Maxillofacial Radiology Research Articles

Idiopathic osteosclerosis of the jaws on panoramic radiograpic analysis in Indonesian Sub-Population

Objective: To determine prevalence of Idiopathic osteosclerosis (IO) by radiographic evaluation and to investigate the relationship between the finding in relation with age, gender and location in Indonesia Sub-Population.
 Material and Methods: this was a cross-sectional study that panoramic radiograph of patients (1030 male and 1914 female) whose age range 10-82 years old and who visited Department of Oral and Maxillofacial Radiology Hasanuddin University Dental Hospital from 2017 and 2020. We evaluated group of age, location, appearance and occurrence of IO and analyzed using chisquare test.
 Results: in total, 2944 panoramic radiographs were examined, IO found in 144 (4.8%) patients and 170 IO’s were detected. IO detected mostly in mandible than maxilla (p<0.005) where premolar and molar area was the most common location of IO (42.3% and 41.7%; respectively). Most of cases was solitary lesion (<0.005) and unilateral (<0.005). In addition, most of IO separate from teeth (45.8%) and also related with periapical site (35.3%).
 Conclusion: Idiopathic Osteosclerosis can defined as developmental variation that can occur in any age range, no predilection of sex. The frequency of IO in Indonesia Sub-population is slightly lower than other country

Design and construction of a wireless robot that simulates head movements in cone beam computed tomography imaging

AbstractOne of the major challenges in the science of maxillofacial radiology imaging is the various artifacts created in images taken by cone beam computed tomography (CBCT) imaging systems. Among these artifacts, motion artifact, which is created by the patient, has adverse effects on image quality. In this paper, according to the conditions and limitations of the CBCT imaging room, the goal is the design and development of a cable-driven parallel robot to create repeatable movements of a dry skull inside a CBCT scanner for studying motion artifacts and building up reference datasets with motion artifacts. The proposed robot allows a dry skull to execute motions, which were selected on the basis of clinical evidence, with 3-degrees of freedom during imaging in synchronous manner with the radiation beam. The kinematic model of the robot is presented to investigate and describe the correlation between the amount of motion and the pulse width applied to DC motors. This robot can be controlled by the user through a smartphone or laptop wirelessly via a Wi-Fi connection. Using wireless communication protects the user from harmful radiation during robot driving and functioning. The results show that the designed robot has a reproducibility above 95% in performing various movements.

Prevalence, Radiographic Features and Clinical Relevancy of Accessory Canals of the Canalis Sinuosus in Cypriot Population: A Retrospective Cone-Beam Computed Tomography (CBCT) Study.

Background and Objectives: This retrospective study aims to evaluate the prevalence, radiographic features, and clinical relevancy of the accessory canals (AC) of the canalis sinuosus (CS) in patients referred for implant surgery. Materials and Methods: Cone-beam computed tomography (CBCT) images of the patients were collected and ACs were evaluated. Age, sex, bilateral distribution, localization, diameter, distance to the buccal cortical plate, distance to the crest of the alveolar ridge, terminal ending localization, and the presence of tooth or implant were recorded. Ninety-one patients who were eligible for this study were enrolled. Results: A total of 188 ACs were found in 91 patients with 86 bilateral and 5 unilateral distributions. The mean age of the patients was 45.39. All ACs had a terminal ending at the palatal cortical border. All parameters showed a non-normal distribution; thus, the Mann–Whitney U test was preferred. Bilateral AC distribution (p = 0.761), AC distance to the crest of the alveolar ridge (p = 0.614), AC distance to the buccal cortical plate (p = 0.105), and AC diameter (p = 0.423) showed no significant difference between females and males. According to our study, a CS might be an anatomical structure rather than an anatomical variation, as all patients had at least one AC of the CS. It can be inferred that the detection of ACs will be achievable once clinicians are aware of these structures with continuous regular anatomy reworks and with small voxel-sized CBCT devices. Conclusion: This study was conducted to find the features and prevalence of the CS, and it was found that the CS is an anatomical structure rather than an anatomical variation. This argument is in line with the information on the CS in Gray’s Anatomy, 42nd Edition. Impaired healings and complications of the CS can be avoided if clinicians follow the American Academy of Oral and Maxillofacial Radiology guidelines regarding pre-operative implant examination. Otherwise, avertible complications may cause significant impairments in quality of life.

Retrospective study: Evaluating the positioning errors in digital panoramic radiographs

To produce a panoramic cardiograph with a constant image quality common errors must be kept to a minimum. This study is conducted with an objective to analyse the most prevalent positioning and technical errors in panoramic radiographs.300 Orthopantomograms (OPGs) were taken from January 2020 to December 2021 in the Maxillofacial Imaging centre and they were assessed by three maxillofacial radiologists for analysing positional errors.Using the OHP sheet, all radiographs were viewed on a computer monitor to demarcate the ‘’6’’ Zones. Results showed that around 52 radiographs were error free (17.3%) and 248 radiographs had errors (82.6%). The radiographs having single positional error were 205 (82.66%). The radiographs having two positional errors were 35 (14.1%). The radiographs having three positional errors were 8 (3.2%).The outcome of analysis reveals that percentage of positioning errors in panoramic radiographs is fairly high whichreduce its diagnostic value. The Technicians are made aware of the errors and are instructed to double check the patient’s position before taking radiographs.

Comparison of Eruption Level of Third Maxillary Molars in Cone Beam Computed Tomography and Panoramic Images in Patients Referred to the School of Dentistry of Tabriz University of Medical Sciences in 2017-2020

Introduction: Surgical extraction of third maxillary molar can have serious complications. By identifying the factors influencing the success of maxillary third molars surgery, accidents during surgery as well as postoperative complications can be prevented. Considering that knowledge of eruption level type of maxillary third molars is one of the most important factors in the success of tooth extraction surgery. The aim of this study is to examine and compare the type of eruption level in CBCT () cone beam computed tomography and Panoramic radiographs in the population of patients referred to the Department of Oral and Maxillofacial Radiology, Tabriz School of Dentistry. Materials and Method: This study is a descriptive-analytical cross-sectional study on 395 patients who referred to Tabriz School of Dentistry between 2017 and 2020 and had both CBCT images and panoramic radiographs records. The eruption levels of the maxillary third molars relative to the occlusal plane of the adjacent molars in CBCT and panoramic radiographs were examined and compared by a radiologist based on the Pell & Gregory system. Descriptive statistics and chi-square test were used to report and analyze the data. Results: In this study, on both sides of the maxilla, the most common eruption levels of the third molars in both panoramic and CBCT images were: level A, level B, and level C, respectively. Levels B and C on the left were more common, while on CBCT images levels A and B on the right and surface C on the left were more common. Also, comparison of Eruption Level A, B, C in CBCT and panoramic images showed that the eruption level of the third molar on both sides of the maxilla were significantly different (P <0.05). Conclusion: It is recommended that CBCT images replace panoramic radiographs or be used in conjunction with panoramic radiographs as a reassuring method.

Evaluation of mandibular lingual canal in North Indian population by cone beam computed tomography

A numerous unnamed accessory canals and foramina have been reported in maxilla and mandible, especially on the lingual aspect, at the midline, lateral to the lingual and mental foramina as well as in the canine–premolar region of the mandible. Given all the potential complications that could arise from an undetected accessory canal, pre-operative radiographs are the standard diagnostic means to rule out such variations. Out of many radiographic techniques, cone beam computed tomographyCBCT) is a suitable diagnostic method for accessory canals of the jaw due to good image quality, excellent geometric accuracy and low radiation exposure to patient. The purpose of this study is to evaluate the frequency and distribution of median lingual canal (MLC) in North Indian population by the use of CBCT. A retrospective analysis of 100 CBCT scans of mandible showing anterior region (51 males and 49 females) of patients from North India; ages ranging from 20- 60 years who visited a diagnostic centre were randomly selected for this study. The CBCT scan evaluation was carried with Carestream 3D software. The frequency and distribution of median lingual canal in anterior region of mandible were evaluated. Two oral and maxillofacial radiologists examined all images to analyze the location median lingual canal with respect to gender and age.Statistical analysis was performed using SPSS software to determine the frequency and distribution of median lingual canal. About 100 patients (male = 51 and female = 49) shows the presence of median lingual canal with prevalence rate of 100%.Only one patient shows three canals. MLC was observed in all 100 cases with prevalence rate of 100%. The study shows the maximum prevalence of two MLC i.e. 60.0% among all. The maximum number of one MLC was present in female cases and maximum number of two MLC was present in male cases. 1MLC was maximum in the age group of 51–60 years, while the 2 MLC and 3 MLC canal was maximum in the age group of 41–50 years of total 100 scans respectively. Statistically, no significant differences were observed in the presence of MLC between gender and among various age groups. The prevalence of MLC near to 100% mandates a thorough radiographic analysis prior to any surgical procedure especially for implant placement in the anterior region of the mandible. A vigilant examination is required using CBCT to avoid post-operative complications.

Cone-Beam Computed Tomography versus Rendered Panoramic Images in Determination of Dens Invaginatus Characteristics: Retrospective Cohort Study

Background: "Dens in Dente" is another name for Dens invaginatus. It's an uncommon developmental aberration that comes in a range of shapes and sizes. Invagination begins in the crown and may go to the root. The goal of this study was to use CBCT and panoramic pictures created from CBCT scans to evaluate the existence, kind, and features of DI in full-mouth surveys in Saudi patients presenting to Qassim dental college, and to compare the findings of the imaging modalities.
 Methods: This retrospective cohort study was performed by using 302 previously obtained CBCT records of patients from the database of the oral and maxillofacial radiology department of Qassim University, Saudi Arabia from yer 2016 to 2021. The research was ethically approved by the ethical approval committee of Qassim university (Code #: F-2019-3005).
 Results: In the present study, the age of the patients ranged from 9 to 80 years (mean age was 44 years). Out of 302 scans, 153 patients were female, and 149 were found to be male. According to the Cohen kappa test, the inter-examiner agreement was high between the 2 assessments of the observers: k = 0.795, P < .000 for CBCT and k = 0.915, P < .000 for panoramic images rendered from CBCT images. On the basis of the CBCT images, DI was observed in 98 of the 302 patients (frequency, 32.5%). Type I DI was the most commonly observed type of invaginatus (93.9%), followed by type II (6.1%). However, type III was not being observed.
 Conclusion: We can deduce that there is no special relationship between gender and the presence of dens invagnatus. When it comes to diagnosing and classifying dens invaginatus, CBCT images outperform rendered panoramic images. Because it provides an accurate representation of the external and internal dental anatomy, as well as appropriate visualization of associated characteristics with such cases that would be absolutely necessary in their treatment phases, CBCT can be recommended as an effective diagnostic device for identifying DI.

CHARACTERISTICS OF HALLERS CELLS A PREVALENCE BASED PANORAMIC RETROSPECTIVE ANALYSIS

Background: Hallers cells, seen as incidental findings on radiographs, are located at the floor of the orbit and superior most aspect of the maxillary sinus. These cells are attributed to the anatomical variations in the growth and development of nose and paranasal sinuses leading to clinically significant symptoms such as headache, chronic cough, sinusitis, orofacial pain, impaired nasal breathing and various maxillofacial region associated pathologies.Therefore, the present study was carried out on hallers cells considering their clinical significance. Aims and Objectives:To determine the prevalence and radiographic characteristics of hallers cells using digital panoramic radiographs. Materials and Methods:The present retrospective study was carried out in a diagnostic setup, dental hospital, Bengaluru, Karnataka over the period of two years. Initially, the study group consists of 2376 participants, out of which 1800 met the inclusion criteria and were randomly enrolled in the studywith age range of 10 - 60 years. The digital panoramic images obtained were interpreted for presence and characteristics of hallers cells by trained oral and maxillofacial radiologists according to Ahmad M etals criteria. Results:Out of 1800 digital panoramic radiographs the hallers cells were seen in 214 radiographs of study participants, stating the prevalence rate of 11.88 %. The mean age of the study participants with hallers cells were 27.46 ± 17.93 years.Majority of cells seen on digital panoramic radiographs wereround (35.98%) and triangular (5.14%) in shape with unilocular appearance. A significant difference was observed with the shape of the hallers cells with p value of 0.001. Conclusion: The prevalence and characteristics of the hallers cells is in accordance with the various studies published in literature with highest number of panoramic radiographs taken into consideration till our knowledge. The incidental appearance of hallers cells on panoramic radiographs has its own significance in diagnosing various pathologies along with avoiding intraoperative complications in endonasal surgeries.

Trend of Artificial Intelligence technology in oral and maxillofacial radiology

Trend of Artificial Intelligence technology in oral and maxillofacial radiology

Assessing the Degree of Concordance Between Panoramic and Digital Bitewing Images in Showing Cervical Burnout

Background and Objectives Cervical burnout is a diffuse radiolucent area in the interproximal surfaces of the posterior teeth in the cervical region. This phenomenon can mimic interproximal caries and cause false positive detection and irreversible destruction of unaffected tooth surfaces. Panoramic radiography is the most common radiography and bitewing radiography is the most useful radiography for detection of caries. The present study aims to assess the degree of concordance between panoramic and digital bitewing images in diagnosing cervical burnout. Subjects and Methods In this epidemiological analytical study, bitewing and panoramic images of 43 patients (172 first and second maxillary molars) referred to a oral & maxillofacial radiology clinic in Ahvaz, Iran. The presence or absence of cervical burnout on interproximal surfaces of maxillary first and second molars was evaluated by two oral & maxillofacial radiologists. The data were analyzed using McNemar test in SPSS software, version 22. Results There was a significant difference in showing cervical burnout on interproximal surfaces of maxillary first and second molar teeth between panoramic and digital bitewing images. Conclusion Bitewing radiography is superior to panoramic radiography in diagnosis of interproximal caries. Panoramic radiography is not a reliable method for this purpose

Klippel-Trenaunay Syndrome

Klippel–Trenaunay syndrome (KTS) is a congenital, uncommon but a well-recognized disorder, characterized by cutaneous hemangiomas, varicosities, and unilateral bone and soft tissue hypertrophy with different localization. Generally diagnosed at birth or first few years of life. KTS represents a syndrome of interest for those in the field of oral and maxillofacial radiology and pathology because of high incidence of variations seen in the orofacial region in affected patients. A case of a 3-year-old female patient with KTS reported to the Department of Pedodontics and Preventive Dentistry for extraction, and we have documented and tabulated the Orodental manifestation of this patient.

Comparative analysis of impacted maxillary canine and dentigerous cyst diagnosis using panoramic and CBCT imaging

Objectives: This report is aimed to compare diagnostic accuracy of impacted maxillary canine and dentigerous cyst in determining its dimension and position using panoramic and CBCT (cone beam computed tomography) imaging.
 Case Report: A 30-year-old woman was referred to Department of Dental and Maxillofacial Radiology with the suspect of upper right impacted canine. She had chief complaint of swelling pain in the palate for ± 3 months. Panoramic showed 13 impacted superiorly to the maxillary sinus and surrounding with a radiolucent lesion attached on cementoenamel junction. However, panoramic has limitations in assessing the labio-palatal position of impacted canine and lesion extension. CBCT revealed the tooth located closer to palate and no sign of direct contact with sinus. The radiolucent lesion has destructed anteroposterior aspect of cortical plate which explain the reason of swelling and pain.
 Conclusion: Precise dimension and position are important to avoid mistakes since impacted maxillary canine accompanied with dentigerous cyst required invasive management. In our case, panoramic and CBCT contributed to guide the diagnosis and help the referrer determining the exact site of surgery.

The Prevalence of Radix Paramolaris and Entomolaris in Mandibular Molar Teeth: A Retrospective Study

Abstract Objective: The aim of this study is to analyze the frequency of radix paramolaris (RP) and radix entomolaris (RE) in the first and second molars using cone beam computed tomography (CBCT). Materials and Methods: The CBCT images of a total of 400 patients at the ages of 14 to 66 were included in the study. On the images that were included, two maxillofacial radiologists simultaneously examined the presence of radix paramolaris and radix entomolaris by using axial CBCT cross-sections from the pulpal chamber towards the apical. Results: At least one RE or RP was observed in 36 of the 400 patients (9%). A total of 20 RPs (1.25%) were observed, including 2 bilateral and 16 unilateral cases. A total of 38 REs (2.38%) were observed, including 11 bilateral and 16 unilateral cases. There was at least one RE or RP in 16 of the 149 male patients (10.7%) and in 20 of the 251 female patients (8%). Conclusion: Consequently, while the prevalence and types of third root variations differ between different populations, RE is seen more frequently in mandibular first molar teeth, and RP is seen more frequently in mandibular second molar teeth. No significant relationship could be found between sex and the prevalence of third root variations in mandibular molar teeth images included in this study. No significant difference was found between the right and left sides as the localizations of RP and RE in terms of prevalence. Keywords: Radix entomolaris; Radix paramolaris; Root canal morphology; Cone-beam CT; Mandibular molar

Cone-Beam Computed Tomography: A New Tool on the Horizon for Forensic Dentistry.

Teeth and bones of calvarium are important structures from a forensic point of view, as they are extremely resilient to destruction or decomposition, even under temperature variations. Radiology is inevitably an important tool in forensic investigations. Maxillofacial radiology provides a considerable amount of information for the identification of remains and evidence in case of legal matters. The advent of cone-beam computed tomography (CBCT) in the arena of maxillofacial 3D imaging has contributed immensely to forensic science such as the age estimation through teeth, analysis of bite marks, determination of race and sex, etc. The advantages of accuracy in imaging the anatomy, digitized technology favoring easier comparison of records and storage of records for a longer period, cost reduction, dose reduction, and easier portability have made it an unavoidable adjunct in forensic investigations. The aim of this paper is to review and highlight the importance of CBCT in successful forensic identification and analysis. This review is written to address the various aspects of CBCT as a recently developed technology that may be very useful in some forensic contexts, based on searches for current studies in the literature using PubMed, Scopus, Web of Science, and Google Scholar databases, to identify studies published since inception to December 2021, with no language restriction. In conclusion, CBCT is an accessible 3D imaging technology with many applications, one of them being in forensic sciences.

A cartilage-forming tumor of the mandibular angle: a case report\xa0

BackgroundMandible can be the site of benign or malignant lesions of different origins, including odontogenic and non-odontogenic lesions. Cartilage-forming tumors have been rarely reported at this site. Chondrosarcoma is a rare malignant cartilage-producing neoplasm that is extremely rare in the mandible. The rarity of cartilage-forming tumor occurrence in the mandible can make diagnosis difficult for pathologists, as they do not expect this type of tumor at this anatomical site. Here we report a case of chondrosarcoma of mandibular angle.Case presentationA 70-year-old Moroccan male patient consulted a dentist for wisdom tooth pain. Wisdom tooth extraction was conducted. After 6 months, the patient reported the recurrence of pain associated with swelling in the mandibular area and paresthesia along the path of the mandibular nerve. A panoramic radiograph demonstrated a mixed radiolucent–opaque lesion involving the mandibular angle. Computed tomography showed a large osteolytic spontaneously hypointense and multilobulated lesion. A biopsy was done. Histopathological examination revealed sheets and irregular lobules of atypical cells presenting cartilaginous differentiation. Tumor cells showed severe nuclear atypia and were located within a hyaline cartilage matrix. Some foci of necrosis were noted. Osteoid deposits were not found. The patient was diagnosed with grade III chondrosarcoma and underwent a right segmental mandibulectomy with submandibular lymph node dissection. Macroscopically, the tumor was localized in the mandibular angle with extension in the mandibular body. Histopathology confirmed the previous diagnosis of grade III chondrosarcoma and did not show any lymph node metastasis.ConclusionsOwing to many histological similarities, grade III chondrosarcoma must be distinguished from chondroblastic osteosarcoma and metastatic lesions. In addition, chondroblastic osteosarcoma of the jawbones has a worse prognosis than chondrosarcoma, making the distinction between these two malignant tumors the most important concern of the pathologist when dealing with a cartilage-forming tumor at this site. Surgery with wide excision margins remains the best therapeutic approach, while the role of radiotherapy is controversial. The management of mandibular chondrosarcoma requires a multidisciplinary approach involving maxillofacial surgeons, radiologists, pathologists, and oncologists.

Prevalence of Bifid Mandibular Canal Patients Referred to Rafsanjan Oral and Maxillofacial Radiology Clinic in 2019-2021

Introduction: Bifid mandibular canal is one of the types of mandibular canal. Considering that failure to identify the bifid mandibular canals can lead to various complications. In the present study, bifid mandibular canal was evaluated by CBCT (Cone beam Computed tomography) images in Rafsanjan City.
 Methods: In this descriptive cross sectional study, all the patients who underwent CBCT at a private oral and maxillofacial radiology clinic in Rafsanjan City during the May 2019 until May 2021 were evaluated. The mandibular canal and its different types were evaluated by an experienced radiologist, using CBCT images in reconstructed coronal, sagittal and panoramic planes for each quadrant. The bifid mandibular canal was identified and its type was determined based on Naitoh classification. After collecting the data, they were entered into SPSS version 16. Descriptive statistical methods (mean, standard deviation and frequency) were used to evaluate the data.
 Results: In the present study, 815 CBCT radiographs were examined and 62 (7.6%) cases consisting of 29 men (7.2%) and 33 (8%) women had bifid mandibular canal. The results declared there was no significant difference between the prevalence of bifid mandibular canal between the two sexes (P = 0.647). In addition, the type of bifid canal, canal side and canal branch location were not significantly different between the two sexes.
 Conclusion: The present study showed that the prevalence of Bifid mandibular canal in one sample of Iranian population is 7% and its identification before treatment can prevent further problems.

EVALUATION OF ANTEGONIAL ANGLE, ANTEGONIAL DEPTH AND GONIAL ANGLE IN SEX PREDICTION IN THE TURKISH PEDIATRIC POPULATION OF THE EASTERN MEDITERRANEAN REGION

AIM: In this study, it was examined whether antegonial angle (AGA), antegonial depth (AGD), and gonial angle (GA) are associated with sex in a Turkish pediatric sample to be able to determine a reliable method for sex estimation in children. METHODS: The study was retrospectively carried out on panoramic radiographs previously taken for children’s dental treatments for different reasons. An oral and maxillofacial radiologist measured AGA, AGD, and GA on the right and left sides on panoramic radiographs, and their mean values were calculated. RESULTS: The mean age of 197 children was 11.5±1.28 years. The results revealed that AGA and AGD significantly differed between the children by sex. However, it was not the case for GA by sex. CONCLUSION: Overall, it was concluded that AGA and AGD can be used to estimate sex in the Turkish pediatric population from the Eastern Mediterranean region; nevertheless, GA is not reliable.

REASONS OF DENTAL VOLUMETRIC TOMOGRAPHY REQUESTS IN A FACULTY OF DENTISTRY

ABSTRACT Objectives: Examining the reasons for the request of Dental Volumetric Tomography (DVT) by physicians may be beneficial in terms of improving the technique by determining the usage areas in dentistry faculties. The aim of this study is to examine the causes of DVT requests in patients who applied to the faculty of dentistry, and the distribution of these requests according to department, age and gender. Material and Methods: In this study, Dental Volumetric Tomography (Veraviewapocs 3D R100 (J. Morita Corp., Kyoto, Japan)) request forms of 1571 patients between 2016-2019, taken at the Department of Oral, Dental and Maxillofacial Radiology of the Faculty of Dentistry of Zonguldak Bülent Ecevit University, were retrospectively analyzed. The age and gender of the patients included in the study, the reasons for requesting DVT and the departments requesting DVT were recorded. Chi-square test was applied on the obtained data to evaluate the relationship between descriptive statistics and reasons for desire age and gender. SPSS 22.0 Package Data Program (SPSS 22.0 Software Package Program, Inc.. Chicago, IL, ABD) was used as statistical software in the study. Results: Of the 1571 patients included in the study, 836 were female and 735 were male, and the mean age was 40.44±0.624 and 39.93±0.683 respectively. Considering the reasons for the DVT request of the patients included in the study, it is seen that the most requests were made for the evaluation of pre-operative implant planning (29.5%), the lesion (20.6%), and the third molar (11.6%) impacted in the mandible, respectively. In addition to these, a total of 26 different causes of DVT were identified, such as TMJ, sinus and trauma evaluations. When we look at the relationship between the reasons for the request and gender in the whole patient group, a significant difference was found compared to the chi-square test. (p<0.05) Conclusions: With the use of DVT in dentistry, its diagnosis and diagnosis capacity has started to develop rapidly. DVT, which enables three-dimensional imaging, enables the evaluation of anatomical structures in the head and neck region with its high resolution capacity. The use of Dental Volumetric Tomography in dentistry is increasing day by day due to its advantages such as giving clear images in terms of radiographically and examining the obtained sections from different angles.

Validation of different protocols of inferior alveolar canal tracing using cone beam computed tomography (CBCT).

The objective of this study was to evaluate, compare and validate different protocols of inferior alveolar canal tracing. 60 DICOM files with a total of 80 inferior alveolar canals were retrieved and imported to a third-party software where all proposed protocols can be performed. Initially, inferior alveolar canal was traced by two oral and maxillofacial radiologists together on cone beam CT cross-sectional images and considered as the baseline for future comparisons. Oral and maxillofacial surgeon performed the proposed different protocols. The protocols were color-coded differently by the surgeon before being compared with the baseline canal by the radiologists through a 5-point scale. Results showed that no single protocol was successful in all cases, even the cross-sectional protocol. According to the present study, the hybrid protocol was the most accurate while the automatic protocol was the least accurate. The hybrid protocol was reliable and showed the highest number of successful applications followed by the commonly used cross-sectional protocol. Dental practitioners should be aware of the application of multiple protocols and their pros and cons as no single protocol was successful in all the cases. Applying the same protocols on a larger sample size using different cone beam CT and multislice CT machines with different exposure parameters is recommended.

Concordancia inter-examinador entre dos especialidades odontológicas para la detección del canal mandibular bífido y foramen mental accesorio en tomografía computarizada de haz cónico

Introduction: The aim of this study was to assess the agreement between oral and maxillofacial radiologists (OMFR) and oral and maxillofacial surgeons (OMFS) for the detection of bifid mandibular canal (BMC) and accessory mental foramen (AMF) using cone-beam computed tomography (CBCT). Material and Methods: This retrospective study involved 22 examiners (11 OMFR and 11 OMFS) who independently assessed 30 CBCT volumes from patients (n = 60 hemi-mandibles) under preoperative radiographic evaluation for implant placement. The examiners scored the presence of BMC and AMF in each hemimandible. The interexaminer agreements were assessed using Fleiss' kappa statistics. Results: For intra-examiner agreement, 40% of the sample was reevaluated. The interexaminer agreement between OMFR and OMFS was slight (0.12) for the detection of BMC and fair (0.24) for AMF. The agreement among OMFR for detection of BMC was fair (0.22), and it was slight among OMFS (0.15). The agreement among OMFR for detection of AMF was substantial (0.61), and among OMFS it was fair (0.22). Agreements between OMFR and OMFS were slight for BMC and fair for AMF, independently of the years of experience. Intraexaminer agreement ranged from 60% to 90% among OMFR and from 55% to 90% among OMFS. Conclusion: A slight and a fair agreement between OMFR and OMFS was found for the detection of BMC and AMF, respectively. In general, OMFR obtained higher agreement among themselves, mainly for detection of AMF.