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Tunlayadechanont P, Tunlayadechanont P, Sriudomporn N, Wisetsathon P, Duangthip D, Jirarattanasopha V. Association between dental restorations and artefacts on head magnetic resonance images in paediatric patients. Int J Paediatr Dent 2024. [PMID: 38195814 DOI: 10.1111/ipd.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 11/28/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has become an important diagnostic tool for paediatric patients. The association between dental restorations and MRI artefacts/distortions, however, is unclear. AIM To investigate the association between dental restorations and artefacts in head MRI in children. DESIGN This retrospective analysis included patients who underwent head MRI and dental examination at Ramathibodi Hospital from January 2015 to March 2021. From dental records and dental radiographs, a dentist reviewed the amount and type of restorative materials used. Two radiologists examined the MRI scans in five sequences for the presence of distortions and quantified the magnitude and grading of any artefacts. RESULTS Ninety-four patients aged 3-15 years were included. Twenty-four patients who received preformed metal crowns (PMCs) had MRI distortions. Subjects with no restorations or with tooth-coloured material or amalgam restorations or both did not exhibit distortions. The number of PMCs was related to the size of an artefact. Almost all distortions were confined to the oral cavity and maxillary sinus and did not affect the diagnostic brain area. CONCLUSION Among the commonly used dental restorative materials for children, only PMCs were associated with artefacts on head MRI scans.
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Affiliation(s)
- Pitchaya Tunlayadechanont
- Department of Pediatric Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
- Dental Division, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Padcha Tunlayadechanont
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nantana Sriudomporn
- Dental Division, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ploy Wisetsathon
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Juerchott A, Roser CJ, Saleem MA, Nittka M, Lux CJ, Heiland S, Bendszus M, Hilgenfeld T. Diagnostic compatibility of various fixed orthodontic retainers for head/neck MRI and dental MRI. Clin Oral Investig 2023; 27:2375-2384. [PMID: 36640179 PMCID: PMC10160193 DOI: 10.1007/s00784-023-04861-2] [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: 05/24/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate the diagnostic MRI compatibility of different fixed orthodontic retainers using a high-resolution 3D-sequence optimized for artifact reduction. MATERIALS AND METHODS Maxillary and mandibular retainers made of five different materials were scanned in vitro and in vivo at 3 T MRI using an MSVAT-SPACE sequence. In vitro, artifact volumes were determined for all maxillary and mandibular retainers (AVmax; AVmand). In vivo, two independent observers quantified the extent of artifacts based on the visibility of 124 dental and non-dental landmarks using a five-point rating scale (1 = excellent, 2 = good, 3 = acceptable, 4 = poor, 5 = not visible). RESULTS Rectangular-steel retainers caused the largest artifacts (AVmax/AVmand: 18,060/15,879 mm3) and considerable diagnostic impairment in vivo (mean landmark visibility score ± SD inside/outside the retainer areas: 4.8 ± 0.8/2.9 ± 1.6). Smaller, but diagnostically relevant artifacts were observed for twistflex steel retainers (437/6317 mm3, 3.1 ± 1.7/1.3 ± 0.7). All retainers made of precious-alloy materials produced only very small artifact volumes (titanium grade 1: 70/46 mm3, titanium grade 5: 47/35 mm3, gold: 23/21 mm3) without any impact on image quality in vivo (each retainer: visibility scores of 1.0 ± 0.0 for all landmarks inside and outside the retainer areas). CONCLUSIONS In contrast to steel retainers, titanium and gold retainers are fully compatible for both head/neck and dental MRI when using MSVAT-SPACE. CLINICAL RELEVANCE This study demonstrates that titanium and gold retainers do not impair the diagnostic quality of head/neck and dental MRI when applying an appropriate artifact-reduction technique. Steel retainers, however, are not suitable for dental MRI and can severely impair image quality in head/neck MRI of the oral cavity.
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Affiliation(s)
- Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Christoph J Roser
- Department of Orthodontics and Dentofacial Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Muhammad Abdullah Saleem
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Christopher J Lux
- Department of Orthodontics and Dentofacial Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Johannsen KM, de Carvalho E Silva Fuglsig JM, Hansen B, Wenzel A, Spin-Neto R. Magnetic resonance imaging artefacts caused by orthodontic appliances and/or implant-supported prosthesis: a systematic review. Oral Radiol 2023; 39:394-407. [PMID: 36178613 DOI: 10.1007/s11282-022-00652-9] [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: 06/23/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Dental materials, including orthodontic appliances and implants, are commonly mentioned as a possible source of artefacts in magnetic resonance imaging (MRI). The aim of the present study was to undertake a systematic review of the relevant literature on MR image artefacts due to dental materials, limited to orthodontic appliances and implant-supported dental prosthesis, on both technical and diagnostic levels. METHODS The MEDLINE (PubMed) bibliographic database was searched up to September 2020. The search was limited to studies published in English, using the search string: (MRI or magnetic resonance) and (artefact or artifact) and (dental or ortho or implant or restoration or restorative). The studies were assessed independently by three reviewers, focusing on the following parameters: MRI sequences, tested materials, assessed parameters, efficacy level and outcome. RESULTS The search strategy yielded 31 studies, which were included in this systematic review. These studies showed that metallic dental materials, commonly present in orthodontic appliances and implant-supported dental prosthesis led to diverse types/severities of artefacts in MR images. Fifteen studies were in vivo, based on human subjects. The studies differed substantially in terms of tested materials, assessed parameters, and outcome measurements. CONCLUSIONS Metallic dental materials cause artefacts of diverse types and severities in MR images of the head and neck region. However, the diagnostic relevance of the investigated artefacts for the diverse MRI applications is yet to be studied.
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Affiliation(s)
- Katrine Mølgaard Johannsen
- Department of Dentistry and Oral Health, Oral Radiology, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus, Denmark.
| | | | - Brian Hansen
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Ann Wenzel
- Department of Dentistry and Oral Health, Oral Radiology, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus, Denmark
| | - Rubens Spin-Neto
- Department of Dentistry and Oral Health, Oral Radiology, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus, Denmark
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Bhambhani R, Roy SS, Joshi S. Magnetic resonance imaging investigations in patients with metallic dental prosthesis: "The associated dilemma for medical fraternity and the dentist's role". J Indian Prosthodont Soc 2023; 23:203-206. [PMID: 37102548 PMCID: PMC10262089 DOI: 10.4103/jips.jips_473_22] [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: 10/21/2022] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 04/28/2023] Open
Abstract
Background Interdisciplinary referrals for dental examination in hospital setups are common before radiotherapy, kidney transplants, or magnetic resonance imaging (MRI). The patients who walk in could be random patients with metallic or porcelain-fused-to-metal prostheses done elsewhere but might require an opinion before the MRI. This leaves quite a responsibility on the consulting dentist to green signal the procedure. There is a lack of evidence in the literature, to confirm the absence of any untoward consequence during such MRI, which might leave the dentist in dilemma. Dental materials' magnetic behavior raises concern regarding whether they are 100% nonferromagnetic; furthermore, the examining dentist might be unaware of the metal used (Co-Cr, Ni-Cr, or trace elements). Clinicians may also come across full-mouth rehabilitated patients with multiple crown-bridge prostheses or metallic superstructure for implant prostheses. Research in the area leaves many unanswered questions because most studies have evaluated artifacts during MRI and are in vitro. Titanium is considered to be safe due to its paramagnetic behavior, whereas the literature does not rule out the probability of dislodgment of other porcelain fused to metal (PFM) prostheses. Due to less reported literature there exists dilemma to ascertain MRI in these patients. An online Google Search, PubMed, and gray literature portray the ambiguity associated with metal and PFM crowns and their magnetic behavior during MRI. Most studies were associated with the artifacts caused during MRI and methods of reducing them under in vitro situations. The concern for dislodgment has also been expressed in a few reports. Technique Certain steps of a pre-MRI checkup and an innovative technique have been discussed to assure patient safety during the MRI. Conclusion The technique explained is inexpensive and a quick aid that can be executed before the investigation. Clinical and Research Implications There is a need to study and understand the magnetic behavior of Co-Cr and Ni-Cr crowns in the presence of various MRI strengths.
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Affiliation(s)
- Ritika Bhambhani
- Department of Prosthodontics, Gurunank Institute of Dental Sciences and Research, Kolkata, West Bengal, India
| | - Santanu Sen Roy
- Department of Public Health Dentistry, Gurunank Institute of Dental Sciences and Research, Kolkata, West Bengal, India
| | - Shubha Joshi
- Department of Prosthodontics, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
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Crăciunescu I, Ispas GM, Ciorîța A, Leoștean C, Illés E, Turcu RP. Novel Magnetic Composite Materials for Dental Structure Restoration Application. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:1215. [PMID: 37049307 PMCID: PMC10097343 DOI: 10.3390/nano13071215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
In general, magnetic nanoparticles are not often used in dental applications due to some limitations of these materials, such as aggregation problems and low mechanical and chemical resistance but also esthetic problems due to their black color. Our research presents the synthesis of novel magnetic dental composite materials based on magnetic nanoparticles, functionalized and properly coated to overcome the limitations of using magnetic nanoparticles in dental applications. The composites were prepared using a preparation flow containing several integrated reaction steps used previously sequentially. An adequate and deep characterization of dental magnetic composites has been carried out in order to demonstrate that each limitation has been successfully overcome. It was proved that each component brings particular benefits in dental interventions: Fe3O4 nanoparticles have biocompatible, non-toxic properties and also antimicrobial effects; the SiO2 layer significantly increases the mechanical strength of the material; and the Ca(OH)2 layer initiates local calcification and significantly improves the color of the dental composite material. Due to magnetic properties, an innovative application approach on the tooth surface can be achieved under an external magnetic field, which, compared to conventional methods, has a major impact on reducing the occurrence of dental caries under filling materials as well as on reducing microfractures.
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Affiliation(s)
- Izabell Crăciunescu
- National Institute for Research and Development of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania; (G.M.I.); (A.C.); (R.P.T.)
| | - George Marian Ispas
- National Institute for Research and Development of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania; (G.M.I.); (A.C.); (R.P.T.)
| | - Alexandra Ciorîța
- National Institute for Research and Development of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania; (G.M.I.); (A.C.); (R.P.T.)
- Faculty of Biology and Geology, Babes-Bolyai University, 400084 Cluj-Napoca, Romania
| | - Cristian Leoștean
- National Institute for Research and Development of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania; (G.M.I.); (A.C.); (R.P.T.)
| | - Erzsébet Illés
- Department of Food Engineering, University of Szeged, 6724 Szeged, Hungary;
| | - Rodica Paula Turcu
- National Institute for Research and Development of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania; (G.M.I.); (A.C.); (R.P.T.)
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Roser CJ, Hilgenfeld T, Saleem MA, Rückschloß T, Heiland S, Bendszus M, Lux CJ, Juerchott A. In vivo assessment of artefacts in MRI images caused by conventional twistflex and various fixed orthodontic CAD/CAM retainers. J Orofac Orthop 2023:10.1007/s00056-022-00445-z. [PMID: 36700953 DOI: 10.1007/s00056-022-00445-z] [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: 05/25/2022] [Accepted: 12/12/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE To assess magnetic resonance imaging (MRI) artefacts caused by different computer-aided design/computer-aided manufacturing (CAD/CAM) retainers in comparison with conventional hand bent stainless steel twistflex retainers in vivo. MATERIALS AND METHODS MRI scans (3 Tesla) were performed on a male volunteer with different CAD/CAM retainers (cobalt-chromium, CoCr; nickel-titanium, NiTi; grade 5 titanium, Ti5) and twistflex retainers inserted. A total of 126 landmarks inside and outside the retainer area (RA; from canine to canine) were evaluated by two blinded radiologists using an established five-point visibility scoring (1: excellent, 2: good, 3: moderate, 4: poor, 5: not visible). Friedman and two-tailed Wilcoxon tests were used for statistical analysis (significance level: p < 0.05). RESULTS Twistflex retainers had the strongest impact on the visibility of all landmarks inside (4.0 ± 1.5) and outside the RA (1.7 ± 1.2). In contrast, artefacts caused by CAD/CAM retainers were limited to the dental area inside the RA (CoCr: 2.2 ± 1.2) or did not impair MRI-based diagnostics in a clinically relevant way (NiTi: 1.0 ± 0.1; Ti5: 1.4 ± 0.6). CONCLUSION The present study on a single test person demonstrates that conventional stainless steel twistflex retainers can severely impair the diagnostic value in head/neck and dental MRI. By contrast, CoCr CAD/CAM retainers can cause artefacts which only slightly impair dental MRI but not head/neck MRI, whereas NiTi and Ti5 CAD/CAM might be fully compatible with both head/neck and dental MRI.
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Affiliation(s)
- Christoph J Roser
- Department of Orthodontics and Dentofacial Orthopedics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Muhammad Abdullah Saleem
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Thomas Rückschloß
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christopher J Lux
- Department of Orthodontics and Dentofacial Orthopedics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Ioanas HI, Schlegel F, Skachokova Z, Schroeter A, Husak T, Rudin M. Hybrid fiber optic-fMRI for multimodal cell-specific recording and manipulation of neural activity in rodents. NEUROPHOTONICS 2022; 9:032206. [PMID: 35355657 PMCID: PMC8936941 DOI: 10.1117/1.nph.9.3.032206] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/19/2022] [Indexed: 05/08/2023]
Abstract
Significance: Multiscale imaging holds particular relevance to neuroscience, where it helps integrate the cellular and molecular biological scale, which is most accessible to interventions, with holistic organ-level evaluations, most relevant with respect to function. Being inextricably interdisciplinary, multiscale imaging benefits substantially from incremental technology adoption, and a detailed overview of the state-of-the-art is vital to an informed application of imaging methods. Aim: In this article, we lay out the background and methodological aspects of multimodal approaches combining functional magnetic resonance imaging (fMRI) with simultaneous optical measurement or stimulation. Approach: We focus on optical techniques as these allow, in conjunction with genetically encoded proteins (e.g. calcium indicators or optical signal transducers), unprecedented read-out and control specificity for individual cell-types during fMRI experiments, while leveraging non-interfering modalities. Results: A variety of different solutions for optical/fMRI methods has been reported ranging from bulk fluorescence recordings via fiber photometry to high resolution microscopy. In particular, the plethora of optogenetic tools has enabled the transformation of stimulus-evoked fMRI into a cell biological interrogation method. We discuss the capabilities and limitations of these genetically encoded molecular tools in the study of brain phenomena of great methodological and neuropsychiatric interest-such as neurovascular coupling (NVC) and neuronal network mapping. We provide a methodological description of this interdisciplinary field of study, and focus in particular on the limitations of the widely used blood oxygen level dependent (BOLD) signal and how multimodal readouts can shed light on the contributions arising from neurons, astrocytes, or the vasculature. Conclusion: We conclude that information from multiple signaling pathways must be incorporated in future forward models of the BOLD response to prevent erroneous conclusions when using fMRI as a surrogate measure for neural activity. Further, we highlight the potential of direct neuronal stimulation via genetically defined brain networks towards advancing neurophysiological understanding and better estimating effective connectivity.
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Affiliation(s)
- Horea-Ioan Ioanas
- University of Zurich Institute for Biomedical Engineering, ETH, Zürich, Switzerland
- Massachusetts Institute of Technology, Department of Biological Engineering, Cambridge, Massachusetts, United States
- Dartmouth College, Center for Open Neuroscience, Hanover, New Hampshire, United States
- Address all correspondence to Markus Rudin, ; Horea-Ioan Ioanas,
| | - Felix Schlegel
- University of Zurich Institute for Biomedical Engineering, ETH, Zürich, Switzerland
| | - Zhiva Skachokova
- University of Zurich Institute for Biomedical Engineering, ETH, Zürich, Switzerland
| | - Aileen Schroeter
- University of Zurich Institute for Biomedical Engineering, ETH, Zürich, Switzerland
- University of Zurich, USZ Innovation Hub, Zurich, Switzerland
| | - Tetiana Husak
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, Cambridge, Massachusetts, United States
| | - Markus Rudin
- University of Zurich Institute for Biomedical Engineering, ETH, Zürich, Switzerland
- The LOOP Zurich, Zurich, Switzerland
- Address all correspondence to Markus Rudin, ; Horea-Ioan Ioanas,
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Performance of PROPELLER FSE T 2WI in reducing metal artifacts of material porcelain fused to metal crown: a clinical preliminary study. Sci Rep 2022; 12:8442. [PMID: 35589945 PMCID: PMC9120134 DOI: 10.1038/s41598-022-12402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
Abstract
This study aimed to compare MRI quality between conventional fast spin echo T2 weighted imaging (FSE T2WI) with periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) FSE T2WI for patients with various porcelain fused to metal (PFM) crown and analyze the value of PROPELLER technique in reducing metal artifacts. Conventional FSE T2WI and PROPELLER FSE T2WI sequences for axial imaging of head were applied in participants with different PFM crowns: cobalt-chromium (Co–Cr) alloy, pure titanium (Ti), gold–palladium (Au–Pd) alloy. Two radiologists evaluated overall image quality of section in PFM using a 5-point scale qualitatively and measured the maximum artifact area and artifact signal-to-noise ratio (SNR) quantitatively. Fifty-nine participants were evaluated. The metal crown with the least artifacts and the optimum image quality shown in conventional FSE T2WI and PROPELLER FSE T2WI were in Au–Pd alloy, Ti, and Co–Cr alloy order. PROPELLER FSE T2WI was superior to conventional FSE T2WI in improving image quality and reducing artifact area for Co-Cr alloy (17.0 ± 0.2% smaller artifact area, p < 0.001) and Ti (11.6 ± 0.7% smaller artifact area, p = 0.005), but had similar performance compared to FSE T2WI for Au–Pd alloy. The SNRs of the tongue and masseter muscle were significantly higher on PROPELLER FSE T2WI compared with conventional FSE T2WI (tongue: 29.76 ± 8.45 vs. 21.54 ± 9.31, p = 0.007; masseter muscle: 19.11 ± 8.24 vs. 15.26 ± 6.08, p = 0.016). Therefore, the different PFM crown generate varying degrees of metal artifacts in MRI, and the PROPELLER can effectively reduce metal artifacts especially in the PFM crown of Co-Cr alloy.
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Tesfai AS, Vollmer A, Özen AC, Braig M, Semper-Hogg W, Altenburger MJ, Ludwig U, Bock M. Inductively Coupled Intraoral Flexible Coil for Increased Visibility of Dental Root Canals in Magnetic Resonance Imaging. Invest Radiol 2022; 57:163-170. [PMID: 34510099 DOI: 10.1097/rli.0000000000000826] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Accurate visualization of dental root canals is vital for the correct diagnosis and subsequent treatment. This work assesses the improvement of a dedicated new coil for dental magnetic resonance imaging (MRI) in comparison to conventional ones in terms of signal-to-noise ratio (SNR) and visibility. MATERIALS AND METHODS A newly developed intraoral flexible coil was used to display dental roots with MRI, and it provides improved sensitivity with a loop design and size adjusted to a single tooth anatomy. Ex vivo and in vivo measurements were performed on a 3 T clinical MR system, and results were compared with conventional head and surface coil images. Additional comparison was performed with a modified fast spin echo sequence and a constructive interference in steady-state sequence. RESULTS Ex vivo, an SNR gain of 6.3 could be achieved with the intraoral flexible coil setup, and higher visibility down to 200 μm was possible, whereas the external loop coil is limited to 400 μm. In vivo measurements in a volunteer resulted in an SNR gain of up to 4.5 with an improved delineation of the root canals, especially for the branch tissue splitting of the mesial root canal into mesial-buccal and mesial-lingual. CONCLUSIONS In summary, we showed the feasibility of implementing a wireless coil approach with readily available dental practice materials for sealing and placement. Highly improved MRI scans can be acquired within clinically feasible scan times, and this might provide additional medical findings to supplement available x-ray images.
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Affiliation(s)
| | - Andreas Vollmer
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | | | | | - Wiebke Semper-Hogg
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Markus Jörg Altenburger
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ute Ludwig
- From the Department of Radiology, Medical Physics
| | - Michael Bock
- From the Department of Radiology, Medical Physics
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Susceptibility artifacts induced by crowns of different materials with prepared teeth and titanium implants in magnetic resonance imaging. Sci Rep 2022; 12:428. [PMID: 35013440 PMCID: PMC8748466 DOI: 10.1038/s41598-021-03962-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023] Open
Abstract
This study aimed to investigate the artifacts induced by crowns composed of different materials with prepared teeth and titanium implants. Resin, metal-ceramic, ceramic and zirconia crowns were fabricated and placed onto the prepared teeth on a human cadaver head or titanium implants with prosthesis abutments on a dry human mandible. The samples were scanned on a 1.5 T MRI apparatus, and artifact areas were defined as the signal intensity and signal loss adjacent to the prosthesis and measured by a threshold tool with ImageJ2x. Data were analyzed using SPSS 22.0. Resin, ceramic, zirconia, and precious metal-ceramic crowns barely produced artifacts on the cadaver skull (p > 0.999). By contrast, pure Ti and nonprecious metal-ceramic crowns created significant artifacts (p < 0.001). The average artifacts reduction of double Au-Pt and Ag-Pd metal-ceramic crowns combined with titanium implants and abutments was 79.49 mm2 (p < 0.001) and 74.17 mm2 (p < 0.001) respectively, while artifact areas were increased in double Co-Cr and Ni–Cr metal-ceramic crowns by 150.10 mm2 (p < 0.001) and 175.50 mm2 (p < 0.001) respectively. Zirconia, ceramic and precious metal-ceramic crowns induce less MRI artifacts after tooth preparation while precious metal-ceramic crowns alleviate artifacts in combination with titanium implants.
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11
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Sumner O, Goldsmith R, Heath N, Taylor GD. The interaction and interference of preformed metal crowns on magnetic resonance imaging: a scoping review with a systematic methodology. Eur Arch Paediatr Dent 2021; 22:1023-1031. [PMID: 34115334 PMCID: PMC8629884 DOI: 10.1007/s40368-021-00644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/31/2021] [Indexed: 11/05/2022]
Abstract
Purpose Preformed metal crowns are widely used to restore primary and permanent teeth. Children may require magnetic resonance imaging (MRI) for diagnosis and monitoring of diseases in the head and neck region. Metallic objects, in the field of view, may compromise the diagnostic value of an MRI. The impact on the diagnostic quality of an MRI in children who have had preformed metal crowns placed has not been assessed. The aim of this systematic review was to evaluate the impact that PFMCs have on MRI imaging quality and thus the overall diagnostic value. Methods Electronic searches of the following databases were completed: MEDLINE, EMBASE, Cochrane Library, Web of Science and Open Grey. Primary in vivo studies on children who had at least one preformed metal crown placed and required an MRI investigation were to be included. PRISMA guidelines were followed and screening/data extraction was carried out by two independent calibrated reviewers. Results A total of 7665 articles were identified. After removing duplicates, 7062 were identified for title and abstract screening. Thirty-four articles underwent full-text review, of which none met the inclusion criteria. Most common reasons for exclusion were not placing preformed metal crowns (n = 16) or in vitro studies (n = 12). Conclusion No in vivo studies were identified to establish the hypothetical impact preformed metal crowns would have on the diagnostic quality of an MRI in the head and neck region. Decision making needs to be guided on a case by case basis. Further high-quality clinical studies are required.
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Affiliation(s)
- O Sumner
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - R Goldsmith
- Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - N Heath
- Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - G D Taylor
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. .,Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK.
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Tominna M, Vega-Fernandez P, McLaurin W, Meyers AB. Imaging of the Pediatric Temporomandibular Joint. Semin Roentgenol 2021; 56:307-324. [PMID: 34281682 DOI: 10.1053/j.ro.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marie Tominna
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Wallace McLaurin
- Division of Oral and Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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An Update of the Possible Applications of Magnetic Resonance Imaging (MRI) in Dentistry: A Literature Review. J Imaging 2021; 7:jimaging7050075. [PMID: 34460671 PMCID: PMC8321370 DOI: 10.3390/jimaging7050075] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
This narrative review aims to evaluate the current evidence for the application of magnetic resonance imaging (MRI), a radiation-free diagnostic exam, in some fields of dentistry. BACKGROUND Radiographic imaging plays a significant role in current first and second level dental diagnostics and treatment planning. However, the main disadvantage is the high exposure to ionizing radiation for patients. METHODS A search for articles on dental MRI was performed using the PubMed electronic database, and 37 studies were included. Only some articles about endodontics, conservative dentistry, implantology, and oral and craniofacial surgery that best represented the aim of this study were selected. RESULTS All the included articles showed that MRI can obtain well-defined images, which can be applied in operative dentistry. CONCLUSIONS This review highlights the potential of MRI for diagnosis in dental clinical practice, without the risk of biological damage from continuous ionizing radiation exposure.
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Muraoka H, Hirahara N, Ito K, Kondo T, Ichiki S, Kaneda T. Dental implants: a potential cause of bone marrow edema in the jaw-preliminary report. Int J Implant Dent 2021; 7:25. [PMID: 33778900 PMCID: PMC8005384 DOI: 10.1186/s40729-021-00306-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Different magnetic resonance imaging (MRI) sequences are frequently used to examine bone marrow in the jaw, including short tau inversion recovery (STIR). MRI is a sensitive method for detecting bone marrow lesions. Currently, pantomography and computed tomography (CT) are used frequently for preoperative dental implant treatment. However, no study has evaluated bone marrow edema around dental implants using MRI. This study aimed to assess bone marrow edema in the jaw around dental implants using brain magnetic resonance images. METHODS This retrospective cohort study was approved by our university ethics committee (EC19-011). A total of 17 patients (170 sites) who underwent brain MRI between April 2010 and March 2016 were analyzed. All subjects underwent scanning more than 3 years after implant placement. This study investigated two bone marrow signals (with implant site and without implant site). These two groups were then compared using Fisher's exact test. The Mann-Whitney U test was used to analyze bone marrow signal intensity as the dependent variable and the long and short-axis diameters of the implant as the independent variables. RESULTS The were 22/31 sites (71%) and 38/139 sites (27%) of bone marrow edema in the dental implants and without dental implants groups, respectively (p < 0.001). Furthermore, there was a significant correlation between bone marrow signal intensity and the short-axis diameter of the implant (p < 0.001). CONCLUSION The signal intensity in the bone marrow sites in the jaw with dental implants was significantly higher than that in the sites without dental implants. The present study findings suggest that dental implants are a potential cause of bone marrow edema in the jaw.
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Affiliation(s)
- Hirotaka Muraoka
- Department of Radiology, Nihon University School of Dentistry at Matsudo, 2-870-1 Sakaecho-Nishi, Matsudo, Chiba, 271-8587, Japan.
| | - Naohisa Hirahara
- Department of Radiology, Nihon University School of Dentistry at Matsudo, 2-870-1 Sakaecho-Nishi, Matsudo, Chiba, 271-8587, Japan
| | - Kotaro Ito
- Department of Radiology, Nihon University School of Dentistry at Matsudo, 2-870-1 Sakaecho-Nishi, Matsudo, Chiba, 271-8587, Japan
| | - Takumi Kondo
- Department of Radiology, Nihon University School of Dentistry at Matsudo, 2-870-1 Sakaecho-Nishi, Matsudo, Chiba, 271-8587, Japan
| | - Shungo Ichiki
- Department of Radiology, Nihon University School of Dentistry at Matsudo, 2-870-1 Sakaecho-Nishi, Matsudo, Chiba, 271-8587, Japan
| | - Takashi Kaneda
- Department of Radiology, Nihon University School of Dentistry at Matsudo, 2-870-1 Sakaecho-Nishi, Matsudo, Chiba, 271-8587, Japan
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15
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Leontiev W, Bieri O, Madörin P, Dagassan-Berndt D, Kühl S, Krastl G, Krug R, Weiger R, Connert T. Suitability of Magnetic Resonance Imaging for Guided Endodontics: Proof of Principle. J Endod 2021; 47:954-960. [PMID: 33774047 DOI: 10.1016/j.joen.2021.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This proof-of-principle study aimed to demonstrate that magnetic resonance imaging (MRI) is sufficiently accurate for the detection of root canals using guided endodontics. METHODS One hundred extracted human teeth (anterior and premolar) were mounted onto 5 mandibular and 5 maxillary models, fitted with splints designed to accommodate a thin layer of aqueous gel for indirect imaging, and scanned by MRI. After MRI and intraoral scans were aligned using planning software, access cavities were planned virtually, and templates were manufactured with computer-aided design/computer-aided manufacturing, the access cavities were prepared. Cone-beam computed tomographic scans were performed and matched with the virtual preoperative planning data to determine the accuracy of access cavity preparation in terms of deviation between planned and prepared cavities in the mesiodistal and buccolingual dimensions and angle. Descriptive statistical analysis was performed, and the mean values were compared using the t test. RESULTS Ninety-one of 100 root canals were successfully scouted after MRI-guided access cavity preparation. The mean angle deviation was 1.82°. The mean deviation ranged from 0.21-0.31 mm at the base of the bur and from 0.28-0.44 mm at the tip of the bur. Preparation in the buccolingual dimension was significantly more precise in mandibular compared with maxillary teeth, and accuracy in the mesiodistal dimension was more precise in anterior teeth compared with premolars. CONCLUSIONS This in vitro study demonstrated the suitability of MRI for guided endodontic access cavity preparation.
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Affiliation(s)
- Wadim Leontiev
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland
| | - Philipp Madörin
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Sebastian Kühl
- Department of Oral Surgery, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, University Hospital of Würzburg, Würzburg, Germany
| | - Ralf Krug
- Department of Conservative Dentistry and Periodontology, University Hospital of Würzburg, Würzburg, Germany
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Thomas Connert
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, University of Basel, Basel, Switzerland.
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16
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Voss JO, Maier C, Wüster J, Beck-Broichsitter B, Ebker T, Vater J, Dommerich S, Raguse JD, Böning G, Thieme N. Imaging foreign bodies in head and neck trauma: a pictorial review. Insights Imaging 2021; 12:20. [PMID: 33587198 PMCID: PMC7884531 DOI: 10.1186/s13244-021-00969-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/15/2021] [Indexed: 12/26/2022] Open
Abstract
Open injuries bear the risk of foreign body contamination. Commonly encountered materials include gravel debris, glass fragments, wooden splinters or metal particles. While foreign body incorporation is obvious in some injury patterns, other injuries may not display hints of being contaminated with foreign body materials. Foreign objects that have not been detected and removed bear the risk of leading to severe wound infections and chronic wound healing disorders. Besides these severe health issues, medicolegal consequences should be considered. While an accurate clinical examination is the first step for the detection of foreign body materials, choosing the appropriate radiological imaging is decisive for the detection or non-detection of the foreign material. Especially in cases of impaired wound healing over time, the existence of an undetected foreign object needs to be considered. Here, we would like to give a practical radiological guide for the assessment of foreign objects in head and neck injuries by a special selection of patients with different injury patterns and various foreign body materials with regard to the present literature.
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Affiliation(s)
- Jan Oliver Voss
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany. .,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Christoph Maier
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Jonas Wüster
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Benedicta Beck-Broichsitter
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Tobias Ebker
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Jana Vater
- Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, 13353, Germany
| | - Steffen Dommerich
- Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, 13353, Germany
| | - Jan D Raguse
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany.,Department of Oral and Maxillofacial Surgery, Fachklinik Hornheide, Dorbaumstraße 300, 48147, Münster, Germany
| | - Georg Böning
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Nadine Thieme
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
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Implications and Considerations of Dental Materials in MRI: A Case Report and Literature Review. Case Rep Dent 2021; 2020:8891302. [PMID: 33381327 PMCID: PMC7755486 DOI: 10.1155/2020/8891302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022] Open
Abstract
Magnetic resonance imaging (MRI) has an increasing role as a diagnostic imaging modality. Dental materials have important implications on the use of MRI as a diagnostic imaging modality. A case of a dislodged crown while in an MRI machine prompted a review of the literature for the implications and considerations of dental materials with magnetic resonance technology. An understanding of the basic physics involved in magnetic resonance is required to appreciate the relevance of dental materials in an MRI scanner. This case report supported by a literature review recommends assessing a patient's crown retention prior to and after MRI scanning.
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Baysal N, Ayyıldız S, Orujalipoor I, Erol BF. Effect of 1.5-T and 3.0-T magnetic resonance imaging on the ceramic adhesion and physical properties of prosthetic substructures. J Prosthet Dent 2020; 124:809.e1-809.e7. [PMID: 33010923 DOI: 10.1016/j.prosdent.2020.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/25/2022]
Abstract
STATEMENT OF PROBLEM Magnetic resonance imaging (MRI) is a cross-sectional imaging technique that is widely used in the detection of pathologies in the head and neck region. However, information is lacking about the effect of MRI imaging on the clinical success of fixed partial dentures (FPDs). PURPOSE The purpose of this in vitro study was to analyze the effect of MRI on the physical properties and ceramic adhesion of FPD substructure materials. MATERIAL AND METHODS Three hundred disk (12×1 mm) and 255 rectangular (4×2×2 mm) specimens were prepared with different fabrication techniques for 5 experimental groups: direct metal laser sintering (DMLS) with Co-Cr and Ti; casting with Co-Cr and Ni-Cr; and milling with ZrO2. After ceramic application, the disk specimens were subjected to aging and divided into 3 subgroups (n=20) with exposure to 1.5-T and 3.0-T MRI brain scans for 30 minutes and no exposure (control). The shear bond strength (SBS) of the specimens was measured by using a universal testing machine. The rectangular specimens were exposed to MRI with the same procedure, and the nanostructure of the specimens was analyzed with the small-angle X-ray scattering (SAXS) method to detect the nanoscale structural effects of MRI. The average surface roughness (Ra) and Vickers microhardness (Vh) were also measured for complementary analyses. SBS, Ra, and Vh values were statistically analyzed by 1-way ANOVA and the Tukey honestly significant difference test (α=.05). RESULTS: The SBS (MPa) of casting groups (P<.001) and DMLS with the Co-Cr group (P<.05) were significantly affected by MRI exposures. The significant differences were seen on the Ra of casting (P<.001) and DMLS with Co-Cr (P<.05) and Ti (P<.01) groups. Also, the Vh of the casting with Co-Cr (P<.001) and Ni-Cr (P<.01) groups showed significant differences. The SAXS analysis indicated that the physical properties of materials were influenced by MRI exposure. CONCLUSIONS The results indicated that MRI applications affected the metal-ceramic adhesion of Co-Cr and Ni-Cr dental alloys produced by casting and the DMLS technique.
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Affiliation(s)
- Nurten Baysal
- Assistant Professor, Department of Prosthodontics, Faculty of Gulhane Dentistry, University of Health Sciences Turkey, Ankara, Turkey.
| | - Simel Ayyıldız
- Professor, Department of Prosthodontics, Faculty of Gulhane Dentistry, University of Health Sciences Turkey, Ankara, Turkey
| | - Ilghar Orujalipoor
- Assistant Professor, Department of Nanotechnology and Nanomedicine, Institute of Science, Hacettepe University, Beytepe, Ankara and Alptek Engineering and Technological Systems AS, Umraniye, 34774, Istanbul Turkey
| | - Barış Filiz Erol
- Assistant Professor, Department of Prosthodontics, Faculty of Gulhane Dentistry, University of Health Sciences Turkey, Ankara, Turkey
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19
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Flügge T, Ludwig U, Winter G, Amrein P, Kernen F, Nelson K. Fully guided implant surgery using Magnetic Resonance Imaging – An in vitro study on accuracy in human mandibles. Clin Oral Implants Res 2020; 31:737-746. [DOI: 10.1111/clr.13622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Tabea Flügge
- Department of Oral and Maxillofacial Surgery Translational Implantology Medical Center–University of FreiburgFaculty of Medicine–University of Freiburg Freiburg Germany
- Department of Oral and Maxillofacial Surgery Charité–Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute sof Health Berlin Germany
| | - Ute Ludwig
- Department of Radiology, Medical Physics Medical Center–University of FreiburgFaculty of Medicine–University of Freiburg Freiburg Germany
| | - Gita Winter
- Department of Oral and Maxillofacial Surgery Translational Implantology Medical Center–University of FreiburgFaculty of Medicine–University of Freiburg Freiburg Germany
| | - Philipp Amrein
- Department of Radiology, Medical Physics Medical Center–University of FreiburgFaculty of Medicine–University of Freiburg Freiburg Germany
| | - Florian Kernen
- Department of Oral and Maxillofacial Surgery Translational Implantology Medical Center–University of FreiburgFaculty of Medicine–University of Freiburg Freiburg Germany
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery Translational Implantology Medical Center–University of FreiburgFaculty of Medicine–University of Freiburg Freiburg Germany
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Stumpf K, Kaye E, Paul J, Wundrak S, Pauly JM, Rasche V. Two‐dimensional UTE overview imaging for dental application. Magn Reson Med 2020; 84:2616-2624. [DOI: 10.1002/mrm.28312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Kilian Stumpf
- Department of Internal Medicine II Ulm University Medical Center Ulm Germany
| | - Elena Kaye
- Department of Medical Physics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Jan Paul
- Department of Internal Medicine II Ulm University Medical Center Ulm Germany
- Dental Imaging Dentsply Sirona Bensheim Germany
| | - Stefan Wundrak
- Department of Internal Medicine II Ulm University Medical Center Ulm Germany
- Dental Imaging Dentsply Sirona Bensheim Germany
| | - John M. Pauly
- Department of Electrical Engineering Stanford University Stanford California USA
| | - Volker Rasche
- Department of Internal Medicine II Ulm University Medical Center Ulm Germany
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21
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Flügge T, Ludwig U, Hövener JB, Kohal R, Wismeijer D, Nelson K. Virtual implant planning and fully guided implant surgery using magnetic resonance imaging-Proof of principle. Clin Oral Implants Res 2020; 31:575-583. [PMID: 32105363 DOI: 10.1111/clr.13592] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To present a workflow of virtual implant planning and guided implant surgery with magnetic resonance imaging (MRI) and virtual dental models without the use of ionizing radiation. METHODS Five patients scheduled for implant placement underwent an MR examination at three Tesla using individualized 2D and 3D turbo spin-echo (TSE) sequences and dedicated head coils. The MRI data and virtual dental models derived from either optical model scans or intraoral scans were imported to a virtual implant planning software (coDiagnostiX, Dental Wings, Montreal, Canada). Virtual prosthetic planning and implant planning were performed regarding the hard and soft tissue anatomy. A drill guide was designed on the virtual dental model using computer-aided design (CAD) and manufactured in-house, using a 3D printer (Eden 260V, Stratasys, Eden Prairie, MN, USA). RESULTS The MRI displayed all relevant anatomical structures for dental implant planning such as cortical and cancellous bone, floor of the nasal and maxillary sinus, inferior alveolar nerve and neighboring teeth. The manual alignment of virtual dental models with the MRI was possible using anatomical landmarks. Dental implant planning, CAD/CAM of a drill guide and fully guided implant placement were successfully performed. CONCLUSIONS Guided implant surgery is feasible with MRI without ionizing radiation. Further studies will have to be conducted to study the accuracy of the presented protocol and compare it to the current workflow of guided surgery using CBCT.
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Affiliation(s)
- Tabea Flügge
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Berlin, Germany.,Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Translational Implantology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Ute Ludwig
- Medical Physics, Department of Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jan-Bernd Hövener
- Medical Physics, Department of Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.,Section for Biomedical Imaging and MOIN CC, Clinic for Radiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ralf Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Daniel Wismeijer
- Department of Oral Implantology, Academisch Centrum Tandheelkunde Amsterdam (ACTA), Amsterdam, Netherlands
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Translational Implantology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
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22
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Evaluation of magnetic resonance imaging for diagnostic purposes in operative dentistry—a systematic review. Clin Oral Investig 2019; 24:547-557. [DOI: 10.1007/s00784-019-03103-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
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23
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Magnetic Resonance Imaging and Its Effects on Metallic Brackets and Wires: Does It Alter the Temperature and Bonding Efficacy of Orthodontic Devices? MATERIALS 2019; 12:ma12233971. [PMID: 31801202 PMCID: PMC6926903 DOI: 10.3390/ma12233971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 12/02/2022]
Abstract
Magnetic resonance imaging (MRI) is a widely used diagnostic technique. Patients wearing orthodontic appliances are often requested to remove their appliances, even when the MRI exam involves anatomical areas far from mouth, in order to avoid heating of the metal and detachment of the appliance. The purpose of the present investigation was to measure and compare temperature changes and orthodontic appliances’ adhesion to enamel after different MRIs. A total of 220 orthodontic brackets were bonded on bovine incisors and wires with different materials (stainless steel and nickel titanium). Moreover, various sizes (0.014″ and 0.019″ × 0.025″) were engaged. Appliances were submitted to MRI at two different powers (1.5 T and 3 T). The temperatures of brackets and wires were measured before and after MRI. Subsequently, the shear bond strength (SBS) and adhesive remnant index (ARI) scores were recorded. Statistical analysis was performed. After MRI, a significant increase in the temperature was found for both the brackets and wires in some groups, even if the mean temperature increase was clinically insignificant, as the temperature ranged between 0.05 °C and 2.4 °C for brackets and between 0.42 °C and 1.74 °C for wires. The MRI did not condition bracket adhesion in any group. No differences were reported when comparing the 1.5 T with 3 T groups. The ARI Scores were also significantly lower after MRI. The results of the present report show that, under MRI, orthodontic appliances present a low temperature rise and no debonding risk. Therefore, the removal of orthodontic appliance is not recommended routinely, but is suggested only in the case of a void risk or potential interference in image quality.
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Tran LTX, Sakamoto J, Kuribayashi A, Watanabe H, Tomisato H, Kurabayashi T. Quantitative evaluation of artefact reduction from metallic dental materials in short tau inversion recovery imaging: efficacy of syngo WARP at 3.0 tesla. Dentomaxillofac Radiol 2019; 48:20190036. [PMID: 31188678 DOI: 10.1259/dmfr.20190036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the effects of syngo WARP on reducing metal artefacts from dental materials. METHODS Short tau inversion recovery (STIR) with syngo WARP [a dedicated metal artefact reduction sequence in combination with view-angle-tilting (VAT)] was performed using phantoms of three dental alloys: cobalt-chromium (Co-Cr), nickel-chromium (Ni-Cr), and titanium (Ti). Artefact volumes and reduction ratios of black, white and overall artefacts in the standard STIR and syngo WARP images with several different parameter settings were quantified according to standards of the American Society for Testing and Materials F2119-07. In all sequences, the artefact volumes and reduction ratios were compared. The modulation transfer function (MTF) and contrast-to-noise ratio (CNR) were also measured for evaluation of image quality. RESULTS In standard STIR, the overall artefact volume of Co-Cr was markedly larger than those of Ni-Cr and Ti. All types of artefacts tended to be reduced with increasing receiver bandwidth (rBW) and VAT. The effect of artefact reduction tended to be more obvious in the axial plane than in the sagittal plane. Compared with standard STIR, syngo WARP with a matrix of 384 × 384, receiver bandwidth of 620 Hz/pixel, and VAT of 100 % in the axial plane obtained reduction effects of 30 % (white artefacts), 45 % (black artefacts), and 38 % (overall artefacts) although MTF and CNR decreased by 30 and 22 % compared with those of standard STIR, respectively. CONCLUSIONS syngo WARP for STIR can effectively reduce metal artefacts from dental materials.
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Affiliation(s)
- Lan Thi Xuan Tran
- Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University (TMDU)
| | - Junichiro Sakamoto
- Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University (TMDU)
| | - Ami Kuribayashi
- Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University (TMDU)
| | - Hiroshi Watanabe
- Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University (TMDU)
| | - Hiroshi Tomisato
- Oral and Maxillofacial Radiology Clinic, Dental Hospital, Tokyo Medical and Dental University (TMDU)
| | - Tohru Kurabayashi
- Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University (TMDU)
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25
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Rocha BDC, Rosa BSPA, Visconti MA. Utilização da imagem por ressonância magnética na odontologia: revisão de literatura. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2018.v44.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A Imagem por Ressonância Magnética (IRM) tem sido considerada a modalidade de escolha para o diagnóstico de processos patológicos que acometem a articulação temporomandibular, tecidos moles e outros processos inflamatórios. Devido a sua característica não invasiva e livre de radiação ionizante, novas aplicações para a técnica têm sido propostas e estudadas nas mais diversas áreas da Odontologia, como Endodontia, Dentística, Periodontia e Cirurgia Oral. O objetivo neste trabalho é apresentar uma revisão de literatura acerca da utilização da IRM na Odontologia, destacando as vantagens e limitações da técnica.
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Demirturk Kocasarac H, Ustaoglu G, Bayrak S, Katkar R, Geha H, Deahl ST, Mealey BL, Danaci M, Noujeim M. Evaluation of artifacts generated by titanium, zirconium, and titanium-zirconium alloy dental implants on MRI, CT, and CBCT images: A phantom study. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:535-544. [PMID: 30879914 DOI: 10.1016/j.oooo.2019.01.074] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 01/16/2019] [Accepted: 01/20/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to assess artifacts generated by zirconium, titanium, and titanium-zirconium alloy implants on magnetic resonance imaging(MRI), computed tomography(CT), and cone beam computed tomography(CBCT) and to correlate the findings to the dose-area product and exposure factors on CT and CBCT. STUDY DESIGN Three phantoms were built by embedding zirconium, titanium, and titanium-zirconium implants in ultrasound gel. MRI, CT, and CBCT images were acquired by using multiple sequences and settings. For MRI, "artifact" was described as the length of signal void beyond the limits of the implant. For CT and CBCT, "artifact" was calculated by subtracting the gray level of the darkest pixel from the level of the lightest pixel. RESULTS On MRI, zirconium implants had minor distortion artifacts, whereas titanium and titanium-zirconium implants created extensive artifacts (P < .05). On CT and CBCT, artifacts were less prominent with titanium and titanium-zirconium implants compared with zirconium (P < .05). Titanium grade 5 implants with 0.3 and 0.4 mm3 voxels produced the least severe artifacts. CONCLUSIONS MRI images were less affected by artifacts from zirconium implants, whereas CT and CBCT images showed less severe artifacts from titanium and titanium-zirconium alloy implants. CT generated greater artifacts compared with CBCT. Larger CBCT voxel sizes reduced the dose-area product and the severity of artifacts.
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Affiliation(s)
- Husniye Demirturk Kocasarac
- Department of Comprehensive Dentistry, University of Texas Health San Antonio, TX, USA and Department of General Dental Sciences, Marquette University, Milwaukee, WI, USA.
| | - Gulbahar Ustaoglu
- Chair, Department of Periodontology, Abant Izzet Baysal University, Bolu, Turkey
| | - Seval Bayrak
- Chair, Department of Oral and Maxillofacial Radiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Rujuta Katkar
- Department of Comprehensive Dentistry, University of Texas Health San Antonio, TX, USA and Department of General Dental Sciences, Marquette University, Milwaukee, WI, USA
| | - Hassem Geha
- Department of Comprehensive Dentistry, University of Texas Health San Antonio, TX, USA and Department of General Dental Sciences, Marquette University, Milwaukee, WI, USA
| | - S Thomas Deahl
- Department of Comprehensive Dentistry, University of Texas Health San Antonio, TX, USA and Department of General Dental Sciences, Marquette University, Milwaukee, WI, USA
| | - Brian L Mealey
- Graduate Program Director, Department of Periodontology, University of Texas Health San Antonio, TX, USA
| | - Murat Danaci
- Chair, Department of Radiology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Marcel Noujeim
- Department of Comprehensive Dentistry, University of Texas Health San Antonio, TX, USA and Department of General Dental Sciences, Marquette University, Milwaukee, WI, USA
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Are titanium implants actually safe for magnetic resonance imaging examinations? Arch Plast Surg 2019; 46:96-97. [PMID: 30685951 PMCID: PMC6369045 DOI: 10.5999/aps.2018.01466] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/28/2018] [Indexed: 11/25/2022] Open
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Ruetters M, Juerchott A, El Sayed N, Heiland S, Bendszus M, Kim TS. Dental magnetic resonance imaging for periodontal indication - a new approach of imaging residual periodontal bone support. Acta Odontol Scand 2019; 77:49-54. [PMID: 30156125 DOI: 10.1080/00016357.2018.1499959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The standard imaging techniques used in dentistry consist of two-dimensional radiographic techniques like intraoral periapical (PA) radiographs, bitewings or extraoral panoramic X-rays. Three-dimensional methods, such as cone beam computed tomography (CBCT), are not standard procedures. In several fields of dentistry, such as oral surgery or implantology, dental magnetic resonance imaging (DMRI), a technique without radiation exposure, has already been introduced as a new promising diagnostic tool. The aim of this study was to compare the agreement of DMRI and PA radiographs in measuring residual periodontal bone support. MATERIAL AND METHODS In this study, the residual periodontal bone support of 21 teeth was investigated and compared with DMRI and PA radiographs by two independent raters. Intra-class correlation coefficients (ICCs) were calculated using the software R to identify the intra-rater and inter-rater agreement of the two modalities. Bland-Altman plots were created to directly compare the two methods. RESULTS Overall, all calculated ICC values showed an excellent intra-rater and inter-rater agreement (>0.9) for DMRI, as well as PA radiographs. Bland-Altman analysis also showed a strong agreement between both diagnostic methods in this study. CONCLUSIONS In conclusion, there was a strong agreement between DMRI and PA. Thus, DMRI proved to be a comparable method to PA radiographs for evaluating the proportion of residual periodontal bone support.
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Affiliation(s)
- Maurice Ruetters
- Section of Periodontology, Clinic for Conservative Dentistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Juerchott
- Division of Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nihad El Sayed
- Section of Periodontology, Clinic for Conservative Dentistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabine Heiland
- Division of Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Bendszus
- Division of Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ti-Sun Kim
- Section of Periodontology, Clinic for Conservative Dentistry, University Hospital Heidelberg, Heidelberg, Germany
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Chockattu SJ, Suryakant DB, Thakur S. Unwanted effects due to interactions between dental materials and magnetic resonance imaging: a review of the literature. Restor Dent Endod 2018; 43:e39. [PMID: 30483463 PMCID: PMC6237727 DOI: 10.5395/rde.2018.43.e39] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/25/2018] [Indexed: 12/20/2022] Open
Abstract
Magnetic resonance imaging (MRI) is an advanced diagnostic tool used in both medicine and dentistry. Since it functions based on a strong uniform static magnetic field and radiofrequency pulses, it is advantageous over imaging techniques that rely on ionizing radiation. Unfortunately, the magnetic field and radiofrequency pulses generated within the magnetic resonance imager interact unfavorably with dental materials that have magnetic properties. This leads to unwanted effects such as artifact formation, heat generation, and mechanical displacement. These are a potential source of damage to the oral tissue surrounding the affected dental materials. This review aims to compile, based on the current available evidence, recommendations for dentists and radiologists regarding the safety and appropriate management of dental materials during MRI in patients with orthodontic appliances, maxillofacial prostheses, dental implants, direct and indirect restorative materials, and endodontic materials.
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Affiliation(s)
- Sherin Jose Chockattu
- Department of Conservative Dentistry & Endodontics, Bapuji Dental College & Hospital, Davangere, KA, India
| | - Deepak Byathnal Suryakant
- Department of Conservative Dentistry & Endodontics, Dental College, Regional Institute of Medical Sciences, Imphal, MN, India
| | - Sophia Thakur
- Department of Conservative Dentistry & Endodontics, Bapuji Dental College & Hospital, Davangere, KA, India
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Rendenbach C, Schoellchen M, Bueschel J, Gauer T, Sedlacik J, Kutzner D, Vallittu PK, Heiland M, Smeets R, Fiehler J, Siemonsen S. Evaluation and reduction of magnetic resonance imaging artefacts induced by distinct plates for osseous fixation: an in vitro study @ 3 T. Dentomaxillofac Radiol 2018; 47:20170361. [PMID: 29718688 DOI: 10.1259/dmfr.20170361] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES: To analyze MRI artefacts induced at 3 T by bioresorbable, titanium (TI) and glass fibre reinforced composite (GFRC) plates for osseous reconstruction. METHODS: Fixation plates including bioresorbable polymers (Inion CPS, Inion Oy, Tampere, Finland; Rapidsorb, DePuy Synthes, Umkirch, Germany; Resorb X, Gebrueder KLS Martin GmbH, Tuttlingen, Germany), GFRC (Skulle Implants Oy, Turku, Finland) and TI plates of varying thickness and design (DePuy Synthes, Umkirch, Germany) were embedded in agarose gel and a 3 T MRI was performed using a standard protocol for head and neck imaging including T1W and T2W sequences. Additionally, different artefact reduction techniques (slice encoding for metal artefact reduction & ultrashort echo time) were used and their impact on the extent of artefacts evaluated for each material. RESULTS: All TI plates induced significantly more artefacts than resorbable plates in T1W and T2W sequences. GFRCs induced the least artefacts in both sequences. The total extent of artefacts increased with plate thickness and height. Plate thickness had no influence on the percentage of overestimation in all three dimensions. TI-induced artefacts were significantly reduced by both artefact reduction techniques. CONCLUSIONS: Polylactide, GFRC and magnesium plates produce less susceptibility artefacts in MRI compared to TI, while the dimensions of TI plates directly influence artefact extension. Slice encoding for metal artefact reduction and ultrashort echo time significantly reduce metal artefacts at the expense of scan time or image resolution.
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Affiliation(s)
- Carsten Rendenbach
- 1 Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,2 Berlin Institute of Health (BIH) , Berlin , Germany
| | - Max Schoellchen
- 3 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Julie Bueschel
- 3 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Tobias Gauer
- 4 Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Jan Sedlacik
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Daniel Kutzner
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Pekka K Vallittu
- 6 Department of Biomaterials Science, Institute of Dentistry, University of Turku, and City of Turku, Welfare Division , Turku , Finland
| | - Max Heiland
- 1 Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Ralf Smeets
- 3 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Jens Fiehler
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Susanne Siemonsen
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Juerchott A, Pfefferle T, Flechtenmacher C, Mente J, Bendszus M, Heiland S, Hilgenfeld T. Differentiation of periapical granulomas and cysts by using dental MRI: a pilot study. Int J Oral Sci 2018; 10:17. [PMID: 29777107 PMCID: PMC5966810 DOI: 10.1038/s41368-018-0017-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 02/08/2023] Open
Abstract
The purpose of this pilot study was to evaluate whether periapical granulomas can be differentiated from periapical cysts in vivo by using dental magnetic resonance imaging (MRI). Prior to apicoectomy, 11 patients with radiographically confirmed periapical lesions underwent dental MRI, including fat-saturated T2-weighted (T2wFS) images, non-contrast-enhanced T1-weighted images with and without fat saturation (T1w/T1wFS), and contrast-enhanced fat-saturated T1-weighted (T1wFS+C) images. Two independent observers performed structured image analysis of MRI datasets twice. A total of 15 diagnostic MRI criteria were evaluated, and histopathological results (6 granulomas and 5 cysts) were compared with MRI characteristics. Statistical analysis was performed using intraclass correlation coefficient (ICC), Cohen's kappa (κ), Mann-Whitney U-test and Fisher's exact test. Lesion identification and consecutive structured image analysis was possible on T2wFS and T1wFS+C MRI images. A high reproducibility was shown for MRI measurements of the maximum lesion diameter (intraobserver ICC = 0.996/0.998; interobserver ICC = 0.997), for the "peripheral rim" thickness (intraobserver ICC = 0.988/0.984; interobserver ICC = 0.970), and for all non-quantitative MRI criteria (intraobserver-κ = 0.990/0.995; interobserver-κ = 0.988). In accordance with histopathological results, six MRI criteria allowed for a clear differentiation between cysts and granulomas: (1) outer margin of lesion, (2) texture of "peripheral rim" in T1wFS+C, (3) texture of "lesion center" in T2wFS, (4) surrounding tissue involvement in T2wFS, (5) surrounding tissue involvement in T1wFS+C and (6) maximum "peripheral rim" thickness (all: P < 0.05). In conclusion, this pilot study indicates that radiation-free dental MRI enables a reliable differentiation between periapical cysts and granulomas in vivo. Thus, MRI may substantially improve treatment strategies and help to avoid unnecessary surgery in apical periodontitis.
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Affiliation(s)
- Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, Germany
| | - Thorsten Pfefferle
- Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, Germany
| | - Christa Flechtenmacher
- Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, Heidelberg, Germany
| | - Johannes Mente
- Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, Germany
| | - Sabine Heiland
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, Germany.
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Akutagawa M, Emoto T, Tokitani T, kinouchi Y. A computer simulation of the metallic artifacts in MRI caused by dental magnetic attachments. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aab646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Di Nardo D, Gambarini G, Capuani S, Testarelli L. Nuclear Magnetic Resonance Imaging in Endodontics: A Review. J Endod 2018; 44:536-542. [DOI: 10.1016/j.joen.2018.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/30/2017] [Accepted: 01/01/2018] [Indexed: 01/31/2023]
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Kirnbauer B, Jakse N, Rugani P, Schwaiger M, Magyar M. Assessment of impacted and partially impacted lower third molars with panoramic radiography compared to MRI-a proof of principle study. Dentomaxillofac Radiol 2018; 47:20170371. [PMID: 29388826 DOI: 10.1259/dmfr.20170371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Third molars often require surgical removal. Since three-dimensional radiological assessment is often indicated in difficult cases to avoid surgical complications, the radiation burden has to be considered. Here, MRI may offer a dose-free alternative to conventional X-ray techniques. The aim of this retrospective analysis was to evaluate the assessment quality of MRI compared to panoramic radiography in impacted and partially impacted lower third molars. METHODS Panoramic radiographs and MRI scans of 28 Caucasian patients were assessed twice by four investigators. Wisdom teeth were classified according to Juodzbalys and Daugela 2013. RESULTS When radiological lower third molar assessments with panoramic radiography and MRI were compared, staging concurred in 73% in the first round of assessments and 77% in the second. CONCLUSIONS The presented study demonstrates that MRI not only provides much the same information that panoramic radiography usually does, but also has the advantages of a dose-free three-dimensional view. This may facilitate and shorten third molar surgery. Image interpretation, however, can differ depending on training and experience.
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Affiliation(s)
- Barbara Kirnbauer
- 1 Department of Oral surgery and Orthodontics, Medical University of Graz , Graz , Austria
| | - Norbert Jakse
- 1 Department of Oral surgery and Orthodontics, Medical University of Graz , Graz , Austria
| | - Petra Rugani
- 1 Department of Oral surgery and Orthodontics, Medical University of Graz , Graz , Austria
| | - Michael Schwaiger
- 2 Department of Maxillofacial surgery, Medical University of Graz , Graz , Austria
| | - Marton Magyar
- 3 Department of Radiology, Medical University of Graz , Graz , Austria
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Wanner L, Ludwig U, Hövener JB, Nelson K, Flügge T. Magnetic resonance imaging-a diagnostic tool for postoperative evaluation of dental implants: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:e103-e107. [PMID: 29501353 DOI: 10.1016/j.oooo.2018.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Compared with cone beam computed tomography (CBCT), magnetic resonance imaging (MRI) might be superior for the diagnosis of nerve lesions associated with implant placement. STUDY DESIGN A patient presented with unilateral pain associated with dysesthesia in the region of the right lower lip and chin after implant placement. Conventional orthopantomography could not identify an association between the position of the inferior alveolar nerve and the implant. For 3-dimensional display of the implant in relation to the surrounding anatomy, CBCT was compared with MRI. RESULTS MRI enabled the precise depiction of the implant position and its spatial relation to the inferior alveolar nerve, whereas the nerve position and its exact course within the mandible could not be directly displayed in CBCT. CONCLUSION MRI may be a valuable, radiation-free diagnostic tool for the visualization of intraoral hard and soft tissues, offering an objective assessment of nerve injuries by a direct visualization of the inferior alveolar neurovascular bundle.
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Affiliation(s)
- Laura Wanner
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Ute Ludwig
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jan-Bernd Hövener
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tabea Flügge
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Heil A, Schwindling FS, Jelinek C, Fischer M, Prager M, Lazo Gonzalez E, Bendszus M, Heiland S, Hilgenfeld T. Determination of the palatal masticatory mucosa thickness by dental MRI: a prospective study analysing age and gender effects. Dentomaxillofac Radiol 2017; 47:20170282. [PMID: 28959890 DOI: 10.1259/dmfr.20170282] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The aim of this prospective study was to evaluate age and gender effects on the palatal masticatory mucosa thickness by using non-invasive and non-ionizing MRI. METHODS 40 periodontally healthy participants of five gender-balanced age groups (20-29, 30-39, 40-49, 50-59 and 60-69 years, respectively) underwent dental MRI at 3 Tesla using a contrast-enhanced, high-resolution 3D-sequence. The palatal masticatory mucosa was measured at 40 standard measurement points by two independent observers. Statistical analysis was performed by using intraclass correlation coefficient (ICC), Shapiro-Wilk test, two-way analysis of variance and post-hoc Tukey HSD test. RESULTS Measurements of the palatal masticatory mucosa thickness were highly reliable with a mean intraobserver ICC of 0.989 and a mean interobserver ICC of 0.987. Mean palatal masticatory mucosa thickness increased with the distance from the gingival margin in all tooth regions. Molars showed a considerably lower average palatal masticatory mucosa thickness at intermediate heights in comparison to canines and premolars. Average palatal masticatory mucosa thickness continuously increased with age and significantly differed between age groups (p < 0.01). A significant increase was observed between the age groups of 30-39 years and 40-49 years (p = 0.04). Gender had no significant effect on average palatal mucosa thickness (p = 0.19). However, there was a tendency towards thicker mucosa in males (mean ± SD, 3.36 mm ± 0.47) compared to females (3.23 mm ± 0.44). CONCLUSIONS In the present study, dental MRI allowed for a highly reliable determination of the palatal masticatory mucosa thickness. Considerable intra- and interindividual variations in palatal masticatory mucosa thickness were observed. Average palatal masticatory mucosa thickness was dependent on age but not on gender.
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Affiliation(s)
- Alexander Heil
- 1 Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Constanze Jelinek
- 3 Department of Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Manuel Fischer
- 4 Section of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcel Prager
- 4 Section of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Martin Bendszus
- 1 Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- 4 Section of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tim Hilgenfeld
- 1 Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Boldt J, Rottner K, Schmitter M, Hopfgartner A, Jakob P, Richter EJ, Tymofiyeva O. High-resolution MR imaging for dental impressions: a feasibility study. Clin Oral Investig 2017; 22:1209-1213. [PMID: 28929419 DOI: 10.1007/s00784-017-2204-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 09/07/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Magnetic resonance imaging is an emerging technology in dental medicine. While low-resolution MRI has especially provided means to examine the temporomandibular joint due to its anatomic inaccessibility, it was the goal of this study to assess whether high-resolution MRI is capable of delivering a dataset sufficiently precise enough to serve as digital impression of human teeth. MATERIALS AND METHODS An informed and consenting patient in need of dental restoration with fixed partial dentures was chosen as subject. Two prepared teeth were measured using MRI and the dataset subjected to mathematical processing before Fourier transformation. After reconstruction, a 3D file was generated which was fed into an existing industry standard CAD/CAM process. RESULTS A framework for a fixed dental prosthesis was digitally modeled and manufactured by laser-sintering. The fit in situ was found to be acceptable by current clinical standards, which allowed permanent placement of the fixed prosthesis. CONCLUSIONS Using a clinical whole-body MR scanner with the addition of custom add-on hardware, contrast enhancement, and data post-processing, resolution and signal-to-noise ratio were sufficiently achieved to allow fabrication of a dental restoration in an acquisition time comparable to the setting time of common dental impression materials. Furthermore, the measurement was well tolerated. CLINICAL RELEVANCE The herein described method can be regarded as proof of principle that MRI is a promising option for digital impressions when fixed partial dentures are required.
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Affiliation(s)
- Julian Boldt
- Department of Prosthodontics, University of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
| | - Kurt Rottner
- Department of Prosthodontics, University of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Marc Schmitter
- Department of Prosthodontics, University of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Andreas Hopfgartner
- Institute of Experimental Physics V, University of Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Peter Jakob
- Institute of Experimental Physics V, University of Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Ernst-Jürgen Richter
- Department of Prosthodontics, University of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Olga Tymofiyeva
- Institute of Experimental Physics V, University of Würzburg, Am Hubland, 97074, Würzburg, Germany
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Ahlbrecht CA, Ruellas ACDO, Paniagua B, Schilling JA, McNamara JA, Cevidanes LHS. Three-dimensional characterization of root morphology for maxillary incisors. PLoS One 2017; 12:e0178728. [PMID: 28594852 PMCID: PMC5464764 DOI: 10.1371/journal.pone.0178728] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/17/2017] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to test the reproducibility of three-dimensional (3D) surface models of maxillary incisors and to propose a characterization of root morphology. The sample was comprised of pre-treatment cone-beam computed tomography (CBCT) images of fifty-five patients. The CBCTs were used to construct 3D surface models of the maxillary incisors. The reproducibility of surface models was tested by repeated construction of them by two observers. A 3D surface model that corresponded to the average of all lateral and all central incisors was generated. 3D surface distances and vector differences were calculated for each individual tooth and the average of the teeth considered. The corresponding points on the 3D surface mesh for each subgroup were compared statistically to those of the neutral subgroup using shape analysis MANCOVA and Hotelling's t-statistic (p < 0.05). Repeated construction of surface models demonstrated adequate inter-rater reproducibility. The distribution of 3D models into root morphology subgroups was: blunt (11% and 26% of the central and lateral incisors, respectively), conical (15% of the central incisors), long (27% and 20% of the central and lateral incisors, respectively), and short (15% and 4% of the central and lateral incisors, respectively). Compared to the neutral average, statistically significant differences in root morphology were found for blunt, long, conical, and short central incisors and for blunt, long, and short lateral incisors. We can conclude that 3D surface models construction for upper incisors is reproducible. 3D shape analysis using CBCT images allows a phenotypic characterization of incisor root morphology.
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Affiliation(s)
- Carly A. Ahlbrecht
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Antonio Carlos de Oliveira Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Orthodontics and Pediatric Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Beatriz Paniagua
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Juan A. Schilling
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - James A. McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Lucia Helena Soares Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
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Smeets R, Schöllchen M, Gauer T, Aarabi G, Assaf AT, Rendenbach C, Beck-Broichsitter B, Semmusch J, Sedlacik J, Heiland M, Fiehler J, Siemonsen S. Artefacts in multimodal imaging of titanium, zirconium and binary titanium-zirconium alloy dental implants: an in vitro study. Dentomaxillofac Radiol 2016; 46:20160267. [PMID: 27910719 DOI: 10.1259/dmfr.20160267] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To analyze and evaluate imaging artefacts induced by zirconium, titanium and titanium-zirconium alloy dental implants. METHODS Zirconium, titanium and titanium-zirconium alloy implants were embedded in gelatin and MRI, CT and CBCT were performed. Standard protocols were used for each modality. For MRI, line-distance profiles were plotted to quantify the accuracy of size determination. For CT and CBCT, six shells surrounding the implant were defined every 0.5 cm from the implant surface and histogram parameters were determined for each shell. RESULTS While titanium and titanium-zirconium alloy induced extensive signal voids in MRI owing to strong susceptibility, zirconium implants were clearly definable with only minor distortion artefacts. For titanium and titanium-zirconium alloy, the MR signal was attenuated up to 14.1 mm from the implant. In CT, titanium and titanium-zirconium alloy resulted in less streak artefacts in comparison with zirconium. In CBCT, titanium-zirconium alloy induced more severe artefacts than zirconium and titanium. CONCLUSIONS MRI allows for an excellent image contrast and limited artefacts in patients with zirconium implants. CT and CBCT examinations are less affected by artefacts from titanium and titanium-zirconium alloy implants compared with MRI. The knowledge about differences of artefacts through different implant materials and image modalities might help support clinical decisions for the choice of implant material or imaging device in the clinical setting.
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Affiliation(s)
- Ralf Smeets
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schöllchen
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Gauer
- 2 Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- 3 Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandre T Assaf
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Rendenbach
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedicta Beck-Broichsitter
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Semmusch
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Sedlacik
- 4 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Max Heiland
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- 4 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Siemonsen
- 4 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kang KM, Choi SH, Kim DE, Yun TJ, Kim JH, Sohn CH, Park SW. Application of Cardiac Gating to Improve the Reproducibility of Intravoxel Incoherent Motion Measurements in the Head and Neck. Magn Reson Med Sci 2016; 16:190-202. [PMID: 27818467 PMCID: PMC5600025 DOI: 10.2463/mrms.mp.2016-0051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose: To prospectively evaluate whether cardiac gating can improve the reproducibility of intravoxel incoherent motion (IVIM) parameters in the head and neck, we performed IVIM diffusion-weighted imaging (DWI) using 4 b values (4b), 4 b values with cardiac gating (4b gating) and 17 b values (17b). Methods: We performed IVIM DWI twice per person on nine healthy volunteers using 4b, 4b gating and 17b and five patients with head and neck masses using 4b gating and 17b. The ADC, perfusion fraction (f), diffusion coefficient (D) and perfusion-related diffusion coefficient (D*) were calculated in the brain, masticator muscle, parotid gland, submandibular gland, tonsil and masses. Intraclass coefficient (ICC), Bland-Altman analysis (BAA) and coefficient of variation (CV) were used to assess short-term test-retest reproducibility. Kruskal-Wallis test and Mann-Whitney test were used to investigate whether 4b, 4b gating or 17b had significant influences on the parameters. Results: For normal tissues and masses, ICC was excellent for all maps except the D* map. All parameters showed the lowest CV in the 4b gating. BAA also revealed the narrowest 95% limits of agreement using 4b gating for all parameters. In the subgroup analysis, almost all parameters in brain, muscle, parotid gland and submandibular gland showed the best reproducibility using 4b gating. In the muscle, parotid gland and submandibular gland, the values of ADC, f and D were not significantly different between among the three methods. Conclusion: 4b gating was more reproducible with respect to measurements of IVIM parameters in comparison with 4b or 17b.
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Affiliation(s)
- Koung Mi Kang
- Department of Radiology, Seoul National University Hospital.,Department of Radiology, Seoul National University College of Medicine
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital.,School of Chemical and Biological Engineering, Seoul National University
| | | | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital.,Department of Radiology, Seoul National University College of Medicine
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital.,Department of Radiology, Seoul National University College of Medicine
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital.,Center for Nanoparticle Research, Institute for Basic Science (IBS)
| | - Sun-Won Park
- Department of Radiology, Seoul National University Boramae Hospital
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Kreutner J, Hopfgartner A, Weber D, Boldt J, Rottner K, Richter E, Jakob PM, Haddad D. High isotropic resolution magnetic resonance imaging of the mandibular canal at 1.5 T: a comparison of gradient and spin echo sequences. Dentomaxillofac Radiol 2016; 46:20160268. [PMID: 27786556 DOI: 10.1259/dmfr.20160268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The precision of localizing the mandibular canal prior to surgical intervention depends on the achievable resolution, whereas identification of the nerve depends on the image contrast. In our study, we developed new protocols based on gradient and spin echo sequences. The results from both sequences were quantitatively compared for their agreement to identify the most suitable approach. METHODS By limiting the field of view to one side of the mandible, three-dimensional acquisitions with T1 weighted gradient and spin echo sequences were performed with 0.5 × 0.5 × 0.5 mm3 resolution within 6.5 min covering the mandibular canal from the mandibular to the mental foramen. Aliasing artefacts were suppressed by different techniques. A manual segmentation of the mandibular canal from seven healthy volunteers was performed on this section by three different observers. The surface distance of the segmented volumes was computed between both sequences as well as between the different observers as a measure of equality. RESULTS The quantitative comparison of the segmentation resulted in an average surface distance of 0.26 ± 0.05 mm between both sequences and an interobserver difference of 0.26 ± 0.08 mm for gradient and 0.29 ± 0.07 mm for spin echo data. By repeated evaluation, a difference of 0.15 ± 0.02 mm for gradient and 0.18 ± 0.03 mm for spin echo data was observed, indicating a slightly higher variability for spin echo images. CONCLUSIONS Both sequences can be used to achieve high-resolution images with good contrast and can be used for precise localization of the mandibular canal. Despite a slightly increased difference for the spin echo data, the advantage of an easy and robust setup remains.
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Affiliation(s)
- Jakob Kreutner
- 1 Research Center for Magnetic Resonance Bavaria, Würzburg, Germany
| | - Andreas Hopfgartner
- 2 Department of Experimental Physics V, University of Würzburg, Würzburg, Germany
| | - Daniel Weber
- 1 Research Center for Magnetic Resonance Bavaria, Würzburg, Germany.,3 Department of Magnetic Resonance and X-Ray Imaging MRB, Fraunhofer Development Center X-Ray Technology EZRT, Fraunhofer Institute for Integrated Circuits IIS, Würzburg, Germany
| | - Julian Boldt
- 4 Department of Prosthodontics, Dental School, University of Würzburg, Würzburg, Germany
| | - Kurt Rottner
- 4 Department of Prosthodontics, Dental School, University of Würzburg, Würzburg, Germany
| | - Ernst Richter
- 4 Department of Prosthodontics, Dental School, University of Würzburg, Würzburg, Germany
| | - Peter Michael Jakob
- 2 Department of Experimental Physics V, University of Würzburg, Würzburg, Germany.,3 Department of Magnetic Resonance and X-Ray Imaging MRB, Fraunhofer Development Center X-Ray Technology EZRT, Fraunhofer Institute for Integrated Circuits IIS, Würzburg, Germany
| | - Daniel Haddad
- 1 Research Center for Magnetic Resonance Bavaria, Würzburg, Germany.,3 Department of Magnetic Resonance and X-Ray Imaging MRB, Fraunhofer Development Center X-Ray Technology EZRT, Fraunhofer Institute for Integrated Circuits IIS, Würzburg, Germany
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Niraj LK, Patthi B, Singla A, Gupta R, Ali I, Dhama K, Kumar JK, Prasad M. MRI in Dentistry- A Future Towards Radiation Free Imaging - Systematic Review. J Clin Diagn Res 2016; 10:ZE14-ZE19. [PMID: 27891491 DOI: 10.7860/jcdr/2016/19435.8658] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/11/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Magnetic Resonance Imaging (MRI), being a technique with huge potential, has become the primary diagnostic investigation for many clinical problems. Its application now has been successfully used in dentistry to maximize the diagnostic certainty. AIM The present review aims to analyze the applicability, feasibility and efficacy of MRI in the field of dentistry. MATERIALS AND METHODS A literature search was performed in main databases like Pub Med Central, Cochrane Library, Embase and Google Scholar from 1970 up to December 2015. The 2672 titles that appeared, 25 fulfilled the criteria and were included in the review. Two articles were hand searched and three articles through e-mail were also included. RESULTS The review highlights the increasing role of MRI in dentistry. In the available literature, it was found that T1 and T2 weighted images were the acceptable diagnostic images for detection of dental related diseases. CONCLUSION MRI can be used in diagnosis and treatment planning of implants, jaw lesions, diseases of Temporomandibular Joints (TMJ), orthodontic treatment, endodontic treatment etc., to achieve better prognosis.
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Affiliation(s)
- Lav Kumar Niraj
- Tutor, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Basavaraj Patthi
- Professor and Head, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Ashish Singla
- Reader, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Ritu Gupta
- Senior Lecturer, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Irfan Ali
- Tutor, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Kuldeep Dhama
- Tutor, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Jishnu Krishna Kumar
- Tutor, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Monika Prasad
- Tutor, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
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Poorsattar-Bejeh Mir A, Rahmati-Kamel M. Should the orthodontic brackets always be removed prior to magnetic resonance imaging (MRI)? J Oral Biol Craniofac Res 2016; 6:142-52. [PMID: 27195213 PMCID: PMC4862114 DOI: 10.1016/j.jobcr.2015.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 01/31/2023] Open
Abstract
Request for temporary removal of orthodontic appliances due to medical conditions that require magnetic resonance (MR) imaging is not uncommon in daily practice in the field of orthodontics. This may be at the expense of time and cost. Metal Orthodontic appliances cause more signal loss and image distortion as compared to ceramic and titanium ones. Stainless steel and large brackets in addition to the oriented miniscrews in relation to the axis of magnetic field may cause severe signal loss and image distortion. Moreover, gradient echo and frequency-selective fat saturation MR protocols are more susceptible to metal artifacts. The spin echo and fat-suppression protocols, low magnetic field strength (e.g., 1.5 Tesla vs. 3 Tesla), small field of view, high-resolution matrix, thin slice, increased echo train length and increased receiver band width could be applied to lessen the metal artifacts in MR images. The larger the distance between an appliance and desired location to be imaged, the lower the distortion and signal loss. Decision to remove brackets should be made based on its composition and desired anatomic location. In this review, first the principles of MR imaging are introduced (Part-I) and then the interactions of orthodontic appliances and magnetic field are farther discussed (Part-II).
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Affiliation(s)
- Arash Poorsattar-Bejeh Mir
- Researcher, Dental Materials Research Center, Dentistry School, Babol University of Medical Sciences, Babol, Mazandaran Province, Iran
- Fusion Dental Research Center, Dallas, TX, USA
| | - Manouchehr Rahmati-Kamel
- Head, Department of Orthodontics, Dentistry School, Babol University of Medical Sciences, Babol, Mazandaran Province, Iran
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Detterbeck A, Hofmeister M, Hofmann E, Haddad D, Weber D, Hölzing A, Zabler S, Schmid M, Hiller KH, Jakob P, Engel J, Hiller J, Hirschfelder U. MRI vs. CT for orthodontic applications: comparison of two MRI protocols and three CT (multislice, cone-beam, industrial) technologies. J Orofac Orthop 2016; 77:251-61. [DOI: 10.1007/s00056-016-0028-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/13/2015] [Indexed: 10/21/2022]
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Drăgan OC, Fărcăşanu AŞ, Câmpian RS, Turcu RVF. Human tooth and root canal morphology reconstruction using magnetic resonance imaging. ACTA ACUST UNITED AC 2016; 89:137-42. [PMID: 27004037 PMCID: PMC4777457 DOI: 10.15386/cjmed-555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/25/2015] [Indexed: 01/09/2023]
Abstract
Background and aims Visualization of the internal and external root canal morphology is very important for a successful endodontic treatment; however, it seems to be difficult considering the small size of the tooth and the complexity of the root canal system. Film-based or digital conventional radiographic techniques as well as cone beam computed tomography provide limited information on the dental pulp anatomy or have harmful effects. A new non-invasive diagnosis tool is magnetic resonance imaging, due to its ability of imaging both hard and soft tissues. The aim of this study was to demonstrate magnetic resonance imaging to be a useful tool for imaging the anatomic conditions of the external and internal root canal morphology for endodontic purposes. Methods The endodontic system of one freshly extracted wisdom tooth, chosen for its well-known anatomical variations, was mechanically shaped using a hybrid technique. After its preparation, the tooth was immersed into a recipient with saline solution and magnetic resonance imaged immediately. A Bruker Biospec magnetic resonance imaging scanner operated at 7.04 Tesla and based on Avance III radio frequency technology was used. InVesalius software was employed for the 3D reconstruction of the tooth scanned volume. Results The current ex-vivo experiment shows the accurate 3D volume rendered reconstruction of the internal and external morphology of a human extracted and endodontically treated tooth using a dataset of images acquired by magnetic resonance imaging. The external lingual and vestibular views of the tooth as well as the occlusal view of the pulp chamber, the access cavity, the distal canal opening on the pulp chamber floor, the coronal third of the root canals, the degree of root separation and the apical fusion of the two mesial roots, details of the apical region, root canal curvatures, furcal region and interradicular root grooves could be clearly bordered. Conclusions Magnetic resonance imaging offers 3D image datasets with more information than the conventional radiographic techniques. Due to its ability of imaging both hard and soft dental tissues, magnetic resonance imaging can be successfully used as a 3D diagnostic imaging technique in dentistry. When choosing the imaging method, dental clinicians should weight the benefit-risk ratio, taking into account the costs associated to magnetic resonance imaging and the harmful effects of ionizing radiations when cone beam computed tomography or conventional x-ray are used.
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Affiliation(s)
- Oana Carmen Drăgan
- Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Radu Septimiu Câmpian
- Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Wang ZJ, Rollins NK, Liang H, Park YJ. Induced magnetic moment in stainless steel components of orthodontic appliances in 1.5 T MRI scanners. Med Phys 2015; 42:5871-8. [PMID: 26429261 DOI: 10.1118/1.4930796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Most orthodontic appliances are made of stainless steel materials and induce severe magnetic susceptibility artifacts in brain MRI. In an effort for correcting these artifacts, it is important to know the value of induced magnetic moments in all parts of orthodontic appliances. In this study, the induced magnetic moment of stainless steel orthodontic brackets, molar bands, and arch-wires from several vendors is measured. METHODS Individual stainless steel brackets, molar bands, and short segments of arch-wire were positioned in the center of spherical flask filled with water through a thin plastic rod. The induced magnetic moment at 1.5 T was determined by fitting the B0 map to the z-component of the magnetic dipole field using a computer routine. RESULTS The induced magnetic moment at 1.5 T was dominated by the longitudinal component mz, with a small contribution from the transverse components. The mz was insensitive to the orientation of the metal parts. The orthodontic brackets collectively dominated the magnetic dipole moment in orthodontic appliances. In brackets from six vendors, the total induced mz from 20 brackets for nonmolar teeth ranged from 0.108 to 0.158 (median 0.122) A ⋅ m(2). The mz in eight molar bands with bracket attachment from two vendors ranged from 0.0004 to 0.0166 (median 0.0035) A ⋅ m(2). Several full length arch wires had induced magnetic moment in the range of 0.006-0.025 (median 0.015) A ⋅ m(2). CONCLUSIONS Orthodontic brackets collectively contributed most to the total magnetic moment. Different types of brackets, molar bands, and arch wires all exhibit substantial variability in the induced magnetic moment.
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Affiliation(s)
- Zhiyue J Wang
- Department of Radiology, Children's Medical Center, Dallas, Texas 75235 and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - Nancy K Rollins
- Department of Radiology, Children's Medical Center, Dallas, Texas 75235 and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - Hui Liang
- Baylor College of Dentistry, Texas A&M University, Dallas, Texas 75246
| | - Yong Jong Park
- Division of Orthodontics, Children's Medical Center, Dallas, Texas 75235
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Shalish M, Dykstein N, Friedlander-Barenboim S, Ben-David E, Gomori JM, Chaushu S. Influence of common fixed retainers on the diagnostic quality of cranial magnetic resonance images. Am J Orthod Dentofacial Orthop 2015; 147:604-9. [PMID: 25919106 DOI: 10.1016/j.ajodo.2014.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/01/2014] [Accepted: 11/01/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Orthodontists are often asked to remove fixed retainers before magnetic resonance imaging (MRI). This study was undertaken to assess the effects of 2 commonly used fixed retainers on MRI distortion and whether they should be removed. METHODS MRI scans were performed on a dry skull with Twistflex (Dentaurum, Ispringen, Germany) and Ortho Flex Tech (Reliance Orthodontic Products, Itasca, Ill) retainers. Two neuroradiologists independently ranked the distortions. The influence of the fixed retainers' alloys, their distance to the area of diagnosis, location, strength of the magnetic field, and the spin-echo sequence were examined. Statistical analysis included kappa and Pearson chi-square tests. RESULTS Ortho Flex Tech retainers caused no distortion. Twistflex retainers caused distortion in 46% of the tests in areas close to the retainer (tongue and jaws). Maxillary fixed retainers and the combination of maxillary and mandibular fixed retainers further increased the distortion. Greater distortion was observed with 3-T magnetic fields and T1-weighted spin-echo sequences. CONCLUSIONS Removal of the Ortho Flex Tech retainer is unnecessary before MRI. Removal of the Twistflex should be considered if the MRI scans are performed to diagnose areas close to the fixed retainers, when 3-T magnetic fields and T1-weighted sequences are used, and when both maxillary and mandibular fixed retainers are present.
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Affiliation(s)
- Miriam Shalish
- Clinical lecturer and director, Postgraduate Program, Department of Orthodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
| | - Nimrod Dykstein
- Clinical instructor, Department of Orthodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Silvina Friedlander-Barenboim
- Head, Oral & Maxillofacial Radiology Unit, Oral Medicine Department, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Eliel Ben-David
- Clinical instructor, Department of Radiology, Hadassah Medical Center, Jerusalem, Israel
| | - John Moshe Gomori
- Professor and head, Neuroradiology Unit, Department of Radiology, Hadassah Medical Center, Jerusalem, Israel
| | - Stella Chaushu
- Associate professor and chair, Department of Orthodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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Benic GI, Elmasry M, Hämmerle CHF. Novel digital imaging techniques to assess the outcome in oral rehabilitation with dental implants: a narrative review. Clin Oral Implants Res 2015; 26 Suppl 11:86-96. [DOI: 10.1111/clr.12616] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Goran I. Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Moustafa Elmasry
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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Akgun OM, Polat GG, Turan Illca A, Yildirim C, Demir P, Basak F. Does magnetic resonance imaging affect the microleakage of amalgam restorations? IRANIAN JOURNAL OF RADIOLOGY : A QUARTERLY JOURNAL PUBLISHED BY THE IRANIAN RADIOLOGICAL SOCIETY 2014; 11:e15565. [PMID: 25763074 PMCID: PMC4341166 DOI: 10.5812/iranjradiol.15565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 12/04/2022]
Abstract
BACKGROUND The effect of MRI on microleakage of amalgam restorations is an important health issue that should be considered. If MRI application causes increase of microleakage, amalgam fillings should be reassessed after MRI and replaced if necessary. OBJECTIVES The aim of this study is to compare the effect of magnetic resonance imaging (MRI) on microleakage of class II bonded amalgam versus classical amalgam restorations. MATERIALS AND METHODS Class II cavities (3 mm width × 1.5 mm depth) with gingival margins ending 1 mm below the cementoenamel junction (CEJ) were prepared in 40 permanent molar teeth. The teeth were randomly divided into four groups. Cavities in the first and second groups were restored with dentin adhesive and amalgam (bonded amalgam), and those in the third and fourth groups with amalgam only. MRI was performed with the teeth specimens from the first and third groups. All specimens were then thermocycled at 5° to 55° C with a 30-second dwell time for 1000 cycles. The samples were then immersed in 0.5% methylene blue dye for 24 hours and sectioned longitudinally. Dye penetration at the occlusal and gingival margins was quantified by 15× stereomicroscopy. IBM SPSS Statistics ver. 21.0 (IBM Corp., Released 2012., IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp.) and MS-Excel 2007 programs were used for statistical analyses and calculations. "nparLD" module was used for F2_LD_F1 design analysis at R program. P<0.05 was considered statistically significant. RESULTS In teeth with amalgam filling, there were no significant differences of occlusal and gingival surface microleakage after MRI exposure. Occlusal and gingival surface microleakages were also similar with and without MRI in teeth with bonded amalgam filling. CONCLUSIONS The results of this study suggest that MRI does not increase microleakage of amalgam restorations.
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Affiliation(s)
- Ozlem Marti Akgun
- Department of Pediatric Dentistry, Gulhane Medical Academy, Ankara, Turkey
| | | | - Ahmet Turan Illca
- Department of Radiology, Izmir Mevki Military Hospital, Izmir, Turkey
| | - Ceren Yildirim
- Department of Pediatric Dentistry, Gulhane Medical Academy, Ankara, Turkey
| | - Pervin Demir
- Department of Biostatistics and Medical Informatics, Yildirim Beyazit University, Ankara, Turkey
| | - Feridun Basak
- Department of Pediatric Dentistry, Gulhane Medical Academy, Ankara, Turkey
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Duttenhoefer F, Mertens ME, Vizkelety J, Gremse F, Stadelmann VA, Sauerbier S. Magnetic resonance imaging in zirconia‐based dental implantology. Clin Oral Implants Res 2014; 26:1195-202. [DOI: 10.1111/clr.12430] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Fabian Duttenhoefer
- Department of Oral and Craniomaxillofacial Surgery University Hospital Freiburg Freiburg Germany
| | - Marianne E. Mertens
- Department of Experimental Molecular Imaging Helmholtz‐Institute for Biomedical Engineering RWTH‐Aachen University Aachen Germany
| | - Josef Vizkelety
- Department of Oral and Craniomaxillofacial Surgery University Hospital Freiburg Freiburg Germany
| | - Felix Gremse
- Department of Experimental Molecular Imaging Helmholtz‐Institute for Biomedical Engineering RWTH‐Aachen University Aachen Germany
| | | | - Sebastian Sauerbier
- Department of Oral and Craniomaxillofacial Surgery University Hospital Freiburg Freiburg Germany
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