Objectives. The aims of this study were to compare radiation absorbed dose (AD) and effective dose (ED) to tissues from cone beam computed tomography (CBCT) scans with 360-degree versus 180-degree rotations with use of different fields of view (FOV), to compare EDs calculated from measured ADs versus dose area product (DAP) values, and to compare doses to the lens of the eye (LOE) from different scan parameters. Study Design. ADs for each protocol were measured in tissues, including the LOE, by using an anthropometric phantom. EDs were calculated on the basis of dosimetry (EDm) and DAP values (EDd). Dose differences were determined with analysis of vari-ance (ANOVA). Results. ADs and EDs were substantially lower for 180-degree rotation scans compared with 360-degree rotation scans (P < .01). Remainder tissues had the greatest effect on effective dose for most FOVs. Doses were generally lower with small FOVs compared with large FOVs. Most EDm values were lower than EDd values in large FOVs but higher in small FOVs. Differences in EDm and EDd were variable and unpredictable. LOE doses were smaller with the 180-degree scans and smaller FOVs. Conclusions. Radiation doses were generally lower with 180-degree rotation scans and smaller FOVs. These parameters should be used for CBCT acquisitions, whenever possible, and should be made available in all units.

Objective: To investigate the value-addition of obtaining lateral cephalometric radiographs during the treatment planning phase of orthodontic treatment. Materials and Methods: The records of 100 orthodontic patients were presented to seven scorers during two phases that were 6 weeks apart. In the first phase, scorers completed a seven-question survey with questions regarding treatment planning. They were given various diagnostic records that did not include a lateral cephalometric radiograph. Six weeks later, the same scorers completed the same survey for the same patient cases with the same diagnostic records that additionally included a lateral cephalometric radiograph. Correlation coefficients were used to calculate intrarater agreement and inter-rater agreement within the study. Results: Cohen's kappa values showed moderate to almost perfect agreement for the majority of survey questions. Intrarater agreement ranged between 0.430 and 1. Cronbach's alpha reliability statistics showed good interrater agreement for all questions in the survey. Agreement ranged from 0.710 to 0.913 across the survey questions. Diagnosing Angle classification of occlusion had the highest level of agreement and differentiating between skeletal and dental malocclusion had the lowest level of agreement. Conclusions: The lateral cephalometric radiograph is not a necessary diagnostic tool for most cases in orthodontic diagnosis and treatment planning. Weighing the usefulness of a lateral cephalometric on a case-by-case basis should be recommended to align with the principle of ALARA (as low as reasonably achievable), especially in a primarily pediatric population.

BackgroundTo determine the root canal morphology of human permanent maxillary and mandibular teeth in a Malaysian subpopulation using cone-beam computed tomography (CBCT).MethodsA total of 208 CBCT images were examined retrospectively. Prevalence of an extra root/canal and internal morphology based on Vertucci's classification were observed in human maxillary and mandibular permanent teeth. Variations in the external and internal morphology were compared in relation to gender and tooth side (left vs right) using Pearson Chi-square and Fisher's exact tests with significance level set at p<0.05.ResultsIn the maxillary arch, the prevalence of three canals were observed in 0.3% of first premolars and two canals in 46.5% of second premolars. Males displayed significantly higher prevalence of two canals in maxillary second premolars than females (p<0.05). The prevalence of a second mesiobuccal canal in maxillary first and second molars were 36.3 and 8.5%, respectively. Males displayed significantly higher prevalence of a second mesiobuccal canal in maxillary second molars than females (p<0.05). The prevalence of a second palatal canal in maxillary first and second molars were 0.9 and 0.6%, respectively. In the mandibular arch, the prevalence of two canals were observed in 5.1% of central incisors, 12.3% of lateral incisors, 6.1% of canines, 18.7% of first premolars and 0.5% of second premolars. The prevalence of a middle mesial canal, second distal canal and extra root (radix entomolaris) were detected in 1.9, 19.5 and 21.4% of mandibular first molars, respectively. The prevalence of a C-shaped canal was observed in 48.7% of mandibular second molars. Females displayed significantly higher prevalence of a C-shaped canal in the right mandibular second molars than males (p<0.05). No other statistically significant differences in root anatomy and root canal morphology were observed in relation to gender and tooth side.ConclusionsWide variations in the root canal morphology exist among Malaysians. CBCT is a clinically useful tool in the identification of external and internal morphological variations in the human teeth.

OBJECTIVES:Cone beam CT scans in current day dental practice are highly collimated yet involve areas along the course of the extracranial carotid artery. Detecting an extracranial carotid calcification on small volume scans leaves the dentist with two questions: whether the patient is likely to have intracranial carotid calcifications and whether the patient warrants further medical attention. This study aimed to assess the presence of intracranial carotid artery calcifications (ICAC) in the presence of extracranial carotid artery calcifications (ECAC).METHODS:450 CBCT scans were retrospectively evaluated for ECAC and ICAC. Erby et al's classification was modified to classify calcifications as mild, moderate, and severe. The presence of ICAC when ECAC were present was evaluated in all three orthogonal planes. The risk of ICAC in the presence of ECAC was calculated as odds ratio and the association between the two was calculated using a χ2 test.RESULTS:The odds ratio for bilateral ICAC in the presence of bilateral ECAC was 15.09. The odds ratio for left ICAC/right ICAC in the presence of left/ right ECAC was 0.833 and 2.564, respectively. The number and severity of calcifications increased with age. The χ2 test showed that there was a strong association (p < 0.001) between bilateral ECAC with bilateral ICAC.CONCLUSIONS:The results of this group of patients showed that there is an increased presence of ICAC in the presence of ECAC.

Objective: Several incidental findings with varying degrees of clinical significance are often found on cone beam computed tomography (CBCT) scans of the maxillofacial skeleton acquired for dental procedures. The present study analyzed CBCT scans of dental implant therapy patients to identify incidental findings and assign those findings an appropriate clinical significance. Method and Materials: A total of 500 CBCT scans of patients were evaluated for this study. The incidental findings recorded in different anatomical regions were assigned a clinical significance score of mild, moderate, or severe. These findings were further segregated based on age and sex to evaluate specific trends for prevalence of incidental findings and their clinical significance. Results: Out of the 298 intracranial findings, four were categorized as moderate. Out of 407 sinonasal findings, 19 were categorized as severe. Most (43%) of the airway findings were classified as mild. Among the cervical vertebrae findings the severe category included degenerative changes and vertebral-body fusion along with other degenerative changes. Most (259 [51.8%]) of the vascular findings were categorized as severe. Conclusion: Patients referred for dental implant treatment present with a myriad of incidental radiographic findings in the head and neck region. It is important that care providers recognize and understand these findings so appropriate care and timely intervention may be initiated.

Background: Oral lichen Planus (OLP) is a chronic inflammatory mucocutaneous disease with an uncertain etiology. OLP is predominantly seen in middle aged women. The symmetric lesions of OLP are often accompanied by burning sensation. The lesions have a low risk of malignant transformation. This study aims to describe the clinical characteristics among patients visiting the out-patient department. Material and Method: This study was conducted for a duration of 1 year. Patients diagnosed with OLP according to the modified WHO diagnostic criteria and histopathological examination were included in the study. Demographic data, detailed history and clinical findings of the patients with OLP were recorded. Results: Among a total of 15,670 individuals examined, 8973 (57.26%) were male and 6877 (42.74%) were female. Patients diagnosed with OLP were 85, among whom 44 (51.8%) were female and 41 (48.2%) were male. The overall prevalence of OLP is 0.54%. Symptomatic OLP was noted in 77.6 % of the patients. The most frequently affected oral sites were buccal mucosa, tongue and gingiva. The most frequently associated systemic diseases were diabetes and hypertension. Conclusion: The data observed is mostly similar to previous studies reported. Difference in geographic area and number of enrolled patients may justify the observed differences.

PURPOSE:Pineal gland calcification has been proposed to play a role in the pathogenesis of Alzheimer disease. This study evaluated the prevalence and extent of pineal gland calcification in cone-beam computed tomography (CBCT) scans of patients referred for dental implant therapy who could possibly be a vulnerable group for this condition.MATERIALS AND METHODS:A retrospective evaluation of 500 CBCT scans was conducted. Scans that showed the area where the pineal gland was located were included. The scans were initially screened by a single observer to record the prevalence and extent of calcification. Six weeks following the completion of the study, another investigator randomly reviewed and selected 50 scans to investigate inter-observer variation, which was evaluated using reliability analysis statistics. The prevalence and measurements of the calcifications were reported using descriptive statistics. The chi-square test was used to compare the prevalence between males and females.RESULTS:The prevalence of pineal gland calcification was 58.8%. There was no statistically significant correlation between age and the extent of the calcification. The prevalence of calcification was 58.6% in females and 59.0% in males. The average anteroposterior measurement was 3.73±1.63 mm, while the average mediolateral measurement was 3.47±1.31 mm. The average total calcified area was 9.79±7.59 mm2.CONCLUSION:The prevalence of pineal gland calcification was high in patients undergoing implant therapy. While not all pineal gland calcifications lead to neurodegenerative disorders, they should be strongly considered in the presence of any symptoms as a reason to initiate further investigations.

Forensic odontology plays a vital role in the identification and age estimation of unknown deceased individuals. The purpose of this study is to estimate the chronological age from Cone-Beam Computed Tomography (CBCT) images by measuring the buccal alveolar bone level (ABL) to the cemento-enamel junction and to investigate the possibility of employing the age-related structural changes of teeth as studied by Gustafson. In addition, this study will determine the forensic reliability of employing CBCT images as a technique for dental age estimation. A total of 284 CBCT images of Malays and Chinese patients (150 females and 134 males), aged from 20 years and above were selected, measured and stages of age-related changes were recorded using the i-CAT Vision software. Lower first premolars of both left and right side of the jaw were chosen and the characteristics described by Gustafson, namely attrition, secondary dentine formation and periodontal recession were evaluated. Linear regression analysis was performed for the buccal bone level and the R values obtained were 0.85 and 0.82 for left and right side respectively. Gustafson's characteristics were analysed using multiple regression analysis with chronological age as the dependent variable. The results of the analysis showed R values ranged from 0.44 to 0.62. Therefore it can be safely concluded that the buccal bone level highly correlated with the chronological age and is consequently the most suitable age-related characteristic for forensic age estimation.

Background: Determining margin status is the key in management of oral squamous cell carcinoma, indicating risk of local recurrence and guiding the use of adjuvant therapy. Frozen sections are commonly employed intraoperatively to assess the adequacy of resections. There is however no standard approach as to how frozen sections are used. A practice based survey was carried out in an attempt to establish consensus between surgeons and pathologists with regards to margin sampling and acceptable surgical margins. Methods: A questionnaire consisting of twelve questions was sent to surgical oncologists in various head and neck cancer centers in India. It was divided into two main subsets: 1) The definition of surgical margins and 2) The use of frozen sections to evaluate tumor margins. Results: Of 440 surveys mailed, 50 completed surveys were received. Majority of responses stated that acceptable clear margins varied according to site, and individual patient factors. Macroscopically clear surgical margins ranged between 0.5-1.5 cm. Best practice for intraoperative margin assessment was frozen tissue analysis of the entire specimen. The majority of responses for choice of sampling site were for both the surgical bed and tumor margin. The overwhelming majority defined microscopically clear margins as 5 mm of tissue or more without tumor. Conclusion: No standard guidelines and strategies exist among head and neck surgeons about the definition of clear margins and the practice patterns. However, these results have to be applied on a larger sample size in order to validate and authenticate our findings. (C) 2017 Published by Elsevier Ltd on behalf of Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI.

PURPOSE:With the advent of cone-beam computed tomography (CBCT) for maxillofacial imaging, there has been a paradigm shift from two dimensional panoramic radiography to three dimensional imaging. This study investigated the microanatomy of the maxillary permanent first molar socket and its relationship to the floor of the maxillary sinus, especially for immediate or early implant placement.MATERIALS AND RESULTS:Sixty CBCT scans of 30 Malay and 30 Chinese subjects were selected from over 300 archived images. Ninety-five percent of the subjects had sinus floor extending anterior to the first molar, while 72% had the floor dipping between the roots. Seventy-five percent of the patients had inter-radicular bone and almost 50% had intrusion of root apices into the floor of the maxillary sinus. The dimensions of the socket were as follows: the mean width was 11.42 ± 0.86 mm; the mean length was 7.70 ± 0.56 mm; the mean height on the coronal plane was 6.48 ± 3.77 mm while on the sagittal plane it was 6.85 ± 3.67 mm.CONCLUSIONS:Any implant length greater than the mean height of the socket (approximately 7 mm) has a fair chance of perforation into the maxillary sinus if placed without any additional adjunct procedures. In addition, 50% of the apices opened into the maxillary sinus, thereby risking the creation of perforations or root displacements into the maxillary sinus during exodontia-mandating CBCT scanning prior to any surgical implant procedures.

Hypercementosis is excessive deposition of non-neoplastic cementum over normal root cementum, which alters root morphology. This cementum may be either hypocellular or cellular in nature. The aetiopathogenesis of hypercementosis is ambiguous. Although most of the cases are idiopathic, several local and systemic factors are also linked to this condition, such as Paget's disease, acromegaly, vitamin A deficiency, etc. We report two rare cases of hypercementosis associated with systemic lupus erythematosus, not previously described in the literature, and also discuss the possible aetiopathogenesis.

S100A4, a biomarker of epithelial mesenchymal transition (EMT), plays an important role in invasion and metastasis by promoting cancer cell motility. In oral squamous cell carcinoma (OSCC), metastasis results in 90% of cancer associated mortality. Objective To investigate the role of S100A4 expression as an important component of the epithelial mesenchymal transition (EMT) program in oral squamous cell carcinoma (OSCC). Material and Methods S100A4 protein expression was assessed semi-quantitatively by immunohistochemistry in 47 histologically confirmed cases of oral squamous cell carcinoma (OSCC) and 10 normal oral mucosal biopsies. The association between the S100A4 overexpression and the aggressive features of OSCC were analyzed by X2 test. Results Moderate to strong cytoplasmic expression of S100A4 was observed in 30 out of 47 specimens of OSCC (64%). Overexpression of S100A4 was significantly associated with the clinical stage, lymph node involvement, metastases, pattern of invasion and recurrence (p<0.05). Conclusion S100A4 expression represents an important biomarker of prognostic significance that may be used to identify a subset of patients at high risk of invasion and metast

BACKGROUND Oral leukoplakia is a potentially malignant disorder of the oral cavity. Leukoplakias with chances of undergoing malignant transformation owing to the presence of dysplastic changes may not be clinically distinguishable from leukoplakias without dysplasia. The study was carried out to evaluate the usefulness of biopsy in assessing the clinico-pathologic correlations of oral leukoplakia at the patient's initial visit. MATERIALS AND METHODS Hospital records with clinical diagnosis of oral leukoplakia were retrospectively analysed. All these patients had undergone biopsy in their initial visit. Histopathological slides were reviewed and reported by a single pathologist. Diagnosis agreement was considered to be present if the clinical diagnosis matched the histopathological diagnosis. Misdiagnosis was considered if the clinical diagnosis did not match the histopathological diagnosis and underdiagnosis when malignancy was detected on histopathological examination. RESULTS A total of 115 patients were clinically diagnosed with oral leukoplakia. According to clinical appearance of the leukoplakia patch was categorized in to three types viz homogeneous leukoplakia (n= 24 i.e. 20.87%), speckled leukoplakia (n=76 i.e. 66.08%) and verrucous leukoplakia (n=15 i.e. 13.04%). Histopathological examination confirmed clinical diagnosis in 88 cases (a diagnosis agreement of 76.52%). Histopathological examination of 19 cases revealed a different diagnosis, thus categorized as misdiagnosis (16.52%) and 8 cases had unexpected malignancy which accounted for underdiagnosis in 6.96% cases. There was dysplasia in 45 (51.13%) of the histopathologically confirmed cases of leukoplakia. CONCLUSION The clinical appearance of suspicious white lesions does not provide a true nature of its disease status and malignant changes may be missed.

AIM:To highlight the importance of considering tuberculosis in the differential diagnosis even in the absence of confirmation from several investigations and diagnostic aides.BACKGROUND:Tuberculosis is a common infectious granulomatous disease caused by various strains of mycobacteria. An oral lesion when seen in association with tuberculosis is very rare and in most cases is noticed secondary to pulmonary forms.CASE REPORT:We report a case of primary gingival tuberculosis in 20-year-old female patient who presented with treatment resistant gingivitis. Patient had no evidence of disease elsewhere in the body and several diagnostic tests also failed to reveal the presence of the causative organism. Resolution of gingivitis was noted following a therapeutic trial of antitubercular drugs.CONCLUSION:Therefore the importance of including tuberculosis in the differential diagnosis of inflammatory disorder of the gingiva is very essential in order to avoid one of the most lethal forms of infections often overlooked.CLINICAL SIGNIFICANCE:It is essential to consider tuberculosis as one of the differential diagnosis in India even when several diagnostic tests are negative for tuberculosis.

BACKGROUND:Identification is of paramount importance in any forensic investigation. Positive identification of living or deceased using distinctive traits is a cornerstone of forensic science. The uniqueness of these patterns and subtle distinction between traits has offered worthy supplemental tools in establishing the true nature of facts.AIM:The first aim of our study was to determine the most common pattern of lip prints, palatal rugae, and finger prints in the study subjects. Secondly, to determine if any specific pattern of lip print, palatal rugae, or the finger print concurs in individuals, and thereby establish a database of these prototypes for human identification from a defined cohort.MATERIALS AND METHODS:The sample size comprised 100 female students of a dental college staying together in the hostel. Lip prints were recorded on a white bond sheet using lipstick, palatal rugae on dental casts, and finger prints using printer's blue ink.RESULTS:Our observation suggested that the reticular pattern of lip print, the wavy pattern of palatal rugae, and the loop pattern of finger prints were the predominant patterns. Correlation of the three parameters did not reveal significant differences.CONCLUSIONS:This approach of human identification utilizing conventional techniques and relevant parameters is pertinent in defined groups. However, larger representative sample with robust analytical tools may provide a necessary blueprint of human identification.

Odontogenic tumors are a group of heterogeneous lesions, features of which have been catalogued for several decades. Adenomatoid odontogenic tumor (AOT) is a relatively rare and distinct odontogenic tumor that is exclusively odontogenic epithelium in origin. Although considerable number of reports is available with regard to the clinical and histological spectrum of AOT, very few have highlighted its varied histological presentations. Therefore, this article focuses on the assorted histoarchitectural patterns of AOT.

Benign Cementoblastoma is a rare tumor of Odontogenic ectomesenchyme origin characterized by proliferation of cementum-like tissue. The neoplasm is closely related to and partly surrounds the roots of teeth. In most cases, this lesion is asymptomatic and was considered as an indolent lesion for several years. Nevertheless, recent studies have demonstrated that some cementoblastoma may exhibit an aggressive biological behavior and can affect several teeth. An unusual case of benign cementoblastoma that was clinically extensive, involving multiple deciduous and permanent teeth is presented. This report also corroborates with some papers that have demonstrated the aggressive behavior of cementoblastomas.

Rabson-Mendenhall syndrome is a rare, autosomal recessive disorder characterized by insulin resistance syndrome, growth retardation, coarse and senile-looking faces, mental precocity, early dentition, and pineal hyperplasia. Mutations of the insulin receptor gene affecting insulin action appear to be the basic mechanism underlying this syndrome. We report on Rabson-Mendenhall syndrome in two siblings and briefly review the literature.