Gold-wire artifacts on diagnostic radiographs: A case report
A 76-year-old woman was referred to the Department of Periodontology at the University Hospital, Catholic University Leuven, Belgium. The patient consulted the department for a preoperative implant rehabilitation follow-up. During the consultation, she reported a vague toothache in her right maxilla. The medical history of the patient revealed hypertension and hypothyroidism, two chronic conditions that were being controlled by medication. The patient could not remember any further surgical intervention, apart from oral implant placement.\nAn extra-oral examination of the head and neck showed no obvious abnormalities (). An intra-oral examination revealed the presence of several implants in the posterior areas of the mandible and the maxilla, and natural teeth in the front. Neither periodontitis nor peri-implantitis symptoms were observed. Digital intra-oral radiographs (Digora® PSP imaged with Minray®, Soredex, Tuusula, Finland) identified the subgingival caries on the canine and the first premolar. The intra-oral images showed irregular strings and curved lines of a dense radiopaque material (). These foreign bodies demonstrated typical dense metallic characteristics.\nAs part of the implant therapy, a panoramic image (Veraview 2D, J. Morita Corp., Kyoto, Japan) was taken to verify the health of the maxillary sinuses, the absence of bone pathology, and the presence of sufficient bone height. On the panoramic image, irregular strings and curved lines of a dense radiopaque material were observed. Lines were observed bilaterally on the posterior part of the mandible, maxilla, and ramus (). In order to plan the implant surgery, a three-dimensional (3D) Acuitomo® 170 CBCT (Morita Corp., Kyoto, Japan) was taken. This radiographic image confirmed the irregular strings of dense radiopaque lines, but now, they were clearly located in the soft tissues of the cheek, far away from the alveolar bone ().\nIn the differential diagnosis, various options were considered. A MEDLINE-PubMed search gave the following possible explanations for radiopaque marks in the lateral areas of the craniofacial area: synthetic hair braid extension artifacts,, multiple miliary osteoma cutis,,, tonsillolith, acupuncture needles, surgical clips, plastic surgery,,, traumatic insertions (accidental insertions), and calcified phleboliths associated with soft tissue haemangioma.,,\nThe medical history of the patient was re-explored. Now, the patient confirmed that she had undergone a kind of plastic surgery approximately 25 years ago. The physician could confirm that the patient had indeed undergone a face lifting procedure with gold-wire (thickness: 0.1 mm) in 1986.