Candan Semra Paksoy

Interpretation of chemically created periapical lesions using 2 different dental cone-beam computerized tomography units, an intraoral digital sensor, and conventional film

OBJECTIVE To assess the diagnostic potential of 2 different cone-beam computerized tomography (CT) units and compare this with intraoral digital and conventional film in the detection of chemically created periapical lesions. STUDY DESIGN Periapical lesions were created chemically in 27 intact roots of 23 teeth (6 incisors, 4 canines, 6 premolars, and 7 molars). Cone-beam CT and digital and film images of the teeth were obtained before and after the lesions were created. Three observers separately used a 5-point scale to rate the images for the presence or absence of periapical pathology. Images were scored twice by each observer, with an interval of 4 weeks. Kappa values were calculated to assess intra- and interobserver agreement. Data were analyzed using repeated-measures analysis of variance for nested designs. R(2) values were used to assess the models for each observer for each method. Differences between observers and methods were tested for statistical significance with the paired t test. RESULTS Kappa coefficients for intraobserver agreement ranged from 0.196 to 0.542 for the 2-dimensional (2D) images and from 0.533 to 0.699 for the cone-beam CT images, whereas kappa coefficients for interobserver agreement ranged from 0.223 to 0.302 for the 2D images and from 0.417 to 0.461 for the cone-beam CT images. The R(2) values for each observer showed that cone-beam CT images were superior to 2D intraoral images. There was no difference between the 2 cone-beam CT units tested (P > .05), and no difference was found between the 2 intraoral radiographic techniques tested (P > .05). CONCLUSION The 2 cone-beam CT units tested performed similarly, and both performed better than intraoral digital and film radiography in detecting chemically created periapical lesions.

Assessment of bone mineral density in the jaws and its relationship to radiomorphometric indices

OBJECTIVES The aim of this study was to evaluate maxillary, mandibular and femoral neck bone mineral density using dual energy X-ray absorptiometry (DXA) and to determine any correlation between the bone mineral density of the jaws and panoramic radiomorphometric indices. METHODS 49 edentulous patients (18 males and 31 females) aged between 41 and 78 years (mean age 60.2 +/- 11.04) were examined by panoramic radiography. Bone mineral density (BMD) of the jaws and femoral neck was measured with a DXA; bone mineral density was calculated at the anterior, premolar and molar regions of the maxilla and mandible. RESULTS The mean maxillary molar BMD (0.45 g cm(-2)) was significantly greater than the maxillary anterior and premolar BMD (0.31 g cm(-2), P < 0.05). Furthermore, the mean mandibular anterior and premolar BMD (1.39 g cm(-2) and 1.28 g cm(-2), respectively) was significantly greater than the mean mandibular molar BMD (1.09 g cm(-2), P < 0.01). Although BMD in the maxillary anterior and premolar regions were correlated, BMD in all the mandibular regions were highly correlated. Maxillary and mandibular BMD were not correlated with femoral BMD. In addition, mandibular cortical index (MCI) classification, mental index (MI) or panoramic mandibular index (PMI) values were not significantly correlated with the maxillary and mandibular BMDs (P > 0.05). CONCLUSIONS The BMD in this study was highest in the mandibular anterior region and lowest in the maxillary anterior and premolar regions. The BMD of the jaws was not correlated with either femoral BMD or panoramic radiomorphometric indices.

Assessment of buccal marginal alveolar peri-implant and periodontal defects using a cone beam CT system with and without the application of metal artefact reduction mode

OBJECTIVES To investigate the accuracy of cone beam CT (CBCT) images obtained with and without artefact reduction (AR) in detecting simulated buccal peri-implant and buccal periodontal defects. METHODS 42 implants inserted into edentulous mandibles, and 38 teeth present in dry mandibles were used. Simulated buccal peri-implant defects (n = 22) and buccal periodontal defects (n = 22) were prepared. 20 implants and 18 teeth without simulated defects were the control group. Images of the mandibles were obtained using a Planmeca ProMax(®) 3D Max CBCT unit (Planmeca Oy, Helsinki, Finland). Image reconstructions were prepared without and with low, medium and high AR modes. Images were viewed randomly by six observers twice for the presence of defects. Kappa coefficient was calculated. F2_LD_F1 design for non-parametric analysis of longitudinal data was used. Area under curves (AUCs) were calculated for each observer. Significance level was taken as α = 0.05. RESULTS Intraobserver kappa ranged from 0.140 to 0.792 for peri-implant and from 0.189 to 1.0 for periodontal defects. All factors were statistically significant (p < 0.001), except for image mode and implant brand. Pairwise interactions were found between periodontal defects and peri-implant defects (p < 0.001), observers (p < 0.001), observer and image mode (p < 0.001), defect model and observer (p < 0.001) and defect model, image mode and observer (p = 0.04). AUC values ranged from 0.39 to 0.52 for peri-implant and from 0.45 to 0.71 for periodontal defects. Higher AUC values were found for periodontal defects than for peri-implant defects. CONCLUSIONS Buccal peri-implant defects were more difficult to detect than buccal periodontal defects. No difference was found among CBCT images obtained with and without AR modes.

Occlusal caries detection by using a cone-beam CT with different voxel resolutions and a digital intraoral sensor

OBJECTIVES This study assessed in vitro the diagnostic ability of intraoral digital CCD sensor images and CBCT images at different voxel resolutions in the detection of occlusal caries. STUDY DESIGN The study sample consisted of 130 mandibular molars (61 sound and 69 diseased). Digital intraoral images and CBCT images were obtained at 0.1-mm, 0.2-mm, and 0.3-mm voxel sizes. All images were evaluated separately by 4 observers, and evaluations were repeated after a 4-week interval. Weighted kappa coefficients were calculated to assess intra- and interobserver agreement for each image set, and scores were compared with the histological gold. For the estimation of nonparametric imaging modality effects and tests of hypotheses, SAS 9.0 and SAS macros were used for F1_LD_F1 factorial design. An a priori level of significance of P equals .05 was used. RESULTS High intra- and interobserver agreements were obtained (Kappa value range: 0.825 to 0.948 for intraobserver agreement and 0.700 to 0.903 for interobserver agreement). Estimated relative treatment effects (RTE) ranged from 0.26 to 0.85, which varied with caries level and imaging modality. Differences between RTE values obtained with ultra-resolution and high- and low-resolution images were not statistically significant for all caries levels. Comparing 3D and intraoral imaging modalities among caries levels showed that imaging modality performance was different for deep enamel, superficial dentine, and deep dentine; however, imaging modality performance was not statistically different for healthy and superficial enamel caries groups. CONCLUSION At all voxel sizes, CBCT images can be considered a tool for use in the diagnosis of occlusal caries.

Radiographic detection of artificially created horizontal root fracture using different cone beam CT units with small fields of view

OBJECTIVES To compare limited cone beam computerized tomography (CBCT) units with different field of views (FOVs) and voxel sizes in detecting artificially created horizontal root fracture (HRF) in extracted human teeth. METHODS Artificial HRF was created in the horizontal plane in 40 teeth. Another 40 intact teeth served as a control group. 80 teeth were placed in the respective maxillary anterior sockets of a human dry skull in groups. Six image sets were obtained: (1) Accuitomo 170, 40 × 40 mm FOV (0.080 mm(3)); (2) Accuitomo 170, 60 × 60 mm FOV (0.125 mm(3)); (3) Kodak 9000, 50 × 37 mm FOV (0.076 mm(3)); (4) Kodak 9000, 50 × 37 mm FOV (0.100 mm(3)); (5) Vatech Pax-Duo3D 50 × 50 mm FOV (0.080 mm(3)) and (6) Vatech Pax-Duo3D 85 × 85 mm FOV (0.120 mm(3)). Images were evaluated twice by five observers. Kappa values were calculated for observer agreement. Areas under the receiver operating characteristic (ROC) curves (Az values) were calculated, and the Az values for each image type were compared using t-tests (α = 0.05). RESULTS Intraobserver kappa coefficients ranged from 0.81 to 0.95 for the Accuitomo 170 images, from 0.80 to 0.92 for the Kodak 9000 images and from 0.76 to 0.95 for Vatech PanX-Duo3D. The Az values for different image types and observers ranged from 0.93 to 0.97 for Accuitomo 170 images, from 0.93 to 0.98 for Kodak 9000 images and from 0.93 to 0.97 for the Vatech PanX-Duo3D images. No statistically significant differences (p > 0.05) were found between the Az values. CONCLUSIONS Limited CBCT units performed similarly in detecting simulated HRF.

A Comparison of Peripheral Marginal Bone Loss at Dental Implants Measured With Conventional Intraoral Film and Digitized Radiographs

The purpose of the present study was to examine the effects of conventional and bone-condensing implantation techniques and time (6 and 12 months after implantation) on levels of marginal bone surrounding implants and to assess the level of agreement between measurements made using digitized intraoral images and film. The study group consisted of 14 healthy patients (9 female, 5 male; age range, 23-59 years; mean age, 41.1 years) with 28 single-tooth dental implants. In each patient, an implant was placed on one side using a conventional technique and on the opposite side using a bone-condensing technique. Film radiographs were taken at 6 and 12 months following implant placement and were digitized at 300 dpi and 600 dpi using a laser scanner. All scanned images were stored as both TIFF and JPEG files. A single observer twice measured distal and mesial marginal bone loss from film and digitized images. At the mesial site, there was a significant main effect of time (6 and 12 months after implantation) on the measurement of bone loss, F(1, 26) = 6.08, P = .02, but no significant main effect of implantation technique, F(1, 26) = 1.56, P = .223, and no significant interaction between time and technique, F(1, 26) = 2.09, P = .160. Similarly, at the distal site, there was a significant main effect of time on the measurement of bone loss, F(1, 26) = 14.1, P = .001, but no significant main effect of implantation technique, F(1, 26) = 1.21, P = .281. However, in contrast to the mesial site, there was also significant interaction between technique and time on the distal site, F(1, 26) = 4.974, P = .035. Intraobserver intraclass correlation coefficients and repeatability measurements showed high agreement for all image types. The bone-condensing technique resulted in greater marginal bone loss. Marginal bone measurements made using digitized intraoral images and conventional film showed high levels of agreement.

The usefulness of standard endodontic diagnostic tests in establishing pulpal status

AbstractThe purpose of the present study was to evaluate the efficiency of cold and electric pulp tests in combination with other standard endodontic diagnostic methods used to assess pulpal status. Methods selected for evaluation were history of pain, tenderness to lateral and vertical percussion, sensitivity to probing, cold test, electric pulp test, tooth sensitivity on caries removal without anaesthesia and radiographical examination (caries pulp exposure, width of periodontal ligament space and loss of lamina dura periapically). Forty-nine intact teeth and 93 teeth which needed endodontic treatment were tested. The sensitivity was 0.93 for the cold test and 0.83 for the electrical test. The specificity was 0.98 for the cold and 0.96 for the electrical test. The positive predictive value was 0.97 for the cold test and 0.94 for the electrical test. The negative predictive value was 0.94 for the cold test and 0.87 for the electrical test. The accuracy rate was 0.95 for the cold test and 0.90 for the ele...

Relationship between genuine and pseudohalitosis and social anxiety disorder

Halitosis is described as offensive breath caused by various factors such as periodontal diseases, bacterial coating of tongue, systemic disorders and different types of foods. Pseudohalitosis is a situation that patients complain of oral malodor even though they do not have offensive odour. The purpose of this study was to compare the relationships between social anxiety estimations and both pseudohalitosis and genuine halitosis cases. Liebowitz Social Anxiety Scale (LSAS) and questionnaire regarding halitosis were applied to 100 participants. Halitosis was determined using organoleptic method, gas chromatography and portable sulphur monitor. anova test and 2-tailed Spearmans rank-order correlation coefficient were used to determine the differences and relations between groups. With reference to LSAS, 62% of participants had anxiety. Among these patients, 98% had genuine halitosis (P < 0·05). The mean measurements of VSC values were 248·65 ppm in halimeter, 298·02 ppm of H2 S, 95·33 ppm of CH3 SH and 47·00 ppm of (CH3 )2 S in gas chromatography. Halitosis was present in 90% of participants, and it was absent in 10% by organoleptic assessment. There was a significant correlation between organoleptic and halimeter measurements. Moreover, statistically significant relationship was detected between anxiety and halitosis. Genuine halitosis patients exhibit social anxiety, so it can be said that there is a causal relationship between halitosis and anxiety. Comparison of the results of objective measurements (sulphur monitor, gas chromatography, organoleptic method) was statistically significant; therefore, it can be said that these methods can be used in diagnosis of halitosis with high accuracy.

Fronto-orbital sphenoethmoidal fibrous dysplasia

Cranial fibrous dysplasias (FDs) are rare and comprise less than 1% of all primary bone lesions. They may produce cosmetic deformities, peripheral compressive cranial neuropathies, and compressive central neurologic manifestations. We describe an unusual presentation of a fronto-orbital sphenoethmoidal FD in a 32-year-old woman with conventional radiographic, CBCT, and MRI findings. In the head and neck examination, an asymmetry was noticed on the left side, without evidence of adenopathy, paresthesia, or motor nerve deficiency. Panoramic radiographs showed a radiopaque expanded bone in the region of the posterior maxillary sinus and orbita. Computed tomography with three-dimensional reconstruction demonstrated an expanding lesion of the cranial bones, involving the ethmoid and periorbital bone, producing a ground-glass appearance. After the radiologic examination, the patient was referred for surgery with a diagnosis of cranial FD and underwent a cranioplasty. The CT and MRI features were typical for FD, but physicians and dental professionals should be aware of this diagnosis, even if no symptom is apparent and the patient came in only for a routine dental examination. Maxillofacial radiologists should also consider that the signal intensity on both T1- and T2-weighted images and the degree of contrast enhancement on T1-weighted images depend on the amount and degree of bony trabeculae, cellularity, collagen, and cystic and hemorrhagic changes.