Oral and Maxillofacial Pathology in Three Dimensions

doi:10.1016/j.cden.2008.06.004

Dental Clinics of North America

Volume 52, Issue 4, October 2008, Pages 843-873

https://doi.org/10.1016/j.cden.2008.06.004 Get rights and content

It is clear that the dental profession has entered a new age of radiographic diagnostic imaging. A number of examples have shown that being able to visualize oral and maxillofacial pathologic entities in three dimensions assists in diagnosing and planning the appropriate treatment. The technology is an improvement for our profession and for the patients it serves.

Section snippets

Plain film radiography

During the past 4 decades, dentistry has seen a dramatic expansion and refinement of the technology used to identify dental and intraosseous disorders. Whereas the profession had always depended on intraoral radiographs (primarily periapical bite wings and occlusals), during the 1960s, commercially available extraoral panoramic radiography became available for use in the dental office. This introduction allowed the practitioner to gain much more information about the teeth and jaws, especially

Digital radiography

Then in the 1980s computed tomograms (CTs) became available and many of the films that had been previously taken for evaluation of the facial skeleton began to fade from use. There is little question that at this point, CT is the standard for maxillofacial hard tissue evaluation. However, within the dental community, with the exception of major pathology or trauma, there was a hesitancy to use this technology. This was understandable because (1) patients had to be sent out of the office to have

Cone beam computed tomography compared with plain film tomography

As compared with plain film tomograms, CBCT technology requires less time for the images to be captured, which is useful for patients who are not comfortable or are unable to keep still. In addition, the images generated via CBCT are less distorted and give the practitioner a better understanding of the density of the bone being imaged.

Cone beam computed tomography compared with panoramic radiography

While panoramic radiography has been the workhorse for most dental and oral and maxillofacial surgery practices, the images generated do have some shortcomings. Only flat, two dimensional, supero-inferior or postero-anterior images are created. And, as is typical with plain film radiography, panoramic x-rays suffer from superimposition of all structures that lie in the path between the x-ray source and the film or detector. CBCT allows these anatomic entities to be viewed in three dimensions

Cone beam computed tomography use in dentistry

CBCT technology allows the dental practitioner to virtually immediately, in her or his office, evaluate patients for a wide variety of maladies, ranging from dental and jaw trauma and infections, edentulism (quantitative and qualitative osseous evaluation for dental implants), temporomandibular joint osseous pathology, impacted and supernumerary teeth, developmental and congenital jaw deformities, dental endodontic lesions, and oral and maxillofacial pathology.

It is clear that CBCT is an

Case studies

There is no better way to illustrate the utility of cone beam computed radiography than to demonstrate a variety of oral and maxillofacial pathology cases in which its use assists in the diagnosis and helps to guide the treatment. Viewing the disease processes in three dimensions provides the practitioner with a more global view of their pathogenesis and extent.

Summary

It is clear that the dental profession has entered a new age of radiographic diagnostic imaging. As has been shown through a number of examples, being able to visualize oral and maxillofacial pathologic entities in three dimensions assists in the diagnosis as well as in planning the appropriate treatment. The technology is an improvement for our profession and for the patients it serves.

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Cited by (31)

Role of CT scan in medical and dental imaging
2021, Biomedical Imaging Instrumentation: Applications in Tissue, Cellular and Molecular Diagnostics
The use of advanced imaging in form of computed tomography (CT) scans and magnetic resonance imaging (MRI) has become a regular diagnostic in medical institutions. CT in particular has ameliorated both image quality and scanner efficiency, leading to CT replacing plain films and conventional catheter angiography. It is also useful when imaging complex bone fractures, severely eroded joints, or bone tumors since it usually produces more comprehensive images than would be possible with a conventional x-ray. However, CT scans use x-rays, and all x-rays produce ionizing radiation. Ionizing radiation has the potential to cause biologic effects in living tissue. This is a risk that increases with the number of exposures added up over the life of an individual. However, the likelihood of developing cancer from radiation exposure is generally inconsequential. In this chapter we discuss the CT functioning, applications, and advancements in the dental and medical fields.
Accord between cone-beam computed tomographic images and panoramic radiographs
2019, American Journal of Orthodontics and Dentofacial Orthopedics
Comparing panoramic radiographs and cone beam computed tomography: Impact on radiographic features and differential diagnoses
2018, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
The aims of this study were to determine whether lesion features appear differently on panoramic radiography (PAN) and cone beam computed tomography (CBCT), and whether the use of CBCT affects diagnostic accuracy and observers' confidence in comparison with PAN.
Three oral and maxillofacial radiologists reviewed 33 sets of PAN images and CBCT volumes of biopsy-proven lesions. They described 12 different lesion features and provided up to 3 ranked differential diagnoses, as well as their confidence with respect to those diagnoses. Their confidence was weighted by the rank at which the correct diagnosis was provided.
Odds ratios (ORs) were statistically significant for border definition (OR = 5.45; P = .004), continuity of border cortication (OR = 0.34; P = .035), effect on neurovascular canals (OR = 6.38; P = .043), expansion (OR = 18.56; P < .001), cortical thinning (OR = 30.22; P < .001), and cortical destruction (OR = 9.80; P < .001). There was no association between the 2 modalities and the rank at which the correct differential diagnoses were made or the observers' weighted confidence.
Before acquiring a CBCT scan to aid in the diagnosis of an intraosseous lesion, clinicians should consider the diagnostic information that is expected to be gained. In this study, although there were differences between PAN and CBCT with respect to some lesion features, CBCT did not help improve diagnostic accuracy.
Delayed diagnosis in the maxillofacial region: Two case reports
2017, Journal of Taibah University Medical Sciences
Citation Excerpt :
Such misdiagnoses affect patient health and can cause medicolegal problems for dental professionals. A number of studies have also demonstrated that being able to visualize oral and maxillofacial pathologic entities in three dimensions assists in diagnosing and planning the appropriate treatment for the patient and minimizes misdiagnosis in the maxillofacial region.10,12,13 For these reasons, it is important to prevent these delays or misdiagnosed cases by addressing the gap in knowledge.
على الرغم من أنه تاريخيا كانت الأشعة المقطعية التقليدية تستخدم لتصوير عظام الوجه والفكين، فإن دخول الأشعة المخروطية في الألفية الجديدة قد أحدث ثورة في استخدام الأشعة المقطعية لتشخيص أمراض الأسنان والوجه والفكين. نستعرض في هذه الورقة حالتين سريرية تأخر تشخيصهما باستخدام تصوير الوجه والفكين، وأسباب التأخير والتدابير الوقائية الممكنة. الحالة الأولى تحكي تأخر تشخيص لمفومة لاهودجكينية لسيدة عمرها ٤٩ عاما وتمت معالجتها على أن لديها مشكلة سنية. وتعرض الحالة الثانية تأخر التشخيص لمريضة تبلغ من العمر ٩ أعوام تعاني من تحدد القدرة على فتح الفم وتم تشخيصها على أنها تعاني من تشنج العضلات. وبعد ذلك، تم تشخيصها بوجود تمدد في اللوحة الجناحية الجانبية مما أدى إلى تداخلها مع عظم الفك السفلي الأيمن مسببا عدم القدرة على فتح الفم. سنشرح الحالة وكيفية تفادي التأخر في التشخيص. الفحص السريري المتكامل والتصوير الإشعاعي جنبا إلى جنب مع التاريخ المرضي يمكن أن يقلل التأخر في التشخيص. يجب على طبيب الأسنان تحويل المريض عاجلا للمتخصص الذي يمكنه علاج المشكلة الطبية المحددة إذا لم يتوصل هو إلى التشخيص.
While conventional CT scan has historically been used for maxillofacial bone imaging. The introduction of cone beam CT (CBCT) in the new millennium has revolutionized the use of CT for dental and maxillofacial diagnoses. This paper presents two clinical examples of delayed diagnoses associated with maxillofacial imaging, describes the reasons for the delays and offers potential preventive measures. The first case involves a delay in the diagnosis of non-Hodgkin's lymphoma in a 49-year-old female who was being treated for an odontogenic problem. In the second case, a 9-year-old female who presented with a limited ability to open her mouth was mistakenly diagnosed with muscles spasm. Subsequently, she was found to have an elongation of the right lateral pterygoid plate that interfered with her right mandibular body, which restricted the degree to which she could open her mouth. A thorough clinical examination and accurate radiographic interpretation combined with a complete medical history can minimize these types of diagnostic delays. If the dentist is unable to conclusively reach a diagnosis, the patient should be referred immediately to a specialist who can better manage the specific medical problem.
Evaluation of dehiscence and fenestration in adolescents affected by bilateral cleft lip and palate using cone-beam computed tomography
2017, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
However, the investigations of alveolar dehiscence and fenestration in patients affected by BCLP have been almost neglected in the literature; thus, this retrospective study was performed to present important findings about alveolar defects in BCLP patients. CBCT images were used to assess alveolar dehiscence and fenestration, since this technology has the potential to identify those defects without the disadvantages that are common in conventional radiographs.32-34 This technology is reported to be an important option for many clinical dental situations because of better image resolution, lower dose of radiation, and lower costs compared with multislice computed tomography.33,35
We evaluated the dehiscence and fenestration presence in maxillary and mandibular anterior teeth of patients affected by bilateral cleft lip and palate (BCLP) and compared the findings with a well-matched control group of noncleft patients using cone-beam computed tomography.
Cone-beam computed tomography images of 51 patients were divided into 2 groups (group 1, 21 patients affected by BCLP; mean age; 14.62 ± 2.89 years; and group 2, 30 patients as the noncleft control group; mean age, 14.22 ± 1.05 years) and assessed them for dehiscence and fenestration in the anterior maxillary and mandibular teeth. Data were analyzed with the Student t test, Pearson chi-square test, and Fischer exact test.
The prevalences of dehiscence in patients affected by BCLP were 61.11% in the maxillary and 48.41% in the mandibular anterior teeth, whereas the rates in the noncleft group were 7.78% and 16.67%, respectively (P < 0.001). The presence of fenestration was found to be statistically significantly higher in the maxillary central incisors of the BCLP group compared with the noncleft controls (P < 0.05), and almost similar rates were noted for the other teeth, with no statistically significant differences (P > 0.05).
Our data suggest that patients affected by BCLP may have higher prevalences of dehiscence in the maxillary and mandibular anterior teeth and of fenestration in the maxillary central incisors.
Incidental cone beam computed tomographic findings among Taibah University patients, KSA: A retrospective study
2017, Journal of Taibah University Medical Sciences
Citation Excerpt :
Using CBCT equipment, the dentist is able to evaluate the patient for a broad variety of diseases and conditions, including trauma and infections, bone density, temporomandibular joint (TMJ) bony pathology, dental anomalies, developmental and congenital jaw deformities, endodontic lesions, and upper airway dimensions. CBCT can also be used to prepare for orthognathic surgery, such as cases of craniofacial/cleft lip and palate and of oral and maxillofacial pathology.4 CBCT discloses not only concealed anatomy but also hidden pathology, decreasing the risk of neglecting a clinically significant disease.5
The aim of this study was to retrospectively evaluate the prevalence, type, and location of incidental findings by cone beam computed tomography (CBCT) scans. This study was performed to diagnose dental problems in the female population at Taibah University Dental Clinics (TUDC), KSA.
A series of 150 consecutive CBCT scans were identified between January 2014 and February 2016. The record was retrieved from the Carestream (CS) R4 Clinical and Practice Management Software database of TUDC. We retrospectively assessed them for incidental findings and then summarized and categorized them into five anatomical regions: nasopharyngeal airway, temporomandibular joint (TMJ), paranasal sinuses, dental findings, and alveolar bone region. We then analysed the frequency and percentage of findings in each category.
A total of 248 incidental findings were reported in 83 of 90 scans (2.76 findings/scan). The prevalence of all incidental findings was 92.2%. The most common incidental findings were located in the paranasal sinuses and alveolar area, each representing about a quarter (27.4%) of all of the findings. Other common findings were in the TMJ (22.9%), followed by those in the nasopharyngeal airway (10.9%), dental area (10.5%), and others (0.8%).
This study confirms the high prevalence of incidental maxillofacial findings as shown by CBCT scans in a sample of female patients at TUDC. This emphasizes the need to thoroughly examine CBCT volumes for clinically significant findings inside and beyond the region of interest for the benefit of patients and the protection of practitioners.

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