Micro-computed tomography in preventive and restorative dental research: A review

Evaluating Micro-computed Tomography in Dental Implant Osseointegration: A Systematic Review and Meta-analysis

RATIONALE AND OBJECTIVES

The success of dental implants is heavily dependent on the implant's efficient integration with the surrounding bone, a process known as osseointegration. This integration is influenced by a range of individual characteristics of each patient, as well as the accuracy of diagnostic imaging techniques. Micro-computed tomography (micro-CT) is capable of capturing detailed three-dimensional images with high resolution. It may offer superior capabilities for assessing the connections between bones and implants compared to older techniques such as cone-beam computed tomography (CBCT) and intraoral radiography. This systematic review will discuss the uses of micro-CT in dental implant osseointegration, compare it to other radiography methods, and discuss it's effect on patients, especially those with previous history of periodontal disease.

MATERIALS AND METHODS

This research performed an extensive search across multiple databases, choosing papers based on specific criteria for inclusion and exclusion. The study focus was on using micro-CT to evaluate bone osseointegration. Meta-analyses were conducted to measure the impact of micro-CT on bone loss and the success rates of implants, while comparing various surgical procedures and depths of implantation. This systematic review is registered in PROSPERO with the registration number CRD42023482747.

RESULTS

The result of this study comprised 28 papers, incorporating a meta-analysis of 8. It emphasized the exceptional spatial resolution of micro-CT, which enables accurate assessments of bone volume and density, crucial factors for implant success. Micro-CT, when compared to CBCT and intraoral radiography, provides more comprehensive information, but it faces limitations due to its elevated expenses and radiation exposure. The analysis also indicated that micro-CT could be particularly advantageous in tailored therapy planning, particularly for patients with impaired conditions. Systemic factors like diabetes or periodontal disease can cause bone conditions.

CONCLUSION

Micro-CT is a highly advanced imaging technique that offers extensive information about dental implants, which is essential for evaluating osseointegration. Although micro-CT has several limitations, it has the capacity to improve clinical outcomes by providing more accurate diagnoses and tailored implant techniques. Subsequent investigations should focus on assessing its cost-effectiveness and establishing protocols to mitigate radiation exposure.

Emerging technologies for the evaluation of spatio-temporal polymerisation changes in flowable vs. sculptable dental resin-based composites

BACKGROUND

This study presents a novel multi-technique approach that integrates micro-CT and optical photothermal infrared spectroscopy (O-PTIR) to evaluate polymerisation differences, so-called spatio-temporal polymerisation properties, between flowable and sculptable dental resin-based composites.

METHODS

Ten commercially available dental composites were investigated, including flowable and sculptable counterparts from the same manufacturer. Eight parameters were evaluated: short-term polymerisation characteristics (degree of conversion after 5 min, maximum polymerisation rate, time to reach maximum polymerisation rate) was measured using ATR-FTIR with real-time monitoring; changes in the degree of conversion with depth were evaluated with O-PTIR, 3D visualisation of shrinkage patterns, overall volumetric shrinkage, depth-specific shrinkage, and porosity were measured using micro-CT; surface morphology with detailed measurements of elemental composition was characterised using SEM/EDX; light transmittance was analysed with a NIST-referenced spectrometer.

RESULTS

The study found that the increase in filler weight and volume ratio reduced the degree of conversion and polymerisation shrinkage, while moderately influencing the maximum polymerisation rates. The time to reach maximum polymerisation rates and light transmittance were not dependent on the filler amount. O-PTIR assessed a depth-dependent decrease in the degree of conversion for both composite types, with flowable composites generally showing a greater decrease in the degree of conversion than sculptable composites, except for bulk-fill composites. Micro-CT scans showed significantly higher flowable shrinkage values than their sculptable counterparts, highlighting the performance differences between the two types of composites.

CONCLUSIONS

The findings of this study have practical implications for the selection and use of dental composites. Flowable composites, despite their higher degrees of conversion and polymerisation rates, also exhibit higher volumetric shrinkage, which can be detrimental for clinical applications. The new measurement methods used in this study provide a comprehensive overview of the polymerisation behaviour of commercially available dental composites, offering valuable insights for material optimisation.

3D micro-CT and O-PTIR spectroscopy bring new understanding of the influence of filler content in dental resin composites

BACKGROUND

Dental resin composites' performance is intricately linked to their polymerisation shrinkage characteristics. This study compares polymerisation shrinkage using advanced 3D micro-computed tomography (micro-CT) and traditional 2D linear assessments. It delves into the crucial role of filler content on shrinkage and the degree of conversion in dental resin composites, providing valuable insights for the field.

METHODS

Five experimental dental composite materials were prepared with increasing filler contents (55-75 wt%) and analysed using either 3D micro-CT for volumetric shrinkage or a custom-designed linometer for 2D linear shrinkage. The degree of conversion was assessed using Optical Photothermal Infrared (O-PTIR) and Fourier-Transform Infrared (FTIR) spectroscopy. Light transmittance through a 2-mm layer was evaluated using a NIST-calibrated spectrometer. Scanning Electron Microscopy (SEM) and Energy-Dispersive X-ray Spectroscopy (EDX) examined surface morphology and elemental distribution. Correlation between the investigated parameters was determined using Spearman correlation analyses.

RESULTS

The study found significant differences in polymerisation-related properties among different filler content categories, with volumetric shrinkage consistently demonstrating higher mean values than linear shrinkage across most groups. Volumetric shrinkage decreased with increasing curing depth, showing no direct correlation between filler content and shrinkage levels at different curing depths. The results highlighted a strong negative correlation between filler content and degree of conversion, volumetric and linear shrinkage, as well as maximum shrinkage rate. Light transmittance showed a moderate correlation with the filler content and a weak correlation with other tested parameters.

CONCLUSIONS

This study underscores the importance of considering both volumetric and linear shrinkage in the design and analysis of dental composite materials. The findings advocate optimising filler content to minimise shrinkage and enhance material performance. Integrating micro-CT and O-PTIR techniques offers novel insights into dental composites' polymerisation behaviour, providing a foundation for future research to develop materials with improved clinical outcomes.

Validation of Age Estimation Using the Compositional Variation of Dental Hard Tissue: An X-ray Diffraction Analysis

Introduction X-rays and X-ray diffraction (XRD) are two non-destructive techniques that determine a material's crystallographic structure, chemical composition, and physical properties. They can also be used to estimate a person's age when it is unknown, assess the need for orthodontic treatment, or predict the likelihood of tooth decay. This research aims to validate the accuracy of age estimation through X-ray diffraction analysis of tooth hard tissue with compositional changes. Methodology Four tooth samples were analyzed using the Pan Analytical XRD (Malvern Panalytical Ltd., UK) unique d8 family platform, which uses Cu Kα radiation (0.154 nm) and a 0.02° scan rate from 0 to 80°. Results The angle of incidence (ω) is established between the sample and the X-ray source. The angle of diffraction, 2θ, is established between the detector and the incident beam. The detector angle 2θ and the incident angle ω always equal half. Inter-atomic distance, or d-spacing (D = 10^-8 cm in Angstrom units), is measured. A greater crystal size or a greater degree of crystallinity may be indicated by a higher peak intensity, which translates to an increased amount of atoms in the crystal. Conclusion The study's findings suggest that XRD is a promising new technique for age determination, as it has an advanced and dynamic approach to finding the crystallographic characteristics of the provided sample.

Assessment of Anatomical Dentin Thickness in Mandibular First Molar: An In Vivo Cone-Beam Computed Tomographic Study

Aim

To determine the minimum dentin thickness in the mesial and distal walls of the mesiobuccal (MB) and mesiolingual (ML) canals of the mandibular first molars using cone-beam computed tomography (CBCT).

Materials and Methods

CBCT examinations of 624 mandibular first molars from an Indian subpopulation were analyzed. The mesial and distal minimum dentin thickness was evaluated in 1 mm intervals apical to the furcation area. Independent t-test was used to analyze the data (α = 0.05). Using Cohen's kappa coefficient, the interexaminer and intraexaminer reliability was evaluated.

Results

The mesial dentin thickness was significantly higher than the distal dentin thickness for MB and ML canals (P=0.01). The average dentin thickness in the distal and mesial plane of the MB canal was 1.15 ± 0.15 mm and 1.52 ± 0.19 mm at the 1 mm level and 0.83 ± 0.13 and 1.08 ± 0.18 at the 5 mm level, respectively. For the ML canal, the average dentin thickness in the distal plane and the mesial plane was 1.24 ± 0.18 mm and 1.44 ± 0.21 at the 1 mm level and 0.91 ± 0.16 and 1.01 ± 0.17 at the 5 mm level, respectively. Statistical analysis between the MB and ML canals showed significant differences in the dentin thickness at 4 and 5 mm levels in both the distal and the mesial planes (P=0.01). In more than 85% of the cases, the minimum dentin thickness was seen at the 5 mm level in both the distal and mesial planes in MB and ML canals.

Conclusion

The distal planes of the mesiolingual and mesiobuccal canals were thinner in most cases, making the distal surface more prone to iatrogenic perforations. Considerably, at 4 and 5 mm from the furcation, the distal wall was significantly thinner than the mesial walls. Understanding the anatomy of the danger zone in the mesial roots of the mandibular first molars may serve to minimize the risk of endodontic mishaps such as strip perforations.

Retrospective study of the morphology of third maxillary molars among the population of Lower Silesia based on analysis of cone beam computed tomography

INTRODUCTION

Understanding the anatomy of root canal systems and being aware of their variations is crucial for successful endodontic treatment. Specifically, the intricate and diverse nature of the root anatomy in maxillary third molars poses a significant challenge for dental clinicians. The study analyzed the morphology of the root canal system in maxillary third molars among residents of the Lower Silesia region in Poland using cone beam computed tomography (CBCT).

MATERIAL AND METHODS

This retrospective cross-sectional imaging study was conducted at the X-Ray Diagnostics Laboratory of the Academic Dental Polyclinic of Wroclaw Medical University, Poland. The study evaluated 316 CBCT scans and included 196 maxillary third molars. They were obtained from 118 females and 78 males over the age of 18, in the period from January to April 2022 (three consecutive months). The number of roots, root canals, and root canal configurations according to Vertucci's classification were analyzed.

RESULTS

Three-rooted maxillary molars were found most often (64.29%), followed by single-rooted (24.49%), two-rooted (7.65%), and four-rooted (3.57%) teeth. Among all the roots examined, Vertucci Type I root canals were the most prevalent. Our research found that single-rooted forms (40 teeth, 33.89% vs. 8 teeth, 10.26%, p = 0.0013) of maxillary third molars were significantly more common in females than in males. However, three-rooted forms (62 teeth, 79.49% vs. 64 teeth, 54.24%, p = 0.0013) of maxillary third molars were significantly more common in males than in females.

DISCUSSION

In the Lower Silesia region, the typical maxillary third molar in the Polish population has a three-rooted structure with Vertucci Type I root canal configuration. We noted a sex-dependent correlation in maxillary third molar morphology, with single-rooted forms more prevalent in women and three-rooted forms in men.

Internal Adaptation of Composite Fillings Made Using Universal Adhesives-A Micro-Computed Tomography Analysis

This study aimed to evaluate internal tooth-filling interfaces of composite fillings made using universal adhesives using micro-computed tomography (µCT). Sixty class V cavities were randomly assigned into six groups: Peak Universal etch and rinse (PER), Peak Universal self-etch (PSE), Adhese Universal etch and rinse (AER), and Adhese Universal self-etch (ASE). Two further adhesives considered gold standards were used as control groups: OptiBond FL (OER) for the etch and rinse technique and Clearfil SE for the self-etch technique (CSE). All teeth were subjected to thermomechanical loading and four-year water storage. Next, they were analyzed using µCT to investigate the internal tooth-filling interfaces. The proportions between the gap volume (GV) at the tooth-filling interface and the volume of applied composite filling (FV), between the gap and cavity volumes (CV), and between the gap volumes at the tooth-filling interface of the external (EGV) and internal (IGV) parts were calculated. Adhese Universal achieved the significantly lowest gap-to-filling- and gap-to-cavity-volume ratios for both types of etching techniques comparing to those of the Peak Universal and control groups. Significant differences between the gaps in external and internal parts of the tooth-filling interface were only noted in the control groups. Internal gap formation and development at the tooth-filling interface depend on the material as well as the type of its application.

In Vitro Comparison of Differences in Setting Time of Premixed Calcium Silicate-Based Mineral Trioxide Aggregate According to Moisture Content of Gypsum

Recently, a paste-type premixed calcium silicate-based mineral trioxide aggregate (MTA) product that quickly solidifies through a pozzolanic reaction was introduced to replace existing MTA, which has the disadvantage of a long setting time. In this study, we evaluated the effect of moisture content in the root canal on the setting time of premixed calcium silicate-based MTA in a simulated root canal environment using Endoseal MTA and Well-Root ST, among commercially available products. The setting time was measured according to ISO 6876/2012. A mold made using grades 2, 3, and 4 dental gypsum according to the classification of ISO 6873/2013 was used to reproduce the difference in moisture environment. Differences in moisture content were measured using micro-computed X-ray tomography (micro-CT). The micro-CT results showed that the moisture content was the highest and lowest in the grade 2 and 4 gypsum molds, respectively. Moreover, the setting time indicated by the manufacturer was the shortest for the grade 2 gypsum mold. Hence, the differences in moisture content significantly affect the setting time of MTA. This result can help set future experimental conditions and develop premixed calcium silicate-based MTA products.

The applications of MicroCT in studying age-related tooth morphological change and dental age estimation: A scoping review

Conventional dental age estimation relies on destructive methods such as sectioning and staining, which are unpreferable when the tooth is required for evidential or archeological preservation. MicroCT is a non-destructive, high-resolution imaging technique that allows for accurate morphometrical measurement. Although microCT technology has been applied in a variety of dental studies, studies focusing on dental age-related change and dental age estimation based on microCT imaging remain lacking. Based on the question: "How has microCT technology been applied in studying human age-related tooth morphological change and dental age estimation studies?", the authors conducted a scoping review in accordance with the Arksey and O'Malley (2005) and the PRISMA-ScR guidelines. A literature search using five major scientific databases identified 452 articles, with 11 full-text articles being eligible to be included in the scoping review. Furthermore, 6 out of the 11 studies performed dental age estimation modeling. An overview of the parameters used in the selected articles revealed a variety of tooth characteristics, such as pulp cavity to whole tooth volume ratio, secondary dentin, as well as the diameter of root canal orifice. The findings of this scoping review highlight the extent microCT is used in studying dental age-related changes, as well as the effectiveness of microCT in dental age estimation studies. This review serves as a guide for future forensic odontology age estimation studies.

Characterization of dynamic process of carious and erosive demineralization - an overview

To review the analytical methods for carious and erosive demineralization an initial search of peer-reviewed scientific literature from the digital library database of PubMed/Medline indexed journals published up to early 2022 was carried out based on keywords relevant to the topic criteria including bibliographic citations from the papers to gather the most updated information. This current review aims to provide an updated overview of the advantages, limitations, and potential applications of direct and indirect research methods available for studying various dynamic stages of carious and erosive demineralization in enamel and dentin. This paper categorizes and describes the most suitable, frequently adopted and widely used quantitative and qualitative techniques in in vitro/in vivo research which are well-established, emerging, or comparatively novel techniques that are being explored for their potential validation.