Radiological findings in 1135 edentulous patients

Panoramic radiographs made before complete removable dental prostheses fabrication: A retrospective study of clinical significance

STATEMENT OF PROBLEM

The value of digital panoramic radiographs to screen for problems before fabricating conventional complete dentures is unclear.

PURPOSE

The purpose of this retrospective study was to examine the influence of pretreatment digital panoramic radiographs on the clinical management of patients receiving complete removable dental prostheses.

MATERIAL AND METHODS

The clinical records, including panoramic radiographs, of 169 patients seeking new complete removable dental prostheses over a 6-year period were interpreted independently by both a prosthodontist and an oral and maxillofacial radiologist to identify radiographic findings that influenced clinical patient management. A 95% confidence interval and an observed proportion of agreement were used to interpret the results.

RESULTS

Sixty percent of the 169 radiographs examined had 1 or more abnormal or positive radiographic findings; however, only 6 (<4%) of 165 abnormalities detected influenced patient management, and 3 of them were identified during the clinical examination.

CONCLUSIONS

Pretreatment digital panoramic radiographs revealed very few abnormalities that influenced the treatment of patients requiring complete removable dental prostheses. Furthermore, the digital images in this study revealed positive findings at a rate similar to those found in studies assessing analog radiographs, reinforcing current guidelines that recommend against radiographic screening of patients who seek new complete removable dental prostheses.

A study of the impact of screening or selective radiography on the treatment and postdelivery outcome for edentulous patients

OBJECTIVE

The purpose of this study was to assess the impact of radiographic findings on complete denture treatment and on the postdelivery course of those patients who had pretreatment radiographs (the screening group) and those who did not (the selection group).

METHOD

In total, 375 cases were randomly selected by systematic sampling. Data collected included patient demographic information and denture history, predenture fabrication radiographic findings, and postdenture delivery complaints.

RESULTS

Of the screening patients, 100% had pretreatment radiographs made; this compared with 13.5% of the selection patients. In the screening group, 68.3% of patients had one or more positive radiographic findings recorded. Of the screening patients, 8.3% received treatment before denture fabrication; this compared with 1.2% of the selection patients. Of the 375 cases, 2 screening patients had postdelivery complaints that required management other than denture adjustment.

CONCLUSION

The results indicate that there is weak scientific support for the guideline recommending routine pretreatment radiography for new denture patients.

An analysis of the scientific basis for the radiographic guideline for new edentulous patients

The FDA Radiology Guideline for the new edentulous patient recommends an initial survey of the arches. In the process of developing this recommendation, the expert panel reviewed the available literature and concluded that there was sufficient evidence to warrant screening radiography rather than selective radiography, which is the principle on which all the other recommendations are based. Our evaluation of the literature used by the panel for the edentulous recommendation identifies critical errors in the analysis of the data. Factors such as a vague definition of abnormality and a geographically diverse sample population might have led the expert panel to suggest a very conservative recommendation for this group of patients. The recommendation failed to consider the treatment impact of findings and was based simply on the large number of observations, regardless of their treatment or pathologic significance. However, in studies in which treatment is considered, it is clear that screening radiography for new edentulous patients does not yield sufficient clinically relevant information to support the guideline.

The use of panoramic radiology in dental practice

OBJECTIVES

Approximately 1.5 million panoramic radiographs are taken annually in the general dental service in England and Wales. The aim of this review was to assess the clinical role of panoramic radiology in the diagnosis of diseases associated with the teeth and to consider its value in routine screening of patients.

METHOD

This was carried out by critical review of the literature.

RESULTS

In addition to common problems with radiographic technique and processing, there are limitations in image quality inherent to panoramic radiology. These factors contribute to a reduced diagnostic accuracy for caries diagnosis, demonstration of periodontal bone support and periapical pathology when compared with intraoral radiography. Routine screening is unproductive for large proportions of dentate and edentulous populations, while in those cases where pathology is detected the diagnostic accuracy can be questioned. Furthermore, the "detection' of asymptomatic anomalies may have no effect on patient management. Attempts to develop and test panoramic radiographic selection criteria are reviewed.

CONCLUSIONS

New, high-yield selection criteria for panoramic radiography are proposed as a means of reducing unnecessary examinations, limiting radiation doses and reducing financial costs to patients and health service providers. However, research is indicated to develop further and to test such selection criteria.

Radiographic maxillary sinus findings in the elderly

The prevalence of radiographic maxillary sinus findings in 293 elderly subjects (76, 81, and 86 years old) were investigated with the use of panoramic radiography: 124 subjects were edentulous in both jaws, 167 had an edentulous maxilla, and 169 had at least one natural tooth left. Mucous cysts or diffuse mucosal thickenings were found in 12% of the subjects. Of the mucosal thickenings, 70% were found in subjects with a dentate upper jaw (p < 0.05), suggesting an odontogenic origin for that proportion (40%) exceeding the prevalence in subjects edentulous in the maxilla. That the prevalence of mucous cysts was 5% both in subjects with a dentate upper jaw and in those with a edentulous upper jaw suggests nonodontogenic causes.

A survey of the radiographic practices of general dentists for edentulous patients

OBJECTIVE

The objective of the study was to evaluate the radiographic practice of general dentists for edentulous patients.

STUDY DESIGN

A questionnaire was sent to a sample of graduates from the two Ontario dental schools.

RESULTS

The adjusted response rate for the survey was 80%. Fifty-three percent of the respondents used screening radiography for new patients. The overwhelming choice for these dentists was the panoramic film. There was a significant positive association between ownership of a panoramic unit and use of this radiograph. Dentists who do not own a panoramic unit rarely chose to refer their patients for this radiograph either routinely or selectively. When dentists, rather than the auxiliaries, made the greater proportion of the radiographs, they tended to use selective radiography. Most dentists chose selective radiography for the recall patient.

CONCLUSIONS

Almost half the dentists did not follow the Food and Drug Administration/American Dental Association guideline of screening radiography for the new edentulous patient. Of those dentists who did follow the guideline the vast majority both owned panoramic units and chose to use a panoramic survey. Most dentists followed the guideline for selective radiography for the recall patient.

Radiographic findings in the jaws of clinically edentulous old people living at home in Helsinki, Finland

In the present survey the radiographic findings in the jaws of 124 clinically edentulous old people living at home in Helsinki, Finland, were studied, using panoramic radiography supplemented by intraoral radiographs. Only 9% of the subjects had root remains. Impacted teeth were found in 4%, radiolucent lesions in 3%, and radiopaque findings in 13%. Deviations from normal condylar structure were found in 17% and mucosal thickenings in the maxillary sinuses in 7%. The mental foramen was situated at the top of the residual ridge in 42% of the subjects. Topically situated mental foramen and condylar changes were commoner in women. The radiographic oral health status of the population studied was good.

Panoramic radiographs: necessary for edentulous patients?

With recent concern about the cumulative effects of radiation exposure, routine radiographic examination of edentulous patients is being questioned. While the present study reports a lower incidence of positive findings than previous panoramic surveys, we still find potentially complicating conditions. Radiographic examination of new edentulous patients still appears warranted.