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Kaaber L, Matzen LH, Schropp L, Spin-Neto R. Low-dose CBCT protocols in implant dentistry: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:427-439. [PMID: 38679501 DOI: 10.1016/j.oooo.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE To evaluate the state-of-the-art evidence for applying low-dose CBCT protocols in 3 stages of implant therapy (planning, insertion, and follow-up examination of peri-implantitis) and assess the overall body of evidence presented in the literature. STUDY DESIGN The search was conducted in the MEDLINE/Pubmed and Scopus databases. Studies comparing low-dose CBCT protocols to a relevant reference standard in relation to any stage of implant therapy were included. Data extraction and quality assessment were performed for all included studies. RESULTS Sixteen studies were included. Low-dose protocols were reported to result from reduction of the exposure parameters of kV, mA, resolution (through increased voxel size), exposure time, and scanning trajectory. The current literature suggests that low-dose CBCT protocols perform similarly in the 3 stages of implant therapy compared to higher resolution protocols regarding objective measurements, with adverse impacts mostly on subjective assessment of image quality. The results also suggest that CBCT-based bone measurements are similar to direct measurements, independent of the imaging protocol. Reduction in all parameters except kV seems feasible as the basis of low-dose CBCT protocols for implant therapy. CONCLUSIONS The use of low-dose CBCT protocols does not impact objective image quality assessment in any stage of implant therapy. Clinical studies are needed to indicate if the reported results can be extrapolated to improve patient care in relation to the responsible use of ionizing radiation.
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Affiliation(s)
- Laurits Kaaber
- Department of Dentistry and Oral Health, Oral Radiology, Aarhus University, Aarhus, Denmark.
| | - Louise Hauge Matzen
- Department of Dentistry and Oral Health, Oral Radiology, Aarhus University, Aarhus, Denmark
| | - Lars Schropp
- Department of Dentistry and Oral Health, Oral Radiology, Aarhus University, Aarhus, Denmark
| | - Rubens Spin-Neto
- Department of Dentistry and Oral Health, Oral Radiology, Aarhus University, Aarhus, Denmark
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Kaaber L, Matzen LH, Spin-Neto R, Schropp L. Low-dose, standard, and high-resolution cone beam computed tomography for alveolar bone measurements related to implant planning: An ex vivo study in human specimens. Clin Oral Implants Res 2024. [PMID: 38970301 DOI: 10.1111/clr.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/24/2024] [Accepted: 06/21/2024] [Indexed: 07/08/2024]
Abstract
AIM To evaluate the performance of low-dose cone beam computed tomography (CBCT) protocols with regard to linear bone measurements in the posterior mandible for implant planning compared with higher dose protocols. MATERIALS AND METHODS Forty-two edentulous posterior sites in human cadaveric mandibles were imaged in three CBCT scanners using three or four protocols with varying exposure parameters to achieve lower dose. Co-registration was performed to generate sagittal and cross-sectional image sections representative of the implant site. Three observers measured bone height, from the alveolar crest to the mandibular canal, and width, three mm from the top of the alveolar crest. Intra- and interobserver reproducibility were assessed for the cases rated as nonmeasurable as well as for completed measurements. The measurements were analyzed using paired t-tests for differences among the CBCT protocols and the frequency distribution of nonmeasurable cases with a Pearson Chi-square test. RESULTS Reproducibility for registering nonmeasurable cases varied among observers; however, no consistent significant differences were found in the frequency distribution of these cases among observers, units, and protocols. Intraclass correlation coefficients (ICC) were >0.9 for all measurements of bone height and width. Mean differences of <0.5 mm were found regardless of protocol; however, one observer did in some cases produce larger differences. CONCLUSION Linear bone measurements did not differ significantly and could be performed with excellent reliability, using low-dose CBCT protocols compared with standard and high-resolution ones. Varying approaches for rating nonmeasurable cases were found, indicating differences in diagnostic strategies related to implant planning among observers.
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Affiliation(s)
- Laurits Kaaber
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus C, Denmark
| | - Louise Hauge Matzen
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus C, Denmark
| | - Rubens Spin-Neto
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus C, Denmark
| | - Lars Schropp
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus C, Denmark
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Carneiro ALE, Reis INR, Bitencourt FV, Salgado DMRA, Costa C, Spin-Neto R. Accuracy of linear measurements for implant planning based on low-dose cone beam CT protocols: a systematic review and meta-analysis. Dentomaxillofac Radiol 2024; 53:207-221. [PMID: 38429951 PMCID: PMC11056743 DOI: 10.1093/dmfr/twae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES The aim of this systematic review was to verify the accuracy of linear measurements performed on low-dose CBCT protocols for implant planning, in comparison with those performed on standard and high-resolution CBCT protocols. METHODS The literature search included four databases (Pubmed, Web of Science, Embase, and Scopus). Two reviewers independently screened titles/abstracts and full texts according to eligibility criteria, extracted the data, and examined the methodological quality. Risk of bias assessment was performed using the Quality Assessment Tool For In Vitro Studies. Random-effects meta-analysis was used for pooling measurement error data. RESULTS The initial search yielded 4684 titles. In total, 13 studies were included in the systematic review, representing a total of 81 samples, while 9 studies were included in the meta-analysis. The risk of bias ranged from medium to low. The main results across the studies indicate a strong consistency in linear measurements performed on low-dose images in relation to the reference methods. The overall pooled planning measurement error from low-dose CBCT protocols was -0.24 mm (95% CI, -0.52 to 0.04) with a high level of heterogeneity, showing a tendency for underestimation of real values. Various studies found no significant differences in measurements across different protocols (eg, voxel sizes, mA settings, or dose levels), regions (incisor, premolar, molar) and types (height vs. width). Some studies, however, noted exceptions in measurements performed on the posterior mandible. CONCLUSION Low-dose CBCT protocols offer adequate precision and accuracy of linear measurements for implant planning. Nevertheless, diagnostic image quality needs must be taken into consideration when choosing a low-dose CBCT protocol.
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Affiliation(s)
- Ana Luiza E Carneiro
- Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, 05508-000, Brazil
| | - Isabella N R Reis
- Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, 05508-000, Brazil
| | - Fernando Valentim Bitencourt
- Section for Oral Ecology and Inflammation, Department of Dentistry and Oral Health, Aarhus University, Aarhus, 8000, Denmark
- Steno Diabetes Center Aarhus, Aarhus, 8200, Denmark
| | - Daniela M R A Salgado
- Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, 05508-000, Brazil
| | - Claudio Costa
- Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, 05508-000, Brazil
| | - Rubens Spin-Neto
- Department of Dentistry and Oral Health—Section for Oral Radiology and Endodontics, Aarhus University, Aarhus, 8000, Denmark
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OUP accepted manuscript. Eur J Orthod 2022; 44:513-521. [DOI: 10.1093/ejo/cjac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Horsch L, Labis C, Trebing CT, Kronsteiner D, Hilgenfeld T, Rammelsberg P, Schwindling FS. Predictability and image quality of low-dose cone-beam computed tomography in computer-guided implantology: An experimental study. J Dent 2021; 112:103744. [PMID: 34252488 DOI: 10.1016/j.jdent.2021.103744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the predictability and image quality of low-dose cone-beam computed tomography (LD-CBCT) in computer-guided implantology. METHODS Pig cadaver mandibles were imaged using high-definition CBCT (HD-CBCT) and LD-CBCT (HD-CBCT: 85 kV, 6 mA, 14.2 s, 767 frames, 1184 mGycm2, voxel size 80 µm, effective dose 231 µSv; LD-CBCT: 85 kV, 10 mA, 2.1 s, 384 frames, 84 mGycm2, voxel size 160 µm, effective dose 16 µSv; Orthophos SL, Dentsply Sirona, Bensheim, Germany). Digital impressions were taken using intraoral scanning (IOS; Omnicam, Dentsply Sirona). Data of CBCT modalities and IOS were aligned. Forty-eight implants were planned virtually (24 implants per modality; Bone Level 4.1 × 10 mm; Straumann AG, Basel, Switzerland). Implants were inserted using templates by initial pilot drilling ("partially-guided implantation"). Implant positions were recorded using IOS. Geometric deviations between planned and definitive positions were assessed regarding implant apex, entry-point and angle. CBCT image quality was evaluated by raters twice on a four point scale. The results were exploratively compared (linear models, Mann-Whitney-U tests). RESULTS Regarding implant apex, deviations were greater for LD-CBCT (mean 3.0±1.2 mm), as compared to HD-CBCT (mean 2.3±1.1 mm). For entry-point, no distinct difference was detected with a mean deviation of 1.4±0.9 mm in LD-CBCT, and 1.7±0.6 mm in HD-CBCT. Regarding angle, deviations were greater for LD-CBCT (mean 13.2±6.3°), as compared to HD-CBCT (mean 9.2±5.3°). The image quality of HD-CBCT provided to be better (mean 2.7±0.6) than that of LD-CBCT (mean 2.5±0.6). CONCLUSIONS Within the partially-guided approach, the results underline the potential of LD-CBCT alternatively to HD-CBCT for computer-guided implantology. Advantages of HD-CBCT need to be balanced against the higher radiation dose.
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Affiliation(s)
- Laura Horsch
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Christos Labis
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Charlotte Theresa Trebing
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Franz Sebastian Schwindling
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Schulze RKW, Drage NA. Cone-beam computed tomography and its applications in dental and maxillofacial radiology. Clin Radiol 2020; 75:647-657. [PMID: 32451060 DOI: 10.1016/j.crad.2020.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
Cone-beam computed tomography (CBCT) was first used in dental and maxillofacial radiology (DMFR) at the end of the 1990s. Since then, it has been successfully established as the standard three-dimensional radiographic imaging technique in DMFR, with a wide variety of applications in this field. This manuscript briefly reviews the background information on the technology and summarises available data on effective dose and dose optimisation. In addition, typical clinical applications and indications of the technique in DMFR are presented.
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Affiliation(s)
- R K W Schulze
- Department of Oral and Maxillofacial Surgery, Section of Oral Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - N A Drage
- Department of Dental and Maxillofacial Radiology, University Dental Hospital, Cardiff, UK
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Novel low-dose protocols using cone beam computed tomography in dental medicine: a review focusing on indications, limitations, and future possibilities. Clin Oral Investig 2019; 23:2573-2581. [PMID: 31025192 DOI: 10.1007/s00784-019-02907-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/09/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES A narrative review on the potential use of low-dose protocols for cone beam computed tomography (CBCT) was conducted to identify indications and their relevance for various dental disciplines. MATERIALS AND METHODS Google Scholar was searched using the words "low-dose CBCT". Reviews, consensus papers, clinical studies, and experimental studies were eligible for the initial screening process, but for data extraction only original articles were selected. Similar search procedures were then performed with the additional search words "pedo," "ortho," "endo," "implant," "perio," and "oral surgery." Furthermore, references of included articles were examined to identify further relevant articles. RESULTS After screening, 27 publications remained for the data extraction process. Low-dose protocols have been reported for specialties such as pediatric dentistry (evaluating orofacial clefts, periapical lesions, impacted teeth, and autotransplantation), orthodontics (cephalometric analysis and interim assessment of treatment results), endodontics (detecting root fractures, resorptions and periapical bone loss), implant dentistry (planning implant insertion, evaluating peri-implant fenestration and dehiscence), periodontology (assessing periodontal structures), and oral and maxillofacial surgery (assessing mandibular third molars and TMJs). Nevertheless, most of the literature available is related to non-clinical studies. Furthermore, there is a lack of position statements or guidelines from authoritative bodies regarding the use of low-dose protocols in dental medicine. CONCLUSIONS Low-dose protocols for CBCT imaging seem to have potential in various disciplines in dental medicine ranging from pediatric dentistry to oral and maxillofacial surgery. Dose reduction is usually achieved by mAs reduction, use of partial rotations, reduced number of projections, and larger voxel sizes, but seldom by kV reduction. CLINICAL RELEVANCE Albeit low-dose protocols have potential to result in a reduction of dose exposure for 3D imaging due to dental indications, there is a need to more clearly specify indications and limitations to avoid indiscriminate use of standard and high-dose CBCT scans in the future on the lines of ALARA/ALADA principles.
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Brasil DM, Pauwels R, Coucke W, Haiter-Neto F, Jacobs R. Image quality optimization using a narrow vertical detector dental cone-beam CT. Dentomaxillofac Radiol 2019; 48:20180357. [PMID: 30604636 DOI: 10.1259/dmfr.20180357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES: To determine the optimized kV setting for a narrow detector cone-beam CT (CBCT) unit. METHODS: Clinical (CL) and quantitative (QUANT) evaluations of image quality were performed using an anthropomorphic phantom. Technical (TECH) evaluation was performed with a polymethyl methacrylate phantom. Images were obtained using a PaX-i3D Green CBCT (Vatech, Hwaseong, Korea) device, with a large 21 × 19 and a medium 12 × 9 cm field of view (FOV), and high-dose (HD-ranging from 85 to 110 kV) and low-dose (LD-ranging from 75 to 95 kV) protocols, totaling four groups (21 × 19 cm HD, 21 × 19 cm LD, 12 × 9 cm HD, 12 × 9 cm LD). The radiation dose within each group was fixed by adapting the mA according to a predetermined dose-area product. For CL evaluation, three observers assessed images based on overall quality, sharpness, contrast, artefacts, and noise. For QUANT evaluation, mean gray value shift, % increase of standard deviation (SD), % of beam hardening and contrast-to-noise ratio (CNR) were calculated. For TECH evaluation, segmentation accuracy, CNR, metal artefact SD, metal object area, and sharpness were measured. Representative parameters were chosen for CL, QUANT, and TECH evaluations to determine the optimal kV based on biplot graphs. kV values of the same protocol were compared by the bootstrapping approach. The ones that had statistical differences with the best kV were considered as worse quality. RESULTS: Overall, kV values within the same group showed similar quality (p > 0.05), except for 110 kV in 21 × 19 cm HD and 85 kV in 12 × 9 cm HD of CL score; also 85, 90 kV in 21 × 19 cm HD and 75, 80 kV in 21 × 19 cm LD of QUANT score which were worse (p < 0.05). CONCLUSION: At a constant dose, low and high kV protocols yield acceptable image quality for a narrow-detector CBCT unit.
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Affiliation(s)
- Danieli Moura Brasil
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP) , Piracicaba , Brazil
| | - Ruben Pauwels
- 2 Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven , Leuven , Belgium.,3 Department of Oral & Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium.,4 Department of Mechanical Engineering, Catholic University of Leuven , Leuven , Belgium.,5 Department of Radiology, Faculty of Dentistry, Chulalongkorn University , Bangkok , Thailand
| | - Wim Coucke
- 6 Freelance statistician , Leuven , Belgium
| | - Francisco Haiter-Neto
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP) , Piracicaba , Brazil
| | - Reinhilde Jacobs
- 2 Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven , Leuven , Belgium.,3 Department of Oral & Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium.,7 Department of Dental Medicine, Karolinska Institute , Stockholm , Sweden
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El Sahili N, David-Tchouda S, Thoret S, Nasseh I, Berberi A, Fortin T. Effect of Milliamperage Reduction on Pre-surgical Implant Planning Using Cone Beam Computed Tomography by Surgeons of Varying Experience. J Maxillofac Oral Surg 2018; 17:520-530. [PMID: 30344396 PMCID: PMC6181865 DOI: 10.1007/s12663-017-1075-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Differences in CBCT units and the lack of standardization result in exposure to radiation doses beyond what is required for diagnostic purposes, especially when planning the surgical placement of dental implants. AIM To assess the influence of low- and high-dose milliamperage settings on CBCT images for objective and subjective implant planning among senior specialists (5 years of experience) and juniors (fresh graduates). MATERIALS AND METHODS Two dry skulls (4 hemi-maxillary segments of the maxilla and 4 hemi-maxillary segments of the mandible) were scanned under low (2 mA) and high (6.3 mA) dosage settings using the Carestream CS 9300 machine. Cross-sectional slices of both image qualities were evaluated by the 5 seniors and the 5 juniors for subjective image utility for implant planning and for objective linear bone measurements. RESULTS There were no significant differences in bone measurements taken on high- or low-dose images by all seniors and by the majority of juniors (p > 0.05). In qualitative image assessments, there was independence between assessment and image quality for almost all observers. For planning posterior mandibular implant placement, increased dosage improved concordance and kappa values between low- and high-dose images for senior observers (from K = 0.287 at low dose to K = 0.718 at high does) but not for juniors (K = 0.661 and K = 0.509 for low and high dose, respectively). CONCLUSION Reduction in milliamperage did not affect diagnostic image quality for objective bone measurements and produced sufficient concordance for qualitative assessment. Judicious optimization of milliamperage settings based on individual diagnostic requirements can result in significant dose reduction without compromising diagnostic decision-making.
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Affiliation(s)
- N. El Sahili
- School of Dentistry, Lebanese University, Beirut, Lebanon
| | - S. David-Tchouda
- Medico-economic Evaluation Unit, University Hospital of Grenoble, France/ThEMAS TIMC, UMR CNRS 5525, Grenoble Joseph Fourier University, Grenoble, France
| | - S. Thoret
- Investigation Clinical Center of Grenoble, INSERM, Grenoble, France
| | - I. Nasseh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon
| | - A. Berberi
- Department of Oral and MaxilloFaciale Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon
| | - T. Fortin
- Department of Oral Surgery, Dental University of Lyon, University Claude Bernard, Lyon 1, France. UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525, 38041 Grenoble, France
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El Sahili N, Nasseh I, Berberi A, David-Tchouda S, Thoret S, Fortin T. Impact of Cone Beam Computed Tomography Dose in Pre-Surgical Implant Analysis. Open Dent J 2018; 12:94-103. [PMID: 29492175 PMCID: PMC5814949 DOI: 10.2174/1874210601812010094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/20/2017] [Accepted: 01/05/2018] [Indexed: 01/05/2023] Open
Abstract
Objectives Cone-Beam Computed Tomography (CBCT) produces vital information required for the accurate and prudent placement of dental implants. Lack of standardization between CBCT machines may result in unsafe patient exposure to harmful radiation; higher doses are not necessarily associated with improved image quality. Aim The study aimed to assess the influence of low- and high-dose milliamperage settings on CBCT images for objective and subjective implant planning. Methods Two dry skulls (4 hemi-maxillary segments of the maxilla and 4 hemi-maxillary segments of the mandible) were scanned under low (2 mA) and high (6.3 mA) dosage settings using a CBCT (Carestream CS 9300). Cross-sectional slices of both image qualities were evaluated by five expert clinicians, for image quality for implant planning and objective bone measurements. Results There were no significant differences in bone measurements taken on high or low dose images (p > 0.05). In qualitative image assessments, assessment and image quality for almost all observers were independent of each other. For planning posterior mandibular implant placement, increased dosage improved concordance and kappa values between low and high dose images. Conclusion Reduction in milliamperage did not affect diagnostic image quality for objective bone measurements and produced sufficient intra-rater reliability for qualitative assessment; therefore dose reduction can be achieved without compromising diagnostic decision- making.
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Affiliation(s)
| | - Ibrahim Nasseh
- Department of Oral & Maxillofacial Radiology, School of Dentistry, Lebanese University, Beirut, Lebanon
| | - Antoine Berberi
- Medico-Economic Evaluation Unit, University Hospital of Grenoble, Grenoble, France
| | - Sandra David-Tchouda
- Medico-Economic Evaluation Unit, University Hospital of Grenoble, Grenoble, France.,ThEMAS TIMC UMR CNRS 5525, Grenoble Joseph Fourier University, France
| | - Sophie Thoret
- Investigation Clinical Center of Grenoble, INSERM, Paris, France
| | - Thomas Fortin
- Department of Oral Surgery, Dental University of Lyon, University Claude Bernard, Lyon 1, France.,UJF-Grenoble 1 / CNRS / TIMC-IMAG UMR 5525, Grenoble, F-38041, France
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Tangari-Meira R, Vancetto JR, Dovigo LN, Tosoni GM. Influence of Tube Current Settings on Diagnostic Detection of Root Fractures Using Cone-beam Computed Tomography: An In Vitro Study. J Endod 2017; 43:1701-1705. [PMID: 28818444 DOI: 10.1016/j.joen.2017.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/30/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study assessed the influence of tube current settings (milliamperes [mA]) on the diagnostic detection of root fractures (RFs) using cone-beam computed tomographic (CBCT) imaging. METHOD Sixty-eight human anterior and posterior teeth were submitted to root canal preparation, and 34 root canals were filled. The teeth were divided into 2 groups: the control group and the fractured group. RFs were induced using a universal mechanical testing machine; afterward, the teeth were placed in a phantom. Images were acquired using a Scanora 3DX unit (Soredex, Tuusula, Finland) with 5 different mA settings: 4.0, 5.0, 6.3, 8.0, and 10.0. Two examiners (E1 and E2) classified the images according to a 5-point confidence scale. Intra- and interexaminer reproducibility was assessed using the kappa statistic; diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS Intra- and interexaminer reproducibility showed substantial (κE1 = 0.791 and κE2 = 0.695) and moderate (κE1 × E2 = 0.545) agreement, respectively. AUROC was significantly higher (P ≤ .0389) at 8.0 and 10.0 mA and showed no statistical difference between the 2 tube current settings. CONCLUSIONS Tube current has a significant influence on the diagnostic detection of RFs in CBCT images. Despite the acceptable diagnosis of RFs using 4.0 and 5.0 mA, those settings had lower discrimination abilities when compared with settings of 8.0 and 10.0 mA.
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Affiliation(s)
- Ricardo Tangari-Meira
- Department of Oral Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil.
| | - José Ricardo Vancetto
- Department of Oral Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil
| | - Lívia Nordi Dovigo
- Department of Social Dentistry, School of Dentistry, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil
| | - Guilherme Monteiro Tosoni
- Department of Oral Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil
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Menezes CC, Janson G, da Silveira Massaro C, Cambiaghi L, Garib DG. Precision, reproducibility, and accuracy of bone crest level measurements of CBCT cross sections using different resolutions. Angle Orthod 2016; 86:535-542. [PMID: 26488463 PMCID: PMC8601492 DOI: 10.2319/040115-214.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 09/01/2015] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To evaluate the precision, reproducibility, and accuracy of alveolar crest level measurements on CBCT images obtained with different voxel sizes. MATERIALS AND METHODS CBCT exams were made of 12 dried human mandibles with voxel dimensions of 0.2, 0.3, and 0.4 mm. Bone crest level was measured directly on the mandibles with a digital caliper and on CBCT images. Images were measured twice by two examiners. Intra- and interexaminer precision and reproducibility were assessed using paired and t-tests, respectively. Accuracy was evaluated using t-tests. RESULTS Precision and reproducibility of bone crest level tomographic measurements was good for all voxel sizes evaluated. The images with 0.2-mm voxel size showed a decreased number of intraexaminer errors. A high accuracy for measurements of bone crest level was observed for all CBCT definitions, except for the mandibular incisors using the 0.4-mm voxel size. CONCLUSIONS Precision and reproducibility of alveolar bone level measurements were good for various voxel sizes. CBCT images demonstrated good accuracy for 0.2-mm and 0.3-mm voxel sizes. The mandibular incisor region needs better resolution than that provided by 0.4-mm voxel size for bone crest level measurements.
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Affiliation(s)
- Carolina Carmo Menezes
- Orthodontic Graduate Student, Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
| | - Guilherme Janson
- Professor, Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
| | - Camila da Silveira Massaro
- Orthodontic Graduate Student, Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
| | - Lucas Cambiaghi
- Periodontic Graduate Student, Department of Prosthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
| | - Daniela Gamba Garib
- Associate Professor, Department of Orthodontics, Bauru Dental School, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
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de Rezende Barbosa GL, Wood JS, Pimenta LA, Maria de Almeida S, Tyndall DA. Comparison of different methods to assess alveolar cleft defects in cone beam CT images. Dentomaxillofac Radiol 2015; 45:20150332. [PMID: 26648387 DOI: 10.1259/dmfr.20150332] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the accuracy of three different methods for assessing the volume of cleft defects in CBCT images. The influence of field of view (FOV) and voxel sizes was also assessed. METHODS Using three radio-opaque plastic skulls, unilateral defects were created to mimic alveolar clefts and were filled with wax following the contralateral side contours. They were scanned in a CBCT unit using four different acquisition protocols, varying FOV and voxel sizes. Using three different methods, the defect/wax volume was evaluated on the images by defining: (1) the width, height and facial-palatal length of the defect in maximum intensity projection; (2) the areas of the defect on axial slices; and (3) the threshold and segmentation of the region of interest. The values obtained from each method using different acquisition protocols were compared with the real volume of the wax (gold standard) using ANOVA and Tukey's test. RESULTS Methods 2 and 3 did not differ from the gold standard (p > 0.05). Conversely, Method 1 presented statistically significant overestimated values (p < 0.01). No differences were found among the different FOV and voxel sizes (p > 0.05). CONCLUSIONS CBCT volumes proved reliable for the volumetric assessment of alveolar cleft defects, when using Methods 2 and 3 regardless of FOV and voxel sizes. It may be possible to improve surgical planning and outcomes by knowing the exact volume of grafting material needed prior to the surgical intervention.
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Affiliation(s)
- Gabriella Lopes de Rezende Barbosa
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Jeyhan S Wood
- 2 Division of Plastic and Reconstructive Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Luiz A Pimenta
- 3 Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Solange Maria de Almeida
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Donald A Tyndall
- 4 Department of Diagnostic Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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