Vol. 86 No.

3 September 1998

ORAL AND MAXILLOFACIAL RADIOLOGY Editor: Sharon L. Brooks

A study of the impact of screening or selective radiography on

the treatment and postdelivery outcome for edentulous
patients
Richard N. Bohay, DMD, Dip Oral Rad, MSc, MRCD(C), a Russell G. Stephens, DDS, MSc, b and
Stanley L. Kogon, DDS, MSc, c London, Ontario, Canada
UNIVERSITY OF WESTERN ONTARIO

Objective. The purpose of this study was to assess the impact of radiographic findings on complete denture treatment and on
the postdelivery course of those patients who had pretreatment radiographs (the screening group) and those who did not (the
selection group).
Method. In total, 375 cases were randomly selected by systematic sampling. Data collected included patient demographic
information and denture history, predenture fabrication radiographic findings, and postdenture delivery complaints.
Results. Of the screening patients, 100% had pretreatment radiographs made; this compared with 13.5% of the selection
patients. In the screening group, 68.3% of patients had one or more positive radiographic findings recorded. Of the screening
patients, 8.3% received treatment before denture fabrication; this compared with 1.2% of the selection patients. Of the 375
cases, 2 screening patients had postdelivery complaints that required management other than denture adjustment.
Conclusion. The results indicate that there is weak scientific support for the guideline recommending routine pretreatment
radiography for new denture patients.
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:353-9)

Radiographic guidelines developed by the US Food and
Drug Administration (FDA) and endorsed by the
American Dental Association recommend "a full-
mouth intraoral radiographic examination or a pan-
oramic examination for the new edentulous patient?'1,2
The recommendation of pretreatment radiographic
surveys for the initial assessment of these patients
differs from the guideline for dentate patients, which
recommends an individualized radiographic prescrip-
tion on the basis of selection criteria derived from the
clinical examination. 1 The FDA expert panel justified
this exception to the principle of selective radiography
on the basis of cited literature reporting that "33-41
percent of edentulous patients exhibited radiographic
evidence of pathologic conditions. ''1 Most studies
published since the FDA recommendation was devel-
aAssociate Professor and Chair, Oral Medicine and Radiology,
School of Dentistry.
bprofessor Emeritus, Oral Medicine and Radiology, School of
Dentistry.
cprofessor, Oral Medicine and Radiology, School of Dentistry.
Received for publication Jan. 12, 1998; returned for revision Feb. 23,
1998; accepted for publication Apr. 1, 1998.
Copyright © 1998 by Mosby, Inc.
1079-2104/98/$5.00 + 0 7/16/91244
oped have consistently found similar percentages of
radiographic findings, leading their authors to reaffirm
support for the guideline) -7 In contrast to the conven-
tional method of reporting total "positive findings," a
few authors 8-12 have included an assessment of the
impact on treatment of the findings reported. This
approach led these authors to question the benefit of
routine pretreatment radiography because most of the
findings had no impact on treatment. The obvious
importance of assessing the treatment impact of radi-
ographic findings prompted the authors of one study 10
to comment, "What is of great interest and usually has
not been addressed is the extent to which positive radi-
ographic findings lead to treatment intervention and
significantly alter the treatment plan [emphasis added]."
The purpose of this study was an assessment of the
impact of radiographic findings on complete denture
treatment and on the postdelivery course of patients in
the teaching clinic at the University of Western
Ontario. Until 1988 the radiography protocol for the
initial assessment of edentulous patients was a
panoramic examination. After 1988 radiographs were
prescribed selectively, as determined by clinical signs,
symptoms, and history. Consequently it was feasible to
study the treatment impact and postdelivery course for
353
354 Bohay, Stephens, andKogon ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
September 1998

Table I. Demographics of screening and selection Table II. Clinical findings leading to radiographic
groups of edentulous patients examination in selection group
Significance Clinical finding No. prescriptions
Screening Selection (P)
Pain and/or swelling 15
Age (yr) 58.88 -+ 12.58 63.46 + 11.58 .000 Exposed tooth or bone 1
Age range (yr) 20-86 29-85 Other (ridge defect, roots visible under mucosa) 2
Years edentulous 18.25 --- 11.90 23.03 _ 12.87 .000 None* 5
No. (and range) 1.33 _+0.80 1.45 _+0.93 .208 Total 23
of previous (0-5) (0-5)
*In 4 of 5 cases in which specificreason for radiographywas not stated, clinical
dentures
examination described mandibularridges as flat or nonexistent.
Gender .198
Male 93 65
Female 112 105
The authors of this study interpreted all radiographs.
The report included type of radiographs, all radi-
each method of radiographic examination on 2 fully ographic findings, location of findings, and information
edentulous groups. on how each case was treated. Treatment was deter-
mined from chart review. Film reading was done under
METHOD ideal viewing conditions. All available chart informa-
Case selection tion was at hand during the radiographic interpretation.
All available patient records in the teaching clinics at Consultation among reviewers was done freely, and any
the University of Western Ontario School of Dentistry finding for which more than one interpretation could
were reviewed to find patients for whom complete have been provided was settled by consensus.
dentures had been fabricated. A total of 1261 cases were Postdelivery complaints were abstracted from chart
identified. These cases were stratified into 2 groups. entries. Routine denture adjustments were not included
Patients in the pre-1987 cases all received pretreatment unless they were extensive and considered to be related
radiographic surveys and were designated the to some underlying abnormality. Complaints were
"screening group." Patients in cases dated 1989 or later recorded with respect to location, radiographs made,
were designated the "selection group," inasmuch as radiographic findings, and treatment provided.
radiographic examinations were selectively ordered for
patients on the basis of clinical findings. Sample size Analysis
estimates were based on previously reported, least Data analysis was primarily descriptive. When
common radiographic findings in edentulous patients. comparisons were made, t tests, chi-square analyses,
Through use of a systematic, random sampling method, and Fisher's exact test were used.
205 screening cases and 170 selection cases were
obtained. All cases included complete chart documenta- RESULTS
tion and fabrication and delivery of complete dentures. Table I presents the demographics of the 2 groups of
In addition, for each screening case, predenture fabrica- patients. Similarity between the groups was evaluated
tion radiographs had to be present in the chart. by comparison of variables that were common to the
groups. To further assess the similarity between the 2
Data collection groups, patient chief complaint or positive clinical
The data collected for each case included demo- findings (or both) were determined from chart entries.
graphic information, radiographic interpretation of Each of 24% of screening patients and 27% of selec-
predenture fabrication radiographs (where available), tion patients had a positive chief complaint or clinical
and information on postdelivery complaints and finding (P = .555).
management. The demographic data included chart
year, patient age and gender, number of previous Radiographic prescriptions
dentures, and number of years edentulous. Patient best- Each of the 205 screening patients had a pretreatment
estimates were recorded for number of previous radiograph; 99.0% of these were panoramic films. In
dentures and number of years edentulous. In each case the selection group of 170 patients, 23 (13.5%) had
in which a range was recorded, the mean of the upper radiographs prescribed, as determined by the chief
and lower limit, rounded down, was entered. Patients complaint or clinical findings disclosed by examina-
edentulous for less than 1 year were recorded as 0 years tion. Of the radiographic prescriptions selected, 65%
edentulous. Finally, the presenting chief complaint was included panoramic films; the balance consisted of
recorded for each patient. periapical and occasional occlusal views. None of the
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY Bohay, Stephens, and Kogon 355
Volume 86, Number 3

Table III. Radiographic findings in screening patients lable IV. Treated abnormalities in screening patients
(n = 205) Radiographic Clinical Years
Type of finding No. patients with findings Case no. finding evidence edentulous
Mucous retention cyst 8 l Root* Yes 14
Pneumatized sinus 62 2 Root* No 3
Sinus mucositis 5 3 3 Roots* No 4
Degenerative joint disease, 2 4 Root,* sawtooth ridges No 0
temporomandibular joint 5 2 Roots + No 38
Lymph node calcification 5 6 Root in soft tissue No 16
Calcified stylohyoid ligament 25 7 Root in soft tissue No 20
Mental foramen at crest 16 8 Tooth* Yes 10
Hyperplastic mucosa 3 9 Tooth* No 0
Foreign body (metal) in alveolar mucosa 2 10 Tooth* No 25
Idiopathic osteosclerosis 17 11 2 Teeth* Yes 10
Bone (other)* 3 12 Tooth* Yes 11
Sawtooth or irregular ridge 20 13 Sawtooth ridge Yes 10
Root completely embedded in bone, 19 14 Sawtooth ridge Yes 12
surrounding bone normal 15 Sawtooth ridge Yes 8
Root completely embedded in bone, 1 16 Irregular ridge Yes 8
surrounding bone abnormal 17 Enlarged tuberosity Yes 25
Root partially embedded in bone, 7 *Root or tooth partially embedded in bone, with surrounding bone appearing
surrounding bone normal normal.
Root partially embedded in bone, 2 *Root partially embedded in bone, with surrounding bone showing rarefaction
surrounding bone abnormal of ridge immediately around superior part of roots.
Root in soft tissue 3
Tooth completely embedded in bone, 4
surrounding bone normal
findings in the denture-bearing bone. These findings
Tooth completely embedded in bone, 1
surrounding bone abnormalt usually consisted of root tips, unerupted teeth, foreign
Tooth partially embedded in bone, 11 bodies, and radiopacities or radiolucencies. In our
surrounding bone normal study, 58 patients (28.3%) in the screening group had
Total 216' findings in these categories.
*Findings: 1 radiolncent analomic variant; 1 third molar socket partially
calcified; 1 bone chip in mncosa on ridge. Impact on treatment of radiographic findings in
*Large zone of dense bone or cementum enclosed root of this unerupted third
molar. screening group
;In many of 140 patients with findings, more than 1 abnormality was In the screening group, 17 (8.3%) of the patients were
recorded. treated for findings observed in the pretreatment radi-
ographs. Findings in only 3 categories--roots,
unerupted teeth, and irregular ridges--led to treatment.
remaining 147 (86.5%) patients in the selection group A detailed listing is shown in Table IV. Of these
had clinical signs, symptoms, or history that indicated patients, 9 had clinical findings that would have indi-
a need for radiographs. Table II shows the clinical find- cated a need for radiographic investigation. The clinical
ings that led to radiographic prescriptions. The prin- evidence consisted of partial exposure of roots or
cipal clinical finding was pain or swelling (or both). crowns, sharp ridges, bony protuberances, and hyper-
trophic mucosa on ridges. The remaining 8 patients (4%
Radiographic findings from screening of the total screening group), were treated for findings
radiography that were disclosed only by radiography. These occult
Because some earlier studies recorded various findings consisted of 9 root tips and 2 teeth. There was
anatomic and morphologic variations, most of which no radiographic evidence of pathosis related to these
were located b e y o n d the alveolar processes, the findings except in 1 patient (case 5 in Table IV), in
reviewers included these in their assessment. On the whom 2 roots showed some related ridge resorption.
basis of these data, the number of screening patients Although 17 patients in the screening group had
with findings was 140 (68.3%), whereas 65 (31.7%) roots, unerupted teeth, or irregular ridges treated surgi-
had no radiographic findings recorded. The findings cally before denture construction, there were 41
are listed in Table III. patients with radiographic findings in these 3 categories
In the supporting literature referenced for the FDA for whom no treatment was recommended. Table III
guideline I and in subsequent studies, 3-7 the principal shows that 23 patients had roots or teeth completely
focus in reporting results has been on radiographic embedded in bone; none of these was treated. Of the 20
356 Bohay, Stephens, and Kogon
Fig 1. Maxillary periapical image shows retained root
completely embedded in bone, with surrounding bone
appearing normal. No symptoms or signs were noted in chart
and no treatment was provided.
Fig 2. Panoramic image shows retained mandibular root
partially embedded in bone, with surrounding bone appearing
normal. No symptoms were reported, but root was seen under
mucosa and removed. (Case 1, Table IV.)
patients identified with irregular or saw tooth ridges, 14
were not treated. Five patients with roots partially
embedded in bone had these removed, but 4 patients
with similar findings were not treated. Where roots
were lying entirely in soft tissue, 2 of the 3 patients had
surgery. Figs 1, 2, and 3 show examples of root find-
ings. For teeth partially embedded in bone, 5 patients
had surgery but 6 patients did not (Fig 4).
Treatment impact of findings in the selection
group
Twenty-three patients in the selection group were
examined by radiographs; 2 patients (1.2%) in the entire
selection group had findings treated. In both cases the
findings were roots that were clinically visible. This
was significantly fewer patients (P = .004) than the
8.3% of patients treated in the screening group. Twelve
of the 23 patients radiographed exhibited incidental
findings similar to those listed in Table III, including l
tooth and 3 roots. There were no associated pathologic
bone changes, and none of these findings was treated.
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
September 1998
Fig 3. Panoramic image shows 2 retained maxillary roots in
soft tissue. No symptoms or signs were noted in chart; these
root tips were removed. (Case 5, Table IV.)
Fig 4. Panoramic image shows partially impacted mandibular
third molar, with surrounding bone appearing normal. No
symptoms were reported, but chart notes that tooth was
partially exposed; this tooth was removed. (Case 11, Table IV.)
Postdelivery outcome
In the initial design of this study, patients were
included in the postdelivery complaint category if they
had problems that extended beyond a routine 3-month
postdelivery adjustment period. In analyzing the data,
it was found that many patients fell into this category
but that virtually all of them were patients requiring
routine denture adjustments. This group was excluded
from the outcome analysis, leaving only 2 patients who
had complaints that required other forms of treatment;
one of these patients was treated symptomatically for
temporomandibular joint pain, and the other had a
small bone chip removed from the alveolar mucosa.
The bone chip was not evident in the pretreatment radi-
ograph. No patients from the selection or screening
groups were treated for retained root tips or impacted
teeth during the postdelivery follow-up period.
Further analysis included assessment of whether
there was any relationship between the location of
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
Volume 86, Number 3
postdelivery complaints and the location of pretreat-
ment radiographic findings. Only 4 patients had
complaints located in sites where pretreatment findings
were recorded. Three of these were "mental foramen at
crest" and 1 was "ridge irregularity." None of these
findings was treated before denture construction.
DISCUSSION
A central assumption in this retrospective study was
that the screening and selection groups were similar
and therefore comparable. Case selection bias was
controlled with the scientifically determined sample
size calculation and method of case acquisition. When
the demographic variables for the 2 groups were
compared, they were not found to be significantly
different except with respect to mean years edentulous
and mean age. However, we believe that the clinical
significance of this difference is minimal. No differ-
ences were found with respect to presenting chief
complaints or positive clinical findings at initial assess-
ment. Finally, although the sample was small, those
patients in the selection group who did have radi-
ographs made before denture fabrication demonstrated
incidental findings similar to those observed in the
screening group.
The justification for routine pretreatment radiographs
for edentulous patients, as stated in textbooks 13-15 and
by the FDA expert panel, 1 is the high percentage o f
positive findings disclosed by these films. The results
of this study show that 28.3% of patients who had
pretreatment radiographs had positive findings in the
denture-bearing bone. These included root tips,
unerupted teeth, foreign bodies, "radiopacities," and
"radiolucencies." This percentage is comparable to
those reported in recent US studies by Jones et al.
(35%), 16 Edgerton and Clark (23%), 6 and Seals et al.
(12%). 7 The higher percentages of 33% to 41% quoted
by the FDA panel resulted from the inclusion of inter-
national studies in which the prevalence of findings,
especially of root fragments, is significantly greater
than in North American samples. 17-19 Based on these
high percentages of total findings, edentulous persons
have been described as members of a group at high risk
for oral disease. 20
A weakness of many studies is the imprecise defini-
tion of "positive radiographic findings." These have been
commonly described as pathologic conditions, pathoses,
or lesions--terms that indicate the presence of disease
and imply an impact on treatment. To determine the
significance of recorded observations, the radiographic
interpretation should attempt to distinguish between
those findings that pose a health risk or affect denture
construction and those that do not. For example, in our
study the jaw "radiopacities" were interpreted as idio-
pathic osteosclerosis, and the "foreign bodies" were
Bohay, Stephens, andKogon 357
amalgam scrap. None of these showed evidence of
adverse tissue reaction and none should be described as
pathologic conditions. Similarly, calcified lymph nodes,
mucous retention cysts, antral pneumatization, and other
commonly interpreted radiographic findings listed in
Table III had no recorded impact on patient treatment.
The primary focus of attention in previous studies of
pretreatment radiography has been the identification of
root tips and unerupted teeth. These constitute approxi-
mately one half of the positive findings reported. 21 In
our results, of the patients who had roots and teeth
removed, only 1 showed radiolucent changes in the bone
surrounding 2 partially embedded roots; this patient had
been edentulous for 38 years, and there were no clinical
signs or symptoms. These results and analysis of data
from other studies clearly indicate that although
embedded root tips and teeth may have pathoses associ-
ated with them, in and of themselves they should not be
described as "pathologic conditions" or "lesions." There
were no instances in the pretreatment radiographic
examinations of pathologic conditions such as cysts,
osteitis, metabolic disease, and neoplasia.
Furthermore, the value of pretreatment radiographs
should be determined not by percentages of total find-
ings but by the proportion of such findings that have an
impact on patient treatment. In most studies, including
the 4 referenced by the FDA expert panel, 16-19 it is
either stated or implied that the reported findings modi-
fied treatment, when in fact their impact was not
assessed. To address an obvious shortcoming, our
study was designed to determine the impact of radi-
ographic findings on preprosthetic treatment and post-
delivery outcome. Table IV shows the detailed list of
those findings that affected treatment, as judged by the
clinicians who supervised the management of the
patients. Of the patients with pretreatment radiographs,
8% had surgical intervention before construction of
dentures; of these, one half had clinical findings that
would have indicated a need for radiography. In effect,
only 4% had occult findings treated. These results indi-
cate that although there might be a high percentage of
total positive findings, this fact cannot be used as a
measure of the impact of radiography on treatment.
Unless the percentage findings are qualified by deter-
mination of their actual influence on treatment, they
grossly inflate the yield of significant information.
A common reason given in support of the routine use
of pretreatment radiographs for asymptomatic edentu-
lous patients is the need to disclose the presence of
occult root fragments and unerupted teeth. 20 For two
thirds of the patients in whom such findings were
observed the clinicians determined that no treatment
was necessary. Where treatment was delivered the
patients had been edentulous on average for 13 years
(range, 0-38 years), whereas those not treated had been
358 Bohay, Stephens, and Kogon
edentulous on average for 19 years (range, 0-43 years).
Although the difference is not statistically significant
(P = .09), it does suggest that dentists might consider
the number of years that the patient has been edentu-
lous when deciding on treatment. For whatever reason,
this study demonstrates that the clinicians did not
follow a specific protocol for surgical removal of all
root fragments and unerupted teeth but rather weighed
other factors in determining treatment choices.
A further argument has been made that it is in the
interest of both the patient and the dentist to be aware
of the presence of innocuous findings even though
treatment is not required. 2° With the exception of root
tips, there is no evidence to suggest that the prevalence
of positive radiographic findings in edentulous persons
is not comparable to that in dentate patients. 22
Furthermore, the FDA expert panel did not suggest that
dentate patients should be made aware of all radi-
ographic observations not requiring treatment. On the
basis of data from this study and others previously
cited, there are no grounds for the asymmetric applica-
tion of this doctrine to edentulous patients.
Effect of screening or selection radiography on
postdelivery outcome
There were 4 patients--all from the screening
g r o u p - - i n w h o m a postdelivery complaint was in an
area with a pretreatment radiographic finding. These
were 3 cases of a mental foramen at the crest of the
alveolar process and 1 case of a ridge irregularity.
According to our data, there is no compelling evidence
that the pretreatment radiographic findings in the
screening group had a significant impact on the post-
delivery course. In addition, it is apparent that the
absence of pretreatment radiographic information for
patients in the selection group did not lead to unex~
pected postdelivery difficulties. Although the short
period of follow-up was a limitation (resulting from the
requirements of the teaching program), it is clear when
the numbers of years edentulous before treatment are
considered that most of the patients had been without
signs or symptoms of disease for many years--even, in
some cases, for decades. Given the absence of any
pathologic findings in the group with pretreatment
radiographs, it can reasonably be predicted that the
likelihood of roots and unerupted teeth causing disease
in asymptomatic edentulous patients is remote.9,10
Identifying selection criteria
Inclusion in the study of a selective radiography
group presented us with an opportunity to identify
from the patient records the clinical findings that may
have determined the prescription. In Table II it is seen
that pain or swelling (or both) was the most common
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
September 1998
sign or symptom recorded for patients selectively radi-
ographed. In these cases the clinical judgment that a
radiograph would contribute to the diagnosis is a
classic application of a selection criterion. Excessive
resorption or irregularity (or both) of ridges was the
most c o m m o n physical finding that may have led to
radiography. In our view, the value of a pretreatment
radiograph made to confirm or document alveolar ridge
resorption or irregularity is debatable, especially if
preprosthetic surgery is not anticipated from clinical
examination. Finally, the only clinical sign in the selec-
tion group of patients that resulted in surgical treatment
was visible evidence of root fragments. Of course,
there are many clinical findings beyond those identi-
fied in our patients that influence the prescription of
radiographs for both edentulous and dentate patients. It
is noteworthy that as a result of the use of selective
radiography only 13.5% of patients had pretreatment
radiographs. This percentage is the same as that
reported in a previous study 11 (14%) in which selection
criteria determined the radiographic prescriptions for
edentulous patients.
CONCLUSION
The data in our study clearly demonstrate that the
evidence for the claim that edentulous patients are at
high risk for occult disease is fundamentally flawed.
Positive radiographic findings should not indiscrimi-
nately be described as pathologic conditions. The
practice of using total percentage findings without an
assessment of their clinical significance results in
gross exaggeration of the efficacy o f pretreatment
radiography. The postdelivery outcome for patients in
w h o m radiographic prescriptions were individualized
was as uneventful as that for the members o f the
pretreatment screening radiography group. The
continued use of pretreatment radiography for edentu-
lous adults does not represent a justifiable use of a
health resource.
REFERENCES
1. US Department of Health and Human Services, Public Health
Service, Food and Drug Administration. The selection Of
patients for x-ray examinations: dental radiographic examina-
tions (publication FDA 88-8273). Rockville, Md.: Health and
Human Services; 1987. p. 9, 16.
2. Council on Dental Materials, Instruments and Equipment.
Recommendations in radiographic practices: an update, 1988. J
Am Dent Assoc 1989;118:115-7.
3. Dias AP, Jiffry MTM. Orthopantomographicsurvey of edentu-
lous patients and different age groups in Malaysia. Aust Dent J
1988;33:23-6.
4. Axelsson G. Orthopantomographicexamination of the edentu-
lous mouth. J Prosthet Dent 1988;59:592-8.
5. Soikkonen K, Ainamo A, Wolf J, Xie Q, Tilvio R, Valanne J, et
al. Radiographicfindings in the jaws of clinically edentulous old
people living at home in Helsinki, Finland. Acta Odontol Scand
1994;52:229-33.
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
Volume 86, Number 3
6. Edgerton M, Clark E Location of abnormalities in panoramic
radiographs of edentulons patients. Oral Surg Oral Med Oral
Pathol 1991;71:106-9.
7. Seals RR, Williams EO, Jones JD. Panoramic radiographs:
necessary for edentulous patients? J Am Dent Assoc
1992;123:74-8.
8. Lyman S, Boucher LJ. Radiographic examination of edentulous
mouths. J Prosthet Dent 1990;64:180-2.
9. Lloyd PM, Gambert SR. Periodic oral examinations and
panoramic radiographs in edentulous elderly men. Oral Surg
Oral Med Oral Pathol 1984;57:678-80.
10. Garcia RI, Valachovic RW, Chauncey HH. Longitudinal study of
the diagnostic yield of panoramic radiographs in aging edentu-
lous men. Oral Surg Oral Med Oral Pathol 1987;63:494-7.
11. Kogon SL, Charles DH, Stephens RG. A clinical study of radi-
ographic selection criteria for edentulous patients. J Can Dent
Assoc 1991;57:794-8.
12. White SC, Forsythe AB, Joseph LR Patient-selection criteria for
panoramic radiography. Oral Surg Oral Med Oral Pathol 1984;
57:681-90.
13. Goaz PW, White SC. Oral radiology. 3rd ed. St. Louis: CV
Mosby; 1994. p. 218.
14. Zarb GA, Bolender CL, Hickey JC, Carlsson GE. Boucher's
prosthodontic treatment for edentulous patients, lOth ed. St.
Louis: CV Mosby; 1990. p. 67-8.
15. Winkler S. Essentials of complete denture prosthodontics. 2nd
ed. Littleton, Mass.: PSG Publishing; 1988. p. 51-2.
16. Jones, JD, Seals RR, Schelb E. Panoramic radiographic exami-
nation of edentulous patients. J Prosthet Dent 1985;53:535-9.
Bohay, Stephens, and Kogon 359
17. Spyropoulos ND, Patsakas AJ, Angelopolous AR Findings from
radiographs of the jaws of edentulous patients. Oral Surg Oral
Med Oral Pathol 1981 ;52:455-9.
18. Perrelet LA, Bernhard M, Spirgi M. Panoramic radiography in
the examination of edentulous patients. J Prosthet Dent
1977;37:494-8.
19. Keur JJ, Campbell JPS, McCarthy JF, Ralph WJ. Radiological
findings in 1,135 edentulous patients. J Oral Rehabil
1987; 14:183-91.
20. Matteson SR. Radiographic guidelines for edentulous patients.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:
624-6.
21. Kogon SL, Stephens RG, Bohay RN. An analysis of the scien-
tific basis for the radiographic guideline for new edentulous
patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
1997;83:619-23.
22. Alattar MM, Baughman RA, Collett WK. A survey of
panoramic radiographs for evaluation of normal and pathologic
findings. Oral Surg Oral Med Oral Pathol 1980;50:472-8.
Reprint requests:
Richard N. Bohay, DMD, MSc, MRCD(C)
Division of Oral Medicine and Radiology
Dental Sciences Building
University of Western Ontario
London, Ontario N6A 5C1
Canada