Binali Çakur

Reliability of mandibular cortical index and mandibular bone mineral density in the detection of osteoporotic women

OBJECTIVES Measuring the bone mineral density (BMD) of the femur and lumbar vertebrae has been the traditional method for determining osteoporosis in women. In this study, we tried to determine the relationships between mandibular dual-energy X-ray absorptiometry (m-DXA) values obtained with a new methodology, mandibular cortical index (MCI), total BMD values of the femur and lumbar vertebrae in 80 women with osteoporosis determined by DXA in conformity with T-score thresholds, as defined by the World Health Organization (WHO). METHODS m-DXA and panoramic radiography were performed on 80 women with osteoporosis. m-DXA was calculated by manual analysis of DXA scans. MCI was determined by the appearance of the mandibles on panoramic radiographs. DXA measurements of the skeletal BMD (femur and lumbar vertebras) and MCI values were also calculated. Correlations between these variables were assessed. RESULTS Although there were no correlations between skeletal BMD (total BMD values of the femur and lumbar vertebras) and mandibular measurements (mDXA and MCI), we found that there was a significant correlation between the skeletal BMDs (r = 0.355, P = 0.001). CONCLUSIONS It is concluded that no significant correlations were found between the mandibular and non-mandibular measures in women with osteoporosis.

Relationship among Schneiderian Membrane, Underwood's Septa, and the Maxillary Sinus Inferior Border

BACKGROUND Osseo-integrated implants are increasingly being used to restore functional dentition; however, in the posterior region, implant placement can be problematic because of inadequate bone height. In this condition, maxillary sinus floor elevation surgery has become the treatment of choice. The presence of anatomic variations within the maxillary sinus such as Underwoods septa and thin Schneiderian membrane decreases the success of the sinus floor elevation. PURPOSE In this study, we tried to determine the relationship between the anatomic variations of the maxillary sinus: Underwoods septa, Schneiderian membrane thickness, and the cortical thickness of the inferior border of the maxillary sinus. MATERIAL AND METHODS The left and right maxillary sinus images of 74 patients were obtained by using dental computed tomography (CT). The Schneiderian membrane and the cortical thickness of the inferior border of the maxillary sinus were measured on the coronal images of dental CT scans at the deepest portion of the sinus cavity. The presence of Underwoods septa was identified on the axial images. The correlations between these variables were assessed. RESULTS We found that there was only a negative correlation between the Schneiderian membrane thickness and the presence of Underwoods septa (r = -0.168 p = .042). CONCLUSION It is suggested that Underwoods septa may be the reason for the thinness of the Schneiderian membrane. However, future studies among larger groups are necessary for confirming the finding by using well-designed clinical studies.

Dental Panoramic Radiography in the Diagnosis of Osteoporosis

Osteoporosis is common in the elderly and the dentist is often the only healthcare professional that they visit regularly. Since dental panoramic radiographs (DPRs) are widely used for routine examinations when planning treatment, this study evaluated whether the presence of osteoporosis might be apparent in a population of patients who underwent DPR. The mandibular cortical index (MCI) and a new method of measuring the mandibular radiographic density (m-RD), which used DPR that incorporated an aluminium step-wedge, were compared with the total vertebral bone mineral density (v-BMD) of the lumbar vertebrae measured using dual energy X-ray absorptiometry (DXA) in 25 osteoporotic women. Although there was only a weak correlation between m-RD and v-BMD, significant correlation was found between MCI and v-BMD. Since both m-RD and MCI were related to v-BMD, dental radiographic density and MCI may be useful in clinical dental practice to identify osteoporotic women with previously undetected low BMD.

The importance of cone beam CT in the radiological detection of osteomalacia

Although osteomalacia is one of the most common osteometabolic diseases among the elderly, there is no case in the literature that presents the effects of osteomalacia in detail using cone beam CT (CBCT). While thin and porous bones are the most common radiographic sign of the disease, the radiological hallmarks are pseudofractures (Loosers zone). We coincidentally detected osteomalacia in a 23-year-old female and we showed the pseudofracture on CBCT images. In the present case, we aim to present the images of osteomalacia that were detected by CBCT in detail. CBCT has an important value in screening for osteomalacia.

A retrospective analysis of sphenoid sinus hypoplasia and agenesis using dental volumetric CT in Turkish individuals.

PURPOSE In adults, sphenoid sinus agenesis is an extremely rare anomaly. The objective of this study was to investigate the prevalence of sphenoid sinus hypoplasia and agenesis using dental volumetric computed tomography (DVCT) in a population of Turkish individuals. MATERIALS AND METHODS DVCT scans in the axial, coronal and sagittal planes of the sphenoid sinus of 384 patients were examined for evidence of sphenoid sinus agenesis and hypoplasia. RESULTS In the DVCT scans, bilateral agenesis of sphenoid sinus was not seen. Unilateral agenesis of sphenoid sinus was seen in 0.26% of the sample, and sphenoid sinus hypoplasia was seen in 0.52%. Unilateral hypoplasia of the sphenoid sinus was observed in 0.26% of the sample, and bilateral hypoplasia of sphenoid sinus was observed in 0.26%. CONCLUSION In this study, we found a low frequency of sphenoid sinus agenesis. Compared with sphenoid sinus agenesis, the frequency of sphenoid sinus hypoplasia was higher. DVCT may be used as a diagnostic tool to investigate the paranasal sinus.

Prevalence of the types of the petrotympanic fissure in the temporomandibular joint dysfunction

Background Petrotympanic fissure (PTF) is a fissure in the temporal bone that runs from the temporomandibular joint (TMJ) to the tympanic cavity (TC). In PTF, the discomallear ligament (DML) connects the malleus in the tympanic cavity and the articular disc and capsule of the temporomandibular joint. PTF with the DML is a possible cause of aural symptoms related to temporomandibular joint dysfunction (TMD). Purpose To investigate the prevalence of different types of PTF in TMD using dental volumetric tomography (DVT) and determine whether PTF type correlates with age. Material and Methods DVT scans in the sagittal planes of PTFs of 134 patients with TMD were examined for the types of PTF present. Three main PTF types were described: wide, tunnel-shaped structure (type 1); tunnel-shaped structure that is wide open in the PTF entrance to the mandibular fossa and gradually thins out in the tympanic cavity (type 2), tunnel-shaped structure that is wide open in the entrance of the mandibular fossa, with a middle region with a flat-shaped tunnel structure and a narrow exit in the tympanic cavity (type 3). Results In DVT scans, PTF types 1, 2 and 3 were seen in 67.2%, 1.5%, and 31.3% of cases, respectively. We found no significant relationship between age or gender and PTF type. Conclusion The low percentage of type 2 PTF and high percentage of type 1 PTF must be taken into consideration during pre-surgical planning related to TMD. However, future well-designed clinical studies involving larger numbers of subjects will be necessary to confirm the findings of this study.

No correlation between mandibular and non-mandibular measurements in osteoporotic men

Background: Screening for low bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) has been the traditional method for determining osteoporosis. Panoramic radiography is widely used in dentistry. Purpose: To determine the relationships between the values of dental panoramic indices (the mental index (MI), antegonial index (AI), panoramic mandibular index (PMI)) and the values of skeletal BMD (femoral BMD (f-BMD), and vertebral BMD (v-BMD)) in 25 osteoporotic men. Material and Methods: In the panoramic radiographs obtained from a total of 25 male individuals with osteoporosis, the means were calculated for MI, AI, and PMI values measured in the right and left mandible. DXA measurements of the femur and lumbar vertebrae BMD were also calculated. The correlation between these variables was assessed. Results: No correlation was found between the BMD values of the femur and lumbar vertebrae and values of MI, AI, and PMI. Conclusion: No significant correlation was found between the mandibular and non-mandibular measurements in men with osteoporosis. MI, AI, and PMI indices should not be used in the evaluation of the skeletal status, because they are not reliable tools in screening for osteoporosis.

Relationship between Mandibular Nutrient Canals and Hypertension

This study was undertaken to investigate the correlation between the presence of nutrient canals in the mandibular anterior region and hypertension. Periapical radiographs taken from the mandibular anterior region of 139 normotensive and 76 hypertensive edentulous patients were examined. There was no statistical difference in the incidence of nutrient canals between normotensive and hypertensive patients, suggesting that the presence of nutrient canals is not indicative of the existence of hypertension.

Mucoepidermoid carcinoma in a minor salivary gland in a child.

Mucoepidermoid carcinoma (MEC), one of the most common salivary gland malignancies, is rare in children. MEC mainly occurs in the parotid gland, along with minor glands being the second common site, particularly in palate. Clinical, histological, and radiological findings of palatal MEC in a 12-year-old girl are presented with three-year follow-up. Pathologic lesions must be considered in differential diagnoses of intraoral asymptomatic lesions, and their detailed inspection should be taken into consideration.

Dental volumetric tomography in the radiological detection of carotid artery calcification.

Ebstein’s anomaly occurs in approximately 1 per 200.000 live births and accounting for <1% of all congenital heart diseases (5). The main finding of Ebstein’s anomaly is the downward displacement of the septal and posterior leaflets of the tricuspid valve in relation to the mitral anterior leaflet more than 8 mm/m2 (6). Ebstein’s anomaly is a disorder which is not confined to the right heart and left-sided valve abnormalities are also more common than the general population (3). Mitral valve prolapse (3), dysplasia of the mitral valve (3), anomalies of cords and papillary muscles (7) have been described in patients with Ebstein’s anomaly. Subaortic stenosis due to the presence of a accessory mitral valve has also been reported in an adult case of Ebstein’s anomaly (4). This is the first case in the literature which reveal LVOT obstruction due to native mitral valve in an adult patient of Ebstein’s anomaly who had a surgical closure of atrial septal defect. The patient`s condition improved with the medical treatment and normal sinus rhythm was obtained. The signs of heart failure or cyanosis, and any recurrent syncope attack were not observed during the one year control of our case. If exercise-induced syncope as a symptom and mid-systolic murmur heard over the aortic area as a physical examination finding exist in a patient with Ebstein’s anomaly, mitral valve tissue leading to LVOT obstruction should be kept in mind. Two-dimension and color Doppler echocardiogram may clearly demonstrate such finding and for this reason we did not use an additional imaging technique in our case. In patients with Ebstein’s anomaly who developed recurrent syncope attacks as a result of LVOT obstruction or heart failure due to severe mitral regurgitation caused by redundancy of the mitral leaflets and chordae, a reconstructive surgery for mitral valve leaflets and chordae may be considered.