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This study aimed to develop a deep learning system for the detection of three-rooted mandibular first molars (MFMs) on panoramic radiographs and to assess its diagnostic performance. Panoramic radiographs, together with cone beam computed tomographic (CBCT) images of the same subjects, were retrospectively collected from 730 patients, encompassing a total of 1444 MFMs (367 teeth were three-rooted and the remaining 1077 teeth were two-rooted). Five convolutional neural network (CNN) models (ResNet-101 and - 50, DenseNet-201, MobileNet-v3 and Inception-v3) were employed to classify three- and two-rooted MFMs on the panoramic radiographs. The diagnostic performance of each model was evaluated using standard metrics, including accuracy, sensitivity, specificity, precision, negative predictive value, and F1 score. Receiver operating characteristic (ROC) curve analyses were performed, with the CBCT examination taken as the gold standard.Among the five CNN models evaluated, ResNet-101 demonstrated superior diagnostic performance, and the AUC value attained was 0.907, significantly higher than that of all other models (all P < 0.01). The accuracy, sensitivity, and specificity were 87.5%, 83.6%, and 88.9%, respectively. DenseNet-201, however, showed the lowest diagnostic performance among the five models (all P < 0.01), with an AUC value of 0.701 and an accuracy of 73.2%. Overall, the performance of the CNNs diminished when using image patches containing only the distal half of MFMs, with AUC values ranging between 0.680 and 0.800. In contrast, the diagnostic performance of the two clinicians was poorer, with AUC values of only 0.680 and 0.632, respectively. In conclusion, the CNN-based deep learning system exhibited a high level of accuracy in the detection of three-rooted MFMs on panoramic radiographs., Competing Interests: Competing interests: The authors declare no competing interests. Ethical approval: Approval for this study was obtained from the Institutional Ethics Committee (IEC) for Human Research (Issuing Number: KY2022-089-01). Due to the retrospective nature of the study, the IEC of Suzhou Ninth People’s Hospital waived the need of obtaining informed consent. The study was performed in accordance with the Declaration of Helsinki., (© 2024. The Author(s).)

Background: The aim of this study is to evaluate the changes in the trabecular structure of the mandibular bone and temporomandibular joint following Rapid Maxillary Expansion., Methods: Thirty-nine patients who received Rapid Maxillary Expansion treatment in the Department of Orthodontics of the Faculty of Dentistry were selected from the archieve for the study. Trabecular structure changes of the angulus mandible, corpus mandible, and condyle regions were examined using fractal analysis on the dental panoramic radiographs. Radiographs taken before the treatment (T0) and at the end of the 3-month retention period (T1) of the patients., Results: There was no statistically significant difference between T0 and T1 in the condyle, ramus mandible, and corpus mandible regions depending on time and sex. (p < 0.05) CONCLUSION: The results of this study showed that Rapid Maxillary Expansion treatment does not have a significant impact on the trabecular structure of the mandible and temporomandibular joint depending on time and gender., Competing Interests: Declarations. Ethics approval and consent to participate: This retrospective study was approved by the Ethics Committee of the Biruni University (Decision no: 2023/79 − 27) and the consent to participate was waived by Ethics Committee of the Biruni University. The study material was selected from the archives. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: The C-shaped mandibular second molars (MSMs) may pose an endodontic challenge. The aim of this study was to develop a convolutional neural network (CNN)-based deep learning system for the diagnosis of C-shaped MSMs on panoramic radiographs., Materials and Methods: Panoramic radiographs and cone beam computed tomographic (CBCT) images were collected from a hospital in China and subsequently divided into two groups. In Group A, conventional panoramic images and CBCT images were derived from the same patients (n = 730 individuals), and the dataset consisted of conventional panoramic image patches of 1453 MSMs. In Group B (n = 610 individuals), the patients underwent CBCT examinations in the absence of available panoramic images; CBCT images were acquired and utilized to generate simulated panoramic images, and the dataset consisted of image patches of 1211 MSMs. Five pretrained CNN networks (ResNet-101 and - 50, DenseNet-121 and - 161, and Inception-V3) were utilized for the classification of C-shaped and non-C-shaped MSMs. Finally, the networks trained on the Group B dataset were tested on the Group A dataset. The diagnostic performance of each model was evaluated using receiver operating characteristic (ROC) curve analysis, and the CBCT images were taken as the gold standard. The results were compared with those achieved by three dental professionals., Results: In Group A, all five networks exhibited satisfactory diagnostic performance, with AUC values ranging from 0.875 to 0.916 and accuracies ranging from 81.8 to 86.7%. No statistical differences were detected among the five CNNs. Notably, the models trained with Group B dataset (CBCT-generated panoramic images) achieved enhanced performance as tested on Group A dataset. The AUC values reached 0.984-0.996, and the accuracies ranged between 94.5% and 98.1%. CNNs outperformed dental professionals in classification performance, and the AUC values achieved by dental specialist, novice dentist, and dental graduate student were only 0.806, 0.767 and 0.730, respectively., Conclusion: CNN-based deep learning system demonstrated higher accuracy in the detection of C-shaped MSMs on panoramic radiographs compared to dental professionals. CBCT-generated panoramic images can serve as a substitute for conventional panoramic images in the training of CNN models when the quantity and quality of conventional panoramic image dataset is insufficient., Clinical Relevance: CNN-based deep learning models have demonstrated significant potential in assisting dentists with the identification of C-shaped MSMs on panoramic radiographs, which facilitating more effective, efficient and safer dental treatment., Competing Interests: Declarations Ethics approval This study was conducted in accordance with the code of ethics of the World Medical Association (Declaration of Helsinki). The approval of this study was granted by the Institutional Review Board of Suzhou Ninth People’s Hospital and informed consent were not required as all image data were anonymized and de-identified prior to analysis (KY2022-089-01). Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Schizophrenia is a chronic severe mental disorder characterized by impairment in cognition, emotion, perception, and other aspects of behavior. In light of the association of craniofacial dysmorphology with schizophrenia, mandibular morphology may provide clues about the role of neurodevelopment in the pathophysiology of schizophrenia. This retrospective cross-sectional study aimed to compare the mandibular morphology of patients with schizophrenia with controls using digital panoramic radiography (DPR)., Methods: 302 recorded diagnostic panoramic images obtained from 143 schizophrenia patients (98 males, 45 females), and 159 controls (73 males, 86 females), aged 18-45 years, were evaluated. Seven mandibular measurements consisting of ramus height, condylar height, gonial angle, antegonial angle, antegonial notch depth, ramal notch depth and bigonial width were measured from the DPRs in a double-blinded manner. Bivariate comparisons were carried out using the Independent t-test and Mann-Whitney U test. Logistic regression analysis was used for multivariate comparisons., Results: Linear measurements were higher while angular measurements were lower in schizophrenia patients. Regression analyses indicated that female patients had greater ramus height (OR = 1.243; P = 0.001), condylar height (OR = 1.463; P = 0.048) and bigonial width (OR = 1.082; P < 0.001); male patients had greater ramus heights (OR = 1.216; P = 0.001) and bigonial width (OR = 1.076; P < 0.001) as well as lower antegonial angle (OR = 0.908; P = 0.012) compared to their respective controls., Conclusion: Quantitative differences in mandibular morphology in schizophrenia patients versus controls deserve attention and corroborate with the concept of abnormal neurodevelopment in schizophrenia., (© 2024. The Author(s).)

Objective: This systematic review aimed to verify if individuals with thalassemia present changes in radiomorphometric indices and fractal analysis that can be accessed using panoramic radiographs., Material and Methods: Observational studies that evaluated cortical and trabecular bone patterns in dental routine radiographs were selected from six bibliographic databases. Risk of bias was analyzed using the Joanna Briggs Institute Critical Appraisal Checklists. Quality of evidence was verified using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach., Results: Two hundred three studies were initially retrieved from databases. Three cross-sectional studies, encompassing a total of 129 thalassemic patients, were deemed eligible after applying the inclusion criteria. Bone mineral density (BMD) evaluations were performed using panoramic radiographs and considered the following radiomorphometric indexes: mandibular cortical index (MCI), mandibular cortical width (MCW), panoramic mandibular index (PMI). Fractal dimension analysis (FDA) and simple visual estimation (SVE) were also employed. Overall, FDA and MCW from thalassemia individuals were lower than controls., Conclusion: FDA and MCW are frequently altered in patients with thalassemia and may be employed as screening tools for reduced BMD. However, the certainty of evidence for this outcome was very low, mainly due to methodological flaws., (© 2024 Special Care Dentistry Association and Wiley Periodicals LLC.)

Objective: The present study aimed to evaluate the mandibular bone structure of patients with different malocclusions by using fractal dimension (FD) analysis on dental panoramic radiographic images., Material and Methods: Pre-treatment panoramic radiographic images of 103 patients were included in the study and divided into 3 groups as Class I (group 1: 0

Background: It is still unclear whether the trabecular structure of the jaw is different in individuals with hypodontia than in those without hypodontia; this is important for clinicians. The aim was to determine whether the mandibular trabecular bone structure of children and adolescents with hypodontia differs from the control group by using the fractal analysis (FA) method in this study., Methods: A total of 138 panoramic radiographs of 69 cases and 69 control subjects (mean age 13.2 ± 10.1) were evaluated. The age and gender of subjects in the case and control groups were matched. Three regions of interest (ROIs) were selected from the panoramic radiographs. ROI1 refers to the center of the ramus rising above the mandibular foramen. ROI2 refers to the area between the apical level of the mandibular molar and the upper border of the mandibular canal. ROI3, the missing tooth region, refers to the apical third of the mesial side of the erupting or fully erupted permanent mandibular first molar. Mann-Whitney U and Wilcoxon tests were used. p < 0.05 was accepted for the significance value., Results: The mean fractal dimension (FD) values of ROI1, ROI2, and ROI3 were 1,25, 1,20, and 1,13, respectively. The means FD values obtained from the ramus region were higher than the other regions (p < 0.05). The FD values did not differ significantly according to gender and age (p > 0.05). The FD values of the case group were lower than the control group for ROI3 (p < 0.05)., Conclusion: The results of this study showed that the mandibular trabecular bone quality of pediatric patients with one missing tooth was different from the healthy group. The difference in the mean FD values from the ROIs indicates that the ramus has a denser structure than the mandibular corpus. Clinicians should factor this into their dental treatment planning process., (© 2024. The Author(s).)

This review aims to evaluate the accuracy of various mandibular radiomorphometric indices in comparison with DEXA BMD measurements in the diagnosis of osteopenia and osteoporosis based on a meta-analysis of the sensitivity and specificity of the indices. PRISMA statement was followed. The materials for analysis were collected in August 2023 by searching three databases: PubMed Central, Web of Science, and Scopus. The selection of studies consisted of three selection stages, and 64 articles were finally obtained. Quality assessment was performed with the QUADAS-2 tool, and the general methodological quality of retrieved studies was low. Statistical analysis was performed based on 2 × 2 tables and estimated sensitivity and specificity were obtained using SROC curves. The most used indices were MCI, MCW and PMI. The best results in detecting reduced BMD obtained for MCW ≤ 3 mm, estimated sensitivity and specificity were 0.712 (95% CI, 0.477-0.870) and 0.804 (95% CI, 0.589-0.921), respectively. The most prone to the risk of bias is the MCI due to the examiner's subjectivism. Radiomorphometric indices of the mandible can be useful as a screening tool to identify patients with low BMD, but should not be used as a diagnostic method. Further research needs to focus on analysing the ability of the indices to detect osteoporosis and also in combination the indices with clinical parameters., (© 2023. The Author(s).)

Background: Bruxism may cause increased alveolar bone thickness and density and irregular enlargement of the periodontal space., Aim: This study aimed to evaluate the mandibular bone quality using radio-morphometric indices and Fractal Dimension (FD) analysis in orthopantomography (OPG)., Material and Methods: OPGs of 100 patients, 50 bruxers and 50 non-bruxers, were included in this study. Values, such as mental index (MI), panoramic mandibular index (PMI), gonial index (GI), antegonial notch depth (AND), mandibular cortical index (MCI), and antegonial index (AI), were calculated in OPG. Eight bilateral areas of interest (ROI) were selected on ort for FD analysis: ROI 1, mandibular condyle; ROI 2, mandibular ramus; ROI 3, mandibular angulus; and ROI 4, mandibular mental area., Results: MI, PMI, and AND values were higher in bruxers than in the control group (p&#60;0.05). MCI and AI values calculated on both sides were not statistically significantly related in bruxism and control group individuals (p>0.05). As a result of the calculations, the FD values of the left condyle (p=0.02) and left angulus (p=0.03) areas showed a statistically significant difference between individuals with and without bruxer. No statistically significant difference was found in the FD measurements calculated from the ramus and mental areas on the right and left sides (p>0.05). The relationship between FD values and gender in these areas was examined, and no statistically significant difference was found (p&#60;0.05)., Conclusion: In dentistry, bruxism can be diagnosed and treated by measuring MI, PMI, and AND values. No difference was found in mandibular cortical bone thickness in bruxers and non-bruxers, according to AI and MCI. The mean GI measured on the right side differed between groups. FD values of the mandibular trabecular bone were affected by bruxism in the right condyle and right angulus areas., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background and Objectives : The purpose of this study was to develop and evaluate a deep learning model capable of autonomously detecting and segmenting radiolucent lesions in the lower jaw by utilizing You Only Look Once (YOLO) v8. Materials and Methods : This study involved the analysis of 226 lesions present in panoramic radiographs captured between 2013 and 2023 at the Clinical Hospital Dubrava and the School of Dental Medicine, University of Zagreb. Panoramic radiographs included radiolucent lesions such as radicular cysts, ameloblastomas, odontogenic keratocysts (OKC), dentigerous cysts and residual cysts. To enhance the database, we applied techniques such as translation, scaling, rotation, horizontal flipping and mosaic effects. We have employed the deep neural network to tackle our detection and segmentation objectives. Also, to improve our model's generalization capabilities, we conducted five-fold cross-validation. The assessment of the model's performance was carried out through metrics like Intersection over Union (IoU), precision, recall and mean average precision (mAP)@50 and mAP@50-95. Results : In the detection task, the precision, recall, mAP@50 and mAP@50-95 scores without augmentation were recorded at 91.8%, 57.1%, 75.8% and 47.3%, while, with augmentation, were 95.2%, 94.4%, 97.5% and 68.7%, respectively. Similarly, in the segmentation task, the precision, recall, mAP@50 and mAP@50-95 values achieved without augmentation were 76%, 75.5%, 75.1% and 48.3%, respectively. Augmentation techniques led to an improvement of these scores to 100%, 94.5%, 96.6% and 72.2%. Conclusions : Our study confirmed that the model developed using the advanced YOLOv8 has the remarkable capability to automatically detect and segment radiolucent lesions in the mandible. With its continual evolution and integration into various medical fields, the deep learning model holds the potential to revolutionize patient care.

The aim of the study was to establish the normality ranges of the linear and angular measurements that can be carried out in orthopantomographies (OPGs) of a paediatric sample from Madrid, according to sex and dentition. OPGs performed in the Radiology Service of the Faculty of Dentistry of the Complutense University of Madrid (UCM) from caucasic children between 4-14 years old were selected. A total of 44 measurements were made in the OPGs, and the sex and type of dentition of each child were recorded. Panoramic Mandibular Index and Antegonial Index were also calculated. Statistical tests were performed with a confidence level of 95% ( p < 0.05) and bilateral significance to analyse the differences between sex and type of dentition, and the correlation between the measurements of the right and left sides. A total sample of 160 OPGs (50% boys, 50% girls) were analysed. 16.25% of the sample was in primary dentition, 50% in first phase mixed dentition, 17.5% in second phase mixed dentition and 16.25% in permanent dentition. Statistically significant differences were found with respect to the sex of the subjects in 11 of the measurements; and 44 in relation to the dentition stages of the subjects. A strong correlation is found between the measurements on the right and left sides. The application of panoramic measurements as indicators of normality can help in the detection of craniofacial alterations in growth and development of the lower facial third., Competing Interests: The authors declare no conflict of interest., (©2023 The Author(s). Published by MRE Press.)

Background: The extraction of impacted third molars (M3) is a common surgical procedure in dentistry and oral surgery. Various complications, including inferior alveolar nerve (IAN) damage, may occur during and after extraction of this tooth. Radiographic examination should provide information about the M3 itself, but also about the surrounding bony structure and the relationship of the roots to the IAN and the adjacent second molar, which is often traumatized during this extraction. The aim of our study was to evaluate the depth and angulation of impacted mandibular third molars (M3) from panoramic radiographs, according to the classifications proposed by Winter and Pell & Gregory., Methods: Radiographic signs present on the orthopantomogram showing M3 depth, and retromandibular available space according to the Pell & Gregory classification were evaluated. Evaluation of the M3 angulation relative to the M2 according to Winter's classification was also done. Student's t test was used to determine the association between side or sex and different variables., Results: The depth of impaction of the M3 crown was level A accounting for 54.4% (n=260) of the PR while level B constituted 35.7% (n=171) of the images. Regarding the availability of retromandibular space, Class I constituted 36.8% (n=176). The Class II accounted for 55.9% (n=267) of PR., Conclusion: Our study showed that 54.4% of M3 were located at the same level as the occlusal plane of the second molar, while in 56% of PR the space between the second molar and the ramus of the mandible is less than the mesiodistal diameter of the third molar. This research showed that 23.1% of M3 had a level of vertical angulation, a level that allows for less painful luxation of the impacted molars. These results seem to show a relatively high level of difficulty in mobilizing and extracting M3 from Cameroonian patients., (© 2023 Edouma J., et al.)

Understanding the variations in root canal morphology is important for successful endodontic treatment. Mandibular first premolars have a single root in 98% of cases, and multiple root canals are found in approximately 20% of cases. However, the details of these characteristic findings in panoramic radiography and their diagnostic accuracy are unknown. This study aimed to investigate the characteristic radiographic findings of mandibular first premolars possessing multiple root canals and determine the diagnostic accuracy using panoramic radiography. Four radiologists evaluated 347 mandibular first premolars in 186 patients who underwent panoramic radiography and dental cone beam computed tomography (CBCT). Two radiologists confirmed the existence of single or multiple root canals using CBCT. The remaining two radiologists evaluated the imaging findings of the root canal morphology and classified them into two patterns: gradual narrowing and sudden narrowing. In the case of the sudden narrowing pattern, the location of sudden narrowing was also evaluated. A gradual narrowing pattern was observed in 56% of teeth with a single root canal, and a sudden narrowing pattern was observed in 83% of teeth with multiple root canals. When sudden narrowing between the cervical and apical 1/4 of the root canal was used as the diagnostic criterion for multiple root canal teeth, the highest diagnostic performance was observed (sensitivity, 76.1%; specificity, 73.9%). The sudden narrowing between the cervical level and the apical 1/4 level of the root canal is a practical diagnostic criterion for mandibular first premolar with multiple root canals., (© 2022. The Author(s), under exclusive licence to The Society of The Nippon Dental University.)

This study aimed to evaluate sexual dimorphism in Brazilian edentulous individuals using a formula based on mandible-related linear radiomorphometric measurements. A cross-sectional observational study was conducted with 390 panoramic radiographs (PRs) distributed into three age groups (51-60, 61-70, and 71-80 years). PRs were used to obtain linear measurements of the mandible and derived indices (superior and inferior panoramic mandibular indices [s-PMI and i-PMI, respectively], alveolar bone resorption [ABR] index), and the mandibular cortical index (MCI). Sex-related differences (and sex classifications) increased in the oldest cohort. Both s-PMI and i-PMI were shown to be significant in predicting sex in the age group from 71 to 80 years (p = 0.001 and p = 0.003, respectively) and, when considering the mean of the sides, only the s-PMI was significant (p = 0.037). The ABR index was significantly associated with sex (p = 0.004) and not influenced by MCI, and was used to construct a formula for sex estimation, which demonstrated 69.0% accuracy in the age group of 71-80 years. Sexual dimorphism was evidenced by the formula based on the s-PMI, i-PMI, and ABR indices., Competing Interests: Conflict of interest The authors declare no conflicts of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Chemotherapy, one of the most important treatment modalities for treating childhood cancers, is a major cause of bone loss in patients and survivors., Objectives: This study aimed to evaluate mandibular bone structures in childhood cancer survivors (CCSs) by means of fractal dimension (FD) analysis and the Klemetti index (KI), and to compare them with regard to the control group., Material and Methods: In this retrospective study, the panoramic radiographs of 49 CCSs were included as the study group and the panoramic radiographs of 49 cancer-free volunteers were included as the control group. Based on the panoramic radiographs, FD and KI were determined., Results: No significant differences were observed between the study and control groups in terms of mean FD values for regions of interest (ROIs) ROI&#95;1, ROI&#95;2 and ROI&#95;3 (p = 0.750, p = 0.490 and p = 0.910, respectively). The mean FD values for ROI&#95;1 for the study and control groups were 1.08 ±0.18 and 1.07 ±0.14, respectively. The mean FD values for ROI&#95;2 for the study and control groups were 1.11 ±0.13 and 1.09 ±0.13, respectively. The mean FD values for ROI&#95;3 for the study and control groups were 1.15 ±0.14 and 1.15 ±0.15, respectively. Statistically significant differences between the study and control groups were noted only in the distribution of the KI categories (p = 0.015)., Conclusions: Childhood chemotherapy may affect mandibular bone structures during a lifetime. The Klemetti index should be considered a useful clinical diagnostic tool for the examination of mandibular bone structures.

Stafne bone cavity (SBC) is a bone defect which appears unilaterally round or oval shaped radiolucent area with well-defined border. The most common location of the defect is the mandibular molar area at the lingual side of the mandible, below the mandibular canal. Additionally other rarer variants of SBC, anterior lingual, buccal aspect of ascending ramus, and lingual aspect of ascending ramus are also reported. In this paper, a rare case of posterior and anterior variant of double SBCs with buccal cortical bone perforation was presented. An 83-year-old male patient was referred to our clinic for a routine dental examination. Panoramic examination presented two well-defined radiolucent areas. One was located at the right posterior region of the mandible, below the inferior alveolar canal and the second in the region of right canine-premolar area, anterior of the mental foramen. Cone beam computed tomography also confirmed the defects. Magnetic resonance imaging of patient showed that posterior variant was filled with part of submandibular gland and anterior variant was filled with part of sublingual gland. The diagnosis was made as double SBCs and the patient was informed about the lesions., (© 2022. The Author(s) under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology.)

Objective: This study aimed to investigate AI-based computer-aided diagnosis (AI-CAD) for panoramic radiographs, especially quantitative evaluation of mandibular cortical morphology in relation to age and gender., Methods: 321 patients with jaw lesions who underwent panoramic radiography were prospectively included. The mandibular cortical morphology was analyzed with an AI-CAD that evaluated the degree of deformation of mandibular inferior cortex and mandibular cortical index (MCI) automatically. Those were analyzed in relation to age and gender, such as younger (≦ 20 years), middle (21-60 years) and older group (≧ 61 years) in men and women., Results: The degree of deformation in older men (33.0 ± 18.5) was higher than those of middle (25.0 ± 15.3, p = 0.030) and younger (32.5 ± 16.9, p = 0.993), and those in older women (46.2 ± 22.5) was higher than those of middle (19.4 ± 16.5, p < 0.001) and younger (22.4 ± 14.5, p < 0.001). The MCI of women was a significant difference for aging (p < 0.001), although those of men was not significant difference for aging (p = 0.189)., Conclusion: The AI-CAD could be a useful tool for the quantitative analysis of mandibular cortical morphology., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Objective: To map the shape, location, and thickness of the focal trough of a panoramic radiography device with a multilayer imaging program., Methods: An acrylic plate (148 × 148 × 3 mm) containing 1156 holes distributed in a matrix of 34 × 34 rows was placed in the OP300 Maxio at the levels of the maxilla and mandible. 20 metal spheres (3.5 mm in diameter) were placed on the holes of the plate under 15 different arrangements and panoramic images were acquired for each arrangement at 66 kV, 8 mA, and an exposure time of 16 s. The resulting panoramic radiographs from the five image layers were exported, the horizontal and vertical dimensions of the metal spheres were measured in all images using the Image J software, and the magnification and distortion rates of the spheres were calculated. All metal spheres presenting a magnification rate lower than 30% in both vertical and horizontal dimensions and a distortion rate lower than 10% were considered to map the focal troughs of each of the five image layers., Results: All panoramic image layers had a curved shape ranging from 39° to 51° for both dental arches and varied in position and thickness. The anterior region of maxilla was anteriorly displaced when compared to the anterior region of the mandible for all layers. Image layers are thicker at the level of the mandible than those at the level of the maxilla; also, inner layers were thinner and outer layers were thicker., Conclusion: All image layers in the studied panoramic radiography device had a curved shape and varied in position and thickness. The anterior region of maxilla was anteriorly displaced when compared to that of the mandible for all layers.

Objective: To assess the serum and salivary levels of biomarkers related to bone metabolism in cirrhotic patients as well as the evidence of osteoporotic changes on panoramic radiographs., Materials and Methods: Thirty-eight cirrhotic patients underwent anamnesis and physical examination. Specimens of blood and saliva were collected for evaluation by using Luminex™ xMAP technology to quantify RANKL, OPG, IL-1β, IL-6 and TNF-α. Panoramic radiographs were evaluated based on the mandibular cortical index (MCI) and the resulting data were compared to the expression of biomarkers in serum and saliva. Descriptive data analysis was performed and the Mann-Whitney's test and Spearman's correlation were used., Results: Most of the sample consisted of males (68.4%) who had cirrhosis mostly resulting from alcoholism (28.9%). Median concentration values of RANKL (74.44 pg/mL), IL-1 β (45.91 pg/mL), IL-6 (67.69 pg/mL) and TNF-α (5.97 pg/mL) in saliva were higher than those observed in serum. In 72.7% of the panoramic radiographs, MCI was found to be suggestive of osteoporotic changes. No statistically significant correlation was observed between salivary and serum expressions of biomarkers or between biomarkers and MCI., Conclusion: RANKL, OPG, IL-1β, IL-6 and TNF-α are expressed differently in serum and saliva and the concentration of these biomarkers is not related to MCI., Clinical Relevance: This study contributes to the study of the mechanisms of osteoporosis in cirrhotic individuals., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To investigate mandibular morphologic measurements and trabecular structures that may cause mandibular third molar (MM3) impaction according to MM3 subgroups., Methods: A total of 150 MM3 of 2175 panoramic radiographs (PRs) were reviewed. MM3s according to Winter (vertical), Pell & Gregory Class 1 and group: A, B, C on PRs were included in the study group. Fractal dimensions (FD) and mandibular morphologic measurements were evaluated. Statistical analysis for parametric values was performed using one-way analysis of variance (ANOVA). Statistical analysis for non-parametric values was performed using the Kruskal-Wallis H test., Results: Statistically, a significant difference was found only in terms of angle of impaction among the groups of MM3 (p < 0.05) [Winter (vertical), and Pell & Gregory Class 1 and group A, B, C]. There was no difference among groups A, B, C in mandibular morphology and trabecular structure, but group C showed different characteristics than the other groups only in terms of impaction angle., Conclusion: The trabecular structure and morphometric properties except for the angle of impaction do not affect impacted MM3s with adequate retromolar space and vertical angle., (© 2021. The Author(s), under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd.)

Background: Accurate detection of the mandibular canal is a difficult process despite cutting-edge radiographic methods. The present study analyses whether mandibular canal roof visibility is comparable to panoramic radiography (PR) and cone-beam computed tomography (CBCT) and, further, examines whether the visibility in PR and CBCT is dependent on cortical bone thickness in the mandible., Methods: This study was conducted on a group of 343 selected patients. It incorporated anonymised data on 343 patients in which a CBCT and PR were available. The first stage examines whether the mandibular canal roof visibility is comparable to PR and CBCT. In the second stage, measurements of cortical bone thickness showed buccal and lingual in the P2, M1, M2 and M3 teeth areas, both to the left and right of the mandible in CBCT images. Statistical analysis was supported by statistical software (IBM SPSS 25; Armonk, NY, USA)., Results: The mean age of the patients was 58.8 years with an almost equal gender distribution. When performing a McNemar test on the P2, M1, M2 and M3 on both the left and right jaws, the difference between the two image modalities, with regard to the visibility of the canal roof, was found to be significant (McNemar test, p < 0.001). Statistically (U test, p≥0.05), it follows that the thickness of the cortical bone of the mandible exerts no influence on the visibility of the roof of canalis mandibulae in PR and CBCT images., Conclusion: We conclude that the visibility of the mandibular canal in PR and CBCT rays is not identical, and that the thickness of the cortical bone in the mandible does not represent a factor affecting the visibility of the roof of the mandibular canal.

The mandibular canal is nowadays acknowledged as a major trunk with multiple smaller branches running roughly parallel to it. Most of these accessory canals contain branches of the inferior alveolar neurovascular bundle that supplies the dentition, jawbone, and soft tissue around the gingiva and lower lip. This article reviews the prevalence, classification and morphometric measurements of the retromolar canal and its aperture. A retromolar canal is a bifid variation of the mandibular canal that divides from above this main canal, and travels anterosuperiorly within the bone to exit via a single foramen or multiple foramina into the retromolar fossa. This foramen, termed the retromolar foramen, allows accessory branches of the inferior alveolar neurovascular bundles to supply tissues at the retromolar trigone. Clinically, it is of the utmost importance to determine the exact location of the mandibular canal and to identify its retromolar accessory branches when surgery in the posterior mandible is to be performed., (© 2020 Wiley Periodicals, Inc.)

Objective: The study aimed to describe the diagnostic imaging features of idiopathic osteosclerosis (IO) to aid in differential diagnosis of similar dentomaxillomandibular conditions., Materials and Methods: An archive of 550 dentomaxillofacial radiographic (panoramic radiography (PR) and cone beam computed tomography (CBCT)) images and 33,000 histopathological records were reviewed to identify IO cases. Chi-square, Student's t test, and ANOVA tests, with a significance of p < 0.05, were applied for comparative analysis. In addition, we analyzed various studies to present a short review., Results: After meticulous observation, 36 images of 34 patients revealed 60 IO lesions in 31 PR and 5 CBCT. Sex, age group, anatomical site, shape, regularity, and root relationship showed statistical significance: sex and age group (p = 0.046), sex and IO regularity (p = 0.007), age group and IO regularity (p = 0.014), anatomical site and IO shape (p = 0.010), anatomical site and IO regularity (p = 0.003), and IO shape and IO regularity (p = 0.002). We presented a short review from 26 articles, including retrospective, cross-sectional, and longitudinal studies, documenting 2307 patients with 2435 IO lesions from 51,160 imagiological examinations., Conclusions: A radiographic diagnostic profile of IO may guide the clinical practitioners in differentiating an incidental radiopacity. PR is a preliminary examination, with CBCT facilitating the IO diagnosis., Clinical Relevance: Knowledge of imaging characteristics variability of idiopathic osteosclerosis is crucial for accurate diagnosis process when incidental radiopacities are found in the panoramic radiographs, thus avoiding unnecessary biopsies. CBCT scans facilitate the interpretation of idiopathic osteosclerosis overlapping the mandibular canal.

The present study used an aluminum phantom to calculate accurate vertical magnification values around the mental foramen on panoramic radiography (PR) and compared corrected PR (Cor-PR) thickness measurements of the aluminum phantom and mandibular cortical width (MCW) of the human head with cone-beam computed tomography (CBCT) measurements at two fields of view (FOVs). The calculated vertical magnification value for PR around the mental foramen was 1.37. Measurements of the aluminum phantom significantly differed between Cor-PR and CBCT with an FOV of 100 mm and between CBCT with FOVs of 40 and 100 mm; however, MCW measurements did not significantly differ among the three methods. There was a very strong correlation between Cor-PR and CBCT with an FOV of 40 mm and between CBCT with FOVs of 40 mm and 100 mm, and intraobserver and interobserver agreement was good-to-excellent for all methods. These results suggest that Cor-PR and CBCT with small and large FOVs are acceptable for measuring MCW.

Objective: To compare the radiomorphometric parameters of mandibular trabecular and cortical bone of females with and without cemento-osseous dysplasia (COD)., Methods: A retrospective cross-sectional paired study was conducted. Digital panoramic radiographs were obtained from females diagnosed in a public service of Oral Medicine. The participants were divided into two groups of 50 subjects each: females with a diagnosis of COD (COD group) and females without a diagnosis of COD (non-COD group), randomly chosen from the image database and paired for age. The radiomorphometric parameters analyzed were: mandibular cortical width (MCW), fractal dimension (FD) and mandibular cortical index (MCI). The paired t -test and Wilcoxon test were used to compare MCW and FD values and the McNemar-Bowker test compared the MCI., Results: The mean age of both groups was 46.84 ± 11.38 years. The median MCW index was 3.12 mm (2.15-4.55) for the COD group and 3.52 mm (1.90-4.70) for the non-COD group ( p = 0.034). The mean FD value of the COD group (1.2039 ± 0.0926) was lower than that of the non-COD group (1.2472 ± 0.0894) in the anatomical region of the interest of mandibular cortical bone ( p = 0.031), while no difference was detected in alveolar trabecular bone. The C3 degree of MCI was more frequent in the COD group ( p = 0.009)., Conclusion: Females with COD had lower values of radiomorphometric parameters in mandibular cortical bone than females of the same age without COD. These results suggest that, in addition to the dental care recommended in the literature, COD females also require more attention and screening for low bone mineral density.

Stafne bone cavity (SBC) is a rare lingual bone depression that is asymptomatic and contains salivary glands. Radiographically, an SBC is usually seen as well-defined homogenous oval radiolucency in the mandibular posterior region, below the mandibular canal. In this paper, a rare case of posterior-variant, double SBCs was presented. A 43-year old male patient was referred to our clinic with the complaint of third molar teeth. Panoramic and cone-beam computed tomographic images showed two well-defined oval radiolucencies on the left mandibular molar region, inferior to mandibular canal borders. No pain or swelling was detected in the region of the radiolucencies. Previous dental radiographs had the same images. Magnetic resonance imaging was performed to evaluate the presence of salivary gland in the radiolucent contents. Images showed that the bone cavities were filled with soft tissue having a signal similar to the submandibular gland. The diagnosis was made as double SBCs and the patient was informed about the lesions.

Aim: The aim of this retrospective study is to determine the level of visibility of the lingual foramen in panoramic radiography using cone-beam computed tomography (CBCT) as a reference tool., Method: A total of 200 patients (111 females and 89 males) were included in the study. Cross-sectional CBCT images of the mandible in the midline were used to locate and define the orifice and diameter of each lingual canal that was detected. The appearance of the lingual foramen in the anterior mandible in panoramic radiography was assessed using a five-point ordinal scale. Descriptive statistics including tables and graphs were used. The correlation between CBCT and panoramic radiography findings were analyzed using Chi-square tests., Results: The lingual foramen was found to be located most frequently in the mandibular midline, above the genial tubercle (78.5%). A narrow-diameter type was found to occur most frequently (56.5%). A prominent genial tubercle was the most commonly found type (57.5%). The lingual foramen could be definitively identified in panoramic radiographs in only 8 cases (4%), while a high degree of probability was found in 25 cases (12.5%). The lingual foramen appears wider and therefore more distinctive in panoramic radiographs when the angulation of the lingual canal is less than 20° to the ground plane., Conclusions: Radiological evaluation with panoramic radiographs alone may lead to inadequate assessments prior to surgical procedures involving the anterior mandible. Clinicians may consider using three-dimensional imaging for procedures with a risk of hemorrhagic and neurosensory complications such as dental implant placement in the anterior mandible., Competing Interests: None

Mandibular third molar teeth have the highest impaction frequency for several reasons such as lack of space which may be related to the direction of facial growth. Gonial angle is used for the definition of facial growth pattern with some other measures such as mandibular plane angle. Winter and Pell-Gregory classifications are used for defining the level and pattern of mandibular third molar impaction. The aim of this study is to define the relationship between mandibular third molar impaction pattern and gonial angle; also to evaluate relationship between mandibular third molar roots and inferior alveolar canal. Study included 90 patients who had undergone cone beam computed tomography assessment for mandibular third molar impaction. Impacted teeth were grouped according to Pell-Gregory depth (A, B, C) and ramus (1, 2, 3) classification and sub-groups were composed. Winter classification was used for angulation of third molars and their relationship between with inferior alveolar canal was recorded. Gonial angle was measured on panoramic radiographs. Of the evaluated 90 impacted third molars, mesioangular position was the most frequent (34.4%), followed by vertical, horizontal and distoangular positions. Nearly 77% of the impacted third molar roots were related to inferior alveolar canal. While no correlation was determined between gender, age, third molar angulation and gonial angle, C2 sub-group of Pell-Gregory classification showed statistically significant higher gonial angle values. Although no significance was found, gonial angle was higher in level C group. In conclusion, gonial angle is higher in patients with C2 impaction level. Also, although statistically insignificant, Pell-Gregory C group had higher gonial angle averages.

Objectives: To assess the root proximity and the insertion angles of miniscrews after miniscrew placement at a variety of maxillary and mandibular buccal sites using cone-beam computed tomography (CBCT) and to determine the differences in root proximity between CBCT and panoramic radiography (PR)., Materials and Methods: This retrospective study included 50 patients (mean age, 22.0 ± 4.5 years) who underwent postoperative CBCT and PR after miniscrew placements for intermaxillary fixation in orthognathic surgery. Twelve miniscrews were placed in the buccal bone of each patient: at sites between the central incisor and lateral incisor (SII), sites between the canine and first premolar (SCP), and sites between the second premolar and first molar (SPM) on the right and left sides of the mandible and maxilla. The insertion angles were measured on CBCT, and the root proximity was assessed on CBCT and PR., Results: The mean vertical placement angles ranged from 84.27° to 95.12°, and the mean horizontal placement angles ranged from 90.93° to 101.1°. The rates of no contact between the root and the miniscrew were 68.0% in the SII, 50.5% in the SCP, and 57.8% in the SPM, which were significantly different ( P = .000). The total concordance rate between PR and CBCT was 41.3%., Conclusions: Clinicians should use extreme caution during placement of miniscrews in the SCP. There are limitations on the use of PR for evaluating the root proximity of miniscrews.

This study aimed to evaluate the impact of factors related to the patient (age, sex, bruxism, and general health) or prosthesis (use of old dentures, duration of denture wear, and nocturnal wear) on the mandibular ridge resorption rate (RRR) of complete denture (CD) wearers. This retrospective cohort study was composed of edentulous patients who sought prosthodontic treatment for maxillary and mandibular CDs. The mandibular RRR was estimated based on panoramic radiographs (n = 120) obtained at the time of the clinical examination. The total height of the alveolar process was considered to be 3 times the distance from the inferior border of the mandible to the lower border of the mental foramen. Radiographic measurements were performed by 1 calibrated examiner. Data were collected from dental records related to the patient or prosthesis. Data were evaluated by 1-way analysis of variance or Student t test at a significance level of 5%. Of the factors evaluated, age (P ∼ 0.000), previous use of CDs (P ∼ 0.000), and bruxism history (P = 0.003) were statistically significant for the mandibular RRR. The RRR was greater among patients older than 60 years, those who had been wearing old CDs, and those who reported bruxism. Thus, the study results showed the negative influence of advanced age, use of old dentures, and bruxism on mandibular RRR., Competing Interests: The authors report no conflicts of interest pertaining to any of the products or companies discussed in this article.

Background: The aim of this study was to compare the morphological differences in the mandible between patients with six age groups and to detect the correlation between these parameters on panoramic radiography (PR) and cone-beam computed tomography (CBCT)., Materials and Methods: A total of 121 subjects (50 males and 71 females) were included in the study and were divided into six age groups (10-19, 20-29, 30-39, 40-49, 50-59, and 60-69) on the basis of the chronological age. CBCT and PR methods were used to record the mandibular measurements for the same 121 patients. Differences between male and female mandibular morphometric measurements, between right and left side measurements, and differences in age subgroups compared by using independent samples t-test, paired samples t-test, and one-way ANOVA test, respectively. P < 0.05 value was considered statistically significant for all analysis., Results: Males mostly have higher mandibular measurement values. There were statistically significant differences between CBCT and PR measurements (p < 0.05). PR mostly showed higher values than CBCT measurements., Conclusions: Based on the fact that PRs showing significant differences from CBCT in the morphometric measurements made on mandible, it is recommended that forensic doctors and anthropologists consider this information in their age and gender prediction studies.

Background: The mandibular cortical index (MCI) is a measurement based on the visual assessment of changes in the morphology of the mandibular cortex on panoramic radiographs., Objectives: The present study aimed to investigate age, gender, dental status (DS), occlusal function, and presence of torus mandibularis (TM) as variables that might have a possible effect on MCI., Material and Methods: A total of 381 patients (155 men and 226 women) aged 21-84 years (mean age: 43.8 ±14.5 years) were included in this study. Age, gender and DS were recorded for each patient. The occlusal function was evaluated using the Eichner index (EI). The presence of tori was assessed by visual inspection and digital palpation. The MCI assessments were done based on Klemetti's classification (C1-C3). Statistical comparisons were performed using the χ2 test, independent samples t-test and multiple logistic regression analysis (p < 0.05)., Results: Significant differences were observed between the MCI categories regarding age, gender, DS, EI, and TM. The likelihood of the MCI categories C2 and C3 was increased in males (odds ratio (OR) 9.33; p < 0.001), when TM was absent (OR 2.73; p < 0.001), in EI Class B (OR 2.68; p = 0.027), and in the age group 50-70 years (OR 2.5; p = 0.018)., Conclusions: Morphological changes of the mandibular cortical bone are related to gender, presence of TM, occlusal function expressed as EI, and age.

Objectives: To compare the performance of panoramic radiography (PAN) and cone beam CT (CBCT) in the detection of juxta-apical radiolucency (JAR), as well as to investigate, in CBCT images, if there are factors associated with the detection of JAR on PAN., Methods: Two oral radiologists assessed the presence of JAR in PAN and CBCT images of 175 individuals (308 mandibular third molars). The cortical plates involvement and the JAR size and location were assessed on CBCT to evaluate if these factors were related to JAR detection on PAN. McNemar's test and multiple logistic regression were performed., Results: PAN and CBCT differed significantly in the detection of JAR (p = 0.001). On PAN, JAR was identified on 24% of the patients while on CBCT its detection increased to 32.6%. JAR was detected only on CBCT and only on PAN in 26 and 7 cases, respectively. Distal/mesial surfaces of dental roots were where JAR was mostly located (84.5%), cortical thinning was found in 59.2% of cases and the mean (SD) of JAR size was 5.03 (±1.8) mm. However, these factors were not associated with JAR detection on PAN (p > 0.05). On the other hand, the location of the cortical involvement (if buccal or lingual) was associated with JAR detection on PAN, which was more detectable when the thinning was on buccal cortical., Conclusions: Juxta-apical radiolucency is more often detected on CBCT than on PAN. JAR detection on PAN was improved when it was related to the buccal cortical plate of the mandible.

Background: Torus mandibularis (TM) is one of the most common oral exostoses. The presence of TMs has been correlated with high skeletal bone mineral density. This study aimed to evaluate the relationship between TM and mandibular bone quality based on the measurement of mandibular cortical index (MCI)., Materials and Methods: A case-control study was designed for patients who attended the Department of Dentomaxillofacial Radiology at the University of Hacettepe for routine dental examination. Patients with TMs were defined as cases, and those without TMs were defined as controls. The presence of tori was assessed by visual inspection and digital palpation. MCI assessments were done based on Klemetti's classification. The associations between the presence of TMs, MCI, and the parafunctional activity were assessed., Results: The sample consisted of 80 subjects with TMs and 80 control subjects. The presence of TMs was strongly associated with the parafunctional activity (p = 0.036) and a non-eroded mandibular cortex (MCI C1, p = 0.001)., Conclusions: Parafunctional activity may be a factor related to the formation or existence of TMs. The association between TMs and mandibular morphology may suggest that subjects with TMs may have a higher mandibular bone quality compared to those without TMs.

Objectives: The aim of this study was to investigate the applicability of Drusini's and Cameriere's methods to a sample of Turkish people., Methods: Panoramic images of 200 individuals were allocated into two groups as study and test groups and examined by two observers. Tooth coronal indexes (TCI), which is the ratio between coronal pulp cavity height and crown height, were calculated in the mandibular first and second premolars and molars. Pulp/tooth area ratios (ARs) were calculated in the maxillary and mandibular canine teeth. Study group measurements were used to derive a regression model. Test group measurements were used to evaluate the accuracy of the regression model. Pearson's correlation coefficients and regression analysis were used., Results: The correlations between TCIs and age were -0.230, -0.301, -0.344 and -0.257 for mandibular first premolar, second premolar, first molar and second molar, respectively. Those for the maxillary canine (MX) and mandibular canine (MN) ARs were -0.716 and -0.514, respectively. The MX ARs were used to build the linear regression model that explained 51.2% of the total variation, with a standard error of 9.23 years. The mean error of the estimates in test group was 8 years and age of 64% of the individuals were estimated with an error of <±10 years which is acceptable in forensic age prediction., Conclusions: The low correlation coefficients between age and TCI indicate that Drusini's method was not applicable to the estimation of age in a Turkish population. Using Cameriere's method, we derived a regression model.

Purpose: The purpose of this study was to carry out morphologic and topographic analyses of retromolar canals on cone beam computerized tomography (CBCT) scans, comparing findings to others obtained from the corresponding digital panoramic radiographs., Methods: Sixty-one CBCT scans were analysed digitally, as well as their corresponding digital panoramic radiographs. The prevalence and distribution of these canals, foramen diameters, and intraosseous communications were also evaluated., Results: On CBCT scans, we found that 24.6% of individuals had at least one retromolar canal. The mean foramen diameter was slightly higher than 1 mm and we could not determine the intraosseous anatomical connections in most cases. The morphology and topography of the retromolar canals were not affected by gender and antimere. In addition, only 22.2% of all tomographically identified canals could be confirmed on digital panoramic radiographs (26.7% of such patients). Regarding all sample, 6.6% of individuals showed retromolar canals on digital panoramic radiographs., Conclusion: We may consider that these structures are clinically relevant findings and, due to the low accuracy of the panoramic radiographs, high-quality tomographic exams should always be asked for presurgical treatment planning.

Objectives: To analyze the influence of Type 2 diabetes on bone mineral density (BMD) and panoramic radiomorphometry in postmenopausal females, comparing with results from non-diabetic postmenopausal females., Methods: A total of 228 postmenopausal females (mean age: 59.51 ± 11.08 years) were included in this study. Demographics, T scores and Z scores from peripheral dual X-ray absorptiometry (DXA) and mandibular cortical index (MCI) from panoramic radiographs were assessed. Mean comparison between results for diabetics and non-diabetics was carried out with the Student's t-test. In addition, non-parametric correlations between MCI and DXA results were carried out with Spearman's test, at a level of significance of 5%., Results: Mean Z score values were significantly higher in diabetics than in non-diabetics (p = 0.001). T and Z score values were also significantly correlated with MCI (r = 0.428, p = 0.001, and r = 0.356, p = 0.022, respectively)., Conclusions: Within the limitations of this study, the present results suggest that Type 2 diabetes might increase BMD in postmenopausal females.

Objective: The aim of the study was to determine and compare the position of the mental foramen MF in the north and south Indian populations using Panoramic radiographs., Materials and Methods: A total of 100 Panoramic radiographs were selected from the archives of PMNM Dental College and the Department of Oral Medicine and Radiology, of which 50 radiographs belonged to a north Indian population and 50 radiographs belonged to a local population of Bagalkot Karnataka. The position of the MF was classified into 6 positions depending on the relationship to the mandibular teeth. The distance from the superior border of the MF to the lower border of the mandible was also measured., Results: The most common position of the MF was along the long axis of the second premolar in the north Indian population and in south Indian populations it was found to be between the first and second premolar. Descriptive analysis was used to compare the distance between the superior border of the mental foramen and the lower border of the mandible bilaterally., Conclusion: There was a significant difference in the position of the MF between the north and south Indian populations., (Copyright © 2017 by Academy of Sciences and Arts of Bosnia and Herzegovina.)

Purpose: We determined actual bucco-lingual angulation values and morphological variations of residual bone in the mandibular posterior edentulous region using cone-beam computed tomography (CBCT) and panoramic radiography. A second aim was to investigate whether it was possible to predict bone morphology from panoramic radiographs., Methods: Data were collected from 77 consecutive patients referred for both CBCT and panoramic radiography in our department. Two-dimensional and three-dimensional images of the probable implant placement region were investigated. The bucco-lingual angulation values and crest type were determined directly from the cross-sectional images of the posterior edentulous region. The edentulous region was divided into three groups: second premolar, first molar, or second molar region. The observations were evaluated by the computer software, SPSS 22.0 (SPSS Inc. Chicago, USA). The crest type was classified into three groups: type U, type C, or type P. Kappa statistics, Kolmogorov-Smirnov tests, ANOVA, and Kruskal-Wallis tests were used in statistical analyses. The significance level was set at p < 0.05., Results: Type C was more frequent in the second premolar region and the crest type had changed to type U in the second molar region. The predictability of the type U was highest in the second molar region. Moderate agreement was found in the predictability of type U in the molars (κ = 0.602). The mean value of bucco-lingual angulation was highest in the second molar region, followed by the first molar region. There were statistically significant differences between the bucco-lingual angulation of the crest types in the second premolar and first molar regions (p < 0.05)., Conclusions: Bucco-lingual angulation values and morphology change through the posterior mandible. Type U was predicted at a higher rate in the second molar region from panoramic radiographs. These results demonstrate predicting high-risk areas in the posterior mandible for implant therapy from panoramic radiography.

Objectives: The purpose of this study was to evaluate fractal analysis as a tool to quantitatively determine the mandibular trabecular bone changes in patients with chronic renal failure (CRF)., Methods: In the present study, fractal analysis was performed using ImageJ (National Institutes of Health, Bethesda, MD) program with box-counting method over panoramic radiographs of 25 patients (14 females and 11 males) with CRF and 26 healthy individuals (14 females and 12 males) as a control group. The fractal dimension (FD) values of the patients and healthy individuals were compared. In addition, average biochemical parameters [parathyroid hormone (PTH), calcium (Ca), phosphorus (P), product of Ca and P levels (CaxP), alkaline phosphatase (ALP), vitamin D] of the patients with CRF, as measured during the 3 months before the panoramic radiographs, were compared with FD values., Results: According to the results, FD values of the patients with CRF were found to be statistically lower than the control group (p < 0.05). The average PTH levels of the patients with CRF were 416.16 ± 310.3 pg ml(-1); average Ca levels were 8.94 ± 1.2 mg dl(-1); average P levels were 5.76 ± 1.7 mg dl(-1); average CaxP values were 51.12 ± 15.03; average ALP levels were 83.44 ± 36.8 U l(-1); and the average vitamin D values were 19.43 ± 9.7 ng ml(-1). In addition, there was no significant correlation between FD values and the biochemical parameters of the patients, and there was no correlation between age, gender and FD., Conclusions: The FD values of the patients with CRF were lower than those of the controls. This finding suggests that FD analysis might be a promising simple and cost-effective tool for evaluating trabecular bone structure.

Objectives: To investigate the anatomical variations of the mandibular canal through assessment in situ, panoramic radiography, CT or CBCT and assess their frequency., Methods: Articles were selected from databases (Cochrane Library, LILACS, ProQuest, PubMed, Scopus, Web of Science and Google Scholar), articles without limitations of language, in which the main objective was to evaluate the frequency of bifurcation of the mandibular canal through assessment in situ, panoramic radiography, CT or CBCT were selected. A meta-analysis of prevalence using random effects was performed., Results: Using a selection process in two phases, 15 articles were identified, and a meta-analysis was conducted. The results from these meta-analyses showed that the overall prevalence of anatomical variations for in situ studies was 6.46%, and through assessment of panoramic radiography and CT or CBCT the overall prevalence shown was 4.20% and 16.25%, respectively., Conclusions: There are two types of variations of the mandibular canal: the retromolar canal and bifid mandibular canal. The frequency variations through assessing in situ, panoramic radiography and CT or CBCT were 6.46%, 4.20% and 16.25%, respectively.

Objective: This study aims to assess the relationship between the inferior alveolar canal (IAC) and inferior third molars using digital panoramic images (DPI) with and without enhancement and compare the panoramic signs with cone beam computed tomography (CBCT) findings., Methods: The DPIs and CBCT of 50 patients were analyzed. The DPIs were copied and enhanced using edge enhancement and an invert tool and then analyzed by two observers using the scores: darkening of the root; deflection of the root; narrowing of the root; superimposition of the root; bifurcation of the root over the IAC; diversion of the IAC; interruption of the cortex of the IAC, and no radiographic findings noted. Kappa and exact binominal tests were used to analyze the correlation between DPIs and CBCT images. The intimate relationship scores were evaluated using a t-test and Mann-Whitney test., Results: The original DPIs, and the edge enhanced and invert tool images produced kappa coefficients of 0.528, 0.528 and 0.551, respectively. There was no difference among the methods evaluated in this study (p = 0.981)., Conclusion: Similar agreement was observed between DPIs with and without enhancement. However, panoramic radiography is not the ideal method to analyze the relationship between lower third molars and the IAC., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this study was to investigate the association of the shape of the mandibular cortex on panoramic radiographs with the risk of an osteoporosis diagnosis without prevalent fractures and with the risk of osteoporotic fractures in Japanese men and women., Subjects and Methods: One thousand and twenty-one subjects aged 40-89 years, who visited our university hospital and underwent panoramic radiography between 2007 and 2013, participated in this study. Eighty-eight patients received a diagnosis of osteoporosis without prevalent fractures, and 55 were diagnosed with osteoporotic fractures. Blinded to the groupings, we classified the shape of the mandibular cortex on panoramic radiographs as normal, moderately eroded or severely eroded., Results: After adjustment for confounding factors, the odds ratios for an osteoporosis diagnosis associated with moderately eroded and severely eroded mandibular cortices were 1.4 (95% CI, 0.8-2.6) and 2.6 (95% CI, 1.4-5.0), respectively. The odds ratios for an osteoporotic fracture associated with moderately eroded and severely eroded cortices were 0.8 (95% CI, 0.4-1.7) and 1.1 (95% CI, 0.5-2.5), respectively., Conclusions: Subjects in Japan with eroded mandibular cortices tended to be at increased risk of osteoporosis diagnoses but not of fractures., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

We hypothesized that mandibular cortical width (MCW) is smaller in children with osteogenesis imperfecta (OI) than in healthy children and that pamidronate can improve the cortical mandibular thickness. The aim of this study was to assess changes in the MCW on dental panoramic radiographs (DPRs) of children with normal bone mineral density (BMD) and with OI. We also compared the MCW of children with different types of OI regarding the number of pamidronate cycles and age at the beginning of treatment. MCW measurements were retrospectively obtained from 197 DPRs of 66 children with OI types I, III, and IV who were in treatment with a comparable dosage of cyclical intravenous pamidronate between 2007 and 2013. The control group had 92 DPRs from normal BMD children. Factorial analysis of variance was used to compare MCW measurements among different age groups and between sexes and also to compare MCW measurements of children with different types of OI among different pamidronate cycles and age at the beginning of treatment. No significant differences in results were found between male and female subjects in both OI and healthy children, so they were evaluated altogether (P > 0.05). There was an increase of MCW values related to aging in all normal BMD and OI children but on a smaller scale in children with OI types I and III. Children with OI presented lower mean MCW values than did children with normal BMD at the beginning of treatment (P < 0.05). A linear model estimated the number of pamidronate cycles necessary to achieve mean MCW values equivalent to those of healthy children. The thinning of the mandibular cortex depended on the number of pamidronate cycles, the type of OI, and the age at the beginning of treatment. DPRs could thus provide a way to identify cyclic pamidronate treatment outcomes in patients with OI., (© International & American Associations for Dental Research.)

Intravascular papillary endothelial hyperplasia was a rare benign vascular proliferative process as a result of papillary proliferation of the endothelial cells within the vessels. To our knowledge, we reported the second case occurring in the madibule, and the first reported in 1984 in the literature. We discussed manifestations of multislice computed tomography and panoramic radiography about the lesion and relevant literature was reviewed., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: To examine the presence and morphologic characteristics of bifid mandibular canals (BMCs) and retromolar foramens (RFs) using cone beam CT (CBCT) and to determine their visualization on panoramic radiographs (PANs)., Methods: A sample of 225 CBCT examinations was analysed for the presence of BMCs, as well as length, height, diameter and angle. The diameter of the RF was also determined. Subsequently, corresponding PANs were analysed to determine whether the BMCs and RFs were visible or not., Results: The BMCs were observed on CBCT in 83 out of the 225 patients (36.8%). With respect to gender, statistically significant differences were found in the number of BMCs. There were also significant differences in anatomical characteristics of the types of BMCs. Only 37.8% of the BMCs and 32.5% of the RFs identified on CBCT were also visible on PANs. The diameter had a significant effect on the capability of PANs to visualize BMCs and RFs (B = 0.791, p = 0.035; B = 1.900, p = 0.017, respectively)., Conclusions: PANs are unable to sufficiently identify BMCs and RFs. The diameter of these anatomical landmarks represents a relevant factor for visualization on PANs. Pre-operative images using only PANs may lead to underestimation of the presence of BMCs and to surgical complications and anaesthetic failures, which could have been avoided. For true determination of BMCs, a CBCT device should be considered better than a PAN.

Aim: The purposes of this study were (1) to investigate the bucco-lingual course of the mandibular canal in the bony structure and (2) to figure out the relationship between the position of mental foramen on panoramic radiographs and the horizontal course of the mandibular canal., Materials and Methods: A database of panoramic radiography and spiral computed tomography (CT) scans was searched and 100 subjects were selected based on the criteria. Mental foramina were classified into four groups according to its antero-posterior position. Three measurements were made on each slice of coronal CT scans at three different points: (1) apex of second premolar; (2) median point of two root apexes of first molar; and (3) median point of two root apexes of second molar. The bucco-lingual ratios were calculated to access the relative bucco-lingual position of the mandibular canal., Results: The distribution of subjects according to the type of mental foramen was: (1) type 3, 67%; (2) type 2, 26%; (3) type 4, 5%; and (4) type 1, 2%. The overall horizontal course of the mandibular canal was relatively constant from the second molar to first molar, whereas much significant directional change was found on the remaining course. Between types 2 and 3, no statistically significant differences were found at the level of the second molar and first molar (P = 0.461 and 0.965, respectively). Only below the second premolar, significant differences were found (P = 0.001)., Conclusions: Based on the findings of our computed tomographic image analysis, the position of mental foramen on panoramic radiographs was affected by its horizontal course of inferior alveolar nerve. The significant horizontal direction change of the course was found after the canal passing below the mandibular first molar regardless of the antero-posterior position of mental foramen., (© 2012 John Wiley & Sons A/S.)

This study reports a rare case of a dentigerous cyst in a malformed tooth in the mandible of a 5-year-old Japanese boy. Panoramic radiography revealed a cystic lesion with hard tissues inside. The patient underwent surgery under general anesthesia. The histopathological diagnosis was dentigerous cyst associated with a malformed tooth. [ABSTRACT FROM AUTHOR]

Background: Cemento-osseous dysplasias (CODs) are rare lesions of the jawbone. Their occurrence, localization, type, size, and shape can vary between cases. This fibro-osseous lesion is typically found in the jaw near tooth-bearing areas and is often asymptomatic, discovered incidentally, and may be associated with the periapical region of the teeth. In rare cases, COD can lead to secondary bone osteomyelitis. Currently, there is limited information in the literature on the occurrence and characteristics of COD. This paper's main aim was to focus on the authors' COD experience in the lower Silesian area. Methods: A retrospective evaluation of radiographies (RTG-Panx, cone-beam computed tomography (CBCT)) was conducted on patients treated, diagnosed, or consulted by the authors. A statistical correlation analysis was made to establish any relationship within the gathered data. Results: COD is predominantly an incidental finding in the mandibular bone near tooth apices. It is most commonly diagnosed in females. Both CBCT and panoramic radiographies are generally sufficient for diagnosing the lesion. COD rarely requires treatment. Conclusions: COD lesions are mostly discovered incidentally during routine radiographies or cone-beam computed tomography (CBCT) scans. In most cases, clinical and radiological monitoring is sufficient, along with evaluating the teeth's response to cold stimuli and assessing the surrounding bone structures. Biopsies or tooth extractions are seldom necessary. When oral hygiene is well-maintained and no periapical inflammation is present, COD lesions typically remain asymptomatic. [ABSTRACT FROM AUTHOR]