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Fulltext Latest recommendations for dental radiography in general dental practice

Purmal, Kathiravan, Nambiar, Phrabhakaran

Malaysian Dental Journal, 2008;29(2):104-112.
MyJurnal

Radiology is important in the diagnostic assessment, treatment and monitoring progress of patients having dental and maxillofacial diseases. The central question in dental radiology is whether there is any risk with regard to low doses of radiation and what are the necessary protection needed to prevent any hazardous outcome with X-raying. With the emergence of the new millennium, major changes are happening in the field of science and technology. More efficient equipments are being discovered and more researches are being conducted to elicit better understanding of the radiation process and its effect on the human health. This article will review the latest guidelines for proper radiographic practice from the USA and Europe. It will address topics like the risks from dental radiography, selection criteria, protection for patients and staff, improvement to X-ray equipments, room dimensions and lead lining requirements. We have limited our research to intraoral, panoramic and cephalometric radiographs because these are the radiographs or images that are commonly taken in the general practice setting. (Copied from article).
Fulltext The reliability of bitemark evidence: analysis and recommendations in the context of Malaysian criminal justice system

Singh, Shamser, Nambiar, Phrabhakaran

Malaysian Dental Journal, 2008;29(2):119-127.
MyJurnal

Forensic odontological examination of a disputed bitemark can furnish the police and the prosecutor with useful evidence to either implicate or exonerate a person in relation to a crime, on the basis that each person’s bitemark is as distinctive as his or her dentition. The aims of this article are (a) to evaluate the extent of which bitemark evidence is reliable as a proof of identification of a biter for the purposes of criminal investigation and prosecution in Malaysia and (b) to make the necessary recommendations (if any) for the purpose of improving the reliability of such evidence. Where a questioned bitemark is not sufficiently detailed, any findings made from its examination shall be highly unreliable and prejudicial. On the other hand, where a bitemark is sufficiently detailed, then any findings made from its examination may be reliable, provided that the forensic odontologists and other practitioners in the criminal justice system are professionally trained to handle the said bitemark. Therefore, police officers must be given a basic training in the field of forensic odontology so that they will be able to appreciate the evidential value of bitemark and contribute to the development of bitemark cases in Malaysia. The relevant authorities governing the dental practice in Malaysia should standardize the methodology and terminology used in bitemark examination and in the reporting of its findings so that confusion and inconsistency among the forensic odontologists are kept absolutely low. Finally, forensic odontologists must be given specialized training in bitemark examination so that the probative value of their findings can be improved.
Mediation--the Malaysian Dental Association experience

Purmal K, Nambiar P

Int Dent J, 2009 Jun;59(3):155-60.
PMID: 19637524

To study the success and failures of the mediation process of complaints from 2004-2007 by the Complaints Bureau Steering Committee and the Public Complaints Bureau Committee of the Malaysian Dental Association (MDA).
Restorative dental treatment of a canine tooth in a Bornean orang utan

Purmal K, Nambiar P

J Vet Dent, 2009;26(1):36-9.
PMID: 19476086
Fulltext Assessment of condyle and glenoid fossa morphology using CBCT in South-East Asians

Al-koshab M, Nambiar P, John J

PLoS One, 2015;10(3):e0121682.
PMID: 25803868 DOI: 10.1371/journal.pone.0121682

INTRODUCTION: Proper imaging allows practitioners to evaluate an asymptomatic tempormandibular joint (TMJ) for potential degenerative changes prior to surgical and orthodontic treatment. The recently developed cone-beam computed tomography (CBCT) allows measurement of TMJ bony structures with high accuracy. A study was undertaken to determine the morphology, and its variations, of the mandibular condyle and glenoid fossa among Malay and Chinese Malaysians.
METHODS: CBCT was used to assess 200 joints in 100 subjects (mean age, 30.5 years). i-CAT CBCT software and The Mimics 16.0 software were employed to measure the volume, metrical size, position of each condyle sample and the thickness of the roof of the glenoid fossa (RGF).
RESULTS: No significant gender differences were noted in thickness of the RGF and condylar length; however condylar volume, width, height and the joint spaces were significantly greater among males. With regards to comparison of both TMJs, the means of condylar volume, width and length of the right TMJ were significantly higher, while the means of the left condylar height and thickness of RGF were higher. When comparing the condylar measurements and the thickness of RGF between the two ethnic groups, we found no significant difference for all measurements with exception of condylar height, which is higher among Chinese.
CONCLUSION: The similarity in measurements for Malays and Chinese may be due to their common origin. This information can be clinically useful in establishing the diagnostic criteria for condylar volume, metrical size, and position in the Malaysian East Asians population.
Genetic study of 12 X-STRs in Malay population living in and around Kuala Lumpur using Investigator Argus X-12 kit

Samejima M, Nakamura Y, Nambiar P, Minaguchi K

Int J Legal Med, 2012 Jul;126(4):677-83.
PMID: 22584910 DOI: 10.1007/s00414-012-0705-7

We investigated 12 X-chromosomal short tandem repeat (STR) polymorphisms in 283 unrelated Malay individuals (160 males and 123 females) living in and around Kuala Lumpur using the Investigator Argus X-12 kit. Heterozygosity among the present 12 X-STRs showed a distribution of from 55.3 to 93.5 %. The diversity values of the haplotypes constructed using four closely linked groups were all higher than 0.9865. A comparison of allelic frequency in each system and haplotype variation indicated that the nature of these X-STRs in the Malay population differed from that in East Asian, European, or African populations. Several microvariant alleles found in the Malay population were characterized and compared with known sequence data. The present data may be helpful in forensic casework such as personal identification and kinship testing in the Malay population in Malaysia.
Fulltext Cosmetic "Gold Thread Therapy": A Nuisance That Decreases the Diagnostic Quality of a Dental Panoramic Image

Ching ME, Joan LZY, Nambiar P

Case Rep Dent, 2021;2021:4077930.
PMID: 34777877 DOI: 10.1155/2021/4077930

During routine imaging of the craniofacial region, it is recognised that some "cosmetic" procedures with metallic insertions can be revealed radiographically. These objects however make it difficult to obtain a good interpretation of anatomical structures for management of diseases. A 58-year-old female patient visited a private dental facility in Kuala Lumpur for prosthodontic replacement of missing teeth. The dental panoramic image revealed generalized bone loss and numerous unusual multiple thread-like radioopacities. These gold threads made radiographic evaluation difficult and complicated the process of treatment planning for dental implant placement advocated for this patient.
Fulltext Population Genetics of Identifiler System in Malaysia

Nakamura Y, Samejima M, Minaguchi K, Nambiar P

Bull. Tokyo Dent. Coll., 2016;57(4):233-239.
PMID: 28049971 DOI: 10.2209/tdcpublication.2016-1400

Short tandem repeat (STR) polymorphisms were investigated in 341 unrelated Malay individuals (218 males and 123 females) living in or around Kuala Lumpur by using a forensic analysts kit. The following STRs were targeted: D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818, and FGA. The purpose of this study was to elucidate population genetics in Malaysia and calculate statistical parameters for forensic and anthropological research. Data on these STRs in the target population were obtained and subjected to statistical analysis. Accordance with the Hardy-Weinberg equilibrium was proven for all the loci targeted. The combined power of discrimination was greater than 0.9999999999, indicating that this multiplex system is an excellent tool for forensic casework. The allele frequency in the data were weighed against that in four other local populations (Chinese, Iranian, Belgian, and African). The average coefficient of correlation was strongest in the order of Africa (0.092522), Belgium (0.264822), Iran (0.404363), and China (0.706661). These results are consistent with what is known about the anthropological history of and prehistoric human migration in the Malay region. We believe that these data offer a valuable anthropological resource, being applicable to the statistical evaluation of DNA evidence in human identification, as well as the determination of ethnicity in healthy populations.
Safe zone for bone harvesting from the interforaminal region of the mandible

Al-Ani O, Nambiar P, Ha KO, Ngeow WC

Clin Oral Implants Res, 2013 Aug;24 Suppl A100:115-21.
PMID: 22233422 DOI: 10.1111/j.1600-0501.2011.02393.x

The mandibular incisive nerve can be subjected to iatrogenic injury during bone graft harvesting. Using cone beam computed tomography (CBCT), this study aims to determine a safe zone for bone graft harvesting that avoids injuring this nerve.
Fulltext Effect of ageing towards location and visibility of mental foramen on panoramic radiographs

Ngeow WC, Dionysius DD, Ishak H, Nambiar P

Singapore Dent J, 2010 Jun;31(1):15-9.
PMID: 23739252 DOI: 10.1016/S0377-5291(12)70004-4

Mental foramen is an opening of the mental canal onto the lateral surface of the mandible. In this pilot radiographical study, in Malay population the effects of ageing towards the location and visibility of the mental foramen were determined. Most of the mental foramina were found to be located inferior to the apex of the second premolar. Non-visibility of the foramen was greatly increased in patients aged 50 years and above (Pearson Chi-square; p = 0.00). This finding may provide a guide to dental surgeries in Malay patients of different age groups.
A radiographic study on the visualization of the anterior loop in dentate subjects of different age groups

Ngeow WC, Dionysius DD, Ishak H, Nambiar P

J Oral Sci, 2009 Jun;51(2):231-7.
PMID: 19550091

The anterior loop is defined as where the mental neurovascular bundle crosses anterior to the mental foramen then doubles back to exit the mental foramen. It cannot be seen clinically but can be detected in 11-60% of panoramic radiographs. As this anatomical structure is important in determining the placement position of endosseous implants in the mandibular premolar region, a pilot study was undertaken to determine its visibility on dental panoramic radiographs in dentate subjects of various age groups. One or more anterior loops were visible in 39 (40.2%) radiographs encompassing 66 sites (34.4%). Interestingly, anterior loops were most commonly observed bilaterally, followed by on the right side of the mandible only. An anterior loop on the left side only was observed in just 1 radiograph. Visibility of anterior loops reduced as the age of subjects increased. More than half (58.1%) of subjects aged 20-29 years exhibited at least one anterior loop; this gradually reduced to only 15 percent of subjects aged 50 and older. There was no association between visualization of the anterior loop and subject gender.
Uncommon radiological findings: a case report

Tandjung YR, Hong CP, Nambiar P, Ibrahim N

Int Dent J, 2007 Jun;57(3):173-6.
PMID: 17695738

A 50-year-old friendly and attractive Chinese lady was examined by the Primary Care Unit, Faculty of Dentistry, University of Malaya. Her requests for treatment included implants and crowns. Two periapical radiographs of teeth 16 and 48 were taken to aid diagnosis. Interestingly, pin-like radio-opaque objects were found over the crown of the impacted tooth 15 and also tooth 17. These objects were initially interpreted as silver points or radiographic artifacts but further investigation employing panoramic radiography revealed the distribution of more radio-opaque objects in the orofacial region. Based on a review of the literature and the opinion of experienced radiology and oral surgery lecturers, these foreign radio-opaque objects were diagnosed as susuks or charm needles.
Anatomical considerations for implant placements in first maxillary molar extracted sites in East Asian patients

Ananda GK, Nambiar P, Mutalik S, Shanmuhasuntharam P

Surg Radiol Anat, 2015 Nov;37(9):1099-108.
PMID: 25850735 DOI: 10.1007/s00276-015-1473-0

With the advent of cone-beam computed tomography (CBCT) for maxillofacial imaging, there has been a paradigm shift from two dimensional panoramic radiography to three dimensional imaging. This study investigated the microanatomy of the maxillary permanent first molar socket and its relationship to the floor of the maxillary sinus, especially for immediate or early implant placement.
Fulltext Variation in Lingual Nerve Course: A Human Cadaveric Study

Al-Amery SM, Nambiar P, Naidu M, Ngeow WC

PLoS One, 2016 09 23;11(9):e0162773.
PMID: 27662622 DOI: 10.1371/journal.pone.0162773

The lingual nerve is a terminal branch of the mandibular nerve. It is varied in its course and in its relationship to the mandibular alveolar crest, submandibular duct and also the related muscles in the floor of the mouth. This study aims to understand the course of the lingual nerve from the molar area until its insertion into the tongue muscle. This cadaveric research involved the study of 14 hemi-mandibles and consisted of two parts: (i) obtaining morphometrical measurements of the lingual nerve to three landmarks on the alveolar ridge, and (b) understanding non-metrical or morphological appearance of its terminal branches inserting in the ventral surface of the tongue. The mean distance between the fourteen lingual nerves and the alveolar ridge was 12.36 mm, and they were located 12.03 mm from the lower border of the mandible. These distances were varied when near the first molar (M1), second molar (M2) and third molar (M3). The lingual nerve coursed on the floor of the mouth for approximately 25.43 mm before it deviated toward the tongue anywhere between the mesial of M1 and distal of M2. Thirteen lingual nerves were found to loop around the submandibular duct for an average distance of 6.92 mm (95% CI: 5.24 to 8.60 mm). Their looping occurred anywhere between the M2 and M3. In 76.9% of the cases the loop started around the M3 region and the majority (69.2%) of these looping ended at between the first and second molars and at the lingual developmental groove of the second molar. It gave out as many as 4 branches at its terminal end at the ventral surface of the tongue, with the presence of 2 branches being the most common pattern. An awareness of the variations of the lingual nerve is important to prevent any untoward complications or nerve injury and it is hoped that these findings will be useful for planning of surgical procedures related to the alveolar crest, submandibular gland/ duct and surrounding areas.
Fulltext Population Genetics in Malaysia and Japanese Populations Using Power Plex Y23 System

Nakamura Y, Samejima M, Minaguchi K, Nambiar P, Hashimoto M

Bull. Tokyo Dent. Coll., 2020 Jul 04;61(2):83-94.
PMID: 32522936 DOI: 10.2209/tdcpublication.2019-0023

Population flow between Southeast Asian countries and Japan continues to gather pace. Accordingly, the number of foreigners involved in incidents in Japan has markedly increased, which means that forensic dentistry is now increasingly being faced with the need to analyze DNA from persons of non-Japanese extraction. The DNA test currently used for personal identification mainly utilizes short tandem repeats (STRs) on autosomal chromosomes and the Y-chromosome. This test was developed for use in personal identification, not for distinguishing among races; nonetheless, the standard method for personal identification is often used because the procedure has been established. To determine the degree to which racial differences can be distinguished by standard DNA analysis, 23 STRs located on the Y chromosome were investigated in 218 Malay and 426 Japanese males. The frequencies of each STR were calculated in the two populations. The difference in the power of discrimination between the Malay and Japanese populations ranged from a minimum of 0.01 to a maximum of 0.27; the difference in polymorphic information content ranged from 0.01 (minimum) to 0.23 (maximum). No major differences were noted in the polymorphisms in these two Mongoloid populations, but the distributions of the 17 STRs differed significantly. Short tandem repeat types demonstrating a likelihood of racial differences were identified in 14 of the STRs. Race-specific STR types were identified in 10 STRs. These results suggest that the likelihood of Malay or Japanese genetic background can be judged based on Y-chromosome STR test results.
Age estimation from developing third molars

Wilson YP, Nambiar P, Yaacob H, Asif MK

Med Leg J, 2021 Dec;89(4):254-259.
PMID: 34758645 DOI: 10.1177/00258172211052930

We investigated the development of third molars among Malaysians (including variations between jaws and genders) using Demirjian's method. Dental panoramic radiographs of 1224 subjects aged 8 to 24 years were examined, and the molars were assigned Demirjian et al.'s development grades (A-H). Results indicated that 18.8% had congenitally missing or extracted third molars. Development of molars begins earlier in females (also in the mandible), but by age 9, male children's molar development speeds up with more advanced grades in their middle teens than females. Grade C indicates the subject is a juvenile, while initiation of root development (Grade E), was observed from 13 years on. Grade H can occur in a child aged 18 years who technically is still a juvenile. We compared the development and growth patterns of the third molar from both the maxilla and the mandible.
The Management of Persistent Pain From a Branch of the Trifid Mandibular Canal due to Implant Impingement

Aljunid S, AlSiweedi S, Nambiar P, Chai WL, Ngeow WC

J Oral Implantol, 2016 Aug;42(4):349-52.
PMID: 27078072 DOI: 10.1563/aaid-joi-D-16-00011

The mandibular canal is a conduit that allows the inferior alveolar neurovascular bundle to transverse the mandible to supply the dentition, jawbone, and soft tissue around the lower lip. It is now acknowledged that the mandibular canal is not a single canal but an anatomical structure with multiple branches and variations. Iatrogenic injury to branches of the mandibular canal that carry a neurovascular bundle has been reported to cause injury to the main canal as severe as if the main canal itself is traumatized. These injuries include bleeding, neurosensory disturbance, or the formation of traumatic neuroma, and so far, they have involved cases with the bifid mandibular canal. This current report presents a case of neurosensory disturbance that resulted from the impingement of a branch of a trifid mandibular canal during implant insertion. Its management included analgesics, reexamination, and reinserting a shorter implant.
Middle mesial canal in mandibular first molar: A narrative review

Penukonda R, Pattar H, Nambiar P, Al-Haddad A

Saudi Dent J, 2023 Jul;35(5):468-475.
PMID: 37520597 DOI: 10.1016/j.sdentj.2023.05.008

PURPOSE: This review aimed to assess the incidence, anatomical characteristics, identification, and clinical management using conventional techniques and advanced tools to manage MMCs successfully.
METHODS: Medline/PubMed and Scopus databases were searched using "Middle mesial canal," "Middle mesial root canal," OR "Accessory mesial canal" keywords from 1 January 1970 and 1 February 2023. The most pertinent articles were chosen for the review from the retrieved articles. In addition, relevant articles were added by manually searching the list of references.
RESULTS: The incidence of MMC is noticeable in younger people, and the confluent canal is the most common type. The majority of MMCs merged with mesiobuccal (MB) canals rather than mesiolingual (ML) canals. Clinical management could be employed using the standard endodontics protocol, and recent radiography technologies, magnification, rotary, and obturation materials can facilitate the procedures.
CONCLUSION: The possibility of the incidence of MMC is not unusual. Detection and thorough debridement followed by obturation of the canal could increase the success rate of clinical outcomes.
Fulltext Cone beam computed tomography assessment of the maxillary incisive canal and foramen: considerations of anatomical variations when placing immediate implants

Al-Amery SM, Nambiar P, Jamaludin M, John J, Ngeow WC

PLoS One, 2015;10(2):e0117251.
PMID: 25679505 DOI: 10.1371/journal.pone.0117251

The maxillary incisive canal connects the roof of the oral cavity with the floor of nasal cavity and has the incisive and nasal foramina respectively at its two opposite ends. Its close proximity with the anterior incisors affects one's ability to place immediate implants in ideal position.
Three-dimensional image analysis of developing mandibular third molars apices for age estimation: A study using CBCT data enhanced with Mimics & 3-Matics software

Asif MK, Nambiar P, Ibrahim N, Al-Amery SM, Khan IM

Leg Med (Tokyo), 2019 Jul;39:9-14.
PMID: 31158731 DOI: 10.1016/j.legalmed.2019.05.003

Three-dimensional imaging has improved the method of analysis in many forensic science investigations. The study aimed to derive regression equation for age estimation by investigating the relationship between chronological age and surface area of the developing mandibular 3rd molars apices. Furthermore, other predictor variables: ethnicity (Malay and Chinese), gender and status of the root development completion (open/closed apices) were also investigated in terms of fit to the age estimation model. One hundred and twenty eight training and 55 validation samples of intact mandibular 3rd molars were selected from 183 CBCT scans. The samples comprised of 93 Malays and 90 Chinese, ranging in age from 13 to 24 years. Three-dimensional image modeling and surface area analysis of the developing mandibular 3rd molars apices were performed using Mimics and 3-Matics software. Multiple linear regression analysis was used to derive age estimation model using chronological age as a dependent variable and surface area of the apices, ethnicity, gender and status of the root development completion (open/closed apices) as predictor variables. A strong inverse correlation (r = 0.95, SD = 1.144) was observed between chronological age and all the predictor variables. The results showed that 89.6% of the variation in age can be explained by the predictor variables. Mean absolute error (MAE) value of 0.8223 was observed when the derived regression equation was tested on the independent validation sample. In conclusion, three-dimensional surface area analysis of the developing mandibular 3rd molars apices can be used as a reliable method for age estimation.

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