Lamina Dura Research Articles

Efficacy of Chitosan in promoting wound healing in extraction socket: A prospective study

PurposeChitosan has been shown to promote wound healing and induce bone formation. The aim of this split-mouth study was to evaluate the effectiveness of chitosan based dressing in wound healing after lower third molar extraction. MethodAsymptomatic symmetrical mandibular third molars were extracted simultaneously in 27 patients and Chitosan dressing was placed into the extraction socket in the test side. Pain scores were recorded on VAS using a 0 to 10 pain score. Wound healing was compared between right and left side. Radiographic findings were evaluated by observing lamina dura and density of extraction socket. ResultsTest group had more pain than control at all time intervals and unerupted tooth sites showed mean pain score significantly more than erupted tooth sites. Test group was superior to control in event of wound healing. Healing was significantly better in erupted tooth than unerupted tooth. At second week 12 sites showed better radiographic findings in chitosan treated group compared to 3 sites in the control group. At third month, 14 sites showed improved bone formation in chitosan treated group compared to 4 in control group. None of the unerupted teeth group showed better radiographic finding in test side at 2 week and 3 month compared to erupted teeth group. ConclusionChitosan is effective in promoting wound healing and early osteogenesis in erupted tooth socket after extraction. We recommend that chitosan dressing should be used in the sockets of erupted tooth after extraction but should be avoided in unerupted or impacted teeth cases.

Prevalence of radiographic findings on jaws exposed to antiresorptive therapy: a meta-analysis.

Determine the prevalence of radiographic findings (RF) on both jaws among patients receiving antiresorptive bone therapy. Six electronic databases and partial grey literature were searched. Data was collected based on predetermined criteria. The key features from the included studies were extracted. The MAStARI tool assessed the potential risk of bias (RoB) among the studies, while the GRADE approach determined the level of evidence. 29 studies were identified and included in the qualitative analysis, totalling 1133 patients. 27 studies had sufficient data to be included in a series of meta-analysis reporting 12 types of radiographic findings, and were split in two groups based on their study design. G1 comprised descriptive observational studies and G2 analytical cross-sectional studies. Two studies presented a high RoB, 16 had a moderate RoB, and 11 had low RoB. The overall level of evidence identified was very low. The most frequent RF were mixed lytic-sclerotic areas (73.88%), followed by osteolytic changes (66.18%), osteosclerosis (65.75%), cortical bone erosion (50.83%), persisting alveolar socket (45.77%), periodontal ligament (PDL) widening (44.69%), and inferior alveolar canal (IAC) involvement (43.40%). Less frequent, but equally important, were the periosteal reaction (34.27%), lamina dura thickening (32.97%), sequestrum (29.94%), pathologic fracture (20.90%), and density confluence of cortical and cancellous bone (16.61%). 20 patients reported no signs. RF prevalence was high and mainly included mixed lytic-sclerotic areas, osteolysis, osteosclerosis, cortical bone erosion, persisting alveolar socket, PDL-widening, IAC-involvement. Due to the very low level of evidence (GRADE) caution should be exercised when considering these findings.

Oral Manifestations of Secondary Hyperparathyroidism: A Case Report and Literature Review

A 52-year-old male with secondary hyperparathyroidism resulting from polycystic kidney disease, undergoing dialysis for 18 years, is documented. The case showed radiographic mandibular bilateral osteolytic lesions with ground glass appearance, diminished lamina dura, maxillary horizontal bone loss, but no maxillofacial expansion. Additionally, cases of hyperparathyroidism are reviewed to associate oral radiographic features with disease severity. The review suggests that in secondary hyperparathyroidism: 1) jaw demineralization, lamina dura loss, and osteolytic lesions occur with varying consistency depending on disease stage; 2) there is no gender predilection of oral manifestation occurrence; and 3) with advancing age, lamina dura changes may occur with increasing frequency. CPD/Clinical Relevance: This article discusses the oral radiographic signs and symptoms that present in patients with secondary hyperparathyroidism.

Primary Hyperparathyroidism Caused by Single Parathyroid Adenoma

Primary hyperparathyroidism is rarely found in children under sixteen years old. We report the first case seen at the Department of Child Health, Medical School, University of Indonesia, Jakarta. This 15-year old girl was admitted to the Department, referred by an orthopedic surgeon because of pathologic fractures suspected to be caused by hyperparathyroidism. The physical examination was unremarkable, and the laboratory findings showed increased level of parathyroid hormone. Roentgenologic examination showed lytic skull lesions, loss of the lamina dura of the dentis, subperiosteal resorption of the symphysis and generalized osteoporosis with pathologic fractures. Color Doppler USG using a high resolution ultrasound examination was performed to find the etiology of primary hyperparathyroidism. The result revealed single parathyroid adenoma in the right superior region measuring 2.7 x 1.7 x 1 cm. The clinical manifestation and laboratory findings showed improvement following surgery.

Determination of optimum exposure parameters for dentoalveolar structures of the jaws using the CB MercuRay system with cluster signal-to-noise analysis

To determine the optimum cone beam computed tomography exposure parameters for specific diagnostic tasks. A Teflon phantom attached to a half-mandible in a large container was scanned in dental (D), implant (I), and panoramic (P) modes. An identical phantom in a small container was scanned in D mode. Both were scanned at 60, 80, 100, and 120kV. We evaluated the image quality of five anatomical structures [dentinoenamel junction (1), lamina dura and periodontal ligament space (2), trabecular pattern (3), cortex-spongy bone junction (4), and pulp chamber and root canal (5)] and analyzed the diagnostic image quality with cluster signal-to-noise analysis. We then evaluated correlations between the two image qualities and calculated the threshold of acceptable diagnostic image quality. Optimum exposure parameters were determined from images with acceptable diagnostic image quality. For the small container, the optimum exposure parameters were D mode, 80kV for (1), (3), and (4) and D mode, 100kV for (5). For the large container, they were D mode, 120kV for (1), (3), and (5) and D mode, 100kV for (4). I mode, 120kV reached the acceptable level for (4). No images reached the acceptable level for (2). No optimum exposure parameters were identified for the evaluation of the lamina dura and periodontal ligament space. D mode was sufficient for the other structures; however, the tube voltage required for each structure differed. Smaller patients required lower tube voltage. I mode, 120kV may be used for larger lesions.

Evaluation of radiomorphometric indices and bone findings on panoramic images in patients with scleroderma

The aim of this study was to make radiomorphometric measurements on panoramic images and evaluate the radiologic findings of bones and teeth in patients with scleroderma. Panoramic images of 49 patients with scleroderma and 51 healthy controls were assessed. Mandibular radiomorphometric indices, including mandibular cortical index (MCI), mental index (MI), panoramic mandibular index (PMI), gonial index (GI), and antegonial index (AI), were determined. Furthermore, mandibular osteolysis, changes of periodontal ligament (PDL) space and changes in the lamina dura were recorded for the scleroderma group. Statistically significant differences were found for MCI (P = .003), MI (P = .001), and PMI (P < .001) between the scleroderma and control groups, but not for GI or AI (P > .05). Widening of the PDL space (79.6%), thickening of the lamina dura (44.9%), limited mouth opening (71.4%), and osseous resorption of the mandible (8%) were detected in the scleroderma group. The radiomorphometric indices determined in the present study can be used on panoramic images to identify the existence of a porous structure in the mandibular cortical bone in patients with scleroderma. The most common prevalent oral radiographic manifestations of scleroderma were widening of the PDL space and of the lamina dura.

Primary Intraosseous Carcinoma, Not Otherwise Specified, of the Gnathic Bones: Report of Two Cases

Primary intraosseous carcinoma, NOS (PIOC) is a rare central jaw carcinoma, not classified as any other type of carcinoma, with a suggested odontogenic origin. Here, we present 2 additional cases of PIOC. A 39-year-old man presented with an irregular asymptomatic swelling in the anterior upper vestibule and palate and palpable fixed lymph nodes. Periapical radiography analysis revealed an ill-defined unilocular radiolucency in the periradicular region of endodontically treated maxillary incisors with irregular root resorption. The second case involved a 35-year-old man presenting with an asymptomatic, unilocular, ill-defined radiolucency superimposed on the mandibular molars roots, with loss of lamina dura. Microscopically, both the cases showed small islands of neoplastic epithelial proliferation with cellular atypia and keratinization, confirming the final diagnosis of PIOC. Patients were referred to an oncology service. Clinicians should consider PIOC when evaluating an ill-defined radiolucency in tooth-bearing areas of gnathic bones of young adults.

Medication Related Osteonecrosis of the Jaw: Basic Research and Clinical Practice for Prevention and Treatment by Ultrasound/Laser Pulsation

Objective: The latest survey by Japanese Society of Oral and Maxillofacial Surgeons suggested that the number of medication related osteonecrosis of the jaw (MRONJ) patients who received oral bisphosphonate, mostly for postmenopausal osteoporosis, may exceed that by intravenous bisphosphonate for cancer treatment. Consequently, the number of female patients with MRONJ can be 3 times that of male in Japan. The predominance of oral bisphosphonate related cases is more apparent in Korea. MRONJ treatment by laser including that by low level laser (LLLT) is uncommon in Japan partly because of insufficient referrals and collaboration between medical and dental professionals. Here, we evaluated the potential and prospective effectiveness of low-intensity pulsed ultrasound (LIPUS) treatment for MRONJ in terms of translational research. Materials and Methods: Primary pathophysiology of MRONJ described in the revised position paper (2016) by the allied task force committee of 6 Japanese societies was listed and used as outcome measures to compare the following therapeutic methods: LIPUS, LLLT, parathyroid hormone (PTH) and cellular transplantation in a review of laboratory and clinical (PTH and LLLT) studies. Results: Characteristics of periodontal lesions observed in early stages, including periosteal reaction, thickening of lamina dura and persisting alveolar sockets, were all prevented by LIPUS treatment in model rat experiments. Discussion: While half of patients diagnosed as stage 0 may have been overdiagnosed, not progressing to later stages, it remains important to diagnose and treat early stage patients to prevent deterioration of their condition. Non-invasive LIPUS treatment prevented all early symptoms of MRONJ and is promising as a preventive measure for MRONJ.

Radiographic Interpretation Skills of Clinical Dental Undergraduates Studying in Karachi, Pakistan

Radiographs facilitate dentists to envision diseases of the teeth and neighboring tissues that cannot be visualize through a clinical oral examination. A competent authority, in Pakistan for approving and monitoring dental curricula – Pakistan Medical and Dental Council has set 5 hours for didactic and clinical teaching of oral radiology to undergraduate dental students. This study has been planned to confirm whether the undergraduate students acquire the obligatory knowledge and interpretation competency or not within the stipulated time for oral radiology teaching. Material and Methods: A pretested power point presentation was shown to the clinical undergraduates present on the day of the evaluation. Among the twelve slides presented, seven slides contained radiographs showing basic pathological lesions like caries, bone loss, periodontal pocket, apical radiolucency and amalgam restoration opacity & five slides showed radiographs with anatomical structures; enamel, lamina dura, PDL, mental foramen and inferior alveolar nerve. The responders were asked to answer with anonymity on provided response sheets. Results: A total of N=97 students took part in the study; n=43 were from third year of Bachelors of Dentistry tenure and n=54 were from the final year. Apical radiolucencies, PDL spaces, and mental foramina were the toughest to identify for most of the participants involved whereas it was considerably too easy for both groups to radiographically report caries, missing teeth, and amalgam restorations. Conclusion: Despite very easy interpretation skill assessment, none of the student could score 100% marks revealing some weakness in radiology teaching which could be attributed to lesser number of teaching hours allocated for oral radiology.

The Effect of Original and Invert Enhanced Panoramic Modality on the Assessment of the Relationship Between the Maxillary Posterior Roots and the Maxillary Sinus Floor

Background: Having knowledge about the anatomical and pathological relationship between the maxillary posterior root tip and the maxillary sinus floor is very significant for preoperative treatment planning. Aims and Objectives: The purpose of the present study was to compare the accuracy of original panoramic radiographs and digital panoramic images over cone beam computed tomography (CBCT) images in evaluating the relationship between the maxillary posterior teeth and the maxillary sinus floor, and to verify the accuracy of the signs of the relationship between the roots of the maxillary posterior teeth and maxillary sinus on the panoramic radiographs over CBCT images. Materials and Methods: From 106 subjects (47 males and 59 females; mean age = 39 years; range = 18-67 years) referred to our university, a pair of panoramic and CBCT images was selected for further analysis. The relationship between the maxillary posterior teeth, the maxillary sinus, and panoramic radiography signs (root projection into the sinus, interruption of the maxillary sinus floor cortex, absence of lamina dura, darkening of the root apex, and curvature of the sinus floor on the root apex) associated with the protrusion of root apexes into the sinus was evaluated. Results: The P values of the data obtained from the original and invert enhanced panoramic images were .53 and .52, respectively, and there was no statistically significant difference in the accuracy of the 2 methods ( P &gt; .05). Conclusion: The root projection into the sinus is an indicative sign of root protrusion into the sinus on CBCT.

Radiographic patterns of multiple myeloma in the jawbones of patients treated with intravenous bisphosphonates

BackgroundThe purpose of this study was to evaluate whether intravenous (IV) bisphosphonate (BP) therapy can change the radiographic patterns of multiple myeloma (MM) in the jawbones. MethodsThe authors evaluated panoramic radiographs obtained from 188 patients with MM for the presence of solitary osteolytic lesions, multiple osteolytic lesions, diffuse osteoporosis, diffuse sclerosis, lamina dura abnormalities, nonhealing alveolar sockets, and bone sequestration. The authors compared results obtained from patients treated with IV BPs with those obtained from patients who had never been exposed to BPs. ResultsMultiple osteolytic lesions (P = .001), diffuse osteoporosis (P = .001), and diffuse sclerosis (P = .0036) occurred more often in the mandible in both groups. Solitary osteolytic lesions occurred less frequently in the BP group (P = .0078). Lamina dura abnormalities (P = .0006) and nonhealing alveolar sockets (P = .0021) were associated with BP treatment. ConclusionsIV BP therapy changes the radiographic patterns of MM in the jawbones. Practical ImplicationsThe effect of BPs in the maxillofacial area is a matter of concern for health practitioners because this type of medication causes several alterations of the jawbones in patients with cancer.

Radiographic alveolar bone morphology and progressive periodontitis.

This study evaluated the relationship between radiographic crestal alveolar bone morphology and progressive periodontitis. A total of 1,356 posterior interproximal sites in 56 adults treated for chronic periodontitis and receiving systematic 3-month maintenance care were scored for angular or horizontal marginal bone morphology, as well as for alveolar crestal lamina dura, on radiographs obtained at baseline of a 30-month post-treatment period. Semi-annually, the study patients were clinically evaluated for progressive periodontitis. Logistic regression analysis assessed baseline parameters to progressive periodontitis over the 30-month post-treatment period. Progressive periodontitis was detected at 33 (2.4%) posterior interproximal sites in 20 (35.7%) patients. Sites with post-treatment angular bony defects developed progressive periodontitis more frequently (14.7%) than sites with a horizontal bone topography (1.8%). Angular bony defects (odds ratio=10.6) and periodontal probing depths ≥5mm (odds ratio=4.2) were identified as statistically significant independent predictors of progressive periodontitis at posterior interproximal sites. Angular bony and horizontal lesions with intact radiographic lamina dura revealed an absence of progressive periodontitis through 24 months. Post-treatment presence of angular bone morphology and periodontal probing depths ≥5mm significantly increased risk of progressive periodontitis at posterior interproximal sites. Sites of all morphology and probing depth that displayed radiographic crestal lamina dura at post-treatment baseline exhibited clinical stability for ≥24 months.

Brown Tumour in the Mandible and Skull Osteosclerosis Associated with Primary Hyperparathyroidism – A Case Report

BACKGROUND:The hyperparathyroidism (HPT) is a condition in which the parathyroid hormone (PTH) levels in the blood are increased. HPT is categorised into primary, secondary and tertiary. A rare entity that occurs in the lower jaw in association with HPT is the so-called brown tumour, which an osteolytic lesion is predominantly occurring in the lower jaw. It is usually a manifestation of the late stage of the disease. Osteosclerotic changes in other bones are almost always associated with renal osteodystrophy in secondary HPT and are extremely rare in primary HPT. This article reports a rare case of a brown tumour in the mandible as the first sign of a severe primary HPT, associated with osteosclerotic changes on the skull.CASE REPORT:A brown tumour in the mandible was diagnosed in 60 - year old female patient with no previous history of systemic disease. The x - rays showed radiolucent osteolytic lesion in the frontal area of the mandible affecting the lamina dura of the frontal teeth, and skull osteosclerosis in the form of salt and pepper sign. The blood analyses revealed increased values of PTH, calcitonin and β – cross-laps, indicating a primary HPT. The scintigraphy of the parathyroid glands showed a presence of adenoma in the left lower lobe. The tumour lesion was surgically removed together with the lower frontal teeth, and this was followed by total parathyroidectomy. The follow - up of one year did not reveal any signs of recurrence.CONCLUSION:It is critical to ensure that every osteolytic lesion in the maxillofacial region is examined thoroughly. Moreover, a proper and detailed systemic investigation should be performed. Patients should undergo regular check-ups to prevent late complications of HPT.

Evaluation of permanent premolars intended for endodontic treatment in term of root number &amp; form, condition of periapical area and state of lamina dura (Radiographic survey).

The radiographic film serves an extremely important need in detecting disease process that affects the tooth and its surrounding structures. The aim of the present study is to take a radiographic view to determine root number and form, condition of the periapical area and state of the lamina dura for permanent premolar teeth intended for root canal therapy. One hundred ninety radiographs representing the step of working length determination for permanent premolars intended for root canal therapy were selected from a number of private clinics in Baghdad. Results of this study shows that 52.1 % of the endodontically treated teeth having curvature free roots, while 47.9 % of them were presented with curved roots, most of teeth 94.2% were free of periapical lesions and lamina dura was absent in 65.8 % of the teeth.

Effects of artifact removal on cone-beam computed tomography images

Dental implants and metal fillings may cause artifacts in cone-beam computed tomography (CBCT) images and reduce image quality and anatomic accuracy. The purposes of this study are a subjective evaluation of anatomic landmarks and linear bone measurements after applying artifact removal (low-medium) option on CBCT images. In this cross-sectional study, thirty CBCT images from thirty qualified patients were selected in a private radiology center. Low and medium artifact removal was applied to images. Three radiologists assessed the visibility of the mandibular canal, mental foramen, and lamina dura in images. Crestal width and bone length were also measured in three groups of images and was compared by exact McNemar test. ICC test (two-way random model, absolute agreement types) was calculated for comparison of linear bone measurements in three images groups. P ≤ 0.05 was considered statistically significant. Percent agreement of determining mental foramen (outline and location), mandibular canal (outline and location), and lamina dura between three groups of images were 100%, 100%, 83.3%, 96.7%, and 56.6%, respectively. The results of exact McNemar test revealed that medium artifact removal group had a statistical difference in lamina dura observation with none and low artifact removal groups (P < 0.001). Intraclass correlation coefficient showed no statistical differences in crestal width and bone length between groups (P < 0.001). Applying artifact removal does not affect the visibility of large anatomical structures and linear bone measurements, but delicate structures such as lamina dura may become less clear after artifact removal.

Healing Potential of Platelet Rich Fibrin in Impacted Mandibular Third Molar Extraction Sockets.

Background:Healing of both hard and soft tissues have become one of the great challenges, faced in clinical research in development of bioactive surgical additives responsible for regulating inflammation and increasing healing. Platelet-rich fibrin (PRF) represents a new step in the platelet gel therapeutic concept with simplified processing minus artificial biochemical modification.Aims and Objectives:The aim of this study is to evaluate the effectiveness of PRF on soft-tissue healing and bone tissue healing in terms of postoperative pain, postoperative swelling, soft tissue healing, and the quality of bone healing at the mandibular third molar socket.Materials and Methods:A clinical study will be done on patients reporting to the Department of Oral and Maxillofacial Surgery in Government Dental College, Srinagar, requiring disimpaction of bilateral mesioangular impacted mandibular third molars in 60 patients.Results:The present prospective clinical study evaluates the effect of PRF in healing of mandibular third molar extraction sockets. There was no difference in the age gender and type of impaction between the two groups as the mean postoperative pain score (visual analog scale) was lower for the PRF group (Group A) at all points of time when compared with the control (Group B), and this was statistically significant (P < 0.05). The mean percentage swelling was lower for the PRF group (Group A) at all points of time when compared with the control (Group B). Evaluating the effect of treatments (with or without PRF) on lamina dura score shows that in both the groups at different time periods, significant (P < 0.001) difference was observed on lamina dura score.Conclusion:The results of the present study suggest that application of autologous PRF gel has a beneficial effect on the healing of extraction sockets after third molar surgery.

Dental radiography image enhancement for treatment evaluation through digital image processing.

BackgroundEvaluation of dental treatment is performed by observing dental periapical radiography to obtain information of filling’s condition, pulp tissue, remain dentin thickness, periodontal ligament, and lamina dura. Nevertheless, the radiographic image used often has low quality due to the level of x-ray radiation made low purposely in order to prevent health problem and limited tools capability. This low quality of the radiographic image, for examples, low image contrast, less brightness, and noise existence cause periapical radiography evaluation hard to be performed. This study aims to improve dental radiographic image quality for assisting pulp capping treatment evaluation.Material and MethodsThe research methodology consists of three main stages, i.e. data collection, image enhancement method production, and result validation. Radiographic image data collection in The Dental Hospital UMY. Image enhancement method has been conducted by comparing several methods: contourlet transform (CT), wavelet transform, contrast stretching (CS), and contrast limited adaptive histogram equalization (CLAHE) to reduce noise, to optimize image contrast, and to enhance image brightness.ResultsThe result of this study is according to mean square error (MSE) and peak signal to noise ratio (PSNR) statistics evaluation, it obtains that the highest scores of MSE and PSNR in row gained from CT method totaled 5.441453 and 40.53652, followed by CLAHE method with the scores are 10.66326 and 38.00736, CS method whose scores are 12.39881 and 39.18518, and the last is wavelet method with the scores are 15.41569 and 36.25343.ConclusionsNonetheless, MSE and PSNR scores are not enough merely to give a recommendation of any suitable methods for improving contrast, therefore, it needs another success parameter coming from the dentist. Key words:Dental radiography, image enhancement, digital image processing.

Hypercementosis: A case report and review

Hypercementosis (cemental hyperplasia) is a non-neoplastic deposition of excessive cementum that is continuous with the normal radicular cementum. Although some cases of hypercementosis are idiopathic, this condition is associated with several local and systemic factors such as supraeruption of a tooth, inflammation at the apex of a tooth, traumatic occlusion, Paget's disease, etc. Radiographically, affected teeth demonstrate a thickening or blunting of the root. The enlarged root is surrounded by the radiolucent PDL space and the adjacent intact lamina dura. The histologic study of teeth with hypercementosis shows that the cementum formed is usually osteocementum (acellularcementum). Patients with hypercementosis require no treatment. This article discusses a case report of hypercementosis of maxillary molar teeth and its management.

Autotransplantation of mature and immature third molars in 23 Chinese patients: a clinical and radiological follow-up study

BackgroundWe investigated the clinical and radiographic outcomes of autotransplanted teeth over a follow-up period of 2 to 8 years, and summarize the findings of other relevant studies with regard to the primary factors that influence a good prognosis in such patients.MethodsTwenty-three patients (6 men, 17 women) who attended Tanggu Stomatological Hospital, Tianjin, China, from 2008 through 2013, were included in the study. These patients presented with a variety of dental problems, including tooth loss, residual crowns, missing first or second molars, dental trauma, tooth fracture, and unrestored teeth. A total of 26 third molars, including 2 immature molars, were autotransplanted in these patients. The success rate of autotransplantation was assessed on the basis of clinical and radiographic outcomes after follow-up periods ranging from 2 to 8 years.ResultsClinical examination revealed stability of all 26 transplanted teeth, with satisfactory masticatory function and no patient discomfort. Radiographic examination revealed normal periapical tissues and an intact lamina dura surrounding the tooth root, indicating adequate healing of periodontal tissues.ConclusionsAutotransplantation achieved good results in the Chinese sample population investigated, and was associated with an excellent prognosis. Rigorous case selection, adequate protection of the periodontal ligament, and proper oral hygiene contribute significantly to the long-term success of the procedure.

Juxta-Apical Radiolucency: Prevalence, Characterization, and Association With the Third Molar Status

This study aimed to investigate the prevalence of juxta-apical radiolucency (JAR), assessing its association with third molar status and describing its radiologic features through panoramic radiography. We evaluated 1,050 radiographs (1,830 third molars) for the presence of JAR. The JAR and control groups were classified according to the third molar's angulation, impaction, and root development. The presence of radiographic signs of proximity between the mandibular canal and third molar and the imaging features of JAR also were recorded. JAR was identified in 116 patients (11%) and 130 third molars (7.1%), being significantly associated with female patients and with the second and third decades of life. There also was an association with teeth with a vertical angulation and complete root formation. Radiographic signs of proximity to the mandibular canal were absent in 66.2% of JAR cases. In most cases, there was lamina dura in the juxta-apical area that appeared to overlap the mandibular canal and to have a cortical outline. JAR is not a rare imaging finding. Given its possible relationship with nerve injuries and its differential diagnostic possibilities, knowing the characteristics of JAR is important to assist professionals in treatment planning and making the correct diagnosis.