Comparison of ultrasound imaging and cone-beam computed tomography for examination of the alveolar bone level: A systematic review.
ABSTRACT: BACKGROUND AND OBJECTIVE:The current methods to image alveolar bone in humans include intraoral 2D radiography and cone-beam computed tomography (CBCT). However, these methods expose the subject to ionizing radiation. Therefore, ultrasound imaging has been investigated as an alternative technique, as it is both non-invasive and free from ionizing radiation. In order to assess the validity and reliability of ultrasonography in visualizing alveolar bone, a systematic review was conducted comparing ultrasound imaging to CBCT for examination of the alveolar bone level. STUDY DESIGN:Seven databases were searched. Studies addressing examination of alveolar bone level via CBCT and ultrasound were selected. Risk of bias under Cochrane guidelines was used as a methodological quality assessment tool. RESULTS:All the four included studies were ex vivo studies that used porcine or human cadaver samples. The alveolar bone level was measured by the distance from the alveolar bone crest to certain landmarks such as cemento-enamel junction or gingival margin. The risk of bias was found as low. The mean difference between ultrasound and CBCT measurements ranged from 0.07 mm to 0.68 mm, equivalent to 1.6% - 8.8%. CONCLUSIONS:There is currently preliminary evidence to support the use of ultrasonography as compared to CBCT for the examination of alveolar bone level. Further studies comparing ultrasound to gold standard methods would be necessary to help validate the accuracy of ultrasonography as a diagnostic technique in periodontal imaging.
Project description:OBJECTIVE:This Cross-sectional study used cone-beam computed tomography (CBCT) to evaluate the difference in the alveolar bone of the anterior teeth between high-angle adults with severe skeletal Class II malocclusions and Class III malocclusions. MATERIALS AND METHODS:The CBCT archives from 62 high-angle adults were selected from patients of the Stomatology Hospital of Peking University between October 2017 to January 2018. The 62 high-angle adult subjects were divided into the following 2 groups based on their sagittal jaw relationships: severe skeletal Class II and severe skeletal Class III. Vertical bone level (VBL), alveolar bone area (ABA), and thickness of alveolar bone were measured at 2 mm, 4 mm, and 6 mm below and above to the cemento-enamel junction (CEJ) level, as well as at the apical level. Then, independent samples t-test were conducted for statistical comparisons. RESULTS:In the maxillary incisors, the labial VBL was smaller in the patients in skeletal Class III group than those in skeletal Class II group (P<0.05). On the labial side, the ABA was significantly thinner in patients in skeletal Class II group than those in skeletal Class III group, especially in terms of the maxillary central incisors' ABA at 4 mm and 6 mm above the CEJ level (P<0.05), in terms of apical ABA and total ABA of the maxillary lateral incisors (P<0.05). The alveolar bone thickness around maxillary lateral incisors was significantly thinner in patients of skeletal Class II than that of patients of skeletal Class III, especially regarding the apical level on the labial side (P<0.05). The ABA of the mandibular alveolar bone in the area of the lower anterior teeth was significantly thinner in patients in skeletal Class III group than those in skeletal Class II group, especially in terms of apical ABA, total ABA on the labial and lingual sides, and ABA at 6 mm below the CEJ level on the lingual side (P<0.05). In the mandibular lateral incisors, the alveolar bone thickness was significantly thinner in patients in skeletal Class III group than it was in patients in skeletal Class II group, especially regarding the apical level on the lingual side (P<0.05). CONCLUSIONS:The ABA and the alveolar bone thickness of the mandibular anterior teeth were significantly thinner in the severe high-angle group of skeletal Class III adult patients than in the sample of severe high-angle skeletal Class II adult cases. Our study firstly revealed that the roots of the maxillary central and lateral incisors were placed more labially in the subjects of severe high-angle skeletal Class II than in those of severe high-angle skeletal Class III, especially in the lateral incisors.
Project description:OBJECTIVES:The purpose of this study was to investigate whether a novel in situ interdental bone elevation method could achieve vertical bone augmentation around natural teeth. METHODS:Horizontal periodontal bone defects were created at nine quadrants of mandibles in five dogs. Six weeks later, one of the nine quadrants was randomly chosen as the model control. The remaining mandibles were allocated into two experimental groups: cortical bone removing (CBR) or interdental bone elevation (IBE). For the IBE group, four millimetres of interdental bone blocks were separated and elevated from the base of alveolar bone. Then bone xenografts were implanted beneath the elevated alveolar blocks. Animals were euthanised 12 weeks post-operation. Cone beam computed tomography (CBCT) examination and histological analysis were performed to evaluate the surgical outcomes. RESULTS:Enhanced soft tissue profiles were observed in the two experimental groups as compared to the model control group. CBCT images showed that the height of alveolar bone was significantly higher in the IBE group with bone blocks seated near the cementoenamel junction. Significantly larger area of bone tissues with the highest coronal level of new bone was observed in the IBE group. New bone was observed around the elevated bone blocks with bone remodelling and neovascularisation inside the elevated blocks. CONCLUSIONS:Vertical bone augmentation at interdental sites may be performed through in situ interdental bone elevation for patients with horizontal alveolar bone resorption.
Project description:<h4>Background/purpose</h4>In the immediate implantation of maxillary central incisors, the height of the alveolar bone is lost, and there is often a risk of bone fracture due to the thin buccal bone wall (BBW). The purpose of this study was to assess the effects of smoking, age, and root position in the alveolar bone on the BBW and the distance between the cemento-enamel junction (CEJ) and the facial bone crest (FBC) of Chinese maxillary central incisors.<h4>Materials and methods</h4>The patients were divided by smoking, gender, age, and root sagittal position in the alveolar bone. BBW thickness was measured at the following sites: the 4?mm apical to the CEJ, the middle of the root, and the apex. The distance from the CEJ to the FBC was also evaluated.<h4>Results</h4>Cone beam CT (CBCT) data for the maxillary central incisors of 645 patients (323 males and 322 females) were selected and analyzed. The CEJ-FBC distance in patients who smoked (2.79?±?0.78?mm) was significantly greater than that of non-smokers (2.54?±?0.69?mm). The BBW in subtype III (0.74?±?0.43?mm, 0.81?±?0.36?mm) was thinner than that in subtypes I and II at 4?mm apical to the CEJ and in the middle of the root, with a statistically significant difference (<i>p</i>?<?0.05).<h4>Conclusion</h4>In most Chinese people, smoking, gender, age, and the position of the root in alveolar bone are all important factors that must be considered before immediate implantation is undertaken.
Project description:Domestic rabbits are increasing in popularity as household pets; therefore, veterinarians need to be familiar with the most common diseases afflicting rabbits including dental disease. Current diagnostic approaches include gross oral examination, endoscopic oral examination, skull radiography, and computed tomography (CT). Cone beam computed tomography (CBCT), a new oral and maxillofacial imaging modality that has the capability to produce high-resolution images, has not yet been described for use in evaluating dental disease in rabbits. A total of 15 client-owned rabbits had CBCT, oral examination, dental charting, and dental treatment performed under general anesthesia. Images were evaluated using transverse and custom multiplanar (MPR), 3D, and panoramic reconstructed images. The CBCT findings were grouped into abnormalities that could be detected on conscious oral examination vs. abnormalities that could not be detected by conscious oral examination. Potential associations between the two categories were examined by pairwise Fisher's exact test with statistical significance determined by P?<?0.05. The most common findings identified on CBCT images were periodontal ligament space widening (14/15), premolar and molar malocclusion (13/15), apical elongation (13/15), coronal elongation (12/15), inflammatory tooth resorption (12/15), periapical lucency (11/15), moth-eaten pattern of osteolysis of the alveolar bone (9/15), ventral mandibular border contour changes (9/15), and missing teeth (8/15). Of the CBCT abnormalities likely to be observed on oral examination, coronal elongation (detectable on oral examination) was significantly associated with apical elongation (P?=?0.029). There were no other significant associations between CBCT findings that are also clinically detectable and CBCT findings that are not be detectable on oral examination. This suggests that pathology often exists that is not apparent upon oral examination. This study establishes the common CBCT findings associated with dental disease in rabbits and demonstrates the feasibility of this technology to diagnose and plan treatment in dental disorders in this species.
Project description:OBJECTIVES: The purpose of this study was to examine the ability of CT to assess the relative difference of degree of bone mineralization (grey level) parameters in a human mandible. METHODS: Ten mandibular sections from cadavers (81.5 ± 12.1 years) were scanned using micro-CT with 27.2 μm voxel size and cone beam CT (CBCT) with 200 μm, 300 μm, and 400 μm voxel sizes. In addition, 15 clinical CBCT images from young patients (mean age 18.9 ± 3.3 years) were identified. After segmentation of bone voxels, alveolar bone and basal cortical bone regions were digitally isolated. A histogram of grey level, which is equivalent to degree of bone mineralization, was obtained from each region of the CT images. Mean, standard deviation (SD), coefficient of variation (COV), fifth percentile low (Low(5)) and high (High(5)) of alveolar bone and basal cortical bone regions were obtained. Percentage differences of grey level parameters between alveolar and basal cortical bones were computed. RESULTS: The alveolar bone region had significantly lower Mean, Low(5) and High(5) values but significantly higher SD and COV than the basal cortical bone region for all CT images (p < 0.05). All parameters were significantly lower for the old cadaver group than for the young patient group (p < 0.05). CONCLUSIONS: CBCT and micro-CT provide comparable results in the assessment of relative difference in grey level distribution between alveolar and basal cortical bone regions in the human mandible. The percentage difference relative to an internal reference (basal cortical bone) can be a reliable method when assessing the degree of bone mineralization using CBCT images for both cross-sectional and longitudinal comparisons.
Project description:Objective:This study was performed to investigate the alveolar bone of lower incisors in skeletal Class III adults of different vertical facial patterns and to compare it with that of Class I adults using cone-beam computed tomography (CBCT) images. Methods:CBCT images of 90 skeletal Class III and 29 Class I patients were evaluated. Class III subjects were divided by mandibular plane angle: high (SN-MP > 38.0°), normal (30.0° < SN-MP < 37.0°), and low (SN-MP < 28.0°) groups. Buccolingual alveolar bone thickness was measured using CBCT images of mandibular incisors at alveolar crest and 3, 6, and 9 mm apical levels. Linear mixed model, Bonferroni post-hoc test, and Pearson correlation analysis were used for statistical significance. Results:Buccolingual alveolar bone in Class III high, normal and low angle subjects was not significantly different at alveolar crest and 3 mm apical level while lingual bone was thicker at 6 and 9 mm apical levels than on buccal side. Class III high angle group had thinner alveolar bone at all levels except at buccal alveolar crest and 9 mm apical level on lingual side compared to the Class I group. Class III high angle group showed thinner alveolar bone than the Class III normal or low angle groups in most regions. Mandibular plane angle showed negative correlations with mandibular anterior alveolar bone thickness. Conclusions:Skeletal Class III subjects with high mandibular plane angles showed thinner mandibular alveolar bone in most areas compared to normal or low angle subjects. Mandibular plane angle was negatively correlated with buccolingual alveolar bone thickness.
Project description:OBJECTIVES:To evaluate the influence of cone beam CT (CBCT) volume orientation on alveolar bone measurements for dental implant planning using CBCT in patients with different facial profiles. METHODS:74 CBCT volumes were selected from a database and classified according to the facial profile of the patient. Height and width measurements of the alveolar bone were carried out with the volume of the mandible in two different orientations: occlusal plane and mandibular base parallel to the horizontal plane. The data were subjected to the mixed model methodology for repeated measures, through the PROC MIXED procedure. Multiple comparisons were performed by Tukey Kramer test (? = 0.05). RESULTS:Alveolar bone width was significantly greater when the CBCT volume was oriented with the mandibular base parallel to the horizontal plane, for all facial profiles (p ? 0.05). Alveolar bone height was significantly higher (p ? 0.05) for dolichofacial individuals when compared to that of mesofacial and brachyfacial individuals, who did not differ significantly between each other (p > 0.05), regardless of the CBCT volume orientations used in this study. CONCLUSIONS:CBCT-based alveolar bone width is increased when the image volume is oriented with the mandibular base parallel to the horizontal plane and dolichofacial individuals present greater alveolar bone height.
Project description:Background: Grafting of biomaterial in alveolar defect facilitates bone healing and orthodontic treatment. BMP2-functionalized biomimetic calcium phosphate (BioCaP) graft had shown excellent bone defect healing potential in many preclinical studies. In this study, we aimed to investigate the influence of BioCaP graft on surgical alveolar bone defect healing during orthodontic tooth movement (OTM) in beagle dogs. Methods: Nine Beagle dogs were randomly assigned to three groups: control, deproteinized bovine bone (DBB), and BioCaP. The maxillary second premolars were protracted into the defects of the extracted maxillary first premolar for 8 weeks. The rate of OTM, alveolar remodeling and bone defect healing were evaluated by histology, histomorphometry, and cone beam computed tomography (CBCT) imaging. Periodontal probing depth was analyzed. Gingival cervicular fluid was collected at week 4 and 8, and the IL-1? level was measured by ELISA. Results: The histological sections of the bone defect showed more newly formed bone in the BioCaP group. The percentage of new bone formation in the BioCaP group was 1.61-, and 1.25-fold higher compared to the control and DBB group, respectively. After 8 weeks of OTM, the resorption rate of BioCaP was 1.42-fold higher compared to DBB. The root resorption index in the DBB group was 1.87-, and 1.39-fold higher compared to the control and BioCaP group, respectively. CBCT images showed 1.92-, and 1.36-fold higher bone mineral density in the BioCaP group compared to the control and DBB group, respectively. There was no significant difference in OTM among the three groups. The distance between the enamel cementum and the crest of the alveolar ridge in the control group was 1.45-, and 1.69-fold higher compared to DBB and BioCaP group, respectively. Periodontal probing depth at week 8 was reduced in the BioCaP group compared to the control. IL-1? concentration in the gingival cervicular fluid was significantly lower in the BioCaP group compared to the control group at week 4 and 8. Conclusion: BioCaP graft robustly promoted bone regeneration and alveolar bone defect healing without affecting OTM. BioCaP graft caused less alveolar bone recession and root resorption of traction tooth with favorable periodontal attachment level indicating that BioCaP as a bioactive and functional bone filling material for alveolar bone defects during orthodontic treatment.
Project description:Cone-beam computed tomography (CBCT) has been recently used to analyse trabecular bone structure around dental implants. To validate the use of CBCT for three-dimensional (3D) peri-implant trabecular bone morphometry by comparing it to two-dimensional (2D) histology, 36 alveolar bone samples (with implants n=27 vs. without implants n=9) from six mongrel dogs, were scanned ex vivo using a high-resolution (80 µm) CBCT. After scanning, all samples were decalcified and then sectioned into thin histological sections (∼6 μm) to obtain high contrast 2D images. By using CTAn imaging software, bone morphometric parameters including trabecular number (Tb.N), thickness (Tb.Th), separation (Tb.Sp) and bone volume fraction (BV/TV) were examined on both CBCT and corresponding histological images. Higher Tb.Th and Tb.Sp, lower BV/TV and Tb.N were found on CBCT images (P<0.001). Both measurements on the peri-implant trabecular bone structure showed moderate to high correlation (r=0.65-0.85). The Bland-Altman plots showed strongest agreement for Tb.Th followed by Tb.Sp, Tb.N and BV/TV, regardless of the presence of implants. The current findings support the assumption that peri-implant trabecular bone structures based on high-resolution CBCT measurements are representative for the underlying histological bone characteristics, indicating a potential clinical diagnostic use of CBCT-based peri-implant bone morphometric characterisation.
Project description:A precise volumetric assessment of maxillary alveolar defects in patients with cleft lip and palate can reduce donor site morbidity or allow accurate preparation of bone substitutes in future applications. However, there is a lack of agreement regarding the optimal volumetric technique to adopt. This study measured the alveolar bone defects by using two cone-beam computed tomography (CBCT)-based surgical simulation methods. Presurgical CBCT scans from 32 patients with unilateral or bilateral clefts undergoing alveolar bone graft surgery were analyzed. Two hands-on CBCT-based volumetric measurement methods were compared: the 3D real-scale printed model-based surgical method and the virtual surgical method. Different densities of CBCT were compared. Intra- and inter-examiner reliability was assessed. For patients with unilateral clefts, the average alveolar defect volumes were 1.09 ± 0.24 and 1.09 ± 0.25 mL (p > 0.05) for 3D printing- and virtual-based models, respectively; for patients with bilateral clefts, they were 2.05 ± 0.22 and 2.02 ± 0.27 mL (p > 0.05), respectively. Bland-Altman analysis revealed that the methods were equivalent for unilateral and bilateral alveolar cleft defect assessment. No significant differences or linear relationships were observed between adjacent different densities of CBCT for model production to obtain the measured volumes. Intra- and inter-examiner reliability was moderate to good (intraclass correlation coefficient (ICC) > 0.6) for all measurements. This study revealed that the volume of unilateral and bilateral alveolar cleft defects can be equally quantified by 3D-printed and virtual surgical simulation methods and provides alveolar defect-specific volumes which can serve as a reference for planning and execution of alveolar bone graft surgery.