Erdoğan Fişekçioğlu

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.

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.

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.

In vitro detection of dental root fractures with cone beam computed tomography (CBCT).

Background: Since the diagnosis of non-displaced longitudinal fractures present difficulties for the dentist, three-dimensional evaluation is necessary. Objectives: The aim of this study is to demonstrate the accuracy of cone beam computed tomography (CBCT) in detecting dental root fractures in vitro. Materials and Methods: An in vitro model consisting of 210 recently extracted human mandibular teeth was used. Root fractures were created by mechanical force. The teeth were placed randomly in the empty dental alveoli of a dry human mandible and 15 different dental arcs were created. Images were taken with a unit Iluma ultra cone-beam CT scanner (Imtec Corporation, Germany). Three dental radiologists separately evaluated the images. Results: According to the fracture types and fracture presence, there was an overall statistically significant agreement between the key and readings. Kappa values for intra observer agreement ranged between 0.705 and 0.804 indicating that each observer gave acceptable ratings for the type and presence of fractures. Conclusions: Detailed information about root fractures may be obtained using CBCT.

Evaluation of Pneumatization in the Articular Eminence and Roof of the Glenoid Fossa with Cone-Beam Computed Tomography

BACKGROUND Detection of air cavities, so called pneumatizations, nearby to the temporomandibular joint (TMJ) area is important, as they represent sites of minimal resistance and facilitate the spread of various pathologies into the joint as inflammation, tumor or fractures and serve as a possible complicating factor in TMJ surgery. AIMS To determine the prevalence of pneumatization of the articular eminence (PAT) and roof of the glenoid fossa (PRGF) using cone-beam computed tomography (CBCT). STUDY DESIGN Cross-sectional study. METHODS Acquired images of 111 patients (222 TMJs) were evaluated. The presence of pneumatization was recorded at the articular eminence and roof of the glenoid fossa. Age and gender were recorded for all patients and type (unilocular or multilocular) and laterality were noted for the cases of pneumatization. RESULTS The mean age of the study group was 48.86±18.31 years. Among all the patients, 73 (65.8%) had PAT, while 13 (11.7%) had PRGF. Forty-two (37.8%) of the patients had PAT bilaterally; whereas 3 of them (2.7%) presented PRGF bilaterally. The percentage of PAT was higher for females (73.6%) than males (51.3%) (p<0.05). CONCLUSION CBCT images are an accurate and reliable means of detection of the exact size and type of pneumatization and the relationship of pneumatization to the adjacent tissues. This is especially significant before a surgical intervention is planned in this region, in order to make a sound diagnosis.

Perceived sources and levels of stress, general self-efficacy and coping strategies in preclinical dental students

Abstract Dental education programs are known to be highly stressful and stress can affect general health. The aims were to identify sources of stress among preclinical students and to evaluate their perceived levels of stress, self-efficacy and effective coping strategies in a private dental school. One hundred preclinical students in a Turkish private dental school were surveyed using dental environment stress (DES), perceived stress (PSS), general self-efficacy (G-SES) and brief coping scales (Brief-COPE). Age, gender, history of psychiatric treatment, factors that affected the choice of dentistry, choice rank of dental school, scholarship and income was recorded. ‘Exams and grades’ followed by ‘Fear of failing course or year’ were found to be the most stressprovoking factors. The most and the least stressprovoking DES domains were ‘Workload’ and ‘Social stressors’, respectively. ‘Social stressors’ affected male more than female (p < .05). The most and the least common coping strategies were found to be ‘Planning’, and ‘Drug’, respectively. Female used ‘Instrumental support’ more than male (p < .05). Demographic factors had impact on the perceived stress factors and levels, as well as coping strategies. Unlike previous studies establishing high stress levels in dental students, preclinical students displayed moderate level of stress. Clinical dental education might be more responsible for creating stress.