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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 29  |  Issue : 2  |  Page : 138-140

Unusual radiopacities spotted in a dental radiograph: Case report


1 Faculty of Dentistry, SEGi University, Malaysia
2 Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India

Date of Submission15-Sep-2016
Date of Acceptance24-Oct-2017
Date of Web Publication9-Nov-2017

Correspondence Address:
Ranjana Garg
Faculty of Dentistry, SEGi University
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.JIAOMR_118_16

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   Abstract 

During the routine radiographic investigation of a 65-year-old female we came across radiodense string-like artifacts on the orthopantomograph. These artifacts can be mistaken for electrostatic discharges, ghost images, or ligature wires. The patient revealed a history of undergoing facial lift surgery 7 years ago. Here, we are presenting a case of unexpected and coincidental radiographic finding seen as multiple, linear radiopacities in the jaw bones stressing the need for sufficient knowledge of all the possible types of artifacts.

Keywords: Artifacts, face-lift, gold thread


How to cite this article:
Garg R, Fernandes B, Sunil MK. Unusual radiopacities spotted in a dental radiograph: Case report. J Indian Acad Oral Med Radiol 2017;29:138-40

How to cite this URL:
Garg R, Fernandes B, Sunil MK. Unusual radiopacities spotted in a dental radiograph: Case report. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2020 Dec 5];29:138-40. Available from: https://www.jiaomr.in/text.asp?2017/29/2/138/217906


   Introduction Top


In dental clinics, digital radiographs are routinely taken for the patients. Before taking any dental radiograph, patients are instructed to remove any metallic objects such as ear rings, chain, or hair clips in the head and neck region to avoid ghost images on the radiographs. Recently, we came across a case with numerous radiopaque strings visible on the panoramic radiograph. Wrinkles are the first sign of the aging process, indicating where the smiles have been. However, being youthful is desired by all. Many antiaging procedures are done across the globe to maintain youthfulness such as Botox injections, chemical peel, or face-lift procedures. The highly effective cosmetic technique for improving the youthfulness of the skin is the gold filament rejuvenation technique, which has been used for more than 10 years across Europe and Asia; this technique that uses a gold thread to repair wrinkles, tighten jawlines, and eliminate dark circles is the latest weapon in the war against ageing.


   Case Report Top


A 65-year-old female patient visited the SEGi Oral Health care center for replacement of missing teeth. Medical history of the patient revealed that the patient was hypertensive and under medication. Patient had got her teeth extracted because of mobility. The patient could not remember any surgical intervention done previously. An extraoral examination of the head and neck showed no obvious abnormalities [Figure 1]. Intraoral examination revealed many mising teeth in the maxilla and the mandible. An orthopantomogram (OPG) was taken as a routine radiographic investigation. OPG revealed generalized bone loss and numerous thread like radio-opacities in the posterior aspect of the maxilla and the mandible. Radio-opacities were very thin and torturous, forming a fragmented, mesh-like structure over the maxilla and the mandible region in the posterior aspect [Figure 2].
Figure 1: Extraoral photograph of the patient showing no wrinkles over the face and visible sharply defined jaw line

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Figure 2: Radiopaque string like mesh over right and left side in both the arches near molar area

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Patient was enquired about whether she had undergone any kind of surgery before on her face. Patient mentioned a facelift procedure done 7 years back. She mentioned that during the face-lift procedure, very thin needle with the gold thread was inserted under her skin, forming a mesh beneath it. The entire procedure was done under local anesthesia and took 45 minutes to 1 hour. She also mentioned that she was very satisfied with the results of the surgery. However, she felt little numbness over the right and left cheek region after the procedure. She was not interested in the treatment of the mild paresthesia over her face as she thought that our treatment probably can affect her facial esthetics. After this, patient was referred to the prosthodontic department for the replacement of the missing teeth.


   Discussion Top


Panoramic radiology aims to produce a complete view of both dental arches and their adjacent structures with minimal geometric distortion and with minimal overlap of anatomic details from the contralateral side. Objects that are within the selected image layer are clearly visible in the image, whereas objects outside the image layer are deliberately blurred out of recognition.[1] In literature, different metallic artifacts such as bracelets, glasses, removable dentures, and piercings have been described.[2] Unrecognized artifacts in the dental radiographs have become a major area of concern in many South Asian and European countries. Unexpected objects such as metallic foreign bodies inserted into the body during surgery or abandoned acupuncture needles might be hidden in the body and are less frequently described in literature.[3]

In an attempt to maintain young and adolescent appearances, physicians are greeting the new technologies around the world. Unfortunately, these technologies should be used with care as many complications are associated with them.[4] Gold face-lift procedure is increasingly being used since the last decade as a versatile and safe nonsurgical alternative for the correction of contours and volumetric augmentation with multiple aesthetic applications. The so-called gold thread face-lift, developed in Russia, has recently been adopted in all the European and Asian countries. The use of gold thread in dermatology was first introduced by Dr. Caux in France approximately 30 years ago.[5] In its original version, this method relied on the noninvasive suspension of the facial tissues by insertion of gold threads to reduce the laxity of the tissue via induction of myofibroblast contraction.[6]

Gold wires or threads consist of a surgical suture made from 24-carat gold which are introduced into the skin with a needle, in a mesh or fan-like pattern, which allows new collagen to form around it and tighten the surrounding area. It is said that the closer the threads are placed in the “mesh” or “fan” the tighter the achievable lift. Gold thread implantation promotes angiogenesis, as the immediate area surrounding the capsule is rich in blood vessels compared with other regions, and the number of mast cells around gold thread increases over time.[5],[7]

Several reports have suggested that the gold threads usually migrate and get fragmented over a period of time. Gold threads may complicate radiographic assessment as they may overlap important anatomical structures.[8] Fragmented gold threads can visibly hamper analysis of radiographic images, as seen in this case. Sometimes artifacts other than the above mentioned strings may also be observed on radiographs, making it difficult to obtain a good interpretation of the image. This could well lead to misinterpretation, with all its consequences. Therefore, sufficient knowledge of the all probable types of artifacts is a primary requirement.[9]


   Conclusion Top


The purpose of reporting this case is that the numerous artifacts can be seen on dental radiographs. Hence, a thorough medical history including questions on such facial rejuvenation therapies is recommended to rule out the radiopaque artifacts seen in the radiographs.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Allan G. Farman. Panoramic Radiology: Seminars on Maxillofacial Imaging and Interpretation. Heidelberg: Springer Verlag; 2007.  Back to cited text no. 1
    
2.
Murray D, Whyte A. Dental panoramic tomography: What the general radiologist needs to know. Clin Radiol 2002;57:1-7.  Back to cited text no. 2
[PUBMED]    
3.
Armstrong DT, Gilliland WR, Murphey MD, Salesky J. Clinical images: Gold thread acupuncture for rheumatoid arthritis. Arthritis Rheum 2011;63:3021.  Back to cited text no. 3
[PUBMED]    
4.
Kontis TC, Rivkin A. The history of injectable facial fillers. Facial plast Surg 2009;25:67-72.  Back to cited text no. 4
[PUBMED]    
5.
Shin KC, Bae TH, Kim WS, Kim HK. Usefulness of gold thread implantation for Crow's feet. Arch Plast Surg 2012;39:42-5.  Back to cited text no. 5
[PUBMED]    
6.
Stark GB, Bannasch H. The “golden thread lift”: Radiologic findings. Aesthetic Plast Surg 2007;31:206-8.  Back to cited text no. 6
[PUBMED]    
7.
Rondo Junior W, Vidarte G, Michalany N. Histologic study of the skin with gold thread implantation. Plast Reconstr Surg 1996;97:256-8.  Back to cited text no. 7
    
8.
Cho J, Park YS. Gold thread acupuncture for a headache. Am J Med Sci 2015;350:420.  Back to cited text no. 8
[PUBMED]    
9.
Keestra JA, Jacobs R, Quirynen M. Gold-wire artifacts on diagnostic radiographs: A case report. Imaging Sci Dent 2014;44:81-4.  Back to cited text no. 9
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

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