OPG Radiographs Research Articles

Evaluation of Styloid Process Elongation in Madinah, Saudi Arabia: A Retrospective Radiographic Investigation.

This study aimed to identify the prevalence of an elongated styloid process and analyze the presence of its calcification in the Saudi population using panoramic radiographs. The Taibah Outpatient Dental Clinic's OPG radiographs for 962 patients who attended screening clinics between December 2022 and October 2023 were all included in the study. Patients' demographics, such as age, gender, and nationality, as well as radiological data, were included in the following study variables: the presence of an elongated styloid on both sides of a panoramic radiograph, right side styloid length, left side styloid length, right side distal end thickness, and left side distal end thickness. The study evaluated 438 (45.5%) processes found in individuals aged 16-80 years old. The elongated process length ranged from 30.0 to 40.1 mm, and the diameter ranged from 0.81 to 7.79 mm at the origin to 0.56-3.79 mm at the end. There was no statistically significant difference in process length across genders or age groups. The diameters of the styloid bones on the left side vary significantly across genders at the start and completion of the process. The prevalence of elongated styloids in the studied population was 4.26%. The radiological evaluation of the styloid process is a crucial stage in dental surgery planning.

To evaluate the crestal bone loss in mandibular implant overdenture via locator and ball socket attachments

Edentulism is a debilitating and irreversible condition and is described as final marker of disease burden for oral health. Rehabilitating edentulous patients with residual ridge resorption has improved tremendously because of Implant dentistry . Aims and Objectives: To evaluate the crestal bone loss in mandibular implant over denture via locator and ballsocket attachments: An In - Vivo study. Material and method: This study was undertaken in the Department of Prosthodontics and Crown &Bridge Methodology • According to the inclusion and exclusion criteria, twenty subjects were selected for this study. OPG radiographs were recorded for each subject. They were divided into two groups: Group A and Group B. • Group A subjects (10) received ball and socket retained mandibular implant overdenture against a maxillary complete denture with ball diameter of 2.25mm and gingival height of 3mm while Group B subjects (10) received locator retained mandibular implant overdenture. Results The result obtained was subject to comparison by ANOVA statistical analysis. It was found that for ball and socket attachment, highest crestal bone was observed on the mesial aspect of the right implant followed by the distal aspect of the same implant.

Assessment of Peri Implant Osteal Changes by Radiographic Evaluation Using Standard Orthopantomograph and Periapical View a Retrospective Study

Aims: The aims of the study are to evaluate the radiographical views, OPG and periapical views on the changes in peri- implant bony tissue around dental implant at time of placement and another reading after 16 weeks before functional prosthetic loading and regard it as a prognostic parameter. Material and methods: Nineteen cases with 24 implant were enrolled for standardization. Radiographical measurement undertaken by a periapical and OPG radiographs after implant placement, then after16 weeks later, again a second periapical and OPG radiographs were taken for measurements using Dimaxis 3.2.1. Software program to estimate marginal bone height of both sides of implant and its changes during times of evaluation. Results: 19 medically fit patients, male and female with age 22-65 years, twenty four implants with average bone loss 0.59 mm mesialy and 0.60 mm distally at T0 as standered base line in compared to 0.98mm mesialy and 1.11mm distally at T1as average bone loss. There was a significant bone resorption in both sides in relation of implant size and in comparison to time of placement and after 16 weeks according to statistical analysis. Conclusion: OPG and periapical views are a good parameter for evaluation of successful implant and monitoring of the prognosis and stability and durability, as these radiographs more available in most dental centers and clinics with less cost.

Assessment of condylar changes in patients with temporomandibular joint pain using digital volumetric tomography.

Objective. To evaluate the efficiency of DVT in comparison with OPG in the assessment of bony condylar changes in patients of TMJ pain. Methods. 100 temporomandibular joints of 62 patients with the complaint of temporomandibular joint pain were included in the study. DVT and OPG radiographs were taken for all the 100 joints. Three observers interpreted the DVT and OPG radiograph for the bony changes separately for two times with an interval of one week. The bony changes seen in the condyle were given coding from 0 to 6. (0: Normal, 1: Erosion, 2: Flattening, 3: Osteophyte, 4: Sclerosis, 5: Resorption, and 6: other changes). Interobserver and intraobserver variability was assessed with one-way ANOVA statistics. Z test was used to see the significant difference between OPG and DVT. Results. In the present study the interexaminer reliability for OPG and DVT was 0.903 and 0.978, respectively. Intraexaminer reliability for OPG and DVT was 0.908 and 0.980, respectively. The most common condylar bony change seen in OPG and DVT was erosion followed by flattening and osteophyte. There was significant difference between OPG and DVT in detecting erosion and osteophytes. The other changes observed in our study were Ely's cyst, pointed condyle, and bifid condyle. All the bony changes are more commonly seen in females than males. Conclusion. DVT provides more valid and accurate information on condylar bony changes. The DVT has an added advantage of lesser radiation exposure to the patient and cost effectiveness and could be easily accessible in a dental hospital.

Incidence of craniofacial pain of cardiac origin: results from a prospective multicentre study

The aim of this study was to reveal the incidence and distribution pattern of craniofacial pain of cardiac origin. We undertook a prospective study of 248 consecutive patients (aged 26 to 88 years) hospitalized with confirmed cardiac ischaemic periods. Digital OPG radiographs were obtained from all patients for radiographic examination of the jaws and dentition. Patients underwent clinical and radiographic examinations, and symptoms were evaluated in detail to determine the prevalence and distribution pattern of craniofacial pain of cardiac origin. Craniofacial pain was the sole symptom of cardiac ischaemia in 13 patients (5.2%); two developed acute myocardial infarction (AMI). Pain in the craniofacial region, chest, shoulders and arms was experienced by 72 patients. The most frequently affected region was the left mandible. In the absence of chest pain, patients most frequently experienced pain in craniofacial structures. Incidence of craniofacial pain was significantly higher in females than males (p = 0.024). Cardiac pain commonly radiates to the craniofacial structures. Pain of cardiac origin is usually described as pressure and/or a burning sensation that is provoked by physical activity and relieved by rest. Craniofacial pain of cardiac origin usually occurs bilaterally. Dental practitioners can play a crucial role in the diagnosis of craniofacial pain of cardiac origin.

An unusual cause of a ‘floating tooth’

Background Teeth that have lost their supporting alveolar bone may be described radiographically as ‘floating’. Common causes of this phenomenon include advanced periodontitis, Langerhans cell histiocytosis, Burkitt’s lymphoma and metastatic malignancy involving the jawbones. We report an unusual case of a ‘floating tooth’. Case report A 68-year-old male presented with an exophytic, multi-lobulated, red-blue swelling involving anterior maxillary gingiva with associated mobility of upper anterior teeth. His medical history included hypertension, chronic renal failure and hepatocellular carcinoma (HCC) with known lung metastases. An OPG radiograph demonstrated an ill-defined radiolucency associated with the maxillary anterior teeth, which appeared to be a ‘floating tooth’. Histopathological examination of the biopsy showed an ulcerated, infiltrating tumour with polygonal cells arranged in trabeculae and occasional gland-like structures. Individual tumour cells showed finely granular cytoplasm with central, hyperchromatic nuclei and prominent nucleoli. Immuno-peroxidase stains demonstrated positive staining with cytokeratin 20, 5D3 and alpha feto-protein. Staining with hepatocyte specific antigen demonstrated a granular cytoplasmic staining in almost all tumour cells. Conclusion HCC is the most common primary malignant neoplasm of the liver and is a common cause of cancer-related death worldwide. Metastasis of HCC to the jawbones is extremely uncommon and is an unusual cause of ‘floating teeth’.

A prospective study on the clinico-pathological presentation and management of odontogenic myxoma at Muhimbili National Hospital, Dar es Salaam, Tanzania

Main objective: To determine the clinico-pathological presentation and management of odontogenic myxoma at Muhimbili National Hospital, Dar es Salaam Tanzania.Study design: A prospective descriptive study.Setting: The Oral Surgery and Oral Pathology Department and the Department of Histopathology and Morbid Anatomy, Muhimbili University of Health and Allied Sciences Methodology: Patients’ demographic features, clinical and radiological presentation and histological results were recorded in special forms. The treatment plan, the treatment procedure and the outcome of the treatment were also recorded. Follow ups were conducted at different intervals for a minimum of one year. OPG radiographs were used to assess whether there was presence of any signs of recurrence. Patients were asked on the presence of any complications or any disabilities resulting from the surgical treatment that affected their quality of life.Results: Twenty five cases of OM were seen during the five-year period. The age range was 3 to 56 years with a mean of 28.2 years. Majority (84%) of the cases were aged between 10 and 39 years. There was only one patient who was below 10 years of age. There were more females with OM than males with a male to female ratio of 1:1.5. Most (48%) of the lesions were located on the mandible with only 36% on the maxilla and the rest (16%) were soft tissue (peripheral) lesions. Radiographically the majority of the lesions appeared multilocular with a soap bubble appearance. Very few (four) showed a honeycomb appearance. None of the lesions was seen to have clear boundaries. Tooth displacement was apparent in 10 cases and root resorption was seen in 8 mandibular lesions. The hospital stay after treatment was moderately long. Postoperative complications included disfigurement in cases with big tumours, recurrence, loss of masticatory function and difficulties with speech in cases of maxillary OM.Conclusion: Aggressive local resections in both the maxilla and the mandible result in low rates of recurrence. Early suspicion of the possibility of existent of OM, early reporting by patients and appropriate referrals could be the only possible means of minimizing such complications and improving the postoperative quality of life.Key words: Odontogenic myxoma, clinicopathological, management, Muhimbili

A Case Report of Solitary, Intraosseous, Adult-Onset Myofibroma of the Mandible

Myofibroma is a benign proliferation of myofibroblasts in the connective tissue. Solitary intraosseous myofibromas are a rare finding especially in an adult. Myofibroma is a benign lesion and its treatment is similar to any other benign lesion.This article reports a rare case of a 32year old lady presenting with a complaint of a painful swelling in the lower third molar region, on examination the tender swelling had expansion of the buccal cortex. The diagnostic work up included OPG radiograph, CT Scan, and a deep incisional biopsy of the mass under L.A. The final diagnosis of myofibroma was made only after the histopathological diagnosis and Immunohistochemistry (IHC). The patient was treated with wide local excision of the lesion in the mandible under GA.

P59 Can OPG radiographs predict ease of nasal intubation in Oral and Maxillofacial Surgery?

P59 Can OPG radiographs predict ease of nasal intubation in Oral and Maxillofacial Surgery?

A hidden cause of renal failure.

A frail 84-year-old man of SE Asian origin with a history of metastatic prostate cancer presented with non-specific deterioration. Initial investigations showed acute on chronic renal failure (creatine 648 μmol/L; baseline 153), hyperkalaemia (K+ 6.4 mmol/L) and a marked leucocytosis (WBC 46 × 109/L; neutrophils 33 × 109/L). The only significant features found on examination were mild supra-pubic tenderness and a diffuse tender left submandibular mass (Figure 2). This was thought to be a lymph node, but was difficult to assess due to a dense beard and communication limitation by language barriers. Immediate treatment was correction of the hyperkalaemia by haemodialysis. A renal ultrasound did not show any obstruction and the prostate-specific antigen was normal. Other investigations revealed a serum paraprotein IgG lambda 14.3 g/L with high concentrations of free lambda light chains in blood and urine. Bone marrow aspirate was consistent with myeloma and this was accepted as the cause of his renal failure. The patient's main complaint was ‘toothache’. Nothing was found on examination of the mouth, and the patient was advised to visit his dentist after discharge. After further requests from the patient, a maxillofacial review was sought. Unexpectedly, orthopantogram films showed a large destructive mass in the left mandible (Figure 3). A CT scan confirmed this (Figures 1 and 4), and a biopsy showed a plasmacytoma (now over a month since admission). The patient received local radiotherapy and chemotherapy with dexamethasone, cyclophosphamide and thalidomide. Conflict of interest statement. None declared. Fig. 1. CT scan and 3D reconstructed CT scan, as performed by UHL. Fig. 2. The patients jaw as photographed by UHL medical illustrations. Fig. 3. OPG radiograph performed by UHL. Fig. 4. CT scan and 3D reconstructed CT scan, as performed by UHL.

Decompression and cystectomy of the odontogenic keratocysts of the mandible: a clinical study.

Owing to the aggressive nature of OKC's if one could stop or even reverse the growth of the cyst with a simple procedure like decompression, regardless of the histologic type, it would be an alternative to radical and disfiguring surgery. Eight patients who were diagnosed with Odontogenic keratocyst of the mandible were chosen and the first stage of treatment being, insertion of the decompression stent into the most prominent or dependent part of the cystic cavity. Then based on assessment of regular second monthly OPG radiograph the second stage ie. Enucleation of the cyst and treatment of the cystic cavity with Carnoy's solution was carried out, when the size of the cystic cavity had decreased. The radiographs of all the patients were analyzed at a two month interval and compared with the pre operative radiograph. The percentage of change in radiodensity of the lesion ranged from 35.15% to 66.16% with a mean decrease of 53.85%. This also indicated that the quantum of bone regeneration which occurred simultaneously and as observed during the cystectomy procedure was commendable. Reduction of surgical morbidity while preserving anatomy and function, is the greatest advantage of decompression, however one should not forget the emphasis on the value of long term studies needed to be carried out with regular follow-up, to keep a check on those patients treated with decompression.

The oral health status of patients on oral bisphosphonates for osteoporosis

The oral health status of patients on bisphosphonates is the key to the patient's ongoing health and well-being. If they are orally healthy, invasive bone procedures, particularly extractions can be avoided, then the risk of osteonecrosis of the jaws (ONJ) is low. The records of 49 consecutive patients on oral bisphosphonates, referred to the Oral and Maxillofacial Surgery Unit (OMSU) for an oral health check and probable extractions, were retrospectively reviewed. The DMFT, periodontal and pathologic state were calculated from the OPG radiographs. An age and gender matched control group, from patients referred to the OMSU but who were not on oral bisphosphonates, were similarly assessed. Community data were also obtained. The DMFT score for the oral bisphosphonate group was 29: Decayed 3, Missing 10, Filled 16. The control group DMFT score was 24: Decayed 5, Missing 11, Filled 8. Both groups had advanced periodontal disease (over 95 per cent) and were medically compromised (over 90 per cent). The DMFT for general community data for age matched government pensioners was 19.1: Decayed 0.8, Missing 10.4, Filled 7.9. With severe periodontal disease 23 per cent. Thus, the oral health of the oral bisphosphonate group was similar to the control group and both had more decayed teeth and periodontal disease than community values. This study confirms that one cannot assume that a patient on an oral bisphosphonate for osteoporosis has a healthy mouth. It supports the view that all patients on bisphosphonates need to be seen by a dentist either before or soon after commencement of bisphosphonate therapy.

Treatment of an “ankylosed” upper central incisor in the mixed dentition

Abstract A ten-year-old boy presented with an unerupted upper right central incisor (UR1). An OPG radiograph showed a super-numerary tooth lying over its crown, preventing its eruption. Standard orthodontic treatment involving removal of the super-numerary tooth, attaching a gold chain to the UR1 and treatment with fixed orthodontic appliances failed to bring the tooth down, until it was found that tough fibrous gingival tissue entwined in the gold chain had “ankylosed” the tooth. Once this tissue had been removed and the wound packed open, the tooth was brought down successfully into occlusion.