Tuberculosis (TB) is a frequent health problem in developing nations. It has two forms pulmonary and secondary causing other kinds of TB, collectively denoted extra pulmonary tuberculosis. The prevalence of extra pulmonary TB has increased in the last couple of years. Maxillofacial manifestations of tuberculosis form nearly 10% of all extra pulmonary manifestations of the disease. Extra pulmonary TB involving maxillofacial region is our prime concern. Very few cases of TB of the temporomandibular joint (TMJ) and mandible have been reported in literature. The clinical appearance of TB infection of the TMJ has been described as unspecific, resembling arthritis, osteomyelitis, cancer or any kind of chronic joint diseases. This article describes two cases where the bone, namely TMJ and angle of mandible are affected by tuberculosis. In addition to conventional radiographs we used Cone Beam Computed tomography (CBCT) to explore the third dimension of the lesion.
Key words:Tuberculosis, bone, osteomyelitis, CBCT.
Aim: A clinical study was done to assess the clinical diagnostic accuracy of cone beam computed tomography (CBCT) in detecting proximal cavitated carious lesions in order to determine whether cavitation should be reported when a CBCT examination is available. Materials and Methods: 79 adjacent proximal surfaces without restorations in permanent teeth were examined. Patients suspected to have carious lesions after a visual clinical and a bitewing examination participated in a CBCT examination (Kodak 9000 3D, 5 × 3.7 cm field of view, voxel size 0.07 mm). Ethical approval and informed consent were obtained according to the Helsinki Declaration. Radiographic assessment recording lesions with or without cavitation was performed by two observers in bitewings and CBCT sections. Orthodontic separators were placed interdentally between two lesion-suspected surfaces. The separator was removed after 3 days and the surfaces recorded as cavitated (yes/no), i.e. validated clinically. Differences between the two radiographic modalities (sensitivity, specificity and overall accuracy) were estimated by analyzing the binary data in a generalized linear model. Results: For both observers, sensitivity was significantly higher for CBCT than for bitewings (average difference 33%, p < 0.001) while specificity was not significantly different between the methods (p = 0.19). The overall accuracy was also significantly higher for CBCT (p < 0.001). Conclusion: CBCT was more accurate in detecting cavitation in proximal surfaces than bitewing radiographs; therefore a CBCT examination performed for other clinical applications should also be assessed for proximal surface cavities in teeth without restorations, and when detected, this pathology must be part of the dentist's report.
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