Ann Wenzel

Cone beam computed tomography and periapical lesions: a systematic review analysing studies on diagnostic efficacy by a hierarchical model

AIMnTo evaluate using a systematic review approach the diagnostic efficacy of CBCT for periapical lesions, focusing on the evidence level of the included studies using a six-tiered hierarchical model.nnnMETHODOLOGYnThe MEDLINE bibliographic database was searched from 2000 to July 2013 for studies evaluating the potential of CBCT imaging in the diagnosis and planning of treatment for periapical lesions. The search strategy was limited to English language publications using the following combined terms in the search strategy: apical pathology or endodontic pathology or periapical or lesion or healing and CBCT or cone beam CT. The diagnostic efficacy level of the studies was assessed independently by four reviewers.nnnRESULTSnThe search identified 25 publications that qualitatively or quantitatively assessed the use of CBCT for the diagnosis of periapical lesions, in which the methodology/results comprised at least one of the following parameters: the methods, the imaging protocols or qualitative/quantitative information on how CBCT influenced the diagnosis and/or treatment plan.nnnCONCLUSIONnFrom the assessed studies, it can be concluded that although there is a tendency for a higher accuracy for periapical lesion detection using CBCT compared to two-dimensional imaging methods, no studies have been conducted that justify the standard use of CBCT in diagnosing periapical lesions. In addition, it should be considered that, at the present time, the efficacy of CBCT as the diagnostic imaging method for periapical lesions has been assessed merely at low diagnostic efficacy levels.

Early, delayed, or late single implant placement : 10-year results from a randomized controlled clinical trial

AIMnThe aim of this study was to present the 10-year clinical and radiographic data from a RCT on single-tooth implants placed early, delayed, or late after tooth extraction.nnnMATERIALS AND METHODSnSixty-three patients were randomly allocated to three groups and received an implant on average 10 days (Ea), 3 months (De), or 17 months (La) after tooth extraction. Second-stage surgery was performed after 3 months of submerged healing; metal-ceramic crowns were cemented after one additional month. Standardized periapical radiographs were taken 1 week after implant placement (TP), 1 week (TC) and 1-1.5 year (T1) after crown delivery, and 10 years after implant placement (T10). Pocket depth (PD) and bleeding on probing were registered during controls (TC - T10).nnnRESULTSnTwo Ea and one De implants failed to osseointegrate. Seven patients (4 Ea, 1 De, and 2 La) were not available at T10 . No significant differences were found among groups regarding implant survival or radiographic peri-implant marginal bone levels (Ea: 1.15 ± 0.77; De: 1.53 ± 1.06; La: 1.42 ± 1.07) at T10 . Similarly, no differences were observed among groups in the number of implants with PD ≥ 5 mm (Ea: 29%; De: 35%; La: 44%) or the average depth of the sites with PD ≥ 5 mm (Ea: 5.4 ± 0.7; De: 6.1 ± 1.4; La: 5.4 ± 0.5) at T10 . Peri-implant mucositis was found in 70% of the cases; peri-implantitis was diagnosed only in two implants (1 De, 1 La) corresponding to 4.3%.nnnCONCLUSIONnSingle-tooth implants placed early or delayed after tooth extraction show high survival rates and limited peri-implant marginal bone resorption or biological complications, similar to what is observed with implants placed according to the conventional (late) protocol.

Comparison of images from digital intraoral receptors and cone beam computed tomography scanning for detection of voids in root canal fillings: an in vitro study using micro-computed tomography as validation

OBJECTIVEnTo compare the diagnostic value of six intraoral digital receptors and a cone beam computed tomography scanning system for detection of voids in root fillings.nnnMETHODSnSixty-seven root-filled roots with oval and ribbon-shaped canals were included. Three standardized radiographic examinations were performed for each root with six intraoral digital receptors. Further, the roots were examined using CBCT. Four observers measured the extension of voids in all images. The true extension of voids was recorded in cross-sectional images from micro-computed tomography scans (micro-CT). The proportion of voids observed in the radiographic image validated against micro-CT was calculated for each system.nnnRESULTSnAll intraoral receptors underestimated the extension of voids, and few false positives were recorded. CBCT resulted in a higher proportion of correctly observed voids, but with several false-positive recordings.nnnCONCLUSIONSnThe diagnostic value differed little among the six intraoral systems. CBCT overestimated in many cases the proportion of voids in root fillings.

Diagnostic accuracy of conventional and digital radiography for detecting misfit between the tooth and restoration in metal-restored teeth

STATEMENT OF PROBLEMnAlthough the postprocessing of digital images with enhancement filters could lead to the presence of artifacts and result in false-positive diagnoses, no study has analyzed whether the use of digital radiographs and/or postprocessing of digital images interferes with the diagnosis of marginal adaptation in metal-restored teeth.nnnPURPOSEnThe purpose of this study was to compare the diagnostic accuracy of conventional and digital radiographic images with and without filters for detecting a misfit between the tooth and restoration in metal-restored teeth.nnnMATERIAL AND METHODSnForty teeth with mesial-occlusal-distal inlays and 40 with complete crowns (each with a perfect fit, 20 with a 0.2-mm gap and 20 with a 0.4-mm gap) were imaged with conventional film and digital phosphor plate systems. Digital radiographs were exported as original images and with edge enhancement (high and low), inversion, and pseudo-3-dimensional filters. Four examiners assessed the presence of gaps by using a categorical scale (fit, misfit, cannot decide). Sensitivity, specificity, and overall accuracy were calculated for each variable. In addition, time spent scoring the images was recorded. A multivariate logistic regression was performed with accuracy as the dependent variable.nnnRESULTSnOf the images, 6.2% received the score cannot decide, most of them with a high edge enhancement filter and in the crown group. A tendency for higher sensitivity (range 0.67-0.83), specificity (range 0.81-0.92), and accuracy (range 0.73-0.86) values was found in conventional and digital original images. Results of a logistic regression found that restoration type, gap size, and high enhancement and inversion filters had a statistically significant impact on accuracy (P<.05).nnnCONCLUSIONSnOriginal nonfiltered images should be used to assess teeth with metal restorations. High enhancement filters and image inversion should be avoided, especially when metal crowns are present.

Diagnostic accuracy of cone beam computed tomography sections with various thicknesses for detecting misfit between the tooth and restoration in metal-restored teeth

OBJECTIVEnTo evaluate the diagnostic accuracy of cone beam computed tomography (CBCT) sections with various reconstruction thicknesses for detecting misfit between tooth and restoration in metal-restored teeth.nnnSTUDY DESIGNnEighty teeth (perfect fit, 40 of these used with 0.2 mm gap, and 40 with 0.4 mm gap), were imaged with large FOV i-CAT. Images were reconstructed in five thicknesses: 0.2 (voxel size), 1, 2, 5, and 10 mm. Four examiners assessed the presence of gaps using a 5-point scale. Area under the receiver operating characteristics curve (aucROC) for misfit detection was calculated for each variable. A multivariate logistic regression was performed by using misfit detection accuracy as the dependent variable.nnnRESULTSnThe score cannot decide decreased when the reconstruction thickness was increased. Mean aucROC ranged between 0.60 and 0.72. Logistic regression showed that the presence of a gap and reconstruction thickness had an impact on diagnostic accuracy.nnnCONCLUSIONSnDiagnostic accuracy of CBCT sections was low for detecting misfit in metal-restored teeth.

Factors affecting the possibility to detect buccal bone condition around dental implants using cone beam computed tomography

OBJECTIVESnTo evaluate factors with impact on the conspicuity (possibility to detect) of the buccal bone condition around dental implants in cone beam computed tomography (CBCT) imaging.nnnMATERIAL AND METHODSnTitanium (Ti) or zirconia (Zr) implants and abutments were inserted into 40 bone blocks in a way to obtain variable buccal bone thicknesses. Three combinations regarding the implant-abutment metal (TiTi, TiZr, or ZrZr) and the number of implants (one, two, or three) were assessed. Two CBCT units (Scanora 3D - Sc and Cranex 3D - Cr) and two voxel resolutions (0.2 and 0.13xa0mm) were used. Reconstructed sagittal images (2.0 and 5.0xa0mm thickness) were evaluated by three examiners, using a dichotomous scale when assessing the condition of the buccal bone around the implants. A multivariate logistic regression was performed using examiners detection of the buccal bone condition as the dependent variable. Odds ratio (OR) were calculated separately for each CBCT unit.nnnRESULTSnImplant-abutment combination (ZrZr) (OR Scxa0=xa019.18, OR Crxa0=xa011.89) and number of implants (3) (OR Scxa0=xa012.10, OR Crxa0=xa04.25) had major impact on buccal bone conspicuity. The thinner the buccal bone, the higher the risk that the condition of the buccal bone could not be detected. The use of lower resolution protocols increased the risk that buccal bone was not properly detected (OR Scxa0=xa01.46, OR Crxa0=xa02.00). For both CBCT units, increasing the image reconstruction thickness increased the conspicuity of buccal bone (OR Scxa0=xa00.33, OR Crxa0=xa00.31).nnnCONCLUSIONSnBuccal bone conspicuity was impaired by a number of factors, the implant-abutment material being the most relevant. Acquisition and reconstruction factors had minor impact on the detection of the buccal bone condition.

Clinical cavitation and radiographic lesion depth in proximal surfaces in an Indian population

Abstract Objectives. To assess the relationship between clinical cavitation and radiographic caries lesion depth in proximal surfaces of permanent posterior teeth in an Indian population. This study also assessed the clinical feasibility of applying ’western guidelines’ to this population from the developing world. Materials and methods. Relationship between clinical cavitation and radiographic caries lesion depth in proximal surfaces in an Indian population was assessed. Proximal surfaces (n = 126) without restorations were examined on bitewing radiographs in patients with suspected caries and lesion depth was recorded by five observers. The radiographic scoring scale was 0 = sound; 1 = lesion in enamel; 2 = lesion in outer 1/3 of dentine and 3 = lesion in inner 2/3 of dentine. Orthodontic separators were placed interdentally and removed after 3 days, where surfaces were recorded as cavitated (yes/no) by two clinical validators (gold standard). Results. Enamel lesions were cavitated in 25.6–38.3%, outer dentinal lesions were cavitated in 83.3–100% and inner dentinal lesions were cavitated in 96.4–100% depending on observer and validator. On applying ‘western guidelines’ for treatment decision to the radiographic findings of lesion depth, 80–100% of the lesions observed in outer dentine would lead to a false (non-operative) treatment decision. Conclusions. Radiographic shallow carious lesions were often cavitated in this population. The threshold for cavitation in this study population is suggested to be set between enamel and outer dentine in contrast to western guidelines.

Radiographic diagnosis of dental restoration misfit: a systematic review

The objective of this study was to perform a systematic review on the use of radiographic methods for the diagnosis of misfit in dental prostheses and restorations. The MEDLINE bibliographic database was searched from 1950 to February 2014 for reports on the radiographic diagnosis of misfits. The search strategy was limited to English-language publications using the following combined MeSH terms in the search strategy: (Dental Restoration OR Dental Prosthesis OR Crown OR Inlays OR Dental Abutments) and (Dental Leakage OR Prosthesis Fitting OR Dental Marginal Adaptation OR Surface Properties) and (Radiography, Dental OR Radiography, Dental, Digital OR Cone-Beam Computed Tomography). Twenty-eight publications were identified and read in full text, and 14 studies fulfilled criteria for inclusion. Information regarding the use of radiographic methods for the diagnosis of misfits in dental prosthesis and restorations, and in which the methodology/results comprised information regarding how the sample was collected/prepared, the method, imaging protocol, presence of a reference test and the outcomes were evaluated. QUADAS criteria was used to rate the studies in high, moderate or low quality. The evidence supporting the use of radiographic methods for the diagnosis of misfits in dental prosthesis and restorations is limited to low-/moderate-quality studies. The well-established intra-oral orthogonal projection is still under investigation and considered the most appropriate method, both when evaluating the relation between dental restoration to tooth and abutment to implant. Studies using digital radiographs have not evaluated the effect of image post-processing, and tomography has not been evaluated.

Biological complications after early/delayed/late implant placement : 10-year results from a RCT

European Association of Osseointegration, EAO 22nd Annual Scientific Meeting, Dublin, Ireland 17-19 October 2013

Influence of fresh-frozen allogeneic bone grafts architecture on its incorporation : radiographic and histomorphometric comparison to the gold-standard

European Association of Osseointegration, EAO 22nd Annual Scientific Meeting, Dublin, Ireland 17-19 October 2013