Prevalence of bony septa, antral pathology, and dimensions of the maxillary sinus from a sinus augmentation perspective: A retrospective cone-beam computed tomography study

Tadinada, Aditya,Jalali, Elnaz,Al-Salman, Wesam,Jambhekar, Shantanu,Katechia, Bina,Almas, Khalid Korean Academy of Oral and Maxillofacial Radiology 2016 Imaging Science in Dentistry Vol.46 No.2

Purpose: Sinus elevation procedures have become a routine and reliable way to gain bone volume in the edentulous maxilla for dental implant placement. Presence of bony septations and pathology in the maxillary sinus often cause complications leading to graft or implant failure or both. The aim of this study was to retrospectively evaluate the prevalence of pathology, direction of the septa, and sinus width measured at 2 mm, 5 mm, and 10 mm from the sinus floor in maxillary sinuses using cone-beam computed tomography (CBCT). Materials and Methods: Seventy-two sinuses from 36 random preoperative CBCT scans referred for implant therapy were retrospectively evaluated for the number, prevalence, and direction of bony septations and presence of pathology. Width of the sinus was also measured at 2 mm, 5 mm, and 10 mm from the sinus floor to account for the amount of bone available for implant placement. Results: Maxillary sinus septa were found in 59.7%. Presence of a single septum was noted in 20 sinuses (27.7%), followed by two septa in 17 sinuses. The most common direction of the septum was the transverse direction. Retention pseudocyst and mucosal thickening were the most commonly seen abnormality/pathology. Conclusion: Based on the high prevalence of septa and sinus pathology in this sample, a preoperative CBCT scan might be helpful in minimizing complications during sinus augmentation procedures for dental implant therapy.

The reliability of tablet computers in depicting maxillofacial radiographic landmarks

Tadinada, Aditya,Mahdian, Mina,Sheth, Sonam,Chandhoke, Taranpreet K,Gopalakrishna, Aadarsh,Potluri, Anitha,Yadav, Sumit Korean Academy of Oral and Maxillofacial Radiology 2015 Imaging Science in Dentistry Vol.46 No.1

Purpose: This study was performed to evaluate the reliability of the identification of anatomical landmarks in panoramic and lateral cephalometric radiographs on a standard medical grade picture archiving communication system (PACS) monitor and a tablet computer (iPad 5). Materials and Methods: A total of 1000 radiographs, including 500 panoramic and 500 lateral cephalometric radiographs, were retrieved from the de-identified dataset of the archive of the Section of Oral and Maxillofacial Radiology of the University Of Connecticut School Of Dental Medicine. Major radiographic anatomical landmarks were independently reviewed by two examiners on both displays. The examiners initially reviewed ten panoramic and ten lateral cephalometric radiographs using each imaging system, in order to verify interoperator agreement in landmark identification. The images were scored on a four-point scale reflecting the diagnostic image quality and exposure level of the images. Results: Statistical analysis showed no significant difference between the two displays regarding the visibility and clarity of the landmarks in either the panoramic or cephalometric radiographs. Conclusion: Tablet computers can reliably show anatomical landmarks in panoramic and lateral cephalometric radiographs.

Radiographic evaluation of the maxillary sinus prior to dental implant therapy: A comparison between two-dimensional and three-dimensional radiographic imaging

Tadinada, Aditya,Fung, Karen,Thacker, Sejal,Mahdian, Mina,Jadhav, Aniket,Schincaglia, Gian Pietro Korean Academy of Oral and Maxillofacial Radiology 2015 Imaging Science in Dentistry Vol.46 No.1

Purpose: This study was performed to evaluate the diagnostic efficacy of panoramic radiography and cone-beam computed tomography (CBCT) in detecting sinus pathology. Materials and Methods: This study was based on a retrospective evaluation of patients who had undergone both a panoramic radiograph and a CBCT exam. A total of 100 maxillary sinuses were evaluated. Four examiners with various levels of expertise evaluated the images using a five-point scoring system. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficacy of the two modalities. The image analysis was repeated twice, with at least two weeks between the evaluation sessions. Interobserver reliability was assessed using Cronbach's alpha, and intraobserver reliability was assessed using Cohen's kappa. Results: Maxillary sinus pathology was detected in 72% of the patients. High interobserver and intraobserver reliability were observed for both imaging modalities and among the four examiners. Statistical analyses using ROC curves demonstrated that the CBCT images had a larger area under the curve (0.940) than the panoramic radiographs (0.579). Conclusion: Three-dimensional evaluation of the sinus with CBCT was significantly more reliable in detecting pathology than panoramic imaging.

Diagnostic efficacy of a modified low-dose acquisition protocol for the preoperative evaluation of mini-implant sites

Tadinada, Aditya,Marczak, Alana,Yadav, Sumit Korean Academy of Oral and Maxillofacial Radiology 2017 Imaging Science in Dentistry Vol.47 No.3

Purpose: The objective of this study was to compare the outcomes of surgical mini-implant placement when potential mini-implant sites were scanned using a lower-dose $180^{\circ}$ acquisition protocol versus a conventional $360^{\circ}$ acquisition protocol. Materials and Methods: Ten dentate human skulls were used to provide sites for potential mini-implant placement. The sites were randomly divided into 2 groups: $360^{\circ}$ and $180^{\circ}$ cone-beam computed tomography (CBCT) acquisition protocols. A small-volume $180^{\circ}$ CBCT scan and a $360^{\circ}$ CBCT scan of each site were acquired using a Morita Accuitomo-170 CBCT machine and then a mini-implant was placed. A follow-up $360^{\circ}$ CBCT scan was done as a gold standard to evaluate the location of the mini-implant and root perforation. Two raters evaluated the scans. Results: Ninety-eight percent of the mini-implants placed did not perforate any root structure. Two percent of the sites had an appearance suggestive of perforation. On a Likert scale, both raters agreed that their subjective evaluation of the diagnostic quality of the protocols, ability to make and read measurements of the sites, and preferences for the specified diagnostic task were comparable. The Cohen kappa showed high inter-rater and intrarater agreement. Conclusion: In this ex vivo study, we found that the $180^{\circ}$ rotational acquisition was as effective as the conventional $360^{\circ}$ rotational acquisition for the preoperative evaluation of potential mini-implant sites.

radioRadiographic evaluation of the maxillary sinus prior to dental implant therapy: A comparison between two-dimensional and three-dimensional radiographic imaging

Aditya Tadinada,Karen Fung,Sejal Thacker,Mina Mahdian,Aniket Jadhav,Gian Pietro Schincaglia 대한영상치의학회 2015 Imaging Science in Dentistry Vol.45 No.3

Purpose: This study was performed to evaluate the diagnostic efficacy of panoramic radiography and cone-beam computed tomography (CBCT) in detecting sinus pathology. Materials and Methods: This study was based on a retrospective evaluation of patients who had undergone both a panoramic radiograph and a CBCT exam. A total of 100 maxillary sinuses were evaluated. Four examiners with various levels of expertise evaluated the images using a five-point scoring system. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficacy of the two modalities. The image analysis was repeated twice, with at least two weeks between the evaluation sessions. Interobserver reliability was assessed using Cronbach’s alpha, and intraobserver reliability was assessed using Cohen’s kappa. Results: Maxillary sinus pathology was detected in 72% of the patients. High interobserver and intraobserver reliability were observed for both imaging modalities and among the four examiners. Statistical analyses using ROC curves demonstrated that the CBCT images had a larger area under the curve (0.940) than the panoramic radiographs (0.579). Conclusion: Three-dimensional evaluation of the sinus with CBCT was significantly more reliable in detecting pathology than panoramic imaging.

The reliability of tablet computers in depicting maxillofacial radiographic landmarks

Aditya Tadinada,Mina Mahdian,Sonam Sheth,Taranpreet K Chandhoke,Aadarsh Gopalakrishna,Anitha Potluri,Sumit Yadav 대한영상치의학회 2015 Imaging Science in Dentistry Vol.45 No.3

Purpose: This study was performed to evaluate the reliability of the identification of anatomical landmarks in panoramic and lateral cephalometric radiographs on a standard medical grade picture archiving communication system (PACS) monitor and a tablet computer (iPad 5). Materials and Methods: A total of 1000 radiographs, including 500 panoramic and 500 lateral cephalometric radiographs, were retrieved from the de-identified dataset of the archive of the Section of Oral and Maxillofacial Radiology of the University Of Connecticut School Of Dental Medicine. Major radiographic anatomical landmarks were independently reviewed by two examiners on both displays. The examiners initially reviewed ten panoramic and ten lateral cephalometric radiographs using each imaging system, in order to verify interoperator agreement in landmark identification. The images were scored on a four-point scale reflecting the diagnostic image quality and exposure level of the images. Results: Statistical analysis showed no significant difference between the two displays regarding the visibility and clarity of the landmarks in either the panoramic or cephalometric radiographs. Conclusion: Tablet computers can reliably show anatomical landmarks in panoramic and lateral cephalometric radiographs.

Diagnostic efficacy of a modified low-dose acquisition protocol for the preoperative evaluation of mini-implant sites

Aditya Tadinada,Alana Marczak,Sumit Yadav 대한영상치의학회 2017 Imaging Science in Dentistry Vol.47 No.3

Purpose: The objective of this study was to compare the outcomes of surgical mini-implant placement when potential mini-implant sites were scanned using a lower-dose 180° acquisition protocol versus a conventional 360° acquisition protocol. Materials and Methods: Ten dentate human skulls were used to provide sites for potential mini-implant placement. The sites were randomly divided into 2 groups: 360° and 180° cone-beam computed tomography (CBCT) acquisition protocols. A small-volume 180° CBCT scan and a 360° CBCT scan of each site were acquired using a Morita Accuitomo-170 CBCT machine and then a mini-implant was placed. A follow-up 360° CBCT scan was done as a gold standard to evaluate the location of the mini-implant and root perforation. Two raters evaluated the scans. Results: Ninety-eight percent of the mini-implants placed did not perforate any root structure. Two percent of the sites had an appearance suggestive of perforation. On a Likert scale, both raters agreed that their subjective evaluation of the diagnostic quality of the protocols, ability to make and read measurements of the sites, and preferences for the specified diagnostic task were comparable. The Cohen kappa showed high inter-rater and intrarater agreement. Conclusion: In this ex vivo study, we found that the 180° rotational acquisition was as effective as the conventional 360° rotational acquisition for the preoperative evaluation of potential mini-implant sites.

Prevalence of bony septa, antral pathology, and dimensions of the maxillary sinus from a sinus augmentation perspective: A retrospective cone-beam computed tomography study

Aditya Tadinada,Elnaz Jalali,Wesam Al-Salman,Shantanu Jambhekar,Bina Katechia,Khalid Almas 대한영상치의학회 2016 Imaging Science in Dentistry Vol.46 No.2

Purpose: Sinus elevation procedures have become a routine and reliable way to gain bone volume in the edentulous maxilla for dental implant placement. Presence of bony septations and pathology in the maxillary sinus often cause complications leading to graft or implant failure or both. The aim of this study was to retrospectively evaluate the prevalence of pathology, direction of the septa, and sinus width measured at 2 mm, 5 mm, and 10 mm from the sinus floor in maxillary sinuses using cone-beam computed tomography (CBCT). Materials and Methods: Seventy-two sinuses from 36 random preoperative CBCT scans referred for implant therapy were retrospectively evaluated for the number, prevalence, and direction of bony septations and presence of pathology. Width of the sinus was also measured at 2 mm, 5 mm, and 10 mm from the sinus floor to account for the amount of bone available for implant placement. Results: Maxillary sinus septa were found in 59.7%. Presence of a single septum was noted in 20 sinuses (27.7%), followed by two septa in 17 sinuses. The most common direction of the septum was the transverse direction. Retention pseudocyst and mucosal thickening were the most commonly seen abnormality/pathology. Conclusion: Based on the high prevalence of septa and sinus pathology in this sample, a preoperative CBCT scan might be helpful in minimizing complications during sinus augmentation procedures for dental implant therapy.

Arrested pneumatization of the sphenoid sinus mimicking intraosseous lesions of the skull base

Jalali, Elnaz,Tadinada, Aditya Korean Academy of Oral and Maxillofacial Radiology 2015 Imaging Science in Dentistry Vol.45 No.1

Arrested pneumatization of the sphenoid sinus is a developmental variant that is not always well recognized and is often confused with other pathologies associated with the skull base. This report describes the case of a patient referred for cone-beam computed tomography (CBCT) imaging for dental implant therapy. CBCT demonstrated a well-defined incidental lesion in the left sphenoid sinus with soft tissue-like density and sclerotic borders with internal curvilinear opacifications. The differential diagnoses included intraosseous lipoma, arrested pneumatization of the sphenoid sinus, chondrosarcoma, chondroid chordoma, and ossifying fibroma. The radiographic diagnosis of arrested pneumatization was based on the location of the lesion, its well-defined nature, the presence of internal opacifications, and lack of expansion. Gray-scale CBCT imaging of the area demonstrated values similar to fatty tissue. This case highlighted the fact that benign developmental variants associated with the skull base share similar radiographic features with more serious pathological entities.

Prevalence of pineal gland calcification as an incidental finding in patients referred for implant dental therapy

Mutalik, Sunil,Tadinada, Aditya Korean Academy of Oral and Maxillofacial Radiology 2017 Imaging Science in Dentistry Vol.47 No.3

Purpose: Pineal gland calcification has been proposed to play a role in the pathogenesis of Alzheimer disease. This study evaluated the prevalence and extent of pineal gland calcification in cone-beam computed tomography (CBCT) scans of patients referred for dental implant therapy who could possibly be a vulnerable group for this condition. Materials and Methods: A retrospective evaluation of 500 CBCT scans was conducted. Scans that showed the area where the pineal gland was located were included. The scans were initially screened by a single observer to record the prevalence and extent of calcification. Six weeks following the completion of the study, another investigator randomly reviewed and selected 50 scans to investigate inter-observer variation, which was evaluated using reliability analysis statistics. The prevalence and measurements of the calcifications were reported using descriptive statistics. The chi-square test was used to compare the prevalence between males and females. Results: The prevalence of pineal gland calcification was 58.8%. There was no statistically significant correlation between age and the extent of the calcification. The prevalence of calcification was 58.6% in females and 59.0% in males. The average anteroposterior measurement was $3.73{\pm}1.63mm$, while the average mediolateral measurement was $3.47{\pm}1.31mm$. The average total calcified area was $9.79{\pm}7.59mm^2$. Conclusion: The prevalence of pineal gland calcification was high in patients undergoing implant therapy. While not all pineal gland calcifications lead to neurodegenerative disorders, they should be strongly considered in the presence of any symptoms as a reason to initiate further investigations.