Cone Beam Computed Tomography Research Articles

Middle mesial canal incidence and morphology in mandibular first molars: A cone-beam computed tomography and micro-computed tomography evaluation.

Mandibular first molar (MFM) being the first permanent posterior tooth to erupt, quite often gets involved in dental caries, which subsequently requires endodontic treatment in many cases. Thus, it is essential that the clinicians be aware of the root canal and the morphology of these teeth in detail. Over a period of years, the cases reporting with middle mesial canals (MMCs) in the MFMs have been seen on the rise; thus, it is imperative to know its incidence so that the data can be passed on to the clinicians for better management. The aim of the current research was to evaluate the incidence of MMC in the MFMs using cone-beam computed tomography (CBCT) and further evaluating its morphology with micro-computed tomography (micro-CT). Five hundred and fifty extracted permanent MFMs were collected and subjected to CBCT scan. The teeth in which MMC was found, were further subjected to micro-CT to evaluate the detailed morphology. The data exhibited the presence of MMC in 29 teeth out of 550 (5.27%). The most frequent morphological pattern observed in the MMC as per micro-CT was the confluent type (86.2%), followed by independent type (6.8%) and fin type (3.4%). Double MMC was observed in 1 tooth (3.4%). The incidence of MMC was observed to be 5.27% and the confluent type of morphological configuration was the most common type noticed.

Conventional versus cone-beam computed tomography in lung biopsy: diagnostic performance, risks, and the advantages of tract embolization with gelfoam particle suspension.

With the widespread adoption of computed tomography (CT) technology, the number of detected pulmonary nodules has gradually increased. CT-guided percutaneous needle biopsy has become the primary method for qualitative diagnosis of pulmonary nodules. Benefiting from its three-dimensional (3D) reconstruction capability, cone-beam CT (CBCT) technology has also been widely adopted. Nevertheless, pneumothorax remains the most common complication of these diagnostic and therapeutic procedures. This study assessed the diagnostic accuracy of conventional CT (CCT)- and CBCT-guided coaxial core needle biopsy (CCNB) and the effectiveness of gelfoam particle suspension in reducing complications through tract embolization. A retrospective analysis was conducted on 320 patients who had undergone CCNB for nodules ≤3 cm from January 2020 to June 2022 at Zhongshan People's Hospital, comprising 325 biopsies (145 CCT-guided and 180 CBCT-guided). Gelfoam tract embolization was specifically used in biopsies of patients identified with a high risk of complications. Comparative statistics involved diagnostic outcomes (sensitivity, specificity, accuracy), procedural lengths, complication occurrences, and radiation doses. Diagnostically, both CCT (sensitivity 93.3%, specificity 100%, accuracy 94.1%) and CBCT (sensitivity 92.8%, specificity 100%, accuracy 93.8%) offered a similarly high performance. The CCT technique was preferable in terms of shorter median operational times (19 vs. 24 minutes; P<0.001) and greater radiation exposure (13.9 vs. 10.1 mSv; P<0.001). The complication rates of CBCT and CCT, such as those of pneumothorax (18.9% vs. 20.7%; P=0.69) and hemorrhage (23.9% vs. 18.6%; P=0.25), were comparable. Of note, the comparison of biopsies with and without gelfoam embolization revealed a marked reduction in postoperative pneumothorax incidence (1.24% vs. 7.9%; P=0.004) and the requirement for drainage (0% vs. 4.27%; P=0.02), indicating the effectiveness of this procedure. CCT- and CBCT-guided lung biopsies demonstrate equivalent diagnostic capacities, with CCT providing shorter median operational times. Importantly, gelfoam embolization substantially diminishes the risk of postoperative pneumothorax, underscoring its value in high-risk patients.

Weekly Image Guidance in Patients With Cervical Cancer Treated With Intensity-Modulated Radiation Therapy: Results of a Large Cohort Study.

Image guidance is recommended for patients undergoing intensity-modulated radiation therapy (IMRT) for cervical cancer. In this study, we evaluated the feasibility of a weekly image guidance pattern and analyzed the long-term outcomes in a large cohort of patients. The study enrolled patients with Stage IB-IVA cervical cancer who received definitive radiotherapy or concurrent chemoradiotherapy. IMRT was delivered at a dose of 50.4 Gy in 28 fractions, with weekly cone-beam computed tomography (CBCT). Physicians advised patients on rectum and bladder preparation to help them prepare on nonimaging guidance days. When significant tumor regression was observed, a second computed tomography simulation and replanning were performed. The median follow-up periods were 63.4 months. The incidence rates of loco-regional and distant failure were 9.9% and 13.6%. The 5-year overall survival (OS), disease-free survival (DFS), loco-regional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 80.1%, 72.9%, 78.3%, and 74.8%, respectively. For patients with different stages, the 5-year OS, DFS, LRFS, and DMFS rates were statistically significant. For patients with and without positive regional lymph nodes, the 5-year OS, DFS, LRFS, and DMFS rates were 64.5% and 86.0%, 56.8% and 78.8%, 62.7% and 84.3%, and 58.8% and 81.0%, respectively. Multivariate analysis showed that age, histology, tumor size, cancer stage, pretreatment squamous cell carcinoma antigen level, and para-aortic metastatic lymph nodes were independent prognostic factors of OS. Fifty-six (4.0%) patients experienced late Grade 3/4 chronic toxicities. IMRT with weekly CBCT is an acceptable image guidance strategy in countries with limited medical resources.

Association between maxillary incisor width and craniofacial measurements: A cone beam computed tomography study

Accurate prediction of maxillary central incisor width (CIW) is essential in prosthodontics for selecting appropriately sized denture teeth. While traditional methods exist, the digital era may offer more reliable techniques for anterior tooth selection. The purpose of this study was to investigate the correlation between CIW and craniofacial measurements derived from cone beam computed tomography (CBCT) scans to identify predictors for CIW and examine possible sexual dimorphism. A retrospective analysis was conducted on 80 three-dimensional skull models (40 men, 40 women; age range: 20 to 48 years) generated from segmented CBCT scans. Measurements included CIW, interpterygoid hamulus distance, bi-orbital width, interorbital distance, and piriform aperture width. Statistical analyses comprised independent t tests, bivariate correlations, and multiple linear regression (α=.05). Significant sexual dimorphism was observed in CIW, interpterygoid hamulus distance, and bi-orbital width (P<.05). CIW positively correlated with bi-orbital width (r=.75, P<.001) and piriform aperture width (r=.49, P<.001). Multiple regression analysis revealed bi-orbital width, and interorbital distance, along with sex, as significant predictors of CIW (R²=.59, P<.001). Bony bi-orbital width, interorbital distance, and sex can be used to estimate the maxillary CIW.

LEADING-EDGE DEVELOPMENTS IN GUIDED ENDODONTICS: UTILIZING NEXT-GENERATION TOOLS

Guided endodontics has revolutionized root canal therapy by integrating advanced technologies to improve precision, safety, and outcomes. This method combines imaging technologies like cone beam computed tomography (CBCT) with computer-assisted navigation systems to enhance the accuracy of root canal treatments. Key stages include initial diagnostic imaging, 3D virtual treatment planning, and the use of customized guides or templates during procedures. These guides help accurately identify canal orifices, reducing procedural errors and improving access to complex root structures. Benefits include better treatment predictability, reduced procedure time, and lower risk of complications. Recent advancements, such as high-resolution CBCT, advanced 3D printing for custom guides, and improved virtual planning, have enhanced the precision of access cavity preparations. Innovations like low-profile clinical templates address challenges with restricted mouth openings, while improved intraoral scanning and virtual planning streamline preparation processes. Despite higher costs and increased planning time, guided endodontics is increasingly seen as a standard method, offering substantial improvements in clinical practice and patient outcomes. This review consolidates these advancements, emphasizing their impact on precision, efficiency, and future research directions in endodontics.

A study on the precision of voxel- and surface-based mandibular superimposition.

To apply the more accurate technique for mandibular superimposition and provide a valuable reference for the assessment of mandibular tooth movement and condylar remodeling before and after orthodontic treatment. This retrospective study involved 38 adult patients who underwent two cone beam computer tomography (CBCT) scans at different stages of treatment at Fujian Provincial People's Hospital between September, 2020 and December, 2022. The software Dolphin was used for mandible segmentation, enabling voxel-based mandibular superimposition with the mandibular ramus as the reference region. The Geomagic Wrap software was employed to process surface-based mandibular superimposition with the mandibular ramus as a reference. Additionally, the voxel and surface-based methods were compared for precision, with the mandibular ramus being the reference. After voxel-based mandibular superimposition using the mandibular ramus as a reference, with all measurement errors (< 0.20 mm). In contrast, the results of surface-based mandibular superimposition with the same reference, and the measurement errors were all less than 0.10 mm. The Wilcoxon signed-rank test revealed statistically significant differences between AS1 and BS1, AS2 and BS2, AS3 and BS3, and AS4 and BS4 (all r< 0.05). Moreover, the absolute mean distances of AS1-AS4 were all greater than those of BS1-BS4. All mandibular superimposition procedures, including the voxel- and surface-based ones using the mandibular ramus as a reference, have acceptable surface errors (< 0.20 mm), indicating the good reliability of these techniques. Under the specified conditions, surface-based mandibular superimposition appears to yield a higher degree of precision compared with the voxel-based technique.

Evaluation of root and root canal morphology in maxillary premolar teeth: A cone-beam computed tomography study using two classification systems in a Japanese population

Background/purposeInadequate knowledge increases the risk of overlooking root canals and causing procedural errors that can lead to root canal treatment failure. This study aimed to analyze the root and root canal morphology in maxillary premolar teeth using two classification systems assessed by cone-beam computed tomography (CBCT) in a large Japanese population. Materials and methodsThis study evaluated 1443 maxillary teeth including 726 first and 717 s premolars, from 642 Japanese individuals aged 16–84 years. CBCT images were analyzed according to the Vertucci and Ahmed classification systems, focusing on the root and root canal morphology. Variations were analyzed based on gender and age using the chi-square test (P < 0.05). ResultsMaxillary first premolars were predominantly single-rooted (64.9%) and had two root canals (86.2%). Females exhibited a higher prevalence of single-rooted (71.0%) compared to males (49.8%) (P < 0.05). Additionally, single root canals occurred significantly more frequently in females (14.0%) than in males (7.5%) (P < 0.05). Maxillary second premolars mostly had a single root (97.8%) with a single root canal (72.1%). The frequency of second premolars with two root canals significantly increased with age (P < 0.001). The three-rooted configuration occurred in 1.2% and 0.3% of the first and second premolars, respectively. ConclusionMaxillary premolars in a Japanese population showed significant anatomical variations, highlighting the importance of understanding anatomical characteristics specific to age and gender. Ahmed's system provides a more comprehensive description of the morphological variations.

Genicular Artery Embolization for Treatment of Symptomatic Knee Osteoarthritis—2-Year Outcomes from a Prospective IDE Trial

PurposeTo report the 24-month outcomes and subgroup analysis evaluating the safety and effectiveness of the genicular artery embolization (GAE) for the treatment of symptomatic knee osteoarthritis (OA). Materials and MethodsForty participants with symptomatic moderate-to-severe knee OA from a single-center, single-arm, prospective investigational device exemption trial of GAE were included in this study. Abnormal genicular artery neovascularity was identified at the subject’s focal knee pain with digital subtraction angiography and cone-beam computed tomography (CT). Embolization was performed with 100-μm microspheres. The primary end point was treatment effectiveness as measured by sustained improvement in OA symptoms at 24 months, quantified using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Treatment success was defined as ≥50% decrease in WOMAC relative to baseline. Clinical outcomes were assessed with mean age of 66.0 years (SD ± 8.1) and body mass index of 30.1 kg/m2 (SD ± 6.2). ResultsOf the 40 patients, 2 (5.0%) were lost to follow-up. Overall, 18 of 38 (47.4%) patients demonstrated ≥50% reduction in WOMAC at 24 months. In the subset of patients with initial clinical success at 12 months, 18 of 25 (72.0%) reported sustained clinical success at 24 months. Seven of 25 (28.0%) patients had symptom recurrence between 12 and 24 months and were determined to be clinical failures. All treatment-related adverse events occurred within 12 months after GAE, without additional events after 12 months. ConclusionsGAE is effective in achieving sustained symptom relief related to moderate-to-severe knee OA for up to 24 months with an acceptable safety profile.

Morphological changes in temporomandibular joint architecture in patients with temporomandibular disorders: systematic review protocol

ObjectiveThe review involves the assessment of morphological variations in the temporomandibular joint (TMJ) and its associated structures in patients with temporomandibular disorder.IntroductionTemporomandibular disorders (TMD) are debilitating conditions that affect the...

Assessment of Diagnosis of Apical Root Fractures During Tooth Extraction Using Different Radiographic Techniques: An Ex-vivo Study

Objective: This study aimed to examine the diagnostic ability of different imaging techniques for apical root fractures that occur during tooth extraction by specialist dentists in different branches. Methods: Dry human mandibles used for education at Faculty of Dentistry and teeth extracted for routine treatment were used. After the root lengths were measured using a periodontal probe, the samples were adjusted to different lengths. These specimens were placed on a dry human mandible, and images were obtained and recorded using a periapical device, panoramic device, and computed tomography. Radiographs and recordings were performed by an oral and maxillofacial radiologist. The evaluation process was performed by an oral and maxillofacial radiologist, periodontologist, and oral and maxillofacial surgeon. Results: The diagnosis of 1 mm root presence and absence on periapical radiographs showed significant agreement among all observers. In the presence of 2 mm and 3 mm roots, all observers stated that the roots were present. On the panoramic radiographs, moderate agreement was observed in teeth with a 1 mm root. However, poor agreement between observers was observed for teeth with 2 mm and 3 mm roots. Cone-beam computed tomography (CBCT) was effective for the diagnosis of all observers. Conclusion: Consistent with the literature, the present study showed a higher interobserver agreement in CBCT. However, considering the patient's anxiety during the procedure, the duration of local anesthesia, and the surgeon's fatigue, two-dimensional radiographs are generally preferred over CBCT, which has a longer image processing time. Diagnosis using periapical radiographs was more effective than that using panoramic radiographs.

Application of Cone-Beam Computed Tomography-Generated Cephalograms in Children and Adolescents

This study investigates the potential of cone-beam computed tomography (CBCT)-generated cephalograms as a replacement for conventional lateral cephalograms (LCs) in children and adolescents. This retrospective study included 60 individuals, equally divided into permanent and mixed dentition groups. Both groups underwent conventional LCs and CBCT scans on the same day. LCs were then derived from CBCT scans. The same examiner performed digital measurements twice, with a week’s interval, identifying landmarks and obtaining 7 angular and 5 linear measurements. In the permanent dentition group, significant differences were observed between the two imaging modalities for 6 angular and 2 linear measurements. In the mixed dentition group, significant differences were observed for 3 angular and 2 linear measurements. However, none of these differences exceeded the clinically acceptable limit of 2.0º or 2.0 mm. No significant differences in any measurement were found between the two groups (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). CBCT-generated LCs demonstrated comparable results with good reliability in both dentition groups, suggesting their potential as suitable alternatives for children and adolescents who require CBCT for clinical purposes.

Application of Artificial Intelligence in Cone-Beam Computed Tomography for Airway Analysis: A Narrative Review.

Cone-beam computed tomography (CBCT) has emerged as a promising tool for the analysis of the upper airway, leveraging on its ability to provide three-dimensional information, minimal radiation exposure, affordability, and widespread accessibility. The integration of artificial intelligence (AI) in CBCT for airway analysis has shown improvements in the accuracy and efficiency of diagnosing and managing airway-related conditions. This review aims to explore the current applications of AI in CBCT for airway analysis, highlighting its components and processes, applications, benefits, challenges, and potential future directions. A comprehensive literature review was conducted, focusing on studies published in the last decade that discuss AI applications in CBCT airway analysis. Many studies reported the significant improvement in segmentation and measurement of airway volumes from CBCT using AI, thereby facilitating accurate diagnosis of airway-related conditions. In addition, these AI models demonstrated high accuracy and consistency in their application for airway analysis through automated segmentation tasks, volume measurement, and 3D reconstruction, which enhanced the diagnostic accuracy and allowed predictive treatment outcomes. Despite these advancements, challenges remain in the integration of AI into clinical workflows. Furthermore, variability in AI performance across different populations and imaging settings necessitates further validation studies. Continued research and development are essential to overcome current challenges and fully realize the potential of AI in airway analysis.

Evaluation of Anatomical Landmark Consistency in the Auditory Meatus Using Cone-Beam Computed Tomography (CBCT) Imaging

IntroductionThe present study evaluated the consistency and reliability of five anatomical landmarks in the external auditory meatus using CBCT (cone beam computed tomography) scans. The goal was to determine if these landmarks could reliably replace the commonly used point Porion for superimposing CBCT scans in clinical practice. Consistent anatomical features in the external auditory meatus are essential for accurate cranial assessments in dentistry and medicine. Despite their importance, these features have been underexplored, making this study a valuable contribution to improving clinical evaluation accuracy. Materials and methods22 CBCT scans were analyzed using ITK-Snap software. The shape of the External Auditory Meatus had been rendered by segmentation. These segmentations were used as a basis to locate the landmarks. The spread in location of the suggested landmarks concerning a reference coordinate system was treated as a measure for consistency. For that purpose, the absolute mean distance from all registered landmarks to the center of the location cloud was calculated for each dataset. ResultsThe smallest spread in locations was measured for the so-called Epitympanic Notch, with 4.3 mm on average (SD 1.7). However, recognizing this landmark in the segmented images appeared to be relatively difficult. The landmark with the second smallest spread in locations (4.4 mm (SD 2.2)) and an easier recognition in the segmented image was the most superior point of the external auditory meatus. The most inferior point appeared to be the least reliable of all five landmarks. ConclusionBased on the present study, a consistently reliable landmark in the External Auditory Meatus to replace point Porion could not be identified. The hypothesis that any landmark could suffice for superimposing CBCT scans was not confirmed.

Comprehensive sinus contour classification and its characteristics from radiographic examination: a cross-sectional study

ObjectiveThe aim of this study was to propose a comprehensive maxillary sinus (MS) contour classification system based on the evaluation of anatomical characteristics from cone beam computed tomography (CBCT) examination and investigate the relationship between sinus contours and sinus floor elevation (SFE).MethodsA total of 283 CBCT scans from patients who had single tooth loss in the posterior maxilla and underwent SFE were analyzed. The MS was classified at each tooth position. For buccal-palatal evaluation, the classification from Type A to E was narrow-taper, taper, ovoid, square, and irregular, respectively. For mesial-distal evaluation, the classification from Type 1 to 4 was flat, slope, concave, and septa, respectively. The major anatomical parameters evaluated were (1) residual bone height (RBH), (2) sinus width (SW), (3) maxillary sinus angle (MSA), (4) buccal dip angle (BDA), (5) palatonasal recess (PNR), and (6) sinus depth.ResultsEleven groups of MS contour were classified after detailed calculation. Differences in the RBH, MSA, BDA, and SW among different groups were statistically significant. The narrow-taper and slope MS (A2) group had the highest RBH (8.66 ± 0.77 mm), largest BDA (79.9° ± 3.18°), smallest MSA (19.8° ± 2.01°), and narrowest SW (6.30 ± 1.23 mm). The lowest RBH was in the square and concave sinus (D3) group (5.11 ± 2.70 mm). The ovoid and concave sinus (C3) group had the smallest BDA (50.64 ± 8.73 mm) and largest MSA (74.11° ± 11.52°). The square and flat MS (D1) group had the widest SW (19.13 ± 3.69 mm). A strongly significant positive correlation was observed between the SW and MSA (r = 0.67) and a strongly negative correlation between the SW and BDA (r = − 0.65). The prevalence of PNR (mean angle: 104.06° ± 16.83°, mean height: 14.72 ± 11.78 mm) was 38% and frequently observed in the ovoid and slope MS (C2) group.ConclusionDespite certain characteristics at different tooth sites, the same tooth position was categorized differently using different classification systems, indicating large anatomical variations in the MS. The classification system proposed herein allows for classification based on general characteristics at a single tooth site, aiming to help surgeons in improving presurgical evaluation.

Morphometric Analysis of the Mandibular Canal and Its Anatomical Variants in a Chilean Subpopulation: Cone Beam Computed Tomography Study.

The inferior alveolar nerve (IAN), contained within the mandibular canal (MC), is a structure prone to damage in clinical and surgical procedures on the mandible. This study aimed to analyze the MC morphology and its anatomical variants in a Chilean subpopulation using cone beam computed tomography (CBCT). In total, 342 images from patients with the following parameters were observed: 120 kV, 9 mA, field of view 12 × 9 MC, and voxel size 0.12 mm. The average length of the MC recorded a mean value of 70.493 ± 4.987 mm on the right side and 70.805 ± 5.177 mm on the left side. The location of the mental foramen (MF) was most frequently found between the mandibular first and second premolar. The greatest bone thickness was found at the level of the basilar border of the 2MPM. The root closest to the MC was distal from the mandibular second molar. The lowest thickness was in the lingual area at 1MM. The prevalence of the anterior loop (AL) (61.5%) and the retromolar canal (RC) (17.5%) showed no significant differences between men and women. The results obtained showed that the morphology of the MC in the Chilean subpopulation can vary.

Relationship between interincisal angles and TMJ morphology/position and trabecular structure: a retrospective study

BackgroundTMJ morphology/position and trabecular structure are influenced by various factors. The role of the interincisal angle, an indicator of the anterior occlusal relationship, on TMJ remains unclear. This study aims to investigate the morphology, trabecular bone structure, and position of the condyle, as well as the glenoid fossa’s morphology in skeletal class II populations with different interincisal angles.Materials and methodsA total of 150 adult patients with normodivergent facial types and skeletal class II malocclusions were selected and divided into three groups based on their interincisal angles: normal, small, and large angle groups. The indexes of TMJ were measured using cone-beam computed tomography (CBCT) data and analyzed using Dolphin Imaging, Mimics, and ImageJ.ResultsThe small angle group had the smallest anteroposterior diameter (APD), while the large angle group had a greater mediolateral diameter (MLD). The large angle group exhibited significantly the largest maximum axial area, bone surface area, and bone volume (P < 0.05). Small and large angle groups exhibited greater bone trabeculae (Tb. N) and thinner trabecular thickness (Tb. Th). Compared to the normal angle group, the small angle group exhibited a larger horizontal condylar angle and smaller bilateral condylar angles on the axial plane, while the large angle group showed the opposite trend. Small and large angle groups showed a reduced vertical condyle angle on the coronal plane, with the largest reduction observed in the large angle group (P < 0.05). Small and large angle groups had higher heights of the glenoid fossa (GFH). The large angle group exhibited the greatest GFH and width of the glenoid fossa (GFW) (P < 0.05).ConclusionThe large angle group had elongated oval and large condyles, and deeper glenoid fossae, while a flattened-oval and smaller condyle, and wider and shallower glenoid fossae were observed in the small angle group. Small and large interincisal angle affects the structure of condylar trabeculae, resulting in thinner Tb. Th and greater Th. N. In the condylar position, small and large angle groups exhibit condylar rotation in the axial and coronal planes. Therefore, the interincisal angle affects the morphology, position, and trabecular structure of the TMJ. This implies that we must pay attention to the impact of the interincisal angle on TMJ, and it is crucial to restore the normal interincisal angle during orthodontic treatment.

1261: A safe clinical introduction of MR-only workflow in cone-beam CT based palliative spine radiotherapy

1261: A safe clinical introduction of MR-only workflow in cone-beam CT based palliative spine radiotherapy

Incidental Findings Following Dental Implant Procedures in the Mandible: A New Post-Processing CBCT Software Analysis.

Background/Objectives: The aim of this study was to evaluate incidental findings in the mandible after the placement of dental implants using a new cone-beam computed tomography (CBCT) software. Methods: The initial sample consisted of 2872 CBCT scans of patients of both sexes. The parameters evaluated in this study were the location of the implants in the mandible, implant length, anatomical relationship of the implant with the mandibular canal, presence or absence of damage to the adjacent teeth, presence or absence of implant fractures, and presence or absence of bone support. Fisher's exact test was performed to compare the variables. The significance level was set at p = 0.05. Results: Out of 2872 CBCT scans, 214 images of patients with an average age of 44.5 years were included. The most frequent location of the implants was the posterior region (93.5%), with 54% of the implants having a length between 9 and 14 mm. It was found that 92% of the implants were positioned above the mandibular canal. Damage to adjacent teeth was observed, with no correlation with the implant positioning (p = 1.000). In 100% of cases of implants in the anterior region, there was bone support. Fracture was observed in 1.7% of implants with a length between 9 and 14 mm. Conclusions: The installation of implants in the mandible occurs more frequently in the posterior region, with a high presence of bone support and a low incidence of damage to adjacent teeth, anatomical structures, and fractures.

The assessment of bone health in children with juvenile idiopathic arthritis; comparison of different imaging-based methods

BackgroundOsteoporosis is increasingly being recognized in children, mostly secondary to systemic underlying conditions or medication. However, no imaging modality currently provides a full evaluation of bone health in children. We compared DXA, a radiographic bone health index (BHI (BoneXpert) and cone-beam CT for the assessment of low bone mass in children with juvenile idiopathic arthritis (JIA).MethodsData used in the present study was drawn from a large multicentre study including 228 children aged 4–16 years, examined between 2015 and 2020. All had a radiograph of the left hand, a DXA scan and a cone-beam CT of the temporomandibular joints within four weeks of each other. For the present study, we included 120 subjects, selected based on DXA BMD and BoneXpert BHI to secure values across the whole range to be tested.ResultsOne hundred and twenty children (60.0% females) were included, mean age 11.6 years (SD 3.1 years). There was a strong correlation between the absolute values of BHI and BMD for both total body less head (TBLH) (r = 0.75, p < 0.001) and lumbar spine (L1-L4) (r = 0.77, p < 0.001). The correlation between BHI standard deviation score (SDS) and BMD TBLH Z-scores was weak (r = 0.34) but significant (0 = 0.001), varying from weak (r = 0.31) to moderate (r = 0.42) between the three study sites.Categorizing BHI SDS and DXA BMD Z-scores on a 0–5 scale yielded a weak agreement between the two for both TBLH and LS, with w-kappa of 0.2, increasing to 0.3 when using quadratic weights. The agreement was notably higher for one of the three study sites as compared to the two others, particularly for spine assessment, yielding a moderate kappa value of 0.4 – 0.5.For cone-beam CT, based on a 1–3 scale, 59 out of 94 left TMJ’s were scored as 1 and 31 as score 2 by the first observer vs. 87 and 7 by the second observer yielding a poor agreement (kappa 0.1).ConclusionsCategorizing DXA LS and automated radiographic Z-scores on a 0–5 scale gave a weak to moderate agreement between the two methods, indicating that a hand radiograph might provide an adjuvant tool to DXA when assessing bone health children with JIA, given thorough calibration is performed.

Novel 3-dimensional classification of cervical abrasion using CBCT: A comprehensive analysis

IntroductionTooth cervical abrasion (CA) is a prevalent non-carious cervical lesion that poses challenges for accurate diagnosis from periapical radiographs due to difficulties in assessing the lesion's extent, associated bone loss, and pulpal involvement. The presence of overlying bone structures on the palatal side when lesions are located on the buccal side, or vice versa, further complicates radiographic interpretation. So it is important to define the lesions in all three dimensions. ObjectiveTo provide a three-dimensional descriptive classification for cervical abrasion lesions using Cone Beam Computed Tomography (CBCT). MethodA total of 50 patients with cervical abrasion were selected for the study. From these patients, teeth (n = 10) from each of the four different quadrants were chosen. A CBCT scan with a 6 × 6 cm field of view (FOV) was performed, and the DICOM files of the cervical lesions were transferred to 3-D imaging software. The CBCT images of the cervical abrasion lesions were assessed at the level of the deepest point of the lesion along the long axis of the tooth in both axial and sagittal planes. The height (A), buccolingual dimension (B), circumferential spread (C), and remaining dentine thickness (D) were evaluated and classified using new scoring criteria for each dimension. The reliability and reproducibility of the classification were assessed to ensure its clinical applicability. ConclusionCBCT can be utilized to classify tooth cervical abrasion in endodontics, enhancing diagnosis, analysis, and treatment outcomes. This three-dimensional view facilitates easier communication among clinicians, allows for tailored treatment approaches, and opens new avenues for research.