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PURPOSE: This study aimed to summarize the impact of neck and head radiation treatment on maxillofacial structures detected on panoramic radiographs. MATERIALS AND METHODS: In this systematic review, the authors searched PubMed Central, Embase, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar for original research studies up to February 2020 that included the following Medical Subject Headings keywords: words related to "radiotherapy" and synonyms combined with keywords related to "panoramic radiography" and "oral diagnosis" and synonyms. Only original studies in English that investigated the maxillofacial effects of radiotherapy via panoramic radiographs were included. The quality of the selected manuscripts was evaluated by assessing the risk of bias using Cochrane's ROBINS-I tool for non-randomized studies. RESULTS: Thirty-three studies were eligible and included in this review. The main objectives pertained to the assessment of the effects of radiation on maxillofacial structures, including bone architecture alterations, periodontal space widening, teeth development abnormalities, osteoradionecrosis, and implant bone loss. The number of participants evaluated ranged from 8 to 176. CONCLUSION: The interaction between ionizing radiation and maxillofacial structures results in hazard to the tissues involved, particularly the bone tissue, periosteum, connective tissue of the mucosa, and endothelium. Hard tissue changes due to radiation therapy can be detected on panoramic radiographs.

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OBJECTIVES: Proteus syndrome (PS) is an extremely rare disorder with asymmetric and disproportionate bone overgrowth. Craniofacial abnormalities in PS are less frequent than skeletal abnormalities. Although there are recognized oral and maxillofacial manifestations of PS, few case reports describing these manifestations are available. Thus, the objective of this systematic review and case report is to describe oral and maxillofacial manifestations of PS and to report a PS case. METHODS: A 31-year-old male presented with restricted mouth opening and pain during mastication. A panoramic radiograph and an occlusal radiograph were obtained. Reports with relevant keywords were assessed. Data were summarized and demonstrated using a critical appraisal checklist for case reports. RESULTS: The panoramic radiograph demonstrated unilateral overgrowth of the mandible, impacted teeth, and deciduous prolonged retention. Thirteen PS case reports were identified. CONCLUSIONS: Proteus syndrome oral and maxillofacial manifestations may include dental agenesis, impacted teeth, malocclusion, asymmetric dental growth and maturation, frontal line displacement, asymmetric tongue enlargement, mandibular hemihypertrophy and asymmetry, presence of exostoses/hyperostosis, degenerative changes in the temporomandibular joint, alterations of maxillary and mandibular vertical and/or horizontal growth, and enlargement of mandibular canal and foramen. The PROSPERO systematic review registration number is CRD42019140942.

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OBJECTIVES: Studies performed in the medical area have shown that an indirect diagnosis of bone mineral density (BMD) is feasible by assessing the amount of bone marrow fat with non-ionizing magnetic resonance imaging (MRI). In dentistry, radiographic methods are still the most used for alveolar bone diagnosis. The present literature review aimed at addressing the role of MRI in assessing BMD in medicine and dentistry. METHODS: MEDLINE and EMBASE databases were searched for articles published up to 2019. RESULTS: A total of 428 potentially eligible papers were screened. Of these, 397 were excluded after title, abstract and keyword assessment, yielding 31 papers that potentially met the inclusion criteria. Eleven studies were then excluded because their full texts did not discuss the role of MRI in the indirect diagnosis of BMD. As a result, a total of 20 studies were finally identified as eligible for inclusion in this literature review. Most studies found satisfactory accuracy of MRI for indirectly assessing BMD by quantifying bone mineral fat (BMF). However, only one of these studies was on dentistry. CONCLUSION: Within the limitations of this study, the present findings suggest that MRI is accurate to indirectly estimate bone density by assessing BMF, and could be clinically relevant during dental treatment planning.

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PURPOSE: Pixel values from cone-beam computed tomography (CBCT) are proportional to bone density. This study aimed to correlate and compare pixel values of healed maxillary sinus grafts and adjacent native bone (NB). MATERIAL AND METHODS: This study was conducted on CBCT scan patients referred for maxillary sinus floor augmentation with biphasic calcium phosphate (n = 31). Graft height and width measurements were performed. In addition, mean pixel values were calculated in 3 different regions: NB, sinus graft close to NB (CNB), and sinus graft far from NB (FNB). Micro-CT and histological analyses of bone specimens of a representative case were also performed. RESULTS: Significant correlations were found between CNB and graft height (r = 0.41; P < 0.021); and FNB and graft width (r = 0.519, P < 0.003). In addition, pixel values from both graft groups (CNB and FNB) differed significantly (P < 0.001). Finally, histological sections revealed smaller areas with newly formed bone in the FNB area. CONCLUSIONS: Within the limitations of this study, the present findings suggest that pixel values of sinus grafted areas are directly correlated with the extension of the grafted area.

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