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Flagler CK, Troici CM, Rathore SA. Authors' Response. J Am Dent Assoc 2023; 154:111. [PMID: 36566149 DOI: 10.1016/j.adaj.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Affiliation(s)
| | - Christopher M Troici
- Postbaccalaureate student, Virginia Commonwealth University School of Dentistry, Richmond, VA
| | - Sonali A Rathore
- Associate Professor and Director, Diplomate, Oral and Maxillofacial Radiology, James B. Edwards College of Dental Medicine, Charleston, SC
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Brasil DM, Merken K, Binst J, Bosmans H, Haiter-Neto F, Jacobs R. Monitoring cone-beam CT radiation dose levels in a University Hospital. Dentomaxillofac Radiol 2023; 52:20220213. [PMID: 36802857 PMCID: PMC9944015 DOI: 10.1259/dmfr.20220213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/24/2022] [Accepted: 01/10/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To present patient dose levels for different CBCT scanners, acquired by a dose monitoring tool in a University Hospital, as a function of field of view (FOV), operation mode, and patient age. METHODS An integrated dose monitoring tool was used to collect radiation exposure data [type of CBCT unit, dose-area product (DAP), FOV size, and operation mode] and patient demographic information (age, referral department) performed on a 3D Accuitomo 170 and a Newtom VGI EVO unit. Effective dose conversion factors were calculated and implemented into the dose monitoring system. For each CBCT unit, the frequency of examinations, clinical indications, and effective dose levels were obtained for different age and FOV groups, and operation modes. RESULTS A total of 5163 CBCT examinations were analyzed. Surgical planning and follow-up were the most frequent clinical indications. For the standard operation mode, effective doses ranged from 35.1 to 300 µSv and 9.26-117 µSv using 3D Accuitomo 170 and Newtom VGI EVO, respectively. In general, effective doses decreased with increasing age and FOV size reduction. CONCLUSIONS Effective dose levels varied notably between systems and operation modes.Operation mode selection and FOV size were indication-oriented, with larger FOV sizes election serving surgical planning and follow-up. Seeing the influence of FOV size on effective dose levels, manufacturers could be advised to move toward patient-specific collimation and dynamic FOV selection. Systematically monitoring patient doses could be recommended for steering future CBCT optimization.
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Affiliation(s)
| | - Karen Merken
- Department of Imaging and Pathology, KU Leuven, Division of Medical Physics & Quality Assessment, Leuven, Belgium
| | - Joke Binst
- Department of Radiology, UZ Leuven, Leuven, Belgium
| | | | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
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Hennig CL, Schüler IM, Scherbaum R, Buschek R, Scheithauer M, Jacobs C, Mentzel HJ. Frequency of Dental X-ray Diagnostics in Children and Adolescents: What Is the Radiation Exposure? Diagnostics (Basel) 2023; 13:diagnostics13030394. [PMID: 36766499 PMCID: PMC9913895 DOI: 10.3390/diagnostics13030394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Children are exposed to ionizing radiation through radiographs during their development for various reasons. At present, there are no officially valid reference values for dental X-rays in children and adolescents for dental X-ray diagnostics. This study retrospectively examined 9680 extraoral dental radiographs in pediatric patients between 2002 and 2020. The aim was to analyze the radiation doses in pediatric patients, which indications were used, and whether there were specific age and gender differences. The evaluation showed that radiation doses were considered low, with dose area products of 2.2 cGy × cm2 for a lateral cephalogram, 14 cGy × cm2 for an orthopantomogram (OPG), and 45 cGy × cm2 for cone beam computer tomography (CBCT). This corresponds to an effective dose of 1.5 μSv for a lateral cephalogram, 7 μSv for an OPG, and 33.8 μSv for CBCT. Of the 9680 images, 78% were orthopantomograms, and only 0.4% were CBCT images. OPG has become more important over the years, as reflected in the indication. Approximately one-third of all extraoral exposures are orthodontic indications. Overall, the indications were similar for both genders. According to the dental indications, boys were X-rayed slightly more frequently than girls (54.5-45.5%). A future publication of dose guide values and corresponding guidelines is of high priority.
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Affiliation(s)
- Christoph-Ludwig Hennig
- Department of Orthodontics, Center of Dental Medicine, Jena University Hospital, An der Alten Post 4, 07743 Jena, Germany
- Correspondence:
| | - Ina Manuela Schüler
- Section Preventive Dentistry and Pediatric Dentistry, Department of Orthodontics, Center of Dental Medicine, Jena University Hospital, An der Alten Post 4, 07743 Jena, Germany
| | - Rebecca Scherbaum
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Rika Buschek
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Marcel Scheithauer
- Radiation Protection, Center for Health and Safety Management, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Collin Jacobs
- Department of Orthodontics, Center of Dental Medicine, Jena University Hospital, An der Alten Post 4, 07743 Jena, Germany
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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Ruetters M, Kim TS, Hagenfeld D, Kronsteiner D, Gehrig H, Lux CJ, Sen S. Ex vivo assessment of the buccal and oral bone by CBCT. J Orofac Orthop 2023; 84:41-48. [PMID: 34370050 PMCID: PMC9852115 DOI: 10.1007/s00056-021-00335-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/08/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE Identifying buccal and oral bone as an important supporting periodontal structure for teeth provides important information for treatment planning in periodontics and orthodontics. This study aims to add evidence to the knowledge of preciseness of cone beam computed tomography (CBCT) measurements of the vertical dimension of buccal and oral bone. The hypothesis is that CBCT is an accurate and reliable method to measure vertical vestibular and oral bone loss. METHODS The amount of vertical buccal and oral bone loss (bl) of 260 sites of 10 human cadavers was investigated clinically and radiographically by CBCT. Radiographic measurements were rated by two blinded raters. Measurements and the corresponding differences between clinical and radiological findings are described by medians and quartiles (Q1-Q3). For statistical analysis, Lin's concordance correlation coefficient (CCC) and Bland-Altman plots were calculated. RESULTS The CCC between the raters was 0.994 (95% confidence interval 0.992-0.995). The median bone loss (bl) distance from the cementoenamel junction (CEJ) to the bony defect (BD) was 3.5 mm (range 3-5 mm). The median bl measured in the CBCT was 3.8 mm (range 3.1-4.8 mm). The median difference of the 2 measurements for all sites included in the study (N = 260) was -0.2 mm (-0.7 to 0.3 mm). CONCLUSIONS CBCT seems to be an accurate and highly reliable method to detect and describe vertical buccal and oral bone loss. It could improve planning and prediction for successful combined periodontal and orthodontic therapies.
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Affiliation(s)
- M. Ruetters
- Section of Periodontology, Department of Operative Dentistry, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - T.-S. Kim
- Section of Periodontology, Department of Operative Dentistry, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - D. Hagenfeld
- Department of Periodontology and Restorative Dentistry, University Hospital Münster, Waldeyer Str. 30, 48149 Münster, Germany
| | - D. Kronsteiner
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - H. Gehrig
- Section of Endodontology, Department of Operative Dentistry, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - C.-J. Lux
- Department of Orthodontics, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - S. Sen
- Department of Orthodontics, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Pinto Nicodemo O, Fiori-Chíncaro GA, Agudelo-Botero AM, Llaguno-Rubio JM, García Díaz R. [Radiation dose permitted in dentistry patients. A review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2023; 11:e144. [PMID: 38303741 PMCID: PMC10832395 DOI: 10.21142/2523-2754-1101-2023-144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/01/2023] [Indexed: 02/03/2024] Open
Abstract
In dental practice, the use of imaging has increased over the years, generating an increase in the radiation dose for the dental patient. One factor under discussion is the amount of dose used in patients, men, women and children, at different stages of their life, due to the scientific evidence of the harmful effects of ionizing radiation. This review of the literature analyzed the characteristics of radiation and its effects in relation to the doses administered, and its equivalences in dental practice in panoramic periapical radiographs and cone beam tomographies. A search of the literature was carried out in the main information sources such as Medline (via PubMed), SEVIER, SCIELO, and LILACS, using the search terms with a date limitation of the last 10 years. The selected articles had to include information regarding the keywords used, including "Dental Offices, Radiation Dose, X-Rays, Ambulatory Care."
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Affiliation(s)
- Omar Pinto Nicodemo
- Carrera de Estomatologia, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca. Sucre, Bolivia. Universidad Mayor de San Francisco Xavier Carrera de Estomatologia Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca Sucre Bolivia
| | - Gustavo Adolfo Fiori-Chíncaro
- Division de Radiologia Bucal y Maxilofacial, Instituto Latinoamericano de Altos Estudios en Estomatologia. Lima, Peru. , Division de Radiologia Bucal y Maxilofacial Instituto Latinoamericano de Altos Estudios en Estomatologia Lima Peru
| | - Ana María Agudelo-Botero
- Facultad de Estomatologia, Universidad Autonoma de Manizales. Manizales, Colombia. Universidad Autonoma de Manizales Facultad de Estomatologia Universidad Autonoma de Manizales Manizales Colombia
| | - Jhoana M Llaguno-Rubio
- Division de Radiologia Bucal y Maxilofacial, Instituto Latinoamericano de Altos Estudios en Estomatologia. Lima, Peru. , Division de Radiologia Bucal y Maxilofacial Instituto Latinoamericano de Altos Estudios en Estomatologia Lima Peru
| | - Rosaura García Díaz
- Facultad de Estomatologia, Universidad de Guadalajara. Guadalajara, Mexico. Universidad de Guadalajara Facultad de Estomatologia Universidad de Guadalajara Guadalajara Mexico
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Establishment of Diagnostic Reference Levels in Cone Beam Computed Tomography Scans in the United Arab Emirates. Tomography 2022; 8:2939-2945. [PMID: 36548539 PMCID: PMC9783302 DOI: 10.3390/tomography8060247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022] Open
Abstract
This study aimed to address the knowledge gap in assessing the radiation doses from cone beam computed tomography (CBCT) procedures, establishing a typical value, and estimating effective and organ doses. A total of 340 patients aged 18-80 years were included in this study. Organ doses were estimated using VirtualDose IR software. The typical values were based on median values estimated as 1000 mGy cm2. The mean ED (µSv) per procedure was 149.5 ± 56, and the mean of the peak skin dose during the CBCT examination was 39.29 mGy. The highest organ dose was received by the salivary glands (2.71 mGy), the extrathoracic region (1.64 mGy), thyroid (1.24 mGy) and eyes (0.61 mGy). The patients' doses were higher than in previous studies. Staff awareness, education, training and dose optimisation are highly recommended. With the establishment of local DRLs, patient dosages can be reduced successfully without compromising image quality.
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A Full Computerized Workflow for Planning Surgically Assisted Rapid Palatal Expansion and Orthognathic Surgery in a Skeletal Class III Patient. Case Rep Dent 2022; 2022:6413898. [PMID: 36312572 PMCID: PMC9605851 DOI: 10.1155/2022/6413898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/05/2022] [Indexed: 01/24/2023] Open
Abstract
In the present case report, we present and discuss the digital workflow involved in the orthodontic/orthognathic combined treatment of a skeletal malocclusion correction in a 17-year-old male patient affected by a skeletal class III, facial asymmetry, sagittal and transversal deficiency of the medium third of the skull, dental crowding, and bilateral cross-bite. The first stage of the treatment involved surgically assisted rapid palatal expansion and occlusal decompensation, using fixed self-ligating appliance. An orthodontic software package (i.e., Dolphin 3D Surgery module) was used to perform virtual treatment objective evaluation by integrating data from cone beam computer tomography acquisition, intraoral scan, and extraoral photographs. The software allowed a comprehensive evaluation of skeletal, dento-alveolar, and soft-tissue disharmonies, qualitative and quantitative simulation of surgical procedure according to skeletal and aesthetic objectives, and, consequently, the treatment of the malocclusion. Using a specific function of the software, the surgical splint was designed according to the pre-programmed skeletal movements, and subsequently, the physical splint was generated with a three-dimensional (3D) printing technology. Once a proper occlusal decompensation was reached, a Le Fort I osteotomy of the maxilla and a bilateral sagittal surgical osteotomy of the mandible were executed to restore proper skeletal relations. The whole treatment time was 8 months. The orthodontic/orthognathic combined treatment allowed to correct the skeletal and the dental imbalance, as well as the improvement of facial aesthetics. Accordingly, the treatment objectives planned in the virtual environment were achieved. Virtual planning offers new possibilities for visualizing the relationship between dental arches and surrounding bone and soft structures in a single virtual 3D model, allowing the specialists to simulate different surgical and orthodontic procedures to achieve the best possible result for the patient and providing an accurate and predictable outcome in the treatment of challenging malocclusions.
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A historical review of the effects of dental radiography on pregnant patients. J Am Dent Assoc 2022; 153:989-995. [PMID: 35985884 DOI: 10.1016/j.adaj.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/18/2022] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The safety of dental radiography performed on pregnant patients has been a controversial topic since the 1960s. This review synthesizes and consolidates findings, from 1957 through 2021, of the effects dental ionizing radiation could have on a pregnant patient and in utero birth defects. TYPES OF STUDIES REVIEWED Using PubMed, the following key words were searched: pregnancy, radiology, radiograph, radiation dose, fetus, x-ray, and dental. Criteria evaluation was done on the basis of availability, completeness, quality, relevance, technicality (that is, dental radiography), topicality (that is, pregnant patients), and usability. These results were then filtered on the basis of quantitative and qualitative data as well as the period (decades within the historical framework). The final selection of relevant literature consisted of various studies including cohort studies, systematic reviews, meta-analyses, case reports, and other narrative reviews. RESULTS If properly performed, the amount of ionizing radiation produced during dental radiographic procedures is so low that it is unlikely to reach the teratogenic threshold. Thus, dental ionizing radiation is unlikely to cause in utero birth defects because it has been detected to have a deterministic (not stochastic) effect. With this information and historical context, this article shows that necessary dental radiography is safe at any stage during pregnancy, as long as proper safety equipment is appropriately used. CONCLUSIONS AND PRACTICAL IMPLICATIONS As technology advances, more research can further clarify ionizing radiation safety for pregnant patients and its potential effects on in utero birth defects, improving overall oral health care. The dental community must remain educated about current ionizing radiation safety guidelines to make better-informed decisions and successfully provide proper oral health care to pregnant patients.
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Antic S, Markovic-Vasiljkovic B, Radivojević O, Janovic A, Bracanovic D. Can lower third molar position indicate the need for preoperative cone beam computed tomography exploration of retromolar canal? Oral Radiol 2022; 38:618-624. [PMID: 35157183 DOI: 10.1007/s11282-022-00597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study aims to reveal whether and which position of lower third molar (M3), assessed on a 2D image, indicates or potentially exclude the need for the CBCT exploration of the retromolar canal (RMC). We hypothesized that some positions of M3 are associated with overall higher incidence of the RMC, and particularly clinically relevant ones, thus justifying additional CBCT diagnostics. METHODS CBCT exam of 186 hemi-mandibles with present M3 were selected for the study. Explorations were made during the 2-year period from January 1th 2018 to December 31th 2019 with Scanora 3Dx Sorodex (Tussula, Finland). The following variables were assessed: the presence and width of the RMC, eruption status, and angulation of the M3. The RMC presence in relation to the M3 eruption status and angulation was analyzed using appropriate statistical tests. RESULTS RMC was present in 89 (47.8%) out of 186 hemi-mandibles. Mean canal width was 1.51 mm. 22.5% of detected canals had the diameter exceeding 2 mm. Third molar's eruption status showed no statistical correlation with the occurrence of RMC. We observed significantly higher occurrence of RMC in the hemi-mandibles containing distally angulated M3 in comparison to other orientations (p = 0.025). CONCLUSION Based upon our findings, we recommend preoperative CBCT in cases where distal angulation of M3 is observed on 2D images, for the purpose of RMC exploration. Lower resolution CBCT mode and limited field of view (XS or S) are sufficient for the visualization of potentially clinically relevant RMCs, with as much reducing the patient dose.
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Affiliation(s)
- Svetlana Antic
- School of Dental Medicine, Center for Radiological Diagnostics, University of Belgrade, Rankeova 6, 11000, Belgrade, Serbia.
| | - Biljana Markovic-Vasiljkovic
- School of Dental Medicine, Center for Radiological Diagnostics, University of Belgrade, Rankeova 6, 11000, Belgrade, Serbia
| | - Ognjen Radivojević
- School of Dental Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Aleksa Janovic
- School of Dental Medicine, Center for Radiological Diagnostics, University of Belgrade, Rankeova 6, 11000, Belgrade, Serbia
| | - Djurdja Bracanovic
- School of Dental Medicine, Center for Radiological Diagnostics, University of Belgrade, Rankeova 6, 11000, Belgrade, Serbia
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Efficacy of Platelet Rich Plasma and Platelet Rich Fibrin for Direct Pulp Capping in Adult Patients with Carious Pulp Exposure- A Randomised Controlled Trial. Eur Endod J 2022; 7:114-121. [PMID: 35786576 PMCID: PMC9285992 DOI: 10.14744/eej.2021.04834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This study evaluated the effectiveness of Platelet Rich Plasma (PRP), Platelet Rich Fibrin (PRF) and Mineral Trioxide Aggregate (MTA) as direct pulp capping materials in patients with carious pulp exposure using cone beam computed tomography. METHODS This parallel, triple blinded, randomised trial was done on 30 permanent posterior teeth chosen as candidates for direct pulp capping based on stringent inclusion and exclusion criteria. The samples were allocated based on sequentially numbered opaque sealed envelope method into three groups: MTA, PRP and PRF for direct pulp capping. The treated teeth were restored with Glass Ionomer cement liner and light-cured resin composite. Patients were followed up for a period of 12 months. Statistical analyses were performed with statistical software SPSS version 25. Data were analysed for normality using Shapiro Wilk's test. Dentine bridge volume analysis across the groups were done using Kruskal Wallis test with the significance level at P=0.05. As the test revealed a significant difference, post hoc analysis was done with Dunn test. RESULTS CBCT analysis revealed that the volume of dentine bridge formed by PRP and PRF was significantly higher than the volume of dentine bridge formed by MTA (P<0.001; CI: 90%). There was no significant difference in the efficacy between the three direct pulp capping agents based on clinical assessment. A total of 27 teeth (90%) showed positive response to pulp sensibility testing and evidence of dentine bridge formation in radiograph at 12 months. No adverse events were encountered.
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Wanzeler AMV, Silveira HLDD, Buligon RP, Corsetti A, Vieira HT, Arús NA, Vizzotto MB. Can CBCT change the level of confidence of oral maxillofacial surgeons in mandibular third molar management? Braz Oral Res 2022; 36:e078. [PMID: 35703704 DOI: 10.1590/1807-3107bor-2022.vol36.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/03/2021] [Indexed: 11/21/2022] Open
Abstract
This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.
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Affiliation(s)
| | | | - Rodrigo Pagliarini Buligon
- Universidade Federal do Rio Grande do Sul - UFRS, Surgery and Orthopedics Department , Porto Alegre , RS , Brazil
| | - Adriana Corsetti
- Universidade Federal do Rio Grande do Sul - UFRS, Surgery and Orthopedics Department , Porto Alegre , RS , Brazil
| | | | - Nádia Assein Arús
- Universidade Federal do Rio Grande do Sul - UFRS, Surgery and Orthopedics Department , Porto Alegre , RS , Brazil
| | - Mariana Boessio Vizzotto
- Universidade Federal do Rio Grande do Sul - UFRS, Surgery and Orthopedics Department , Porto Alegre , RS , Brazil
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Imaging furcation defects with low-dose cone beam computed tomography. Sci Rep 2022; 12:6824. [PMID: 35474083 PMCID: PMC9043180 DOI: 10.1038/s41598-022-10781-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/11/2022] [Indexed: 11/08/2022] Open
Abstract
Different cone beam computed tomography (CBCT) protocols have shown promising results for imaging furcation defects. This study evaluates the suitability of low-dose (LD)-CBCT for this purpose. Fifty-nine furcation defects of nine upper and 16 lower molars in six human cadavers were measured by a high-dose (HD)-CBCT protocol, a LD-CBCT protocol, and a surgical protocol. HD-CBCT and LD-CBCT measurements were made twice by two investigators and were compared with the intrasurgical measurements, which served as the reference. Furcation defect volumes generated from HD-CBCT and LD-CBCT imaging were segmented by one rater. Cohen's kappa and intraclass correlation coefficient (ICC) values were calculated to determine intra- and interrater reliability. The level of significance was set at α = 0.05. In total, 59 furcation defects of nine upper and 16 lower human molars were assessed. Comparing CBCT furcation defect measurements with surgical measurements revealed a Cohen's kappa of 0.5975 (HD-and LD-CBCT), indicating moderate agreement. All furcation defects identified by HD-CBCT were also detected by LD-CBCT by both raters, resulting in a Cohen's kappa of 1. For interrater agreement, linear furcation defect measurements showed an ICC of 0.992 for HD-CBCT and 0.987 for LD-CBCT. The intrarater agreement was 0.994(r1)/0.992(r2) for HD-CBCT and 0.987(r1)/0.991(r2) for LD-CBCT. The intermodality agreement was 0.988(r1)/0.991(r2). Paired t-test showed no significant differences between HD-CBCT and LD-CBCT measurements. LD-CBCT is a precise and reliable method for detecting and measuring furcation defects in mandibular and maxillary molars in this experimental setting. It has the potential to improve treatment planning and treatment monitoring with a far lower radiation dose than conventional HD-CBCT.
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Root canal length estimated by cone-beam computed tomography at different slice thicknesses, dedicated endodontic software, or measured by an electronic apex locator. Sci Rep 2022; 12:6531. [PMID: 35444163 PMCID: PMC9021240 DOI: 10.1038/s41598-022-10534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study was to evaluate the agreements between the root canal length estimations using cone-beam computed tomography (CBCT) at different slice thicknesses, dedicated software, or an electronic apex locator (EAL) and the actual lengths (AL). In total, 111 extracted human molars with 302 root canals were chosen. Teeth were scanned using a CBCT device at a voxel size of 0.075 mm. Root canal lengths were estimated using CBCT software at different slice thicknesses (0.6, 1.2, and 2.4 mm) and dedicated software for proposed or operator lengths. The endodontic access cavities were created, and root canal lengths were estimated with an EAL for electronic length (EL) and a ruler for AL. Data were tested using paired t-tests and Bland–Altman plots to detect the differences between the methods in length estimation at a significance of 0.05. The accuracy in the range of ± 0.5 mm was 100% for the EAL. There was an agreement between the EL and CBCT at a slice thickness of 1.2 mm (p = 0.349). CBCT at the smallest slice thickness estimation was not the best modality in agreement with the AL. The EAL was an accurate and reliable method for root canal length measurement.
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Standardization of mineral density maps of physiologic and pathologic biominerals in humans using cone-beam CT and micro CT. Dent Mater 2022; 38:989-1003. [DOI: 10.1016/j.dental.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/04/2022] [Accepted: 03/19/2022] [Indexed: 11/19/2022]
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Han M, Kim HJ, Choi JW, Park D, Han JG. Diagnostic usefulness of cone‐beam computed tomography versus multi‐detector computed tomography for sinonasal structure evaluation. Laryngoscope Investig Otolaryngol 2022; 7:662-670. [PMID: 35734052 PMCID: PMC9195011 DOI: 10.1002/lio2.792] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Cone‐beam computed tomography (CBCT) is a promising imaging modality for sinonasal evaluation, with advantages of relatively low radiation dose, low cost, and quick outpatient imaging. Our study aimed to compare the diagnostic performance and image quality of CBCT with those of multi‐detector computed tomography (MDCT) with different slice thickness. Methods We retrospectively reviewed 60 consecutive patients who had undergone both CBCT and MDCT. MDCT images was reconstructed with 1 and 3 mm slice thickness. The quantitative image quality parameters (image noise, signal‐to‐noise ratio [SNR], and contrast‐to noise ratio [CNR] were calculated and compared between the two imaging modalities. Two observers (ENT surgeon and neuroradiologist) evaluated the presence of seven sinonasal anatomic variations in each patient and interobserver agreements were analyzed. The diagnostic performance of CBCT (0.3 mm) and MDCT (3 mm) was assessed and compared with that of high resolution MDCT (1 mm), which is considered as the gold standard. Results The image noise was significantly higher and SNR and CNR values were lower in the CBCT (0.3 mm) group than in the MDCT groups (1 and 3 mm). The diagnostic performance of CBCT (0.3 mm) was similar to that of MDCT (1 mm) and superior to that of MDCT (3 mm). The highest interobserver agreement was for high resolution MDCT (1 mm), followed by CBCT (0.3 mm), and MDCT (3 mm). Conclusion Considering its low radiation dose, low cost, and ease of clinical access, CBCT may be a useful imaging modality for as first line sinonasal evaluation and repeated follow up. Study design: Retrospective study in a tertiary referral university center. Level of evidence: NA.
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Affiliation(s)
- Miran Han
- Department of Radiology Ajou University Hospital, Ajou University School of Medicine Suwon Republic of Korea
- Department of Radiology Graduate School of Kangwon National University Chuncheon Republic of Korea
| | - Hyun Jun Kim
- Department of Otolaryngology Ajou University Hospital, Ajou University School of Medicine Suwon Republic of Korea
| | - Jin Wook Choi
- Department of Radiology Ajou University Hospital, Ajou University School of Medicine Suwon Republic of Korea
| | - Do‐Yang Park
- Department of Otolaryngology Ajou University Hospital, Ajou University School of Medicine Suwon Republic of Korea
| | - Jang Gyu Han
- Department of Otolaryngology Ajou University Hospital, Ajou University School of Medicine Suwon Republic of Korea
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Rozema R, Doff MHJ, Delli K, Spijkervet FKL, van Minnen B. Diagnostic accuracy of physical examination findings for midfacial fractures: a systematic review and meta-analysis. Clin Oral Investig 2022; 26:3405-3427. [PMID: 35298710 PMCID: PMC8979892 DOI: 10.1007/s00784-022-04423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/19/2022] [Indexed: 12/03/2022]
Abstract
Objectives To conduct a systematic review and meta-analysis to assess the diagnostic accuracy of physical examination findings and related clinical decision aids for midfacial fractures in comparison to computed tomography and cone beam computed tomography. Material and methods A systematic review was performed by searching the MEDLINE, Cochrane, EMBASE, and CINAHL databases. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity, specificity, and diagnostic odds ratios with the corresponding 95% confidence intervals were calculated for each physical examination finding and reported clinical decision aids. Results After screening 2367 records, 12 studies were included. High risk of patient selection bias was detected in three studies (25%). Additionally, high concerns regarding applicability were found for the patient selection in five studies (41.7%), and for the reference standard in eleven studies (91.7%). Of the total 42 individual physical examination findings, only 31 were suitable for a meta-analysis. High specificity and low sensitivity were found for most findings. The pooled diagnostic odds ratio ranged from 1.07 to 11.38. Clinical decision aids were reported by 8 studies, but none were constructed specifically for midfacial fractures. Conclusion Based on the current available evidence, the absence of physical examination findings can successfully identify patients who do not have a midfacial fracture, but the presence of individual findings does not necessarily mean that the patient has a midfacial fracture. Although various clinical decision aids were presented, none focused on exclusively midfacial fractures. Clinical relevance The diagnostic accuracy of physical examination findings can be used to diagnose a midfacial fracture so as to reduce unnecessary imaging, health care costs, and exposure to ionizing radiation. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-022-04423-y.
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Affiliation(s)
- Romke Rozema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Michiel H J Doff
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Frederik K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Baucke van Minnen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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The Effects of Additional Filtration on Image Quality and Radiation Dose in Cone Beam CT: An In Vivo Preliminary Investigation. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7031269. [PMID: 35281593 PMCID: PMC8906961 DOI: 10.1155/2022/7031269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/03/2022] [Indexed: 11/18/2022]
Abstract
Purpose. The aim of this study was to investigate the effect of reduced radiation doses on the image quality of cone-beam computed tomography scans and the suitability of such imaging for orthodontics, oral surgery, dental implantology, periodontology, and endodontology. Materials and Methods. Cone-beam computed tomography scans of a live patient were performed using seven attenuation filters with increased thickness to decrease the effective radiation dose from 22.4 to 1.8 μSv, and the effects of different radiation doses on image quality were further analysed. Quantitative image quality was calculated using dedicated measures, such as signal and contrast-to-noise ratio and sharpness. A panel of five certified raters assessed the cone-beam computed tomography scans qualitatively. Nine anatomical structures relevant to dentistry were identified, and the overall acceptance was assessed. Results. Linear reduction of the effective radiation dose had a nonlinear effect on image quality. A 5-fold reduction in the effective dose led to acceptable quantitative and qualitative image quality measures, and the identification rate of dental anatomical structures was 80% or greater. The use of less than 40% of the reference dose was unacceptable for all dental specialties. Conclusions. The ideal radiation dose for specific diagnostic requirements remains a patient-related and specialty-related decision that must be made on an individual basis. Based on the results of this study, it is possible to reduce exposure in selected patients, and at the same time obtain sufficient quality of images for clinical purposes.
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Evaluating the X-ray-Shielding Performance of Graphene-Oxide-Coated Nanocomposite Fabric. MATERIALS 2022; 15:ma15041441. [PMID: 35207983 PMCID: PMC8875570 DOI: 10.3390/ma15041441] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 02/01/2023]
Abstract
Exposure to ionizing radiation (IR) during diagnostic medical procedures brings certain risks, especially when experiencing recurrent exposures. The fabrication of nano-based composites, doped with different nanoparticles, have been suggested as effective shielding materials to replace conventional lead-based ones in material sciences and nanotechnology. In this study, commercially available fabrics, used to produce scrubs and gowns for clinical staff, are modified utilizing graphene oxide (GO) nanoparticles using a layer-by-layer (LBL) technique. GO was obtained from graphite through environmentally friendly technology by using a modified-improved Hummers' method without NaNO3. Lightweight, flexible, air- and water-permeable shielding materials are produced that are wearable in all-day clinical practice. The nanoparticles are kept to a minimum at 1 wt%; however, utilizing the LBL technique they are distributed evenly along the fibers of the fabrics to achieve as much shielding effect as possible. The evaluation of samples is accomplished by simulating real-time routine clinical procedures and the radiographic programs and devices used daily. The GO-coated nanocomposite fabrics demonstrated promising results for X-ray shielding.
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Hanozin B, Li Manni L, Lecloux G, Bacevic M, Lambert F. Digital vs. conventional workflow for one-abutment one-time immediate restoration in the esthetic zone: a randomized controlled trial. Int J Implant Dent 2022; 8:7. [PMID: 35129763 PMCID: PMC8821739 DOI: 10.1186/s40729-022-00406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare short-term outcomes after immediate restoration of a single implant in the esthetic zone with one-abutment one-time technique comparing a conventional (control) vs. a fully digital workflow (test). Materials and methods Eighteen subjects were randomly assigned to the two groups, and a digital implant planning was performed for all. In the test group, a custom-made zirconia abutment and a CAD–CAM provisional crown were prepared prior to surgery; implants were placed using a s-CAIS guide allowing immediate restoration after surgery. In the control group, the implant was placed free-handed using a conventional surgical guide, and a custom-made zirconia abutment to support a stratified provisional crown was placed 10 days thereafter, based on a conventional impression. Implant accuracy (relative to the planning), the provisional restoration outcomes, as well as PROMs were assessed. Results The implant positioning showed higher accuracy with the s-CAIS surgical guide compared to free-handed surgery (angular deviation (AD): 2.41 ± 1.27° vs. 6.26 ± 3.98°, p < 0.014; entry point deviation (CGD): 0.65 ± 0.37 mm vs. 1.27 ± 0.83 mm, p < 0.059; apical deviation (GAD): 1.36 ± 0.53 mm vs. 2.42 ± 1.02 mm, p < 0.014). The occlusion and interproximal contacts showed similar results for the two workflows (p = 0.7 and p = 0.69, respectively). The PROMs results were similar in both groups except for impression taking with intra-oral scanning preferred over conventional impressions (p = 0.014). Conclusions Both workflows allowed implant placement and immediate/early restoration and displayed similar clinical and esthetic outcomes. The fully digital workflow was associated with a more accurate implant position relative to planning. Clinical relevance Our results show that both conventional and digital workflow are predictive and provide similar clinical outcomes, with extra precision provided by digitalisation.
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Li B, Spronk D, Luo Y, Puett C, Inscoe CR, Tyndall DA, Lee YZ, Lu J, Zhou O. Feasibility of dual-energy CBCT by spectral filtration of a dual-focus CNT x-ray source. PLoS One 2022; 17:e0262713. [PMID: 35113908 PMCID: PMC8812859 DOI: 10.1371/journal.pone.0262713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/01/2022] [Indexed: 11/19/2022] Open
Abstract
Cone beam computed tomography (CBCT) is now widely used in dentistry and growing areas of medical imaging. The presence of strong metal artifacts is however a major concern of using CBCT especially in dentistry due to the presence of highly attenuating dental restorations, fixed appliances, and implants. Virtual monoenergetic images (VMIs) synthesized from dual energy CT (DECT) datasets are known to reduce metal artifacts. Although several techniques exist for DECT imaging, they in general come with significantly increased equipment cost and not available in dental clinics. The objectives of this study were to investigate the feasibility of developing a low-cost dual energy CBCT (DE-CBCT) by retrofitting a regular CBCT scanner with a carbon nanotube (CNT) x-ray source with dual focal spots and corresponding low-energy (LE) and high-energy (HE) spectral filters. A testbed with a CNT field emission x-ray source (NuRay Technology, Chang Zhou, China), a flat panel detector (Teledyne, Waterloo, Canada), and a rotating object stage was used for this feasibility study. Two distinct polychromatic x-ray spectra with the mean photon energies of 66.7keV and 86.3keV were produced at a fixed 120kVp x-ray tube voltage by using Al+Au and Al+Sn foils as the respective LE and HE filters attached to the exist window of the x-ray source. The HE filter attenuated the x-ray photons more than the LE filter. The calculated post-object air kerma rate of the HE beam was 31.7% of the LE beam. An anthropomorphic head phantom (RANDO, Nuclear Associates, Hicksville, NY) with metal beads was imaged using the testbed and the images were reconstructed using an iterative volumetric CT reconstruction algorithm. The VMIs were synthesized using an image-domain basis materials decomposition method with energy ranging from 30 to 150keV. The results were compared to the reconstructed images from a single energy clinical dental CBCT scanner (CS9300, Carestream Dental, Atlanta, GA). A significant reduction of the metal artifacts was observed in the VMI images synthesized at high energies compared to those from the same object imaged by the clinical dental CBCT scanner. The ability of the CNT x-ray source to generate the output needed to compensate the reduction of photon flux due to attenuation from the spectral filters and to maintain the CT imaging time was evaluated. The results demonstrated the feasibility of DE-CBCT imaging using the proposed approach. Metal artifact reduction was achieved in VMIs synthesized. The x-ray output needed for the proposed DE-CBCT can be generated by a fixed-anode CNT x-ray source.
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Affiliation(s)
- Boyuan Li
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Derrek Spronk
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Yueting Luo
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Connor Puett
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Christina R. Inscoe
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Donald A. Tyndall
- Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Yueh Z. Lee
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jianping Lu
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Otto Zhou
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
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Low-dose CBCT imaging of alveolar buccal bone adjacent to mandibular anterior teeth- a pilot study. Clin Oral Investig 2022; 26:4173-4182. [PMID: 35103838 PMCID: PMC9072474 DOI: 10.1007/s00784-022-04389-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022]
Abstract
Objectives Accurate description of buccal bone adjacent to mandibular anterior teeth is helpful for planning and monitoring periodontal and orthodontic treatment. Low-dose cone beam computed tomography (LD-CBCT) imaging has shown promising results for very small dental structures in animals. This study asserts that LD-CBCT is sufficiently accurate to measure buccal alveolar bone adjacent to human mandibular anterior teeth. Materials and methods Buccal bone level adjacent to 16 mandibular anterior teeth from four human cadavers was measured radiographically using one high-dose (HD) CBCT protocol and two LD-CBCT protocols. The resulting radiographic measurements of buccal bone height (bl) and thickness (bt) were compared with reference probe and reflected-light microscopy measurements. Measurement medians and Bland–Altman plots were calculated, and a linear mixed model was used to compare raters and imaging modalities. Results All regression coefficients were approximately 0, indicating high interrater, intrarater, and intermodality agreement. No significant differences were found between reference measurements and CBCT protocols. The mean differences for bl measurements were 0.07 mm (rater 1 [r1]) and 0.12 mm (rater 2 [r2]) for HD-CBCT; 0.07 mm (r1) and 0.13 mm (r2) for LD-CBCT-1; and 0.02 mm (r1) and 0.01 mm (r2) for LD-CBCT-2. For bt measurements, mean differences were 0.02 mm (r1) and 0.02 mm (r2) for HD-CBCT; 0.01 mm (r1) and 0.01 mm (r2) for LD-CBCT-1; and 0.00 mm (r1) and 0.01 mm (r2) for LD-CBCT-2. Conclusions Within the limitations of the present study, LD-CBCT seems to be a precise method for describing buccal bone and its thickness adjacent to mandibular anterior teeth in this experimental setting. Clinical relevance For the first time, this study showed LD-CBCT produces excellent results and is a reliable modality for imaging buccal bone in vitro. If clinical studies confirm these results, LD-CBCT could enable better treatment planning and monitoring at a radiation dose that is far lower than that of conventional HD-CBCT but similar to that of panoramic views. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-022-04389-x.
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Demirturk Kocasarac H, Koenig LJ, Ustaoglu G, Oliveira ML, Freitas DQ. CBCT image artefacts generated by implants located inside the field of view or in the exomass. Dentomaxillofac Radiol 2022; 51:20210092. [PMID: 34289314 PMCID: PMC8802698 DOI: 10.1259/dmfr.20210092] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To compare artefacts in cone-beam computed tomography (CBCT) arising from implants of different materials located either inside the field of view (FOV) or in the exomass, and to test different image-acquisition parameters to reduce them. METHODS CBCT scans of a human mandible prepared with either a titanium, titanium-zirconium, or zirconia implant were acquired with the Planmeca ProMax utilizing FOV sizes of 8 × 5 cm and 4 × 5 cm, which placed the implant inside the FOV (8 × 5 cm) or in the exomass (4 × 5 cm). The scanning parameters considered three conditions of metal artefact reduction (MAR), disabled, low, and high, and 2 kVp levels (80 and 90). The standard deviation (SD) of grey values of regions of interest was obtained. The effects of implant material, implant position, MAR condition, kVp level, and their interactions were evaluated by Analysis of Variance (α = 5%). RESULTS The zirconia implant produced the highest SD values (more heterogeneous grey values, corresponding to greater artefact expression), followed by titanium-zirconium, and titanium. In general, implants in the exomass produced images with higher SD values than implants inside the FOV. MAR was effective in decreasing SD values, especially from the zirconia implant, only when the implant was inside the FOV. Images with 80 kVp had higher SD values than those with 90 kVp, regardless of the other factors (p < 0.05). CONCLUSIONS Implants in the exomass lead to greater artefact expression than when they are inside the FOV. Special attention should be paid to scanning parameters that reduce metal-related artefacts, such as MAR activation and increasing kVp. This is especially important with a zirconia implant inside the FOV.
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Affiliation(s)
- Husniye Demirturk Kocasarac
- Division of Oral and Maxillofacial Radiology, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wisconsin, United States
| | - Lisa J Koenig
- Division of Oral and Maxillofacial Radiology, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wisconsin, United States
| | - Gulbahar Ustaoglu
- Department of Periodontics, Bolu Abant Izzet Baysal University Faculty of Dentistry, BAIBU Golkoy Yerleskesi, Merkez/Bolu, Turkey
| | - Matheus Lima Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Schallenberger V, Maracci LM, Malta CP, Serpa GF, Liedke GS. Smartphone use for tomographic evaluation: application in endodontic diagnosis. J Endod 2022; 48:614-619. [PMID: 35121003 DOI: 10.1016/j.joen.2022.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Portable equipment that allows quick exchanges of information, such as smartphones, is increasingly important in Dentistry. Thus, they have become frequently used, with the potential to contribute to the tomographic evaluation. This study aimed to evaluate the accuracy of smartphone applications for diagnosing the root canal system (RCS) and measuring the root canal length. METHODS DICOM files of 92 lower incisor teeth were evaluated by two trained and calibrated examiners using the CS 3D Imaging software and two smartphone applications (DroidRender and Horos Mobile). The RCS was assessed according to Vertucci's classification, and the tooth length was measured using linear cusp-apex measurements. The diagnostic reference standard was obtained by the mode and the mean of the evaluations made by three experienced examiners using the CS 3D Imaging software. The diagnostic performance of RCS was evaluated using sensitivity (Se), specificity (Sp), and overall accuracy (Ac). The Bland-Altman analysis was used to assess the agreement of linear measurements. RESULTS The diagnostic tests showed similar performance between the smartphone applications (DroidRender: Se = 1.00; Sp = 0.95; Ac = 0.97; Horos: Se = 0.95; Sp = 0.94; Ac = 0.95) and the computer software (Se = 0.97 - 0.95; Sp = 0.93 - 0.96; Ac = 0.95 - 0.96). The smartphone applications showed discrepancies greater than 1.0 mm for the dental lengths, which may signal relevant differences in some clinical situations. CONCLUSION Smartphone applications offered similar diagnostic performance in comparison to the computer software for the RCS evaluation.
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Affiliation(s)
- Verônica Schallenberger
- Undergraduate Student, School of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
| | - Lucas Machado Maracci
- Me Student, Dental Sciences Post-Graduation Program, Federal University of Santa Maria, Santa Maria, Brazil
| | - Cristiana Pereira Malta
- PhD Student, Dental Sciences Post-Graduation Program, Federal University of Santa Maria, Santa Maria, Brazil
| | - Geraldo Fagundes Serpa
- PhD, Associate Professor, Section of Oral Radiology, Department of Stomatology, Federal University of Santa Maria, Santa Maria, Brazil
| | - Gabriela Salatino Liedke
- PhD, Adjunct Professor, Section of Oral Radiology, Department of Stomatology, Federal University of Santa Maria, Santa Maria, Brazil.
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Andraws Yalda F, Theodorakou C, Clarkson RJ, Davies J, Feinberg L, Sengupta A, Horner K. Determination of a cone-beam CT low-dose protocol for root fracture diagnosis in non-endodontically treated anterior maxillary teeth. Dentomaxillofac Radiol 2022; 51:20210138. [PMID: 34494874 PMCID: PMC8802703 DOI: 10.1259/dmfr.20210138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine a "low-dose protocol" which provides acceptable diagnostic accuracy for detection of root fractures in unrestored anterior maxillary teeth, using an ex vivo model. METHODS 48 maxillary anterior teeth, half with horizontal or oblique root fractures, were imaged using CBCT in an anthropomorphic model. Nine X-ray exposure combinations were used, including the manufacturer's standard ("reference") exposure and high-resolution settings ("HiRes"), by varying kV, exposure time, and rotation angle. Measurements of Dose Area Product (DAP) were recorded. Five dental radiologists assessed the scans for root fractures and judged image quality. Parameters of diagnostic accuracy were calculated, including area under the Receiver Operating Characteristic curve (Az). Objective measures of image quality were made at the same exposure combinations using an image quality phantom. RESULTS Although there was a significant linear relationship between DAP and mean Az, only the lowest DAP exposure combination had a mean Az significantly different to the reference exposure. There was no significant effect on other diagnostic accuracy parameters when using HiRes compared with the reference exposure. There was a significant positive relationship between DAP and contrast resolution. HiRes did not significantly improve contrast resolution and made a small improvement to spatial resolution. CONCLUSIONS Scope existed for radiation dose reduction compared with the manufacturer's guidance. There was no improvement in diagnostic accuracy using HiRes settings. A cautious recommendation for this CBCT machine is that it is possible to achieve a dose reduction of about 20% compared with the reference exposure parameters.
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Affiliation(s)
| | - Chrysoula Theodorakou
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rosalyn J Clarkson
- Department of Radiology, Leeds Dental Institute, Clarendon Way, Leeds, UK
| | - Jonathan Davies
- Department of Dental Radiological Imaging, Guy's and St Thomas' NHS FoundationTrust, Guy's Hospital, London, UK
| | - Lee Feinberg
- Department of Radiology, Kings College Hospital, London, UK
| | - Anita Sengupta
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine andHealth, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Keith Horner
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine andHealth, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Aktuna-Belgin C, Serindere G, Belgin HB, Serindere M, Orhan K. Efficacy of low dose and ultra-low dose on the visibility of peri-implant fenestration and dehiscences: a computed tomography study. Pol J Radiol 2022; 87:e24-e29. [PMID: 35140825 PMCID: PMC8814895 DOI: 10.5114/pjr.2022.112466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study aimed to evaluate the visibility of peri-implant fenestration and dehiscences on computed tomography (CT) images taken with 2 different doses. MATERIAL AND METHODS The defects were created on the apical of 6 implants randomly selected from 20 titanium implants placed in the ribs, and dehiscences were created on the cervical of 8 implants. No defects were created around 6 implants. Macroscopic analysis of the implanted ribs was accepted as the gold standard. From the samples, images were taken by using both ultra-low dose (80 kVp, 50 mA, 1.25 mm slice thickness) and low dose (100 kVp, 50 mA, 1.25 mm slice thickness) protocols in CT. The images obtained were evaluated using a 5-point scale. RESULTS No significant difference was found between the area under the receiver operating characteristic of ultra-low dose protocol and low dose protocol in both defects based on the Wilcoxon test (p > 0.05). CONCLUSIONS The ultra-low dose protocol could be applied by adhering to the "as low as reasonably achievable" principle in the diagnosis of peri-implant defects.
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Affiliation(s)
- Ceren Aktuna-Belgin
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Gozde Serindere
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hatay Mustafa Kemal University, Hatay, Turkey
| | | | | | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Apostolakis D, Michelinakis G, Kamposiora P, Papavasiliou G. The current state of Computer Assisted Orthognathic Surgery: A narrative review. J Dent 2022; 119:104052. [DOI: 10.1016/j.jdent.2022.104052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 12/23/2022] Open
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Mahesh KP, Deshpande P, Viveka S. Prevalence of artifacts in cone-beam computed tomography: A retrospective study. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2022. [DOI: 10.4103/jiaomr.jiaomr_142_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Ruetters M, Gehrig H, Kronsteiner D, Weyer V, Kim TS, Lux CJ, Sen S. Ex-vivo imaging of buccal and oral periodontal bone with low-dose CBCT in porcine jaws. Dentomaxillofac Radiol 2022; 51:20210233. [PMID: 34233504 PMCID: PMC8693329 DOI: 10.1259/dmfr.20210233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES New CBCT devices have been developed which can provide "low-dose CBCTs (LD-CBCT)". Aim of this study is to investigate the suitability of LD-CBCT for measurement of alveolar buccal/oral bone. METHODS AND MATERIALS Vestibular and oral bone loss of the teeth of seven porcine mandibles free of soft tissues were investigated by Micro-CT and three CBCT-modes: high-dose (HD), standard-dose (SD) and low-dose (LD). Radiographic measurements of bone loss (bl) and vestibular and oral bone thickness (bt) were made by two raters at 69 sites. Measurement means and differences, Intraclass correlation (ICC) and Bland-Altman plots were calculated. RESULTS ICCs between raters(r) concerning bl were 0.954 for HD, 0.949 for SD and 0.945 for LD; concerning bt they were 0.872 for HD, 0.845 for SD and 0.783 for LD. Means of differences of bt measurements were -0.01 mm(r1)/0.00 mm(r2) for HD, 0.04 mm(r1)/0.02 mm(r2) for SD and 0.02 mm(r1)/0.04 mm(r2) for LD; for bl measurements they were 0.06 mm(r1)/0.05 mm(r2) for HD, -0.01 mm(r1)/0.13 mm(r2) for SD and 0.07 mm(r1)/0.16 mm(r2) for LD.Linear regression indicates no noticeable differences between methods and the raters with respect to bl and bt. CONCLUSIONS Relating to the CBCT-device used in this study, LD-CBCT is a promising method to detect and describe buccal and oral periodontal bl and bt. Further studies with human anatomic structures must confirm these results.
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Affiliation(s)
- Maurice Ruetters
- Section of Periodontology, Department of Operative Dentistry, University Hospital Heidelberg, Germany Im Neuenheimer Feld, Heidelberg, Germany
| | - Holger Gehrig
- Section of Periodontology, Department of Operative Dentistry, University Hospital Heidelberg, Germany Im Neuenheimer Feld, Heidelberg, Germany
| | - Dorohtea Kronsteiner
- Institute of Medical Biometry, University Hospital Heidelberg Im Neuenheimer Feld, Heidelberg, Germany
| | | | - Ti-Sun Kim
- Section of Periodontology, Department of Operative Dentistry, University Hospital Heidelberg, Germany Im Neuenheimer Feld, Heidelberg, Germany
| | - Christopher J. Lux
- Department of Orthodontics, University Hospital Heidelberg, Germany Im Neuenheimer Feld, Heidelberg, Germany
| | - Sinan Sen
- Department of Orthodontics, University Hospital Heidelberg, Germany Im Neuenheimer Feld, Heidelberg, Germany
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Muñoz-Galván A, Fiori-Chíncaro GA, Agudelo-Botero AM. [Applications of cone beam computed tomography of the craneofacial structure in medical specialties. A review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2022; 10:e100. [PMID: 38389916 PMCID: PMC10880726 DOI: 10.21142/2523-2754-1001-2022-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/01/2022] [Indexed: 02/24/2024] Open
Abstract
Cone-beam computed tomography (CBCT) of the craniofacial structure has demonstrated its usefulness in the dental area during the last decades, thus it has become a fundamental tool in the diagnosis, planning, and evaluation of treatment, and although it was not developed for the exclusive use in dentistry, as it is commonly considered, it is used in other areas such as medicine. It is specifically used in the head and neck area where different medical specialties interact, and at the same time these interact with dental specialties, so knowing the advantages of CBCT over different imaging technologies in the medical area is necessary. The purpose of this review was to describe the applications of observation, diagnosis, planning, and evolution of treatments using maxillofacial HSCT in different medical specialties. This work highlights the use of TCHC in different medical applications and highlights where it is most useful compared to other technologies.
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Affiliation(s)
- Agustín Muñoz-Galván
- Division de Radiologia Bucal y Maxilofacial, Universidad Cientifica del Sur. Lima, Peru. Universidad Científica del Sur Division de Radiologia Bucal y Maxilofacial Universidad Cientifica del Sur Lima Peru
| | - Gustavo Adolfo Fiori-Chíncaro
- Instituto Latinoamericano de Altos Estudios en Estomatologia (ILAE). Lima, Peru. , Instituto Latinoamericano de Altos Estudios en Estomatologia (ILAE) Lima Peru
| | - Ana María Agudelo-Botero
- Instituto Latinoamericano de Altos Estudios en Estomatologia (ILAE). Lima, Peru. , Instituto Latinoamericano de Altos Estudios en Estomatologia (ILAE) Lima Peru
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OUP accepted manuscript. Eur J Orthod 2022; 44:513-521. [DOI: 10.1093/ejo/cjac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Yan YQ, Wang HL, Liu Y, Zheng TJ, Tang YP, Liu R. Three-dimensional inlay-guided endodontics applied in variant root canals: A case report and review of literature. World J Clin Cases 2021; 9:11425-11436. [PMID: 35071574 PMCID: PMC8717512 DOI: 10.12998/wjcc.v9.i36.11425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/06/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Root canal retreatment is common after root canal therapy in clinical situations. Especially, completing the retreatment of variant root canals can be challenging. This is particularly true for the molars located at the end of the dental arch. However, advancements in digital dental diagnosis and treatment techniques can solve these problems. Here, we describe a case of a maxillary second molar with a variant distobuccal root canal treated via a novel “inlay-guided endodontics” technique based on improved computer-generated programs.
CASE SUMMARY A 63-year-old man complained of a defect in the maxillary left second molar. The tooth, diagnosed with post-treatment endodontic disease, was initially treated by conventional methods, which were ineffective. Our “inlay-guided endodontics” technique was subsequently adopted, with the establishment of a precise integrated three-dimensional (3D) plate model of cone-beam computed tomography data and a digital impression of the dentition. An optimal root canal approach was generated for the “virtual file” in the 3D model. The plate data were imported into a 3D printer and printed. With the help of the guide plate, the file was accurately placed into the cervical third of the distal root canal. The root canal and prosthodontic treatments successfully proceeded subsequently.
CONCLUSION Our newly developed inlay guide plates may facilitate individualized and minimally invasive root canal treatment.
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Affiliation(s)
- Yin-Qiu Yan
- Department of Stomatology, Daping Hospital, The Third Military Medical University (Army Medical University), Chongqing 400042, China
- College of Stomatology, Chongqing Medical University, Chongqing 400016, China
| | - Hui-Li Wang
- Department of Nursing, Xi’an International University, Xi’an 710077, Shaanxi Province, China
| | - Yu Liu
- Chuang Neng Technology Co., Ltd., Chongqing 400042, China
| | - Tai-Jing Zheng
- Department of Stomatology, Daping Hospital, The Third Military Medical University (Army Medical University), Chongqing 400042, China
| | - Ya-Ping Tang
- Department of Stomatology, Daping Hospital, The Third Military Medical University (Army Medical University), Chongqing 400042, China
| | - Rui Liu
- Department of Stomatology, Daping Hospital, The Third Military Medical University (Army Medical University), Chongqing 400042, China
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Mathew A, Almahi S, Mohamed R, Abu Fanas S, Jaber MA, Luke AM, Radeideh A, Shetty S. Comparison of Surface Equivalent Dose in CBCT, Digital Panoramic and Intra-Oral X-Ray Generators Using InstadoseTM Device: An In-Vitro Study. Open Dent J 2021. [DOI: 10.2174/1874210602115010689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Radiation protection in the dental examination is often overlooked because the doses delivered are negligible. However, the volume of dental radiological examinations will constitute almost 15% of all the radiological examinations carried out in the medical field.
Aim:
This study aims to evaluate and compare the surface equivalent dose on various target organs from various radiology devices on the RINN phantom, and the effect of numerous scanning protocols on said dose using dosimetry badge (Instadose).
Objectives:
The main objective is to study surface equivalent doses delivered in various critical organ regions in the facial region with the help of an Instadose device and to compare the doses delivered between 2D programs against 3D programs.
Materials and Methods:
RINN phantom was mounted on a dental chair for use against Planmeca ProMax 3D Classic and Planmeca intraoral ProX. Models. An Instadose badge was placed on various anatomical landmarks, and radiographic exposure protocols were applied to vary the parameters. The equivalent dose was calculated by connecting the dosimeter to a laptop and performing an instant reading output on the Instadose software.
Results:
The Thyroid showed a mean of 0.350, 0.0000, 0.0133, and 0.0000 in response to exposure by intraoral machine ProX, Panoramic, CBCT, and CBCT in ULD mode respectively. The dose absorbed by the left salivary glands was found to be significantly lower than the right salivary glands in panoramic exposures.
Conclusion:
It was revealed that a significant reduction in the dose when applying the Ultra-Low Dose protocol was noticed, and it reached up to 100% in the thyroid. It was also noted that there is no need for a thyroid collar in CBCT and Panoramic exposures. Maintaining the KVp at a constant and the exposure time as a variant caused a change in the dose equivalent received by the floor of the mouth and the right salivary gland.
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Maryn Y, Zarowski A, Loomans N. Exploration of the Influences of Temporary Velum Paralysis on Auditory-Perceptual, Acoustic, and Tomographical Markers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4149-4177. [PMID: 34699253 DOI: 10.1044/2021_jslhr-20-00587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose To better understand hypernasality (HN), we explored the relations between velopharyngeal orifice, auditory perception of HN, and acoustic-spectral measures in an in vivo within-subject design: (a) with a normally functioning velum as the control condition and (b) with a temporarily paralyzed velum as the experimental condition. Method The velum of eight volunteers was injected with ropivacaine hydrochloride (Naropin) in the area of the levator veli palatini and tensor veli palatini muscles to induce temporary velopharyngeal inadequacy (VPI) and HN. Sustained [a] and [i] and oronasal text readings were recorded, and 3D cone-beam computed tomography images of the vocal tract were built before and during velar anesthesia. Differences between conditions and correlations in normal-to-numb differences between velopharyngeal cross-sectional area (VParea), mean ratings of HN severity, and nine acoustic-spectral measures were determined. Results Three subjects already had some incomplete velopharyngeal closure in the control condition. Temporary motor nerve blockage of the velum (increased VParea) was accomplished in seven subjects, leading to increased HN and changes in three acoustic-spectral measures. Furthermore, significant correlations only emerged between VParea, HN, and ModelKataoka. Conclusions In most of the participants, it was possible to temporarily increase the velopharyngeal orifice to investigate HN while controlling other speech variables and cephalic morphology. Although this study was exploratory and its are findings preliminary, it provided additional evidence for the possible clinical value of ModelKataoka, A 3-P 0, and B F1 for the objective measurement of VPI or HN.
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Affiliation(s)
- Youri Maryn
- Department of Otorhinolaryngology & Head and Neck Surgery, European Institute for ORL-HNS, GZA Sint-Augustinus, Wilrijk, Belgium
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- Department of Speech-Language Therapy and Audiology, University College Ghent, Belgium
- School of Logopedics, Faculty of Psychology and Educational Sciences, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Phonanium, Lokeren, Belgium
| | - Andrzej Zarowski
- Department of Otorhinolaryngology & Head and Neck Surgery, European Institute for ORL-HNS, GZA Sint-Augustinus, Wilrijk, Belgium
| | - Natalie Loomans
- Department of Maxillo-Cranio-Facial Surgery, Craniofacial and Cleft Lip & Palate Team GZA Sint-Augustinus, Wilrijk, Belgium
- Face Ahead, Private Maxillo-Cranio-Facial Surgery Clinic, Antwerp, Belgium
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Kim J, Kim HK. A NOVEL METHOD FOR ESTIMATING PATIENT-SPECIFIC PRIMARY DOSE IN CONE-BEAM COMPUTED TOMOGRAPHY. RADIATION PROTECTION DOSIMETRY 2021; 196:71-84. [PMID: 34487179 DOI: 10.1093/rpd/ncab128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/12/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
For the purpose of real-time scan-protocol optimisation and patient-specific dose management in cone-beam computed tomography, we introduce a numerical algorithm that estimates the primary dose distributions in reconstructed images. The proposed algorithm is based on the ray-tracing technique and utilises reconstructed voxel data and scanning protocol. The algorithm is validated with the Monte Carlo (MC) and conventional model-based dose reconstruction methods for the simple cylindrical water and anthropomorphic head phantoms. The algorithm shows good agreement with both methods in terms of the zeroth-order x-ray interactions, which exclude the higher-order x-ray interactions at sites distant from the first interactions, and it consumes a significantly lower computational cost compared with the MC method. The differences between the proposed algorithm and the model-based dose reconstruction method as well as the improvement strategies of the algorithm are discussed in detail.
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Affiliation(s)
- Jinwoo Kim
- Center for Advanced Medical Engineering Research, Pusan National University, Busan 46241, Republic of Korea
| | - Ho Kyung Kim
- Center for Advanced Medical Engineering Research, Pusan National University, Busan 46241, Republic of Korea
- School of Mechanical Engineering, Pusan National University, Busan 46241, Republic of Korea
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85
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Pinto CA, Caetano GFDR, Andrade MEA, Panzarella FK, Junqueira JLC, Peroni LV, Nascimento MDCC. Dosimetric evaluation for temporomandibular joint cone beam computed tomography exams using different field of view. Biomed Phys Eng Express 2021; 7. [PMID: 34488205 DOI: 10.1088/2057-1976/ac240a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/06/2021] [Indexed: 11/12/2022]
Abstract
Objectives.To optimize the absorbed organ dose in relation to the field of view for temporomandibular joint examinations in four cone beam computed tomography devices.Methods.An anthropomorphic adult head and neck phantom, and 192 LiF dosimeters (TLD-100) were used. The dosimeters were placed in the region corresponding to the lens, parotid glands, submandibular glands, and thyroid. Small, medium and large FOVs were selected on Orthopantomograph OP300 Maxio, PaX-i3D Smart, ORTHOPHOS XG, and i-CAT Next Generation device when it was possible.Results.A wide range of absorbed dose values was recorded for all organs due to the different exposure parameters of each device. The radiosensitive organ with the highest dose was the parotid glands. The devices with 5 × 5 cm FOV recorded a lower dose in this protocol, while for the device without a small FOV (≤5 × 5 cm), the lowest dose was observed with the large FOV (6 × 16 cm).Conclusions.We recommend a double exposure with an FOV of 5 × 5 cm in the OP300 Maxio, PaX-i3D Smart, and ORTHOPHOS XG device, while in the i-CAT Next Generation device, a single exposure FOV of 6 × 16 cm is indicated.
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Affiliation(s)
- Carla Alves Pinto
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP), 13045-755, Brazil
| | - Gabriela Franco da Rosa Caetano
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP), 13045-755, Brazil
| | | | - Francine Kull Panzarella
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP), 13045-755, Brazil
| | - José Luiz Cintra Junqueira
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP), 13045-755, Brazil
| | - Leonardo Vieira Peroni
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, 13045-755, Brazil
| | - Monikelly do Carmo Chagas Nascimento
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP), 13045-755, Brazil
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Abstract
Background: In 2013, the American Thyroid Association (ATA) issued a "Policy Statement on Thyroid Shielding During Diagnostic Medical and Dental Radiology." The recently updated National Council on Radiation Protection and Measurement Radiation Protection in Dentistry and Oral and Maxillofacial Imaging (NCRP Report No. 177) prompts this review of progress related to patient thyroid shielding since the ATA statement was published. Summary: Relevant publications appearing since the ATA statement were identified by querying PubMed for "thyroid and dental and (collar or shielding)" and substituting specific dental radiographic procedures in the search. The search was expanded by reviewing the cited papers in the PubMed-retrieved papers and by use of the Web of Science to retrieve papers citing the PubMed retrieved publications. Although many quantitative studies have appeared reflective of current dental radiographic instrumentation and practice, much more can be done to foster minimizing radiation to the thyroid. Conclusions: We list seven areas that should be pursued. Among them are harmonizing guidelines for the use of thyroid collars based on the recent studies and a comprehensive survey of current dental radiological practice patterns.
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Affiliation(s)
- Arthur B Schneider
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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van Bunningen RH, Dijkstra PU, Dieters A, van der Meer WJ, Kuijpers-Jagtman AM, Ren Y. Precision of orthodontic cephalometric measurements on ultra low dose-low dose CBCT reconstructed cephalograms. Clin Oral Investig 2021; 26:1543-1550. [PMID: 34453209 PMCID: PMC8816531 DOI: 10.1007/s00784-021-04127-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/03/2021] [Indexed: 12/01/2022]
Abstract
Objectives To analyze differences in variation of orthodontic diagnostic measurements on lateral cephalograms reconstructed from ultra low dose-low dose (ULD-LD) cone beam computed tomography (CBCT) scans (RLC) as compared to variation of measurements on standard lateral cephalograms (SLC), and to determine if it is justifiable to replace a traditional orthodontic image set for an ULD-LD CBCT with a reconstructed lateral cephalogram. Material and methods ULD-LD CBCT images and SLCs were made of forty-three dry human skulls. From the ULD-LD CBCT dataset, a lateral cephalogram was reconstructed (RLC). Cephalometric landmarks (13 skeletal and 7 dental) were identified on both SLC and RLC twice in two sessions by two calibrated observers. Thirteen cephalometric variables were calculated. Variations of measurements, expressed as standard deviations of the 4 measurements on SLC and RLC, were analyzed using a paired sample t-test. Differences in the number of observations deviating ≥ 2.0 mm or degrees from the grand mean between SLC and RLC were analyzed using a McNemar test. Results Mean SDs for 7 out of 13 variables were significantly smaller for SLCs than those for RLCs, but differences were small. For 9 out of 13 variables, there was no significant difference between SLC and RLC for the number of measurements outside the range of 2 mm or degrees. Conclusions Based on the lower radiation dose and the small differences in variation in cephalometric measurements on reconstructed LC compared to standard dose LC, ULD-LD CBCT with reconstructed LC should be considered for orthodontic diagnostic purposes. Clinical relevance ULD-LD CBCT with reconstructed LC should be considered for orthodontic purposes. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04127-9.
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Affiliation(s)
- R H van Bunningen
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - P U Dijkstra
- Department of Rehabilitation and Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - A Dieters
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - W J van der Meer
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - A M Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.,Faculty of Dentistry, Universitas Indonesia, Campus Salemba, Jalan Salemba Raya No. 4, Jakarta, 10430, Indonesia
| | - Y Ren
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Al-Ekrish AA. Comparative study of the accuracy of CBCT implant site measurements using different software programs. Saudi Dent J 2021; 33:355-361. [PMID: 34434039 PMCID: PMC8376669 DOI: 10.1016/j.sdentj.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/01/2020] [Accepted: 07/06/2020] [Indexed: 01/03/2023] Open
Abstract
Purpose To measure and compare the accuracy of the linear dimensions of implant sites recorded from cone beam computed tomography (CBCT) images using Blue Sky Plan, coDiagnostiX, and RadiAnt. Materials and Methods Five human dry skulls were imaged with a CBCT device then sectioned to obtain sample transverse cross-sections of the edentulous ridges, and the height and width of the ridge were measured with a digital caliper to provide the gold standard measurements. The CBCT datasets were exported in DICOM format and imported into the three test software programs which were used to obtain reformatted sectional images corresponding to the sample transverse cross-sections, and the height and width of the edentulous ridge was recorded using the linear measurement tool. Reliability of the measurements were measured using the intraclass correlation coefficient. One-sample t-test (test value: zero) was used to test the statistical significance of the mean of the absolute errors for each software program. Analysis of Variance with Repeated Measures was used to test the statistical significance of the difference between the means of the absolute errors obtained by the different software programs. Statistical significance was set at a p-value of 0.05. Results The reliability of the gold standard and image measurements were excellent. All three software programs demonstrated a statistically significant mean absolute measurement error of between 0.43 and 0.56 mm (p-value < 0.01), but no significant difference in error values was found between any of the tested programs (p- value = 0.18). Conclusions There was no statistically significant difference in accuracy of linear CBCT measurements of implant sites recorded using Blue Sky Plan, coDiagnostiX, and RadiAnt.
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Affiliation(s)
- Asma'a A Al-Ekrish
- King Saud University, College of Dentistry, Department of Oral Medicine and Diagnostic Sciences, Division of Oral and Maxillofacial Radiology, P.O. Box 60169, Riyadh 11545, Saudi Arabia
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Orthodontists' criteria for prescribing cone-beam computed tomography-a multi-country survey. Clin Oral Investig 2021; 26:1625-1636. [PMID: 34424401 DOI: 10.1007/s00784-021-04135-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to describe and compare CBCT imaging prescription in clinical practice among orthodontists from five countries in Europe and America. Additionally, it investigated factors associated with the prescribing and the use of guidelines for CBCT imaging. MATERIALS AND METHODS A cross-sectional survey was carried out using an online questionnaire sent to all registered orthodontists in Belgium, Brazil, Canada, Romania, and the United States of America (USA). The data were analyzed by descriptive statistics, bivariate tests, and Poisson regression. RESULTS The final sample consisted of 1284 participants. CBCT was prescribed by 84.4% of the participants for selected cases (84.9%), mainly for impacted teeth (92.4%), presurgical planning (54.1%), and root resorption (51.9%). High cost was most frequently the limiting factor for CBCT prescription (55.4%). Only 45.2% of those who were using CBCT imaging reported adhering to guidelines. CBCT imaging prescription was associated with the orthodontists' countries (p < .009, except for Belgium, p = .068), while the use of guidelines was associated with the respondents' country and additional training on CBCT imaging (p < .001). CONCLUSIONS Orthodontists refer patients for CBCT for selected indications (impacted teeth, root resorption, presurgical planning, dentofacial deformities, as suggested by the international guidelines, and also for upper airway and temporomandibular joint evaluation). Many do not adhere to specific guidelines. There are substantial variations between the countries about the orthodontists' referral for CBCT and guideline usage, irrespective of gender. CBCT prescription may be limited by financial barriers, adhering to specific guidelines and prior CBCT training. CLINICAL RELEVANCE CBCT prescription among orthodontists must be based on prescription criteria and current guidelines. It is advised to improve CBCT education and training to enhance CBCT selection, referral, analysis, and interpretation in orthodontic practice.
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Klatt JC, Sorowka T, Kluwe L, Smeets R, Gosau M, Hanken H. Does a preoperative cone beam CT reduce complication rates in the surgical removal of complex lower third molars? A retrospective study including 486 cases. Head Face Med 2021; 17:33. [PMID: 34389020 PMCID: PMC8364039 DOI: 10.1186/s13005-021-00271-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 05/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKROUND This study was designed to analyse the value of preoperative Cone Beam CTs (CBCT) prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve (IAN) bundle and postoperative neurological disorders depending on the position of the lower third molar and the inferior alveolar nerve bundle. METHODS In this retrospective examination preoperative Cone Beam CTs and Orthopantomographs (OPT) of 324 patients were analysed concerning the location of the lower third molars in relation to the mandible and the inferior alveolar nerve bundle. Surgery protocols of all patients who underwent the surgical removal of at least one complex lower third molar were analysed concerning patient data, length of surgery, intraoperative haemorrhage, intraoperative exposure of the inferior alveolar nerve bundle, postoperative swelling and postoperative neurological disorders. The data was then compared to data from international studies. RESULTS In all 324 patients a permanent neurological damage was not found. Temporary neurological damage was recorded in 13 cases (2.6%). A caudal nerve position with no measurable distance to the root of the lower third molar was associated with the highest risk of a temporal neurological damage. A vestibular touching nerve route also correlated with postoperative sensitivity impairment. If a mesioangulation (Winter) or a Pell and Gregory Type IIIC appears in the OPT, risk of neurological damage is at its highest. CONCLUSIONS Three-dimensional radiographic imaging, in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars. Therefore, it should only be utilized for risk assessment, especially in cases of symptom-free lower third molars. A preoperative orthopantomogram still can be accepted as standard for radiographic imaging. An intraoperative exposure of the IAN bundle does not necessarily predict simultaneous neurological damage. Exposure of the IAN bundle is no indication for a discontinuation of the surgery.
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Affiliation(s)
- Jan C Klatt
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Tony Sorowka
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Lan Kluwe
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Henning Hanken
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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91
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Kaasalainen T, Ekholm M, Siiskonen T, Kortesniemi M. Dental cone beam CT: An updated review. Phys Med 2021; 88:193-217. [PMID: 34284332 DOI: 10.1016/j.ejmp.2021.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/16/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022] Open
Abstract
Cone beam computed tomography (CBCT) is a diverse 3D x-ray imaging technique that has gained significant popularity in dental radiology in the last two decades. CBCT overcomes the limitations of traditional two-dimensional dental imaging and enables accurate depiction of multiplanar details of maxillofacial bony structures and surrounding soft tissues. In this review article, we provide an updated status on dental CBCT imaging and summarise the technical features of currently used CBCT scanner models, extending to recent developments in scanner technology, clinical aspects, and regulatory perspectives on dose optimisation, dosimetry, and diagnostic reference levels. We also consider the outlook of potential techniques along with issues that should be resolved in providing clinically more effective CBCT examinations that are optimised for the benefit of the patient.
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Affiliation(s)
- Touko Kaasalainen
- HUS Diagnostic Center, Radiology, Helsinki University and Helsinki University Hospital, P.O. Box 340, Haartmaninkatu 4, 00290 Helsinki, Finland.
| | - Marja Ekholm
- Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland; South West Finland Imaging Center, Turku University Hospital, Lemminkäisenkatu 2, 20520 Turku, Finland
| | - Teemu Siiskonen
- Radiation Practices Regulation, Radiation and Nuclear Safety Authority - STUK, P.O. Box 14, FI-00881 Helsinki, Finland
| | - Mika Kortesniemi
- HUS Diagnostic Center, Radiology, Helsinki University and Helsinki University Hospital, P.O. Box 340, Haartmaninkatu 4, 00290 Helsinki, Finland
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92
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Horsch L, Labis C, Trebing CT, Kronsteiner D, Hilgenfeld T, Rammelsberg P, Schwindling FS. Predictability and image quality of low-dose cone-beam computed tomography in computer-guided implantology: An experimental study. J Dent 2021; 112:103744. [PMID: 34252488 DOI: 10.1016/j.jdent.2021.103744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the predictability and image quality of low-dose cone-beam computed tomography (LD-CBCT) in computer-guided implantology. METHODS Pig cadaver mandibles were imaged using high-definition CBCT (HD-CBCT) and LD-CBCT (HD-CBCT: 85 kV, 6 mA, 14.2 s, 767 frames, 1184 mGycm2, voxel size 80 µm, effective dose 231 µSv; LD-CBCT: 85 kV, 10 mA, 2.1 s, 384 frames, 84 mGycm2, voxel size 160 µm, effective dose 16 µSv; Orthophos SL, Dentsply Sirona, Bensheim, Germany). Digital impressions were taken using intraoral scanning (IOS; Omnicam, Dentsply Sirona). Data of CBCT modalities and IOS were aligned. Forty-eight implants were planned virtually (24 implants per modality; Bone Level 4.1 × 10 mm; Straumann AG, Basel, Switzerland). Implants were inserted using templates by initial pilot drilling ("partially-guided implantation"). Implant positions were recorded using IOS. Geometric deviations between planned and definitive positions were assessed regarding implant apex, entry-point and angle. CBCT image quality was evaluated by raters twice on a four point scale. The results were exploratively compared (linear models, Mann-Whitney-U tests). RESULTS Regarding implant apex, deviations were greater for LD-CBCT (mean 3.0±1.2 mm), as compared to HD-CBCT (mean 2.3±1.1 mm). For entry-point, no distinct difference was detected with a mean deviation of 1.4±0.9 mm in LD-CBCT, and 1.7±0.6 mm in HD-CBCT. Regarding angle, deviations were greater for LD-CBCT (mean 13.2±6.3°), as compared to HD-CBCT (mean 9.2±5.3°). The image quality of HD-CBCT provided to be better (mean 2.7±0.6) than that of LD-CBCT (mean 2.5±0.6). CONCLUSIONS Within the partially-guided approach, the results underline the potential of LD-CBCT alternatively to HD-CBCT for computer-guided implantology. Advantages of HD-CBCT need to be balanced against the higher radiation dose.
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Affiliation(s)
- Laura Horsch
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Christos Labis
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Charlotte Theresa Trebing
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Franz Sebastian Schwindling
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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93
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Optimization of X-ray Investigations in Dentistry Using Optical Coherence Tomography. SENSORS 2021; 21:s21134554. [PMID: 34283107 PMCID: PMC8271642 DOI: 10.3390/s21134554] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022]
Abstract
The most common imaging technique for dental diagnoses and treatment monitoring is X-ray imaging, which evolved from the first intraoral radiographs to high-quality three-dimensional (3D) Cone Beam Computed Tomography (CBCT). Other imaging techniques have shown potential, such as Optical Coherence Tomography (OCT). We have recently reported on the boundaries of these two types of techniques, regarding. the dental fields where each one is more appropriate or where they should be both used. The aim of the present study is to explore the unique capabilities of the OCT technique to optimize X-ray units imaging (i.e., in terms of image resolution, radiation dose, or contrast). Two types of commercially available and widely used X-ray units are considered. To adjust their parameters, a protocol is developed to employ OCT images of dental conditions that are documented on high (i.e., less than 10 μm) resolution OCT images (both B-scans/cross sections and 3D reconstructions) but are hardly identified on the 200 to 75 μm resolution panoramic or CBCT radiographs. The optimized calibration of the X-ray unit includes choosing appropriate values for the anode voltage and current intensity of the X-ray tube, as well as the patient’s positioning, in order to reach the highest possible X-rays resolution at a radiation dose that is safe for the patient. The optimization protocol is developed in vitro on OCT images of extracted teeth and is further applied in vivo for each type of dental investigation. Optimized radiographic results are compared with un-optimized previously performed radiographs. Also, we show that OCT can permit a rigorous comparison between two (types of) X-ray units. In conclusion, high-quality dental images are possible using low radiation doses if an optimized protocol, developed using OCT, is applied for each type of dental investigation. Also, there are situations when the X-ray technology has drawbacks for dental diagnosis or treatment assessment. In such situations, OCT proves capable to provide qualitative images.
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94
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Alshammery D, Alqhtani N, Alajmi A, Dagriri L, Alrukban N, Alshahrani R, Alghamdi S. Non-surgical correction of gummy smile using temporary skeletal mini-screw anchorage devices: A systematic review. J Clin Exp Dent 2021; 13:e717-e723. [PMID: 34306536 PMCID: PMC8291159 DOI: 10.4317/jced.58242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/15/2021] [Indexed: 01/14/2023] Open
Abstract
Background There are no studies that have systematically reviewed randomized control trials and/or prospective cohort studies that have assessed the significance of temporary skeletal mini-screw anchorage devices (TSAD) for the correction of gummy-smile. The aim of the present systematic review was to assess the significance of non-surgical correction of gummy smile using TSAD.
Material and Methods The addressed focused question was “Are temporary skeletal mini-screw anchorage devices effective for the correction of gummy smile?” Indexed databases were searched up to and including May 2020. Different combinations of the following key-indexing terms were used: anchorage; gummy smile, mini-screw; orthodontic; and vertical maxillary excess. The literature search was performed without time and language barriers. Randomized clinical trials and prospective cohort studies that addressed the focused questions were included. Risk of bias was assessed using the Downs and Black and Cochran collaboration tools. Letters to the Editor, commentaries, case-reports/series and articles published in non-indexed databases were excluded.
Results The initial search yielded 2118 studies out of which, four studies met the inclusion criteria and were processed for data extraction. All studies had a prospective research design. One study was a clinical trial and 3 had a non-randomized design. Results of the clinical trial showed no statistically significant difference in the extent of intrusion between the test- and control-groups. The non-randomized studies showed that TSAD are useful in reducing deep overbite. All studies had a high risk of bias.
Conclusions The TSAD are an effective and practical option in facilitating reduction of excessive gingival display or gummy-smile. However, further long-term follow-up, well-designed and power-adjusted clinical trials are warranted in this regard. Key words:Anchorage, Excessive gingival display, Gummy-smile, Mini-screw.
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Affiliation(s)
- Deema Alshammery
- Department of Preventive Dental Science, College of Dentistry, Riyadh Elm University, Saudi Arabia
| | - Nasser Alqhtani
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 19942, Saudi Arabia
| | - Asmaa Alajmi
- Dental Students, College of Dentistry, Riyadh Elm University, Saudi Arabia
| | - Lamis Dagriri
- Dental Students, College of Dentistry, Riyadh Elm University, Saudi Arabia
| | - Nouf Alrukban
- Dental Students, College of Dentistry, Riyadh Elm University, Saudi Arabia
| | - Rahaf Alshahrani
- Dental Students, College of Dentistry, Riyadh Elm University, Saudi Arabia
| | - Shahad Alghamdi
- Dental Students, College of Dentistry, Riyadh Elm University, Saudi Arabia
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95
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Wenzel A. Radiographic modalities for diagnosis of caries in a historical perspective: from film to machine-intelligence supported systems. Dentomaxillofac Radiol 2021; 50:20210010. [PMID: 33661697 PMCID: PMC8231685 DOI: 10.1259/dmfr.20210010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 01/17/2023] Open
Abstract
Radiographic imaging for the diagnosis of caries lesions has been a supplement to clinical examination for approximately a century. Various methods, and particularly X-ray receptors, have been developed over the years, and computer systems have focused on aiding the dentist in the detection of lesions and in estimating lesion depth. The present historical review has sampled accuracy ex vivo studies and clinical studies on radiographic caries diagnosis that have compared two or more receptors for capturing the image. The epochs of film radiography, xeroradiography, digital intraoral radiography, panoramic radiography and other extraoral methods, TACT analysis, cone-beam CT and artificial intelligence systems aiding in decision-making are reviewed. The author of this review (43 years in academia) has been involved in caries research and contributed to the literature in all the mentioned epochs.
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Affiliation(s)
- Ann Wenzel
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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96
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Maret D, Vergnes JN, Peters OA, Peters C, Nasr K, Monsarrat P. Recent Advances in Cone-beam CT in Oral Medicine. Curr Med Imaging 2021; 16:553-564. [PMID: 32484089 DOI: 10.2174/1573405615666190114152003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/09/2018] [Accepted: 12/19/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The cone-beam computed tomography (CBCT) technology has continuously evolved since its appearance in oral medicine in the early 2000s. OBJECTIVES To present recent advances in CBCT in oral medicine: i) selection of recent and consensual evidence-based sources, ii) structured summary of the information based on an iterative framework and iii) compliance with ethical, public health and patient-centered concerns. MAIN FINDINGS We will focus on technological advances, such as sensors and reconstruction algorithms used to improve the constant quality of the image and dosimetry. CBCT examination is now performed in almost all disciplines of oral medicine: currently, the main clinical disciplines that use CBCT acquisitions are endodontics and oral surgery, with clearly defined indications. Periodontology and ear, nose and throat medicine are more recent fields of application. For a given application and indication, the smallest possible field of view must be used. One of the major challenges in contemporary healthcare is ensuring that technological developments do not take precedence over admitted standards of care. The entire volume should be reviewed in full, with a systematic approach. All findings are noted in the patient's record and explained to the patient, including incidental findings. This presupposes the person reviewing the images is sufficiently trained to interpret such images, inform the patient and organize the clinical pathway, with referrals to other medical or oral medicine specialties as needed. CONCLUSION A close collaboration between dentists, medical physicists, radiologists, radiographers and engineers is critical for all aspects of CBCT technology.
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Affiliation(s)
- Delphine Maret
- Oral Rehabilitation Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,AMIS Laboratory - Laboratoire Anthropologie Moléculaire et Imagerie de Synthèse, Université de Toulouse, UMR 5288 CNRS, UPS, Toulouse, France
| | - Jean-Noel Vergnes
- Epidemiology and Public Health Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Ove A Peters
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, United States.,School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
| | - Christine Peters
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, United States
| | - Karim Nasr
- Oral Rehabilitation Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France
| | - Paul Monsarrat
- Oral Rehabilitation Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, ENVT, Inserm U1031, UPS, Toulouse, France
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97
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Siiskonen T, Gallagher A, Ciraj Bjelac O, Novak L, Sans Merce M, Farah J, Dabin J, Malchair F, Knežević Ž, Kortesniemi M. A European perspective on dental cone beam computed tomography systems with a focus on optimisation utilising diagnostic reference levels. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:442-451. [PMID: 33461178 DOI: 10.1088/1361-6498/abdd05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
Cone beam computed tomography (CBCT) has been available since the late 1990s for use in dentistry. European legislation requires optimisation of protection and the use of diagnostic reference levels (DRLs) as well as regular quality control (QC) of the imaging devices, which is well outlined in existing international recommendations. Nevertheless, the level of application is not known. Earlier studies have indicated that few European countries have established DRLs and that patient doses (exposure parameters) have not been properly optimised. The EURADOS Working Group 12-Dosimetry in Medical Imaging undertook a survey to identify existing practices in Member States. Questionnaires were developed to identify equipment types, clinical procedures performed, and exposure settings used. The surveys were circulated to 22 countries resulting in 28 responses from 13 countries. Variations were identified in the exposure factors and in the doses delivered to patients for similar clinical indicators. Results confirm that patient doses are still not properly optimised and DRLs are largely not established. There is a need to promote the importance of performing QC testing of dental CBCT equipment and to further optimise patient exposure by establishment and use of DRLs as a part of a continuous optimisation process.
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Affiliation(s)
- Teemu Siiskonen
- Radiation and Nuclear Safety Authority (STUK), P.O. Box 14, FI-00881 Helsinki, Finland
| | | | - Olivera Ciraj Bjelac
- University of Belgrade, Vinca Institute of Nuclear Sciences (VINCA), Belgrade, Serbia
| | - Leos Novak
- National Radiation Protection Institute (NRPI), Prague, Czech Republic
| | - Marta Sans Merce
- Hôpitaux Universitaires de Genève, Genève, Switzerland
- Switzerland and Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jad Farah
- Hôpitaux universitaires Paris-Sud (APHP), Paris Sud University Hospitals, Paris, France
| | - Jérémie Dabin
- Belgian Nuclear Research Centre (SCK-CEN), Boeretang 200, BE-2400 Mol, Belgium
| | - Françoise Malchair
- CAATS, 119 Grande Rue, 92310 Sevres, France
- ZEPHYRA, 13 rue Forgeur, 4000 Liege, Belgium
- Centre Hospitalier Universitaire de Liège (CHULg), Sart-Tilman, 4000 Liège, Belgium
| | - Željka Knežević
- Ruđer Bošković Institute (RBI), Bijenicka 54, Zagreb, Croatia
| | - Mika Kortesniemi
- HUS Medical Imaging Center, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
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98
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Johnson KB, Green PT, Dorsey AK. Adopting dental radiographic guidelines for selection criteria: Is a pandemic all it takes? J Am Dent Assoc 2021; 152:415-420. [PMID: 34044966 DOI: 10.1016/j.adaj.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/18/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
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99
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Al-Okshi A, Horner K, Rohlin M. A meta-review of effective doses in dental and maxillofacial cone beam CT using the ROBIS tool. Br J Radiol 2021; 94:20210042. [PMID: 33989050 DOI: 10.1259/bjr.20210042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To apply the ROBIS tool for assessment of risk of bias (RoB) in systematic reviews (SRs) in a meta-review on effective doses (EDs) in dental and maxillofacial cone beam CT. METHODS Three electronic databases and reference lists of included SRs were searched. Eligible SRs were classified as having low, high or unclear RoB. Findings of SRs were synthesised and data from primary studies combined to relate ED to field of view (FOV) and operating potential (kV). RESULTS Seven SRs were included: three displayed low RoB, three high and one had unclear RoB. Only one SR related ED to image quality. Deficiencies in reporting of eligibility criteria, study selection and synthesis of results in SRs were identified. FOV height had a significant relationship with ED, explaining 27.2% of its variability. Median ED for three FOV categories differed significantly. Operating potential had a weak relationship with ED, with no significant difference in median ED between three operating potential groups. CONCLUSION The ROBIS tool should have a role for meta-reviews of different aspects of radiology. The disappointing results for RoB might be remedied by developing standards to improve the quality of reporting of primary dosimetry studies and of SRs. Future dosimetry studies should always relate ED to image quality or diagnostic accuracy. ADVANCES IN KNOWLEDGE This meta-review is the first to implement ROBIS for SRs of ED and identified that trustworthiness of some SRs is questionable. The percentage change in average ED per cm increase in FOV height could be calculated, emphasizing the importance of FOV as a determinant of ED in CBCT.
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Affiliation(s)
- Ayman Al-Okshi
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Sebha University, Sebha, Libya.,Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Keith Horner
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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100
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Jha N, Kim YJ, Lee Y, Lee JY, Lee WJ, Sung SJ. Projected lifetime cancer risk from cone-beam computed tomography for orthodontic treatment. Korean J Orthod 2021; 51:189-198. [PMID: 33984226 PMCID: PMC8133899 DOI: 10.4041/kjod.2021.51.3.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/20/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To estimate the projected cancer risk attributable to diagnostic cone-beam computed tomography (CBCT) performed under different exposure settings for orthodontic purposes in children and adults. Methods We collected a list of CBCT machines and their specifications from 38 orthodontists. Organ doses were estimated using median and maximum exposure settings of 105 kVp/156.8 mAs and 130 kVp/200 mAs, respectively. The projected cancer risk attributable to CBCT procedures performed 1-3 times within 2 years was calculated for children (aged 5 and 10 years) and adult (aged 20, 30, and 40 years) male and female patients. Results For maximum exposure settings, the mean lifetime fractional ratio (LFR) was 14.28% for children and 0.91% for adults; this indicated that the risk to children was 16 times the risk to adults. For median exposure settings, the mean LFR was 5.25% and 0.58% for children and adults, respectively. The risk of cancer decreased with increasing age. For both median and maximum exposure settings, females showed a higher risk of cancer than did males in all age groups. Cancer risk increased with an increase in the frequency of CBCT procedures within a given period. Conclusions The projected dental CBCT-associated cancer risk spans over a wide range depending on the machine parameters and image acquisition settings. Children and female patients are at a higher risk of developing cancer associated with diagnostic CBCT. Therefore, the use of diagnostic CBCT should be justified, and protective measures should be taken to minimize the harmful biological effects of radiation.
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Affiliation(s)
- Nayansi Jha
- Department of Dentistry, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon-Ji Kim
- Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang-Jin Sung
- Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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