Evaluation of juxta-apical radiolucency in cone beam CT images

OBJECTIVES

The aim of this study was to analyse the position and relationship of juxta-apical radiolucency (JAR) to the mandibular canal and buccal and/or lingual cortical plates using cone beam CT (CBCT).

METHODS

A retrospective study was carried out to analyse the JAR on CBCT for 27 patients. These findings were compared with 27 age- and sex-matched patients without the presence of JAR, which acted as the control group. The CBCT images were analysed according to a checklist, to evaluate the position of the JAR and its relationship to the mandibular canal. Then, any thinning or perforation of either the buccal or lingual cortical plate due to JAR was noted, and a classification to quantify the thinning of cortical plates was proposed. The findings in the two groups were analysed using a paired comparison by McNemar test.

RESULTS

A statistical increased thinning of cortical plates was seen in the JAR group compared with the control group, and most of the cases were in the J3 group. None of the patients in either the JAR or the control group showed perforation of the buccal and/or lingual cortical plate on CBCT images.

CONCLUSIONS

A classification to quantify the thinning of cortical plates was proposed, which may be used for objective evaluation of the thinning of the cortical plates in future studies. The present study gives an insight into the relationship of the juxta-apical area with the mandibular canal and cortical plates in the mandible using CBCT.

Reduction of dark-band-like metal artifacts caused by dental implant bodies using hypothetical monoenergetic imaging after dual-energy computed tomography

OBJECTIVE

The aim of this study was to evaluate the usefulness of hypothetical monoenergetic images after dual-energy computed tomography (DECT) for assessment of the bone encircling dental implant bodies.

STUDY DESIGN

Seventy-two axial images of implantation sites clipped out from image data scanned using DECT in dual-energy mode were used. Subjective assessment on reduction of dark-band-like artifacts (R-DBAs) and diagnosability of adjacent bone condition (D-ABC) in 3 sets of DECT images-a fused image set (DE120) and 2 sets of hypothetical monoenergetic images (ME100, ME190)-was performed and the results were statistically analyzed.

RESULTS

With regards to R-DBAs and D-ABC, significant differences among DE120, ME100, and ME190 were observed. The ME100 and ME190 images revealed more artifact reduction and diagnosability than those of DE120.

CONCLUSIONS

DECT imaging followed by hypothetical monoenergetic image construction can cause R-DBAs and increase D-ABC and may be potentially used for the evaluation of postoperative changes in the bone encircling implant bodies.

Relationships between third-molar juxta-apical radiolucencies and mandibular canals in panoramic and cone beam computed tomography images

OBJECTIVE

This study aimed to determine the relationship between third-molar juxta-apical radiolucencies and mandibular canals on panoramic and cone beam computed tomography (CBCT) images.

STUDY DESIGN

Forty-two patients were included in this retrospective study. The root apices and the relationships of the juxta-apical radiolucencies to the mandibular canals were evaluated on both panoramic and CBCT images. The McNemar test (P < .05) was used to compare panoramic with CBCT findings.

RESULTS

Root apices were visualized clearly with CBCT in most cases for which the apices were not seen clearly on panoramic images. Similarly, juxta-apical radiolucencies were separate from the mandibular canals with CBCT in most cases.

CONCLUSIONS

The present study found that there is no consistent intimate relationship between juxta-apical radiolucencies and the mandibular canals. Similar studies with larger sample sizes are required to further confirm these findings.

Condylar process contributes to mandibular asymmetry: In vivo 3D MRI study

The purpose of this study was to investigate the differences in mandibular morphology between the deviated and nondeviated sides in patients with noncongenital skeletal mandibular asymmetry. Divergences from control values were assessed to determine which region of the mandible contributes most to mandibular asymmetry. We measured various dimensions of the mandible in 20 young patients and 20 controls using noninvasive high-quality three-dimensional (3D) volumetric magnetic resonance imaging. Mandibular dimensions including the length of the condylar process were significantly greater on the nondeviated side of patients than the deviated side. Measurements of the deviated side were similar to control values, but measurements of the nondeviated side including condylar process length differed significantly from control values. These findings strongly suggest that overgrowth of the condylar process on the nondeviated side in these patients results in mandibular asymmetry, and therefore needs attention in orthodontic treatment, orthognathic surgery, and follow-up.

Localization of the primary taste cortex by contrasting passive and attentive conditions

The primary taste cortex is located in the insula. However, exactly where in the insula the human primary taste cortex is located remains a controversial issue. Human neuroimaging studies have shown prominent variation concerning the location of taste-responsive activation within the insula. A standard protocol for gustatory testing in neuroimaging studies has not been developed, which might underlie such variations. In order to localize the primary taste cortex in an fMRI experiment, we used a taste delivery system to suppress non-taste stimuli and psychological effects. Then, we compared brain response to taste solution during a passive tasting task condition and a taste quality identification task condition to verify whether this cognitive task affected the location of taste-responsive activation within the insula. To examine which part of insula is the primary taste area, we performed dynamic causal modeling (DCM) to verify the neural network of the taste coding-related region and random-effects Bayesian model selection (BMS) at the family level to reveal the optimal input region. Passive tasting resulted in activation of the right middle insula (MI), and the most favorable model selected by DCM analysis showed that taste effect directly influenced the MI. Additionally, BMS results at the family level suggested that the taste inputs entered into the MI. Taken together, our results suggest that the human primary taste cortex is located in the MI.

Localization of brain activation by umami taste in humans

There are no credible data to support the notion that individual taste qualities have dedicated pathways leading from the tongue to the end of the pathway in the brain. Moreover, the insular cortex is activated not only by taste but also by non-taste information from oral stimuli. These responses are invariably excitatory, and it is difficult to determine whether they are sensory, motor, or proprioceptive in origin. Furthermore, umami is a more unfamiliar and complex taste than other basic tastes. Considering these issues, it may be effective to minimize somatosensory stimuli, oral movement, and psychological effects in a neuroimaging study to elicit cerebral activity by pure umami on the human tongue. For this purpose, we developed an original taste delivery system for functional magnetic resonance imaging (fMRI) studies for umami. Then, we compared the results produced by two authorized models, namely, the block design model and event-related design model, to decide the appropriate model for detecting activation by umami. Activation by the umami taste was well localized in the insular cortex using our new system and block design model analysis. The peaks of the activated areas in the middle insular cortex by umami were very close to another prototypical taste quality (salty). Although we have to carefully interpret the perceiving intensities and brain activations by taste from different sessions, this study design might be effective for detecting the accession area in the cortex of pure umami taste on the tongue.

Three-dimensional analysis of the temporomandibular joint and fossa-condyle relationship

AIM

To assess the three-dimensional (3D) position of the temporomandibular joint (TMJ) in the cranial base structure, the 3D morphology of the TMJ, and the fossa-condyle interspaces in subjects with normal occlusion and patients with mandibular asymmetries using 3D computed tomography (CT) images. We hypothesized that the fossa-condyle interspaces and the shape or size of the TMJ would correlate with mandibular asymmetry.

METHODS

Twenty women with mandibular asymmetry and nine control subjects were recruited. The TMJ position, linear distances, angles, surface areas, and the fossa-condyle relationship were assessed with 3D CT images of the TMJ.

RESULTS

The fossa surface area was larger on the contralateral side, although no significant difference was observed in the linear or angular measurements of the fossa. The condylar neck height and condylar angle on the contralateral side were larger than those on the deviated side, and the frontal neck angle on the deviated side was larger than that on the contralateral side and of the control. No significant difference was observed in the condylar area. The fossa-condyle interspaces in the posterolateral section of the TMJ were smaller on the deviated side.

CONCLUSION

The condyle in the patients with mandibular asymmetry was rotated posterolaterally within the fossa on the deviated side. Patients with mandibular asymmetry showed larger fossas and longer condylar processes on the contralateral side and narrower fossa-condyle interspaces on the deviated side, especially in the posterolateral section of the TMJ.

A 3-dimensional method for analyzing the morphology of patients with maxillofacial deformities

INTRODUCTION

Traditionally, cephalograms have been used to evaluate a patient's maxillofacial skeleton and facial soft-tissue morphology. However, magnification and distortion of the cephalograms make detailed morphologic analysis difficult in patients with complex deformities. The purpose of this article was to introduce a new method for visualizing deformation and deviation of the maxillofacial skeleton and facial soft tissues.

METHODS

Standard 3-dimensional Japanese head models were sized to match the sella-to-nasion distance obtained from 2 patients' (1 man, 1 woman) maxillofacial skeletal images. Then, the scaled standard model was superimposed on each patient's 3-dimensional computed tomography image.

RESULTS

This system provided clear shape information independent of size and facilitated the visualization of shape variations in maxillofacial skeletal and facial soft-tissue morphology.

CONCLUSIONS

This method will be useful for 3-dimensional morphologic analysis of patients with jaw deformities.

Relationship between the unilateral TMJ osteoarthritis/osteoarthrosis, mandibular asymmetry and the EMG activity of the masticatory muscles: a retrospective study

The purpose of this retrospective study was to investigate the relationship between the unilateral temporomandibular joint (TMJ) osteoarthritis/osteoarthrosis (OA), mandibular asymmetry and electromyographic (EMG) activity of the masticatory muscles. Twenty-two Japanese women (aged 23.2 +/- 5.4 years) and 10 Japanese men (aged 22.4 +/- 2.8 years) exhibiting unilateral TMJ OA were included in this study. Two angular and seven linear measurements were obtained for the analysis of the skeletal hard tissues. The cephalometric measurement values (CV) were normalized using the CV ratio for the evaluation of the degree of mandibular asymmetry. The EMG was recorded during maximal voluntary clenching efforts for 10 s in the intercuspal position. The average values of integral EMG (iEMG) of three trials were normalized using the iEMG ratio for the evaluation of the functional balance of the masticatory muscles. The mandibular midline was shifted to the TMJ OA side with a median value of 9.85 mm. The CV ratio of the ramus height of the TMJ OA side was significantly smaller than that of the non-OA side. For the masseter muscle, the iEMG ratio of the TMJ OA side was significantly larger than that of the non-OA side (P < 0.05). These results suggest that unilateral TMJ OA is related to the dentofacial morphology, thus resulting in a mandibular midline shift to the affected side and it is associated with a masticatory muscle imbalance.

A 3-dimensional method for analyzing facial soft-tissue morphology of patients with jaw deformities

INTRODUCTION

Traditional cephalometric radiographs can analyze facial soft-tissues 2 dimensionally. Because they cannot provide information about the nose, lips, cheeks, and mouth, another method is needed to analyze these soft tissues. We introduce a new method for analyzing the 3-dimensional (3D) shape and size of facial soft-tissue morphology.

METHODS

A 3D average face model was constructed based on 3D computed tomography images of Japanese male and female adult volunteers who had well-balanced faces and normal occlusions. To test the feasibility of evaluating the quantitative effects of surgery, preoperative and postoperative 3D computed tomography images of facial soft tissues of 1 man and 1 woman were superimposed on the average faces.

RESULTS

This quantitative assessment provided a comprehensive evaluation of the characteristics that separate size and shape. It was possible to view the superimposed images from any desired angle on a personal computer.

CONCLUSIONS

This method provides easy-to-understand information for patients and appears to be useful for clinical diagnosis and pretreatment and posttreatment soft-tissue morphologic evaluations of patients with jaw deformities.

TMJ osteoarthritis/osteoarthrosis and immune system factors in a Japanese sample

OBJECTIVE

To determine whether there is an association between temporomandibular joint (TMJ) osteoarthritis/osteoarthrosis (OA) and immune system factors in a Japanese sample.

MATERIALS AND METHODS

The records of 41 subjects (7 men, aged 22.0 +/- 3.8 years; 34 women, aged 24.8 +/- 6.3 years) and 41 pair-matched controls (7 men, aged 22.1 +/- 2.3 years; 34 women, aged 24.8 +/- 6.4 years) based on age and gender were reviewed. Information on medical history included local or systemic diseases, details on medication type and use, and the presence of allergies and asthma. Dental history questions referred to details regarding past oral injuries. The validity of the hypothesis, defining allergies and asthma as risk factors in OA, was tested by using a logistic regression analysis.

RESULTS

The incidence of allergy was significantly higher in the TMJ OA (P = .008), with a mean odds ratio of 4.125 and a 95% confidence interval of 1.446-11.769.

CONCLUSION

These results suggest that allergy may be a risk factor in association with TMJ OA in this Japanese sample.

Relationship of TMJ osteoarthritis / osteoarthrosis to head posture and dentofacial morphology

OBJECTIVE

The purpose of this study was to test the hypothesis that there is a relationship between the temporomandibular joint (TMJ) osteoarthritis/osteoarthrosis (OA), head posture and dentofacial morphology.

DESIGN

Case-control study.

SUBJECTS AND METHODS

The subjects consisted of 34 Japanese females with TMJ OA (aged 24.7 +/- 6.1 years) and a control group of 25 healthy Japanese females (aged 23.6 +/- 1.3 years). Six cranio-cervical angular measurements were constructed for head posture analysis. Nine angular and three linear measurements were constructed for the skeletal hard tissue analysis. Five angular and one linear measurements were constructed for the dental hard tissue analysis. Unpaired t-tests were used to compare the mean differences of head posture measurements and dentofacial cephalometric measurements between the TMJ OA and the control group.

RESULTS

The TMJ OA group had significantly larger cranio-cervical angles (p < 0.05) and had more posteriorly rotated mandibles (p < 0.0001) than those in the control group. They also had a significantly shorter posterior facial height (p < 0.0001). The TMJ OA group had more retroclined lower incisors (p < 0.05).

CONCLUSION

These results suggest that an association may exist between TMJ OA, head posture and dentofacial morphology.

Relationship between head posture and dentofacial morphology in patients with TMJ osteoarthritis/osteoarthrosis

AIM

To test whether there is a relationship between head and cervical posture and dentofacial morphology in patients with temporomandibular joint osteoarthritis/osteoarthrosis (OA).

METHODS

The subjects consisted of 34 Japanese females with TMJ OA (aged 24.7 +/- 6.1 years). Six craniocervical angular measurements were constructed for head posture. Two angular and 6 linear measurements were constructed for the skeletal relationship, while 1 angular and 6 linear measurements were constructed for the dental relationship. Pearson correlation coefficients were calculated between head posture and dentofacial variables.

RESULTS

In the skeletal relationship, increased craniocervical angulations were significantly associated with a more posterior position of the maxilla, a decreased Frankfort to mandibular plane angle, decreased mandibular length, and a decreased lower facial height. In the dental relationship, increased craniocervical angulations were significantly associated with more posterior positions of the anterior teeth to the basal bone and decreased alveolar height of the anterior-posterior teeth.

CONCLUSION

The hypothesis was rejected. These results suggest that an association may exist between head and cervical posture and dentofacial morphology in patients with TMJ OA.

The accuracy of 3-dimensional magnetic resonance 3D vibe images of the mandible: an in vitro comparison of magnetic resonance imaging and computed tomography

OBJECTIVE

The purpose of this study was to investigate in vitro the accuracy of three-dimensional (3D) magnetic resonance imaging (MRI) to measure the mandible.

STUDY DESIGN

The optimal MRI sequence for 3D mandible from the data of 2 volunteers was determined to be 3D vibe. MRI and computed tomography (CT) scans of tube, mandible, and hemimandible phantoms were obtained. MRI with 3D vibe and standard parameters used in clinical practice for 3D reconstructions of jawbones on CT were used. Pearson's correlation coefficient, standard deviation (SD), and accuracy in measurement on reconstructed 3D MRI and CT were compared to direct osteometric measurement of the phantoms.

RESULTS

The correlation coefficient between MRI and direct osteometry was high, with r = 0.85 to 0.99 (P < .001). The difference ranged from -1.5 to 0.7 mm (-8.9%-11.1%) on smaller distances, which is important for orthognathic surgery. The accuracy of MRI was similar to that of CT.

CONCLUSION

3D vibe MRI provided adequate dimensional accuracy and image quality during in vitro examination of the mandible.

Correlation of mandibular deviation with temporomandibular joint MR dimensions, MR disk position, and clinical symptoms

OBJECTIVE

The objective of this study was to investigate the difference of the temporomandibular joint (TMJ) between deviated and nondeviated sides of the mandible in adult patients with mandibular deviation.

STUDY DESIGN

TMJ size, disk displacement, and clinical symptoms of 28 patients were examined clinically and by magnetic resonance imaging (MRI). Twelve age- and sex-matched control subjects were also used to evaluate which side of the mandible in patients was similar to the control.

RESULTS

The TMJ on the deviated side showed a smaller condyle and a higher incidence of disk displacement than the nondeviated side and those in the controls. However, the clinical symptoms showed no differences between the deviated and nondeviated sides, and no association with disk displacement.

CONCLUSIONS

Our results suggest that the deviated side was the abnormal side and may have some association with mandibular deviation. However, the clinical symptoms could not indicate those differences.

Correlation between diagnostic accuracy and perceptibility

OBJECTIVES

To correlate diagnostic accuracy for proximal caries with perceptibility of low contrast image details using regression analysis. The other purpose was to determine the attenuation range required for proximal caries diagnosis.

METHODS

The results of the two types of observer performance tests described above were retrieved from previous studies. Recording media included in those studies were the Compuray and the Dixel, direct digital radiographic systems, and Ektaspeed Plus film. The average numbers of perceptibility of image details from five observers were calculated for each step and for every combination of contiguous steps of the aluminium test phantom from the perceptibility test. The average diagnostic accuracy for proximal caries from the same five observers was correlated with the total number of perceptible details from the phantom using regression analysis. Finally, attenuation range required for proximal caries diagnosis was calculated from the attenuation range of the phantom where the maximum correlation coefficient was obtained.

RESULTS

Maximum correlation (r=0.68) was obtained at the combination of five contiguous steps of the aluminium test phantom. Attenuation range required for proximal caries diagnosis corresponded to the 2 mm to 6 mm thickness of aluminium with acrylic block of 12 mm thickness.

CONCLUSIONS

There is a correlation between perceptibility of low contrast image details and diagnostic accuracy for proximal caries. There may be a possibility to simplify observer performance tests for proximal caries diagnosis by using the standardized phantom simulating its attenuation range.

Effects of the automatic exposure compensation on the proximal caries diagnosis

OBJECTIVE

To elucidate the effect of automatic exposure compensation (AEC) on the diagnostic accuracy of proximal caries by comparing several digital intraoral imaging systems with a film.

MATERIALS AND METHODS

Twenty-seven extracted teeth served as proximal caries samples. Three digital radiographic systems; the Compuray, the Dixel, and the Sens-A-Ray without scintillator layer, and Kodak Ekta-speed Plus films were used as recording media. Radiographs of the teeth samples were obtained with each recording medium under seven to eight different exposures including the optimum level. Six oral radiologists evaluated the possibility of proximal caries with the five-grade-confidence-scale. On digital radiographs, image manipulations were allowed after the initial assessment. Receiver operating characteristic (ROC) curves were obtained at each exposure in each recording medium. The area under the ROC curve (Az) was used as the representative value of diagnostic accuracy. Diagnostic accuracy (DA) curves were obtained by plotting averaged Az values from all observers as a function of incident exposure in each system.

RESULTS

The effect of exposure variation on the DA was slight in the film while it was significantly larger in the digital systems without AEC. Among digital systems, the effect of exposure variation was smaller in the system with AEC than those without AEC. There was no significant effect on the diagnostic accuracy even if digital image manipulation was employed.

CONCLUSION

AEC minimizes the decrease of DA due to inadequate exposures. Since it compensates for the narrow exposure range in the digital intraoral sensor systems, the system with AEC may be preferable for the clinical diagnostic tasks.

Interpretation of the origin of a submandibular mass by CT and MRI imaging

OBJECTIVE

To clarify the useful findings for determining whether the submandibular mass is intraglandular or extraglandular.

STUDY DESIGN

Forty-eight patients with swelling of the submandibular region were reviewed. The relationship between the lesion and the submandibular gland and the displacement of the anterior facial vein were analyzed.

RESULTS

The accuracy of the predictions based on the relationship between the lesion and the submandibular gland (SMG) was 87% on contrast-enhanced CT (CECT), 85% on CT sialography (CTS), and 91% on MRI. Although the displacement of the facial vein outside the lesion suggested an intraglandular lesion, and inside the lesion suggested an extraglandular lesion, these were not sufficient to differentiate the lesions in 7 out of 23 CECT cases and 4 out of 11 MRI cases.

CONCLUSION

The finding of a relationship between the lesion and the SMG is the most important finding of this study.

Volume changes in human masticatory muscles between jaw closing and opening

Most jaw muscles are complex, multipennate with multiple components. The morphologic heterogeneity of masticatory muscles reflects their functions. We hypothesized that the volume of masticatory muscles changes between jaw closing and opening, and that there is a difference in the volume change among the muscles. Magnetic resonance images of the entire head were obtained in ten normal young adult subjects before and after maximum jaw opening. The volume changes of the masseter, medial, and lateral pterygoid muscles were measured. Only slight changes were seen in the masseter and medial pterygoid muscles. The lateral pterygoid muscle, however, significantly decreased its volume during jaw opening. The results provide normative values of muscle volume in living subjects, and suggest that the volume changes differ among jaw muscles.