Developing evidence-based clinical imaging guidelines of justification for radiographic examination after dental implant installation

Developing evidence-based clinical imaging guidelines for the diagnosis of vertically fractured teeth

OBJECTIVES

This study aimed to develop an evidence-based clinical imaging guideline for teeth suspected with vertical root fractures.

METHODS

An adaptation methodology based on the Korean Clinical Imaging Guidelines (K-CIG) was used in the guideline development process. After searching for guidelines using major databases such as Ovid-Medline, Elsevier-Embase, National Guideline Clearinghouse, and Guideline International Network, as well as domestic databases such as KoreaMed, KMbase, and KoMGI, two reviewers analyzed the retrieved articles. The retrieved articles were included in this review using well-established inclusion criteria.

RESULTS

Twenty articles were identified through an online search, of which three were selected for guideline development. Based on these three guidelines, this study developed specific recommendations concerning the optimal imaging modality for diagnosing teeth suspected of vertical root fractures.

CONCLUSIONS

Periapical radiography is the preferred method for assessing teeth with mastication-related pain and suspected vertical root fractures. However, if intraoral radiographs do not provide sufficient information about root fractures, a small FOV CBCT may be considered. However, the use of CBCT in endodontically treated teeth is significantly constrained by the presence of artificial shading.

Evaluation of peri-implant bone defects on cone-beam computed tomography and the diagnostic accuracy of detecting these defects on panoramic images

Purpose

This study was conducted to identify the typical sites and patterns of peri-implant bone defects on cone-beam computed tomography (CBCT) images, as well as to evaluate the detectability of the identified bone defects on panoramic images.

Materials and Methods

The study population included 114 patients with a total of 367 implant fixtures. CBCT images were used to assess the presence or absence of bone defects around each implant fixture at the mesial, distal, buccal, and lingual sites. Based on the number of defect sites, the presentations of the peri-implant bone defects were categorized into 3 patterns: 1 site, 2 or 3 sites, and circumferential bone defects. Two observers independently evaluated the presence or absence of bone defects on panoramic images. The bone defect detection rate on these images was evaluated using receiver operating characteristic analysis.

Results

Of the 367 implants studied, 167 (45.5%) had at least 1 site with a confirmed bone defect. The most common type of defect was circumferential, affecting 107 of the 167 implants (64.1%). Implants were most frequently placed in the mandibular molar region. The prevalence of bone defects was greatest in the maxillary premolar and mandibular molar regions. The highest kappa value was associated with the mandibular premolar region.

Conclusion

The typical bone defect pattern observed was a circumferential defect surrounding the implant. The detection rate was generally higher in the molar region than in the anterior region. However, the capacity to detect partial bone defects using panoramic imaging was determined to be poor.

Anatomy and function of the canalis sinuosus and its injury prevention and treatment strategies in implant surgery

The canalis sinuosus, a canal containing the anterior superior alveolar nerve bundle, originates from the infraorbital canal and extends along the maxillary sinus and nasal cavity edges to the anterior maxilla. It was once regarded as an anatomical variation. However, with the widespread application of cone beam computed tomography (CBCT), the detection rate of canalis sinuosus in the population has increased. The canalis sinuosus exhibits diverse courses, branching into multiple accessory canals and terminating at the nasal floor or the anterior tooth region, with the majority traversing the palatal side of the central incisor. The anterior superior alveolar nerve bundle within the canalis sinuosus not only innervates and nourishes the maxillary anterior teeth, their corresponding soft tissues, and the maxillary sinus mucosa, but also relates to the nasal septum, lateral nasal wall, and parts of the palatal mucosa. To minimize surgical complications, implantologists need to investigate strategies for preventing and treating canalis sinuosus injuries. Preoperatively, implantologists should use CBCT to identify the canalis sinuosus and virtually design implant placement at a distance of more than 2 mm from the canalis sinuosus. Intraoperatively, implantologists should assess bleeding and patient comfort, complemented by precision surgical techniques such as the use of implant surgical guide plates. Postoperatively, CBCT can be employed to examine the relationship between the implant and the canalis sinuosus, and treatment of canalis sinuosus injuries can be tailored based on the patient's symptoms. This review summarizes the detection of canalis sinuosus in the population, its anatomical characteristics, and its physiological functions in the anterior maxilla, and discusses strategies for effectively avoiding canalis sinuosus injuries during implant surgery, thereby enhancing implantologists' awareness and providing references for clinical decision-making.

Influence of the Tube Angle on the Measurement Accuracy of Peri-Implant Bone Defects in Rectangular Intraoral X-ray Imaging

BACKGROUND

Intraoral radiography in the right-angle technique is the standard procedure to examine the peri-implant bone level in implant follow-up and implant-related studies. For the implementation of the right-angle or parallel technique, mostly ready-made image receptor holders are used. The aim of this experimental study is to analyze changes in the measurement of standardized peri-implant defects caused by a deviation in the position of the image receptor.

METHODS

Eleven Xive® implants (Dentsply Sirona, Bensheim, Germany) were placed in bovine bone, and peri-implant defects of varying depths were created. The preparations were fixed in a specially made test stand, and intraoral radiographs were taken using the right-angle technique with standard film holders at various horizontal and vertical projection angles. Defect measurement was carried out with the imaging software Sidexis 4 V 4.3 (Dentsply Sirona, Bensheim, Germany).

RESULTS

With increasing angular deviation, larger deviations between the measured and the real extent of the defect occurred. Vertical tilting caused significant distortion, while horizontal rotation showed less effect.

CONCLUSION

Intraoral radiography only provides a valid representation of the peri-implant bone level for follow-up or as a tool in implant-related studies if a reproducible projection direction is assured.

Visual grading experiments and optimization in CBCT dental implantology imaging: preliminary application of integrated visual grading regression

This study uses a general formulation of integrated visual grading regression (IVGR) and applies it to cone beam computed tomography (CBCT) scan data related to anatomical landmarks for dental implantology. The aim was to assess and predict a minimum acceptable dose for diagnostic imaging and reporting. A skull phantom was imaged with a CBCT unit at various diagnostic exposures. Key anatomical landmarks within the images were independently reviewed by three trained observers. Each provided an overall image quality score. Statistical analysis was carried out to examine the acceptability of the images taken, using an IVGR analysis that was formulized as a three-stage protocol including defining an integrated score, development of an ordinal regression, and investigation of the possibility for dose reduction through estimated parameters. For a unit increase in the logarithm of radiation dose, the odds ratio that the integrated score for an image assessed by observers being rated in a higher category was 3.940 (95% confidence interval: 1.016-15.280). When assessed by the observers, the minimum dose required to achieve a 75% probability for an image to be classified as at least acceptable was 1346.91 mGy·cm² dose area product (DAP), a 31% reduction compared to the 1962 mGy·cm² DAP default dosage of the CBCT unit. The kappa values of the intra and inter-observer reliability indicated moderate agreements, while a discrepancy among observers was also identified because each, as expected, perceived visibility differently. The results of this work demonstrate the IVGR's predictive value of dose saving in the effort to reduce dose to patients while maintaining reportable diagnostic image quality.

Two decades of research on CBCT imaging in DMFR - an appraisal of scientific evidence

OBJECTIVE

This article aims to appraise how scientific evidence related to CBCT has changed over the years, based on levels of evidence and diagnostic efficacy.

METHODS

A general search strategy was used in different databases (Pubmed, Embase, and Web of Science) to identify systematic reviews (SRs) on CBCT until November of 2020. The SRs included were divided according to different specialties of dentistry. A critical review of the articles was made, describing the level of evidence and efficacy.

RESULTS

In total, 75 articles were selected. There was an increase in the number of SRs on CBCT from 2014 onwards, as 83% of the SRs on this topic were published after 2013, and 72% between 2016 and to date. Twenty SRs (27%) performed meta-analysis. Only 28% of the SRs provided a detailed description of CBCT protocols. According to SR evidence, almost all specialties of dentistry have advanced concomitantly with the introduction of CBCT. The majority of SRs were related to clinical applications (level 2 of efficacy), followed by technical parameters (level 1 of efficacy). Only some CBCT models were mentioned in the SRs selected.

CONCLUSION

Over the course of 20 years, SRs related to CBCT applications for a broad range of dental specialties have been published, with the vast majority of studies at levels 1 and 2 of diagnostic efficacy. Not all CBCT models available on the market have been scientifically validated. At all times, one should remain cautious as such not to simply extrapolate in vitro results to the clinical setting. Also, considering the wide variety of CBCT devices and protocols, reported results should not be overstated or generalized, as outcomes often refer to specific CBCT devices and protocols.