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Purpose To evaluate the diagnostic accuracy of computed tomography (CT) of the parotid gland for Sjogren's syndrome in comparison with conventional X-ray sialography. Methods CT scans and X-ray sialography were performed in 34 patients with confirmed Sjogren's syndrome and 22 symptomatic controls without the disease. CT data from 57 asymptomatic controls were included for quantitative analysis. The CT findings of heterogeneity, abnormal diffuse fat tissue deposition, diffuse punctate calcification, swelling or atrophy, nodularity or cystic changes of the parotid gland were analyzed by two independent blinded readers. The correlation between CT and X-ray sialography findings was evaluated. Diagnostic performance and receiver operating characteristics curves were calculated. Results On CT, heterogeneity of the parotid gland was seen in 30/31 (reader 1/reader 2) Sjogren's syndrome patients by the two readers (sensitivity 88.2%/91.2%; specificity 100%/90.9%). Abnormal diffuse fat tissue deposition was seen in 28/28 SS patients by the readers (sensitivity 82.3%/82.3%; specificity 100%/90.9%). Diffuse punctate calcification was seen in 10/12 Sjogren's syndrome patients (sensitivity 29.4%/35.2%; specificity 100%/100%). Stagings of CT findings correlate positively with sialography. The areas under the receiver operating characteristics curves were 0.887 (P = 0.000) and 0.908 (P = 0.000) for the maximum and standard deviation (SD) of the CT value. Conclusions Parotid CT is accurate and reliable in the diagnosis of Sjogren's syndrome. Heterogeneity, abnormal diffuse fat tissue deposition, and diffuse punctate calcification are specific for Sjogren's syndrome. CT attenuation analysis is helpful in diagnosis.

Objective The aim of this study was to evaluate and compare the measurement accuracy of the temporomandibular joint (TMJ) space in the Promax 3D cone-beam computerized tomography (CBCT) images scanned with 2 different dental protocols. Study Design TMJ space impression models were made according to the occlusion. Forty joints were scanned with the standard and the large view protocol of the Promax 3D CBCT scanner. Two observers measured the joint spaces 3 times on both radiographs and the photocopies of the impression models. Results A total of 120 CBCT images were measured. There were no significant differences among the actual joint spaces and the CBCT measurements performed with the 2 scanning protocols ( P = .305). The inter- and intraobserver variabilities were not significant. Conclusions The 2 scanning protocols provided by the Promax 3D CBCT scanner were reliable and similar for recording the TMJ space.

Objective The aim of this study was to primarily investigate the usefulness of computerized tomographic (CT) fistulography in the diagnosis and management of branchial cleft fistulae and sinuses. Study Design Fifteen patients with confirmed branchial fistulae or sinuses who had undergone CT fistulography were included. The diagnoses were confirmed by clinical, radiologic, or histopathologic examinations. The internal openings, distribution, and neighboring relationship of the lesions presented by CT fistulography were analyzed to evaluate the usefulness in comparison with x-ray fistulography. Results Nine patients were diagnosed with first branchial fistulae or sinuses, 2 with second branchial fistulae, and 4 with third or fourth branchial fistulae. The presence and location of the lesions could be seen on x-ray fistulography. The distribution of the lesions, internal openings, and neighboring relationship with parotid gland, carotid sheath, and submandibular gland could be clearly demonstrated on CT cross-sectional or volume-rendering images. Conclusions CT fistulography could provide valuable information and benefit surgical planning by demonstrating the courses of branchial anomalies in detail.

Aims To evaluate the diagnostic accuracy of approximal carious lesions among five CBCT systems and to assess the effect of detector types employed by different CBCT systems on the accuracy of approximal caries diagnosis. Materials and methods Thirty-nine extracted non-cavitated human permanent teeth were employed in the study. Seven observers evaluated 78 approximal surfaces of the teeth with respect to caries by the images from the following five CBCT systems: (1) NewTom 9000; (2) Accuitomo 3DX; (3) Kodak 9000 3D; (4) ProMax 3D; and (5) DCT PRO, respectively. The lesions were validated by histological examination. The area under receiver operating characteristic (ROC) curve ( A z ) was used to evaluate the diagnostic accuracy. Results Microscopy of approximal surfaces found 47.4% sound, 39.8% enamel and 12.8% dentin lesions. The differences of A z values among the five CBCT systems were not statistically significant ( p =0.348). No significant difference was found between the two detector types of CBCT systems ( p =0.47). Conclusions The five CBCT systems employed in the study showed no significant difference in the in vitro approximal caries detection. Neither the detector nor the FOV employed by the CBCT systems has an impact on the detection accuracy of approximal caries.

Objective The objective of this study was to investigate the clinical and radiographic features of osteoarthrosis (OA) of the temporomandibular joints (TMJOA) in human adolescents and young adults. Study design Patients (n = 4883) with temporomandibular disorders (age, 11 to 30 years) underwent clinical and radiographic examinations. The radiographic findings were classified as erosive bony changes, proliferative changes mainly, including flattening with uneven sclerosis, and osteophytes of the condyle, and bilaterally short condylar processes. In addition, we interpreted the reassessment radiographs of 156 of the patients. Results Seven hundred eleven patients had radiographic signs of OA. The frequency of OA was higher in women (563/3360, 16.8%) than in men (148/1523, 9.7%). Most patients (541/711, 76.1%) with signs of OA showed proliferative changes of OA. Moreover, 56.4% of patients with TMJOA (88/156) remained stable. Conclusions These results suggest that although OA is an age-related disease, aging is not the crucial factor in the pathogenesis of OA.

Objectives To evaluate the accuracy of cone-beam computerized tomography (CBCT) for the detection of noncavitated proximal caries and to compare the detection accuracies of 2 CBCT imaging systems with those based on plain-film radiographs and phosphor-plate images. Study design Test radiographs of 39 noncavitated unrestored human permanent teeth were obtained with film, phosphor-plate, ProMax 3D, and Kodak 9000 3D imaging systems. Seven observers used a 5-level scale to evaluate test images for the presence of proximal caries. With histologic examination serving as the reference standard, observer performances were assessed with receiver operating characteristic (ROC) curves, and the areas under the ROC curves (Az values) for the observers, and modalities were analyzed with a repeated-measures analysis of variance. Results The mean Az values for film, phosphor plates, ProMax 3D, and Kodak 9000 3D imaging systems were 0.541, 0.523, 0.528, and 0.525, respectively (P = .763). Conclusion For detecting subtle noncavitated proximal caries, the detection accuracy with the CBCT images was little better than chance performance and was similar to that with phosphor plate– and film-based intraoral images.

Objectives The aim of this study was to compare effective doses resulting from different scan protocols for cone-beam computerized tomography (CBCT) using International Commission on Radiological Protection (ICRP) 1990 and 2007 calculations of dose. Study design Average tissue-absorbed dose, equivalent dose, and effective dose for a ProMax 3D CBCT with different dental protocols were calculated using thermoluminescent dosimeter chips in a human equivalent phantom. Effective doses were derived using ICRP 1990 and the superseding 2007 recommendations. Results Effective doses (ICRP 2007) for default patient sizes from small to large ranged from 102 to 298 μSv. The coefficient of determination ( R 2 ) between tube current and effective dose (ICRP 2007) was 0.90. When scanning with lower resolution settings, the effective doses were reduced significantly ( P Conclusions ProMax 3D can provide a wide range of radiation dose levels. Reduction in radiation dose can be achieved when using lower settings of exposure parameters.

Objectives The aim of this study was to evaluate if the diagnostic accuracy of proximal dental caries in digital radiographs was similar when obtained in in vivo and in vitro conditions. Study design Thirty-nine noncavitated teeth were collected from 11 subjects who had part of upper or lower jaws excised owing to cyst or neoplasm. Before operation, radiographs of the teeth involved were taken with the digital imaging system Digora Optime (Soredex, Helsinki, Finland), and after operation, the same extracted teeth were mounted in plaster blocks and exposed with the same digital imaging system. The teeth were subsequently sectioned for histologic validation of the lesions. Six observers evaluated all of the radiographs according to a 5-category scale. Receiver operating characteristic analysis was performed. Repeated-measure analysis of variance was used for the statistical analysis. Results There were no significant differences between digital radiographs taken in in vivo and in vitro conditions for diagnosis of proximal dental caries (P = .286). Conclusion Detection accuracy of proximal dental caries obtained from an in vitro study can be considered to be representative of diagnostic accuracy of proximal dental caries obtained in the real clinical situation.

Objective The aim was to evaluate a semirigid endoscopic technique for diagnosis and management of sialolithiasis. Study design Diagnostic and interventional sialendoscopic procedures were performed in 90 patients with sialoliths (78 submandibular glands and 12 parotid glands). Results Owing to its extreme flexibility and rigidity, the endoscope can be introduced easily into the ductal system. Sialoliths with a round or irregular shape were detected by endoscopy in all cases, including 84 radiopaque and 6 radiolucent stone cases. Of the 78 cases with sialoliths in the submandibular (Wharton's) duct, 14 were present in the hilum of the main duct, 34 in the premolar region of the duct, 24 in the molar region of the duct, and 6 in both the premolar and the molar regions of the duct. Among these cases, we could remove the stones intraductally in 44 cases by endoscopy alone. Additionally, 6 cases were treated with basket retrieval and endoscopic-assisted surgery, and the remaining 27 were treated with endoscopic-assisted surgery. Of the 12 cases of sialoliths in the parotid (Stensen's) duct, 9 were treated with basket retrieval and 1 with basket-capturing and open surgery via a buccal incision. In total, 87 of 90 cases were successfully treated, with (n = 34) or without (n = 53) endoscopic-assisted surgery. These patients were stone free at their last follow-up (3 to 30 months). Conclusions The semirigid endoscope permits a better visualization of sialoliths and coexisting obstructive pathologies. With minimally invasive procedures, most stones in the main duct of the salivary gland can be removed using either an intraductal or an extraductal approach.

Objective The aim of this study was to investigate with cone-beam computed tomography (CBCT) the locations of impacted maxillary canines and resorption of neighboring incisors. Study design Two hundred ten impacted maxillary canines were analyzed using CBCT images. The locations of the impacted canines were assessed and angular and linear measurements were taken using NewTom proprietary software. In addition, root resorption of neighboring incisors was investigated. Results Among these impactions, 45.2% were impacted buccal-labially, 40.5% were impacted palatally, and 14.3% in the midalveolus. The locations varied: mesial-labial impaction (n = 67), mesial-palatal impaction (n = 74), in situ impaction (n = 31), distal impaction (n = 12), horizontal impaction (n = 18), and inverted impaction (n = 8). Quantitive measurements further depicted these variations. Root resorption was present in 27.2% of lateral and 23.4% of central incisors, and 94.3% of these resorptions occurred where the impacted canines were in close contact with the incisors. Conclusion The location of impacted maxillary canines varies greatly in 3 planes, and the resorption of neighboring permanent incisors is common.