Surgical peri-implantitis treatment with and without guided bone regeneration. A randomized controlled trial

OBJECTIVE

To evaluate the efficacy of reconstructive peri-implantitis treatment.

MATERIALS AND METHODS

Forty participants, with peri-implantitis and a contained intraosseous defect, were randomized to access flap (control) or access flap with xenograft and collagen membrane (test). All received systemic antimicrobials. Blinded examiners recorded probing depths (PD), bleeding and suppuration on probing (BOP & SOP), soft tissue levels, and marginal bone levels (MBL) at baseline and 12 months. Patient reported outcomes were recorded. The primary outcome was PD change.

RESULTS

All 40 participants (40 implants) completed the 12-month study. The mean (standard deviation) PD reduction (deepest site) was 4.2 (1.8) mm in the control and 3.7 (1.9) mm in the test group. MBL gain (deepest site) was 1.7 (1.6) mm in the control and 2.4 (1.4) mm in the test group. Absence of BOP & SOP was observed at 60% of both control and test implants. Buccal recession was 0.9 (1.6) mm in the control and 0.4 (1.1) mm in the test group. A successful outcome (absence of PD ≥ 5 mm with BOP, absence of SOP and absence of progressive bone loss) was achieved for 90% of the control and 85% of test group implants. No statistically significant differences in clinical or radiographic parameters were found between treatment groups. 30% of participants experienced mild gastro-intestinal disturbances. Reporting followed CONSORT guidelines.

CONCLUSION

Similar clinical and radiographic improvements at 12 months were observed with high levels of patient satisfaction for both the access flap and xenograft covered by collagen membrane groups. Registered clinical trials.gov. ID:NCT03163602 (23/05/2017).

Incidental finding of juvenile angiofibroma from pre-orthodontic radiographs: two case reports and a literature review

This case series presents two asymptomatic cases of juvenile angiofibroma which were initially incidentally identified in pre-orthodontic radiographs. Juvenile angiofibroma is an uncommon, locally aggressive benign, vascular neoplasm with invasive growth patterns. Due to the hypervascularity of these tumours, there are biopsy associated risks and multi-slice computed tomography, magnetic resonance imaging and angiography are usually employed for diagnosis. Early pre-symptomatic identification of this lesion facilitates early management and limiting potential life-threatening complications. This highlights the importance of thorough interpretation of dental radiographs, including the evaluation of structures which are not in the primary region of interest. © 2022 Australian Dental Association.

Incidental findings detected on cone beam computed tomography in an older population for pre-implant assessment

OBJECTIVES

The aim of this retrospective study was to record incidental findings in CBCT scans taken in an older population for pre-implant assessment, and to examine whether these findings would influence the intended dental implant placement.

METHODS

300 consecutive CBCT scans over the age of 40 years was carried out. The incidental findings were grouped into regions as follows: dentoalveolar structures, maxilla and mandible, paranasal sinuses, temporomandibular joint (TMJ), naso/oral-pharyngeal airway, cervical spine and neurovascular canals. The incidental findings are further categories into their significance towards the intended treatment plan.

RESULT

Incidental findings were noted on all of the scans. 555 incidental findings (1.85 findings/scan) were identified. The highest number of incidental findings was in the sinuses (34%), followed by dentoalveolar structures (31%), nasal/oral-pharyngeal airway (12%), maxilla and mandible (10%), TMJ (6%), cervical spine (4%) and neurovascular canals (3%). A total of 37% of findings required follow-up. In 12% of cases detection of the incidental findings lead to amendment or abortion of the intended implant treatment plan.

CONCLUSION

Incidental findings within and beyond the region of interest are common in CBCT scans. The numbers of incidental findings per scan in an older population is higher than in a younger population.

A significant incidental finding on cone beam computed tomography: multiple myeloma

Cone beam computed tomography is widely used in dentistry. Incidental findings are common, with many requiring intervention or monitoring. We present a rare case of previously undiagnosed, asymptomatic multiple myeloma first identified incidentally on cone beam computed tomography and panoramic radiography. This case highlights the diverse range of lesions that may appear on cone beam computed tomography and the importance of radiologic interpretation.

The reliability of using postero-anterior cephalometry and cone-beam CT to determine transverse dimensions in clinical practice

AIM

This study primarily aimed to assess the accuracy of classically-advocated reference points for the measurement of transverse jaw-base and dental relationships using conventional Postero-Anterior Cephalometry (PAC) and Cone-Beam Computed Tomography (CBCT).

METHOD

PAC and CBCT images were collected from 31 randomly selected orthodontic patients (12 males, 19 females), all of whom had a full permanent dentition. The transverse widths of the maxilla, mandible and the dentition were measured using reference points on both image modalities. Confidence intervals, intra-class coefficients and Bland Altman plots were used to assess the measurement differences derived from the two acquirement methods.

RESULTS

Measurements on PAC and CBCT images demonstrated statistically significant differences in the majority of the assessed variables. The interjugal (J-J) width was one of only two variables which did not demonstrate a statistically significant difference on image comparison. The mean differences of the antegonial width (Ag-Ag) (-4.44mm, 95% CI -5.38 to -3.51) represented the greatest difference between the imaging techniques. The application of these points to a transverse skeletal analysis (J-J/Ag-Ag ratio) revealed that five of the 31 subjects (16%) recorded 'false positive' readings according to the derived data.

CONCLUSION

It is recommended that clinicians are cautious when interpreting and making decisions related to transverse dimensions derived from a PAC. The PAC has a higher tendency to falsely identify individuals who require maxillary expansion procedures based on conventional clinical criteria. The errors primarily associated with identifying structures which represent the width of the mandible are significant in both PAC and CBCT techniques and require further investigation. It is postulated that the confounding effects of overlying soft tissues have a sianificant impact on a clinician's ability to identify relevant landmarks.

The validity of transverse intermaxillary analysis by traditional PA cephalometry compared with cone-beam computed tomography

AIM

To assess the validity of using jugale (J) and Antegonion (Ag) on Posterior-Anterior cephalograms (PAC) as landmarks for transverse intermaxillary analysis when compared with Cone Beam Computed Tomography (CBCT).

MATERIAL AND METHODS

Conventional PAC and CBCT images were taken of 28 dry skulls. Craniometric measurements between the bilateral landmarks, Antegonion and Jugale, were obtained from the skulls using a microscribe and recorded as the base standard. The corresponding andmarks were identified and measured on CBCT and PAC and compared with the base standard measurements. The accuracy and reliability of the measurements were statistically evaluated and the validity was assessed by comparing the ability of the two image modalities to accurately diagnose an arbitrarily selected J-J/Ag-Ag ratio. All measurements were repeated at least 7 weeks apart. Intra-class correlations (ICC) and Bland-Altman plots were used to analyse the data.

RESULTS

All three methods were shown to be reliable as all had a mean error of less than 0.5 mm between repeated measurements. When compared with the base standard, CBCT measurements were shown to have higher agreement (ICC: 0.861-0.964) compared with measurements taken from PAC (ICC: 0.794-0.796). When the arbitrary J-J/Ag-Ag ratio was assessed, 18 per cent of cases were incorrectly diagnosed with a transverse discrepancy on the PAC compared with the CBCT which incorrectly diagnosed 8.7 per cent.

CONCLUSION

CBCT was shown to be more reliable in assessing intermaxillary transverse discrepancy compared with PAC when using J-J/Ag-Ag ratios.

The basic principles of radiological interpretation

Radiologic interpretation is a complex process which involves the application of an appropriate algorithm in the study of radiologic images and the ability to understand the meaning and to weight the various findings, ultimately contributing to diagnosis. Prerequisites include the knowledge of orofacial radiologic anatomy and the various pathoses which may arise or manifest in this region of the body. An understanding of the strengths and limitations of the modality employed is also essential. The process of interrogating radiologic images for abnormalities varies, depending on the modality. This paper outlines the basic steps involved in the radiologic examination of abnormalities which affect the jaws, primarily in relation to plain 2-D imaging.

Methods of determining the relationship of the mandibular canal and third molars: a survey of Australian oral and maxillofacial surgeons

BACKGROUND

Surgical extraction of third molars is one of the most common oral and maxillofacial surgical procedures performed and may have a number of associated complications. One of these complications is inferior alveolar nerve (IAN) dysaesthesia or impairment of sensory perception (including paraesthesia and/or anaesthesia). Previous studies assume that most clinicians use various combinations of nine radiologic criteria on panoramic radiographs as indicators of the relationship and, therefore, predictors of the risk of postoperative dysaesthesia. Our study assessed both the current radiologic modalities and assessment criteria used by Australian oral and maxillofacial surgeons when determining the proximity of mandibular canal to third molars.

METHODS

A survey of all surgeon members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZOMS) practising in Australia was undertaken.

RESULTS

Of the 105 questionnaires sent to surgeons, 72 responses (68 per cent) were returned. All surgeons reported using the panoramic radiograph but only 25 per cent considered it sufficiently accurate in determining the relationship between the mandibular canal (MC) and the third molar root, while 61 per cent of surgeons use CT for this purpose but the average frequency of use was very low (five per cent). This study also revealed that the nine radiologic criteria on a panoramic radiograph are used to varying extents by Australian surgeons. Nearly all surgeons use 'change in MC direction' and 'MC narrowing' to determine and close relationship. Thirty-one per cent used superimposition of the MC and the root of the third molar alone and 24 per cent used appearance of contact of the root with the MC alone in the absence of any other radiologic criteria to indicate close or intimate relationship.

CONCLUSION

Further research is required to determine the accuracy and observer agreement or reliability of using the nine panoramic characteristics, to determine this relationship and whether the presurgical determination of proximity and position (buccal or lingual) of the canal utilizing CT has any usefulness in determining the surgical protocol or affect on postoperative morbidity.