Panoramic Radiograph and CBCT in Unilateral Mandibular Condylar Hyperplasia—A Case Report

Condylar hyperplasia (CH) of the mandible is a rare developmental disorder that results in enlargement of the condyle. It is predominant in females, mostly unilateral and self-limiting. This report presents a case of a 35-year-old female patient with unilateral condylar hyperplasia with an increase in vertical height of mandibular ramus of the affected side. After initial radiographic evaluation, the asymmetry index using a panoramic radiograph was determined and also analyzed using cone-beam computed tomography (CBCT). Condylar dimensions in all the planes were measured for both sides using CBCT. This case report emphasizes the importance of CBCT and its role in the diagnosis and assessment of mandibular condylar hyperplasia.

Maxillary Distomolar Associated with Dentigerous Cyst: An Unusual Entity

Supernumerary teeth may be encountered as an incidental finding on a radiograph. When impacted, they may be associated with clinical signs related to different problems such as failure of eruption, teeth displacement, root resorption or cystic lesions. They may occur in primary and permanent dentition, in both the maxilla and mandible and can be single or multiple in patients with syndromes. Mesiodens is the most commonly impacted tooth and appears between the central maxillary incisors in pediatric ages. Supernumerary teeth distal to the third molar are rare, usually impacted and referred to as a distomolar. A 46-year-old male consulted with the main complaint of pain on the left side of the maxilla. A panoramic radiograph revealed a right impacted maxillary fourth molar located posterior to the third molar associated with a pericoronal radiolucency. The supernumerary tooth was removed surgically under local anesthesia and the pericoronal lesion enucleated. Histopathological examination was consistent with the diagnosis of a dentigerous cyst associated with an impacted distomolar. Healing was uneventful, and the patients remained asymptomatic. The occurrence of a maxillary distomolar is rare and even rarer the association with a dentigerous cyst.

Panoramic and periapical radiographs utilization in Disaster Victim Identification (DVI): narrative review

Objectives: The purpose of this narrative review is to discover radiographic images in panoramic and periapical radiographs that are used as identifiers and to compare the use of panoramic and periapical radiographs in identification based on DVI. Review: The databases used in this narrative review are Google Scholar, PubMed, and Science Direct. A total of 1258 search results appeared based on keywords. The search results were selected by title and abstract according to their relevance to the review topic, then results are selected again based on the inclusion and exclusion criteria. Total of 38 literatures were reviewed. This review shows radiographic identifiers used in panoramic radiographs are tooth restorations, crown, Root Canal Treatment (RCT), dental bridge, dental implants, maxillary sinus, rectilinear metal plate, orthodontic brackets, tooth anomaly, and root morphology. The radiographic identifiers used in periapical radiograph are tooth restorations, PSA, tooth anomaly, and root morphology. In this review, 53.8% of the literatures used panoramic radiograph for identification, whereas 46.2% used periapical radiograph. Conclusion: This review concluded that the most used radiographic identifier in panoramic radiograph is tooth restoration (57,1%) whereas in periapical radiograph is RCT (83,3%). Panoramic radiography were used in 53,8% of the literatures in this review, it was used more than periapical radiography.

Sensitivity of panoramic radiographs in diagnosing maxillary sinusitis: a scoping review

Objectives: The purpose of this study was to determine the sensitivity of using this panoramic radiograph in diagnosing maxillary sinusitis. Review: Scoping Review with article searches was carried out through NCBI's PubMed database, Science Direct, and EbscoHost from January 2020 to March 2021, with the inclusion criteria being articles published in 2010-2020. Conclusion: Panoramic radiographs were found to be less sensitive for diagnosing maxillary sinusitis, but due to the low availability and accessibility of CBCT and CT, and related to their expensive cost and high radiation, panoramic radiographs are considered to be quite optimal.

CORRELATION OF PANORAMIC RADIOGRAPHIC FINDINGS AND CLINICAL FINDINGS OF DENTAL PATIENTS AT MOI TEACHING AND REFERRAL HOSPITAL, KENYA

Purpose: The purpose of this study was to determine the correlation of panoramic radiographic findings and clinical findings among dental patients at Moi Teaching and Referral Hospital (MTRH), Kenya. Materials and Methods: This was a hospital based cross sectional study conducted at the Radiology and Imaging department and dental department at Moi Teaching and Referral Hospital from September, 2019 to June, 2020. A total of 93 consenting patients were enrolled using systematic random sampling. Standard chart review forms were administered, and clinical examination findings documented. Panoramic radiograph findings were then discussed with a consultant radiologists and findings recorded. Descriptive statistics were carried out. Categorical variables were summarized as frequencies and proportions, and reported in tables. Numerical variables were summarized as median and interquartile ranges. Cross tabulation was done to compare clinical examination and panoramic radiograph findings where total raw agreement was reported as proportions. Results: 93 patients whose ages ranged from 5-73 years with a mean of 29 years were included into the study. Radiographic features of dental caries were present in 54% of panoramic radiographs compared to clinical examination (50.5%) while 23.7% of radiographs revealed impacted teeth compared to clinical examination (19.4%). Radiographic features of periodontitis were observed in 14% compared to clinical examination (16.1%). Fractures (12.9%) were observed radiographically compared to (10.7%) clinically. Periapical lesions (8.6%) were observed radiographically compared to clinical examination (6.4%). Temporo-mandibular disorder (6.5%) were observed both on radiographs and clinical examination. Radiographic features of missing teeth (3.2%) were observed compared to clinical examination (1.1%) while only 1.1% of malpositioned teeth were observed radiographically compared to clinical examination (2.2%). Notably, mandibular lesions (3.2%) and nasal congestion (14%) were only discovered radiographically. The overall raw agreement between panoramic radiograph and clinical examination was 75.3% (70/93) with a p value of less than 0.001. Unique contribution to theory, practice and policy: The study recommends that all patients presenting with dental conditions should be done panoramic radiograph to improve diagnosis. Moi Teaching and Referral Hospital and the Ministry of Health to consider routine panoramic radiographs in the guidelines for the assessment of dental patients in all the hospitals offering, dental health services

Radiographic Detection of the Relationship Between Tonsilloliths and Dental Plaque-Related Pathologies in a Series of Digital Panoramic Radiographs

Objective: The purpose of this study was to analyse the prevalence of tonsilloliths and to determine radiographically whether there is a relationship between tonsilloliths and dental plaque-related pathologies in a series of digital panoramic radiographs. Materials and Methods: This retrospective study included digital panoramic radiographs of 859 patients admitted for a routine dental examination. The panoramic images were examined for both the presence of tonsilloliths and the number of decayed, missing, restored tooth and apical periodontitis. Periodontal bone loss was also measured in thirds of optimal bone height according to the root length and finally a percentage of bone loss was obtained for each panoramic radiograph evaluated. Results: Tonsilloliths were observed in 141 (16.4%) of all individuals. While there was no significant difference regarding the number of decayed teeth and restored teeth between tonsillolith cases (TT) and cases without tonsillolith (TC), the number of missing teeth and apical periodontitis in TT was significantly higher than TC (p: 0.004, p: 0.030, respectively). There was a significant difference between the groups in terms of the mean percentage of bone loss (p: 0.001; p< 0.05). In addition, cases showing bone loss between one-third and two-thirds of the optimal bone height in the TT group (52.5%) were significantly higher than those in TC (45.5%) (p: 0.035; p< 0.05). Conclusion: The relationship between dental plaque-related pathologies and tonsilloliths, observed in this retrospective study, should be confirmed by Computed Tomography studies and randomized, prospective, clinical trials conducted in a multidisciplinary manner.

Is Dental Panoramic Radiography Reliable to Assess Position of Bicortical Fixation Screws in Mandibular Fractures? Case Report

Background: Panoramic radiography is widely used as a diagnostic tool before oral surgeries and can be considered the foremost follow-up image after. It provides a broad observation of the maxillomandibular complex at a lower cost and radiation dose. But cone-beam computed tomography (CBCT) examination, after panoramic radiograph evaluation, can produce a change in the diagnostic thinking of maxillofacial surgeons leading to alterations in treatment plans. Objective: We aim to report a case with incidentally discovered radiographic findings where diagnostic changes were caused by switching from panoramic to CBCT imaging. Conclusion: Radiographic assessment of the position and angulation of screws by panoramic x-ray should be approached with extreme caution. The image of choice is CBCT if nerve injury is suspected.

Prevalence of Incidental Radiopacities in Panoramic Radiographs

Routine panoramic radiographs often reveal hidden lesions other than those related to the patient's chief complaint [1]. The study aims to determine the prevalence of incidental radiopacities in panoramic views. There are several conditions where calcifications can occur in soft tissue, including major and minor salivary glands, lymph nodes, and blood vessels, such as sialolith, phlebolith, exostosis, dystrophic calcifications, etc. [2]. Interpretation of panoramic radiograph should consider the possibilities of soft tissue calcification super-imposed in bone. Three hundred and sixty (360) panoramic radiographs are included in the study. The prevalence and distribution of radiopacities were documented along with the probable diagnosis. In addition, statistical analysis was done by SPSS software to evaluate the age and gender-related distribution of radiopacities in panoramic radiographs.

Brown Tumors of the Mandible Revealing Hyperparathyroidism: About Two Cases

The diagnosis of osteolytic lesions of the jaws can be challenging. Case Reports: Two cases of brown tumor of hyperparathyroidism were reported. A 76- year-old female patient presented with indolent swelling of her right lower jaw measuring approximately 5 cm /6 cm. The panoramic radiograph showed a well-defined osteolytic radiolucency involving the entire mandibular symphysis. Blood investigations revealed High level of parathyroid Hormone (PTH): 102pg/ml. The diagnosis of a brown tumor of hyperparathyroidism was suspected. A parathyroid technetium scintiscan revealed abnormally high uptake at the lower pole of the thyroid lobe interpreted as hyperplasia of right inferior parathyroid gland with possible brown tumor of the mandible. Second case: A 36- year-old female patient presented for the replacement of her missing teeth. Her medical history revealed chronic renal failure and a recent surgical excision of an Osteitis fibrosa cystica of her fifth left proximal phalange. Panoramic radiograph showed multiple well defined osteolytic lesions of the mandible. The diagnosis of a brown tumor of the mandible secondary to hyperparathyroidism was suspected. Laboratory investigations showed increased PTH level, serum hypocalcemia and hyperphosphatemia and vitamin D deficiency. The patient was referred to the department of endocrinology for further investigation and the correction of PTH level. At Six months follow up all the lesions disappeared on radiological control. Discussion: Brown tumor of hyperparathyroidism is a metabolic disorder causing bone resorption that can affect the jaw bones. Clinical symptoms depend on the size and the location of the lesion. Radiographically, it appears as radiolucent unique or multiple well-defined intra-osseous radiolucency. Biological examination is the key to the diagnosis and it is marked by high level of parathyroid hormone (PTH). Key words: Jaw, Tumors, Osteitis Fibrosa Cystica, Hyperparathyroidism, Diagnosis.

Traumatic Bone Cyst in the Mandibular Symphysis : Case Reports

Traumatic bone cyst (TBC) is an asymptomatic lesion seen most in adolescents. TBC is found incidentally on routine panoramic examinations and appears as a relatively well-demarcated unilocular radiolucency with scalloped margins. Histological examination reveals a vacant cavity of cancellous bone usually unlined or very occasionally lined with a thin connective tissue layer. The lack of lining epithelial membrane is common histological feature. The most affected site is between the mandibular canine and third molar. The involvement of the mandibular symphysis is rare. The etiopathogenesis of the TBC is unclear. TBC is treated with surgical exploration and curettage; new bone is formed in place of the lesion within 6 - 12 months of surgery. Diagnosis of TBC prior to surgical intervention has limitations in most of the cases. Both of our patients were diagnosed through radiological examination and biopsy. Neither patient had a history of trauma. After surgery, the panoramic radiograph and CBCT were used to confirm bone healing.