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Lennholm C, Westerlund A, Lund H. Assessment of thin bony structures using cone-beam computed tomography. Angle Orthod 2023; 93:490740. [PMID: 36795048 PMCID: PMC10117211 DOI: 10.2319/090922-633.1] [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: 09/01/2022] [Accepted: 01/01/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES To investigate the validity and reliability of marginal bone level measurements on cone-beam computed tomography (CBCT) images of thin bony structures using various reconstruction techniques, two image resolutions, and two viewing modes. MATERIALS AND METHODS CBCT and histologic measurements of the buccal and lingual aspects of 16 anterior mandibular teeth from 6 human specimens were compared. Multiplanar (MPR) and three-dimensional (3D) reconstructions, standard and high resolutions, and gray scale and inverted gray scale viewing modes were assessed. RESULTS Validity of radiologic and histologic comparisons were highest using the standard protocol, MPR, and the inverted gray scale viewing mode (mean difference = 0.02 mm) and lowest using a high-resolution protocol and 3D-rendered images (mean difference = 1.10 mm). Mean differences were significant (P < .05) at the lingual surfaces for both reconstructions, viewing modes (MPR windows), and resolutions. CONCLUSIONS Varying the reconstruction technique and viewing mode does not improve the observer's ability to visualize thin bony structures in the anterior mandibular region. The use of 3D-reconstructed images should be avoided when thin cortical borders are suspected. The small difference when using a high-resolution protocol is unjustified due to the higher radiation dose required. Previous studies have focused on technical parameters; the present study explores the next link in the imaging chain.
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Al-Haj Husain A, Stadlinger B, Özcan M, Schönegg D, Winklhofer S, Al-Haj Husain N, Piccirelli M, Valdec S. Buccal bone thickness assessment for immediate anterior dental implant planning: A pilot study comparing cone-beam computed tomography and 3D double-echo steady-state MRI. Clin Implant Dent Relat Res 2023; 25:35-45. [PMID: 36454235 DOI: 10.1111/cid.13160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To evaluate image quality and diagnostic accuracy of buccal bone thickness assessment in maxillary and mandibular anterior region using cone-beam computed tomography (CBCT) and 3-dimensional double-echo steady-state (DESS) MRI for preoperative planning of immediate dental implants in healthy individuals. METHODS One hundred and twenty teeth in 10 volunteers were retrospectively evaluated for image quality and artifacts using Likert scale (4 = excellent to 0 = decreased). Buccal bone thickness was measured at three measurement points (M1 = 2 mm from the cementoenamel junction, M2 = middle of the root, and M3 = at the root apex) for each tooth in the maxillary (13-23) and the mandibular anterior region (33-43). Descriptive statistics and two-way ANOVA with Tukey's Post-hoc test were performed to evaluate the significant differences (α = 0.05) between both imaging modalities. RESULTS Image quality showed little to no artifacts and enabled confident diagnostic interpretation (CBCT (3.72 ± 0.46); MRI (3.65 ± 0.49)), with no significant differences between both imaging modalities (p > 0.05). Regarding the assessment of buccal bone thickness at M1-M3 for the teeth 13-23 and 33-43, no significant differences were noted (p > 0.05). MRI demonstrated slight, nonsignificant overestimation of thickness with the canines having mainly a thick buccal bone wall, where thin buccal wall was evident for the central incisors. CONCLUSION Black bone MRI sequences, such as 3D-DESS MRI, for immediate implant planning provided confidential diagnostic accuracy in bone thickness assessment without significant disadvantages compared to CBCT. Thus, the implementation of no-dose protocols for dental rehabilitation using an immediate loading approach seems promising and could further improve the treatment strategy for dental rehabilitation.
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Affiliation(s)
- Adib Al-Haj Husain
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Mutlu Özcan
- Division of Dental Biomaterials, Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daphne Schönegg
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nadin Al-Haj Husain
- Division of Dental Biomaterials, Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Marco Piccirelli
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Heimes D, Schiegnitz E, Kuchen R, Kämmerer PW, Al-Nawas B. Buccal Bone Thickness in Anterior and Posterior Teeth-A Systematic Review. Healthcare (Basel) 2021; 9:1663. [PMID: 34946389 PMCID: PMC8700878 DOI: 10.3390/healthcare9121663] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Immediate dental implant placement has been a subject of great interest over the last decade. Here, information regarding the anatomy and bone thickness of the jaw prior to dental implant placement is crucial to increase the surgery's success and the patient's safety. The clinical premises for this approach have been controversially discussed. One of those heavily discussed premises is a buccal bone thickness of at least 1 mm thickness. This meta-analysis aims to systematically review buccal bone thickness (BBT) in healthy patients. Thus, the feasibility of immediate dental implant placement in daily practice can be assessed. (2) Methods: A search in the electronic databases was performed to identify articles reporting on BBT that was measured by computed tomography in adults. (3) Results: We were able to find 45 studies, including 4324 patients with 25,452 analyzed teeth. The analysis showed a BBT at the alveolar crest of 0.76 ± 0.49 mm in the maxillary frontal and of 1.42 ± 0.74 mm in the maxillary posterior region. In the mandible, the average measured values were similar to those in the maxilla (front: 0.95 ± 0.58 mm; posterior: 1.20 ± 0.96 mm). In the maxillary frontal region 74.4% and in the mandibular frontal region 61.2% of the crestal buccal bones showed widths <1 mm. (4) Conclusions: In more than 60% of the cases, the BBT at the alveolar crest is <1 mm in maxillary and mandibular frontal regions. This anatomic data supports careful pre-surgical assessment, planning of a buccal graft, and critical selection of indication for immediate implant placement, especially in the maxillary and mandibular frontal and premolar region.
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Affiliation(s)
- Diana Heimes
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (E.S.); (P.W.K.); (B.A.-N.)
| | - Eik Schiegnitz
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (E.S.); (P.W.K.); (B.A.-N.)
| | - Robert Kuchen
- Institute for Medical Statistics, Epidemiology and Informatics, University Medical Center of the Johannes-Gutenberg-University Mainz, 55131 Mainz, Germany;
| | - Peer W. Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (E.S.); (P.W.K.); (B.A.-N.)
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (E.S.); (P.W.K.); (B.A.-N.)
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Tanaka Y, Dutra V, Lin WS, Levon J, Hamada Y. Evaluation of the accuracy of buccal bone thickness measurement from cone beam computed tomography compared with histologic analysis. J Prosthet Dent 2021:S0022-3913(21)00499-6. [PMID: 34756426 DOI: 10.1016/j.prosdent.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
STATEMENT OF PROBLEM Three-dimensional radiographic assessment of buccal bone thickness and its integrity from cone beam computed tomography (CBCT) plays an essential role in immediate implant placement. However, the accuracy of CBCT measurements for the assessment of buccal bone thickness adjacent to maxillary anterior teeth is not well understood. PURPOSE The purpose of this observational study was to evaluate the accuracy of measuring the buccal bone thickness of maxillary anterior teeth from CBCT compared with direct measurement from histologic sections. A secondary objective was to analyze whether a minimal level of buccal bone thickness of maxillary anterior teeth can be detected from the CBCT scan. MATERIAL AND METHODS Five embalmed human cadavers with a complete anterior dentition were included in this study, providing 30 teeth for evaluation. After preparing reference notches at the gingival margin of each tooth, the anterior segments were scanned. The buccal bone thickness at 3, 5, and 7 mm from the notches was measured on the cross-sections obtained from the CBCT and histomorphometric images for a total of 90 sites. The CBCT measurements were compared with the histomorphometric measurements, and their agreement was assessed by using the Bland-Altman plots and intraclass correlation coefficients. The sensitivity and specificity of buccal bone detection were calculated from the CBCT scan. RESULTS Histologic examination showed absence of the buccal bone in 29 sites (32%). The mean ±standard deviation thickness of the buccal bone was 0.52 ±0.05 mm (range: 0 to 1.97 mm) from the CBCT analysis and 0.40 ±0.05 mm (range: 0 to 1.67 mm) from histology. Measurements obtained from the CBCT sections significantly overestimated the buccal bone thickness when compared with the histologic evaluation (P=.001). The intraclass correlation coefficient of buccal bone thickness between the CBCT and histology was ≤0.53, an agreement considered as poor. The sensitivity of the CBCT as a diagnostic tool to detect the presence or absence of the buccal bone was 75.4%, and the specificity was 65.5%. CONCLUSIONS The buccal bone thickness of maxillary anterior teeth was less than 2 mm at all sites as measured with both CBCT and histology evaluations. CBCT measurements had relatively low accuracy and reliability for the measurement of buccal bone thickness. These findings should be considered when using CBCT as a measuring tool for thin bone structures.
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Affiliation(s)
- Yoshiatsu Tanaka
- Resident, Postdoctoral Program in Prosthodontics, Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Ind
| | - Vinicius Dutra
- Clinical Associate Professor, Department of Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry, Indianapolis, Ind
| | - Wei-Shao Lin
- Associate Professor, Program Director, and Interim Chair, Advanced Education Program in Prosthodontics, Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Ind
| | - John Levon
- Clinical Associate Professor, Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Ind
| | - Yusuke Hamada
- Assistant Professor and Program Director, Advanced Education Program in Periodontics, Department of Periodontology, Indiana University School of Dentistry, Indianapolis, Ind.
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de Oliveira GB, Rebello IMC, Montanha Andrade K, Araujo NS, Dos Santos JN, Cury PR. Evaluation of alveolar process resorption after tooth extraction using the socket shield technique without immediate installation of implants: a randomised controlled clinical trial. Br J Oral Maxillofac Surg 2021; 59:1227-1232. [PMID: 34256958 DOI: 10.1016/j.bjoms.2021.04.001] [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: 12/19/2020] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
Our aim was to evaluate resorption of the alveolar ridge using the socket shield technique (SST) without immediate placement of dental implants. This randomised controlled clinical trial included 27 patients: 14 maxillary non-molar teeth were partially extracted using the SST (test group) and 13 were extracted using a minimally traumatic extraction approach (control group). Alterations in height and thickness of the alveolar ridge were evaluated by cone beam computed tomograms taken immediately after, and 100 days after, surgery. Minor resorption was observed in the height of the buccal and palatal plates, without intergroup difference (p ≥ 0.10). The test group showed significantly better preservation of the buccal-to-palatal crest dimension (p ≤ 0.05). In the control group, preservation of buccal plate thickness was significantly greater (p ≤ 0.05), but intragroup vertical resorption of the buccal plate and reduction in the buccal-to-palatal crest distance were greater (p ≤ 0.05). The SST without the immediate placement of implants showed greater preservation of the buccal-to-palatal crest dimension and lower preservation of buccal wall thickness compared with minimally traumatic extraction. In addition, it provided superior maintenance of the baseline buccal wall height. The modified SST is a promising approach, but factors that interfere with the results should be investigated.
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Affiliation(s)
- Getúlio Batista de Oliveira
- Post-graduate Program in Dentistry and Health, School of Dentistry, Federal University of Bahia, Salvador, Brazil
| | | | - Kátia Montanha Andrade
- Post-graduate Program in Dentistry and Health, School of Dentistry, Federal University of Bahia, Salvador, Brazil
| | - Nara Santos Araujo
- Post-graduate Program in Dentistry and Health, School of Dentistry, Federal University of Bahia, Salvador, Brazil
| | - Jean Nunes Dos Santos
- Division of Oral Pathology, School of Dentistry, Federal University of Bahia, Salvador, Brazil
| | - Patricia Ramos Cury
- Division of Periodontics, School of Dentistry, Federal University of Bahia, Salvador, Brazil.
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