Effect of voxel size on accuracy of cone beam computed tomography-aided assessment of periodontal furcation involvement

Assessing the Impact of the Metal Artifact Reduction Tool on Detecting Furcation Lesions in Maxillary Molars with Different Intracanal Posts: An Ex Vivo Cone-beam Computed Tomography Study

INTRODUCTION

Considering the potential image compromise and diagnostic challenges posed by metals, this study aimed to assess the efficacy of the metal artifact reduction (MAR) tool in cone-beam computed tomography examinations for detecting furcation lesions in upper molars treated endodontically and restored with different intracanal posts.

METHODS

This ex vivo study used 45 endodontically treated maxillary first molars, categorized into the following3 groups (n = 15): control (without intracanal post), metal post, and fiberglass post. Simulations were conducted in the laboratory to replicate alveolar bone, periodontal ligament, and grade I, II, and III furcation lesions. Cone-beam computed tomography scans were obtained with and without the MAR tool, and the furcation lesions were evaluated considering a 5-point Likert scale. Data were analyzed at 5%.

RESULTS

In the control group, there was no influence of MAR (P > .05); grade II lesions were not diagnosed, and grade III lesions were the most detected (P < .05). In the metal post group with MAR, grade III lesions were diagnosed more frequently than I and II (P < .05) and grade III without MAR (P < .05). In the fiberglass post group, the diagnosis of grade I lesions decreased with MAR (P < .05), and without MAR, grade III was most diagnosed (P < .05); grade III lesions were the most diagnosed (P < .05).

CONCLUSIONS

The MAR tool was only effective for diagnosing grade III furcation lesions, regardless of the intracanal material. Its application for grade I and II lesions did not contribute to improved diagnosis. Furthermore, in the fiberglass post group with grade I lesions, the MAR tool negatively affected the detection of the lesions.

Effect of voxel size on detection of fenestration, dehiscence and furcation defects using cone-beam computed tomography

OBJECTIVES

This study aimed to assess the effect of voxel size on detection of fenestration, dehiscence, and furcation defects using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

This in vitro, experimental study evaluated 4 sheep skulls with both the maxilla and mandible accompanied by the surrounding soft tissue. Fenestration (n = 30), dehiscence (n = 65), and furcation defects (n = 46; 18 grade I, 25 grade II, and 3 grade III) were randomly created by round and needle burs in both jaws, and 40 areas served as control sites. CBCT scans were obtained with 0.300 and 0.150 mm³ voxel sizes and 8 × 11cm² field of view (FOV), and were randomly observed by four observers (two oral and maxillofacial radiologists and two periodontists). The kappa values, sensitivity and specificity were calculated for each voxel size and compared using paired t test.

RESULTS

By an increase in image resolution, diagnostic sensitivity increased while specificity decreased. The kappa values for fenestration (0.602-0.623), and grade III furcation defects (0.903-1.00) were optimal (> 0.6), and almost similar for both voxel sizes. The kappa values for dehiscence, and grades I and II furcation defects were unfavorable (< 0.6) and almost similar for both voxel sizes, except for grade I furcation defects, which had a significant difference in kappa values between the two voxel sizes (0.014 and 0.34).

CONCLUSION

Smaller voxel size had higher sensitivity and lower specificity for detection of all defects except for grade I furcation defects, for which the smaller voxel size had higher sensitivity and higher specificity.

Linear measurement accuracy of CBCT panoramic reconstructions: experimental study with dry human mandibles

INTRODUCTION

Studies on software accuracy of reformatted panoramic computed tomography (CT) images are scarce.

OBJECTIVES

The aim of this study was to evaluate the software accuracy of reformatted panoramic views from cone-beam computed tomography (CBCT).

METHODS

Ten dry mandibles were scanned using CBCT with different voxel sizes. Following the reconstruction of panoramic views with three different software, horizontal and vertical linear measurements were performed using the electronic rules of each software. Measurements of the corresponding dry mandibles were taken with a digital caliper and defined as the gold standard.

RESULTS

There were no statistically significant differences in linear distances among the dry mandibles and reformatted panoramic CT views. The relative error ranged from 1.3 to 8.0%, depending on the software and voxel size.

CONCLUSIONS

The linear measurements on reformatted panoramic views are reliable.

Microtomographic analysis of the effect of sodium alendronate on orthodontic movement in rats

OBJECTIVE

To evaluate the effect of sodium alendronate on orthodontic tooth movement in rats using microtomographic analysis.

SETTINGS AND SAMPLE POPULATION

Thirty male Wistar rats (Rattus norvegicus) were divided into three groups of 10 rats and administered saline (control), 1 mg/kg sodium alendronate or 6 mg/kg sodium alendronate, respectively.

MATERIALS AND METHODS

The drug was administered once per week for 5 weeks by gavage. Orthodontic movement was induced during the last 2 weeks of medication administration by inserting a closed nickel-titanium spring between the left upper first molar and central incisors. The opposite side served as the control. Tooth movement and bone trabeculation in the furcation region were evaluated by microtomographic analysis in the first (moved) and third (static) molars. The data were subjected to one-way or two-way ANOVA and Bonferroni test (P < .05).

RESULTS

The microtomographic images of the group that received 6 mg/kg sodium alendronate demonstrated significantly less tooth movement (P = .048), less space between the trabeculae (P = .031) and greater number of bone trabeculae (P = .033) compared to the other groups. There were no statistically significant differences in bone volume and mean trabecular thickness between the three groups. The static teeth did not show the same alterations (P > .05).

CONCLUSION

Sodium alendronate treatment reduced tooth movement in rats.

The crucial role of imaging in digital dentistry

One of the recent trends in dentistry - and this in every field from the restorative to the orthodontic one- is the introduction of simplified completely digital workflows. Digital dentistry is supposed to allow dentists to work more efficiently, and this at higher precision, and with the possibility of all-in-one sessions using in-house computerized techniques. In this workflow, one of the major tools for simulating and transferring dental treatments is imaging. Both 3D low dose radiographic as well as optical imaging are playing crucial roles and have been overwhelming the market. Novel design platforms, compact and extremely fast milling and printing units are now also plentiful and rapidly being adopted in practice. Nevertheless, many of the steps in this digital dentistry process, no matter how simplified, present risks that can contribute to reduced precision and clinical difficulties. It is therefore the purpose of the article to briefly describe the role of imaging in this digital workflow, and where the pitfalls can be found that may lead to errors and imprecision.

Qualitative and Quantitative Assessment of Alveolar Bone Destruction in Adult Rats Using CBCT

Cone-beam computed tomography (CBCT) has strong potential to be utilized in various aspects of veterinary dentistry. Using ex vivo rat maxillary bone and teeth, the purpose of this study was to compare gray value, surface area, and volumetric measurements of teeth with and without experimental periodontitis by CBCT. Periodontitis was induced in 36 molar teeth, while 36 teeth with a healthy periodontium served as control. Images of each specimen along with teeth were obtained using CBCT. The following measurements for each tooth with periodontitis (n = 36) were recorded: gray value measurement, width, height, depth, surface area, and volume of the alveolar bone loss. For the control group (n = 36), gray value measurement, surface area, and volume of the alveolar bone were recorded. All measurements were repeated after 3 weeks. As the gold standard, the rat maxillas were decalcified and paraffin-embedded for further immunocytochemical study. One-way analysis of variance (ANOVA) was used. Significance level was set at P < .05. Correlation values for gray value, width, height, depth, surface area, and volume measurements were 0.983, 0.966, 0.962, 0.880, 0.998, and 0.999, respectively, for the first and second measurements. One way ANOVA showed statistically significant differences between teeth with and without alveolar bone destruction conducted for gray value, surface area, and volume measurements (P = .000). Mean gray value, surface area, and volume measurements decreased 56.46%, 81.89%, and 78.56%, respectively, for teeth with alveolar bone destruction in comparison to healthy teeth. Cone-beam computed tomography provided useful qualitative and quantitative information regarding induced periodontitis in the rat maxilla.

Comparison of cone-beam computed tomography with bitewing radiography for detection of periodontal bone loss and assessment of effects of different voxel resolutions: an in vitro study

OBJECTIVE

The aim of the study was to compare intraoral radiographs and CBCT images for detection of horizontal periodontal bone loss, and to investigate the diagnostic effect of different voxel resolutions in CBCT imaging.

METHODS

A total of 240 sites with horizontal bone loss were measured on the buccal, lingual, mesial, and distal surfaces of 60 posterior teeth in four maxillary and six mandibular bones obtained from cadavers (dry skulls). Direct measurements on the dry skulls were accepted as the gold standard values. Measurements on CBCT images at two different voxel resolutions (0.250 and 0.160 mm³) and intraoral bitewing radiographs were compared with one another and with the gold standard values.

RESULTS

The measurements on the CBCT images at two voxel resolutions and bitewing radiographs did not differ significantly (p > 0.05) from the direct measurements on the dry skulls. No significant difference was found between the bitewing radiographs and CBCT images for measurements in the mesial and distal regions (p > 0.05). There was no significant difference between the measurements on the buccal and lingual surfaces at the two different voxel resolutions (p > 0.05).

CONCLUSIONS

CBCT scans are recommended for evaluation of buccal and lingual bone loss to avoid intraoral radiographs that exceed routine examination of interproximal alveolar bone loss. Furthermore, instead of basing the voxel size on the required CBCT scans, it is recommended to select the smallest possible field of view to reduce the dose of radiation.

Three-dimensional analysis of bone remodeling following ridge augmentation of compromised extraction sockets in periodontitis patients: A randomized controlled study

OBJECTIVES

The aim of this study was to analyze linear and volumetric hard tissue changes in severely resorbed alveolar sockets after ridge augmentation procedure and to compare them with spontaneous healing using three-dimensional cone beam computed tomography (CBCT).

MATERIAL AND METHODS

Thirty patients (mean age 53.2 ± 6.3 years) requiring tooth extraction for advanced periodontitis were randomly allocated to test and control groups. The test sites were grafted using a collagenated bovine-derived bone (DBBM-C) covered with a collagen membrane, while control sites had spontaneous healing. Both groups healed by secondary intention. Linear and volumetric measurements were taken on superimposed CBCT images obtained after tooth extraction and 12 months later.

RESULTS

Greater horizontal shrinkage, localized mainly in the crestal zone, was observed in the control group (4.92 ± 2.45 mm) compared to the test group (2.60 ± 1.24 mm). While both groups presented a rebuilding of the buccal wall, it was most pronounced in the grafted sockets (2.50 ± 2.12 mm vs. 0.51 ± 1.02 mm). A significant difference was also registered in the percentage of volume loss between grafted and non-grafted sites (9.14% vs. 35.16%, p-value <.0001).

CONCLUSION

Alveolar sockets with extensive buccal bone deficiencies undergo significant three-dimensional volumetric alterations following natural healing. The immediate application of a slow-resorbing xenograft with a covering collagen membrane seems to be effective in improving alveolar ridge shape and dimensions, thus potentially reducing the need for adjunctive regenerative procedures at the time of implant placement.

Influence of acquisition parameters on the evaluation of mandibular third molars through cone beam computed tomography

OBJECTIVES

The aim of the study was to assess the influence of cone beam computed tomography (CBCT) acquisition parameters on the evaluation of mandibular third molars and their relationship to the mandibular canal.

STUDY DESIGN

Eight dry human mandibles with 13 mandibular third molars were scanned with one CBCT unit. Voxel size (0.2 and 0.3 mm), field of view (FOV) size (12 × 8.5 cm and 5 × 5 cm), and number of basis images (450 and 720) were the variables studied. Two examiners evaluated the images, and the resulting data were compared through McNemar, McNemar-Bowker, and Student t tests. Additionally, dosimetry was determined for all protocols tested, and radiation doses were compared through analysis of variance.

RESULTS

The variables did not influence evaluation of mandibular third molars, except for voxel size, when assessing contact between the tooth and the mandibular canal (P = .021). Although FOV and number of basis images affected radiation dose, voxel size did not.

CONCLUSIONS

FOV size and number of basis images did not influence the evaluation of mandibular third molars and their relationship to the mandibular canal in the CBCT unit used. Conversely, smaller voxel size affected the assessment of contact between the tooth and the mandibular canal. In units in which voxel size does not influence radiation dose, the most appropriate CBCT protocol is the one using a smaller voxel size and delivering the lowest radiation dose to the patient.

The Use of Cone-Beam Computed Tomography in Furcation Defects Diagnosis

Background: The use of cone-beam computed tomography (CBCT), as an additional diagnostic tool in daily dental practice, has expanded rapidly in recent years. Since CBCT allows assessment of dento-maxillofacial structures in three-dimensional manner, its use may be very tempting in alveolar bone furcation defects (FDs) diagnosis.

Aim: The aim of this study was to determine the impact of clinical experience and experience with CBCT on FD detection in patients with periodontitis.

Material and Methods: Fifteen patients with chronic generalized severe periodontitis were included in the study. In total, 168 furcation sites were analyzed on CBCT images by a previously trained senior year undergraduate student (O1) and a PhD student with three years of CBCT experience (O2), and compared to clinical findings (probing). CBCT images were analyzed on two separate occasions, within a 7-day interval. FDs were assessed both clinically and on CBCT images, using a dichotomous scale (present/absent). Intraobserver agreement for each observer was calculated by using Kappa coefficient (k). Interobserver agreement and agreement between CBCT and clinical findings for both observers were calculated.

Results: Kappa coefficient value for both observers indicated a high intraobserver agreement (k1=0.75; k2=0.94). Interobserver agreement of CBCT image analyses was present in 72.6% (73.0% in maxilla, 71.7% in mandible). Agreement between CBCT image analyses and clinical findings for O1 was 48.8% and 51.2% for O2.

Conclusion: It can be assumed that clinical experience and CBCT proficiency do not have an impact on FD detection on CBCT images, if an appropriate training was previously performed.

Cone beam computed tomography-based models versus multislice spiral computed tomography-based models for assessing condylar morphology

OBJECTIVE

To quantitatively compare condylar morphology using cone beam computed tomography (CBCT) and multislice spiral computed tomography (MSCT) virtual three-dimensional surface models.

STUDY DESIGN

The sample consisted of secondary data analyses of CBCT and MSCT scans obtained for clinical purposes from 74 patients treated with condylar resection and prosthetic joint replacement. Three-dimensional surface models of 146 condyles were constructed from each scan modality. Across-subject models were approximated and voxel-based registration was performed between homologous CBCT and MSCT images, making it possible to create average CBCT- and MSCT-based condylar models. SPHARM-PDM software provided matching points on each corresponding model. ShapeAnalysisMANCOVA software assessed statistically significant differences between observers and imaging modalities. One-sample t-tests evaluated the null hypothesis that the mean differences between each CBCT- and MSCT-based model were not clinically significant (<.5 mm). Tests were conducted at a significance level of P < .05.

RESULTS

ShapeAnalysisMANCOVA showed no statistically significant difference between the average CBCT- and MSCT-based models (P > .68). During pairwise comparison, the mean difference observed was .406 mm (SD, .173). One sample t-test showed that mean differences between each set of paired CBCT- and MSCT-based models were not clinically significant (P = .411).

CONCLUSION

Three-dimensional surface models constructed from CBCT images are comparable to those derived from MSCT scans and may be considered reliable tools for assessing condylar morphology.