Texture analysis of cone beam computed tomography images reveals dental implant stability

Radiomics-Driven CBCT Texture Analysis as a Novel Biosensor for Quantifying Periapical Bone Healing: A Comparative Study of Intracanal Medications

This study aimed to evaluate the effectiveness of two intracanal medications in promoting periapical bone healing following endodontic treatment using radiomics-enabled texture analysis of cone-beam computed tomography (CBCT) images as a novel biosensing technique. By quantifying tissue changes through advanced image analysis, this approach seeks to enhance the monitoring and assessment of endodontic treatment outcomes. Thirty-four single-rooted teeth with pulp necrosis and periapical lesions were allocated to two groups (17 each): calcium hydroxide +2% chlorhexidine gel (CHX) and Ultracal XS®. CBCT scans were obtained immediately after treatment and three months later. Texture analysis performed using MaZda software extracted 11 parameters based on the gray level co-occurrence matrix (GLCM) across two inter-pixel distances and four directions. Statistical analysis revealed significant differences between medications for S [0,1] inverse difference moment (p = 0.043), S [0,2] difference of variance (p = 0.014), and S [0,2] difference of entropy (p = 0.004). CHX treatment resulted in a more organized bone tissue structure post-treatment, evidenced by reduced entropy and variance parameters, while Ultracal exhibited less homogeneity, indicative of fibrous or immature tissue formation. These findings demonstrate the superior efficacy of CHX in promoting bone healing and underscore the potential of texture analysis as a powerful tool for assessing CBCT images in endodontic research.

Unveiling degenerative bone changes in the condyle: a texture analysis approach using cone-beam computed tomography

PURPOSE

The degenerative joint disease is a temporomandibular disorder. By analysing texture parameters, it becomes possible to characterize and differentiate various tissues, based on their textural properties according to cone-beam computed tomography (CBCT). This study evaluated degenerative diseases in the temporomandibular joint through texture analysis.

METHODS

Eighty images of the jaw condyle with three types of degenerative diseases, flattening, osteophytes, erosion and control group were analysed, obtained through CBCT. The analyses were carried out through texture analysis with three regions of interest (ROIs) corresponding to specific bone sites. The scans were exported to MaZda software, in which the ROIs were delimited following previously marked contours, and the co-occurrence matrix values were calculated for selected texture analysis parameters.

RESULTS

The erosion group showed a significantly different behaviour from the other groups for all analysed parameters.

CONCLUSION

This study highlights the potential of texture analysis in characterizing medullary bone changes in condyles affected by erosion. Texture analysis allows for a more comprehensive assessment of bone condition on CBCT images. These results have implications for early detection and monitoring of degenerative changes in the temporomandibular joint, thus allowing preventive intervention and personalized treatment planning, improving the prognosis of the disease.

Texture Analysis in Volumetric Imaging for Dentomaxillofacial Radiology: Transforming Diagnostic Approaches and Future Directions

This narrative review explores texture analysis as a valuable technique in dentomaxillofacial diagnosis, providing an advanced method for quantification and characterization of different image modalities. The traditional imaging techniques rely primarily on visual assessment, which may overlook subtle variations in tissue structure. In contrast, texture analysis uses sophisticated algorithms to extract quantitative information from imaging data, thus offering deeper insights into the spatial distribution and relationships of pixel intensities. This process identifies unique "texture signatures", serving as markers for accurately characterizing tissue changes or pathological processes. The synergy between texture analysis and radiomics allows radiologists to transcend traditional size-based or semantic descriptors, offering a comprehensive understanding of imaging data. This method enhances diagnostic accuracy, particularly for the assessment of oral and maxillofacial pathologies. The integration of texture analysis with radiomics expands the potential for precise tissue characterization by moving beyond the limitations of human eye evaluations. This article reviews the current trends and methodologies in texture analysis within the field of dentomaxillofacial imaging, highlights its practical applications, and discusses future directions for research and dental clinical practice.

Radiographic texture analysis of the hard tissue changes following socket preservation with allograft and xenograft materials for dental implantation: a randomized clinical trial

OBJECTIVES

This study aimed to assess the hard tissue changes following socket preservation with allograft and xenograft materials for dental implantation by texture analysis (TA) using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

This prospective clinical trial was conducted on 25 patients who required the extraction of carious mandibular posterior teeth and their subsequent replacement with dental implants. The patients were categorized into three groups: (I) no socket preservation, (II) socket preservation with xenograft material, and (III) socket preservation with allograft material. Four months after tooth extraction, the patients were recalled for preoperative assessment before dental implantation, and CBCT scans were obtained (Kvp:110, mA:1.94, S:3.6). MaZda software was used to compare homogeneity, contrast, and texture complexity on axial CBCT sections among the three groups.

RESULTS

Significant differences existed among the three groups in all parameters (P < 0.05) except for the mean correlation parameter (P > 0.05). The results showed no significant difference between the no graft and xenograft groups regarding contrast and differential (dif.) entropy (P > 0.05). Also, no significant difference was found between the xenograft and allograft groups regarding the dif. variance and also between the no graft and allograft groups regarding the inverse difference moment(InvDfMom) and dif. variance parameters (P > 0.05). All other pairwise comparisons revealed significant differences (P < 0.05).

CONCLUSION

TA can be used for the quantification of radiographic changes of bone following socket preservation and potentially accelerate the process of decision-making for dental implant treatment.

Differential diagnosis of cemento-osseous dysplasia and periapical cyst using texture analysis of CBCT

BACKGROUND

Radiolucencies found at the root apex in patients with cemento-osseous dysplasia (COD) may be mistaken for periapical cysts (PC) of endodontic origin. The purpose of this study was to examine the utility of quantitative texture analysis using cone-beam computed tomography (CBCT) to differentiate between COD and PC.

METHODS

Patients who underwent CBCT at Wonkwang University Daejeon Dental Hospital between January 2019 and December 2022 and were diagnosed with COD and PC by clinical, radiologic, and, if necessary, histopathologic examination were included. Twenty-five patients each were retrospectively enrolled in the COD and PC group. All lesions observed on axial CBCT images were manually segmented using the open-access software MaZda version 4.6 to establish the regions of interest, which were then subjected to texture analysis. Among the 279 texture features obtained, 10 texture features with the highest Fisher coefficients were selected. Statistical analysis was performed using the Mann-Whitney U-test, Welch's t-test, or Student's t-test. Texture features that showed significant differences were subjected to receiver operating characteristics (ROC) curve analysis to evaluate the differential diagnostic ability of COD and PC.

RESULTS

The COD group consisted of 22 men and 3 women, while the PC group consisted of 14 men and 11 women, showing a significant difference between the two groups in terms of sex (p=0.003). The 10 selected texture features belonged to the gray level co-occurrence matrix and included the sum of average, sum of entropy, entropy, and difference of entropy. All 10 selected texture features showed statistically significant differences (p<0.05) when comparing patients with COD (n=25) versus those with PC (n=25), osteolytic-stage COD (n=11) versus PC (n=25), and osteolytic-stage COD (n=11) versus cementoblastic-stage COD (n=14). ROC curve analysis to determine the ability to differentiate between COD and PC showed a high area under the curve ranging from 0.96 to 0.98.

CONCLUSION

Texture analysis of CBCT images has shown good diagnostic value in the differential diagnosis of COD and PC, which can help prevent unnecessary endodontic treatment, invasive biopsy, or surgical intervention associated with increased risk of infection.

Correlation Between Acquisition of Dental Implant Stability and Hounsfield Units at Dental Implant Placement

Alveolar bone quality at the implantation site affects the initial stability of dental implant treatment. However, the relationship between bone quality and osseointegration has yet to be evaluated. Herein, we aimed to investigate the effect of bone quality on dental implant stability in osseointegration formation changes. Patients underwent computed tomography imaging before dental implantation at the posterior. Hounsfield units were measured at the platform, middle, and tip sites. Implant stability was measured using resonance frequency analysis immediately and at 3 months postoperatively, in which the difference in implant stability quotients (ISQ) was defined as the change between primary and secondary fixation. In multiple regression analysis, the dependent variable was the change between the immediate and secondary fixations. We included 81 implants that conformed to the criteria. Primary fixation yielded the following results: R2 = 0.117, F = 2.529, and P = .047. The difference between the maxilla and mandible of the implantation site (P = .02) and the platform-site Hounsfield units (P = .019) were identified as significant factors. The following results were obtained regarding the change between the immediate and secondary fixation: R2 = 0.714, F = 40.964, and P < .001. The difference between diameter (P = .008) and the immediate ISQ (P < .001) were identified as significant factors. Overall, the bone quality of the implantation site affected initial fixation; however, it had limited effect on secondary fixation. Our findings clarified the period where bone quality affects dental implant treatment and is expected to advance dental implant treatment.

Effect of the pulsed electromagnetic field in the repair of a calvaria critical bone defect in rats: cone beam computed tomographic and histomorphometric analysis.: PEMF in the repair of a calvaria critical bone defect: CBCT analyses

INTRODUCTION

The present study evaluated the effect of two protocols of Pulsed Electromagnetic Field (PEMF) therapy on bone neoformation on calvaria critical defects in rats.

MATERIAL & METHODS

96 rats were randomly divided into 3 groups: Control Group (CG; n=32); Test Group - PEMF 1 hour (TG1h; n=32) and Test Group - PEMF 3 hour (TG3h; n=32). A Critical-size Bone Defect (CSD) was surgically created in the calvaria of rats. The animals in the test groups were exposure to PEMF for 5 days a week. The animals were euthanized at 14, 21, 45 and 60 days. The specimens were processed for volume and texture (TAn) analysis, by Cone Beam Computed Tomography (CBCT) and histomorphometric analysis, RESULTS: Histomorphometric and volume analyses revealed that there was no statistically significant difference in the repair of bone defects between groups receiving PEMF therapy and CG. TAn revealed a statistically significant difference between the groups only for the entropy parameter, in which TG1h group presented a higher value compared to CG on 21 days. TG1h and TG3h did not accelerate bone repair in calvarial critical size defect and the parameters of PEMF should be considered.

DISCUSSION

This study showed that PEMF application on CSD in rats does not accelerate bone repair. Although literature showed a positive association in biostimulation on bone tissue with the parameters applied, studies with other PEMF parameters are essential to verify improving this study design.

Reproducibility and location-stability of radiomic features derived from cone-beam computed tomography: a phantom study

OBJECTIVES

This study aims to determine the reproducibility and location-stability of cone-beam computed tomography (CBCT) radiomic features.

METHODS

Centrifugal tubes with six concentrations of K2HPO4 solutions (50, 100, 200, 400, 600, and 800 mg ml-1) were imaged within a customized phantom. For each concentration, images were captured twice as test and retest sets. Totally, 69 radiomic features were extracted by LIFEx. The reproducibility was assessed between the test and retest sets. We used the concordance correlation coefficient (CCC) to screen qualified features and then compared the differences in the numbers of them under 24 series (four locations groups * six concentrations). The location-stability was assessed using the Kruskal-Wallis test under different concentration sets; likewise, the numbers of qualified features under six test sets were analyzed.

RESULTS

There were 20 and 23 qualified features in the reproducibility and location-stability experiments, respectively. In the reproducibility experiment, the performance of the peripheral groups and high-concentration sets was significantly better than the center groups and low-concentration sets. The effect of concentration on the location-stability of features was not monotonic, and the number of qualified features in the low-concentration sets was greater than that in the high-concentration sets. No features were qualified in both experiments.

CONCLUSIONS

The density and location of the target object can affect the number of reproducible radiomic features, and its density can also affect the number of location-stable radiomic features. The problem of feature reliability should be treated cautiously in radiomic research on CBCT.

Systemic effects of oral tolerance in bone healing

Bone fractures cause acute inflammation that, despite being important for initial repair, may delay the healing of the damaged bone. Parenteral injection of dietary protein has been shown to decrease inflammation and accelerate the repair of skin wounds and other inflammatory pathologies. Thus, our aim was to evaluate whether the intraperitoneal (i.p.) immunization with zein, an abundant protein in rodent chow, would favor bone healing. Wistar rats received i.p. immunization: saline (SG), adjuvant (AG) and zein associated with adjuvant (ZG). Then, a 2 mm of defect bone was performed on the right tibia, and on days 7, 14, 28 and 45 thereafter, analyses were performed. The results showed that the injection of zein reduced inflammation without impairing bone mineralization. Moreover, biomechanical tests demonstrated higher levels of maximum force (N) in ZG, indicating better mechanical resistance in relation to the others. The computerized tomography also indicated lower levels of medullary content in the ZG than in the SG, suggesting the absence of trabeculae in the medullary region in the ZG. These findings suggest that the injection of zein in previously tolerated animals may improve bone repair, leading to mechanically functional bone formation.

Magnetic resonance imaging texture analysis for quantitative evaluation of the mandibular condyle in juvenile idiopathic arthritis

OBJECTIVES

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that affects the joints and other organs, including the development of the former in a growing child. This study aimed to evaluate the feasibility of texture analysis (TA) based on magnetic resonance imaging (MRI) to provide biomarkers that serve to identify patients likely to progress to temporomandibular joint damage by associating JIA with age, gender and disease onset age.

METHODS

The radiological database was retrospectively reviewed. A total of 45 patients were first divided into control group (23) and JIA group (22). TA was performed using grey-level co-occurrence matrix (GLCM) parameters, in which 11 textural parameters were calculated using MaZda software. These 11 parameters were ranked based on the p value obtained with ANOVA and then correlated with age, gender and disease onset age.

RESULTS

Significant differences in texture parameters of condyle were demonstrated between JIA group and control group (p < 0.05). There was a progressive loss of uniformity in the grayscale pixels of MRI with an increasing age in JIA group.

CONCLUSIONS

MRI TA of the condyle can make it possible to detect the alterations in bone marrow of patients with JIA and promising tool which may help the image analysis.

An Experimental Anodized and Low-Pressure Oxygen Plasma-Treated Titanium Dental Implant Surface-Preliminary Report

Chemical composition and physical parameters of the implant surface, such as roughness, regulate the cellular response leading to implant bone osseointegration. Possible implant surface modifications include anodization or the plasma electrolytic oxidation (PEO) treatment process that produces a thick and dense oxide coating superior to normal anodic oxidation. Experimental modifications with Plasma Electrolytic Oxidation (PEO) titanium and titanium alloy Ti6Al4V plates and PEO additionally treated with low-pressure oxygen plasma (PEO-S) were used in this study to evaluate their physical and chemical properties. Cytotoxicity of experimental titanium samples as well as cell adhesion to their surface were assessed using normal human dermal fibroblasts (NHDF) or L929 cell line. Moreover, the surface roughness, fractal dimension analysis, and texture analysis were calculated. Samples after surface treatment have substantially improved properties compared to the reference SLA (sandblasted and acid-etched) surface. The surface roughness (Sa) was 0.59-2.38 µm, and none of the tested surfaces had cytotoxic effect on NHDF and L929 cell lines. A greater cell growth of NHDF was observed on the tested PEO and PEO-S samples compared to reference SLA sample titanium.

Cone-beam computed tomography texture analysis can help differentiate odontogenic and non-odontogenic maxillary sinusitis

Purpose

This study aimed to assess texture analysis (TA) of cone-beam computed tomography (CBCT) images as a quantitative tool for the differential diagnosis of odontogenic and non-odontogenic maxillary sinusitis (OS and NOS, respectively).

Materials and Methods

CBCT images of 40 patients diagnosed with OS (N=20) and NOS (N=20) were evaluated. The gray level co-occurrence (GLCM) matrix parameters, and gray level run length matrix texture (GLRLM) parameters were extracted using manually placed regions of interest on lesion images. Seven texture parameters were calculated using GLCM and 4 parameters using GLRLM. The Mann-Whitney test was used for comparisons between the groups, and the Levene test was performed to confirm the homogeneity of variance (α=5%).

Results

The results showed statistically significant differences (P<0.05) between the OS and NOS patients regarding 3 TA parameters. NOS patients presented higher values for contrast, while OS patients presented higher values for correlation and inverse difference moment. Greater textural homogeneity was observed in the OS patients than in the NOS patients, with statistically significant differences in standard deviations between the groups for correlation, sum of squares, sum of entropy, and entropy.

Conclusion

TA enabled quantitative differentiation between OS and NOS on CBCT images by using the parameters of contrast, correlation, and inverse difference moment.

In vivo study of cone beam computed tomography texture analysis of mandibular condyle and its correlation with gender and age

OBJECTIVE

Texture analysis is an image processing method that aims to assess the distribution of gray-level intensity and spatial organization of the pixels in the image. The purpose of this study was to investigate whether the texture analysis applied to cone beam computed tomography (CBCT) images could detect variation in the condyle trabecular bone of individuals from different age groups and genders.

METHODS

The sample consisted of imaging exams from 63 individuals divided into three groups according to age groups of 03-13, 14-24 and 25-34. For texture analysis, the MaZda^® software was used to extract the following parameters: second angular momentum, contrast, correlation, sum of squares, inverse difference moment, sum entropy and entropy. Statistical analysis was performed using Mann-Whitney test for gender and Kruskal-Wallis test for age (P = 5%).

RESULTS

No statistically significant differences were found between age groups for any of the parameters. Males had lower values for the parameter correlation than those of females (P < 0.05).

CONCLUSION

Texture analysis proved to be useful to discriminate mandibular condyle trabecular bone between genders.

Risk assessment of external apical root resorption associated with orthodontic treatment using computed tomography texture analysis

OBJECTIVES

This study aimed to quantitatively assess maxillary central incisor roots using pre-orthodontics computed tomography (CT) texture analysis as part of a radiomics quantitative analysis.

METHODS

This retrospective case-control study included 16 patients with external apical root resorption (EARR) and 16 age- and sex-matched patients without EARR, after orthodontic treatment who underwent pre-orthodontics CT for jaw deformities. All patients were treated with a fixed orthodontic appliance before and after surgical orthodontic treatment. EARR was defined as root resorption ≥ 2 mm of the left and right maxillary central incisors on CT images more than 2 years after the start of orthodontic treatment. Texture features of the maxillary central incisor with and without EARR after orthodontic treatment were analyzed using the open-access software, MaZda Ver. 3.3. Ten texture features were selected using the Fisher method in MaZda from 279 original parameters, which were calculated for each of the maxillary central incisors with and without EARR. The results were tested using the Student's t test, Welch's t test, or Mann-Whitney U test.

RESULTS

Four gray-level run length matrix features and six gray-level co-occurrence matrix features displayed significant differences between both the groups (p < 0.01).

CONCLUSIONS

CT texture analysis was able to quantitatively assess maxillary central incisor roots and distinguish between maxillary central incisor roots with and without EARR. CT texture analysis may be a useful method for predicting EARR after orthodontic treatment.

Reliability of Using Texture Analysis of Periapical Radiographs Obtained Using Radiovisiography for Assessing Bone Quality in Dental Implant Planning: A Cross-Sectional Study

Background Pre-prosthetic implant radiographic imaging helps in the quantitative and qualitative analysis of the bone structure and also enables the evaluation of the relationship between critical structures and potential implant sites. Purpose The aim of the study was to define the reliability of utilizing the analysis of textures from the periapical radiographic images obtained through Radiovisiography (RVG) in order to better plan for dental implantations. Methods A cross-sectional study was conducted using 50 intraoral periapical radiographs which were obtained through RVG performed prior to the placement of implants. The radiographs were segregated based on anatomical locations i.e. 12 for the anterior maxilla, nine for the posterior maxilla, seven for the anterior mandible, and 22 for the posterior mandible. Each of the radiographs was visually assessed by four experienced examiners, namely a Prosthodontist E1, Periodontist E2, Oral surgeon E3, and Oral radiologist E4, which was then compared to an experienced operator's tactile perception during a pilot drill for implant placement. As a reference, the Lekholm and Zarb classification was provided to all the examiners for them to qualitatively assess the bone structure in the radiographs. Results The examiners' results were correlated with the assessment provided by the experienced operator. E1 and E4 successfully assessed 42% of the radiographs while E2 had the least success with only 26%. Of the 12 anterior maxillary radiographs, only eight were accurately assessed by E1. With respect to the posterior maxilla, all examiners correctly assessed four radiographs each. Of the seven anterior mandibular radiographs, except for E2, the rest correctly assessed three radiographs each. Of the 22 posterior mandibular radiographs, only nine were accurately assessed by E4. Conclusion Intraoral periapical radiographs obtained through RVG did not meet the desired parameters for assessing the bone quality during the planning stage for implants.

Diagnostic utility of magnetic resonance imaging texture analysis in suppurative osteomyelitis of the mandible

PURPOSE

This study aimed to determine the diagnostic utility of magnetic resonance imaging (MRI) texture analysis for evaluating mandibular suppurative osteomyelitis (OM).

MATERIALS AND METHODS

In this retrospective cohort study, we analyzed the records of 50 patients with and without OM who underwent MRI between April 2019 and March 2021. The presence or absence of OM served as a predictor variable. The outcome variables were the texture features of the region of interest, which were analyzed. Quantitative parameters based on histogram features (90th percentile) and gray-level co-occurrence matrix (GLCM) features (Sum Averg) were calculated using short-tau inversion-recovery data with a region of interest. These six features out of 279 parameters were selected using Fisher, probability of error, and average correlation coefficient methods in MaZda. For the analysis of trivariate statistics, the post-Mann-Whitney test of the Kruskal-Wallis test with Bonferroni adjustment was used, and the p value was set to 0.05. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic effect of texture function to distinguish between acute and chronic diseases.

RESULTS

One histogram feature and five GLCM features showed differences among the non-OM patients, acute OM patients, and chronic OM patients (p < 0.05). The ROC analysis revealed a high area under the curve ranging from 0.91 to 0.96 for six texture features.

CONCLUSION

The six texture features of the mandibular bone marrow demonstrated differences among patients without and with acute and chronic OM. MRI texture analysis may facilitate accurate assessment of the mandibular OM stage.

Two-Dimensional EspEn: A New Approach to Analyze Image Texture by Irregularity

Image processing has played a relevant role in various industries, where the main challenge is to extract specific features from images. Specifically, texture characterizes the phenomenon of the occurrence of a pattern along the spatial distribution, taking into account the intensities of the pixels for which it has been applied in classification and segmentation tasks. Therefore, several feature extraction methods have been proposed in recent decades, but few of them rely on entropy, which is a measure of uncertainty. Moreover, entropy algorithms have been little explored in bidimensional data. Nevertheless, there is a growing interest in developing algorithms to solve current limits, since Shannon Entropy does not consider spatial information, and SampEn2D generates unreliable values in small sizes. We introduce a proposed algorithm, EspEn (Espinosa Entropy), to measure the irregularity present in two-dimensional data, where the calculation requires setting the parameters as follows: m (length of square window), r (tolerance threshold), and ρ (percentage of similarity). Three experiments were performed; the first two were on simulated images contaminated with different noise levels. The last experiment was with grayscale images from the Normalized Brodatz Texture database (NBT). First, we compared the performance of EspEn against the entropy of Shannon and SampEn2D. Second, we evaluated the dependence of EspEn on variations of the values of the parameters m, r, and ρ. Third, we evaluated the EspEn algorithm on NBT images. The results revealed that EspEn could discriminate images with different size and degrees of noise. Finally, EspEn provides an alternative algorithm to quantify the irregularity in 2D data; the recommended parameters for better performance are m = 3, r = 20, and ρ = 0.7.