Diagnostic Applications of Cone-Beam CT for Periodontal Diseases

The Role of Cone Beam Computed Tomography in Periodontology: From 3D Models of Periodontal Defects to 3D-Printed Scaffolds

The treatment of osseous defects around teeth is a fundamental concern within the field of periodontology. Over the years, the method of grafting has been employed to treat bone defects, underscoring the necessity for custom-designed scaffolds that precisely match the anatomical intricacies of the bone cavity to be filled, preventing the formation of gaps that could allow the regeneration of soft tissues. In order to create such a patient-specific scaffold (bone graft), it is imperative to have a highly detailed 3D representation of the bone defect, so that the resulting scaffold aligns with the ideal anatomical characteristics of the bone defect. In this context, this article implements a workflow for designing 3D models out of patient-specific tissue defects, fabricated as scaffolds with 3D-printing technology and bioabsorbable materials, for the personalized treatment of periodontitis. The workflow is based on 3D modeling of the hard tissues around the periodontal defect (alveolar bone and teeth), scanned from patients with periodontitis. Specifically, cone beam computed tomography (CBCT) data were acquired from patients and were used for the reconstruction of the 3D model of the periodontal defect. The final step encompasses the 3D printing of these scaffolds, employing Fused Deposition Modeling (FDM) technology and 3D-bioprinting, with the aim of verifying the design accuracy of the developed methodοlogy. Unlike most existing 3D-printed scaffolds reported in the literature, which are either pre-designed or have a standard structure, this method leads to the creation of highly detailed patient-specific grafts. Greater accuracy and resolution in the macroarchitecture of the scaffolds were achieved during FDM printing compared to bioprinting, with the standard FDM printing profile identified as more suitable in terms of both time and precision. It is easy to follow and has been successfully employed to create 3D models of periodontal defects and 3D-printed scaffolds for three cases of patients, proving its applicability and efficiency in designing and fabricating personalized 3D-printed bone grafts using CBCT data.

Comparative Assessment of Reliability and Accuracy of Cone-Beam Computed Tomography (CBCT) Over Direct Surgical Measurement for Periodontal Bone Loss: A Prospective, Cross-Sectional Study

INTRODUCTION

Assessing bone condition holds significant value in the diagnosis, treatment planning, and prognosing the periodontal disease; its importance is undeniable. The main aim of the present study was to evaluate the accuracy of alveolar bone measurements due to periodontal disease using cone-beam computed tomography (CBCT), by comparing with surgical measurements, considered as the gold standard.

MATERIALS AND METHODS

A prospective cross-sectional study included a sample of 40 individuals diagnosed with chronic periodontitis who required periodontal surgery. A total of 202 sites were assessed for vertical and horizontal bone loss in the anterior (76 sites) and posterior (126 sites) teeth. Bone loss was measured using CBCT and a UNC 15 periodontal probe during the surgical intervention, and then compared. The statistical analysis involved employing a Student's t-test to compare measurements. Unpaired t-tests and correlation analyses were conducted using Pearson's correlation coefficient test. To establish statistical significance, a threshold of p<0.05 was considered appropriate.

RESULTS

The statistical analysis carried out on the mean values of CBCT and direct surgical measurements for vertical bone loss demonstrated a significant difference (p<0.01). However, the values obtained for horizontal bone loss did not display statistical significance. A strong correlation of 0.94-0.99 existed between surgical and CBCT measurements. A statistically significant distinction was observed between the two methods in measuring bone loss at the distal and palatal sites of the anterior teeth.

CONCLUSION

Both CBCT and direct surgical measurement exhibit comparable accuracy potential in assessing alveolar bone loss. CBCT provides an accessibility advantage by enhancing visual access to challenging sites during surgical interventions, including palatal and distal areas of the teeth.

CBCT-Based Design of Patient-Specific 3D Bone Grafts for Periodontal Regeneration

The purpose of this article is to define and implement a methodology for the 3D design of customized patient-specific scaffolds (bone grafts) for the regeneration of periodontal tissues. The prerequisite of the proposed workflow is the three-dimensional (3D) structure of the periodontal defect, i.e., the 3D model of the hard tissues (alveolar bone and teeth) around the periodontal damage, which is proposed to be generated via a segmentation and 3D editing methodology using cone beam computed tomography (CBCT) data. Two types of methodologies for 3D periodontal scaffold (graft) design are described: (i) The methodology of designing periodontal defect customized block grafts and (ii) the methodology of designing extraction socket preservation customized grafts. The application of the proposed methodology for the generation of a 3D model of the hard tissues around periodontal defects of a patient using a CBCT scan and the 3D design of the two aforementioned types of scaffolds for personalized periodontal regenerative treatment shows promising results. The outputs of this work will be used as the basis for the 3D printing of bioabsorbable scaffolds of personalized treatment against periodontitis, which will simultaneously be used as sustained-release drug carriers.

Automatic segmentation of inferior alveolar canal with ambiguity classification in panoramic images using deep learning

Background

Manual segmentation of the inferior alveolar canal (IAC) in panoramic images requires considerable time and labor even for dental experts having extensive experience. The objective of this study was to evaluate the performance of automatic segmentation of IAC with ambiguity classification in panoramic images using a deep learning method.

Methods

Among 1366 panoramic images, 1000 were selected as the training dataset and the remaining 336 were assigned to the testing dataset. The radiologists divided the testing dataset into four groups according to the quality of the visible segments of IAC. The segmentation time, dice similarity coefficient (DSC), precision, and recall rate were calculated to evaluate the efficiency and segmentation performance of deep learning-based automatic segmentation.

Results

Automatic segmentation achieved a DSC of 85.7% (95% confidence interval [CI] 75.4%-90.3%), precision of 84.1% (95% CI 78.4%-89.3%), and recall of 87.7% (95% CI 77.7%-93.4%). Compared with manual annotation (5.9s per image), automatic segmentation significantly increased the efficiency of IAC segmentation (33 ms per image). The DSC and precision values of group 4 (most visible) were significantly better than those of group 1 (least visible). The recall values of groups 3 and 4 were significantly better than those of group 1.

Conclusions

The deep learning-based method achieved high performance for IAC segmentation in panoramic images under different visibilities and was positively correlated with IAC image clarity.

The Radiographic Assessment of Furcation Area in Maxillary and Mandibular First Molars while Considering the New Classification of Periodontal Disease

This study aimed to evaluate the radiographic reliability in the diagnosis of furcation involvement in first molars. A total of 52 subjects were included in the current study. Personal history regarding smoking was recorded and a periodontal examination was performed. Pocket depth (PD), clinical attachment level (CAL), gingival recession, and furcation involvement in all first molars were assessed for each patient. Periodontal staging and grading were evaluated using the new classification of periodontal disease. Class II and Class III furcation classification were more frequently observed in radiographs than the Class I furcation; however, no significant differences were observed. Radiographic observation of the furcation was seen more when PD and CAL were >5 mm in all molars. The presence of gingival recession and its relation to the radiographic assessment did not reveal any statistically significant association (p > 0.05) except for tooth #16. The trend of visibility of furcation radiographically was more as the grade of staging was increased. Moreover, the presence of smoking habits and visibility of furcation radiographically did not have any statistical significance. Smoking may not be a factor in the furcation involvement. There is a direct relationship between the staging and grading of the periodontitis and furcation involvement.

The Effects of Additional Filtration on Image Quality and Radiation Dose in Cone Beam CT: An In Vivo Preliminary Investigation

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.

Cone-Beam Computed Tomography in Periodontal Diagnosis and Treatment Planning

Diagnosis of periodontal disease depends on conventional clinical parameters. In periodontitis with extensive bone defects, radiographs play a crucial role in arriving at a proper diagnosis. The emergence of cone-beam computed tomography (CBCT) became a boon in oral radiology. Limitations of conventional two-dimensional (2D) radiographs include inadequate visualization of bone defects, lamina dura, and furcation involvement. CBCT generates 3D images of anatomical structures necessary for the periodontal diagnosis of furcation involvement, intrabony defects, and implant placement. CBCT, thus, imparts various potential applications in the field of periodontics which serves to arrive at better diagnostic conclusions.

Accuracy of cone beam computed tomography in evaluation of palatal mucosa thickness

AIM

The purpose of this study was to investigate the accuracy of the measurement of palatal mucosa thickness using cone beam computed tomography (CBCT) and to create a conversion formula to evaluate palatal mucosa thickness more accurately. We then evaluated the palatal mucosa thickness in a Japanese population using CBCT and the conversion formula.

MATERIALS AND METHODS

We evaluated palatal mucosa thickness in 10 healthy subjects at 15 sites using CBCT, digital impression, and K file. Multiple regression analysis was performed to create a conversion formula to measure thickness accurately. We then obtained CBCT data from 174 patients retrospectively, applied the conversion formula, and evaluated palatal mucosa thickness.

RESULTS

Sites of measurement affected measurement error. Measurement using CBCT was 0.34 ± 0.04 mm smaller than actual measurement; therefore, a conversion formula was created. Male, age ≥60 years, and probing pocket depth ≥4 mm had significant and positive associations with palatal mucosa thickness; however, no association was observed between bleeding on probing and palatal mucosa thickness.

CONCLUSION

CBCT is useful for the noninvasive and accurate measurement of palatal mucosa thickness.

A Comparison of Clinical and Radiological Parameters in the Evaluation of Molar Furcation Involvement in Periodontitis

Objective

The aim of this study was to compare clinical, intra-surgical, 2D (panoramic) and 3D (CBCT)-based parameters in assessing molar furcation involvement (FI).

Materials and Methods

Six patients with generalized periodontitis Stage II to IV, Grade B and C who were scheduled for the periodontal flap surgical treatment were recruited in the study. In total, 38 molar teeth with 93 furcation sites were analysed. All subjects had comprehensive periodontal examination, which included an assessment of molar FI using Naber’s probe according to modified Glickman’s classification. Periodontal surgery was performed in patients with at least one maxillary molar with probing depth of ≥6 mm. This probing demonstrated lower grade of FI compared with intra-surgical findings.

Results

Periodontal probing, intra-surgical measurement and measurements based on CBCT significantly correlated with each other regarding the assessment of FI, with r values ranging between 0.81 to 1.00 (p<0.01). The correlation of panoramic radiograph with periodontal probing is 0.49, with CBCT 0.39 and with intra-surgical measurements 0.36. The results showed an excellent agreement and higher accuracy between intra-surgical measurements and CBCT (0.96), in contrast to clinical examination and panoramic radiography- 0.87 and 0.63 respectively. Different clinical and radiological modalities showed a correlation among each other. They are accurate and have their own benefits, which makes (renders) them useful in establishing periodontal diagnosis and treatment planning.

Conclusion

However, CBCT offers significant advantages including excellent agreement and higher accuracy and can be used as justified as excellent diagnostic tool in detecting and locating FI to provide a more reliable diagnosis and basis for treatment decisions.

Ex vivo comparison of CBCT and digital periapical radiographs for the quantitative assessment of periodontal defects

OBJECTIVES

Accurate imaging is essential for effective treatment planning in periodontology. The aim of this ex vivo study was to investigate the accuracy of cone beam computed tomography (CBCT) and digital periapical radiographs (PA) in imaging periodontal defects. Hypotheses are: 1. That CBCT is a more accurate method than PA concerning vertical measurements of periodontal bone defects2. That CBCT itself is an accurate method to describe vertical periodontal bone loss MATERIAL AND METHODS: In this study, 117 periodontal defects from 10 human cadavers were investigated radiographically by CBCT and PA by one calibrated observer. Afterwards the vertical bone loss was measured with a periodontal probe by the same calibrated observer. Differences between radiographic and clinical measurements were calculated and analyzed. Bland-Altmann plots including 95% limits of agreement were calculated.

RESULTS

The 95% limits of agreement ranged from 3.29 to -3.27 mm between clinical measurements and measurements in PAs, and from 2.13 to -1.97 mm in CBCTs. The mean difference between clinical and radiographic measurements was 0.0009 mm for PA and 0.0835 mm for CBCT.

CONCLUSIONS

When comparing the clinical measurements, CBCT had a higher agreement and less deviations than PAs, and CBCT seems to be an accurate method to describe vertical periodontal bone loss.

CLINICAL RELEVANCE

Accurate description of defects is helpful for accurate treatment planning.

The Diagnostic Yield of Dental Radiography and Cone-Beam Computed Tomography for the Identification of Dentoalveolar Lesions in Cats

The objective of this study was to evaluate the diagnostic yield of dental radiography (DR) and 3 cone-beam computed tomography (CBCT) software modules for the identification of 32 pre-defined dentoalveolar lesions in cats. For 5 feline cadaver heads and 22 client-owned cats admitted for evaluation and treatment of dental disease, 32 predefined dentoalveolar lesions were evaluated separately and scored by use of dental radiography and 3 CBCT software modules [multiplanar reconstructions (MPR), tridimensional (3-D) rendering, and reconstructed panoramic views]. A qualitative scoring system was used. Dentoalveolar lesions were grouped into 14 categories for statistical analysis. Point of reference for presence or absence of a dentoalveolar lesion was determined as the method that could be used to clearly identify the disorder as being present. Accuracy, sensitivity, specificity, and positive and negative predictive values were calculated with the McNemar χ² test of marginal homogeneity of paired data. When all 3 CBCT software modules were used in combination, the diagnostic yield of CBCT was significantly higher than that of dental radiography for 4 of 14 categories (missing teeth, horizontal bone loss, loss of tooth integrity, feline resorptive lesions), and higher, although not significantly so, for 9 categories (supernumerary teeth, supernumerary roots, abnormally shaped roots, vertical bone loss, buccal bone expansion, periapical disease, inflammatory root resorption, and external replacement root resorption). In conclusion, we found that CBCT provided more clinically relevant detailed information as compared to dental radiography. Therefore, CBCT should be considered better suited for use in diagnosing dentoalveolar lesions in cats.

Imaging of symptomatic total knee arthroplasty with cone beam computed tomography

BACKGROUND

Computed tomography (CT) can be used to assess the rotational alignment of prosthesis components to identify possible underlying causes of symptomatic total knee arthroplasty (TKA). The use of cone beam computed tomography (CBCT) for the imaging of extremities is relatively new, although it has been widely used in dental imaging.

PURPOSE

To assess the intra- and inter-observer reproducibility of CBCT, as well as to validate CBCT for TKA component and periprosthetic bone diagnostics.

MATERIAL AND METHODS

CBCT scans were performed on 18 patients the day before a scheduled revision TKA, from which the intra- and inter-observer reproducibility were assessed. Component rotation and loosening were evaluated. Perioperative bone defects were classified.

RESULTS

The inter-observer intraclass coefficient correlation (ICC) for femoral component rotation was 0.41 (95% confidence interval [CI] = 0.12-0.69). For the tibial component, the ICC was 0.87 (95% CI = 0.74-0.94). Intra-observer reproducibilities were 0.70 (95% CI = 0.35-0.87) and 0.92 (95% CI = 0.80-0.97), respectively. The sensitivity for tibial component loosening was 97% and the specificity was 85%. The reliability of bone defect classification was only weak to moderate.

CONCLUSION

Two-dimensional (2D) CBCT scanning provides reliable and reproducible data for determining the rotation of femoral and tibial components, while showing minor overestimation of tibial component loosening. CBCT is a promising new tool for the evaluation of symptomatic knee arthroplasty patients, with a substantially lower radiation dose compared to conventional 2D multi-slice CT.

Comparison of conventional imaging techniques and CBCT for periodontal evaluation: A systematic review

Purpose

This study aimed to carry out a systematic review of studies in the literature comparing conventional imaging techniques with cone-beam computed tomography in terms of the role of these techniques for assessing any of the following periodontal conditions and parameters: infrabony defects, furcation involvement, height of the alveolar bone crest, and the periodontal ligament space.

Materials and Methods

Interventional and observational studies comparing conventional imaging techniques with cone-beam computed tomography were considered eligible for inclusion. The MEDLINE and Embase databases were searched for articles published through 2017. The PRISMA statement was followed during data assessment and extraction.

Results

The search strategy yielded 351 publications. An initial screening of the publications was performed using abstracts and key words, and after the application of exclusion criteria, 13 studies were finally identified as eligible for review.

Conclusion

These studies revealed cone-beam computed tomography to be the best imaging technique to assess infrabony defects, furcation lesions, the height of the alveolar bone crest, and the periodontal ligament space.

A retrospective study on molar furcation assessment via clinical detection, intraoral radiography and cone beam computed tomography

Background

Accurate determination of bone loss at the molar furcation region by clinical detection and intraoral radiograph is challenging in many instances. Cone beam computed tomography (CBCT) is expected to open a new horizon in periodontal assessment. The purpose of this study was to compare and correlate accuracy of molar furcation assessment via clinical detection, intraoral radiography and CBCT images.

Methods

Eighty-three patients with chronic periodontitis who had existing CBCT scans were included. Furcation involvement was assessed on maxillary and mandibular first molars. Periodontal charts (modified Glickman’s classification), intraoral (periapical and/or bitewing) radiographs (recorded as presence or absence) and axial CBCT reconstructions were used to evaluate furcation involvement on buccal and palatal/lingual sites. The correlation of furcation assessment by the three methods was evaluated by Pearson analysis.

Results

There were significant correlations (p < 0.05) between clinical detection and intraoral radiography, clinical detection and CBCT, as well as intraoral radiography and CBCT at all the measured sites (r values range between 0.230 to 0.644). CBCT generally exhibited higher correlation with clinical detection relative to intraoral radiography, especially at distal palatal side of maxillary first molar (p < 0.05). In addition, CBCT provided more accurate assessment, with bone loss measurement up to 2 decimals in millimeters, whereas clinical detection had 3 classes and the intraoral radiographs usually only detected the presence of furcation involvement in Glickman Class 2 and 3.

Conclusions

This study validates that CBCT is a valuable tool in molar furcation assessment in addition to clinical detection and intraoral radiography.

Comparison of periodontal evaluation by cone-beam computed tomography, and clinical and intraoral radiographic examinations

OBJECTIVES

Cone-beam computed tomography (CBCT) has been widely used in many fields of dentistry. However, little is known about the accuracy of CBCT for evaluation of periodontal status. The objective of this study was to compare and correlate periodontal assessments among CBCT, clinical attachment loss (CAL) measurement, and periapical (PA)/bitewing (BW) radiography.

METHODS

Eighty patients (28 males, 52 females; age range, 19-84 years) from the University of Texas School of Dentistry at Houston were evaluated retrospectively. Measurements were taken on the central incisors, canines, and first molars of the right maxilla and left mandible. CAL was extracted from periodontal charts. The radiographic distance from the cementum-enamel junction (CEJ) to the alveolar crest was measured for tooth mesial and distal sites on PA/BW and CBCT images using MiPacs software and Anatomage Invivo software, respectively. One-way ANOVA and Pearson analysis were performed for statistical analyses.

RESULTS

The CEJ-crest distances for CBCT, PA/BW, and CAL were 2.56 ± 0.12, 2.04 ± 0.12, and 2.08 ± 0.17 mm (mean ± SD), respectively. CBCT exhibited larger values than the other two methods (p < 0.05). There were highly significant positive correlations among CBCT, PA/BW, and CAL measurements at all examined sites (p < 0.001). The Pearson correlation coefficient was higher for CBCT with CAL relative to PA/BW with CAL, but the difference was not significant (r = 0.64 and r = 0.55, respectively, p > 0.05).

CONCLUSIONS

This study validates the suitability of CBCT for periodontal assessment. Further studies are necessary to optimize the measurement methodology with CBCT.

Detection of Dental Pathologies in Routine Paranasal CT Scans: A Retrospective Study

INTRODUCTION

Multidetector Computed Tomography (MDCT) is a widespread method for evaluating paranasal sinuses and nasal cavity in daily practice. The maxillary teeth are in field of view in a paranasal sinus CT scan and it is possible to detect dental pathologies with CT.

AIM

To determine the incidence of maxillary teeth pathologies in routine paranasal sinus CT scans.

MATERIALS AND METHODS

A retrospective study was conducted. Consecutive 395 paranasal sinus CT scans were evaluated. All CT images were obtained with a 64 detector-CT. Patients with previous facial trauma, operation, invasive tumors and repeated exams were excluded. Detected findings were classified as "tooth loss, dental restorations or procedures and dental pathologies (carious lesions, dental developmental anomalies, periapical lesions and periodontal diseases). The proportion of findings was reported as simple percentiles.

RESULTS

Three hundred and eighty-four CT scans were included in the study. Dental restorations or procedures were determined in 129 (33.5%) patients. A total of 34 (8.8%) patients had normal teeth count and morphology. A total of 264 (64.3%) patients had at least one tooth loss. A total of 195 (51%) patients had at least one or more dental pathology. Number of dental carious lesions, dental developmental anomalies, periapical lesions and periodontal disease were 104 (27.0%), 78 (14.3%), 46 (11.9%), 44 (11.4%), respectively.

CONCLUSION

Dental pathologies were encountered in more than half of the patients. Detecting dental pathologies may prevent tooth loss and improve oral health. The radiologist should keep in mind dental pathologies while evaluating paranasal sinus CT in daily practice.

Detection of furcation involvement using periapical radiography and 2 cone-beam computed tomography imaging protocols with and without a metallic post: An animal study

Purpose

The purpose of this study was to assess the accuracy, sensitivity, and specificity of the diagnosis of incipient furcation involvement with periapical radiography (PR) and 2 cone-beam computed tomography (CBCT) imaging protocols, and to test metal artifact interference.

Materials and Methods

Mandibular second molars in 10 macerated pig mandibles were divided into those that showed no furcation involvement and those with lesions in the furcation area. Exams using PR and 2 different CBCT imaging protocols were performed with and without a metallic post. Each image was analyzed twice by 2 observers who rated the absence or presence of furcation involvement according to a 5-point scale. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy, sensitivity, and specificity of the observations.

Results

The accuracy of the CBCT imaging protocols ranged from 67.5% to 82.5% in the images obtained with a metallic post and from 72.5% to 80% in those without a metallic post. The accuracy of PR ranged from 37.5% to 55% in the images with a metallic post and from 42.5% to 62.5% in those without a metallic post. The area under the ROC curve values for the CBCT imaging protocols ranged from 0.813 to 0.802, and for PR ranged from 0.503 to 0.448.

Conclusion

Both CBCT imaging protocols showed higher accuracy, sensitivity, and specificity than PR in the detection of incipient furcation involvement. Based on these results, CBCT may be considered a reliable tool for detecting incipient furcation involvement following a clinical periodontal exam, even in the presence of a metallic post.

[Prospects of endoscopic technology for diagnostics of inflammatory periodontal disease]

The aim of the study was to analyze research methods for periodontitis severity and elaborate the most effective diagnostic combination. Twenty patients with moderate periodontal disease were included in the study. In addition to conventional diagnostic methods depth of periodontal pockets (PP) was measured by means of endoscopic system and cone bean CT. Differences in PP depth estimated by probing and endoscopic evaluation was 1.2±0.4 mm proving endoscopic method to be useful and most precise tool for periodontal diagnostics.

Comparing Intraoral Radiography and Computed Tomography for Detecting Radiographic Signs of Periodontitis and Endodontic Disease in Dogs: An Agreement Study

OBJECTIVE

To determine whether computed tomography (CT) and intraoral radiography are interchangeable for detecting signs of periodontitis and endodontic disease in dogs.

MATERIALS AND METHODS

An agreement study was performed using 40 dogs that previously underwent intraoral radiography and CT during the same anesthetic episode. Images of each tooth were examined by two blinded observers for signs of periodontitis and/or endodontic disease. Agreement between imaging modalities and between observers was assessed using the Kappa statistic.

RESULTS

Agreement between modalities for detecting periodontitis in the maxillae ranged from poor to very good (κ 0.07-1.00) with 16/20 (80%) of the teeth having a score of moderate or better (κ ≥ 0.41). Agreement between modalities for detecting signs consistent with periodontitis in the mandibles ranged from poor to very good (κ 0.01-1.00) with 10/22 (45%) of the teeth having a score of good or better (κ ≥ 0.61); 50% of the disagreement was present in the incisors. Agreement between modalities for detecting signs consistent with endodontic disease in the whole mouth ranged from fair to very good (κ 0.21-1.00) with 30/42 (71%) of the teeth having a score of moderate or better (κ ≥ 0.41). Agreement between observers evaluating intraoral radiology ranged from poor to very good (κ 0.05-1) for detecting signs consistent with periodontitis and from fair to very good (κ 0.36-1) for detecting signs consistent with endodontic disease, in the whole mouth. Agreement between observers evaluating CT ranged from fair to very good (κ 0.35-1) for detecting signs consistent with periodontitis and from fair to very good (κ 0.36-1) for detecting signs consistent with endodontic disease, in the whole mouth.

CONCLUSION

Performing both CT and intraoral radiography may be unnecessary to detect signs consistent with periodontitis and endodontic disease in dogs based on the amount of agreement between modalities and observers when CT images are acquired and reconstructed in 0.5 or 1 mm slice thickness, except for diagnosing periodontitis in the mandibular incisors.

Detection of simulated periodontal defects using cone-beam CT and digital intraoral radiography

OBJECTIVES:

This study sought to assess the diagnostic value of CBCT and digital intraoral radiography for the detection of periodontal defects in the sheep mandible.

METHODS:

In this in vitro study, 80 periodontal defects including Grades I, II and III furcation involvements, one-, two-, three-wall and trough-like infrabony defects, fenestration and dehiscence were artificially created in the sheep mandible by burr. Intraoral digital radiographs using photostimulable phosphor plates and CBCT scans were obtained. Three periodontists evaluated the images for the presence and type of defects. The results were compared with the gold standard (photographs of the created defects).

RESULTS:

CBCT scans were significantly superior to digital radiographs for the detection of Grade I furcation involvements, three-wall defects, fenestrations and dehiscence (p < 0.05). No significant difference was noted between CBCT and digital radiography for the detection of Grades II and III furcation involvements, one-wall, two-wall and trough-like defects (p-value > 0.05).

CONCLUSIONS:

CBCT was superior to digital intraoral radiography for the detection of Grade I furcation involvements, three-wall defects, dehiscence and fenestrations.

Accuracy and precision of cone beam computed tomography in periodontal defects measurement (systematic review)

Systematic review of literature was made to assess the extent of accuracy of cone beam computed tomography (CBCT) as a tool for measurement of alveolar bone loss in periodontal defect. A systematic search of PubMed electronic database and a hand search of open access journals (from 2000 to 2015) yielded abstracts that were potentially relevant. The original articles were then retrieved and their references were hand searched for possible missing articles. Only articles that met the selection criteria were included and criticized. The initial screening revealed 47 potentially relevant articles, of which only 14 have met the selection criteria; their CBCT average measurements error ranged from 0.19 mm to 1.27 mm; however, no valid meta-analysis could be made due to the high heterogeneity between the included studies. Under the limitation of the number and strength of the available studies, we concluded that CBCT provides an assessment of alveolar bone loss in periodontal defect with a minimum reported mean measurements error of 0.19 ± 0.11 mm and a maximum reported mean measurements error of 1.27 ± 1.43 mm, and there is no agreement between the studies regarding the direction of the deviation whether over or underestimation. However, we should emphasize that the evidence to this data is not strong.

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

OBJECTIVE

To assess the accuracy of cone beam computed tomography (CBCT) images obtained at different voxel sizes in detecting ligature-induced furcation involvement.

STUDY DESIGN

Furcation lesions were prepared in 36 molar teeth in rats, and 24 intact teeth served as controls. CBCT Kodak 9000 images at three different voxel sizes were acquired: 0.076 mm, 0.100 mm, and 0.200 mm. Four observers assessed 3 sets of images using a 5-point evaluation scale. κ-Coefficients were calculated for intra- and interobserver agreement. Receiver operating characteristic analysis measured the true positive rate (TPR), true negative rate (TNR), and area under the curve (AUC). Accuracy values were compared by using Mood's Median Chi-Square (α<0.05).

RESULTS

Intra- and interobserver agreement ranged from 0.600 to 0.999 and from 0.366 to 0.573, respectively. Highest median AUC and true positive rate (TPR) values were obtained for voxel size of 0.076 mm. The highest median TNR values were obtained for the voxel size 0.1 mm. There were no significant differences (P≥.05) among the median AUC, TPR, or TNR values for the 3 different CBCT voxel sizes.

CONCLUSIONS

Given the limitations of this study, all voxel sizes performed similarly in the detection of furcation involvement.

Comparison of the influence of FOV sizes and different voxel resolutions for the assessment of periodontal defects

OBJECTIVES

This study assessed the influence of different voxel resolutions of two different CBCT units on the in vitro detection of periodontal defects.

METHODS

The study used 12 dry skulls with a maxilla and a mandible. Artificial defects (dehiscence, tunnel, fenestration) were separately created on the anterior, premolar and molar teeth using burrs. A total of 14 dehiscences, 13 fenestrations, 8 tunnels and 16 non-defect controls were used in the study. Images were obtained from two different CBCT units in six voxel sizes (voxel size: 0.080, 0.100, 0.125, 0.150, 0.160 and 0.200 mm3). Kappa coefficients were calculated to assess both intra- and interobserver agreements for each image set.

RESULTS

Overall intraobserver kappa coefficients ranged between 0.978 and 0.973 for the 0.080-mm3 images and between 0.751 and 0.737 for the 0.160-mm3 images, suggesting notably high intraobserver agreement for detecting periodontal defects. CBCT performed significantly better at detecting fenestrations (p<0.05) than tunnel and dehiscence defects. No statistically significant difference was found between the detection of dehiscence and tunnel defects (p>0.05).

CONCLUSIONS

A voxel size of 0.150 mm3 was identified as the cut-off point for overall detection of periodontal defects. CBCT should be considered the most reliable imaging modality for the diagnosis of periodontal defects.