Cone Beam Computed Tomography Measurements Research Articles

Comparative Evaluation of Cone Beam Computed Tomography and Surgical Measurements of Periodontal Bone Defects in Periodontitis Patients: An In Vivo Study.

The present study aimed to evaluate the accuracy of noninvasive cone beam computed tomography (CBCT) in the estimation of periodontal bone defects and compare it with that of measurements obtained by invasive surgical exploration using open flap debridement procedure for the evaluation of bony topography. Bone defects in 384 sites with moderate-to-severe periodontitis from eight patients were considered. Probing depth was measured in the following six sites in the selected teeth: mesiobuccal (MB), mesiopalatal (MP)/mesiolingual (ML), buccal (B), palatal (P)/lingual (L), distobuccal (DB) and distopalatal (DP)/distolingual (DL). The bone defects were measured from CBCT images followed by surgical intervention at all six sites. Data were recorded and statistically analyzed. There was no significant difference observed between CBCT and surgical intervention. However, surgical intervention was found to have higher mean values than the CBCT measurements. The Pearson correlation showed a significantly positive correlation (p < 0.05) between CBCT and surgical intervention in all sites except L/P site. Additionally, there were negative correlations observed for all sites except B and L/P sites; however, these were not statistically significant. Moreover, there were significant differences (p < 0.05) observed between anterior and posterior sites measured via CBCT except for the MB site. On the other hand, a comparison between anterior and posterior teeth measured via surgical interventions showed significant differences (p = 0.0001) in all measured sites. A significant correlation has been observed between measurements acquired from CBCT and surgical intervention for the anterior teeth. On the contrary, no significant correlation was observed for the posterior teeth. Overlapping and the absence of 3D information are two of traditional radiography's main drawbacks. Surgerical exposure can yield precise information, but it gives less time to plan the kind of periodontal regeneration that will be needed. The accuracy and feasibility of CBCT have been established. How to cite this article: Alzahrani E, Soman C, Alasqah M, et al. Comparative Evaluation of Cone Beam Computed Tomography and Surgical Measurements of Periodontal Bone Defects in Periodontitis Patients: An In Vivo Study. J Contemp Dent Pract 2024;25(8):772-777.

Comparison of Craniofacial Anthropometric Measurement Accuracy of Manual Technique vs. Cone-Beam CT Scanning.

This study aimed to compare the accuracy of linear measurements obtained using the classical (manual) method versus cone-beam computed tomography (CBCT) in craniofacial anthropometry, specifically targeting the infraorbital foramen (IOF). This study involved two sample groups: one of 40 dry skulls measured manually using digital calipers, and the other of 40 CBCT 3D images digitally measured. Measurements included IOF height, distances between the IOF and nasion (N), IOF and frontomalar orbital (FMO), and between the two IOFs. Statistical analysis was performed using an ANOVA, t-test, and Fisher's test with a significance level of 0.05. The manual method recorded a mean IOF height of 2.1 mm, while CBCT showed a mean of 3.52 mm. Significant differences were recorded between the two methods when measuring IOF height, with a p < 0.001. However, CBCT measurements generally yielded higher accuracy and lower variance due to the absence of significant differences (p > 0.05). The distance between the two IOFs measured by both methods differed significantly (p = 0.03157), with CBCT measurements showing higher values. In conclusion, although no significant differences were found in the overall accuracy of the two methods, CBCT proved to be a more reliable tool for detailed craniofacial measurements due to its higher accuracy and reproducibility. CBCT demonstrated superior consistency in measurements, offering enhanced precision in assessing craniofacial structures. These findings support the growing preference for CBCT in maxillofacial surgery, where precision is critical for successful outcomes. Nonetheless, manual techniques remain valuable in settings where advanced imaging is not accessible.

Accuracy of Mandibular Foramen Localization Using Digital Orthopantomogram (OPG) in Middle Eastern Population.

Locating the mandibular foramen (MF) through imaging is clinically important for inferior alveolar nerve (IAN) anesthesia and mandibular ramus osteotomies. Although cone-beam computed tomography (CBCT) is superior in imaging the mandible, an orthopantomogram (OPG) is preferred for its ease of use and availability. Therefore, the present study aimed to evaluate the accuracy of digital OPG in localizing the MF, in a subset of the Middle Eastern population. Radiographic images (OPG and CBCT) of selected patients (adults, dentulous and no mandibular abnormalities) were used to locate the MF through digital measurements (mm) of the anteroposterior distance from the anterior border of the ramus (MF-AP) and the superoinferior position from the mandibular occlusal plane (MF-SI). Measurements were statistically compared between OPG and CBCT for accuracy. Differences in measurements between OPG and CBCT were compared against the anatomic location (right/left), age and biological sex, assuming a p-value < 0.05 as significant. A total of 204 radiographic records (males: 100/females: 104/mean age: 34.65 ± 11.55 years) were evaluated. The measurements for the MF were MF-AP-OPG (right: 13.53 ± 2.44/left: 13.19 ± 2.25), MF-AP-CBCT (right: 13.61 ± 2.39/left: 13.36 ± 2.19), MF-SI-OPG (right: 5.25 ± 1.71/left: 5.41 ± 1.65) and MF-SI-CBCT (right: 5.59 ± 1.66/left: 5.52 ± 1.61). Measurements between OPG and CBCT were not significantly different, except for MF-SI (right) (p = 0.042). While the overall difference between OPG and CBCT (MF-AP/MF-SI) measurements showed a significant association (p < 0.01) with the anatomic location (right/left), a significant association (p < 0.05) with biological sex was observed only for MF-AP. Based on this study's outcomes, digital OPG is an accurate modality to locate the MF based on anteroposterior (MF-AP) and superoinferior (MF-SI) measurements. This would be clinically beneficial for dental and oral surgeons to achieve the optimum IAN block anesthesia based on preoperative panoramic radiographs. Similarly, it would assist maxillofacial surgeons in planning mandibular orthognathic surgeries and ramus osteotomies without complications.

Risk Assessment of Nasal Cavity Perforation in the Maxilla: A Virtual Implant Placement Study Using Cone Beam Computed Tomography.

Implant surgery in individuals with atrophic maxilla presents challenges, particularly concerning nasal cavity complications such as perforations, implant migration, and airway obstruction. While panoramic radiographs offer diagnostic convenience, their two-dimensional nature limits the evaluation of anatomical structures. Cone beam computed tomography (CBCT) provides a three-dimensional assessment, enhancing surgical planning accuracy and potentially reducing complications. With the aim of understanding the measurement differences between panoramic radiographs and CBCT images, this retrospective study examined CBCT images of patients with severely atrophic maxilla taken between September 2021 and December 2023 at the Ahmet Keleşoğlu Faculty of Dentistry. Virtual implants were placed in various tooth regions using OnDemand3D software. The incidence of nasal cavity perforations and vertical bone height differences between panoramic radiographs and CBCT images were evaluated. For this purpose, vertical bone length measurements in panoramic and CBCT images were compared for the virtual implant placement areas. Statistical analyses, including t-tests and ANOVA, were performed to determine significant differences among quantitative measurements, and a chi square test with Bonferroni corrected z-tests were used for possible associations between ratios. CBCT data from 59 patients, totaling 1888 virtual implants, revealed significant differences in implant depths among tooth regions (F = 9.880, p < 0.001). Canine regions showed higher perforation risks, especially with 12 mm and 14 mm implants. Panoramic radiographs often overestimated vertical bone height in canine and first premolar regions compared to CBCT measurements, which could lead to increased perforation risks. Radiographic evaluations using CBCT prior to implant surgery in atrophic maxilla cases are crucial to prevent nasal cavity complications. Panoramic radiographs may inadequately represent three-dimensional anatomy, underscoring the importance of CBCT for accurate implant placement and surgical planning. Further studies should consider varying implant sizes and brands to generalize findings.

Evaluation of ozonated olive oil in the success of immediate dental implants placed into infected sockets

Abstract Purpose This prospective study was conducted to assess the clinical and radiographic influences of topical application of ozonated olive oil on immediate implants inserted into infected fresh extraction sockets. Patients and methods This study was implemented on 14 cases with infected nonrestorable teeth or remaining roots. All cases underwent two-stage implant surgery, stage I: extraction of the tooth, application of ozonated olive oil gel into the infected postextraction socket, and immediate insertion of dental implant fixture, and stage II: 4 months after stage I surgery, the abutment was installed onto the implant fixture. After soft tissue healing around the abutment, the implant was loaded with the final functional prosthesis. All the patients had regular follow-up intervals throughout the study period to evaluate soft tissue and bone healing and implant stability. Results Fourteen patients enrolled in this study, of which there were six (42.9%) males and eight (57.1%) females. The age of the patients ranged between 21 and 45 years with a mean of 33.21 ± 9.16 years. The clinical outcomes including visual analog scale, soft tissue dehiscence, infection, implant stability quotient, gingival index, and peri-implant probing depth all indicated uneventful postoperative healing and 100% survival rate of the implants throughout the follow-up intervals. Radiographic outcome included interpreting cone beam computed tomography measurement of alveolar bone height which showed marked significant positive difference between stage I and stage II surgeries indicating a potential enhancing effect of ozonated olive oil on osseointegration and tissue healing. Conclusion Based on the outcomes of this study, we concluded that topical administration of ozonated olive oil might potentially enhance healing and osseointegration of implants immediately inserted into infected fresh extraction sockets and could exhibit a significant influence on increasing the success rate and minimizing complications. However, further investigation employing a control group, larger sample size, and longer follow-up duration is required to confirm this influence.

Healing of Extraction Sites after Alveolar Ridge Preservation Using Advanced Platelet-Rich Fibrin: A Retrospective Study.

Over time, numerous surgical procedures and biomaterials have been proposed for the reconstruction of post-extraction bone defects, each with their advantages and disadvantages. The main objective of this study was to evaluate dimensional changes in the alveolar bone 3 months after tooth extraction, before implant planning, comparing alveolar ridge preservation (ARP) with spontaneous healing. A total of 84 patients with non-restorable molars were included in the study. Forty-two patients received ARP with advanced platelet-rich fibrin (A-PRF) and spontaneous healing was evaluated in these patients. Cone beam computed tomography (CBCT) analysis performed before and after surgical intervention was used to determine the changes in vertical and horizontal bone dimensions produced after tooth extraction. CBCT measurements showed reduction in both vertical and horizontal alveolar bone size in both groups. For the study group, the alveolar parameters (height, width) were higher compared to the control group. The percentage variations between dimensional differences from the two groups were 38.58% for height, and for width were 36.88% at 0 mm, 35.56% at 3 mm, 36.61% at 5 mm, and 38.73% at 7 mm. The differences were statistically significant (p ˂ 0.0005). The results obtained after ARP with A-PRF showed a reduced loss of bone volume compared to spontaneous healing.

Cone beam computed tomography assessment of maxillary anterior teeth cervix dimensions in healthy adults for optimal anatomic healing abutments.

The abutments produced with circular symmetry failed to accurately replicate the natural teeth's cervical shapes. The purpose of this study was to measure cervical cross-sections of maxillary anterior teeth using cone beam computed tomography (CBCT) images to design anatomic healing abutments. CBCT data of 61 patients were analyzed using Ez3D Plus software. Measurements were taken at the cemento-enamel junction (CEJ) and 1 mm coronal to CEJ for maxillary central incisors, lateral incisors, and canines. Various parameters, including area, perimeter, and eight line segments in the distal (a), disto-palatal (b), palatal (c), mesio-palatal (d), mesial (e), mesio-labial (f), labial (g), and disto-labial (h) directions, were used to describe dental neck contours. The ratios (f/b and h/d) were analyzed, and differences based on sex and dental arch morphology were explored. Significant differences were found in area and perimeter between males and females, but not in f/b and h/d ratios. Differences in the f/b ratio were observed among dental arch morphologies for maxillary central incisors, lateral incisors, and canines. CBCT measurements of cervical cross-sections provide more accurate data for designing anatomic healing abutments. The fabrication of anatomical healing abutments needs to consider the influence of gender on cervical size and to explore the potential effect of arch shape on cervical morphology. The novel method provides detailed measurements for the description of dental cervical contours for patients with bilateral homonymous teeth missing. The measurements of this study could be utilized to design more accurate anatomic healing abutments to create desired morphology of peri-implant soft tissue.

A potential novel technique for measurement of pulp volume on periapical radiography: A pilot study.

Pulp volume can be assessed during dental treatment. Three-dimensional imaging techniques are not routinely used for this purpose because of high radiation doses. This study aimed to develop a novel method to measure pulp volume using periapical radiography. In this study, cone-beam computed tomography (CBCT) was used as a reference method. Periapical radiography and CBCTs obtained from the same patients (n = 32) were recorded. Pulp volume was determined by observing the density differences between the pulp and peripheral structures using ImageJ. A method of graph and volume calculation was developed for each tooth. The Shapiro-Wilk test and Mann-Whitney U test were used to show normality and non-normal distributions. The Bland-Altman plot was used to show the scattering of the mean versus difference values of the measurements of the two methods used to calculate the pulp volume. Normality was evaluated using the Shapiro-Wilk test. CBCT measurements are normally distributed (p = 0.307), while ImageJ is not normally distributed (p = 0.027). Therefore, the mean difference between the two groups was analyzed using the nonparametric Mann-Whitney U test. There was a statistically significant difference between the CBCT and ImageJ measurements (p = 0.01). According to Spearman's correlation analysis, the results obtained from the novel method were moderately correlated with those obtained from the reference method (r = 0.444). The results of this study indicated that a novel method-based Java software can be used to calculate pulp volume using low-dose radiation containing periapical radiography.

Is the assessment of the mandibular molar danger zone affected by field of view and voxel size in cone beam computed tomography examinations?

ObjectiveTo verify if assessment of the danger zone (DZ) in the mesial root of mandibular molars is affected by field of view (FOV) and voxel sizes in cone beam computed tomography (CBCT) scans. Study DesignForty mandibular molars were scanned by micro-computed tomography, creating the reference standard. The teeth were then submitted for CBCT scans with FOVs of 10 × 5.5 cm and 5 × 5.5 cm and voxel sizes of 0.4, 0.2, 0.15, and 0.075 mm3. The smallest dentin thickness in the DZ from the mesiobuccal and mesiolingual canals was measured at 2, 4, and 6 mm apical to the root furcation. Descriptive statistics, paired t-tests, and intraclass correlation coefficients were used for statistical analysis with significance established at P<0.05. ResultsAll CBCT measurements overestimated the DZ dentin thickness (P<0.001) compared to the reference standard. The greatest overestimation occurred in the 5 × 5.5 cm FOV with 0.4 mm3 voxels (P = 0.007). Dentin thickness measured with the 5 × 5.5 cm FOV and 0.075 mm3 voxels was significantly smaller and produced the best ICC value with the reference standard (0.936). ConclusionsCBCT overestimates the dentin thickness of the DZ regardless of FOV and voxel sizes. The 5 × 5.5 cm FOV showed the best performance with the 0.075 mm3 voxel size, but it performed poorly with 0.4 mm3 voxels.

Reliability and agreement of root length measurements during orthodontic treatment in images from different CBCT machines using multiplanar reconstruction.

To assess inter- and intrarater reliability and agreement for measurements of root lengths using multiplanar reconstruction (MPR) in cone beam computed tomography (CBCT) examinations.Furthermore, to determine whether using MPR from different CBCT machines was a reliable and reproducible method for assessment of root length during orthodontic treatment of adolescents. A total of 40 CBCT examinations obtained before, during and after orthodontic treatment of 14 adolescents, with fixed appliances from a multicentre randomised controlled trial, were used. All roots from the incisors to the first molars were measured by two independent raters and in accordance with a protocol preceded by a multi-step calibration. Reliability was assessed by intra class correlation (ICC). Agreement was assessed by measurement error according to the Dahlberg formula and Bland-Altman plot. The number of repeated measurements varied from 436 to 474 for the different timepoints. Good to excellent inter- and intrarater reliability for different tooth groups and timepoints were shown. Measurement error for inter- and intrarater agreement varied between 0.41 mm and 0.77 mm. The Bland-Altman plot with 95% limits of agreement varied between +1.43 mm and -2.01 mm for different tooth groups and timepoints. The results of this study indicate that CBCT using MPR from different machines is a reproducible method for measuring root length during different phases of orthodontic treatment. When interpreting root shortening measurements in CBCT using MPR for clinical or research purposes, values below 2 mm should be approached with caution, as they may contain measurement errors.

Maxillary sinus in gender determination: a morphometric analysis using cone beam computed tomography.

Gender determination of skeletal remains is an important forensic procedure in the identification process. Maxillary sinus remains intact even when the skull and other bones may be badly disfigured. Cone beam computed tomography (CBCT) can provide precise information about complex anatomical structures, as it is characterized by rapid volumetric image acquisition with high resolution. The present study aimed to assess the accuracy of maxillary sinus measurements using cone beam computed tomography in gender determination and to develop a formula using discriminate function analysis. Bilateral maxillary sinus images (left and right) were acquired for 200 patients (100 females and 100 males) and different parameters (width, length, height, area, perimeter, and volume) were measured and evaluated. Mean and standard deviation of both maxillary sinuses measurements were calculated and compared. The data was subjected to discriminative statistical analysis and analyzed using an unpaired t-test. The difference between all these variables was statistically significant between males and females. Based on discriminant analysis, the most pronounced variable in the differentiation of gender groups was maxillary sinus height. Gender assessment was established correctly with an accuracy of 75% for females and 64% for males with an overall accuracy of 69.5%. Adding other independent variables to the model did not result in an improvement in overall accuracy. Cone beam computed tomography measurement of maxillary sinus can be used as an aid in forensic anthropology for gender determination.

Comparative Assessment of Three Different Alveolar Ridge Dimension Measurement Methods before Implant Placement: An In Vivo Study.

The purpose of this study was to compare the three various techniques for measuring the alveolar ridge's dimensions prior to implant insertion. For this study, a total of 36 participants were chosen. To prepare a surgical stent, a study model was created from an alginate impression. A first point (reference point) was marked on the crest of the ridge in relation to the adjacent teeth. Then, one point (point 1) and another point (point 2) were marked at distances of 3 and 6 mm, respectively, from the reference point. Based on the procedure for measuring the size of the alveolar ridge, the study was divided into the following groups. Group I: Cone-beam computed tomography (CBCT) measurement method; Group II: Ridge mapping measurement method; Group III: Direct caliper measurements method. Descriptive statistics were used to estimate the mean and standard deviation (SD). The Student's unpaired t-test was utilized for the statistical analysis. The 5% level of significance was used. There was no significant difference found between CBCT with ridge mapping and direct caliper measurements. However, on comparison of ridge mapping and direct caliper measurements technique, at point 1, the ridge mapping was 3.88 ± 0.12 and the direct caliper measurement was 3.62 ± 0.08. At point 2, the ridge mapping was 6.58 ± 0.06 and the direct caliper measurement was 6.32 ± 0.04. There was a statistically significant difference found between these two measurement methods. Within the limitation, the current study came to the conclusion that when CBCT and ridge mapping measurements were individually compared with the gold standard-the surgical open method, CBCT-demonstrated to be a highly specific and sensitive method for detecting the residual alveolar ridge width in the treatment planning of dental implants. Evaluation of alveolar bone is necessary during treatment planning for dental implant placement. Using simply panoramic and/or periapical radiographs to evaluate the bone may not be sufficient because it only provides two-dimensional information regarding the implant locations. Therefore, for better implant placement, three-dimensional information of the implant site, such as CBCT and ridge mapping technique, should be assessed.

The contribution of image processing in the evaluation of guided bone regeneration

One of the most ambitious goals of modern bone surgery is to predict the shape of the bone defect, monitor the progress of bone regeneration, and assess the quantity and quality of newly formed bone. Calcium phosphate biomaterials such as hydroxyapatite and tricalcium phosphate are commonly used as bone substitutes in maxillofacial and dental surgery. The objective of this work is to use cone-beam computed tomography (CBCT) and image processing to assess the spatial (architectural) layout, rate of bone generation and osseointegration of implanted commercial granules (PAH 40%, β-TCP 60%, size 0.5 to 1 mm) in the bone defect generated after tooth extraction. CBCT measurements were performed at 48 hours and 12 months. The analysis of 3D images and the application of appropriate morphological mathematical operations allowed us to evaluate the volume of the cavity to be filled, the volume occupied by the granules and the volume of porosity generated by the random stacking of the granules. The result shows that the bone generation rate reaches a value of 89% after one year of implantation. This study shows that by using 3D image processing techniques CBCT, the same results as classical anatomical and histological studies can be obtained.

Comparative Assessment of Reliability and Accuracy of Cone-Beam Computed Tomography (CBCT) Over Direct Surgical Measurement for Periodontal Bone Loss: A Prospective, Cross-Sectional Study.

Assessing bone condition holds significant value in the diagnosis, treatment planning, and prognosing the periodontal disease; its importance is undeniable. The main aimof the present study was to evaluate the accuracy of alveolar bone measurements due to periodontal disease using cone-beam computed tomography (CBCT), by comparingwith surgical measurements, considered as the gold standard. A prospective cross-sectional study included a sample of 40 individuals diagnosed with chronic periodontitis who required periodontal surgery. A total of 202 sites were assessed for vertical and horizontal bone loss in the anterior (76 sites) and posterior (126 sites) teeth. Bone loss was measured using CBCT and a UNC 15 periodontal probe during the surgical intervention, and then compared. The statistical analysis involved employing a Student's t-test to compare measurements. Unpaired t-tests and correlation analyses were conducted using Pearson's correlation coefficient test. To establish statistical significance, a threshold of p<0.05 was considered appropriate. The statistical analysis carried out on the mean values of CBCTand direct surgical measurements for vertical bone loss demonstrated a significant difference (p<0.01). However, the values obtained for horizontal bone loss did not display statistical significance. A strong correlation of 0.94-0.99 existed between surgical and CBCT measurements. A statistically significant distinction was observed between the two methods in measuringbone loss at the distal and palatal sites of the anterior teeth. Both CBCTand direct surgical measurement exhibit comparableaccuracy potentialin assessing alveolar bone loss. CBCT provides an accessibility advantage by enhancing visual accessto challenging sites during surgical interventions, including palatal and distal areas of the teeth.

CBCT Compared to Transgingival Probing as a Tool for Estimating Alveolar Bone Crest Level in Patients with Altered Passive Eruption.

Alveolar bone crest level is essential in determining the need for bone removal in subjects with altered passive eruption (APE). This study assessed the validity of Cone Beam Computed Tomography (CBCT) and transgingival probing. Patients presenting with APE were assessed. Transgingival probing was performed to clinically assess the distance between the cementoenamel junction (CEJ) and the crest of the bone at the mid-point of upper anterior teeth. CBCT was used to assess this distance at the same point. Upon reflection of a full mucoperiosteal flap the actual distance was measured. Similar actual and CBCT measurements of the distance between the CEJ and bone crest at upper right 3, upper left 2 and upper left 3 (P>0.05) were recorded. However, in upper right 2, upper right 1 and upper left 1 the distance was significantly greater on CBCT (P<0.05). No significant difference was detected between transgingival probing and the actual distance at all teeth assessed. Careful transgingival probing provides an accurate measure of the distance between the CEJ and crest of the Bone. CBCT gives an accurate estimate, However, it might not be justified for each patient in the presence of safer methods.

Comparison of linear and angular measurements in mandibular symphyseal region using lateral cephalometric and cone beam CT images

AbstractAimTo compare the linear and angular measurements of the mandibular symphyseal region using lateral cephalometric (LC) and cone beam computed tomography (CBCT) images.Materials and MethodsOne hundred patients justifying both LC and CBCT exposures were included. Both lateral cephalometric and CBCT images of the patients were used for angular and linear measurements. Angular measurements included vestibular concavity and lingual and tooth inclination angles. Vestibular and lingual cortical bone and total bone thickness measurements were obtained for the comparison of linear measurements. Three radiologists performed the measurements on 200 images. Comparison of the measurements and the imaging methods were done using paired‐ and Wilcoxon t‐tests. Inter‐observer reliability was evaluated with the intra‐class correlation coefficient (ICC).ResultsA significant difference was observed between measurements of two imaging methods for tooth inclination and vestibular concavity angles; however, no difference was found between LC and CBCT measurements for lingual inclination angle (p &gt; 0.05). Vestibular cortical bone and total bone thickness measurements showed a significant difference (p &lt; 0.05), whereas no difference was obtained in lingual bone thickness measurements of two imaging methods (p &gt; 0.05).ConclusionCBCT imaging is recommended in selected patients where recipient bone or bone augmentation site(s) reveal suspect in clinical examination and lateral cephalometric imaging may not reveal the true anatomic structure and relationships.

Novel biomaterial advanced platelet rich fibrin plus block for multiple gingival recession.

The study was aimed to assess and compare hard and soft tissue augmentation clinicoradiographically with and without advanced platelet rich fibrin + (A-PRF+) block for the treatment of multiple gingival recession using vestibular incision subperiosteal tunnel access (VISTA). A total of 24 patients, exhibiting multiple Miller's Class I or II recession in maxillary esthetic zone were included. Participants were divided into 2 groups, Group 1 treated with VISTA & A-PRF+ block whereas Group 2 with VISTA technique alone. Clinical parameters Probing Depth (PD), Width of Keratinized Gingiva (WKG), Gingival Biotype (GB), Recession Depth (RD) and Clinical Attachment Level (CAL) were recorded at baseline and at the end of 6 months. The radiographic CBCT measurements of labial plate thickness was taken at baseline and 6 months postoperatively. From baseline to 6 months both the groups showed a clinical and statistical improvement in the parameters. However, a statistically significant difference between both the treatment modalities was not observed. In the inter group comparison radiographically, labial plate thickness was statistically significant at the end of 6 months when compared to the baseline. A-PRF+ block along with VISTA technique can be an alternative effective root coverage procedure for the management of multiple gingival recession in the maxillary esthetic zone. This article is protected by copyright. All rights reserved.

Clinical and cone beam computed tomography outcomes of maxillary anterior implant restorations after immediate implant placement with interim restorations: A 1- to 14-year retrospective analysis

Statement of ProblemAchieving and maintaining optimal tissue health and esthetics when immediately placing maxillary anterior implants with interim restorations has been challenging and the clinical outcomes heterogenous. PurposeThe purpose of this retrospective study was to evaluate the clinical outcomes of immediate placement of maxillary anterior implants with interim restorations and compare the tomographic and clinical results before and after implant placement in participants followed for 1 to 14 years. Material and methodsTwenty participants receiving 25 postextraction single implants in the anterior maxilla were studied. Clinical parameters included pink esthetic score (PES) and white esthetic score (WES), peri-implant phenotype, implant probing, plaque index, and cone beam computed tomography (CBCT) to compare initial and at least 1 year after crown placement (postoperative). For qualitative variables, a descriptive analysis was carried out. The PES and WES results were analyzed by using nonparametric statistics, the median (ME) and the interquartile range (IQR) were used as summary measures, and the Wilcoxon sum of signs test was used to compare the total scores between the intervention area and the contralateral tooth. To compare pre- and postoperative data points, the paired t test was used (α=.05). ResultsMean ±standard deviation (SD) time of follow-up was 7.6 ±4.2 years. Twenty participants with a mean ±SD age of 62.4 ±11.0 years old received 25 implants. Mean ±SD initial torque value at implant placement was 38.6 ±9.63 Ncm. Bone height at the top of the alveolar ridge (BH) and bone width at the middle of the alveolar ridge (BW2) showed a statistically significant decrease between the initial and subsequent CBCT measurements (both P<.001). Likewise, the bone width at the alveolar crest (BW1) showed a statistically significant decrease between the initial and post-CBCT measurements (P=.006). Facial bone integrity (FBI) revealed a statistically significant increase between the initial and postoperative time periods (P<.001). The PES index showed a median of 9.0 IQR (8-10), statistically lower than the contralateral tooth (P=.032). No significant differences were found for the WES index or for FBI, regardless of the peri-implant phenotype. ConclusionsImmediate implant placement in the maxillary anterior sextant was found to be a predictable procedure with good esthetic results when the protocol described was used. Labial bone loss is inevitable after tooth extraction but can be compensated for by filling the space with a xenograft material. Long-term gingival tissue integrity was maintained, regardless of phenotype, in periodontally healthy participants.

Evaluation of the validity of mental foramen USG measurements by comparison with CBCT and determination of blood flow.

To examine mental foramen (MF) morphology and morphometry in comparison with ultrasonography (USG) and cone-beam computed tomography (CBCT), and to determine the relationship between mental artery blood flow parameters and age, gender, dental status, alveolar crest height, mandibular cortical index (MCI) with USG. A total of 120 MF and mental arteries of 60 patients (21 males and 39 females), including 20 patients in each group, aged 18-39, 40-59, and 60years and above, were evaluated. The horizontal and vertical diameter of the MF and the distance between it and the alveolar crest were evaluated with USG and CBCT. In addition, mental artery blood flow parameters were examined by USG. When the horizontal diameter values of MF were compared in USG and CBCT measurements; the diameter was significantly lower in the measurements obtained by USG (p < 0.05). It was observed that there were no mental arteries whose blood flow could not be recorded, 31 (25.8%) had strong blood flow and 89 (74.2%) had weak blood flow. No significant correlation was observed between gender and blood flow parameters (p > 0.05). Considering that CBCT images are used as gold standard in our study, it may be said that USG is not as reliable as CBCT in evaluating the MF dimensions in the maxillofacial region. Nevertheless, USG is a suitable technique for determining the visualizing and blood flow of the MF.

Modeling the effect of bilateral sagittal split osteotomy on posterior, superior and medial space dimensions of the temporomandibular joint: a retrospective controlled cohort study

BackgroundTo model the effect of isolated bilateral sagittal split osteotomy (BSSO) on changes in posterior (PSD), superior (SSD), and medial space dimensions (MSD) of the temporomandibular joint.MethodsUsing a retrospective cohort study design, pre- and postoperative (immediately after surgery; 1 year follow-up) cone-beam computed tomography measurements of 36 patients who had undergone BSSO for mandibular advancement were compared with a control group of 25 subjects from whom a mandibular odontogenic cyst was removed under general anesthesia. Generalized estimation equation (GEE) models were used to examine the independent effects of study group, preoperative condylar position, and time points on PSD, SSD, and MSD adjusting for covariates (age, sex, and mandibular advancement).ResultsNo significant differences were found regarding changes in PSD (p = 0.144), SSD (p = 0.607), or MSD (p = 0.565) between the BSSO and control groups. However, the preoperative posterior condylar position showed significant effects on PSD (p < 0.001) and MSD (p = 0.043), while the preoperative central condylar position demonstrated a significant effect on PSD (p < 0.001).ConclusionThe data suggest that preoperative posterior condylar position is a significant effect modifier of PSD and MSD over time in this cohort.