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   Table of Contents - Current issue
May-August 2019
Volume 7 | Issue 2
Page Nos. 21-48

Online since Tuesday, October 1, 2019

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Audit of the quality of intraoral periapical radiograph: An institutional study p. 21
Sunita Shankarrao Patankar, Freny R Karjodkar, Kaustubh P Sansare, Shalvi Vora
Objectives: To reduce the radiation exposure to patients, to improve the diagnostic proficiency of radiographs, and to collect data which will help decide the action of improvement in performance. Materials and Methods: The audit consisted of two cycles: Audit Cycle 1 analyzed randomly selected 400 recently taken intraoral periapical (IOPA) radiograph and the quality of each film was recorded according to subjective quality rating of radiograph given by the national board of radiation protection (NPRB) guidance and put them into Grades 1, 2, or 3. Audit Cycle 2 radiographs from Grades 2 and 3 were further randomly reevaluated to determine the causes of error and these are classified into faults due to positioning, exposure, and chemical processing. Frequency (n) and percentage (%) of outcome of various grades overall and with respect to independent variables will be compared using Chi-square test. Results: Of the 400 IOPA radiographs, 180 (45%) score Grade 1, 165 (41.3%) score Grade 2, and 55 (13.8%) score Grade 3. In Grade 2, IOPA radiographs of 163 (40.7%) were found to be positioning error, 45 (11.2%) exposure error, and 9 (5.5%) chemical processing. In Grade 3 (out of 57 IOPA), radiographs were rejected due to positioning faults in 45 (28.8%), exposure error in 7 (4.3%), and chemical processing in 3 (1.8%). Conclusion: The overall quality of radiographs was not found to be satisfactory when compared with standard recommendations of the National Board of Radiation Protection of UK. When the audit of the quality was done at regular intervals, it can be used as a guide to effective dose reduction and reduction of unnecessary irradiation of the patients and staff.
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Association between impacted mandibular third molar and occurrence of mandibular angle fracture: A radiological study p. 25
Karpal Singh Sohal, Jeremiah Robert Moshy, Sira Stanslaus Owibingire, Elison N M. Simon
Background: Presence of an impacted mandibular third molar contributes to the weakness of the angle region of the mandible and increases the risk of its fracture. The influence of the presence of impacted mandibular third molars on the occurrence of angle fractures is, however, imprecisely estimated despite boundless research on this subject. Aim: To determine the influence of impacted third molars on the incidence of mandibular angle fractures. Materials and Methods: This was a retrospective study of panoramic radiographs (orthopantomogram [OPG]) that were taken at the Radiology Unit of the Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, for 2 years. The collected data included presence of fracture of mandibular angle, presence/absence of impacted lower third molar, and classification of impacted tooth. Data were analyzed using Statistical Package for the Social Sciences software Version 22. A significant level of P < 0.05 was considered. Results: Two-hundred and sixty-eight OPGs were studied. Fracture of the mandibular angle was in about a quarter (25.4%) of them. According to Winter's classification, 44.3% of the impacted teeth had mesioangular inclination, and by Pell and Gregory's classification, 72.2% and 60.8% of the impacted teeth were in Class II and Position A, respectively. In more than half (59.7%) of the fractures of mandibular angle, there was the presence of impacted mandibular third molars. The odds of sustaining fracture to the angle of mandible was about nine times higher in the presence of an impacted lower third molar (odds ratio 8.7, 95% confidence interval: 4.71–16.11). Conclusion: The presence of impacted third molars increases the risk of mandibular angle fracture; however, the classification of impacted tooth by Winter's or Pell and Gregory's methods had no significant role in occurrence of the mandibular angle fracture.
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Characteristics of the patients with temporomandibular joint effusion on magnetic resonance imaging p. 30
Ichiro Ogura, Fumi Mizuhashi, Yoshihiro Sugawara, Makoto Oohashi, Hirokazu Sekiguchi, Hisato Saegusa
Background: Magnetic resonance imaging (MRI) is widely used in the region of temporomandibular joint (TMJ), particularly to examine disc position and configuration, posterior disc attachment, and mandibular marrow status and to assess the presence of TMJ effusion. Aims: The aim of this study is to investigate the characteristics of the patients with TMJ effusion on MRI. Materials and Methods: MR images of 98 TMJs of 49 patients with temporomandibular disorders were evaluated in this study. The patients with TMJ effusion were concerning age, gender, TMJ pain, disc displacement with or without reduction, and osteoarthrosis. Results: The incidence of the patients with TMJ effusion was significantly different between male (19.2%) and female (51.4%, P = 0.005) and between TMJ pain present (53.7%) and absent (29.5%, P = 0.024), respectively. Logistic multivariate regression analysis demonstrated that gender (odds ratio = 4.188, P = 0.012) and TMJ pain (odds ratio = 2.704, P = 0.027) were significant in patients with TMJ effusion. Conclusions: This study suggests that characteristics of the patients with TMJ effusion include female and TMJ pain.
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Intraoperative three-dimensional imaging in the management of orbital trauma p. 34
Ravi Chandran, Pia Chatterjee Kirk, Walter Moses
Background: Intraoperative three-dimensional (3D) imaging can be utilized to detect bone malpositioning during facial fracture repair. Aim: This article exhibits a case of left Zygomatic maxillary complex fracture that was repaired with the aid of intraoperative 3D imaging technology. Methods: A critical size orbital floor defect was apparent on the imaging, necessitating an immediate repair avoiding a second-revision surgery. Results and Conclusion: The use of 3D imaging has historically been underutilized due to financial and time constraints. However, when comparing to costs and time utilized to undergo a second surgery, usage of 3D imaging intraoperatively is beneficial to the patient, team, and the institution.
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Interdisciplinary management of a patient with a gummy smile p. 38
Mohamed Moataz Khamis, Aly Ahmed Abdelrehim
This article describes the novel use of cone-beam computed tomography (CBCT) to predictably plan a crown-lengthening procedure without osseous contouring. The method aimed to achieve maximum incisal tooth reduction while avoiding endodontic treatment as a method for conservative management of a patient with excessive gingival display. Managing the case involved performing gingivoplasty without osseous recontouring. Prosthetic reconstruction was also performed to replace the missing canines and adjust the incorrect position of the maxillary incisors. A CBCT was used to precisely locate the alveolar bone level and pulp chamber level to avoid the risk of pulp exposure during tooth preparation. Laser was used to perform gingivoplasty. Computer-aided design/Computer-aided manufacturing technology was used to construct all-ceramic restorations making the use of smile design and virtual articulator features in the software. The patient's excessive gingival display was conservatively treated without osseous surgery or root canal treatment. Six monthly checks were performed for 5 years to check pulp vitality, and all teeth responded normally to vitality tests. The patient expressed great satisfaction with the result with minimal postoperative pain. With careful preoperative planning and novel use of CBCT, esthetic, and conservative treatment of excessive gingival display was made possible, while avoiding osseous resective surgery and root canal treatment. This made the treatment prompt with little need for a recovery period, more appealing to the patient, and longevity of treatment was ensured.
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Unusual location of calcifying epithelial odontogenic tumor p. 44
Burak Cankaya, Sabri Cemil İşler, Aydın Gümüşdal, Begüm Genç, Cavanşir Asadov
Calcifying epithelial odontogenic tumor (CEOT), also known as Pindborg tumor, is locally aggressive and rare odontogenic epithelial neoplasm. It is mostly located in the posterior mandible. Maxillary occurrence is extremely rare, and this location leads the lesion to become more aggressive and rapidly involves to the surrounding tissues. Treatment of the lesion has a variety of choice due to location of the lesion, rapid invasion, proximity to vital structures, and early diagnosis. We present clinical, radiographic, and histopathologic examinations and surgical operation of a CEOT in the alveolar process between maxillary first and second molar roots.
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