Reliability of two different presurgical preparation methods for implant dentistry based on panoramic radiography and cone-beam computed tomography in cadavers

Comparison of the Efficacy of the Panoramic and Cone Beam Computed Tomography Imaging Methods in the Surgical Planning of the Maxillary All-On-4, M-4, and V-4

This study is aimed at analyzing the difference between the measurements made according to certain anatomical signs of the maxillary jaw using panoramic radiography and cone beam computed tomography (CBCT) to decide whether to use all-on-4, M-4, or V-4 configuration to prevent complications caused by incorrect measurements during the presurgical planning stage of the placement of implants in the all-on-4 technique. A retrospective study was conducted with 50 patients with upper edentulous jaws suitable for the all-on-4 technique, who underwent preoperative panoramic radiography and cone beam computed tomography evaluation for dental implant surgery. The shortest vertical distances between anatomical structures were measured. Measurements were made independently by two oral and maxillofacial surgeons, one experienced and the other inexperienced. A statistically significant difference was found between the mean values according to gender (p=0.045). When the measurements made by the experienced surgeon and the inexperienced surgeon were compared, there was no significant difference between panoramic radiography and cone beam computed tomography. In situations where bone measurements are required for deciding on all-on-4 or one of its configurations (M-4 and V-4), it was found that panoramic radiography gives significantly incorrect results compared to cone beam computed tomography (p<0.05). Cone beam computed tomography is more reliable than panoramic radiography and eliminates the margin of error in the planning of all-on-4 or its variations to be made by either an experienced or an inexperienced oral surgeon.

Distribution of implant failure caused by positioning in a certain part of Turkish society on CBCT

Purpose: The aim of this report was to evaluate the prevalence of implant failure rates due to implant positioning on Cone beam Computerized Tomography. Methods: Study sample (n= 333) consisted of CBCT(Cone-beam computerized tomography) scans of patients who were referred to the Department of Dentomaxillofacial Radiology, University of Health Sciences Turkey, Gülhane Faculty of Dentistry, Ankara, Turkey. Obtained data such as age, gender, number of implants and locations from CBCT images gathered and recorded. Results: The data consists of 333 patients and so the total data evaluated was 844. The implant survival rate of the patients between 20-40 years old (49.4%) was lower significantly than that of the patients ≥ 40 years old (P=0.001). In the R4 (right mandibular region), implant failure rate is 17.5% shows quite low rate compared to other regions. At the R1 (right maxillar region) (39%) and R2 (45%) the most common reason of failure was maxillary sinus perforation, the least common reason was palatinal bone perforation, respectively 4% and 1%. Conclusion: Preventing misinterpretations of clinicians is only possible by correct evaluation of incidental findings and better knowledge of head and neck anatomy.

Cone-Beam Computed Tomography in Periodontal Diagnosis and Treatment Planning

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

Comparison of the performances of low-crystalline carbonate apatite and Bio-Oss in sinus augmentation using three-dimensional image analysis

BACKGROUND

In locations where the alveolar bone height is low, such as at the maxillary molars, implant placement can be difficult, or even impossible, without procedures aimed at generating new bone, such as sinus lifts. Various types of bone graft materials are used after a sinus lift. In our study, a three-dimensional image analysis using a volume analyzer was performed to measure and compare the volume of demineralized bovine bone mineral (Bio-Oss®) and carbonate apatite (Cytrans®) after a sinus lift, as well as the amount of bone graft material resorption. Patient data were collected from cone-beam computed tomography images taken before, immediately following, and 6 months after the sinus lift. Using these images, both the volume and amount of resorption of each bone graft material were measured using a three-dimensional image analysis system.

RESULTS

The amount of bone resorption in the Bio-Oss®-treated group was 25.2%, whereas that of the Cytrans®-treated group was 14.2%. A significant difference was found between the two groups (P < 0.001).

CONCLUSIONS

Our findings indicate that the volume of bone resorption was smaller in the Cytrans®-treated group than in the Bio-Oss®-treated group, suggesting that Cytrans® is more promising for successful implant treatments requiring a sinus lift.

Linear measurement accuracy of CBCT panoramic reconstructions: experimental study with dry human mandibles

INTRODUCTION

Studies on software accuracy of reformatted panoramic computed tomography (CT) images are scarce.

OBJECTIVES

The aim of this study was to evaluate the software accuracy of reformatted panoramic views from cone-beam computed tomography (CBCT).

METHODS

Ten dry mandibles were scanned using CBCT with different voxel sizes. Following the reconstruction of panoramic views with three different software, horizontal and vertical linear measurements were performed using the electronic rules of each software. Measurements of the corresponding dry mandibles were taken with a digital caliper and defined as the gold standard.

RESULTS

There were no statistically significant differences in linear distances among the dry mandibles and reformatted panoramic CT views. The relative error ranged from 1.3 to 8.0%, depending on the software and voxel size.

CONCLUSIONS

The linear measurements on reformatted panoramic views are reliable.

2D vs. 3D Radiological Methods for Dental Age Determination around 18 Years: A Systematic Review

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.

Comparing the precision of panoramic radiography and cone-beam computed tomography in avoiding anatomical structures critical to dental implant surgery: A retrospective study

Purpose

The aim of this study was to evaluate the correlations between measurements made using panoramic radiography and cone-beam computed tomography (CBCT) based on certain anatomical landmarks of the jaws, with the goal of preventing complications due to inaccurate measurements in the pre-surgical planning phase of dental implant placement.

Materials and Methods

A total of 56 individuals who underwent panoramic radiography and a CBCT evaluation before dental implant surgery were enrolled in the study. Measurements were performed to identify the shortest vertical distance between the alveolar crest and neighboring anatomical structures, including the maxillary sinus, nasal floor, mandibular canal, and foramen mentale. The differences between the measurements on panoramic radiography and CBCT images were statistically analyzed.

Results

Statistically significant differences were observed between the measurements on panoramic radiography and CBCT for all anatomical structures (P<.05). The correlation coefficients (r) between the paired samples obtained from panoramic radiography and CBCT were closely correlated (P<.05), with r values varying from 0.921 and 0.979 for different anatomical regions.

Conclusion

The results of this study support the idea that panoramic radiography might provide sufficient information on bone height for preoperative implant planning in routine cases or when CBCT is unavailable. However, an additional CBCT evaluation might be helpful in cases where a safety margin cannot be respected due to insufficient bone height.

Comparison of Dental Panoramic Radiography and CBCT for Measuring Vertical Bone Height in Different Horizontal Locations of Posterior Mandibular Alveolar Process

STATEMENT OF THE PROBLEM

Accurate measurement of the available bone height is an essential step in the pre-surgical phase of dental implantation. Panoramic radiography is a unique technique in the pre-surgical phase of dental implantations because of its low cost, relatively low-dose, and availability.

PURPOSE

This article aimed to assess the reliability of dental panoramic radiographs in the accurate measurement of the vertical bone height with respect to the horizontal location of the alveolar crest.

MATERIALS AND METHOD

132 cone-beam computed tomography (CBCT) of the edentulous mandibular molar area and dental panoramic radiograph of 508 patients were selected. Exclusion criteria were bone abnormalities and detectable ideal information on each modality. The alveolar ridge morphology was categorized into 7 types according to the relative horizontal location of the alveolar crest to the mandibular canal based on CBCT findings. The available bone height (ABH) was defined as the distance between the upper border of the mandibular canal and alveolar crest. One oral radiologist and one oral surgeon measured the available bone height twice on each modality with a 7-dayinterval.

RESULTS

We found a significant correlation between dental panoramic radiographs and cone-beam computed tomography values (ICC=0.992, p< 0.001). A positive correlation between the horizontal distance of the alveolar crest to the mandibular canal and measured differences between two radiographic modalities had been found (r=0.755, p< 0.001). For each single unit of increase in the horizontal distance of the alveolar crest to the mandibular canal, dental panoramic radiographs showed 0.87 unit of overestimation (p< 0.001).

CONCLUSION

Dental panoramic radiographs can be employed safely in the pre-surgical phase of dental implantation in posterior alveolus of mandible, especially in routine and simple cases.

Use of cone beam computed tomography in implant dentistry: current concepts, indications and limitations for clinical practice and research

Diagnostic radiology is an essential component of treatment planning in the field of implant dentistry. This narrative review will present current concepts for the use of cone beam computed tomography imaging, before and after implant placement, in daily clinical practice and research. Guidelines for the selection of three-dimensional imaging will be discussed, and limitations will be highlighted. Current concepts of radiation dose optimization, including novel imaging modalities using low-dose protocols, will be presented. For preoperative cross-sectional imaging, data are still not available which demonstrate that cone beam computed tomography results in fewer intraoperative complications such as nerve damage or bleeding incidents, or that implants inserted using preoperative cone beam computed tomography data sets for planning purposes will exhibit higher survival or success rates. The use of cone beam computed tomography following the insertion of dental implants should be restricted to specific postoperative complications, such as damage of neurovascular structures or postoperative infections in relation to the maxillary sinus. Regarding peri-implantitis, the diagnosis and severity of the disease should be evaluated primarily based on clinical parameters and on radiological findings based on periapical radiographs (two dimensional). The use of cone beam computed tomography scans in clinical research might not yield any evident beneficial effect for the patient included. As many of the cone beam computed tomography scans performed for research have no direct therapeutic consequence, dose optimization measures should be implemented by using appropriate exposure parameters and by reducing the field of view to the actual region of interest.

Reliability of Orthopantomography and Cone-beam Computed Tomography in Presurgical Implant Planning: A Clinical Study

BACKGROUND

Preoperative diagnosis and treatment planning are fundamental requirements to ensure success rate of implant. Cone-beam computed tomography (CBCT) provides all three dimensions and has been proved as a tool for radiology, especially in the success of implant. This study was conducted to evaluate the reliability of orthopantomography (OPG) and CBCT in presurgical implant planning.

MATERIALS AND METHODS

The study was conducted on 110 partially or completely edentulous adult patients (male 50 and female 60). Patient information regarding name, age, gender, and so forth was recorded. Thorough clinical examination was done to locate the edentulous site for the placement of implant. All patients were subjected to OPG and CBCT. The OPG was taken with digital panoramic unit (Planmeca) operating at 120 kVp, 2 mA, and exposure time of 17 seconds. The CBCT was taken using NewTom machine with field of view 11 × 8 cm and resolution of 0.3 × 0.3 × 0.3 mm operating at 120 kVp at 5 mA. NNT software with slice thickness of 0.1 mm was used in this study. Measurement of bone height and distance from anatomical structures was done on OPG, whereas bone height and bone width were measured on CBCT scan in all three planes, such as coronal plane, sagittal plane, and axial plane. The measurement was done by two experienced observers.

RESULTS

The present study comprised 110 patients (male 50 and female 60). About 102 (16.7%) implants were placed in anterior region, and 508 (83.3%) implants were placed in posterior region. Implant site was incisor region (55), canine (30), premolar (250), and molar (275). The difference was significant (p < 0.01). Variations are usually observed in presurgical planning with CBCT and OPG. The length and width of implant remained unchanged in 90 and 85% of the cases respectively. In 8% of cases, OPG revealed more length of implant than CBCT, whereas only in 2% cases CBCT revealed more length of implant than OPG. The difference was significant (p < 0.05). When we compared the diameter, OPG revealed more diameter in 10% of cases, whereas CBCT only revealed 5% of cases. The difference was significant (p < 0.05). Observer found CBCT as effective in 95% of cases and ineffective in only 5% of cases, whereas OPG was effective in 78% of cases and ineffective in 22% of cases. The different was significant (p < 0.05).

CONCLUSION

The CBCT being three-dimensional provides detailed information that two-dimensional radiographs cannot offer, which aids in precision to further improve the entire implant process.

CLINICAL SIGNIFICANCE

In recent times, implant has become the treatment of choice for edentulous patients. The CBCT has increased the success rate of implant due to its high resolution, ability to demonstrate anatomical structures more effectively than other radiographic diagnostic tools.

Reliability and accuracy of cone-beam computed tomography voxel density and linear distance measurement at different voxel sizes: A study on sheep head cadaver

Background/purpose

The reliability and accuracy of linear distance and voxel density (VD) measurements are very important in dentistry. The purpose of this study was to assess the accuracy and reliability of linear distances and VD measurements of cone-beam computed tomography (CBCT) at different voxel sizes.

Materials and methods

Eighteen-millimeter linears of size 40 gutta-percha were prepared in fresh sheep head. The head was scanned using CBCT with 0.25, 0.3, and 0.40 voxel sizes. Standard linear distances of gutta-percha were measured in panoramic CBCT images at 0.25, 0.3, and 0.4 voxel sizes. VD measurements were made separately on spongeous bone of palatal surfaces of the roots of teeth 4, 5, and 6 of maxilla and on cortical bone of teeth 4, 5, and 6 regions of the left and right hemimandibles through cross-sectional imaging.

Results

We found that linear distance measurements on panoramic image of CBCT were slightly lower than physical measurements. A significant difference was not found for the gutta-percha linear distances and cortical VD measurements at different voxel sizes (P ≥ 0.05). The correlation between measurements of VD at different voxels in cortical bone was greater than 0.85 (P = 0.000).

Conclusion

Linear distance measurements on the sheep head cadaver of 0.25, 0.3, and 0.4 voxel sizes were similar and reliable when compared with physical measurements. In minimizing radiation exposure, VD measurement of cortical bone at 0.4 voxel-based CBCT could be used to estimate cortical bone density. However, studies should be performed on the human head cadaver.

Correlation of radiographic analysis during initial planning and tactile perception during the placement of implants

Most of the decisions made in planning treatment with implants rely on the clinician's assessment of the density of the jawbone. However, we know of only a few studies that have evaluated the clinicians' subjectivity and the objective quantitative methods. Our aim was to assess whether the characteristics of the bone seen on preoperative imaging are similar to the features faced during the operation. We collected data about 32 implant procedures done during the Specialisation Course for Implant Dentistry, Universidade de Ribeirão Preto, San Paulo. First, the clinicians evaluated the panoramic radiograph and computed tomographic scans preoperatively, classified the bone density according to the Lekholm and Zarb classification, and marked their subjective evaluation on a visual analogue scale. Postoperatively the surgeons filled out a questionnaire based on their subjective perceptions obtained during the insertion of the implants. Another examiner answered the same questionnaire after looking at the patient's images but without knowing the surgeon's results. There was a good correlation between the surgeons' preoperative classification of the type of bone and their tactile perception (p=0.000), and a good correlation between the surgeon's preoperative classification of the bone and the examiner's findings (p=0.000). We conclude that imaging is an important part of preoperative planning and can predict the quality of the bone when coupled with the opinion of a trained clinician, objective analysis, and standard classification of the bone.

Comparison of Cone Beam Computed Tomography, Orthopantomography with Direct Ridge Mapping for Pre-Surgical Planning to Place Implants in Cadaveric Mandibles: An Ex-Vivo Study

BACKGROUND

Implant treatment is today a common and most widely accepted prosthetic therapy worldwide. The quality and quantity of the bone available at the anticipated implant site is of prime importance. Accurate measurement of alveolar bone and adjacent anatomic structures are of paramount importance in implant insertion. Proper pre-surgical assessment requires precise radiographic visualization of anatomic structures and pathologic conditions. However, the concern for radiation exposure has also grown.

MATERIALS AND METHODS

A total of 15 partially or completely edentulous human cadaveric mandibles were used which were further subdivided into three further groups for cone-beam computed tomography (CBCT), orthopantomography (OPG), and direct measurements (DM). Mandibles were prepared for each sample and subjected to radiographs according to the respective techniques, and radiographic measurements were done using the appropriate software. The cadaveric mandibles were then sectioned, and the actual measurements were done using a digital vernier caliper.

RESULTS

Analysis of variance test revealed that there was no significant difference among the three different measurements techniques.

CONCLUSION

A sizable portion of the CBCT measurements with respect to width showed slight overestimation when compared to DMs. There were no statistically significant differences found between CBCT, OPG, and DM when height was taken into consideration.

Interactive 3D imaging technologies: application in advanced methods of jaw bone reconstruction using stem cells/pre-osteoblasts in oral surgery

Cone beam computed tomography has created a specific revolution in maxillofacial imaging, facilitating the transition of diagnosis from 2D to 3D, and expanded the role of imaging from diagnosis to the possibility of actual planning. There are many varieties of cone beam computed tomography-related software available, from basic DICOM viewers to very advanced planning modules, such as InVivo Anatomage, and SimPlant (Materialise Dental). Through the use of these programs scans can be processed into a three-dimensional high-quality simulation which enables planning of the overall treatment. In this article methods of visualization are demonstrated and compared, in the example of 2 cases of reconstruction of advanced jaw bone defects using tissue engineering. Advanced imaging methods allow one to plan a miniinvasive treatment, including assessment of the bone defect's shape and localization, planning a surgical approach and individual graft preparation.

Assessment of the mandibular incisive canal by panoramic radiograph and cone-beam computed tomography

Objectives. The region between mental foramens is considered as a zone of choice for implants. However, complications may arise due to an extension anterior to the mental foramen that forms the mandible incisive canal [MIC]. Our goal is to evaluate identification of MIC by both panoramic radiograph [PAN] and cone-beam computed tomography [CBCT]. Methods. 150 cases with bilateral MIC were analyzed. Images of a radiolucent canal, within the trabecular bone, surrounded by a radiopaque cortical bone representing the canal walls, and extending to the anterior portion beyond the mental foramen, were considered by two independent radiologists as being images of MIC. PAN and CBCT of these cases were evaluated by 2 other radiologists at different times. Agreement between results of examination methods was assessed by the Kappa coefficient. The interexaminer and intramethod rates for detection of MIC were analyzed by the McNemar test. Gender, mandible side, examiner, and type of method were analyzed by the generalized estimating equations [GEE] model. Results. significant difference between examiners [PAN: P = 0.146; CBCT: P = 0.749] was not observed. Analysis by GEE model showed no significant difference between genders [P = 0.411] and examiners [P = 0.183]. However, significant difference was observed for identification in both mandible right side [P = 0.001], where the identification frequency was higher, and CBCT method [P < 0.001]. Conclusions. PAN was not shown to be a safe examination to identify MIC. CBCT should always be used in preoperative planning and to reduce the number of complications in implant surgeries.

Impact of cone-beam computed tomography on implant planning and on prediction of implant size

The aim was to investigate the impact of cone-beam computed tomography (CBCT) on implant planning and on prediction of final implant size. Consecutive patients referred for implant treatment were submitted to clinical examination, panoramic (PAN) radiography and a CBCT exam. Initial planning of implant length and width was assessed based on clinical and PAN exams, and final planning, on CBCT exam to complement diagnosis. The actual dimensions of the implants placed during surgery were compared with those obtained during initial and final planning, using the McNemmar test (p < 0.05). The final sample comprised 95 implants in 27 patients, distributed over the maxilla and mandible. Agreement in implant length was 50.5% between initial and final planning, and correct prediction of the actual implant length was 40.0% and 69.5%, using PAN and CBCT exams, respectively. Agreement in implant width assessment ranged from 69.5% to 73.7%. A paired comparison of the frequency of changes between initial or final planning and implant placement (McNemmar test) showed greater frequency of changes in initial planning for implant length (p < 0.001), but not for implant width (p = 0.850). The frequency of changes was not influenced by implant location at any stage of implant planning (chi-square test, p > 0.05). It was concluded that CBCT improves the ability of predicting the actual implant length and reduces inaccuracy in surgical dental implant planning.