Purpose: The purpose of this study was to find the relationship among the joint status, pain and effusion in patients with temporomandibular joint disorders. Materials and Methods: Materials included 406 patients (812 joints) with clinical records and bilateral TMJ MRIs in TMJ clinic, Yongdong Severance Hospital. All joints were classified in 4 groups in MR images according to the disc status of joint; normal disc position, disc displacement with reduction (DDcR), early and late stage of disc displacement without reduction (DDsR), and also 2 groups according to the bony status of joint; normal bony structure and osteoarthrosis. MR evidence of joint effusion was categorized in 4 groups according to its amount. To determine the relationship between joint pain and joint effusion, 289 patients with unilateral TMJ symptoms were selected from total materials. Result: Joint effusion was found 8.0% in normal disc position, 32.6% in DDcR, and 59.2% in DDsR (83.1 % in early state and 23.1 % in late stage). Joint effusion was found 39.7% in osteoarthrosis and 35.0% in normal bony structure. Joint effusion was more found in the painful joints (49.8%) than in the painless joints (22.4% )(p<0.001). Joint effusion in the early stage of DDsR only was more found significantly in painful joints (91.9%) than in painless joints (62.1 %) (p<0.001). Conclusion : MR evidence of joint effusion might be related to disc displacement regardless of the presence of osteoarthrosis, and the early stage of DDsR was found more frequently combined with joint effusion and joint pain.
Purpose: To evaluate the effect of the slice thickness and the size of region of interest (ROI) on CT number using quantitative CT phantom Materials and Methods: The phantom containing 150 mg/cc, 75 mg/cc and 0 mg/cc calcium hydroxyapatite was scanned with 1, 3, 5 and 10 mm slice thicknesses by single energy quantitative computed tomography (QCT). CT numbers were measured on center position of the phantom. Shape of ROI was circular and sizes were 1, 3, 5, 11, 16, 21, 26 and 33 mm². ANOVA and Tukey's multiple comparison method were performed for statistical comparison of CT numbers according to different slice thicknesses. Coefficient of variation of CT number measured in each size of ROI was evaluated in same slice thickness. Results : CT numbers had statistically significant difference according to slice thicknesses (p<0.05). As the slice thickness increased, CT number also increased. As the density of phantom became lower and the size of ROI became smaller, the coefficient of variation of CT number increased. When the size of ROI was more than 11 mm² in 1 mm slice thickness, 5 mm² in 3 mm slice thickness and 3 mm² in 5 mm slice thickness, the coefficient of variation became consistent. In 10 mm slice thickness, the size of ROI had little effect on the coefficient of variation. Conclusion: CT number had variation according to the slice thickness and the size of ROI although the object was homogeneous. The slice thickness and the size of ROI are critical factors in precision of the CT number measurements.
Purpose: To observe the histologic pattern of healing in molar tooth extraction sockets of streptozotocin-induced diabetic rats following irradiation. Materials and Methods: Mature Sprague-Dawley rats were divided into three groups: control, diabetic, and diabetic-irradiated groups. Diabetes mellitus was induced by injecting streptozotocin. Control rats were injected with a citrate buffer only. After 5 days, the right maxillary first molar was extracted under general anesthesia from each of the rats. After the extraction, rats in the diabetic-irradiated group were irradiated with a single absorbed dose of 10 Gy to the head and neck region. The rats were killed at 1, 3, 7, 14, 21, and 28 days after treatment. Tissue sections were stained with hematoxylin-eosin and Masson's trichrome. Results: In the diabetic and diabetic-irradiated groups, the early healing process of the socket extraction was similar to the control group, but bone formation was delayed at 7 days after the treatment. In the diabetic-irradiated group, alveolar bone surrounding the extraction socket showed signs of necrosis at 3 days after treatment, and hemorrhage was observed in connective tissue within the extraction socket at 14 days after treatment. Conclusion: This experiment revealed that the healing process of the extraction socket was severely delayed and retarded by irradiation in the diabetic state.
Purpose : To evaluate the differences in bone height, bone width, and visibility of posterior spiral tomographic images according to various exposure directions, image layer thickness, and inclination of the mandibular inferior border. Materials and Methods: Six partially and completely edentulous dry mandibles were radiographed using Scanora spiral tomography. Spiral tomography was performed at different exposure directions (dentotangential and maxillotangential projection), image layer thicknesses (2 mm, 4 mm and 8 mm), and at various inclinations to the mandibular border (+ 100, 00 and -10°). The bone height and width was measured using selected tomographic images. The visibility of mandibular canal, crestal bone, and buccal and lingual surfaces were graded as 0, 1, or 2. Results : The bone width at the maxillo-tangential projection was wider than at the dento-tangential projection (p < 0.05). The visibility of buccal and lingual surface at the maxillo-tangential projection was higher than at the dento-tangential projection (p<0.05). Thinner image layer thicknesses resulted in greater visibility of buccal and lingual surfaces (p < 0.05). Bone height was greatest in the -10° group, and at the same time the bone width of the same group was the narrowest (p < 0.05). The visibility of alveolar crest and buccal surface of the + 10° group was the highest, while the visibility of the mandibular canal was greatest in the 00 group. Conclusion: When spiral tomography is performed at the mandibular posterior portion for visualization prior to implant surgery, it is important that the inferior border of mandible be positioned as parallel as possible to the floor. A greater improvement of visibility can be achieved by maintaining a thin image layer thickness when performing spiral tomography.
Purpose : To determine if ultrasonography is a reliable technique to assess masseter muscle sites within intra- and interobserver and the scanning level and/or the muscle condition affect local cross-sectional dismension (LCSD) measurements of masseter muscle. Materials and Methods : 10 subjects without sign and symptom of temporomandibular disorders and missing posterior teeth were examined by ultrasonography. Bilateral ultrasonographic examinations were performed with a linear (B-scan) 7.5 MHz small-part transducer to register LCSDS of the masseter muscle on three different levels. Scans were made on relaxed and clenching condition. Three oral and maxillofacial radiologists measured at two sessions with a time interval of at least 5 minutes. Results : Variables such as 'condition' and 'level' had a significant effect on muscle measurements (p<0.05). There was no significant difference between 'sessions'(p>0.05) and 'observers' (p>0.05). LCSDS on lower scan level were significantly thinner than those on upper and middle level. Those on clenching condition were significantly thicker than those on relaxed condition (p<0.05). The scanning level with the highest reproducibility was middle with clenching condition (ICC=0.90, $MSE=0.55\%$). Conclusion : The data suggested that ultrasonography was a reliable method for measuring LSCD of masseter muscle in intra- and Interobserver and middle scan level showed the most reliable data.
Purpose: This study evaluated the association between cone beam computed tomography (CBCT) and panoramic radiographs in the assessment of a superimposed relationship between the mandibular canal and impacted third molars. Materials and Methods: The study samples consisted of 175 impacted third molars from 131 patients who showed a superimposed relationship between the mandibular canal and third molars on panoramic radiographs and were referred for the examination of the mandibular canal with CBCT. Panoramic images were evaluated for the darkening of the root and the interruption of the mandibular canal wall. CBCT images were used to assess the buccolingual position of the mandibular canal relative to the third molar, the proximity of the roots to the canal, and lingual cortical bone loss. The association of the panoramic and CBCT findings was examined using a Chi-square test and Fisher's exact test. Results: Panoramic radiographic signs were statistically associated with CBCT findings (P<0.01). In cases of darkening roots, lingual cortical bone loss or buccally positioned canals were more frequent. In cases in which the mandibular canal wall was interrupted on panoramic radiographs, contact or lingually positioned canals were more frequent. Conclusion: The results of this study suggest that contact between the mandibular third molar and canal and a lingually positioned canal could be more frequently observed in cases of the interruption of the white line of the mandibular canal and that there could be more lingual cortical loss in cases of darkening roots.
Purpose: This study was performed to investigate the prevalence, morphology, and calcification pattern of the elongated styloid process in the Mathura population and its relation to gender, age, and mandibular movements. Materials and Methods: The study analyzed digital panoramic radiographs of 2,706 adults. The elongated styloid process was classified with the radiographic appearance based on the morphology and calcification pattern. The limits of mandibular protrusion were evaluated for each subject. The data were analyzed by using a Student's t-test and chi-squared test with significance set at p=0.05. Results: Bilateral elongation having an "elongated" type styloid process with a "partially mineralized" pattern was the most frequent type of styloid process. No correlation was found between styloid process type and calcification pattern on the one hand and gender on the other, although elongated styloid was more prevalent in older and male populations (p<0.05). Further styloid process elongation showed no effect on mandibular protrusive movement (p>0.05). Conclusion: Dentists should recognize the existence of morphological variation in elongated styloid process or Eagle syndrome apparent on panoramic radiographs. We found higher prevalence of elongated styloid process in the population of the Mathura region when compared with other Indian populations. The calcification of the styloid process was more common in the older age group with no correlation to gender, mandibular movement and site. "Type I" with a "partially calcified" styloid process was observed more frequently in the population studied.
Purpose : The purpose of this study was to examine the inferior expansion of the maxillary sinus floor following maxillary molar extraction. Materials and Methods : Cone beam computed tomographic images of 59 subjects were used to evaluate the height difference of the maxillary sinus floor between extraction sites and contralateral dentate sites. The height of the maxillary sinus floor was defined as the vertical distance to the Frankfort plane from the level of the anterior nasal spine to the most inferior point of the sinus floor. We examined the difference in sinus pneumatization according to the number of missing teeth and the vertical relationship of the molar roots to the sinus floor. Results : The inferior expansion of the maxillary sinus floor was $1.20{\pm}1.86\;mm$ on the maxillary first molar and $1.90{\pm}2.42\;mm$ on the maxillary second molar. Increased expansion was observed in cases where two proximate molars were extracted. There was no significant difference in sinus pneumatization following extraction according to the vertical relationship of the molar roots to the sinus floor. Conclusion : The results of this study confirm that sinus pneumatization occurs following maxillary molar extraction. In situations where pneumatization can affect treatment after molar extraction, three-dimensional radiography should be considered.
Purpose : To compare the CT numbers on 3 cone-beam CT (CBCT) images with those on multi-detector CT (MDCT) image using CT phantom and to develop linear regressive equations using CT numbers to material density for all the CT scanner each. Materials and Methods : Mini CT phantom comprised of five 1 inch thick cylindrical models with 1.125 inches diameter of materials with different densities (polyethylene, polystyrene, plastic water, nylon and acrylic) was used. It was scanned in 3 CBCTs (i-CAT, Alphard VEGA, Implagraphy SC) and 1 MDCT (Somatom Emotion). The images were saved as DICOM format and CT numbers were measured using OnDemand 3D. CT numbers obtained from CBCTs and MDCT images were compared and linear regression analysis was performed for the density, $\rho$ ($g/cm^3$), as the dependent variable in terms of the CT numbers obtained from CBCTs and MDCT images. Results : CT numbers on i-CAT and Implagraphy CBCT images were smaller than those on Somatom Emotion MDCT image (p<0.05). Linear relationship on a range of materials used for this study were $\rho$=0.001H+1.07 with $R^2$ value of 0.999 for Somatom Emotion, $\rho$=0.002H+1.09 with $R^2$ value of 0.991 for Alphard VEGA, $\rho$=0.001H+1.43 with $R^2$ value of 0.980 for i-CAT and $\rho$=0.001H+1.30 with $R^2$ value of 0.975 for Implagraphy. Conclusion: CT numbers on i-CAT and Implagraphy CBCT images were not same as those on Somatom Emotion MDCT image. The linear regressive equations to determine the density from the CT numbers with very high correlation coefficient were obtained on three CBCT and MDCT scan.
Purpose : Stroke is one of the leading causes of death in Korea. Atherosclerotic disease in the carotid artery bifurcation is the most common cause of stroke. The carotid artery calcification is easily appreciated by CT (Computed tomography). CT is often taken in a dental hospital for the diagnosis of inflammation, injury, cyst or tumor on maxillofacial region. However, there was no report of carotid artery calcification on CT in dental patients. This study was to determine the prevalence of carotid artery calcification on CT in dental patients. Materials and Methods : The presence of carotid artery calcification was evaluated by an experienced radiologist on CT scans of 287 patients (166 males, 121 females, average age 42, range 6 to 86 years) and the medical history of the patient and the interpretation of CT were reviewed. Results : Carotid artery calcification was detected on CT scans of 57 patients (19.8%; 35 males, 22 females). All the male patients with carotid artery calcification were older than 50, and all the female patients with carotid artery calcification were older than 60. Among the 57 patients, 10 had Diabetes mellitus, 20 had cardiovascular disease, 3 had history of stroke and 3 underwent radiation therapy for head and neck cancer. Carotid artery calcification was not included in the interpretation of CT of dental patients except one patient. Conclusion : The prevalence of carotid artery calcification on CT of dental patients was about 20% in this study. Carotid artery calcification should be included in the interpretation of CT of dental patients.
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