Search

Objective Our previous study of patients with unilateral temporomandibular joint (TMJ) osteoarthritis (OA) showed that the affected joints had greater horizontal condylar angle (HCA) compared with the contralateral unaffected joints. However, it was unclear whether the HCA changes preceded or were the result of OA changes. The aim of this longitudinal study was to investigate the relationship between HCA and OA progression. Study Design In total, 127 patients (with or without TMJ disorders) completed baseline and follow-up examinations (average time to follow-up 7.9 years). Generalized estimating equation models were used to account for correlation of observations within the same patients. Results (1) HCA was greater in OA-affected joints than in unaffected joints (P = .04). (2) Increased HCA at follow-up was associated with change in joint status from no OA to OA. (P = .001). (3) Baseline HCA value alone did not predict future OA diagnosis. (4) All OA changes in fossa/articular eminence morphology, and some combinations of condylar changes, were associated with a greater HCA. (5) OA diagnosis was associated with pain during maximum opening (P = .005) and pain history (P = .002). (6) Aging alone was not correlated with increased HCA. Conclusions Clinical progression of OA preceded increases in HCA. HCA alone did not predict OA development.

Research using magnetic resonance imaging analysis has shown that internal temporomandibular joint derangement is associated with significantly greater horizontal condylar angle. However, the association between osteoarthritic (OA) bony changes as shown on computed tomography and horizontal condylar angle has never been evaluated.To investigate the relationship between mandibular condylar angle and OA degenerative changes.This is a retrospective study using cone beam computed tomography images and reports from 60 patients with unilateral OA degenerative changes and 43 control patients with no OA-affected joints.Condylar angles in the joints of control patients and the unaffected joints in OA patients were not significantly different. The mean horizontal condylar angle in the unilaterally OA-affected joints (29.5° ± 10.5°) was larger than in the contralateral unaffected joints (22.5° ± 7.7°) (P .001). In the OA-affected joints, flattening and erosion of the articular eminence was associated with a greater condylar angle (P .05).Moderate to severe degenerative temporomandibular joint change is associated with greater horizontal condylar angle.

Introduction Many endodontic treatment failures in maxillary molars result from missed second mesiobuccal (MB2) canals. An MB2 canal orifice is present in as many as 95% of maxillary molars, but these canals are not always located during endodontic procedures. Additional tools, such as cone-beam computed tomographic (CBCT) imaging, may be needed to locate these canals in maxillary molars. Hence, the aims of this study were to investigate the frequency of use of CBCT imaging during the treatment of maxillary molars and to evaluate the influence of its use on the detection of MB2 canals. Methods Endodontic treatment records, digital intraoral radiographs (when present), and CBCT images from all maxillary first and second molars treated at the University of Washington, Seattle, WA, between 2010 and 2014 (N = 886) were reviewed. Statistical analysis was performed to assess differences between the groups. Results Overall, an MB2 canal was found in 55.8% of the maxillary molars studied, and CBCT imaging assisted in detecting 11.7% of these canals. CBCT imaging was used in 16.5% of the cases treated and was used significantly more for retreatment cases. CBCT imaging was used preoperatively in 5.6% of cases, and the data show that significantly more MB2 canals were located when a preoperative CBCT image was available. More MB2 canals were located in first molars without full-coverage crowns. Conclusions The data show that CBCT imaging is a valuable tool in locating MB2 canals. Based on the results of his study, the use of CBCT imaging could be warranted when treating maxillary molars.

Purpose: The purpose of this study was to evaluate patient satisfaction and clinical outcomes among subjects with mandibular overdentures supported by one or two immediately placed dental implants 5 years after loading. Materials and Methods: Thirty-six subjects (16 men and 20 women) received one or two dental implants in the anterior mandible, and all implants were loaded the day of surgery. Subjects were scheduled for follow-up 3-, 6-, and 12 months after implant placement and thereafter annually for 4 more years. Patient satisfaction scores were measured with the Oral Health Impact Profile-EDENT (OHIPEDENT) questionnaire. Results: Seventeen subjects (7 male and 10 female) with a mean age of 59.4 years (range, 44 to 74 years) were available for the 5-year follow-up examination. Nine subjects with 10 failing implants were excluded during the first year and nine subjects were lost to follow-up. No implants failed between the 12- and 60-month follow-up examinations, and the need for denture maintenance was low. Mean peri-implant bone change was 0.92 mm, and the Spearman test failed to show correlation between the insertion torque value and implant stability quotient. Patient satisfaction scores increased significantly when compared with baseline values and continued to be high for both groups, with no significant differences. Conclusion: Ten implants in nine subjects failed early, but no failures were observed after the 12-month examination. No significant differences were found between subjects in the two groups with respect to implant survival rates and peri-implant bone loss, and patient satisfaction scores continued to be high. Although patient satisfaction and implant success were high during the 12- to 60-month period, the results should be interpreted with caution because of the high number of failing implants and patients lost to followup. More research is needed to study outcomes of treatment with immediately loaded mandibular implant overdentures.

The longitudinal course of temporomandibular joint (TMJ) disc displacement (DD) and degenerative joint disease (DJD) has never been conclusively described with magnetic resonance imaging and computed tomography, respectively. This 8-y observational study’s objective was to assess the longitudinal stability of DD and DJD among 401 subjects. The Validation Project provided baseline measures; follow-up was performed in the TMJ Impact Project. With magnetic resonance imaging, 2 radiologists rendered a consensus diagnosis of normal/indeterminate, DD with reduction, or DD without reduction. Computed tomography consensus diagnoses included normal/indeterminate, grade 1 DJD, or grade 2 DJD. Radiologist reliability was assessed by kappa; a Hui-Walter model was used to estimate, after accounting for diagnostic disagreement, the frequency of diagnostic progression and reversal. Permutation tests were used to test the statistical influence of concurrent baseline diagnoses on diagnostic changes at follow-up. Of 789 baseline joint-specific soft tissue diagnoses of DD, 598 (76%) joints showed no change; 109 (14%) demonstrated progression; and 82 (10%) had reversal. Of 794 joints with baseline joint-specific hard tissue diagnoses of DJD, progression was observed in 122 (15%) joints, no change in 564 (71%), and reversal in 108 (14%). Radiologist reliability (kappa) was 0.73 (95% CI, 0.64 to 0.83) for DD and 0.76 (95% CI, 0.68 to 0.83) for DJD. After accounting for the influence of diagnostic disagreement, progression of hard tissue diagnoses in the right TMJ occurred in 15.2% of subjects (95% CI, 10.5% to 20.8%) and reversal in 8.3% (95% CI, 4.9% to 12.3%); results were similar for soft tissue diagnoses and the left TMJ. Concurrent baseline soft tissue diagnoses were associated with hard tissue diagnostic changes at follow-up ( P < 0.0001). Baseline hard tissue diagnoses showed no statistical association with soft tissue changes at follow-up ( P = 0.11). Longitudinally, 76% of baseline TMJ soft tissue diagnoses and 71% of the baseline hard tissue diagnoses remained stable. Diagnostic reversal and progression were confirmed for both soft and hard tissues.

Aim The objective of the study was to evaluate and compare treatments with mandibular overdentures supported by one or two immediately placed implants 3 years after loading. Materials and Methods Thirty-six edentulous subjects were eligible for inclusion. Using a random sampling system, one or two implants were placed in the mandible. Separate ball attachments were connected to the implants, and the denture was relined and delivered the day of surgery with the retentive components incorporated in the denture base. At the follow-up examinations peri-implant bone levels, implant and denture stability/retention, and need for maintenance and adjustments were evaluated. Moreover, the OHIP-EDENT questionnaire was used to measure patient satisfaction. Results Nineteen subjects (10 men and 9 women) with a mean age of 56 years were available for the 3-year follow-up examination. The group with 1 implant (Group 1) consisted of 11 subjects (5 women and 6 men) while the remaining 8 (5 women and 3 men) belonged to Group2. Nine subjects had been excluded during the first year due to failing implants, 6 had moved, 1 had died, and 1 reported severe illness. No implant failures between the 12-and 36 month follow-up were observed. The mean peri-implant bone change was.86 mm and the Implant Stability Quotient showed only minor changes with no significant difference between the groups when compared with the 12-month follow-up. Patient satisfaction scores increased significantly when compared with the baseline values and continued to be high for both groups and need for denture maintenance was low. Conclusion No significant differences were found between subjects in the two groups with respect to implant survival and peri implant bone loss, and patient satisfaction scores continued to be high for both groups. Need for denture maintenance was low in both groups.

The aim of this study was to (1) evaluate the fractal dimension (FD) in regions of the mandible on cone beam CT (CBCT) images of patients with bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) and (2) to select the most suitable region of interest (ROI) for further study on detection of bone alterations associated with bisphosphonates.CBCT images of patients with BP-ONJ were included with matched controls. Values of FD were compared between groups. Selected ROIs were: ROI-1 - below the mandibular foramen; ROI-2 - above the mandibular foramen; ROI-3 - anterior to the mental foramen; ROI-4 - above the mandibular canal. The area of bone exposure was included as ROI-5. The results were analysed using generalized estimating equations and conditional logistic regression.There were 36 patients (67% female) with a mean age of 60.7 years. The mean FDs were: ROI-1 - 1.678 for controls and 1.673 for patients (P = 0.81); ROI-2 - 1.657 for controls and 1.653 for patients (P = 0.78); ROI-3 - 1.661 for controls and 1.684 for patients (P = 0.17); and ROI-4 - 1.670 for controls and 1.698 for patients (P = 0.03). The value of the FD in the area of exposed bone was the highest (1.729). The odds of being a BP-ONJ patient vs being a control was six times as high for individuals with a higher FD score at ROI-4, although the confidence interval was quite wide owing to the small sample size.In this preliminary study, BP-ONJ patients had higher FD values than controls at regions close to the alveolar process. The results suggest that FD is a promising tool for detection of bone alterations associated with BP-ONJ.

Introduction The aim of this study was to evaluate craniofacial asymmetry by using 2-dimensional (2D) posteroanterior cephalometric images, 3-dimensional cone-beam computed tomography (CBCT), and physical measurements (gold standard). Methods Ten dry human skulls were assessed, and radiopaque markers were placed on 17 skeletal landmarks. Twenty linear measurements were taken on each side to compare the right and left sides and to compare these measurements with the physical measurements made with a digital caliper. To acquire the 2D posteroanterior radiographs, an Extraoral Phosphor Storage Plate (Air Techniques, Chicago, Ill) was used as the image receptor with a Eureka x-ray-Duocon Machlett unit (Machlett Laboratores, Chicago, Ill). Three-dimensional imaging data were acquired from a CB MercuRay (Hitachi Medical, Tokyo, Japan). Results On average, the right side was larger than the left for most of the 20 distances evaluated in the digital 2D and the CBCT images, and there was poor agreement between the digital 2D images and the physical measurements (kappa = 0.0609) and almost perfect agreement (kappa = 0.92) between the CBCT and physical measurements when individual measurements were considered. Conclusions Human skulls, with no apparent asymmetry, had some differences between the right and left sides, with dominance for the right side but with no clinical significance. CBCT can better evaluate craniofacial morphology when compared with digital 2D images.

Introduction: The high prevalence of orthodontic treatment in young people makes the associated radiation to the head and neck of potential public-health significance. In this study, we estimated secular changes (1963-2003) in age-specific organ doses associated with orthodontic care and collective organ doses in the United States in 1999. Methods: A survey of radiographic records at 1 university clinic was combined with published estimates to provide organ-specific radiation doses. Collective organ doses were estimated from the 1999 US Nationwide Evaluation of X-ray Trends and published orthodontic utilization surveys. Results: Before 1992, orthodontic care in a university setting was associated with mean doses of 7.0 milligrays (mGy) to the thyroid, 0.8 mGy to the red bone marrow, 2.7 mGy to the brain, 13.2 mGy to the salivary glands, and 5.1 mGy to the bone. After 1992, the doses decreased to 2.8 mGy to the thyroid, 0.3 mGy to the red bone marrow, 0.7 mGy to the brain, 6.2 mGy to the saliva glands, and 2.4 mGy to the bone. Around 1999, the collective doses associated with orthodontic care in the United States in patients less than 19 years of age were 400 Gy to the red bone marrow and 3800 Gy to the thyroid. Conclusions: Orthodontic care, in part due to its high prevalence, potentially contributes significantly to the diagnostic radiation burden in those less than 19 years old in the United States.

Introduction Cone-beam computed tomographic (CBCT) imaging is a valuable adjunct to endodontic practice. Among the endodontic applications of CBCT imaging, it aids in the diagnosis of apical periodontitis, often in cases in which there is no evidence of pathosis identified by conventional imaging. The purpose of this study was to correlate the presence of apical periodontitis of teeth evaluated with 2-dimensional periapical (PA) radiographs and 3-dimensional CBCT volumes with clinical signs and symptoms. Methods Clinical records were reviewed from patients examined at the graduate endodontics clinic. The examination included clinical examination, sensibility tests, PA radiographs, and limited field-of-view CBCT scans. Of 498 cases, 67 fulfilled the inclusion criteria and were evaluated for apical periodontitis and symptomology. CBCT slices and PA radiographs were evaluated by 2 board-certified endodontists and a board-certified oral and maxillofacial radiologist for the presence of apical periodontitis. Results Thirty eight of 67 teeth showed the presence of apical radiolucencies on PA radiographs and on CBCT imaging, whereas 14 teeth had no evidence of apical radiolucencies on either imaging modality. Fifteen cases showed the presence of apical radiolucencies visible on CBCT imaging that were not visible on PA radiographic images. The presence of apical radiolucencies on CBCT slices and PA radiographic images was correlated with clinical signs and symptoms, including the chief complaint. Conclusions This research has important implications to prevent overexposure to radiation and to provide treatment for those patients with persistent symptoms lacking proper diagnosis based on conventional (2D) radiographs.

Introduction: Dental relapse of the mandibular incisors after orthodontic treatment is a common problem, and few risk factors have been identified. The purpose of this case-control study was to evaluate whether the amount or the structure of mandibular bone affects the potential for postorthodontic mandibular incisor relapse. Methods: The subject sample was selected from the postretention database at the University of Washington. Subjects were chosen based on the availability of lateral cephalograms and mandibular periapical radiographs taken approximately 10 years postretention (T3). The mandibular incisor irregularity index (II) was measured on the T3 casts. Two groups were identified: subjects with the II greater than 6 mm (relapse or case) and those with the II less than 3.5 mm (stable or control). Once the case/control status was determined, the II was measured on models taken at the initial orthodontic examination (T1) and at the end of treatment (T2). Sixty relapse and 263 stable subjects were identified. Mandibular cortical thickness measured on both panoramic and lateral cephalometric radiographs was used to assess the amount of mandibular bone, and fractal analysis was used to analyze the trabecular bone structure around the mandibular incisors on the periapical radiographs. Logistic regression analyses were used to determine the association between dental relapse and significant bone parameters. The models were adjusted for potentially confounding variables (initial II, sex, age, and postretention time). Results: The relapse subjects had a larger mean II at T1 and a longer postretention time than the stable subjects. The mean cephalometric mandibular cortical thickness was significantly smaller in the relapse group than in the stable group at T1, T2, and T3. There were no statistically significant differences in the trabecular structure of bone, as measured with fractal analyses, between the relapse and stable groups. Conclusions: These results indicate that patients with thinner mandibular cortices are at increased risk for dental relapse.

Obtaining lifetime diagnostic radiation histories in head and neck cancer studies is often challenging due to the almost universal lack of centralized registries on X-ray utilization in medicine and dentistry. Both the common nature of orthodontics and the young age at which orthodontics typically occurs make it important to quantify what diagnostic radiographs are typically taken during orthodontic therapy. The aim of this study was to assess the number and type of radiographic films associated with one episode of orthodontic therapy in an educational setting. Charts stored in an orthodontic clinic at one academic setting were randomly sampled, and the type and number of radiographic examinations were tallied for the 325 individuals who were in orthodontic therapy for at least one year. Being under orthodontic therapy for one or more years was associated with a median number of seven extra-oral radiographs and twenty-four intra-oral radiographic films. The extra-oral radiographs included three panoramic radiographs and three cephalometric radiographs. Less than 10 percent of the variability was explained by factors such as age, gender, calendar year, surgical orthodontic therapy, and duration of therapy. Head and neck cancer etiology studies should take into account the ionizing radiation during episodes of orthodontic care. The substantial variability in radiographic practices in orthodontics could be reduced by research into clinical utility and by establishing guidelines.

Objective To see if a method for digitizing trabecular pattern of bone could be used to quantitatively evaluate changes in bone pattern following endodontic treatment of teeth with periapical osteolytic lesions. Study design Periapical radiographs were digitized and further processed with mathematical morphology operations known as skeletonization. The trabecular patterns resulting from this skeletonization process were further analyzed with fractal dimension analysis using box-counting. Results The periapical area in digitized radiographic images showed fractal behavior. Twenty-five of 27 patients showed increase of the fractal dimension after root canal treatment. Significant changes of the box-counting could be noted 3 months after root canal treatment ( P Conclusions Mathematical morphology operation and box-counting might be helpful in early detection of changes of periapical trabecular pattern after root canal treatment.

Few studies have examined the association between periodontitis risk, gender, and marital status in older adults. The purpose of this study was to assess if the oral health status of older subjects could be explained by differences in: 1) marital status; 2) gender; and 3) ethnicity.Clinical and radiographic periodontal oral conditions were studied in 701 older subjects from the TEETH clinical trial. Medical conditions as well as ethnic and marital status and smoking habits were considered.A total of 89 married couples were identified; 40.7% of these were of European descent and 48.1% of Chinese descent. The mean age was 67.7 years (SD +/- 4.7). The men were older than the women (mean difference: 1.5 years, SD +/- 4.6, 95% confidence interval [CI]: 0.5 to 2.5, P0.01). No significant differences in periodontal conditions were found between spouses or by marital status. Chinese descent was associated with a higher risk for periodontitis, regardless of marital status (odds ratio: 1.5, 95% CI: 1.05 to 2.04, P0.03).1) Married couples have similar social habits, similar oral health perceptions, and similar patterns of periodontal disease. 2) Dental studies including married couples do not bias data for married subjects as such. 3) Marital status has a limited impact on periodontal health but may have a greater impact on several systemic conditions, especially in widowed, divorced, or never married women. 4) Older Chinese subjects perceive themselves as being at lower risk for periodontitis but have more objective signs of periodontitis than older subjects of European descent.

Background: Depression and periodontitis are common conditions in older adults. There is some evidence that these two conditions may be related. Aims: To study a population of dentate elders and assess the prevalence of depression, self-assessment of risk for periodontitis and tooth loss, in relation to periodontal disease status. Material and methods: Data were obtained from 701 older subjects (mean age 67.2 years (SD′4.6), of whom 59.5% were women. Self-reports of a diagnosis of depression, scores of the Geriatric Depression Scale (GDS), and self-assessment of risk for future tooth loss and periodontitis were compared with a diagnosis of periodontitis based on probing depth, and bone loss assessed from panoramic radiographs. Other systemic diseases and smoking habits were also determined and studied in relation to depression. Results: A history of depression was reported by 20% of the subjects. GDS scores ≥ 8 were reported by 9.8% of the elders. Periodontitis was identified in 48.5% of the subjects. Depression was associated with heart attack (p

Background: An increased risk for periodontitis has been associated both with type-1 or insulin dependent diabetes (IDDM) and with type-2 or non-insulin dependent diabetes (NIDDM). Aims: 1) To describe and analyze periodontal conditions in older low-income ethnic diverse subjects with or without a diagnosis of diabetes. 2) To assess to what extent diabetes mellitus is associated with periodontal status, and 3) how periodontitis ranks as a coexisting disease among other diseases in subjects with diabetes mellitus. Material and methods: Radiographic signs of alveolar bone loss were studied in 1101 older subjects 60–75 years old (mean age 67.6, SD±4.7). The number of periodontal sites and the proportions of teeth with probing depth (PD) 5 mm, clinical attachment levels (CAL) 4 mm were studied in a subset of 701 of the subjects. Results: IDDM was reported by 2.9% and NIDDM by 9.2% of the subjects. The number of remaining teeth did not differ by diabetic status. The number of sites with PD 5 mm and the proportion of PD with 5 mm was significantly smaller in the non-diabetic group (χ2=46.8, p

BACKGROUND: Osteoporosis (OPOR) is a common chronic disease, especially in older women. Patients are often unaware of the condition until they experience bone fractures. Studies have suggested that OPOR and periodontitis are associated diseases and exaggerated by cytokine activity. Panoramic radiography (PMX) allows studies of mandibular cortical index (MCI), which is potentially diagnostic for OPOR.AIMS: i). To study the prevalence of self-reported history of OPOR in an older, ethnically diverse population, ii). to assess the agreement between PMX/MCI findings and self-reported OPOR, and iii). to assess the likelihood of having both a self-reported history of OPOR and a diagnosis of periodontitis.MATERIALS AND METHODS: PMX and medical history were obtained from 1084 subjects aged 60-75 (mean age 67.6, SD +/- 4.7). Of the films, 90.3% were useful for analysis. PMXs were studied using MCI. The PMXs were used to grade subjects as not having periodontitis or with one of three grades of periodontitis severity.RESULTS: A positive MCI was found in 38.9% of the subjects, in contrast to 8.2% self-reported OPOR. The intraclass correlation between MCI and self-reported OPOR was 0.20 (P < 0.01). The likelihood of an association between OPOR and MCI was 2.6 (95%CI: 1.6, 4.1, P < 0.001). Subjects with self-reported OPOR and a positive MCI had worse periodontal conditions (P < 0.01). The Mantel-Haentzel odds ratio for OPOR and periodontitis was 1.8 (95%CI: 1.2, 2.5, P < 0.001).CONCLUSIONS: The prevalence of positive MCI was high and consistent with epidemiological studies, but only partly consistent with a self-reported history of osteoporosis with a higher prevalence of positive MCI in Chinese women. Horizontal alveolar bone loss is associated with both positive self-reported OPOR and MCI.

The goal of this study was to detect dimensional changes in the mandibular cortical bone associated with bisphosphonate (BP) use and to correlate measurements of the cortical bone with the cumulative dose of BPs.Mandibular inferior cortical bone thickness (MICBT) was measured under the mental foramen on panoramic radiographs of patients with and without bisphosphonate-related osteonecrosis of the jaws (BRONJ) taking BPs and controls.Patients with BRONJ had the highest mean MICBT (6.81 ± 1.35 mm), compared with patients without BRONJ taking BPs (5.44 ± 1.09 mm) and controls (4.79 ± 0.85 mm) (P.01). Mean MICBT of patients with BRONJ was significantly higher than that of patients without BRONJ taking BPs. There was a correlation between MICBT and cumulative dose of zolendronate.Measurement of MICBT on panoramic radiographs is a potentially useful tool for the detection of dimensional changes associated with BP therapy.

Temporomandibular disorders (TMD) are a significant public health problem affecting approximately 5% to 12% of the population.1 TMD is the second most common musculoskeletal condition (after chronic low back pain) resulting in pain and disability.1 Pain-related TMD can impact the individual's daily activities, psychosocial functioning, and quality of life. Overall, the annual TMD management cost in the USA, not including imaging, has doubled in the last decade to $4 billion.1 Patients often seek consultation with dentists for their TMD, especially for pain-related TMD. Diagnostic criteria for TMD with simple, clear, reliable, and valid operational definitions for the history, examination, and imaging procedures are needed to render physical diagnoses in both clinical and research settings. In addition, biobehavioral assessment of pain-related behavior and psychosocial functioning—an essential part of the diagnostic process—is required and provides the minimal information whereby one can determine whether the patient's pain disorder, especially when chronic, warrants further multidisciplinary assessment. Taken together, a new dual-axis Diagnostic Criteria for TMD (DC/TMD) will provide evidence-based criteria for the clinician to use when assessing patients, and will facilitate communication regarding consultations, referrals, and prognosis.2 The research community benefits from the ability to use well-defined and clinically relevant characteristics associated with the phenotype in order to facilitate more generalizable research. When clinicians and researchers use the same criteria, taxonomy, and nomenclature, then clinical questions and experience can be more easily transferred into relevant research questions, and research findings are more accessible to clinicians to better diagnose and manage their patients. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) have been the most widely employed diagnostic protocol for TMD research since its publication in 1992.3 This classification system was based on the biopsychosocial model of pain4 that included an Axis I physical assessment, using reliable and well-operationalized diagnostic criteria, and an Axis II assessment of psychosocial status and pain-related disability. The intent was to simultaneously provide a physical diagnosis and identify other relevant characteristics of the patient that could influence the expression and thus management of their TMD. Indeed, the longer the pain persists, the greater the potential for emergence and amplification of cognitive, psychosocial, and behavioral risk factors, with resultant enhanced pain sensitivity, greater likelihood of additional pain persistence, and reduced probability of success from standard treatments.5 The RDC/TMD (1992) was intended to be only a first step toward improved TMD classification, and the authors stated the need for future investigation of the accuracy of the Axis I diagnostic algorithms in terms of reliability and criterion validity—the latter involving the use of credible reference standard diagnoses. Also recommended was further assessment of the clinical utility of the Axis II instruments. The original RDC/TMD Axis I physical diagnoses have content validity based on the critical review by experts of the published diagnostic approach in use at that time and were tested using population-based epidemiologic data.6 Subsequently, a multicenter study showed that, for the most common TMD, the original RDC/TMD diagnoses exhibited sufficient reliability for clinical use.7 While the validity of the individual RDC/TMD diagnoses has been extensively investigated, assessment of the criterion validity for the complete spectrum of RDC/TMD diagnoses had been absent until recently.8 For the original RDC/TMD Axis II instruments, good evidence for their reliability and validity for measuring psychosocial status and pain-related disability already existed when the classification system was published.9–13 Subsequently, a variety of studies have demonstrated the significance and utility of the original RDC/TMD biobehavioral measures in such areas as predicting outcomes of clinical trials, escalation from acute to chronic pain, and experimental laboratory settings.14–20 Other studies have shown that the original RDC/TMD biobehavioral measures are incomplete in terms of prediction of disease course.21–23 The overall utility of the biobehavioral measures in routine clinical settings has, however, yet to be demonstrated, in part because most studies have to date focused on Axis I diagnoses rather than Axis II biobehavioral factors.24 The aims of this article are to present the evidence-based new Axis I and Axis II DC/TMD to be used in both clinical and research settings, as well as present the processes related to their development.

The American Academy of Oral and Maxillofacial Radiology developed these Parameters of Care to provide national guidelines for the use of radiographs prescribed for the diagnosis of disease, treatment planning, and follow-up care of patients with abnormalities of the oral and maxillofacial region. The Parameters cover radiographic techniques, imaging of the temporomandibular joint, imaging of diseases of the jaws, and imaging of dental implant sites.

Objectives. The purpose of this case-control study was to determine whether the radiographic appearance of the mandibular cortical bone in patients who were elderly and noninstitutionalized was related to a self-reported history of osteoporotic fractures. Study Design. Patients who had a billing statement at the School of Dentistry dated between 1993 and 1996, who were older than 60, and who had a panoramic radiograph were invited to be interviewed regarding fracture history (circumstances and year of fracture) and risk factors for osteoporosis. Cases (n = 93) were individuals reporting osteoporotic fractures (fractures occurring after minor impact). Controls (n = 394) were individuals reporting traumatic fractures (n = 105) or no fractures (n = 289). Blinded to case-control status, we evaluated the mandibular cortex on a panoramic radiograph and classified them as normal (even and sharp endosteal margin), moderately eroded (evidence of lacunar resorption or endosteal cortical residues), or severely eroded (unequivocal porosity). In addition, cortical thickness was measured below the mental foramen. Results. After adjustment for potentially confounding factors, the odds ratio for an osteoporotic fracture associated with moderately eroded and severely eroded mandibular cortices was 2.0 (95% CI, 1.2 to 3.3) and 8.0 (95% CI, 2.0 to 28.9), respectively. After adjusting for all potentially confounding factors, we found that the cortex was 0.54 mm (or 12%) thinner in subjects with an osteoporotic fracture compared with controls (95% CI, 0.25 to 0.84 mm). Conclusions. Subjects with a self-reported history of osteoporotic fractures tend to have increased resorption and thinning of the mandibular lower cortex. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:518-24)

Objective. The purpose of this study was to validate the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the diagnostic subgroup of disk displacement with reduction, with magnetic resonance imaging used as a gold standard. Study design. The diagnoses from the clinical examination of 78 joints in 39 patients, each with disk displacement with reduction in at least one TMJ, were compared with magnetic resonance imaging diagnoses. The readers of the magnetic resonance images were blinded to the clinical diagnoses. The data analysis included kappa statistics and calculation of predictive values. Results. The predictive value of the RDC/TMD for disk displacement with reduction was 0.65. For disk displacement alone—the movement of the disk on opening not being considered—the predictive value was 0.92. The diagnostic agreement between RDC/TMD and magnetic resonance imaging diagnoses for all joints examined was 53.8%. Most of the disagreement was due to false negative clinical diagnoses for asymptomatic joints. Conclusions. A positive RDC/TMD examination is predictive for internal derangement but not reliable with regard to the type of disk displacement; such examination is therefore of limited value in determining the true disk position and its functional movements. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88: 37-43)

Objective. The purpose of this study was to investigate interobserver reliability of a new technique for quantification of magnetic resonance images of temporomandibular joint disk status. Study design. Sixty magnetic resonance images of adolescent temporomandibular joints were randomly drawn for analysis. Four experienced observers traced the articular disk and osseous structures on sagittal magnetic resonance slice images. Quantitative measurements of disk length and disk displacement were recorded for each slice of 57 joints traced by each observer through use of a new quantification technique. Intraclass correlation coefficients were computed to assess interobserver agreement in the tracing of joint structures. Results. The calculated intraclass correlation coefficient was 0.681 for disk length and 0.830 for disk displacement. In addition, the mean variability among observers was 1.041 mm for measurement of disk length and 0.972 mm for measurement of disk displacement. Conclusions. Interobserver agreement is high when the new quantification technique is used to interpret magnetic resonance images.

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

Various imaging techniques for the temporomandibular joint are discussed with respect to uses, strengths, and limitations. An imaging protocol is outlined for evaluating patients with a wide variety of temporomandibular joint related signs and symptoms.

To evaluate experimentally how in direct digital radiography heterogenous detector response may influence the depiction of small mass differences.A step wedge of a bone-simulating resin was imaged at 70 kVp using RadioVisioGraphy ZHR 32000. Exposure time and step wedge position on the detector varied. The pixel values of the stored images of the step wedge were converted to luminance values of the displayed images.The relationship between pixel and luminance values was non-linear. The difference in luminance between adjacent steps varied with position of step wedge. Regardless of position, there was an increase in difference of luminance between steps with increasing exposure. A greater relative change in luminance was consequently seen in the thinner parts of the step wedge. The failure to perceive individual steps of the wedge in its thicker parts was related to insufficient relative change in luminance between steps.The heterogeneous response of the detector resulted in a varying ability to depict small mass changes over the detector area.

According to a long-established protocol, biopsy specimens of bony lesions sent to the University of Washington Histopathology Service are accompanied by relevant radiographs. In this study, the authors evaluated the quality of 114 radiographs, both intraoral and panoramic, from 89 consecutive cases. The radiographs were judged on their clinical usefulness, rather than on criteria for technically ideal images, and on the severity, rather than the number, of errors. Only 33 percent of the panoramic radiographs were of acceptable quality, while the quality of the intraoral radiographs was markedly better. The most striking feature was the lack of three-dimensional radiographic coverage of the site of surgical exploration.

The objective of the study was to evaluate and compare treatments with mandibular overdentures supported by one or two immediately placed implants 3 years after loading.Thirty-six edentulous subjects were eligible for inclusion. Using a random sampling system, one or two implants were placed in the mandible. Separate ball attachments were connected to the implants, and the denture was relined and delivered the day of surgery with the retentive components incorporated in the denture base. At the follow-up examinations peri-implant bone levels, implant and denture stability/retention, and need for maintenance and adjustments were evaluated. Moreover, the OHIP-EDENT questionnaire was used to measure patient satisfaction.Nineteen subjects (10 men and 9 women) with a mean age of 56 years were available for the 3-year follow-up examination. The group with 1 implant (Group 1) consisted of 11 subjects (5 women and 6 men) while the remaining 8 (5 women and 3 men) belonged to Group2. Nine subjects had been excluded during the first year due to failing implants, 6 had moved, 1 had died, and 1 reported severe illness. No implant failures between the 12-and 36 month follow-up were observed. The mean peri-implant bone change was.86 mm and the Implant Stability Quotient showed only minor changes with no significant difference between the groups when compared with the 12-month follow-up. Patient satisfaction scores increased significantly when compared with the baseline values and continued to be high for both groups and need for denture maintenance was low.No significant differences were found between subjects in the two groups with respect to implant survival and peri implant bone loss, and patient satisfaction scores continued to be high for both groups. Need for denture maintenance was low in both groups.

Objectives Research diagnostic criteria for temporomandibular disorders (RDC/TMDs) were proposed in 1992 with the aim of standardizing and testing methods for diagnosing TMDs. RDC/TMDs have so far been lacking standardized methods for imaging and criteria for imaging diagnosis of disorders of the temporomandibular joint (TMJ). Criteria for disorders of the TMJ have recently been proposed for MRI. The aim of this study was to publish MR images of the TMJ on the web and to test the agreement of five observers using the criteria. Methods 20 cases of MRI of the TMJ were published on the web together with the criteria. The MR images were taken in closed and open mouth positions, and sagittal and coronal views. Five observers diagnosed disc position, disc shape, joint effusion and loose calcified bodies in the TMJ. Results In all cases except one, three or more observers agreed upon the diagnosis. All agreed on whether a loose calcified body was present or not. The second best agreement was obtained for disc position in the sagittal view, where all observers agreed in 16 of the 20 cases. For disc position in the coronal view and the evaluation of the disc shape, observer agreement was lower. Conclusion Criteria were useful in order to standardize and simplify evaluation and thereby probably increase the diagnostic outcome among different observers for MRI of the TMJ. We recommend that the criteria be used internationally to facilitate comparisons between different studies.

Made available in DSpace on 2013-09-27T14:52:55Z (GMT). No. of bitstreams: 1 WOS000303402200027.pdf: 1347223 bytes, checksum: 7fcaee346b2b2f11feb818d108564c68 (MD5) Previous issue date: 2012-05-01 Made available in DSpace on 2013-09-30T19:24:43Z (GMT). No. of bitstreams: 1 WOS000303402200027.pdf: 1347223 bytes, checksum: 7fcaee346b2b2f11feb818d108564c68 (MD5) Previous issue date: 2012-05-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:34:45Z No. of bitstreams: 1 WOS000303402200027.pdf: 1347223 bytes, checksum: 7fcaee346b2b2f11feb818d108564c68 (MD5) Made available in DSpace on 2014-05-20T15:34:45Z (GMT). No. of bitstreams: 1 WOS000303402200027.pdf: 1347223 bytes, checksum: 7fcaee346b2b2f11feb818d108564c68 (MD5) Previous issue date: 2012-05-01 Office of Research, University of Washington School of Dentistry (United States) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Objectives. The objective of this study was to develop a technique for detecting cortical bone dimensional changes in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ).Study Design. Subjects with BRONJ who had cone-beam computed tomography imaging were selected, with age- and gender-matched controls. Mandibular cortical bone measurements to detect bisphosphonate-related cortical bone changes were made inferior to mental foramen, in 3 different ways: within a fixed sized rectangle, in a rectangle varying with the cortical height, and a ratio between area and height.Results. Twelve BRONJ cases and 66 controls were evaluated. The cortical bone measurements were significantly higher in cases than controls for all 3 techniques. The bone measurements were strongly associated with BRONJ case status (odds ratio 3.36-7.84). The inter-rater reliability coefficients were high for all techniques (0.71-0.90).Conclusions. Mandibular cortical bone measurement is a potentially useful tool in the detection of bone dimensional changes caused by bisphosphonates. (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:695-703) Univ Fed Rio de Janeiro, Dept Oral Pathol & Diag, BR-22291170 Rio de Janeiro, Brazil Univ Washington, Dept Oral Med, Div Oral Radiol, Seattle, WA 98195 USA Univ Estadual Paulista, Sch Dent, Araraquara, Brazil Univ Washington, Dept Biol, Seattle, WA 98195 USA Univ Estadual Paulista, Sch Dent, Araraquara, Brazil CAPES: 5403/09-0

An impulse train method to control aliasing was used to measure the modulation transfer function of a digital dental x-ray system (RVG 32000 ZHR, Trophy Radiologie, Vincennes, France). The detector of this system is composed of an intensifying screen, a fiber optics taper, and a charged couple device chip. The modulation transfer function could not be measured by impulse method such as the line spread function or edge response function because of aliasing from undersampling of the digital system. The system modulation transfer function was difficult to recover at the spatial frequencies smaller than the Nyquist frequency. The modulation transfer function beyond the Nyquist frequencies was impossible to recover in this study.

The RadioVisioGraphy system (RVG 32000 ZHR) was studied with respect to some physical properties including the precision and linearity of the exposure control and the detector response to x-rays. The x-ray unit was found to yield repetitive exposures that are precisely controlled by the CCX timer. A “preheat” and an “after exposure” period were noticed, and their resulting x-ray exposures were measured. Two RVG detectors were compared for their responses with x-rays. The differences between the detectors were insignificant. However, inhomogeneous detector responses were found in both of the detectors; with the same exposure, the central parts of the detectors yielded lower pixel values than the peripheral parts. A calibration equation was developed to correct for the inhomogeneity.

The purpose of the present study was to evaluate and compare treatment with mandibular overdentures supported by one or two implants placed and loaded immediately.Edentulous subjects with maxillary and mandibular complete dentures were recruited to participate in the study. All subjects received new maxillary and mandibular complete dentures, after which they were scheduled for implant surgery. Using a randomized sampling system, one or two implants were placed in the interforaminal area, and separate ball attachments were connected to the implants. The existing mandibular denture was relined, provided with retentive o-rings, and delivered the day of surgery. Subjects were seen for follow-up examinations after 3, 6, and 12 months, during which marginal bone levels and implant stability were measured. Survival rates were calculated and the data were analyzed statistically.Thirty-six subjects (16 men and 20 women with a mean age of 53.2 years [range, 38 to 69 years]) received 55 implants. Seventeen subjects received one implant in the symphyseal area, and the other 19 received two implants in the canine positions. Ten implants in nine subjects failed during the observation period, and three subjects with two implants each withdrew from the study, resulting in a 12-month implant survival rate of 81.8%. Three subjects lost their only implant and one patient lost both implants. The remaining five subjects lost one of their two implants. Six of the failures occurred during the first month after placement.Immediate loading of one or two separate implants by means of ball attachment-supported mandibular overdentures should be performed with caution, as a higher than expected implant failure rate was observed. No statistically significant differences in failure rates between the two groups were observed.

The purpose of this study was to test the hypothesis that retraction of maxillary front teeth may lock the mandible in a posterior position, and to evaluate any relationship between condylar position and signs and symptoms of internal derangements in the temporomandibular joint. A total of 29 female patients treated for Angle Class II, Division 1 malocclusion with extraction of maxillary first premolars and 34 female patients treated for Angle Class I malocclusion without tooth extraction consented to participate in a radiographic and clinical follow-up examination. The mean ages of the patients were 16.9 (SD 3.0) and 16.6 (SD 2.6) years, and the mean times after treatment were 1.6 (SD 1.0) and 1.5 (SD 0.9) years, respectively. Condylar position was measured in percent anterior and posterior displacement from absolute concentricity on lateral, central, and medial tomographic sections of each joint. Mean condylar position was more posterior at right central (P less than 0.05) and medial (P less than 0.01) tomographic sections in patients treated with extraction. The difference was due to a higher frequency of anteriorly positioned condyles in the nonextraction cases. No intergroup differences in the sagittal occlusal slide from CR to CO and the number of patients with clicking were found. However, the condyles were located more posteriorly in all tomographic sections (P less than 0.05 for lateral, P less than 0.001 for central and medial) in patients with clicking than in those without.

Mathematical morphology and box counting were used to extract trabecular pattern and to evaluate changes of reactive bone following root canal treatment.Periapical radiographs were digitized and processed with mathematical morphology operations known as skeletonization. The trabecular patterns resulting from this skeletonization process were further analyzed with fractal dimension (FD) analysis using the box-counting method. Two groups of regions of interest (ROI) were selected from 19 subjects for the analysis.Seventeen patients in one group and 13 patients in the other showed decreased FD in the reactive bone region after clinically successful root canal treatment (RCT). Significant changes in FD were noted 6 months after RCT (P.05). Kappa analysis indicated significant reproducibility between the 2 groups of ROIs.Mathematical morphology combined with box counting showed decrease of FD in reactive bone regions after clinically successful endodontic treatment.

Recognizing an abnormality is the first and most essential step when diagnosing a pathosis. All health care providers are responsible for evaluating suspicious symptoms and clinical and laboratory findings. Without a baseline evaluation, dentists cannot guarantee that patients are free of potentially serious disease. This article documents how the prognosis for and morbidity of cancer therapy may have been affected by the failure to recognize abnormal signs. Professional responsibility and liability for recognition of abnormality and subsequent diagnosis is emphasized.

The purpose of this case-control study was to determine if elderly subjects with a history of osteoporotic fractures have fewer teeth and greater residual ridge resorption than subjects without such fractures. Patients older than 60 with a panoramic radiograph were invited to a phone interview. Information was obtained regarding fracture history, smoking, and hormone replacement therapy (HRT). The number of teeth was obtained from the panoramic radiograph. The residual ridge height of the edentulous mandible was measured at the site of the mental foramen. Multiple regression models were used to assess the association between fracture status and number of teeth or residual ridge height (controlling for age, gender, HRT, smoking, height and weight). Cases (n=93) were individuals reporting osteoporotic fractures (fractures occurring after minor impact). Controls (n=394) were individuals reporting traumatic fractures (n=105) or no fractures (n=289). Fracture status in this population affect neither the number of teeth nor the residual ridge height. In the regression model, the variables that had a statistically-significant effect on the number of teeth were age (p

BACKGROUND: Panoramic radiographs (PMX)s may provide information about systemic health conditions.AIMS: i). To study clinical periodontal conditions and collect self-reported health status in a cohort of 1084 older subjects; ii). to study signs of alveolar bone loss and carotid calcification from panoramic radiographs obtained from these subjects; and iii). to study associations between study parameters.MATERIAL AND METHODS: PMXs from 1064 adults aged 60-75 (mean age 67.6, SD +/- 4.7) were studied. Signs of alveolar bone loss, vertical defects, and molar furcation radiolucencies defined periodontal status. Medical health histories were obtained via self-reports. Signs of carotid calcification were identified from panoramic radiographs.RESULTS: The PMX allowed assessment of 53% of the films (Seattle 64.5% and Vancouver 48.4%). A self-reported history of a stroke was reported by 8.1% of men in Seattle and 2.9% of men in Vancouver (P < 0.01). Heart attacks were reported by 12% of men in Seattle and 7.2% in Vancouver (N.S.). PMX evidence of periodontitis was found in 48.5% of the subjects, with carotid calcification in 18.6%. The intraclass correlation score for PMX findings of carotid calcification and stroke was 0.24 (95% CI: 0.10-0.35, P < 0.001). The odds ratio for PMX carotid calcification and periodontitis was 2.1 (95% CI: 1.3-3.2, P < 0.001), and for PMX carotid calcification and stroke 4.2 (95% CI: 1.9-9.1, P < 0.001). The associations disappeared when smoking was accounted for. A history of a heart attack was associated with stroke, gender, age, and PMX scores of alveolar bone loss.CONCLUSIONS: PMXs may provide valuable information about both oral conditions and signs of carotid calcification, data that are consistent with self-reported health conditions. Alveolar bone loss as assessed from PMXs is associated with cardiovascular diseases.

Placement of endosseous dental implants in edentulous areas of the anterior maxilla poses a unique challenge due to variations in the amount of residual alveolar bone. Implant position becomes crucial in cases demanding high esthetic results but possessing minimal ridge width or in cases requiring augmentation. Recent advances in spiral tomography have allowed for more precise planning and placement of endosseous implants in these challenging areas.The purpose of this report is to describe a series of clinical cases in which spiral tomography was utilized in the planning and placement of endosseous dental implants. Two cases will be described utilizing initial spiral tomographic radiographs for implant planning and surgical guide fabrication, followed by post-insertion tomography to evaluate the results of implant position and inclination.Preimplant spiral tomograms revealed that the initial prosthetic trajectory through the proposed incisal edge of each tooth replacement would result in a final osteotomy site that would compromise the overall thickness of the facial cortical plate. After adjusting for magnification and distortion factors, new prosthetic/surgical trajectories were fabricated into the surgical guide, and this information was utilized to prepare the final implant osteotomy site. This adjustment resulted in 2 mm of residual crestal facial bone postimplant insertion, which became wider at more apical measurements. These findings were verified in the postimplant serial tomograms.Spiral tomography was a valuable adjunct in the treatment planning phases of endosseous dental implant placement especially in cases with minimal crestal width, high esthetic demands, or where exact implant placement is critical for successful treatment outcomes.

Objectives. To determine interobserver agreement in interpretation of magnetic resonance images of the temporomandibular joint by independent observers and to evaluate interobserver agreement within each subjectively assigned category. Study Design. Sixty magnetic resonance images of adolescent temporomandibular joints were randomly drawn for evaluation by 4 observers who had not previously worked together. All observers independently classified disk position on sagittal magnetic resonance images according to written classification criteria consisting of 6 categories. Results. Kappa statistics of agreement show moderate agreement among all observers for both medial (95% CI, 0.486-0.622) and lateral (95% CI, 0.450-0.566) components of the joint. Disk displacement without reduction was the category with the greatest agreement among all observers (κ = 0.914). Conclusion. Moderate to substantial observer agreement across all defined categories of disk status may be achieved among a number of observers when standardized classification criteria are used. Interobserver agreement is, however, not uniform across all categories of disk position described. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:102-7)

Alveolar bone levels were studied from intraoral radiographs of 24 non-hospitalized patients with AIDS, 17 HIV seropositive subjects, and 39 matched control subjects. The AIDS/HIV subjects were seeking dental care in a faculty practice. The matched control subjects came from those non-HIV-infected patients seeking dental care at the University of Washington. Magnified intraoral radiographs were used to assess the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL). The extent of vertical defects and furcation invasions was also assessed. The mean age of the AIDS, HIV, and control subjects was 38.9 +/- 6.6 years, 37.1 +/- 7.6, and 39.9 +/- 5.6, respectively, and was not statistically different. Among the AIDS patients, 75% were smokers, while 88.2% of the HIV subjects were cigarette smokers. Therefore, the matched control subjects were also smokers to the same extent. The mean difference in distance CEJ-BL was 0.1 mm (mesial) and 0.3 mm (distal) and greater in the HIV/AIDS group than in the control group, but not statistically different. No vertical defectsor = 3.0 mm were found in 69.2% of the control subjects and in 58.5% of the combined HIV/AIDS group. None of the HIV/AIDS subjects had more than 5 defects3.0 mm, while 7.6% of the control subjects had such defects. Significant associations were found between smoking and extent of alveolar bone loss (distance) (P0.001) as well as the number and extent of vertical defects (P0.01), but were not associated with HIV status. The extent of furcation invasions, as read radiographically, did not differ between groups. In conclusion, smoking but not HIV status was the primary factor for alveolar bone loss.

Studies have shown that

The objectives of the present investigation were to analyze intraoral radiographs and to study 1) the distribution of the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL) and 2) the prevalence and severity of vertical defects, and furcation lesions in 416 individuals seeking dental care. Full mouth radiographs were enlarged 7.5 times and the mesial and distal distances between CEJ and bone level were measured. The extent of interradicular molar radiolucencies was also measured. Images of 10,282 teeth were studied. Subjects were between 15 to 94 years (mean age: 47.2, S.D.+/-15.2). On average they had 24.8 teeth (S.D.+/-5.5). The mean distance CEJ-BL increased significantly up to age 45 (r2=0.07; beta=0.29; P0.0001) and remained stable thereafter r2=0.09, beta=-0.02, N.S.). The mean distance CEJ-bone level was 1.4 mm (S.D.+/-0.7) in the 15 to 24 age group; 3.0 (S.D.+/-1.5) in the 45 to 54 age group; and 3.02 (S.D.+/-1.4) in the 75 to 94 age group. No vertical defects were found in 163 participants (39.3%); vertical defectsor = 3.0 mm were found in 30.2% (126). Mesial defects were significantly more common that distal defects (P0.001). The extent of horizontal bone loss was correlated to extent of vertical defects (r2=0.88; P0.0001). The number of remaining teeth was not associated with horizontal or vertical bone loss. In conclusion, the study indicated that few of the individuals had extensive horizontal bone loss. Vertical defects suitable for guided tissue regeneration procedures however, were found in many patients.

We found that identification of an anterior displaced disc of the temporomandibular joint was difficult with traditional coronal oblique MR images. We describe the use of a new coronal oblique imaging plane which overcomes this problem.

Original Article Longstreth WT Jr, Phillips LE, Drangsholt M, Koepsell TD, Custer BS, Gehrels JA, et al. Dental x-rays and the risk of intracranial meningioma: a population-based case-control study. Cancer 2004;100(5):1026-34. Level of Evidence 3a Purpose The purpose of the study was to investigate whether dental radiography increases the risk for intra-cranial meningioma. Source of Funding National Cancer Insitute Type of Study/Design Population-based case-control study

Radiovisiography was compared clinically to conventional D-speed and E-speed radiographs viewed with ×2 magnification using the mesiobuccal root of maxillary molars of 22 patients. Clarity of size 8 and 10 endodontic file tips in relation to the radiographic apex was the object of comparison. Five images of radiovisiography, (original, enhanced, negative-to-positive, standard zoom, and zoom in the negative-to-positive mode), were compared to D-speed and E-speed radiographs. D-speed radiographs were also compared to E-speed radiographs. D-speed radiographs were statistically superior to all five radiovisiography images. Four of the radiovisiography images were equivalent to E-speed radiographs. D-speed radiographs provided superior recognition of small file tips when compared to E-speed radiographs 100% of the time. Accurate identification of the small file tips was achieved on 95% of D-speed and 70% of E-speed radiographs. With radiovisiography, identification was achieved on 95% of the zoom images in the negative-to-positive mode, 86% of enhanced, 82% of standard zoom, and 77% of the images in negative-to-positive conversion.

The Siemens Orthophos (Siemens, Mu¨nchen, Germany) is a panoramic machine that uses a microchip to control the movements of the radiation source and film. Several programs are available for different views of the facial skeleton and associated structures. Program 16 is dedicated to cross-sectional imaging of the posterior mandible. Three millimeter cross-sections were cut from 12 cadaver specimens of the mandible. These sections were imaged separately by contact radiography, 48° hypocycloidal tomography of Philips Polytome (Philips-Massiot, Paris, France), and program 16 of the Orthophos panoramic machine. Program 16 of the Orthophos was also used to image the cross-sections after they were glued back together with the surrounding parts of the specimens. Four different images of the cross-sections were thus obtained. The contact radiographs were used as gold standards. Frequency domain analysis, which was used to compare the images resulting from each imaging modality, demonstrated that useful diagnostic information was in the range of 0.12 to 0.60 cycles/mm for the contact radiographs. In spite of differing tomographic angles for the Orthophos program 16 and the hypocycloidal tomography, the images of the 3 mm cross-sections showed similar frequency distribution. However, the Orthophos Program 16 did not produce diagnostically useful images when the cross-sections were imaged with the surrounding parts of the specimens probably because of the narrow tomographic angle used for this program. These images had strong low to medium frequency components compared with the gold standard images. These results suggest that diagnostically more useful images with the Orthophos might be obtained by increasing the tomographic angle.

In 1987, the U.S. Department of Health and Human Services issued guidelines for prescription of dental radiographic examinations, and although these recommendations have been reprinted in several widely circulated publications, it seems that the adoption of these guidelines is far from common, even among U.S. dental schools. The recommended criteria are founded on the existing knowledge of prevalence and progression of the most common dental diseases and on the fact that occult diseases within the jaws are uncommon. There are, however, other factors that may influence the decision on the time and extent of a radiographic examination, which may lead to deviations from the suggested guidelines. These factors include: education, peer influence, patient9s preference, legal considerations, the dentist9s field of interest or specialty, the training of the staff, and practice routine. The diagnostic interpretation of radiographs is far from a completely objective process, even if it is a question as simple as the presence and/or extent of a carious lesion. Numerous studies have shown a large variation among observers, both with regard to the occurrence and extent of carious lesions, in bite-wing radiographs. Caries diagnosis is only one example of many situations where significant observer variation is found. The more complex the diagnostic task, the more variation can be expected. The effect of observer variation on treatment decisions regarding carious lesions is used as an example of the problems encountered daily in the dental practice.