Recent advances in imaging technologies in dentistry

A Prototype Intraoral Periapical Sensor with High Frame Rates for a 2.5D Periapical Radiography System

X-ray radiography is currently used in dentistry and can be divided into two categories: two-dimensional (2D) radiographic images (e.g., using periapical film, cephalometric film, and panoramic X-ray) and three-dimensional (3D) radiographic images (e.g., using dental cone-beam computed tomography (CBCT)). Among them, 2D periapical film images are most commonly used. However, 2D periapical film compresses 3D image information into a 2D image, which means that depth cannot be identified from the image. Such compressed images lose a considerable amount of information, reducing their clinical applicability. A 2.5D periapical radiography system prototype was developed by our research team. Our previous study indicated that this prototype could be used to capture images at different depths of an object. However, the prototype was limited by its commercially available intraoral periapical sensor, which had a low temporal resolution and could not capture multiple images in a short period of time. Therefore, the total time required for image capture was too long for practical clinical application. The present study developed a high-frame-rate intraoral periapical sensor with a sensor imaging speed of up to 15 Hz. The primary components of the developed intraoral periapical sensor include a scintillator, complementary metal oxide semiconductor chip, component circuit board, and video processing board. The external dimensions of the sensor are 41 × 26 × 6.6 mm³. The performance of the developed high-frame-rate intraoral periapical sensor was verified through qualified and quantified analyses using line pairs. The results showed that the resolution of the developed intraoral periapical sensor could reach 18 lp/mm. The sensor was further installed in our 2.5D periapical radiography system to conduct image capturing. The results indicated that the developed sensor could be used for high-frame-rate imaging to incorporate tomosynthesis to obtain reconstructed slice images of different depths. The developed sensor has the potential for clinical dentistry applications in the future.

Indocyanine green-assisted dental imaging in the first and second near-infrared windows as compared with X-ray imaging

Indocyanine green (ICG) has been widely used in medical imaging, such as in retinal angiography. Here, we describe a pilot ex vivo study of ICG-assisted near-infrared fluorescence (NIRF) dental imaging in the first (700-950 nm for ICG-NIRF-I) and second (1000-1700 nm for ICG-NIRF-II) NIR windows using human extracted teeth; our study is compared with the traditional prevalent X-ray imaging and NIR II illumination (NIRi-II, 1310 nm) without ICG enhancement. The results show that ICG fluorescence has much better imaging contrast in both windows compared with NIRi-II (by quantitatively comparing NIR intensity of the critical neighboring structures, such as enamel and dentin). Cracked teeth, notoriously hard to diagnose by dental X-ray and computed tomography, were clearly profiled in NIRF dental imaging. An insidious occlusal caries, missing in X-ray imaging, became a bright dot that was readily observed in ICG-NIRF-I images. For dental decay, NIRF imaging with ICG enhancement could clearly delineate the decay boundary. NIRF in both windows distinguished interproximal and occlusal superficial caries. Overall, ICG-assisted NIRF dental imaging has unique advantages in identifying cracked teeth and insidious caries. The two NIR imaging windows used in our study might one day serve as noninvasive and nonionizing-radiation methods for the diagnosis of critical dental diseases in situ.

On the Symmetry of the Bone Structure Density over the Nasopalatine Foramen via Accurate Fractal Dimension Analysis

The objective of the present paper is to describe all the anatomical considerations surrounding the nasopalatine foramen by relating them to the study of bone structure density via an accurate fractal dimension analysis in that area. We consecutively selected a sample of 130 patients, all of them with cone beam computed tomography (CBCT) images performed for treatment needs. We chose a specific window (ROI), which coincides with an axial cut at the level of the anterior nasal spine. Different anthropometric measurements were analyzed and a novel fractal dimension analysis was performed. Our sample consisted of 130 patients and was divided into two groups: group one (consisting of 65 subjects without loss of teeth) and group two (consisting of 65 patients with the absence of some teeth). In the sample, 52.31% were women (68 people). Mann–Whitney tests were applied to obtain the statistical results. The mean age of the patients in that sample was 53 . 67 years with a standard deviation of 8 . 20 years. We conclude that fractal dimension, a mathematical invariant, behaves symmetrically for binary images from the CBCT scanners of each subject of our sample of study. We also conclude that there were no significant differences between all the anthropometric measures used neither in the subjects themselves nor in the different groups. Therefore, some patterns of symmetry were appreciated at a complete range of levels.

Preoperative imaging findings as predictors of postoperative inferior alveolar nerve injury following mandibular cyst surgery

The purpose of the present study was to predict inferior alveolar nerve (IAN) exposure and associated neurosensory deficits after mandibular cyst surgery based on imaging findings. The study includes 193 sites in 184 consecutive patients who underwent enucleation of cystic lesions around a mandibular third molar (MM3) and extraction of the associated MM3. Absence/presence of white lines on panoramic radiographs (PR) and absence/presence of cortication surrounding the mandibular canal on computed tomography (CT) are evaluated as predictor variables. Outcome variables are operative IAN exposure and postoperative lower lip and/or chin dysesthesia. There is a significant correlation between interruption of white lines and loss of cortication. The predictor variables are statistically associated with IAN exposure and dysesthesia. Positive predictive values of CT findings (loss of cortication) for each outcome variable are slightly higher than those of PR findings (interruption of white lines). When considering the variables, type IV, with interruption of white lines and loss of cortication, shows a statistically significant difference compared to the other groups. White lines on PR images and cortication status of the mandibular canal on CT images predict operative IAN exposure and postoperative dysesthesia in mandibular cyst surgery.

Density estimation based on the Hounsfield unit value of cone beam computed tomography imaging of the jawbone system

The aim of this study is to investigate the estimation of density from the Hounsfield unit of cone beam computed tomography data in dental imaging, especially for dental implant application. A jaw phantom with various known densities of anatomical parts (e.g. soft tissue, cortical bone, trabecular bone, tooth enamel, tooth dentin, sinus cavity, spinal cord and spinal disc) has been used to test the accuracy of the Hounsfield unit of cone beam computed tomography in estimating the mechanical density (true density). The Hounsfield unit of cone beam computed tomography data was evaluated via the MIMICS software using both two-dimensional and three-dimensional methods, and the results showed correlation with the true density of the object. In addition, the results revealed that the Hounsfield unit of cone beam computed tomography and bone density had a logarithmic relation, rather than a linear one. To this end, the correlation coefficient of logarithmic correlation (R2 = 0.95) is higher than the linear one (R2 = 0.77).

Osteo-regeneration personalized for children by rapid maxillary expansion: an imaging study based on synchrotron radiation microtomography

Background

Personalized maxillary expansion procedure has been proposed to correct maxillary transversal deficiency; different protocols of stem cell activation have been suggested and rapid maxillary expansion (RME) is the most commonly used among clinicians. The present study aimed to quantify in three-dimensions (3D) the osteo-regeneration of the midpalatal suture in children submitted to RME.

Methods

Three patients (mean age 8.3 ± 0.9 years) were enrolled in the study to preform biopsy of midpalatal suture. Two patients (subjects 1 and 2) were subjected to RME before biopsy. The third patient did not need maxillary expansion treatment and was enrolled as control (subject 3). Midpalatal suture samples were harvested 7 days after RME in subject 1, and 30 days after RME in subject 2. The samples were harvested with the clinical aim to remove bone for the supernumerary tooth extraction. When possible, maxillary suture and bone margins were both included in the sample. All the biopsies were evaluated by complementary imaging techniques, namely Synchrotron Radiation-based X-ray microtomography (microCT) and comparative light and electron microscopy.

Results

In agreement with microscopy, it was detected by microCT a relevant amount of newly formed bone both 7 days and 30 days after RME, with bone growth and a progressive mineralization, even if still immature respect to the control, also 30 days after RME. Interestingly, the microCT showed that the new bone was strongly connected and cross-linked, without a preferential orientation perpendicular to the suture’s long axis (previously hypothesized by histology), but with well-organized and rather isotropic 3D trabeculae.

Conclusions

The microCT imaging revealed, for the first time to the authors’ knowledge, the 3D bone regeneration in children submitted to RME.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0590-7) contains supplementary material, which is available to authorized users.

Ultrasound in Dentistry: Toward a Future of Radiation-Free Imaging

Ultrasonography (US) is a noninvasive, nonionizing, inexpensive, and painless imaging tool proven to be a valuable diagnostic tool in soft tissue assessment that also shows promise for hard tissue evaluation in dentistry. US has been investigated for its capability to identify carious lesions, tooth fractures or cracks, periodontal bony defects, maxillofacial fractures, and more. It has been used as a diagnostic aid in temporomandibular disorders, implant dentistry, and to measure muscle and soft tissue thickness. Unfortunately, the use of US in dentistry is still in its infancy; however, relevant research is promising.

Dental radiography image enhancement for treatment evaluation through digital image processing

Background

Evaluation of dental treatment is performed by observing dental periapical radiography to obtain information of filling’s condition, pulp tissue, remain dentin thickness, periodontal ligament, and lamina dura. Nevertheless, the radiographic image used often has low quality due to the level of x-ray radiation made low purposely in order to prevent health problem and limited tools capability. This low quality of the radiographic image, for examples, low image contrast, less brightness, and noise existence cause periapical radiography evaluation hard to be performed. This study aims to improve dental radiographic image quality for assisting pulp capping treatment evaluation.

Material and Methods

The research methodology consists of three main stages, i.e. data collection, image enhancement method production, and result validation. Radiographic image data collection in The Dental Hospital UMY. Image enhancement method has been conducted by comparing several methods: contourlet transform (CT), wavelet transform, contrast stretching (CS), and contrast limited adaptive histogram equalization (CLAHE) to reduce noise, to optimize image contrast, and to enhance image brightness.

Results

The result of this study is according to mean square error (MSE) and peak signal to noise ratio (PSNR) statistics evaluation, it obtains that the highest scores of MSE and PSNR in row gained from CT method totaled 5.441453 and 40.53652, followed by CLAHE method with the scores are 10.66326 and 38.00736, CS method whose scores are 12.39881 and 39.18518, and the last is wavelet method with the scores are 15.41569 and 36.25343.

Conclusions

Nonetheless, MSE and PSNR scores are not enough merely to give a recommendation of any suitable methods for improving contrast, therefore, it needs another success parameter coming from the dentist.

Key words:Dental radiography, image enhancement, digital image processing.

MRI for Dental Applications

Imaging of hard and soft tissue of the oral cavity is important for dentistry. However, medical computed tomography, cone beam computed tomography (CBCT), nor MRI enables soft and hard tissue imaging simultaneously. Some MRI sequences were shown to provide fast soft and hard tissue imaging of hydrogen, which increased the interest in dental MRI. Recently, MRI allowed direct visualization of cancellous bone, intraoral mucosa, and dental pulp despite that cortical bone and dental roots are indirectly visualized. MRI seems to be adequate for many indications that CBCT is currently used for: implant treatment and inflammatory diseases of the tooth.

Evaluation of the 3dMDface system as a tool for soft tissue analysis

OBJECTIVES

To evaluate the accuracy of three-dimensional stereophotogrammetry by comparing values obtained from direct anthropometry and the 3dMDface system. To achieve a more comprehensive evaluation of the reliability of 3dMD, both linear and surface measurements were examined.

SETTING AND SAMPLE POPULATION

UCLA Section of Orthodontics. Mannequin head as model for anthropometric measurements.

MATERIAL AND METHODS

Image acquisition and analysis were carried out on a mannequin head using 16 anthropometric landmarks and 21 measured parameters for linear and surface distances. 3D images using 3dMDface system were made at 0, 1 and 24 hours; 1, 2, 3 and 4 weeks. Error magnitude statistics used include mean absolute difference, standard deviation of error, relative error magnitude and root mean square error. Intra-observer agreement for all measurements was attained.

RESULTS

Overall mean errors were lower than 1.00 mm for both linear and surface parameter measurements, except in 5 of the 21 measurements. The three longest parameter distances showed increased variation compared to shorter distances. No systematic errors were observed for all performed paired t tests (P<.05). Agreement values between two observers ranged from 0.91 to 0.99.

CONCLUSIONS

Measurements on a mannequin confirmed the accuracy of all landmarks and parameters analysed in this study using the 3dMDface system. Results indicated that 3dMDface system is an accurate tool for linear and surface measurements, with potentially broad-reaching applications in orthodontics, surgical treatment planning and treatment evaluation.

Effective Radiation Dose in the Wrist Resulting from a Radiographic Device, Two CBCT Devices and One MSCT Device: A Comparative Study

The objective of the present study was to assess and compare the effective doses in the wrist region resulting from conventional radiography device, multislice computed tomography (MSCT) device and two cone beam computed tomography (CBCT) devices using MOSFET dosemeters and a custom made anthropomorphic RANDO phantom according to the ICRP 103 recommendation. The effective dose for the conventional radiography was 1.0 μSv. The effective doses for the NewTom 5 G CBCT ranged between 0.7 μSv and 1.6 μSv, for the Planmed Verity CBCT 2.4 μSv and for the MSCT 8.6 μSv. When compared with the effective dose for AP- and LAT projections of a conventional radiographic device, this study showed an 8.6-fold effective dose for standard MSCT protocol and between 0.7 and 2.4-fold effective dose for standard CBCT protocols. When compared to the MSCT device, the CBCT devices offer a 3D view of the wrist at significantly lower effective doses.

Delayed diagnosis in the maxillofacial region: Two case reports

While conventional CT scan has historically been used for maxillofacial bone imaging. The introduction of cone beam CT (CBCT) in the new millennium has revolutionized the use of CT for dental and maxillofacial diagnoses. This paper presents two clinical examples of delayed diagnoses associated with maxillofacial imaging, describes the reasons for the delays and offers potential preventive measures. The first case involves a delay in the diagnosis of non-Hodgkin's lymphoma in a 49-year-old female who was being treated for an odontogenic problem. In the second case, a 9-year-old female who presented with a limited ability to open her mouth was mistakenly diagnosed with muscles spasm. Subsequently, she was found to have an elongation of the right lateral pterygoid plate that interfered with her right mandibular body, which restricted the degree to which she could open her mouth. A thorough clinical examination and accurate radiographic interpretation combined with a complete medical history can minimize these types of diagnostic delays. If the dentist is unable to conclusively reach a diagnosis, the patient should be referred immediately to a specialist who can better manage the specific medical problem.

Evaluation of symptomatic maxillary sinus pathologies using panoramic radiography and cone beam computed tomography-influence of professional training

Background

A comparison of panoramic radiography (PAN) alone and PAN together with small field of view cone beam computed tomography (sFOV-CBCT) for diagnosis of symptomatic pathologies of the maxillary sinus was carried out by clinicians of different experience.

Methods

Corresponding radiographic images (PAN/sFOV-CBCT) of 28 patients with symptomatic maxillary sinus pathologies were chosen and analyzed by two general practitioners (GP), two junior maxillofacial surgeons (MS1), and three senior maxillofacial surgeons (MS2) via questionnaire.

Results

Visibility of maxillary pathologies in PAN was significantly different between the groups (GP 39%, MS1 48%, MS2 61%; p < 0.05). The number of incidental findings varied within examiner groups in PAN with a significant increase in MS2 (p = 0.027). The majority of examiners rated an additional sFOV-CBCT as “reasonable”/“required” with a significant influence of the examining groups (GP 98.2%, MS1 94.6%, MS2 80.9%; p = 0.008). In 58% of cases, an additional sFOV-CBCT was seen as “affecting therapy” with significant differences between the groups (GP 68%, MS1 50%, MS2 55%; p < 0.001).

Conclusions

PAN alone is not sufficient for the evaluation of pathologies of the maxillary sinus. But, depending on the examiners’ clinical experience, it remains a useful diagnostic tool. Along with the observers’ training, significant benefits of an additional sFOV-CBCT for evaluation of symptomatic maxillary sinus pathologies were detected.

Role of Cortico-Cancellous Heterologous Bone in Human Periodontal Ligament Stem Cell Xeno-Free Culture Studied by Synchrotron Radiation Phase-Contrast Microtomography

This study was designed to quantitatively demonstrate via three-dimensional (3D) images, through the Synchrotron Radiation Phase-Contrast Microtomography (SR-PhC-MicroCT), the osteoinductive properties of a cortico-cancellous scaffold (Osteobiol Dual Block—DB) cultured with human Periodontal Ligament Stem Cells (hPDLSCs) in xeno-free media. In vitro cultures of hPDLSCs, obtained from alveolar crest and horizontal fibers of the periodontal ligament, were seeded onto DB scaffolds and cultured in xeno-free media for three weeks. 3D images were obtained by SR-PhC-microCT after one and three weeks from culture beginning. MicroCT data were successively processed with a phase-retrieval algorithm based on the Transport of Intensity Equation (TIE). The chosen experimental method, previously demonstratively applied for the 3D characterization of the same constructs in not xeno-free media, quantitatively monitored also in this case the early stages of bone formation in basal and differentiating conditions. Interestingly, it quantitatively showed in the xeno-free environment a significant acceleration of the mineralization process, regardless of the culture (basal/differentiating) medium. This work showed in 3D that the DB guides the osteogenic differentiation of hPDLSCs in xeno-free cultures, in agreement with 2D observations and functional studies previously performed by some of the authors. Indeed, here we fully proved in 3D that expanded hPDLSCs, using xeno-free media formulation, not only provide the basis for Good Manufacturing Practice (preserving the stem cells’ morphological features and their ability to differentiate into mesenchymal lineage) but have to be considered, combined to DB scaffolds, as interesting candidates for potential clinical use in new custom made tissue-engineered constructs.

Presurgical evaluation of bony implant sites using panoramic radiography and cone beam computed tomography-influence of medical education

OBJECTIVES

The aim of this study was to compare the subjective quality rating of panoramic radiography (PAN) and CBCT in the planning of dental implant procedures by clinicians with different educational backgrounds.

METHODS

Radiographic images (PAN and CBCT) of 42 patients were examined as follows: the maxillary (MX) anterior region of patients, the MX posterior region of 16 patients and the mandibular (MD) posterior region of 16 patients. These sites were used for planning of dental implant insertion. Data sets were analyzed by examiners with different training backgrounds: three general practitioners (GP), three oral surgeons (OS) and three maxillofacial surgeons (MS). A standardized questionnaire in a standardized setting was answered by participants.

RESULTS

The majority of participants rated an additional CBCT as "required" (14.0%) or "reasonable" (56.1%). These ratings depended strongly on the area of interest (MX anterior region: 31.1 and 58.9%; MX posterior region: 14.6 and 62.5%; and MD posterior region: 2.8% and 47.9%). MS classified CBCT as required more often than GP and OS (23.8 vs 10.3 and 7.9%; p < 0.001). With the additional information of CBCT, "therapy affecting" ratings were stated high in all groups.

CONCLUSIONS

Especially in the anterior and posterior MX, significant subjective benefits for an additional CBCT were seen for planning of dental implant procedures. Participants with fundamental medical education asked for CBCT more often. The results indicate that an improved education in three-dimensional dental radiology is necessary.

MRI in Dentistry- A Future Towards Radiation Free Imaging - Systematic Review

INTRODUCTION

Magnetic Resonance Imaging (MRI), being a technique with huge potential, has become the primary diagnostic investigation for many clinical problems. Its application now has been successfully used in dentistry to maximize the diagnostic certainty.

AIM

The present review aims to analyze the applicability, feasibility and efficacy of MRI in the field of dentistry.

MATERIALS AND METHODS

A literature search was performed in main databases like Pub Med Central, Cochrane Library, Embase and Google Scholar from 1970 up to December 2015. The 2672 titles that appeared, 25 fulfilled the criteria and were included in the review. Two articles were hand searched and three articles through e-mail were also included.

RESULTS

The review highlights the increasing role of MRI in dentistry. In the available literature, it was found that T1 and T2 weighted images were the acceptable diagnostic images for detection of dental related diseases.

CONCLUSION

MRI can be used in diagnosis and treatment planning of implants, jaw lesions, diseases of Temporomandibular Joints (TMJ), orthodontic treatment, endodontic treatment etc., to achieve better prognosis.

Early diagnosis of atherosclerosis with panoramic radiographs: a review

Carotid artery disease has been linked with cerebral vascular accident, also known as stroke, cerebral hemorrhage, or cerebral ischemia. It is caused by narrowing or obstruction of arteries in the neck (the carotid arteries) that are responsible for transporting blood from the aorta to the brain. Panoramic radiographs are used in dentistry to show both dental arches as a supplement to the clinical dental examination. The objective of this study is to highlight the importance of panoramic radiographs for diagnosis of arterial disease, by means of a bibliographic review. The PubMed database was searched using the keywords “atherosclerosis” and “panoramic”, with the filters “last 5 years” and “humans”. Twenty articles were identified, six of which were chosen for this study because they were open access. The review concluded that panoramic radiographs enable early diagnosis of carotid artery calcification, resulting in earlier interventions, and offer an accessible cost.

Ultrasonography in the diagnosis of bone lesions of the jaws: a systematic review

The diagnostic use of ultrasonography in dentistry and maxillofacial surgery has previously been described in the literature. Considering that ultrasonography may be useful for the diagnosis of bone lesions of the jaws, a systematic review was carried out to examine the evidence. This review determined that ultrasonography has been used effectively for the diagnosis of infective and/or inflammatory lesions, cysts, nonodontogenic tumors, odontogenic tumors, and arteriovenous malformations and for the differential diagnosis of lesions of endodontic origin, compared with the gold standard of histologic analysis. Ultrasonography may be a viable adjunct to other special tests for the diagnosis of intraosseous lesions of the jaws, as it is noninvasive and does not involve ionizing radiation exposure of the patient.

Effect of Time Lapse on the Diagnostic Accuracy of Cone Beam Computed Tomography for Detection of Vertical Root Fractures

Accurate and early diagnosis of vertical root fractures (VRFs) is imperative to prevent extensive bone loss and unnecessary endodontic and prosthodontic treatments. The aim of this study was to assess the effect of time lapse on the diagnostic accuracy of cone beam computed tomography (CBCT) for VRFs in endodontically treated dog's teeth. Forty-eight incisors and premolars of three adult male dogs underwent root canal therapy. The teeth were assigned to two groups: VRFs were artificially induced in the first group (n=24) while the teeth in the second group remained intact (n=24). The CBCT scans were obtained by NewTom 3G unit immediately after inducing VRFs and after one, two, three, four, eight, 12 and 16 weeks. Three oral and maxillofacial radiologists blinded to the date of radiographs assessed the presence/absence of VRFs on CBCT scans. The sensitivity, specificity and accuracy values were calculated and data were analyzed using SPSS v.16 software and ANOVA. The total accuracy of detection of VRFs immediately after surgery, one, two, three, four, eight, 12 and 16 weeks was 67.3%, 68.7%, 66.6%, 64.6%, 64.5%, 69.4%, 68.7%, 68% respectively. The effect of time lapse on detection of VRFs was not significant (p>0.05). Overall sensitivity, specificity and accuracy of CBCT for detection of VRFs were 74.3%, 62.2%, 67.2% respectively. Cone beam computed tomography is a valuable tool for detection of VRFs. Time lapse (four months) had no effect on detection of VRFs on CBCT scans.

Surgical Classification of the Mandibular Deformity in Craniofacial Microsomia Using 3-Dimensional Computed Tomography

Background:

Grading systems of the mandibular deformity in craniofacial microsomia (CFM) based on conventional radiographs have shown low interrater reproducibility among craniofacial surgeons. We sought to design and validate a classification based on 3-dimensional CT (3dCT) that correlates features of the deformity with surgical treatment.

Methods:

CFM mandibular deformities were classified as normal (T0), mild (hypoplastic, likely treated with orthodontics or orthognathic surgery; T1), moderate (vertically deficient ramus, likely treated with distraction osteogenesis; T2), or severe (ramus rudimentary or absent, with either adequate or inadequate mandibular body bone stock; T3 and T4, likely treated with costochondral graft or free fibular flap, respectively). The 3dCT face scans of CFM patients were randomized and then classified by craniofacial surgeons. Pairwise agreement and Fleiss' κ were used to assess interrater reliability.

Results:

The 3dCT images of 43 patients with CFM (aged 0.1–15.8 years) were reviewed by 15 craniofacial surgeons, representing an average 15.2 years of experience. Reviewers demonstrated fair interrater reliability with average pairwise agreement of 50.4 ± 9.9% (Fleiss' κ = 0.34). This represents significant improvement over the Pruzansky–Kaban classification (pairwise agreement, 39.2%; P = 0.0033.) Reviewers demonstrated substantial interrater reliability with average pairwise agreement of 83.0 ± 7.6% (κ = 0.64) distinguishing deformities requiring graft or flap reconstruction (T3 and T4) from others.

Conclusion:

The proposed classification, designed for the era of 3dCT, shows improved consensus with respect to stratifying the severity of mandibular deformity and type of operative management.

Oral and Maxillofacial Imaging

This article provides the reader with the knowledge and skills of identification and diagnostic interpretative skills using planar images, tomographic images, CBCT, MDCT, pertinent MR images, as well as bone scans and PET images. The goal is to provide sufficient in-depth knowledge of the technique, anatomy, and radiographic identifiers for the diagnosis of local and systemic pathoses. The information will train the reader to be an advocate of selection criteria as well as a follower of the "Image Gently" campaign and philosophy supported by the organized dentistry in the United States, especially in Diagnostic Radiology.

Surgical evaluation of panoramic radiography and cone beam computed tomography for therapy planning of bisphosphonate-related osteonecrosis of the jaws

OBJECTIVES

The purpose of this retrospective study was to compare the clinical significance of panoramic radiography (orthopantomography [OPTG]) and cone beam computed tomography (CBCT) for therapy planning of bisphosphonate-related osteonecrosis of the jaw (BRONJ) by surgeons.

STUDY DESIGN

Using standardized questionnaire, eight maxillofacial surgeons evaluated intraoral photographs of the clinical situation of 14 patients with BRONJ as well as the corresponding radiographic images (OPTG, CBCT). The presence of five typical BRONJ signs (bone-remodeling, periosteal reaction, osteosclerosis, sequestra, and continuity of cortical bone) was evaluated with OPTG and CBCT. The influence of radiologic information on therapy decision was examined as well.

RESULTS

On the basis of the information from intraoral photographs only, seven of the eight surgeons indicated that an additional radiographic examination was necessary for further therapy planning. For evaluation of the five radiographic BRONJ signs, CBCT provided significantly better values compared with OPTG (all P < .05). A before-and-after comparison showed that four of the eight surgeons changed their therapy concept after having three-dimensional CBCT information. The majority (6 of 8) of the surgeons considered that an additional CBCT was required for therapy planning, even after having studied the clinical photographs and OPTG images.

CONCLUSION

These data demonstrate a significant advantage of CBCT over OPTG for surgeons with regard to therapeutic planning for BRONJ.

Cariogram outcome after 90 days of oral treatment with Streptococcus salivarius M18 in children at high risk for dental caries: results of a randomized, controlled study

Dental caries is the most common chronic disease of childhood. Cariogram is a well-recognized algorithm-based software program based on different caries-related risk factors and intended to aid clinicians in performing more objective and consistent dental caries risk assessments. This type of approach precedes the diagnosis of caries and allows the dentist to identify at-risk patients and then take appropriate preventive measures before caries develop further. One of the etiological factors favoring the development of dental caries is the mutans streptococci. These acidogenic dental plaque inhabitants can be effectively antagonized by the activity of bacteriocins released by the probiotic Streptococcus salivarius M18 (salivarius M18). Moreover, salivarius M18 after colonizing the human oral mucosa produces the enzymes dextranase and urease that are able to counteract plaque formation and saliva acidity, respectively. Seventy-six subjects at high risk of dental caries were randomized and then either treated or not treated for 90 days with an oral formulation containing the oral probiotic salivarius M18 (Carioblis(®)). The results indicate that the use of salivarius M18 increases the chances of avoiding new dental caries development in children, and its application could be proposed as a new tool in the dentist's armory to be adopted in subjects considered at high risk on the basis of their Cariogram outcome.

Intraoperative Measurement of the Distance from the Bottom of Osteotomy to the Mandibular Canal Using a Novel Ultrasonic Device

BACKGROUND

In our previous study, we found that a novel ultrasound (US) device may serve as a useful intraoperative tool to measure the distance from osteotomy to the inferior alveolar canal (IAC).

PURPOSE

To validate our previous results in a larger group of osteotomies in the posterior mandible.

METHODS

During dental implant placement surgery, osteotomies were created using a standardized 2-mm-diameter pilot drill. The distance from the bottom of the osteotome to the IAC was assessed using an ultrasonic device and compared with a standard panoramic radiograph used to measure the same residual distance. The total distance from the crestal bone to the IAC was measured on a preoperative computed tomography (CT) and compared with total US measurements by summing the drill depth with residual depth measurements.

RESULTS

Mean radiographic and US residual distances were 5.19 ± 1.95 mm, 5.01 ± 1.82 mm, p = 0.79 respectively. These measurements presented strong positive correlations (r = 0.61, p = .01). Mean total CT distance was 13.48 ± 2.66 mm; mean total US calculation was 13.69 ± 2.51 mm. No significant difference was found (p > .05).

CONCLUSIONS

The results support our previous pilot study and confirm that the tested US device identifies the IAC and measures the distance from the osteotomy to the roof of the mandibular canal.

Effective radiation dose of a MSCT, two CBCT and one conventional radiography device in the ankle region

BACKGROUND

The aim of this study was to assess and compare the effective doses (ICRP 103) in the ankle region of X-ray imaging resulting from a multi slice computed tomography (MSCT) device, two cone beam CT (CBCT) devices and one conventional x-ray device.

METHODS

Organ dose measurements were performed using 20 metal oxide field effect transistor (MOSFET) dosimeters that were placed in a custom made anthropomorphic RANDO ankle phantom. The following scanners were assessed in this study: Siemens Sensation Open 24-slice MSCT-scanner (120 kVp, 54 mAs), NewTom 5G CBCT scanner (110 kVp, 2.3 - 59 mAs), Planmed Verity CBCT-scanner (90 kVp, 48 mAs), Shimadzu FH-21 HR direct radiography equipment (AP + LAT), (57 kVp, 16 mAs).

RESULTS

Measurements of the MSCT device resulted in 21.4 μSv effective dose. The effective doses of CBCTs were between 1.9 μSv and 14.3 μSv for NewTom 5G and 6.0 μSv for Planmed Verity. Effective doses for the Shimadzu FH-21 HR conventional radiography were 1.0 μSv (LAT) and 0.5 μSv (AP), respectively.

CONCLUSIONS

Compared with a conventional 2D radiographic device, this study showed a 14-fold effective dose for standard MSCT and 1.3 -10 fold effective dose for standard CBCT protocols. CBCT devices offers a 3D view of ankle imaging and exhibited lower effective doses compared with MSCT.