James R. Geist

American Academy of Oral and Maxillofacial Radiology executive opinion statement on performing and interpreting diagnostic cone beam computed tomography

The American Academy of Oral and Maxillofacial Radiology (AAOMR) is the professional organization representing oral and maxillofacial radiologists in the United States. The Academy is a nonprofit professional society the primary purposes of which are to advance the science of radiology, improve the quality and access of radiologic services to the patient, and encourage continuing education for oral and maxillofacial radiologists, dentists, and persons practicing oral and maxillofacial imaging in allied professional fields. The AAOMR embraces the introduction of cone beam computed tomography (CBCT) as a major advancement in the imaging armamentarium available to the dental profession. The AAOMR is currently in the process of developing a position paper on appropriate application of CBCT to provide evidence-based guidelines. In the interim, the Executive Committee (EC) of the AAOMR considers it necessary to provide an opinion document addressing the principles of application of CBCT as it relates to acquisition and interpretation of maxillofacial imaging in dental practice.

The frequency and distribution of idiopathic osteosclerosis.

Full-mouth radiographs of 1921 patients were examined for the presence of radiopacities that could not be attributed to any known sources of bone formation. A total of 103 patients, or 5.4%, exhibited these foci of idiopathic osteosclerosis. Most lesions were located in the vicinity of the mandibular premolars, and the majority had some connection to the apices of the teeth. No difference in frequency between males and females was detected overall, but a statistically significant preponderance of idiopathic osteosclerosis was found in blacks, with a predilection for black females also noted.

Oral manifestations of neurofibromatosis types I and II

The disease known as neurofibromatosis is now recognized to consist of distinct variants that differ from each other genetically, microscopically, and clinically. Neurofibromatosis type I (NF-I) is often referred to as von Recklinghausens disease of skin, and its features are well known. Neurofibromatosis type II (NF-II) is a much more uncommon manifestation that probably results from a structural defect in chromosome 22, as opposed to NF-I, which is related to chromosome 17. Although neurofibromas occur in NF-II, neurilemmomas and acoustic neuromas are the predominant neural tumors; bilateral acoustic neuromas are the hallmark of the disease. NF-II largely afflicts the central nervous system and has a more gradual onset than and different clinical features from NF-I. One case each of NF-I and NF-II is presented, with emphasis on oral manifestations. Diagnostic techniques, treatment, and prognosis are reviewed.

Anatomic relationship of the genial tubercles to the dentition as determined by cross-sectional tomography

PURPOSE This study determined the anatomic location and the dimensions of the genial tubercles in relation to the apices of the mandibular central incisors. MATERIALS AND METHODS Linear cross-sectional tomographic images were made of 41 adult human skulls. A 2-mm-thick section was produced through each central incisor. The vertical distance between the apex of each central incisor and the level of the superior aspect of the genial tubercle was measured on the radiographs. Additional measurements were taken on the dry skulls to determine the horizontal distance between the apices of the two central incisors and the width and height of the genial tubercle. RESULTS Although 5 mm is considered a safe zone for geniotomies, 29 of the genial tubercles (35.4%) were less than 5 mm from the apices of the mandibular central incisors. The distance between the apices of these incisors ranged from 9 mm to 15 mm. CONCLUSION Osteotomy of the genial tubercles can be performed within the confines of the mandibular central incisors, but care must be taken to avoid the root apices.

Necrotizing stomatitis: report of 3 Pseudomonas aeruginosa–positive patients

Necrotizing oral lesions have been described in immunosuppressed patients, usually in association with gingival and periodontal pathoses. The etiology of these lesions has not been completely elucidated. We present 3 patients with a type of necrotizing stomatitis in which clinical patterns appear distinct from the periodontal forms of the disease. The lesions yielded bacterial cultures positive for Pseudomonas aeruginosa and reverted to no growth in 2 patients after proper antibiotic therapy. We propose that P aeruginosa may be responsible for selected necrotizing oral lesions with a clinical presentation lacking typical necrotizing periodontal disease and that this condition may represent the intraoral counterpart of ecthyma gangrenosum. In such cases, bacterial culture of the lesion becomes imperative because the disease does not respond to typical periodontal and antimicrobial therapy.

Thoracic malignant fibrous histiocytoma metastatic to the tongue and skin of the face

A 60-year-old white man was found to to have metastatic malignant fibrous histocytoma in the tongue and facial skin 15 months after diagnosis of the primary lesion in the thorax. This is believed to be only the fourth reported case of this tumor metastatic to the oral cavity and the first lingual metastasis from outside the jaws.

Dens evaginatus: Case report and review of the literature

Dens evaginatus is a disturbance in tooth formation that produces a tubercle of hard tissue on the occlusal surfaces of the teeth. This unusual condition occurs most frequently in Oriental persons and is relatively uncommon in the western hemisphere. The tubercle, which often contains pulp tissue, can cause alterations in occlusion; pulpal and periapical inflammation are common sequelae of attrition or fracture of the evagination. Although teeth with necrotic pulps require extraction or endodontic therapy, prophylactic pulp capping is recommended for vital teeth. This case report of a 24-year-old Chinese-Canadian woman with three affected teeth demonstrates the clinical consequences of dens evaginatus.

The effect of automated nonroller processing on the sensitometric characteristics of 3 intraoral film types

OBJECTIVES We sought to compare the sensitometric characteristics of 3 intraoral film types processed in an automated roller solution with the characteristics of the films processed in 4 automated nonroller solutions. STUDY DESIGN Eastman Kodak Ultra-Speed, Flow X-ray EV-57, and Eastman Kodak InSight films were exposed to varying levels of radiation and processed in 1 automated roller solution and in 4 nonroller solutions. Speed and contrast were measured at various density levels and ranges. RESULTS With the exception of 1 nonroller solution, there was little difference in speed between roller and nonroller processing chemicals at various density levels. Some nonroller solutions were faster than the roller chemicals for all films. Nonroller processing mostly increased contrast compared with roller processing over various ranges. CONCLUSIONS Sensitometric properties of films processed in automatic nonroller solutions are comparable in many cases to those in roller solutions, sometimes resulting in greater speed and contrast. Different adjustments in exposure factors are required for specific film/processing combinations.

Densitometric properties of rapid manual processing solutions: Abbreviated versus complete rapid processing

Rapid manual processing solutions produce wet, readable radiographs in 1 to 2 min. However, some manufacturers permit time reductions for various processing steps to obtain images even more quickly. Differences in densitometric characteristics and spatial resolution between abbreviated rapid processing (ARP) and complete rapid processing were examined in four rapid manual processing systems on D- and E-speed film. When compared with films processed conventionally in an automatic processor, films processed in rapid manual processing chemistries had more fog and generally lower levels of speed and contrast. ARP radiographs were excessively stained unless they were washed for at least 60 s after fixing. The most severe depreciation in ARP film quality occurred when developing time was reduced by 50%; the complete rapid processing developing time should always be used. E-speed films produced radiographs with comparable densitometric and resolution characteristics to D-speed films for ARP and complete rapid processing techniques while requiring 40% less radiation.

Characteristics of an oral and maxillofacial radiology department. Report of the ad hoc Department Characteristics Committee of the American Academy of Oral and Maxillofacial Radiology.

Oral and maxillofacial radiology is a dynamic and multifaceted discipline that plays a critical role in patient care, the education of general dentists and dental specialists, and the academic health of the dental school. Diagnostic and treatment advances in temporomandibular joint disorders (TMD), implants trauma and orthognathic surgery, and craniofacial abnormalities depend heavily on conventional and advanced imaging techniques. Oral and maxillofacial radiology contributes to the education of pre- and post-doctoral dental students with respect to biomedical and clinical knowledge, cognitive and psychomotor skills, and the professional and ethical values necessary to properly prescribe, obtain, and interpret radiographs. The development of an active and successful oral and maxillofacial radiology department, division, or section requires the committment of institutional resources. This document may serve as a guide to dental schools committed to excellence in oral and maxillofacial radiology.