Apex Of Tooth Research Articles

Evaluation of Odontogenic Maxillary Sinusitis with Cone Beam Computed Tomography: A Retrospective Study with Review of Literature.

Aim and Objectives:The purpose of this study was to describe the radiographic characteristics of odontogenic maxillary sinusitis as seen on cone beam computed tomography (CBCT) scans and determine whether any tooth or any tooth root, was more frequently associated with this disease.Materials and Methods:The present study included 500 CBCT images that included the entire maxillary sinus of both the sides in all the three planes. The modified classification of Abrahams and Glassberg was used to assess maxillary sinusitis of odontogenic origin. Furthermore, the proximity of the tooth root to the sinus floor, periapical pathology, and the septae within the maxillary sinus were also assessed.Results:In the present study, 1000 hemimaxillas were analyzed. Majority of the cases (74.9%) the apex of either tooth was touching the floor of the sinus. While 16.9% were in close relationship to the sinus while 8.2% of the cases, the apices were present within the sinus. Furthermore, in the present study, 38 of the total cases had an odontogenic cause of maxillary sinusitis, whereas 273 of them had a nonodontogenic cause, 96 have an undetermined cause, and the rest 593 cases had healthy sinus.Conclusion:The incidence of odontogenic sinusitis is likely under-reported in the available literature. The introduction of low-dose CBCT is particularly useful to establish a definitive diagnosis to augment in the treatment of chronic maxillary sinusitis of odontogenic origin.

Zygomaticomaxillary "lateral swing" osteotomy for augmentation of midface deficiency.

Introduction:Various surgical modalities have been proposed for the augmentation of midface deficiency without correction of the occlusal component. They include autogenous bone and cartilage grafts, alloplastic materials, and osteotomies. We propose an innovative osteotomy technique for augmentation of the midface including the infraorbital rims, the zygoma, the anterior maxillae, and the paranasal areas without advancing the dental-bearing segment.Materials and Methods:This procedure was carried out on a 21-year-old male patient who had a deficiency of the anterior maxillae including the infraorbital rims. His occlusion was in Class I molar relation. The surgical exposure was carried out through a midface degloving approach. This bilateral osteotomy encompasses the anterior maxillae and the zygoma; the osteotomy line running superiorly from the medial aspect of the infra-orbital rim to the root of the frontal process of maxilla. Inferiorly, the line runs above the apices of the maxillary teeth laterally underneath the zygomatic buttress, separating part of the zygomaticomaxillary suture posteriorly. Medially, the osteotomy line runs parallel to the piriform aperture. The osteotomy is pedicled on the zygomaticotemporal suture. A greenstick fracture at the zygomatic arch pedicled the osteotomized segment to the zygomatic process of the temporal bone. The entire segment was swung laterally outward, effectively separating part of the zygomaticomaxillary suture posteriorly. Fixation was achieved with a single 2-mm L-shaped, 4-hole plate with gap at the zygomatic buttress region.Results:This osteotomy technique resulted in fullness of the anterior maxillae and infraorbital rims, with increased anterior and lateral projection of the zygoma.Conclusion:The zygomaticomaxillary “lateral swing” osteotomy is a reliable and stable technique for total midface augmentation not requiring occlusion correction.

Contiguity between the mandibular canal and the mandibular third molar in panoramic tomography compared with cone beam computed tomography: a topographic analysis.

The aim of the present study was to evaluate the topographic relationship between mandibular third molars and the mandibular canal in panoramic tomography and cone beam computed tomography (CBCT). Records of all patients visiting for removal of a mandibular third molar between January 2014 and December 2015 were evaluated retrospectively. In panoramic tomography, the relationship of the roots to the mandibular canal was diagnosed according to the literature. In CBCT scans, the panoramic plane was rebuilt and orthogonal images to that plane were analyzed. A total of 56 mandibular third molars were eligible for the study. Superimposition of tooth apex and mandibular canal (Class I) was similarly often found in both radiographic techniques (P = .22). In contrast, contact of tooth apex and mandibular canal (Class II) was significantly more often seen in CBCT scans than in panoramic tomography (P = .039). No contact of tooth apex and mandibular canal (Class III) was similarly often seen in both radiographic techniques (P = .59). Contact of tooth apex and the mandibular canal (Class II) was significantly more often verified by CBCT imaging than was assumed in panoramic tomography. Preoperative CBCT may be helpful in Class II cases for verification of the topographic relationship between the mandibular canal and mandibular third molars.

Analysis of preparation time, wear, transportation and centering ability of Flexofile and Prodesign® M manual instruments in curved root canals preparation

OBJECTIVE: This in vitro study aimed to evaluate preparation time, wear, transportation, and centering ability of two manual instruments, namely Flexofile and Prodesign® M, in curved root canal preparation.METHODS: Forty mesiobuccal and mesiolingual canals of the first or second lower molars were used, with standard length, degree, and radius of curvature among all samples. The canals were randomly divided into two experimental groups (n=20) according to the preparation instrument analyzed. The preparations were performed by a single operator. The preparation time was controlled, and the values obtained were analyzed. To verify the wear, transportation, and centering ability of the instruments, tomography images were taken before and after instrumentation. The analysis was performed using axial sections previously identified at 2 mm below the tooth apex with the aid of the OnDemand3DTM Dental program. For statistical analysis, Student’s t-test was used, with a significance level of 5%.RESULTS: The time required to prepare root canals was lesser using Prodesign® M instruments than using Flexofile instruments. Regarding tooth wear, no statistical difference was observed. However, Flexofile instruments had a low centralization capacity in root canal preparation, and there is a trend of transport in the mesial direction of the root canal.CONCLUSION: Although no statistical difference was observed between the two instruments, the Prodesign® M instruments had a better cantering ability in the preparation. As well as, the time required to prepare the root canals was inferior when Prodesign® M was used.

Periodontite Apical Crônica: Aspectos clínicos e histológicos

INTRODUÇÃO: A periodontite apical crônica (PAC) é uma doença inflamatória crônica, de progressão lenta, frequentemente assintomática e que envolve o ápice dentário. OBJETIVO: Analisar os aspectos clínicos e histopatológicos mais relevantes dos casos de periodontite apical crônica diagnosticados no Centro de Referência de Lesões Bucais. MATERIAIS E MÉTODOS: Realizou-se um estudo descritivo retrospectivo, utilizando 82 laudos histopatológicos compatíveis com as PACs diagnosticados no período de 2006 a 2017. As variáveis avaliadas foram referentes aos aspectos clínicos e histológicos das PACs. A análise estatística foi realizada pelo programa Software Statistical Package for the Social Sciences (SPSS) versão 17. RESULTADOS: A análise clínica das lesões mostrou que estas acometeram preferencialmente a maxila (94,6%), com lesões medindo até 10 mm (75%). Nas radiografias, as mais comuns foram as de lesão radiolúcida com halo radiopaco (32,1%) e as de lesão radiolúcida sem halo radiopaco (32,1%). Histologicamente, houve a prevalência de cistos radiculares (63,4%), com presença de tecido conjuntivo (95%), deposição de colágeno (87,5%) e infiltrado inflamatório (100%), sendo frequente a presença da cápsula cística (63,4%). Os cistos radiculares representaram a maioria das suspeitas clínicas (81,4%), mas não houve diferença estatística entre a suspeita clínica e o diagnóstico histopatológico (p=0,09). CONSIDERAÇÕES FINAIS: Observou-se que, na população avaliada os cistos radiculares foram as PACs mais encontradas, sendo importante que novos estudos sejam realizados a fim de apurar a concordância do diagnóstico clínico e histológico.

Suppression of AKT-mTOR signal pathway enhances osteogenic/dentinogenic capacity of stem cells from apical papilla

BackgroundStem cells from apical papilla (SCAP) are a subpopulation of mesenchymal stem cells (MSCs) isolated from the apical papilla of the developing tooth root apex of human teeth. Because of their osteogenic/dentinogenic capacity, SCAP are considered as a source for bone and dentin regeneration. However, little is understood about the molecular mechanism of osteogenic/dentinogenic differentiation of SCAP. Phosphoinositide 3 kinase (PI3K)-AKT-mammalian target of rapamycin (mTOR) signal pathway participates in regulating the differentiation of various cell types, such as MSCs. In this study, we examined the role of the PI3K-AKT-mTOR signal pathway in the osteogenic/dentinogenic differentiation of SCAP. Moreover, we challenge to fabricate scaffold-free SCAP-based spheroidal calcified constructs.MethodsSCAP were pretreated with or without small interfering RNA for AKT (AKT siRNA), PI3K inhibitor LY294402, and mTOR inhibitor rapamycin and were cultured under osteogenic/dentinogenic differentiation to examine in vitro and in vivo calcified tissue formation. Moreover, SCAP-based cell aggregates were pretreated with or without LY294402 and rapamycin. The cell aggregates were cultured under osteogenic/dentinogenic condition and were analyzed the calcification of the aggregates.ResultsPretreatment with AKT siRNA, LY294402, and rapamycin enhances the in vitro and in vivo calcified tissue-forming capacity of SCAP. SCAP were fabricated as scaffold-free spheroids and were induced into forming calcified 3D constructs. The calcified density of the spheroidal constructs was enhanced when the spheroids were pretreated with LY294402 and rapamycin.ConclusionsOur findings indicate that the suppression of PI3K-AKT-mTOR signal pathway plays a role in not only enhancing the in vivo and in vitro osteogenic/dentinogenic differentiation of SCAP, but also promoting the calcification of scaffold-free SCAP-based calcified constructs. These findings suggest that a suppressive regulation of PI3K-AKT-mTOR signal pathway is a novel approach for SCAP-based bone and dentin regeneration.

Computer-aided autotransplantation of teeth with 3D printed surgical guides and arch bar: a preliminary experience.

Background/AimAutotransplantation of teeth is a method to restore the missing teeth and computer-aided techniques have been applied in this field. The aim of this study was to describe a novel approach for computer-aided autotransplantation of teeth and to preliminarily assess its feasibility, accuracy, and stability.MethodsEight wisdom teeth with complete root formation of eight adult patients were autotransplanted. Individual replicas of donor teeth with local splints, surgical templates, and arch bars were virtually designed and fabricated using three-dimensional printing, these were then applied in the autotransplantation surgeries. Clinical and radiological outcomes were observed, the extra-alveolar time, success rate, and 1-year survival rate were analyzed, and accuracy and stability of this approach were evaluated.ResultsThe extra-alveolar time of donor teeth were less than 3 min. The average follow-up duration was 2.00 ± 1.06 years. All autotransplanted teeth showed normal masticatory function. Ankylosis was found in one patient, and the overall success rate was 87.5%, whereas the 1-year survival rate was 100%. Linear differences between the designed and the immediate autotransplanted positions at crowns and apexes of the donor teeth were 1.43 ± 0.57 and 1.77 ± 0.67 mm, respectively. Linear differences between immediate and the stable positions at crowns and apexes of the donor teeth were 0.66 ± 0.36 and 0.67 ± 0.48 mm, respectively.ConclusionThe present study illustrated the feasibility, clinical satisfied accuracy, and stability of a novel approach for computer-aided autotransplantation of teeth. This new approach facilitated the surgical procedure and might be a viable and predictable method for autotransplantation of teeth.

Testing and comparing the accuracy of two dental age estimation methods on saudi children: Measurements of open apices in teeth and the London Atlas of Tooth Development

Evaluation of dental development is frequently performed to assess maturity and estimate age. The aim of this study was to test and compare the accuracy of two dental age estimation methods in a sample of Saudi children by using Cameriere’s formula (measurements of mandibular teeth open apices) and The London Atlas of Tooth Development. Four hundred archived digital panoramic radiographs of healthy children (200 males and 200 females) between the ages of 6 to 15.99years attending the Pediatric Dental clinics of King Saud University, College of Dentistry, Riyadh, Saudi Arabia were used. The mean difference between the Estimated Age (EA) and Real Age (RA) was (−0.89years) for Cameriere’s formula with a standard deviation of (±1.14years), and it was (−0.59years) with a standard deviation of (±1.45years) for The London Atlas. Both methods consistently underestimated the age. No statistically significant difference between the sexes was found in both methods In conclusion, the London Atlas was found to be slightly more accurate and easier to use than was Cameriere’s formula.

Mandibular first premolar apical morphology: A stereomicroscopic study.

The aim of this study was to investigate the size, shape and position of the physiological foramen and the relationship between the age and gender to the location and size of the apical foramen of mandibular first premolars. One hundred and one extracted human mandibular first premolar teeth were examined; age and gender of the patients were recorded. Apices of teeth were examined stereomicroscopically for number, size and shape of apical foramina; frequency and deviation of accessory foramina from the apex and the relation with age and gender. Sixty-four of the premolars had one foramen and 23% had two. The distances from the foramina openings to the apices ranged from 0.07 to 2.18mm. In younger range irregular shape was dominant (41%), whilst in older range, round shape was dominant (45%). The shape of the apical foramen changed with age and the distance from the foramen to the anatomical apex increased with age.

Risk Factor in Endodontic Treatment: Topographic Evaluation of Mandibular Posterior Teeth and Lingual Cortical Plate Using Cone Beam Computed Tomography (CT).

BackgroundTopographic relationships of mandibular posterior teeth with mandibular cortical plate are extremely important both in terms of infection spread and endodontic and surgical procedures to be performed. The aim of this study was to determine the relationship between root apex of the mandibular posterior teeth and lingual plate of the mandible.Material/MethodsCBCT data of 138 patients were retrospectively analyzed. The topographic relationship between root apex and lingual plate was classified as non-contact, contact, or perforation. Morphology of the mandibular lingual plate was classified into the 4 types (convex, parallel, undercut, slanted) and recorded for each tooth region. The prevalence of each group was calculated.ResultsIn 6.2% of all mandibular posterior teeth, the lingual plate was perforated by at least 1 root of the corresponding tooth. The teeth with the highest perforation rate were the third molar tooth (31.6%) and the second molar tooth (14.7%). The most common mandibular lingual plate morphology type was “undercut type” (61.3%) in the molar teeth region, while “parallel type” (55.7%) was most common in the premolar teeth region.ConclusionsIn conclusion, a high percentage of mandibular second and third molars root apex have topographically close relationships to the lingual plate of the mandible. Hence, endodontic consultants must be aware by this anatomical relationship and be aware of possible complications during endodontic and surgical procedures using radiographical modalities.

Dendritic cells and their relation to apical peridontitis.

The purpose of this manuscript was to re-discuss apical periodontitis, apical biofilm, and its possible relationship with dendritic cells (DC). DCs are potent regulators of the immune system and their function is divided into three categories that involve the presentation of antigens: the presentation of antigens and activation of T cells; a not well established category suggested that DCs induce and maintain immunological tolerance; and the maintenance of the immune memory in conjunction with B cells. DCs in periapical inflammatory lesions are composed of at least two subpopulations that can be distinguished on the basis of ultrastructure and phenotype. These populations might differ in lineage, state of maturation, differentiation, activation, and/or function. The authors hereby analyzed the root apexes of teeth under SEM, after performing apicoectomy due to the failure of conventional endodontic treatment. Microbial biofilm with multispecies and areas of resorption with the presence of Howship lacunae, and images suggestive of denditric cells could be observed. The presence of DCs in periapical lesion could be an indication of the severity of the lesion, with a constant presence of antigen in the periradicular region.

Odontogenic maxillary sinusitis. Etiological, clinical, diagnostic and therapeutic aspects. Systematic review

Odontogenic maxillary sinusitis is an inflammatory process of odontogenic origin, located in the maxillary sinuses and involving the sinus mucosa and sometimes the surrounding bone structures. It is a well-known, usually unilateral condition, which is related to periodontal diseases; abscessеs; radicular cysts; osteomyelitis; iatrogenic and traumatic causes, e.g. the displacement of tooth apices or other foreign bodies into the sinus; root canal overfills; dental implants, penetrating the sinus membrane. This inflammatory process differs sufficiently from sinusitis of other causes in its aetiology, clinical and radiological features, microbiology and treatment. This requires a multidisciplinary approach, combining the work of dentists, oral and maxillofacial surgeons, otorhinolaryngologists, radiologists and microbiologists. The close relation of maxillary sinuses with other anatomical structures (maxillary molars and premolars, paranasal sinuses) should be considered during treatment in order to prevent recurrence, spread to other sinuses and complications. Based on the studied literature, we summarised the most common causes, clinical and radiological aspects, diagnosis and management of odontogenic maxillary sinusitis. Therefore, we created a detailed medical protocol, corresponding to the specific features of this condition.

Distances of root apices to adjacent anatomical structures in the anterior maxilla: an analysis using cone beam computed tomography.

The aim was to assess the anatomical relationship of anterior maxillary teeth to the nasal floor in patients referred for apical surgery. Cone beam computed tomographic images (CBCT) of 83 patients were analysed retrospectively to quantify the distances between the root apices of maxillary anterior teeth (canine to canine) to the nasal floor or maxillary sinus (whichever was closer). Secondary outcome variables were the distances of the periapical lesion to the nasal floor, distances of the apices to the labial and palatal bone plates as well as to the neighbouring teeth. A total of 93 teeth (39 central, 35 lateral incisors and 19 canines) were analysed. The mean shortest distances of the apices to the nasal floor (or maxillary sinus) were 8.54mm for central incisors, 9.49mm for lateral incisors and 5.39mm for the canines. The canines exhibited a significantly shorter distance to the nasal floor/maxillary sinus. In the presence of an osteolysis, the distance to the nasal floor was significantly shorter compared to the teeth without lesions. The lateral and central incisors showed significant proximity to each other at the level of the future surgical resection (3mm from the apex). A close proximity between apices and adjacent anatomical structures such as nasal floor, maxillary sinus or adjacent roots could be shown in some cases. CBCT could be a valuable adjunctive imaging tool prior to apical surgery in the anterior maxilla to assess the risk for and decrease the incidence of damage to neighbouring anatomical structures such as the nasal floor, maxillary sinus or adjacent roots.

Mental foramen and accessory mental foramen: a dry human mandibles study in South Indian population

Abstract Introduction and aim: Mandible usually has a bilateral oval or circular mental foramen [MF] situated on the anterolateral aspect of the body of mandible. Variations of the MF are often encountered ranging from difference in incidence, shape, size, position and supernumerary [accessory MF] to even complete absence. So, the aim of the present study was to evaluate the incidence and the anatomical features of the mental foramen and the accessory mental foramen. Materials & method: 61 dry human mandibles of unknown sex were examined. Size and distance of mental foramen and accessory mental foramen from symphysis menti [Mandibular midline], inferior border of the mandible, posterior border of ramus and superior border of body of mandible were measured using vernier calliper and statistically analyzed by mean and standard deviation. Results: Bilateral mental foramina [MF] were present in all 61 [100%] mandibles. Out of 122 mental foramina [MF], 86 [70.5%] were round and 36 [29.5%] were oval in shape. Approximately half [47.54%] of MF were present below the apex of 2nd premolar tooth. MF was located approximately half way between alveolar crest and mandibular body. Bilateral AMF were present in 1.64% mandibles. All 5 AMFs were round in shape. AMF was separated from MF by a median distance of 2mm. Conclusion: The knowledge about incidence and variability in position of mental foramen and accessory mental foramen is important in order to avoid nerve damage in connection with surgical procedure and to achieve complete effect of anaesthesia after mental nerve block

Periodontally Accelerated Osteogenic Orthodontics (PAOO) Using Platelet‐Rich Fibrin Alone: A Modified Approach With a 3‐Year Follow‐Up

IntroductionOrthodontists are reportedly seeing more adult patients in their practices. Hence, it becomes increasingly important to evaluate the periodontium for any existing problems or potential issues that could be caused by orthodontic treatment. Periodontally accelerated osteogenic orthodontics (PAOO) is a method of surgically assisted tooth movement achieved through a combination of corticotomy and bone grafting allowing rapid tooth movement and decreased treatment time. Platelet‐rich fibrin (PRF) is shown to have osteoinductive effects along with enhanced soft and hard tissue healing outcomes. The aim of this case report is to describe a variation of the PAOO technique using PRF membranes alone and provide a proof of concept for the effect of PRF on soft and hard tissue healing outcomes when used with PAOO.Case PresentationA 43‐year‐old female expressed displeasure over her malaligned lower anterior teeth and difficulty performing oral hygiene in that area. Clinical examination showed inadequate keratinized tissue, and cone‐beam computed tomography (CBCT) images revealed extensive loss of buccal bone. Ultrasonic buccal corticotomies were made using a piezoelectric device from the alveolar crest extending past the tooth apices in the lower anterior region. Five PRF membranes were placed over the teeth and secured with sutures.ConclusionsThree‐year follow‐up showed exceptional improvement in soft tissue appearance and keratinized tissue width. CBCT images revealed no further loss of buccal bone. This is the first case to demonstrate that PAOO using PRF can be a viable option for orthodontic movement of periodontally compromised teeth.

Correlation between crestal alveolar bone loss with intracanal bacteria and apical lesion area in necrotic teeth

ObjectiveThis study aimed to analyze the correlation between crestal alveolar bone loss with the presence of some bacterial species in root canals and the apical lesion area of necrotic teeth. DesignData from 20 patients with diagnosis of pulp necrosis and acute apical abscesses, without active periodontal diseases, were evaluated. Patients with history of antibiotic usage three months prior to the study, with exposed pulp cavity, and with probing depth >3 mm were not included. The root size, the distance between the bone crest to the tooth apex in the mesial and distal surfaces, and the apical lesion area were measured from standard periapical radiographies by a calibrated examiner. Root canal samples were collected using sterilized paper points. In multirooted teeth, the largest root canal was sampled. Culture, microbial isolation and identification by phenotypic methods were performed. Spearman correlation and exact Fischer test were calculated between higher/lower existing bone crests, according to the median and the presence of specific bacteria. ResultsNo statistically significant differences were found between occurrence of pathogenic bacteria, such as Porphyromonas gingivalis, Porphyromonas endodontalis, and Prevotella intermedia, and groups with higher/lower degree of bone loss (p > 0.05). A negative significant correlation was found between Parvimonas micra and periodontal bone loss (p = 0.02). Additionally, no statistically significant association was found between crestal bone loss and the apical lesion area. ConclusionsIt was concluded that, in patients without active periodontitis, the presence of pathogenic bacteria in the root canal was not correlated with periodontal bone loss.

Endodontic-related inferior alveolar nerve injuries: A review and a therapeutic flow chart

IntroductionInferior alveolar nerve (IAN) lesions related to endodontic treatments can be explained by the anatomical proximity between the apices of the mandibular posterior teeth and the mandibular canal. The aim of this article is to review the management of inferior alveolar nerve lesions due to endodontic treatments and to establish a therapeutic flow chart. MethodsA review of publications reporting IAN damage related to endodontic treatment over the past 20 years has been conducted, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; it combines an electronic search of the Pubmed® and Google Scholar® databasis. Forty-two full-text articles corresponding to 115 clinical cases have been selected. Two personal clinical cases were additionally reported. ResultsIAN lesions due to endodontic treatments require urgent management. Early surgical removal of the excess of endodontic material, in contact with the nerve allows the best recovery prognosis (72h). Beyond this delay, irreversible nervous lesions prevail and a medical symptomatic treatment, most of the time with pregabalin, must be/can be carried out. A delayed surgical procedure shows some good benefits for patients. However, the healing prognosis remains poorly predictable.

Pathosis or Additional Maxillary Neurovascular Channel? A Case Report

This case report highlights an incidental finding of an anatomic variation of a neurovascular channel in close proximity to the maxillary right permanent lateral incisor (tooth #7). A 32-year-old patient presented with discomfort and a history of trauma in childhood to the right maxillary central incisor (tooth #8). A periapical radiograph of tooth #8 revealed an incidental finding of a radiolucent area in the apical one third of the right maxillary lateral incisor (tooth #7) root with the appearance of inflammatory apical root resorption. A cone-beam computed tomographic scan taken to assess the suspected area of resorption revealed this to be a neurovascular channel within the bone passing distal to the apex of tooth #7, which has been superimposed over the root of tooth #7 on the periapical radiograph. This case report highlights that additional bone channels are a common finding in the maxillary alveolus. These channels can in fact be the canalis sinuosus (or branches of it), a bone channel that is a frequent anatomic variant arising from the infraorbital canal. The canalis sinuosus has been reported rarely in the literature, but it should be considered to be a potentially common finding in the maxillary incisal region. Clinicians are made aware of the presence of additional neurovascular bone channels such as the canalis sinuosus when interpreting radiographs for assessing periapical status of teeth and for surgical planning in the anterior maxilla.

New approach in Bisecting angle technique

Since the conventional radiograph was introduced in 1901, it seems that it has wide spectrum in it use in medical, dentistry & engineering branches.The importance came from its value in diagnosis and predicate the causes of different effects. This lead to more researches for more advanced programs , which continued through last century lead to an advanced radiography like digital one, C.T. scan and M.R.I. Still the conventional radiographs are the baseline for this progress a far farther for future progression.Aim of the study is to prove a new approach in "Bisecting angle technique".The present study indicate the new approach in using the bisecting angle technique since the old one give instructions on three main lines:-A. Patients positioning in the dental chair.B. Positioning of dental intraoral film inside patient mouth.C. The position of the cone of X-ray machine in both vertical and horizontal angles.But Al-Safi method gives instructions number D- about the anatomical landmarks that lead to the apex of the tooth to which central beam is directed, by drawing a line from ala of the nose to the tragus of the ear called ala tragus line indicate the apecies of maxillary teeth , for the mandibular arch a line draw indicate apices of mandibular teeth from the angle of the chin to the angle of the mandible in proper manner.In present study, two groups of fifth years students in the college of Dentistry in Baghdad had been taken. The first group had given instructions A-B-C-, second group had given instructions A-B-C- and D- according to Al-Safi method.The statically analysis using t-test shows , a significant difference between the first and second group in the effectiveness of sharpness and allignments artifacts , from the same point of view there were no significant difference between members of second group while there is a significant difference between members of the first group.The results indicate that the new approach in instructing the second group of students were gave wide predictors for their work and better results in decreasing the technical errors and dental artifacts.

Progress in the diagnosis of florid cemento-osseous dysplasia

Florid cemento-osseous dysplasia (FLCOD) is a rare, extensive bone metabolism disorder, which occurs only in the jaw bone. It is usually asymptomatic for a long time and discovered incidentally during a radiological examination. The characteristics of FLCOD in the initial stages are similar to those of periapical granuloma or jaw cyst, which may lead to misdiagnosis. After the lesion is mature, the imaging findings show that radiopaque with a thin radiolucent peripheral halo, which is crucial for the diagnosis of FLCOD, but other jaw lesions have similar imaging findings. Due to the poor blood supply of the lesion, the alveolar bone of root apices of vital teeth is slow to heal after trauma, increasing the chance of infection, which can lead to the osteomyelitis of the jaws and emerge sequestrum. This paper reviews the aspects of pathogenesis, clinical characteristics, diagnosis, differential diagnosis and treatment.