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    Comparison of cone-beam computed tomography and panoramic radiography in the evaluation of maxillary sinus pathology related to maxillary posterior teeth: Do apical lesions increase the risk of maxillary sinus pathology?
    (Korean Acad Oral & Maxillofacial Radiology, 2019) Terlemez, Arslan; Tassoker, Melek; Kizilcakaya, Makbule; Gulec, Melike
    Purpose: The aims of this study were first, to compare panoramic radiography with cone-beam computed tomography (CBCT) for evaluating topographic relationships, such as the classification of maxillary posterior teeth and their distance to the maxillary sinus floor; and second, to determine the relationship between maxillary sinus pathology and the presence of apical lesions. Materials and Methods: In total, 285 paired CBCT and panoramic radiography records of patients (570 maxillary sinuses) were retrospectively analyzed. Both imaging modalities were used to determine the topographic relationship of the maxillary posterior teeth to the sinus floor. Mucosal thickening > 2 mm was considered a pathological state. Data were analyzed using the chi-square, Wilcoxon, and Mann-Whitney U tests. Odds ratios (ORs) and confidence intervals (CIs) were calculated. Results: The closest vertical distance measurements made between posterior maxillary teeth roots and the maxillary sinus on panoramic radiography and CBCT scans showed statistically significant differences from each other (P<0.05). Compared to panoramic radiography, CBCT showed higher mean values for the distance between the maxillary sinus floor and maxillary posterior teeth roots. The CBCT images showed that at least 1 apical lesion adjacent to the right maxillary sinus increased the risk of maxillary sinus pathology by 2.37 times (OR, 2.37; 95% CI, 1.58-3.55, P<0.05). Conclusion: Panoramic radiography might lead to unreliable diagnoses when evaluating the distance between the sinus floor and posterior roots of the maxillary teeth. Periapical lesions anatomically associated with maxillary sinuses were a risk factor for sinus mucosal thickening.
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    Evaluation of cortical and trabecular bone structure of the mandible in patients using L-Thyroxine
    (Bmc, 2023) Gulec, Melike; Tassoker, Melek; Erturk, Mediha
    Background: Long-term use of L-Thyroxine (LT4), the synthetic thyroxine hormone used for thyroid hormone replacement therapy, is an important risk factor for osteoporosis. The aim of this study was to investigate the differences between mandibular cortical index (MCI) and trabecular bone fractal dimension (FD) values on panoramic radiographs of patients using LT4 and control subjects.Methods: A total of 142 female patients, 71 cases and 71 controls, were analyzed in the study. Ages were matched in case and control groups and the mean age was 36.6 +/- 8.2 (18 to 50) years. MCI consisting of C1 (Normal Mandibular Cortex), C2 (Moderately Resorbed Mandibular Cortex) and, C3 (Severely Resorbed Cortex) scores was determined for case and control groups. Fractal analysis was performed using ImageJ on selected regions of interest from the gonial and interdental regions. The box-count method was used to calculate FD values. Wilcoxon signed-rank test, Mann-Whitney U test, and Spearman correlation analysis were applied to compare the measurements. Statistical significance of differences was established at P < 0.05 level.Results: FD values did not show statistically significant differences between case and control groups (p > 0.05). The mean FD in the right gonial region was 1.38 +/- 0.07 in the case group and 1.38 +/- 0.08 in the control group (p = 0.715). The mean FD in the right interdental region was 1.37 +/- 0.06 in the cases and 1.36 +/- 0.06 in the control group (p = 0.373). The mean FD in the left gonial region was 1.39 +/- 0.07 in the cases and 1.39 +/- 0.07 in the control group (p = 0.865). The mean FD in the left interdental region is 1.37 +/- 0.06 in the cases and 1.38 +/- 0.05 in the control group (p = 0.369). The most common MCI score was C1, with 62% in the cases and 83.1% in the control group. MCI scores showed a statistically significant difference between cases and controls (p = 0.016, p < 0.05). While the C2 score was higher in the cases, the C1 score was higher in the controls.Conclusions: LT4 use was not associated with the FD of mandibular trabecular bone, but was associated with MCI values of cortical bone. Further studies on larger samples with different imaging modalities and image processing methods are needed.
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    Evaluation of cortical and trabecular bone structure of the mandible in patients with ankylosing spondylitis
    (Nature Portfolio, 2023) Gulec, Melike; Erturk, Mediha; Tassoker, Melek; Basdemirci, Muserref
    This study aimed to examine the difference between the fractal dimension (FD) values of the mandibular trabecular bone and the panoramic mandibular index (PMI), mandibular cortical index (MCI) and mandibular cortical thickness (MCW) of patients with ankylosing spondylitis (AS) and healthy control group. A total of 184 individuals (92 cases, 92 controls), were examined in our study. PMI, MCI, and MCW values were calculated on panoramic images of all individuals. For FD values, the region of interest (ROI) was selected with the size of 100 x 100 pixels from the right-left gonial and interdental regions and 50 x 50 pixels from the condylar region. Degenerative changes in the temporomandibular joint (TMJ) region were recorded. PMI, MCI, and MCW values showed statistically significant differences between the groups (p = 0.000, p < 0.001). The radiological signs of mandibular cortical resorption were more severe in the case group than in the control group. PMI and MCW values were found to be lower in the case group than in the control group. It was determined that the number of C3 and C2 values, among the MCI values, was higher in the case group. Only the FD values of the ROI selected from the condyle region were found to be statistically significant and were lower in the case group (p = 0.026, p < 0.05). Degenerative changes in the TMJ region were significantly more frequent in the case groups (p = 0.000, p < 0.001). The fact that the mandibular cortex shows more resorptive features in individuals with AS may require further evaluation in terms of osteoporosis. Because of the low FD values of the condylar regions of these patients and the more frequent degenerative changes, the TMJ region should be followed carefully. Detailed examination of the mandibular cortex and condylar region is beneficial in patients with AS for screening and following osteoporotic changes in these individuals, which is essential for the patient's life quality.
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    Evaluation of the mandibular trabecular bone in patients with bruxism using fractal analysis
    (Springer, 2021) Gulec, Melike; Tassoker, Melek; Ozcan, Sevgi; Orhan, Kaan
    Objective The aims of this study were (1) to investigate the effect of bruxism on the fractal dimension (FD) of the mandibular trabecular bone through digital panoramic radiographs, and (2) to evaluate the effectiveness of fractal analysis as a diagnostic test for bruxism. Methods One hundred and six bruxer and 106 non-bruxer patients were included in the study. Three bilateral regions of interest (ROI) were selected: ROI-1, the mandibular condyle; ROI-2, the mandibular angle; ROI-3, the-area between the apical regions of the mandibular second premolar and the first molar teeth. FD values for the bruxer and non-bruxer groups were compared for each ROI. Results Only the FD measurements for the right mandibular condyle (ROI-1) showed a statistically significant difference (p = 0.041) between the bruxer and non-bruxer individuals. FD values measured in the bruxers (1.40 +/- 0.09) were lower than in the non-bruxers (1.42 +/- 0.08). Conclusion Fractal analysis may be a useful method for discerning trabecular differences in the condylar areas of bruxer individuals. In future studies, the unilateral mastication habits, the characteristics of dental wear, and the occlusal bite forces of individuals should be documented.
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    Is the maxillary sinus volume affected by concha bullosa, nasal septal deviation, and impacted teeth? A CBCT study
    (Springer, 2020) Tassoker, Melek; Magat, Guldane; Lale, Bekir; Gulec, Melike; Ozcan, Sevgi; Orhan, Kaan
    Purpose Various mechanisms play an important role in the growth of maxillary sinus cavities. The purpose of this study was to investigate the correlations of maxillary sinus volume (MSV) with nasal septal deviation (NSD), concha bullosa (CB) and impacted teeth using cone-beam computed tomography (CBCT) images. Methods From 55 patients, a total of 110 maxillary sinus images were obtained and examined. Data including age, gender, impacted third molar, canine teeth, NSD, and CB were examined. MSV was measured using the MIMICS software (Materialise HQ Technologielaan, Leuven, Belgium). All statistical analyses were performed using the SPSS (Statistical Package for Social Sciences, version 21) software and p values < 0.05 were considered to indicate statistical significance. Results Mean volume of the right maxillary sinus was 13.566 cm(3), while the left was 13.882 cm(3). The rate of patients with right and left impacted third molar teeth was 49.1% and 47.3%, respectively. The rate of right and left impacted canines was 1.8% and 5.5%, respectively. NSD was found in 56.4% of CBCT examinations and right and left CB were observed in 30.9% and 32.7% of the patients' examinations, respectively. Males had a significantly higher mean sinus volume than females for both sides (p < 0.05). There were no significant correlations between MSV and age (p > 0.05). No significant differences were found between MSV and impacted teeth, NSD and CB (p > 0.05). Conclusion NSD, CB, impacted teeth, and age were not found to be related to MSV. Gender had an effect on MSV and males had higher mean sinus volume than females.