Lennart Flygare

Preoperative imaging procedures for lower wisdom teeth removal

The aims of this paper were to critically review the role of radiographic imaging before lower third molar removal and to suggest a strategy for preoperative imaging based on available scientific evidence and clinical experience. Original articles and reviews including the MESH terms “third molar” and “radiography” were selected from the Medline database. Other sources were taken from references of selected papers. It was found that the scientific evidence on the usefulness of different preoperative imaging techniques of wisdom teeth is low. Therefore, information gathered from the literature was combined with the authors’ clinical experience to suggest a strategy for preoperative imaging of lower third molars. Currently available radiological techniques used for preoperative imaging of lower third molars are also presented. It is suggested that panoramic and/or intraoral radiographs are sufficient as preoperative imaging in the vast majority of cases where there is no overlap between the mandibular canal and the wisdom tooth. Supplement with a posteroanterior open mouth projection will solve most of the remaining cases. In a restricted number of cases where there is an intimate relationship between the mandibular canal and the wisdom tooth, volume tomography such as cone beam computed tomography or low-dose computed tomography is indicated.

Microscopy and tomography of erosive changes in the temporomandibular joint An autopsy study

Thirty-nine temporomandibular joint autopsy specimens were examined by microscopy and tomography for erosive changes. We found two types of erosive changes, an extensive type with complete loss of cartilage and a local type with retained articular cartilage. On microscopic examination nearly twice as many temporal components as condyles were eroded. The erosions were generally more extensive in the condyle. Erosions in the condyle were evenly distributed. In the temporal component there was a slight predominance of erosions located to the lateral part of the tubercle. The radiologic investigation underestimated both the presence and the extent of the erosions. Positive predictive values and negative predictive values were 0.70 and 0.83, respectively, for erosions in the condyle and 0.91 and 0.68 for erosions in the temporal component. It is suggested that the initial event in osteoarthrosis of the TMJ can occur as a subarticular hard-tissue change. The need for more accurate diagnostic tools than radiography should be stressed.

Chronic recurrent multifocal osteomyelitis involving both jaws : report of a case including magnetic resonance correlation

A case of chronic recurrent multifocal osteomyelitis in a 14-year-old girl is presented. The disease had an initial aggressive osteolytic appearance involving both the maxilla and the mandible. Conservative treatment with minimal surgical intervention has been successful in this case during a 2-year follow-up period. The value of magnetic resonance imaging and bone scintigraphy in this case and the cause of chronic recurrent multifocal osteomyelitis is discussed.

Macroscopic and microscopic findings of areas with radiologic erosions in human temporomandibular joints

The aim was to describe the macroscopic and microscopic findings of areas with radiologic erosions in the human temporomandibular joint. An autopsy material of 40 human joints, removed as blocks, was examined with tomography, and an erosion was found in 37 areas. A macroscopic and a microscopic examination focused on the presence of the calcified cartilage zone (CCZ) was performed in these areas. In the condyle 13 of 14 areas with a radiologic erosion showed denudation of bone macroscopically. Microscopically, these areas were covered by a thin fibrocellular tissue, and the CCZ was absent. In the temporal component, only 1 of the 23 areas showed bone exposure macroscopically. Microscopically, the soft tissue in these areas varied in thickness. The CCZ was missing in 13 of the 23 areas, even in some areas that appeared normal macroscopically and were microscopically covered by intact soft tissue. Thus, in areas with a radiologic erosion the macroscopic and microscopic appearance differed between the condyle and the temporal component. The nature of the findings is discussed.

The impact of cone beam computed tomography on the choice of endodontic diagnosis.

AIM To determine whether the outcome of cone beam computed tomography (CBCT) examinations performed in accordance with the European Commission guidelines in a clinical setting has an impact on choosing diagnoses in endodontics. METHODOLOGY A prospective observational study was conducted. Fifty-three consecutive patients (81 teeth) from two different endodontic specialist clinics in Sweden were followed. After performing a thorough clinical examination (based on the history, clinical findings, and diagnostic tests such as intra-oral radiography), the examiner wrote down a preliminary diagnosis before CBCT examination. After the CBCT examination, a new diagnosis was made by the same examiner. Both the pre- and the post-CBCT examination diagnoses were plotted according to patients and teeth. The CBCT examinations were performed using similar equipment and protocols that were standardized amongst the clinics. RESULTS The diagnoses were changed for at least one tooth in 22 patients (41%); overall, the diagnoses were changed for 28 teeth (35%). CONCLUSION CBCT has a substantial impact on diagnostic thinking in endodontics when used in accordance with the European Commission guidelines.

The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics

OBJECTIVES The aim was to assess to what extent cone beam CT (CBCT) used in accordance with current European Commission guidelines in a normal clinical setting has an impact on therapeutic decisions in a population referred for endodontic problems. METHODS The study includes data of consecutively examined patients collected from October 2011 to December 2012. From 2 different endodontic specialist clinics, 57 patients were referred for a CBCT examination using criteria in accordance with current European guidelines. The CBCT examinations were performed using similar equipment and standardized among clinics. After a thorough clinical examination, but before CBCT, the examiner made a preliminary therapy plan which was recorded. After the CBCT examination, the same examiner made a new therapy plan. Therapy plans both before and after the CBCT examination were plotted for 53 patients and 81 teeth. As four patients had incomplete protocols, they were not included in the final analysis. RESULTS 4% of the patients referred to endodontic clinics during the study period were examined with CBCT. The most frequent reason for referral to CBCT examination was to differentiate pathology from normal anatomy, this was the case in 24 patients (45% of the cases). The primary outcome was therapy plan changes that could be attributed to CBCT examination. There were changes in 28 patients (53%). CONCLUSIONS CBCT has a significant impact on therapeutic decision efficacy in endodontics when used in concordance with the current European Commission guidelines.

Calcified cartilage zone and its dimensional relationship to the articular cartilage in the human temporomandibular joint of elderly individuals

The aim was to describe the appearance of the calcified cartilage zone (CCZ) and to determine its dimensional relationship to the articular cartilage thickness in the normal human temporomandibular joint. An autopsy material comprising 21 joints from 12 elderly individuals was examined microscopically. The appearance of the CCZ was examined, and the thickness of the CCZ and of the total articular cartilage was measured in 18 different positions in each joint. The CCZ was outlined by a flat or gently undulating tidemark and an irregular osteochondral junction. The cellularity of the CCZ varied extensively. The cells were numerous in the CCZ when the overlying articular cartilage displayed high cellularity. Statistical analysis of the measurements demonstrated a relationship (p < 0.001) between the thickness of the CCZ and of the articular cartilage. Our findings, both qualitative and quantitative, indicate a close relationship between the physiology of the CCZ and of the overlying articular cartilage.

Bone Volume in Human Temporomandibular Autopsy Joints with and Without Erosive Changes

The aim was to compare the trabecular bone volume (TBV) and the total bone volume (TOBV) of human temporomandibular joints (TMJ) with erosive changes with those of joints without erosive changes. We examined 35 TMJ autopsy specimens from 19 individuals aged 66 88 years. Sagittal sections of the joints were analyzed microscopically for erosive hard-tissue changes. The TBV and the TOBV of the sections were assessed with the aid of computerized image analysis. A significant increase in trabecular and total bone volume was found in condyles with erosive changes (TBV = 21%, TOBV = 54%) as compared with condyles without erosive changes (TBV = 15%, TOBV = 40%). The trabecular bone volume of the temporal component was also increased (TBV = 24%) in joints with erosive changes in the condyle as compared with joints with unaffected condyles (TBV = 16%). The findings indicate that the relative bone mass may play a role in the development of erosive changes in the TMJ.

Diagnostic thinking and therapeutic decision confidence after cone beam computed tomography in endodontics measured by a visual analogue scale (VAS)

withdrawn. R7 C. Giampietro Brand~ao*, M.M. Almeida, M.H. Villas Bôas, P.A. Amoroso Silva, B.M. Guimar~aes, R. Ordinola-Zapata, I.G. Moraes & M.A.H. Duarte Department of Endodontics, Cascavel Dental School, University of State of West of Paran a (Unioeste), Cascavel, Paran a & Department of Endodontics, Bauru Dental School, University of S~ao Paulo, Bauru, S~ao Paulo, Brazil Micro–CT evaluation of mandibular incisors root canals: anatomic, linear and volume analysis Aim To describe the anatomy of mandibular incisors using micro-computed tomography analysis, including configuration, linear and volume aspects. Methodology Three hundred and forty extracted mandibular incisors were scanned at 18 lm voxel resolution (SkyScan 1076). The canal morfology were classified according to Vertucci criteria and the major and minor diameters and three-dimensional analysis of the apical third was performed (CTan-CTvol softwares). Data was presented in terms of median and range for each anatomical classification. Results Ninety-one percent of the teeth were classified as Vertucci’s Type I (256) and Type III (56). The medians of major diameter at 1, 2 and 3 mm level of these most prevalent anatomies were 0.36 (type I)-0.41 mm (type III), 0.39–0.51 mm and 0.47–0.66 mm, respectively. Apical volume appears to be constant amongst the main anatomies (0.59 and 0.63 mm). Oval canals were found at the 1 mm apical level in 16.7% of Vertucci’s type I anatomy and 37.3% for type III. The presence of oval canals increased at the 3 mm apical level to 32.4% and 75.9% for Vertucci’s type I and III classifications, respectively. Conclusions Oval shaped canals were common among Vertucci’s types I and III mandibular incisors, which comprised 91% of the analyzed teeth. Moreover, the anatomy of mandibular incisors may vary widely and should be known and identified for a correct root canal treatment. R8

When Maxillary Sinusitis Does Not Heal : Findings on CBCT Scans of the Sinuses With a Particular Focus on the Occurrence of Odontogenic Causes of Maxillary Sinusitis

This study sought to investigate the proportion of patients with suspected sinusitis referred for radiological examination who have radiologically verified sinusitis of odontogenic origin and to describe this type of sinusitis.