Tushar Phulambrikar

Incidental findings on cone beam computed tomography and reasons for referral by dental practitioners in indore city (m.p).

INTRODUCTION Cone beam computed tomography is a new diagnostic innovation to dental imaging. Despite the use of CBCT in oral and maxillofacial imaging, reports on its use either by individual practitioners or referral patterns to CBCT centers is lacking. Hence, a study was conducted to determine incidental findings on CBCT and reasons for referral by dental practitioners in Indore city. MATERIALS AND METHODS A retrospective analysis of 795 records that were referred for CBCT imaging at Institutional and Oracal CBCT Centre, Indore was undertaken. Referrals from both within and outside institution, as well as from private practitioners were considered. The reason for CBCT referral, provision diagnosis, final diagnosis and any incidental diagnosis were recorded. RESULTS This retrospective chart audit revealed that 56.7 % were male and 43.3% were females. Greatest source of patients was referred by oral surgeons (21.9%) followed by oral and maxillofacial radiologist (14.2%) and prosthodontist (9.3%). The most common reason for referral was for implant analysis (24.2%) and the most common incidental finding diagnosed by CBCT was oral malignancies. CONCLUSION In Institutional set-up, CBCT referrals were mostly for the reason of planning implant placement followed by trauma whereas private practitioners used CBCT mostly for implant placement followed by impaction. CBCT was being utilized more by Oral surgeons in private sector whereas it in an Institutional setup majority of referrals from Department of Oral Diagnosis and Radiology. Findings that were most commonly diagnosed incidentally on CBCT were Orofacial malignancies followed maxillary sinus pathologies.

Foramen magnum as a tool for sexual dimorphism: A cone beam computed tomography study

Background and Objectives: (1) To evaluate dimensions of the foramen magnum (FM) among males and females and to establish its role in sexual dimorphism using cone beam computed tomography (CBCT). (2) To evaluate sagittal diameter, transverse diameter, area, and circumference of FM among males and females. Materials and Methods: Two hundred and eighty CBCT scans (140 males and 140 females; age range, 20-80 years) were selected for this study. The sagittal diameter, transverse diameter, area, and circumference of FM were measured, and data were subjected to discriminant analysis for the evaluation of sexual dimorphism. Results: The area of FM was the best discriminant parameter which is used to study the sexual dimorphism with an overall accuracy of 72%. Interpretation and Conclusions: It can be concluded that the reconstructed CBCT image provides valuable measurements for the FM and could be used for sexing even when other methods are inconclusive.

Evaluation of the Role of Creatine Phosphokinase as a Biomarker in Acute Myocardial Infarction Patients

Introduction: The study hypothesized that salivary creatine phosphokinase (CPK) can act as a biomarker in diagnosing acute myocardial infarction (AMI) as an alternative to serum CPK, which is a contributory effort towards noninvasive procedures to detect the disease. Aims and Objectives: The main aim of our study was to propose the normal range of salivary CPK in patients with AMI, and to explore the relationship between serum and saliva levels of CPK with comparison of salivary CPK as a biomarker between healthy individuals and patients with AMI. Materials and Methods: A case-control study was carried out including 144 participants who were divided in two main groups – 72 normal healthy individuals and 72 with AMI. CPK levels were assayed in serum and unstimulated whole saliva of AMI and controls by International Federation of Clinical Chemistry (IFCC) method. Statistical Analysis: Statistical analysis was performed using unpaired t-test and Pearson correlation coefficient test. Results: The normal proposed range of salivary CPK of patients with AMI was found to range from 11.30 to 184.50 U/L in males and 20.17 to 69.00 U/L in females. The mean salivary and serum CPK was significantly higher in patients with AMI as compared to healthy individuals with P < 0.001. Saliva CPK concentration correlated significantly with serum CPK of AMI and healthy individuals with r = 0.247. Conclusion: Salivary CPK can be used as an alternative to serum CPK in patients with AMI.

A Focus on Variation in Morphology of Soft Palate Using Cone-Beam Computed Tomography with Assessment of Need's Ratio in Central Madhya Pradesh Population.

INTRODUCTION Soft palate is an anatomical structure that helps in modifying the quality of voice and to breathe while swallowing. Through the variants and shapes of the soft palate, we can assess the age and gender of an individual. AIM The aim of the present study was to investigate the variation in morphology of soft palate and to find its association with the Needs ratio, Velar Length (VL), Velar Width (VW) and Pharyngeal Depth (PD), in age groups and gender using CBCT in Central Madhya Pradesh population. MATERIALS AND METHODS The study sample consisted of 121 CBCT scans of individuals aged between 15 to 45 years. These scans were retrieved from the Department of Oral Radiology. The velar morphology on CBCT was examined and grouped into six types. The results obtained were subjected to a statistical analysis to find the association between variants of the soft palate with gender and different age groups. ANOVA and Z-test were used for statistical analysis. The p≤0.05 was considered as significant while p≤0.001 was considered as highly significant. RESULTS The most frequent type of soft palate was rat tail shaped. The mean VL and VW values were significantly higher in males while PD and Needs ratio were higher among females, insignificantly associated with the types of soft palate. A significant association was observed between the mean VL and VW with various age groups, showing an increase in values with an increase in age. CONCLUSION A variation in morphology of soft palate plays an important role in the assessment of velopharyngeal closure and in diagnosing obstructive sleep apnoea individuals.

Panoramic Radiographic Appearance of Giant Bilateral Tonsilloliths.

A 52-year-old male patient reported with a chief complaint of pus discharge from left mandibular posterior region, with an associated history of extraction of tooth 36 one year ago. Past medical history of patient was not significant in relation to patient’s current complaint. Draining sinus was observed near the left body region of the mandible extraorally [Table/Fig-1]. Intraorally associated region disclosed a mobile root remnant [Table/Fig-2]. A provisional diagnosis of chronic suppurative osteomyelitis was made because of mobile root remnant of mandibular left first molar. A periapical radiograph showed extensive radiolucent bony changes surrounding the root remnant and hence a panoramic radiograph was advised. Interestingly, the panoramic radiograph showed the presence of two ovoid shaped radiopaque areas superimposed one on either side of the ramus of mandible measuring of size approximately 2.5cm x 2.8cm and 1.3cm x 1.6cm respectively on right and left side [Table/Fig-3] and large radiolucent lesion associated with periapical to root piece of lower left first molar. A lateral oblique view of left ramus showed the large ovoid shaped radiopacity above the sigmoid notch excluding intraosseous radiopaque lesion [Table/Fig-4], right lateral oblique view of ramus showed small calcified radiopaque area superimposed on sigmoid notch [Table/Fig-5]. On comparison with panoramic image radiopacity on right side ramus area appears larger in size giving an impression of “Ghost Image” formation. To rule out the size and determine the exact anatomical location patient was advised Computed Tomography (CT) Scan. Radiographic diagnosis of osteomyelitis of left body mandible and soft tissue calcification was given with a differential diagnosis of calcification of phleboliths, calcified lymph node, foreign bodies, an elongated styloid apparatus, large maxillary tuberosity, displaced mandibular third molar and calcified tuberculous lymphadenitis was made. His blood and serological investigations was normal.

Unusual Morphological Alteration in Sigmoid Notch: An Insight Through CBCT.

The Temporomandibular Joint (TMJ) is a ginglymo-diarthrodial joint known to be the most complex joint in human body. Growth disturbances, owing to genetic influences or trauma during the intrauterine life or during early developmental age may lead to morphological and functional variations in the mandible resulting in developmental anomaly. We report a rare case of altered sigmoid notch morphology on the right side and condylar hypoplasia on the left side, not related to any clear pathological disorder. Cone Beam Computed Tomography (CBCT) was helpful in evaluating this case. This case of unknown aetiology was thoroughly examined; based on clinical and radiographic findings, we suggest that this case is of congenital origin.

Bulls' teeth: An insight through CBCT

Taurodontism is a morphologic alteration in the shape of the tooth, in which there is an enlargement of the pulp chamber with apical displacement of the pulpal floor and lack of the normal constriction at the level of the cemento-enamel junction. Although its developmental etiology is evidential and well documented, it occurs as a part of multiple syndromes as well as several developmental anomalies. This review compiles different facets of origin of taurodontism, rather than viewing it just as a developmental malformation, cited so far in the literature. A case report in which all the first permanent molars are being affected with taurodontism is also presented.

Neurofibroma of mandible: A case report

Neurofibroma is a benign neoplasm of non-odontogenic origin arising from peripheral nerves. It may occur as a solitary lesion or as a part of the generalized syndrome of neurofibromatosis or von Recklinghausen′s disease of the skin. It occurs rarely in the head and neck region; intraorally, it affects the tongue, buccal mucosa, and vestibular area, with the posterior mandible being the most common intraosseous location. Clinically, oral neurofibromas usually appear as pedunculated or sessile nodules with slow growth and are usually asymptomatic. The diagnosis can be confirmed by histological examination. Treatment is surgical with excellent prognosis. For illustration, a rare case of a solitary neurofibroma in the mandible is presented.

Incidental findings of root canal anatomy of first and second molars with the eyes of cone beam computed tomography

Cone beam computed tomography (CBCT) is an imaging modality that enables to visualize the dental structures in three dimensions, which is beyond the scope of conventional radiographs being used. A thorough understanding of the complexity of dental structures is necessary to devise a proper treatment plan and assure the best prognosis. This is made possible by the use of CBCT in all the specialties of dentistry. This case report presents the incidental findings as visualized on CBCT, viz., C-shaped canal and a molar with six root canals, which may pose a problem while being treated endodontically. Thus, the use of CBCT while treating them ensured the success of treatment and its prognosis.

Takayasu's arteritis—Report of a case with masquerading jaw pain

Takayasus arteritis (TA) often referred to as pulseless disease, is a chronic inflammatory disorder affecting the aorta and its main branches. While the first reported case was documented in Japan in 1908, it does occur worldwide, but is more prevalent in young oriental females from China and Southeast Asia. The main complications of the disease are due to occlusion of major branches of the aorta. During the initial stages, one of the presenting symptoms may be jaw pain. This may prove to be a diagnostic challenge for the dentist, since many diseases cause orofacial pain and the diagnosis must be established before final treatment. A literature review of TA is presented along with clinical presentation and treatment modalities. A case report is also presented.