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Willershausen I, Kopp M, Scholz M, Ströbel A, Seidel CL, Paulsen F, Uder M, Gölz L, May MS. Feasibility of 3 Tesla MRI for the assessment of mid-palatal suture maturation: a retrospective pilot study. Odontology 2024:10.1007/s10266-024-00950-0. [PMID: 38758257 DOI: 10.1007/s10266-024-00950-0] [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: 03/08/2024] [Accepted: 05/04/2024] [Indexed: 05/18/2024]
Abstract
The maxilla occupies a key position in dentofacial orthopaedics, since its transversal development can be directly influenced by orthodontic therapy. The maturation stages of the mid-palatal suture, which are obtained from cone-beam computed tomography images (CBCT), present an addition to clinical decision-making in transversal discrepancies of the upper jaw. In an endeavour to reduce ionizing radiation in adolescents and young adults, who are particularly susceptible to long term stochastic irradiation effects, we investigated the feasibility of 3 Tesla (3T) MRI in detecting the maturation stages of the mid-palatal suture. A collective of 30 patients aged 24-93 years with routine neck MRI at 3T, underwent an additional three-dimensional isotropic T1 weighted study sequence of the midface. Image evaluation was performed on axial, multi-planar formatted reconstructions of the dataset aligned to the midline axis of the palate, and curved reconstructions aligned to the concavity of the palate. Inverted images helped to achieve an image impression similar to the well-known CBCT appearance. All datasets were reviewed by three readers and mid-palatal maturation was scored twice according to Angelieri et al. Intra- and inter-rater agreement were evaluated to measure the robustness of the images for clinical evaluation. 3T MRI deemed reliable for the assessment of mid-palatal suture maturation and hence for the appraisal of the hard palate and its adjacent sutures. The data of this pilot study display the feasibility of non-ionizing cross-sectional MRI for the determination of sutural maturation stages. These findings underline the potential of MRI for orthodontic treatment planning, further contributing to the avoidance of unnecessary radiation doses.
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Affiliation(s)
- Ines Willershausen
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
| | - Markus Kopp
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Scholz
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Armin Ströbel
- Center for Clinical Studies (CCS), Medical Faculty, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | - Corinna Lesley Seidel
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Lina Gölz
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Stefan May
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Kim JW, Seo YS. An atypical case involving real, ghost, and pseudo-ghost images on a panoramic radiograph. Imaging Sci Dent 2024; 54:57-62. [PMID: 38571771 PMCID: PMC10985519 DOI: 10.5624/isd.20230256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 04/05/2024] Open
Abstract
Purpose This report presents a unique case featuring real, ghost, and pseudo-ghost images on the panoramic radiograph of a patient wearing earrings. It also explains the formation of these images in an easy-to-understand manner. Material and Methods One real image and two ghost images appeared on each side of a panoramic radiograph of a patient wearing earrings on both sides. Of the two ghost images on each side, one was considered a typical ghost image and the other was considered a ghost-like real image (pseudo-ghost image). The formation zones of the real, double, and ghost images were examined based on the path and angles of the X-ray beam from the Planmeca ProMax. To simulate the pseudo-ghost and typical ghost images on panoramic radiography, a radiopaque marker was affixed to the right mandibular condyle of a dry mandible, and the position of the mandible was adjusted accordingly. Results The center of rotation of the Planmeca ProMax extended beyond the jaw area, and the area of double image formation also reached beyond the jaw. The radiopaque-marked mandibular condyle, situated in the outwardly extending area of double image formation, exhibited triple images consisting of real, double (pseudo-ghost), and ghost images. These findings helped to explain the image formation associated with the patient's earrings observed in the panoramic radiograph. Conclusion Dentists must understand the characteristics and principles of the panoramic equipment they use and apply this understanding to taking and interpreting panoramic radiographs.
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Affiliation(s)
- Jong-Won Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Chosun University, Gwangju, Korea
| | - Yo-Seob Seo
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Chosun University, Gwangju, Korea
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Fux-Noy A, Rohana R, Rettman A, Moskovitz M, Nadler C. Panoramic errors in pediatric patients with special needs. Sci Rep 2023; 13:11757. [PMID: 37474557 PMCID: PMC10359285 DOI: 10.1038/s41598-023-38823-1] [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: 05/28/2023] [Accepted: 07/15/2023] [Indexed: 07/22/2023] Open
Abstract
This study aimed to analyze the types and frequencies of panoramic technical errors in pediatric patients with special needs, as compared to matching images of patients with normal developmental patterns. Panoramic images of 100 pediatric patients, with equal numbers of either special needs or healthy controls, referred to our Oral Maxillofacial Imaging unit, were retrospectively examined by four blinded observers for the presence of four common technical errors: palatoglossal air space, movement, positioning errors, and foreign bodies appearance. In addition, they subjectively determined the image quality on an ordinal scale. The statistical examination included inter-observer correlation and correlations between demographic factors (age, gender, developmental status) and the number and types of errors. The frequencies of demonstrated errors were, in descending order: movement, positioning, palatoglossal air space, and foreign bodies' appearance. The special needs group images showed significantly more errors and were rated as low-quality radiographs. Younger patients in both groups showed more movement and positioning errors. Technical errors in panoramic images of patients with special needs were more frequently found. Therefore, increased awareness of the staff and appropriate pre-imaging instructions to the patients, are required when imaging pediatric patients, especially those with special needs.
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Affiliation(s)
- Avia Fux-Noy
- Department of Pediatric Dentistry, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, P.O.B. 12272, 9112102, Jerusalem, Israel.
| | - Rasha Rohana
- Department of Pediatric Dentistry, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, P.O.B. 12272, 9112102, Jerusalem, Israel
| | - Andra Rettman
- Oral Maxillofacial Imaging Unit, Oral Medicine, Sedation and Maxillofacial Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Moti Moskovitz
- Department of Pediatric Dentistry, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, P.O.B. 12272, 9112102, Jerusalem, Israel
| | - Chen Nadler
- Oral Maxillofacial Imaging Unit, Oral Medicine, Sedation and Maxillofacial Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Willershausen I, Necker F, Kloeckner R, Seidel CL, Paulsen F, Gölz L, Scholz M. Cinematic rendering to improve visualization of supplementary and ectopic teeth using CT datasets. Dentomaxillofac Radiol 2023; 52:20230058. [PMID: 37015249 PMCID: PMC10170174 DOI: 10.1259/dmfr.20230058] [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: 02/01/2023] [Accepted: 03/06/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES Ectopic, impacted, and supplementary teeth are the number one reason for cross-sectional imaging in pediatric dentistry. The accurate post-processing of acquired data sets is crucial to obtain precise, yet also intuitively understandable three-dimensional (3D) models, which facilitate clinical decision-making and improve treatment outcomes. Cinematic rendering (CR) is anovel visualization technique using physically based volume rendering to create photorealistic images from DICOM data. The aim of the present study was to tailor pre-existing CR reconstruction parameters for use in dental imaging with the example of the diagnostic 3D visualization of ectopic, impacted, and supplementary teeth. METHODS CR was employed for the volumetric image visualization of midface CT data sets. Predefined reconstruction parameters were specifically modified to visualize the presented dental pathologies, dentulous jaw, and isolated teeth. The 3D spatial relationship of the teeth, as well as their structural relationship with the antagonizing dentition, could immediately be investigated and highlighted by separate, interactive 3D visualization after segmentation through windowing. RESULTS To the best of our knowledge, CR has not been implemented for the visualization of supplementary and ectopic teeth segmented from the surrounding bone because the software has not yet provided appropriate customized reconstruction parameters for dental imaging. When employing our new, modified reconstruction parameters, its application presents a fast approach to obtain realistic visualizations of both dental and osseous structures. CONCLUSIONS CR enables dentists and oral surgeons to gain an improved 3D understanding of anatomical structures, allowing for more intuitive treatment planning and patient communication.
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Affiliation(s)
- Ines Willershausen
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nürnberg, Gluecksstrasse, Erlangen, Germany
| | | | - Roman Kloeckner
- Institute of Interventional Radiology University Hospital of Schleswig-Holstein-Campus Lübeck, Ratzeburger Allee, Lübeck, Germany
| | - Corinna Lesley Seidel
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nürnberg, Gluecksstrasse, Erlangen, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse, Erlangen, Germany
| | - Lina Gölz
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nürnberg, Gluecksstrasse, Erlangen, Germany
| | - Michael Scholz
- Institute of Functional and Clinical Anatomy Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse, Erlangen, Germany
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Li K, Xu W, Zhou T, Chen J, He Y. The radiological and histological investigation of the dental follicle of asymptomatic impacted mandibular third molars. BMC Oral Health 2022; 22:642. [PMID: 36567318 PMCID: PMC9791750 DOI: 10.1186/s12903-022-02681-6] [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] [Received: 09/07/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The indication for removal of asymptomatic fully impacted third molars is still controversial. In this study, radiological and histological investigation of the dental follicle of asymptomatic impacted mandibular third molars was performed, aiming to provide a reference for clinical prophylactic extraction of these teeth. METHODS Patients with impacted mandibular third molars were included and the maximum width of the dental follicle around the crown was measured in horizontal, sagittal and coronal sections by cone beam computed tomography. The dental follicles were stained with haematoxylin-eosin, analysed by a pathologist and classified as normal, inflammatory or cystic. A Chi-squared test was used to analyse the association of the incidence of inflammation and cysts with the clinical variables of the impacted mandibular third molars. RESULTS Thirty-seven samples were normal dental follicles; 52 samples showed inflammatory infiltration with an incidence of 57.14%; 2 samples with a maximum dental follicle width of 2-3 mm were diagnosed as odontogenic cysts, and the incidence was 2.20%. There was no significant difference in the incidence of inflammatory and cystic dental follicles between males and females, or between different age groups (P > 0.05). With an increase of the maximum width of the dental follicle, there was a rise in the incidence and degree of infiltration of chronic nonspecific inflammation. CONCLUSION Asymptomatic impacted mandibular third molars tend to be extracted, especially for teeth with a 2-3 mm maximum width of the dental follicle on radiological examination.
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Affiliation(s)
- Kuncai Li
- grid.410578.f0000 0001 1114 4286Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China ,Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Luzhou, China
| | - Wei Xu
- grid.410578.f0000 0001 1114 4286Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China ,Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Luzhou, China
| | - Tiejun Zhou
- grid.488387.8Department of Pathology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Junliang Chen
- grid.410578.f0000 0001 1114 4286Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China ,Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Luzhou, China
| | - Yun He
- grid.410578.f0000 0001 1114 4286Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, China ,Oral and Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, Luzhou, China
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Artificial intelligence-aided detection of ectopic eruption of maxillary first molars based on panoramic radiography. J Dent 2022; 125:104239. [PMID: 35863549 DOI: 10.1016/j.jdent.2022.104239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Ectopic eruption (EE) of maxillary permanent first molars (PFMs) is among the most frequent ectopic eruption, which leads to premature loss of adjacent primary second molars, impaction of premolars and a decrease in dental arch length. Apart from oral manifestations such as delayed eruption and discoloration of PFMs, panoramic radiography can reveal EE of maxillary PFMs as well. Identifying eruption anomalies in radiographs can be strongly experience-dependent, leading us to develop here an automatic model that can aid dentists in this task and allow timelier interventions. METHODS Panoramic X-ray images from 1480 patients aged 4-9 years old were used to train an auto-screening model. Another 100 panoramic images were used to validate and test the model. RESULTS The positive and negative predictive values of this auto-screening system were 0.86 and 0.88, respectively, with a specificity of 0.90 and a sensitivity of 0.86. Using the model to aid dentists in detecting EE on the 100 panoramic images led to higher sensitivity and specificity than when three experienced pediatric dentists detected EE manually. CONCLUSIONS Deep learning-based automatic screening system is useful and promising in the detection EE of maxillary PFMs with relatively high specificity. However, deep learning is not completely accurate in the detection of EE. To minimize the effect of possible false negative diagnosis, regular follow-ups and re-evaluation are required if necessary. CLINICAL SIGNIFICANCE Identification of EE through a semi-automatic screening model can improve the efficacy and accuracy of clinical diagnosis compared to human experts alone. This method may allow earlier detection and timelier intervention and management.
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