Imaging Sci Dent.  2020 Mar;50(1):53-64. 10.5624/isd.2020.50.1.53.

Incidental findings in a consecutive series of digital panoramic radiographs

• MacDonald
• Yu W

• KMID: 2471846
• DOI: http://doi.org/10.5624/isd.2020.50.1.53

Abstract

PURPOSE
The aim of this study was to determine the prevalence of incidental findings (IFs) on digital dental panoramic radiographs (DPRs) of asymptomatic patients attending a general dental practice.
MATERIALS AND METHODS
This was a retrospective study of 6,252 consecutive digital (photostimulatable phosphor) DPRs of patients who visited a Canadian general dental practice for a complete new patient examination. The IFs were grouped into dental-related anomalies, radiopacities and radiopacities in the jaws, changes in the shape of the condyles, and other findings in the jaws, such as tonsilloliths and mucosal antral pseudocysts. Their prevalence was determined.
RESULTS
Thirty-two percent of the DPRs showed at least 1 IF. The highest prevalence was found for dental-related anomalies (29% of all DPRs), of which impacted teeth were the most prevalent finding (24% of all DPRs), followed by idiopathic osteosclerosis (6% of all DPRs). A lower prevalence was noted for tonsilloliths (3%), and the prevalence of root tips, mucosal antral pseudocysts, and anomalies in condylar shape was approximately 1% each.
CONCLUSION
The observed prevalence of 32.1% for IFs of any type underscores the need for a dental practitioner to review the entire DPR when a patient presents for an initial dental examination (or check-up) or for dental hygiene. Only a single IF (a central giant cell granuloma) provoked alarm, as it was initially considered malignant. Similarly, impacted teeth and suspected cysts need careful evaluation upon discovery to determine how they may be optimally managed.

Keyword

Incidental Findings; Jaw; Radiography, Panoramic

MeSH Terms

Giant Cells
Humans
Incidental Findings*
Jaw
Meristem
Oral Hygiene
Osteosclerosis
Prevalence
Radiography, Panoramic
Retrospective Studies
Tooth, Impacted

Figure

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  Fig. 1 Dental-related anomalies. A. An impacted left mandibular third molar, intimately related to the mandibular canal, displacing it downward and reducing its diameter. B. Congenitally missing premolars bilaterally. C. Supernumery mandibular premolars. The left first molar has a radiopacity at its mesial root, which in conjunction with the moderately large restoration should prompt a vitality test in order to distinguish between idiopathic osteosclerosis, which needs no treatment, and condensing osteitis, which does.

• 

  Fig. 2 Dental-related anomalies. A. An impacted right second premolar with a right-angled dilaceration of its root. B. A deeply-buried root apex from an extracted first molar. The radiolucency substantially enclosing it is suggestive of an ongoing infection. The premolar root displays a slight dilaceration, less severe than that in A. C. A post-orthodontically treated patient displaying root resorption of the premolars. A retainer wire has been cemented to the lower incisors. A notable finding is the small radiopacity between the roots of the maxillary first molar and the presumably second premolar. This is an idiopathic osteosclerosis, which are infrequently observed in the maxilla.

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  Fig. 3 Radiopacities. A. Idiopathic osteosclerosis associated with the apex of a molar tooth that displays no caries or large restorations that may suggest pulpal necrosis. B. Sclerosing osteitis associated with a periapical radiolucency at the apex of a root-filled molar tooth.

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  Fig. 4 Radiolucent areas in the bones of the jaws. A. A periapical radiolucency at the first right decayed molar. It is surrounded by a band of condensing osteosclerosis which has extended slightly into the basal process, accentuating the mandibular canal. B. A periapical radiolucent of inflammatory origin associated with the root-filled first molar. It has displaced the mandibular canal downwards and the root of the second molar backwards. C. A pericoronal radiolucency on a unerupted third molar is consistent with a dentigerous cyst. D. A lingual bone defect sited between the lower border of the mandible and mandibular canal.

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  Fig. 5 A central giant cell granuloma extending from the midline of the mandible to the right first molar. It has resorbed the apices of the right premolars and anterior teeth and has expanded and eroded the lower border of the mandible.

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  Fig. 6 Metal fixtures and non dental implants. A. Fixation bimaxillary osteotomy; Le Fort 1, Obwegeser type osteotomy and genioplasty. B. Wire fixation of the chin. Of note, a hearing aid is present in the right ear and a right calcified carotid artery atheroma is located anterior to the vertebral bodies.

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