Journal of Dental Medicine

Background and Aims: According to concerns of technical errors in intraoral radiographs and reports of positive effects of central ray laser pointer on the students, technical errors and shortcomings of earlier research, this study was conducted at Department of Oral and Maxillofacial Radiology of Tehran Azad University to determine the role and use of laser pointer in the technical error made by students.

Materials and Methods: This clinical trials study was carried out at the Department of Radiology, Dental School of Azad Tehran University. A total of eighty students were divided into two groups of forty. In the first group the periapical technique was taught without laser guided indicator, while in the second group laser guided indicator was applied in training the students. All students took X-rays from the phantoms. Laser guided indicator is made of one low power red laser diodes.Totally 560 X-rays were taken and the technical errors and the quality of X-rays were evaluated. Data were analyzed statistically using Mann-Whitney and Chi Square tests (&alpha=0.05).

Results: The X-rays taken by students showed significant differences in cone cutting (P<0.001), and overlapping (P<0.001) between the two study groups. In the subjective review of X-ray quality, the difference was also significant (P=0.03).

Conclusion: The use of laser guided indicator as a training aid seems to be practical for easier learning of central ray adjustment and reduction of technical errors in taking X-rays by dental students.

Background and Aims: Elongation of styloid process may result in development of Eagle syndrome with associated symptoms. This study aimed to assess the frequency of elongated styloid process (ESP) and to evaluate its prevalence according to sex and age.

Materials and Methods: This study was conducted on digital panoramic radiographs of patients refered to the Oral Radiology Department of dental school, Guilan University of Medical Sciences. Styloid process length was measured and classified as elongated, pseudoarticulated, or segmented. Calcification patterns were determined as A, B, C, and D. ESP was defined as length > 30 mm. Data were analyzed by SPSS using T-test, Chi square, Pearson, and Spearman (P<0.05).

Results: A total of 505 digital panoramic radiographs taken from 227 males (45%) and 278 females (55%) aged 10 to 72 (40.1±12.9) years were evaluated. Elongated styloids were present in radiographs of 230 (45.5%) individuals. There was no significant difference in the ESP frequency between males (46.09%) and females (53.91%) (P=0.63). Type I and calcification B pattern showed more frequency than that of other categories.

Conclusion: According to these findings, elongated styloid process was a common condition among the studied population and had a significant correlation to the age.

Background and Aims: Central odontogenic fibroma is a rare odontogenic neoplasm that originates from odontogenic ectomesenchyme. Most cases occur in the mandible and between the ages of 11 and 39 years. The neoplasm shows a definite female preponderance, with a ratio of 2.2:1 and has a very low recurrence rate. The aim of this article was to report a case of this rare lesion which was accidentaly found.

Case Report: A 11-year-old female, during her orthodontic treatment and without any complain and any sign or symptoms, performed a panoramic image for assessing the permanent teeth buds. In the panoramic view a unilocular radiolucent lesion with well-defined and corticated borders in the right mandibular body region was evident. The lesion was treated with simple excision. Simple type of central odontogenic fibroma histopathologic features was observed in the microscopic view.

Conclusion: Although the central odontogenic fibroma is a rare benign neoplasm, however, a careful evaluation of radiographic images is important for early detection of lesions because the patient may have no clinical symptoms such as swelling, pain and paresthesia.

Background and Aims: In response to esthetic demand and use of zirconia abutments; detection of implant-abutment connection misfit is so important. The purpose of this study was to evaluate the sensitivity and specificity of radiographic images in the detection of abutment-implant connection misfit in zirconia and titanium abutments of three different implant connections.

Materials and Methods: One regular implant fixture of Branemark, Noble active and Replace systems were mount in acrylic models. Two pieces titanium and zirconium abutments were attached to the implants, once with correct adaptation and once with 0.5 mm spacer. Digital radiographic images were taken of 12 created states with zero degree vertical and horizontal inclination and evaluated by 10 specialists in implant treatment in two different time penods. Data were analyzed using Kappa analysis.

Results: Interclass Correlation Coefficients (ICC) of the agreement of answers in the first and second times were 97.4 and 97.5, respectively (P<0/001). Sensitivity of detecting gap in all groups was acceptable (95-100%) except titanium abutment in Noble active which was the lowest value (35%). Specificity of all groups were acceptable (80-95%) except zirconia abutments in Noble active and Replace with 45% and 30% values, respectively, and titanium abutments in Branemark had the highest value (95%).

Conclusion: The sensitivity of radiographic images in detection of abutment-implant connection misfit only in Noble active with titanium abutment was not acceptable. Specificity of radiographic images in the absence of gap in titanium abutments was more favorable.

Background and Aims: Estimating the canal length is essential for reaching to a proper endodontic treatment. Any error and miscalculation in estimation of the working length, especially in curved canals, can result in complication during and after root canal therapy. The introduction of digital radiography has enabled us to measure curved canal length. The purpose of this study was to evaluate the calibration tool of Complementary Metal Oxide Semiconductor (CMOS) digital system in estimation of working length.

Materials and Methods: In this in-vitro study, 80 extracted molar teeth were selected and randomly divided into three groups based on angle and radius of canal curvature. A 5 mm orthodontic wire was placed on the lateral surface of the root. Conventional radiographs were taken after insertion of endodontic file in the apical third of root canals. Radiographic images were scanned and imported to the software of CMOS digital system. Two observers estimated the file lengths with and without using calibration tool of digital measurement software. The correlation between observers was evaluated and then data were analyzed using Paired T-test with 95% confidence.

Results: Overall agreement between observers was good. There was no significant difference between the mean values of calibrated measurement and true file length in the basis of canal curves (P>0.001). However, there was significant difference between the mean values of uncalibrated measurement and true file length in the basis of canal curvature (P<0.001).

Conclusion: The calibrated measurement of file length was more accurate than that of the uncalibrated file length measurement.

Background and Aims: The purpose of this study was to evaluate the relationship between the mandible anatomy with age and gender in panoramic radiography of patients.

Materials and Methods: In this descriptive-sectional study, 322 panoramic radiography of patients at the age of 25-55 years old were evaluated. The patients were devided in three groups of 25-34, 35-44, 45-55 years old and the radiomorphometric indexes in panoramic radiography of the patients were measured. The collecting data were analyzed using independent two-sample t-test, one-way anova and multiple linear regression using SPSS statistical software (version 18).

Results: The average of radiomorphometric indexes don’t show a meaningfull statistical defference between different age groups. The average of all angles higher in females than that of males and other measured indexes were higher in males than females. Also, the mandibular foramen moved forward with the increase of age.

Conclusion: Based on the result of this study which was done on limited numbers, it can be concluded that the measured radiomorphometric indexes in this study didn’t have a high accuracy to predict Age and Gender.

Background and Aims: Radiopacity is an essential requirement for all restorative materials. Radiopaque materials allow the dentist to diagnose and assess radiographically the restoration, primary caries, assessment of contours, overhang and secondary caries. The aim of this study was to evaluate the radiopacity of two types of dental bases and liners in comparison whit dental structure using a digital radiography system.
Materials and Methods: Two classes of materials were prepared: 1 mm and 2 mm thickness disks for glass inomer and 1 mm and 0.5 mm thicknesses for dycal. Specimens of enamel and dentine with the same thicknesses were obtained. As a control, an aluminum step wedge was used. Samples were positioned over a phosphor-ray, plate of min ray soredex system, exposed, and the images were analyzed using the contour dent software. ANOVA analysis was used to investigate the significance of differences among the groups. For pairwise comparisons, the Bonferroni test was applied (P<0.005).
Results: 0.5 mm diameter of self-cure and light cure dycal and enamel, presented radio-opacity higher than that of dentine, except for the light cure dycal that had radiopacity lowers than enamel. 1 mm diameter of all the groups presented higher radiopacity than dentin. Light cure and self-cure glass inomer and self-cure dycal presented radiopacity higher than enamel. Enamel showed radipacity higher than light cure dycal in 2 mm diameter self-cure. Light cure glass inomer presented radiopacity higher than that of enamel and dentin.
Conclusion: The increased thickness of the materials evaluated increased their radio-opacity. It was concluded that all the materials had lower radiopaaty than dentin. Only enamel showed higher radiopacity than light-cured dycal.

Background and Aims: Accurate diagnosis of vertical root fracture (VRF) is a fundamental importance in endodontics. Because of poor prognosis of VRF, digital radiographs with two horizontal angles have limitations in VRF detection. Also, Gutta-percha can produce artifacts that impair CBCT scan accuracy. The aim of this study was to compare accuracy of CBCT and digital radiography system in vertical root fracture in endodentically treated teeth.
Materials and Methods: In this study, 60 endodentically treated single teeth were selected and randomly coded. The teeth were divided into two groups: 30 with induced root fracture and 30 with no fracture. CBCT scan and digital radiographs with two horizontal angles with a difference of fifteen degrees for all teeth were performed. Two observers assessed the CBCT images and digital radiographies for presence of VRF. The statistical analysis used in this study was Weighted Kappa.
Results: CBCT had the highest sensivity (75.8) and specificity (90). Digital radiography with 68.3 sensitivity and 79.1 specificity were not as efficient as CBCT (P<0.05).
Conclusion: According to this study, the accuracy of CBCT seems to be higher than that of digital radiography in detecting VRF and provides the most reliable data in comparison of digital radiography.

Background and Aims: Dental diagnosis may be affected by the occurrence of the errors in the intra-oral radiographic images and the patients’ treatment plan can be problematic in these cases. The repetition of these radiographs increases the risks of radiation exposure for the patients in turn. The present study assessed the incidences of common periapical radiographic errors taken by dental students in oral and maxillofacial radiology department of Mashhad dental school in 2017.
Materials and Methods: In this cross-sectional descriptive study, 1470 periapical radiographs prepared by student during a semester of 2017 were collected and evaluated. Radiographic observations were done and the incidence of conventional radiographic errors were determined. Finally, the frequency and percentage of radiographic errors were determined based on the type of radiography sex, the age of the patient, and the history of radiography. Then, results were analyzed using the Chi-Square test and SPSS19 (P=0.05).
Results: Film placement (27.2%), cone-cut (27.2%), elongation (13.2%) and horizontal angle (10.9%) were reported as the most common radiographic errors. The repetition rate of the radiographs was 2.9%; among them, the highest errors were Cone-cut errors in the upper jaw
Conclusion: Based on the results of this study, the most radiographic errors included film position and Cone-cut errors and these two errors were the most frequent cause of repetitive radiographies that required the provision of specific training for the prevention of these errors.

Background and Aims: Radiography is one of the most important para-clinical methods in diagnosing and selecting treatment in dentistry. Due to the potential dangers of X-rays for patients, the professional responsibility of the dentist requires that unnecessary radiographs to be avoided. The aim of this study was to investigate the awareness of dentists in Zanjan about the principles of radiation protection in 2019.
Materials and Methods: This cross-sectional study was performed on 107 general dentists and specialists working in Zanjan and the questionnaires were distributed among them. The level of awareness of dentists in 27 questions of radiographic prescribing questionnaire was evaluated and in each of the mentioned questions, their gender, age, work experience, participation in retraining, having X-ray machine in the field of dentistry and type of activity were evaluated. Data were analyzed by Chi-square test, Independent T-test, and ANOVA using SPSS software version 22.
Results: The results showed that the level of knowledge of general dentists about the principles of radiation protection (14.35±3.08) was lower than that of specialized dentists (17.19±2.35). Those who participated in retraining workshops (13.85±2.99) had less knowledge than those who did not (15.97±3.97), which was statistically significant (P<0.05); However, there was no significant difference in the dentists' knowledge about the principles of radiation protection based on gender, age, type of activity, having an X-ray machine at the place of treatment, and history of clinical experience (P≥0.05).
Conclusion: Awareness of dentists at various levels was moderate. Therefore, designing and holding more purposeful retraining courses to maintain and improve the level of awareness of dentists according to the guidelines provided by the authorities, still seems to be necessary.

Background and Aims: Pulpal exposures originated from the external cervical root resorptions have major effects on the treatment and prognosis. Therefore, the aim of this study was performed to compare the two different imaging systems-digital radiography with PSP (Photostimulable Phosphor) sensor in three horizontal different views and CBCT (cone beam computed tomography) images to assess the pulpal exposure in simulated cavity of external cervical root resorptions that was performed in 1398 in the School of Dentistry of Azad University.
Materials and Methods: 40 intact maxilla anterior teeth with straight roots were included. Teeth were randomly divided to two groups (20 teeth with and 20 without pulpal exposures). Each sample was assessed using PSP digital radiography (in 3 horizontal angles) and CBCT image system, to detect the presence of pulpal exposures. False negative and false positive results in 2 imaging procedures were judged with ratio test.
Results: The results showed in CBCT (P.P.V=85.7%) and (N.P.V=89.5%), and in digital intraoral radiography (P.P.V=80%) and (N.P.V=80%) in proximal defects. Ratio test showed that there were no significant differences in the proximal defects (P<0.4).
Conclusion: The results showed that there were no significant differences in detection of exposure in the proximal surfaces between two imaging systems.

Background and Aims: In impacted third molar surgery, panoramic radiography is a preliminary technique for assessing the consequences associated with inferior alveolar nerve injury. However, this technique cannot provide enough information to determine the true risk in all cases. The aim of this study was to compare the accuracy of panoramic and CBCT radiographs in evaluating the relationship between the mandibular impacted third molars and the inferior alveolar nerve.
Materials and Methods: In this cross-sectional study, the relationship between mandibular third molar and inferior alveolar nerve in 15 patients referred to the oral and maxillofacial radiology department of Birjand dental school including 20 mandibular third molars were evaluated using two panoramic and CBCT radiographs. Data were analyzed using descriptive statistics and chi-square test and sensitivity analysis in SPSS22.
Results: In the evaluation of the teeth using panoramic radiography, the highest frequency was related to root darkening (65%) and root deflection (65%), and the lowest frequency was related to root narrowing (20%) and canal deviation (5%). The highest sensitivity of panoramic criteria was related to the root darkening with 100% sensitivity and the lowest sensitivity was related to the canal deviation with 17% sensitivity. On the other hand, the highest specificity of panoramic criteria between the mandibular third molars with the inferior alveolar nervewas was related to the two criteria of bifid apex and canal deviation with 100% specificity. The lowest specificity was related to the root deflection with 21% of specificity.
Conclusion: According to the results of this study, the probability of observing relationship between the mandibular third molars with the inferior alveolar nerve in CBCT radiography was very high.

Background and Aims: Knowing the depth and type of the teeth impaction with radiographic approaches can guide the clinicians into selecting the most appropriate treatment and prevent surgical complications. Therefore, the purpose of this article was to evaluate the prevalence of canine and premolar impaction in the digital panoramic view of patients referred to Rasht dental school in 2019.
Materials and Methods: This annalistic-descriptive cross-sectional study comprised patients who attended the Faculty of Dentistry, Rasht, Iran in 2019. Dental records and panoramic radiographs of 500 patients were reviewed retrospectively. Demographic information as well as the type and depth of impaction, involved jaw, and also, the associated pathological lesions were recorded. Data were analyzed with SPSS24 version with significant level of P<0.05.
Results: The findings revealed that among 500 individuals (300 (60%) were females and 200 (40%) were males), 35 individuals (7%) had at least one impacted tooth, 80% of impacted teeth were canines and the others were premolars. The most common impaction type, impaction level, and pathological lesion were mesioangular, B, and carries of the adjacent tooth, respectively. A significant relation was not observed between the type and level of impaction with the involved jaw (P=0.15, P=0.99) and also, the relation between the type of pathological lesion and gender was insignificant (P=0.85).
Conclusion: Functional and esthetic complications of impacted tooth can be prevented or declined by on-time radiographic screening.

Background and Aims: Achieving non-invasive methods for the proper detection of secondary caries adjacent to dental restorations has a great importance. As alterations in horizontal and vertical angles of X-ray beam would affect the detection of dental caries on radiographs, this study was designed to evaluate the effect of changing the horizontal angle of X- ray on detection of dental caries adjacent to class II amalgam restorations in posterior teeth on periapical radiographs.
Materials and Methods: In this in vitro study, artificial carious lesions were prepared in axial walls of the amalgam restoration cavities in interproximal surfaces of 27 human extracted premolar teeth. Periapical radiographies with different horizontal X- ray angles were obtained, observed, and rated by 5 maxillofacial radiologists for detection of carious lesions. For each observer, the sensitivity, specificity, accuracy, PPV, and NPV of radiographs in the individual horizontal angles were calculated and compared by nonparametric Kruskal Wallis test. Interobserver agreement was assessed by fleiss’ kappa coefficient.
Results: The highest accuracy of periapical radiographs for the detection of secondary caries of mesial dental surfaces was in 5-degree of mesial and distal X- ray angle (86.66%) and for the distal dental surfaces was allocated to 10-degree of distal X- ray angle (85.90%). Also, there was a significant difference in the accuracy between different horizontal angles (mesial and distal 0, 5, 10, 15-degree) (P=0.01). The higher agreement between observers in detecting mesial surface caries was in 10-degree of distal angle (0.86) and in detecting distal caries was in 5-degree of distal angle (0.89).
Conclusion: In the case of doubt in the existence of recurrent caries in the interproximal tooth surface, if the carious lesion is not visible on standard radiographic image with direct angle of X- ray, A 5- 10 degree of x- ray horizontal angle can improve the detection of secondary caries under amalgam restorations in interproximal dental surfaces.

Background and Aims: Idiopathic osteosclerosis is an asymptomatic local growth of cortical bone and is discovered incidentally on panoramic radiographs. The purpose of this study is to evaluate the frequency of idiopathic osteosclerosis and its radiographic features in panoramic images of patients referred to the Department of Maxillofacial Radiology, Faculty of Dentistry, Arak University of Medical Sciences (Iran) in 2022-2023.
Materials and Methods: In this cross-sectional study, 460 panoramic images from the radiology department of Arak Faculty of Dentistry were randomly selected and analyzed. The demographic information of patients, frequency of idiopathic osteosclerosis, location, and also its relationship with adjacent teeth in terms of proximity to lamina dura and periodontal ligament and radiographic features in terms of size and morphology were evaluated. The data were analyzed using the SPSS24 software.
Results: Panoramic images of 460 patients (266 men and 194 women) with an average age of 38.12 (11.75) years were evaluated. The frequency of idiopathic osteosclerosis was 6.1% (28 images). 92.9% of the lesions were in the lower jaw and 46.4% of them were near the premolar teeth. In 39.3% of the cases, the lesion was adjacent to the periodontal ligament and laminadora of the tooth. In 3.6% of the cases, it was associated with a small displacement of the adjacent tooth, and 17.9% was associated with tooth root resorption. According to the results, there was no correlation between the incidence of this lesion with age and gender (P>0.05).
Conclusion: According to the findings of this study, the frequency of idiopathic osteosclerosis in the patients referred to Arak dental school was reported as 6.1%. Most of these lesions were observed in the back of the lower jaw and thus, it is important to be able to distinguish this lesion from the radiopaque lesions of the jaw which need treatment.