Clinical Significance and a Review of Incidental Findings in CBCT
more common in males . Philipsen et al . reported a 6:1 male : female ratio . 26 These asymptomatic , benign process require no referral . Periodic follow-up is recommended to evaluate any possible growth . Recognition of a Stafne defect as a distinctive radiographic feature of essentially normal anatomy is critical in panoramic radiography . Anterior Stafne defects may be more challenging and require cone beam computed tomography scan for confirmation .
For when misdiagnosed as a radiolucent pathologic process this defect may be referred for an unnecessary biopsy of a major salivary gland .
Figure 6
Axial view of CBCT image showing radiopaque pineal gland calcification .
Pineal Gland Calcification Pineal gland calcification ( Figure 6 ) is a common finding associated with aging and pathological processes such as schizophrenia and Alzheimer ’ s disease . 27 Calcified concretions called “ brain sand ” form within the gland and are composed of primarily of calcium and magnesium salts . 28 These calcifications are typically benign findings in older individuals . Pette et al . reported an incidence of 19.18 % and noted that the lesions are found more commonly in women . 15 In an axial view , pineal gland calcifications appear as radiopacities in the center of the brain . In a sagittal view , such calcifications appear as radiopacities posterior to the sphenoidal sinus located within the brain . Size of pineal gland varies and the degree of calcification may be an indicator of glandular function . 29 It has also been shown that the degree of calcification is higher in Alzheimer patients . 29
Figure 7
Axial view of CBCT image showing radiopaque bilateral choroid plexus calcifications .
Choroid Plexus Calcifications Choroid plexus calcification ( Figure 7 ) occurs when calcium is deposited in the walls of blood vessels or in the stromal matrix . 30 This mineralization may be physiologic 31 or the result of pathologic diseases such as neurofibromatosis and infections such as toxoplasmosis . 32 Physiologic calcification is
common in adults . Modic et al . reported that physiologic calcification was an incidental finding in 51 % of medical computed tomography scans . 32 General dentists should consider referral for further evaluation when calcifications are identified in younger patients . Barghan et al . reported an incidence of 2.6 %. 33 In a coronal view , choroid plexus calcifications appear as linear radiopacities lateral to the midline of the brain .
Figure 8
Axial view of CBCT image showing radiopaque tonsilloliths in the left side
Tonsilloliths Tonsilloliths , or tonsil stones , ( Figure 8 ) form when the polymicrobial biofilm trapped within tonsillar crypts calcifies . Calcifications may provide protection for the bacteria and is primarily composed of calcium salts . 34 When asymptomatic , tonsilloliths require no treatment . General dentists should consider referral when tonsilloliths are associated with significant tonsillar enlargement or clinical symptoms such as pain , dysphagia , or halitosis . Pette et al . reported an incidence of 10.06 %. 15 Radiographically , tonsilloliths appear as a single or multiple small , radiopacities within tonsillar tissue . Palatine tonsilloliths are more commonly identified whereas lingual tonsilloliths less , especially in panoramic radiographs due to their size and location . Lingual tonsilloliths are more easily identified in CT scans compared to panoramic radiographs . 35
Figure 9
Axial view of CBCT image showing radiopaque dermal filler in the left side of the face .
Dermal Fillers Injectable dermal fillers ( Figure 9 ) are used for cosmetic procedures to restore lost volume by smoothing creases and reducing the prominence of wrinkles by the deposition of natural and synthetic materials such as hyaluronic acid , calcium hydroxylapatite , silicone , and poly-L-lactic acid in the dermis or subcutaneous tissue . 36 This smoothing effect of natural materials is temporary , and the body resorbs the material over time . Radiographically , some dermal fillers appear as granular radiopacities commonly in the areas of the cheeks and chin . 37
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