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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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Kurt Demirsoy K, Türker G, Amuk M, Kurt G. How much should incisors be decompensated? periodontal bone defects during presurgical orthodontic treatment in class III double-jaw orthognathic surgery patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e133-e139. [PMID: 35263684 DOI: 10.1016/j.jormas.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 05/16/2023]
Abstract
INTRODUCTION The aims of this study were to evaluate periodontal bone defects around the lower and upper incisors and to identify changes in the buccolingual inclination of the incisors during orthodontic decompensation in skeletal Class III orthognathic surgery patients. MATERIALS AND METHODS The sample consisted of 26 adults with skeletal Class III deformity who had undergone presurgical orthodontic treatment and orthognathic surgery. Lateral cephalograms obtained before orthodontic treatment and before surgery were used to determine the inclination and position changes of the incisors. Cephalometric measurements were taken using Dolphin Imaging 11.95. Three-dimensional images were generated from cone-beam computed tomography (CBCT) scans prior to surgery and used to detect periodontal bone defects, including fenestration (F) and dehiscence (D). RESULTS Intraclass correlation coefficients (ICC) were determined and the measurements showed high reproducibility. The cephalometric data showed normal distribution and there were no differences between genders in terms of cephalometric changes, dehiscence, fenestration, or coexistent (D-F/DF) formation. The patients presented maxillary incisor retroclination and mandibular incisor proclination, which was consistent with the tooth decompensation. CBCT assessment was performed for a total of 208 teeth; while 81 upper and 94 lower incisors had D-F/DF formation, 23 upper and 10 lower incisors were healthy. Statistically significant correlations were not found between the inclination degree of the incisors and D-F/DF formation. CONCLUSIONS Decompensation of incisors during presurgical orthodontic treatment increases the risk of periodontal defects. There is no linear relationship between the increase in the inclination degrees of incisors and D-F/DF formation.
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Affiliation(s)
- Kevser Kurt Demirsoy
- Department of Orthodontics, Faculty of Dentistry Nevşehir Hacı Bektaş Veli University, Nevşehir, Türkiye.
| | - Gökhan Türker
- Department of Orthodontics, Faculty of Dentistry, Mersin University, Mersin, Türkiye
| | - Mehmet Amuk
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Türkiye
| | - Gökmen Kurt
- Department of Orthodontics, Faculty of Dentistry, Bezmialem Foundation University, İstanbul, Türkiye
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Adurty C, Tejaswi KS, Shivani CRN, Navya D, Gopinath C, Dhulipalla R. Accuracy of digital intraoral periapical radiography and cone-beam computed tomography in the measurement of intrabony defects: A comparative study. J Indian Soc Periodontol 2021; 25:491-495. [PMID: 34898914 PMCID: PMC8603792 DOI: 10.4103/jisp.jisp_518_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Periodontal disease is an inflammatory process resulting in clinical attachment loss (CAL), pocket depth (PD), and resulting in the loss of alveolar bone. Diagnostic imaging provides an adjunctive guidelines to assess the alveolar bone height in addition to clinical parameters such as PD and CAL. Aims and Objectives: The objectives of the study are to determine whether the digital intraoral periapical (IOPA) radiographs can be reliably used as an alternative to cone-beam computed tomography (CBCT) in the diagnosis of intrabony defects. Materials and Methods: A total of 25 patients with the presence of intrabony defects were included in the study. All the radiographic parameters were recorded using digital IOPA and CBCT. Various intrabony defect morphological characteristics such as height, depth, width, and angle were measured and compared between digital IOPA and CBCT. Statistics: The data was subjected to statistical analysis. Mann–Whitney U-test was performed for interexaminer comparison and independent t-test for intergroup comparison. Results: The mean intergroup comparison values between digital IOPA and CBCT in relation to defect width were 3.22 ± 1.10 and 3.20 ± 1.16, respectively (P = 0.970), in relation to defect depth were 7.71 ± 2.3 and 7.91 ± 2.4, respectively (P = 0.769), in relation to defect height were 3.80 ± 1.20 and 3.90 ± 1.2, respectively (P = 0.794), and in relation to defect angle were 34.82 ± 8.4 and 35.28 ± 0.8.6, respectively (P = 0.851). Conclusion: With the drawbacks of such as high radiation exposure, unavailability, and high financial cost, digital IOPA with digital software can be used as an alternative to CBCT for measuring intrabony defect morphological characteristics in periodontitis patients.
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Affiliation(s)
- Chaitanya Adurty
- Department of Periodontology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Kanikanti Siva Tejaswi
- Department of Periodontology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | | | - Didla Navya
- Department of Periodontology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Cheni Gopinath
- Department of Periodontology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Ravindranath Dhulipalla
- Department of Periodontology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
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Eftekhar M, Kaviani H, Rouzmeh N, Torabinia A, Akbarzadeh Baghban A. Effect of voxel size on detection of fenestration, dehiscence and furcation defects using cone-beam computed tomography. Oral Radiol 2021; 37:677-686. [PMID: 33432538 DOI: 10.1007/s11282-020-00508-0] [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: 10/17/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to assess the effect of voxel size on detection of fenestration, dehiscence, and furcation defects using cone-beam computed tomography (CBCT). MATERIALS AND METHODS This in vitro, experimental study evaluated 4 sheep skulls with both the maxilla and mandible accompanied by the surrounding soft tissue. Fenestration (n = 30), dehiscence (n = 65), and furcation defects (n = 46; 18 grade I, 25 grade II, and 3 grade III) were randomly created by round and needle burs in both jaws, and 40 areas served as control sites. CBCT scans were obtained with 0.300 and 0.150 mm3 voxel sizes and 8 × 11cm2 field of view (FOV), and were randomly observed by four observers (two oral and maxillofacial radiologists and two periodontists). The kappa values, sensitivity and specificity were calculated for each voxel size and compared using paired t test. RESULTS By an increase in image resolution, diagnostic sensitivity increased while specificity decreased. The kappa values for fenestration (0.602-0.623), and grade III furcation defects (0.903-1.00) were optimal (> 0.6), and almost similar for both voxel sizes. The kappa values for dehiscence, and grades I and II furcation defects were unfavorable (< 0.6) and almost similar for both voxel sizes, except for grade I furcation defects, which had a significant difference in kappa values between the two voxel sizes (0.014 and 0.34). CONCLUSION Smaller voxel size had higher sensitivity and lower specificity for detection of all defects except for grade I furcation defects, for which the smaller voxel size had higher sensitivity and higher specificity.
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Affiliation(s)
| | - Hanieh Kaviani
- Department of Oral-Maxillofacial Radiology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Nina Rouzmeh
- Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Aitin Torabinia
- Department of Oral-Maxillofacial Radiology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Pilloni A, Montanaro L, Dell'olmo F, Fonzar A, Cairo F, Rojas MA. A retrospective pilot study of correlation of first maxillary premolar root trunk length with age and gender: a cone beam computed tomography study. MINERVA STOMATOLOGICA 2020; 69:27-36. [PMID: 32181606 DOI: 10.23736/s0026-4970.19.04228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Root trunk length (RTL) plays an important role in the diagnosis, prognosis and treatment of periodontitis. The aim of this retrospective pilot study was to evaluate the RTL of first maxillary premolar and to study the correlation with age and sex in this value. METHODS The sample included 110 cone beam computed tomography (CBCT) images comprising 220 maxillaries first premolars from systemically healthy patients aged between 18 and 70 years. The tooth length (TL), root length (RL) and RTL were measured (dependent variables). Age and sex were considered as independent variables. RESULTS No statistically significant correlation was found between the RTL and the TL. Longer RL and longer RTL were observed in younger patients than older subjects only in the left maxillary premolars. On the other hand, the sex of the patients had no effect on either of the dependent variables. The single rooted maxillary premolars were more frequent (relative to those with two roots) in woman and in elderly patients. CONCLUSIONS A correlation between the age and the RTL and RL has been found but only in left premolars. Sex seemed to have only a slight correlation on the frequency of single-rooted teeth of the right side of the mouth. Further studies should be addressed to clarify the significance of the asymmetries observed in the present study between the two sides of the mouth with the aim of deepening the knowledge and understanding of the different variables that could be correlated with the RTL.
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Affiliation(s)
- Andrea Pilloni
- Section of Periodontics, Department of Dentistry and Maxillofacial Surgery, Sapienza University, Rome, Italy
| | - Lorenza Montanaro
- Section of Periodontics, Department of Dentistry and Maxillofacial Surgery, Sapienza University, Rome, Italy
| | - Fabiola Dell'olmo
- Section of Periodontics, Department of Dentistry and Maxillofacial Surgery, Sapienza University, Rome, Italy
| | | | - Francesco Cairo
- Department of Periodontology, School of Dentistry, University of Florence, Florence, Italy
| | - Mariana A Rojas
- Section of Periodontics, Department of Dentistry and Maxillofacial Surgery, Sapienza University, Rome, Italy -
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Icen M, Orhan K, Şeker Ç, Geduk G, Cakmak Özlü F, Cengiz Mİ. Comparison of CBCT with different voxel sizes and intraoral scanner for detection of periodontal defects: an in vitro study. Dentomaxillofac Radiol 2020; 49:20190197. [PMID: 32134338 DOI: 10.1259/dmfr.20190197] [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: 11/05/2022] Open
Abstract
OBJECTIVES This study aimed to compare the diagnostic accuracy of cone beam CT (CBCT) units with different voxel sizes with the digital intraoral scanning technique in terms of the detection of periodontal defects. METHODS AND MATERIALS The study material comprised of 12 dry skulls with maxilla and mandible. Artificial defects were created on teeth separately using burs randomly on dry skulls. In total 46 dehiscences, 10 fenestrations, 17 furcations, 12 wall defects and 13 without periodontal defect were used in the study. Each tooth with and without defects was imaged at various vertical angles using each of the following modalities: a Veraviewepocs 3D R100 CBCT device and a 3D Shape TRIOSㄾ Color P13 Shade Intraoral Scanner. RESULTS The κ values for interobserver agreement between observers ranged between 0.29 and 0.86 for the CBCT 10 × 8 cm field of view (FOV) with 0,160 mm3 voxel size; 0.35 and 1 for the CBCT 8 × 8 cm FOV with 0,125 mm3 voxel size; and 0.30 and 1 of intraoral scans. The κ values for detecting defects on anterior teeth were the least, following premolar and molar teeth both CBCT and intraoral scanning. CONCLUSIONS Smaller voxel sizes and smaller CBCT FOV has the highest sensitivity and diagnostic accuracy for detecting various periodontal defects among the scanner modalities examined. ADVANCES IN KNOWLEDGE Adequate evaluation of the condition of the alveolar bone and periodontal tissues is important for the diagnosis, treatment, and prognosis of periodontal disease. Limited examination methods, such as palpation, inspection, and periodontal probe examination, may provide insufficient information for the diagnosis of periodontal diseases.
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Affiliation(s)
- Murat Icen
- Department of Dentomaxillofacial Radiology, Nevşehir Hacı Bektaş Veli University, Faculty of Dentistry, Nevşehir, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Ankara University, Faculty of Dentistry, Ankara, Turkey
| | - Çiğdem Şeker
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Gediz Geduk
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Fethiye Cakmak Özlü
- Department of Orthodontics, Ondokuz Mayıs University, Faculty of Dentistry, Samsun, Turkey
| | - Murat İnanç Cengiz
- Department of Periodontology, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
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Eshraghi VT, Malloy KA, Tahmasbi M. Role of Cone-Beam Computed Tomography in the Management of Periodontal Disease. Dent J (Basel) 2019; 7:dj7020057. [PMID: 31159356 PMCID: PMC6631177 DOI: 10.3390/dj7020057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 12/20/2022] Open
Abstract
The goal of this paper was to review the current literature surrounding the use of cone beam computed tomography (CBCT) related to the diagnosis, prognostic determination, and treatment of periodontal diseases. A literature review was completed to identify peer-reviewed articles related to CBCT and periodontics. The results were filtered to pool only articles specific to CBCT and periodontal diagnosis, prognosis, and treatment/outcomes. The articles were reviewed and findings summarized. Author’s commentary on technological advances and additional potential uses of CBCT in the field of periodontics were included. There is evidence to suggest that CBCT imaging can be more accurate in diagnosing specific periodontal defects (intrabony and furcation defects), and therefore be helpful in the prognostic determination and treatment planning. However, at this time, CBCT cannot be recommended as the standard of care. It is up to the individual clinician to use one’s own judgment as to when the additional information provided by CBCT may be beneficial, while applying the As Low As Reasonably Achievable (ALARA) principle. With continued technological advances in CBCT imaging (higher resolution, reduced imaging artifacts, lower exposure, etc.) the author’s believe that CBCT usage will become more prominent in diagnosis and treatment of periodontal diseases.
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Affiliation(s)
- V Thomas Eshraghi
- Private Practice, Tualatin, OR 97062, USA.
- Private Practice, Beaverton, OR 97006, USA.
- Department of Periodontology, Oregon Health & Science University, Portland, OR 97201, USA.
| | | | - Mehrnaz Tahmasbi
- Department of Diagnostic Sciences, Texas A&M College of Dentistry, Dallas, TX 75246, USA.
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Haas LF, Zimmermann GS, De Luca Canto G, Flores-Mir C, Corrêa M. Precision of cone beam CT to assess periodontal bone defects: a systematic review and meta-analysis. Dentomaxillofac Radiol 2017; 47:20170084. [PMID: 28869397 DOI: 10.1259/dmfr.20170084] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Evaluate the diagnostic validity of CBCT in measuring periodontal bone defects when compared with the reference standard (in situ measurement). METHODS Studies in which the main objective was to evaluate the diagnostic validity of CBCT in measuring periodontal bone defects when compared with the reference standard were selected. Four databases were searched. The studies were selected by two independent reviewers. The methodology of selected studies was assessed using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies. The quality of evidence and strength of recommendation was assessed by The Grading of Recommendations Assessment Tool, Development and Evaluation. RESULTS Using a selection process in two phases, 16 studies were identified and, in seven articles meta-analysis was performed. The results from these meta-analyses showed that no difference between the measurements of CBCT and in situ for alveolar bone loss, and demonstrated a concordance of 82.82% between CBCT and in situ for the classification of the degree of furcation involvement. CONCLUSIONS Based on a moderate level of evidence, CBCT could be useful for furcation involvement periodontal cases, but it should only be used in cases where clinical evaluation and conventional radiographic imaging do not provide the information necessary for an adequate diagnosis and proper periodontal treatment planning.
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Affiliation(s)
- Letícia Fernanda Haas
- 1 Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - G De Luca Canto
- 2 Department of Dentistry, Federal University of Santa Catarina, Santa Catarina, Brazil.,3 Department of Dentistry, Faculty of Medicine and Dentistry University of Alberta, Edmonton, AB, Canada
| | - Carlos Flores-Mir
- 3 Department of Dentistry, Faculty of Medicine and Dentistry University of Alberta, Edmonton, AB, Canada
| | - Márcio Corrêa
- 2 Department of Dentistry, Federal University of Santa Catarina, Santa Catarina, Brazil
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Zhang W, Rajani S, Wang BY. Comparison of periodontal evaluation by cone-beam computed tomography, and clinical and intraoral radiographic examinations. Oral Radiol 2017; 34:208-218. [PMID: 30484028 DOI: 10.1007/s11282-017-0298-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/12/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Cone-beam computed tomography (CBCT) has been widely used in many fields of dentistry. However, little is known about the accuracy of CBCT for evaluation of periodontal status. The objective of this study was to compare and correlate periodontal assessments among CBCT, clinical attachment loss (CAL) measurement, and periapical (PA)/bitewing (BW) radiography. METHODS Eighty patients (28 males, 52 females; age range, 19-84 years) from the University of Texas School of Dentistry at Houston were evaluated retrospectively. Measurements were taken on the central incisors, canines, and first molars of the right maxilla and left mandible. CAL was extracted from periodontal charts. The radiographic distance from the cementum-enamel junction (CEJ) to the alveolar crest was measured for tooth mesial and distal sites on PA/BW and CBCT images using MiPacs software and Anatomage Invivo software, respectively. One-way ANOVA and Pearson analysis were performed for statistical analyses. RESULTS The CEJ-crest distances for CBCT, PA/BW, and CAL were 2.56 ± 0.12, 2.04 ± 0.12, and 2.08 ± 0.17 mm (mean ± SD), respectively. CBCT exhibited larger values than the other two methods (p < 0.05). There were highly significant positive correlations among CBCT, PA/BW, and CAL measurements at all examined sites (p < 0.001). The Pearson correlation coefficient was higher for CBCT with CAL relative to PA/BW with CAL, but the difference was not significant (r = 0.64 and r = 0.55, respectively, p > 0.05). CONCLUSIONS This study validates the suitability of CBCT for periodontal assessment. Further studies are necessary to optimize the measurement methodology with CBCT.
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Affiliation(s)
- Wenjian Zhang
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, 7500 Cambridge Street, Suite 5366, Houston, TX, 77054, USA.
| | - Shazia Rajani
- Dental Hygiene Program, School of Dentistry, University of Texas Health Science Center at Houston, 7500 Cambridge Street, Suite 5366, Houston, TX, 77054, USA
| | - Bing-Yan Wang
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas Health Science Center at Houston, 7500 Cambridge Street, Suite 5366, Houston, TX, 77054, USA
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Bagis N, Kolsuz ME, Kursun S, Orhan K. Comparison of intraoral radiography and cone-beam computed tomography for the detection of periodontal defects: an in vitro study. BMC Oral Health 2015; 15:64. [PMID: 26016804 PMCID: PMC4446848 DOI: 10.1186/s12903-015-0046-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/12/2015] [Indexed: 02/07/2023] Open
Abstract
Background This study aimed to compare the diagnostic accuracy of cone-beam computed tomography (CBCT) unit with digital intraoral radiography technique for detecting periodontal defects. Methods The study material comprised 12 dry skulls with maxilla and mandible. Artificial defects (dehiscence, tunnel, and fenestration) were created on anterior, premolar and molar teeth separately using burs. In total 14 dehiscences, 13 fenestrations, eight tunnel and 16 without periodontal defect were used in the study. These were randomly created on dry skulls. Each teeth with and without defects were images at various vertical angles using each of the following modalities: a Planmeca Promax Cone Beam CT and a Digora photostimulable phosphor plates. Specificity and sensitivity for assessing periodontal defects by each radiographic technique were calculated. Chi-square statistics were used to evaluate differences between modalities. Kappa statistics assessed the agreement between observers. Results were considered significant at P < 0.05. Results The kappa values for inter-observer agreement between observers ranged between 0.78 and 0.96 for the CBCT, and 0.43 and 0.72 of intraoral images. The Kappa values for detecting defects on anterior teeth was the least, following premolar and molar teeth both CBCT and intraoral imaging. Conclusions CBCT has the highest sensitivity and diagnostic accuracy for detecting various periodontal defects among the radiographic modalities examined.
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Affiliation(s)
- Nilsun Bagis
- Faculty of Dentistry, Department of Periodontology, Ankara University, 06560, Besevler, Ankara, Turkey.
| | - Mehmet Eray Kolsuz
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara University, 06560, Ankara, Turkey.
| | - Sebnem Kursun
- Ministry of Health, Bolu Oral and Dental Health Centre, 14000, Bolu, Turkey.
| | - Kaan Orhan
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara University, 06560, Ankara, Turkey.
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Zengin AZ, Sumer P, Celenk P. Evaluation of simulated periodontal defects via various radiographic methods. Clin Oral Investig 2015; 19:2053-8. [PMID: 25677242 DOI: 10.1007/s00784-015-1421-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/30/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare the diagnostic accuracy of conventional films and direct digital radiographs (DDR), in the determination of the depth and type of simulated periodontal intrabony defects. MATERIALS AND METHODS Three types of periodontal intrabony defects (one, two, and three walled) were artificially created in dry mandibles. Standard radiographic images were taken with Ultraspeed, Ektaspeed, Insight films, and DDR. The radiographic images were evaluated by three oral radiologists to identify the type and depth of these defects on the radiographs. RESULTS The average measured depth of the defects on the dry mandibles was 7.85 mm. The average depth of the type 1 defect on the radiographs was 7.19 mm, type 2 was 7.18 mm, and type 3 was 7.15 mm. The average depth of the defects via the Ultraspeed film was 7.15 mm, Ektaspeed film was 7.17 mm, Insight film was 7.19 mm, and DDR was 7.20 mm. Type 1, type 2, and type 3 defect depth measurements showed 8.9, 9.7, and 16.3% understated, respectively (p < 0.01). The accurate estimation rates of type 1, type 2, and type 3 defects were 93.8, 53, and 25.4%, respectively. CONCLUSIONS Both radiographic techniques have the same diagnostic value and display the minor destructive changes in the bone. As the number of osseous walls increases, it becomes difficult to determine the defect type and morphology. Further research is needed to monitor the intrabony defects, with less radiation exposure. CLINICAL RELEVANCE The accurate identification of defect type and depth depends on the number of walls, not the imaging methods.
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Affiliation(s)
- Ayse Zeynep Zengin
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology (Oral Diagnosis and Radiology), Ondokuz Mayis University, Atakum, 55139, Samsun, Turkey.
| | - Pinar Sumer
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology (Oral Diagnosis and Radiology), Ondokuz Mayis University, Atakum, 55139, Samsun, Turkey
| | - Peruze Celenk
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology (Oral Diagnosis and Radiology), Ondokuz Mayis University, Atakum, 55139, Samsun, Turkey
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Baysal A, Uysal T, Veli I, Ozer T, Karadede I, Hekimoglu S. Evaluation of alveolar bone loss following rapid maxillary expansion using cone-beam computed tomography. Korean J Orthod 2013; 43:83-95. [PMID: 23671833 PMCID: PMC3650217 DOI: 10.4041/kjod.2013.43.2.83] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 09/17/2012] [Accepted: 10/18/2012] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the changes in cortical bone thickness, alveolar bone height, and the incidence of dehiscence and fenestration in the surrounding alveolar bone of posterior teeth after rapid maxillary expansion (RME) treatment using cone-beam computed tomography (CBCT). Methods The CBCT records of 20 subjects (9 boys, mean age: 13.97 ± 1.17 years; 11 girls, mean age: 13.53 ± 2.12 year) that underwent RME were selected from the archives. CBCT scans had been taken before (T1) and after (T2) the RME. Moreover, 10 of the subjects had 6-month retention (T3) records. We used the CBCT data to evaluate the buccal and palatal aspects of the canines, first and second premolars, and the first molars at 3 vertical levels. The cortical bone thickness and alveolar bone height at T1 and T2 were evaluated with the paired-samples t-test or the Wilcoxon signed-rank test. Repeated measure ANOVA or the Friedman test was used to evaluate the statistical significance at T1, T2, and T3. Statistical significance was set at p < 0.05. Results The buccal cortical bone thickness decreased gradually from baseline to the end of the retention period. After expansion, the buccal alveolar bone height was reduced significantly; however, this change was not statistically significant after the 6-month retention period. During the course of the treatment, the incidence of dehiscence and fenestration increased and decreased, respectively. Conclusions RME may have detrimental effects on the supporting alveolar bone, since the thickness and height of the buccal alveolar bone decreased during the retention period.
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Affiliation(s)
- Asli Baysal
- Department of Orthodontics, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
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de Faria Vasconcelos K, Evangelista KM, Rodrigues CD, Estrela C, de Sousa TO, Silva MAG. Detection of periodontal bone loss using cone beam CT and intraoral radiography. Dentomaxillofac Radiol 2012; 41:64-9. [PMID: 22184627 DOI: 10.1259/dmfr/13676777] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to compare periapical radiographs with cone beam CT (CBCT) imaging in detecting and localizing alveolar bone loss by comparing linear measurements of the height, depth and width of the defects and identifying combined bone defects in tomographic images. METHODS The images were selected from a secondary database containing images of patients referred for periodontal evaluation. The sample consisted of 51 sites showing both horizontal and vertical bone loss, assessed by 3 trained examiners. RESULTS The results showed that there were no statistically significant differences between the imaging methods in terms of identification of the pattern of bone loss. However, there were differences between the two methods when the distance between the cemento-enamel junction (CEJ) and the alveolar crest (AC) was measured. When the distance between the CEJ and the deepest point and width of the defect were measured, the methods showed no statistically significant difference. In this study, 30.8% of the 39 teeth evaluated had combined bone defects. CONCLUSIONS The two methods differ when detecting the height of the alveolar bone crest but present similar views of the depth and width of bone defects. CBCT was the only method that allowed for an analysis of the buccal and lingual/palatal surfaces and an improved visualization of the morphology of the defect.
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Misch KA, Yi ES, Sarment DP. Accuracy of cone beam computed tomography for periodontal defect measurements. J Periodontol 2006; 77:1261-6. [PMID: 16805691 DOI: 10.1902/jop.2006.050367] [Citation(s) in RCA: 237] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Periodontal diagnosis relies heavily on traditional two-dimensional radiographic assessment. Despite efforts in improving reliability, current methods of detecting bone level changes over time or determining three-dimensional architecture of osseous defects are inadequate. To address these issues, computed tomography (CT) has been explored because of its ability to produce accurate three-dimensional imaging, but limitations such as radiation, machine size, and cost have made this approach impractical. Recently, cone beam computed tomography (CBCT) has turned this concept into potential reality because these lower-cost small machines produce high-quality data. Yet there is little research to establish periodontal bone measurement using CBCT as a valid method. Therefore, the aim of this study was to compare CBCT measurements of periodontal defects to traditional methods. METHODS Artificial osseous defects were created on mandibles of dry skulls. CBCT scanning, periapical radiography (PA), and direct measurements using a periodontal probe were compared to an electronic caliper that was used as a standard reference. RESULTS Linear measurements for all defects revealed no statistical differences between bone sounding, radiography, and CBCT. There was a significant difference when comparing isolated interproximal measurements using a probe versus the caliper (P<0.001) but no significant difference for CBCT or radiography. All bony defects were identifiable and measurable directly or with CBCT. In comparison, buccal and lingual defects could not be measured with radiographs. CONCLUSIONS Overall, all three modalities are useful for identifying interproximal periodontal defects. Compared to radiographs, the three-dimensional capability of CBCT offers a significant advantage because all defects can be detected and quantified.
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Affiliation(s)
- Kelly A Misch
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
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Abstract
In clinical microbiology, molecular genetic techniques are increasingly being used to detect and/or differentiate uncultivable, anaerobic, or fastidious microorganisms. During the past decade, DNA probe hybridization and in vitro amplification by polymerase chain reaction have also been introduced to detect oral pathogens. The present review describes experiences with methods and commercial test systems for the detection of pathogens in periodontitis and caries.
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Affiliation(s)
- Georg Conrads
- R. M. Alden Research Laboratory and University of California-Los Angeles Medical Center, Santa Monica, CA, USA.
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16
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Ramesh A, Ludlow JB, Webber RL, Tyndall DA, Paquette D. Evaluation of tuned-aperture computed tomography in the detection of simulated periodontal defects. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:341-9. [PMID: 11925546 DOI: 10.1067/moe.2002.120057] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to compare the diagnostic efficacy of tuned-aperture computed tomography (TACT) and conventional film for the detection of simulated periodontal defects. STUDY DESIGN Periodontal defects were created in 15 premolar-molar interproximal sites selected from 8 cadaver jaw segments. Ten observers viewed 45 image pairs (baseline and follow up) in 4 TACT modalities and film to assess the presence of defect. The TACT modalities were 1st and 2nd generation prototype systems (TACT-1 and TACT-2) with circular (C) and random (R) distribution patterns of source projection (TACT-1C, TACT-1R, TACT-2C, TACT-2R). Observer performance and related factors were analyzed by using receiver operating characteristic and analysis of variance. RESULTS Mean A(z) values were 0.64 for film, 0.74 for TACT-1C, 0.82 for TACT-1R, 0.64 for TACT-2C, and 0.69 for TACT-2R. TACT-1R was significantly better than film (P < .001), TACT-2C (P < .001) and TACT-2R (P = .007). CONCLUSION TACT-1R provided the best diagnostic performance in the detection of simulated periodontal defects among the 5 modalities compared in this study.
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Affiliation(s)
- Aruna Ramesh
- Division of Oral and Maxillofacial Radiology, Department of General Dentistry, Tufts University School of Dental Medicine, Boston, Mass 02111, USA.
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17
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Dove SB, McDavid WD, Hamilton KE. Analysis of sensitivity and specificity of a new digital subtraction system: an in vitro study. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 89:771-6. [PMID: 10846136 DOI: 10.1067/moe.2000.106295] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare a new digital subtraction system with conventional radiograph images for the detection of periapical and periodontal bone lesions. STUDY DESIGN Periapical and periodontal bone lesions were simulated with cortical bone chips of varying sizes placed on a human dry mandible. Radiographic film images were acquired from varying projections and were subsequently digitized, registered, and subtracted. Four clinicians evaluated the subtracted images, and sensitivity and specificity were calculated. RESULTS The mean sensitivity and specificity of the Diagnostic Subtraction Radiography system for detecting bone lesions of all sizes with varying projection geometry were 87.90% and 85.23%, respectively. The corresponding results for conventional radiograph images were 47.54% and 97.38%. The difference in sensitivity was statistically significant, whereas the difference in specificity was not. CONCLUSIONS These results indicate that, even when radiographs are taken from disparate projection geometries, the Diagnostic Subtraction Radiography system is capable of excellent discrimination between healthy and disease states in this in vitro model.
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Affiliation(s)
- S B Dove
- University of Texas Health Science Center, San Antonio, Texas 78284-7919, USA
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Mandel ID. Overview of clinical trials of periodontal diagnosis methods and devices. ANNALS OF PERIODONTOLOGY 1997; 2:98-107. [PMID: 9151546 DOI: 10.1902/annals.1997.2.1.98] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Changing views of the pathogenesis and progression of the periodontal diseases and new modalities for treatment have stimulated a plethora of physical, biochemical, microbiologic, and immunologic diagnostic procedures, tests, and devices. Clinical trials address needs for: 1) screening tests and risk assessment for disease susceptibility; 2) identification of active and progressive disease sites; 3) making therapeutic decisions; 4) monitoring therapy; 5) establishing a maintenance schedule; and 6) prognosis assessment. Needs and priorities of general, specialty, and public health practitioners differ. Validation of tests proceeds in a hierarchy of study designs from cross sectional and case control studies to retrospective and prospective longitudinal multi-center trials. For broad-scale application, randomized controlled trials (and eventual meta-analysis) will be required. Design issues are those common to all clinical trials in periodontics plus special considerations depending on type of test and its intended use. For diagnostic tests, recommended surrogate endpoints are attachment and alveolar bone levels-the traditional "gold standards." Validation of diagnostic tests is best accomplished by generation of 2 x 2 contingency tables to calculate sensitivity and specificity, positive and negative predictive values, relative and absolute risks, and odds rations. Each has a place-depending on the clinical situation and needs of the clinician.
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Affiliation(s)
- I D Mandel
- Columbia University School of Dental and Oral Surgery, New York, New York, USA
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Zambon JJ. Principles of evaluation of the diagnostic value of subgingival bacteria. ANNALS OF PERIODONTOLOGY 1997; 2:138-48. [PMID: 9151550 DOI: 10.1902/annals.1997.2.1.138] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This paper describes steps in the process of evaluating subgingival bacteria assays for the diagnosis of periodontal disease. The first step examines the infectious etiology of periodontal disease in pointing to specific oral bacteria as periodontal pathogens. Second is characterization of the laboratory test to detect and quantitate these pathogens as to sensitivity, specificity, and positive and negative predictive value. Third is the role of the laboratory test in the diagnosis of the different forms of periodontal disease which is related to the current clinical rather than microbiological definition of these diseases. The fourth and most important step is an analysis of the significance of subgingival bacterial tests in clinical decision-making.
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Affiliation(s)
- J J Zambon
- Department of Periodontology, School of Dental Medicine, State University of New York at Buffalo, USA
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Reddy MS. The use of periodontal probes and radiographs in clinical trials of diagnostic tests. ANNALS OF PERIODONTOLOGY 1997; 2:113-22. [PMID: 9151548 DOI: 10.1902/annals.1997.2.1.113] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Periodontal probing attachment level measurements and intraoral radiographs are used to assess the level of the clinical attachment and bone support in the diagnosis of periodontitis. Together these physical measurements of tooth support comprise the standard against which new diagnostic tests are compared. Since probing and radiographs provide a measure of the severity of attachment or bone loss at one point in time, serial measurements must be compared to determine whether periodontitis is progressive. Periodontal probing may be performed manually or by using controlled force electronic instruments. The resolution, depending on the instrument, will vary from 1.0 mm to 0.1 mm. Variations in probing force, size and shape of tip, location of tip placement, detection or reference landmarks for attachment level probing, degree of gingival inflammation, and transcription may adversely influence accuracy. Electronic probes offer the advantage of improved resolution, force control, and automatic recording, but the literature is inconsistent about the advantages in terms of repeatability and accuracy. Radiographic assessment of alveolar bone loss may be achieved by visual interpretation, measurement, or digital image analysis. While visual interpretation of unstandardized radiographs is insensitive to changes in bone, standardized radiographs can permit measurement of changes on the order of 0.2 mm when computerized methods are used. Newer techniques such as digital subtraction radiography permit detection of bony changes too small to be seen by the unaided eye and are over 95% sensitive and specific in detecting bony changes less than 10 mg.
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Affiliation(s)
- M S Reddy
- Department of Periodontics, University of Alabama School of Dentistry, Birmingham, USA
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Abstract
During the past 15 years, advances in basic science related to periodontal biology, and clinical trials on prevention and treatment of periodontal disease, have dramatically changed many treatment concepts in periodontics. The most pertinent information for orthodontic practice from these studies is summarized. Also, recent advances in orthodontics, particularly regarding bonding of attachments to artificial tooth surfaces and improved long-term stabilization of orthodontic treatment results in adults by means of bonded lingual retainers have significant implications. This article outlines how recent research information from both dental specialties may be used by orthodontists to improve treatment planning, clinical management, and retention of their adult and elderly patients in whom different malocclusions are complicated by moderate to advanced periodontal destruction.
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Affiliation(s)
- G J Kerry
- University of Michigan School of Dentistry, Ann Arbor, USA
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