Precision of cone beam CT to assess periodontal bone defects: a systematic review and meta-analysis

Sonography in the diagnosis of peri-implant bone defects: An in vitro study on native human mandibles

AIM

The aim of this study on native human cadavers was to compare clinical, sonographic, and radiological measurements of fenestrations, dehiscences, and 3-wall bone defects on implants.

MATERIALS AND METHODS

The examination was carried out on five human mandibles. After the insertion of 27 implants, dehiscences (n = 14), fenestrations (n = 7) and 3-wall bone defects (n = 6) were prepared in a standardized manner. The direct measurement of the bone defects was carried out with a periodontal probe and the radiological examination was carried out using digital volume tomography (DVT). The ultrasound examination (US) was performed using a clinical 24-MHz US imaging probe. Means and standard deviations of the direct, US, and DVT measurements were calculated. Measurements were statistically compared using the Pearson correlation coefficient and Bland-Altman analysis.

RESULTS

Bone defects were on average 3.22 ± 1.58 mm per direct measurement, 2.90 ± 1.47 mm using US, and 2.99 ± 1.52 mm per DVT assessment. Pairwise correlations of these measurements were R = .94 (p < .0001) between direct and US, R = .95 (p < .0001) between DVT and US, and R = .96 (p < .0001) between direct and DVT. The mean differences of the measurements (and 95% CI) between direct and US was 0.41 (-0.47 to 1.29), US and DVT 0.33 (-0.30 to 0.97), and direct and DVT 0.28 (-0.50 to 1.07).

CONCLUSION

All peri-implant bone defects could be identified and sonographically measured. US measurements showed a strong correlation with direct and DVT measurements. The sonographic measurement accuracy was highest for dehiscences, followed by fenestrations and 3-wall bone defects.

Assessing the Impact of the Metal Artifact Reduction Tool on Detecting Furcation Lesions in Maxillary Molars with Different Intracanal Posts: An Ex Vivo Cone-beam Computed Tomography Study

INTRODUCTION

Considering the potential image compromise and diagnostic challenges posed by metals, this study aimed to assess the efficacy of the metal artifact reduction (MAR) tool in cone-beam computed tomography examinations for detecting furcation lesions in upper molars treated endodontically and restored with different intracanal posts.

METHODS

This ex vivo study used 45 endodontically treated maxillary first molars, categorized into the following3 groups (n = 15): control (without intracanal post), metal post, and fiberglass post. Simulations were conducted in the laboratory to replicate alveolar bone, periodontal ligament, and grade I, II, and III furcation lesions. Cone-beam computed tomography scans were obtained with and without the MAR tool, and the furcation lesions were evaluated considering a 5-point Likert scale. Data were analyzed at 5%.

RESULTS

In the control group, there was no influence of MAR (P > .05); grade II lesions were not diagnosed, and grade III lesions were the most detected (P < .05). In the metal post group with MAR, grade III lesions were diagnosed more frequently than I and II (P < .05) and grade III without MAR (P < .05). In the fiberglass post group, the diagnosis of grade I lesions decreased with MAR (P < .05), and without MAR, grade III was most diagnosed (P < .05); grade III lesions were the most diagnosed (P < .05).

CONCLUSIONS

The MAR tool was only effective for diagnosing grade III furcation lesions, regardless of the intracanal material. Its application for grade I and II lesions did not contribute to improved diagnosis. Furthermore, in the fiberglass post group with grade I lesions, the MAR tool negatively affected the detection of the lesions.

Periodontitis was associated with mesial concavity of the maxillary first premolar: a cross-sectional study

The association between the anatomical features of teeth and the pathogenesis of periodontitis is well-documented. This study aimed to evaluate the influence of the mesial concavity of the maxillary first premolar on periodontal clinical indices and alveolar bone resorption rates. Employing a cross-sectional design, in 226 patients with periodontitis, we used cone beam computed tomography(CBCT) to examine the mesial concavity and alveolar bone resorption of 343 maxillary first premolar. Periodontal clinical indicators recorded by periodontal probing in the mesial of the maxillary first premolar in patients with periodontitis. Our findings indicate that the presence of mesial concavity at the cemento-enamel junction of the maxillary first premolar was not significantly influenced by either tooth position or patient sex (p > 0.05). Nonetheless, the mesial concavity at the cemento-enamel junction of the maxillary first premolar was found to exacerbate alveolar bone resorption and the inflammatory condition (p < 0.05). We infer that the mesial concavity at the cemento-enamel junction of the maxillary first premolar may contribute to localized alveolar bone loss and accelerate the progression of periodontal disease.

The use of digital technologies in peri-implant soft tissue augmentation - A narrative review on planning, measurements, monitoring and aesthetics

OBJECTIVE

To identify the different uses and modalities of digital technologies to diagnose, plan and monitor peri-implant soft tissue conditions and aesthetics.

METHODS

A comprehensive narrative review of pertinent literature was conducted, critically appraising key digital technologies that may assist peri-implant soft tissue augmentation and assessment. An electronic search on four databases including studies published prior to 1st July 2023 was performed and supplemented by a manual search.

RESULTS

Predominantly, tools such as cone beam computed tomography (CBCT), intraoral scanning (iOS), intraoral ultrasonography and digital spectrophotometry were commonly to assess and monitor peri-implant soft tissues. The main clinical and research applications included: (i) initial assessment of mucosal thickness, supra-crestal tissue height and keratinized mucosa width, (ii) evaluation of peri-implant soft tissue health and inflammation, (iii) monitoring profilometric changes and midfacial mucosal margin stability over time and (iv) aesthetic evaluation through colour assessment. While evidence for some digital tools may be limited, the integration of digital technologies into peri-implant soft tissue management holds great promise. These technologies offer improved precision, comfort and speed in assessment, benefiting both patients and clinicians.

CONCLUSION

As digital technologies progress, their full potential in peri-implant soft tissue augmentation and their value will become more evident with ongoing research. Embracing these innovations and their potential benefits is recommended to ensure that during progress in implant dentistry, patient care is not hindered.

Detection of periodontal bone loss patterns and furcation defects from panoramic radiographs using deep learning algorithm: a retrospective study

BACKGROUND

This retrospective study aimed to develop a deep learning algorithm for the interpretation of panoramic radiographs and to examine the performance of this algorithm in the detection of periodontal bone losses and bone loss patterns.

METHODS

A total of 1121 panoramic radiographs were used in this study. Bone losses in the maxilla and mandibula (total alveolar bone loss) (n = 2251), interdental bone losses (n = 25303), and furcation defects (n = 2815) were labeled using the segmentation method. In addition, interdental bone losses were divided into horizontal (n = 21839) and vertical (n = 3464) bone losses according to the defect patterns. A Convolutional Neural Network (CNN)-based artificial intelligence (AI) system was developed using U-Net architecture. The performance of the deep learning algorithm was statistically evaluated by the confusion matrix and ROC curve analysis.

RESULTS

The system showed the highest diagnostic performance in the detection of total alveolar bone losses (AUC = 0.951) and the lowest in the detection of vertical bone losses (AUC = 0.733). The sensitivity, precision, F1 score, accuracy, and AUC values were found as 1, 0.995, 0.997, 0.994, 0.951 for total alveolar bone loss; found as 0.947, 0.939, 0.943, 0.892, 0.910 for horizontal bone losses; found as 0.558, 0.846, 0.673, 0.506, 0.733 for vertical bone losses and found as 0.892, 0.933, 0.912, 0.837, 0.868 for furcation defects (respectively).

CONCLUSIONS

AI systems offer promising results in determining periodontal bone loss patterns and furcation defects from dental radiographs. This suggests that CNN algorithms can also be used to provide more detailed information such as automatic determination of periodontal disease severity and treatment planning in various dental radiographs.

Evaluation of 3D Modeling Workflows Using Dental CBCT Data for Periodontal Regenerative Treatment

The cone beam computed tomography (CBCT) technology is nowadays widely used in the field of dentistry and its use in the treatment of periodontal diseases has already been tackled in the international literature. At the same time, advanced segmentation methods have been introduced in state-of-the-art medical imaging software and well-established automated techniques for 3D mesh cleaning are available in 3D model editing software. However, except for the application of simple thresholding approaches for the purposes of 3D modeling of the oral cavity using CBCT data for dental applications, which does not yield accurate results, the research that has been conducted using more specialized semi-automated thresholding in dental CBCT images using existing software packages is limited. This article aims to fill the gap in the state-of-the-art research concerning the usage of CBCT data for 3D modeling of the hard tissues of the oral cavity of patients with periodontitis using existing software tools, for the needs of designing and printing 3D scaffolds for periodontal regeneration. In this context, segmentation and 3D modeling workflows using dental CBCT data that belong to a patient with periodontitis are evaluated, comparisons between the 3D models of the teeth and the alveolar bone generated through the experiments that yielded the most satisfactory results are made, and an optimal and efficient methodology for creating 3D models of teeth and alveolar bone, especially for being used as the basis for generating bioabsorbable 3D printed scaffolds of personalized treatment against periodontitis, is discussed.

Cone-Beam Computed Tomography in Periodontal Diagnosis and Treatment Planning

Diagnosis of periodontal disease depends on conventional clinical parameters. In periodontitis with extensive bone defects, radiographs play a crucial role in arriving at a proper diagnosis. The emergence of cone-beam computed tomography (CBCT) became a boon in oral radiology. Limitations of conventional two-dimensional (2D) radiographs include inadequate visualization of bone defects, lamina dura, and furcation involvement. CBCT generates 3D images of anatomical structures necessary for the periodontal diagnosis of furcation involvement, intrabony defects, and implant placement. CBCT, thus, imparts various potential applications in the field of periodontics which serves to arrive at better diagnostic conclusions.

Periodontal effects of maxillary expansion in adults using non-surgical expanders with skeletal anchorage vs. surgically assisted maxillary expansion: a systematic review

OBJECTIVES

Describe and compare harmful periodontal effects as a consequence of maxillary expansion in adult patients with different types of anchorage devices in non-surgical expanders with skeletal anchorage and surgically assisted maxillary expansion.

MATERIALS AND METHODS

An exhaustive search was carried out on the electronic databases PubMed (MEDLINE), Embase, Cochrane and LILACS. Additionally, journal references and grey literature were searched without any restrictions. After the selection and extraction process; risk of bias was assessed by the ROB-1 Cochrane tool and Newcastle-Ottawa Scale (NOS) for randomized trials and cohort studies, respectively.

RESULTS

Of 621 studies retrieved from the searches, six were finally included in this review. One of them presented a low risk bias, while five were excellent respective to selection, comparability and outcomes. Results showed that maxillary expansion in adults using non-surgical expanders (bone-borne or tooth-bone-borne with bicortical skeletal anchorage) produce less harmful periodontal effects, such as: alveolar bending with an average range from 0.92° to 2.32°, compared to surgically assisted maxillary expansion (tooth-borne) of 6.4°; dental inclination with an average range from 0.07° to 2.4°, compared to surgically assisted maxillary expansion (tooth-borne) with a range from 2.01° to 5.56°.

CONCLUSIONS

Although limited, the current evidence seems to show that the bone-borne or tooth-bone-borne with bicortical skeletal anchorage produces fewer undesirable periodontal effects.

Ultrasonography for noninvasive and real-time evaluation of peri-implant soft and hard tissue: a case series

BACKGROUND

The diagnosis of soft and hard tissue at dental implants will be challenging in the future, as high prevalence of mucositis and peri-implantitis were described in the population. Ultrasonography is a promising non-invasive, inexpensive, painless, and radiation-free method for imaging hard and soft tissue at implants, especially an ultrasound device with a 25-MHz probe demonstrating a high correlation between ultrasound, clinical, and radiological measurements.

CASE PRESENTATION

The following case series demonstrates the use of ultrasonography with high spatial resolution probe in patients with dental implants affected by soft tissue recession and/or crestal bone loss.

CONCLUSION

These ultrasound images can provide valuable additional information for the assessment of peri-implant soft and hard tissue.

Two decades of research on CBCT imaging in DMFR - an appraisal of scientific evidence

OBJECTIVE

This article aims to appraise how scientific evidence related to CBCT has changed over the years, based on levels of evidence and diagnostic efficacy.

METHODS

A general search strategy was used in different databases (Pubmed, Embase, and Web of Science) to identify systematic reviews (SRs) on CBCT until November of 2020. The SRs included were divided according to different specialties of dentistry. A critical review of the articles was made, describing the level of evidence and efficacy.

RESULTS

In total, 75 articles were selected. There was an increase in the number of SRs on CBCT from 2014 onwards, as 83% of the SRs on this topic were published after 2013, and 72% between 2016 and to date. Twenty SRs (27%) performed meta-analysis. Only 28% of the SRs provided a detailed description of CBCT protocols. According to SR evidence, almost all specialties of dentistry have advanced concomitantly with the introduction of CBCT. The majority of SRs were related to clinical applications (level 2 of efficacy), followed by technical parameters (level 1 of efficacy). Only some CBCT models were mentioned in the SRs selected.

CONCLUSION

Over the course of 20 years, SRs related to CBCT applications for a broad range of dental specialties have been published, with the vast majority of studies at levels 1 and 2 of diagnostic efficacy. Not all CBCT models available on the market have been scientifically validated. At all times, one should remain cautious as such not to simply extrapolate in vitro results to the clinical setting. Also, considering the wide variety of CBCT devices and protocols, reported results should not be overstated or generalized, as outcomes often refer to specific CBCT devices and protocols.

Guidelines for oral and maxillofacial imaging: COVID-19 considerations

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing the current coronavirus disease 2019 (COVID-19) pandemic, is not only highly infectious but can induce serious outcomes in vulnerable individuals including dental patients and dental health care personnel (DHCPs). Responses to COVID-19 have been published by the Centers for Disease Control and Prevention and the American Dental Association, but a more specific response is required for the safe practice of oral and maxillofacial radiology. We aim to review the current knowledge of how the disease threatens patients and DHCPs and how to determine which patients are likely to be SARS-CoV-2 infected; consider how the use of personal protective equipment and infection control measures based on current best practices and science can reduce the risk of disease transmission during radiologic procedures; and examine how intraoral radiography, with its potentially greater risk of spreading the disease, might be replaced by extraoral radiographic techniques for certain diagnostic tasks. This is complemented by a flowchart that can be displayed in all dental offices.

Effect of section thickness on cone beam computed tomography-based measurements of intrabony defects compared with clinical measurements

BACKGROUND

It is unknown whether cone beam computed tomography (CBCT) image reconstruction characteristics, including section thickness, may affect linear bone measurements of periodontal intrabony defects. The aim of this study was to compare intrasurgical and CBCT-based linear measurements of intrabony defects focusing on CBCT section thickness.

METHODS

Sixty-six intrabony defects were assessed in 21 patients with chronic generalized severe periodontitis. Linear measurements of alveolar bone (radiographic bone level [rBL]), assessed in CBCT images at diverse section thicknesses: 0.25 mm (voxel size), 1 mm, and 3 mm, were compared with clinical bone level (cBL) measurements obtained intrasurgically. To provide identical reference points for rBL and cBL measurements, individually adjusted grooves on the reference stent were prepared for each periodontal defect site. CBCT measurements were performed in two rounds by two trained observers. Observer agreement was assessed by intraclass correlation coefficients (ICC). ANOVA assessed the difference among cBL and rBL at different section thicknesses.

RESULTS

Intra- and inter-observer agreement was excellent (ICC >0.99) and highly significant independent of the observer, evaluation round, and CBCT section thickness. Mean rBL in the diverse CBCT section thicknesses was very close to that measured clinically (cBL). There was no statistically significant difference between cBL and rBL for any section thickness, neither for the overall evaluated sites, nor the maxilla or mandible separately.

CONCLUSIONS

No statistically significant difference between clinical and radiographic bone level for 0.25-, 1-, and 3-mm CBCT section thicknesses were observed when assessing intrabony periodontal defects.

Cone beam computed tomography (CBCT) in periodontal diseases: a Systematic review based on the efficacy model

Background

Periodontal diseases are prevalent among adult populations. Its diagnosis depends mainly on clinical findings supported by radiographic examinations. In previous decades, cone beam computed tomography has been introduced to the dental field. The aim of this study was to address the diagnostic efficacy of cone-beam computed tomographic (CBCT) imaging in periodontics based on a systematic search and analysis of the literature using the hierarchical efficacy model.

Methods

A systematic search of electronic databases such as PubMed, Scopus, Web of Science, and Cochrane was conducted in February 2019 to identify studies addressing the efficacy of CBCT imaging in Periodontics. The identified studies were subjected to pre-identified inclusion criteria followed by an analysis using a hierarchical model of efficacy (model) designed for an appraisal of the literature on diagnostic imaging modality. Four examiners performed the eligibility and quality assessment of relevant studies and consensus was reached in cases where disagreement occurred.

Results

The search resulted in 64 studies. Of these, 34 publications were allocated to the relevant level of efficacy and quality assessments wherever applicable. The overall diagnostic accuracy of the included studies showed a low or moderate risk of bias and applicability concerns in the use of CBCT. In addition, CBCT is accurate in identifying periodontal defects when compared to other modalities. The studies on the level of patient outcomes agreed that CBCT is a reliable tool for the assessment of outcomes after the treatment of periodontal defects.

Conclusion

CBCT was found to be beneficial and accurate in cases of infra-bony defects and furcation involvements.

[Accuracy of cone beam computed tomography in assessing maxillary molar furcation involvement]

OBJECTIVE

This study aimed to assess the accuracy of cone beam computed tomography (CBCT) in detecting furcation involvement (FI) in maxillary molars.

METHODS

Thirty-one maxillary molars of 15 patients with generalized chronic periodontitis considered for furcation surgery were assessed. Clinical examination and CBCT were performed, and the FI degree was evaluated. Clinical and CBCT-based FI assessments were compared with intrasurgical data.

RESULTS

The agreement between clinical and intrasurgical assessments was weak in all sites, with a kappa of less than 0.4; the complete, overestimated, and underestimated agreement percentages were 42.0%, 24.7%, and 33.3%, respectively. The agreement between the CBCT and intrasurgical assessments was strong, with a ka ppa of 0.831; the complete, overestimated, and underestimated agreement percentages were 88.2%, 3.2%, and 8.6%, respectively. The agreement between both assessments was the highest in the buccal furcation entrance (κ=0.896), followed by that in the distopalatal (κ=0.822) and mesiopalatal (κ=0.767) furcation entrances.

CONCLUSIONS

CBCT images demonstrated high accuracy in assessing the horizontal bone loss of FI in maxillary molars.

Comparison of anterior mandibular alveolar thickness and height in young adults with different sagittal and vertical skeletal relationships: A CBCT Study

OBJECTIVE

Alveolar bone surrounding mandibular incisors dictates the range of buccolingual inclination that can be achieved with treatment. The objective of this study was to evaluate the mandibular anterior alveolar thickness and height in individuals with different sagittal and vertical skeletal relationships.

MATERIALS AND METHODS

Cone beam computed tomography scans of 53 individuals (22 males and 31 females; mean age 21.19±3.7 years) were classified into 3 groups according to the sagittal skeletal relationship (class I, class II, and class III) and the vertical growth pattern (hyperdivergent, normodivergent, and hypodivergent). The alveolar thickness and height of both mandibular central incisors were measured. Group comparisons were performed with analysis of variance and post hoc Scheffé tests. Multiple linear regression was applied to evaluate the influence of all variables on the alveolar conditions.

RESULTS

Alveolar thickness and height showed no significant differences among the class I, II and III groups (6 and 7mm regardless of the sagittal group, P>0.05). The middle and lower alveolar thicknesses were significantly smaller in hyperdivergent (5.76mm and 6.34mm) and normodivergent (6.29mm and 7.40mm) than hypodivergent individuals (6.63mm and 8.27mm respectively). The lingual alveolar height was smaller in hyperdivergent (6.04mm) than hypodivergent individuals (7.93mm) (P=0.029, 95%CI: 0.15-3.63) and the lingual bone height was smaller in hypodivergent (3.24mm) than hyperdivergent individuals (5.06mm) (P=0.029, 95%CI: 0.15-3.48). Multiple linear regression indicated a significant influence of the root length on the alveolar thickness and height.

CONCLUSIONS

The sagittal skeletal relationship showed no influence on the alveolar thickness or height, even if dental compensation was present. Hyperdivergent individuals showed smaller alveolar thicknesses and heights than hypodivergent individuals.

Comparison of ultrasound imaging and cone-beam computed tomography for examination of the alveolar bone level: A systematic review

Background and objective

The current methods to image alveolar bone in humans include intraoral 2D radiography and cone-beam computed tomography (CBCT). However, these methods expose the subject to ionizing radiation. Therefore, ultrasound imaging has been investigated as an alternative technique, as it is both non-invasive and free from ionizing radiation. In order to assess the validity and reliability of ultrasonography in visualizing alveolar bone, a systematic review was conducted comparing ultrasound imaging to CBCT for examination of the alveolar bone level.

Study design

Seven databases were searched. Studies addressing examination of alveolar bone level via CBCT and ultrasound were selected. Risk of bias under Cochrane guidelines was used as a methodological quality assessment tool.

Results

All the four included studies were ex vivo studies that used porcine or human cadaver samples. The alveolar bone level was measured by the distance from the alveolar bone crest to certain landmarks such as cemento-enamel junction or gingival margin. The risk of bias was found as low. The mean difference between ultrasound and CBCT measurements ranged from 0.07 mm to 0.68 mm, equivalent to 1.6% - 8.8%.

Conclusions

There is currently preliminary evidence to support the use of ultrasonography as compared to CBCT for the examination of alveolar bone level. Further studies comparing ultrasound to gold standard methods would be necessary to help validate the accuracy of ultrasonography as a diagnostic technique in periodontal imaging.