styloid process than females. Elongated styloid process was present in 26.5% of the patients. Langlais type I elongated styloids and type D calcification pattern were more common than others. Conclusion: Panoramic radiography is useful for the detection of an elongated styloid process in patients with or without symptoms, and helps avoid misdiagnosis of tonsillar pain or pain of dental, pharyngeal, or muscular origin.

Evaluation of dental panoramic radiographic findings in edentulous jaws: A retrospective study of 743 patients "Radiographic features in edentulous jaws".

PURPOSEThe aim of this study was to determine the frequency of significant panoramic radiographic findings and eventual treatment requirements before conventional or implant supported prosthetic treatment in asymptomatic edentulous patients.MATERIALS AND METHODSA total of 743 asymptomatic edentulous patients were retrospectively evaluated using a digital panoramic system. We analyzed the radiographic findings, including impacted teeth, retained root fragments, foreign bodies, severe atrophy of the posterior maxillary alveolar bone, mucous retention cysts, soft tissue calcifications and radiopaque-radiolucent conditions.RESULTSFour-hundred-eighty-seven (65.6%) patients had no radiographic finding. A total of 331 radiographic findings were detected in 256 (34%) patients. In 52.9% (n=175) of these conditions, surgical treatment was required before application of implant-supported fixed prosthesis. However, before application of conventional removable prosthesis surgical treatment was required for 6% (n=20) of these conditions.CONCLUSIONThe edentulous patients who will have implant placement for implant-supported fixed prosthesis can frequently require additional surgical procedures to eliminate pathological conditions.

A study on assessment of the length of styloid process in digital panoramic radiographs

Introduction: The styloid process (SP) is an anatomical structure whose clinical importance is not well understood. Aims and Objectives: This study aimed to study the type of SP as per Langlais' classification and to assess the feasibility of digital panoramic radiographs in measuring the length of SP. Materials and Methods: Eighty digital panoramic radiographs of patients with dental problems were retrieved from archives of our department as soft copies. The radiographs were taken using a digital panoramic system. The radiographic length of SP was measured on both sides using measurement toolbars on accompanying analysis software. The type of elongation patterns of SP was classified as per Langlais' classification. Finally, the data were subjected to statistical analysis. Results: The average length of the left and right side SPs was 29.1882 ± 6.86 and 28.16 ± 6.44, respectively. Majority of patients were found to be asymptomatic, and Langlais' Type I elongated SP was more common than others. Conclusion: Digital panoramic radiographs are valuable tools in early detection of elongated SP. Digital radiographs help in avoiding a misdiagnosis of tonsillar pain or pain of dental, pharyngeal, or muscular region.

Evaluation of styloid process using digital panoramic radiographs

Context: The styloid process (SP) is an anatomical structure, whose clinical importance is not well understood. Proper clinical and radiographic evaluation can detect an elongated styloid process (ESP) and calcification of the stylohyoid ligament. SP is said to be elongated if it is longer than 3 cm in length. Anatomical variations are very common. It has been reported that 2-28% of the general population show radiographic evidence of mineralization of a portion of the stylohyoid chain. SP could be elongated although symptoms are present only in some individuals. Panoramic radiography is most economical and readily available imaging modality to view the SP bilaterally. Aim: The aim of this present study was to assess the SP on digital panoramic radiographs. Subjects and Methods: The study was conducted on 500 digital panoramic radiographs available as a soft copy in our Radiology Department. These radiographs were taken using a digital panoramic system. The radiographic length of the SP was measured on both sides using the measurement toolbars on the accompanying analysis software. Statistical Analysis Used: The collected data was entered in a spreadsheet (Excel 2007, Microsoft, Richmond, USA) and was analyzed using statistical analysis software (SPSS version 17, Chicago, USA). Results: Average length of SP on the left side was 34.54 ± 7.54 mm and 33.02 ± 6.70 mm in male and female population, respectively. The average length of SP on right side was 35.30 ± 7.46 mm and 34.54 ± 7.31 mm in male and female population, respectively. The length of both styloids increased with age and males had longer styloids than females. Elongated styloids were present in 82.2% of the panoramic radiographs. Langlais type I elongated styloids were more common than others. Conclusions: Panoramic radiography is useful for detection of an ESP and/or ossification of the stylohyoid ligament in patients with or without symptoms and helps to avoid a misdiagnosis of tonsillar pain or pain of dental, pharyngeal, or muscular origin.

Comparative Evalution of G bone (Hydroxyapatite) and G-Graft (Hydroxyapatite with Collagen) as Bone Graft Material in Mandibular III Molar Extraction Socket.

Bone grafting is a dynamic phenomenon. It is a surgical procedure that replaces missing bone with material either from patient's own body, or, an artificial, synthetic or natural substitute. A successful bone graft when applied, heals, becomes incorporated, re-vascularises and eventually assumes the form desired. The main purpose of this present study was to radiologically assess and compare the regenerative potential of hydroxyapatite with Collagen (G-Graft) and hydroxyapatite (G-Bone) and to evaluate the clinical usefulness of these materials to enhance bone healing in third molar extraction sites through bone formation. The study was carried out in the Department of Oral & Maxillofacilal Surgery, patients were divided into three groups. The rationale for assigning the patients to the groups was strictly random: Group I - G-Graft (Hydroxyapatite with Collagen) was used as Bone graft material, Group II - Bone graft material used was G-Bone (Hydroxyapatite), Group III-control group (no grafts was used). Orthopentomogram(OPG) images were taken intra-operatively, just after extraction in the Group III (control), after extraction but before graft placement in Group I & II (study groups) and post-operatively at the end of first month and third month. Bone density of the post-extraction sockets was measured at four random areas through 'densitometric analysis' software in the OPG program (Kodak 8000C Digital Panoramic System, Eastman Kodak Company) and an average value was recorded at each review. The percentage increase in bone density between 1(st) month & 3(rd) month was 7.55± 12.43 in Group I (G Graft), 4.41± 5.4859 in Group II (G Bone), while that Group III (control) was found to be -0.82 ± 3.96. The bone density increase was found to be statistically highly significant (p<0.01)) between all groups. The present study concluded that G-Graft has a definite regenerative potential and is better than G-bone and can be used in bony defects to enhance the bone healing without provoking any significant inflammatory process. The study also indicates that defects treated with G-Graft attain more density initially and that G-Graft enhances bone healing in early stage.

Comparison Accuracy Study of E Speed Intraoral Films and Extraoral PSP Digital Panoramic System, for Identifying the Extent of Alveolar Bone Destruction in Anterior Maxillary Region of Periodontitis Patients

Background: Radiographs play an integral role in the assessment of periodontal disease. In recent years, advent of digital imaging has revolutionized radiology in dentistry. Objectives: The aim of this study was to compare the E speed intra oral films and extra oral digital systems in identifying the extent of alveolar bone loss in anterior maxillary region of periodontitis patients. Patients and Methods: In this diagnostic accuracy study, 48 inter proximal surfaces were evaluated in eight patients. These patients had alveolar bone loss in anterior regions because of periodontitis. Intraoral (parallel peri-apical) and extra oral (PSP: panoramic-photostimulable phosphor) radiography were taken from all the patients. The distance between Cemento-Enamel Junction (CEJ) to the alveolar crest was measured in radiographies. This distance was compared with the surgical distance as gold standard. Results: Accuracy differences between conventional E speed films and digital extra oral system are not statistically significant. All two radiographic modalities in comparison with surgical gold standard have significant difference and both underestimate the extent of bone loss. Conclusions: According to this study, accuracy of two imaging systems in assessment of alveolar crest bone loss level is nearly equal. Digital panoramic instead of intraoral film-based radiography can be used in periodontitis patients.

Image quality assessment in panoramic dental radiography: a comparative study between conventional and digital systems.

This study is designed to compare and evaluate the diagnostic image quality of dental panoramic radiography between conventional and digital systems. Fifty-four panoramic images were collected and divided into three groups consisting of conventional, digital with and without post processing image. Each image was printed out and scored subjectively by two experienced dentists who were blinded to the exposure parameters and system protocols. The evaluation covers of anatomical coverage and structures, density and image contrast. The overall image quality score revealed that digital panoramic with post-processing scored the highest of 3.45±0.19, followed by digital panoramic system without post-processing and conventional panoramic system with corresponding scores of 3.33±0.33 and 2.06±0.40. In conclusion, images produced by digital panoramic system are better in diagnostic image quality than that from conventional panoramic system. Digital post-processing visualization can improve diagnostic quality significantly in terms of radiographic density and contrast.

Evaluation of the anterior loop of the mental nerve incidence and extension in different age groups in Sulaimania city using digital panoramic imaging system

The anterior loop of mental nerve is commonly described as that part of the neurovascular bundle that transverses anterior and inferior to the mental foramen only to loop back to exit the mental foramen. The aim of the study is to evaluate the incidence and extension of anterior loop of mental nerve by using digital panoramic imaging system to avoid nerve damage during different surgical procedures in dentistry. Materials and Method: Panoramic image was taken for all 400 patients and stored in the computer. Then Horizontal and Vertical for the anterior loop extension when exist was measured and recorded in a special case sheet prepared for each subject. Results: Results indicated that out of 400 patients there were only 25 patients (6.25%) having anterior of the inferior alveolar nerve, 14 cases (56%) of them were males and 11 cases (44%) were females. The extension of the anterior loop of mental nerve was with wide range, for horizontal extension it was 1.3-6.36mm with significant difference between right and left sides, and with vertical extension was between 1.44 -5.98mm with no significant difference between the right and left sides. Conclusion: No significant difference among subjects according to sex and the pattern of visualization of the anterior loop was shown. The anterior loop was visible in 6.25% of the dental panoramic radiographs with 3.5% for males and 2.75% for females.

Anatomical changes in the structure of the temporomandibular joint caused by complete edentulousness

The posterior slope of the articular eminence of completely edentulous patients compared to patients with maintained occlusion shows significant flattening. The aim of this present study was to reveal a possible correlation between edentulousness and the flattening of the eminence and to find out whether this deformation is connected to age. Thirty patients were examined in three groups, each consisting of 10 persons (group I: 18- to 25-year-old patients with maintained occlusion, group II: patients over 60 with maintained occlusion, group III: edentulous patients over 60). The three groups were compared according to dental status, age, sex and side. Measurements were carried out on orthopantomographic images taken with Kodak 8000 Digital Panoramic System. The angle of the posterior slope of the articular eminence relative to the Frankfort plane was measured on both sides. Data were analysed statistically with the one-way anova test (α = 0.05). The highest values were measured in group I (right side: 39.8 ± 5.4°, left side: 43.0 ± 5.9°), values were somewhat lower in group II (right side: 38.9 ± 4.7°, left side: 39.5 ± 7.4°) and were the lowest in group III, which was significantly lower on both sides than the results of group I and group II (right side: 29.8 ± 6.0°, left side: 31.9 ± 5.2°, p < 0.01). The correlation coefficient between age and the flattening of the eminence in group I, II and III was 0.23, 0.35 and 0.92, respectively. The flattening of the articular eminence could be correlated with age; however, the rate of deformation is significantly higher in completely edentulous patients than in patients with maintained occlusion.

Magnification rate of digital panoramic radiographs and its effectiveness for pre-operative assessment of dental implants

The purpose of this study was to determine the accuracy and effectiveness of digital panoramic radiographs for pre-operative assessment of dental implants. We selected 86 patients (221 implants) and calculated the length of the planned implant based on the distance between a selection of critical anatomical structures and the alveolar crest using the scaling tools provided in the digital panoramic system. We analysed the magnification rate and the difference between the actual inserted implant length and planned implant length according to the location of the implant placement and the clarity of anatomical structures seen in the panoramic radiographs. There was no significant difference between the planned implant length and actual inserted implant length (P > 0.05). The magnification rate of the width and length of the inserted implants, seen in the digital panoramic radiographs, was 127.28 ± 13.47% and 128.22 ± 4.17%, respectively. The magnification rate of the implant width was largest in the mandibular anterior part and there was a significant difference in the magnification rate of the length of implants between the maxilla and the mandible (P < 0.05). When the clarity of anatomical structures seen in the panoramic radiographs is low, the magnification rate of the width of the inserted implants is significantly higher (P < 0.05), but there is no significant difference between the planned implant length and actual inserted implant length according to the clarity of anatomical structures (P < 0.05). Digital panoramic radiography can be considered a simple, readily available and considerably accurate pre-operative assessment tool in the vertical dimension for dental implant therapy.

Evaluation of the styloid process on digital panoramic radiographs

Background:The styloid process is an anatomical structure, whose clinical importance is not well understood. Proper clinical and radiographic evaluation can detect an elongated styloid process and calcification of the stylohyoid ligament. It has been reported that 2 – 28% of the general population show radiographic evidence of mineralization of a portion of the stylohyoid chain. The elongated styloid process may be symptomatic in many cases. Panoramic radiography is the best imaging modality to view the styloid process bilaterally.Aim:To assess the styloid process on digital panoramic radiographs.Materials and Methods:The study was conducted on 500 digital panoramic radiographs available in the archives of our department as soft copies. These radiographs were taken using a digital panoramic system. The radiographic length of the styloid process was measured on both sides using the measurement toolbars on the accompanying analysis software. For statistical analysis we used the unpaired t test, Chi-square test, and one-way ANOVA test, as necessary.Results:The average length of the left styloid was 25.41 ± 6.32 mm and that of the right styloid was 25.53 ± 6.62 mm. The length of both styloids increased with age and males had longer styloids than females. Elongated styloids were present in 19.4% of the panoramic radiographs. Langlais type I elongated styloids and a partial calcification pattern were more common than others.Conclusion:Panoramic radiography is useful for detection of an elongated styloid process and / or ossification of the stylohyoid ligament in patients with or without symptoms, and helps avoid a misdiagnosis of tonsillar pain or pain of dental, pharyngeal, or muscular origin.