The prevalence of foreign bodies in jaw bones on panoramic radiography

Proper Management of Amalgam Powder Embedded in the Alveolus

The presence of foreign bodies in the mandible is not listed as a risk factor or absolute contraindication for implant rehabilitation. However, possible complications caused by foreign bodies, such as infection and cyst formation, could lead to implant failure. The authors report a case of dental implant placed 4 months after the surgical removal of embedded amalgam in the mandibular alveolus using a trephine bur and bone grafting with mineralized freeze-dried bone allograft. Clinical and radiographic evaluations were performed at each appointment to assess factors such as pain, implant mobility, probing depth, and marginal bone loss around the implant. Within 3 years of implant placement, there were no clinical signs and symptoms and no obvious radiographic marginal bone loss. Dental implant installation appears to be safe following the elimination of foreign materials, so long as anatomic and biological factors and appropriate implant choice, are taken into consideration.

Periapical foreign body findings - histological and radiological comparison

OBJECTIVE

This study aimed to clarify the perceptibility of periapical foreign materials in imaging compared with histopathology. We hypothesized that dentoalveolar imaging is sufficient to detect periapical foreign bodies.

MATERIAL AND METHODS

Radiological and histopathological records of patients diagnosed with periapical granuloma or radicular cyst from 2000 to 2013 were evaluated retrospectively. Patients with histologically verified foreign bodies were included in the study and their pathological samples and radiological images were reviewed. The outcome variable was radiologically detectable foreign material. The predictor variables were histopathological diagnosis, type of inflammation, type and number of foreign bodies, imaging modality, and site of foreign material.

RESULTS

Compared to the histopathological diagnosis of foreign bodies as the gold standard, the level of radiologic detectability was mild. Histologically verified foreign material could be detected by imaging in 32/59 (53.5%) patients. Histological diagnosis, type of inflammation, type or number of foreign bodies, imaging modality or site of foreign material had no association with radiological detectability (p > 0.05).

CONCLUSIONS

According to our results, histopathology is a more accurate diagnostic tool than radiology in periapical foreign bodies or foreign body reactions. Clinicians should keep in mind the limitations of imaging when setting the diagnosis and planning treatment.

Unexpected metallic foreign bodies on panoramic scans - a narrative review

BACKGROUND

The digital panoramic radiograph (orthopantomogram, OPG) is the standard radiographic technique for basic diagnostics in dental practice. A correctly taken image provides a good overview of teeth and jaw, whereas radiopaque foreign materials, e. g. metal, can obscure relevant findings.

METHODS

A literature review on unexpected metallic foreign bodies in OPG was performed to determine the spectrum of metallic foreign bodies that may cause radiopaque areas on panoramic radiographs in routine clinical use.

RESULTS AND CONCLUSION

A total of 37 different unexpected metallic foreign bodies were found. They can be categorized as jewelry, clothing, personal protective equipment, medical devices, iatrogenic foreign bodies, and rare incidental findings. Radiopaque foreign materials in the OPG are often relatively easy to recognize as artifacts because of their location, and they are avoidable in most cases. If unclear, a three-dimensional radiograph was helpful for determining the location. Radiopaque areas caused by foreign bodies can lead to misinterpretation or partial or complete non-evaluability and should therefore be avoided.

KEY POINTS

· The OPG is the standard radiograph for dentists, oral surgeons, and oral and maxillofacial surgeons.. · Foreign bodies made of metal can lead to non-evaluability of panoramic radiographs. Based on a review of the literature and exemplary radiographs, this article provides an overview of rare but typical metallic foreign bodies in OPG, thus addressing the problem of the subfield of radiography by making radiologists more familiar with these images.. · The spectrum of unexpected metallic foreign bodies includes unremoved earrings with the typical ghost images on the contralateral side, piercings, hearing aids, acupuncture needles, rare iatrogenic foreign bodies, incidental findings in infants in the nose and external auditory canal, vascular clips after surgical interventions, and ritual subcutaneous foreign materials..

CITATION FORMAT

· Brauer HU, Bartols A, Hellmann D et al. Unexpected metallic foreign bodies on panoramic scans - a narrative review. Fortschr Röntgenstr 2023; 195: 809 - 818.

Optical surgical navigation-assisted removal of a foreign body using a splint to simplify the registration process: a case report

Background

Oral and maxillofacial surgeons often encounter foreign objects within the human body. Despite the visual identification of foreign objects via imaging techniques, the accurate determination of their position in the maxillofacial area can be challenging. The clinical application of a navigation system can solve this issue. This system provides a useful guide for a safer and more accurate surgical technique by accurately determining the location of the lesion in real time during the surgery. However, complications with regard to registration may be encountered. We describe a navigation system that simplifies registration using a dental splint with embedded reference points for foreign body removal in the maxilla.

Case presentation

A 78-year-old Japanese woman was referred with the chief complaint of pain in the left upper molar region. We found the symptoms to be associated with a foreign body in the maxilla and decided to remove it. A minimally invasive treatment procedure was desirable. However, the lesion was in contact with the maxillary sinus, and it was difficult to pinpoint its position because of the absence of an anatomical landmark. Therefore, we decided to use a navigation system. In order to simplify registration, a dental splint with embedded reference points was created. The registration could be reliably performed before surgery using an optical navigation system that facilitates the process, using splints with embedded reference points. Following preoperative registration, the splint with the reference frame was placed in the patient’s mouth, and the accuracy of the navigation was confirmed. The position with respect to the maxillary sinus was precisely identified followed by the removal of the surrounding bone and excision of the lesion. Therefore, the surgery could be accurately performed without perforating the maxillary sinus. In addition, owing to preoperative registration, the operative time could be shortened. After the surgical procedure, the patient’s symptoms disappeared.

Conclusions

The procedure was performed in a precise, minimally invasive manner. Furthermore, the operative time was reduced by the simplified registration process, wherein a splint was embedded with reference points. This technique may prove useful for performing maxillofacial surgical procedures.

Comparison of accuracy between panoramic radiography, cone-beam computed tomography, and ultrasonography in detection of foreign bodies in the maxillofacial region: an in vitro study

Objectives

Foreign bodies (FBs) account for 3.8% of all pathologies of the head and neck region, and approximately one third of them are missed on initial examination. Thus, FBs represent diagnostic challenges to maxillofacial surgeons, rendering it necessary to employ an appropriate imaging modality in suspected cases.

Materials and Methods

In this cross-sectional study, five different materials, including wood, metal, glass, tooth and stone, were prepared in three sizes (0.5, 1, and 2 mm) and placed in three locations (soft tissue, air-filled space and bone surface) within a sheep's head (one day after death) and scanned by panoramic radiography, cone-beam computed tomography (CBCT), and ultrasonography (US) devices. The images were reviewed, and accuracy of the detection modalities was recorded. The data were analyzed statistically using the Kruskal-Wallis, Mann-Whitney U-test, Friedman, Wilcoxon signed-rank and kappa tests (P<0.05).

Results

CBCT was more accurate in detection of FBs than panoramic radiography and US (P<0.001). Metal was the most visible FB in all of modalities. US was the most accurate technique for detecting wooden materials, and CBCT was the best modality for detecting all other materials, regardless of size or location (P<0.05). The detection accuracy of US was greater in soft tissue, while both CBCT and panoramic radiography had minimal accuracy in detection of FBs in soft tissue.

Conclusion

CBCT was the most accurate detection modality for all the sizes, locations and compositions of FBs, except for the wooden materials. Therefore, we recommend CBCT as the gold standard of imaging for detecting FBs in the maxillofacial region.