Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2019
Objectives The aim of the study was to determine if the same critical measurement of vertical alv... more Objectives The aim of the study was to determine if the same critical measurement of vertical alveolar ridge height at a dentoalveolar implant recipient site can be measured to the same degree of accuracy from cone beam computed tomography (CBCT) volumetric data with 2 very popular but different commercially available DICOM (Digital Imaging and Communications in Medicine) imaging software: InVivoDental (Anatomage, San Jose, CA, USA) and CareStream 3D (CareStream Dental, Rochester, NY, USA). To determine the degree of precision of alveolar ridge height measurements, we used 2 different DICOM imaging software: InVivoDental (Anatomage, San Jose, CA, USA) and CareStream 3D (CareStream Dental, Rochester, NY, USA). Methods Fifteen maxillary and 15 mandibular posterior implant sites were selected from CBCT patient records (institutional review board # 5160188) at the Loma Linda University School of Dentistry (Loma Linda, CA). The sites also had radiographic stents with directional guide ho...
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2019
Background This study aimed to establish a quantitative method for measuring dental pulp disease ... more Background This study aimed to establish a quantitative method for measuring dental pulp disease in vivo. Current clinical examinations of the dental pulp use thermal (hot/cold), (percussive/palpatory), and electric pulp testing to evaluate tooth vitality. These tests offer some utility, but the results are extremely variable and subjective. Standard radiography has also been used, but it lacks diagnostic sensitivity until the disease process is advanced. Objective The study combines 2 novel areas of contemporary medical research: positron emission tomography (PET) and immune pathway modulation to develop a noninvasive diagnostic tool that can be used for the detection and localization of dental pulp disease. The calcitonin-gene-related peptide (CGRP), a neuropeptide released when the peripheral nervous system, regulates the immune system by activating the inflammatory process. We used a specific PET-tracer, [11C]MK-4232, a CGRP receptor marker to locate and quantify CGRP released a...
Background Objective quantification of periapical disease on radiographs has evolved since the 19... more Background Objective quantification of periapical disease on radiographs has evolved since the 1980s.1-3 The periapical index (PAI)1 was developed for classifying findings on periapical radiographs to assist in the diagnosis of pulpal disease. The PAI uses subjective, descriptive terminology that is too broad for the degree of detail present with cone beam computed tomography (CBCT) imaging. The CBCT-PAI2 uses measurable objective findings. However, the measurement intervals are large and do not distinguish the fine details of smaller or early-stage lesions seen on CBCT, thus limiting the ability to categorize early periapical disease or healing. The revised CBCT-PAI3 defines in more detail how to position the tooth in 3 fixed and reproducible planes. Tsai4 showed that small-volume, high-resolution CBCT scans could distinguish periapical radiolucencies measuring less than 0.5 mm. Therefore, the CBCT–endodontic radiolucency index (CBCT-ERI) is presented as an objective, repeatable in...
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Background There is evidence that capture and processing of the digital radiographic images may c... more Background There is evidence that capture and processing of the digital radiographic images may contain artifacts that could reduce the diagnostic value of dental radiographs. This phenomenon has been reported through various case reports. However, its effect on radiographic image quality has not been studied. Objective(s) The purpose of this study was to evaluate the effect of image processing on the quality of dental digital radiographs using the most common type of filter—sharpening. Study Design Three imaging modalities (2 complementary metal-oxide-semiconductor [CMOS], 1 photostimulable phosphor [PSP]) were used to image a DDQA imaging phantom (Digital Dental Quality Assurance phantom) and to create a flatfield radiograph. Contrast resolution, spatial resolution, dynamic range, and radiographic noise were assessed for image quality. Overshoot artifact was also assessed. Each image was sharpened and then highly sharpened. Images were compared using Friedman's 2-way nonparametric analysis of variance (ANOVA). Results Image sharpening significantly affected spatial resolution and noise. Conversely, dynamic range and contrast resolution were not significantly affected by image sharpening. Overshoot artifact increased with image sharpening. Discussion/Conclusions Image sharpening can create artifacts that could be misinterpreted. Although image sharpening significantly affects spatial resolution, no significant effect was seen on dynamic range or contrast resolution.
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Background Benign, solitary osteochondromas arise in response to an event (e.g., trauma, x-radiat... more Background Benign, solitary osteochondromas arise in response to an event (e.g., trauma, x-radiation), rather than as true neoplasms. Typically, osteochondromas represent 10% to 15% of all bone tumors and approximately 35% of benign bone tumors. They usually develop during a known age range and at largely predictable anatomic sites, whether the osteochondroma is benign or malignant. The most important piece of clinical information is the patient's age, although exceptions exist. Most osteochondromas occur on the metaphysis of appendicular long bones. Clinical and Radiographic findings Three cases are of temporomandibular condylar osteochondromas are presented. All patients were adult males with ages 29, 55, and 56 years. Each tumor arose from the condylar articular surface and developed into abnormal morphologies that followed the outline of adjacent structures. Definitive Interpretation The radiographic findings of an exostotic bony tumor with smooth but irregular outlines, sclerosed cortices, and moderately dense trabeculation confined within the joint capsule were consistent with the radiographic appearance of osteochondroma. Discussion Radiographically, 2-D imaging is adequate to establish an initial radiographic diagnosis. However, more advanced modalities (computed tomography/magnetic resonance imaging [CT/MRI) are indicated to better evaluate the orientation of the tumor and assist in the surgical management. The 3-D imaging of the 3 cases presented here emphasize this point. Positron emission tomography/fluorodeoxyglucose (PET/FDG) imaging has also been recommended for specific cases. MRI may overestimate tumor aggressiveness secondary to the influence of bone marrow and soft tissue edema. The recognition of an osteochondroma is significant because it is benign, but it can lead to disfigurement and loss or altered mandibular function, if not treated.
The purpose of this study was to determine the incidence and size of periapical radiolucencies us... more The purpose of this study was to determine the incidence and size of periapical radiolucencies using cone-beam computed tomographic (CBCT) imaging in teeth without apparent signs of intraoral radiographic lesions. One hundred twenty roots from 53 patients who had been determined to have no signs of intraoral radiographic lesions were included in this study. Limited-volume CBCT scans were taken at 0.125-mm3 voxel size. The widest area of apical radiolucency of each root canal-treated tooth was measured and assigned a numeric score based on the CBCT-Endodontic Radiolucency Index (ERI). CBCT data were evaluated by 2 radiologists with an interclass correlation coefficient of 0.96. The majority of roots (53.3%) had periodontal ligament widths ≤0.5 mm; 26.7% had radiolucency widths of 0.5 < x ≤ 1 mm, 15.0% had radiolucency widths of 1.0 < x ≤ 1.5 mm, 0.8% had radiolucency widths of 1.5 < x ≤ 2.0 mm, 1.7% had radiolucency widths of 2.0 < x ≤ 2.5 mm, and 2.5% had radiolucency wi...
The International journal of periodontics & restorative dentistry
This study was conducted to evaluate the accuracy of implants placed using two different guided i... more This study was conducted to evaluate the accuracy of implants placed using two different guided implant surgery materials: thermoplastic versus three-dimensionally (3D) printed. A cone beam computed tomography (CBCT) scan previously obtained and selected for single-tooth implant replacement was converted into a Digital Imaging and Communications in Medicine (DICOM) file. All models were planned and exported for printing using BlueSkyBio Plan Software with the DICOM files. A total of 20 3D-printed mandibular quadrant jaws replicating the CBCT were printed by Right Choice Milling, as was the control model to accept the control implant. Previously, 10 thermoplastic and 10 3D-printed surgical guides had been made by the same lab technician at Right Choice Milling. One Nobel Biocare implant with a trilobe connection was placed per guide and replica jaw model pair. Implants were placed using the thermoplastic and 3D-printed surgical guides, representing the two test groups, following the ...
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2019
Objectives The aim of the study was to determine if the same critical measurement of vertical alv... more Objectives The aim of the study was to determine if the same critical measurement of vertical alveolar ridge height at a dentoalveolar implant recipient site can be measured to the same degree of accuracy from cone beam computed tomography (CBCT) volumetric data with 2 very popular but different commercially available DICOM (Digital Imaging and Communications in Medicine) imaging software: InVivoDental (Anatomage, San Jose, CA, USA) and CareStream 3D (CareStream Dental, Rochester, NY, USA). To determine the degree of precision of alveolar ridge height measurements, we used 2 different DICOM imaging software: InVivoDental (Anatomage, San Jose, CA, USA) and CareStream 3D (CareStream Dental, Rochester, NY, USA). Methods Fifteen maxillary and 15 mandibular posterior implant sites were selected from CBCT patient records (institutional review board # 5160188) at the Loma Linda University School of Dentistry (Loma Linda, CA). The sites also had radiographic stents with directional guide ho...
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2019
Background This study aimed to establish a quantitative method for measuring dental pulp disease ... more Background This study aimed to establish a quantitative method for measuring dental pulp disease in vivo. Current clinical examinations of the dental pulp use thermal (hot/cold), (percussive/palpatory), and electric pulp testing to evaluate tooth vitality. These tests offer some utility, but the results are extremely variable and subjective. Standard radiography has also been used, but it lacks diagnostic sensitivity until the disease process is advanced. Objective The study combines 2 novel areas of contemporary medical research: positron emission tomography (PET) and immune pathway modulation to develop a noninvasive diagnostic tool that can be used for the detection and localization of dental pulp disease. The calcitonin-gene-related peptide (CGRP), a neuropeptide released when the peripheral nervous system, regulates the immune system by activating the inflammatory process. We used a specific PET-tracer, [11C]MK-4232, a CGRP receptor marker to locate and quantify CGRP released a...
Background Objective quantification of periapical disease on radiographs has evolved since the 19... more Background Objective quantification of periapical disease on radiographs has evolved since the 1980s.1-3 The periapical index (PAI)1 was developed for classifying findings on periapical radiographs to assist in the diagnosis of pulpal disease. The PAI uses subjective, descriptive terminology that is too broad for the degree of detail present with cone beam computed tomography (CBCT) imaging. The CBCT-PAI2 uses measurable objective findings. However, the measurement intervals are large and do not distinguish the fine details of smaller or early-stage lesions seen on CBCT, thus limiting the ability to categorize early periapical disease or healing. The revised CBCT-PAI3 defines in more detail how to position the tooth in 3 fixed and reproducible planes. Tsai4 showed that small-volume, high-resolution CBCT scans could distinguish periapical radiolucencies measuring less than 0.5 mm. Therefore, the CBCT–endodontic radiolucency index (CBCT-ERI) is presented as an objective, repeatable in...
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Background There is evidence that capture and processing of the digital radiographic images may c... more Background There is evidence that capture and processing of the digital radiographic images may contain artifacts that could reduce the diagnostic value of dental radiographs. This phenomenon has been reported through various case reports. However, its effect on radiographic image quality has not been studied. Objective(s) The purpose of this study was to evaluate the effect of image processing on the quality of dental digital radiographs using the most common type of filter—sharpening. Study Design Three imaging modalities (2 complementary metal-oxide-semiconductor [CMOS], 1 photostimulable phosphor [PSP]) were used to image a DDQA imaging phantom (Digital Dental Quality Assurance phantom) and to create a flatfield radiograph. Contrast resolution, spatial resolution, dynamic range, and radiographic noise were assessed for image quality. Overshoot artifact was also assessed. Each image was sharpened and then highly sharpened. Images were compared using Friedman's 2-way nonparametric analysis of variance (ANOVA). Results Image sharpening significantly affected spatial resolution and noise. Conversely, dynamic range and contrast resolution were not significantly affected by image sharpening. Overshoot artifact increased with image sharpening. Discussion/Conclusions Image sharpening can create artifacts that could be misinterpreted. Although image sharpening significantly affects spatial resolution, no significant effect was seen on dynamic range or contrast resolution.
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Background Benign, solitary osteochondromas arise in response to an event (e.g., trauma, x-radiat... more Background Benign, solitary osteochondromas arise in response to an event (e.g., trauma, x-radiation), rather than as true neoplasms. Typically, osteochondromas represent 10% to 15% of all bone tumors and approximately 35% of benign bone tumors. They usually develop during a known age range and at largely predictable anatomic sites, whether the osteochondroma is benign or malignant. The most important piece of clinical information is the patient's age, although exceptions exist. Most osteochondromas occur on the metaphysis of appendicular long bones. Clinical and Radiographic findings Three cases are of temporomandibular condylar osteochondromas are presented. All patients were adult males with ages 29, 55, and 56 years. Each tumor arose from the condylar articular surface and developed into abnormal morphologies that followed the outline of adjacent structures. Definitive Interpretation The radiographic findings of an exostotic bony tumor with smooth but irregular outlines, sclerosed cortices, and moderately dense trabeculation confined within the joint capsule were consistent with the radiographic appearance of osteochondroma. Discussion Radiographically, 2-D imaging is adequate to establish an initial radiographic diagnosis. However, more advanced modalities (computed tomography/magnetic resonance imaging [CT/MRI) are indicated to better evaluate the orientation of the tumor and assist in the surgical management. The 3-D imaging of the 3 cases presented here emphasize this point. Positron emission tomography/fluorodeoxyglucose (PET/FDG) imaging has also been recommended for specific cases. MRI may overestimate tumor aggressiveness secondary to the influence of bone marrow and soft tissue edema. The recognition of an osteochondroma is significant because it is benign, but it can lead to disfigurement and loss or altered mandibular function, if not treated.
The purpose of this study was to determine the incidence and size of periapical radiolucencies us... more The purpose of this study was to determine the incidence and size of periapical radiolucencies using cone-beam computed tomographic (CBCT) imaging in teeth without apparent signs of intraoral radiographic lesions. One hundred twenty roots from 53 patients who had been determined to have no signs of intraoral radiographic lesions were included in this study. Limited-volume CBCT scans were taken at 0.125-mm3 voxel size. The widest area of apical radiolucency of each root canal-treated tooth was measured and assigned a numeric score based on the CBCT-Endodontic Radiolucency Index (ERI). CBCT data were evaluated by 2 radiologists with an interclass correlation coefficient of 0.96. The majority of roots (53.3%) had periodontal ligament widths ≤0.5 mm; 26.7% had radiolucency widths of 0.5 < x ≤ 1 mm, 15.0% had radiolucency widths of 1.0 < x ≤ 1.5 mm, 0.8% had radiolucency widths of 1.5 < x ≤ 2.0 mm, 1.7% had radiolucency widths of 2.0 < x ≤ 2.5 mm, and 2.5% had radiolucency wi...
The International journal of periodontics & restorative dentistry
This study was conducted to evaluate the accuracy of implants placed using two different guided i... more This study was conducted to evaluate the accuracy of implants placed using two different guided implant surgery materials: thermoplastic versus three-dimensionally (3D) printed. A cone beam computed tomography (CBCT) scan previously obtained and selected for single-tooth implant replacement was converted into a Digital Imaging and Communications in Medicine (DICOM) file. All models were planned and exported for printing using BlueSkyBio Plan Software with the DICOM files. A total of 20 3D-printed mandibular quadrant jaws replicating the CBCT were printed by Right Choice Milling, as was the control model to accept the control implant. Previously, 10 thermoplastic and 10 3D-printed surgical guides had been made by the same lab technician at Right Choice Milling. One Nobel Biocare implant with a trilobe connection was placed per guide and replica jaw model pair. Implants were placed using the thermoplastic and 3D-printed surgical guides, representing the two test groups, following the ...
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