Correlation of stress radiographs to injuries associated with lateral ankle instability

BACKGROUND Stress radiographs have demonstrated superior efficacy in the evaluation of ankle instability.AIM To determine if there is a degree of instability evidenced by stress radiographs that is associated with pathology concomitant with ankle ligamentous instability.METHODS A retrospective review of 87 consecutive patients aged 18-74 who had stress radiographs performed at a single institution between 2014 and 2020 was performed.These manual radiographic stress views were then correlated with magnetic resonance imaging and operative findings.RESULTS A statistically significant association was determined for the mean and median stress radiographic values and the presence of peroneal pathology(P=0.008 for tendonitis and P=0.020 for peroneal tendon tears).A significant inverse relationship was found between the presence of an osteochondral defect and increasing degrees of instability(P=0.043).CONCLUSION Although valuable in the clinical evaluation of ankle instability,stress radiographs are not an independent predictor of conditions associated with ankle in-stability.

Development and Application of an Instrument for Analysis of Bone Structure on Radiographs

An instrument used for quantitative assessment of trabecular structure of radius on radiograph including trabecular number and trabecular width was developed using a microdensitometer and a single-chip microcomputer. The device is characterized by its high sensitivity, good reproducibility, convenience and economy. The results obtained with the instrument were significantly correlated to actual bone mineral content, This device can be used for the diagnosis of osteoporosis, fluorosis, rickets and bone damages caused by cadmium.

Can immediate postoperative radiographs predict outcomes in pediatric clubfoot?

BACKGROUND The goal of treatment for pediatric idiopathic clubfoot is to enable the patient to comfortably walk on his or her soles without pain.However,currently accepted treatment protocols are not always successful.Based on the abnormal bone alignment reported in this disease,some studies have noted a correlation between radiographic characteristics and outcome,but this correlation remains debated.AIM To assess the correlation between immediately postoperative radiographic parameters and functional outcomes and to identify which best predicts functional outcome.METHODS To predict the outcome and prevent early failure of the Ponseti’s method,we used a simple radiographic method to predict outcome.Our study included newborns with idiopathic clubfoot treated with Ponseti’s protocol from November 2018 to August 2022.After Achilles tenotomy and a long leg cast were applied,the surgeon obtained a single lateral radiograph.Radiographic parameters included the tibiocalcaneal angle(TiCal),talocalcaneal angle(TaCal),talofirst metatarsal angle(Ta1st)and tibiotalar angle(TiTa).During the follow-up period,the Dimeglio score and functional score were examined 1 year after surgery.Additionally,recurring events were reported.The correlation between functional score and radiographic characteristics was analyzed using sample and multiple logistic regression,and the optimal predictor was also identified.RESULTS In total,54 feet received approximately 8 manipulations of casting and Achilles tenotomy at a mean age of 149 days.The average TiCal,TaCal,Ta1st,and TiTa angles were 75.24,28.96,7.61,and 107.31 degrees,respectively.After 12 mo of follow up,we found 66%excellent-to-good and 33.3%fair-to-poor functional outcomes.The Dimeglio score significantly worsened in the poor outcome group(P value<0.001).Tical and TaCal showed significant differences between each functional outcome(P value<0.05),and the TiCal strongly correlated with outcome,with a smaller angle indicating a better outcome,each 1 degree decrease improved the functional outcome by 10 percent.The diagnostic test revealed that a TiCal angle of 70 degrees predicts an inferior functional outcome.CONCLUSION The TiCal,derived from lateral radiographs immediately after Achilles tenotomy,can predict functional outcome at 1 year postoperatively,justifying its use for screening patients who need very close follow-up.

Investigation of coronoid process hyperplasia using Levandoski analysis on panoramic radiographs

BACKGROUND The diagnosis of coronoid process hyperplasia(CPH)is usually based on symptoms and radiological imaging.Because of its similar symptoms,it can be confused with temporomandibular joint diseases.Therefore,an objective and reproducible way of diagnosis should be determined.AIM To investigate CPH using Levandoski analysis on panoramic radiographs to determine its prevalence.METHODS A total of 300 panoramic radiograph images(600 coronoid processes)were examined.Having measured the Condyle-Gonion(Cd-Go)and Coronoid-Gonion(Cor-Go)distances,the Cor-Go:Cd-Go ratio was calculated for the left and right sides of each image.RESULTS There was a statistically significant difference in Cd-Go and Cor-Go distances between male and female participants(P<0.001).There was no statistically significant relationship between Cor-Go:Cd-Go ratios and gender(P>0.05).CONCLUSION Cd-Go and Cor-Go distances were statistically significantly increased in males on both the left and right sides.The ratio of Cor-Go:Cd-Go was preserved in both genders.The prevalence of CPH was found to be 0.3%.

A Method for Measurement of the Hypertrophic First Metatarsal Medial Eminence on Foot Radiographs—A Reliability Study with Surgical Implications

Background: It has been suggested that hypertrophic eminence on the medial head of the first metatarsal is a component of the patho-anatomy of hallux valgus. However, research findings in this area are inconsistent, possibly due to differences in methods in identifying and measuring the medial eminence. To date, reliability of any method of measurement has not been reported. The purpose of this study was to determine the reliability of measurement of the medial eminence on medial oblique and dorsoplantar radiographs using a previously described geometric technique. Methods: To evaluate the reliability of a method of measurement of the medial eminence of the first metatarsal duplicate standardized dorsoplantar and medial oblique radiographs were taken of one foot of 15 subjects. The feet included both rectus feet and subjects with hallux valgus. The medial eminence was measured on the digital images using Inteleviewer 2.5 (Intelerad medical systems incorporated, Montreal, Quebec) software. Observer 1 measured one randomly selected image from each subject to determine inter-observer reliability. Observer 2 measured all images to determine the overall intraobserver reliability. Reliability was calculated using intra-class correlation coefficients (ICC). Results: The mean projection of the medial eminence ranged from 0.39 to 0.44 cm in both views. The ICCs were calculated for the dorsoplantar view and the 2 medial oblique view measures between observers. They ranged from 0.76 intra-rater and 0.86 interrater in the dorsoplantar view to 0.80 intra-rater and 0.90 inter-rater in the medial oblique view indicating good reliability in all measures. The average of the 4 oblique views also showed a high level of reliability with a coefficient of 0.96. Conclusions: The medial eminence can be reliably measured in the medial oblique and dorsoplantar view using the described technique. The medial oblique and the dorsoplantar views are valuable and reliable projections for visualising the dorso medial aspect of the first metatarsal.

Transformer-Based Deep Learning Network for Tooth Segmentation on Panoramic Radiographs

Panoramic radiographs can assist dentist to quickly evaluate patients’overall oral health status.The accurate detection and localization of tooth tissue on panoramic radiographs is the first step to identify pathology,and also plays a key role in an automatic diagnosis system.However,the evaluation of panoramic radiographs depends on the clinical experience and knowledge of dentist,while the interpretation of panoramic radiographs might lead misdiagnosis.Therefore,it is of great significance to use artificial intelligence to segment teeth on panoramic radiographs.In this study,SWin-Unet,the transformer-based Ushaped encoder-decoder architecture with skip-connections,is introduced to perform panoramic radiograph segmentation.To well evaluate the tooth segmentation performance of SWin-Unet,the PLAGH-BH dataset is introduced for the research purpose.The performance is evaluated by F1 score,mean intersection and Union(IoU)and Acc,Compared with U-Net,Link-Net and FPN baselines,SWin-Unet performs much better in PLAGH-BH tooth segmentation dataset.These results indicate that SWin-Unet is more feasible on panoramic radiograph segmentation,and is valuable for the potential clinical application.

A Study on Extension－Flexion Dynamic Lumbar Spine Radiographsin Patients with Lumbar Intervertebral Disc Herniation

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Occult Andersson lesions in patients with ankylosing spondylitis: undetectable destructive lesions on plain radiographs

Background:Andersson lesions(ALs)are not uncommon in ankylosing spondylitis(AS).Plain radiography(PR)is widely used for the diagnosis of ALs.However,in our practice,there were some ALs in AS patients that could not be detected on plain radiographs.This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients.Methods:A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital,Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed.The AS patients with ALs who met the following criteria were included for the investigation of occult ALs:(1)with pre-operative plain radiographs of the whole-spine and(2)availability of pre-operative computed tomography(CT)and/or magnetic resonance imaging(MRI)of the whole-spine.The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI.The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body.Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs.Chi-square or Fisher exact test was applied to compare the types,distribution,and radiographic characteristics between detectable and occult ALs as appropriate.Results:Ninety-two AS patients with a mean age of 44.4±10.1 years were included for the investigation of occult ALs.Twenty-three patients had occult ALs and the incidence was 25%(23/92).Fifteen extensive ALs were occult,and the proportion of extensive ALs was significantly higher in detectable ALs(97%vs.44%,χ^(2)=43.66,P<0.001).As assessed by PR,the proportions of osteolytic destruction with reactive sclerosis(0 vs.100%,χ^(2)=111.00,P<0.001),angular kyphosis of the affected discovertebral units or vertebral body(0 vs.22%,χ^(2)=8.86,P=0.003),formation of an osseous bridge at the intervertebral space adjacent to ALs caused by the ossification of the anterior longitudinal ligament(38%vs.86%,χ^(2)=25.91,P<0.001),and an abnormal height of the affected intervertebral space were all significantly lower in occult ALs(9%vs.84%,χ^(2)=60.41,P<0.001).Conclusions:Occult ALs presented with more subtle radiographic changes.Occult ALs should not be neglected,especially in the case of extensive occult ALs,because the stability of the spine might be severely impaired by these lesions.

Deformable Registration of Chest Radiographs Using B-spline Based Method with Modified Residual Complexity

Accurate registration of chest radiographs plays an increasingly important role in medical applications.However, most current intensity-based registration methods rely on the assumption of intensity conservation that is not suitable for alignment of chest radiographs. In this study, we propose a novel algorithm to match chest radiographs, for which the conventional residual complexity(RC) is modified as the similarity measure and the cubic B-spline transformation is adopted for displacement estimation. The modified similarity measure is allowed to incorporate the neighborhood influence into variation of intensity in a justified manner of the weight, while the transformation is implemented with a registration framework of pyramid structure. The results show that the proposed algorithm is more accurate in registration of chest radiographs, compared with some widely used methods such as the sum-of-squared-differences(SSD), correlation coefficient(CC) and mutual information(MI)algorithms, as well as the conventional RC approaches.

Algorithm fusion to improve detection of lung cancer on chest radiographs

Purpose-The purpose of this paper is to show an efficient method for the detection of signs of early lung cancer.Various image processing algorithms are presented for different types of lesions,and a scheme is proposed for the combination of results.Design/methodology/approach-A computer aided detection(CAD)scheme was developed for detection of lung cancer.It enables different lesion enhancer algorithms,sensitive to specific lesion subtypes,to be used simultaneously.Three image processing algorithms are presented for the detection of small nodules,large ones,and infiltrated areas.The outputs are merged,the false detection rate is reduced with four separated support vector machine(SVM)classifiers.The classifier input comes from a feature selection algorithm selecting from various textural and geometric features.A total of 761 images were used for testing,including the database of the Japanese Society of Radiological Technology(JSRT).Findings-The fusion of algorithms reduced false positives on average by 0.6 per image,while the sensitivity remained 80 per cent.On the JSRT database the system managed to find 60.2 per cent of lesions at an average of 2.0 false positives per image.The effect of using different result evaluation criteria was tested and a difference as high as 4 percentage points in sensitivity was measured.The system was compared to other published methods.Originality/value-The study described in the paper proves the usefulness of lesion enhancement decomposition,while proposing a scheme for the fusion of algorithms.Furthermore,a new algorithm is introduced for the detection of infiltrated areas,possible signs of lung cancer,neglected by previous solutions.

Transfer learning-based super-resolution in panoramic models for predicting mandibular third molar extraction difficulty: a multi-center study

Background:This study aims to predict the extraction difficulty of mandibular third molars based on panoramic images using transfer learning while employing super-resolution(SR)technology to enhance the feasibility and validity of the prediction.Methods:We reviewed a total of 608 preoperative mandibular third molar panoramic radiographs from two medical facilities:the First Affiliated Hospital of Zhengzhou University(n=509;456 in the training set and 53 in the test set)and the Henan Provincial Dental Hospital(n=99 in the validation set).We conducted a deep-transfer learning network on high-resolution(HR)panoramic radiographs to improve the longitudinal resolution of the images and obtained the SR images.Subsequently,we constructed models named Model-HR and Model-SR using high-dimensional quantitative features extracted through the Least Absolute Shrinkage and Selection Operator method.The models’performances were evaluated using the receiver operating characteristic curve(ROC).To assess the reliability of the model,we compared the results from the test set with those of three dentists.Results:Model-SR outperformed Model-HR(area under the curve(AUC):0.779,sensitivity:85.5%,specificity:60.9%,and accuracy:79.8%vs.AUC:0.753,sensitivity:73.7%,specificity:73.9%,and accuracy:73.7%)in predicting the difficulty of extracting mandibular third molars.Both Model-HR(AUC=0.821,95%CI 0.687–0.956)and Model-SR(AUC=0.963,95%CI 0.921–0.999)demonstrated superior performance compared to expert dentists(highest AUC=0.799,95%CI 0.671–0.927).Conclusions:Model-SR yielded superior predictive performance in determining the difficulty of extracting mandibular third molars when compared with Model-HR and expert dentists’visual assessments.

Non-invasive optical characterization and estimation of Zn porosity in gas tungsten arc welding of Fe–Al joints using CR model and OES measurements

In this study,we employed a non-invasive approach based on the collisional radiative(CR)model and optical emission spectroscopy(OES)measurements for the characterization of gas tungsten arc welding(GTAW)discharge and quantification of Zn-induced porosity during the GTAW process of Fe–Al joints.The OES measurements were recorded as a function of weld current,welding speed,and input waveform.The OES measurements revealed significant line emissions from Zn-I in 460–640 nm and Ar-I in 680–800 nm wavelength ranges in all experimental settings.The OES coupled CR model approach for Zn-I line emission enabled the simultaneous determination of both essential discharge parameters i.e.electron temperature and electron density.Further,these predictions were used to estimate the Zn-induced porosity using OES-actinometry on Zn-I emission lines using Ar as actinometer gas.The OES-actinometry results were in good agreement with porosity data derived from an independent approach,i.e.x-ray radiography images.The current study shows that OES-based techniques can provide an efficient route for real-time monitoring of weld quality and estimate porosity during the GTAW process of dissimilar metal joints.

Intra-Articular Distal Radius Fracture with Lunate Fossa Rotated and Associated Lesions: Radiologic Analysis

Introduction: Intra-articular distal radial fractures in young patients occur in high energy trauma which can lead to a combination of bone and ligaments lesions. An articular step superior to 2 mm is pejorative, for that an adequate radiologic analysis is necessary accessing to the best surgical treatment. The purpose of our study was to investigate this type of fracture and expose radiologic analysis (radiograph and CT-scan) of bone and ligamentous associated lesions of this specific twisted lunate facet fracture for recognizing it and accessing to the best surgical treatment. Patients and Methods: Seven patients with severely displaced type 4 articular fractures of the distal radius whose wrists had been exposed to violent compression are reported in our series, they are required open treatment for the reduction and fixation of disrupted articular surfaces by using an antero-medial approach which allows direct access to the fragment of the lunate facet and easier visualization of the distal radio-ulnar joint. Results: All the patients were clinically examined with antero-posterior and lateral X ray, completed by a CT scan, all the fractures were type IV according to Melone classification. In all of our seven cases there was a lesion of the distal radioulnar joint (DRUJ) identified in the CT scan. The CT scan allowed us to individualize well the void of the lunate fossa and calculate his exact degree of rotation, which is very important for planning therapeutic management. Discussion: In all of our cases the CT scan was to expose all of the osseous and ligamentous injuries;in the sagittal reconstruction we were able to objectify and calculate the exact degree of the rotation of the lunate fossa fragment;in the frontal reconstruction the void of the lunate fossa is visible and in the axial reconstruction we can determine the incongruence of the distal radio-ulnar joint (DRUJ). Intra-articular involvement has long been recognized as a poor prognostic factor in fractures of the distal radius. However, despite early studies reporting poor results with non operative treatment for these injuries, most authors opposed operative intervention, due to lack of a good radiological analysis and the CT scan;knowledge that a number of studies have shown that inadequate reduction of intra-articular distal radius fractures leads to the development of arthritis.

GE飞天6000型DR安装调试研究

介绍了DR的工作原理,以及在GE飞天6000型DR的安装和调试过程中的一些体会。

5-year audit of the range and volume of diagnostic radiographic services at the University of Nairobi Dental Hospital

Background: Dental and cranio-maxillofacial diagnostic imaging constitutes an invaluable tool in the accurate diagnosis and management of a diverse range of conditions and diseases that afflict the oral and cranio-maxillofacial region. In order to improve on any existing facility, periodic audit evaluation is paramount. In this way proper and relevant service delivery can be achieved. Objective: To evaluate the range and volume of dental and cranio-maxillofacial diagnostic radiographic services offered at the University of Nairobi Dental Hospital (UNDH) in Kenya over a 5-year period (2006-2010). Methods: Retro-spective survey involving manual examination of patient records at the Division of Dental and cra-nio-maxillofacial Radiology registry of the UNDH. Results: Over the study period, the range of diagnostic radiographic services offered comprised of both intra- and extra- oral examinations. The total volume of radiographs taken was 48,874 among which 41,980 (86%) were intraoral and 6894 (14%) extraoral views. Among the intraoral views, 74% were bitewing, 25% periapical and only 1% were occlusal diagnostic views. The majority (95%) of the extraoral projections consisted of panoramic views and only 5% constituted other techniques. The volume of radiographs was high from January to September while November and December had the lowest number of examination requests. Conclusion: Intraoral radiography was the commonest examination with bitewings having been the majority while the panoramic tomography was the commonest extraoral examination performed.

Analysis of photostimulable phosphor image plate artifacts and their prevalence

BACKGROUND Digital radiography has recently been used in dentistry as a substitute for conventional film radiography worldwide.Digital imaging has many advantages and provides new possibilities for recording and interpreting radiographic data.This system uses different types of digital receptors.AIM To detect the frequency,type,and reasons behind the appearance of intraoral image artifacts acquired by photostimulable phosphor plates(PSP).METHODS This retrospective descriptive study was conducted in the oral and maxillofacial radiology unit of the dental clinics of the College of Dentistry,Princess Nourah University(PNU).All intraoral digital radiographs were acquired using(Gendex Expert DC.,United States)an intraoral X-ray machine with 7-mA,65-kVP using a PSP system(Soredex DIGORA Optime imaging plate)and laser scanners(Soredex DIGORA Optime),which can house all sizes of reusable intraoral PSP sensor plates with image acquisition software(MIPACS Dental Enterprise viewer 3.2.2).A total of 50000 intraoral radiographs were retrieved from the clinical database from April 2018 to April 2020 to evaluate the reason,type,and solutions to these image artifacts.RESULTS Overall,50000 intraoral digital radiographs were acquired in a two-year-period;that is,from April 2018 to April 2020.Of these,3550(7.1%)retakes were performed due to the presence of image artifacts.Periapical radiographs were the most common image type of intraoral retakes(80.8%).Imaging artifacts were divided into three categories:operator,plate and scanning errors.Out of 3550 retakes,5%,1.37%,and 0.73%were related to operator,plate,and scanning errors,respectively.The cone cut was the most common operator error(988 images),Bite marks were the most common plate error(276 images),and delayed scanning artifacts were the most common scanning errors(145 images).The calculated kappa value for interobserver reliability was 0.99,indicating almost perfect interobserver agreement.CONCLUSION Our study discussed intraoral image artifacts that were characteristic of PSP,where the most common artifacts were bitemarks,image size reduction,scratches,and delayed scanning.

Radiation Field Preference for Radiographic Anatomical Markers by Radiographers in a University Teaching Hospital in Nigeria

Objective: The work aims to determine the radiographers’ preference between primary and secondary radiation fields for imprinting anatomical markers on radiographs. Methodology: Processed radiographs from the darkroom with evidence of radiographic anatomical markings were selected randomly and reviewed using a viewing box, within a 4-week period. The radiation field in which markers were placed was noted for each radiograph. Faintly-appearing and partly coned- off markers were excluded. Simple statistical tools were used to derive central tendency. Result: 623 radiographs were assessed. 89.0% (n = 555) had markers in the primary radiation field while 11.0% (n = 68) were in the secondary radiation field. 98% (n = 611) of markers did not obstruct essential anatomy while 2% (n = 12) did, but the radiographs were neither repeated nor rejected because of the twin reason of reportability and the need to avoid additional radiation dose to patients. Conclusion: Radiographers in the centre preferred the primary radiation field for marker placement to avoid cone-off, cut-off and illegibility which leads to repeat. This, however, does not offer superior advantage to markers placed in secondary radiation field. It is recommended that marker placement preference should be guided by the need for legibility, aesthetics and avoidance of essential anatomy.

Augmentation of literature review of COVID-19 radiology

We suggest an augmentation of the excellent comprehensive review article titled“Comprehensive literature review on the radiographic findings,imaging modalities,and the role of radiology in the coronavirus disease 2019(COVID-19)pandemic”under the following categories:(1)“Inclusion of additional radiological features,related to pulmonary infarcts and to COVID-19 pneumonia”;(2)“Amplified discussion of cardiovascular COVID-19 manifestations and the role of cardiac magnetic resonance imaging in monitoring and prognosis”;(3)“Imaging findings related to fluorodeoxyglucose positron emission tomography,optical,thermal and other imaging modalities/devices,including‘intelligent edge’and other remote monitoring devices”;(4)“Artificial intelligence in COVID-19 imaging”;(5)“Additional annotations to the radiological images in the manuscript to illustrate the additional signs discussed”;and(6)“A minor correction to a passage on pulmonary destruction”.

Radiography of Clavicle Fractures— A Review of the Literature —Do Various Radiographic Views of Clavicle Fractures Affect the Management Plan?

Introduction: Fractures of the clavicle are common and make up 5% - 10% of all fractures. Treatment options in part depend on the location of the fracture along the bone and degree of displacement. These two parameters are best determined by good quality, standardized radiographs of the clavicle. We reviewed the literature to determine the optimal radiographs of clavicle fractures and their influence on the treatment plan. Methods: A comprehensive search of Medline? database was undertaken with the following search terms and MeSH headings: clavicle, fractures, bone, radiography, and X-ray. We included articles in English published from 1950 to present. We ruled out fractures in children, fracture dislocations, open fractures, those with neurological and vascular injuries and fractures involving the acromioclavicular or sternoclavicular joints. Findings: Of the 821 citations obtained, only four studies proved eligible. In the most pertinent, four orthopaedic surgeons were shown standard views (antero-posterior and 20&#176;cephalic tilt) of 50 clavicle fractures and then additional two views (45&#176;cephalic and caudal tilt), and found that alternative views influenced their decision making, with more surgeons opting for surgical fixation. In a different study, it was shown that orthogonal views of the clavicle increased surgeons’ understanding and improved their treatment of these fractures. The third paper was a case series on clavicle fractures that were missed on the initial antero-posterior radiograph, and the fourth paper postulated that postero-anterior views of the thorax were most accurate in determining length of the clavicle. Conclusion: Studies showing an optimal view for assessment of clavicle fractures with a decision to then progressing to operative fixation are few, but the evidence points towards surgical fixation when alternative views of mid-shaft clavicle fractures are present.

Extra-Oral Digital Panoramic Radiographic Interpretation and Clinical Findings of Stage IV Periodontitis among Some Samples Concerning Saudi/Non-Saudi Nationality

Background: There are associations between the severity of periodontal diseases and some predisposing factors, such as age, race, and income rate. Therefore, the present study was designed to evaluate the extra-oral digital panoramic radiographic interpretation and clinical findings of stage IV periodontitis among some samples concerning Saudi/non-Saudi nationality. Material and Methods: The study comprised a random sample of 298 residents in Saudi Arabia referred to the internship program clinics at the College of Dentistry, King Khalid University. They were according to the age of participants as follows: youth (15 - 24 years), adults (25 - 64 years), and seniors (65 years and over) within two groups according to nationality (Saudi and non-Saudi). Clinical periodontal examination and radiographic extra oral digital panoramic radiographs were done, and then the periodontal parameters, the percentage of bone loss, and the pattern of bone loss were recorded. The data was collected, and the statistical analysis was performed with ANOVA test, Tukey’s test, Chi-square test, and T-test and considered a P-value at (p Results: The samples included 62 (20%) youth participants with mean of age (21.806 ± 3.390), 182 (57%) adults’ participants with mean age (42.802 ± 9.094), and 54 (23%) seniors participants with a mean age (69.074 ± 6.810). There were highly statistically significant differences in the comparison between the participants’ ages (P 0.05). Conclusion: At the end of this study, we concluded that there are alterations in clinical and radiographic and clinical findings of stage IV periodontitis with the alteration of participants’ ages and nationality.