Evaluation of Panoramic Radiographs in Relation to the Mandibular Third Molar and to Incidental Findings in an Adult Population

The effect of gender and menstrual cycle phase on patıents undergoıng ımpacted thırd molar surgery: a cross-sectıonal study

BACKGROUND

Achieving the best outcomes in surgical procedures requires optimizing all patient-related psychological and physiological factors. This study was carried out to evaluate the preoperative anxiety and fear levels, and postoperative symptoms in patients undergoing impacted third molar surgery, and to compare the relevant psychological and physical findings between genders and between women in different menstrual cycle phases.

MATERIAL AND METHODS

The population of this prospective and clinical study consisted of patients who applied to faculty of dentistry for the extraction of impacted third molars. The menstrual cycles of the female patients included in the study ranged from 26 to 32 days. The female patients included in the study were divided into three groups according to the first day of the menstrual cycle and bleeding status. All patients were administered Spielberger State-Trait Anxiety Inventory Short Version (STAI-S), Dental Fear Survey (DFS), Modified Dental Anxiety Scale (MDAS) preoperatively, and postoperative satisfaction and complication questionnaires.

RESULTS

The mean age of the 128 patients included in the study was 27.04±4.62 years. Of these patients, 79 (61.7%) were female and 49 (38.3%) were male. Female patients had significantly higher STAI-S, MDAS and DFS scores than male patients (94 vs. 53; 16 vs. 9; 58 vs. 27; p<0.001, respectively). In parallel, female patients had significantly higher complication rates, thus significantly lower satisfaction levels than male patients (116 vs. 51; 40 vs. 13; p<0.001, respectively). STAI-S, MDAS and DFS scores were high in women during the secretory phase (p<0.001). In the secretory phase, complications were high and satisfaction was low (p<0.001).

CONCLUSIONS

The findings of the study reveal that women have a harder time getting through the operation process and that timing is important in reducing preoperative anxiety and fear levels and increasing postoperative satisfaction levels and complication rates.

Effect of using different strips on reducing the most common error in panoramic imaging: A randomised controlled trial on palatoglossal air space shadow

INTRODUCTION

Panoramic radiography quality can be impaired by some errors such as positioning errors. Palatoglossal air space shadow error is one of the most common positioning errors and it is due to the tongue not sticking to the roof of the palate. Techniques used to deal with this error might help prevent unnecessary radiation to patients and save them time and money. The study aimed to investigate the effects of using celluloid matrix and edible tapes (fruit leather and chewing gum) on reducing the palatoglossal air space shadow error in panoramic imaging.

METHODS

In our study, 270 patients referred to the Department of Radiology were randomised into three groups: a control group, a celluloid matrix group and an edible tapes group. Before panoramic imaging, all patients were instructed to adhere their tongues to the roof of their mouths, with the distinction that for the celluloid matrix and edible tapes groups, patients were asked to place celluloid tapes, fruit leathers, or chewing gums on their tongues before doing so. The routine imaging process was then performed, and the results were compared across groups to evaluate the incidence of palatoglossal air space shadow error.

RESULTS

The number of error-free images in each fruit leather, chewing gum and celluloid tape group were significantly higher than the control group (all cases P < 0.05). The chances of error-free images in the fruit leather groups were the highest (9.57 times). The age (P = 0.136) and gender (P = 0.272) of patients had no significant effect on the results of interventions.

CONCLUSION

The application of fruit leathers, chewing gums and celluloid tapes reduced the palatoglossal air space shadow error of panoramic imaging.

Role of CBCT in Prediction of Oro-antral Communication Post Third Molar Extraction: A Retrospective Study

OBJECTIVE

 Oro-antral communication (OAC) is one of the most frequently encountered complications during third molar extraction. Various radiographic factors, like excessive maxillary sinus pneumatization, long periods of edentulism, periapical lesions, etc., have been considered high-risk factors for OAC. However, a panoramic radiograph has not proven to be accurate in predicting the chances of OAC. Through this retrospective study, we evaluated the efficacy of a CBCT in predicting the incidence of OAC after maxillary third molar extraction.

MATERIALS AND METHODS

 We conducted a retrospective study in our department, which included the patients who had undergone extraction of a maxillary third molar over five years with the presence of panoramic X-rays and/or CBCT scans prior to extraction. Primary outcomes assessed from the case files were intra-operative complications like OAC, root fracture, tuberosity fracture, pterygoid plate fracture, etc. The incidence of these complications was correlated with the presence or absence of CBCT before extraction.

RESULTS

 Out of 920 extracted maxillary third molar, only 148 teeth (16.1%) had a CBCT record before extraction. The most commonly encountered complication was broken inaccessible root piece/s (4.9%), followed by OAC (3.5%). An inter-group comparison showed that a significantly higher percentage of patients (p < 0.001) with CBCT records had an incidence of OAC (11.5%) as against the group of patients with no CBCT record (1.9%).

CONCLUSION

 A CBCT scan prior to cases with high-risk factors for OAC can be a valuable tool in accurately predicting the chances of OAC after maxillary third molar extraction.

Incidental Pathologic Findings from Orthodontic Pretreatment Panoramic Radiographs

Panoramic radiography is frequently performed for new patients, follow-ups and treatment in progress. This enables dental clinicians to detect pathology, view important structures, and assess developing teeth. The objective of the study was to determine prevalence of incidental pathologic findings (IPFs) from orthodontic pretreatment panoramic radiographs at a university dental hospital. A retrospective cross-sectional review was conducted of pretreatment panoramic radiographs, using data collection sheets with predefined criteria. Demographic data and abnormalities (impacted teeth, widening of periodontal ligament, pulp stones, rotated teeth, missing teeth, unerupted teeth, crowding, spacing, supernumerary teeth, and retained deciduous teeth) were reviewed. SPSS 28.0 was used to analyze data with statistical tests set at a 5% significance level. Results: One hundred panoramic radiographs were analyzed with an age range of 7 to 57 years. The prevalence of IPFs was 38%. A total of 47 IPFs were detected with altered tooth morphology predominantly (n = 17). Most IPFs occurred in males (55.3%), with 44.7% in females. A total of 49.2% were in the maxilla and 50.8% in the mandible. This difference was statistically significant (p < 0.0475). Other abnormalities were detected in 76% of panoramic radiographs; 33 with IPFs and 43 without. A total of 134 other abnormalities detected showed predominantly impacted teeth (n = 49). Most of these abnormalities were in females (n = 77). Conclusions: The prevalence of IPFs was 38%, predominated by altered tooth morphology, idiopathic osteosclerosis, and periapical inflammatory lesions. Detection of IPFs from panoramic radiographs underscored the importance for clinicians to examine them for comprehensive diagnosis and treatment planning, especially in orthodontics.

Visibility of anatomical landmarks in the region of the mandibular third molar, a comparison between a low-dose and default protocol of CBCT

OBJECTIVE

Optimization of radiographic examinations is essential for radiation protection. The objective of the study was to investigate the clinical applicability of a low-dose CBCT protocol as compared to the default for pre-surgical evaluation of mandibular third molars.

MATERIAL & METHODS

Forty-eight patients (62 teeth) referred for pre-surgical mandibular third molar investigation were recruited after justification for CBCT. Two CBCT scans of each site were made using a default protocol and a low-dose protocol (Veraviewepocs 3D F40, J Morita Corp, Kyoto, Japan). The low-dose protocol had the same tube potential (90 kV) and exposure time (9.4 s) as the default, but with reduced tube current, from 5 mA to 2 mA. Four observers evaluated the visibility of five relevant anatomical variables. Image quality was ranked on a 3-point scale as diagnostically acceptable, doubtful, or unacceptable. The Wilcoxon signed-rank test compared differences between the two protocols. The significance level was set at p ≤ .05.

RESULTS

No significant differences were found between the two protocols for any observer regarding the visibility of the relationship and proximity between the roots and the mandibular canal; root morphology; and possible root resorption of the second molar. The periodontal ligament differed significantly in visibility between the two protocols (p ≤ .05).

CONCLUSIONS

This study indicates that a low-dose CBCT protocol with a 60% reduction of the tube current provides, in most cases, acceptable image quality for pre-surgical assessment of mandibular third molars. Optimization of CBCT protocols should be a priority according to recommended guidelines.

Computer-Aided System of the Mandibular Cortical Bone Porosity Assessment on Digital Panoramic Radiographs

OBJECTIVES

 The loss of bone mineral density (BMD) in various sites of the body, including the mandible, is the main sign of osteoporosis. Thus, the computer-aided diagnosis (CAD) system was developed for bone density assessment and patients were classified into normal, osteopenia, and osteoporosis groups using a digital panoramic radiograph.

MATERIAL AND METHODS

 Data of dental panoramic radiographs and corresponding BMD assessments from 123 postmenopausal women were collected. For the proposed CAD system test, regions of interest (ROI) that were located below the left and right mental foramen on dental panoramic radiographs were determined. The width and texture of the mandibular cortical bone in each ROI were used to classify the data into normal, osteopenia, and osteoporosis classes. The width of the mandibular cortical was measured using the polynomial fitting method. The texture feature of the cortical bone is obtained by calculating the average value of the grayscale intensity of cortical bone. The classification result was obtained by using a multiclass support vector machine.

RESULTS

 The experimental results using 10-fold cross-validation showed that the proposed system achieved an average accuracy of 86.50% for osteoporosis classification on dental panoramic radiographs. The average misclassification error and relative foreground area error of the segmentation process were 5.21 and 12.98%, respectively. From the analysis of the cortical width measurement process, highest average mandibular cortical width (MCW) was found in the normal patient category compared with the other classes.

CONCLUSION

 This research showed that the proposed computer-aided system can be used for osteoporosis and osteopenia assessment by measuring the MCW and texture on dental panoramic radiographs with the average system accuracy of 89.52%.

Radiographic imaging in relation to the mandibular third molar: a survey among oral surgeons in Sweden

Objectives

To query the experience of oral surgeons concerning referral routines and preferences for radiographic imaging modality before surgical removal of mandibular third molars and investigate factors that influence imaging modality preferences.

Materials and methods

Members of the Swedish Association of Oral and Maxillofacial Surgeons (n = 280) were invited to participate in a web-based digital survey concerning their experiences and use of three imaging modalities in pre-surgical assessment of mandibular third molar removal. The survey comprised multiple-choice questions and four cases depicted in images; respondents reported whether they would supplement the cases with other images and, if so, from which modality.

Results

The response rate was 64%. Panoramic radiographs were most commonly used in pre-surgical planning (response options: always or often), significant difference between professions (p = 0.039), and considered to facilitate treatment planning (87%), as was CBCT (82%); for 51%, CBCT reduced post-operative complications. Preferred modality for localizing the mandibular canal was fairly evenly distributed and for non-complex case, significant difference between subgroups of OMFS surgeons was found (p = 0.003) as to preference for intraoral radiographs.

Conclusions

A majority of respondents received a report within 2 weeks of their referral for CBCT and would read the report and view the images before surgery. Image modality preference differed depending on case complexity, with a greater perceived need for CBCT. Profession and practical experience affected choice.

Clinical relevance

Choice of imaging modality in mandibular third molar assessment is also important from dose delivery and social economy standpoints.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-04189-9.