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Dr. Sarah Chen
Stanford · NLP & interpretability
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Deeba Kashtwari
· Chair and Clinical Professor of Oral & Maxillofacial Radiology;Chief Radiation Safety Officer, GSDMVerified
Boston University · Department of General Dentistry
Deeba Kashtwari is the Chair and Clinical Professor of Oral & Maxillofacial Radiology at the Boston University Henry M. Goldman School of Dental Medicine (GSDM). She also serves as the Chief Radiation Safety Officer at GSDM. She earned her BDS degree from Rajiv Gandhi University of Health Sciences in India in 2003 and completed her MS in Oral and Maxillofacial Radiology at the University of North Carolina at Chapel Hill in 2014. Her professional focus includes oral and maxillofacial radiology, with an emphasis on radiation safety and clinical education in dental radiology.
DOAJ (DOAJ: Directory of Open Access Journals) · 2025-01-01
articleOpen access
Background/Aim: Root resorption (RR) refers to a cellular response resulting in loss of hard and soft dental tissue due to injury, irritation of the periodontal ligament, and/or tooth pulp. Typically, it is considered a physiologic response; however, in permanent dentition, it is associated with the presence of active pathology, and the basis of it has two main aspects: injury and stimulus. This is a presentation of two cases that show evidence of external apical resorption with concurrent periodontal bone loss of the involved teeth as the only evident stimulus in the history of the patient, clinically and radiographically. Case Report: The first case was that of a 43-year-old patient who presented himself with mild generalized pain in the second quadrant. The medical history revealed no underlying condition, and the patient provided informed consent. The clinical examination included periodontal charting of the dentition, which confirmed the presence of pockets in various locations, measuring between 4 mm and 6 mm. The initial panoramic radiograph (orthopantomogram: OPG) at the day of the appointment revealed a diffuse pattern of root resorption on the tooth #26 in contrast to the distinct and clear, although asymptomatic, root resorption of #47. The second case involved a 73-year-old patient who presented himself with mild generalized pain in the first quadrant, mostly while eating. Medical history revealed only the administration of furosemide as anti-hypertensive treatment, and the patient provided informed consent. Clinical examination included periodontal charting that confirmed deep pockets, more prominently in the posterior teeth of the maxilla, and specifically the first quadrant. The orthopantomogram examination on the day of the appointment confirmed the presence of the pockets radiographically. #16 did not respond to cold and therefore the patient was referred to an endodontist, who initiated the root canal treatment and suggested an exploratory flap, which in turn revealed the root resorption of the palatal root. Conclusions: Historically, intraoral periapical radiographs (PAs) were the first tool that was used to diagnose RR. However, over the years, the development of panoramic radiograph (OPG) and the later development of Cone Beam Computed Tomography (CBCT) has incrementally altered our ability to visualize and diagnose dental pathosis. Root resorption involves shortening or blunting of the root concomitant with loss of cementum and/or dentin. Physiological root resorption involves exclusively deciduous teeth and thus is considered pathological when affecting the permanent dentition. The periodontal status acts as a precursor since periodontal disease-related root resorption is reportedly found about three times more frequently. Root resorption presents with significant variation in the affected teeth and, with no guidelines in place correlating a specific class of root resorption with a singular treatment, a case-by-case approach is the gold-standard.
Osteomas are slow-growing benign tumors that almost exclusively occur in the craniofacial region and more often in the ethmoid air cells. When they occasionally occur in the maxillary sinuses, they can interfere with dental procedures like sinus augmentation. This study presents the case of a 59-year-old male patient who was treated for sinus augmentation of the left maxillary sinus. During the treatment planning phase, a peripheral osteoma was identified with cone beam computed tomography (CBCT) as an incidental finding without any clinical signs or symptoms. The sinus augmentation procedure was accomplished, and the patient underwent follow-up to confirm no changes in the osteoma. Peripheral osteomas of the head and neck region are usually described radiographically as well-defined and well-circumscribed without clinical signs. Their presence can sometimes interfere with dental treatment, complicating the surgical procedure and even compromising results. Due to their benign and slow-growing nature, and based on their location, size, and clinical relevance, they may not require treatment; however, follow-up is recommended. Peripheral osteomas constitute one of the early findings of familial adenomatous polyposis (Gardner syndrome). This rare autosomal dominant disease is characterized by intestinal polyps and extra-intestinal features, like multiple osteomas and soft-tissue tumors. The early detection of such lesions in the maxillofacial region can lead to timely diagnosis and subsequently improve the prognosis of the patient.
: UAs typically exhibit less aggressive behavior. However, cases like this one, where mural involvement is noted and no associated impaction is detected, underline the possibility of variable radiographic presentation and the significance of a multidisciplinary approach in correct diagnosis and treatment. Histological subtyping is crucial for guiding treatment.
An accurate diagnosis and treatment plan can increase the chances for a timely and effective treatment and better outcomes of our patients. Clinicians can use clinical and radiographic examinations to help them in their everyday practice for making a correct differential diagnosis. Traditionally, a periapical lesion that is treated by non-surgical endodontic therapy is not biopsied. As a result, no histological diagnosis is available prior to end- odontic treatment. While this approach is effective in the vast majority of cases, some cases are more complex and may be deceptive, resulting in failed treatment. One such case is presented in this case report. Interdisciplinary consultation and collaboration as a team of the endodontist, radiologist, oral surgeon and histopa- thologist is very important to be able to make a correct diagnose, treatment plan and to give the best treatment to our patients.
A dentigerous cyst (DC) is the most common developmental cystic lesion of the jaws. Histologically, these cysts derive from the odontogenic epithelium that includes the reduced enamel epithelium, epithelial cell rests of Serres, and epithelial cell rests of Malassez. Radiographically, DCs are usually presented as well-defined radiolucencies associated with the crown of an unerupted tooth at the level of the cementoenamel junction (CEJ). Glandular odontogenic cysts (GOCs) are classified under the same category as DCs. Radiographically, glandular odontogenic cysts (GOCs) may appear as unilocular or more commonly as multilocular radiolucencies with well-defined margins. It is evident that there is a significant overlap in the radiographic features of the two pathologies. This case report describes one of those cases. A 49-year-old male patient was referred for a cone beam computed tomography (CBCT) imaging series for the evaluation of possible pathology in areas #17-#19 and ramus to the Graduate Oral and Maxillofacial Radiology Clinic, Health Science Center, San Antonio, University of Texas. The radiographic interpretation revealed a well-defined corticated low-density lesion in the left mandibular molar-ramus region. The mandibular canal was intact and traceable but displaced buccally and inferiorly. The radiographic findings were suggestive of a slow-growing odontogenic process, most likely cystic. Marsupialization and incisional biopsy of the lesion were carried out, which was highly suggestive of GOC. Two months after the initial incisional biopsy, it was decided that enucleation and curettage, as well as extraction of #17, #18, and #19, should be carried out. The enucleated specimen was sent to the histopathology laboratory for evaluation. The second biopsy showed a dentigerous cyst associated with impacted #17. Histopathology continues to be, statistically, the most reliable method for diagnosing these types of abnormalities. However, in certain cases, such as this one, the accuracy of histopathological examination may falter due to overlapping characteristics and different histopathological features based on the location of acquisition of the specimen. The initial radiographic estimation included the differential diagnosis of a DC as a second differential and, although contradicted by the first biopsy result, was eventually supported by the second final biopsy of the entire specimen. Although DCs do not tend to recur, the need for regular follow-ups should not be underestimated, neither by the attending clinician nor by the patients themselves. In conclusion, the radiographically proven, uneventful wound healing constitutes the only reassurance for the patient's well-being.
Journal of Clinical Pediatric Dentistry · 2021-09-17 · 2 citations
article
Chronic recurrent multifocal osteomyelitis (CRMO) is an uncommon, aseptic, autoinflammatory condition characterized by multifocal bone lesions with pain, swelling, and frequent exacerbations and remissions. It is noteworthy that these lesions occur without any identifiable etiology or microbiologic finding. The clavicle and metaphyses of the long bones are often involved whereas involvement of the mandible is considered rare. It is usually diagnosed by exclusion of other diseases. As it shares most of its features with the more commonly occurring infective osteomyelitis, patients are often unnecessarily subjected to prolonged courses of antibiotics, serial radiation exposures, and repeated bone biopsies. We present a case of CRMO involving the mandible. Our primary objective is to demonstrate the clinical features of this uncommon disorder, highlighting the radiographic appearance. Familiarity with this condition among radiologists greatly increases the likelihood for early diagnosis and formulating an appropriate treatment plan.
