Objectives: The study aimed to evaluate the effect of plasma rich in growth factors (PRGF) mixed ... more Objectives: The study aimed to evaluate the effect of plasma rich in growth factors (PRGF) mixed with xenograft in direct maxillary sinus lift using cone-beam computed tomography (CBCT). CBCT was used for analysis of bone quantity and quality at the future implant site. Methods: Twenty patients of both sexes (16 females and 4 males) with missing maxillary first or second molar teeth, bone height ≤ 4mm, and crestal ridge width of at least 5 mm were included. A blood sample was collected from each patient that was subjected to centrifugation to obtain the PRGF preparation. Direct maxillary sinus lift with lateral approach was performed and xenograft mixed with PRGF was used as sinus graft. Bone height, bone width, graft volume and bone grey value/density were assessed using CBCT scan immediately after surgery and after 6 months. Results: After 6 months, there was 13.22 % decrease in total bone height (TBH) that was statistically significant. Also, there was a decrease in the crestal, middle, and apical bone widths which was significant at the middle bone width (MBH). Graft volume (GV) decreased by 20.98%; however, this decrease was statistically non-significant. Bone grey value/density showed a significant increase of 25.47 % in residual ridge density (RRD) and 21.09 % in residual ridge and graft density (RRGD). Conclusion: PRGF combined with xenograft increased the bone height, established middle and apical bone widths required for the implant support. Additionally, the used graft improved the bone density as measured by the grey value on CBCT scans.
Objective: The determination of sex and age is necessary in forensic practice and medico legal pu... more Objective: The determination of sex and age is necessary in forensic practice and medico legal purposes. Mandible may play a vital role in sex estimation as it is the most dimorphic bone of skull that often recovered intact. In this respect, the availability of plentiful antemortem orthopantomograms may be of great value in studying and developing population specific standards for accurate sex and age estimation. Therefore, the purpose of the current study was to assess the usefulness of various mandibular ramus linear and gonial angle measurements on digital panoramic images as indicators for sex and age in an Egyptian population sample. Methods: 191 panoramic images (105 males and 86 females) of Egyptian patients aged (6-70) years old were selected. Five mandibular ramus linear measurements (upper ramus breadth, lower ramus breadth, projective height, condylar ramus height and coronoid ramus height) and gonial angle measurements were performed bilaterally resulting in a total of 382 rami being assessed. Stepwise discriminant and regression analyses were performed to determine the most significant predictors of sex and age respectively. Results: Males showed statistically significant higher mean linear ramus measurements and lower mean gonial angle values than females. Condylar and coronoid ramus heights were the most significant predictors for sex and age respectively. The discriminate function equation was: (D=14.698-1.895 Condylar ramus height) with an accuracy of 81% in males and 77.9% in females and an overall accuracy of 79.6%. The regression equation for age estimation in the whole studied sample was: (Age=-32.306+8.481 Coronoid ramus height) that yields no significance on comparing actual and estimated ages. Conclusion: In the selected Egyptian population sample, the mandibular ramus showed a high sexual dimorphism and proved to be beneficial in sex and age estimation; while, the gonial angle could assist in sex estimation only.
Objectives: The aim of the present study was to assess the role of CBCT in the assessment of the ... more Objectives: The aim of the present study was to assess the role of CBCT in the assessment of the length, angulations, and different morphologic variations of the stylohyoid complex (SHC). Methods: CBCT scans of 112 subjects (41 males, 71 females, age range 5-52 years old) were included in the study. SHC was evaluated bilaterally. Length, anteroposterior angulation (APA), mediolateral angulation (MLA), morphologic and calcification patterns were evaluated. 25th-75th percentiles were calculated to detect the normal length and angulation ranges. Results: The normal range of the SHC length was 25.5-33.6 mm. SHC elongation was found in 32 cases (28.6%). APA and MLA normal ranges were (24.9o-34.2o and 66.6o-72.8o respectively). Males showed higher mean values than females regarding the SHC length and angulations with statistically significant difference in APA and MLA between both sexes. New morphologic pattern was detected in (2.7%) of cases. Normal length (Patterns A, B, C, D) was found in (74.65%) of the bilaterally evaluated SHC. Among the elongation cases, calcified SHC (Patterns F-K and the new pattern) was the most prevalent (17.8%). Absent SP was observed in (0.45%). The most prevalent calcification pattern was type B. Conclusion: CBCT revealed a new SHC morphologic pattern that may contribute to the proposed classification in literature. CBCT is a valuable imaging modality for accurate identification and analysis of the SHC in terms of length, angulations, and anatomic discrepancy.
Homo : internationale Zeitschrift fur die vergleichende Forschung am Menschen, 2021
Determination of the age of majority is of critical importance in forensic and legal practice. Th... more Determination of the age of majority is of critical importance in forensic and legal practice. This study aimed to assess the mandibular third molar maturation stage in discriminating adults and minors in an Egyptian population sample using two methods: Cameriere's third molar maturity index (I3M) and Demirjian's stage of maturation; further, the I3M cut-off value of < 0.08 for age 18 years and older was tested. The study included 350 digital panoramic radiographs of 14-24 years old participants. The effectiveness of I3M < 0.08 and Demirjian's stages were assessed using sensitivity, specificity, accuracy, post-test probability, positive likelihood ratio, and negative likelihood ratio. Receiver operating characteristic (ROC) curves were constructed to detect the overall effectiveness of I3M and Demirjian's stages to determine adults. I3M < 0.08 showed accuracy, sensitivity, specificity, post-test probability, positive and negative likelihood ratios of 88.65%,...
Purpose: Oral carcinoma cuniculatum is a rare well-differentiated variant of oral squamous cell c... more Purpose: Oral carcinoma cuniculatum is a rare well-differentiated variant of oral squamous cell carcinoma. The purpose was to systematically review its unique features to differentiate it from other variants as verrucous carcinoma, papillary squamous cell carcinoma and well-differentiated squamous cell carcinoma. Materials and Methods: A systematic review was performed using MEDLINE, Dentistry and Oral Sciences Source and PubMed databases and any existing articles related to the research subject missed in the search strategy to screen ones reporting cases occurring exclusively in the oral cavity in English literature. Variables analyzed included clinical, etiologic, imaging, histopatholgical features, treatment, follow-up and survival rates. Results: From 229 hits, 17 articles with 43 cases were included in the systematic review. Clinically it showed a female predilection with pain and/or ulceration of a relatively long duration and exudation being the most common symptoms. Histologically, it showed more endophytic features comprising well-differentiated squamous epithelium with absent or minimal cytological atypia and multiple keratin filled crypts or cuniculus. Inflammatory stromal reaction and discharging abscesses were reported in most of the cases. Bone destruction was predominant in most imaging features. Complete surgical resection with a safety margin was the treatment of choice in most of the cases with few recorded recurrence cases. Conclusion: Apprehensive knowledge of oral carcinoma cuniculatum unique features is essential to avoid its misdiagnosis and provide proper treatment especially for recurrent cases.
Purpose: To evaluate osseous changes of temporomandibular joint (TMJ) in patients with rheumatoid... more Purpose: To evaluate osseous changes of temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA) using cone-beam computed tomography (CBCT) and to correlate the imaging findings with the severity of TMJ dysfunction, clinical findings, and laboratory findings. Materials and Methods: This study consisted of 28 subjects, including 14 RA patients and 14 controls, who were scheduled to undergo CBCT imaging for the diagnosis of a complaint not related to or affecting the TMJ. The Fonseca's questionnaire was used to assess the severity of TMJ dysfunction. Rheumatoid factor (RF) and the erythrocyte sedimentation rate (ESR) were assessed in the RA patients. CBCT was then performed in all subjects and osseous TMJ abnormalities were assessed. results: According to the Fonseca's questionnaire, 14.3% of the patients had no TMJ dysfunction, while 50%, 21.4%, and 14.3% had mild, moderate, and severe dysfunction, respectively. RF was positive in 64.3% of patients, and the ESR level was high in 100%. Imaging findings revealed a statistically significantly higher prevalence of erosion (85.7%), flattening (89.3%), osteophyte formation (32.1%), subchondral cyst (32.1%), sclerosis (64.3%), and condylar irregularities (28.6%) in the RA patients than in the controls. No correlations were found between CBCT findings and the clinical findings, the severity of TMJ dysfunction, disease duration, or laboratory results. conclusion: RA patients might show extensive osseous abnormalities with no/mild clinical signs or symptoms of TMJ dysfunction that necessitate TMJ imaging for these patients. CBCT is a valuable and efficient modality that can assess osseous TMJ changes in RA patients.
The conventional sialography (CS) and minor salivary gland biopsy have been considered the corner... more The conventional sialography (CS) and minor salivary gland biopsy have been considered the cornerstones of the diagnosis of Sjögren’s syndrome (SS). However, they are invasive and with risk of complications to the patient. Magnetic resonance imaging (MRI) has been widely replacing conventional invasive examinations. They provide insufficient data for diagnosing and staging SS, because while they address the detection and diagnosis of parenchymal salivary gland disease they do not assess duct abnormalities. The introduction of magnetic resonance sialography (MRS) protocol was the first step towards non-ionizing non-invasive technique enables a more accurate assessment of the duct system. Moreover, it is postulated that the combined use of MRI and MRS is useful for the assessment of damaged salivary glands in SS.This preliminary study aimed to assess the role and efficacy of MRS and MRI in imaging the parotid gland in SS patients’ and to compare their results with that of CS in the diagnosis and staging of SS.The parotid gland was examined by MRS, MRI and CS in 15 SS patients. Scoring system for overall branching pattern, ductal system staging, sialectasis for both CS and MRS was used. MRI scoring system for glandular parenchymal pattern, size and contour and lymph node was used.This revealed non-significant difference between CS and MRS findings in the diagnosis and staging of SS. Furthermore, no statistically significant correlation was found between the clinical and SS stage in both CS and MRS. On the other hand, a statistically significant positive correlation was found between the clinical findings and the MRI parenchymal stages. Moreover, MRS showed higher sensitivity and diagnostic accuracy values than CS. Combining the MRS and MRI abnormalities, 100% sensitivity diagnostic accuracy values were achieved in the diagnosis and staging of SS. The inter-observer agreement was higher in MRS than in CS and was perfect in MRI.In this preliminary study, MRS showed a higher sensitivity and accuracy in diagnosing and staging SS and may safely and securely replace CS. MRI and MRS give information on different aspects of glandular and duct pathology; therefore, both should be performed when examining the parotid glands in SS patients.
Objectives: The study aimed to evaluate the effect of plasma rich in growth factors (PRGF) mixed ... more Objectives: The study aimed to evaluate the effect of plasma rich in growth factors (PRGF) mixed with xenograft in direct maxillary sinus lift using cone-beam computed tomography (CBCT). CBCT was used for analysis of bone quantity and quality at the future implant site. Methods: Twenty patients of both sexes (16 females and 4 males) with missing maxillary first or second molar teeth, bone height ≤ 4mm, and crestal ridge width of at least 5 mm were included. A blood sample was collected from each patient that was subjected to centrifugation to obtain the PRGF preparation. Direct maxillary sinus lift with lateral approach was performed and xenograft mixed with PRGF was used as sinus graft. Bone height, bone width, graft volume and bone grey value/density were assessed using CBCT scan immediately after surgery and after 6 months. Results: After 6 months, there was 13.22 % decrease in total bone height (TBH) that was statistically significant. Also, there was a decrease in the crestal, middle, and apical bone widths which was significant at the middle bone width (MBH). Graft volume (GV) decreased by 20.98%; however, this decrease was statistically non-significant. Bone grey value/density showed a significant increase of 25.47 % in residual ridge density (RRD) and 21.09 % in residual ridge and graft density (RRGD). Conclusion: PRGF combined with xenograft increased the bone height, established middle and apical bone widths required for the implant support. Additionally, the used graft improved the bone density as measured by the grey value on CBCT scans.
Objective: The determination of sex and age is necessary in forensic practice and medico legal pu... more Objective: The determination of sex and age is necessary in forensic practice and medico legal purposes. Mandible may play a vital role in sex estimation as it is the most dimorphic bone of skull that often recovered intact. In this respect, the availability of plentiful antemortem orthopantomograms may be of great value in studying and developing population specific standards for accurate sex and age estimation. Therefore, the purpose of the current study was to assess the usefulness of various mandibular ramus linear and gonial angle measurements on digital panoramic images as indicators for sex and age in an Egyptian population sample. Methods: 191 panoramic images (105 males and 86 females) of Egyptian patients aged (6-70) years old were selected. Five mandibular ramus linear measurements (upper ramus breadth, lower ramus breadth, projective height, condylar ramus height and coronoid ramus height) and gonial angle measurements were performed bilaterally resulting in a total of 382 rami being assessed. Stepwise discriminant and regression analyses were performed to determine the most significant predictors of sex and age respectively. Results: Males showed statistically significant higher mean linear ramus measurements and lower mean gonial angle values than females. Condylar and coronoid ramus heights were the most significant predictors for sex and age respectively. The discriminate function equation was: (D=14.698-1.895 Condylar ramus height) with an accuracy of 81% in males and 77.9% in females and an overall accuracy of 79.6%. The regression equation for age estimation in the whole studied sample was: (Age=-32.306+8.481 Coronoid ramus height) that yields no significance on comparing actual and estimated ages. Conclusion: In the selected Egyptian population sample, the mandibular ramus showed a high sexual dimorphism and proved to be beneficial in sex and age estimation; while, the gonial angle could assist in sex estimation only.
Objectives: The aim of the present study was to assess the role of CBCT in the assessment of the ... more Objectives: The aim of the present study was to assess the role of CBCT in the assessment of the length, angulations, and different morphologic variations of the stylohyoid complex (SHC). Methods: CBCT scans of 112 subjects (41 males, 71 females, age range 5-52 years old) were included in the study. SHC was evaluated bilaterally. Length, anteroposterior angulation (APA), mediolateral angulation (MLA), morphologic and calcification patterns were evaluated. 25th-75th percentiles were calculated to detect the normal length and angulation ranges. Results: The normal range of the SHC length was 25.5-33.6 mm. SHC elongation was found in 32 cases (28.6%). APA and MLA normal ranges were (24.9o-34.2o and 66.6o-72.8o respectively). Males showed higher mean values than females regarding the SHC length and angulations with statistically significant difference in APA and MLA between both sexes. New morphologic pattern was detected in (2.7%) of cases. Normal length (Patterns A, B, C, D) was found in (74.65%) of the bilaterally evaluated SHC. Among the elongation cases, calcified SHC (Patterns F-K and the new pattern) was the most prevalent (17.8%). Absent SP was observed in (0.45%). The most prevalent calcification pattern was type B. Conclusion: CBCT revealed a new SHC morphologic pattern that may contribute to the proposed classification in literature. CBCT is a valuable imaging modality for accurate identification and analysis of the SHC in terms of length, angulations, and anatomic discrepancy.
Homo : internationale Zeitschrift fur die vergleichende Forschung am Menschen, 2021
Determination of the age of majority is of critical importance in forensic and legal practice. Th... more Determination of the age of majority is of critical importance in forensic and legal practice. This study aimed to assess the mandibular third molar maturation stage in discriminating adults and minors in an Egyptian population sample using two methods: Cameriere's third molar maturity index (I3M) and Demirjian's stage of maturation; further, the I3M cut-off value of < 0.08 for age 18 years and older was tested. The study included 350 digital panoramic radiographs of 14-24 years old participants. The effectiveness of I3M < 0.08 and Demirjian's stages were assessed using sensitivity, specificity, accuracy, post-test probability, positive likelihood ratio, and negative likelihood ratio. Receiver operating characteristic (ROC) curves were constructed to detect the overall effectiveness of I3M and Demirjian's stages to determine adults. I3M < 0.08 showed accuracy, sensitivity, specificity, post-test probability, positive and negative likelihood ratios of 88.65%,...
Purpose: Oral carcinoma cuniculatum is a rare well-differentiated variant of oral squamous cell c... more Purpose: Oral carcinoma cuniculatum is a rare well-differentiated variant of oral squamous cell carcinoma. The purpose was to systematically review its unique features to differentiate it from other variants as verrucous carcinoma, papillary squamous cell carcinoma and well-differentiated squamous cell carcinoma. Materials and Methods: A systematic review was performed using MEDLINE, Dentistry and Oral Sciences Source and PubMed databases and any existing articles related to the research subject missed in the search strategy to screen ones reporting cases occurring exclusively in the oral cavity in English literature. Variables analyzed included clinical, etiologic, imaging, histopatholgical features, treatment, follow-up and survival rates. Results: From 229 hits, 17 articles with 43 cases were included in the systematic review. Clinically it showed a female predilection with pain and/or ulceration of a relatively long duration and exudation being the most common symptoms. Histologically, it showed more endophytic features comprising well-differentiated squamous epithelium with absent or minimal cytological atypia and multiple keratin filled crypts or cuniculus. Inflammatory stromal reaction and discharging abscesses were reported in most of the cases. Bone destruction was predominant in most imaging features. Complete surgical resection with a safety margin was the treatment of choice in most of the cases with few recorded recurrence cases. Conclusion: Apprehensive knowledge of oral carcinoma cuniculatum unique features is essential to avoid its misdiagnosis and provide proper treatment especially for recurrent cases.
Purpose: To evaluate osseous changes of temporomandibular joint (TMJ) in patients with rheumatoid... more Purpose: To evaluate osseous changes of temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA) using cone-beam computed tomography (CBCT) and to correlate the imaging findings with the severity of TMJ dysfunction, clinical findings, and laboratory findings. Materials and Methods: This study consisted of 28 subjects, including 14 RA patients and 14 controls, who were scheduled to undergo CBCT imaging for the diagnosis of a complaint not related to or affecting the TMJ. The Fonseca's questionnaire was used to assess the severity of TMJ dysfunction. Rheumatoid factor (RF) and the erythrocyte sedimentation rate (ESR) were assessed in the RA patients. CBCT was then performed in all subjects and osseous TMJ abnormalities were assessed. results: According to the Fonseca's questionnaire, 14.3% of the patients had no TMJ dysfunction, while 50%, 21.4%, and 14.3% had mild, moderate, and severe dysfunction, respectively. RF was positive in 64.3% of patients, and the ESR level was high in 100%. Imaging findings revealed a statistically significantly higher prevalence of erosion (85.7%), flattening (89.3%), osteophyte formation (32.1%), subchondral cyst (32.1%), sclerosis (64.3%), and condylar irregularities (28.6%) in the RA patients than in the controls. No correlations were found between CBCT findings and the clinical findings, the severity of TMJ dysfunction, disease duration, or laboratory results. conclusion: RA patients might show extensive osseous abnormalities with no/mild clinical signs or symptoms of TMJ dysfunction that necessitate TMJ imaging for these patients. CBCT is a valuable and efficient modality that can assess osseous TMJ changes in RA patients.
The conventional sialography (CS) and minor salivary gland biopsy have been considered the corner... more The conventional sialography (CS) and minor salivary gland biopsy have been considered the cornerstones of the diagnosis of Sjögren’s syndrome (SS). However, they are invasive and with risk of complications to the patient. Magnetic resonance imaging (MRI) has been widely replacing conventional invasive examinations. They provide insufficient data for diagnosing and staging SS, because while they address the detection and diagnosis of parenchymal salivary gland disease they do not assess duct abnormalities. The introduction of magnetic resonance sialography (MRS) protocol was the first step towards non-ionizing non-invasive technique enables a more accurate assessment of the duct system. Moreover, it is postulated that the combined use of MRI and MRS is useful for the assessment of damaged salivary glands in SS.This preliminary study aimed to assess the role and efficacy of MRS and MRI in imaging the parotid gland in SS patients’ and to compare their results with that of CS in the diagnosis and staging of SS.The parotid gland was examined by MRS, MRI and CS in 15 SS patients. Scoring system for overall branching pattern, ductal system staging, sialectasis for both CS and MRS was used. MRI scoring system for glandular parenchymal pattern, size and contour and lymph node was used.This revealed non-significant difference between CS and MRS findings in the diagnosis and staging of SS. Furthermore, no statistically significant correlation was found between the clinical and SS stage in both CS and MRS. On the other hand, a statistically significant positive correlation was found between the clinical findings and the MRI parenchymal stages. Moreover, MRS showed higher sensitivity and diagnostic accuracy values than CS. Combining the MRS and MRI abnormalities, 100% sensitivity diagnostic accuracy values were achieved in the diagnosis and staging of SS. The inter-observer agreement was higher in MRS than in CS and was perfect in MRI.In this preliminary study, MRS showed a higher sensitivity and accuracy in diagnosing and staging SS and may safely and securely replace CS. MRI and MRS give information on different aspects of glandular and duct pathology; therefore, both should be performed when examining the parotid glands in SS patients.
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