Cone-beam Computed Tomography Parameters Research Articles

Distribution of the intraosseous branch of the posterior superior alveolar artery relative to the posterior maxillary teeth.

Preoperative identification of the intraosseous posterior superior alveolar artery (PSAA) is critical when planning sinus surgery. This study was conducted to determine the distance between the cementoenamel junction and the PSAA, as well as to identify factors influencing the detection of the PSAA on cone-beam computed tomography (CBCT). In total, 254 CBCT scans of maxillary sinuses, acquired with 2 different scanners, were examined to identify the PSAA. The distance from the cementoenamel junction (CEJ) to the PSAA was recorded at each maxillary posterior tooth position. Binomial logistic regression and multiple linear regression were employed to evaluate the effects of scanner type, CBCT parameters, sex, and age on PSAA detection and CEJ-PSAA distance, respectively. P-values less than 0.05 were considered to indicate statistical significance. The mean CEJ-PSAA distances at the second molar, first molar, second premolar, and first premolar positions were 17.0±4.0 mm, 21.8±4.1 mm, 19.5±4.7 mm, and 19.9±4.9 mm for scanner 1, respectively, and 17.3±3.5 mm, 16.9±4.3 mm, 18.5±4.1 mm, and 18.4±4.3 mm for scanner 2. No independent variable significantly influenced PSAA detection. However, tooth position (b=-0.67, P<0.05) and scanner type (b=-1.3, P<0.05) were significant predictors of CEJ-PSAA distance. CBCT-based estimates of CEJ-PSAA distance were comparable to those obtained in previous studies involving cadavers, CT, and CBCT. The type of CBCT scanner may slightly influence this measurement. No independent variable significantly impacted PSAA detection.

Age-related changes in the midpalatal suture: Comparison between CBCT staging and bone micromorphology

The age-related maturation of the human midpalatal suture is challenging to predict, but critical for successful non-surgical rapid maxillary expansion (RME). While cone-beam computed tomography (CBCT) can be used to categorize the suture into stages, it remains unclear how well the stages predict the actual micromorphology of the palate. To address this clinically relevant question, we used CBCT together with three-dimensional micro-computed tomography (μCT) analysis on 24 human palate specimens from individuals aged 14–34 years. We first classified the specimens into stages (A-E) using CBCT images and then correlated the results with our comprehensive μCT analysis. Our analysis focused on several factors, including bone volume fraction (BV/TV), sutural width, volume, interdigitation, ossification, and their associations with age, CBCT stage, and sex. Our μCT analysis revealed a decrease in sutural width and volume after the age of 20 years, accompanied by sutural closure beginning in the palatal segment. The overall rate of ossification remained low but increased after the age of 20 years. No significant differences were found between males and females. Importantly, we also found no correlation between individual age and CBCT stages. Furthermore, there was no association between CBCT stages and patalal suture volume, ossification and interdigitation.Taken together, our findings cast doubt on the reliability of CBCT stage as a means of predicting skeletal maturity of the palatal suture, as it appears to lack the precision required to accurately assess the true micromorphology of the palatal suture. Future investigations should explore whether alternative CBCT parameters may be more useful in addressing the challenging question of whether RME requires surgical bone weakening.

Artificial Neural Network as a Predictive Tool for Gender Determination using Volumetric and Linear Measurements of Maxillary Sinus CBCT: An Observational Study on South Indian Population

Introduction: Determination of age and gender using bones of skull is central aspect of forensic odontology. Maxillary sinuses in this regard have shown high accuracy in predicting gender. Aim: To identify gender using the volumetric and linear measurements of maxillary sinuses obtained from a Cone Beam Computed Tomography (CBCT) by using Artificial Neural Network (ANN) based tool. Materials and Methods: A retrospective study was conducted on 80 volumes of CBCT (derived from n=80 patients) with equal gender distribution. The CBCT images were analysed for eight linear and two volumetric measurements namely the maxillary sinus height, maxillary sinus length, maxillary sinus width, distance between infraorbital foramen and distance between maxillary sinus. The data from these parameters were reported by two experts and subjected to discriminant analysis and McNemars test for gender determination. The same data was also fed to the ANN software and the accuracy of its gender prediction was analysed by Receiver Operating Characteristics Curve (ROC) and Area Under the Curve (AUC). Results: The ROC test and AUC (ANN –test) had shown high accuracy for prediction of gender form the data of the CBCT parameters for maxillary sinuses. McNemars test showed that the difference in proportion between the actual gender and ANN predicted gender was not significant (p-value=0.687) and the agreement between the actual gender and ANN in measuring the gender was 84.6%. The male sex was predicted correctly upto 89.7% and female sex upto 94.9%. Conclusion: This study has found ANN to have an encouraging predictive power in gender determination based on linear and volumetric measurements of maxillary sinus obtained from CBCT

Influence of CBCT parameters on image quality and the diagnosis of vertical root fractures in teeth with metallic posts: an ex vivo study.

The aim of this study was to evaluate the influence of peak kilovoltage (kVp) and a metal artifact reduction (MAR) tool on image quality and the diagnosis of vertical root fracture (VRF) in cone-beam computed tomography (CBCT). Twenty single-rooted human teeth filled with an intracanal metal post were divided into 2 groups: control (n = 10) and VRF (n = 10). Each tooth was placed into the socket of a dry mandible, and CBCT scans were acquired using a Picasso Trio varying the kVp (70, 80, 90, or 99), and the use of MAR (with or without). The examinations were assessed by 5 examiners for the diagnosis of VRF using a 5-point scale. A subjective evaluation of the expression of artifacts was done by comparing random axial images of the studied protocols. The results of the diagnoses were analyzed using 2-way analysis of variance and the Tukey post hoc test, the subjective evaluations were compared using the Friedman test, and intra-examiner reproducibility was evaluated using the weighted kappa test (α = 5%). The kVp and MAR did not influence the diagnosis of VRF (p > 0.05). According to the subjective classification, the 99 kVp protocol with MAR demonstrated the least expression of artifacts, while the 70 kVp protocol without MAR led to the most artifacts. Protocols with higher kVp combined with MAR improved the image quality of CBCT examinations. However, those factors did not lead to an improvement in the diagnosis of VRF.

Changes in Cone-Beam Computed Tomography Pediatric Airway Measurements After Adenotonsillectomy in Patients With OSA

Early intervention using cone-beam computed tomography (CBCT) and adenotonsillectomy for children with obstructive sleep apnea (OSA) may prevent impaired growth, adverse cardiovascular consequences, learning deficits, and poor quality of life. To assess changes in CBCT airway measurements and polysomnography (PSG) parameters that occur after adenotonsillectomy in children with OSA and to determine whether CBCT changes are correlated with apnea-hypopnea index (AHI) reduction. This prospective cohort study was conducted at a tertiary medical center from 2013 to 2016. Children aged 7 to 13 years with PSG-confirmed OSA (ie, AHI ≥1) were recruited. Data analysis was performed from March to July 2021. All participants underwent CBCT and PSG before and after adenotonsillectomy. Changes in PSG and CBCT parameters after adenotonsillectomy were analyzed. A total of 49 children (mean [SD] age, 9.5 [1.8] years; 34 boys [69.4%]) were recruited. Eighteen participants (36.7%) had obesity. After adenotonsillectomy, AHI significantly decreased from 11.4 to 1.2 events per hour (mean difference, -10.24 events per hour; 95% CI, -13.84 to -6.64 events per hour). The following CBCT parameters significantly increased: total airway volume (from 11 265 to 15 161 mm3; mean difference, 3896.6 mm3; 95% CI, 2788.0 to 5005.2 mm3), nasopharyngeal volume (from 2366 to 3826 mm3; mean difference, 1459.7 mm3; 95% CI, 1122.9 to 1796.5 mm3), minimal nasopharyngeal airway area (from 128 to 191 mm2; mean difference, 63.1 mm2; 95% CI, 47.4 to 78.8 mm2), mean nasopharyngeal airway area (from 144 to 231 mm2; mean difference, 86.8 mm2; 95% CI, 67.0 to 106.5 mm2), oropharyngeal volume (from 8898 to 11 335 mm3; mean difference, 2436.9 mm3; 95% CI, 1477.0 to 3396.8 mm3), minimal oropharyngeal airway area (from 82 to 158 mm2; mean difference, 76.2 mm2; 95% CI, 57.0 to 95.4 mm2), and mean oropharyngeal airway area (from 182 to 234 mm2; mean difference, 52.5 mm2; 95% CI, 33.6 to 71.4 mm2). Among all parameters, only body mass index percentile showed large effect size between the group with residual OSA (postoperative AHI ≥1) and the group with resolved disease, with the residual OSA group having a higher body mass index percentile (87.8 vs 61.4; mean difference, 26.33; 95% CI, 10.00 to 42.66). A quantile regression model revealed that total airway volume and minimal oropharyngeal airway area were significantly correlated with reductions in AHI. These findings suggest that in children undergoing adenotonsillectomy, improvements in total airway volume and oropharyngeal minimal airway area were correlated with reduction of AHI. Future studies are needed to assess whether CBCT has a role in the evaluation of children with OSA who are being considered for adenotonsillectomy.

A framework for automated and streamlined kV cone beam computed tomography image quality assurance: a multi-institutional study

The purpose of this study was to develop and evaluate a framework to support automated standardized testing and analysis of Cone Beam Computed Tomography (CBCT) image quality QA across multiple institutions. A survey was conducted among the participating institutions to understand the variability of the CBCT QA practices. A commercial, automated software platform was validated by seven institutions participating in a consortium dedicated to automated quality assurance. The CBCT image analysis framework was used to compare periodic QA results among 23 linear accelerators (linacs) from seven institutions. The CBCT image quality metrics (geometric distortion, spatial resolution, contrast, HU constancy, uniformity and noise) data are plotted as a function of means with the upper and lower control limits compared to the linac acceptance criteria and AAPM recommendations. For example, mean geometric distortion and HU constancy metrics were found to be 0.13 mm (TG142 recommendation: ≤2 mm) and 13.4 respectively (manufacturer acceptance specification: ≤±50).Image upload and analysis process was fully automated using a MATLAB-based platform. This analysis enabled a quantitative, longitudinal assessment of the performance of quality metrics which were also compared across 23 linacs. For key CBCT parameters such as uniformity, contrast, and HU constancy, all seven institutions used stricter goals than what would be recommended based on the analysis of the upper and lower control limits. These institutional goals were also found to be stricter than that found in AAPM published guidance. This work provides a reference that could be used to machine-specific optimized tolerance of CBCT image maintenance via control charts to monitor performance we well as the sensitivity of different tests in support of a broader quality assurance program. To ensure the daily image quality needed for patient care, the optimized statistical QA metrics recommended to using along with risk-based QA.

Assessing the Prevalence of Velopharyngeal Dysfunction and Obstructive Sleep Apnea by Correlating Cone Beam Computed Tomography Parameters of Soft Palate with the Stop Bang Questionnaire

Introduction: The relationship between soft palate length and nasopharyngeal depth can be used to determine the velopharyngeal dysfunction and is called Need's ratio. Need's ratio should be in a range of 0.6–0.7 in normal subjects. Any increase greater than 80% demonstrated a risk for developing velopharyngeal dysfunction. Aim: To assess the prevalence risk rate of obstructive sleep apnea using snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck circumference, gender (STOP-BANG) questionnaire and to evaluate various parameters of the soft palate, pharyngeal depth, and determination of Need's ratio using CBCT. Materials and Method: In this prospective study, patients who reported for CBCT assessment in the age group ranging from 20 to 50 years were included. The sample size of the study was calculated to be 42. Furthermore, the patients were screened with the STOP- BANG questionnaire and shapes of the soft palate, velar length, width, and pharyngeal depth were obtained with the CBCT sections, and Need's ratio was calculated. Results: The collected data were analyzed with IBM. SPSS software 23.0. Based on the results of the STOP- BANG questionnaire, P value was found to be significant. Based on the CBCT parameters, the most common shape was the leaf-shaped soft palate. The velar length, width, and pharyngeal depth were found to be higher in males. Need's ratio was found to be increasing with an increase in age. A significant correlation of risk for OSA was established based on a comparison of questionnaire results with the results obtained from CBCT parameters with Need's ratio. Conclusion: CBCT is a static imaging technique, it can identify the anatomic risk factors for developing sleep apnea.

Effects of Orthognathic Surgery on Voice Characteristics

Orthognathic surgery not only corrects dentofacial deformities but also affects some vital structures involving voice production. The primary aim of this study was to analyze the effects of bimaxillary orthognathic surgery on voice characteristics of patients with class II and III skeletal deformities; the second aim was to evaluate possible associations among acoustic parameters, pharyngeal airway, and skeletal changes after surgery. Using a prospective cohort study design, we enrolled a sample of patients who underwent bimaxillary orthognathic surgery in the university hospital between January 2018 and January 2019. Voice records and cone-beam computed tomography (CBCT) scans of the patients were acquired before surgery and 6months after surgery. Pharyngeal airway volume, minimum cross-sectional area, hyoid bone position, and skeletal movements of the maxilla and mandible were assessed with Dolphin Imaging software using CBCT data as predictor variables. Acoustic analysis of voice samples (vowel/a/) were performed with Praat software as outcome variables. The within-group and between-group differences in data were analyzed using paired-sample and independent-sample t tests. The degree of relationship between voice and CBCT parameters was assessed using Pearson correlation and multiple regression analysis. The study sample comprised 33 patients; 14 patients had class II skeletal deformity and 19 patients had class III skeletal deformity. Orthognathic surgery in both patients with class II and III skeletal deformities resulted in significant changes in all the voice parameters (All P<.05). Only patients with class II skeletal deformity showed significant changes in airway parameters (increase; all P<.001) and hyoid bone positions (anterosuperior movement; P=.001 and P=.008, respectively). Multiple regression analysis showed that some specific structural changes significantly affected some specific acoustic parameters. Bimaxillary orthognathic surgery significantly changed the acoustic parameters of voice in patients with class II and III skeletal deformities. Some of the structural changes were significantly associated with some of the acoustic parameters.

Features of the relationship between cone-beam computed tomography and the severity of oxidative stress in chronic generalized periodontitis with and without bronchoectatic disease

The study identified and analyzed the relationship between cone-beam computed tomography (CBCT) and markers of oxidative stress in patients with chronic generalized periodontitis (CGP) without somatic pathology and with bronchoectatic disease. 90 patients with CGP were examined, which were divided into two groups: patients with CGP without somatic pathology (n=40) and patients with CGP with comorbid pathology in the form of bronchiectatic disease (n=50). Somatically healthy persons with intact periodontal disease (n=40) were examined as a control group. Enzyme immunoassay was used to determine the levels of malondialdehyde (MDA), advanced oxidation protein products (AOPP) and total superoxide dismutase (total SOD) of all three types — Cu/Zn-SOD + Mn-SOD + Fe-SOD) in oral fluid. In patients with CGP observed intensification of oxidative stress expressed in an increase in oxidation products of lipids and proteins, as well as a decrease in antioxidant protection. Greater intensification of the process of oxidative stress and deeper changes in periodontal tissues were detected in patients with CGP with bronchiectatic disease. According to the results of correlation analysis, statistically significant, positive relationships of different strength between changes in the level of MDA, AOPP, total SOD and CBCT parameters in patients with CGP, both without somatic pathology, and with bronchiectatic disease were revealed. The revealed interrelations evidence of the influence of the intensification of the process of oxidative stress on a condition of periodontal tissues at patients with CGP. The strength of the identified relationships between most of the indicators characterizing CB CT deep periodontal lesions was greater in patients with CGP with bronchiectatic disease.

Correlation between the thickness of the crestal and buccolingual cortical bone at varying depths and implant stability quotients.

Background/purposeResonance frequency analysis (RFA) is clinically used in dentistry to access the stiffness of dental implants in surrounding bone. However, the clear advantages and disadvantages of this method are still inconclusive. The aim of this study was to investigate and compare implant stability quotient (ISQ) values obtained from RFA with parameters obtained from a cone beam computed tomography (CBCT) scan of the same region.Materials and methodsNineteen implants (Conelog) were inserted in the posterior maxillary and mandibular partially edentulous regions of 16 patients. At the time of implant placement, the ISQ values were obtained using RFA (Osstell). CBCT was used to measure the thickness of the crestal, cortical, buccolingual cortical, and cancellous bone at 3, 6, and 9 mm below the crestal bone level, as indicated by radiographic markers. The ratio of the thickness of the cortical to cancellous bone at varying depths was also calculated and classified into 4 groups (Group 1–4).ResultsThere was a strong correlation between the crestal cortical bone thickness and ISQ values (P<0.001). The thickness of the buccolingual cortical bone and ratio of the cortical to cancellous bone thickness at 3 mm were significantly related to the ISQ (P = 0.018 and P = 0.034, respectively). Furthermore, the ISQs in Group 1 were the highest compared with those in Group 2 and Group 3, whereas the CBCT parameters at 6 and 9 mm did not have any specific correlation with the ISQ values.ConclusionThis study showed that the ISQ values obtained from RFA highly correlated with the quantity and quality of bone 3 mm below the crestal bone level. The correlation between the ISQ and bone surrounding the implant site was dependent on the depth of measurement. Therefore, RFA can help to predict the marginal bone level, as confirmed in this study.

Diagnostic role of cone beam computed tomography for the position of straight array

Objective: To assess the usefulness of cone beam computed tomography (CBCT) for characterizing electrode insertion and evaluate the influence of electrode insertion status on post-cochlear implantation (CI) outcomes.Design: Twenty-six ears with post-CI CBCT scans were included. The devices were MED-EL Flex28 (n = 21) and Nucleus slim straight (n = 5). The parameters including cochlear duct length (CDL), insertion depth angle (IDA), insertion length of electrode (IL), and cochlear coverage (CC) were analyzed and compared with aided pure-tone threshold (PTA) with implant in free field, and open-set sentence score.Results: The mean CDL was 36.8 ± 1.4 mm. Electrode array was dislocated into scala tympani in two ears. The mean IL and IDA were 26.5 ± 1.9 mm and 541.4 ± 70.2°. The mean linear CC (IL/CDL, 0.73 ± 0.06) was larger than the mean angular CC (IDA/900, 0.60 ± 0.08). The CBCT parameters showed correlation one another. While the aided pure-tone threshold was correlated with IL and IDA, there were no significant correlations in the open-set sentence score. For the postlingually deaf patients with single electrode (Flex 28), the sentence score had no significant correlation and the aided PTA was positively correlated with IL (R = 0.517, p = .028).Conclusions: This study validated the CBCT evaluating the electrode array position. The CBCT could be helpful for the preoperative selection of the optimal array and prediction of the CC.

Effect of 1% sodium alendronate in the non-surgical treatment of periodontal intraosseous defects: a 6-month clinical trial.

Background and objectives Few studies have evaluated the effect of the topical application of sodium alendronate (ALN) on the treatment of intrabuccal bone defects, especially those caused by periodontitis. This 6-month randomized placebo controlled clinical trial aimed at evaluating the effect of non-surgical periodontal treatment associated with the use of 1% ALN, through clinical evaluations and cone-beam computed tomography (CBCT).Material and Methods Twenty individuals with chronic periodontitis underwent periodontal examination at the baseline as well as 3 and 6 months after periodontal treatment, registering clinical attachment level (CAL), periodontal probing depth (PPD), and bleeding on probing (BOP) as the clinical outcomes. After manual scaling and root planing, 40 bilateral sites with interproximal vertical bone defects were randomly treated with either 1% ALN gel or a placebo. Bone defects were evaluated through CBCT at the baseline and 6 months post-treatment. The clinical and CBCT parameters were compared using the Wilcoxon and Friedman tests (p<0.05).Results Although ALN produced a greater CAL gain when compared to the placebo at 6 months post-treatment (p=0.021), both treatments produced similar effects on the PPD, BOP, and bone height. Significant differences in bone fill were observed only in patients of the ALN group (4.5 to 3.8 mm; p=0.003) at 6 months post-treatment.Conclusions Topical application of 1% ALN might be a beneficial adjuvant to non-surgical periodontal therapy.

Cone beam computed tomography after round window vibroplasty: do the radiological findings match the auditory outcome?

Conclusion: The cone beam computed tomography (CBCT) imaging technique has proved to be reliable for assessing the appropriate positioning of the floating mass transducer (FMT) in the round window (RW) niche, although some parameters do not seem to be essential for achieving a satisfactory functional outcome. Objectives: To evaluate the role that specific imaging parameters derived from CBCT of the temporal bone have for predicting the functional outcome after RW vibroplasty (RW-VP). Methods: CBCT imaging was carried out in a homogeneous group of patients who presented with a mixed type of hearing loss after open tympanoplasty. Three arbitrary radiological parameters were taken into account: the FMT/RW membrane contact, bony contacts of the FMT margins, and the inferior FMT tissue support. The audiological assessment took into consideration the PTA4 (500–4000 Hz), the PTA2 (125–250 Hz), and the word recognition score (WRS) in quiet and in noise. Results: One subject presented with all positive CBCT parameters and showed a good, but not the best auditory performance among the study group. In the majority of the subjects, with a satisfactory postoperative hearing improvement, at least two of the three radiological parameters were present. In comparison with the unaided condition, an improvement in both the PTA4 and PTA2 was found in all the subjects.