Dilhan İlgüy

Incidence of the type and calcification patterns in patients with elongated styloid process.

We investigated the incidence of elongated styloid process (Eagles syndrome) using panoramic radiographs taken of 860 patients referred to our clinic. Any styloid process identified was classified according to its length, type and the pattern of calcification. Fifty-nine elongated styloid processes were identified in 32 patients (3.7%), most being bilateral; 24 patients were female and eight were male (female/male ratio: 3:1). The mean age of these patients was 43 ± 14 years (range: 18 − 78 years). Type I (elongated) was the most frequent type on both sides (42/59); and the most frequent patterns of calcification were partially calcified on the left side (18/59) and completely calcified on the right side (16/59). Only two patients were symptomatic. A corrected differential diagnosis is important to distinguish elongated styloid process from other pathologies with partially overlapping symptoms. We would recommend that clinicians consider the possibility of Eagles syndrome when both the clinical and radiographic evidence support this diagnosis.

Detection of jaw and root fractures using cone beam computed tomography: a case report

The aim of this case report is to demonstrate jaw and root fractures using a combination of cone beam CT (CBCT), CT and conventional radiographs. In this presentation a 23-year-old female patient who was referred to our dental clinic with a severe facial trauma is reported. The patient was initially examined by a general dentist and a fracture in the mandibular right canine region was diagnosed on the CT images. Once referred to our clinic, the raw CT images were re-evaluated by three maxillofacial radiologists in the Oral Diagnosis and Radiology Department. Two new fracture lines that were not reported on the original CT analysis were diagnosed among the raw CT images. More detailed information was obtained about dentoalveolar fractures with CBCT compared with CT and conventional radiography.

Reliability and Validity of the Modified Dental Anxiety Scale in Turkish Patients

We aimed to determine dental anxiety among Turkish patients and assess the sensitivity, specificity, positive/negative predictive values and reliability of the Modified Dental Anxiety Scale (MDAS) and Corahs Dental Anxiety Scale (DAS). Patients referred to our clinic for dental treatment who had a history of dental anxiety were included in the study. 294 randomly selected patients (mean age 38.8 years) completed a questionnaire combining Corahs DAS and MDAS. They were retested 15 days later. The prevalence of dental anxiety was found to be 9.9% (29/294) for Corahs DAS at the cut-off point ≥ 15 and 8.8% (26/294) for the MDAS at the cut-off point ≥ 19. Both dental anxiety scales gave acceptable sensitivity, specificity, positive and negative predictive values at these cut-off points.

Diagnosis of jaw and dentoalveolar fractures in a traumatized patient with cone beam computed tomography

The purpose of this case report is to discuss and illustrate the clinical usage of Cone Beam Computed Tomography (CBCT) for the diagnosis of maxillofacial fractures in a traumatized patient. In this presentation, a 30-year-old male patient who was referred to Oral Diagnosis and Radiology Department with a limitation of mouth opening was reported. The history of the patient revealed a traumatic injury on his face because of a fall. The patient was initially examined by a medical practitioner in the emergency department of a public hospital. According to 2D cephalometric analysis, no fracture existed. Panoramic radiograph and postero-anterior reverse-town showed bilateral condyle fractures. In addition, a fracture in the left mandibular incisor region could clearly be detected on the panoramic radiograph. For further diagnosis, digital images were taken with CBCT. Cross-sectional views showed two vertical fracture lines on the alveolar bone between teeth numbers 17, 18 and 14, 15. A palatal root fracture was observed associated with tooth number 18. A fracture line in the left mandibular incisor region as well as bilateral condyle fractures could be seen clearly on CBCT views. CBCT is becoming a popular tool in modern dental practise. In the diagnosis of dentoalveolar fractures, CBCT has made it possible for the practitioner to get more detailed information.

Articular Eminence Inclination, Height, and Condyle Morphology on Cone Beam Computed Tomography

Aim. The aim of the present study was to examine the relationship between articular eminence inclination, height, and thickness of the roof of the glenoid fossa (RGF) according to age and gender and to assess condyle morphology including incidental findings of osseous characteristics associated with osteoarthritis (OA) of the temporomandibular joint (TMJ) using cone beam computed tomography (CBCT). Materials and Methods. CBCT images of 105 patients were evaluated retrospectively. For articular eminence inclination and height, axial views on which the condylar processes were seen with their widest mediolateral extent being used as a reference view for secondary reconstruction. Condyle morphology was categorized both in the sagittal and coronal plane. Results. The mean values of eminence inclination and height of males were higher than those of females (P < 0.05). There were significant differences in the RGF thickness in relation to sagittal condyle morphology. Among the group of OA, the mean value of the RGF thickness for “OA-osteophyte” group was the highest (1.59 mm), whereas the lowest RGF values were seen in the “OA-flattening.” Conclusion. The sagittal osteoarthritic changes may have an effect on RGF thickness by mechanical stimulation and changed stress distribution. Gender has a significant effect on eminence height (Eh) and inclination.

Evaluation of the posterior superior alveolar artery and the maxillary sinus with CBCT

Assessment of the maxillary sinus anatomy before sinus augmentation is important for avoiding surgical complications, because of the close anatomical relationship between the posterior maxillary teeth and the maxillary sinus. The posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and overlying membrane. We evaluated the location of the PSAA and its relationship to the alveolar ridge and maxillary sinus using cone beam computed tomography (CBCT). The study group consisted of 135 CBCT scans (270 sinuses) obtained from the archive of the dentomaxillofacial radiology department at Yeditepe University Faculty of Dentistry, Istanbul, Turkey. The distance between the lower border of the artery and the alveolar crest, bone height from the sinus floor to the ridge crest, distance from the artery to the medial sinus wall, and the diameter and location of the artery were determined. The occurrence of septa and pathology were recorded from CBCT scans. The PSAA was observed in 89.3% of sinuses, and 71.1% of arteries were intraosseous with diameters mostly < 1 mm (68.9%). The prevalence of sinus septa was 55.2%, and that of sinus pathology was 57.4%. The mean age was 43.07 ± 17.55 years. There was a statistically significant difference between the location of the artery and gender (p < 0.05). The prevalence of sinus membrane thickening was 57.4%. Detailed knowledge about the location of the PSAA and sinus morphology may be obtained with CBCT before maxillary sinus surgery.

The usage of digital radiography and cone beam computed tomography among Turkish dentists

OBJECTIVES The aim of this study was to determine the prevalence of the use of digital radiography and report how it was used by Turkish dentists. METHODS The survey was based on 383 dentists who were present at the sixteenth International Congress organized by the Turkish Dental Association. A questionnaire which consisted of 19 questions was given to the dentists who participated in the study. Data were assessed according to frequency distribution and the χ(2) test was used to determine the significance of differences between two independent groups. RESULTS 376 questionnaires were analysed. The mean age of the dentists who participated in the study was 37.14 ± 9.6 years (range: 20-63 years). The distribution of the dentists according to the 7 regions of Turkey were: Marmara 58%, Aegean 13% and Mediterranean 10%, Central Anatolia 8%, Black Sea 7%, Southeastern Anatolia 3%, Eastern Anatolia 1%. 124 dentists (33%) said they did not work with digital radiography. 95 dentists indicated that they did not use digital radiography owing to cost (60%). 252 dentists (67%) said they used digital radiography. 40% of the participants noted that the repetition of periapical radiographs was due to digital radiography. 166 dentists (55.9%) and 79.1% academicians had knowledge about cone beam CT (CBCT). CONCLUSION Digital radiography users are increasing in Turkey and levels of knowledge of CBCT and awareness of radiation safety has also increased.

Measurements of the Foramen Magnum and Mandible in Relation to Sex Using CBCT

The purpose of this study was to evaluate pre‐existing CBCT images of a large sample of adult females and males to provide data on foramen magnum and mandibular measures of sexual dimorphism for use as a reference sample in cases of establishing identity in unknown fragmentary skulls. The study group consisted of 161 adult patients. 3D images of the patients were assessed retrospectively. FM measurements were obtained from reformatted axial sections. Six mandibular measurements were taken. According to the results, the study identified four mandibular measurements as final predictors of sex which are as follows: the gonial angle (G‐angle) and ramus length (Ramus‐L), gonion–gnathion length (G–G‐L) and bigonial breadth (BG‐Br). It was found that the cross‐validated grouped overall predictive accuracy was 83.2% for FM and mandible measurements. It could correctly identify males in 77.3% and females in 87.4% of the cases. To assess sexual dimorphism, the gonial angle and ramus, gonion–gnathion lengths, and bigonial breadth of the mandible and sagittal diameter of the FM may be used on CBCT images.

How many times can we use a phosphor plate? A preliminary study

OBJECTIVES Digital radiography has become a useful tool in daily dental practice due to the advances in imaging technologies. Charge coupled devices (CCDs) and photostimulable phosphor plates (PSPs) are currently in use for dental imaging; however, the longevity of PSPs in dental practice is not yet established. The aim of this study was to determine the service life of PSPs in a clinical setting. METHODS Five unused PSPs were exposed with a conventional X-ray device and converted into digital images with Digora Optime (Soredex, Milwaukee, WI). These were recorded as the baseline images. Subsequent digital images of the plates were obtained after 20, 40, 60, 80, 100, 120, 140, 160, 180 and 200 exposures. All radiographic images were subtracted from the first digital image (baseline) and the mean grey values (MGVs) of the subtracted images were established using software. The data were grouped in 3 classes according to the number of exposures (20-80; 100-140; 160-200), and were analysed using variance analysis and chi(2) tests. RESULTS The MGVs of the subtracted images varied between 126.25 and 127.59, and the difference was not significant among the groups (P = 0.11). However, the differences between the MGVs of the plates on each exposure settings were significantly different than those of the baseline image (P < 0.05). CONCLUSIONS The findings of this study revealed that even though a slight deterioration occurred after the first exposure, each plate can be used up to 200 times. Further studies are required to reach a more concrete conclusion.

Assessment of the Stylohyoid Complex with Cone Beam Computed Tomography

Background Orientation of the stylohyoid complex (SHC) may be important for evaluation of the patient with orofacial pain or dysphagia. Objectives Our purpose was to assess the length and angulations of SHC using cone beam computed tomography (CBCT). Patients and Methods In this study, 3D images provided by CBCT of 69 patients (36 females, 33 males, age range 15-77 years) were retrospectively evaluated. All CBCT images were performed because of other indications. None of the patients had symptoms of ossified SHC. The length and the thickness of SHC ossification, the anteroposterior angle (APA) and the mediolateral angle (MLA) were measured by maxillofacial radiologists on the anteroposterior, right lateral and left lateral views of CBCT. Student’s t test, Pearsons correlation and Chi-square test tests were used for statistical analysis. Results According to the results, the mean length of SHC was 25.3 ± 11.3 mm and the mean thickness of SHC was 4.8 ± 1.8 mm in the study group. The mean APA value of SHCs was 25.6° ± 5.4° and the mean MLA value was 66.4° ± 6.7°. A positive correlation coefficient was found between age and APA (r = 0.335; P < 0.01); between thickness and APA (r = 0.448; P < 0.01) and also between length and thickness was found (r=0.236). Conclusion The size and morphology of the SHC can be easily assessed by 3D views provided by CBCT. In CBCT evaluation of the head and neck region, the radiologist should consider SHC according to these variations, which may have clinical importance.