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Zhang J, Yu Y, Tang W, Pan J, Jing W. Cemento-Osseous Dysplasia: A Detailed Comparison of the 2005 and 2017 WHO Classifications and Case Analysis. Cureus 2023; 15:e49041. [PMID: 38116337 PMCID: PMC10729712 DOI: 10.7759/cureus.49041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/21/2023] Open
Abstract
The WHO substantially redefined cemento-osseous dysplasia (COD) in 2017. The descriptions of COD in the 2005 and 2017 WHO classifications are quite different. In this study, we compared the difference in COD description between the 2005 and 2017 editions of the WHO classifications in detail. There are remarkable differences in the terminology, definition, synonyms, epidemiology, classifications, clinical features, radiation/pathology, prognosis, and predictive factors of COD between the two versions. At present, the surgical treatment of COD is less defined, and there is no clear guidance for the treatment of sclerotic bone. In this study, we extracted the affected teeth without removing the sclerotic bone when the bone absorption line can be only found between the root and the lesion, and we extracted the teeth as well as the lesion and curetted the granulation tissue when a bone absorption line could be seen between the lesion and the alveolar bone. According to our observation, the position of the bone absorption line can be used as a reference for the selection of sclerotic bone treatment. Sclerotic bone preservation did not increase its volume and density after tooth extraction. Sclerotic bone was composed of highly mineralized tissue with less blood vessels and cells. The position of the bone resorption line can be used as a basis for treatment selection. The high mineralization of the lesion may weaken its anti-infection ability.
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Affiliation(s)
- Jiankang Zhang
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, CHN
| | - Yunbo Yu
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Chongqing Medical University, Chongqing, CHN
| | - Wei Tang
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, CHN
| | - Jian Pan
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, CHN
| | - Wei Jing
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, CHN
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2
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Yfanti Z, Tetradis S, Nikitakis NG, Alexiou KE, Makris N, Angelopoulos C, Tsiklakis K. Radiologic findings of osteonecrosis, osteoradionecrosis, osteomyelitis and jaw metastatic disease with cone beam CT. Eur J Radiol 2023; 165:110916. [PMID: 37300936 DOI: 10.1016/j.ejrad.2023.110916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to assess CBCT scans of patients with medication related osteonecrosis of the jaws (MRONJ), osteoradionecrosis (ORN), osteomyelitis (OM) and jaw metastatic disease (JM), evaluate the presence and extent of radiologic findings, identify radiologic parameters that may distinguish the four entities and last, introduce a new modified radiographic index (CRIm), in order to contribute to the diagnosis of these conditions. METHODS Τwo major databases were retrospectively searched for fully documented and diagnosed CBCT scans of MRONJ, ORN, OM and JM from 2006 to 2019. 335 CBCT scans met the inclusion criteria and were assessed under standardized viewing conditions blindly by 2 observers. The CRIm index proposed in this study evaluates: lytic changes, sclerosis, periosteal bone formation, sequestration, non-healing extraction sockets and other findings which included: sinus implication, inferior alveolar canal implication and jaw fracture. Lytic changes, sclerosis, periosteal bone formation, sequestration and non-healing extraction sockets were scored as: absent (0), localized/single (1) and extensive/multiple (2). Each one of other findings were scored individually as: absent (0) and present (1). For statistical analysis t-test, Pearson's r correlation coefficient, one-way ANOVA and Bonferonni were performed. RESULTS Extensive lytic changes were the most common finding, especially for ORN, where it occurred in all CBCT scans (100%). The mean value of the CRIm index differs significantly between CBCT scans with MRONJ and JM, as well as between those with OM and JM (Bonferroni p < 0.001). CONCLUSIONS The new modified Composite Radiographic Index introduced in this study, appears to have improved an objective approach to the previously used Composite Radiographic Index by means of cumulative radiologic features. Τhe predominance of certain radiologic features in one or more of these entities may lead the diagnostician towards the correct diagnosis.
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Affiliation(s)
- Zafeiroula Yfanti
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Sotirios Tetradis
- Section of Oral Maxillofacial Radiology, UCLA School of Dentistry, Los Angeles, CA, USA.
| | - Nikolaos G Nikitakis
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Konstantina Eleni Alexiou
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nikolaos Makris
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Christos Angelopoulos
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Kostas Tsiklakis
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
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3
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Michalski CD, Pollizzi A, Dhar D, Hayes LL, Chandra T. Bifid Mandibular Condyle With Associated Temporomandibular Joint Ankylosis: A Rare Skeletal Abnormality. Cureus 2022; 14:e29624. [DOI: 10.7759/cureus.29624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
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4
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He P, Francois K, Missaghian N, Le AD, Flynn TR, Shanti RM. Are Bacteria Just Bystanders in the Pathogenesis of Inflammatory Jaw Conditions? J Oral Maxillofac Surg 2022; 80:1094-1102. [DOI: 10.1016/j.joms.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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5
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Tiwari P, Bera RN, Kanojia S, Chauhan N, Hirani MS. Assessing the optimal imaging modality in the diagnosis of jaw osteomyelitis. A meta-analysis. Br J Oral Maxillofac Surg 2021; 59:982-992. [PMID: 34503859 DOI: 10.1016/j.bjoms.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/23/2020] [Indexed: 12/26/2022]
Abstract
Osteomyelitis is an inflammatory infectious disease that affects bone and bone marrow. Histopathology remains the gold standard method for diagnosis, but imaging modalities also play an important role. We systematically reviewed five articles with comparative studies on plain films, computed tomography (CT) scan, magnetic resonance imaging (MRI), cone beam computed tomography (CBCT), positron emission tomography (PET), single photon-emission computed tomography (SPECT), scintigraphy, and SPECT/CT. Scintigraphy and SPECT/CT has the highest sensitivity of 100%. PET is only to be used in cases of follow up. Orthopantomography (OPG) is the most common initial diagnostic tool despite its low sensitivity. CT provides the necessary specificity needed for radionuclide imaging, which has the highest negative predictive value of 100% and a positive predictive value >95%. SPECT/CT with 100% sensitivity and 85% specificity can be considered as the imaging modality of choice for initial diagnosis and follow up.
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Affiliation(s)
- P Tiwari
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences.
| | - R N Bera
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Room No 142 Sushruta Hostel Trauma Centre BHU, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India.
| | - S Kanojia
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
| | - N Chauhan
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
| | - M S Hirani
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
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6
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Díaz-Castellón DF, Llaguno-Rubio JM, Medina-Ocampo PE. [Imaging features of osteomyelitis of the jaws with different diagnostic methods. A review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e077. [PMID: 38464859 PMCID: PMC10919801 DOI: 10.21142/2523-2754-0903-2021-077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/24/2021] [Indexed: 03/12/2024] Open
Abstract
Osteomyelitis of the jaws (OM) is an infectious pathology involving the bone marrow. It is due to various etiologies, the main one being odontogenic. The diagnosis of OM is a challenge for dentists, who must rely on clinical and imaging examinations. Panoramic radiography is the most frequently used imaging test, but it has some limitations that have improved with the incorporation of new imaging methods such as computed tomography, cone beam computed tomography, magnetic resonance imaging, and bone scintigraphy with radionuclides. The purpose of this review was to describe the imaging characteristics of OM of the jaws according to the radiological diagnostic methods available in the literature in order to provide radiologisst with greater knowledge and improve reporting in daily practice.
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Affiliation(s)
- Dirce Fernanda Díaz-Castellón
- Facultad de Odontología de la Universidad San Francisco Xavier de Chuquisaca. Sucre, Bolivia. Facultad de Odontología Universidad San Francisco Xavier de Chuquisaca Sucre Bolivia
| | - Jhoana Mercedes Llaguno-Rubio
- División de Radiología Bucal y Maxilofacial de la Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur División de Radiología Bucal y Maxilofacial Universidad Científica del Sur Lima Peru
| | - Paola Eliana Medina-Ocampo
- División de Radiología Bucal y Maxilofacial de la Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur División de Radiología Bucal y Maxilofacial Universidad Científica del Sur Lima Peru
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7
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Wei LY, Kok SH, Lee YC, Chiu WY, Wang JJ, Cheng SJ, Chang HH, Lee JJ. Prognosis of medication-related osteonecrosis of the jaws in metastatic prostate cancer patients. Oral Dis 2020; 28:182-192. [PMID: 33254278 DOI: 10.1111/odi.13737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/29/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to find out the prognosis of medication-related osteonecrosis of the jaws (MRONJ) in prostate cancer patients who received two different types of antiresorptive agents for bone metastasis. MATERIALS AND METHODS We retrospectively surveyed a cohort of 95 metastatic prostate cancer patients with 122 MRONJ lesions treated in a single medical center. Treatment outcomes and prognostic factors were investigated. The cumulative complete response rate was calculated with the Kaplan-Meier method, and significance was examined with the log-rank and Breslow tests. Cox regression was used for the univariate and multivariate analyses of prognostic factors. RESULTS The cumulative complete response rate of all patients at 12 months was 37.8%, and that of patients treated with zoledronic acid and denosumab was 22.9% and 70.5%, respectively. Denosumab, pretreatment C-terminal telopeptide of collagen I (CTX) level > 150 pg/ml, and anemia were identified as independent prognostic factors in a multivariate analysis with adjusted hazard ratios of 3.18 (95% confidence interval [CI], 1.24-8.11), 3.24 (95% CI, 1.39-7.53), and 0.42 (95% CI, 0.19-0.93), respectively. CONCLUSION A higher pretreatment level of CTX, using denosumab as the antiresorptive agent and without anemia, indicates a better treatment outcome of MRONJ in prostate cancer patients.
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Affiliation(s)
- Ling-Ying Wei
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, Bei-hu Branch of National Taiwan University Hospital, Taipei, Taiwan
| | - Sang-Heng Kok
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Ching Lee
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Yih Chiu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jai-Jen Wang
- Department of Finance, Feng Chia University, Taichung, Taiwan
| | - Shih-Jung Cheng
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hao-Hueng Chang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jang-Jaer Lee
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
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Gaêta-Araujo H, Vanderhaeghen O, Vasconcelos KDF, Coucke W, Coropciuc R, Politis C, Jacobs R. Osteomyelitis, osteoradionecrosis, or medication-related osteonecrosis of the jaws? Can CBCT enhance radiographic diagnosis? Oral Dis 2020; 27:312-319. [PMID: 32623770 DOI: 10.1111/odi.13534] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/25/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To attempt defining differential radiographic diagnostic characteristics for osteonecrotic lesions using 2D as opposed to 3D images. MATERIALS AND METHODS This was a cross-sectional study. Subjects presenting mandibular osteonecrotic lesions (osteomyelitis, osteoradionecrosis, and medication-related osteonecrosis of the jaws) were selected and compared to a group of age- and gender-matched controls, all having both cone-beam computed tomographic images (CBCT) and panoramic radiographs (PANO). Both imaging modalities (predictor variables) were evaluated by two radiologists that scored lesion presence, eight additional radiological features, and a composite severity index (outcome variables). For each pathologic condition, characteristic features were assessed in PANO and CBCT by the Wilcoxon signed-rank test. Regression tree analysis revealed the predictive value of PANO and CBCT (α = 5%). RESULTS Overall, the predictive value of PANO reached 74%, while for CBCT it became 90%. Regarding the composite severity index, CBCT enabled to detect more subtle lesions. Also, CBCT imaging allowed showing more distinct radiographic diagnostic features as compared to PANO imaging, more specifically when distinguishing osteomyelitis from both other lesions. CONCLUSIONS Cone-beam computed tomography enabled showing more differences in radiological features between distinct osteonecrosis disease entities. CBCT imaging might be a better contributor for the detection of early lesions and to monitor further pathological developments in the mandible.
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Affiliation(s)
- Hugo Gaêta-Araujo
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Olivier Vanderhaeghen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Wim Coucke
- Scientific Institute of Public Health Section Quality of Medical Laboratories, Brussels, Belgium
| | - Ruxandra Coropciuc
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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9
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Weiss R, Read-Fuller A. Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review. Dent J (Basel) 2019; 7:dj7020052. [PMID: 31052495 PMCID: PMC6631689 DOI: 10.3390/dj7020052] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 12/24/2022] Open
Abstract
Cone Beam Computed Tomography (CBCT) is a valuable imaging technique in oral and maxillofacial surgery (OMS) that can help direct a surgeon’s approach to a variety of conditions. A 3-dimensional analysis of head and neck anatomy allows practitioners to plan appropriately, operate with confidence, and assess results post-operatively. CBCT imaging has clear indications and limitations. CBCT offers the clinician 3-dimensional and multi-planar views for a more accurate diagnosis and treatment without the financial burden and radiation exposure of conventional computed tomography (CT) scans. Furthermore, CBCT overcomes certain limitations of 2-dimensional imaging, such as distortion, magnification, and superimposition. However, CBCT lacks the detailed depiction of soft tissue conditions for evaluation of pathologic conditions, head and neck infections, and temporomandibular joint (TMJ) disc evaluation. This review evaluates the evidence-based research supporting the application of CBCT in the various fields of oral and maxillofacial surgery, including dentoalveolar surgery, dental implants, TMJ, orthognathic surgery, trauma, and pathology, and will assess the value of CBCT in pre-operative assessment, surgical planning, and post-operative analysis when applicable. Additionally, the significant limitations of CBCT and potential areas for future research will be discussed.
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Affiliation(s)
- Robert Weiss
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Dallas, TX 75246, USA.
- Baylor Scott and White Health, Baylor University Medical Center-Dallas, Dallas, TX 75246, USA.
| | - Andrew Read-Fuller
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Dallas, TX 75246, USA.
- Attending Physician, Baylor Scott and White Health, Baylor University Medical Center-Dallas, Dallas, TX 75246, USA.
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10
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Comparative evaluation of SPECT/CT and CBCT in patients with mandibular osteomyelitis and osteonecrosis. Clin Oral Investig 2019; 23:4213-4222. [PMID: 30806799 DOI: 10.1007/s00784-019-02862-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/14/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Therapy of osteomyelitis and osteonecrosis very often requires surgery. Proper preoperative radiological evaluation of a lesion's localization and extent is a key in planning surgical bone resection. This study aims to assess the differences between single-photon emission computed tomography and cone beam computed tomography when detecting an osteomyelitis/osteonecrosis lesion as well as the lesion's qualitative parameters, extent, and localization. MATERIAL AND METHODS Identification of candidates was performed retrospectively following a search for patients with histologically or clinically confirmed osteomyelitis or osteonecrosis. They were matched with a list of patients whose disease extent and localization had been evaluated using single-photon emission computed tomography and cone beam computed tomography in the context of clinical investigations. Subsequently, two experienced examiners for each imaging technique separately performed de novo readings. Detection rate, localization, extent, and qualitative parameters of a lesion were then compared. RESULTS Twenty-one patients with mandibular osteomyelitis and osteonecrotic lesions were included. Cone beam computed tomography detected more lesions than single-photon emission computed tomography (25 vs. 23; 100% vs. 92%). Cone beam computed tomography showed significantly greater depth, area, and volume, whereas length and width did not differ statistically between the two groups. CONCLUSION Both single-photon emission computed tomography and cone beam computed tomography could sensitively detect osteomyelitis/osteonecrosis lesions. Only single-photon emission computed tomography showed metabolic changes, whereas cone beam computed tomography seemed to display anatomic morphological reactions more accurately. The selection of the most adequate three-dimensional imaging and the correct interpretation of preoperative imaging remains challenging for clinicians. CLINICAL RELEVANCE In daily clinical practice, three-dimensional imaging is an important tool for evaluation of osteomyelitis/osteonecrosis lesions. In this context, clinicians should be aware of differences between single-photon emission computed tomography and cone beam computed tomography when detecting and assessing an osteomyelitis/osteonecrosis lesion, especially if a surgical bone resection is planned.
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11
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Albarillo FS, Varma GT, MacLeod SPR. Mandibular blastomycosis: A case report and review of the literature. Germs 2018; 8:207-213. [PMID: 30775340 DOI: 10.18683/germs.2018.1148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 11/08/2022]
Abstract
Introduction Blastomycosis is an endemic mycosis in the United States known to primarily cause pneumonia. However, dissemination to different organs including the musculoskeletal system has been described. Case report We report a case of mandibular blastomycosis in a healthy patient with no evidence of lung involvement. A 28 year-old female presented with recurrent right mandibular osteomyelitis despite courses of antibiotics and surgical debridement. She eventually underwent right hemimandibulectomy. Budding yeasts visualized on Gomori Methenamine-Silver (GMS) and Periodic acid-Schiff (PAS) were morphologically consistent with Blastomyces dermatitidis, and intra-operative cultures showed growth of mold identified as B. dermatitidis by DNA probe. She was placed on a prolonged course of itraconazole with clinical improvement. We also reviewed the literature and found 5 cases of similar presentation which we briefly summarized in this present case report. Conclusion Blastomycosis should be considered in patients with recurrent or persistent mandibular osteomyelitis even in immunocompetent individuals.
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Affiliation(s)
- Fritzie S Albarillo
- MD, Division of Infectious Diseases, Loyola University Medical Center, 2160 S. 1st Ave., Maywood, IL 60153, USA
| | - Gotam T Varma
- DO, Carle Foundation Hospital, 611 W. Park Street, Urbana, IL 61801, USA
| | - Stephen P R MacLeod
- BDS, MB ChB, FRCS, FACS, Division of Oral and Maxillofacial Surgery, Loyola University Medical Center, 2160 S. 1st Ave., Maywood, IL 60153, USA
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12
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Dutra KL, Haas LF, Zimmermann GS, Melo G, Minamisako MC, Flores-Mir C, Corrêa M. Prevalence of radiographic findings on jaws exposed to antiresorptive therapy: a meta-analysis. Dentomaxillofac Radiol 2018; 48:20180112. [PMID: 30346802 DOI: 10.1259/dmfr.20180112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES: Determine the prevalence of radiographic findings (RF) on both jaws among patients receiving antiresorptive bone therapy. METHODS: Six electronic databases and partial grey literature were searched. Data was collected based on predetermined criteria. The key features from the included studies were extracted. The MAStARI tool assessed the potential risk of bias (RoB) among the studies, while the GRADE approach determined the level of evidence. RESULTS: 29 studies were identified and included in the qualitative analysis, totalling 1133 patients. 27 studies had sufficient data to be included in a series of meta-analysis reporting 12 types of radiographic findings, and were split in two groups based on their study design. G1 comprised descriptive observational studies and G2 analytical cross-sectional studies. Two studies presented a high RoB, 16 had a moderate RoB, and 11 had low RoB. The overall level of evidence identified was very low. The most frequent RF were mixed lytic-sclerotic areas (73.88%), followed by osteolytic changes (66.18%), osteosclerosis (65.75%), cortical bone erosion (50.83%), persisting alveolar socket (45.77%), periodontal ligament (PDL) widening (44.69%), and inferior alveolar canal (IAC) involvement (43.40%). Less frequent, but equally important, were the periosteal reaction (34.27%), lamina dura thickening (32.97%), sequestrum (29.94%), pathologic fracture (20.90%), and density confluence of cortical and cancellous bone (16.61%). 20 patients reported no signs. CONCLUSIONS: RF prevalence was high and mainly included mixed lytic-sclerotic areas, osteolysis, osteosclerosis, cortical bone erosion, persisting alveolar socket, PDL-widening, IAC-involvement. Due to the very low level of evidence (GRADE) caution should be exercised when considering these findings.
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Affiliation(s)
- Kamile Leonardi Dutra
- 1 School of Dentistry, Federal University of Santa Catarina , Florianópolis, Santa Catarina , Brazil
| | - Letícia Fernanda Haas
- 1 School of Dentistry, Federal University of Santa Catarina , Florianópolis, Santa Catarina , Brazil
| | - Glaucia S Zimmermann
- 2 Department of Dentistry, Federal University of Santa Catarina , Florianópolis, Santa Catarina , Brazil
| | - Gilberto Melo
- 1 School of Dentistry, Federal University of Santa Catarina , Florianópolis, Santa Catarina , Brazil
| | | | - Carlos Flores-Mir
- 4 School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta , Edmonton, AB , Canada
| | - Márcio Corrêa
- 2 Department of Dentistry, Federal University of Santa Catarina , Florianópolis, Santa Catarina , Brazil
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13
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Venkatesh E, Elluru SV. Cone beam computed tomography: basics and applications in dentistry. J Istanb Univ Fac Dent 2017; 51:S102-S121. [PMID: 29354314 PMCID: PMC5750833 DOI: 10.17096/jiufd.00289] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/11/2017] [Indexed: 01/31/2023] Open
Abstract
The introduction of cone beam computed tomography (CBCT) devices, changed the way oral and maxillofacial radiology is practiced. CBCT was embraced into the dental settings very rapidly due to its compact size, low cost, low ionizing radiation exposure when compared to medical computed tomography. Alike medical CT, 3 dimensional evaluation of the maxillofacial region with minimal distortion is offered by the CBCT. This article provides an overview of basics of CBCT technology and reviews the specific application of CBCT technology to oral and maxillofacial region with few illustrations.
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Affiliation(s)
- Elluru Venkatesh
- Department of Oral, Basic and Clinical Sciences, College of Dentistry, Qassim Private Colleges, Kingdom of Saudi Arabia
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14
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Florid Cemento-Osseous Dysplasia Simultaneous the Chronic Suppurative Osteomyelitis in Mandible. J Craniofac Surg 2017; 27:2173-2176. [PMID: 28005783 DOI: 10.1097/scs.0000000000003095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The florid cemento-osseous dysplasia is an uncommon condition nonneoplastic, of unknown cause with higher prevalence in melanodermic women, limited the maxillary bones, is characterized by the presence of dispersed and diffuse radiopaque calcifications, constituted of bone and dense cemento; however, when the bone is infected it induces the suppuration and formation of osseous sequestra, thus resulting in an osteomyelitis frame. CLINICAL REPORT The patient was attended in a Dental Specialties Center in the state of Alagoas, Brazil, presenting on clinical examination edema and extra oral fistula with pus drainage in hemiface submandibular of the right side. Radiographically it was possible to observe area of sclerosis and osseous sequestra involving the right side region of the mandible body, and it increases zones of the bone density. In association with clinical data and complementary diagnosis examinations, the option of treatment adopted was the complete removal of the bone fragment, followed by adaptation and plate fixation and titanium screws to reduce the risk of mandibular fracture. OBJECTIVE The aim of the present paper was to relate a clinical patient of florid cemento-osseous dysplasia simultaneous the chronic suppurative osteomyelitis, highlighting their clinical, radiographic, and histological characteristics, as well as their diagnosis and treatment.
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Grisar K, Schol M, Schoenaers J, Dormaar T, Coropciuc R, Vander Poorten V, Politis C. Osteoradionecrosis and medication-related osteonecrosis of the jaw: similarities and differences. Int J Oral Maxillofac Surg 2016; 45:1592-1599. [PMID: 27427547 DOI: 10.1016/j.ijom.2016.06.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/24/2016] [Accepted: 06/21/2016] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to compare medication-related osteonecrosis of the jaw (MRONJ) with osteoradionecrosis (ORN). Group 1 comprised 74 MRONJ patients (93 lesions) and group 2 comprised 59 ORN patients (69 lesions). Patient characteristics, clinical presentation of the lesions, the presence of complications, and the relationship with previous dental extractions were analyzed for both groups. Significant differences were found between the groups with regard to the characteristics of the patient populations, extraction as the precipitating event, the type of initial complaint, the prevalence of pain, and the location of the lesions. In the ORN group, significantly more patients complained of pain (P=0.0108) compared with the MRONJ group. Furthermore, significantly more pathological fractures (P<0.0001) and skin fistulae (P<0.0001) occurred in the ORN group. The treatment was more often conservative in the MRONJ group than in the ORN group (61.3% vs. 36.2%). Despite similarities in terms of imaging, risk factors, prevention, and treatment, MRONJ and ORN are two distinct pathological entities, as highlighted by the differences in patient characteristics, the initial clinical presentation, course of the disease, and outcome.
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Affiliation(s)
- K Grisar
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - M Schol
- Department of Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - J Schoenaers
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - T Dormaar
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - R Coropciuc
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - V Vander Poorten
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - C Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Endoscopically-assisted operations in the treatment of odontogenic peripheral osteomyelitis of the posterior mandible. Br J Oral Maxillofac Surg 2016; 54:542-6. [DOI: 10.1016/j.bjoms.2016.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 02/17/2016] [Indexed: 11/23/2022]
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Oral Rehabilitation of an Osteopetrosis Patient with Osteomyelitis. Case Rep Dent 2016; 2016:6930567. [PMID: 27148461 PMCID: PMC4842355 DOI: 10.1155/2016/6930567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/14/2016] [Indexed: 11/17/2022] Open
Abstract
Osteopetrosis is a congenital disorder characterized by increasing osteoclastic function resulting in osteomyelitis in the jaws. Orofacial findings in osteopetrosis patients are unerupted, malformed, or delayed teeth and many dental caries due to vulnerable enamel and dentin and osteomyelitis. Many reports have described that maxilla is an uncommon site of occurrence for osteomyelitis due to cortical bone morphology and collateral circulation. This report aims to discuss clinical features and prosthodontic management of a patient with clinical features of adult form of osteopetrosis and osteomyelitis in both jaws. The patient has reported better masticatory and speech efficiency with removable dentures in maxillary and mandibular jaw and also self-esteem improvement and family interaction.
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Pittayapat P, Limchaichana-Bolstad N, Willems G, Jacobs R. Three-dimensional cephalometric analysis in orthodontics: a systematic review. Orthod Craniofac Res 2013; 17:69-91. [DOI: 10.1111/ocr.12034] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2013] [Indexed: 11/27/2022]
Affiliation(s)
- P. Pittayapat
- Oral Imaging Center; OMFS-IMPATH research group; Department of Imaging & Pathology; Faculty of Medicine; University of Leuven; Leuven Belgium
- Department of Radiology; Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | | | - G. Willems
- Orthodontics; Department of Oral Health Sciences; KU Leuven & Dentistry, University Hospitals Leuven; University of Leuven; Leuven Belgium
| | - R. Jacobs
- Oral Imaging Center; OMFS-IMPATH research group; Department of Imaging & Pathology; Faculty of Medicine; University of Leuven; Leuven Belgium
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Clinical management of suppurative osteomyelitis, bisphosphonate-related osteonecrosis, and osteoradionecrosis: report of three cases and review of the literature. Case Rep Dent 2013; 2013:402096. [PMID: 24222866 PMCID: PMC3814104 DOI: 10.1155/2013/402096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/23/2013] [Indexed: 11/24/2022] Open
Abstract
In the past, osteomyelitis was frequent and characterized by a prolonged course, treatment response uncertainty, and occasional disfigurement. Today, the disease is less common; it is believed that the decline in prevalence may be attributed to increased availability of antibiotics and improvement of overall health patterns. Currently, more common osteomyelitis variants are seen, namely, osteoradionecrosis (ORN) and bisphosphonate-related osteonecrosis of the jaws (BRONJ). Osteomyelitis, ORN, and BRONJ can present with similar symptoms, signs, and radiographic findings. However, each condition is a separate entity, with different treatment approaches. Thus, accurate diagnosis is essential for adequate management and improved patient prognosis. The aim of this paper is to report three cases of inflammatory lesions of the jaws—osteomyelitis, ORN, and BRONJ—and to discuss their etiology, clinical aspects, radiographic findings, histopathological features, treatment options, and preventive measures.
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20
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Demirel O, Kaya E, Üçok CÖ. Evaluation of mastoid pneumatization using cone-beam computed tomography. Oral Radiol 2013. [DOI: 10.1007/s11282-013-0150-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lee JJ, Cheng SJ, Wang JJ, Chiang CP, Chang HH, Chen HM, Kok SH. Factors predicting the prognosis of oral alendronate-related osteonecrosis of the jaws: a 4-year cohort study. Head Neck 2013; 35:1787-95. [PMID: 23508560 DOI: 10.1002/hed.23235] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Studies concerning prognostic factors specific for alendronate-related osteonecrosis of the jaws (ONJ) are rare. METHODS We surveyed a cohort of 100 osteoporotic patients with 111 alendronate-related ONJ lesions treated during a 4-year period. Prognostic values of clinical variables and serum markers of bone turnover were assessed by univariate and multivariate analyses. RESULTS The cumulative complete response rate at 6 months was 48.65%. Serum bone-specific alkaline phosphatase (BSAP) level >10 μg/L, lesion depth ≦ 10 mm, and lesions in anterior regions denoted a better chance of healing within 6 months and the adjusted hazard ratios were 2.48 (95% confidence interval [CI], 1.41-4.37), 2.71 (95% CI, 1.57-4.70), and 3.94 (95% CI, 1.87-8.30), respectively. CONCLUSIONS Early discovery of lesions and prevention of their deeper extension are crucial for improving the prognosis of alendronate-related ONJ. A higher pretreatment level of BSAP indicates a better prognosis.
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Affiliation(s)
- Jang-Jaer Lee
- School of Dentistry, National Taiwan University Medical Center, Taipei, Taiwan
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Roza MR, Silva LAF, Barriviera M, Januario AL, Bezerra ACB, Fioravanti MCS. Cone beam computed tomography and intraoral radiography for diagnosis of dental abnormalities in dogs and cats. J Vet Sci 2012; 12:387-92. [PMID: 22122905 PMCID: PMC3232399 DOI: 10.4142/jvs.2011.12.4.387] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The development of veterinary dentistry has substantially improved the ability to diagnose canine and feline dental abnormalities. Consequently, examinations previously performed only on humans are now available for small animals, thus improving the diagnostic quality. This has increased the need for technical qualification of veterinary professionals and increased technological investments. This study evaluated the use of cone beam computed tomography and intraoral radiography as complementary exams for diagnosing dental abnormalities in dogs and cats. Cone beam computed tomography was provided faster image acquisition with high image quality, was associated with low ionizing radiation levels, enabled image editing, and reduced the exam duration. Our results showed that radiography was an effective method for dental radiographic examination with low cost and fast execution times, and can be performed during surgical procedures.
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Affiliation(s)
- Marcello R Roza
- Department of Veterinary Medicine, Federal University of Goias, Goiânia 74001-970, Brazil.
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Hard and soft tissue changes of osteomyelitis of the jaws on CT images. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:118-26. [DOI: 10.1016/j.oooo.2012.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 12/13/2011] [Accepted: 01/03/2012] [Indexed: 11/19/2022]
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The role of surgical therapy in the management of intravenous bisphosphonates-related osteonecrosis of the jaw. ACTA ACUST UNITED AC 2011; 111:153-63. [DOI: 10.1016/j.tripleo.2010.04.015] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 04/05/2010] [Accepted: 04/09/2010] [Indexed: 11/21/2022]
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Cankaya AB, Erdem MA, Isler SC, Demircan S, Soluk M, Kasapoglu C, Oral CK. Use of cone-beam computerized tomography for evaluation of bisphosphonate-associated osteonecrosis of the jaws in an experimental rat model. Int J Med Sci 2011; 8:667-72. [PMID: 22135613 PMCID: PMC3204436 DOI: 10.7150/ijms.8.667] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 10/18/2011] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Bisphosphonate-induced osteonecrosis of the jaw (BONJ) is a frequently reported complication. The aim of this study was to investigate the clinical and histopathological presentation of BONJ with the Hounsfield score and to evaluate the reliability of the score for determining necrosis in an animal model. MATERIAL/METHODS Eighty rats were prospectively and randomly divided into two groups of 40 each: a control group and an experimental group. Half of the animals from each group underwent extraction of the left mandibular molars, and the other half underwent extraction of the left maxillary molars under pentobarbital-induced general anesthesia. All animals were euthanized 28 days after tooth extraction. Maxillae and mandibles were extracted, cone beam computed tomography (CBCT) was performed, and Hounsfield scores were evaluated. RESULTS The Hounsfield scores of the experimental group were found to be compatible with chronic osteomyelitis and periosteal reactions. The Hounsfield scores of the control group were compatible with a healthy healing period. CONCLUSION In light of these results, both cone beam computed tomography (CBCT) and the Hounsfield Units (HU) evaluations together are thought to be efficient in the diagnosis of BONJ.
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Olutayo J, Agbaje JO, Jacobs R, Verhaeghe V, Velde FV, Vinckier F. Bisphosphonate-Related Osteonecrosis of the Jaw Bone: Radiological Pattern and the Potential Role of CBCT in Early Diagnosis. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2010; 1:e3. [PMID: 24421968 PMCID: PMC3886047 DOI: 10.5037/jomr.2010.1203] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 03/30/2010] [Indexed: 11/30/2022]
Abstract
Objectives To systematize the clinico-radiological symptoms and course of
bisphosphonate-related osteonecrosis of jaw bone and
toevaluate the diagnostic potential of various radiological techniques to
detect mild osteonecrosis in each stage of the disease. Material and Methods The sample consisted of 22 patients previously diagnosed with extraoral
malignant disease. Diagnosis was based on a clinical examination in
conjunction to digital panoramic radiography and cone beam computed
tomography (CBCT). Two dentomaxillofacial radiologists reviewed all
images. Results Twenty
patients showed mandibular involvement clinically, while two others had
a maxillary involvement. Four stages of the disease were proposed based
on the clinico-radiological findings. Subclinical cortical and lamina
dura thickening was detected with only three-dimensional CBCT and
periapical images, while ulceration and cortical bone thickening was
detected only by three-dimensional CBCT. Mixed sclerotic, lytic bone
destruction involving alveolar and basal bone with or without
encroachment on the mandibular canal, pathological mandibular fractures
were detected by two-dimensional panoramic and three-dimensional CBCT
images. Other findings are non healing extraction sockets, periapical
radiolucencies, osteolysis, sequestra, oroantral fistula, and periosteal
new bone formation. Conclusions The
present study showed that bisphosphonate-related osteonecrosis of jaw
bone occurs in four distinct clinico-radiological stages. For mild
cases, panoramic image diagnosis was much less obvious, whereas cone
beam computed tomography was able to fully characterise the bony lesions
and describe their extent and involvement of neighbouring structures in
all cases. Thus cone beam computed tomography might better contribute to
the prevention of bisphosphonate-related osteonecrosis of jaw bone as
well to the disease management.
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Affiliation(s)
- James Olutayo
- Oral Imaging Center, Department of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium. ; Department of Dentistry, Faculty of Clinical Sciences, University of Maiduguri, Maiduguri Nigeria
| | - Jimoh Olubanwo Agbaje
- Department of Paediatric Dentistry and Special Dental Care, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium
| | - Reinhilde Jacobs
- Oral Imaging Center, Department of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium
| | - Vicky Verhaeghe
- Department of Paediatric Dentistry and Special Dental Care, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium
| | | | - Frans Vinckier
- Department of Paediatric Dentistry and Special Dental Care, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium
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Modern dental imaging: a review of the current technology and clinical applications in dental practice. Eur Radiol 2010; 20:2637-55. [PMID: 20544352 DOI: 10.1007/s00330-010-1836-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/15/2010] [Accepted: 04/29/2010] [Indexed: 02/02/2023]
Abstract
A review of modern imaging techniques commonly used in dental practice and their clinical applications is presented. The current dental examinations consist of intraoral imaging with digital indirect and direct receptors, while extraoral imaging is divided into traditional tomographic/panoramic imaging and the more recently introduced cone beam computed tomography. Applications, limitations and current trends of these dental "in-office" radiographic techniques are discussed.
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Use of cone-beam computerized tomography for evaluation of bisphosphonate-associated osteonecrosis of the jaws. ACTA ACUST UNITED AC 2010; 109:753-64. [DOI: 10.1016/j.tripleo.2009.12.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 12/01/2009] [Accepted: 12/05/2009] [Indexed: 11/20/2022]
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29
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Roza MR, Silva LA, Januário AL, Barriviera M, Oliveira AC, Fioravanti MC. Tomografia computadorizada de feixe cônico na odontologia veterinária: descrição e padronização da técnica. PESQUISA VETERINARIA BRASILEIRA 2009. [DOI: 10.1590/s0100-736x2009000800004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Onze cães e quatro gatos, portadores de alterações buco-dentárias e atendidos no Centro Veterinário do Gama, em Brasília, DF, foram submetidos à tomografia computadorizada de feixe cônico. Os exames foram realizados em um tomógrafo i-CAT, utilizando para aquisição das imagens, altura de seis centímetros, tempo de 40 segundos, 0,2 voxel, 120 kilovolts e 46,72 miliampéres por segundo. O melhor posicionamento dos animais para realização do exame foi definido neste estudo. Esse é um fator fundamental para a realização do exame, que necessitou um protocolo anestésico simples e seguro, em função do tempo mínimo necessário à obtenção das imagens. Várias alterações e enfermidades foram identificadas, com extrema acurácia, credenciando a tomografia computadorizada de feixe cônico como um exame seguro, acessível e exeqüível e que pode ser incorporado à rotina odontológica das clínicas de pequenos animais.
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De Vos W, Casselman J, Swennen GRJ. Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: A systematic review of the literature. Int J Oral Maxillofac Surg 2009; 38:609-25. [PMID: 19464146 DOI: 10.1016/j.ijom.2009.02.028] [Citation(s) in RCA: 473] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 02/27/2009] [Indexed: 12/20/2022]
Affiliation(s)
- W De Vos
- Division of Maxillo-Facial Surgery, Department of Surgery, General Hospital St-Jan Bruges, Bruges, Belgium
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Wilde F, Steinhoff K, Frerich B, Schulz T, Winter K, Hemprich A, Sabri O, Kluge R. Positron-emission tomography imaging in the diagnosis of bisphosphonate-related osteonecrosis of the jaw. ACTA ACUST UNITED AC 2009; 107:412-9. [DOI: 10.1016/j.tripleo.2008.09.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 09/15/2008] [Accepted: 09/24/2008] [Indexed: 11/27/2022]
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Treister N, Sheehy N, Bae EH, Friedland B, Lerman M, Woo S. Dental panoramic radiographic evaluation in bisphosphonate-associated osteonecrosis of the jaws. Oral Dis 2009; 15:88-92. [DOI: 10.1111/j.1601-0825.2008.01494.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Eggers G, Klein J, Welzel T, Mühling J. Geometric accuracy of digital volume tomography and conventional computed tomography. Br J Oral Maxillofac Surg 2008; 46:639-44. [DOI: 10.1016/j.bjoms.2008.03.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2008] [Indexed: 11/28/2022]
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Abstract
Cone-beam imaging has gained broad acceptance in dentistry in the last 5 years. The purpose of this review is to describe the use in dentistry and consider issues requiring further development. Cone-beam machines emit an x-ray beam shaped liked a cone rather than a fan as in conventional computed tomography (CT) machines. After this beam passes through the patient the remnant beam is captured on an amorphous silicon flat panel or image intensifier/charge-coupled device (CCD) detector. The beam diameter ranges from 4 to 30 cm and exposes the head in one pass around the patient capturing from 160 to 599 basis images. These images are used to compute a volume from which planar or curved reconstructions can be extracted in any orientation. Voxels are isotropic and can be as small as 0.125 mm. 3-D images of bone or soft tissue surfaces can also be generated. In dentistry the most common indications for cone-beam imaging are assessment of the jaws for placement of dental implants, evaluation of the temporomandibular joints for osseous degenerative changes, examination of teeth and facial structures for orthodontic treatment planning, evaluation of the proximity of lower wisdom teeth to the mandibular nerve prior to extraction, and evaluation of teeth and bone for signs of infections, cysts, or tumors. Cone-beam images have largely replaced conventional tomography for these tasks. The effective dose from cone-beam imaging ranges from 6 to 477 microSv. The cost of the equipment is relatively low, about $150,000 to $300,000. Issues to be considered are the training of individuals making and interpreting cone-beam images, as well as means to further reduce patient exposure.
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MESH Headings
- Cone-Beam Computed Tomography/instrumentation
- Cone-Beam Computed Tomography/methods
- Dental Implants
- Dentistry/methods
- Humans
- Image Processing, Computer-Assisted/methods
- Phantoms, Imaging
- Radiographic Image Enhancement/instrumentation
- Radiographic Image Enhancement/methods
- Radiographic Image Interpretation, Computer-Assisted/instrumentation
- Radiographic Image Interpretation, Computer-Assisted/methods
- Radiography, Dental, Digital/instrumentation
- Radiography, Dental, Digital/methods
- Temporomandibular Joint Disorders/diagnostic imaging
- Temporomandibular Joint Disorders/therapy
- Tomography, X-Ray Computed/instrumentation
- Tomography, X-Ray Computed/methods
- X-Ray Intensifying Screens
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Affiliation(s)
- Stuart C White
- UCLA School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095-1668, USA.
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35
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Stratemann SA, Huang JC, Maki K, Miller AJ, Hatcher DC. Comparison of cone beam computed tomography imaging with physical measures. Dentomaxillofac Radiol 2008; 37:80-93. [PMID: 18239035 DOI: 10.1259/dmfr/31349994] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES The goal of this study was to determine the accuracy of measuring linear distances between landmarks commonly used in orthodontic analysis on a human skull using two cone beam CT (CBCT) systems. METHODS Measurements of length were taken using volumetric data from two CBCT systems and were compared with physical measures using a calliper applied to one human adult skull. Landmarks were identified with chromium steel balls embedded at 32 cranial and 33 mandibular landmarks and the linear measures were taken with a digital calliper. The skull was then scanned with two different CBCT systems: the NewTom QR DVT 9000 (Aperio Inc, Sarasota, FL) and the Hitachi MercuRay (Hitachi Medico Technology, Tokyo, Japan). CT data including the landmark point data were threshold segmented using CyberMed's CB Works software (CB Works 1.0, CyberMed Inc., Seoul, Korea). The resulting segmentations were exported from CB Works as VRML (WRL) files to Amira software (Amira 3.1, Mercury Computer Systems GmbH, Berlin, Germany). RESULTS The error was small compared with the gold standard of the physical calliper measures for both the NewTom (0.07+/-0.41 mm) and CB MercuRay (0.00+/-0.22 mm) generated data. Absolute error to the gold standard was slightly positive, indicating minor compression relative to the calliper measurement. The error was slightly smaller in the CB MercuRay than in the NewTom, probably related to a broader greyscale range for describing beam attenuation in 12-bit vs 8-bit data. CONCLUSIONS The volumetric data rendered with both CBCT systems provided highly accurate data compared with the gold standard of physical measures directly from the skulls, with less than 1% relative error.
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Affiliation(s)
- S A Stratemann
- Division of Orthodontics, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143-0438, USA
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