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Introduction: The term of idiopatic osteosclerosis (I.O) have been used to describe a localised area of radiopacity of unknown origin. The condition is usually asymptomatic and discovered on a radiograph taken for other reason. The radiopacity is variable in size, shape, outline and density. The purpose of this investigation was to determine the frequncy, age and sex distribution and anatomic location of I.O and its relation to history of extraction of decidious teeth. Materials and Methods: Standard panoramic radiographs of 917 patients(494 female & 423 male) were examined at the Department of oral and maxillofacial radiology, Yazd dental college and private clinic. The age, sex as well as the anatomic location of I.O is outlined I.O mass were observed in patients. The radiographs was studies carefully by oral radiologist and sclerosis mass place was marked then clinical examination was done. Results: In total 54 sclerosis mass in 52 mandibuls were observed According to the location of lesions premolars of lower jaws was higher than other (59.6% in female & 40.4% in male P=0.392). Most of cases were occurred in 3rd & forth decade of life (P=0.018). The most prevalence areas were premolar/ molar/ between firstmolar second premolar/ between canin & first premolar. Conclusion: According to the our finding that the most prevalence was belogned to sclerotic mass that was not related to the root, the developing theory in a cause of mass that seems to be accepted.

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Introduction: Idiopathic osteosclerosis is a common radiopaque lesion in the jaw bones, which is asymptomatic and usually detected accidentally in various radiographs. The purpose of this study was to determine the radiographic features of idiopathic osteosclerosis in the jawbones of patients referring to the maxillofacial radiology center of Mashhad Dental Faculty. Methods: In this descriptive study, panoramic radiographs of 300 patients ( 125 males, 175 females ) who had referred to the maxillofacial radiology department were evaluated for the presence of idiopathic osteosclerosis. The radiographic information included location, number, shape, size, relationship with teeth, pattern of density ( trabecular-cortical ) and demographic data ( age, sex ) and evidence of disease in the gastrointestinal tract and kidneys were also recorded . Then data was analyzed using chi-square and t-student test. Results : A total of 27 patients (9%), exhibited 40 foci of idiopathic osteosclerosis with different shapes and sizes (4 cm2 to 1/09 cm 2 ), most of which had well defined borders (65%) and trabecular density (62/5%) . The most common region for these lesions was in the mandible, especially in the second premolar (47/5%) and first molar (42/5%) regions and the majority had no connection to the teeth (57/5%). The lesions were most prevalent in the second decade of life (29/6%) followed by third and fourth decades. (25/9%) Conclusion: The results of this study were the same as that of previous similar studies. In addition, chronic renal failure was seen in 1/3 of patients with idiopathic osteosclerosis .

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Introduction: Mandibular fracture is the most common facial bone fracture due to facial trauma. A variety of imagings have been used for diagnosis of mandibular fractures. However, the choice of imaging for diagnosis of mandibular fractures is controversial.Present study compares the accuracy of the three most common imaging methods in mandibular fracture diagnosis panoramic radiography, coronal CT and axial CT scan. Methods: This cross sectional diagnostic study was performed on 45 patients with a clinical diagnosis of post traumatic mandibular fracture at the ENT department of Shaheed Sadoughi hospital,Yazd.‍‍‍ Patients underwent panoramic radiography and CT scan (both axial and coronal). Then, all were operated for reduction of fracture (either closed or open) and fixation done with arch bar and MMF in combination with or without rigid internal fixation. The physical examination and observation during operation was considered as the exact diagnosis. The radiological findings were reported by three different radiologists. Finally, the accuracy and sensitivity of each method was compared with the other methods. Results: There was no significant difference between the accuracy of panoramic radiography and coronal CT scan in all of the regions, but the accuracy of axial CT was significantly less than coronal CT in certain regions. Conclusion: The accuracy of panoramic radiography and coronal CT scan in diagnosis of mandibular fractures is the same or higher than axial CT scan. Additionally, panoramic radiography is more accessible and less expensive than coronal CT scan. Therefore, this study recommends oral panoramic radiography as the first radiologic test for diagnosis and localization of mandibular fracture

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Introduction: The height of the alveolar bone, is normally maintained by equilibrium between bone formation and bone resorption, but in periodontal disease more destruction or lack of bone formation will reduce the alveolar bone height. However the radiography is important in diagnosis, treatment plan and detection of quality and quantity of the alveolar bone although the type of radiography is more important. The purpose of this study is the comparison between panaromic, P.A (Parallel), Bite Wing radiographs in diagnosis of periodontitis. Methods: This study was descriptive cross-Sectional study Periapical (PA), Bitewing (B.W) & Panoramic radiographic images in 32 pationent 13 male and 19 female with moderate to advanced periodontitis (mean age 38 year) were taken before surgical treatment. Actual hight of defect were measured by a William's probe during surgery, the distance between cemento enamel junction (CEJ) and alveolar crest were measured on radiographs using a digital vernie scale as will as. Actual measurements were compared with values taken from panoramic PA, B.W radiographs. For Data analysis Paired t test was used. Results: A total of 314 linear distances from the panoramic PA , B.W, and CEJ/BL were measured. The mean difference between panoramic and actual Measurements (0.115 and 0.28) P=(0.24-0.07), were not satistically significant (P> 0.05). The mean difference between P.A and actual measurements (0.279-0.498) P=(0.0001-0.004) showed a satistically significant difference (P< 0.05). The mean deference between BW and actual Measurements (0.576-0.613) P=(0.24-0.07) were satistically significant (P<0.05). Conclusion: Although, all forms of radiographic images showed agreement in detection of periodontal bone loss, the accuracy of panoramic radiographs was more than PA & BW radiographs'. Specially when the magnification was adjusted in panoramic radiography.

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Introduction: soft tissue calcification is a relatively common issue in panoramic radiography. These opacities include calcification of lymph nodes, tonsilolith, sialolith, calcification of stylohyoid complex and carotid artery bifurcation. This study aimed to determine the prevalence of soft tissue calcification in panoramic radiographs, their differential diagnosis, and their correlation with the underlying disease such as diabetes mellitus, tuberculosis, hypertension, cardiovascular disease and cerebrovascular accident. Methods: In this study, panoramic radiographs of 510 patients referring to radiology department of shahid sadoughi dental school of Yazd in one year were examined. Moreover, prevalence of soft tissue calcification, their location and factors such as age, sex, underlying disease and smoking were examined. The data was analyzed by Chi-square, Fishers exact test and odds ratio. Result: The prevalence of soft tissue calcification was 2.0% for calcification of carotid artery, 7.3% for tonsilolith, 2.0% for sialolith, 6.5% for calcified lymph node, 21.4% for elongated stylohyoid process. There was a significant correlation between ectopic calcification and diabetes mellitus, hypertension, cardiovascular disease and tuberculosis (p-value<0.05). There was no significant correlation between ectopic calcification and smoking and cerebrovascular accident (p-value>0.05). Conclusion: The study showed that detection of soft tissue calcification and ectopic calcification on panoramic radiographs should be taken into account, and the dentist should refer the patients to related specialist for more complete examinations.

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Introduction: Panoramic is the most widely used radiographs for the oral and dental diagnosis. This study aimed to investigate the common errors of digital panoramic radiographs in patients who referred to School of Dentistry (Yazd, Iran). Methods: This study was a cross-sectional descriptive one. Four-hundred radiographs available in the department archive were utilized. They aged from 10 – 70 years. The common positioning errors were divided into 13groups and the study data were analyzed via SPSS (Version 17). Results: The frequencies of errors were as followed: there were only 47(11/7%) error free radiographs and its prevalence involved forward position (8.7%) of patient, back position of patient(9%), head twisted (6/2%), head tilted (3/7%), chin tipped too low (11%). chin raised too high (27/7%), slumped position (14/5%), chin not on chin rest (0%), tongue not on plate (21/5%). Moreover, bite guide was not used (5%), Prostheses was not removed (1/2%), and metallic accessories were not separated (4%). Conclusions: Most errors were related to “Chin raised too high”. The lowest error was associated with “Chin not on chin rest”. It seems that the best strategy for having radiographs with fewer errors is appropriate and accurate positioning of the patient.

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Introduction: The aim of this study is to determine and compare the eruption space of unerupted and erupted third molars by the means of digital panoramic radiography in patients referring to Yazd dental college during 2011-2013. Methods: In this cross-sectional descriptive study, 150 archived digital panoramic radiographies in radiology department were evaluated with Romexis software under the standard circumstances. The radiographic pictures belonged to 73 men and 77 women with the average age of 21.18±1.67 years. In patients with erupted third molars as well as unerupted third molars (mesio-angular and vertical), several parameters were examined including: angle of the tooth axis of second and third molar, Gonial angle, the width of third molar, retro-molar space and its ratio to the width of third molar, the development stage of third molar root as well as the distance between the center of ramus and the most distal point of second molar. The data related to age, sex and the eruption situation of lower third molar- unerupted or erupted- were extracted from the patient’s log. The data were analyzed by SPSS (ver.17) via applying descriptive tests and T-test. Results: A statistically significant difference was observed between the two groups in regard with the average angle between second and third molar, the mean space of retro-molar and its ratio to the width of third molar as well as the mean distance between centers of ramus and second molar (P=0.0001). Moreover, no significant difference was observed in Gonial angle mean (P=0.213) and the width of third molar (P.value=0.348). Conclusion: Increasing the angle between second and third molar as well as inadequate space of retro-molar can lead to impaction of lower third molar, but the width of third molar and the Gonial angle size did not reveal any significant role in determination of impaction or eruption of third molar.

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Introduction: Dental caries and periodontal disease are probably the most common oral chronic diseases in worldwide, and their prevalence is progressively increasing from day to day. Therefore, this study was conducted to investigate the relationship between caries and periodontal disease. Methods: In this cross sectional study, 237 panoramic radiographies of patients aged 10 to 65 years (110males and 127 females) were selected utilizing convenience sampling. In order to measure the variables, a graduate caliper with 0/2 mm accuracy and Negatoscope with optimum light were used. Moreover, in order to diagnose the caries and minimize the errors, “calibration” method was selected. Results: There was no significant relationship between crown caries and mean of alveolar bone loss. (p=0/19). As the age increased in patients, the mean of alveolar bone loss also increased and a significant association was detected between the severity of caries, alveolar bone loss and male gender. Conclusion: Generally, no relationship was observed between dental caries and periodontal disease in this study.

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Introduction: This study aimed to assess the position of impacted maxillary canine in panoramic radiography via two variables of angulation and magnification. Methods: In this cross-sectional study, each panoramic radiography was numbered on which the patient ‘s name was written as well. Two variables, angulation (The angle of impacted maxillary canine was measured in relation to Occlusal plane) and magnification( the ratio of the widest dimension of mesiodistal canine crown to that of the ipsilateral central incisor crown) were assessed in each panoramic radiography (44 impacted maxillary canines), then they were compared with CBCT. Kappa test was used to assess the agreement of the two variables in panoramic radiography and CBCT. Results: Utilizing angulation variable, 41.6% buccally impacted maxillary canines and 84.3% palatally impacted maxillary canines were determined in their real positions. Moreover, magnification variable also detected 58.3% buccally impacted maxillary canines and 37.5% palatally impacted maxillary canines in their real positions. Degree of agreement between angulation and CBCT was 0.275, and it was reported 0.03 between magnification and CBCT. Conclusion: The study findings revealed that the angulation and magnification methods were not reliable in order to assess the impacted maxillary canines in panoramic radiography, though Angulation proved to be more successful than magnification method.

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Introduction: Nowadays, the use of panoramic radiographs for evaluation of uprighting and root parallelism, after the closure of spaces and before the debanding of fixed appliances, often been accepted, and the use of radiography to evaluate the results at the end of orthodontic treatment is discussed.It is not clear whether panoramic radiography reflects the exact mesiodistal position of the maxilla and mandible tooth roots. Findings: This study aimed to determine the accuracy of panoramic radiography in the assessment of mesiodistal angulations of the teeth. Methods: We had 10 patients with class I molar relationships, and took an alginate impression from both jaws then poured that with moldano plaster.To determine the long axis of the teeth, orthodontic wires (0.7) Parallel to the long axis of the teeth, (on diagnostic casts) was used. To take a panoramic radiography from casts, Panoramic imaging device “Planmeca 2002 CC” with 4mA and 60kvp was used.Photo was taken from Casts and Panoramic radiographs, then the angles between the wires and the reference line, were measured by the Autocad 2005 software, and the values related to casts and panoramic radiographs, were compared. Results: Significant percentage of achieved angles of the panoramic images (71.2%), statistically,were not in the acceptable range(±2 degree). Generally, the lowest accuracy of panoramic radiography in assessment of mesiodistal angulation of the teeth was in the lower lateral incisor region. ( ICC=-0.237). Also, the differences between the actual angles and radiographic angles in maxilla, was considerably less than in mandible. Conclusion: Dentists should act cautiously in making clinical decisions for requirements of angle adjustments, according to panoramic radiograph findings, with the knowledge of permanent distortion panaoramic image

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Background: Understanding the anatomical and pathological relationship between posterior teeth or edentulous area with maxillary sinus is essential for diagnosis and treatment planning. This study aimed to assess the correlation between maxillary sinus floor topography and related root position of posterior teeth. Method: 55 panoramic images were selected through census. These images were chosen from sajad oral and maxillofacial radiology and Navab Azam oral and maxillofacial surgery clinic in yazd from 2001-2015. Totally, 440 first and second premolars, maxillary, first, and second molars(from each 110) were investigated. The interpretation of CBCT scans were performed by oral radiologist specialist and also panoramic radiography and the results were carried out by a trained senior dental student. The results were repeated two weeks later to investigate intra-observer. The collected data were analyzed using SPSS version 17 and, Anova, Chi square, Fisher, Exautts and t-test. Result: The agreement between the CBCT and panoramic radiographs in determining root form was measured with Kappa test and it was kappa=0.549, which was meaningful with P-value=0.0001. This meaned that CBCT and panoramic radiographs showed an agreement in determining the position of maxillary sinus floor and posterior teeth roots. According to the results of this study, it was recommended to establish the exact correlation between maxillary sinus floor and posterior teeth roots especially in classification 3(projected in panoramic radiographs)CBCT images were prepared for minimal damage and infection transmission.

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Background: Currently, dental implant is one of the most modern approaches to teeth replacement. Panoramic radiography is considered as the prerequisite for implant therapy. The purpose of the present study was to investigate the vertical magnification of digital panoramic images in various anatomic parts of the mandible. Method: A total of 30 patients referred to Sajjad Radiography Center for implant therapy with high quality images of both panoramic radiography and CBCT were selected. The panoramic images were acquired with Prolin EX set and the CBCT images were recorded via Planmeca ROMEXIC2.9.2.R. Specific areas of panoramic images with certain anatomic structures were considered. The vertical distance between two desired points A and B were measured in the panoramic radiography and compared to CBCT images. In this way, the magnification index of panoramic radiography was obtained. Measurements were calculated in four areas including posterior maxilla, posterior mandible, anterior maxilla, and anterior mandible. Results: Based on the statistical findings of the study, the rate of panoramic radiography magnification compared to CBCT was 21% in the anterior and 13% in the posterior regions, that showed a statistical significant difference(P<0.001). Also, the proportion of mean magnification of panoramic radiography to CBCT was 1.18 in maxilla and 1.16 in mandible, and there was a statistical significant difference(P<0.001). Based on the results of statistical testes, there was interaction between anterior-posterior and inferior-superior. Conclusion: In the case of application of panoramic images in implant placement, the site factor of the implant, being in the maxilla or mandible and in the posterior or anterior, should be considered.

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Introduction: Eagle syndrome, which can be a source of craniofacial pain, is caused by elongation of styloid process more than 25 mm. The present study aimed to assess the structural characteristics and prevalence of elongated styloid process (ESP), Eagle syndrome and the related symptoms in the adults aged above 20 years in Shiraz.

Methods: In this cross- sectional study, 500 panoramic radiographs were evaluated in regard with styloid process length and morphology. In the presence of any symptoms in patients with ESP, they were clinically evaluated. Those symptoms reproduced by tonsillar fossa palpation were regarded relevant to ESP.

Results: The prevalence of ESP was 35.2%, which  was proved not to be sex-dependent. Individuals aged 40-60 years and those with more than 60 years had respectively 1.76 (1.16-2.66, CR: 95%) and 2.01 (1.10-3.66, CR: 95%) times greater chance for ESP compared to those aged below 40. The most and the least prevalent structural morphologies were continuous calcification and multiple pseudo articulation respectively. Eagle syndrome was observed in 1.8% of the study population. Moreover, headache, dizziness, and foreign body sensation were respectively reported as the most evaluated symptoms.

Conclusion: ESP was demonstrated to occur commonly in the study population which can get more prevalent by increasing age. With respect to avoiding unnecessary treatments, clinical examination of patients seem to be essential in order to differentiate Eagle syndrome from other sources with the same complications.

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Introduction: Infraorbital ethmoid air cells are such anatomical variations may result sinusitis. CT scan is commonly used for imaging infraorbital ethmoid cells but panoramic radiographs often show infraorbital ethmoid cells. This study aim to determaine the prevalence of infraorbital ethmoid cells on panoramic radiographs in cases older than 4 years referred to Dental School of Islamic Azad University Khorasgan Branch.

Methods: In this descriptive and analytical study, 416 panoramic radiographs (235 wemen and 181 men) were examinded for infraobital ethmoid cells and were recorded hallers cell and characteristics of cell in questionnaire form. Data analysis were done by Chi-square test.

Results: Prevalence of infraorbital ethmoid (hallers) cells on panoramic radiographs in the patients older than 4 years referred to Dental School of Islamic Azad University Khorasgan was 17.8% (14.4% for men and 20.4% for wemen). There was satisically significant differences between men and wemen. The most frequency related to the patients who were between 20-29 years old (28.3%) and the least frequent age was between 40-49 years old (13.5%), but there was no satistically significant differences in several ages. There was no relationship between taller’s cells and cell shape. 11 patients (14.9%) with hallers cell had history or symptoms of sinusitis and 4 patients (5.4%) with hallers cell had sinus disorder (retention cyst) in panoramic radiographs.

Conclusions: In this study, the prevalence of infraorbite ethmoid cells on panoramic radiographs was efficient for first diagnosis. Identification of hallers cells on panoramic radiographs can help dental professional to make differential diagnosis of orofcial pain of sinus origin.

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Introduction: Tooth decay is the most common chronic disease of man in the world and dentists should receive the capability to accurately diagnose of tooth decay during the training courses. In addition to clinical examination, the panoramic view and intraoral radiography is usually used for the caries detection. Therefore, the detection of caries on X-ray images can have a role in treatment planning.

Methods: In this analytical study, 10 panoramic radiographies that randomly selected, separately given to 30 senior dental students and 2 professors (in order to determine the gold standard). Data were analyzed using SPSS 17 software, diagnostic tables and indexes were prepared and the results were analyzed by Kappa test. Moreover, in order to determine the agreement between the professors and students about the depth of the decay the weighted kappa coefficient was used.

Results: The kappa value about detection of presence or absence of proximal caries between professors and students's diagnosis was 0.428 (P value=0.001). Diagnostic sensitivity, specificity, positive predictive value and negative predictive value obtained by students in caries detection were %47, %91.9, %63 and %85.3, respectively. Coefficient of agreement in detection of depth diagnosis obtained by professors and students was 0.361(p value=0.000). 

Conclusion: The diagnostic capability of senior dental students about caries detection was fair and depth diagnosis was slight.

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Title: Evaluation of Haller’s Cell in Panoramic Radiography in Selected Iranian Population.
Background and purpose: The purpose of this study was to evaluate Haller cells in panoramic radiography in Iranian population. Examining the Haller cells in this radiography can be helpful in the differential diagnosis of Orofacial Pain.
 Materials and Methods: This was a descriptive cross-sectional study. 300 panoramic radiographyes were selected including 151 women and 149 men, that they were 18-68 years old. Radiographies were studied by Ahmad et al. Data were analyzed using version 17 of the SPSS software and the Fisher test.
Results: The highest number of Haller cells (%33.33) was founded in the age group of 18- 28 years. The most common form was oval (%45/16) and the least, was cardiac (%1.5). The relationship between the shape and number of Haller cells was significant (P-value <0.001). The prevalence of single Haller cells was (%76.66) more than multiple cells (%23.33). The relationship between the shape and position were significant in Haller cells (P-value = 0.036). Most of the Haller cells were on the left side (%43.66) and the least were bilateral (%15.83).  There were no significant relationship between the shape of the Haller cells and gender (P-value = 0.3), and no presence or absence of cavity were found between the shape of the Haller cells (P-value=%13).
Conclusion: Haller cells have almost the same prevalence in both genders. The most common form of Haller cells was oval and one-sided, and left-handed. There was no significant difference in the existence of cavity in Haller cells.
 

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Introduction: The identification of people with carotid calcified atheroma is an important measure to reduce the incidence of brain stroke. The aim of this study was to evaluate the frequency of carotid artery atheroma in post-menopausal women in panoramic radiographs.
Methods: In this descriptive cross-sectional study, 151 panoramic radiographs from women aged 45 years and above that referred to the Radiology Department of Yazd Dental School during 2016-17, were selected by convenience sampling method. Radiographs were examined by PlanMeca 2002 EC proline panoramic digital machine. In radiographs, the presence or absence of carotid calcified atheroma was investigated and cases with differential diagnosis of atheroma were excluded. Patient's tomography data were recorded in a questionnaire and the collected data were analyzed by SPSS20 software and Chi-square test.
Resultus: In this study, 151 panoramic radiographs evaluated, 69 samples (45.7%) had carotid artery atheroma in radiography, and the largest view 40 samples (26.5%)  were bilaterally.
Conclusion: The more time passes from the menopause of patients,the more they become involved with carotid artery calcification. That means carotid atheroma has a significant relationship with the number of years pass from menopause.

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Introduction: Apical root Resorption is a common occurrence during fixed orthodontic treatment. This study used panoramic radiographs to compare the rate of root resorption in endodontically-treated and non-endodontically-treated roots.
Methods: In this descriptive-analytic study, panoramic radiographs of 20 patients aged 11-18 years with Class I Crowding and Class II Mild Skeletal malocclusions and with one or more endodontically-treated maxillary anterior teeth in one side and corresponding non-endodontically-treated teeth on the other side of the jaw were selected. They had presented to Dental School of Shahid Sadoughi University of Medical Sciences and private dental offices in Yazd. All panoramic radiographs of central and lateral maxillary incisors obtained before and after treatment were scanned and displayed on a large monitor with X2 magnification. In this way, the real magnitude of root degeneration was estimated by comparing the root heights in the pre- and post-treatment radiographs. The data were analyzed by SPSS 22 and T-test.
Results: The findings showed that the greatest rate of root resorption was observed in the upper maxillary lateral incisors of endodontically-treated teeth by 1 mm and in maxillary lateral incisors of the non-endodontically-treated teeth by 1.5 mm. The mean root resorption was 0.325 mm in the endodontically-treated teeth and 1.025 mm in the non-endodontically treated teeth with a statistically significant difference (P>0.001).
Conclusion: The results demonstrated that root resorption was smaller after treatment in endodontically-treated teeth than non-endodontically-treated teeth.
 

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Introduction: Panoramic radiography is a valuable tool in the diagnosis of maxillofacial lesions, due to the visibility of all the teeth, alveolar bone and TMJ. This study was performed to evaluate the status of panoramic radiography in accordance with FDA rules in general dentists in Yazd in 2019.
Methods: In this descriptive cross-sectional study, 170 general dentists (86 women and 84 men) working in Yazd in 2019 were completed questionnaires, including two parts: the first part consisted of demographic information( age, gender, number of years of graduation, university of Education), and the second part was specific questions in three areas: survey (28 questions), case introduction (6 cases) and diagnostic value (6 questions) about panoramic radiography. The collecting data were entered into SPSS software version 18 and analyzed using t-test and linear regression.
Results: The mean score of the survey questions was 103/05±12/86, the mean score of case questions was 5/76±2/22 and the mean score of diagnostic value questions was 8/12±2/56, respectively. There was a significant difference between the mean score of diagnostic value questions in terms of participation in radiology retraining courses (p=0.016). There was a statistically significant relationship between the mean score of diagnostic value questions with the age of dentists (p=0.015) and the mean score of survey questions (p=0.029) and mean score of case questions (p=0.039) with the university of study.
Conclusion Panoramic radiography prescriptions in general dentists working in Yazd, in some cases, do not comply with the FDA guidelines for prescribing panoramic radiography, and further training in this field seems necessary.

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