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Jacobs R, Fontenele RC, Lahoud P, Shujaat S, Bornstein MM. Radiographic diagnosis of periodontal diseases - Current evidence versus innovations. Periodontol 2000 2024. [PMID: 38831570 DOI: 10.1111/prd.12580] [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: 02/07/2024] [Revised: 04/23/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
Accurate diagnosis of periodontal and peri-implant diseases relies significantly on radiographic examination, especially for assessing alveolar bone levels, bone defect morphology, and bone quality. This narrative review aimed to comprehensively outline the current state-of-the-art in radiographic diagnosis of alveolar bone diseases, covering both two-dimensional (2D) and three-dimensional (3D) modalities. Additionally, this review explores recent technological advances in periodontal imaging diagnosis, focusing on their potential integration into clinical practice. Clinical probing and intraoral radiography, while crucial, encounter limitations in effectively assessing complex periodontal bone defects. Recognizing these challenges, 3D imaging modalities, such as cone beam computed tomography (CBCT), have been explored for a more comprehensive understanding of periodontal structures. The significance of the radiographic assessment approach is evidenced by its ability to offer an objective and standardized means of evaluating hard tissues, reducing variability associated with manual clinical measurements and contributing to a more precise diagnosis of periodontal health. However, clinicians should be aware of challenges related to CBCT imaging assessment, including beam-hardening artifacts generated by the high-density materials present in the field of view, which might affect image quality. Integration of digital technologies, such as artificial intelligence-based tools in intraoral radiography software, the enhances the diagnostic process. The overarching recommendation is a judicious combination of CBCT and digital intraoral radiography for enhanced periodontal bone assessment. Therefore, it is crucial for clinicians to weigh the benefits against the risks associated with higher radiation exposure on a case-by-case basis, prioritizing patient safety and treatment outcomes.
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Affiliation(s)
- Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Rocharles Cavalcante Fontenele
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pierre Lahoud
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Periodontology and Oral Microbiology, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
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Zamure-Damberga L, Radzins O, Salms G, Zolovs M, Bokvalde Z, Neimane L. Long-Term Volumetric Stability of Maxillary Sinus Floor Augmentation Using a Xenograft Bone Substitute and Its Combination with Autologous Bone: A 6+ Year Retrospective Follow-Up Study Using Cone Beam Computed Tomography. Dent J (Basel) 2024; 12:121. [PMID: 38786519 PMCID: PMC11119141 DOI: 10.3390/dj12050121] [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: 02/28/2024] [Revised: 03/29/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Deproteinised bovine bone (DBB) is widely used as bone substitute in maxillary sinus floor augmentation (MSFA) surgery. No previous studies have shown the long-term volumetric changes in the augmented bone when using DBB. The selected patients had MFSA performed using a lateral window technique and a xenograft, alone or in combination with the patient's autologous bone from the mandible. Cone beam computed tomography (CBCT) images were used to compare the volumetric changes in the augmented bone for patients over a period of 6 or more years. No significant bone reduction was seen in the augmented bone region when comparing MSFA after 7 months and 6 or more years after dental implantation.
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Affiliation(s)
- Liene Zamure-Damberga
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, LV-1007 Riga, Latvia; (O.R.); (Z.B.); (L.N.)
- RSU Institute of Stomatology, LV-1007 Riga, Latvia;
| | - Oskars Radzins
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, LV-1007 Riga, Latvia; (O.R.); (Z.B.); (L.N.)
- RSU Institute of Stomatology, LV-1007 Riga, Latvia;
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, LV-1073 Riga, Latvia
| | - Girts Salms
- RSU Institute of Stomatology, LV-1007 Riga, Latvia;
- Department of Oral and Maxillofacial Surgery, Riga Stradins University, LV-1007 Riga, Latvia
| | - Maksims Zolovs
- Statistics Unit, Riga Stradins University, LV-1048 Riga, Latvia;
- Institute of Life Sciences and Technology, Daugavpils University, LV-5401 Daugavpils, Latvia
| | - Zanda Bokvalde
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, LV-1007 Riga, Latvia; (O.R.); (Z.B.); (L.N.)
- RSU Institute of Stomatology, LV-1007 Riga, Latvia;
| | - Laura Neimane
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, LV-1007 Riga, Latvia; (O.R.); (Z.B.); (L.N.)
- RSU Institute of Stomatology, LV-1007 Riga, Latvia;
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Kitami R, Izumi M, Taniguchi M, Kozai Y, Sakurai T. Phantom study for CT artifacts of dental titanium implants and zirconia upper structures: the effects of occlusal plane angle setting and SEMAR algorithm. Oral Radiol 2024; 40:251-258. [PMID: 38146041 DOI: 10.1007/s11282-023-00730-6] [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: 08/21/2023] [Accepted: 11/26/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES The single-energy metal artifact reduction (SEMAR) algorithm effectively reduces metal artifacts in computed tomography (CT). The study aimed to evaluate the effect of the occlusal plane angle on metal artifacts caused by dental implants and zirconia upper structures, and the effectiveness of SEMAR for CT prognostic evaluation. METHODS Part of a bovine rib was used as the mandibular implant phantom. First, the phantom immersed in a water tank was scanned using CT to obtain the control image under certain conditions. Subsequently, three titanium implant bodies were implanted in a straight line into the phantom, and a zirconia superstructure was attached. CT scans were performed. The CT-reconstructed images were obtained with and without SEMAR processing. Twelve regions of interest (ROIs) were set at the same site on each sagittal image, and the CT values were measured at all the ROIs. The CT values of the ROIs in the control images and those of the ROIs with and without SEMAR were compared. RESULTS The variations in the occlusal plane angle during CT imaging negligibly affected the number of regions in which metal artifacts appeared. SEMAR improved the CT value of the trabecular bone, which was affected by metal artifacts. CONCLUSION This study showed that the occlusal plane angle occasionally did not affect the area of metal artifacts caused by dental implants or zirconia upper structures. Other results indicate that SEMAR is effective for accurately evaluating the alveolar bone around the implant body by reducing metal artifacts.
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Affiliation(s)
- Ryoji Kitami
- Graduate School of Dentistry, Department of Diagnostic Imaging, Kanagawa Dental University, Yokosuka City, Japan
| | - Masahiro Izumi
- Graduate School of Dentistry, Department of Diagnostic Imaging, Kanagawa Dental University, Yokosuka City, Japan.
| | - Motoe Taniguchi
- Graduate School of Dentistry, Department of Diagnostic Imaging, Kanagawa Dental University, Yokosuka City, Japan
| | - Yusuke Kozai
- Graduate School of Dentistry, Department of Educational Planning, Kanagawa Dental University, Yokosuka City, Japan
| | - Takashi Sakurai
- Graduate School of Dentistry, Department of Diagnostic Imaging, Kanagawa Dental University, Yokosuka City, Japan
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Barros-Costa M, Nascimento EHL, Correia-Dantas IF, Oliveira ML, Freitas DQ. Potential impact of metal crowns at varying distances from a carious lesion on its detection on cone-beam computed tomography scans with several protocols. Imaging Sci Dent 2024; 54:49-56. [PMID: 38571773 PMCID: PMC10985521 DOI: 10.5624/isd.20230202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 04/05/2024] Open
Abstract
Purpose This study evaluated the impact of artifacts generated by metal crowns on the detection of proximal caries lesions in teeth at various distances using cone-beam computed tomography (CBCT). Additionally, the diagnostic impacts of tube current and metal artifact reduction (MAR) were investigated. Materials and Methods Thirty teeth were arranged within 10 phantoms, each containing 1 first premolar, 1 second premolar, and 1 second molar. A sound first molar (for the control group) or a tooth with a metal crown was placed. Of the 60 proximal surfaces evaluated, 15 were sound and 45 exhibited enamel caries. CBCT scans were acquired using an OP300 Maxio unit (Instrumentarium, Tuusula, Finland), while varying the tube current (4, 8, or 12.5 mA) and enabling or disabling MAR. Five observers assessed mesial and distal surfaces using a 5-point scale. Multi-way analysis of variance was employed for data comparison, with P<0.05 indicating statistical significance. Results The area under the curve (AUC) varied from 0.40 to 0.60 (sensitivity: 0.28-0.45, specificity: 0.44-0.80). The diagnostic accuracy was not significantly affected by the presence of a metal crown, milliamperage, or MAR (P>0.05). However, the overall AUC and specificity were significantly lower for surfaces near a crown (P<0.05). Conclusion CBCT-based caries detection was not influenced by the presence of a metal crown, variations in milliamperage, or MAR activation. However, the diagnostic accuracy was low and was further diminished for surfaces near a crown. Consequently, CBCT is not recommended for the detection of incipient caries lesions.
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Affiliation(s)
- Matheus Barros-Costa
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | | | - Iago Filipe Correia-Dantas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Matheus L. Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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Coelho-Silva F, Cascante-Sequeira D, Réa MT, Oliveira ML, Freitas DQ, Haiter-Neto F, de-Azevedo-Vaz SL. High-density objects in exomass affect the volume of high-density objects inside the field of view. Dentomaxillofac Radiol 2024; 53:153-160. [PMID: 38224272 DOI: 10.1093/dmfr/twad014] [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: 09/05/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES To evaluate the effect of the presence and the number of high-density objects in the exomass on the volume of a high-density object in cone-beam CT (CBCT). METHODS Cylinders of cobalt-chromium (Co-Cr), titanium (Ti), and zirconium (Zi) were inserted into a polymethylmethacrylate phantom in five different combinations of number and position: 1-no cylinder; 2-one cylinder in a posterior region; 3-one cylinder in an anterior region; 4-two cylinders in posterior regions; and 5-three cylinders in anterior and posterior regions. The phantom underwent CBCT scanning using OP300 and X800 systems, with the afore mentioned cylinders of the same composition placed in the exomass and an additional high-density cylinder placed in the centre of the field of view (FOV), corresponding to the left-anterior region. The tomographic volume of the cylinder inside the FOV was measured using semi-automatic segmentation. The volumetric alteration (VA) between the segmented and physical volumes, in percentage, was compared among the experimental groups using repeated measures ANOVA and Tukey post-hoc (α = 5%). RESULTS The factors material, combination, and their interaction affected the volume or both CBCT systems. In OP300, more cylinders in the exomass reduced the VA, mainly for Co-Cr. In X800, more cylinders in the exomass tended to increase the VA inside the FOV, except for Zi. CONCLUSIONS In general, the presence of high-density objects in the exomass influences the VA of the object inside the FOV, although this oscillates according to object composition, number and position in the exomass, and CBCT system.
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Affiliation(s)
- Fernanda Coelho-Silva
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, Brazil
| | - Deivi Cascante-Sequeira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, Brazil
| | - Marcela Tarosso Réa
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, Brazil
| | - Matheus L Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, Brazil
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, Brazil
| | - Francisco Haiter-Neto
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, Brazil
| | - Sergio Lins de-Azevedo-Vaz
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, Brazil
- Department of Clinical Dentistry, Federal University of Espírito Santo, Espírito Santo 29075-910, Brazil
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Gurjar BS, Sharma V, Paliwal J, Kalla R, Meena KK, Tahir M. The role of implants and implant prostheses on the accuracy and artifacts of cone-beam computed tomography: an in-vitro study. Sci Rep 2024; 14:704. [PMID: 38184751 PMCID: PMC10771465 DOI: 10.1038/s41598-024-51293-3] [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: 06/21/2023] [Accepted: 01/03/2024] [Indexed: 01/08/2024] Open
Abstract
To assess the accuracy of CBCT in implant-supported prostheses and to evaluate metal artifacts with and without implants or implant prostheses. Accuracy and artifacts were assessed in the dried mandible at three points on the buccal and lingual cortical plates on the mandible's body near the crest and the base. On the buccal cortical plate, these points were labelled as A, B and C near the crest and D, E and F near the base of the body of the mandible. Similarly, points a to f were marked on the lingual cortical plate corresponding to points A to F. The study had two control groups, C0 for physical linear measurement (PLM) and C1 for radiographic linear measurement (RLM) and artifact assessment. There were seven test groups, TG 1 to 7, progressing from a single implant to implant full-arch prosthesis. For accuracy assessment, PLM was compared to RLM. CBCT artifacts were investigated in images integrated at 0.25 mm, 10 mm, and 20 mm at regions of interest on concentric circles at different intersecting angles by comparing grayscale values at C1 and TG1 to 7. The data were collected and statistically analyzed. A significant difference was observed between C0 and C1, and RLM in test groups at the superior axial plane. Similarly, PLM and test RLM in the sagittal plane at A-B, B-C, and D-E were statistically significant. A significant difference between PLM and RLM was also observed in the vertical plane at A-D, B-E, and C-F. Quantification of CBCT artifacts in the presence of implants or prostheses revealed that full-arch prostheses had the highest mean grayscale value, whereas single implants with a prosthesis had the lowest. The mean grayscale change was greatest around the implant and implant prosthesis. The mean grayscale value was maximum at 20 mm voxel integration scales (VIS) and lowest at 0.25 mm. CBCT is a clinically reliable device. Metal in implants or implant-supported prostheses prevents true assessment of the peri-implant area; therefore, lower VIS is suggested in the presence of implants or implant prostheses.
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Affiliation(s)
| | - Vineet Sharma
- Department of Prosthodontics, RUHS College of Dental Sciences, Jaipur, India
| | - Jyoti Paliwal
- Department of Prosthodontics, RUHS College of Dental Sciences, Jaipur, India.
| | - Rajani Kalla
- Department of Prosthodontics, RUHS College of Dental Sciences, Jaipur, India
| | - Kamal Kumar Meena
- Department of Prosthodontics, RUHS College of Dental Sciences, Jaipur, India
| | - Mohammed Tahir
- Department of Prosthodontics, RUHS College of Dental Sciences, Jaipur, India
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Andrade-Bortoletto MFS, Fontenele RC, Farias-Gomes A, Freitas DQ. Mapping artifacts generated in a tooth adjacent to titanium and zirconia implants located in the endomass and exomass in cone beam computed tomography: an ex vivo study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:73-82. [PMID: 37838553 DOI: 10.1016/j.oooo.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE We evaluated artifact expression in a root adjacent to a dental implant located in the endomass or exomass in cone beam computed tomography (CBCT). STUDY DESIGN We placed a single titanium or zirconia implant adjacent to a premolar root in a dried human mandible and acquired CBCT scans using an OP300 Maxio and a Picasso Trio 3D unit exposing a 5x5cm field of view with the implant in the endomass or exomass (implant groups) or without an implant (control group). We measured the mean gray values (MGVs) for 8 lines of interest (LOIs) around the root canal of the premolar and compared the MGVs by analysis of variance, with significance established at P < 0.05. RESULTS For the OP300 Maxio scans, the MGVs of both implant groups in the endomass were lower than the MGVs of the control group. In the exomass, the titanium group had MGVs similar to the control group, but the zirconia group produced significantly lower MGVs than control and titanium groups (P <.0001), indicating the presence of hypodense artifacts. For the Picasso Trio 3D scans, the MGVs of both implant groups in the endomass were similar to the MGVs of the control group. In the exomass, the zirconia group generated lower MGVs than control and titanium groups (P <.0001), indicating hypodense artifacts. CONCLUSIONS When performing CBCT examination, titanium implants produce less artifact expression in the exomass, and zirconia implants have less artifact expression in the endomass.
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Affiliation(s)
| | - Rocharles Cavalcante Fontenele
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Amanda Farias-Gomes
- Department of Oral Diagnosis, Division of Oral Radiology, Dentistry School of Piracicaba, State University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Dentistry School of Piracicaba, State University of Campinas (UNICAMP), Sao Paulo, Brazil
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Nenoff L, Amstutz F, Murr M, Archibald-Heeren B, Fusella M, Hussein M, Lechner W, Zhang Y, Sharp G, Vasquez Osorio E. Review and recommendations on deformable image registration uncertainties for radiotherapy applications. Phys Med Biol 2023; 68:24TR01. [PMID: 37972540 PMCID: PMC10725576 DOI: 10.1088/1361-6560/ad0d8a] [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: 04/11/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023]
Abstract
Deformable image registration (DIR) is a versatile tool used in many applications in radiotherapy (RT). DIR algorithms have been implemented in many commercial treatment planning systems providing accessible and easy-to-use solutions. However, the geometric uncertainty of DIR can be large and difficult to quantify, resulting in barriers to clinical practice. Currently, there is no agreement in the RT community on how to quantify these uncertainties and determine thresholds that distinguish a good DIR result from a poor one. This review summarises the current literature on sources of DIR uncertainties and their impact on RT applications. Recommendations are provided on how to handle these uncertainties for patient-specific use, commissioning, and research. Recommendations are also provided for developers and vendors to help users to understand DIR uncertainties and make the application of DIR in RT safer and more reliable.
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Affiliation(s)
- Lena Nenoff
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, Dresden Germany
- Helmholtz-Zentrum Dresden—Rossendorf, Institute of Radiooncology—OncoRay, Dresden, Germany
| | - Florian Amstutz
- Department of Physics, ETH Zurich, Switzerland
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Martina Murr
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany
| | | | - Marco Fusella
- Department of Radiation Oncology, Abano Terme Hospital, Italy
| | - Mohammad Hussein
- Metrology for Medical Physics, National Physical Laboratory, Teddington, United Kingdom
| | - Wolfgang Lechner
- Department of Radiation Oncology, Medical University of Vienna, Austria
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
| | - Greg Sharp
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Eliana Vasquez Osorio
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
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Xavier PNI, Vizzotto MB, Arús NA, Tiecher PFDS, Gamba TDO, Fontana MP, Beltrão RG, da Silveira HLD. Influence of the presence of dental implants on the accuracy and difficulty level of diagnosis of furcation involvement in molars: An in vitro CBCT study. Clin Oral Implants Res 2023; 34:1385-1394. [PMID: 37752682 DOI: 10.1111/clr.14182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 08/23/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the possible interference of image artifacts (IA) generated by dental implants in the evaluation of furcation involvement (FI) in molars. METHODS Tomographic scans of first molars (1M) were performed in dry skulls in the absence and presence of titanium (TI) and zirconia (ZI) dental implants. FI grades were simulated in the alveoli of the 1Ms. Diagnostic accuracy of FI and level of difficulty were verified. Chi-squared test and logistic regression analysis were used. RESULTS There was no difference in the diagnostic accuracy of FI between the arches (p = .117). The highest diagnostic accuracy value for the implant variable was found in the absence of implants (88.3%) and the lowest in the presence of two ZI implants (66.7%). The highest diagnostic accuracy value for FI was observed in grade 0 (G0). There was no significant difference between the arches regarding the evaluators' perception of difficulty (p > .05). Assessments were considered difficult in 12.7% of the TI implants and in 29% of the ZI implants. Regarding the number of dental implants, assessments were considered difficult in 24.4% cases including one implant and 17.4% cases including two implants. The logistic regression model showed a significant p-value only for one and two ZI implants (p = .0061 and p = .0096, respectively). CONCLUSION The presence of dental implants in the region adjacent to the area of investigation of FI decreased the diagnostic accuracy while increasing the perception of difficulty by the examiners, especially in cases with ZI implants.
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Affiliation(s)
- Paula N I Xavier
- Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Mariana B Vizzotto
- Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nádia Assein Arús
- Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Priscila F da S Tiecher
- Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Thiago de Oliveira Gamba
- Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Mathias Pante Fontana
- Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Heraldo L D da Silveira
- Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Angioi A, Floris M, Lepori N, Cabiddu G, Pani A. Radiopacity of Sodium Zirconium Cyclosilicate in Computed Tomography: a case of a patient with Hyperkalemia and kidney disease. Ren Fail 2023; 45:2284839. [PMID: 37982235 PMCID: PMC11001350 DOI: 10.1080/0886022x.2023.2284839] [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: 10/02/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023] Open
Abstract
Sodium Zirconium Cyclosilicate (SZC) is commonly used for treating hyperkalemia because it sequesters gastrointestinal potassium ions, thereby reducing serum potassium levels. However, a less-discussed aspect of SZC is its radiopacity on x-ray-based imaging techniques. The European Medicines Agency (EMA) has only vaguely addressed this issue. Radiopaque substances like SZC can interfere with diagnostic imaging, creating challenges for clinicians and radiologists. We present the case of a 34-year-old Italian male to illustrate these concerns.
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Affiliation(s)
- Andrea Angioi
- Nephrology, Dialysis and Transplantation Unit, ‘Giuseppe Brotzu’ Hospital, Cagliari, Italy
| | - Matteo Floris
- Nephrology, Dialysis and Transplantation Unit, ‘Giuseppe Brotzu’ Hospital, Cagliari, Italy
| | - Nicola Lepori
- Nephrology, Dialysis and Transplantation Unit, ‘Giuseppe Brotzu’ Hospital, Cagliari, Italy
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Gianfranca Cabiddu
- Nephrology, Dialysis and Transplantation Unit, ‘Giuseppe Brotzu’ Hospital, Cagliari, Italy
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonello Pani
- Nephrology, Dialysis and Transplantation Unit, ‘Giuseppe Brotzu’ Hospital, Cagliari, Italy
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
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Ramage A, Lopez Gutierrez B, Fischer K, Sekula M, Santaella GM, Scarfe W, Brasil DM, de Oliveira-Santos C. Filtered back projection vs. iterative reconstruction for CBCT: effects on image noise and processing time. Dentomaxillofac Radiol 2023; 52:20230109. [PMID: 37665027 DOI: 10.1259/dmfr.20230109] [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] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES To assess the effect of standard filtered back projection (FBP) and iterative reconstruction (IR) methods on CBCT image noise and processing time (PT), acquired with various acquisition parameters with and without metal artefact reduction (MAR). METHODS CBCT scans using the Midmark EIOS unit of a human mandible embedded in soft tissue equivalent material with and without the presence of an implant at mandibular first molar region were acquired at various acquisition settings (milliamperages [4mA-14mA], FOV [5 × 5, 6 × 8, 9 × 10 cm], and resolutions [low, standard, high] and reconstructed using standard FBP and IR, and with and without MAR. The processing time was recorded for each reconstruction. ImageJ was used to analyze specific axial images. Radial transaxial fiducial lines were created relative to the implant site. Standard deviations of the gray density values (image noise) were calculated at fixed distances on the fiducial lines on the buccal and lingual aspects at specific axial levels, and mean values for FBP and IR were compared using paired t-tests. Significance was defined as p < 0.05. RESULTS The overall mean for image noise (± SD) for FBP was 198.65 ± 55.58 and 99.84 ± 16.28 for IR. IR significantly decreased image noise compared to FBP at all acquisition parameters (p < 0.05). Noise reduction among different scanning protocols ranged between 29.7% (5 × 5 cm FOV) and 58.1% (5mA). IR increased processing time by an average of 35.1 s. CONCLUSIONS IR significantly reduces CBCT image noise compared to standard FBP without substantially increasing processing time.
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Affiliation(s)
- Amanda Ramage
- University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | | | - Kathleen Fischer
- University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - Michael Sekula
- University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | | | - William Scarfe
- University of Louisville School of Dentistry, Louisville, Kentucky, USA
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Cascante-Sequeira D, Fontenele RC, Martins LAC, Brasil DM, Oliveira ML, Freitas DQ, Haiter-Neto F. Does the shape of the field-of-view influence the magnitude of artefacts from high-density materials in cone-beam computed tomography? Dentomaxillofac Radiol 2023; 52:20230147. [PMID: 37493606 PMCID: PMC10552126 DOI: 10.1259/dmfr.20230147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To compare cylindrical and convex triangular field-of-views (FOVs) concerning the magnitude of artefacts from high-density materials in cone-beam CT (CBCT). METHODS AND MATERIALS Cylinders of amalgam, chromium-cobalt, titanium, and zirconia were individually placed in the anterior and posterior regions of a polymethylmethacrylate phantom and scanned using cylindrical and convex triangular FOVs of the Veraview X800 CBCT device. Using the Image J software, 15 square regions of interest (ROIs) were placed in the axial reconstruction around the middle level of the cylinder and at distances of 0.5, 1.0, and 1.5 cm from the centre of the cylinder. Mean grey value and standard deviation of each ROI were averaged for each distance and subtracted from the values of a control ROI to calculate the magnitude of the artefacts by the grey value mean difference (GVMD) and grey value standard deviation (GVSD). Multiway analysis of variance with Tukey post-hoc test with a significance level of 5% evaluated the effect of the shape of the FOV, position inside the FOV, high-density material, and the distance of the artefact from the material. RESULTS The convex triangular FOV increased the GVSD for all materials in the anterior and posterior regions at 0.5 cm compared to the cylindrical FOV (p < 0.0001). The convex triangular FOV showed greater GVMD for chromium-cobalt and zirconium in the anterior region and all materials in the posterior region at all distances (p < 0.0001). CONCLUSION The FOV shape influences the magnitude of artefacts from high-density materials. The convex triangular FOV showed greater artefact magnitude with variability among the high-density materials, region in the FOV, and distance from the material.
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Affiliation(s)
- Deivi Cascante-Sequeira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Luciano Augusto Cano Martins
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Danieli Moura Brasil
- Department of Oral Diagnosis & Oral Health, University of Louisville School of Dentistry, Louisville, United States of America
| | - Matheus L Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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13
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Tarce M, de Greef A, Lahoud P, de Faria Vasconcelos K, Jacobs R, Quirynen M. The impact of implant-related characteristics on dental implant blooming: An in vitro study. Clin Oral Implants Res 2022; 33:1199-1211. [PMID: 36189488 DOI: 10.1111/clr.14002] [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: 03/31/2022] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 12/13/2022]
Abstract
AIM To assess, in vitro, variables potentially influencing implant blooming using a human-like imaging phantom and 3D-printed mandibles. MATERIAL AND METHODS Sixty implants were inserted in 3D-printed mandibles in 26 different configurations in order to examine the impact of implant diameter, presence of a cover screw, implant design/material, implant position, and the presence of additional implants on implant blooming using two cone-beam computed tomography (CBCT) devices (Accuitomo [ACC] and NewTom [NWT]). Two observers measured the amount of implant blooming in both buccolingual and mesiodistal directions. Inter-rater agreement and descriptive statistics, grouped by implant characteristic and CBCT device, were calculated. RESULTS Both CBCT devices increased implant diameter (a mean increase of 9.2% and 11.8% for titanium, 20.3% and 24.4% for zirconium, for ACC and NWT, respectively). An increase in implant diameter did not increase the amount of blooming, whereas placing a cover screw did (from 8.0% to 10.9% for ACC, and from 10.0% to 15.6% for NWT). Moreover, implant design, anatomical region, and the presence of another implant also affected the extent of the blooming. CONCLUSIONS Dental implants show a clear diameter increase on CBCT, with the effect being more pronounced for zirconium than for titanium implants. Similar effects are likely to occur in the clinical setting, potentially masking nonosseointegration, reducing the dimensions of peri-implant defects, and/or causing underestimation of the buccal bone thickness.
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Affiliation(s)
- Mihai Tarce
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Alexander de Greef
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Pierre Lahoud
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium.,OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Karla de Faria Vasconcelos
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marc Quirynen
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
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Effect of the Field of View Size on CBCT Artifacts Caused by the Presence of Metal Objects in the Exomass. Int J Dent 2022; 2022:2071108. [PMID: 36117513 PMCID: PMC9481401 DOI: 10.1155/2022/2071108] [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: 06/03/2022] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
Materials and Methods In this in vitro experimental study, titanium implants, teeth with cobalt-chromium (Co-Cr) intracanal posts, and teeth with mesio-occluso-distal (MOD) amalgam restorations were placed in an empty socket of the extracted third molar of a human mandible. These metallic materials were differently arranged in the exomass (zone outside of the FOV). A polypropylene tube containing dipotassium phosphate was placed in the empty socket of the right canine tooth in a dry human mandible. CBCT scans were taken with a NewTom VGI (Verona, Italy) scanner using a 6 × 6 cm and an 8 × 8 cm FOV. The histogram tool of OnDemand software (Cybermed, Seoul, Korea) was used to select circles with a 1.5 mm diameter as the (ROI) at the center of the homogenous solution of dipotassium phosphate tube on the axial plane. The mean gray value (GV) and its standard deviation (SD) in the region of interest (ROI) were calculated (P > 0.05). The data were analyzed by SPSS 26. Results The reduction in the size of the FOV significantly decreased the mean GV (P < 0.001). Metal objects in the exomass significantly decreased the mean GV (P < 0.001), and minimum mean GV and maximum SD were recorded for amalgam, followed by Co-Cr intracanal posts, and titanium implants. The unilateral presence of a metal object was associated with a higher mean GV and lower SD (P < 0.001). Conclusion Using a smaller FOV increases the size of the exomass, which may negatively affect the image quality. Metal objects in the exomass decrease the GV of CBCT scans and adversely affect the image quality.
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Shokri A, Vafaee F, Haghighat L, Shahabi S, Farhadian M, Jamalpour MR. Comparison of the amount of artifacts induced by zirconium and titanium implants in cone-beam computed tomography images. BMC Med Imaging 2022; 22:156. [PMID: 36057551 PMCID: PMC9440550 DOI: 10.1186/s12880-022-00884-5] [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: 03/30/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to compare the amount of artifacts induced by the titanium and zirconium implants on cone-beam computed tomography (CBCT) and assess the effect of different exposure settings on the image quality for both materials.
Methods In this experimental study, 30 zirconium and 30 titanium implants were placed in bovine rib bone blocks. CBCT images were taken in two different fields of view (FOV: 4 × 6 cm2 and 6 × 8 cm2) and at two resolutions (133 µ and 200 µ voxel size). Subsequently, two observers assessed the images and detected the amount of artifacts around the implants through gray values. Data were analyzed by paired t test and independent t test using SPSS 21 and the 0.05 significance level. Results The results showed that titanium implants caused lower amounts of artifacts than zirconium implants, which was statistically significant (P < 0.001). The larger FOV (6 × 8 cm2) resulted in a lower amount of artifacts in both groups, although the results were only statistically significant in the zirconium group (P < 0.001). The amount of artifacts was increased when using the 133 µ voxel size in both groups, which was only significant in the zirconium group (P < 0.001). Conclusion Our results suggest that zirconium implants induce higher amounts of artifacts than titanium ones. We also concluded that the artifacts could be minimized using the larger FOV and voxel size.
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Affiliation(s)
- Abbas Shokri
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fariborz Vafaee
- Department of Prosthodontics, Dental Implants Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Shiva Shahabi
- Dental Implants Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Farhadian
- Department of Biostatistics, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Reza Jamalpour
- Department of Oral and Maxillofacial Surgery, Dental Implants Research Center, Hamadan University of Medical Sciences, Shaheed Fahmideh Avenue, Hamadan, 6517838636, Iran.
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Vitulli I, Fontenele RC, Nascimento EHL, Freitas DQ. Influence of artefacts generated by titanium and zirconium implants in the study of trabecular bone architecture in cone-beam CT images. Dentomaxillofac Radiol 2022; 51:20220066. [PMID: 35466693 PMCID: PMC10043622 DOI: 10.1259/dmfr.20220066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the influence of artefacts generated by titanium and zirconium implants on trabecular bone architecture assessment through cone-beam CT (CBCT). The influence of kilovoltage (kVp) and metal artefact reduction (MAR) in such analysis was also assessed. METHODS CBCT scans were obtained with Picasso Trio with or without a titanium or zirconium implants in a posterior region of a mandible using 70, 80 or 90 kVp, with or without MAR. The other acquisition settings were constant: field of view 8 × 5 cm, voxel size 0.2 mm, 5 mA, 24 s and 720 frames. Two volumes of interest (VOIs) were determined comprising trabecular bone mesial and distal to the implant area. The following morphometric parameters were measured: connectivity density (Conn. Dn.), fractal dimension (FD), bone volume fraction (BV/TV), bone surface density (BS/TV), trabecular thickness (Tb. Th.), and trabecular spacing (Tb. Sp.), and compared by multiway ANOVA (α = 0.05). RESULTS For Conn. Dn. and FD, with MAR, the zirconium group showed values significantly lower than the other groups (p < 0.05). For BV/TV, BS/TV, Tb. Th. and Tb. Sp., the zirconium group showed the highest values, regardless of MAR condition (p < 0.05). MAR increased BS/TV and Tb. Th. values, and decreased FD values for zirconium group. In general, the kVp level did not influence trabecular morphometric parameters. CONCLUSION The assessment of the trabecular bone architecture was mainly influenced by the expression of the artefacts generated by zirconium implants. MAR decreased the FD and increased the BS/TV and Tb.Th. values regardless of the kVp level.
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Affiliation(s)
- Ivana Vitulli
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Rocharles Cavalcante Fontenele
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | | | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
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Moshfeghi M, Safi Y, Różyło-Kalinowska I, Gandomi S. Does the size of an object containing dental implant affect the expression of artifacts in cone beam computed tomography imaging? Head Face Med 2022; 18:20. [PMID: 35765076 PMCID: PMC9241278 DOI: 10.1186/s13005-022-00326-1] [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: 02/11/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background Artifacts fault image quality but handling several factors can affect it. This study was conducted to investigate the effect of object size on artifacts in cone-beam computed tomography systems. Methods Five phantoms, each containing a titanium implant in a sheep bone block, were fabricated of various sizes ranging from XS to XL: The M phantom was the same size as the device’s field of view (FOV). The L and XL phantoms were 20 and 40% larger than the FOV while the S and XS phantoms were 20 and 40% smaller than FOV, respectively. Ballistic gelatin was used to fill the phantoms. Phantoms were scanned by NewTom VGI and HDXWill Q-FACE. The mean and standard deviation (SD) of gray values in each 120 ROI was obtained by OnDemand software. The contrast to noise ratio (CNR) was also calculated. Results The gray value in S and M phantoms were more homogenous. The lowest SD value (10.20) was found in S phantom. The highest value for SD (125.16) was observed in XL phantom. The lowest (4.47) and highest (9.92) CNR were obtained in XL and S phantoms, respectively. HDXWill Q-FACE recorded a higher SD and a lower CNR than NewTom VGI (P < 0.05). Conclusion Object dimensions of the FOV size or up to 20% smaller provided better image quality. Since the dimensions of soft tissue in most patients are larger than the selective FOV, it is recommended that in CBCT artifacts studies, an object with dimensions closer to the patient’s dimensions be used to better relate the results with the clinical condition, because the sample dimensions affect the amount of artifacts.
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Affiliation(s)
- Mahkameh Moshfeghi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yaser Safi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ingrid Różyło-Kalinowska
- Department of Dental and Maxillofacial Radiodiagnostics, Medical University of Lublin, Lublin, Poland
| | - Shiva Gandomi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Wanderley VA, Leite AF, de Faria Vasconcelos K, Pauwels R, Müller-García F, Becker K, Oliveira ML, Jacobs R. Impact of metal artefacts on subjective perception of image quality of 13 CBCT devices. Clin Oral Investig 2022; 26:4457-4466. [PMID: 35166942 DOI: 10.1007/s00784-022-04409-w] [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: 06/22/2021] [Accepted: 02/09/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The overall objective of this study was to assess how metal artefacts impact image quality of 13 CBCT devices. As a secondary objective, the influence of scanning protocols and field of view on CBCT image quality with and without metal artefacts was also assessed. MATERIALS AND METHODS CBCT images were acquired of a dry human skull phantom considering three clinical simulated conditions: one without metal and two with metallic materials (metallic pin and implant). An industrial micro-CT was used as a reference to register the CBCT images. Afterwards, four observers evaluated 306 representative image slices from 13 devices, ranking them from best to worst. Furthermore, within each device, medium FOV and small FOV standard images were compared. General linear mixed models were used to assess subjective perception of examiners on overall image quality in the absence and presence of metal-related artefacts (p < 0.05). RESULTS Image quality perception significantly differed amongst CBCT devices (p < 0.05). Some devices performed significantly better, independently of scanning protocol and clinical condition. In the presence of metal artefacts, medium FOV standard scanning protocols scored significantly better, while in the absence of metal, small FOV standard yielded the highest performance. CONCLUSIONS Subjective image quality differs significantly amongst CBCT devices and scanning protocols. Metal-related artefacts may highly impact image quality, with a significant device-dependent variability and only few scanners being more robust against metal artefacts. Often, metal artefact expression may be somewhat reduced by proper protocol selection. CLINICAL RELEVANCE Metallic objects may severely impact image quality in several CBCT devices.
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Affiliation(s)
- Victor Aquino Wanderley
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium. .,Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
| | - Andre Ferreira Leite
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ruben Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark.,Department of Mechanical Engineering, Catholic University of Leuven, Leuven, Belgium
| | - Francisca Müller-García
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kathrin Becker
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Matheus L Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Demirturk Kocasarac H, Koenig LJ, Ustaoglu G, Oliveira ML, Freitas DQ. CBCT image artefacts generated by implants located inside the field of view or in the exomass. Dentomaxillofac Radiol 2022; 51:20210092. [PMID: 34289314 PMCID: PMC8802698 DOI: 10.1259/dmfr.20210092] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To compare artefacts in cone-beam computed tomography (CBCT) arising from implants of different materials located either inside the field of view (FOV) or in the exomass, and to test different image-acquisition parameters to reduce them. METHODS CBCT scans of a human mandible prepared with either a titanium, titanium-zirconium, or zirconia implant were acquired with the Planmeca ProMax utilizing FOV sizes of 8 × 5 cm and 4 × 5 cm, which placed the implant inside the FOV (8 × 5 cm) or in the exomass (4 × 5 cm). The scanning parameters considered three conditions of metal artefact reduction (MAR), disabled, low, and high, and 2 kVp levels (80 and 90). The standard deviation (SD) of grey values of regions of interest was obtained. The effects of implant material, implant position, MAR condition, kVp level, and their interactions were evaluated by Analysis of Variance (α = 5%). RESULTS The zirconia implant produced the highest SD values (more heterogeneous grey values, corresponding to greater artefact expression), followed by titanium-zirconium, and titanium. In general, implants in the exomass produced images with higher SD values than implants inside the FOV. MAR was effective in decreasing SD values, especially from the zirconia implant, only when the implant was inside the FOV. Images with 80 kVp had higher SD values than those with 90 kVp, regardless of the other factors (p < 0.05). CONCLUSIONS Implants in the exomass lead to greater artefact expression than when they are inside the FOV. Special attention should be paid to scanning parameters that reduce metal-related artefacts, such as MAR activation and increasing kVp. This is especially important with a zirconia implant inside the FOV.
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Affiliation(s)
- Husniye Demirturk Kocasarac
- Division of Oral and Maxillofacial Radiology, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wisconsin, United States
| | - Lisa J Koenig
- Division of Oral and Maxillofacial Radiology, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wisconsin, United States
| | - Gulbahar Ustaoglu
- Department of Periodontics, Bolu Abant Izzet Baysal University Faculty of Dentistry, BAIBU Golkoy Yerleskesi, Merkez/Bolu, Turkey
| | - Matheus Lima Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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20
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Fontenele RC, Nascimento EHL, Imbelloni-Vasconcelos AC, Martins LAC, Pontual ADA, Ramos-Perez FMM, Freitas DQ. Influence of kilovoltage-peak and the metal artifact reduction tool in cone-beam computed tomography on the detection of bone defects around titanium-zirconia and zirconia implants. Imaging Sci Dent 2022; 52:267-273. [PMID: 36238703 PMCID: PMC9530290 DOI: 10.5624/isd.20220040] [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: 02/26/2022] [Revised: 05/07/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to assess the influence of kilovoltage-peak (kVp) and the metal artifact reduction (MAR) tool on the detection of buccal and lingual peri-implant dehiscence in the presence of titanium-zirconia (Ti-Zr) and zirconia (Zr) implants in cone-beam computed tomography (CBCT) images. Materials and Methods Twenty implant sites were created in the posterior region of human mandibles, including control sites (without dehiscence) and experimental sites (with dehiscence). Individually, a Ti-Zr or Zr implant was placed in each implant site. CBCT scans were performed using a Picasso Trio device, with variation in the kVp setting (70 or 90 kVp) and whether the MAR tool was used. Three oral radiologists scored the detection of dehiscence using a 5-point scale. The area under the receiver operating characteristic (ROC) curve, sensitivity, and specificity were calculated and compared by multi-way analysis of variance (α=0.05). Results The kVp, cortical plate involved (buccal or lingual cortices), and MAR did not influence any diagnostic values (P>0.05). The material of the implant did not influence the ROC curve values (P>0.05). In contrast, the sensitivity and specificity were statistically significantly influenced by the implant material (P<0.05) with Zr implants showing higher sensitivity values and lower specificity values than Ti-Zr implants. Conclusion The detection of peri-implant dehiscence was not influenced by kVp, use of the MAR tool, or the cortical plate. Greater sensitivity and lower specificity were shown for the detection of peri-implant dehiscence in the presence of a Zr implant.
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Affiliation(s)
- Rocharles Cavalcante Fontenele
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | | | | | - Luciano Augusto Cano Martins
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Andrea dos Anjos Pontual
- Department of Clinical and Preventive Dentistry, Division of Oral Radiology, Federal University of Pernambuco, Recife, PE, Brazil
| | - Flávia Maria Moraes Ramos-Perez
- Department of Clinical and Preventive Dentistry, Division of Oral Radiology, Federal University of Pernambuco, Recife, PE, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
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21
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Coelho-Silva F, Gaêta-Araujo H, Rosado LPL, Freitas DQ, Haiter-Neto F, de-Azevedo-Vaz SL. Distortion or magnification? An in vitro cone-beam CT study of dimensional changes of objects with different compositions. Dentomaxillofac Radiol 2021; 50:20210063. [PMID: 34111368 DOI: 10.1259/dmfr.20210063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess whether dimensional changes occur as shape distortion (unevenly), contraction or magnification (evenly) in cone beam computed tomography (CBCT) considering materials, anatomical regions and metal artefact reduction algorithms. METHODS Four cylinders of amalgam (Am), cobalt-chromium (Co-Cr), gutta-percha (Gu), titanium (Ti) and zirconium (Zi) were inserted inside a polymethylmethacrylate phantom in anterior and posterior regions for acquisitions in Picasso Trio and OP300 with MAR enabled and disabled. Two observers measured the dimensions of each cylinder in three axes: Y (height), Z (antero posterior diameter) and X (latero-lateral diameter). Repeated measures ANOVA with Tukey post-hoc test compared the data (α = 5%). RESULTS Shape distortion occurred for all materials in anterior region of Picasso Trio without MAR (p < 0.05). With MAR enabled, Gu and Ti contracted (p ≥ 0.05), while the others showed distortion (p < 0.05). In posterior region, all materials distorted in both MAR conditions (p < 0.05), except Gu, which magnified without MAR (p ≥ 0.05) and contracted unevenly with MAR (p < 0.05). In anterior region of OP300, all materials magnified without MAR, (p ≥ 0.05) and had shape distortion with MAR (p < 0.05). In posterior region, only Am showed magnification without MAR (p ≥ 0.05), while all materials presented shape distortion with MAR (p < 0.05). CONCLUSION Dimensional changes of high-density materials in CBCT can be either a magnification, a contraction or a distortion; the last condition is the most prevalent. Furthermore, changes differ considering material, anatomical region and MAR condition.
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Affiliation(s)
- Fernanda Coelho-Silva
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Hugo Gaêta-Araujo
- Oral Radiology Section, School of Dentistry, Federal University of Alfenas, Minas Gerais, Brazil
| | - Lucas P Lopes Rosado
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Sergio Lins de-Azevedo-Vaz
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Clinical Dentistry, Federal University of Espírito Santo, Espírito Santo, Brazil
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Radiopacity of sodium zirconium cyclosilicate on CT imaging. CEN Case Rep 2021; 10:559-562. [PMID: 34009637 DOI: 10.1007/s13730-021-00607-9] [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: 12/06/2020] [Accepted: 04/27/2021] [Indexed: 10/21/2022] Open
Abstract
A patient who post-operatively develops hyperkalemia is treated with sodium zirconium cyclosilicate (Lokelma®), a novel agent used for the treatment of non-life-threatening hyperkalemia with reduced side effects as compared with its predecessors. On CT imaging of the chest, abdomen, and pelvis, a radiopaque fluid is noticed despite the patient not having received any oral or intravenous contrast nor any medications or supplements that may appear radiopaque. Based on previous CT imaging of zirconium-based tooth implants and their radiopaque appearance on images, it is hypothesized that the sodium zirconium cyclosilicate that the patient was administered is the explanation of the radiopacity on CT imaging. We performed an in-vitro experiment to confirm that Lokelma is radiopaque to support our hypothesis. It is important to fully understand the differential of what may cause different appearances on imaging as well as to eliminate potential sources of artifact prior to imaging, or alternatively, to potentially be able to use medications with known radiopaque properties as alternatives to contrast agents.
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Terrabuio BR, Carvalho CG, Peralta-Mamani M, Santos PSDS, Rubira-Bullen IRF, Rubira CMF. Cone-beam computed tomography artifacts in the presence of dental implants and associated factors: an integrative review. Imaging Sci Dent 2021; 51:93-106. [PMID: 34235055 PMCID: PMC8219451 DOI: 10.5624/isd.20200320] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose This study was conducted to review the literature regarding the types of cone-beam computed tomography (CBCT) artifacts around dental implants and the factors that influence their formation. Materials and Methods A search strategy was carried out in the PubMed, Embase, and Scopus databases to identify published between 2010 and 2020, and 9 studies were selected. The implants included 306 titanium, titanium-zirconium, and zirconia implants, as well as 5 titanium cylinders. Results The artifacts around the implants were the beam-hardening artifact, the streaking artifact, and band-like radiolucent areas. Some factors that influenced the formation of artifacts were the implant material, bone type, evaluated regions, distance, type of CBCT, field of view (FOV) size, milliamperage, peak kilovoltage (kVp), and voxel size. The beam-hardening artifact was the most widely reported, and it was minimized in protocols with a smaller FOV, larger voxels, and higher kVp. Conclusion The risk and benefit of these protocols in individuals with dental implants must be considered, and clinical examinations and complementary radiographs play an essential role in implantology.
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Affiliation(s)
- Bianca Rodrigues Terrabuio
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, SP, Brazil
| | - Caroline Gomes Carvalho
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, SP, Brazil
| | - Mariela Peralta-Mamani
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, SP, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, SP, Brazil
| | | | - Cássia Maria Fischer Rubira
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, SP, Brazil
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Do the number of basis images and metal artifact reduction affect the production of artifacts near and far from zirconium dental implants in CBCT? Clin Oral Investig 2021; 25:5281-5291. [PMID: 33625608 DOI: 10.1007/s00784-021-03836-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to evaluate the influence of the number of basis images and the metal artifact reduction (MAR) tool on the production of artifacts near and far from a zirconium implant in cone-beam computed tomography (CBCT). MATERIALS AND METHODS CBCT scans of a mandible were acquired before and after insertion of an implant, using 450 and 720 basis images, with and without MAR activation. The mean and standard deviation (SD) of the gray values of the regions of interest (ROIs) located on the cortices adjacent to the implant and at different distances from it (in the soft tissue) were calculated. The mean of the gray values was used to calculate the absolute contrast difference (ACD) between the control and implant scans. RESULTS In general, the number of basis images did not affect the SD and the ACD values of the buccal and lingual ROIs (p > 0.05). The implant increased the SD in the lingual cortical plate (p < 0.05). In this case, MAR activation decreased SD (p < 0.05). All ROIs located at different distances from the implant showed higher SD on scans acquired with 450 basis images (p < 0.05), regardless of MAR condition. CONCLUSIONS A higher number of basis images reduces the magnitude of artifacts but does not influence the image quality in bone cortical plates. MAR improves the image in the areas most affected by artifacts. CLINICAL RELEVANCE The number of basis images is known as a factor capable of influencing the image quality and radiation dose for the patient. Therefore, it is important to investigate its effect on the expression of artifacts in the CBCT images.
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Mancini AXM, Santos MUC, Gaêta-Araujo H, Tirapelli C, Pauwels R, Oliveira-Santos C. Artefacts at different distances from titanium and zirconia implants in cone-beam computed tomography: effect of tube current and metal artefact reduction. Clin Oral Investig 2021; 25:5087-5094. [PMID: 33544197 DOI: 10.1007/s00784-021-03821-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the effect of cone-beam computed tomography (CBCT) tube current (mA) on the magnitude of artefacts at different distances from titanium or zirconia implants, with and without activation of a proprietary metal artefact reduction (MAR). MATERIAL AND METHODS Human mandibles were scanned on an OP300 Maxio CBCT unit (Instrumentarium, Tuusula, Finland) before and after the installation of dental implants, with four different tube currents (4 mA, 6.3 mA, 8 mA and 10 mA), with and without activation of proprietary MAR. The effect of mA on the standard deviation (SD) of gray values and contrast to noise ratio (CNR) were assessed in regions of interest located 1.5 cm, 2.5 cm, and 3.5 cm from implants. RESULTS In the presence of titanium implants, a significant decrease in SD was found by increasing tube current from 4 mA to 6.3 mA or 8 mA. For zirconia implants, 8 mA yielded better results for all distances. MAR improved CNR in the presence of zirconia implants at all distances, whereas no differences were observed with the use of MAR for titanium implants. CONCLUSION Increased tube current can improve overall image quality in the presence of implants, at all the distances tested. When a zirconia implant is present, such increase in mA should be higher in comparison to that for examinations with titanium implants. Activation of OP300 Maxio proprietary MAR improved image quality only among examinations with zirconia implants. CLINICAL RELEVANCE Artefact-generating implants are common in the field of view of CBCT examinations. Optimal exposure parameters, such as tube current, ensure high image quality with lowest possible radiation exposure.
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Affiliation(s)
- Arthur Xavier Maseti Mancini
- Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. Do Café, s/n, Ribeirao Preto, Sao Paulo, 14040-904, Brazil.
| | - Matheus Urias Cruz Santos
- Department of Stomatology, Public Oral Health and Forensic Dentistry, Division of Oral Radiology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. Do Café, s/n, Ribeirao Preto, Sao Paulo, 14040-904, Brazil
| | - Hugo Gaêta-Araujo
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, Piracicaba, São Paulo, 13414-903, Brazil
| | - Camila Tirapelli
- Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. Do Café, s/n, Ribeirao Preto, Sao Paulo, 14040-904, Brazil
| | - Ruben Pauwels
- Medical Physics & Quality Assessment, Department of Imaging & Pathology, Catholic University of Leuven, Leuven, Belgium and Aarhus Institute of Advanced Studies, Aarhus University, Høegh-Guldbergs Gade 6B, 8000, Aarhus, Denmark
| | - Christiano Oliveira-Santos
- Department of Stomatology, Public Oral Health and Forensic Dentistry, Division of Oral Radiology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. Do Café, s/n, Ribeirao Preto, Sao Paulo, 14040-904, Brazil
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Ribas BR, Nascimento EHL, Freitas DQ, Pontual ADA, Pontual MLDA, Perez DEC, Ramos-Perez FMM. Positioning errors of dental implants and their associations with adjacent structures and anatomical variations: A CBCT-based study. Imaging Sci Dent 2020; 50:281-290. [PMID: 33409136 PMCID: PMC7758259 DOI: 10.5624/isd.2020.50.4.281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/26/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose The objective of the present study was to evaluate the prevalence of dental implants positioning errors and their associations with adjacent structures and anatomical variations by means of cone-beam computed tomography (CBCT). Materials and Methods CBCT images of 207 patients (584 dental implants) were evaluated by 2 oral radiologists. The distance between the implant and the adjacent teeth/implants was measured and classified as adequate (≥1.5 mm and ≥3 mm, respectively) or inadequate. The presence of thread exposure, cortical perforation, implant dehiscence, implant penetration into adjacent structures, and anatomical variations was also recorded. The incisor canal diameter and the depth of the concavity of the submandibular fossa were measured in order to evaluate their correlations with the frequency of implant penetration in these structures. Descriptive analyses, the Fisher exact test, and Spearman correlation analysis were performed (α=0.05). Results The overall prevalence of positioning errors was 82.9%. The most common error was the inadequate distance between the implant and the adjacent teeth/implants. The presence of anatomical variations did not significantly influence the overall prevalence of errors (P>0.05). There was a positive correlation between the diameter of the incisor canal and the frequency of implant penetration in this structure (r=0.232, P<0.05). Conclusion There was a high prevalence of dental implant positioning errors, and positioning errors were not associated with the presence of anatomical variations. Professionals should be aware of the space available for implant placement during the preoperative planning stage.
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Affiliation(s)
- Beatriz Ribeiro Ribas
- Department of Clinical and Preventive Dentistry, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Andréa Dos Anjos Pontual
- Department of Clinical and Preventive Dentistry, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Danyel Elias Cruz Perez
- Department of Clinical and Preventive Dentistry, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Vahdani N, Moudi E, Ghobadi F, Mohammadi E, Bijani A, Haghanifar S. Evaluation of the Metal Artifact Caused by Dental Implants in Cone Beam Computed Tomography Images. MÆDICA 2020; 15:224-229. [PMID: 32952687 DOI: 10.26574/maedica.2020.15.2.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Statement of the problem: The presence of a metal object such as dental implants in the scan field may cause artifacts on the cone-beam computed tomography (CBCT) images, which can reduce the diagnostic quality and accuracy of images. Purpose: The aim of this in vitro study was to compare the severity of implant-induced metal artifacts on CBCT images. Materials and method: To this end, a dry human mandible and a maxilla were selected, then two Roxolid and two Zirconium fixtures with different diameters were placed in the central incisor and first molar sockets and fixed with dental wax. The mandible and maxilla were placed in the simulated phantom for soft tissue, and the occlusal plane was adjusted parallel to the horizon. Images were taken at standard and high resolutions using two CBCT units. The CBCT gray values were measured in three longitudinal sections of the fixture (cervical, middle and apical) and the contrast noise ratio (CNR) was calculated. The CNR values of images were analyzed based on the fixture material, resolution, jaw, unit parameters and fixture size by using the paired t-test and different fixture sections by one-way ANOVA. Results: Depending on the CBCT unit, the CNR values in Roxolid and Zirconium fixtures are completely different. Under higher exposure parameters, the CNR values of the Roxolid and Zirconium fixtures were significantly higher in the maxilla than mandible. However, the fixture size and longitudinal section type did not have a significant effect on the CNR values. Conclusion: In contrast to the fixture material, scanning parameters and jaw type, differences in the size and longitudinal section of the fixtures had no impact on artifact severity.
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Affiliation(s)
- Nazmehr Vahdani
- Oral and Maxillofacial Radiology, Student Research Committee
| | - Ehsan Moudi
- Oral Health Research Center, Health Research Institute
| | - Fatemeh Ghobadi
- Oral and Maxillofacial Radiology, Student Research Committee
| | | | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute
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Nascimento EHL, Fontenele RC, Lopes PDA, Santaella GM, Vasconcelos KF, de Freitas DQ, Oenning AC, Groppo FC. Development of a model of soft tissue simulation using ballistic gelatin for CBCT acquisitions related to dentomaxillofacial radiology research. Dentomaxillofac Radiol 2020; 50:20200191. [PMID: 32941781 DOI: 10.1259/dmfr.20200191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To present the ballistic gelatin as a new material capable of simulating the soft tissues in cone-beam CT (CBCT) images. METHODS CBCT images of three piglet heads were acquired with their soft tissues intact (standard group). Subsequently, the piglet heads were fixed in a container using metallic pins and moulded with acrylic resin; the soft tissues were then removed and replaced by ballistic gelatin, with the same thickness of the original soft tissues. The images were evaluated by two oral radiologists, to check the adaptation on bone surfaces, thickness and density, penetration into large bone cavities and cancellous bone, and the presence of air bubbles using a 5-score scale. Additionally, an objective analysis was carried out by one oral radiologist. For each CBCT scan, three axial reconstructions were selected to represent the mandibular, occlusal, and maxillary levels. The mean and standard deviation (SD) of the grey values were calculated in four regions of interest determined on soft tissue areas and compared by two-way ANOVA. RESULTS The ballistic gelatin showed subjective scores ranging from good to excellent for all parameters evaluated. There was no significant difference in the mean and SD values of the grey values between ballistic gelatin and the gold standard groups for all levels (p > 0.05). Higher SD values were observed in the occlusal level for both groups (p < 0.05). CONCLUSIONS Ballistic gelatin has visual and objective similarity with the gold standard. Thus, the ballistic gelatin is a promising material capable of simulating soft tissues in CBCT images.
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Affiliation(s)
- Eduarda Helena Leandro Nascimento
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil.,Department of Clinical and Preventive Dentistry, Federal University of Pernambuco (UFPE), Recife, PE, Brazil
| | | | - Priscila de Azeredo Lopes
- Odontoclínica Central da Marinha, Serviço de radiologia e Imaginologia Odontológica, Brazilian Navy, Rio de Janeiro, RJ, Brazil
| | - Gustavo Machado Santaella
- Radiology and Imaging Sciences, Department of Diagnosis and Oral Health, University of Louisville, Lousville, KY, USA
| | - Karla Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Deborah Queiroz de Freitas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Anne Caroline Oenning
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Sao Paulo, Brazil
| | - Francisco Carlos Groppo
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
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Influence of Metal Post in Adjacent Teeth in the Detection of Vertical Root Fracture Using Cone-beam Computed Tomography with Different Acquisition Parameters. J Endod 2020; 46:1655-1661. [PMID: 32835757 DOI: 10.1016/j.joen.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/12/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The aim of the present study was to evaluate the detection of vertical root fracture (VRF) in the presence of adjacent teeth restored with a metal post and the influence of acquisition parameters (tube current and metal artifact reduction [MAR] algorithm) on this diagnostic task. METHODS Cone-beam computed tomographic images of 10 single-rooted teeth were acquired before and after the simulation of VRF. The acquisitions were set up to simulate different conditions regarding the presence of adjacent teeth restored with a metal post (control, 1 adjacent tooth, and both adjacent teeth), different tube currents (4, 8, and 10 mA), and the use of MAR (without MAR and with MAR). Images were assessed by 5 oral and maxillofacial radiologists using a 5-point scale for the presence of VRF. Diagnostic values were calculated and compared by 2-way analysis of variance (significance level of 5%). RESULTS The area under the receiver operating characteristic curve (Az) values for VRF detection were affected by the presence of adjacent teeth and the variation of milliamperes. For 4 mA, when both restored teeth were present, Az values were significantly lower than the control group (P ≤ .05). In the presence of both restored teeth, 8 mA presented significantly higher Az values compared with 4 mA (P ≤ .05). CONCLUSIONS The presence of both adjacent teeth restored with a metal post impairs VRF detection; however, an increase in tube current up to 8 mA may aid in this diagnostic task. Moreover, the MAR tool does not seem to be efficient in those cases.
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Fontenele RC, Farias Gomes A, Nejaim Y, Freitas DQ. Do the tube current and metal artifact reduction influence the diagnosis of vertical root fracture in a tooth positioned in the vicinity of a zirconium implant? A CBCT study. Clin Oral Investig 2020; 25:2229-2235. [PMID: 32827079 DOI: 10.1007/s00784-020-03538-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
AIM To evaluate the influence of the tube current and metal artifact reduction (MAR) tool on the diagnosis of vertical root fractures (VRF) in a tooth adjacent to a zirconium implant, in cone-beam computed tomography (CBCT) images. METHODOLOGY Thirty single-rooted teeth (15 with VRF and 15 control group) were individually positioned in a mandible, and scanned with the OP300 CBCT unit. Images were acquired using a standardized protocol: 5 × 5 cm field of view, 0.08-mm voxel size, and 90 kVp. Each tooth was scanned with and without a zirconium implant in its vicinity, using different tube currents (4 mA, 8 mA, and 10 mA) and conditions of MAR (enabled × disabled). Diagnostic values were calculated for each protocol, and compared by multi-way analysis of variance. RESULTS The ROC curve and sensitivity values did not differ significantly among the tube currents, regardless of the presence of the implant and MAR condition (p > 0.05). There were also no significant differences among the tube currents for the specificity values (p > 0.05); however, the specificity differed significantly between the "with implant" and "without implant" conditions, within the same MAR condition and tube current (p < 0.05). Specificity was significantly lower when the implant was present (p < 0.05). CONCLUSION The presence of a zirconium implant impairs the diagnosis of VRF in teeth adjacent to the artifact-generator material. Neither the tube current nor the MAR tool is effective in improving this diagnostic task. Therefore, in this clinical scenario, the use of the lowest tube current (4 mA), without MAR activation, is recommended. CLINICAL RELEVANCE Considering that the tube current is one of the main factors that influence the radiation dose and image quality in CBCT, and that metal artifacts negatively influence the diagnosis of VRF in areas adjacent to the artifact-generator material, it is important to evaluate the effect of this energetic parameter in the diagnosis of VRF in teeth adjacent to zirconium implants.
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Affiliation(s)
- Rocharles C Fontenele
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Avenida Limeira, 901, Piracicaba, São Paulo, 13414-903, Brazil
| | - Amanda Farias Gomes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Avenida Limeira, 901, Piracicaba, São Paulo, 13414-903, Brazil.
| | - Yuri Nejaim
- Oral Radiology Area, Dental School, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Deborah Q Freitas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Avenida Limeira, 901, Piracicaba, São Paulo, 13414-903, Brazil
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Fontenele RC, Farias Gomes A, Rosado LPL, Neves FS, Freitas DQ. Mapping the expression of beam hardening artefacts produced by metal posts positioned in different regions of the dental arch. Clin Oral Investig 2020; 25:571-579. [PMID: 32772328 DOI: 10.1007/s00784-020-03494-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To objectively assess the expression and direction of artefacts in the vicinity of metal posts positioned in different mandibular regions. MATERIALS AND METHODS A human mandible had two sockets prepared-anterior and posterior regions-to accommodate a single-rooted tooth. Two CBCT units, Picasso Trio and OP300, were used. CBCT images of the tooth without metal post, and with silver-palladium, nickel-chromium, or cobalt-chromium posts (experimental groups) were individually acquired. Then, 8 lines of interest (LOIs) were determined around the root canal, in an axial reconstruction: 4 in orthogonal (buccal, lingual, mesial, and distal) directions, and 4 in oblique (mesiobuccal, distobuccal, mesiolingual, and distolingual) directions. The mean of gray values was measured for each LOI. RESULTS For the OP300, in general, all experimental groups showed greater expression of hyperdense streaks in orthogonal LOIs and greater expression of hypodense streaks in oblique LOIs. For the Picasso Trio, for both mandibular regions, the buccal LOI showed greater expression of hypodense streaks; conversely, greater expression of hyperdense streaks was observed in the distal and distobuccal LOIs in the anterior region and in the mesiolingual LOI in the posterior region. The silver-palladium group showed significantly greater expression of beam hardening artefacts in the posterior region of the mandible, regardless of the CBCT unit (p < 0.05). The mandibular posterior region showed significantly lower gray values than the anterior region (p < 0.05). CONCLUSION The expression and direction of artefacts produced in the vicinity of metal posts vary according to the mandibular region, composition of the post, and CBCT unit. CLINICAL RELEVANCE The mapping of artefacts produced by metal posts reveals the root regions with greater expression of hypodense and hyperdense artefacts, which may contribute to recognizing regions more likely to mimic or hide root fracture lines.
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Affiliation(s)
- Rocharles C Fontenele
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil.
| | - Amanda Farias Gomes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil
| | - Lucas P Lopes Rosado
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil
| | - Frederico S Neves
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil.,Department of Propedeutics and Integrated Clinic, Division of Oral Radiology, School of Dentistry, Federal University of Bahia, Salvador, BA, Brazil
| | - Deborah Q Freitas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil
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Influence of the Intracanal Material and Metal Artifact Reduction Tool in the Detection of the Second Mesiobuccal Canal in Cone-beam Computed Tomographic Examinations. J Endod 2020; 46:1067-1073. [DOI: 10.1016/j.joen.2020.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/23/2020] [Accepted: 04/11/2020] [Indexed: 11/22/2022]
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Gaêta‐Araujo H, Nascimento EHL, Oliveira‐Santos N, Pinheiro MCR, Coelho‐Silva F, Oliveira‐Santos C. Influence of adjacent teeth restored with metal posts in the detection of simulated internal root resorption using CBCT. Int Endod J 2020; 53:1299-1306. [DOI: 10.1111/iej.13348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/09/2020] [Indexed: 02/01/2023]
Affiliation(s)
- H. Gaêta‐Araujo
- Division of Oral Radiology Department of Oral Diagnosis Piracicaba Dental School University of Campinas (UNICAMP) PiracicabaBrazil
| | - E. H. L. Nascimento
- Division of Oral Radiology Department of Oral Diagnosis Piracicaba Dental School University of Campinas (UNICAMP) PiracicabaBrazil
| | - N. Oliveira‐Santos
- Division of Oral Radiology Department of Oral Diagnosis Piracicaba Dental School University of Campinas (UNICAMP) PiracicabaBrazil
| | - M. C. R. Pinheiro
- Division of Oral Radiology Department of Oral Diagnosis Piracicaba Dental School University of Campinas (UNICAMP) PiracicabaBrazil
| | - F. Coelho‐Silva
- Division of Oral Radiology Department of Oral Diagnosis Piracicaba Dental School University of Campinas (UNICAMP) PiracicabaBrazil
| | - C. Oliveira‐Santos
- Division of Oral Radiology Department of Stomatology, Public Oral Health, Forensic Dentistry School of Dentistry of Ribeirao Preto University of Sao Paulo (USP) Ribeirao Preto Brazil
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Gaêta-Araujo H, Nascimento EHL, Fontenele RC, Mancini AXM, Freitas DQ, Oliveira-Santos C. Magnitude of beam-hardening artifacts produced by gutta-percha and metal posts on cone-beam computed tomography with varying tube current. Imaging Sci Dent 2020; 50:1-7. [PMID: 32206614 PMCID: PMC7078413 DOI: 10.5624/isd.2020.50.1.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/26/2019] [Accepted: 10/10/2019] [Indexed: 02/01/2023] Open
Abstract
Purpose This study was performed to evaluate the magnitude of artifacts produced by gutta-percha and metal posts on cone-beam computed tomography (CBCT) scans obtained with different tube currents and with or without metal artifact reduction (MAR). Materials and Methods A tooth was inserted in a dry human mandible socket, and CBCT scans were acquired after root canal instrumentation, root canal filling, and metal post placement with various tube currents with and without MAR activation. The artifact magnitude was assessed by the standard deviation (SD) of gray values and the contrast-to-noise ratio (CNR) at the various distances from the tooth. Data were compared using multi-way analysis of variance. Results At all distances, a current of 4 mA was associated with a higher SD and a lower CNR than 8 mA or 10 mA (P<0.05). For the metal posts without MAR, the artifact magnitude as assessed by SD was greatest at 1.5 cm or less (P<0.05). When MAR was applied, SD values for distances 1.5 cm or closer to the tooth were reduced (P<0.05). MAR usage did not influence the magnitude of artifacts in the control and gutta-percha groups (P>0.05). Conclusion Increasing the tube current from 4 mA to 8 mA may reduce the magnitude of artifacts from metal posts. The magnitude of artifacts arising from metal posts was significantly higher at distances of 1.5 cm or less than at greater distances. MAR usage improved image quality near the metal post, but had no significant influence farther than 1.5 cm from the tooth.
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Affiliation(s)
- Hugo Gaêta-Araujo
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Eduarda Helena Leandro Nascimento
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Rocharles Cavalcante Fontenele
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Arthur Xavier Maseti Mancini
- Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Christiano Oliveira-Santos
- Department of Stomatology, Public Oral Health and Forensic Dentistry, Division of Oral Radiology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
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Fontenele RC, Nascimento EHL, Santaella GM, Freitas DQ. Does the metal artifact reduction algorithm activation mode influence the magnitude of artifacts in CBCT images? Imaging Sci Dent 2020; 50:23-30. [PMID: 32206617 PMCID: PMC7078406 DOI: 10.5624/isd.2020.50.1.23] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/19/2019] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose This study was conducted to assess the effectiveness of a metal artifact reduction (MAR) algorithm activated at different times during cone-beam computed tomography (CBCT) acquisition on the magnitude of artifacts generated by a zirconium implant. Materials and Methods Volumes were obtained with and without a zirconium implant in a human mandible, using the OP300 Maxio unit. Three modes were tested: without MAR, with MAR activated after acquisition, and with MAR activated before acquisition. Artifacts were assessed in terms of the standard deviation (SD) of gray values and the contrast-to-noise ratio (CNR) in 6 regions of interest with different distances (10 to 35 mm, from the nearest to the farthest) and angulations (70° to 135°) from the implant region. Results In the acquisitions without MAR, the regions closer to the implant (10 and 15 mm) had a higher SD and lower CNR than the farther regions. When MAR was activated (before or after), SD values did not differ among the regions (P>0.05). The region closest to the implant presented a significantly lower CNR in the acquisitions without MAR than when MAR was activated after the acquisition; however, activating MAR before the acquisition did not yield significant differences from either of the other conditions. Conclusion Both modes of MAR activation were effective in decreasing the magnitude of CBCT artifacts, especially when the effects of the artifacts were more noticeable.
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Affiliation(s)
- Rocharles C Fontenele
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Eduarda H L Nascimento
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Gustavo M Santaella
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Deborah Q Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
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Martins LAC, Queiroz PM, Nejaim Y, Vasconcelos KDF, Groppo FC, Haiter-Neto F. Evaluation of metal artefacts for two CBCT devices with a new dental arch phantom. Dentomaxillofac Radiol 2020; 49:20190385. [PMID: 32155087 DOI: 10.1259/dmfr.20190385] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To create a new phantom design to evaluate the real impact of artefacts caused by titanium on bone structures in cone beam CT images considering different positions and quantity of metals in the dental arch, with and without metal artefact reduction (MAR). METHODS A three cylindrical polymethyl methacrylate (PMMA) plate phantom was designed containing eight perforations arranged to simulate the lower dental arch in the intermediate plate. Three titanium cylinders were positioned in different locations and quantities to test different clinical conditions and to quantify the impact of the metal artefact around five bone cylinders. Scans were carried out in seven different protocols (Control, A-F) in two cone beam CT devices (OP300 Maxio and Picasso Trio). Eight regions of interest around each cortical and trabecular bone were used to measure the grey value standard deviation corresponding the artefact expression in the Image J software. Both the artefact expression and the MAR effect were assessed using the Wilcoxon, Friedman (Dunn) and Kruskal-Wallis tests (significance level of 5%). RESULTS For both devices, MAR was statistically efficient only for the protocols E, and F. Protocol F (three metals on the adjacent area of the analysis region) showed higher artefact expression when compared to the others. CONCLUSION In conclusion, the new phantom design allowed the quantification of the metal artefact expression caused by titanium. The metal artefact expression is higher when more metal objects are positioned in the adjacent bone structures. MAR may not be effective to reduce artefact expression on the adjacencies of those objects for the devices studied.
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Affiliation(s)
- Luciano Augusto Cano Martins
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Polyane Mazucatto Queiroz
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Yuri Nejaim
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Karla de Faria Vasconcelos
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Francisco Carlos Groppo
- Department of Physiological Sciences, Division of Pharmacology, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
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Nascimento EHL, Fontenele RC, Santaella GM, Freitas DQ. Difference in the artefacts production and the performance of the metal artefact reduction (MAR) tool between the buccal and lingual cortical plates adjacent to zirconium dental implant. Dentomaxillofac Radiol 2019; 48:20190058. [PMID: 31276425 DOI: 10.1259/dmfr.20190058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To quantify the artefacts production and the performance of the metal artefact reduction (MAR) tool, enabled before or after the acquisition, in cortical plates (buccal and lingual) and other regions adjacent to zirconium implants. METHODS Cone beam CT scans were acquired using the OP300 Maxio unit before (control group) and after (implant group) the insertion of a zirconium implant into the posterior region of a dry mandible. Three conditions of MAR tool were tested: "without MAR", with "MAR activated after acquisition", and with "MAR activated before acquisition". The standard deviation (SD), contrast-to-noise ratio (CNR) and voxel values were calculated in the buccal and lingual cortical plates, medullary bone and water region, close to the implant. The structural bone analysis was performed in the medullary bone close to the implant. RESULTS Overall, in control and implant groups, the lingual cortical had higher SD, lower CNR and lower voxel values than the buccal cortical, regardless of the MAR condition (p < 0.05). Implant caused higher SD values and lower voxel values in adjacent regions "without MAR" (p < 0.05). MAR activation decreased SD and changed voxel values when the implant was present, regardless of MAR activation mode (p < 0.05). The activation of MAR increased the trabecular thickness values for the implant group (p < 0.05). CONCLUSION The expression of artefacts adjacent to zirconium implants is greater in the lingual than in the buccal cortical. The greater the expression of artefacts in this region, the greater the effectiveness of the MAR tool in homogenizing the grey values, regardless of the time of its activation.
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Affiliation(s)
- Eduarda Helena Leandro Nascimento
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Rocharles Cavalcante Fontenele
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Gustavo Machado Santaella
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
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Freitas DQ, Nascimento EHL, Vasconcelos TV, Noujeim M. Diagnosis of external root resorption in teeth close and distant to zirconium implants: influence of acquisition parameters and artefacts produced during cone beam computed tomography. Int Endod J 2019; 52:866-873. [PMID: 30585641 DOI: 10.1111/iej.13065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/15/2018] [Indexed: 12/16/2022]
Abstract
AIM To assess the influence of artefacts, the metal artefact reduction (MAR) tool and kilovoltage (kVp) on the diagnosis of simulated external root resorption (ERR) in teeth close and distant to zirconium implants in cone beam computed tomography (CBCT) images. METHODOLOGY Cavities (0.62 mm in diameter and 0.19 mm deep) were created in the apical thirds of 12 roots on the buccal, lingual, distal or mesial surface; ten roots served as controls. The roots were randomly positioned in the first and second right and left premolar sockets of a dry human mandible, and a zirconium implant was placed in the socket of the first right molar. A ProMax 3D unit varying kVp (70, 80, or 90 kVp) and with the MAR tool activated or not was used to obtain CBCT scans. Five examiners evaluated all images to determine the area under the receiver operating characteristic (ROC) curve, sensitivity and specificity. RESULTS The ROC values and sensitivity were not affected by MAR or artefacts regardless of the distance to the implant (P > 0.05), whilst increasing kVp from 70 to 90 led to a significant increase in these values (P = 0.0202 and 0.0199, respectively). Specificity was not affected by the factors studied (P > 0.05). CONCLUSIONS Amongst the factors studied, only kVp influenced the diagnosis of simulated external root resorption in CBCT images. Increasing kVp from 70 to 90 improved the accuracy in diagnosing the simulated lesions.
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Affiliation(s)
- D Q Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - E H L Nascimento
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - T V Vasconcelos
- Division of Oral Radiology, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - M Noujeim
- Department of Comprehensive Dentistry, Division of Oral and Maxillofacial Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Freitas DQ, Vasconcelos TV, Noujeim M. Diagnosis of vertical root fracture in teeth close and distant to implant: an in vitro study to assess the influence of artifacts produced in cone beam computed tomography. Clin Oral Investig 2018; 23:1263-1270. [PMID: 29984377 DOI: 10.1007/s00784-018-2558-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/02/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the influence of artifacts produced by zirconium implant on the diagnosis of vertical root fracture (VRF) in teeth close and distant to the implant in cone beam computed tomography (CBCT) images. We also determined if kilovoltage (kVp) and metal artifact reduction (MAR) tool could influence this diagnosis. MATERIALS AND METHODS Twenty single-root teeth were divided in control and fractured groups (n = 10). The teeth were randomly positioned in the first and second and right and left pre-molar alveoli of a dry human mandible. CBCT exams were acquired using a ProMax 3D unit with varying kVp (70, 80, or 90 kVp), with or without MAR, and with and without a zirconium implant placed in the alveolus of first right molar. The images were evaluated by five observers. The area under the receiver operating characteristic curve (ROC), sensitivity, and specificity were calculated and compared by analysis of variance with a significance level of 5%. RESULTS In general, ROC and sensitivity were not affected by the factors studied (p > 0.05). The main effects occurred in specificity; when implant was used without MAR, the values were lower for tooth 45 for all kVps (p = 0.0001). CONCLUSIONS Artifacts produced in the vicinity of teeth with suspected VRF impair the diagnosis by decreasing the specificity, because they can mimic the VRF line generating false positives. However, MAR improves the specificity, being its use recommended when metallic objects are present near teeth with suspected VRF. CLINICAL RELEVANCE Since nowadays, many patients who undergo CBCT show implants and they definitively produce artifacts, it is important to evaluate the influence of such artifacts in the diagnosis of teeth that are close to the generator-artifact object.
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Affiliation(s)
- Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, Piracicaba, São Paulo, 13414-903, Brazil.
| | - Taruska Ventorini Vasconcelos
- Division of Oral Radiology, School of Dentistry, Federal University of Bahia, Rua Araújo Pinho, 62, Salvador, Bahia, 40110-040, Brazil
| | - Marcel Noujeim
- Department of Comprehensive Dentistry, Division of Oral and Maxillofacial Radiology, University of Texas Health Science Center at San Antonio, 7707, Floyd Curl Drive, San Antonio, TX, 78229, USA
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