Dental radiographic changes in chronic renal disease

The clinical and radiological aspects of the consecutive effect of renal osteodystrophy on dental and alveolar were discussed in 42 patients under the hemodialytic treatment with 252 dental and 84 panoramic radiographs used in order to verify the diagnosis. It has been established that the duration with the increase of periodontal indices as well as with the loss of lamine dure, deviations within the trabecular pattern and an increase of pseudocystic formations as well as the calcifications in dental pulp.

[The contribution of imaging in dentistry and oral medicine]

This article discusses the new trends since 1991 in imaging modalities in dentistry and stomatology with special attention for computed tomography, ultrasonography and magnetic resonance imaging.

[Large cysts of dental origin in the maxilla]

The authors give a common survey of clinical and pathological appearance of cysts of maxillary sinuses, especially their dental origin. They review the possibilities of diagnosis and show the treatment technic they used the past 4 years on 11 cases. They emphasise the importance of radiological controlling the root canal treated teeth and the role of the dentist in instructing the patient about this.

Diagnostic imaging with newly developed ortho cubic super-high resolution computed tomography (Ortho-CT)

OBJECTIVE

Ortho cubic super-high resolution computed tomography (Ortho-CT), which we have developed, is characterized by the small size of the unit and the ability to produce 3-dimensional images of high resolution with low-radiation doses. The purpose of this study was to investigate the clinical usefulness of Ortho-CT for the diagnosis of diseases in the oral and maxillofacial region.

STUDY DESIGN

Ortho-CT has been used for the imaging diagnosis of a radicular cyst of the upper first molar, mesiodense, tooth fractures in the upper anterior region, a fracture of the condylar process, or presurgical evaluation for a dental implant. The usefulness of 3-dimensional images obtained by Ortho-CT was investigated in this study.

RESULTS

Ortho-CT produced images of high resolution, enabling identification of the extent of the lesions and the fracture line, the condition of the impacted tooth, and the relationship with the maxillary sinus, mandibular canal, and adjacent teeth.

CONCLUSION

Because Ortho-CT can take high-resolution 3-dimensional images at any tomographic layer with only 1 exposure, it is useful for the diagnosis of diseases in the oral and maxillofacial region.

[A clinical study on treatment results of apicoectomy]

In this study, the treatment results of apicoectomy with orthograde filling were compared with those of apicoectomy with retrograde gutta-percha filling and retrograde sponge gold filling. The long-term follow-up results of the teeth treated by apicoectomy are presented, and the possible prognostic factors are discussed. The healing process of the apical bone cavity was analyzed with standard X-ray techniques and image analysis system. One hundred nineteen teeth were apicoectomized with orthograde filling, 196 teeth with retrograde gutta-percha root filling and 42 teeth with sponge gold filling. There was no significant correlation between the treatment results and the sex or age of the patients, kinds of teeth, preoperative radiolucent areas, the number of operations or histopathological diagnosis of apical lesion. The success rate of apicoectomy with orthograde filling or apicoectomy with retrograde gutta-percha root filling was significantly higher than that with retrograde sponge gold filling. The filling materials and the operation method were considered to be the most important factors for a successful outcome. Bone reconstruction was found to start from the periphery of the bone cavity and the bone defect became gradually reduced in a star-like pattern. At 4 months after operation, in the successful cases, the area of bone cavity decreased 46-64% compared with before operation, but in the unsuccessful cases, the area did not change or increased 75-120%. Thus at 4 months after operation, it is possible to determine whether or not apicoectomy is successful.

Factors influencing the selection of panoramic radiography in general dental practice

OBJECTIVES

To identify factors influencing dentists' decisions to take panoramic radiographs and to determine dentists' perceptions of the value of panoramic radiographs in the diagnosis of common dental pathologies.

METHODS

Questionnaire of dentists with access to panoramic radiography equipment in 22 randomly selected Family Health Service Authorities in England and Wales. Dentists were asked to score 17 factors for their influence upon panoramic use, compare the relative diagnostic value of panoramic and intraoral radiographs for diagnosis of common dental pathologies and state their principal reasons for taking panoramic radiographs.

RESULTS

The response rate to the questionnaire was 73.3%. The factors most likely to influence dentists to take a panoramic radiograph were 'planning oral surgery', 'facial trauma', 'periodontal disease', 'heavily restored dentition' and 'patient first attendance'. Dentists' opinions on the diagnostic usefulness of panoramic radiographs were in broad agreement with those in the scientific literature. The main reasons for taking panoramic radiographs were as a 'general screen' and as a 'view for unerupted or impacted teeth'.

CONCLUSIONS

There are areas where dentists' prescription of panoramic radiographs is in disagreement with recent guidelines. Successful implementation of these guidelines would be likely to lead to a substantial reduction in the numbers of panoramic radiographs taken by GDPs.

Understanding the dental need and care during pregnancy: a review

This paper reviews the oral and dental lesions that are seen during pregnancy. Trimester approach should be adopted in the management of the pregnant patients. A good dental preventive programme is essential. The significance of prescribing fluoride supplements and the use of dental radiography during pregnancy is also briefly reviewed.

Benign oral disease as a cause of false-positive iodine-131 scans

Post-thyroidectomy I-131 whole-body scintigraphy is an important aspect in the management of patients with thyroid cancer. The scan is used to detect residual thyroid tissue and distant functioning metastases. Extrathyroid I-131 accumulation does not always denote metastatic disease, and several potential sources of false-positive I-131 scans have been identified. This report presents four cases of benign oral disease as a cause of false-positive I-131 uptake. Benign oral disease has not been documented previously as an important source of false-positive I-131 whole-body scans.

Oral-dental radiographic examination technique

In general practice, dental radiography is currently being performed more often as a treatment planning technique during routine dental prophylactic procedures than ever before. Medical radiography units, although still useful for the determination of bone cancer, mineral deficiencies, and fracture studies, are yielding to the use of more versatile dental radiograph machines that are being installed in the dental operatory and expose only the dental film. Currently, the technology of intraoral digital radiography, photography, and videography is available. Digital images can be enhanced, preserved on Polaroid film, or stored directly into computer data banks, without the use of dental film. This article acquaints the reader with digital technology, but deals primarily with traditional film-based oral-dental radiographic examination technique. The equipment and techniques described are affordable and well within the capabilities of the general practitioner. The importance of being able to produce dental radiographs of excellent quality is basic when providing competent dental care.

Recent findings in classification of osteogenesis imperfecta by means of existing dental symptoms

The findings are based on a clinical investigation conducted on forty-nine patients suffering from osteogenesis imperfecta (OI), as well as on a questionnaire study in which 117 osteogenesis imperfecta-affected persons or their parents were involved. The survey established pathological tooth discolorations as well as tooth abrasions. Dentinogenesis imperfecta (DI) was more frequently found in primary teeth than in permanent teeth. There were no gender-specific differences. Radiological abnormalities were found in both, abraded and/or discolored teeth, as well as in clinically normal appearing teeth. In most cases there were club-shaped extensions of the pulp chambers and obliterations of the root canals. The probability that dentinogenesis imperfecta occurs as an accompanying symptom of osteogenesis imperfecta was not dependent on the degree of skeletal severity. The self-assignment according to A and B forms of osteogenesis imperfecta types I and IV in accordance with the presence/absence of dental symptoms was contradictory, since the literature was based on varying classifications.

Radiographic evaluation

The bulk of the tooth, that is, the root and most of the periodontium, can be visualized only by means of radiographs. Consequently, a lot of pathology remains undiscovered if clinical examination does not involve radiography. Although lesions such as caries can be recognized without radiography, the full extent of the lesions, and whether pulpal and periapical involvement is present as a consequence, cannot be assessed. In other words, a clinical examination is not complete without radiography. Periodontal disease, endodontic disease, caries, resorptive lesions, fractures, bone pathology, and neoplastic conditions all require radiography for a more complete diagnosis, thus allowing optimal planning of treatment. It is also necessary to know the normal radiographic anatomy to be able to identify the abnormal. Moreover, many dental procedures can be carried out only under radiographic control. Checking adequacy of procedures and success of treatment relies heavily on radiography. In short, radiographs are required to reach a diagnosis and thus plan treatment optimally, to be able to perform certain procedures, and to be able to assess the outcome of treatment performed. Practicing dentistry without using radiography as a tool would be considered negligent in human dentistry. In the author's opinion, the same would apply to veterinary dentistry.

Reasons for taking radiographs in general dental practice in Dar-es-Salaam, Tanzania

This study investigated the reasons why dental practitioners at the Muhimbili Dental OPD clinic in Dar-es-Salaam take radiographs. Information was obtained from medical records at the Department of Dental Radiology for an eighteen month period, during which 28,171 patients were seen at the hospital, and of which 2,672 (9.48 per cent) were radiographed. The main reasons for taking radiographs (percentages) was to detect fractures (17.2), tumours (14.1), caries (12.5), impacted teeth (12.2), periodontal disease (11.3), and non-specific dental pain (10.4). Radiographs were also taken for orthodontic (7.0 per cent) and endodontic (6.8 per cent) reasons. Some of the reasons for taking radiographs such as hypersensitive teeth, apicectomy, neuralgia and xerostomia were previously unheard of, indicating an increasing diversity of dental services. In conclusion, there is a need to increase the utilisation of dental radiographs from the present modest level in order to meet the growing need of the increasingly informed dental population in Dar-es-Salaam.

Controlled diagnosis-oriented enhancement of automatically segmented radiographs in dentistry

A method for controlled diagnosis-oriented enhancement of selected regions of interest in intraoral radiographs is presented. Image enhancement is accomplished by adaptive non-linear grey scale transformation depending on the result of objective quality measurement. In order to assure reliable image quality measurement as well as controlled image enhancement, automatic image segmentation is applied to avoid the influence of disturbing factors (e.g. metallic restorations) on quality measurement and image enhancement. Based on existing a-priori knowledge about object structure and composition of the selected regions of interest in intraoral radiographs, different image segmentation algorithms and image enhancement procedures were developed for different types of diagnosis.

Diagnostic value of full-mouth radiography in dogs

OBJECTIVE

To determine the diagnostic value of full-mouth radiography in dogs.

SAMPLE POPULATION

Prospective series of 226 dogs referred for dental treatment without previous full-mouth radiographic views being available.

PROCEDURE

In a prospective nested case-control analysis of multiple outcomes in a hospital cohort of dogs presented for dental treatment, full-mouth radiographic views were obtained prior to oral examination and charting. After treatment, clinical and radiographic findings were compared, with reference to presenting problems, main clinical findings, additional information obtained from the radiographs, and unexpected radiographic findings. The importance of the radiographic findings in therapeutic decision-making was assessed.

RESULTS

The main clinical findings were radiographically confirmed in all dogs. Selected presenting problems and main clinical findings yielded significantly increased odds ratios for a variety of other conditions, either expected or unexpected. Radiographs of teeth without clinical lesions yielded incidental or clinically important findings in 41.7 and 27.8% of dogs, respectively, and were considered of no clinical value in 30.5%. Radiographs of teeth with clinical lesions merely confirmed the findings in 24.3% of dogs, yielded additional or clinically essential information in 50.0 and 22.6%, respectively, and were considered of no value in 3.1%. Older dogs derived more benefit from full-mouth radiography than did younger dogs. Incidental findings were more common in larger dogs.

CLINICAL RELEVANCE

Diagnostic yield of full-mouth radiography in new canine patients referred for dental treatment is high, and the routine use of such radiographs is justifiable.

Diagnostic value of full-mouth radiography in cats

OBJECTIVE

To determine the diagnostic value of full-mouth radiography in cats.

SAMPLE POPULATION

115 cats referred for dental treatment without a previous full-mouth radiographic series available.

PROCEDURE

In a prospective nested case-control analysis of multiple outcomes in a hospital cohort of cats referred for dental treatment, full-mouth radiography was done prior to oral examination and charting. After treatment, the clinical and radiographic findings were compared, with reference to presenting problems, main clinical findings, additional information obtained from radiography and unexpected radiographic findings. Importance of the radiographic findings in therapeutic decision making was assessed.

RESULTS

The main clinical findings were radiographically confirmed in all cats. Odontoclastic resorption lesions, missed on clinical examination, were diagnosed in 8.7% of cats. Analysis of selected presenting problems and main clinical findings yielded significantly increased odds ratios for a variety of other conditions, either expected or unexpected. Radiographs of teeth without clinical lesions yielded incidental or clinically important findings in 4.8 and 41.7% of cats, respectively, and were considered of no clinical value in 53.6%. Radiographs of teeth with clinical lesions merely confirmed the findings in 13.9% of cats, but yielded additional or clinically essential information in 53.9 and 32.2%, respectively.

CLINICAL RELEVANCE

The diagnostic yield of full-mouth radiography in new feline patients referred for dental treatment is high, and routine use of full-mouth radiography is justifiable.

Completely submerged primary molars

Two mixed dentition cases have been presented which became quite complicated because of ankylosed and submerged primary second molars. These cases demonstrate the need for an early orthodontic evaluation and interceptive orthodontics. The orthodontic and surgical procedures required for these two patients could have easily been avoided by removing the ankylosed primary molars and placing space maintainers. (Of course this depends upon the parents responding to their dental recall notices.) If a submerging primary molar is retained too long, the second premolar may become displaced superiorly and the permanent first molar may migrate mesially as it erupts. Both of these problems can be prevented by extracting the ankylosed primary second molar before it submerges below the mesial height of contour of the permanent first molar. A fixed space maintainer then becomes necessary to prevent loss of arch length by mesial migration of the permanent molar.

[Panoramic radiography using an intraoral tube. Method, anatomy, radiography and dosimetry]

BACKGROUND

There are two techniques giving a panoramic view of the dental arch: orthopantomography and intraoral tube panoramic radiography. The last one is not very well known because images, with a characteristic and variable deformity if compared with orthopantomography are not useful for routinary use in dentistry. The poor radiographic and pathologic anatomy knowledge of intraoral tube panoramic radiography, and the slight improvements brought to the method particularly in order to reduce the dose, partly depend on the scant attention given to the method by investigators, and partly on the dyshomogeneous anatomic sites enlargement and overlapping with consequent deformity of all of them. With intraoral tube panoramic radiography, X-ray exposition is emitted using a miniaturized cylindrical source placed inside the oral cavity and the radiographic film is in contact with the skin of the face. Based on the orientation of the collimator and the inclination of the tube major axis in the oral cavity, a central technique (exposition of either superior or inferior dental arch) and a lateral technique (simultaneous exposition of the two hemiarches of the same side) are recognized. The aim of this study is to give a significative contribution to maxillo-facial characteristic appearance and dosimetry knowledge in intraoral tube panoramic radiography.

METHODS

It consists of: a) a "laboratory" part concerning the evaluation of the enlargement, deformation and visibility of different structures, obtained by positioning about fifty different markers in different maxillary and mandibular anatomic sites, and b) an in vivo dosimetry part obtained with intraoral and extraoral termoluminiscent dosimeters. An original dispositive allowed the right positioning of the film and its adherence to the screen. Deformity characteristics are analitically described and discussed in relation with the different sites.

RESULTS AND CONCLUSIONS

The use of intensifying screens allowed a good reduction of dose, (mean absorbed doses ranging from 25 microGy in the intraoral sites to 1936 microGy in the extraoral sites) without reducing the image quality thanks to the device performed "ad hoc".

Dental problems associated with hypophosphataemic vitamin D resistant rickets

OBJECTIVE

To review a series of cases of hypophosphataemic vitamin D resistant rickets. SUBJECTS INCLUDED: Seventeen cases, aged between 2 years 1 month and 15 years 9 months at first referral, and with an established diagnosis of vitamin D resistant rickets from twelve families were included in the review. Information was drawn from patient records for follow-up periods between 9 months and 20 years 4 months.

SETTING

All subjects had been referred to the Eastman Dental Hospital between 1973 and 1997.

FINDINGS

Abscessed non-carious primary and/or permanent teeth were a presenting feature in eleven of the seventeen cases. Although attrition and exposure of the abnormally formed dentine accounted for the route of infection in primary teeth, the route for microbial invasion of pulpal tissues in permanent teeth remained unexplained in a number of patients. The possible part played by infractures of the enamel as a portal of entry for infection is discussed. Enamel defects were observed in only six patients, in three of whom these changes were limited to the primary dentition. Taurodontism of permanent molar teeth was confirmed as a feature of the condition in the more severely affected male subjects.

Factors affecting the diagnostic quality of bitewing radiographs: a review

The bitewing radiograph (BWR) has been used in dental practice for over 90 years and is a widely used technique. This paper outlines the ideal technique for producing reproducible BWR of good diagnostic quality. In particular, it reviews the technical errors that may occur while exposing and processing BWR and the psychological errors that may result when radiographs are viewed. The consequences of these errors, (unnecessary patient exposure to radiation, poor diagnosis and potentially inappropriate treatment) are outlined in detail. Steps to improve the quality of BWR and decrease patient exposure to radiation are given in line with recent recommendations.