• Imaging Science in Dentistry
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• v.43 no.3
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• pp.163-169
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• 2013

Purpose: Tonsilloliths are calcifications found in the crypts of the palatal tonsils and can be detected on routine panoramic examinations. This study was performed to highlight the benefits of cone-beam computed tomography (CBCT) in the diagnosis of tonsilloliths appearing bilaterally on panoramic radiographs. Materials and Methods: The sample group consisted of 7 patients who had bilateral radiopaque lesions at the area of the ascending ramus on panoramic radiographs. CBCT images for every patient were obtained from both sides of the jaw to determine the exact locations of the lesions and to rule out other calcifications. The calcifications were evaluated on the CBCT images using Ez3D2009 software. Additionally, the obtained images in DICOM format were transferred to ITK SNAP 2.4.0 pc software for semiautomatic segmentation. Segmentation was performed using contrast differences between the soft tissues and calcifications on grayscale images, and the volume in mm3 of the segmented three dimensional models were obtained. Results: CBCT scans revealed that what appeared on panoramic radiographs as bilateral images were in fact unilateral lesions in 2 cases. The total volume of the calcifications ranged from 7.92 to $302.5mm^3$. The patients with bilaterally multiple and large calcifications were found to be symptomatic. Conclusion: The cases provided the evidence that tonsilloliths should be considered in the differential diagnosis of radiopaque masses involving the mandibular ramus, and they highlight the need for a CBCT scan to differentiate pseudo- or ghost images from true bilateral pathologies.

• Imaging Science in Dentistry
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• v.46 no.3
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• pp.159-165
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• 2016

Purpose: The purpose of this study was to detect the anterior loop of the mental nerve and the mandibular incisive canal in panoramic radiographs (PAN) and cone-beam computed tomography (CBCT) images, as well as to determine the anterior/mesial extension of these structures in panoramic and cross-sectional reconstructions using PAN and CBCT images. Materials and Methods: Images (both PAN and CBCT) from 90 patients were evaluated by 2 independent observers. Detection of the anterior loop and the incisive canal were compared between PAN and CBCT. The anterior/mesial extension of these structures was compared between PAN and both cross-sectional and panoramic CBCT reconstructions. Results: In CBCT, the anterior loop and the incisive canal were observed in 7.7% and 24.4% of the hemimandibles, respectively. In PAN, the anterior loop and the incisive canal were detected in 15% and 5.5% of cases, respectively. PAN presented more difficulties in the visualization of structures. The anterior/mesial extensions ranged from 0.0 mm to 19.0 mm on CBCT. PAN underestimated the measurements by approximately 2.0 mm. Conclusion: CBCT appears to be a more reliable imaging modality than PAN for preoperative workups of the anterior mandible. Individual variations in the anterior/mesial extensions of the anterior loop of the mental nerve and the mandibular incisive canal mean that is not prudent to rely on a general safe zone for implant placement or bone surgery in the interforaminal region.

• Imaging Science in Dentistry
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• v.43 no.4
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• pp.235-243
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• 2013

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

• Imaging Science in Dentistry
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• v.46 no.1
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• pp.63-68
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• 2016

Panoramic radiographs are a relatively simple technique that is commonly used in all dental specialties. In panoramic radiographs, in addition to the formation of real images of metal objects, ghost images may also form, and these ghost images can hinder an accurate diagnosis and interfere with the accuracy of radiology reports. Dentists must understand the formation of these images in order to avoid making incorrect radiographic diagnoses. Therefore, the present study sought to present a study of the formation of panoramic radiograph ghost images caused by metal objects in the head and neck region of a dry skull, as well as to report a clinical case in order to warn dentists about ghost images and to raise awareness thereof. An understanding of the principles of the formation of ghost images in panoramic radiographs helps prevent incorrect diagnoses.

• Imaging Science in Dentistry
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• v.51 no.2
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• pp.187-193
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• 2021

Purpose: This study aimed to assess the usefulness of machine learning and automation techniques to match pairs of panoramic radiographs for personal identification. Materials and Methods: Two hundred panoramic radiographs from 100 patients (50 males and 50 females) were randomly selected from a private radiological service database. Initially, 14 linear and angular measurements of the radiographs were made by an expert. Eight ratio indices derived from the original measurements were applied to a statistical algorithm to match radiographs from the same patients, simulating a semi-automated personal identification process. Subsequently, measurements were automatically generated using a deep neural network for image recognition, simulating a fully automated personal identification process. Results: Approximately 85% of the radiographs were correctly matched by the automated personal identification process. In a limited number of cases, the image recognition algorithm identified 2 potential matches for the same individual. No statistically significant differences were found between measurements performed by the expert on panoramic radiographs from the same patients. Conclusion: Personal identification might be performed with the aid of image recognition algorithms and machine learning techniques. This approach will likely facilitate the complex task of personal identification by performing an initial screening of radiographs and matching ante-mortem and post-mortem images from the same individuals.

• Imaging Science in Dentistry
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• v.51 no.4
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• pp.421-427
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• 2021

Purpose: The pulp length to width (PL/W) ratio of the maxillary lateral incisor can be used as an age determination method. This study aimed to investigate the correlation between the PL/W ratio of the maxillary lateral incisor on panoramic radiographs and human chronological age in Indonesian subjects. Materials and Methods: This study analyzed with 134 maxillary lateral incisors on 113 panoramic radiographs from patients who visited the Oral and Maxillofacial Radiology Unit of Dental Hospital Universitas Padjadjaran, Bandung, Jawa Barat, Indonesia, from 2013 to 2018 (age range: between 11 to 60 years). The pulp length was measured from the pulp chamber roof to the apical foramen, and the pulp width was measured on the cervical area of the cementoenamel junction in millimeters using Fiji ImageJ open-source software. Simple linear regression (in SPSS) was used to analyze the results. The reliability of the observers was evaluated. Results: The PL/W ratio of the maxillary lateral incisor was significantly correlated with chronological age (P<0.01). No statistically significant difference was found in the PL/W ratio between the left and right maxillary lateral incisors(P=0.333). There was a very strong correlation (r=0.939) between the PL/W ratio of the maxillary lateral incisor and human chronological age, with the following formula: age= -3.057+1.875×PL/W ratio (R²=0.882, standard error of estimate: 4.659). Conclusion: The PL/W ratio of the maxillary lateral incisor on panoramic radiograph can be used for age determination in Indonesian subjects.

• Imaging Science in Dentistry
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• v.52 no.4
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• pp.383-391
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• 2022

Purpose: Periodontitis, the most prevalent chronic inflammatory condition affecting teeth-supporting tissues, is diagnosed and classified through clinical and radiographic examinations. The staging of periodontitis using panoramic radiographs provides information for designing computer-assisted diagnostic systems. Performing image segmentation in periodontitis is required for image processing in diagnostic applications. This study evaluated image segmentation for periodontitis staging based on deep learning approaches. Materials and Methods: Multi-Label U-Net and Mask R-CNN models were compared for image segmentation to detect periodontitis using 100 digital panoramic radiographs. Normal conditions and 4 stages of periodontitis were annotated on these panoramic radiographs. A total of 1100 original and augmented images were then randomly divided into a training (75%) dataset to produce segmentation models and a testing (25%) dataset to determine the evaluation metrics of the segmentation models. Results: The performance of the segmentation models against the radiographic diagnosis of periodontitis conducted by a dentist was described by evaluation metrics(i.e., dice coefficient and intersection-over-union [IoU] score). MultiLabel U-Net achieved a dice coefficient of 0.96 and an IoU score of 0.97. Meanwhile, Mask R-CNN attained a dice coefficient of 0.87 and an IoU score of 0.74. U-Net showed the characteristic of semantic segmentation, and Mask R-CNN performed instance segmentation with accuracy, precision, recall, and F1-score values of 95%, 85.6%, 88.2%, and 86.6%, respectively. Conclusion: Multi-Label U-Net produced superior image segmentation to that of Mask R-CNN. The authors recommend integrating it with other techniques to develop hybrid models for automatic periodontitis detection.

• Imaging Science in Dentistry
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• v.52 no.4
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• pp.351-357
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• 2022

Purpose: Convolutional neural networks (CNNs) have rapidly emerged as one of the most promising artificial intelligence methods in the field of medical and dental research. CNNs can provide an effective diagnostic methodology allowing for the detection of early-staged diseases. Therefore, this study aimed to evaluate the performance of a deep CNN algorithm for apical lesion segmentation from panoramic radiographs. Materials and Methods: A total of 1000 panoramic images showing apical lesions were separated into training (n=800, 80%), validation (n=100, 10%), and test (n=100, 10%) datasets. The performance of identifying apical lesions was evaluated by calculating the precision, recall, and F1-score. Results: In the test group of 180 apical lesions, 147 lesions were segmented from panoramic radiographs with an intersection over union (IoU) threshold of 0.3. The F1-score values, as a measure of performance, were 0.828, 0.815, and 0.742, respectively, with IoU thresholds of 0.3, 0.4, and 0.5. Conclusion: This study showed the potential utility of a deep learning-guided approach for the segmentation of apical lesions. The deep CNN algorithm using U-Net demonstrated considerably high performance in detecting apical lesions.

• Imaging Science in Dentistry
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• v.54 no.1
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• pp.25-31
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• 2024

Purpose: The purpose of this study was to clarify the panoramic image differences of cleft alveolus patients with or without a cleft palate, with emphases on the visibility of the line formed by the junction between the nasal septum and nasal floor(the upper line) and the appearances of the maxillary lateral incisor. Materials and Methods: Panoramic radiographs of 238 patients with cleft alveolus were analyzed for the visibility of the upper line, including clear, obscure or invisible, and the appearances of the maxillary lateral incisor, regarding congenital absence, incomplete growth, delayed eruption and medial inclination. Differences in the distribution ratio of these visibility and appearances were verified between the patients with and without a cleft palate using the chi-square test. Results: There was a significant difference in the visibility distribution of the upper line between the patients with and without a cleft palate (p<0.05). In most of the patients with a cleft palate, the upper line was not observed. In the unilateral cleft alveolus patients, the medial inclination of the maxillary lateral incisor was more frequently observed in patients with a cleft palate than in patients without a cleft palate. Conclusion: Two differences were identified in panoramic appearances. The first was the disappearance (invisible appearance) of the upper line in patients with a cleft palate, and the second was a change in the medial inclination on the affected side maxillary lateral incisor in unilateral cleft alveolus patients with a cleft palate.

• Imaging Science in Dentistry
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• v.54 no.2
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• pp.171-180
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• 2024

Purpose: This study was conducted to identify the typical sites and patterns of peri-implant bone defects on cone-beam computed tomography (CBCT) images, as well as to evaluate the detectability of the identified bone defects on panoramic images. Materials and Methods: The study population included 114 patients with a total of 367 implant fixtures. CBCT images were used to assess the presence or absence of bone defects around each implant fixture at the mesial, distal, buccal, and lingual sites. Based on the number of defect sites, the presentations of the peri-implant bone defects were categorized into 3 patterns: 1 site, 2 or 3 sites, and circumferential bone defects. Two observers independently evaluated the presence or absence of bone defects on panoramic images. The bone defect detection rate on these images was evaluated using receiver operating characteristic analysis. Results: Of the 367 implants studied, 167 (45.5%) had at least 1 site with a confirmed bone defect. The most common type of defect was circumferential, affecting 107 of the 167 implants(64.1%). Implants were most frequently placed in the mandibular molar region. The prevalence of bone defects was greatest in the maxillary premolar and mandibular molar regions. The highest kappa value was associated with the mandibular premolar region. Conclusion: The typical bone defect pattern observed was a circumferential defect surrounding the implant. The detection rate was generally higher in the molar region than in the anterior region. However, the capacity to detect partial bone defects using panoramic imaging was determined to be poor.