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Ruetters M, Alexandrou K, Gehrig H, Awounvo S, Kim TS, Felten A, Lux C, Sen S. Impact of acquisition volume on cone beam computed tomography imaging of marginal bone: an ex vivo study. Acta Odontol Scand 2024; 83:204-209. [PMID: 38661245 DOI: 10.2340/aos.v83.40494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/16/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The current study explores whether there is a clinically relevant distinction in the measurement of marginal bone loss when comparing high-dose (HD) versus low-dose (LD) cone beam computed tomography (CBCT) protocols in small and large acquisition volumes. Material and Methods: CBCTs of four human cadaveric preparates were taken in HD and LD mode in two different fields of view 8 × 8 cm2 (LV) and 5 × 5 cm2 (SV). In total, 43 sites of 15 teeth were randomly chosen, and marginal bone loss was measured twice in all protocols at 43 sites of 15 teeth by one calibrated investigator. Bland-Altman plots and Lin's concordance correlation coefficient (CCC) were calculated to assess the extent of agreement of the measurements. Additionally, the rater scored the certainty in each of the measurements. RESULTS For HD-CBCT CCC of measurements obtained using SV versus LV was 0.991. CCC of measurements obtained using SV versus LV of LD-CBCT was 0.963. Both CCC values indicated excellent agreement between the two volumes in both protocols. CCC also indicated high intramodality correlation between HD-CBCT and LD-CBCT independent of the acquisition volume (0.963 - 0.992). Bland-Altman plots also indicated no substantial differences. Results of certainty scoring showed significant differences (p = 0.004 (LV), p < 0.001(SV)) between the LD and HD-CBCT. CONCLUSIONS Accuracy of measurements of bone loss shows no clinical noticeable effects depending on the CBCT volume in this ex vivo study. There appears to be no relevant advantage of SV over LV, neither in HD-CBCT nor in LD-CBCT and additionally no relevant advantage of HD versus LD in visualizing marginal bone loss.
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Affiliation(s)
- Maurice Ruetters
- Department of Conservative Dentistry, University Hospital Heidelberg, Heidelberg, Germany.
| | - Korallia Alexandrou
- Department of Orthodontics, University Hospital Heidelberg, Heidelberg, Germany
| | - Holger Gehrig
- Department of Conservative Dentistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Sinclair Awounvo
- Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Ti-Sun Kim
- Department of Conservative Dentistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Felten
- Department of Conservative Dentistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Christopher Lux
- Department of Orthodontics, University Hospital Heidelberg, Heidelberg, Germany
| | - Sinan Sen
- Department of Orthodontics, University Hospital Schleswig Holstein, Kiel, Germany
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Han S, Fan X, Wang S, Du H, Liu K, Ji M, Xiao D. Dehiscence and fenestration of skeletal Class III malocclusions with different vertical growth patterns in the anterior region: A cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2024; 165:423-433. [PMID: 38127040 DOI: 10.1016/j.ajodo.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION This study aimed to evaluate the incidence and distribution of alveolar bone dehiscence and fenestration in skeletal Class III malocclusions with different vertical growth patterns in the anterior region using cone-beam computed tomography (CBCT). METHODS In this retrospective study, 84 patients with skeletal Class III malocclusions who underwent CBCT were selected. This study included 28 patients with hypodivergence (mean age, 22.9 ± 3.9 years), 28 with normodivergence (mean age, 21.0 ± 3.0 years), and 28 with hyperdivergence (mean age, 21.0 ± 3.7 years). Teeth in the anterior region were examined using CBCT to detect dehiscence and fenestration. The incidences of dehiscence and fenestration in the anterior teeth region were recorded, and statistical analysis was conducted using SPSS software (version 25.0, IBM, Armonk, NY). RESULTS Among the patients with skeletal Class III malocclusions, dehiscence and fenestration were prone to occur in the mandible. Dehiscence and fenestration were more prevalent in patients with hyperdivergence compared with in patients with hypodivergence and normodivergence. CONCLUSIONS Dehiscence and fenestration are prevalent among patients with skeletal Class III malocclusion. Furthermore, the occurrence of alveolar bone defects is higher in patients with hyperdivergence.
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Affiliation(s)
- Shaobo Han
- Department of the Graduate School, Tianjin Medical University, Tianjin, China
| | - Xiangfei Fan
- Department of Orthodontics, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Song Wang
- Department of the Graduate School, Tianjin Medical University, Tianjin, China
| | - Hongyu Du
- Postgraduate of School of Medicine, Nankai University, Tianjin, China
| | - Kexin Liu
- Department of the Graduate School, Tianjin Medical University, Tianjin, China
| | - Mengting Ji
- Department of the Graduate School, Tianjin Medical University, Tianjin, China
| | - Danna Xiao
- Department of Orthodontics, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin, China.
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Ruetters M, Kim TS, Hagenfeld D, Kronsteiner D, Gehrig H, Lux CJ, Sen S. Authors' response to: The problem in visualization and measuring tiny structures on CBCT-images. J Orofac Orthop 2023; 84:342-343. [PMID: 37353685 DOI: 10.1007/s00056-023-00478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
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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Christiaens V, Pauwels R, Mowafey B, Jacobs R. Accuracy of Intra-Oral Radiography and Cone Beam Computed Tomography in the Diagnosis of Buccal Bone Loss. J Imaging 2023; 9:164. [PMID: 37623696 PMCID: PMC10455186 DOI: 10.3390/jimaging9080164] [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: 06/28/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND The use of cone beam computed tomography (CBCT) in dentistry started in the maxillofacial field, where it was used for complex and comprehensive treatment planning. Due to the use of reduced radiation dose compared to a computed tomography (CT) scan, CBCT has become a frequently used diagnostic tool in dental practice. However, published data on the accuracy of CBCT in the diagnosis of buccal bone level is lacking. The aim of this study was to compare the accuracy of intra-oral radiography (IOR) and CBCT in the diagnosis of the extent of buccal bone loss. METHODS A dry skull was used to create a buccal bone defect at the most coronal level of a first premolar; the defect was enlarged apically in steps of 1 mm. After each step, IOR and CBCT were taken. Based on the CBCT data, two observers jointly selected three axial slices at different levels of the buccal bone, as well as one transverse slice. Six dentists participated in the radiographic observations. First, all observers received the 10 intra-oral radiographs, and each observer was asked to rank the intra-oral radiographs on the extent of the buccal bone defect. Afterwards, the procedure was repeated with the CBCT scans based on a combination of axial and transverse information. For the second part of the study, each observer was asked to evaluate the axial and transverse CBCT slices on the presence or absence of a buccal bone defect. RESULTS The percentage of buccal bone defect progression rankings that were within 1 of the true rank was 32% for IOR and 42% for CBCT. On average, kappa values increased by 0.384 for CBCT compared to intra-oral radiography. The overall sensitivity and specificity of CBCT in the diagnosis of the presence or absence of a buccal bone defect was 0.89 and 0.85, respectively. The average area under the curve (AUC) of the receiver operating curve (ROC) was 0.892 for all observers. CONCLUSION When CBCT images are available for justified indications, other than bone level assessment, such 3D images are more accurate and thus preferred to 2D images to assess periodontal buccal bone. For other clinical applications, intra-oral radiography remains the standard method for radiographic evaluation.
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Affiliation(s)
- Véronique Christiaens
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Ruben Pauwels
- Department of Dentistry and Oral Health, Aarhus University, 8000 Aarhus, Denmark;
- OMFS IMPATH, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Radiology, Chulalongkorn University, 10330 Bangkok, Thailand
| | - Bassant Mowafey
- OMFS IMPATH, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Oral medicine, Periodontology, Diagnosis and Oral radiology, Faculty of Dentistry, Mansoura University, 35516 Mansoura, Egypt
| | - Reinhilde Jacobs
- OMFS IMPATH, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Dental Medicine, Karolinska Institutet, 14152 Huddinge, Sweden
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Michielsens H, Decreus J, Begnoni G, Verdonck A, Jacobs R, Willems G, Cadenas de Llano-Pérula M. Performance of the Malmgren Index for Assessing Root Resorption on 2D vs. 3D Radiographs: A Pilot Study. Healthcare (Basel) 2023; 11:1860. [PMID: 37444694 DOI: 10.3390/healthcare11131860] [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: 05/30/2023] [Revised: 06/18/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVES To compare the performance of the Malmgren index on 2D and 3D radiographs. METHODS Patients with a panoramic radiograph and a cone beam computed tomography (CBCT) taken at an interval of <3 months and presenting root resorption (RR) on at least one incisor and/or canine were retrospectively included. RR was scored twice by two observers using the Malmgren index in both the 2D and 3D sets, and intra-class correlation coefficient (ICC) was calculated. RESULTS 155 teeth were analyzed. The ICC was the lowest in 2D, followed by overall, transversal and sagittal 3D. Malmgren scores were systematically higher in 2D, which overestimated RR, especially in the transversal plane on all incisors and canines and in the sagittal plane on the maxillary incisors. 2D respectively leads to 28.0-34.8% of false positives and negatives when discriminating between RR or not. The early stages of RR are often misdiagnosed in 2D, while later stages are more accurate. CONCLUSIONS The original Malmgren index is not suited for 3D images, especially axial, where using dichotomized values (resorption yes/no) leads to overestimation of RR. A low-dose CBCT of the upper incisors could detect RR with high diagnostic accuracy in the early stages of orthodontic treatment, especially in patients with dental trauma or familial RR history.
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Affiliation(s)
- Hanne Michielsens
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Julie Decreus
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Giacomo Begnoni
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Anna Verdonck
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Guy Willems
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Maria Cadenas de Llano-Pérula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
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Distefano S, Cannarozzo MG, Spagnuolo G, Bucci MB, Lo Giudice R. The "Dedicated" C.B.C.T. in Dentistry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5954. [PMID: 37297558 PMCID: PMC10252385 DOI: 10.3390/ijerph20115954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/14/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
This position statement represents a consensus of an expert committee composed by the Italian Academy of General Dentistry (Accademia Italiana Odontoiatria Generale COI-AIOG) and Italian Academy of Legal and Forensic Dentistry (Accademia Italiana di Odontoiatria Legale e Forense OL-F) on the appropriate use of cone beam computed tomography (C.B.C.T.) in dentistry. This paper analyzes the use of C.B.C.T. in light of the rapid evolution of volumetric technologies, with the new low- and ultra-low-dose exposure programs. These upgrades are determining an improvement in the precision and safety of this methodology; therefore, the need of a guideline revision of the use of C.B.C.T. for treatment planning is mandatory. It appears necessary to develop a new model of use, which, in compliance with the principle of justification and as low as reasonably achievable (ALARA) and as low as diagnostically acceptable (ALADA), can allow a functional "Dedicated C.B.C.T." exam optimized for the individuality of the patient.
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Affiliation(s)
| | - Maria Grazia Cannarozzo
- Cenacolo Odontostomatologico Italiano-Associazione Italiana Odontoiatria Generale, 95128 Catania, Italy
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Marco Brady Bucci
- Italian Academy of Legal and Forensic Dentistry (OL-F), 19122 La Spezia, Italy
| | - Roberto Lo Giudice
- Department Clinical and Experimental Medicine, Messina University, 98122 Messina, Italy
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Augmented Corticotomy on the Lingual Side in Mandibular Anterior Region Assisting Orthodontics in Protrusive Malocclusion: A Case Report. Medicina (B Aires) 2022; 58:medicina58091181. [PMID: 36143857 PMCID: PMC9505358 DOI: 10.3390/medicina58091181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Adequate alveolar bone volume is a prerequisite condition for successful orthodontic tooth movement and posttreatment stability. Mandibular anterior teeth are more likely to exhibit dehiscence and fenestration in adult patients, which make orthodontic treatment in adults challenging, especially when the amount of retraction of the anterior teeth is large. Herein, we report the treatment of augmented corticotomy only on the lingual side in the mandibular anterior region to increase the volume of soft and hard tissue assisting orthodontics in a Class I bialveolar protrusive malocclusion and propose management strategies of mandibular incisor retractions. A 22-year-old female with a chief complaint of protrusive mouth presented to the Department of Orthodontics for orthodontic treatment, diagnosed with Class I bialveolar protrusive. The orthodontic treatment plan involved the extraction of four premolars and extensive retraction of the anterior teeth using microimplant anchorage. In consideration of the fenestration and dehiscence in the mandibular anterior alveolar bone and the pattern of tooth movement, augmented corticotomy was performed on the lingual side combined with bone grafting. Clinical and radiographic evaluation after treatment revealed significant improvements in the facial profile and in periodontal phenotype. Augmented corticotomy assisting orthodontic treatment could be a promising treatment strategy for adult patients with alveolar protrusion to maintain periodontal health.
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