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Jacobs R, Fontenele RC, Lahoud P, Shujaat S, Bornstein MM. Radiographic diagnosis of periodontal diseases - Current evidence versus innovations. Periodontol 2000 2024. [PMID: 38831570 DOI: 10.1111/prd.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/23/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
Accurate diagnosis of periodontal and peri-implant diseases relies significantly on radiographic examination, especially for assessing alveolar bone levels, bone defect morphology, and bone quality. This narrative review aimed to comprehensively outline the current state-of-the-art in radiographic diagnosis of alveolar bone diseases, covering both two-dimensional (2D) and three-dimensional (3D) modalities. Additionally, this review explores recent technological advances in periodontal imaging diagnosis, focusing on their potential integration into clinical practice. Clinical probing and intraoral radiography, while crucial, encounter limitations in effectively assessing complex periodontal bone defects. Recognizing these challenges, 3D imaging modalities, such as cone beam computed tomography (CBCT), have been explored for a more comprehensive understanding of periodontal structures. The significance of the radiographic assessment approach is evidenced by its ability to offer an objective and standardized means of evaluating hard tissues, reducing variability associated with manual clinical measurements and contributing to a more precise diagnosis of periodontal health. However, clinicians should be aware of challenges related to CBCT imaging assessment, including beam-hardening artifacts generated by the high-density materials present in the field of view, which might affect image quality. Integration of digital technologies, such as artificial intelligence-based tools in intraoral radiography software, the enhances the diagnostic process. The overarching recommendation is a judicious combination of CBCT and digital intraoral radiography for enhanced periodontal bone assessment. Therefore, it is crucial for clinicians to weigh the benefits against the risks associated with higher radiation exposure on a case-by-case basis, prioritizing patient safety and treatment outcomes.
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Affiliation(s)
- Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Rocharles Cavalcante Fontenele
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pierre Lahoud
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Periodontology and Oral Microbiology, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
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Lu J, Ou Y, Zhao W, Chen H, He K, Lin H, Chen J. Cone beam computed tomography assessment of maxillary anterior teeth cervix dimensions in healthy adults for optimal anatomic healing abutments. J ESTHET RESTOR DENT 2024. [PMID: 38605591 DOI: 10.1111/jerd.13236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/14/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES The abutments produced with circular symmetry failed to accurately replicate the natural teeth's cervical shapes. The purpose of this study was to measure cervical cross-sections of maxillary anterior teeth using cone beam computed tomography (CBCT) images to design anatomic healing abutments. MATERIALS AND METHODS CBCT data of 61 patients were analyzed using Ez3D Plus software. Measurements were taken at the cemento-enamel junction (CEJ) and 1 mm coronal to CEJ for maxillary central incisors, lateral incisors, and canines. Various parameters, including area, perimeter, and eight line segments in the distal (a), disto-palatal (b), palatal (c), mesio-palatal (d), mesial (e), mesio-labial (f), labial (g), and disto-labial (h) directions, were used to describe dental neck contours. The ratios (f/b and h/d) were analyzed, and differences based on sex and dental arch morphology were explored. RESULTS Significant differences were found in area and perimeter between males and females, but not in f/b and h/d ratios. Differences in the f/b ratio were observed among dental arch morphologies for maxillary central incisors, lateral incisors, and canines. CONCLUSIONS CBCT measurements of cervical cross-sections provide more accurate data for designing anatomic healing abutments. The fabrication of anatomical healing abutments needs to consider the influence of gender on cervical size and to explore the potential effect of arch shape on cervical morphology. CLINICAL SIGNIFICANCE The novel method provides detailed measurements for the description of dental cervical contours for patients with bilateral homonymous teeth missing. The measurements of this study could be utilized to design more accurate anatomic healing abutments to create desired morphology of peri-implant soft tissue.
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Affiliation(s)
- Jie Lu
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Yanjing Ou
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Wei Zhao
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Huachen Chen
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Kaixun He
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Hanyu Lin
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Jiang Chen
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
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Farook FF, Alodwene H, Alharbi R, Alyami M, Alshahrani A, Almohammadi D, Alnasyan B, Aboelmaaty W. Reliability assessment between clinical attachment loss and alveolar bone level in dental radiographs. Clin Exp Dent Res 2020; 6:596-601. [PMID: 32918518 PMCID: PMC7745069 DOI: 10.1002/cre2.324] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background The clinical attachment level (CAL) and radiographically assessed bone levels are used to assess the loss of periodontal tissue support in periodontitis, a chronic, multifactorial inflammatory disease of the periodontium. However, few studies have been done to study the relationship between these two parameters. According to our knowledge, this is the first study investigating the relationship between the two measurements using intraclass correlation analysis. Aim The aim of the study is to investigate the relationship between CAL and radiographically assessed bone level in teeth affected with periodontitis. Methods A retrospective cross‐sectional study was conducted by selecting a sample of 880 periodontal sites in 104 periodontitis patients, aged 25–60 years. CAL and peri‐apical radiographs of the selected sites were obtained from the computerized patient records. The distance from the cemento‐enamel junction (CEJ) to the base of the alveolar bone level (ABL) was measured. The data was analyzed using SPSS. Results Intraclass correlation analysis (ICC) revealed a moderate degree of reliability between CAL and CEJ to ABL measurements. The average ICC was 0.68 with a 95% confidence interval of 0.53–0.77 (p < .001) indicating moderate to good reliability. Comparing the types of teeth, the central incisors, particularly the lower central incisors showed the highest ICC values (ICC: 0.822, CI: 0.77–0.86) indicating good reliability while the premolar and molars showed poor to moderate agreement (Maxillary premolars ICC: 0.464, CI: −0.18–0.74; maxillary first molar ICC: 0.516, CI: −0.154–0.772; mandibular first premolar ICC: 0.662, CI: 0.269–0.782; mandibular first molar ICC: 0.625, CI: 0.31–0.82). A moderate correlation existed between the radiographic and the clinical assessments (r = 0.5, p < .001). Conclusion Despite the fact that significant varying levels of reliability has been found between CAL and radiographic bone level, both the clinical and radiographic examinations should be performed for the accuracy of diagnosis.
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Affiliation(s)
- Fathima Fazrina Farook
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hussah Alodwene
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Rasha Alharbi
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Meral Alyami
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Amjad Alshahrani
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Duaa Almohammadi
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Bothinah Alnasyan
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Wael Aboelmaaty
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oral Radiology and Diagnostic Sciences, Faculty of Dentistry, Mansoura University, Egypt
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Farook FF, Alnasyan B, Almohammadi D, Alshahrani A, Alyami M, Alharbi R, Alodwene H, Aboelmaaty W. Reliability Assessment of the Clinical and Radiographic Diagnosis of Furcation Involvement. Open Dent J 2020. [DOI: 10.2174/1874210602014010403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim:
The aim of the present study was to compare and assess the relationship and agreement between the clinical and radiographic detection of Furcation Involvement (FI) in the mandibular molars of patients with periodontitis.
Materials and Methods:
The sample size included 360 molars from 283 participants with a total of 180 molars involved with furcation clinically and 180 without. The inclusion criteria involved records of patients in the age range 35-76 years, diagnosed with generalized periodontitis, Stage II to IV, Grade B and C, and existing periapical radiographs/dental panoramic radiographs. The periodontal charts (Hamp’s classification) and radiographs were used to evaluate furcation on the buccal and lingual sites of first and second mandibular molars.
Results:
Of the 360 molars, half of the molars (50%, n=180) had clinical FI. Of the clinical FI group, the majority (73%, n=131) demonstrated FI in the radiological assessment with the periapical radiographs. In the not-clinically detected FI group, just less than half (49%, n=89) demonstrated FI in the radiological assessment. The sensitivity of the radiographic detection of FI as a diagnostic marker was 50.6%, and the specificity was 72.8%. Of the 180 sites analyzed with FI clinically, a slight agreement was found between the clinical assessment and radiographic findings using the kappa analysis (k=0.18). The first mandibular molars showed a fair agreement (k= 0.21) compared to the second mandibular molars (k=0.15). In terms of the individual sites, the lingual sites (k=0.24) had a fair agreement compared to the buccal sites with a slight agreement. The Spearman Correlation analysis for the first mandibular molar showed a moderate positive correlation (r=0.4, p<0.001) compared to the second mandibular molar with no or negligible relationship (r=0.19, p<0.001). Comparatively, the DPT radiograph showed a weak correlation and poor agreement.
Conclusion:
Both diagnostic tools, intraoral radiography and clinical assessment should be used for diagnosing FI in mandibular molars.
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Influence of Invisalign treatment with interproximal enamel reduction (IER) on bone volume for adult crowding: a retrospective three-dimensional cone beam computed tomography study. BMC Oral Health 2016; 16:83. [PMID: 27586057 PMCID: PMC5009673 DOI: 10.1186/s12903-016-0281-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/17/2016] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to use three-dimensional datasets to identify associations between treatment for adult crowding using Invisalign and interproximal enamel reduction (IER) and changes in the bone volume. Methods A total of 60 digital cone beam computed tomography (CBCT) scans from 30 patients (28 women, two men; 30 CBCTs pretreatment, 30 posttreatment) were examined retrospectively in order to record bone volume three-dimensionally before and after treatment. The patients’ average age was 36.03 ± 9.7 years. The data were collected and analyzed using the computer programs Mimics 15.0 and OsiriX. Differences in bone between T0 and T1 were analyzed with IBM SPSS 21.0 using the Wilcoxon test for paired samples. Results Analysis of the orovestibular bone volume showed highly significant changes (bone change P <0.001) only in the mandible where more expansion of the dental arch was carried out using proclination or protrusion. The bone lamella was thinner buccally and thicker lingually. In general, bone increases in the oral direction were slightly greater than bone losses in the vestibular direction. No significant changes were detected in the maxilla (bone change P = 0.13). Significant vertical bone loss in the bone height was detected in both the maxilla and the mandible. The largest bone loss was observed in the vestibular direction in the mandible, at a high level of significance (P <0.001). Conclusions Particularly in the mandible, therapeutic reduction of the vertical and sagittal bone volume shows that caution should be used in the treatment of tertiary crowding with proclination and expansion. The cortical walls appear to represent the limits for orthodontic tooth movement, at least in adult female patients.
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Kook YA, Kim G, Kim Y. Comparison of alveolar bone loss around incisors in normal occlusion samples and surgical skeletal class III patients. Angle Orthod 2012; 82:645-652. [PMID: 22129151 PMCID: PMC8845546 DOI: 10.2319/070111-424.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 09/01/2011] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE To test the hypothesis that there is no difference in vertical alveolar bone loss and alveolar bone thickness around maxillary and mandibular central incisors in normal occlusion samples and skeletal Class III malocclusion patients. MATERIALS AND METHODS The study sample comprised 20 Korean normal occlusion subjects (mean age, 22.1 years; group 1) and patients with skeletal Class III malocclusion with anterior open bite (mean age, 22.4 years; group 2). Three-dimensional (3D) cone beam computed tomography (CBCT) images were taken before orthodontic treatment, and sagittal slices chosen at the labio-lingually widest point of the maxillary and mandibular right central incisor were evaluated, respectively. The amount of vertical alveolar bone loss and/or alveolar bone thickness of the labial and lingual plate at the root apex were measured. RESULTS Group 2 had statistically significant more vertical bone loss than group 1 (P < .05). Alveolar bone at the apex was significantly thinner in group 2 (P < .05), except for the maxillary incisors. Mandibular incisors showed greater alveolar bone loss than was seen in maxillary incisors in both groups, especially at the lingual side in group 2 (P < .05). Overall, alveolar bone thickness at the apex was wider than cementoenamel junction (CEJ) width, except for the mandibular incisors in group 2, for which the percentage was 81.33%. CONCLUSIONS The hypothesis is rejected. Special care should be taken to avoid aggravating preexisting alveolar bone loss in the anterior teeth, especially in the mandible, in skeletal Class III patients, who may be more vulnerable to alveolar bone loss during orthodontic treatment.
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Affiliation(s)
- Yoon-Ah Kook
- Professor, Department of Orthodontics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Guinam Kim
- MS student, Department of Orthodontics, Graduate School of Clinical Dental Science, The Catholic University of Korea, Seoul, South Korea
| | - Yoonji Kim
- Assistant Professor, Department of Orthodontics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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