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Jacobs R, Fontenele RC, Lahoud P, Shujaat S, Bornstein MM. Radiographic diagnosis of periodontal diseases - Current evidence versus innovations. Periodontol 2000 2024. [PMID: 38831570 DOI: 10.1111/prd.12580] [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: 02/07/2024] [Revised: 04/23/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
Accurate diagnosis of periodontal and peri-implant diseases relies significantly on radiographic examination, especially for assessing alveolar bone levels, bone defect morphology, and bone quality. This narrative review aimed to comprehensively outline the current state-of-the-art in radiographic diagnosis of alveolar bone diseases, covering both two-dimensional (2D) and three-dimensional (3D) modalities. Additionally, this review explores recent technological advances in periodontal imaging diagnosis, focusing on their potential integration into clinical practice. Clinical probing and intraoral radiography, while crucial, encounter limitations in effectively assessing complex periodontal bone defects. Recognizing these challenges, 3D imaging modalities, such as cone beam computed tomography (CBCT), have been explored for a more comprehensive understanding of periodontal structures. The significance of the radiographic assessment approach is evidenced by its ability to offer an objective and standardized means of evaluating hard tissues, reducing variability associated with manual clinical measurements and contributing to a more precise diagnosis of periodontal health. However, clinicians should be aware of challenges related to CBCT imaging assessment, including beam-hardening artifacts generated by the high-density materials present in the field of view, which might affect image quality. Integration of digital technologies, such as artificial intelligence-based tools in intraoral radiography software, the enhances the diagnostic process. The overarching recommendation is a judicious combination of CBCT and digital intraoral radiography for enhanced periodontal bone assessment. Therefore, it is crucial for clinicians to weigh the benefits against the risks associated with higher radiation exposure on a case-by-case basis, prioritizing patient safety and treatment outcomes.
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Affiliation(s)
- Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Rocharles Cavalcante Fontenele
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pierre Lahoud
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Periodontology and Oral Microbiology, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
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Mello HN, Bonadiman EA, Bruneli GL, Pitol GA, de-Azevedo-Vaz SL. Influence of CBCT filters and contrast adjustments on peri-implant buccal bone thickness measurement and blooming expression. Clin Oral Investig 2024; 28:315. [PMID: 38748313 DOI: 10.1007/s00784-024-05712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/07/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES To assess whether filter and contrast adjustments can improve the accuracy of CBCT in measuring the buccal bone thickness (BBT) adjacent to dental implants by reducing blooming artifacts. MATERIALS AND METHODS Homogeneous bone blocks with peri-implant BBT of 0.3 mm, 0.5 mm, and 1 mm were scanned using the Orthophos SL system. Three dentists measured the BBT in 234 CBCT scans under different settings of contrast adjustments and 'Sharpen' filter activation. Additionally, implant diameter measurements were taken to assess blooming artifact expression. The differences between tomographic and actual measurements of BBT and implant diameter [(CBCT - actual) * 100 / actual] were subjected to Mixed ANOVA (α = 0.05). RESULTS The group with the thinnest BBT (0.3 mm) had the greatest difference between tomographic and actual measurements (79.9% ± 29.0%). Conversely, the 0.5 mm (36.1% ± 38.4%) and 1 mm (29.4% ± 12.3%) groups exhibited lower differences (p < 0.05). 'Sharpen' filter activation reduced blooming expression since it resulted in a lower difference for implant diameter (p < 0.05), but it did not influence BBT measurements (p = 0.673). Contrast settings had no impact on BBT (p = 0.054) or implant diameter measurements (p = 0.079). CONCLUSION Although filter activation reduced blooming artifacts, neither filter nor contrast adjustments improved the accuracy of CBCT in measuring peri-implant BBT; actual BBT influenced this task. CLINICAL RELEVANCE When assessing the peri-implant buccal bone plate in the CBCT system studied, dental surgeons may find it beneficial to adjust contrast and apply filters according to their preferences, since such adjustments were found to have no adverse effects on the diagnostic accuracy of this task. The use of the 'Sharpen' filter may lead to improved representation of implant dimensions.
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Affiliation(s)
| | | | | | | | - Sergio Lins de-Azevedo-Vaz
- Dental Sciences Graduate Program, Federal University of Espírito Santo (UFES), Av. Marechal Campos 1468, Maruípe Vitória, ES, 29043900, Brazil.
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Kuo HY, Lin KL, Hsu CY, Fu PS, Hung CC, Song SJ. Volumetric analysis of artifacts from fiducial markers under cone beam computed tomography. J Dent Sci 2024; 19:1004-1011. [PMID: 38618050 PMCID: PMC11010787 DOI: 10.1016/j.jds.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/30/2023] [Indexed: 04/16/2024] Open
Abstract
Abstract Background/purpose Computer aided implant surgery has been widely adopted in modern implant dentistry. However, absence of reliable anatomic landmarks for superimposing digital data sets for patients with terminal dentition or complete edentulism remained challenging. Utilization of additional fiducial markers intraorally as the reference points for the improvement of accuracy became crucial in implant digital workflow. Nevertheless, the choice of the material for fiducial markers should present the least radiographic artifacts under cone beam computed tomography (CBCT) for better accuracy. The aim of this in vitro study was to investigate the volume of radiographic artifacts generated through different materials under the image of CBCT. Materials and methods Fifteen dental materials were selected and configured into cubic shape. All the materials were scanned initially with the laboratory scanner as the control groups. The samples were scanned by CBCT machine as test groups and the volume of artifact generated under CBCT images were compared and analyzed using 3D modeling software. Results Eleven out of fifteen materials could be recognized under CBCT images. Volumetric analysis reported that statistically significant differences among the materials could be noted, and the flowable composite resin presented the least volumetric difference. Lithium disilicate glass-ceramic, flowable composite resin, and gutta-percha presented the least deformation and maintained their cubic shapes. Conclusion The results of the present study may imply that flowable composite resin compared to all ceramic materials, amalgam and gutta-percha may be a preferable choice when utilized as fiducial markers under CBCT images.
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Affiliation(s)
- Hsin-Yu Kuo
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
| | - Kuan-Ling Lin
- Division of Prosthodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ching-Ying Hsu
- Division of Prosthodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Po-Sung Fu
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Cheng Hung
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Seung Jun Song
- Division of Prosthodontics, College of Dental Medicine, Columbia University, New York, USA
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Lucca LV, Cascante-Sequeira D, Coelho-Silva F, Ruiz-Imbert AC, Freitas DQ, Haiter-Neto F, de-Azevedo-Vaz SL. The effect of voxel and field of view size on the volumetric alteration artifact of high-density materials with 2 cone beam computed tomography devices. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:290-300. [PMID: 37980244 DOI: 10.1016/j.oooo.2023.10.004] [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: 05/25/2023] [Revised: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE We investigated the influence of voxel and field of view (FOV) sizes on expression of the volumetric alteration artifact (VAA) of 5 high-density materials in 2 cone beam computed tomography (CBCT) devices. STUDY DESIGN Cylinders of amalgam, cobalt-chromium, gutta-percha, titanium, and zirconium were individually positioned in a polymethyl methacrylate phantom. OP300 Maxio and ProMax 3D Classic CBCT devices were used to acquire images with varying voxel and FOV sizes, totaling 585 scans. Two evaluators segmented the high-density cylinder images to obtain the tomographic volumes. The difference between the tomographic and physical volume of each cylinder (i.e., volumetric alteration) was calculated. Statistical analysis was conducted with multiway ANOVA and the Tukey post hoc test (α = 5%). Evaluator reliability was measured with the intraclass correlation coefficient (ICC). RESULTS All studied parameters and nearly all interactions influenced the VAA (P < .05). The post hoc test demonstrated less volumetric alteration for the smallest voxel sizes, 61 × 78 mm FOV, and gutta-percha for OP300, and for the smallest voxel sizes, 80 × 80 mm FOV, and gutta-percha and titanium for ProMax 3D (P < .05). The ICC demonstrated perfect reliability (1.00). CONCLUSIONS Voxel and FOV sizes influenced VAA expression. Using smaller voxel sizes, the 61 × 78 mm FOV for OP300 and the 80 × 80 mm FOV for ProMax 3D, and materials with lower density and lower atomic number reduced VAA expression.
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Affiliation(s)
- Luiza Valdemarca Lucca
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.
| | - Deivi Cascante-Sequeira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Fernanda Coelho-Silva
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Ana Cecilia Ruiz-Imbert
- Department of Diagnostic Sciences, Oral Radiology Section, Dentistry Faculty, Universidad de Costa Rica, San José, Costa Rica
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Francisco Haiter-Neto
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Sergio Lins de-Azevedo-Vaz
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil; Department of Clinical Dentistry, Federal University of Espírito Santo, Espírito Santo, Brazil
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Deng H, Wang J, Liu L, Li Y. Feasibility and accuracy of a task-autonomous robot for zygomatic implant placement. J Prosthet Dent 2023:S0022-3913(23)00710-2. [PMID: 38016868 DOI: 10.1016/j.prosdent.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/30/2023]
Abstract
STATEMENT OF PROBLEM Zygomatic implants (ZIs) should be placed accurately as planned preoperatively to minimize complications and maximize the use of the remaining bone. Current digital techniques such as static guides and dynamic navigation are affected by human error; therefore, new techniques are required to improve the accuracy of ZI placement. PURPOSE The purpose of this clinical study was to assess the feasibility and accuracy of a task-autonomous robot for ZI placement. MATERIAL AND METHODS Patients indicated for ZI placement were enrolled, and an appropriate surgical positioning piece was selected based on the presence of natural teeth in the maxilla. Preoperative cone beam computed tomography (CBCT) scanning was performed with the surgical positioning piece, and virtual implant design and socket preparation procedures were initiated. Implant socket preparation and placement were automatically performed by the robot according to the preoperative plan under the supervision of the surgeon. Postoperative CBCT scanning was performed to evaluate deviations between the virtual and actual implants. All quantitative data were expressed as standardized descriptive statistics (mean, standard deviation, minimum, maximum, and 95% confidence interval [CI]). The Shapiro-Wilk test was used to assess the normal distribution of all variables (α=.05). RESULTS Six participants were enrolled, and 8 ZIs were inserted. No intraoperative or postoperative complications were observed. Robotic ZI placement showed a global coronal deviation of 0.97 mm (95% CI: 0.55 to 1.39 mm), a global apical deviation of 1.27 mm (95% CI: 0.71 to 1.83 mm), and an angular deviation of 1.48 degrees (95% CI: 0.97 to 2.00 degrees). CONCLUSIONS Task-autonomous robots can be used for ZI placement with satisfactory accuracy. Robotic ZI surgery can be an alternative to static guidance and dynamic navigation to improve the accuracy of implant placement.
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Affiliation(s)
- Huanze Deng
- Doctoral student, Department of Stomatology, Fourth Medical Centre, Chinese PLA General Hospital, Beijing, PR China; and Medical School of Chinese PLA, Beijing, PR China
| | - Jing Wang
- Head Nurse, Department of Stomatology, Fourth Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Le Liu
- Attending, Department of Stomatology, Fourth Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Yanfeng Li
- Professor, Department of Stomatology, Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China, Beijing, PR China; and Medical School of Chinese PLA, Beijing, PR China.
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Van Doorne L, Vandeweghe S, Matthys C, Vermeersch H, Bronkhorst E, Meijer G, De Bruyn H. Five years clinical outcome of maxillary mini dental implant overdenture treatment: A prospective multicenter clinical cohort study. Clin Implant Dent Relat Res 2023; 25:829-839. [PMID: 37309711 DOI: 10.1111/cid.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The long-term clinical outcome of mini dental implants (MDIs) to support an overdenture is underreported especially in severely atrophic maxillae and when installed flaplessly. PURPOSE The current report is a 5-years follow-up of the previously published 2- and 3-years clinical outcome of MDIs supporting a maxillary overdenture in narrow alveolar ridges. MDI survival, marginal bone level, peri-implant health, technical complications, and oral health related quality of life (OHIP) and respective changes over time are reported. MATERIALS AND METHODS Subjects aged 50 years or older, in need of improvement of maxillary denture retention, were included. The MDIs were 2.4 mm diameter one-piece tapered implants, Class 4 pure Titanium, and lengths 10 or 11.5 mm. Under local anesthesia, 5-6 MDIs were placed in atrophic maxillae with a free-handed flapless approach. One week postoperative the denture was adapted with a retentive soft reliner. The final prosthetic connection was established after 6 months with a metal-reinforced horse-shoe denture. Clinical outcome after 5 years was assessed with probing pocket depts (PPD), bleeding on probing (BoP), and additional cone beam computed tomography (CBCT) MDI bone level measurements were performed. Oral Health-Related Quality of Life (OHRQoL) investigated with OHIP-14 was assessed preoperative, during provisional loading, and after final prosthetic connection up to 5 years. RESULTS Initially, 31 patients (14 females and 17 males) with mean age 62.30 underwent treatment. In the provisional loading interval, 16 patients encountered 32/185 MDIs failures, resulting in a failure of 17.3%; 170 MDIs were functionally loaded in 29 patients. Additionally, 14 implants were lost in three patients, all of whom had had already previous failures. Reimplantation of 17 MDIs were performed during the provisional loading and 2 MDI after functional loading. After 5 years, the absolute implant failure rate was 46/204 (22.5%), corresponding to a cumulative failure rate of 23.2%. Prosthetic failure was observed in four patients due to implant loss and in two patients related to excessive one-piece implant ball attachment wear, making the 5-years prosthetic success 80.0%. The mean PPD and absence/presence of BoP for 149 implants at 5 years was 4.3 and 0.2 mm, respectively. Average mesial-distal-vestibular-palatal bone loss in the interval 2-5 years was 0.08 mm. No statistically significant difference in marginal MDI bone loss between male or female (p = 0.835), smoking and nonsmoking (p = 0.666) was observed. The five-years total measured CBCT interdental bone level (mesial and distal) correlates with the 5-years PPD (Pearson 0.434; p = 0.01). After 5 years, OHRQoL with the treatment procedure was assessed in 27/31 participants. Decreasing mean total OHIP-14 scores with improved OHRQoL, was observed in 27/31 participants, with values of 21.3 at baseline to 15.6 at the time of provisional loading which significantly (p = 0.006) decrease to 7.3 at the final prosthetic connection. The next 3-5 years further decrease was observed with 6.5 and 4.96, respectively. CONCLUSIONS Maxillary MDIs for overdentures are an accessible and acceptable treatment option. Although after 5 years between one fifth and one fourth of the MDIs were lost, prosthetic success remains 80.0% and high OHRQoL could be achieved.
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Affiliation(s)
- Luc Van Doorne
- Department Oral Health Sciences, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
- Department of Plastic, Oral and Maxillo-Facial Surgery, Ghent University Hospital, Ghent, Belgium
| | - Stefan Vandeweghe
- Department Oral Health Sciences, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
- Department of Reconstructive Dentistry, Ghent University Hospital, Ghent, Belgium
| | - Carine Matthys
- Department Oral Health Sciences, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
- Department of Reconstructive and Prosthetic Dentistry, Ghent University Hospital, Ghent, Belgium
| | - Hubert Vermeersch
- Department Oral Health Sciences, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
- Department of Plastic, Oral and Maxillo-Facial Surgery, Ghent University Hospital, Ghent, Belgium
| | - Ewald Bronkhorst
- Department of Dentistry, Research Institute Health Sciences, Radboud UMC, Nijmegen, Netherlands
| | - Gert Meijer
- Department of Dentistry, Research Institute Health Sciences, Radboud UMC, Nijmegen, Netherlands
| | - Hugo De Bruyn
- Department Oral Health Sciences, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
- Department of Dentistry, Research Institute Health Sciences, Radboud UMC, Nijmegen, Netherlands
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Elgarba BM, Van Aelst S, Swaity A, Morgan N, Shujaat S, Jacobs R. Deep learning-based segmentation of dental implants on cone-beam computed tomography images: A validation study. J Dent 2023; 137:104639. [PMID: 37517787 DOI: 10.1016/j.jdent.2023.104639] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES To train and validate a cloud-based convolutional neural network (CNN) model for automated segmentation (AS) of dental implant and attached prosthetic crown on cone-beam computed tomography (CBCT) images. METHODS A total dataset of 280 maxillomandibular jawbone CBCT scans was acquired from patients who underwent implant placement with or without coronal restoration. The dataset was randomly divided into three subsets: training set (n = 225), validation set (n = 25) and testing set (n = 30). A CNN model was developed and trained using expert-based semi-automated segmentation (SS) of the implant and attached prosthetic crown as the ground truth. The performance of AS was assessed by comparing with SS and manually corrected automated segmentation referred to as refined-automated segmentation (R-AS). Evaluation metrics included timing, voxel-wise comparison based on confusion matrix and 3D surface differences. RESULTS The average time required for AS was 60 times faster (<30 s) than the SS approach. The CNN model was highly effective in segmenting dental implants both with and without coronal restoration, achieving a high dice similarity coefficient score of 0.92±0.02 and 0.91±0.03, respectively. Moreover, the root mean square deviation values were also found to be low (implant only: 0.08±0.09 mm, implant+restoration: 0.11±0.07 mm) when compared with R-AS, implying high AI segmentation accuracy. CONCLUSIONS The proposed cloud-based deep learning tool demonstrated high performance and time-efficient segmentation of implants on CBCT images. CLINICAL SIGNIFICANCE AI-based segmentation of implants and prosthetic crowns can minimize the negative impact of artifacts and enhance the generalizability of creating dental virtual models. Furthermore, incorporating the suggested tool into existing CNN models specialized for segmenting anatomical structures can improve pre-surgical planning for implants and post-operative assessment of peri‑implant bone levels.
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Affiliation(s)
- Bahaaeldeen M Elgarba
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium; Department of Prosthodontics, Faculty of Dentistry, Tanta University, 31511 Tanta, Egypt
| | - Stijn Van Aelst
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium
| | - Abdullah Swaity
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium; Prosthodontic Department, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Nermin Morgan
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium; Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium; King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium, 3000 Leuven, Belgium; Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden.
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Orhan K, Kocyigit D, Firincioglulari M, Adisen MZ, Kocyigit S. Quantitative assessment of image artifacts from zygoma implants on CBCT scans using different exposure parameters. Proc Inst Mech Eng H 2023; 237:1082-1090. [PMID: 37528643 DOI: 10.1177/09544119231190447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
This study was aimed at quantifying artifacts from zygoma implants in cone-beam computed tomography (CBCT) images using different exposure parameters. Two cadaver heads, one with two zygoma implants on each side and the other for control, were scanned using 18 different exposure parameters. Quantitative analysis was performed to evaluate the hypodense and hyperdense artifact percentages calculated as the percentage of the area. Hyperdense artifacts and hypodense artifacts were detected, followed by the calculation of the hyperdense and hypodense artifact percentages in the image. In the qualitative analysis of the artifacts, the scores used were as follows: absence (0), moderate presence (1), or high presence (2) for hypodense halos, thin hypodense lines, and hyperdense lines. Artifact analysis was performed qualitatively and quantitatively using the post-hoc Tukey and Two-way ANOVA tests. As a result, in the qualitative analyses, zygoma implants showed a significant difference compared to the control group with regard to hyperdense and hypodense artifacts (p < 0.05). There was a significant difference between the means according to the FOV size arithmetic averages (p < 0.05). In terms of voxel size, the difference was found to be significant, where 400 microns showed the highest hypodense artifact while 200 microns showed the lowest hypodense artifact. In conclusion, hypodense and hyperdense artifacts were significantly higher in cadavers with zygoma implants than in controls. As FOV and voxel size increase, more hypodense artifacts are produced by zygoma implants so smaller FOV and voxel sizes should be used to prevent poor image quality of adjacent teeth.
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Affiliation(s)
- Kaan Orhan
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
- Medical Design Application and Research Center (MEDITAM), Ankara University, Ankara, Turkey
| | - Doruk Kocyigit
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Kirikkale University, Kirkkale, Turkey
| | - Mujgan Firincioglulari
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Cyprus International University, Nicosia, Cyprus
| | - Mehmet Zahit Adisen
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Kirikkale University, Kirkkale, Turkey
| | - Seda Kocyigit
- Department of Oral and Maxillofacial Surgery, Ministry of Health Turkey, Uskudar, Istanbul, Turkey
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Is the efficacy of cone beam computed tomography in the diagnosis of tooth ankylosis influenced by dose reduction protocols? Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:129-135. [PMID: 36241601 DOI: 10.1016/j.oooo.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/09/2022] [Accepted: 08/17/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the diagnostic efficacy of cone beam computed tomography (CBCT) examinations acquired with varying dose protocols in the diagnosis of simulated tooth ankylosis (TA). STUDY DESIGN Tooth ankylosis was simulated in 15 of 30 teeth, and CBCT examinations were acquired at 3 mA levels (8, 6.3, and 5) and 3 voxel sizes (0.08, 0.125, and 0.2 mm). Four radiologists independently assessed the presence of TA using a 5-point scale. Sensitivity, specificity, and area under the curve (AUC) obtained through receiver operating characteristic analysis were compared among mA levels and voxel sizes using two-way analysis of variance (α = 0.05). Intra- and interexaminer reliability levels were assessed with the weighted kappa examination. RESULTS Sensitivity was low (0.32-0.49), and specificity was reasonably high (0.71-0.83). Mean values of AUC were low, ranging between 0.54 and 0.67, which reveals poor overall discrimination between health and disease. The detection of TA was not significantly influenced by mA level or voxel size (P > .05). Intra- and interexaminer agreements ranged from slight to moderate (0.160-0.535) and from fair to substantial (0.236-0.697), respectively. CONCLUSIONS Despite the limited efficacy of CBCT for TA detection, when indicated as a complementary examination, mA reduction should be considered for dose optimization purposes.
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Chaves GS, Silva JA, Capeletti LR, Silva EJNL, Estrela C, Decurcio DA. Guided Access Cavity Preparation Using a New Simplified Digital Workflow. J Endod 2023; 49:89-95. [PMID: 36375649 DOI: 10.1016/j.joen.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/20/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study evaluated the precision of a simplified workflow using only preoperative cone-beam computed tomographic (CBCT) scans to gain guided access to root canals of extracted mandibular molars. A workflow using CBCT scanning associated with 3-dimensional oral scanning was used as a reference for comparison. The influence of the presence of coronal restoration in the simplified workflow was also evaluated. METHODS Forty-five mandibular molars were randomized into 3 groups: a control group in which digital planning was performed with CBCT and oral scanning and 2 experimental groups in which digital planning was performed only with CBCT examination. In experimental group 1, teeth had no coronal restorations, whereas in group 2 teeth presented with coronal composite restorations. After digital planning, the teeth were accessed using the guides, and a new CBCT scan was made to overlap the pre- and postoperative examinations. Precision was measured by calculating the deviation between the planned and prepared cavities in millimeters and angle. Data were compared using 1-way analysis of variance (P < .05). RESULTS All root canals were accessible after access preparation in all tested groups. Deviations of the planned and prepared access cavities were low, with a mean value of 0.55, 0.58, and 0.47 mm and 1.98°, 2.45°, and 1.43° for the control group, group 1, and group 2, respectively. No significant differences in millimeters or angle were observed among the 3 tested groups (P > .05). CONCLUSIONS The simplified digital workflow using only CBCT examination allowed a high level of precision in obtaining access in extracted molars with and without coronal restoration, presenting similar results compared with the digital workflow using CBCT and 3-dimensional oral scanning.
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Affiliation(s)
- Gustavo S Chaves
- School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil; School of Dentistry, Alfredo Nasser University Center, Aparecida de Goiânia, Goiás, Brazil
| | - Julio A Silva
- School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Lucas R Capeletti
- School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Emmanuel J N L Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Brazil; Department of Endodontics, Grande Rio University, Rio de Janeiro, Brazil
| | - Carlos Estrela
- School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Daniel A Decurcio
- School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil.
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Wanderley VA, Leite AF, de Faria Vasconcelos K, Pauwels R, Müller-García F, Becker K, Oliveira ML, Jacobs R. Impact of metal artefacts on subjective perception of image quality of 13 CBCT devices. Clin Oral Investig 2022; 26:4457-4466. [PMID: 35166942 DOI: 10.1007/s00784-022-04409-w] [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: 06/22/2021] [Accepted: 02/09/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The overall objective of this study was to assess how metal artefacts impact image quality of 13 CBCT devices. As a secondary objective, the influence of scanning protocols and field of view on CBCT image quality with and without metal artefacts was also assessed. MATERIALS AND METHODS CBCT images were acquired of a dry human skull phantom considering three clinical simulated conditions: one without metal and two with metallic materials (metallic pin and implant). An industrial micro-CT was used as a reference to register the CBCT images. Afterwards, four observers evaluated 306 representative image slices from 13 devices, ranking them from best to worst. Furthermore, within each device, medium FOV and small FOV standard images were compared. General linear mixed models were used to assess subjective perception of examiners on overall image quality in the absence and presence of metal-related artefacts (p < 0.05). RESULTS Image quality perception significantly differed amongst CBCT devices (p < 0.05). Some devices performed significantly better, independently of scanning protocol and clinical condition. In the presence of metal artefacts, medium FOV standard scanning protocols scored significantly better, while in the absence of metal, small FOV standard yielded the highest performance. CONCLUSIONS Subjective image quality differs significantly amongst CBCT devices and scanning protocols. Metal-related artefacts may highly impact image quality, with a significant device-dependent variability and only few scanners being more robust against metal artefacts. Often, metal artefact expression may be somewhat reduced by proper protocol selection. CLINICAL RELEVANCE Metallic objects may severely impact image quality in several CBCT devices.
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Affiliation(s)
- Victor Aquino Wanderley
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium. .,Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
| | - Andre Ferreira Leite
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ruben Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark.,Department of Mechanical Engineering, Catholic University of Leuven, Leuven, Belgium
| | - Francisca Müller-García
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kathrin Becker
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Matheus L Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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