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Case Report

Unusual Radiopacities Spotted in a Dental Radiograph:

Case Report
Ranjana Garg, Bennete Fernandes, Mysore K Sunil1
Faculty of Dentistry, SEGi University, Malaysia, Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre,
1

Moradabad, Uttar Pradesh, India

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

Introduction head and neck showed no obvious abnormalities [Figure 1].

Intraoral examination revealed many mising teeth in the
In dental clinics, digital radiographs are routinely taken for
maxilla and the mandible. An orthopantomogram (OPG) was
the patients. Before taking any dental radiograph, patients are
taken as a routine radiographic investigation. OPG revealed
instructed to remove any metallic objects such as ear rings,
generalized bone loss and numerous thread like radio‑opacities
chain, or hair clips in the head and neck region to avoid ghost
in the posterior aspect of the maxilla and the mandible.
images on the radiographs. Recently, we came across a case
Radio‑opacities were very thin and torturous, forming a
with numerous radiopaque strings visible on the panoramic
fragmented, mesh‑like structure over the maxilla and the
radiograph. Wrinkles are the first sign of the aging process,
mandible region in the posterior aspect [Figure 2].
indicating where the smiles have been. However, being youthful
is desired by all. Many antiaging procedures are done across the Patient was enquired about whether she had undergone any
globe to maintain youthfulness such as Botox injections, chemical kind of surgery before on her face. Patient mentioned a facelift
peel, or face‑lift procedures. The highly effective cosmetic procedure done 7 years back. She mentioned that during the
technique for improving the youthfulness of the skin is the gold face‑lift procedure, very thin needle with the gold thread was
filament rejuvenation technique, which has been used for more inserted under her skin, forming a mesh beneath it. The entire
than 10 years across Europe and Asia; this technique that uses procedure was done under local anesthesia and took 45 minutes
a gold thread to repair wrinkles, tighten jawlines, and eliminate to 1 hour. She also mentioned that she was very satisfied with
dark circles is the latest weapon in the war against ageing. 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
Case Report over her face as she thought that our treatment probably can
A 65‑year‑old female patient visited the SEGi Oral Health
care center for replacement of missing teeth. Medical history
Address for correspondence: Dr. Ranjana Garg,
of the patient revealed that the patient was hypertensive and Faculty of Dentistry, SEGi University, Malaysia.
under medication. Patient had got her teeth extracted because E‑mail: [email protected]
of mobility. The patient could not remember any surgical
intervention done previously. An extraoral examination of the
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How to cite this article: Garg R, Fernandes B, Sunil MK. Unusual
radiopacities spotted in a dental radiograph: Case report. J Indian Acad Oral
DOI:
Med Radiol 2017;29:138-40.
10.4103/jiaomr.JIAOMR_118_16
Received: 15‑09‑2016  Accepted: 24‑10‑2017  Published: 09-11-2017

138 © 2017 Journal of Indian Academy of Oral Medicine & Radiology | Published by Wolters Kluwer - Medknow
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Garg, et al.: Unusual radiopacities

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

form around it and tighten the surrounding area. It is said that

the closer the threads are placed in the “mesh” or “fan” the
Figure 1: Extraoral photograph of the patient showing no wrinkles over tighter the achievable lift. Gold thread implantation promotes
the face and visible sharply defined jaw line angiogenesis, as the immediate area surrounding the capsule
is rich in blood vessels compared with other regions, and the
affect her facial esthetics. After this, patient was referred number of mast cells around gold thread increases over time.[5,7]
to the prosthodontic department for the replacement of the
Several reports have suggested that the gold threads usually
missing teeth.
migrate and get fragmented over a period of time. Gold threads
may complicate radiographic assessment as they may overlap
Discussion important anatomical structures.[8] Fragmented gold threads
Panoramic radiology aims to produce a complete view of can visibly hamper analysis of radiographic images, as seen in
both dental arches and their adjacent structures with minimal this case. Sometimes artifacts other than the above mentioned
geometric distortion and with minimal overlap of anatomic strings may also be observed on radiographs, making it difficult
details from the contralateral side. Objects that are within the to obtain a good interpretation of the image. This could well
selected image layer are clearly visible in the image, whereas lead to misinterpretation, with all its consequences. Therefore,
objects outside the image layer are deliberately blurred out of sufficient knowledge of the all probable types of artifacts is a
recognition.[1] In literature, different metallic artifacts such as primary requirement.[9]
bracelets, glasses, removable dentures, and piercings have been
described.[2] Unrecognized artifacts in the dental radiographs Conclusion
have become a major area of concern in many South Asian The purpose of reporting this case is that the numerous
and European countries. Unexpected objects such as metallic artifacts can be seen on dental radiographs. Hence, a thorough
foreign bodies inserted into the body during surgery or medical history including questions on such facial rejuvenation
abandoned acupuncture needles might be hidden in the body therapies is recommended to rule out the radiopaque artifacts
and are less frequently described in literature.[3] seen in the radiographs.
In an attempt to maintain young and adolescent appearances, Declaration of patient consent
physicians are greeting the new technologies around the world. The authors certify that they have obtained all appropriate
Unfortunately, these technologies should be used with care as many patient consent forms. In the form the patient(s) has/have
complications are associated with them.[4] Gold face‑lift procedure given his/her/their consent for his/her/their images and other
is increasingly being used since the last decade as a versatile and clinical information to be reported in the journal. The patients
safe nonsurgical alternative for the correction of contours and understand that their names and initials will not be published
volumetric augmentation with multiple aesthetic applications. The and due efforts will be made to conceal their identity, but
so‑called gold thread face‑lift, developed in Russia, has recently anonymity cannot be guaranteed.
been adopted in all the European and Asian countries. The use of
gold thread in dermatology was first introduced by Dr. Caux in Financial support and sponsorship
France approximately 30 years ago.[5] In its original version, this Nil.
method relied on the noninvasive suspension of the facial tissues Conflicts of interest
by insertion of gold threads to reduce the laxity of the tissue via There are no conflicts of interest.
induction of myofibroblast contraction.[6]
Gold wires or threads consist of a surgical suture made from References
24‑carat gold which are introduced into the skin with a needle, 1. Allan G. Farman. Panoramic Radiology: Seminars on Maxillofacial
in a mesh or fan‑like pattern, which allows new collagen to Imaging and Interpretation. Heidelberg: Springer Verlag; 2007.

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Garg, et al.: Unusual radiopacities

2. Murray D, Whyte A. Dental panoramic tomography: What the general 6. Stark GB, Bannasch H. The “golden thread lift”: Radiologic findings.
radiologist needs to know. Clin Radiol 2002;57:1‑7. Aesthetic Plast Surg 2007;31:206‑8.
3. Armstrong DT, Gilliland WR, Murphey MD, Salesky J. Clinical images: 7. Rondo Junior  W, Vidarte  G, Michalany  N. Histologic study
Gold thread acupuncture for rheumatoid arthritis. Arthritis Rheum of the skin with gold thread implantation. Plast Reconstr Surg
2011;63:3021. 1996;97:256‑8.
4. Kontis TC, Rivkin A. The history of injectable facial fillers. Facial plast 8. Cho J, Park YS. Gold thread acupuncture for a headache. Am J Med Sci
Surg 2009;25:67‑72. 2015;350:420.
5. Shin  KC, Bae  TH, Kim  WS, Kim  HK. Usefulness of gold thread 9. Keestra JA, Jacobs R, Quirynen M. Gold‑wire artifacts on diagnostic
implantation for Crow’s feet. Arch Plast Surg 2012;39:42‑5. radiographs: A case report. Imaging Sci Dent 2014;44:81‑4.

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