Kaan Orhan

Evaluation of the mental foramen and accessory mental foramen in Turkish patients using cone-beam computed tomography images reconstructed from a volumetric rendering program

This study determined the occurrence and location of the mental foramen (MF) and accessory mental foramen (AMF) in Turkish patients using cone‐beam computed‐tomography (CBCT) with 3D‐imaging software. CBCT scans of 386 sites in 193 (92 male, 101 female) patients were retrospectively analyzed to determine MF and AMF occurrence, sizes, and locations. Digital imaging and communications in medicine (DICOM) data were transferred to surface‐rendering software to generate 3D images. Distances between the MF and AMF and from both foramina to the alveolar ridge and to the closest tooth were measured. Differences in AMF incidence by sex, side, and location were evaluated using chi‐squared tests, and MF and AMF measurements were evaluated using Mann–Whitney U‐tests. AMFs were observed in 6.5% of patients and were most commonly in an anteroinferior location. Mean AMF size did not differ significantly by sex or side [males: horizontal = 1.5 mm (1.0–2.4 mm), vertical = 1.4 mm (0.8–2.4 mm); females: horizontal = 1.5 mm (0.8–3 mm), vertical = 1.3 mm (0.8–2.1 mm); P > 0.05]. Males showed significantly greater mean vertical and horizontal MF dimensions compared with females [males: horizontal = 3.9 mm (1.0–7.0 mm), vertical = 3.6 mm (1.2–7.0 mm); females: horizontal = 3.5 mm (1.3–5.6 mm), vertical = 3.3 mm (0.8–5.8 mm); P < 0.05]. Awareness of the AMF is important to avoid mental nerve damage during surgical intervention and anesthetic applications. CBCT is useful for AMF detection, distributes less ionizing radiation, and allows 3D imaging. Clin. Anat. 25:584–592, 2012.

Efficacy of low level laser therapy on neurosensory recovery after injury to the inferior alveolar nerve

BackgroundThe most severe complication after the removal of mandibular third molars is injury to the inferior alveolar nerve or the lingual nerve. These complications are rather uncommon (0.4% to 8.4%) and most of them are transient. However, some of them persist for longer than 6 months, which can leave various degrees of long-term permanent disability. While several methods such as pharmacologic therapy, microneurosurgery, autogenous and alloplastic grafting can be used for the treatment of long-standing sensory aberrations in the inferior alveolar nerve, there are few reports regarding low level laser treatment. This paper reports the effects of low level laser therapy in 4 patients with longstanding sensory nerve impairment following mandibular third molar surgery.MethodsFour female patients had complaints of paresthesia and dysesthesia of the lip, chin and gingiva, and buccal regions. Each patient had undergone mandibular third molar surgery at least 1 year before. All patients were treated with low level laser therapy. Clinical neurosensory tests (the brush stroke directional discrimination test, 2-point discrimination test, and a subjective assessment of neurosensory function using a visual analog scale) were used before and after treatment, and the responses were plotted over time.ResultsWhen the neurosensory assessment scores after treatment with LLL therapy were compared with the baseline values prior to treatment, there was a significant acceleration in the time course, as well as in the magnitude, of neurosensory return. The VAS analysis revealed progressive improvement over time.ConclusionLow level laser therapy seemed to be conducive to the reduction of long-standing sensory nerve impairment following third molar surgery. Further studies are worthwhile regarding the clinical application of this treatment modality.

Familial occurrence of nonsyndromal multiple supernumerary teeth. A rare condition.

The occurrence of multiple supernumerary teeth is a rare phenomenon and is often found in association with syndromes such as cleidocranial dysplasia, Gardners syndrome, or cleft lip and palate. Only a few examples of nonsyndromal multiple supernumerary teeth have been reported in the literature. There is a predilection for the mandible and in the premolar area followed by the molar and anterior regions. This article reports the presence of nonsyndromal multiple supernumerary teeth involving both jaws in children and in their mothers. The clinical and radiographic appearance of the anomalies and treatment modalities are discussed.

Comparison of linear and angular measurements using two-dimensional conventional methods and three-dimensional cone beam CT images reconstructed from a volumetric rendering program in vivo.

OBJECTIVE The aim of this study was to compare the linear and angular measurements made on two-dimensional (2D) conventional cephalometric images and three-dimensional (3D) cone beam CT (CBCT) generated cephalograms derived from a 3D volumetric rendering program. METHODS Pre-treatment cephalometric digital radiographs of 11 patients and their corresponding CBCT images were randomly selected. The digital cephalometric radiographs were traced using Vista Dent OC (GAC International, Inc Bohemia, NY) and by hand. CBCT and Maxilim® (Medicim, Sint-Niklass, Belgium) software were used to generate cephalograms from the CBCT data set that were then linked to the 3D hard-tissue surface representations. In total, 16 cephalometric landmarks were identified and 18 widely used measurements (11 linear and 7 angular) were performed by 2 independent observers. Intraobserver reliability was assessed by calculating intraclass correlation coefficients (ICC), interobserver reliability was assessed with Student t-test and analysis of variance (ANOVA). Mann-Whitney U-tests and Kruskal-Wallis H tests were also used to compare the three methods (P < 0.05). RESULTS The results demonstrated no statistically significant difference between interobserver analyses for CBCT-generated cephalograms (P < 0.05), except for Gonion-Menton (Go-Me) and Condylion-Gnathion (Co-Gn). Intraobserver examinations showed low ICCs, which was an indication of poor reproducibility for Go-Me and Sella-Nasion (S-N) in CBCT-generated cephalograms and poor reproducibility for Articulare-Gonion (Ar-Go) in the 2D hand tracing method (P < 0.05). No statistical significance was found for Vista Dent OC measurements (P > 0.05). CONCLUSIONS Measurements from in vivo CBCT-generated cephalograms from Maxilim® software were found to be similar to conventional images. Thus, owing to higher radiation exposure, CBCT examinations should only be used when the inherent 3D information could improve the outcome of treatment.

Cone Beam CT Evaluation of Maxillary Sinus Septa Prevalence, Height, Location and Morphology in Children and an Adult Population

Objective: The purpose of this study was to determine the prevalence, height, location and morphology of maxillary sinus septa in dentate, partially dentate and edentulous adults as well as in mixed dentition children using cone beam computed tomography (CBCT) for maxillary sinus surgical interventions. Subjects and Methods: Five hundred and fifty-four sides in the CBCT scans of 272 patients (30 children and 242 adults) were retrospectively analyzed. The prevalence, location and morphology were assessed in axial, sagittal, cross-sectional and panoramic 3-dimensional images. The height of septa was measured with the angle between the direction of the septum and median palatine suture. The differences among age, localization and measurements were statistically analyzed. Results: The prevalence of maxillary sinus segments with septa was 58%. There were a total of 13 (3.2%) septa of completely edentulous (CE), 198 (53.9%) septa of edentate and 14 (3.8%) septa of the mixed dentition maxillary segments. The location of septa observed in all study groups demonstrated a greater prevalence (69.1%) in the middle region than in the anterior and posterior regions. No statistically significant differences were observed with regard to gender or age, for septum height (p > 0.05). However, maxillary sinus septa are higher in partially edentulous patients than edentate and CE ones (p < 0.05). Conclusion: Septa of various heights and courses developed in all parts of the maxillary sinus, therefore to prevent possible complications during sinus surgery, extensive evaluation with an appropriate radiographic technique was indispensable.

Cone-Beam Computed Tomographic Evaluation of Spontaneously Healed Root Fracture

INTRODUCTION Dental trauma can lead to injuries in teeth and their supporting structures, which occurs most commonly in young patients and varies in severity from enamel fractures to avulsions. Root fractures are relatively uncommon among dental traumas, mostly affecting the permanent dentition. It has been reported that root fractures can undergo healing, whereas pulp necrosis can also occur. METHODS In this report, we present a case of the utilization of cone-beam computed tomography (CBCT) in the detection of possible cervical or internal resorption secondary to a mid-horizontal fracture in a 36-year-old male patient. The fractured teeth spontaneously healed and were diagnosed radiographically after 28 years. Initially, conventional radiographs showed fractured fragments with radiolucent lines. Because of possible invasive cervical resorption and doubt over internal resorption in the conventional images, it was decided to examine the teeth with cone-beam computed tomography with three-dimensional reconstructions. RESULTS The images clearly showed the displaced fragments of the root fracture. Despite the appearance in the conventional radiograph, no evidence of cervical or internal resorption was detected in the teeth other than the healed root fracture. CONCLUSION It was concluded that CBCT images should be obtained for root fractures, especially those in which cervical or internal resorption is suspected from routine conventional radiographs.

Stafne bone cavity in the anterior mandible.

Lingual mandibular bone defect, also known as Stafne bone cavity, is mostly seen in the posterior portion of the mandible. Inclusions in the anterior portion are very unusual, with around 50 cases reported in the English-language literature. They are often asymptomatic conditions diagnosed during a routine radiographic examination. This article describes a case of anterior Stafne bone cavity in a 52-year-old man mistaken for periapical pathologic defect and referred for treatment. In addition to clinical examination, the patient was imaged using conventional periapical, panoramic radiography, and computed tomography. Confirmation of the salivary gland tissue in the lingual mandibular defect was made with the histopathologic examination after surgical intervention. The differential diagnoses, treatment choices, and pathogenesis of these bone cavities are also discussed after the case presentation along with the literature review.

Comparison of intraoral radiography and cone-beam computed tomography for the detection of horizontal root fractures: an in vitro study

ObjectivesThis study aimed to compare the diagnostic accuracy of two different cone-beam computed tomography (CBCT) units with several intraoral radiography techniques for detecting horizontal root fractures.MethodsThe study material comprised 82 extracted human maxillary incisors without root fractures that had not undergone any root canal treatment. Root fractures were created in the horizontal plane in 31 teeth by a mechanical force using a hammer with the tooth placed on a soft foundation as described in a previous study. The teeth were divided into two groups: a control group with no fractures and a test group with fractures. These were randomized to the empty maxillary anterior sockets of a dry human maxilla. Each tooth was imaged at various vertical angles using each of the following modalities: a 3D Accuitomo 170 CBCT, a NewTom 3G CBCT, a VistaScan PSP, a CCD sensor, and conventional film. Specificity and sensitivity for assessing horizontal root fracture by each radiographic technique were calculated. Chi-square statistics were used to evaluate differences between modalities. Kappa statistics assessed the agreement between observers. Results were considered significant at P < 0.05.ResultsThe kappa values for inter-observer agreement between observers ranged between 0.88 and 0.98 for the 3D Accuitomo 170, 0.82 and 0.91 for the NewTom 3G, and 0.61 and 0.72 for the different types of intraoral images. The diagnostic accuracy for detecting fracture lines in 3D Accuitomo 170 (0.93) was significantly higher than NewTom 3G (0.87), VistaScan (0.71), CCD (0.70), and CF (0.68).Conclusions3D Accuitomo 170 has the highest sensitivity and diagnostic accuracy for detecting horizontal root fracture among the 5 radiographic modalities examined. CBCT should be considered as the most reliable imaging modality of choice for the diagnosis of horizontal root fracture.Clinical relevanceCBCT imaging offers the clear advantage over conventional imaging that traumatized teeth can be visualized in all three dimensions—especially the oro-facial dimension

Investigation of the incidence of stylohyoid ligament calcifications with panoramic radiographs

AIM This study examined and classified patients who were treated at the Faculty of Dentistry at Ankara University Dentistry to determine the incidence of different types of stylohyoid ligament calcification (SLC) using panoramic radiographs. In addition, it also assessed the possible causative symptoms and Eagles syndrome in cases of styloid process elongation. METHODS The study consisted of 2000 patients (1161 females and 839 males), aged 3-88 years, who were treated at our clinic. The panoramic radiographs were evaluated as part of this study. RESULTS Panoramic radiography examination revealed SLC in 1350 patients. Both-sided (right and left), type 1 SLC was observed in 345 patients, while types 2-4 were found in 203, 418, and 384 patients, respectively. CONCLUSION The incidence of SLC was found to be higher in female patients when compared to male patients. In addition, calcifications were seen more often at age 50-59 years, and the incidence of calcification was found to increase with age. Two Eagles syndrome cases were diagnosed among a total of 2000 patients. Finally, it was determined that the incidence of calcified stylohyoid ligament is higher in patients with systemic diseases.

Evaluation of perimandibular neurovascularization with accessory mental foramina using cone-beam computed tomography in children.

ObjectivesThe purpose of this study was to clarify the perimandibular neurovascularization with mandibular accessory mental foramina in a children population using cone-beam computed tomography (CBCT) to avoid complications during anesthetic and surgical procedures. MethodsThis retrospective study evaluated cone-beam CT images for bifid mandibular canals in the mandibles of 63 children (35 girls, 28 boys; age range, 7–16 years; mean age, 12.3 years). Both right and left sides were examined from CT images (n = 126), including axial, sagittal, cross-sectional, and panoramic views as well as reconstructed three-dimensional images, as necessary. The course, length, and superior and inferior angles between canals were classified and measured. ResultsBifid mandibular canals were observed in 34 (27%) of the 126 sides examined. The most frequently encountered type of bifid canal was the retromolar canal (11.1%), followed by the forward (7.14%), buccolingual (6.35%), and dental canal (2.4%). Mean lengths of bifid canals were 10.2 mm on the right side and 10.6 mm on the left side. Mean superior angles were 131 degrees on the right side and 147 degrees on the left side, whereas mean inferior angles were 47 degrees on the right side and 34 degrees on the left side. No statistically significant differences were found in the lengths or angles between the right and left sides or between boys and girls (P < 0.05). The most common position for the mental foramen was between the first and second premolars, and an accessory mental foramen was observed in 4 children (6.34%). ConclusionsThis study utilized CBCT images to identify bifid mandibular canals and accessory mental foramina in children. Cone-beam CT was found to be a useful technique for detecting secondary canals. However, despite the fact that CBCT uses less ionizing radiation than other types of three-dimensional imaging, unless the diagnostic information provided through CBCT improves treatment results, CBCT should not be recommended for use in children or adolescents.