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Popkowski A, Rhodes SC, Hatton JF. Proposed Diagnostic Reference Levels in the Missouri/Southern Illinois Region Associated with Cone-beam Computed Tomography Use in Endodontics. J Endod 2024; 50:966-975. [PMID: 38382736 DOI: 10.1016/j.joen.2024.02.006] [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: 07/28/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Diagnostic reference levels (DRLs) are intended to improve patient safety and ensure that patient ionizing radiation doses are as low as reasonably achievable. The purpose of this dosimetry study was to establish regional DRL levels for cone-beam computed tomography (CBCT) imaging for specialty endodontics. Another aim was to compare phantom-measured ionizing radiation dose index 1 (DI1) index doses to the manufacturer-provided dose area product (DAP) radiation output values for each of the CBCT machines studied, to ascertain their degree of correlation. DAP refers to the dose area product, a measure of radiation dose monitoring which represents the dose within the beam times the area within the beam at that position. METHODS A thimble ionization chamber and polymethyl methacrylate phantom were used to obtain DI1 values using the SEDENTEXTCT method from 21 different CBCT units. DRLs were calculated based on the 75th percentile (third quartile) of the median output values. RESULTS The proposed DRL from the CBCT units surveyed has a DAP value of 838 mGy cm2 and a DI1 value of 3.924 mGy. DAP versus DI1 values of 500.6 mGy cm2 versus 2.006 mGy, and 838 mGy cm2 versus 3.906 mGy represented the third quartile of the median values for the 4-cm × 4-cm and 5-cm × 5-cm field of views (FOVs), respectively. CONCLUSIONS The DI1 and DAP values strongly correlated when 3 outlier CBCT machines (J Morita Veraview X800) using a novel 360° (full rotation) acquisition mode were excluded. The importance of selectable exposure parameters as directly related to ionizing radiation output is illustrated among the CBCT units surveyed. Although the actual FOV that is selected is ultimately dictated by the specific clinical requirements, a 4-cm × 4-cm FOV is recommended for specialist endodontics practice, whenever clinically practical, based on the decreased ionizing radiation output, as compared to that from a 5-cm × 5-cm FOV.
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Affiliation(s)
- Arthur Popkowski
- Department of Endodontics, Center for Advanced Dental Education, Saint Louis University, Saint Louis, Missouri
| | - S Craig Rhodes
- Department of Endodontics, Center for Advanced Dental Education, Saint Louis University, Saint Louis, Missouri.
| | - John F Hatton
- Department of Endodontics, Center for Advanced Dental Education, Saint Louis University, Saint Louis, Missouri
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Simonek M, Türp JC, Bornstein MM, Dagassan-Berndt D. Prevalence and correlation with sex, age, and dental status of bone apposition at the mandibular angle and radiographic alterations of the temporomandibular joints: a retrospective observational study in an adult Swiss population. BMC Oral Health 2024; 24:193. [PMID: 38321445 PMCID: PMC10845652 DOI: 10.1186/s12903-024-03855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of radiographic changes in the mandibular angle (bone apposition) and osseous alterations in the temporomandibular joints (TMJs) in the adult population of Switzerland. In addition, the study intended to investigate possible correlations between the two sites of contour bone changes (mandibular angle and TMJ) and to analyze various patient-related factors, including sex, age, dental status, and medical history. METHODS Panoramic radiographs of 600 patients distributed into six age groups (283 females, 317 males, aged 20 to 79 years) were included to evaluate radiographic changes. The bone in the mandibular angle region and the shape of the condylar heads were examined for contour changes (bone apposition at the jaw angles and osseous changes of the TMJs). General estimating equations, binormal tests, and chi-squared tests were used for statistical analysis. RESULTS Approximately half of the mandibular angles (47.8%) showed bone apposition, mostly bilateral. TMJ alterations were less common (27%), often unilateral, with flattening being the most frequent finding. No significant correlation was found between the two sites. Bone apposition at the mandibular angle showed a significant male predominance, whereas TMJ changes did not differ by sex. Alterations in both sites increased with age, and were not related to dental status or analgesic use. CONCLUSIONS Bone apposition at the mandibular angle should be interpreted as part of the natural functional adaptation of the bone associated with aging. Assuming that parafunctional habits may influence the development and progression of alterations in the mandibular angle or TMJs, the presence of radiographic changes in these areas should prompt dental clinicians to investigate further in this direction. TRIAL REGISTRATION The study was approved by the Swiss Association of Research Ethics Committees (swissethics), BASEC reference number: 2020-00963 (25.05.2020).
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Affiliation(s)
- Michelle Simonek
- Department of Oral Surgery, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland.
| | - Jens Christoph Türp
- Division of Temporomandibular Disorders and Orofacial Pain, Department of Oral Health & Medicine, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
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Peralta-Mamani M, Rubira CMF, López-López J, Honório HM, Rubira-Bullen IRF. CBCT vs panoramic radiography in assessment of impacted upper canine and root resorption of the adjacent teeth: A systematic review and meta-analysis. J Clin Exp Dent 2024; 16:e198-e222. [PMID: 38496811 PMCID: PMC10943682 DOI: 10.4317/jced.61285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 03/19/2024] Open
Abstract
Background The IC may cause reabsorption of adjacent teeth; therefore detailed assessment of its position would enhance decision-making in the clinical workflow. The objective was to compare cone-beam computed tomography (CBCT) and panoramic radiography (PR) in assessing the position of the impacted upper canine (IC) and root resorption of adjacent teeth. Material and Methods Pubmed, EMBASE, Science Direct, Web of Science, and SCOPUS databases were searched for studies published before August 2023. Studies that evaluated IC by using both imaging methods were included. For statistical analysis, the Comprehensive Meta-Analysis software (Biostat; Englewood, NJ) was used, p≤0.05. Results A total of 17 articles were included, with 877 patients (average age of 17.6 years) and 1,115 ICs. The most frequent mesio-distal location of the IC was in sectors 3 and 4. The meta-analysis was performed with eleven studies. CBCT was more accurate in determining the labio-palatal position compared with PR (p<0.001) (CI 95%; 60% in labial position, 0.254-0.542, OR:0.398; 56% in palatal position, 0.350-0.533, OR:0.441; 78% in mid-alveolus position, 0.188-0.234, OR:0.221). For IC angulation to the midline, CBCT showing a smaller and more accurate angle than PR (p<0.001) (CI 95%, 18.008-33.686). IC angulation to the occlusal plane and lateral incisor, there was smaller angle in PR compared to CBCT (p<0.001) (CI 95%, 51.292-65.934; CI 95%, 30.011-55.954). With PR, fewer cases of root resorption of teeth adjacent to the IC were visualized compared with CBCT (86% less) (p<0.001) (CI 95%, 0.089-0.186; OR value: 0.138; n=1049). Conclusions CBCT showed statistically significant differences compared to PR in the assessment of IC position and root resorption of adjacent teeth. CBCT provided clinically relevant information that may contribute to diagnosing and planning IC treatment when PR was not sufficient. Key words:Canine teeth, tooth, impacted, panoramic radiography, Cone-beam computed tomography, systematic review, meta-analysis.
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Affiliation(s)
- Mariela Peralta-Mamani
- Department of Surgery, Stomatology, Pathology and Radiology - Bauru School of Dentistry, University of São Paulo. Alameda Octávio Pinheiro Brisola, 9-75, Vila Universitária, ZIP CODE: 17012-901, Bauru- SP, Brazil
| | - Cássia-Maria-Fischer Rubira
- Department of Surgery, Stomatology, Pathology and Radiology - Bauru School of Dentistry, University of São Paulo. Alameda Octávio Pinheiro Brisola, 9-75, Vila Universitária, ZIP CODE: 17012-901, Bauru- SP, Brazil
| | - José López-López
- Oral Health and Masticatory System Group-IDIBELL / Faculty of Medicine and Health Sciences (School of Dentistry) / Odontological Hospital University of Barcelona, University of Barcelona, Campus Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Heitor-Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo. Alameda Octávio Pinheiro Brisola, 9-75, Vila Universitária, ZIP CODE: 17012-901, Bauru- SP, Brazil
| | - Izabel-Regina-Fischer Rubira-Bullen
- Department of Surgery, Stomatology, Pathology and Radiology - Bauru School of Dentistry, University of São Paulo. Alameda Octávio Pinheiro Brisola, 9-75, Vila Universitária, ZIP CODE: 17012-901, Bauru- SP, Brazil
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Ríos-Osorio N, Quijano-Guauque S, Briñez-Rodríguez S, Velasco-Flechas G, Muñoz-Solís A, Chávez C, Fernandez-Grisales R. Cone-beam computed tomography in endodontics: from the specific technical considerations of acquisition parameters and interpretation to advanced clinical applications. Restor Dent Endod 2024; 49:e1. [PMID: 38449497 PMCID: PMC10912545 DOI: 10.5395/rde.2024.49.e1] [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: 07/25/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 03/08/2024] Open
Abstract
The implementation of imaging methods that enable sensitive and specific observation of anatomical structures has been a constant in the evolution of endodontic therapy. Cone-beam computed tomography (CBCT) enables 3-dimensional (3D) spatial anatomical navigation in the 3 volumetric planes (sagittal, coronal and axial) which translates into great accuracy for the identification of endodontic pathologies/conditions. CBCT interpretation consists of 2 main components: (i) the generation of specific tasks of the image and (ii) the subsequent interpretation report. A systematic and reproducible method to review CBCT scans can improve the accuracy of the interpretation process, translating into greater precision in terms of diagnosis and planning of endodontic clinical procedures. MEDLINE (PubMed), Web of Science, Google Scholar, Embase and Scopus were searched from inception to March 2023. This narrative review addresses the theoretical concepts, elements of interpretation and applications of the CBCT scan in endodontics. In addition, the contents and rationale for reporting 3D endodontic imaging are discussed.
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Affiliation(s)
- Néstor Ríos-Osorio
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | - Sara Quijano-Guauque
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | - Sandra Briñez-Rodríguez
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | - Gustavo Velasco-Flechas
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | | | - Carlos Chávez
- Postgraduate Endodontics Department, IMED, Guadalajara, México
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Ilo AM, Waltimo-Sirén J, Pakbaznejad Esmaeili E, Ekholm M, Kortesniemi M. The effect of optimum, indication-specific imaging fields on the radiation exposure from CBCT examinations of impacted maxillary canines and mandibular third molars. Acta Odontol Scand 2024; 82:66-73. [PMID: 38058132 DOI: 10.1080/00016357.2023.2258981] [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: 05/04/2023] [Accepted: 09/11/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Indication-specific optimum field-of-views (FOVs) have been assessed for CBCT scans of impacted maxillary canines and mandibular third molars, as 40∅ × 35 mm and 35∅ × 35 mm, respectively. The objective was to investigate possible changes in absorbed organs and effective doses, for these two imaging indications, performing CBCT examinations with optimum FOV sizes instead of commonly used FOVs. Additionally, radiation exposure-induced cancer risk was calculated for both imaging indications with optimum FOVs. METHODS An adult female head phantom (ATOM 702-D, CIRS, Norfolk, VA, USA) was scanned using Planmeca Viso G7 CBCT-device (Planmeca, Helsinki, Finland). Scanning factors, different FOV sizes, dose-area product (DAP) values and anatomical FOV locations were used for Monte Carlo PCXMC-simulation and ImpactMC software. In the PCXMC- simulation, 10-year-old child and 30-year-old adult phantoms were used to estimating effective and absorbed organ doses. RESULTS The effective dose varied from 58 µSv to 284 µSv for impacted maxillary canines, and from 38 µSv to 122 µSv for mandibular third molars, the lowest dose value for each corresponding to optimum FOV. Effective dose reduction between the optimum FOV and the smallest common FOV of 50∅ × 50 mm, maintaining other scanning factors constant, was 33% for impacted maxillary canines, and 45% for mandibular third molars. At all examinations, the highest absorbed organ doses were in salivary glands or in oral mucosa. CONCLUSIONS Optimum FOVs, 40∅ × 35 mm for impacted maxillary canine and 35∅ × 35 mm for mandibular third molar, could decrease effective doses received by young patients, and improve radiation safety in these common CBCT imaging procedures.
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Affiliation(s)
- Anne-Mari Ilo
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Janna Waltimo-Sirén
- Department of Pediatric Dentistry and Orthodontics, Institute of Dentistry, University of Turku, Turku, Finland
- Wellbeing Services County of South-West Finland, Finland
| | | | - Marja Ekholm
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry, University of Turku, Turku, Finland
- Wellbeing Services County of South-West Finland, Finland
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Mika Kortesniemi
- HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Jahanshahiafshar Z, Ghorbani H, Seyedmajidi M, Nabahati M, Ebrahimnejad Gorji K, Seyedmajidi S, Moudi E. Genotoxic and Cytotoxic Effects of Cone Beam Computed Tomography and Multidetector Computed Tomography on Exfoliated Buccal Epithelial Cells. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:572-581. [PMID: 38094288 PMCID: PMC10715117 DOI: 10.30476/ijms.2023.96522.2807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/22/2022] [Accepted: 12/25/2022] [Indexed: 12/18/2023]
Abstract
Background Cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) are frequently used in dental and maxillofacial problems. This study aimed to assess the genotoxicity and cytotoxicity effects of CBCT and MDCT radiographies on exfoliated buccal epithelial cells during dental examinations. Methods This prospective experimental study was conducted at Babol University of Medical Sciences (Babol, Iran) from March 2021 to April 2021. Buccal mucosa smears were collected bilaterally pre-exposure and 12 days after CBCT or MDCT examinations. To compare the frequency of micronuclei and other cytotoxic cellular changes such as pyknosis, karyolysis, and karyorrhexis, the paired sample t test and Wilcoxon test were used. In addition, independent sample t test, Mann-Whitney, and Chi square tests were used to investigate the differences between the imaging methods and between men and women. All statistical analyses were performed using the SPSS software, and P≤0.05 was considered statistically significant. Results The current study included 60 adult patients (30 patients in each group), ranging in age from 21 to 50 years. The micronuclei and the other cytotoxic cellular changes increased significantly after CBCT and MDCT radiographic examinations on the 12th day compared to the pre-exposure results (P<0.001). MDCT had statistically higher cytotoxic and genotoxic effects than CBCT (9.4%, 23.1%, and 40% higher values in micronucleus frequency, the mean frequency of micronuclei, and other cytotoxic changes, respectively). There were no significant differences between men and women in the two examination methods (P=0.46 and P=0.49, respectively). Conclusion Dental examinations with CBCT and MDCT can increase cytotoxicity and chromosomal damage in both men and women. Due to its lower radiation toxicities, CBCT can be recommended as an alternative to MDCT for dental examinations.
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Affiliation(s)
| | - Hakimeh Ghorbani
- Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Seyedmajidi
- Dental Materials Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehrdad Nabahati
- Department of Radiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Kourosh Ebrahimnejad Gorji
- Department of Medical Physics, Radiobiology and Radiation Protection, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Seyedali Seyedmajidi
- Dental Materials Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ehsan Moudi
- Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Zhu H, Yu H, Zhang F, Cao Z, Wu F, Zhu F. Automatic segmentation and detection of ectopic eruption of first permanent molars on panoramic radiographs based on nnU-Net. Int J Paediatr Dent 2022; 32:785-792. [PMID: 35315146 DOI: 10.1111/ipd.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this research was to present an artificial intelligence (AI) model, which can automatically segment and detect ectopic eruption of first permanent molars (EMMs) in early mixed dentition on panoramic radiographs using the no-new-Net (nnU-Net) model. DESIGN A total of 438 EMMs obtained from 285 panoramic radiographs were included in this study. An AI model based on nnU-Net was trained to segment and detect EMMs. The performance of the model was evaluated by the intersection over union (IoU), precision, F1-score, accuracy and FROC. Furthermore, the detecting performance of nnU-Net was compared with that of three dentists with different years of experience using the McNemar chi-squared test. The reliability of different dentists was evaluated by intraclass correlation coefficients (ICCs). RESULTS The nnU-Net yielded an IoU of 0.834, a precision of 0.845, an F1-score of 0.902 and an accuracy of 0.990, whereas the dentists yielded a mean IoU of 0.530, a mean precision of 0.539, a mean F1-score of 0.699 and a mean accuracy of 0.811. The ICC of different dentists was 0.776. The statistical analysis of the McNemar chi-squared test showed that the nnU-Net results were statistically significant and superior to those of dentists (p < .05). CONCLUSION This study validated an AI model based on nnU-Net for automatically segmenting and detecting EMMs more consistently and accurately on panoramic radiography.
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Affiliation(s)
- Haihua Zhu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Haojie Yu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Fan Zhang
- College of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, China
| | - Zheng Cao
- College of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Fuli Wu
- College of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, China
| | - Fudong Zhu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
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Zidan M, Schwindling FS, Juerchott A, Mente J, Gehrig H, Nittka M, Hosseini Z, Jende JME, Heiland S, Bendszus M, Hilgenfeld T. Endodontic working length measurements of premolars and molars in high-resolution dental MRI: a clinical pilot study for assessment of reliability and accuracy. Clin Oral Investig 2022; 26:6765-6772. [PMID: 35861757 DOI: 10.1007/s00784-022-04636-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/12/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To prospectively assess the reliability and accuracy of high-resolution, dental MRI (dMRI) for endodontic working length (WL) measurements of premolars and molars under clinical conditions. MATERIALS AND METHODS Three-Tesla dMRI was performed in 9 subjects who also had undergone cone-beam computed tomography (CBCT) (mean age: 47 ± 13.5 years). A total of 34 root canals from 12 molars (4/8, upper/lower jaw; 22 root canals) and 11 premolars (2/9 upper/lower jaw; 12 root canals) were included. CBCT and dMRI datasets were reconstructed to visualize the root canal in one single slice. Subsequently, two radiologists measured the root canal lengths in both modalities twice in blinded fashion. Reliability and accuracy for both modalities were assessed using intraclass correlation coefficients (ICCs) and Bland-Altman analysis, respectively. RESULTS Reliability (intra-rater I/II; inter-rater) of dental MRI measurements was excellent and comparable to CBCT for premolars (0.993/0.900; 0.958 vs. 0.993/0.956; 0.951) and for molars (0.978/0.995; 0.986 vs. 0.992/0.996; 0.989). Bland-Altman analysis revealed a mean underestimation/bias (95% confidence interval) of dMRI measurements of 0.8 (- 1.44/3.05) mm for premolars and 0.4 (- 1.55/2.39) mm for molars. In up to 59% of the cases, the accuracy of dMRI for WL measurements was within the underestimation margin of 0 to 2 mm short of the apical foramen AF. CONCLUSIONS In vivo demonstration and measurement of WL are feasible using dMRI. The reliability of measurements is high and equivalent to CBCT. Nonetheless, due to lower spatial resolution and longer acquisition time, the accuracy of dMRI is inferior to CBCT, impeding its current use for clinical treatment planning. CLINICAL RELEVANCE dMRI is a promising radiation-free imaging technique. Its reliability for endodontic working length measurements is high, but its accuracy is not satisfactory enough yet.
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Affiliation(s)
- Mousa Zidan
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Franz S Schwindling
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Johannes Mente
- Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Holger Gehrig
- Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Mathias Nittka
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
| | - Zahra Hosseini
- Magnetic Resonance R&D Collaborations, Siemens Medical Solutions, Atlanta, GA, USA
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Almohandes A, Lund H, Carcuac O, Petzold M, Berglundh T, Abrahamsson I. Accuracy of bone level assessments following reconstructive surgical treatment of experimental peri-implantitis. Clin Oral Implants Res 2022; 33:433-440. [PMID: 35148451 PMCID: PMC9306925 DOI: 10.1111/clr.13903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
AIMS The purpose was to evaluate the accuracy of bone level assessments using either cone beam computed tomography, intraoral periapical radiographs or histology following reconstructive treatment of experimental peri-implantitis. MATERIALS AND METHODS Six Labrador dogs were used. Experimental peri-implantitis was induced 3 months after implant placement. Surgical treatment of peri-implantitis was performed and peri-implant defects were allocated to one of four treatment categories; no augmentation, bone graft materials with or without a barrier membrane. Six months later, intraoral periapical radiographs and block biopsies from all implants sites were obtained. Marginal bone levels were measured using periapical radiographs, CBCT and histology. RESULTS Significant correlations of MBL assessments were observed between the three methods. The measurements in periapical radiographs consistently resulted in an overestimation of the bone level of about 0.3 - 0.4 mm. The agreement between methods was not influenced by the use of bone substitute materials in the management of the osseous defects. CONCLUSIONS Although MBL assessments obtained from PA radiographs showed an overestimation compared to MBL assessments on corresponding CBCT images and histological sections, PA radiographs can be considered a reliable technique for peri-implant bone level evaluations following reconstructive surgical therapy of experimental peri-implantitis.
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Affiliation(s)
- Ahmed Almohandes
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Henrik Lund
- Department of Oral & Maxillofacial Radiology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Olivier Carcuac
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ingemar Abrahamsson
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Andresen AK, Jonsson MV, Sulo G, Thelen DS, Shi XQ. Radiographic features in 2D imaging as predictors for justified CBCT examinations of canine-induced root resorption. Dentomaxillofac Radiol 2022; 51:20210165. [PMID: 34324382 PMCID: PMC8693324 DOI: 10.1259/dmfr.20210165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES This retrospective observational study aimed to evaluate the diagnostic accuracy of two-dimensional radiographs on canine-induced root resorption (CIRR) in lateral incisors and identify predictors of CIRR in patients with impacted maxillary canines (IMC). METHODS Ninety-nine patients aged 9-17 years, with 156 IMCs, were included in the study. All had CBCT-volumes and two-dimensional radiographs consisting of at least one panoramic radiograph. Two radiologists jointly viewed all cases twice. First, radiographic features related to the IMC and possible CIRR were recorded from two-dimensional radiographs. Then, CIRR was determined from CBCT and according to position and extension classified as mild, moderate and severe. RESULTS CIRRs was detected in 80% of lateral incisors (mild: 45%; moderate: 44%; severe: 11%). The sensitivity was generally low at mild and moderate cut-offs (29 and 29%), and somewhat higher for severe (50%). Corresponding specificities were 48%, 63% and 68%. Canine cusp-tip superimposing the lateral incisor's middle third and root/crown ratio >1 was positively associated with mild CIRR, with an odds ratio (OR) of 3.8 and 6.7, respectively. In addition, the root development stage was positively associated with moderate/severe CIRR when the canine root was nearly or fully developed (OR = 3.1). CONCLUSIONS The diagnostic accuracy of two-dimensional radiographs was inadequate for detecting CIRR amongst patients referred for CBCT examinations. Based on our results, none of the suggested two-dimensional radiographic features could predict moderate/severe CIRR except for root development stage. IMC in a later stage of root development seems to be associated with a higher risk of moderate/severe CIRR.
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Affiliation(s)
- Amanda K.H. Andresen
- Department of Clinical Dentistry, Section for Oral and Maxillofacial Radiology, University of Bergen, Norway, United Kingdom
| | | | | | - Dorina S. Thelen
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway, United Kingdom
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Lee H, Badal A. A Review of Doses for Dental Imaging in 2010-2020 and Development of a Web Dose Calculator. Radiol Res Pract 2021; 2021:6924314. [PMID: 35070450 PMCID: PMC8767401 DOI: 10.1155/2021/6924314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
Dental imaging is one of the most common types of diagnostic radiological procedures in modern medicine. We introduce a comprehensive table of organ doses received by patients in dental imaging procedures extracted from literature and a new web application to visualize the summarized dose information. We analyzed articles, published after 2010, from PubMed on organ and effective doses delivered by dental imaging procedures, including intraoral radiography, panoramic radiography, and cone-beam computed tomography (CBCT), and summarized doses by dosimetry method, machine model, patient age, and technical parameters. Mean effective doses delivered by intraoral, 1.32 (0.60-2.56) μSv, and panoramic, 17.93 (3.47-75.00) μSv, procedures were found to be about1% and 15% of that delivered by CBCT, 121.09 (17.10-392.20) μSv, respectively. In CBCT imaging, child phantoms received about 29% more effective dose than the adult phantoms received. The effective dose of a large field of view (FOV) (>150 cm2) was about 1.6 times greater than that of a small FOV (<50 cm2). The maximum CBCT effective dose with a large FOV for children, 392.2 μSv, was about 13% of theeffective dose that a person receives on average every year from natural radiation, 3110 μSv. Monte Carlo simulations of representative cases of the three dental imaging procedures were then conducted to estimate and visualize the dose distribution within the head. The user-friendly interactive web application (available at http://dentaldose.org) receives user input, such as the number of intraoral radiographs taken, and displays total organ and effective doses, dose distribution maps, and a comparison with other medical and natural sources of radiation. The web dose calculator provides a practical resource for patients interested in understanding the radiation doses delivered by dental imaging procedures.
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Affiliation(s)
- Hawon Lee
- Montgomery Blair High School, Silver Spring, MD, USA
- Division of Imaging, Diagnostics and Software Reliability, OSEL, CDRH, Food and Drug Administration, Silver Spring, MD, USA
| | - Andreu Badal
- Division of Imaging, Diagnostics and Software Reliability, OSEL, CDRH, Food and Drug Administration, Silver Spring, MD, USA
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Feng X, Chen Y, Cai W, Lie SA, Hellén-Halme K, Shi XQ. Aerodynamic characteristics in upper airways among orthodontic patients and its association with adenoid nasopharyngeal ratios in lateral cephalograms. BMC Med Imaging 2021; 21:127. [PMID: 34425762 PMCID: PMC8381502 DOI: 10.1186/s12880-021-00659-4] [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: 05/05/2021] [Accepted: 08/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenoid hypertrophy among orthodontic patients may be detected in lateral cephalograms. The study investigates the aerodynamic characteristics within the upper airway (UA) by means of computational fluid dynamics (CFD) simulation. Furthermore, airflow features are compared between subgroups according to the adenoidal nasopharyngeal (AN) ratios. METHODS This retrospective study included thirty-five patients aged 9-15 years having both lateral cephalogram and cone beam computed tomography (CBCT) imaging that covered the UA region. The cases were divided into two subgroups according to the AN ratios measured on the lateral cephalograms: Group 1 with an AN ratio < 0.6 and Group 2 with an AN ratio ≥ 0.6. Based on the CBCT images, segmented UA models were created and the aerodynamic characteristics at inspiration and expiration were simulated by the CFD method for the two groups. The studied aerodynamic parameters were pressure drop (ΔP), maximum midsagittal velocity (Vms), maximum wall shear stress (Pws), and minimum wall static pressure (Pw). RESULTS The maximum Vms exhibits nearly 30% increases in Group 2 at both inspiration (p = 0.013) and expiration (p = 0.045) compared to Group 1. For the other aerodynamic parameters such as ΔP, the maximum Pws, and minimum Pw, no significant difference is found between the two groups. CONCLUSIONS The maximum Vms seems to be the most sensitive aerodynamic parameter for the groups of cases. An AN ratio of more than 0.6 measured on a lateral cephalogram may associate with a noticeably increased maximum Vms, which could assist clinicians in estimating the airflow features in the UA.
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Affiliation(s)
- Xin Feng
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Yicheng Chen
- School of Energy Science and Engineering, Harbin Institute of Technology, Xi Da Zhi Street, Nangang, Harbin, 150001, People's Republic of China
| | - Weihua Cai
- School of Energy and Power Engineering, Northeast Electric Power University, Changchun Road 169, Changchun, 132012, People's Republic of China
| | - Stein Atle Lie
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Kristina Hellén-Halme
- Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden
| | - Xie-Qi Shi
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway. .,Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden.
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Rodríguez-López S, Escobedo Martínez MF, Junquera L, García-Pola M. Two-Dimensional Analysis of Digital Images through Vector Graphic Editors in Dentistry: New Calibration and Analysis Protocol Based on a Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094497. [PMID: 33922692 PMCID: PMC8122989 DOI: 10.3390/ijerph18094497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/18/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
This review was carried out to analyse the functions of three Vector Graphic Editor applications (VGEs) applicable to clinical or research practice, and through this we propose a two-dimensional image analysis protocol in a VGE. We adapted the review method from the PRISMA-ScR protocol. Pubmed, Embase, Web of Science, and Scopus were searched until June 2020 with the following keywords: Vector Graphics Editor, Vector Graphics Editor Dentistry, Adobe Illustrator, Adobe Illustrator Dentistry, Coreldraw, Coreldraw Dentistry, Inkscape, Inkscape Dentistry. The publications found described the functions of the following VGEs: Adobe Illustrator, CorelDRAW, and Inkscape. The possibility of replicating the procedures to perform the VGE functions was analysed using each study’s data. The search yielded 1032 publications. After the selection, 21 articles met the eligibility criteria. They described eight VGE functions: line tracing, landmarks tracing, linear measurement recording, angular measurement recording, image calibration, image overlay, file transfer, and vector graphics development. The features offered by the VGEs bring great precision and objectivity to two-dimensional image analysis. The image analysis and editing procedures are currently not protocolised. Thus, a protocol for image calibration and measurement recording is proposed in order to guarantee the protocol’s replication.
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Affiliation(s)
- Samuel Rodríguez-López
- Department of Operative Dentistry, School of Dentistry, University of Oviedo, C/. Catedrático Serrano s/n., 33006 Oviedo, Spain;
- Correspondence: ; Tel.: +34-600-74-27-58
| | - Matías Ferrán Escobedo Martínez
- Department of Operative Dentistry, School of Dentistry, University of Oviedo, C/. Catedrático Serrano s/n., 33006 Oviedo, Spain;
| | - Luis Junquera
- Department of Oral and Maxillofacial Surgery and Oral Medicine, School of Dentistry, University of Oviedo, C/. Catedrático Serrano s/n., 33006 Oviedo, Spain; (L.J.); (M.G.-P.)
| | - María García-Pola
- Department of Oral and Maxillofacial Surgery and Oral Medicine, School of Dentistry, University of Oviedo, C/. Catedrático Serrano s/n., 33006 Oviedo, Spain; (L.J.); (M.G.-P.)
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Modern 3D cephalometry in pediatric orthodontics-downsizing the FOV and development of a new 3D cephalometric analysis within a minimized large FOV for dose reduction. Clin Oral Investig 2021; 25:4651-4670. [PMID: 33492515 DOI: 10.1007/s00784-021-03779-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Dose reduction achieved by downsizing the field of view (FOV) in CBCT scans has brought no benefit for pediatric orthodontics, until now. Standard 2D or 3D full-size cephalometric analyses require large FOVs and high effective doses. The aim of this study was to compare a new 3D reduced-FOV analysis using the Frankfurt horizontal (FH) plane as reference plane with a conventional full-size analysis using the Sella-Nasion (S-N) plane as reference plane. MATERIALS AND METHODS Thirty-eight CBCT data sets were evaluated using full- and reduced-FOV analysis. The measurements of a total of 20 skeletal and dental standard 3D full-size variables were compared with the measurements of 22 corresponding 3D reduced-FOV variables. Statistical analysis was performed to prove mathematic relation between standard and alternative variables. Regression analyses were carried out. RESULTS Coefficients of determination (R2) between 0.15 and 0.95 (p < 0.001-0.055) were described. All variables showed obvious relations of different strength except for SNA and its alternative Po_R-Or_R-A (°) (R2 = 0.15, p = 0.055), but a second variable Ba_A (mm) showed stronger relation (R2 = 0.28, p = 0.003). CONCLUSIONS All standard variables related to the reference plane S-N could be described with alternative variables related to the FH. Further research should define more reliable landmarks for coordinate systems and reference points. CLINICAL RELEVANCE Minimized large FOVs meet the demand of 3D cephalometric analyses and enable the application of CBCT scans in pediatric orthodontic patients in many specific indications. Dose reduction is accompanied by increasing access to all the advantages of 3D imaging over 2D imaging.
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Mah E, Ritenour ER, Yao H. A review of dental cone-beam CT dose conversion coefficients. Dentomaxillofac Radiol 2020; 50:20200225. [PMID: 33112658 DOI: 10.1259/dmfr.20200225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The purpose of this study was to review the literature to examine the usage and magnitude of effective dose conversion factors (DCE) for dental cone beam CT (CBCT) scanners. METHODS A PubMed literature search for publications relating to radiation dosimetry in dental radiography was performed. Papers were included if they reported DCE, or reported ICRP 103 effective dose and dose-area product. 71 papers relating to dental CBCT dosimetry were found, of which eight reported effective dose conversion factors or provided enough information to calculate dose conversion factors. Scanner model, effective dose, dose-area product, tube voltage, field of view size and DCE were extracted from the papers for analysis. RESULTS DCE values ranged from 0.035 to 0.31 µSv/mGy-cm2 with a mean of 0.129 µSv/mGy-cm2 (SD = 0.056). When categorized into small (<100 cm2), medium (100-225 cm2) and large (>225 cm2) fields of view (FOV), linear fits to the effective dose and dose-area product yielded slopes of 0.129, 0.111 and 0.074 µSv/mGy-cm2 for small, medium and large FOVs respectively. CONCLUSION The range of reported DCE values and spread with respect to field of view category suggests that DCE values that depend on FOV would provide more accurate effective dose estimates. Tube voltage was found to be a smaller factor in determining DCE. Reasonable values for DCE taking into account FOV size were obtained. There is considerable room for more work to be done to examine the behaviour of DCE with changes to patient age and dental CBCT imaging parameters.
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Affiliation(s)
- Eugene Mah
- Department of Radiology & Radiologic Imaging, Medical University of South Carolina, Charleston, SC, USA.,Department of Bioengineering, Clemson University, Clemson-MUSC Bioengineering Program, Charleston, SC, USA
| | - E Russell Ritenour
- Department of Radiology & Radiologic Imaging, Medical University of South Carolina, Charleston, SC, USA.,Department of Bioengineering, Clemson University, Clemson-MUSC Bioengineering Program, Charleston, SC, USA
| | - Hai Yao
- Department of Bioengineering, Clemson University, Clemson-MUSC Bioengineering Program, Charleston, SC, USA
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Pérez-Losada FDL, López-López J, Martín-González J, Jané-Salas E, Segura-Egea JJ, Estrugo-Devesa A. Apical periodontitis and glycemic control in type 2 diabetic patients: Cross-sectional study. J Clin Exp Dent 2020; 12:e964-e971. [PMID: 33154799 PMCID: PMC7600214 DOI: 10.4317/jced.57191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The objective of this study was to analyze the possible relationship between the glycemic control and the prevalence of apical periodontitis in type 2 diabetic patients. The null hypothesis was that apical periodontitis is not associated with glycemic control. MATERIAL AND METHODS In a cross-sectional design, the radiographic records of 216 type 2 diabetic patients (65.0 ± 10.7 years), 117 men (54.2%) and women (45.8%), were examined. Glycated hemoglobin (HbA1c) was used to assess glycemic control, considering an HbA1c level < 6.5% as well-controlled diabetes. Apical periodontitis was diagnosed as radiolucent periapical lesions using the periapical index score. The Student t test, chi-square test, and logistic regression analysis were used in the statistical analysis. RESULTS The average HbA1c value was 7.0 ± 2.2%. Forty seven (21.8%) had HbA1c levels under 6.5% (mean ± SD = 6.0 ± 2.2%), being considered well-controlled patients, and 169 (78.2%) had an HbA1c level ≥ 6.5% (mean ± SD = 7.8 ± 2.24%), being considered poor controlled patients. Forty four per cent of diabetics had apical periodontitis, 12.5% had root-filled teeth, and 52.3% had root filled teeth with radiolucent periapical lesions. No significant differences were observed in any of these three variables between patients with good or poor glycemic control. In the multivariate logistic regression analysis the presence of radiolucent periapical lesions in at least one tooth did not correlate significantly with HbA1c levels (OR = 1.4; 95% C.I. = 0.70 - 3.09; p = 0.31). CONCLUSIONS The results reveal no association of glycemic control with the prevalence of apical periodontitis or root canal treatment in diabetic patients. Key words:Apical periodontitis, diabetes mellitus, endodontic medicine, glycated haemoglobin.
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Affiliation(s)
- Flor de Liz Pérez-Losada
- DDS, Doctoral fellow, Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona. L'Hospitalet de Llobregat, Barcelona, Spain
| | - José López-López
- MD, DDS, PhD, Professor, Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona- Dental Hospital, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jenifer Martín-González
- DDS, PhD, Associate Professor, Division of Endodontics, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Enric Jané-Salas
- MD, DDS, PhD, Professor, Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona- Dental Hospital, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan J Segura-Egea
- MD, DDS, PhD, Professor, Division of Endodontics, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Albert Estrugo-Devesa
- MD, DDS, PhD, Associate Professor, Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona- Dental Hospital, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Does dose optimisation in digital panoramic radiography affect diagnostic performance? Clin Oral Investig 2020; 25:637-643. [PMID: 32845471 DOI: 10.1007/s00784-020-03535-7] [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: 04/20/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the overall diagnostic performance of digital panoramic radiographs obtained with low-dose protocols and to estimate the absorbed dose in the head and neck. MATERIALS AND METHODS Forty-eight panoramic radiographs were obtained from eight imaging phantoms using six exposure protocols of progressively lower tube voltages (kVp) and currents (mA), as follows: (1) 70 kVp and 12.5 mA, (2) 66 kVp and 10 mA, (3) 66 kVp and 8 mA, (4) 66 kVp and 5 mA, (5) 66 kVp and 4 mA and (6) 66 kVp and 3.2 mA. Five oral radiologists independently evaluated the images and reported all detectable radiographic findings. Intra-examiner reproducibility was assessed by re-evaluation of 25% of the images. The data were analysed using the McNemar and weighted Kappa tests. Absorbed doses of the six protocols were obtained from thermoluminescent dosimeters placed inside a Rando phantom and compared using one-way ANOVA with post hoc Tukey (α = 0.05). RESULTS The overall diagnostic performance of panoramic radiographs obtained with low-dose protocols did not differ from that of panoramic radiographs obtained with the highest dose (p > 0.05). Moreover, substantial agreement was observed between all protocols. Protocol 1 resulted in the highest absorbed dose and protocols 4, 5 and 6 in the lowest absorbed doses, with the difference being significant (p ≤ 0.05). CONCLUSION Although digital panoramic radiography is considered a relatively low-dose examination, the radiation dose can be further reduced without negatively affecting its overall diagnostic performance. CLINICAL RELEVANCE Considering the risks associated with X-rays, digital panoramic radiographs can be obtained at even lower exposure levels.
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Schulze RKW, Drage NA. Cone-beam computed tomography and its applications in dental and maxillofacial radiology. Clin Radiol 2020; 75:647-657. [PMID: 32451060 DOI: 10.1016/j.crad.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
Cone-beam computed tomography (CBCT) was first used in dental and maxillofacial radiology (DMFR) at the end of the 1990s. Since then, it has been successfully established as the standard three-dimensional radiographic imaging technique in DMFR, with a wide variety of applications in this field. This manuscript briefly reviews the background information on the technology and summarises available data on effective dose and dose optimisation. In addition, typical clinical applications and indications of the technique in DMFR are presented.
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Affiliation(s)
- R K W Schulze
- Department of Oral and Maxillofacial Surgery, Section of Oral Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - N A Drage
- Department of Dental and Maxillofacial Radiology, University Dental Hospital, Cardiff, UK
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2D vs. 3D Radiological Methods for Dental Age Determination around 18 Years: A Systematic Review. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10093094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The age of a living human being can be determined by applying a number of different methods; the most diffused are skeletal and dental methods, both principally based on X-rays examinations. This systematic review assesses the current evidence regarding the accuracy and reliability of Cone Beam Computed Tomography (CBCT) vs. Orthopantomography (OPG) in age determination. A computerized systematic literature search of studies published up to January 2020 was conducted without language restrictions in order to identify articles comparing CBCT vs. OPG in dental anatomy evaluation, articles evaluating the accuracy of dental methods for age estimation, both with CT and OPG exams, and articles comparing CBCT vs. OPG in terms of radiation dose. CBCT was found to be more accurate compared to OPG in dental anatomy evaluation. When analyzing young adults, an estimation error of two years is considered forensically acceptable. The radiation dose of a CBCT exam is higher compared to an OPG exam. However, the difference is not as marked with small Fields Of View (FOV) and low-resolution protocols. Final conclusion was that a small FOV CBCT centered on the mandibular angle of a young patient is an accurate and safe method for dental age estimation around the age of 18.
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Rinne CA, Dagassan-Berndt DC, Connert T, Müller-Gerbl M, Weiger R, Walter C. Impact of CBCT image quality on the confidence of furcation measurements. J Clin Periodontol 2020; 47:816-824. [PMID: 32324295 DOI: 10.1111/jcpe.13298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/27/2020] [Accepted: 04/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND To investigate the impact of scanning parameter in cone-beam computed tomography (CBCT) images on accuracy and confidence with measurements of furcation involvement (FI) in maxillary molars. MATERIAL AND METHODS Six half cadaver heads with present maxillary molars (n = 10) were available. CBCT scans with the fixed-parameter field of view (4 × 4 cm, 12 × 17 cm) amperage and voltage (4 mA, 90 kV) and with varying scan modes (SM), that is images/scan (IS), voxel sizes (VZ) and rotation (R), were performed using one CBCT apparatus. The images were analysed by two calibrated investigators. Horizontal FI's were measured in mm or a "through and through" destruction (FI degree III) was recorded. Each rater scored the FI measurements performed in each scan as "confident" or as "not confident". Data were statistically analysed using chi-square tests. RESULTS The agreement between CBCT FI measurements and intra-surgical FI measurements varied according to SM (SM HiSp 180°, 0.08: kappa 0.538, CI; 95%: 0.362-0.714; SM Std. 360°, 0.25: kappa 0.698, CI; 95%: 0.534-0.861). The number of measurements scored as "confident" varied according to SM (SM Std. 360°, 0.08:52 out of 60 measurements; SM Std. 360°, 0.25:16 out of 60 measurements; p < .001). CONCLUSIONS SM of CBCT significantly affect the confidence with FI measurements in maxillary molars.
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Affiliation(s)
- Carin Aime Rinne
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Basel, Switzerland
| | - Dorothea C Dagassan-Berndt
- Department of Oral Surgery, Oral Radiology and Oral Medicine University Center of Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Thomas Connert
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Basel, Switzerland
| | | | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Basel, Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Basel, Switzerland
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X-ray beam angulation can compromise 2-dimensional diagnosis of interradicular space for mini-implants. Am J Orthod Dentofacial Orthop 2019; 156:593-602. [PMID: 31677667 DOI: 10.1016/j.ajodo.2018.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The aim of this research was to evaluate the influence of x-ray projection geometry on interradicular space of the posterior maxillary arch. METHODS Cone-beam computed tomography (CBCT) scans of 32 patients (16.85 ± 4.93 years) who met the selection criteria were enrolled. One hundred ninety-two interradicular sites of the posterior maxillary arch were evaluated. Before measurements, each side of the maxillary arch was orientated in all 3 planes of space to obtain CBCT synthesized periapical radiographs with 0° projection geometry (orthogonal x-ray beam-orthogonal X-ray angulation [OX]). Standardized CBCT axial rotations (10°, 20°, -10°, and -20°) were used to simulate periapical radiographs taken with mesial and distal angulation of the x-ray beam (mesial x-ray angulation [MX] and distal x-ray angulation [DX]). Interradicular space widths were measured on OX, MX, and DX CBCT synthesized periapical radiographs. Measurements were performed parallel to the occlusal plane at 3 mm and 6 mm apical to the midpoint of the alveolar crest. Interradicular distances were statistically compared (P <0.05). RESULTS Interradicular distances measured on MX and DX CBCT synthesized periapical radiographs were significantly smaller than those measured on OX. Interradicular distance was significantly correlated with the horizontal angulation of the x-ray beam. X-ray projection angle was the most influential variable on interradicular distance. About 30% reduction in interradicular space was observed for every 10° of deviation from orthogonal x-ray. CONCLUSION Two-dimensional radiographs obtained away from the 0° projection geometry can reduce the actual interradicular space for mini-implants, inducing misdiagnosis.
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Minimum size and positioning of imaging field for CBCT scans of impacted maxillary canines. Clin Oral Investig 2019; 24:897-905. [DOI: 10.1007/s00784-019-02904-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/04/2019] [Indexed: 11/26/2022]
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Samandara A, Papageorgiou SN, Ioannidou-Marathiotou I, Kavvadia-Tsatala S, Papadopoulos MA. Evaluation of orthodontically induced external root resorption following orthodontic treatment using cone beam computed tomography (CBCT): a systematic review and meta-analysis. Eur J Orthod 2019; 41:67-79. [PMID: 29771300 DOI: 10.1093/ejo/cjy027] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Orthodontically induced external root resorption (OIRR) is a pathologic consequence of orthodontic tooth movement. However, the limitations of two-dimensional radiography suggest that cone beam computed tomography (CBCT) with its three-dimensional capabilities might be more suitable to assess OIRR. Objective The aim of this study was to assess in an evidence-based manner data on linear or volumetric OIRR measurements of permanent teeth by means of CBCT, during and/or after the end of orthodontic treatment. Search methods Unrestricted electronic and hand searches were performed up to January 2017 in 15 databases. Selection criteria methods Randomized clinical trials, prospective, and retrospective non-randomized studies assessing OIRR during and/or after orthodontic treatment using CBCT in human patients were included. Data collection and analysis After duplicate study selection, data extraction, and risk-of-bias assessment according to the Cochrane guidelines, random-effects meta-analyses, followed by subgroup, meta-regression, and sensitivity analyses were also performed in order to evaluate factors that affect OIRR. Results A total of 33 studies (30 datasets) were included in the qualitative analysis while data from 27 of them were included in the quantitative analysis. Direct comparisons from randomized trials found little to no influence of appliance-related factors on OIRR. Explorative analyses including non-randomized studies found a pooled OIRR of 0.79 mm based on all included studies and 0.86 mm when OIRR was assessed at the end of orthodontic treatment. Statistically significant differences in OIRR were found according to tooth type or jaw, inclusion of extractions, treatment duration, and diagnostic accuracy of the CBCT. Conclusions Based on the results of this study, CBCT seems to be a reliable tool to examine OIRR during or at the end of orthodontic treatment. Although the average OIRR measured with CBCT seems to lack clinical relevance, there are certain factors that may affect OIRR following orthodontic treatment. Nevertheless, due to data heterogeneity and low quality of the included studies, the corresponding results should be interpreted with some caution. Registration PROSPERO (CRD42016030131).
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Affiliation(s)
- Aikaterini Samandara
- Department of Orthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | | | | | - Moschos A Papadopoulos
- Department of Orthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, Greece
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Svenson B, Ståhlnacke K, Karlsson R, Fält A. Dentists' use of digital radiographic techniques: Part II - extraoral radiography: a questionnaire study of Swedish dentists. Acta Odontol Scand 2019; 77:150-157. [PMID: 30422025 DOI: 10.1080/00016357.2018.1525763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The present study aims to gain knowledge about the dentist's use and choice of digital extraoral imaging methods, panoramic radiography and cone beam computed tomography (CBCT). MATERIALS AND METHODS A questionnaire sent to 2481 dentists within the Swedish Dental Society contained questions about the panoramic technique and CBCT technique used, education, clinic size and type of service. The response rate was 53%. RESULTS The study showed that 61% of the Swedish dentists had access to panoramic techniques and that 84% used a direct digital sensor, while 6% used storage phosphor plate techniques. Around 8% of the Swedish dentists had access to CBCT. It was also observed that group practices had two times higher odds of having panoramic equipment compared with solo practices. Approximately 40% of the dentists had undergone postgraduate education in oral radiology during the last 5 years. Dental nurses and dental hygienists exposed 92% of the panoramic radiographs and 75% of the CBCTs. Thirty per cent of those clinics with access to a panoramic unit exposed >30 panoramic radiographs per month and 56% of the clinics having access to CBCT did more than 75 examinations per year. CONCLUSIONS Today 61% of Swedish dentists have access to panoramic radiography and 8% have access to CBCT. There is a greater likelihood of having access if the dentist works in the public dental health service or in a group practice and if the dentist has undergone any postgraduate course in oral radiology.
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Affiliation(s)
- Björn Svenson
- Dental Research Department, Postgraduate Dental Education Center, Örebro, Sweden
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Katri Ståhlnacke
- Dental Research Department, Postgraduate Dental Education Center, Örebro, Sweden
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Reet Karlsson
- Department of Radiology, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Anna Fält
- Clinical Epidemiology and Biostatistics School of Medical Sciences, Örebro University, Örebro, Sweden
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Frascino AV, Costa C, de Andrade Salgado DMR, Coracin FL, Fava M, Odone-Filho V. Mandibular radiomorphometric assessment of bone mineral density in survivors of pediatric hematopoietic stem-cell transplantation. Clinics (Sao Paulo) 2019; 74:e929. [PMID: 31166472 PMCID: PMC6530437 DOI: 10.6061/clinics/2019/e929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 02/27/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Hematopoietic stem-cell transplantation (HSCT) childhood survivors of hematologic malignancies are prone to develop late osteopenia and osteoporosis. The purpose of this retrospective study was to quantitatively and qualitatively assess bone mineral density (BMD) in HSCT childhood survivors and to compare the effectiveness of both qualitative and quantitative assessment methods. METHODS DESIGN BMD assessment using panoramic radiographs of childhood HSCT survivors aged 3.69-18.88 years using two radiomorphometric indexes. Case-control double-blinded comparison of panoramic radiographic images from childhood HSCT survivors and age- and sex-matched healthy controls. Quantitative assessment was performed by measuring the cortical bone width bilaterally at the mental foramen level. Qualitative assessment was performed using the mandibular cortical index bilaterally on all panoramic images. RESULTS Radiographs were taken 6.59-83.95 months after bone marrow transplantation [median±SD=25.92±24.9 months]. Fifty-two panoramic radiographic images were analyzed: 21 from HSCT survivors and 31 from healthy controls aged 3.69-25.1 years [mean±SD=11.89±5.28 years]. The mandibular cortical bone width was 17% smaller in childhood HSCT survivors than in healthy controls (case group: 2.420, control group: 3.307; p=0.00617). Qualitative analysis revealed an increased frequency of severe mandibular cortical erosion in childhood HSCT survivors, although no significant difference was observed (case group: 1.540, control group: 1.490; p=0.32). The interobserver agreement was 85% (Kappa index). CONCLUSIONS HSCT childhood survivors exhibit quantitative and qualitative mandibular bone impairments. Further studies are needed to establish an association between mandibular cortical bone impairment and osteoporosis.
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Affiliation(s)
- Alexandre Viana Frascino
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, BR
- Corresponding author. E-mail:
| | - Claudio Costa
- Departamento de Estomatologia, Faculdade de Odontologia, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Fabio Luiz Coracin
- Departamento de Saude, Faculdade de Odontologia, Universidade Nove de Julho, Sao Paulo, SP, BR
| | - Marcelo Fava
- Odontologia Pediatrica, Faculdade de Odontologia, Universidade Estadual Paulista (UNESP), Sao Jose dos Campos, SP, BR
| | - Vicente Odone-Filho
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, BR
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