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The aims of this pilot investigation were to calculate the levels of sensitivity and specificity of salivary glands ultrasonography (SGUS) in diagnosing Sjögren syndrome (SS) and to assess the ultrasonographic findings of parotid and submandibular glands.Patients diagnosed with SS or dry mouth and healthy controls were enrolled. Bilateral parotid and submandibular glands were assessed for (1) parenchymal inhomogeneity (PIH), (2) median size of the glands, (3) visibility of glandular posterior borders, and (4) size of sialolith, if present.This study included 34 female patients, of whom 12 had SS (35.3%), 12 had dry mouth (35.3%), and 10 were healthy controls (29.4%). Patients with SS showed higher PIH scores in all glands with the median differences being statistically higher in the right and left parotids and left submandibular glands (P.001, P = .012, and P.001, respectively). SGUS, with a PIH cutoff ≥2, showed a sensitivity of 100% and a specificity of 81.6% for detecting SS. The majority of SS had invisible glandular posterior borders (P.001). Median size of the glands and size of the sialolith did not show any statistically significant differences between groups.SGUS is a noninvasive imaging modality with good sensitivity and specificity that might be valuable as a diagnostic aid for SS.

Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare benign lesion exhibiting radiographic and histologic features that can be mistaken for malignancy. Most cases have been reported in the small tubular bones of the hands and feet, but involvement of the skull and jaws is extremely rare. Here, we present a case of BPOP involving the mandible in a 23-year-old male that, after initial excision, recurred within 18 months. To the best of our knowledge, this is only the third published case of BPOP arising in the mandible.

IntroductionAdenoid and tonsillar hypertrophy in children often leads to adverse respiratory symptoms and obstructive sleep apnea (OSA). Current clinical guidelines from the American Academy of Pediatrics and American Academy of Otolaryngology-Head and Neck Surgery recommend tonsillectomy as the first line of pediatric OSA treatment for children with tonsillar hypertrophy. Rapid palatal expansion (RPE) performed by orthodontists improves obstructive sleep apnea in children by reducing nasal airway resistance, increasing nasal volume, raising tongue posture, and enlarging pharyngeal airway. However, the role of RPE in alleviating adenoid and tonsillar hypertrophy remains elusive. In this study, we aim to evaluate the changes in adenoid and palatine tonsil sizes following RPE using 3D volumetric analysis of cone beam computational tomography (CBCT) imaging.Materials and methodsIn this retrospective cohort study, a total of 60 pediatric patients (mean age: 8.00, range: 5-15, 32 females and 28 males) who had tonsillar hypertrophy (size 3 and 4) were included and divided into the control group (n=20) and expansion group (n=40). The control group did not undergo any treatment. The expansion group underwent RPE using a conventional Hyrax expander, activated 0.25mm per day for 4-6 weeks. Final CBCT scans (T2) were performed 13.8±6.5 months after the initial scan (T1). Pediatric sleep questionnaire (PSQ) and BMI were obtained at each timepoint. Volumetric analysis of adenoid and palatine tonsils was performed using a combination of bony and soft tissue landmarks in CBCT scans through Anatomage Invivo 6 imaging software. Paired t-tests were used to evaluate the difference between the initial and final adenoid and tonsil volumes. p values less than 0.05 were considered statistically significant.ResultsCompared to the control group, the expansion group experienced a statistically significant decrease in both adenoid and tonsil volume. There was non-statistically significant increase in volume from T1 to T2 for the control group. For the expansion group, 90.0% and 97.5% of patients experienced significant reduction in adenoid and tonsil volume, respectively. The average volume decrease of adenoids was 16.8% while that of tonsils was 38.5%. The patients had up to 51.6% and 75.4% reduction in adenoid and tonsil size, respectively, following RPE orthodontic treatment. Pearson correlation ranged from 0.88 to 0.99 for each measurement, representing excellent internal consistency. There was a significant reduction in the PSQ scores from 5.81±3.31 to 3.75±2.38 in expansion group (p&nbsp

Objective The purpose is to evaluate outcomes of alveolar bone grafting based on the pre-grafting orthodontic preparation methods. Design Retrospective analysis of individuals with unilateral cleft lip and palate. Subjects and Settings 28 individuals with non-syndromic UCLP from two craniofacial centers, 14 individuals each from XXXX and XXXX. Interventions The alignment group underwent maxillary expansion with incisors alignment while the non-alignment group underwent only maxillary expansion for presurgical orthodontic preparation. Methods Initial and post-surgical CBCT scans were compared to observe changes in angulation of the incisor adjacent to the cleft site, alveolar bony root coverage, and bone graft outcomes. Results In the alignment group, the buccolingual rotation decreased by 32.35 degrees ( p = .0002), the anteroposterior inclination increased by 14.01 degrees ( p = .0004), and the mesiodistal angulation decreased by 17.88 degrees ( p = .0001). Alveolar bony coverage did not change after bone graft in both groups, and no difference was observed between the groups. Chelsea scale showed satisfactory bone graft outcome (category A, C) in 12 cases (85.71%) in the alignment group and 11 cases (78.51%) in the non-alignment group. The volumetric measurement showed the alignment group had better bone fill of 69.85% versus 51.45% in the non-alignment group ( p = .0495). Conclusions Alveolar bony coverage on the tooth adjacent to cleft sites did not change with alveolar bone grafting surgery in either of the alignment and non-alignment group. Presurgical orthodontic alignment does not induce root exposure nor poorer bone grafting outcome.

ObjectiveThis systematic review aimed to summarize the morphologic changes in the temporomandibular joint (TMJ) in patients who underwent orthodontic treatment and were assessed by 3-dimensional (3D) imaging techniques (e.g., magnetic resonance imaging, cone beam computed tomography, and multidetector computed tomography).Study designThe authors searched PubMed, Web of Science, and Embase databases to identify original articles from 2014 to 2021 containing keywords for morphologic changes in the TMJ, orthodontic treatment, and three-dimensional imaging methods. Prospective and retrospective studies, including observational, cross-sectional, randomized, and nonrandomized clinical trials, cohort studies, and case-control studies, were reviewed. The review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The risk of bias was assessed in studies selected for the full-text review.ResultsThe search strategy yielded 294 publications. After an initial screening and the application of exclusion criteria, 13 studies were selected for the final review.ConclusionDifferences were found in condylar positioning, typically in an anterior position; condylar morphology, primarily with increased diameter or head height; and articular disk position within the anterior-posterior plane post-treatment. Changes in the glenoid fossa were not consistent between the studies. The overall risk of bias among studies was moderate. The influence of orthodontic treatment on morphologic changes in the TMJ remains unclear.

PURPOSE The use of electronic tools in teaching is growing rapidly in all fields, and there are many options to choose from. We present one such platform, Learning Catalytics™ (LC) (Pearson, New York, NY, USA), which we utilized in our oral and maxillofacial radiology course for second-year dental students. MATERIALS AND METHODS The aim of our study was to assess the correlation between students' performance on course exams and self-assessment LC quizzes. The performance of 354 predoctoral dental students from 2 consecutive classes on the course exams and LC quizzes was assessed to identify correlations using the Spearman rank correlation test. The first class was given in-class LC quizzes that were graded for accuracy. The second class was given out-of-class quizzes that were treated as online self-assessment exercises. The grading in the self-assessment exercises was for participation only and not accuracy. All quizzes were scheduled 1-2 weeks before the course examinations. RESULTS A positive but weak correlation was found between the overall quiz scores and exam scores when the two classes were combined (P

To provide an organized resource for clinicians and patients to use to understand the treatment options and outcomes for orthodontics in terms of extracting or not extracting permanent teeth.Literature published from January 2000 to current was searched in the electronic databases Cochrane Central Register of Controlled Trials and PubMed. Study inclusion criteria included comparing the extraction technique versus no extraction, average age of participants was 10 years old, and if relevant, crowding between 4-10 mm. Each article was arranged by type of extraction and malocclusion corrected to find similarities. The data was observed for common variables measured.From the 23 articles reviewed, 10 appear to fit the criteria. Although some studies showed contradicting results, there can be some associations drawn. A trend can be noted of an increase in the incisor mandibular plane angle (IMPA), an increase in lower lip thickness, and proclination of incisors after orthodontic treatment with no extractions. In extraction cases, findings were almost the opposite, as lips are more retruded and incisors are more retracted. These findings, along with the other variables, provide an insight as to what facial profiles would be best suited for which treatment.Patients with more proclined incisors and more protrusive lips may be better with an extraction treatment plan to help compensate for these traits. Ultimately, to decide the best treatment, each case should be assessed individually, as other factors, such as crowding, age, and malocclusion, can lead to vastly different results.

Aim To test whether the use of collagen matrix seal (CMS) results in similar hard and soft tissue remodelling to that with collagen sponge (CS) used as barriers 4 months following alveolar ridge preservation (ARP), in combination with freeze-dried bone allograft (FDBA). Materials and methods Twenty-eight patients were randomly assigned to the two groups. Clinical and radiographic measurements were recorded with the same stent at baseline and 4 months for standardization. The flapless technique following a traumatic extraction was used for the two types of barriers. Results All patients completed the study, 14 in the CMS group and 14 in the CS group. Reduction in coronal ridge width (1.21 mm-14.91% CMS and 1.47 mm-20.40% CS) and vertical buccal bone resorption (0.30 mm CMS and 0.79 mm CS) were not significantly different. A slight increase in buccal gingival thickness at the coronal part was observed in both groups (0.9 mm CMS and 0.5 mm CS). Conclusions Collagen matrix seal and CS, when combined with FDBA, significantly minimized ridge resorption in all dimensions and maintained buccal soft tissue thickness in sockets with a buccal plate loss of

Objectives Salivary glands ultrasonography (SGUS) is an emerging diagnostic aid for Sjogren syndrome (SS) with positive potentials because of its availability, noninvasiveness, and safety. The aim of this investigation was to assess and compare the ultrasonographic features of the parotid and submandibular salivary glands in patients with SS or dry mouth (DM) and in healthy controls and to evaluate the sensitivity and specificity of SGUS in the diagnosis of SS. Study Design This was a prospective observational 3-group comparison study. Patients diagnosed with SS (according to the 2016 American College of Rheumatology [ACR] and European League Against Rheumatism [EULAR] criteria, patients with DM (diagnosed on the basis of the subjective reporting of oral dryness and unstimulated salivary flow of Results Thirty-four female patients were enrolled in this investigation, of whom 76.5% were white. Twelve patients (35.3%) had definitive diagnosis of SS; 12 (35.3%) had DM; and 10 (29.4%) were healthy controls. The median age (interquartile range [IQR]) of patients in all 3 groups was 56.6 (± 14.2) years. Ninety-two percent of patients in both the SS and DM groups were on sialogogues, with the majority using cevimeline (83.3% and 41.6%, respectively). Overall, patients with SS showed significant SGUS features and had higher scores compared with patients with DM and controls. The median inhomogeneity score was significantly higher in the SS group compared with the DM and control groups in the right parotid gland (RPG), left submandibular gland (LSMG), and left parotid gland (LPG) (P = .000, .000, and .012, respectively), with no statistically significant differences detected between the SS and DM groups in the right submandibular gland (RSMG) only (P = .604). The median size of the hypoechogenic bands was statistically higher in all salivary glands (i.e., RSMG, RPG, LSMG, and LPG) in the SS group compared with the DM and healthy control groups (P =.000). When comparing the sizes of the glands, there were no statistically significant differences among the 3 groups in the median transvers dimension and height of the RPG (P = .846 and .137, respectively) and LPG (P = .382 and .538, respectively). Moreover, no statistically significant differences were observed in the median anteroposterior dimension and depth of the RSMG (P = .470 and .147, respectively) and LSMG (P = .495 and .695, respectively) among the 3 groups. Lack of visibility of the posterior borders of all glands was detected in the majority of patients in the SS group (RSMG = 66.6%; RPG = 83.3%; LSMG = 75%; LPG = 83.3%), whereas all patients in the DM and control groups had visible posterior borders (P = .000). The size of the sialolith, if present, did not show any statistically significant differences among the 3 groups in RSMG, RPG, LSMG, and LPG (P = .160, .136, .065, and .377, respectively). The SGUS, with a cutoff value of ≥ 2, showed sensitivity of 100% and specificity of 81.6% for detecting SS ultrasonographic features. Conclusions SGUS is a useful, noninvasive diagnostic modality with high sensitivity and specificity. Parenchymal inhomogeneity scores, sizes of the hypoechogenic bands, and visibility of the glands’ posterior borders may all have a good potential for detection of SS. We propose that the ACR and the EULAR take SGUS into consideration when reviewing/updating the diagnostic criteria for SS in the future.

This article describes the transition of an oral and maxillofacial radiology course from a traditional lecture format to an interactive case-based, team-based, interdisciplinary, and intraprofessional learning model in advanced dental education. Forty-four postdoctoral dental students were enrolled in the course over a twelve-week period in the fall semester 2012. The class consisted of U.S.- and foreign-trained dentists enrolled in advanced education programs in various dental disciplines. The course faculty preassigned interdisciplinary teams with four or five students in each. The class met once a week for an hour. Ten of the twelve sessions consisted of a team presentation, individual quiz, team quiz, and case discussion. Each member of a team completed peer evaluation of other team members during weeks six and twelve of the course. The final course grade was a composite of individual and team quiz grades, team presentation, and peer evaluation grades. The overall class average was 90.43. Ninety-five percent of the class (42/44) had total team grades equal to or greater than total individual quiz grades. The objective of creating a new case-based, team-based, interdisciplinary, intraprofessional learning model in advanced dental education was achieved, and the initial student perception of the new format was positive.

Tooth extractions are followed by significant dimensional changes in the alveolar crest that may preclude implant placement. This randomized, controlled, prospective compares the preservation of soft and hard tissue dimensional changes after alveolar ridge preservation (ARP) using two membranes consisting of collagen matrix (CM) or extracellular matrix (ECM) as barriers over freeze-dried bone allograft (FDBA).Standardized clinical and radiographic measurements of soft and hard tissues were recorded by means of a stent before and 4 months after ARP. The surgery entailed sulcular incisions with minimal flap elevation and repositioning without advancement.Of 11 patients in the CM group and 12 in the ECM group who completed the study, gingival thickness (GT) increased from 0.1 to 0.2 mm for both groups along with a 0.5-mm decrease in the width of keratinized tissue after healing. Reductions in ridge width were most pronounced on the coronal aspect, 1.8 mm for CM and 2.0 mm for ECM, whereas vertical reduction was most pronounced on the buccal aspect, 0.7 to 1.0 mm. Differences between groups were not statistically significant. However, significant correlation for changes in GT (P = 0.001) and crestal bone width (P = 0.002) with preoperative buccal plate thickness (BPT) was observed.Both xenogeneic collagen matrices combined with FDBA were effective in maintaining soft tissues and minimizing ridge resorption in all dimensions after ARP. BPT was an important determinant for amount of change in crestal GT and ridge width.

Cone beam computed tomography (CBCT) is being extensively used by dentists and dental specialists. Although the advantages of using this modality are enormous, with information comes responsibility. Most dental clinicians are not maxillofacial radiologists and are generally not familiar with interpretation of anatomy and pathosis in the head-and-neck area outside their immediate area of clinical interest. This leaves a larger part of extragnathic anatomy unassessed in a CBCT volume that is prescribed for specific dental diagnosis and treatment planning. This is critical because literature shows that most often, incidental findings--those that are found unrelated to immediate clinical interest--are found in the extragnathic areas. Incidental findings are abnormal findings that are unrelated to the initial purpose of the CBCT study. The failure to identify and report these findings, especially if these findings are pathological in nature, can lead to medical complications in the patient and have potential medicolegal ramifications for the dentist/specialist.

Purpose The objective of this study was to investigate the effect of varying resolutions of cone-beam computed tomography images on the accuracy of linear measurements of edentulous areas in human cadaver heads. Intact cadaver heads were used to simulate a clinical situation. Materials and Methods Fiduciary markers were placed in the edentulous areas of 4 intact embalmed cadaver heads. The heads were scanned with two different CBCT units using a large field of view (13 cm×16 cm) and small field of view (5 cm×8 cm) at varying voxel sizes (0.3 mm, 0.2 mm, and 0.16 mm). The ground truth was established with digital caliper measurements. The imaging measurements were then compared with caliper measurements to determine accuracy. Results The Wilcoxon signed rank test revealed no statistically significant difference between the medians of the physical measurements obtained with calipers and the medians of the CBCT measurements. A comparison of accuracy among the different imaging protocols revealed no significant differences as determined by the Friedman test. The intraclass correlation coefficient was 0.961, indicating excellent reproducibility. Inter-observer variability was determined graphically with a Bland-Altman plot and by calculating the intraclass correlation coefficient. The Bland-Altman plot indicated very good reproducibility for smaller measurements but larger discrepancies with larger measurements. Conclusion The CBCT-based linear measurements in the edentulous sites using different voxel sizes and FOVs are accurate compared with the direct caliper measurements of these sites. Higher resolution CBCT images with smaller voxel size did not result in greater accuracy of the linear measurements.

Purpose: This study was performed to assess the correlation of calcified carotid atheromatous plaque (CCAP), the mandibular cortical index, and periodontal bone loss in panoramic radiographs. Materials and Methods: One hundred eighty-five panoramic radiographs with CCAP and 234 without this finding were evaluated by 3 observers for the presence of osseous changes related to osteoporosis and periodontal bone loss. Chi-squared and Mann-Whitney U tests were used to compare the two groups for an association of CCAP with the mandibular cortical index and periodontal bone loss, respectively. Results: There was a statistically significant coincidence of CCAP and osseous changes related to osteopenia/osteoporosis, with a p-value ⁄0.001. There was no statistically significant coincidence of CCAP and periodontal bone loss. When comparing the 2 groups, “With CCAP” and “Without CCAP”, there was a statistically significant association with the mean body mass index (BMI), number of remaining teeth, positive history of diabetes mellitus, and vascular accidents. There was no statistically significant association with gender or a history of smoking. Conclusion: This study identified a possible concurrence of CCAP and mandibular cortical changes secondary to osteopenia/osteoporosis in panoramic radiographs. This could demonstrate the important role of dental professionals in screening for these systemic conditions, leading to timely and appropriate referrals resulting in early interventions and thus improving overall health. (Imaging Sci Dent 2013; 43 : 235-43)