Panoramic Radiographic Findings Research Articles

Determining the Incidental Pathologic Findings (IPFs) on panoramic radiographs before orthodontic treatments: A retrospective study

Background/Aim: Panoramic radiography is an imaging method that displays teeth, jaws and surrounding structures in two dimensions and is frequently used in the follow-up and treatment phase of patients. This study aims to determine the frequency of incidental findings (IPFs) in panoramic radiographs taken before orthodontic treatment. Material and Methods: In this retrospective study; A total of 330 patients (170 women, 160 men) aged between 7 and 49 years were included. IPFs were grouped into dental anomalies, radiopacities and radiolucent areas in the jaws, impacted teeth, and other anomalies in the jaws. Data were compared according to gender and age groups (6-12 years, 13-49 years). Results: Dental anomalies were detected in 90.6% of the panoramic radiographs examined. No statistically significant relationships were found between gender and dental abnormalities (p>0.05). The incidence of idiopathic osteosclerosis is 3.6%, and all of these people are men; It has been determined that people with sclerosing osteitis are mostly men and alveolar radiopacities are mostly not seen in women. It has been observed that patients are mostly between the ages of 6-12 in the absence of any dental anomalies. It has been determined that people with sclerosing osteitis are mostly between the ages of 13-49 and patients aged 13-49 mostly have alveolar radiopacities. It has been determined that patients with possible periapical or residual cyst and possible dentigerous cyst are mostly between the ages of 13-49, and patients aged 13-49 are mostly seen in radiolucent areas in the jaw bones. As a result of the analysis, a statistically significant relationship was found between age groups and IPFs (p<0.05). Conclusions: According to the results of this study, a high rate of dental anomalies were detected by evaluating panoramic radiographs before orthodontic treatment. Age and gender changes play a role in the presence of Incidental Pathologic Findings.

Prevalence of Total Edentulism and Panoramic Radiographic Findings of Totally Edentulous Patients in a Dental School in Jeddah, Saudi Arabia.

Background The prevalence of total edentulism differs significantly between countries and between cities/regions within the same country. It can be affected by various factors, such as age, sex, and socioeconomic factors along with lifestyle and health behavior. Positive findings on panoramic radiographs are frequently observed in totally edentulous patients (TEP) during routine screening. Objectives This study aimed to retrospectively determine the prevalence of total edentulism and to evaluate the distribution and location of positive findings on panoramic radiographs of TEP at a dental school in Jeddah, Saudi Arabia. Methods A total of 12,428 digital panoramic radiographs of patients aged ≥35 years seeking treatment at a dental school from January 2018 to December 2021 were evaluated to determine the prevalence of total edentulism. Retained root stumps, impacted teeth, radiolucent, and radiopaque lesions were detected on the panoramic radiographs of the TEP. Data were analyzed using descriptive statistics. Results Among the 12,428 patients, 521 (4.2%) showed total edentulism on their panoramic radiographs. The prevalence of edentulism was the highest among patients aged >65 years (n=305, 4.5%), men (n=246, 4.2%), and non-Saudi citizens (n=300, 4.4%). A total of 198 radiographic findings were identified in 150 patients. The frequency rates of retained root stumps and impacted teeth were 19.2% (n=100) and 4.6% (n=24), respectively. Radiolucent and radiopaque lesions each accounted for 2.5% (n=13) of the lesions. Conclusions The prevalence of edentulism was higher in patients aged >65 years, male patients, and non-Saudi citizens. Retained root stumps were most often encountered among the four positive findings on panoramic radiographs. Considering the high frequency of positive radiographic findings in TEP, panoramic radiographs must be routinely obtained for TEP, but caution must be exercised to reduce the effects of radiation.

Evaluation of the Frequency of Incidental Findings on Digital Panoramic Radiographs of Referrals to Maxillofacial Radiology Department of Yazd Dental School in 2019

Introduction: Early treatment of dental anomalies and oral/dental lesions can prevent maxillofacial abnormalities and other complications. Since in most cases these lesions are asymptomatic, they are often discovered randomly in different radiographic images. Therefore, the aim of this study was to investigate the incidental findings on digital panoramic radiographs of referrals to Maxillofacial Radiology Department of Yazd Dental School.
 Methods: In this descriptive cross-sectional study, 1949 panoramic radiographs of patients referred to the Department of Maxillofacial Radiology of Yazd Dental School in Apr 2019_ Apr 2020 were studied. Age, gender, type of lesion / anomaly, position and jaw involved were recorded in the study information form. Data analysis was performed via SPSS16 statistical software and Chi-square test.
 Results: A total of 2915 lesions / anomalies were diagnosed. The frequency of these lesions / anomalies was higher in men (57.5%), middle-aged people (48.6%), mandible (69.3%) and left side of the jaws (76.8%). There was a statistically significant difference in the presence of lesion / anomaly in terms of age, sex, side and jaw involved (P-value = 0.0001).
 Conclusion: Considering the frequency of random findings in panoramic radiographs, it seems that this radiography is useful for detecting many lesions and dental anomalies in the initial examination of patients. It is recommended that dentists examine the radiographs more carefully.

CORRELATION OF PANORAMIC RADIOGRAPHIC FINDINGS AND CLINICAL FINDINGS OF DENTAL PATIENTS AT MOI TEACHING AND REFERRAL HOSPITAL, KENYA

Purpose: The purpose of this study was to determine the correlation of panoramic radiographic findings and clinical findings among dental patients at Moi Teaching and Referral Hospital (MTRH), Kenya.
 Materials and Methods: This was a hospital based cross sectional study conducted at the Radiology and Imaging department and dental department at Moi Teaching and Referral Hospital from September, 2019 to June, 2020. A total of 93 consenting patients were enrolled using systematic random sampling. Standard chart review forms were administered, and clinical examination findings documented. Panoramic radiograph findings were then discussed with a consultant radiologists and findings recorded. Descriptive statistics were carried out. Categorical variables were summarized as frequencies and proportions, and reported in tables. Numerical variables were summarized as median and interquartile ranges. Cross tabulation was done to compare clinical examination and panoramic radiograph findings where total raw agreement was reported as proportions.
 Results: 93 patients whose ages ranged from 5-73 years with a mean of 29 years were included into the study. Radiographic features of dental caries were present in 54% of panoramic radiographs compared to clinical examination (50.5%) while 23.7% of radiographs revealed impacted teeth compared to clinical examination (19.4%). Radiographic features of periodontitis were observed in 14% compared to clinical examination (16.1%). Fractures (12.9%) were observed radiographically compared to (10.7%) clinically. Periapical lesions (8.6%) were observed radiographically compared to clinical examination (6.4%). Temporo-mandibular disorder (6.5%) were observed both on radiographs and clinical examination. Radiographic features of missing teeth (3.2%) were observed compared to clinical examination (1.1%) while only 1.1% of malpositioned teeth were observed radiographically compared to clinical examination (2.2%). Notably, mandibular lesions (3.2%) and nasal congestion (14%) were only discovered radiographically. The overall raw agreement between panoramic radiograph and clinical examination was 75.3% (70/93) with a p value of less than 0.001.
 Unique contribution to theory, practice and policy: The study recommends that all patients presenting with dental conditions should be done panoramic radiograph to improve diagnosis. Moi Teaching and Referral Hospital and the Ministry of Health to consider routine panoramic radiographs in the guidelines for the assessment of dental patients in all the hospitals offering, dental health services

Accuracy of panoramic and periapical radiographs to assess root resorption after incisors intrusion: A comparative study

Abstract: The aim of this study was to compare the accuracy of root resorption measurement on panoramic and periapical films after intrusion of maxillary incisors using either microimplant anchorage system or archwire of accentuated compensating curve. Patients and methods: 40 patients with age ranging from 18 to 24 years old, were randomly divided into two groups of 20 each. Each group was divided into 2 equal subgroups of 10 each: Subgroup A: comprised panoramic radiographic findings. Subgroup B: comprised periapical radiographic findings. Maxillary incisors were intruded using mini-implants in group I, and accentuated compensating curve arch wire in group II. Root resorption was examined with panoramic radiographs (subgroup A) and priapical radiographs (subgroup B) taken at pretreatment and postintrusion. Results: considering panoramic radiograph, root resorption of the upper incisors using the modified four grade ordinal scale showed that group I had 75% of the teeth classified with score 0, and root resorption score 1 in 25%. Group II had 60% of teeth with score 0 and 32.5% with scores of 1 and just 7.5% with score 2. The difference between both groups was significant (P< 0.05). Regarding periapical radiograph the mean amount of root resorption was significantly high in group II compared to group I. Flaring of incisors in group II is more significant than in group I. Conclusion: During taking panoramic radiograph, patient positioning must be checked to decrease error. Periapical film is preferred in cases when root resorption is expected with significant degrees.

A comparison of panoramic radiographic findings in patients with familial adenomatous polyposis and the general population: a multicenter study

Familial adenomatous polyposis (FAP) is a hereditable disorder characterized by early and unremitting development of intestinal polyps and extraintestinal manifestations requiring multidisciplinary surveillance. Herein we describe a multicenter cross-sectional analysis of the dento-osseous radiographic findings of patients with FAP from North and South America. Groups I and II included individuals with FAP diagnosed by standard clinical criteria. Patients were paired with age- and sex-matched participants without FAP. Panoramic radiograph of both cohorts, including children and adults, were analyzed. Of 114 panoramic radiographs, 38 were from patients with FAP, composed of group I (n=22) and group II (n=16), and 76 were from matched control participants. Evaluators had excellent agreement on key findings (intraclass correlation coefficient=0.89). The prevalence of osseous anomalies was higher in adults (75%) than in children (65.4%). Dental anomalies were also higher in children with FAP with a prevalence of 15.4%. We describe important and significant differences in the prevalence of dento-osseous anomalies in children compared with adult patients with FAP. These findings warrant careful consideration and may influence multidisciplinary management of the condition. Conversely, the presence of these abnormalities in pediatric dental patients even if not diagnosed with FAP should be borne in mind as possibly indicating de novo or unrecognized disease.

Evaluation of Timetable of the Second Permanent Molar Calcification among Children between 5 and 17 Years of Age

Objective: This study evaluates timetable of calcification stages of the second permanent molars (SPMs) based on panoramic radiographic findings from a selected group of Iranian patients. Methods: This descriptive, analytical and cross sectional study uses 715 panoramic radiographs of subjects with optimal quality between 5 to 17 years of age (n=60 for each age group) whom were selected from the referrals to the departments of Orthodontics and Pediatric Dentistry of at Tehran University of Medical Sciences, Iran. Patients with systemic diseases or any kind of syndromes were excluded. Calcification stages were determined based on Demirjian's classification. Data were analyzed using generalized estimating equation (GEE). Results: Only 20% of SPMs of 5 year-olds were in their 2nd stage of calcification and the remaining showed higher stages. The mean age of crown completion was around 8.5 years while the mean ages of root completion for the open and closed apices were 13 years and 3 months and 15.5 years, respectively. Also calcification occurred at earlier ages among girls. Conclusion: Timetable of calcification of SPMs is useful to predict the onset of puberty. Demirjian’s classification well matches Iranian population for determining calcification stage of SMPs. Keywords: Permanent Molar, Tooth Calcification, Forensic Dentistry, Iranian Population Key Messages: Mean age at different stages of calcification of the second permanent molars could be effective in forensic dentistry as well as for diagnostic and treatment purposes.

Dental developmental anomalies and post-eruption dental disorder

Panoramic radiographs are complementary exams to evaluate oral alterations in an early manner, these changes can be dental developmental anomalies, and post-eruption dental disorder. Aim: This study evaluated the findings in panoramic radiographs and correlated the variables of gender and dental location. Methods: A retrospective study was through the observation of 1.111 panoramic radiographs from the Radiology Department in Brazil. It was included patients from 5 to 79 years of age of both gender, and it classified the anomalies in shape, size, and number and post-eruption dental changes in and correlated with gender and location. Patients with syndromes were excluded from the sample. Results: The majority of the sample was composed of fameles 752 (67.7%), as to the frequency of dental developmental anomalies related lesions 684 cases (61.6%) and post-eruption dental disorder 567 (51.8%), in the radiographs. The most prevalent change was endodontic treatment (32.6%), followed by root dilaceration (25.9%), and included tooth (19.5%). The most prevailing alteration when correlated with the gender variables was the cyst root (p&lt;0.01) in females, and orthodontic treatment (p=0.02) in males and the variable location in the mandible was root dilaceration, giroversion, impacted tooth, taurodontia, microdontia, and endodontic treatment (p&lt;0.01). Conclusion: Our findings provide evidence that dental developmental anomalies e post-eruption dental disorder are frequent alterations in the population with particular characteristics of distribution by sex and location.

Complete Edentulism of Dental Patients in Northeastern Turkey: Prevalence and Radiographic Findings on Panoramic Radiographs Prevalence and Radiographic Findings on Panoramic Radiographs

The prevalence of complete edentulism varies from country to country and from one region to another. Previous studies have reported the high prevalence of significant radiographic findings in edentulous patients. Objectives: This study aimed to determine the prevalence of complete edentulism retrospectively and to evaluate the frequency and location of significant radiographic findings on panoramic radiographs in edentulous jaws of dental patients in northeastern Turkey. Methods: The digital panoramic images of all ≥35 year-old patients admitted to our faculty from January 2014 to August 2015 were evaluated. The prevalence of complete edentulism was determined among 8314 panoramic images retrospectively. Radiographic findings identified as impacted teeth, retained roots, radiopaque, and radiolucent areas detected in panoramic radiographs of completely edentulous patients (CEP) were recorded. The obtained data were analyzed with descriptive statistics and cross-tabs. Chi-square test was employed to evaluate the statistical significance of the results at 0.05 levels. Results: A total of 8314 panoramic images were examined, and 508 (6.11%) CEP were defined. The prevalence of edentulism was higher (24.85%) among the patients older than 64 years old. A total of 206 radiographic findings were detected on panoramic images of CEP. The prevalence values of retained roots, impacted teeth, radiopacities, and radiolucencies were 18.9%, 7.09%, 2.76%, and 1.57%, respectively. Conclusions: Given the high frequency of significant radiographic findings, the radiographic examination of CEP should be performed with consideration of the cumulative effects of radiation.

Evaluation of Panoramic Radiographs in Relation to the Mandibular Third Molar and to Incidental Findings in an Adult Population.

Objectives The aim was to evaluate the characteristics of the mandibular third molars, especially in relation to the inferior alveolar nerve. Further aims were to investigate incidental findings in panoramic radiographs in an adult population, and to investigate image quality related to patient positioning. Materials and Methods From a previous study with 451 randomly selected adult participants who lived in Sweden, 442 panoramic radiographs from four dental public health clinics were used. The third molars’ characteristics and relation to inferior alveolar nerve were evaluated. Incidental findings and patient positioning were recorded. Statistical Analysis Frequency analysis was used to investigate the occurrence of all findings and their possible interconnections. Whether the patients’ age or gender had an impact or not was also analyzed. Results The third molars were erupted in vertical position among 73% regardless of age. When retained or semi-retained, they were most commonly in mesioangular positions. The inferior alveolar nerve was located inferior to the roots in 52%, whereas an overlapped position was most common if the third molar was retained (90%), semi-retained (83%) or the age was less than 30 years (66%). Common incidental findings were apical radiolucencies, idiopathic osteosclerosis, and tooth fragments. Suboptimal patient positioning was found in one-third of the radiographs. Conclusions Panoramic radiography is a useful method to evaluate third molar prior to surgical removal and may be the only image required. Most incidental findings on panoramic radiographs does not seem to require any further odontological management.

Incidental radiographic finding of charm needle or “susuk” in orthodontic panoramic and lateral cephalometric radiograph: a case report

Background: The most common radiographic examinations in orthodontic are panoramic and lateral cephalometry. In panoramic and lateral cephalometric images in adult patients, sometimes can be found a fine foreign object which sometimes confuses as it scattered the radiographic image, such as needles. The needles found in the patients are known as “susuk” in Malay and Indonesian language or charm needles which believed to enhance beauty, charism, health, youth, luck, and to relieve pain. This case reports aim to elaborate the incidental radiographic finding of charm needle or “susuk” in orthodontic panoramic and lateral cephalometric radiograph.Case Description: There was four adult woman conducted panoramic and cephalometric radiograph as a routine procedure before orthodontic treatment. The number of susuk inserted were varied, as it considered that the more needle increases the magical potency. In Case 1, the panoramic image depicts one “susuk” in the middle of the root of 44 (FDI notation) tooth. Besides, the cephalometric radiographs also show a “susuk” horizontally inserted at the root of the anterior lower teeth area. The panoramic image reveals one susuk around chin area below the apex of 42 teeth on Case 2 as well as on the soft tissue chin area in front of the apex of 41 teeth on cephalometric radiographs. In Case 3, two “susuk” were found inserted bilaterally symmetric at the upper premolar area by the panoramic image. Then, five “susuk” in the mandible and four “susuk” at the upper area of the maxilla were found in Case 4 by the panoramic image. Conclusion: The susuk are often exposed as incidental findings in panoramic and lateral cephalometric radiographs that are taken before performing routine orthodontic treatments. Understanding the presence of susuk is essential to avoid misdiagnosis and mismanagement and help radiologists to prevent confusion while interpreting images.

Radiographic findings in panoramic radiographs of patients attending Kulliyyah of Dentistry, IIUM

This research was done to study the radiographic finding of the jaws amongst the patients attending at the polyclinic using Orthopanthomograph (OPG). The OPG was taken using the Planmeca Promax 3D and the Planmeca Romexis software (Version 2.1.1.R). The first step was collecting all the OPG images from 1st April 2009 until 31st January 2011. Then, the abnormal radiographs were further divided into 3 groups which were radiolucent, radiopaque and mixed. This classification includes site, size, border, and possible diagnosis as part of the lesion`s appearance. One thousand four hundred and five OPG images were retrieved, 96 images were discarded because of poor quality. The data collected were analyzed statistically by using SPSS Version 16.0. Among 77 abnormal radiographic images, 41 images were radiopaque, 30 images were radiolucent and 6 images were mixed. Out of 77 abnormal images, 34 images that showed bone lesion were from male patients while the rest which was 43 images from female. In conclusion, most of the pathological lesion occur in the mandible.

Supernumerary teeth of permanent dentition in patients with neurofibromatosis type 1

PurposeThe purpose of the study was the investigation of supernumerary teeth (ST) in the permanent dentition of patients with neurofibromatosis type 1 (NF1). Material and methodsThe panoramic radiographs of 200 NF1 patients were analysed for ST. The potential impact of certain neurogenic facial tumours on the measured variable was investigated separately. The results were compared to dental findings in panoramic radiographs of 200 age- and sex-matched controls. ResultsThe total number of ST in all individuals was 23 in 12 patients (3% of total population). However, all ST had developed in the group of NF1 patients (6%), (p = 0.0004). ST were particularly common distal to the molar region. Although ST occur in the region of facial plexiform neurofibroma, the numerical aberrations of the dentition are independent of specific type of facial nerve sheath tumour. ConclusionThe unusual accumulation of ST in the terminal sections of molar development could be an indicator of preferred points of developmental disorder, in which the genetic predisposition of the patient is involved. Reviewing the results of other NF1 patient collectives is desirable.

An overview of radiological manifestations of acquired dental developmental disturbances in paediatric head and neck cancer survivors.

In paediatric cancer survivors treated with chemotherapy and radiotherapy therapy, late effects on dental development are quite common. Oral radiologists are not familiar with the radiographic images of these specific dental consequences of chemotherapy and radiotherapy. With the goal of educating colleagues, to raise awareness of the needs of survivors, and to identify directions for future research, we present dental radiographs of survivors treated for head and neck rhabdomyosarcoma with chemotherapy and radiotherapy. Also, based on the survivors reviewed, a radiographic inventory of commonly found late dental developmental effects seen in conjunction with treatment is presented. Panoramic radiographic findings of five illustrative cases are presented, from a group of 42 survivors of head and neck rhabdomyosarcoma treated at the Academic Medical Center Amsterdam, The Netherlands over the past 25 years. Five cases showing dental developmental disorders are presented. These cases show an association of the location of the radiation field and the developmental stage of the teeth with the severity of the effect on dental development. We also report an inventory of severe and moderate effects of chemotherapy and radiotherapy on the development of molars and anterior teeth. This paper presents five cases and a radiographic inventory to illustrate disturbances of dental development associated with chemotherapy and radiotherapy in children. Medical and dental professionals involved in the treatment of cancer survivors are relatively unaware of the dental consequences of radiation therapy and the age dependency of specific regional effects. These effects can be severe, with great impact on quality of life. Further research in this area could help improve planning of radiation therapy for children, potentially preventing or limiting dental or maxillofacial sequelae.

Prevalence of Soft Tissue Calcifications in Panoramic Radiographs of Patients Referred to Guilan School of Dentistry Within 1 Year and its Relationship With Systemic Diseases

Background: Soft tissue calcifications are the deposition of calcium salts, mainly calcium phosphate, in soft tissue. They most often are detected as incidental findings during radiographic examinations. The goal is to identify them correctly to determine whether treatment is required. The aim of this study was to investigate the prevalence of soft tissue calcifications in panoramic radiographs and their relationship with age, gender and underlying diseases. Methods: In this descriptive cross-sectional study, panoramic radiographs of 654 patients were examined within one year. The prevalence of soft tissue calcification, their location and certain factors such as age, sex, underlying disease were examined. Results: The prevalence of elongated stylohyoid ligament calcification, laryngeal cartilage calcification, carotid artery calcification, lymph node calcification, and sialolith were 20.2%, 9.8%, 2.4%, 1.8%, 0.6%, and 0.1%, respectively. Stylohyoid ligament and vascular calcifications were significantly correlated with cardiovascular disease and hypertension. Gender and soft tissue calcification were not significantly associated. The prevalence of tonsillolith was significantly higher in men (P=0.0001). A significant correlation was found between soft tissue calcification and age groups, so that as age increased, the prevalence of carotid artery calcification, stylohyoid ligament calcification, and tonsillolith increased. Conclusions: The present study shows that soft tissue calcifications are not unusual findings in panoramic radiographs. They increase significantly with aging but have no significant association with gender. The prevalence of soft tissue calcification is higher in cardiovascular disease patients.

Evaluation of dental health and thickness of mandibular inferior cortex among menopaused Iraqi cigarette smokers sample by the aid of using digital panoramic radiography

Smoking is linked to osteoporosis through its anti-estrogenic effect in womenwhich results in premature menopause in smokers and increased bone resorption iscorrelated with estrogen loss in menopause women. The aim of this study is toevaluate the effects of smoking and hormonal changes on the thickness of mandibularinferior cortex and the dentition status in both maxilla and mandible (DMFT) inmenopausal females and to estimate the value of panoramic radiographic findings inassessing the possibility of latent osteoporosis. Panoramic images for 80 healthy,median stature, smokers and non-smokers Iraqi female subjects aged (20-35) yearspremenopausal and (45-60) years menopause was done, then the thickness ofmandibular inferior cortex and (DMFT) was evaluated. The results showed thatpanoramic radiographic measurements are considered as indicator of bone turnoverand the dentist is able to identify smokers and non-smokers postmenopausal femaleswith increase risk of osteopenia and osteoporosis by using dental panoramicradiography which is a simple valuable screening tool.

Incidental Findings in Pretreatment and Post-Treatment Orthodontic Panoramic Radiographs

Panoramic radiographs are the most requested imaging exams in dentistry and an essential part of the documentation used by orthodontists in treatment planning Alterations that modify bone density and the trabecular bone pattern can be finding in panoramic radiographs before and after the orthodontic treatment Furthermore the transition between the mixed to the permanent dentition is a complex process that can incur in fails and odontogenic anomalies The identification of incidental findings that may demand specific dental or medical treatment is important to provide satisfactory dental care Material and methods The aim of this study was to evaluate panoramic radiographs obtained before and after the orthodontic treatment in order to identify the most prevalent incidental findings Five hundred panoramic radiographs pretreatment and post treatment from patients between eleven and eighteen years old obtained between and were selected from the archives of the Department of Orthodontics Bauru School of Dentistry University of S atilde o Paulo The image analysis was performed by one single examiner Results The incidence of impacted teeth and supernumerary teeth was significant higher in the pretreatment group p lt The incidence of root dilacerations osteosclerosis and the presence of orthodontic retainers was significant higher in the post treatment group p lt Apical remodeling in the incisors was observed in patients in the post treatment group Conclusion In conclusion clinical relevant incidental findings were observed in both groups Special care should be taken while evaluating post treatment radiographs to diagnosis alterations that may require intervention or interfere in other dental treatments

Does Darkening of Roots or Loss of White Line on Panoramic Radiographs Pose a Risk for Inferior Alveolar Nerve Damage? A CBCT Evaluation

Introduction: Surgical removal of impacted mandibular third molars may cause dysesthesia due to damage to the inferior alveolar nerve (IAN), and the risk increases when there is direct contact between the nerve and the tooth root. An accurate preoperative radiographic examination using Cone beam computed tomography (CBCT) provides precise information pertaining the relationship between the third molar roots and the inferior alveolar canal. Aim & Objective: This study was intended to correlate the two panoramic radiographic findings in predicting the absence of corticalization between the mandibular canal and the third molar on cone beam computed tomography (CBCT) images and to evaluate the possibility of inferior alveolar nerve (IAN) injury. Materials and Methods: The study was conducted on 60 patients, who were divided into two groups of 30 each. Group I included 30 patients whose panoramic radiographic findings showed darkening of the root of impacted mandibular third molar. Group II included 30 patients whose panoramic radiographic findings showed interruption of white line of mandibular canal. The patients whose panoramic radiographic findings showed darkening of the root or interruption in the white line of the canal were subjected to CBCT examination. Surgical removal of impacted mandibular third molar in all the patients was performed under local anesthesia (LA). Evaluation for any nerve injury was performed and recorded as presence or absence of paresthesia at regular postoperatively. Results: The results of this study showed that 46.7% patients had absence of cortication in Group I (darkening of roots), whereas it was absent in 33.3% of patients in Group II (loss of white lines). Presence of cortication was seen in 53.3% of patients in Group I when compared to 66.7% in Group II. The difference between the groups was not found to be statistically significant. Conclusion: Darkening of roots and interruption of white line observed on panoramic radiographs, both as isolated findings and in association, were effective in determining the risk relationship between the tooth roots and the mandibular canal necessitating CBCT evaluation.

Jaws and Dental Panoramic Radiographic Findings in the Elderly in Kerman, Iran

Jaws and Dental Panoramic Radiographic Findings in the Elderly in Kerman, Iran

Objectivity and reliability of panoramic radiographic signs and cone-beam computed tomography in the assessment of a superimposed relationship between the impacted mandibular third molars and mandibular nerve: A comparative study

Aim: To evaluate the relationship between panoramic radiographic signs and cone-beam computed tomography (CBCT) in the assessment of a superimposed relationship of the impacted mandibular third molars and mandibular canal. Materials and Methods: Panoramic and CBCT images were evaluated independently to assess the relationship between the mandibular canal and the impacted mandibular third molar roots by two oral and maxillofacial radiologists. The results were tabulated and the association of panoramic radiographic and CBCT findings was analyzed using Chi-square test and Fisher's exact test. All of the analyses were carried out with PASW Statistics 18.0. Results: Panoramic radiographic findings were statistically significant with CBCT findings (P < 0.01). Cases of darkening roots without interruption and lingual cortical perforation suggested more frequent buccal placement of mandibular canals. Cases of darkening roots with interruption and complete lingual cortex perforation suggested more frequent lingual placement of mandibular canals. Conclusion: The results of the present study suggest that, although panoramic radiography is an effective method for preoperative evaluation prior to mandibular third molar extraction, its predictability is low with regards to the emergence of nerve lesions. Therefore, it is mandatory to know the true three-dimensional imaging relationship between the mandibular canal and impacted mandibular third molars. Thus, CBCT is the best method for risk assessment and planning prior to surgical procedures to prevent inferior alveolar nerve injury.