Radiological assessment of alveolar bone loss associated with overhanging restorations: A retrospective cone beam computed tomography study

Background/purpose

Studies suggested that presence and size of overhanging restoration margins play role in alveolar bone loss. The aim of this study was to determine the prevalence and distribution of overhanging approximal restorations, to evaluate the effect of presence and size of overhang on bone loss using cone beam computed tomography (CBCT) reformatted panoramic images, and to encourage the use of CBCT in retrospective studies on restorative dentistry.

Materials and methods

CBCT images of 382 patients with approximal restorations were included in the study. On CBCT images, alveolar bone loss adjacent to each restored surface was determined and compared to the control tooth. The overhang size was measured and categorized as small, medium, or large. Data obtained were evaluated statistically using Kruskal Wallis, Mann Whitney U, chi-square, and one-sample chi-square tests with a significance level set at P < 0.05.

Results

A total of 216 (32.4%) surfaces with overhanging restorations were detected in CBCT images. The number of overhanging surfaces with alveolar bone loss (71.3%) was higher than the control surfaces with bone loss (49.1%) (P < 0.05). The amount of bone loss adjacent to overhanging surfaces (2.28 ± 1.69 mm) was significantly higher compared to control surfaces (1.53 ± 1.73 mm) (P < 0.05). However, the same trend applied to the surfaces without overhang and their controls. The amount of bone loss was not correlated with the overhang size (P > 0.05).

Conclusion

Approximal restorations with and without overhanging margins may often result in alveolar bone loss, the amount of which is not always correlated with the overhang size.

A retrospective cone beam computed tomography analysis of cemento-osseous dysplasia

Background/purpose

Radiological examination is indispensable in the diagnosis and follow-up of cemento-osseous dysplasia (COD). The aim of this retrospective study was to describe a series of COD cases, identify the frequencies of COD subtypes, and investigate the demographic and radiological characteristics in relation to subtypes.

Materials and methods

Cone beam computed tomography (CBCT) images/reports of patients with a diagnosis of COD were included in the study. The data collected included information on the age, sex, subtype of COD, location of COD, and region involved. Information regarding the internal density, effects on surrounding structures, and presence of concomitant lesions was also collected. The data obtained were evaluated statistically.

Results

The study group included CBCT images of 142 patients (130 females (91.5%) and 12 males (8.5%)) with a mean age of 46.97 ± 10.57 years. The mandible was involved in almost all cases (99.3%). The most common subtype was florid COD (51.4%) and lesions with hyperdense internal density (81.7%) were more commonly observed. Cortical thinning (78.2%) was a prominent feature. The frequency of root resorption in periapical COD cases (57.1%) was observed to be significantly higher (p < 0.05). All hypercementosis cases were associated with florid subtype (p < 0.05). In a minority of cases (6.3%), the lesions were associated with bone cysts and osteomyelitis.

Conclusion

CBCT images clearly demonstrated the effect of COD lesions on surrounding structures. CBCT is an appropriate imaging modality for the diagnosis and follow-up of COD which is the most common fibro-osseous lesion in clinical practice.

Evaluation of cone beam computed tomography referral profile: Retrospective study in a Turkish paediatric subpopulation

AIM

Increasing use of cone beam computed tomography (CBCT) for dentomaxillofacial diagnosis raises concerns about radiation dose which is known to be higher compared to conventional dental imaging methods. This retrospective study investigated the CBCT referrals in a Turkish paediatric subpopulation in terms of referring department, field of view (FOV),and findings.

MATERIALS AND METHODS

A total of 8,880 CBCT images were reviewed retrospectively and images of paediatric patients (?14 years old) were selected. In paediatric patients; data related to patient age and gender, referring department, FOV, region of interest for localised applications, and reason for CBCT referral were recorded. FOVs of CBCT scans were classified as face, jaws (maxilla and mandible), maxilla, mandible, and tooth. CBCT indications were categorised based upon an adaptation of the European DIMITRA (dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks) multicenter and multidisciplinary project recommendations as impacted teeth, trauma, orofacial clefts, dental anomalies, bone pathology, syndromes, and other. Patients undergoing consecutive CBCT examinations for follow-up were also recorded. In order to record the incidental findings noticed in the CBCT evaluation, the radiological report prepared by the radiologist was used. The results were analysed statistically with a significance level set at p<0.05.

RESULTS

Four hundred forty-nine of the 8880 CBCT scans were taken from paediatric patients under the age of 14, representing approximately 5% of all scans. Most of the referrals were from Department of Paediatric Dentistry (36.3%), followed by Department of Orthodontics (25.6%). The most frequently imaged region was the maxilla (33.4%), followed by the face (20.5%). The most common region of interest for localised applications was the maxillary canine/incisor region (85.55%). The most common indication was impacted teeth (41.4%) followed by bone pathology (31%) and dental anomalies (29.6%); 11.6% of the patients underwent follow-up CBCT examinations especially for orofacial clefts and syndromes.

CONCLUSIONS

This retrospective study investigating CBCT indications in a Turkish paediatric subpopulation and comparing existing applications with DIMITRA project recommendations can guide dental professionals in referring paediatric patients for CBCT.

Cross-contamination and infection control in intraoral digital imaging: a comprehensive review

Dental health care workers are subjected to various infectious disease agents that are present in patients' saliva and blood which make infection control and universal prevention methods indispensable to the dental practice given that some of these diseases cause loss of work and time for dental staff and patients; some of them cause serious morbidity; and some of them currently have a poor prognosis and no effective treatments. Although dental radiographic procedures are not invasive, and there are no incidents such as injuries caused by dental instruments, they are a potential infection source because of contamination with saliva and blood, and comprehensive infection control procedures also apply to the radiology clinic. In addition, contact with a large number of patients in dental schools and clinics in a short period of time, and the fact that radiographic procedures are performed in the same environment as other dental procedures in dental offices increase the significance of infection control in dental radiology. Major advances in computer technology have enabled digital imaging systems to develop rapidly and to become common in dental practice as an alternative to conventional film-based imaging. The use of digital sensors in dental radiology introduced unique infection control challenges and required the revision and modification of existing infection control techniques. In this review, studies concerning the risk of cross-contamination and challenges of infection control with digital image sensors are comprehensively reviewed and infection control protocols that should be followed in intraoral digital imaging using both direct and indirect systems are thoroughly examined.