Publications by authors named "Seval Bayrak"

28 Publications

  • Page 1 of 1

Evaluating the effects of functional orthodontic treatment on mandibular osseous structure using fractal dimension analysis of dental panoramic radiographs.

Angle Orthod 2020 11;90(6):783-793

Objective: To evaluate the effects of functional appliance treatment on mandibular trabecular structure using fractal dimension (FD) analysis of dental panoramic radiographs.

Materials And Methods: This study was conducted using digital panoramic radiographs of 45 patients with Class II malocclusion treated with functional appliances (treatment group, mean age: 11.39 ± 0.97 years; 23 girls, 22 boys) acquired before (T0) and after (T1) treatment and the panoramic radiographs of 45 control subjects who had undergone no orthodontic treatment (control group, mean age: 11.31 ± 0.87 years; 23 girls, 22 boys). FD values in the condylar process, mandibular corpus, and mandibular angle were analyzed from the panoramic radiographs of both groups.

Results: Analysis of changes in FD between T0 and T1 revealed significant increases in the FD values of the right and left condylar processes and right mandibular corpus in the treatment group (P < .001) and in the right condylar process in the control group (P < .05). Between-group comparisons demonstrated that the treatment group showed greater changes in the condylar process (right, P < .001; left, P < .05) and right mandibular corpus (P < .05) compared to controls. Correlation analysis between the cephalometric and FD changes in the treatment group showed the right condylar process changes were negatively correlated with GoGn/SN angle (P < .05) and positively correlated with Co-Go (P < .05), although these correlations were weak.

Conclusions: FD analysis demonstrated significant changes in trabeculation of the condyle and mandibular corpus in the treatment group compared to the control group. Functional appliance treatment may lead to skeletal correction by altering skeletal form and trabeculation of the mandibular bone.
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http://dx.doi.org/10.2319/012020-39.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028436PMC
November 2020

Evaluation of different Apexification treatments of teeth with immature apices and apical periodontitis on the fractal dimensions of trabecular bone.

Aust Endod J 2021 Aug 9;47(2):163-169. Epub 2020 Sep 9.

Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Bolu Abant Izzet Baysal University, Bolu, Turkey.

The aim of the present study was to investigate in the fractal dimension (FD) time-dependent changes of periapical bone after two different apexification treatments in teeth with immature apices and apical periodontitis. This study included 55 cases treated with apexification. Cases were divided into two groups: a calcium hydroxide group and a mineral trioxide aggregate group. In each case, the lesion area was evaluated by fractal analysis on periapical radiographs obtained before and 1-year after treatment via Image-J program. The FD of each region of interest on the radiographs was calculated using the fractal analysis method. The data were statistically analysed. In both groups, the FD values increased compare to initial at 1-year follow-up after treatment (P < .05). There was no statistically significant difference between the groups in terms of the time-dependent increase in FD values (P = 0.118). In the present study, time-dependent changes in FD were independent of the apexification method.
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http://dx.doi.org/10.1111/aej.12441DOI Listing
August 2021

Determination of alveolar bone height according to the relationship between molar teeth and maxillary sinus.

Oral Maxillofac Surg 2021 Jun 29;25(2):175-180. Epub 2020 Aug 29.

Department of Statistics, Faculty of Sciences, Ankara University, Ankara, Turkey.

Purpose: This study aims to analyze alveolar bone height (ABH) in the maxillary molar area according to the anatomical relationship between maxillary sinus and maxillary molar teeth via cone beam computed tomography images.

Methods: In 330 patients, 660 maxillary first molar (M1) and 648 maxillary second molar (M2) were evaluated. ABH measurements were made as to the shortest distance between the furcation midpoints of maxillary molars and the lowest point of the sinus floor. After the measurement, the positions of the maxillary molar teeth relative to the maxillary sinus were classified into four categories as type 1, 2, 3, and 4.

Results: ABH measurements in males were significantly higher than females (p < 0.05), but there were no differences between sides (p > 0.05). There were significant differences between types of both M1 and M2 for ABH, and the longest ABH was measured in type 1 (p < 0.05). Type 3 was the most common among 1308 maxillary molars teeth followed by type 1, type 2, and type 4.

Conclusion: Determination of the relationship between maxillary molar teeth and the maxillary sinus and analysis of ABH according to this relationship may help plan endodontic treatment, apical surgery, and immediate implant therapy and prevent their complications.
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http://dx.doi.org/10.1007/s10006-020-00902-2DOI Listing
June 2021

Assessment of Maxillary Sinus Changes After Le Fort I Osteotomy Surgery.

J Craniofac Surg 2020 Jul-Aug;31(5):e497-e501

Dentomaxillofacial Radiology Department, Dentistry Faculty, Bolu Abant Izzet Baysal University, Bolu, Turkey.

Objective: The goal of this retrospective study is to examine the changes of maxillary sinus volume, sinus membrane thickness (SMT) and the distance between the floor of maxillary sinus and ostium after Le Fort I osteotomy.

Methods: A total of 30 patients who underwent Le Fort I osteotomy were evaluated just before and 1 year after the surgical operation. Linear and volumetric measurements were done via 3D-DOCTOR software on sectional and 3D images.

Results: Decrease in maxillary sinus volume, increase in SMT and no change in distance between the floor of the maxillary sinus and ostium were detected after surgery. After surgery, SMT was found higher in advancement + impaction group.

Conclusion: This paper clarified that Le Fort I osteotomy affects the volume and thickness of the maxillary sinuses that may lead to deterioration of the ciliary activity and failure in the drainage which are predisposing factors for sinus pathologies. In maxillary osteotomies of later ages, maxillary sinus examination and follow-up should be performed regularly in order to maintain sinus health.
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http://dx.doi.org/10.1097/SCS.0000000000006659DOI Listing
October 2020

Contrast-to-noise ratios of different dental restorative materials: an in-vitro cone beam computed tomography study.

Eur Oral Res 2020 Jan;54(1):36-41

Kahramanmaras Sütcü İmam University, Dentistry Faculty, Department of Restorative Dentistry, Kahramanmaras,Turkey.

Purpose: In radiological views, strong beam hardening and streaking artifacts occur due to high-density structures and polyenergetic X-ray beams, and these lead to misdiagnosis. This study was performed in vitro to compare the contrast-to-noise ratio (CNR) of commonly used dental restorative materials by using Cone Beam Computed Tomography (CBCT) images with and without artifact reduction (AR) mode.

Materials And Methods: A total of 108 molar teeth were restored with nine different groups of restorative materials, with each group containing 12 teeth. Teeth were placed in a dry human mandible and scanned, one by one, via Planmeca 3D ProMax (Planmeca, Helsinki, Finland) with and without AR mode. Images were analyzed using ImageJ software (National Institutes of Health, Bethesda, MD) to calculate the CNR.

Results: CNR was calculated to be the highest in compomer (Glassiosite) images without AR mode (mean: 3.36) and with AR mode (mean: 3.61). CNR was calculated to be the lowest in amalgam (Tytin) images without AR mode (mean: 0.21) and with AR mode (mean: 0.23). A significant difference was found between materials in terms of CNR measurements (p ≤ 0.05). CNR measurements were increased after the AR mode application (p ≤ 0.05).

Conclusion: AR mode was effective in reducing artifacts arising from dental materials on CBCT images, so it is necessary to use AR mode for correct diagnoses.
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http://dx.doi.org/10.26650/eor.20200079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252535PMC
January 2020

Prediction of rapid palatal expansion success via fractal analysis in hand-wrist radiographs.

Am J Orthod Dentofacial Orthop 2020 Aug 26;158(2):192-198. Epub 2020 May 26.

Department of Orthodontics, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey.

Introduction: This study aimed to evaluate the efficacy of fractal analysis of hand-wrist radiography in the decision of conventional or surgery-assisted rapid palatal expansion (RPE).

Methods: The study included 48 patients who underwent the RPE procedure. Study groups were as follows: group 1 (successful conventional RPE [n = 24, 5 male and 19 female patients; mean age ± standard deviation, 15.85 ± 0.97 years]) and group 2 (failed conventional RPE [n = 24, 5 male and 19 female patients; mean age ± standard deviation, 15.96 ± 1.08 years]). Fractal dimension (FD) analysis was conducted on hand-wrist radiographs of the patients for 4 different regions: the epiphysis-diaphysis line of the radius bone and the proximal, medial (MP3), and distal (DP3) phalanxes of the middle finger. A Student t test was performed to compare fractal values between the groups. A receiver operating characteristic analysis was applied to determine the optimal cutoff value of FDs. In addition, a Pearson correlation coefficient was calculated to evaluate the relationship between the fractal values and either age or hand-wrist stage in a second sample group (n = 90; age range, 8.7-18.7 years).

Results: Fractal values of the radius, MP3, and DP3 were significantly increased in the failed conventional RPE group (P <0.05). The optimal cutoff value of the FD for predicting the success of conventional RPE was 1.16 in the radius, 1.18 in proximal phalanxes, 1.29 in MP3, and 1.08 in DP3. There was a positive correlation between fractal values of the radius and age or hand-wrist stages (P <0.05).

Conclusions: Within the limits of this study, results revealed that fractal analysis of hand-wrist radiographs might be considered a significant tool in the prediction of RPE success.
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http://dx.doi.org/10.1016/j.ajodo.2019.07.018DOI Listing
August 2020

Evaluation of a metal artifact reduction algorithm and an optimization filter in the estimation of peri-implant dehiscence defects by using cone beam computed tomography: an in-vitro study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2020 Aug 18;130(2):209-216. Epub 2020 Mar 18.

Professor, Department of Statistics, Faculty of Sciences, Ankara University, Ankara, Turkey.

Objectives: The aim of this study was to assess the effect of a metal artifact reduction (MAR) algorithm and the adaptive image noise optimizer (AINO) optimization filter in the detection of peri-implant dehiscences with cone beam computed tomography (CBCT).

Study Design: Nine implants (3 zirconium, 3 titanium, and 3 zirconium-titanium) were placed in 3 sheep heads. Dehiscences were created on the buccal and lingual/palatal surfaces. A total of 9 defects and 9 controls with no defects were evaluated by 3 observers. Each sheep head was scanned 5 times with 4 scan modes; (1) without MAR/without AINO; (2) with MAR/without AINO; (3) without MAR/with AINO; and (4) with MAR/with AINO. Receiver operating characteristic analysis and weighted kappa coefficients were used to calculate diagnostic efficacy and intra- and interobserver agreements for each implant type and scan mode.

Results: For all implant types, dehiscences were most accurately detected when both MAR and AINO were applied (P ≤ .045). Detection of dehiscences was more accurate with titanium implants (P ≤ .040). There were no significant differences in agreement among and between the observers.

Conclusions: The use of both MAR and AINO enhanced the detection accuracy of artificially created dehiscences in proximity to implants. Their combined use is recommended for detecting peri-implant dehiscences.
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http://dx.doi.org/10.1016/j.oooo.2020.02.005DOI Listing
August 2020

Evaluation of the Relationship Between Olfactory Fossa Measurements and Nasal Septum Deviation for Endoscopic Sinus Surgery.

J Craniofac Surg 2020 May/Jun;31(3):801-803

Ankara University, Dentistry Faculty, Dentomaxillofacial Radiology Department, Ankara, Turkey.

Introduction: Endoscopic sinus surgeries (ESS) are frequently used in the treatment of optic nerve decompression, other intracranial lesions and sinonasal pathologies. The olfactory fossa can be localized on different levels in relation to the anterior cranial fossa. The aim of the present study was to evaluate the depth and width of the olfactory fossa (OF) in relation to nasal septum deviation (NSD).

Methods: A total of 225 patient (141 female and 84 male, age range between 15 to 56 years) of cone beam computed tomography (CBCT) data was used in this study. NSD, OF width, OF depth were measured. OF depth which was grouped according to the Keros classification as Type I, II, and III was calculated. All measurements were performed bilaterally except for NSD.

Results: In the right and left OF depth were found Keros Type I 32 (14.2%) and 30 (13.3%), Keros Type II 171 (76%) and 167 (74.2%), and Keros Type III 22 (9.8%) and 28 (12.4%) respectively. There was no statistically significant found between OF depth and NSD (P > 0.05). The mean angle of the NSD in men and women were 4.36 ± 4.69 in women 4.11 ± 4.36, respectively. The mean width of the right OF was 2.50 ± 0.64 mm and 2.58 ± 0.72 mm for the left side and there was no statistically significant association between OF width - NSD and OF width - OF depth (P > 0.05).

Conclusion: The anatomy of the OF should be well established before surgical intervention increase of the length of the lateral lamella is also increases the risk of developing complications such as cerebral damage, hemorrhage, and cerebrospinal fluid fistula during endoscopic sinus surgery. Although there is no significant difference between OF measurement and NSD, with three-dimensional imaging detailed research is required before endoscopic sinus surgical operations.
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http://dx.doi.org/10.1097/SCS.0000000000006168DOI Listing
September 2020

Assessment of signal-to-noise ratio and contrast-to-noise ratio in 3 T magnetic resonance imaging in the presence of zirconium, titanium, and titanium-zirconium alloy implants.

Oral Surg Oral Med Oral Pathol Oral Radiol 2020 Jan 16;129(1):80-86. Epub 2019 Sep 16.

Professor, Oral and Maxillofacial Radiology, Private practice, San Antonio, Texas, USA.

Objective: We quantitatively compared the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in T1 weighted imaging (WI) and T2 WI sequences in 3 Tesla (T) magnetic resonance imaging (MRI) using zirconium, titanium (grades 4 and 5), and titanium-zirconium alloy implants to evaluate the effect of implant type and imaging sequence.

Study Design: MRI was acquired using a 3 T magnet with a 16-channel head coil. Implants of each type were mounted in gel and scanned in axial, coronal, and sagittal planes using fast spin echo sequences in T1 WI (TR = 600, TE = 12 milliseconds) and T2 WI (TR = 3000, TE = 80 milliseconds) sequences. Data were transferred to Synapse 3-D software, and images were measured twice by an oral and maxillofacial radiologist blinded to the type of implants.

Results: Zirconium implants resulted in the lowest SNR and CNR values (P < .05). No significant differences were identified between titanium (grades 4 and 5) and titanium-zirconium implants. The T2 WI sequence had a significantly higher SNR and CNR than T1 WI. There was no difference in intraobserver agreement between T1 WI and T2 WI.

Conclusions: CNR and SNR at 3 T MRI are dependent on implant type and imaging sequence. Titanium (grades 4 and 5) and titanium-zirconium implants and the T2 WI sequence produced higher SNR and CNR values.
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http://dx.doi.org/10.1016/j.oooo.2019.08.020DOI Listing
January 2020

Estimation of contrast-to-noise ratio in CT and CBCT images with varying scan settings in presence of different implant materials.

Dentomaxillofac Radiol 2019 Dec 9;48(8):20190139. Epub 2019 Aug 9.

Department of Comprehensive Dentistry, UT Health San Antonio, Texas, USA.

Objectives: To assess the contrast-to-noise ratio (CNR) of four different types of dental implant materials in CT and cone beam CT (CBCT) images with varying scan settings.

Methods: Four different types of implants: zirconium (Zr), titanium (Ti) Grade 4 and 5 and titanium-zirconium (Ti-ZrO2) alloy were placed in a 3% gelatin phantom in a cylindrical plastic container and scanned with two different CT machines (GE Medical systems and Toshiba Medical Systems) and one CBCT machine (I-CAT, Imaging Sciences International) with different voxel sizes of 0.2, 0.25, 0.3 and 0.4 mm. Images were analyzed using ImageJ software with the purpose of estimating the CNR.

Results: The CNR obtained from images acquired with CT was lower than the CBCT with all voxel sizes tested. 0.3 and 0.4 mm voxel sizes exhibited the highest CNR ( < 0.05) that gives the best image quality. Among the implant materials tested, titanium Grade 5 has the highest levels of CNR while Zirconium has the lowest ( < 0.05).

Conclusions: The optimum protocol for radiographic follow-up in areas near implants on the I-CAT is low-resolution settings (0.3 and 0.4 mm voxel sizes) which gave the highest CNR thus image quality. In presence of Zr implants, an alternative imaging modality ( MRI) may be considered to avoid low-quality images.
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http://dx.doi.org/10.1259/dmfr.20190139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6951101PMC
December 2019

Relationship between condyle cortication, sphenooccipital synchondrosis, and chronological age.

Oral Radiol 2020 04 22;36(2):190-196. Epub 2019 Jul 22.

Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey.

Objective: To assess the relationship between chronologic age, mandibular condyle cortication, and sphenooccipital synchondrosis (SOS) fusion.

Methods: Cone Beam Computed Tomography data of 253 patients were retrospectively evaluated. Mandibular condyle cortication was divided into three classes as Types I, II, and III. SOS fusion grade was categorized using a four-stage system (0-3). These variables were evaluated in relation to age and sex.

Results: There were significant positive relationships between age and condyle cortication, and between age and SOS fusion stage and between cortication type and SOS fusion stage.

Conclusion: Due to the positive correlation between the degree of SOS fusion stage, the condyle cortication type, and the chronological age, these indicators can be used for age estimation.
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http://dx.doi.org/10.1007/s11282-019-00398-xDOI Listing
April 2020

Evaluation of sphenoid sinus variations by using cone beam computed tomography in patients with cleft lip/palate.

Oral Radiol 2020 Jul 20;36(3):248-253. Epub 2019 Jul 20.

Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey.

Objective: The purpose of this study is to evaluate the sphenoid sinus variations in patients with cleft lip/palate.

Methods: Sixty three (63) patient's cone beam computed tomography (CBCT) images, taken from the head and neck region, were evaluated. Images were divided into two groups; [Group 1; patients with cleft lip/palate (CLP Group) (n = 23) Group 2; patients without cleft lip/palate (control group) (n = 40)]. The main pneumatization types (conchal, sellar, and presellar) of sphenoid sinuses were assessed on sagittal sections of the CBCT images. The sphenoid body, lateral and lesserwing types were evaluated on coronal sections and anterior type pneumatization was evaluated on axial sections.

Results: The mean age ranged from 12 to 26 (16.57 ± 4.46) in Group 1 and 12 to 25 (16.58 ± 3.71) in Group 2. In both groups, the male and female distribution was found similar (P = 0.342). The sellar type was the most common pneumatization type of sphenoid sinus both for the Group 1 (91.3%) and Group 2 (80%). Any statistically significant difference was not found between the two groups in terms of the incidence of pneumatization types. Combined type pneumatization was detected in 65.6% of the Control group and 76.2% of the CLP group.

Conclusions: In this study, the prevalence of sphenoid sinus pneumatization types in CLP patients was compared with the normal population. Any significant difference was not determined in the two groups.
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http://dx.doi.org/10.1007/s11282-019-00401-5DOI Listing
July 2020

Evaluation of artifacts generated by titanium, zirconium, and titanium-zirconium alloy dental implants on MRI, CT, and CBCT images: A phantom study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Jun 7;127(6):535-544. Epub 2019 Feb 7.

Department of Comprehensive Dentistry, University of Texas Health San Antonio, TX, USA and Department of General Dental Sciences, Marquette University, Milwaukee, WI, USA.

Objective: The aim of this study was to assess artifacts generated by zirconium, titanium, and titanium-zirconium alloy implants on magnetic resonance imaging(MRI), computed tomography(CT), and cone beam computed tomography(CBCT) and to correlate the findings to the dose-area product and exposure factors on CT and CBCT.

Study Design: Three phantoms were built by embedding zirconium, titanium, and titanium-zirconium implants in ultrasound gel. MRI, CT, and CBCT images were acquired by using multiple sequences and settings. For MRI, "artifact" was described as the length of signal void beyond the limits of the implant. For CT and CBCT, "artifact" was calculated by subtracting the gray level of the darkest pixel from the level of the lightest pixel.

Results: On MRI, zirconium implants had minor distortion artifacts, whereas titanium and titanium-zirconium implants created extensive artifacts (P < .05). On CT and CBCT, artifacts were less prominent with titanium and titanium-zirconium implants compared with zirconium (P < .05). Titanium grade 5 implants with 0.3 and 0.4 mm voxels produced the least severe artifacts.

Conclusions: MRI images were less affected by artifacts from zirconium implants, whereas CT and CBCT images showed less severe artifacts from titanium and titanium-zirconium alloy implants. CT generated greater artifacts compared with CBCT. Larger CBCT voxel sizes reduced the dose-area product and the severity of artifacts.
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http://dx.doi.org/10.1016/j.oooo.2019.01.074DOI Listing
June 2019

Prevalence of anatomical variants in the clivus: fossa navicularis magna, canalis basilaris medianus, and craniopharyngeal canal.

Surg Radiol Anat 2019 Apr 6;41(4):477-483. Epub 2019 Feb 6.

Dentomaxillofacial Radiology Department, Dentistry Faculty, Ankara University, Ankara, Turkey.

Purpose: This study determined the prevalence of fossa navicularis magna (FNM), canalis basilaris medianus (CBM), and craniopharyngeal canal (CPC), the size of FNMs, and types of CBM using 3D computed tomography (CT) images.

Methods: A total of 1059 3D images [649 cone beam computed tomography (CBCT) and 410 CT] were evaluated in this study. The prevalence of FNM, CBM, and CPC, length, width, and depth of FNM, and type of CBM were assessed.

Results: Overall, FNM was identified in 7.6%, CPC in 0.3%, and CBM in 2.5% of the study group. Type 2 (0.1%) and Type 6 (0.1%) are the least common CBM types. There was no significant difference between genders for depth and width measurements (p > 0.05), however, the length of FNM was significantly higher in males than females in CBCT images (p = 0.02).

Conclusion: FNM, CBM, and CPC are rare anatomical variants of clivus. However, they can facilitate spread of infection to the skull base or vice-versa. These types of anatomical variations should be known by radiologists to avoid unnecessary diagnosis and treatment procedures and to distinguish anatomic variations from pathological conditions.
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http://dx.doi.org/10.1007/s00276-019-02200-3DOI Listing
April 2019

Evaluation of osseous changes in dental panoramic radiography of thalassemia patients using mandibular indexes and fractal size analysis.

Oral Radiol 2020 01 24;36(1):18-24. Epub 2019 Jan 24.

Medicine Faculty, Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University, Istanbul, Turkey.

Objective: This study aimed to evaluate the radiomorphometric indexes and fractal dimension (FD) on dental panoramic radiography (DPR) of Thalassemia Major (TM) patients.

Methods: In 59 TM patients and in 59 healthy control subjects, mandibular cortical index (MCI), mandibular cortical width (MCW), panoramic mandibular index (PMI), and FD of four different regions (FD1-4) were evaluated and compared using DPRs.

Results: The distribution of MCI in TM patients was similar to control subjects (p > 0.05). The mean MCW was significantly lower in TM patients (p = 0.001). There was no significant difference in PMI between TM patients and control subjects. The mean of FD measured in the supracortical area above the angle of mandible (FD2), in the anterior to the mental foramen (FD4) and mean FD of four different regions was significantly lower in TM patients (p = 0.003, p = 0.001, and p = 0.014, respectively).

Conclusions: The radiomorphometric indices and fractal dimensions evaluated in the panoramic radiograph are capable of identifying thalassemia patients' jaw bone, and the results of DPR scanning can be used to refer these patients to appropriate medical investigation.
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http://dx.doi.org/10.1007/s11282-019-00372-7DOI Listing
January 2020

Relationship Between Pulp Tooth Area Ratio and Chronological Age Using Cone-beam Computed Tomography Images.

J Forensic Sci 2019 Jul 18;64(4):1096-1099. Epub 2018 Dec 18.

Department of Dentomaxillofacial Radiology, Faculty of Dentistry, University of Bolu Abant İzzet Baysal, Bolu, Turkey.

This study investigated the relationship between chronological age and pulp tooth area ratio (PTR) in maxillary central teeth using cone-beam computed tomography (CBCT) images in the Turkish population. The sample consisted of CBCT images of 120 male and female subjects between 14 and 75 years old. The PTR of the maxillary central teeth was calculated using inVivo 5 software (Anatomage, San Jose, CA). Data were analyzed with independent t-test and Pearson's rank correlation test. There was a significant negative correlation between chronological age and PTR (r = -0.615). The results showed that the PTR of maxillary central teeth is a reliable method for age estimation in the Turkish population.
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http://dx.doi.org/10.1111/1556-4029.13986DOI Listing
July 2019

Comparison of Cone Beam Computed Tomography and ultrasonography with two types of probes in the detection of opaque and non-opaque foreign bodies.

Med Ultrason 2018 Dec;20(4):467-474

Abant Izzet Baysal Unıversity Faculty of Dentistry, Department of Dentomaxillofacial Radiology.

Aim: The aim of this study was to compare the diagnostic accuracy of intra-oral and extra-oral ultrasonographic (US) examinations performed with linear and convex probes in the detection of opaque and non-opaque foreign bodies (FBs) located in the maxillofacial area.

Materials And Methods: Thirteen different type of FBs were inserted into a sheep's head: a) on the external bone surface of mandible (between the mandibular corpus and masseter muscle), b) in the intrinsic muscular tissue (in the dorsum of the tongue) and c) in the hollow structures (into the maxillary sinus of the sheep's head). The FBs in muscle tissue were scanned intra-orally whereas FBs in bone external bone surface of mandible and in maxillary sinus were scanned both intra-orally and extra-orally. The sensitivity of cone beam computed tomography (CBCT) and US imaging methods in detection of FBs were compared for FBs on the bone surface and in the muscular tissue.

Results: The intra-observer kappa coefficients provided identical values of 0.236 for the extra-oral convex probe, 0.461 for the intra-oral linear probe for overall FBs detection, which indicated notably poor to fair intra-observer agreement. The inter-observer agreement showed a poor agreement for the extra-oral use of linear probe (0.341 and 0.393) and extra-oral use of convex probe (0.319 and 0.335), However, a fair agreement was determined for use of probe intra-orally (0.530 and 0.534). Overall, the diagnostic accuracy of the CBCT was higher than the US regarding the visualization of FBs in the bone tissue.

Conclusion: US with a linear probe should be the first choice for the detection of the low-radiodensity FBs, which are entrapped in the soft tissue. However, CBCT is a more sensitive technique for the visualization of FBs in air and bone tissue compared to the US, particularly for the diagnosis of high-radiodensity FBs.
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http://dx.doi.org/10.11152/mu-1562DOI Listing
December 2018

Cone Beam Computed Tomographic Evaluation of Intracranial Physiologic Calcifications.

J Craniofac Surg 2019 Mar/Apr;30(2):510-513

Dentomaxillofacial Radiology Department, Faculty of Dentistry, Ankara University, Ankara, Turkey.

Objective: The aim of the present study was to evaluate the incidence of physiologic intracranial calcifications detected in cone beam computed tomography (CBCT) images of a Turkish subpopulation.

Methods: The CBCT image of the full head of 573 patients taken between 2015 and 2018 was evaluated retrospectively. The prevalence of habenular calcification, petroclinoid ligament, coroid plexus, interclinoid ligament (ICL), and carotico-clinoid ligament (CCL) calcifications was investigated. The age and gender of the patients were recorded.

Results: Intracranial calcification was found in 190 (33.1%) of 573 cases. The frequency of physiological calcifications is respectively; 19.2% were found as habenular, 4.88% as ICL, 3.83% as CCL, 2.7% as petroclinoid ligament, and 2.4% as choroid plexus. 38.2% of the women and 29.3% of the men had intracranial calcification. In 4 patients, both ICL and CCL ossification were detected. No statistically significant relationship was found between age, gender, and calcifications.

Conclusion: Cone beam computed tomography is a widely used imaging technique for dental diagnosis and treatment. Intracranial physiological calcifications may be a common incidental finding of CBCT scans.
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http://dx.doi.org/10.1097/SCS.0000000000004918DOI Listing
August 2019

Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study.

Oral Radiol 2019 01 15;35(1):23-28. Epub 2018 Feb 15.

Dentomaxillofacial Radiology Department, Faculty of Dentistry, Ankara University, Besevler, 06500, Ankara, Turkey.

Objective: This study was performed to evaluate the trabecular pattern of patients with cancer taking bisphosphonates on panoramic images using fractal dimension (FD) analysis by comparison with healthy subjects and to assess whether any difference exists between regions.

Methods: FD analysis was conducted using ImageJ 1.3 software (National Institutes of Health, Bethesda, MD, USA) with the box-counting method on panoramic radiographs of 33 patients taking bisphosphonates (13 males and 20 females) and 33 healthy sex- and age-matched individuals.

Results: FD values were higher (1.39 ± 0.14) in the study group than control group (1.38 ± 0.07) (p ≤ 0.05). No difference was detected in the FD values among the tested regions. The mean FD values in the control and study groups were as follows: region 1, 1.49 and 1.41 (p = 0.54); region 2, 1.36 and 1.37 (p = 0.84); region 3, 1.35 and 1.42 (p = 0.11); and region 4, 1.39 and 1.39 (p = 0.90), respectively. Female patients showed significantly lower values above the mandibular canal on the distal side of the second premolar and anterior to the mental foramen than did male patients (p ≤ 0.05). Age was unrelated to the FD in the study group (p ≥ 0.05).

Conclusions: The FD values of the patients with cancer taking bisphosphonates were higher than those of the controls. FD analysis showed the potential for examining bone structure in panoramic radiographs. Studies with a larger sample size are necessary to confirm these results.
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http://dx.doi.org/10.1007/s11282-018-0321-4DOI Listing
January 2019

Comparison of radiopacity of current restorative CAD/CAM blocks with digital radiography.

J Esthet Restor Dent 2019 01 10;31(1):88-92. Epub 2018 Oct 10.

Assistant Professor Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Bolu Abant İzzet Baysal University, Bolu, Turkey.

Objective: While the radiopacity of restorative material affects the radiographic diagnosis of the teeth, there is no data about the radiopacity of current restorative computer-aided design (CAD)/computer-aided manufacturing (CAM) materials. Therefore, the present study compared the radiopacity values of current restorative CAD/CAM blocks to facilitate the material choice within such a wide variety of materials.

Materials And Methods: Specimens were prepared from 13 different restorative CAD/CAM blocks to compare with enamel and dentin. The specimens placed on the occlusal phosphor plate were imaged with aluminum step wedge and tooth section. The radiopacity values were calculated using the Image J program. The radiopacity values of the specimens were converted to mmAl values with the Curve Expert 1.4 program.

Results: The difference between the radiopacity values of dentin and e.max CAD was not significant, however, they exhibited a significant difference from the other 14 groups (P < .05). Enamel and Obsidien, Suprinity, and Celtra Duo had greater radiopacity values with significant differences from the other 12 materials whereas the difference within these groups was not significant (P > .05).

Conclusions: The evaluated restorative CAD/CAM materials have significantly different radiopacity values. Among these permanent restoration blocks, the highest radiopacity value was observed in Celtra Duo, the lowest in Block HC.

Clinical Significance: Cerasmart, Lava Ultimate, Obsidian, Vita Suprinity, Celtra Duo Blocks have adequate radiopacity for inlay, onlay and crown restorations, however, the use of Vita Enamic, Vita Mark II, GC LRF blocks and the others which have lower radiopacity value than dentin for the same kind of restorations depend on the radiopacity of the luting cement for the purpose of recurrent caries detection.
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http://dx.doi.org/10.1111/jerd.12429DOI Listing
January 2019

Evaluation of Anatomical and Volumetric Characteristics of the Nasopalatine Canal in Anterior Dentate and Edentulous Individuals: A CBCT Study.

Implant Dent 2018 Aug;27(4):474-479

Professor, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey.

Objective: To examine the nasopalatine canal (NPC) anatomical and volumetric measurements in anterior edentulous (AE) and anterior dentate (AD) individuals and to compare these findings according to sex, age, shape, and severity of resorption in the premaxilla.

Methods: Two hundred cone beam computed tomography images were divided into 2 groups: AE and AD. The diameter, the length of the NPC and the width, the length of the buccal bone anterior to the NPC were measured and recorded. Linear and volumetric measurement results were evaluated in terms of age, sex, dental status, shape, and severity of resorption.

Results: No significant differences were observed between the AE and AD groups in terms of the NPC volume (P = 0.289). In the AE group, the spindle shape had the highest volume, and in the same group, with aging, the volume significantly increased (P = 0.00). The mean NPC volume was found to be statistically significantly larger in males than females (P = 0.02). A statistically significant relation was observed between NPC volume and resorption status.

Conclusion: Severe bone resorption due to sustained edentation complicated implant surgery because of the increase in incisive and nasal foramen diameters and decrease in buccal residual bone dimensions. The NPC volume was found fewer in edentulous patients, and by the resorption, the volume was decreased.
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http://dx.doi.org/10.1097/ID.0000000000000794DOI Listing
August 2018

Mandibular indexes and fractal properties on the panoramic radiographs of the patients using aromatase inhibitors.

Br J Radiol 2018 Nov 18;91(1091):20180442. Epub 2018 Jul 18.

3 Biostatistics and Medical Informatics Department, Istanbul Medeniyet University, Faculty of Medicine , Istanbul , Turkey.

Objective:: This study was conducted to evaluate fractal dimension (FD), mandibular cortical width (MCW), panoramic mandibular index (PMI), and mandibular cortical index (MCI) on panoramic radiographs to determine the mandibular cortical and trabecular bone changes in females with breast cancer undergoing aromatase inhibitors (AIs) treatment.

Methods:: In this retrospective study, FD analysis, PMI, MCI, and MCW were assessed over panoramic radiographs of 34 females under AI therapy as a patient group and 34 healthy age-gender matched individuals as a control group.

Results:: Mean FD values and MCW were slightly but not significantly lower in the patient group (1.47 ± 0.06 and 4.1 ± 1.2 respectively). FDs measured onthe supracortical area above the angulus mandibula (FD2) and anterior to the mental foramen (FD4) were significantly lower in patients (p = 0.037 and p = 0.046 respectively). Among the measured regions in patients, FD2 was significantly lower (p = 0.001). PMI was also significantly lower in patients (p = 0.001) and MCI were similar in both groups (p = 0.604).

Conclusion:: AI use affects bone quality and evaluating FD, PMI, and MCW in panoramic radiography can be used to determine the effect of this drug on the jaw bones in the early period.

Advances In Knowledge:: Aromatase inhibitors are the most commonly used drugs in breast cancer patients. This drug is thought to have osteoporotic effects on the jawbone. This study is the first study to evaluate osteoporotic changes with measurements made on panoramic radiographs and the results of the study are significant. We think this study will shed light on the studies that will investigate the effects of the drug on the jaw bones.
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http://dx.doi.org/10.1259/bjr.20180442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475946PMC
November 2018

Comparison of fractal dimension analysis and panoramic-based radiomorphometric indices in the assessment of mandibular bone changes in patients with type 1 and type 2 diabetes mellitus.

Oral Surg Oral Med Oral Pathol Oral Radiol 2018 08 3;126(2):184-191. Epub 2018 May 3.

Abant İzzet Baysal University, Dentistry Faculty, Department of Dentomaxillofacial Radiology, Bolu, Turkey. Electronic address:

Objectives: This study compared the fractal dimension (FD) and radiomorphometric indices in the assessment of mandibular bone of patients with type 1 (T1 DM) and type 2 diabetes mellitus (T2 DM).

Study Design: Panoramic radiographs of 104 patients were evaluated to calculate FD, mandibular cortical width (MCW), panoramic mandibular index (PMI), and mandibular cortical index (MCI) in the mandible.

Results: No statistically significant differences were found in FD when T1 DM and T2 DM groups were compared with controls (P ≥ .168). Patients with T1 DM had significantly lower MCW (P < .001) and PMI (P = .030) compared with controls. Patients with T2 DM had no significant differences in MCW (P = .228) or PMI (P = .137) compared with controls. No significant differences were observed between patients with T1 DM and those with T2 DM for FD, MCW, and PMI (P > .05). In the T1 DM and T2 DM groups, there was a significant correlation between MCW and FD (P ≤ .011). No correlation was observed between FD and PMI in either the T1 DM group or the T2 DM group (P ≥ .142). No significant differences in MCI were observed between the DM groups and controls (P = .740) or between the T1 DM and T2 DM groups (P = 1.000).

Conclusions: The cortical and trabecular bone architectures of patients with T1 DM and T2 DM were not different. Patients with T1 DM had lower cortical measurements compared with controls.
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http://dx.doi.org/10.1016/j.oooo.2018.04.010DOI Listing
August 2018

Anatomic Study on Sphenoidal Emissary Foramen by Using Cone-Beam Computed Tomography.

J Craniofac Surg 2018 Jul;29(5):e477-e480

Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey.

Objectives: The goal of this retrospective study is to evaluate the radiologic anatomy of sphenoidal emissary foramen (SEF) by using cone-beam computed tomography (CBCT) scans.

Methods: Three hundred seventeen (189 female and 128 male) full-head CBCT images were evaluated in this study. Incidence, diameter, shape, confluence to foramen ovale, and distance to anatomic structures of SEF were noted.

Results: In the 317 analyzed images, the SEF was identified in 89 (28.1%) images. Of these, 67 (21.1%) were unilateral, 22 were (6.9%) bilateral. The maximum mean diameter of SEF was measured 2.66 mm on the right side and 2.82 mm on the left side (P = 0.16). The most observed SEF shape was oval with the incidence of 68.5% (P ≤ 0.05). Confluence was observed in 23.4% of SEF whereof 84.6% were in the left side (P ≤ 0.05).

Conclusion: Observations in this study tender new anatomic parameters regarding SEF incidence, characteristics, and distances to proximate anatomic structures. Knowledge related to SEF variations will be helpful for neurosurgeons and radiologist.
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http://dx.doi.org/10.1097/SCS.0000000000004492DOI Listing
July 2018

Evaluation of the relationship between mandibular condyle cortication and chronologic age with cone beam computed tomography.

J Forensic Leg Med 2018 Apr 13;55:39-44. Epub 2018 Feb 13.

Abant Izzet Baysal University, Faculty of Dentistry, Department of Orthodontics, Bolu, Turkey.

Purpose: The aim of the present study is to evaluate the relationship between mandibular condyle cortication and chronologic age and gender via cone-beam computed tomography (CBCT) and to investigate the effectiveness of using the condylar cortication as a new method of age estimation.

Methods: CBCT images from 433 subjects aged 8 to 31 years were included in this study. The right and left condyle cortication were assessed on the sagittal plane separately for each individual by the same investigator via a new method that describes the cortication of the condyle. Type I: There is no cortication on the condyle. Type II: The bone that is on the superior surface of the condyle is seen less density than the structures around the condyle. Type III: The surface of the condyle is seen similar or higher density than the surrounding cortical areas.

Results: The type of the condyle cortication in the right and left mandible was similar for almost each subject and there was no statistically significant different between them (p = 0.375). When we evaluated the results without including these patients for male, Type I cortication of the condyle was seen at 14.14 ± 2.3 years, Type II cortication of the condyle was seen at 16.11 ± 3.18 years and Type III cortication of the condyle was seen at 19.39 ± 3.96 years. For the female, Type I cortication of the condyle was seen at 13.01 ± 2.16 years, Type II cortication of the condyle was seen at 15.52 ± 2.71 years and Type III cortication of the condyle was seen at 17.95 ± 3.13 years. The minimum age of Type III cortication was 11 and 15 years old for male and female, respectively. However, there are subjects, who are 30 year old man and 31 year old female, have no cortication as much as similar or higher than the surrounding the cortical areas.

Conclusion: This study is the first investigation of the relationship between condyle cortication and chronologic age with CBCT in the Turkish population. The type of cortication in the right and left condyle may be different for the same individual. Chronologic age increased as the stages of the cortication process from Type I to Type III in male and female individuals, and all the stages of the cortication in the mandibular condyle of male occur later time according to female.
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http://dx.doi.org/10.1016/j.jflm.2018.02.014DOI Listing
April 2018

Evaluation of the Characteristics and Association Between Schneiderian Membrane Thickness and Nasal Septum Deviation.

J Craniofac Surg 2018 May;29(3):683-687

Turey Public Hospital, Ankara, Turkey.

Objective: Nasal septum deviation (NSD) is an anomaly that disturbs normal mucus drainage in sinuses, leading to recurrent sinusitis. Sinusitis, infections, and mucosal irritations are the potential causes of Schneiderian membrane thickening (SMT). The aim of this study was to evaluate the characteristics and association between NSD and SMT along with factors such as age, gender, and tooth groups using cone-beam computed tomography (CBCT) imaging.

Methods: The maxillary sinus and nasal cavity of 249 patients (136 females and 113 males) were examined retrospectively using CBCT. The statistical analysis was performed to determine the association between SMT, NSD, gender, and age.

Results: No statistically significant relation was detected between NSD and SMT. The NSD was found in 50.6% of patients without gender predilection. Age was not associated with the presence of NSD. The mean thickness of the membrane was least in the third molar region and highest in the first molar region. The average SMT was found to be higher in males for all the examined tooth areas (P ≤ 0.05).

Conclusion: A retrospective evaluation of CBCT images emphasized the concept that NSD was not a factor that affected the thickening of maxillary sinus mucosa. The CBCT imaging could be used for evaluating the maxillary sinuses and nasal septum.
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http://dx.doi.org/10.1097/SCS.0000000000004254DOI Listing
May 2018

Gorlin-Goltz syndrome.

Turk Pediatri Ars 2017 Sep 1;52(3):173-177. Epub 2017 Sep 1.

Department of Oral and Maxillofacial Radiology, Abant İzzet Baysal University Faculty of Dentristry, Bolu, Turkey.

Gorlin-Goltz syndrome is a rare multisystemic disease inherited in an autosomal dominant pattern. It is characterized by numerous basal cell carcinoma of the skin, jaw cysts, and skeletal anomalies such as frontal bossing, vertebral anomalies, palmoplantar pits, and falx cerebri calcification. There is a tendency to tumors including medullablastoma, fibroma, rabdomyoma, leiomyosarcoma etc.. The diagnosis is based on major and minor clinical and radiologic criteria. Early diagnosis and treatment are of utmost importance in reducing the severity of long-term sequelae of this syndrome. In this article, we present a 15-year-old boy who was admitted to our clinic with brown-black papules and plaques on his scalp and was thought to have Gorlin-Goltz syndrome. He had a history of medulloblastoma that was treated with surgical resection followed by cranial radiotherapy and unilateral retinoblastoma. We present this case, because association of Gorlin-Goltz syndrome and retinoblastoma has not been described previously in the literature and we aimed to draw attention to radiation-induced basal cell carcinomas.
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http://dx.doi.org/10.5152/TurkPediatriArs.2017.2992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644586PMC
September 2017

Late Side Effects of Chemotherapy and Radiotherapy in Early Childhood on the Teeth: Two Case Reports.

Turk J Haematol 2018 Mar 18;35(1):87-88. Epub 2017 Sep 18.

Ordu University Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Ordu, Turkey.

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http://dx.doi.org/10.4274/tjh.2017.0216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843786PMC
March 2018
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