Journal of Dental Medicine

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In recent years many patients have been received radiotherapy for head and neck tumors and a large number of them have been survived for some years.The side effects of radiotherapy in oral region are mucositis, ulcers, fungal and viral infections and salivary glands dysfunction. Among these, mucositis is the most important one.A randomized double blind clinical trial was performed in radiotherapy department of Tehran Imam Khomeini Hospital to determine chamomile mouth rinse effects on mucositis after radiotherapy.The patients are selected randomly from those with oral oropharyngeal or nasopharyngeal cancers.Data showed that chamomile administration could decrease mucositis rate significantly,

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Nowadays, bone mass estimation, through imaging methods, is widely used in metabolic diseases diagnosis and treatment. One of these methods is called "optical densitometry" which estimates bone density by measuring the intensity of the transmitted light on different parts of a radiographic image. Digital radiography systems act similarly by determining grey levels of the image. The aim of this study is comparing two different methods of optical densitometry and a digital system densitometry known as radiovisiography. 45 samples, containing urografin with three different concentrations, were imaged, by both radiovisiogrphy (RVG) and conventional film systems. To determine the densitometry of films and radiovisiography images, optical densitometry and bone densitometry option of the RVG software, were applied respectively. Data were analyzed and compared for their reliability (repeatability) and correlations with concentration. In RVG densitometry system, the correlation with concentration is moderate (r=0.42) and intra samples and intra group reliability are 97.68% and 88.19%. Moreover, in conventional optical film densitometry, correlation with concentration (r=0.987) is high, intra samples and intra group reliability is high, intra samples and intra group reliability are 99.97% and 99.84%, respectively. According to the results, it is suggested that conventional film optical densitometry is more precise and reliable than RVG densitometry.

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Statement of Problem: Computer Sciences, in radiology, like other fields, is of high importance. It should also be noted that the accuracy of the technique and work conditions affects the radiographs information considerably. There for, in order to get more accurate diagnostic information, it seems necessary to investigate different digitized radiographic techniques and to compare them with the conventional technique.
Purpose: The aim of this study was to compare the accuracy of conventional and digitized radiographic images by three digitization techniques in proximal caries detection.
Material and Methods: In this research study, sixty extracted human canines, premolars and molars were mounted in blocks and imaged on E-Kodak film, similar to bitewing radiographs. Ten bitewing radiographs were then scanned at 600 d.p.i with flat bed scanner and a digital camera, then digitized at 300 d.p.i with another digital camera. The digitized images were displayed randomly on a high-resolution monitor. Six
observers assessed the caries status of 120 proximal surfaces by conventional and digitized images. The observer's scores were compared with the results of the macroscopic examination. Reliability of each technique was calculated. Data were analyzed using chi-square and ANOVA tests.
Results: No significant differences were detected between different techniques in intact proximal surfaces and enamel caries diagnosis. However, digital techniques were more sensitive in dentin caries detection (P<0.05).
Conclusions: When conventional film images are digitized, medium resolution (300 d.p.i) seems to be sufficient. At this resolution the file size is decreased and there is no significant loss of the information necessary for caries diagnosis.

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Statement of Problem: One of the major goals, in most dental researches, is to measure bone destruction or deposition due to the progression or regression of disease. Failure of human eyes to detect minor radiographic density changes resulted in more accurate methods such as optical densitometry and direct or indirect digital densitometry.
Purpose: The aim of this study was to determine the accuracy of a newly proposed method of indirect digital densitometry using modified Photoshop software.
Materials and Methods: Radiographs from 37 samples of urografin solution with three concentrations (12.5%, 25% and 37.5%) were taken on dental radiographic films no.2 and digitized by a scanner. A region with 800*800 pixels was cropped from each image and compressed with the Joint Photographic Experts Group (JPEG) compression algorithm and saved. These new images were then put into registration with new algorithm using MATLAB software version 6.1. This algorithm assigned each image and average pixel value (between 0 and 255). The association between concentration and calculated values for each image was tested with regression analysis and the meaning fullness of differences between calculated values was also analysis by ANOVA test. Tukey HSD and Alpha Krunbach were used whenever needs.
Results: Regression analysis revealed significant correlation between concentration and calculated average pixel value (r=0.883). The differences between average of pixels value for different concentration was significant (P=0.0001). Pixel values showed a good intra- sample and intra-group repeatability (Alpha Krunbach: a=99.96%, a=99.68%).
Conclusion: This method due to its high accuracy, easy usage and densitometer independency can be considered as a suitable alternative for conventional densitometry methods.

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Background and Aim: The goal of dental treatment is to improve oral hygiene, to maintain teeth and minimize the risk of diseases. Although data obtained from radiographs has distinct advantages to patients, the radiation side effects should be considered as well. FDA has developed a guideline for prescribing radiographs in the middle of the eighties. The aim of this study was to evaluate the reasons of ordering panoramic radiographs and their accordance with FDA guidelines in Tehran dental school.

Materials and methods: This descriptive study was carried out on 250 patients referred from different departments of Tehran dental school to radiology department for panoramic radiography. Chief complaints and clinical findings of patients were recorded in a check list and compared with the FDA guidelines prescribed.

Results: Our findings showed that prescription of panoramic radiographs were in accordance with FDA guidelines in 97.2% of cases.

Conclusion: Based of the results of this study, the trend of panoramic radiography ordering in the dental school of Tehran university is adequate. This may be attributed to the academic field of this study.

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Background and Aim: Accurate bone measurements are essential to determine the optimal size and length of dental implants. The magnification factor of radiographic images may vary with the imaging technique used. The purpose of this study was to compare the accuracy of linear tomography and panoramic radiography in vertical measurements, as well as the accuracy of linear tomography in mandibular width estimation.

Materials and Methods: In this test evaluation study, the vertical distances between the crest and the superior border of the inferior alveolar canal, marked with a metal ball, was measured by linear tomography and panoramic radiography in 23 sites of four dry mandible bones. Also the mandibular width was measured at the same sites. Then, the bones were sectioned through the marked spots and the radiographic measurements were compared with actual values.

Results: The vertical magnification factor in tomograms and panoramic radiographs was 1.79 (SD=0.17) and 1.69 (SD=0.23), respectively. The horizontal magnification of tomograms was 1.47 (SD=0.17). A significant correlation was found between the linear tomographic and actual values, regarding vertical dimensions (p<0.001, r=0.968) and width (p<0.001, r=0.813). The correlation was significant but lower in panoramic radiographs (p<0.001, r=0.795). Applying the magnification values suggested by the manufacturer, the mean difference of vertical measurements between the tomographic sections was 2.5 mm (SD=3.4) but 3.8 mm (SD=1.65) in panoramic radiographs. The mean of absolute difference in mandibular width between the tomographic sections and reality was 0.3mm (SD=1.13). In the linear tomograms, 4.3% of vertical and 56.5% of the width measurements were in the ±1mm error limit. Only 4.3% of the vertical measurements were within this range in the panthomographs. The linear regression equation between the actual values and those obtained by radiography in vertical dimensions showed that 87.5% of tomograms and 51.8% of panoramics were located in the ±1 mm error limit.

Conclusion: Based on the results of this study, the linear tomography is more accurate than panoramic radiography in mandibular height estimation. The accuracy of linear tomography in width estimation is within acceptable limits.

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Background and Aim: Image distortion is one of the major problems in panoramic radiography. Horizontal and vertical correction factors could be determined for more efficient clinical applications. The purpose of this study was to determine horizontal and vertical correction factors in panoramic radiography.

Materials and Methods: In this test evaluation study in which an asymetric mandibular phantom was constructed by plexiglass and aluminium as soft and hard tissue equivalents. The right half was slightly shorter than the left half. Steel markers were installed to make vertical and horizontal measurments possible.The length of the markers as well as the intermarker distances were measured by Mitutoyo digital micrometer which was accurate within ±0.05mm. The phantom was then positioned in PM 2002 cc proline (Planmeca, Finland) panoramic machine and panoramic images were obtained. 8 times for each half of the phan. The same length and inter marker distances were measured on digitized panoramic images by Cygnus software, which was accurate whitin ±0.01 mm. Magnification and correction factors were determined for the vertical and horizontal dimensions in each region of pantomograms.

Results: The mean vertical correction factor was 0.77±0.02 (range: 0.75-0.80) in the right and 0.77±0.05 (range: 0.75-0.85) in the left half jaw. The mean horizontal correction factor was calculated as 0.98±0.15 (range: 0.76-1.18) in the right and 1.02±0.14 (range: 0.90-1.25) in the left half jaw.

Conclusion: Dissimilarity of vertical and horizontal correction factors among left and right half jaws and also in different regions of a half jaw is relatively considerable. However, a constant correction factor, specialy in horizontal aspect, could not be applicable. Comparing with horizontal correction factors the vertical correction factors showed less variations between different regions as well as different samples.

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It is quite often for general practitioners who want to use implants in their routine treatments to face with the problem of unfamiliar radiographic techniques commonly prescribed in modern implantology. These types of radiograph, which could show the jaws in multiple aspects, are not routinely used by general practitioners. However, for sophisticated very delicate treatment options like implantology, the main problem is that "a metal object want to be placed in an undercut-full and zigzag area like bone", and the so called plain radiographs cannot be used for this purposes without difficulty. In this literature review, based on the data of the most powerful databases including COCHRANE and PUBMED, the necessity of using cross-sectional techniques in pre-implant treatment discussed in detail.

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Background and Aims: Accurate bone measurements are essential for determining the optimal size and length of proposed implants. The radiologist should be aware of the head position effects on image dimensions in each imaging technique. The purpose of this study was to evaluate the effect of mandibular plane angle on image dimensions in linear tomography.
Materials and Methods: In this in vitro study, the vertical dimensions of linear tomograms taken from 3 dry mandibles in different posteroantenior or mediolateral tilts were compared with actual condition. In order to evaluate the effects of head position in linear tomography, 16 series of images while mandibular plane angle was tilted with 5, 10, 15 and 20 degrees in anterior, posterior, medial, or lateral angulations as well as a series of standard images without any tilt in mandibular position were taken. Vertical distances between the alveolar crest and the superior border of the inferior alveolar canal were measured in posterior mandible and the vertical distances between the alveolar crest and inferior rim were measured in anterior mandible in 12 sites of tomograms. Each bone was then sectioned through the places marked with a radiopaque object. The radiographic values were compared with the real conditions. Repeat measure ANOVA was used to analyze the data.
Results: The findings of this study showed that there was significant statistical difference between standard position and 15º posteroanterior tilt (P<0.001). Also there was significant statistical difference between standard position and 10º lateral tilt (P<0.008), 15º tilt (P<0.001), and 20º upward tilt (P<0.001). In standard mandibular position with no tilt, the mean exact error was the same in all regions (0.22±0.19 mm) except the premolar region which the mean exact error was calculated as 0.44±0.19 mm. The most mean exact error among various postroanterior tilts was seen in 20º lower tilt in the canine region (1±0.88 mm) and for various mediolateral tilts the most exact error was seen in the canine region in 20º upper tilt (2.9±2 mm).
Conclusion: The mean exact errors in various regions and various 5º to 20º posteroanterior and mediolateral mandibular tilts were in the range of acceptable values (≤1 mm) except for the canine region. However, this effect is more considerable in mediolateral tilt compared with posteroanterior tilt, posterior region compared with anterior region, and upper tilt compared with lower tilt.

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Background and Aims: Internal derangement of the Temporomandibular joint (TMJ) is the most common form of Temporomandibular disorders, which represents an abnormal internal strucural and functional change of the disk, as well as an abnormal relationship of the disk to the condyle, glenoid fossa and articular eminence when the teeth are in the closed- mouth position. The aim of this study was to evaluate the correlation between eminence steepness and condyle disk movements in TMJs affected by internal derangements using magnetic resonance imaging (MRI).

Materials and Methods: In this cross-sectional study, digital MRI files of 90 joints belong to 45 patients in open and closed-mouth positions were evaluated. Patients were subdivided into two groups: 64 individuals with anterior disk displacement with reduction and 26 individuals with anterior disk displacement without reduction. Appropriate oblique sagittal sections were selected and printed. Outlines of the fossa, eminence, condyle and disk were traced on matte acetate sheets and evaluated by an oral and maxillofacial radiologist and a postgraduate student of oral and maxillofacial radiology. Disk rotation, condyle rotation, condyle translation and eminence steepness were measured. The data were analyzed using T-test.

Results: In this study, no significant difference was found in measurements between the two groups, (for steepness P=0.64, for Disc rotation P=0.77, for condyle rotation P=0.28 and for condyle translation P=0.12). Disk rotation showed statistically significant correlation with eminence steepness in the anterior disk displacement with reduction group
(P=0.034). Although this correlation was weak (r=0.27) no statistically significant correlations were found between other variables and eminence steepness in this group (for condyle rotation P=0.3 and for condyle translation P=0.98). Disk rotation and condyle translation had statistically significant relationship in the anterior disk displacement without reduction group (P=0.011, r=-0.49). In addition, a significant difference was found between disk rotation and condyle rotation in this group (P=0.004, r=0.54). The relationship between other variables and eminence steepness were not statistically significant (for disc rotation P=0.06, for condyle rotation P=0.72 and for condyle translation P=0.73).

Conclusion: According to the results of the present study, there is no obvious relationship between eminence steepness and movements of the condyle- disk assembly in patients with TMJ internal derangements. Therefore, the hypothesis that a steep articular eminence of the TMJ is a predisposing factor for disk displacement without reduction could not be verified. Performing prophylactic Eminectomy as a part of patient treatment plan is doubtful and need further evaluations.

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Background and Aims: The Panoramic radiography is one of the routine techniques in implant imaging. Although there are some limitations with this technique, panoramic radiography is radiographic choice for basic evaluation for implant treatment. Many studies have been designed to determine magnification in panoramic images but most of them were performed on dry skulls or radiographic phantoms. In recent studies CT or CBCT are used as gold standard. The aim of this study was to determine vertical magnification of panoramic images using renovated CT sections in anterior and posterior regions of both jaws.

Materials and Methods: 30 panoramic radiographs (Planmeca EC or CC Proline) were selected from patients of implant department and Particular anatomic landmarks were selected in those images. Vertical dimensions of these landmarks were measured in both panoramic and renovated cross sectional CT images by a digital caliper and vertical magnification was calculated as the ratio of image dimensions to the real dimensions.

Results: The mean vertical magnification of panoramic radiographs in anterior and posterior maxillae were 1.22±0.02 and 1.16±0.02, respectively. The mean vertical magnification of panoramic radiograph in anterior and posterior mandible were 1.20±0.02 and 1.13±0.02, respectively. The differences between magnification in mandible and maxillae were significant (P<0.001). The differences between magnification in anterior and posterior regions of both jaws were not significant (P=0.11).

Conclusion: Vertical magnification of panoramic images (Planmeca EC or CC Proline) in different regions in both jaws were between 1.13 to 1.22.

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  Background and Aims Bone density is frequently used in medical diagnosis and research. The current methods for determining bone density are expensive and not easily available in dental clinics. The aim of this study was to design and evaluate the accuracy of a digital method for hard tissue densitometry which could be applied on personal computers.

  Materials and Methods: An aluminum step wedge was constructed. 50 E-speed Kodak films were exposed. Exposure time varied from 0.05s to 0.5 s with 0.05 s interval. Films were developed with automatic developer and fixer and digitized with 1240U photo Epson scanner. Images were cropped at 10 × 10mm size with Microsoft Office Picture Manager. By running the algorithm designed in MATLAB software, the mean pixel value of pictures was calculated.

  Results: Finding of this study showed that by increasing the exposure time, the mean pixel value was decreased and at step 12, a significant discrimination was seen between the two subsequent times(P<0.001). By increasing the thickness of object, algorithm could define the density changes from step 4 in 0.3 s and 5 in 0.5 s, and it could determine the differences in the mean pixel value between the same steps of 0.3 s and 0.5 s from step 4.

  Conclusion: By increasing the object thickness and exposure time, the accuracy of the algorithm for recognizing changes in density was increased. This software was able to determine the radiographic density changes of aluminum step wedge with at least 4mm thickness at exposure time of 0.3 s and 5 mm at 0.5 s.

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  Background and Aims: It is crucial to verify the relationship between root apices and maxillary sinus floor in some surgical procedures like extraction and implant placement or in orthodontic movements like intrusion. Protrusion of roots into the sinus increases the risk of post extraction pneumatization which in turn decreases the available bone at the implant or denture sites. The aim of this study was to determine the panoramic radiology accuracy for defining the relationship between posterior root apices and the maxillary sinus floor by Cone Beam CT (CBCT).

  Materials and Methods: Paired panoramic radiographs and CBCT images of 117 subjects were examined. 452 posterior maxillary roots including second premolar, first and second molar were classified by the means of the relationship with maxillary sinus floor. CBCT was used as Gold standard method, and the agreement of panoramic findings with CBCT was examined statistically. Data were analyzed using Chi-square and Multiple logistic regressions.

  Results: Agreement of the panoramic and CBCT results were seen in 57.7% of all cases. Roots which had no contacts with the sinus floor (class 0) showed a high agreement of 89.5% between two imaging techniques. Roots in contact with sinus floor (class 1) showed 58.8 % and cases with root protrusion into sinus cavity (class 3, 4) showed 50% of agreement (P<0.001). Also in 36% of cases with no protrusion into the sinus cavity (class 0, 1, 2), panoramic showed protrusion. The agreement for the premolar was higher than molars (P<0.001)

  Conclusion: The majority of roots which their images were projected on the sinus cavity had no vertical protrusion in CBCT cuts. Considering the results, in these cases CBCT can be recommended.

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