Routine Panoramic Radiographs Research Articles

Carotid Artery Calcification and Sailolith in Partially Edentulous Patient: An Accidental Finding on Panoramic Radiograph

Orthopantomograms are very useful in detecting the pathologies affecting the teeth, development disorders of jaws, foreign bodies, fractures and other hard tissue variations [1]. Calcifications of various structures located in the head and neck region are a relatively common and are detected on routine panoramic radiographs. Three cases with unusual calcification seen incidentally during radiographic examination are reported here.

Ameloblastic Fibro-Odontoma in The Maxilla: Histological Considerations And Surgical Treatment

Ameloblastic fibro-odontoma (AFO) is a rare benign odontogenic tumor that alters the formation of dentin and enamel. Patient, 18, underwent routine panoramic radiographs to evaluate the absence of an upper right second molar that had not erupted. Ectopic inclusion associated with the lesion involved the entire tooth, producing areas of radiolucency and radiopacity. Excision biopsy of the lesion, followed by enucleation, sinusectomy, and excision of the involved tooth were performed. Histopathological examination revealed fragments of neoplasm of mixed odontogenic source with connective tissue similar to dental papilla and islands of odontogenic epithelium—findings consistent with a diagnosis of ameloblastic fibro-odontoma. Six months into follow-up there was persistence of the tissue inside the left maxillary sinus, suggestive of recurrence. A new biopsy was performed, which found fibrous connective tissue and mucosa of the maxillary sinus compatible with scarring.

A retrospective study of panoramic radiographs for zygomatic air cell defect in children

Background and Aim: The aim was to determine the prevalence of zygomatic air cell defect (ZACD) among children of Indian origin and also to determine the dominant form of ZACD. Materials and Methods: One thousand six hundred and eighty-eight routine panoramic radiographs of subjects between 7 and 18 years, processed between January 2006 and January 2009 were screened, recorded and analyzed for ZACD. Results: Of the 1688 panoramic radiographs examined, 768 were of males and 920 of females. The radiographs were divided into two groups, Group I comprising of subjects in the age 7-12 years and other Group II in the age range 13-18 years. ZACD was found in 50 subjects, accounting for prevalence of 2.96%. Other occurrences found were unilateral 38 cases, bilateral 12, unilocular 20 and multilocular 42 respectively.Conclusion: This study described the prevalence and characteristics of ZACD among selected Indian children. It is essential to know and determine this variant of normal anatomy and differentiate it from pathologies.

Can Dental Students Be Taught to Use Dental Radiographs for Osteoporosis Screening?

This study investigated the possibility of teaching dental students to detect radiographic changes suggestive of osteoporosis. Twenty-five panoramic radiographs from dental school patients with a history of osteoporosis and radiographic changes suggestive of the disease and twenty-five normal panoramic radiographs were selected by a clinician from the database of the College of Dentistry, University of Tennessee Health Science Center. Twenty students were taught to use the mandibular cortical index (MCI) and detect changes suggestive of osteoporosis. Students also used a five-point scale to determine the diagnostic accuracy of panoramic images for osteoporosis. Intraclass Correlation Coefficient (ICCC) and Cronbach's alpha internal coefficiency statistical tests were used to evaluate interrater reliability among the twenty students and between the students and the radiologist. To test for differences in diagnosis between the gold standard (dental clinician) and the oral radiologist, we performed a McNemar's chi-square test for matched data. The interrater consistency was excellent for both the students (α=0.902) and between the students and the radiologist (α=0.909). The diagnostic accuracy of panoramic images was moderate (Az=0.81). No statistically significant difference between radiographic and clinical evaluations (McNemar's chi-square=3.063; p=0.0801) was observed. Teaching dental students to recognize radiographic changes suggestive of osteoporosis in routine panoramic radiographs should be emphasized to improve their awareness and identification of this disease.

Radiographic assessment of a keratocystic odontogenic tumour using cone-beam computed tomography

The keratocystic odontogenic tumour (KCOT), formerly known as the odontogenic keratocyst, is a benign intra-osseous odontogenic tumour. The KCOT is characterised by a potential for locally destructive behaviour and a relatively high recurrence rate. Most KCOT are incidentally discovered as well-defined unilocular or multilocular radiolucencies on routine panoramic radiographs. A 15-year-old boy was referred to dental care with a non-syndromic KCOT in the right angle of the mandible. Using cone-beam computed tomography (CBCT) as a diagnostic instrument for precise assessment of the KCOT, the exact location of the lesion was determined. The cystic formation was enucleated without peripheral ostectomy. At post-operative follow-up after 3 and 6months, the boy reported no pain and there was no residual swelling or fracture. Imaging was planned after 1year to decide whether further surgical treatment is indicated. The CBCT is considered beneficial in cases of cystic formations to determine the localisation and borders of the lesion in all three dimensions.

Osteoporosis: Dental Implications

A dramatic rise in osteoporotic fractures is expected due to increase in the aging population worldwide. Prevention and early detection is the solution to this growing ‘silent disease’. Osteoporosis affects the maxillofacial structures and may be detected by various techniques, including DXA, CT, etc. Interestingly, changes due to osteoporosis may also be detected on routine dental and panoramic radiographs. The relationship between osteoporosis and oral health and the effects of therapeutics used in the management of osteoporosis on the oral structures are some intriguing problems to the dentist. The future might witness an increasing role of dental professional in identification, prevention and management of patients with osteoporosis.

Delayed Removal of a Maxillary Third Molar Accidentally Displaced Into the Infratemporal Fossa

The removal of an impacted maxillary third molar is an easy procedure for an oral and maxillofacial surgeon. The most commonly seen complications associated with this type of surgery are excessive hemorrhage, infection, pain, swelling, trismus, and root fractures. Although rarely encountered, unexpected complications may also arise during this procedure, such as the displacement of the tooth into an anatomic space. In this article, a case of a maxillary left third molar accidentally displaced into the infratemporal fossa is presented, and the delayed removal of the tooth after 3 weeks from the initial unsuccessful attempt is described, along with the correlating reasons. The role of the radiologic analysis in determining the localization of the tooth, including the routine panoramic radiographs and more importantly the volumetric computed tomographic scans, is stated. The different surgical treatment options are classified, and the potential for morbidity in the surgical removal of the tooth from the infratemporal fossa is presented by ranging the vital anatomic structures running through it.

Bilateral multiple tonsilloliths

Tonsilloliths or tonsil stones are calcifications that form in the crypts of the palatal tonsils. These calculi are composed of calcium salts, alone or in combination with other mineral salts, and are usually small, although there have been occasional reports of large tonsilloliths or calculi in peritonsillar locations. Most often, these calculi are asymptomatic and small, often detected only by computed tomography (CT), although large calculi may be visible in routine panoramic radiographs. Although tonsilloliths normally do not require medical attention, they may become large enough to cause a variety of symptoms requiring treatment. Here, we report the case of a 45-year-old male with difficulty opening the mouth and previous treatment for carcinoma of the left buccal mucosa 6 years earlier. Routine orthopantomography revealed large, bilateral, radiopaque areas over the ramus of the mandible. A diagnosis of multiple tonsilloliths was made after confirming the exact location of the radiopacities on CT.

Dermoid cyst of the mandibula: a case report.

BackgroundDermoid cysts are rare congenital lesions derived from pluripotential cells.Case PresentationWe present a case of a female patient aged 30 years presenting for a lesion of the mandibula incidentally seen on a routine panoramic radiograph obtained for dental care. The instrumental, clinical and histological characteristics of the lesion are reported. Finally, a bibliographic revision of this pathology at the level of the oral cavity is reported.ConclusionDermoid cysts must be considered in the differential diagnosis of mandibula's lesions.

The prevalence of bifid mandibular condyle detected in a Brazilian population

To determine the prevalence of bifid mandibular condyle (BMC) detected on panoramic radiographs in a Brazilian population. The panoramic radiographs of 50 080 radiographs taken from 1999 to 2006 were retrospectively reviewed in order to identify BMC cases. 9 (0.018%) of the 50 080 patients, 2 men and 7 women, with age ranging from 20 years to 74 years, had BMC. These conditions were unilateral in 7 (78%) subjects and bilateral in 2 (22%) subjects. All patients denied a history of any previous trauma or fracture of the mandible, pain, or trismus. BMC is an uncommon finding in a group of Brazilian subjects and, although it is rare, dentists should be aware of this condition on routine panoramic radiographs and its implications for function and appropriate treatment modalities.

Panoramic Radiographic Appearance of Massive Calcification of Tuberculous Lymph Nodes

The aim of this report is to present a case of multiple calcified tuberculous lymph nodes found in a panoramic radiograph including a discussion of the differential diagnosis of this lesion from other soft tissue calcifications. Concomitant massive submandibular and cervical tuberculosis lymph node calcifications are relatively uncommon lesions and may be encountered on routine panoramic radiographs. This report describes the case of an asymptomatic 35-year-old patient whose dental radiographs showed findings which led to bilaterally, irregularly shaped, multiple calcified lymph nodes especially in the left submandibular and cervical area. Because treatment is unnecessary for symptom-free calcified lymph nodes and the patient was unwilling to any further examination done, surgical removal of the calcified lymph nodes was not done.

Traumatic neuroma following sagittal split osteotomy of the mandible

A 16-year-old male underwent bilateral sagittal split osteotomy of the mandible to correct a mandibular deficiency. Twenty-one years later, a routine panoramic radiograph revealed a radiolucent lesion on the left side of the mandible. The lesion was biopsied. As the patient did not have symptoms and the lesion was connected to the inferior alveolar nerve, the lesion was not totally excised in order to preserve nerve function. The histological features were consistent with traumatic neuroma, and no further surgical procedure was planned.

Non-syndrome Multiple Supernumerary Teeth: A Case Report

The purpose of this case report is to present a case of a non-syndrome male patient with multiple supplemental supernumerary teeth in three quadrants of his mouth. Supernumerary teeth are described as the teeth formed in excess of the number found in a normal dentition. Prevalence of supernumerary teeth varies between 0.1% and 3.8% in the general Caucasian population. Multiple supernumerary teeth are not a common occurrence, although a single or a few supernumerary tooth/teeth in each case have been widely reported in the literature. An 11-year-old male presented for a routine preventive dental visit. A routine panoramic radiograph showed the presence of multiple supernumerary teeth which were located in the maxillary right canine incisor region, the maxillary left premolar region, and the mandibular right premolar region. The family's medical history was non-contributory, and an extraoral examination did not reveal any abnormality. It is rare to find multiple supernumerary teeth in individuals with no other associated diseases or syndromes. This case report presents a case of a non-syndrome male patient with multiple supplemental supernumerary teeth in three quadrants of his mouth.

A prospective multicenter randomized clinical trial of autogenous bone versus β-tricalcium phosphate graft alone for bilateral sinus elevation: Histologic and histomorphometric evaluation

Purpose Two different graft materials, ß-tricalcium phosphate (Cerasorb) and autogenous bone, were used in the same patient. The objective was to determine whether donor site morbidity could be avoided by using pure-phase ß-tricalcium phosphate (Cerasorb). Materials and Methods Bilateral sinus grafting was performed on 20 selected patients; Cerasorb was used on the experimental side, and autogenous bone was used on the control side. In each patient, one side was randomly designated the experimental side. In 10 of the 20 patients, the maxilla reconstruction included sinus grafting and onlay bone grafting. Implants were placed 6 months after the procedure. In addition to routine panoramic radiographs, in 10 of the 20 patients, 2- and 3-dimensional computerized tomographic examinations were performed pre- and postoperatively and after implantation. Eighty bone biopsy specimens were taken at the time of implant placement. Results Histologically and histomorphometrically, there was no significant difference between the experimental and control grafts in terms of the quantity and rate of ossification. For each histologic sample, the total surface area, the surface area that consisted of bone, and the surface area that consisted of graft material were measured in mm2, and bone and graft material were analyzed as percentages of the total. The mean percentage bone areas were 36.47% ± 6.9% and 38.34% ± 7.4%, respectively; the difference was not significant (P=.25). Discussion and Conclusion Comparisons with other studies reveal that ß-tricalcium phosphate (Cerasorb) is a satisfactory graft material, even without autogenous bone.—Reprinted with permission of Quintessence Publishing. Two different graft materials, ß-tricalcium phosphate (Cerasorb) and autogenous bone, were used in the same patient. The objective was to determine whether donor site morbidity could be avoided by using pure-phase ß-tricalcium phosphate (Cerasorb). Bilateral sinus grafting was performed on 20 selected patients; Cerasorb was used on the experimental side, and autogenous bone was used on the control side. In each patient, one side was randomly designated the experimental side. In 10 of the 20 patients, the maxilla reconstruction included sinus grafting and onlay bone grafting. Implants were placed 6 months after the procedure. In addition to routine panoramic radiographs, in 10 of the 20 patients, 2- and 3-dimensional computerized tomographic examinations were performed pre- and postoperatively and after implantation. Eighty bone biopsy specimens were taken at the time of implant placement. Histologically and histomorphometrically, there was no significant difference between the experimental and control grafts in terms of the quantity and rate of ossification. For each histologic sample, the total surface area, the surface area that consisted of bone, and the surface area that consisted of graft material were measured in mm2, and bone and graft material were analyzed as percentages of the total. The mean percentage bone areas were 36.47% ± 6.9% and 38.34% ± 7.4%, respectively; the difference was not significant (P=.25). Comparisons with other studies reveal that ß-tricalcium phosphate (Cerasorb) is a satisfactory graft material, even without autogenous bone.—Reprinted with permission of Quintessence Publishing.

Rhinolith: A radiographic finding in a dental clinic

Rhinolith is a calcified mass found within the nasal cavity. This article is a case report of a 51-year-old woman with an unusual radiopaque lesion located in the nasal maxillary antrum cavity. It was asymptomatic and found accidentally on a routine panoramic radiograph. The rhinolith is presented along with the description of its clinical, radiographic (conventional and CT images), and histopathologic aspects. The objective of this report is to describe and discuss the differential diagnosis of the rhinolith with other oral injuries or conditions and to show how important it is for dental practitioners to be aware of their existence.

Carotid artery calcification detected on panoramic radiographs in a group of Thai population

To determine the prevalence of carotid artery calcification (CAC) detected on panoramic radiographs in a Thai population. The panoramic radiographs of the patients 50 and older (N = 1,370) visiting Mahidol University from January 1998 through September 2004 were retrospectively reviewed for CAC. The medical records of the positive subjects were then reviewed. Thirty-four (2.5%) of the 1,370 patients, 16 men and 18 women, with a mean age of 69 and a range of 50 to 87 years, had 1 or more CACs. These calcifications were unilateral in 25 (73.5%) and bilateral in 9 (26.5%) subjects. Of those positive subjects, 18 reported hypertension, 10 reported diabetes mellitus, and 5 reported hyperlipidemia. Although it is uncommon to find CAC in the Thai population, dentists should be aware of this calcification on the routine panoramic radiographs and promptly refer for cerebrovascular and cardiovascular evaluation.

Routine panoramic radiography of new adult patients in general dental practice: relevance of diagnostic yield to treatment and identification of radiographic selection criteria.

We sought to measure the diagnostic yield of relevance to treatment on routine panoramic radiographs taken of new adult (ie, 18 years and over) patients in general dental practice. Routine panoramic radiographs (n = 1817) obtained from general dental practice were assessed and radiologic yield recorded using consensus viewing by 2 dental radiologists. A modified diagnostic yield of relevance to treatment for each radiograph was calculated by omission of findings that would have been identified on bilateral posterior bitewing radiographs and of radiologic findings of no relevance to treatment. Stepwise logistic regression analysis was used in attempt to identify clinical indicators of a high diagnostic yield of relevance to treatment. The diagnostic yield of relevance to treatment was zero for the majority (56%) of patients. This figure rose to 71% when the symptom-free patients were considered. Five clinical indicators for panoramic radiography were identified, as follows: clinical suspicion of teeth with periapical pathologic conditions, presence of partially erupted teeth, clinically evident caries lesions, swelling, and clinically suspected unerupted teeth. Routine panoramic radiography of adult dental patients is not supported by the results of this study. The use of clinical indicators to select patients may help to improve diagnostic yield.

Spontaneous regression of bilateral dentigerous cysts associated with impacted mandibular third molars

A case is described where a routine panoramic radiograph revealed radiolucencies, compatible with dentigerous cysts, associated with the crowns of bilateral impacted lower third molars. Both cysts had regressed in a follow up radiograph three years later with no intervention. This is the first reported case of spontaneous regression of bilateral dentigerous cysts.

Radiologic appearance of primary jaw lesions in children.

The jaw (an unusual site of primary tumors in children and adolescents) has lesions often found incidentally by dentists on routine panoramic radiographs or during examination of a child who has swelling or tooth pain. This pictorial seeks to familiarize pediatric radiologists with the radiographic appearance of a variety of primary jaw lesions. We retrospectively searched institutional records for cases of primary jaw lesions in children and adolescents. Jaw lesions were characterized as: I, well-circumscribed radiolucent lesions; II, lesions with mixed or variable appearance; III, poorly circumscribed radiolucent lesions; and IV, radiopaque lesions. Although most oral and maxillofacial lesions in children are benign, a broad spectrum of tumors was identified; lesions may occur in patients with unrelated prior malignancy. Because radiologic studies may identify jaw lesions and direct further care, familiarity with the appearance of these entities is prudent.

Levandoski panographic analysis in the diagnosis of hyperplasia of the coronoid process

The Levandoski panographic analysis of routine panoramic radiographs was developed to improve the diagnosis of hyperplasia of the coronoid process. The ratio of the length of the coronoid process to the condylar process in the Levandoski panographic analysis has a linear relationship with that in the cephalometric analysis (r = 0.75, n = 59). The ratio in patients with hyperplasia of the bilateral coronoid process was significantly greater than that of the control on both sides (P< 0.01). Although the minimum value of ratio in the patients was 1.15, the maximum value of the controls was 1.07. These results show that the Levandoski panographic analysis is useful in the evaluation of hyperplasia of the coronoid process in adults. When a patient complains of limited mouth-opening and the ratio is more than 1.1, further investigations should be made to verify the diagnosis of hyperplasia of the coronoid process.