As Dentomaxillofacial Radiology celebrates 50 years of publication, some former editors who have helped the journal reach this milestone reminisce on their time at the helm of the journal.

As Dentomaxillofacial Radiology celebrates 50 years of publication, some former editors who have helped the journal reach this milestone reminisce on their time at the helm of the journal.

Aims: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Methods: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel’s recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project’s data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project—the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. Results: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive selfreport instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. Conclusion: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations. J Oral Facial Pain Headache 2014;28:6–27. doi: 10.11607/jop.1151

In a recent editorial in this journal, Dr. Daniel Orr II discussed the process of recognition of specialties in dentistry and some of the issues and problems associated with this process. I am a member of the ninth specialty recognized by the American Dental Association (ADA), Oral and Maxillofacial Radiology (OMR) – but not actually in my state of Michigan, which lists by name those specialties it recognizes at the state level. It would require a change in the Public Health Code for me to be considered a specialist in Michigan. How did Oral and Maxillofacial Radiology become an ADA-recognized specialty, and what difference does it make to OMRs and dentistry as a whole? The story began many years ago, long before OMR was finally granted specialty status by the ADA House of Delegates. According to a history timeline published on the website of the American Academy of Oral and Maxillofacial Radiology (AAOMR; http://www.aaomr. org), the first oral radiology organization started in 1921 as the American Society of Dental Radiographers, only twenty five years after the first dental radiograph was made. This organization lasted only a few years before it folded, but a new organization, The American Academy of Dental Roentgenologists, was established in 1949. This organization still exists today as AAOMR, having undergone a number of name changes over the years. The members of the group were, and still are, actively involved in education, research and patient care. In 1968, the Academy filed its first application to the ADA for specialty status, but it was disapproved by the ADA Council on Dental Education. The second application in 1970 was also denied. Further applications for specialty status were then put on hold. Meanwhile, in 1979, the American Board of Oral and Maxillofacial Radiology (ABOMR) was formed. The first diplomates of the Board were recognized by credentials, but in 1983, the Board began administering certifying examinations. I passed the examination in 1984, becoming a Diplomate of the Board. What did this get me? At the time, nothing other than to prove to myself and those who cared that I knew a lot about all the facets of oral radiology: physics, biology, technique, safety, and interpretation. Because OMR was not a recognized specialty, diplomate status did not really change things for me. AAOMR was not ready to give up on the idea of specialty recognition, however. It submitted applications in 1993 and 1995. At the ADA House of Delegates in 1996, OMR became a specialty – for one day. However, the next day the issue was brought up again and the decision overturned. The same application was reconsidered in 1997 – and denied. In 1998, another application for specialty status was submitted, and this time, in 1999, it was approved by the ADA House of Delegates. On October 13, 1999, Oral and Maxillofacial Radiology became the ninth dental specialty recognized by the ADA. What has specialty recognition meant for OMRs and the profession of dentistry? At the beginning, not much was changed. Many dentists did not even realize that OMR had become a specialty. After all, dentists were used to being their own radiologists. The majority had intraoral x-ray machines in their offices, and many were adding panoramic radiography capability, and they felt comfortable with interpreting these images. Maybe not the panoramic view all the time, but then, there was always their old x-ray professor at the dental school they attended, so they could get another opinion – for free – if they needed it. At this point, the majority of OMRs were on the faculty of dental schools, involved primarily in education and research. Some of them established imaging services in their institutions, but in general

Herbert Dean Millard, DDS, MS, first president and cofounder of the Organization of Teachers of Oral Diagnosis; cofounder and co-chair of the World Workshops on Oral Medicine with Sir David Mason, dean of the Royal College of Physicians and Surgeons of Glasgow, Scotland; coauthor (with Donald A. Kerr and Major M. Ash) of the groundbreaking textbook Oral Diagnosis, the 7 editions of which were used in dental schools worldwide; first Chair of the Department of Oral Diagnosis and Radiology at the University of Michigan (U of M) from 1958 to 1987; and faculty member of the U of M School of Dentistry from 1952 to 1989, passed away on June 4th, 2013, in Chelsea, Michigan, with family by his side. He was 89. The cause was complications from Parkinson disease.

Olumide Agbaje Wisam al-Rawi Ebtihal Alabdeen Veeratrishul Allareddy Yoshinori Arai Kazuyuki Araki Masao Araki Eiichiro Ariji Yoshiko Ariji Ulkem Aydin Ria Bogaerts Curtis SK Chen Tohru Chikui Soon-Chul Choi Paulo Henrique Couto Souza Ken-ichiro Ejima Francisco Eraso Ademir Franco Francois Gabioud Tazuko K Goto Koji Hashimoto Yoshihiko Hayakawa Takafumi Hayashi João Cesar Henriques Miki Hisatomi Kazuya Honda Mizue Ida Kazuo Iwai Masahiro Izumi Naoya Kakimoto Takashi Kaneda Akitoshi Katsumata Kouji Katsura Taisuke Kawai Ryota Kawamata Osamu Komiyama Hironobu Konouchi Yusuke Kozai Tohru Kurabayashi Hui Liang Xin Liang Li-Min Lin Xu-Chen Ma David MacDonald-Jankowski Hideyuki J Majima Farah Masood Kunihito Matsumoto Takuya Matsumoto Hidenobu Matsuzaki Kazuyuki Minowa Anastasia Mitsea Mutsumi Miyauchi Jun Murakami Olivia Nackaerts Munetaka Naitoh Takashi Nakamoto Motoyasu Nakamura Shin Nakamura Eiji Nakayama Keiichi Nishikawa Hideyoshi Nishiyama Ichiro Ogura

Veeratrishul Allareddy Yoshinori Arai Kazuyuki Araki Masao Araki Eiichiro Ariji Yoshiko Ariji Sharon L Brooks Tohru Chikui Soon-Chul Choi Ken-ichiro Ejima Allan G Farman Masami Fujishita Koji Hashimoto Yoshihiko Hayakawa Takafumi Hayashi Miki Hisatomi Kazuya Honda Hidehiko Hosoki Mizue Ida Masahiro Izumi Naoya Kakimoto Akitoshi Katsumata Kouji Katsura Taisuke Kawai Ryota Kawamata Hironobu Konouchi Yusuke Kozai Tohru Kurabayashi Li-Min Lin Hideyuki J Majima Hidenobu Matsuzaki Kazuyuki Minowa Shintaro Mori Jun Murakami Munetaka Naitoh Motoyasu Nakamura Shin Nakamura Eiji Nakayama Keiichi Nishikawa Hideyoshi Nishiyama Ichiro Ogura Yasuhiko Okumura Mika Otonari-Yamamoto Vijay Parashar Axel Ruprecht Takashi Sakurai Tsukasa Sano Mayumi Shimizu Akira Taguchi Ray Tanaka Akemi Tetsumura Mamoru Wakoh Hiroshi Watanabe Ann Wenzel Stuart C White Yoshinobu Yanagi Yoshiyuki Yonehara Kazunori Yoshiura

Introduction The purpose of this study was to determine the ability of orthodontists and orthodontic residents to identify nonorthodontic incidental findings and false positives in cone-beam computed tomography scans. Methods Two groups of 10 cone-beam computed tomography scans containing equal numbers of scans with no, 1, or several abnormal nonorthodontic lesions were selected from a database. Eight orthodontists and 8 orthodontic residents screened the 2 groups of scans before and after a basic cone-beam computed tomography training course. The paired t test was used for statistical analyses. Results In the initial screening, the orthodontists and residents correctly identified 41.1% of the lesions. This lesion-detection rate improved significantly to a mean of 56.7% after the training course (P <0.0005). In parallel with these findings, the mean percentage of correctly identified extragnathic lesions improved significantly, from 22% to 48% (P <0.0005), and correctly identified temporomandibular joint lesions improved from 20% to 55% (P = 0.01) after the training. In contrast, the rate of correctly identified dentomaxillofacial lesions remained largely unchanged before and after the training. Both groups of evaluators had approximately 5 false positives per 10 scans before training and demonstrated significant decreases in false positives after training. Conclusions Relative to known error rates in medical radiology, both groups of evaluators had high error rates for missed lesions and false positives before and after training. Given these findings and since the most frequent cause of medical radiology malpractice litigation is due to missed lesions, it is recommended that an appropriately trained radiologist should be involved in reading and interpreting cone-beam computed tomography scans.

Purpose This study was performed to evaluate possible variations in maxillary and mandibular bone texture of normal population using the fractal analysis, particles count, and area fraction in intraoral radiographs. Materials and Methods Periapical radiographs of patients who had full mouth intraoral radiographs were collected. Regions of interest (100×100 pixels) were located between the teeth of the maxillary anterior, premolar, and molar area, as well as the mandibular anterior, premolar, and molar areas. The fractal dimension (FD) was calculated by using the box counting method. The particle count (PC) and area fraction (AF) analyses were also performed. Results There was no significant difference in the FD values among the different groups of age, gender, upper, and lower jaws. The mean FD value was 1.49±0.01. The mean PC ranged from 44 to 54, and the mean AF ranged from 10.92 to 11.85. The values of FD, PC, and AF were significantly correlated with each other except for the upper molar area. Conclusion According to the results, patients with normal trabecular pattern showed a FD of approximately 1.5. Based on these results, further investigation would be recommended if the FD value of patient significantly differenct from this number, since the alteration of this value indicates microstructural modification of trabecular pattern of the jaws. Additionally, with periapical radiographs, simple and cost-effective, PC and AF could be used to assess the deviation from the normal.

OBJECTIVE:To test the accuracy of a mathematical model (algorithm) that corrects measurements made on conventional lateral head films to corresponding dimensions observed in a cone beam computed tomography (CBCT) scan in human subjects.MATERIALS AND METHODS:Thirteen subjects had lateral cephalograms taken with a conventional cephalometric machine as well as a CBCT scan. Measurements of midface length, mandibular length, and lower anterior face height (LAFH) from both examinations were calculated. Two other groups of measurements were derived mathematically from the dimensions directly quantified on the lateral cephalogram: the magnification correction group and the algorithm correction group. The data were analyzed statistically, using repeated measures analysis of variance (ANOVA).RESULTS:All measurements from the lateral cephalogram were significantly different from the corresponding measurements derived from the CBCT. Simply taking into account the image magnification did not correct the 2-dimensional (2D) linear measurement obtained from a conventional cephalogram into a 3-dimensional (3D) linear measurement made on a CBCT scan, unless the structures from which the distance will be measured are located on the midsagittal plane. When the algorithm was used to correct the 2D measurements, however, there were no statistically significant differences between the CBCT group and the algorithm group.CONCLUSIONS:Using the mathematical formula presented herein, 2D cephalometric measurements from landmarks both on and off the midsagittal plane can be corrected into a 3D CBCT measurement with accuracy. By applying this algorithm to other existing cephalometric longitudinal growth studies, control groups and standards for CBCT images could be derived without exposing untreated subjects to radiation.

OBJECTIVES:To study the prevalence and the degree of lingual concavity in the edentulous first molar region from cone beam computed tomography (CBCT) scans of the mandibles.MATERIAL AND METHODS:Qualified cross-sectional images in mandibular first molar edentulous region taken from CBCT were selected. The mandible morphology 2 mm above the inferior alveolar canal (IAC) was classified into the convex (C), parallel (P) and undercut (U) type, based on the presence of lingual concavity and the shape of alveolar ridge. The prevalence of each group was determined. Subsequently, the lingual concavity characters, including the depth, the angulation and the vertical location were determined by the measurements of selected anatomic landmarks.RESULTS:One hundred and three subjects (mean age 51 with a range of 23.7-70.4 years) were studied. The U type was the most prevalent, accounting for 66% of the study population. The mean undercut depth and angulation at the level 2 mm above IAC were on average 2.4 mm and 57.7°. The mean vertical distances from the most prominent point (P) of the lingual concavity to the cemento-enamel junction of second premolar and the inferior border of the mandible were 11.7 and 14.9 mm, respectively.CONCLUSIONS:The anatomic location and the degree of the lingual concavity presented in this article add more information in implant treatment planning in the mandibular first molar edentulous region.

Rod J. Zapolski, Mid Michigan Health Renee K. Myers, Chrysler Group LLC James R. Pedersen, International Union UAW Michael Altman, MD, Marquette General Health System Suresh Mukherji, MD, Vice-Chairperson, University of Michigan Health System Sharon L. Brooks, DDS, MS, Chairperson, Michigan Dental Association Lawrence Ashker, DO, Genesys Regional Medical Center Stephen Meier, Xoran Technologies Inc. David J. Kastan, MD, FSIR, Henry Ford Health System Daniel Shumaker, MD, FA, Michigan Radiological Society Abdalmajid Katranji, MD, Michigan State Medical Society

OBJECTIVES:To compare image quality of intraoral radiographs made with the Nomad portable X-ray unit (Aribex, Inc.) and with a wall-mounted dental X-ray machine in a clinical setting.METHODS AND MATERIALS:Twelve patients requiring a full-mouth radiographic series for diagnostic purposes were recruited for the study, in which half of the radiographs (one side selected randomly) were made with the Nomad and half with a wall-mounted dental X-ray machine. Each individual image was evaluated independently by three reviewers for diagnostic utility and quality, using a three-point scale: 2 = perfect radiograph; 1 = acceptable for diagnostic purposes despite a small error; 0 = unacceptable. A total score was derived for each of the 220 images, each of the 12 patients, and the study population as a whole.RESULTS:The combined quality scores of the three reviewers for each set of radiographs ranged from 22-60 for the Nomad and 21-55 for the control units. Median scores were 33 for the Nomad and 33.5 for the control. The maximum possible score was nine films/half mouth x two points for perfect film x three reviewers = 54 (maximum 66 for 11 films). Three of the films, all on the same patient in a wheelchair, showed motion artifact (two with Nomad, one with control).DISCUSSION:Image quality for radiographs taken with the Nomad and a wall-mounted X-ray machine appears to be similar in a variety of clinical situations. Motion artifact is not a significant issue with the Nomad.

BACKGROUND:This study retrospectively analyzed conventional tomograms to estimate the prognostic value of the cross-sectional ridge morphology on the clinical outcome of guided bone regeneration (GBR).METHODS:Presurgical conventional tomograms of 23 single-implant sites were analyzed retrospectively in 20 patients. All sites had a non-space-making buccal dehiscence defect associated with the subsequently placed dental implant. Simultaneous GBR procedures were performed, and 6-month clinical outcomes were assessed. Measurements at baseline and at the 6-month reentry included defect height (from smooth-rough junction to the most apical part of the defect) and horizontal bone gain at three locations (smooth-rough junction, middle, and most apical portion of the defect). All measurements were taken from a reference template. Tomographic parameters included the implant-associated ridge angle and width measured at 6 mm below the alveolar crest and at the most apical point of the implant. Implant exposure and the presence of the barrier membrane were controlled for during statistical analyses.RESULTS:The presurgical ridge angle had a significant negative correlation with the percentage of defect height reduction (r = -0.621; P = 0.002) and horizontal bone gain (r = -0.469; P = 0.024). This difference remained significant even after controlling for implant/membrane exposure (P = 0.001 and P = 0.019, respectively). A statistically and clinically greater percentage of defect height reduction was observed for ridge angles <28 degrees (P = 0.023). Ridge width did not have a significant effect on the regenerative outcome.CONCLUSION:Cross-sectional presurgical ridge angles may have prognostic value in estimating the outcome of simultaneous GBR.

This article reviews the general principles of radiation biology and dose measurement. Effective doses for typical imaging examinations used in orthodontics include: panoramic, 5.5 to 22 microsieverts (μSv); cephalometric, 2.4 to 6.2 μSv; large field-of-view cone beam CT, 58.9 to 1025.4 μSv. This can be compared with average annual natural background radiation of 3000 μSv/yr. Issues of radiation risk, particularly for children, as well as mechanisms for dose reduction are discussed.

Even low doses of radiation have the potential to cause biologic harm by way of stochastic effects, those, like carcinogenesis, whose probability of occurrence is dependent on radiation dose. Effective radiation doses range from 4-16 mu Sv for panoramic radiographs to 33-150 mu Sv for a full-mouth intraoral series, depending on exact technique used. Effective doses from cone-beam CT vary significantly, depending on the specific equipment used, but in general are much higher than for panoramic radiographs but less than for multidetector CT. Methods to reduce the dose from dental x-ray examinations include the use of selection criteria to determine whether a radiograph is needed, the use of fast image receptors, and increased beam collimation, particularly for children.

Background. Aribex (Orem, Utah) recently developed a portable hand-held dental x-ray machine, the Nomad. At least 1 state radiation safety department has expressed concern about the quality of images made with a hand-held x-ray machine, particularly with respect to patient or operator motion.