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   2022| May-August  | Volume 10 | Issue 2  
    Online since July 22, 2022

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Alveolar bone density based on image density of intraoral radiography using artificial intelligence software: Cases of osteoporosis patients with antiresorptive medications administration before tooth extraction
Eizaburo Kobayashi, Yoshiyuki Minami, Ruri Ogawa, Yasuhito Tezuka, Ichiro Ogura
May-August 2022, 10(2):29-33
Background: In recent years, an artificial intelligence (AI) software “DentalSCOPE” for alveolar bone density based on image density of intraoral radiography was developed. Aims: The purpose of this study was to evaluate the alveolar bone density of osteoporosis patients with antiresorptive medications administration before tooth extraction using DentalSCOPE. Materials and Methods: Five osteoporosis patients with antiresorptive medications administration before tooth extraction were analyzed using a computer program “DentalSCOPE” for alveolar bone density based on image density of intraoral radiography. The alveolar bone density around extraction tooth was compared to lytic and sclerotic bone reaction with the opposite side as normal region. Statistical analyses of alveolar bone density were performed with Wilcoxon rank-sum test. P < 0.05 was considered statistically significant. Results: The alveolar bone density of the opposite side as normal region (972.9 ± 74.3 mg/cm2) was significantly higher than those of lytic bone reaction (633.9 ± 114.2 mg/cm2, P = 0.043) and lower than those of sclerotic bone reaction (1144.0 ± 99.4 mg/cm2, P = 0.043). Conclusions: This study evaluated the alveolar bone density of osteoporosis patients with antiresorptive medications administration before tooth extraction using DentalSCOPE and indicated that the computer program could be useful for the evaluation of osteoporosis patients.
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Modified tangential Peeyush's technique: A simplified radiographic technique to visualize zygomatic arch fracture
Peeyush Shivhare, Ajay Kumar, Ajay Parihar, Naqoosh Haidry, Neha Sah, Ankur Singh
May-August 2022, 10(2):34-39
Introduction: Zygomatic arch (ZA) fractures are common in facial trauma. The imaging techniques for the ZA include submentovertex (SMV) and jug handle (a variation of the SMV view) views. These radiographic techniques require neck hyperextension to make the canthomeatal line parallel to the film receptor. Most of the time, these patients will be having cervical injuries also which makes these imaging techniques challenging. Aims and Objectives: This observational study aimed to estimate the efficacy of modified tangential Peeyush's technique (MTP technique) as an alternative to SMV view in patients with ZA fracture along with neck pain. Materials and Methods: A digital panoramic radiography machine and other standard equipment for radiography were used. Twenty patients with clinically diagnosed ZA fracture were selected and imaged using two different techniques, i.e., technique A (canthomeatal line to be about 30°–45° in relation to image receptor) and technique B (MTP technique). Images obtained with both techniques were evaluated for the presence of ZA fracture. The results were tabulated and compared. Results: Technique A showed partial visualization of ZA in 55% of the cases, whereas ZAs were not visualized in 45% of cases. ZA was evident in 100% of the sample selected in technique B (MTP technique). Conclusion: Modified Peeyush's tangential technique can be applied in patients having ZA fracture with neck pain.
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Diagnostic accuracy of ultrasonography verified with computed tomography for the diagnosis of maxillofacial fractures – A prospective study
Abhishek Shailesh Shah, Tejraj Kale, Virupaxi Hattiholi, Husain Dhabaria
May-August 2022, 10(2):40-44
Objectives: The objective of this study was to evaluate the diagnostic accuracy of ultrasonography (USG) if it can be used as a primary diagnostic method for maxillofacial trauma and to determine the sensitivity and specificity of USG verified with a computed tomography (CT) scan. Materials and Methods: This study was a comparative prospective study that consisted of a total of 32 patients. Patients reported to the Trauma Care and Emergency Center of KLES Dr. Prabhakar Kore Hospital with maxillofacial trauma during October 2018–September 2020 were included in the study. Following a CT scan, based on the inclusion criterion, the patient underwent an ultrasonographic examination of any maxillofacial fracture that had been confirmed by a CT scan to verify it. Sensitivity and specificity were calculated to establish the accuracy of USG. Results: A total of14 sites were selected in the maxillofacial region. Out of all the 14 anatomical landmarks, nine were able to detect all the fractures on USG with 100% sensitivity and specificity. Intracapsular condyle fractures were not seen on USG. The region where all the fractures were not identified on USG was medial wall and floor of the orbit, one nondisplaced ramus fracture. Conclusions: The overall sensitivity observed for the diagnosis of maxillofacial fracture was 85.21% and specificity observed was 100%. In conclusion, USG can be a handy, diagnostic, additional, noninvasive, and inexpensive tool in the detection of maxillofacial fractures when compared to CT in the primary health-care center. Furthermore, studies should be conducted with a considerable amount of sample size as the literature mentions limited work regarding USG as a primary technique in maxillofacial fractures detection.
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Examination for the factors contribute to joint effusion in patients with internal derangement on temporomandibular joint disorder
Fumi Mizuhashi, Ichiro Ogura, Yuko Watarai, Tatsuhiro Suzuki, Ryo Mizuhashi, Makoto Oohashi, Hisato Saegusa
May-August 2022, 10(2):45-48
Background/Aim: The aim of this study was to investigate the factors contribute to the joint effusion in the patients with internal derangement on temporomandibular joint (TMJ) disorder. Methods: We reviewed the 83 TMJs that were diagnosed as internal derangement (anterior disc displacement with or without reduction) by magnetic resonance imaging. Joint effusion was diagnosed using T2-weighted images. The differences in the presence of joint effusion according to the gender, age, diagnosis, and TMJ pain were analyzed using cross-tabulation or Mann–Whitney test. The relationship between joint effusion and gender, age, diagnosis, and TMJ pain was analyzed by logistic multivariate regression analysis. Results: The presence of joint effusion was larger on anterior disc displacement without reduction (χ2[1] = 7.47, P = 0.006) and the TMJ with pain (χ2[1] = 7.50, P = 0.006). The results of logistic multivariate regression analyses indicated that the diagnosis of anterior disc displacement without reduction was significant in TMJ with joint effusion (odds ratio = 3.299, P = 0.036) and the TMJ with pain was also significant in TMJ with joint effusion (odds ratio = 4.413, P = 0.007). The gender and age showed no relationships with joint effusion. Conclusions: The results of this study made it clear that joint effusion was easier to occur in the TMJ of anterior disc displacement without reduction and in the TMJ with pain. Anterior disc displacement without reduction and TMJ pain would be related to the higher risk of joint effusion.
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The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in oral squamous cell carcinoma: A systematic review
Simran Naresh Verma, Deepa Achath Das
May-August 2022, 10(2):49-56
Objective: The aim of this study was to systematically review the literature to assess the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in oral squamous cell carcinoma (OSCC). Materials and Methods: The literature was searched using MEDLINE and ScienceDirect databases. Studies comparing fusion imaging PET/CT with other imaging modalities in the staging, identifying secondary metastasis, treatment response assessment, and follow-up of OSCC, were deemed eligible. Results: Six studies met the inclusion criteria. The average mean was found to be 85.47%, 78.80%, 78.50%, and 89.22% for sensitivity, specificity, positive predictive value (PPV), and negative predictive value, respectively. The risk of bias graph shows that there was 50% low risk of bias in selection of patients, more than 25% low risk of bias in conduct/interpretation of the index test, and > 25% risk of bias in reference standard. 18F-FDG PET/CT is a good prognostic factor for overall and progression-free survival. Conclusion: FDG PET/CT has a good diagnostic accuracy for identifying metastatic nodes, especially subcentimeter metastatic nodes that appear morphologically normal on CT images. PET/CT is promising in the diagnosis and evaluation of distant metastases and for identifying unknown and second primary malignancies. Advances in Knowledge: Fusion imaging is gaining importance with its ability to identify tumor as small as 0.5 mm and provide early diagnosis, thereby increasing quality of life of patients. PET/CT provides valuable information for therapeutic planning, therapeutic assessment, follow-up, and surveillance in the care of patients with OSCC.
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Mandibular arterio-venous malformation (case report)-rare life threatening condition
Rinesh Kochummen
May-August 2022, 10(2):57-61
Arteriovenous malformations (AVM) are defects in the vascular system, consisting of tangles of abnormal blood vessels (nidus), in which the feeding arteries are directly connected to venous drainage without the interposition of a capillary bed. AVM can occur anywhere in the body, most common in the brain. Other common locations are hepatic, musculoskeletal AVM, spinal AVM, pulmonary, and uterine AVM. In musculoskeletal soft tissue and joints are the more common sites. Bone AVM is very rare. The mean age is 21.86 years. The patient came with complaints of swelling in the left cheek with slight redness over the skin. There was no of history of pain. On examination, no pulsation present. Clinical diagnosis of parotid swelling was given. On USG- loculated cystic lesion in the left mandible with multiple locules and floating internal echoes. On color Doppler, internal vascularity was noted with in the cystic lesion. On computed tomography (CT) scan, a loculated cystic lesion in the enlarged left mandible – enhancement noted with in this cystic lesion – suggesting vascular channels in arterial and better seen in venous phase of contrast imaging. Patient was referred to interventional radiologist where the patient has undergone angioembolization of the AVM followed by mandibulectomy and artificial teeth fixation. As biopsy of the lesion would be dangerous due to significant hemorrhagic risk. Careful attention to the Doppler uptake in USG and contrast uptake in CT angiogram relative to nearby vessels, detection of nearby enlarged abnormal vessels, and performance of dynamic angiography to document arteriovenous shunting are crucial for appropriate management.
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