Scientific Publications on CBCT - July 2010

Facial soft tissue esthetic predictions: validation in craniomaxillofacial surgery with cone beam computed tomography data.

Bianchi A. Muyldermans L. Di Martino M. Lancellotti L. Amadori S. Sarti A. Marchetti C.

Journal of Oral & Maxillofacial Surgery. 68(7):1471-9, 2010 Jul.

AB PURPOSE: Facial soft tissue prediction in orthognathic surgery could be a valuable aid to preview the results and determine the best surgical treatment. After many years, considerable difficulties are still present in the prediction of the clinical final aspect. The object of the present study was to validate new soft tissue simulation software (SurgiCase CMF; Materialise, Leuven, Belgium), using data acquired by cone beam computed tomography (CBCT), that makes it possible to foresee the final result. MATERIALS AND METHODS: Ten patients with craniomaxillofacial deformations underwent CBCT before surgery. Using the SurgiCase CMF software, the data were reconstructed in 3 dimensions, and various osteotomies were simulated in a 3-dimensional virtual environment by applying different surgical procedures. At 6 months after surgery, the patients underwent repeat CBCT. Thus, it was possible to superimpose the pre- and postoperative CBCT studies to evaluate the reproducibility and reliability of the software. RESULTS: CBCT simulations defined an average absolute error of 0.94 mm, a standard deviation of 0.90 mm, and a percentage of error less than 2 mm of 86.80%. CONCLUSION: The preliminary results have allowed us to conclude that simulations in orthognathic surgery for skull-maxillofacial deformities using CBCT acquisition are reliable, in addition to the low radiation exposure, and could become the reference standard to plan surgical treatment. Copyright 2010 American Association of Oral and Maxillofacial Surgeons.

Use of computerized tomography for diagnosis and follow-up after endodontic surgery: clinical case report with 8 years of follow-up.

Tanomaru-Filho M. Lima RK. Nakazone PA. Tanomaru JM.

Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics. 109(4):629-33, 2010 Apr.

AB Computerized tomography (CT) is a valuable tool for diagnosis and planning in conventional and surgical endodontic therapy. This case report describes the use of CT in the diagnosis of a periapical lesion undetected by periapical radiography in the mandibular molar area. The CT also showed a possible mesial root perforation associated with the lesion. Following CT, surgical planning, periradicular curettage, and sealing of the root perforation were performed. Eight years after surgery, cone beam CT revealed periapical bone repair. Computerized tomography can be an important resource for diagnosis and planning in conventional and surgical endodontic therapy, as well as for evaluation of post-treatment bone repair.

Identification of independent middle mesial canal in mandibular first molar using cone-beam computed tomography imaging.

La SH. Jung DH. Kim EC. Min KS.

Journal of Endodontics. 36(3):542-5, 2010 Mar.

AB INTRODUCTION: The root canal treatment of a mandibular molar with aberrant canal configuration can be diagnostically and technically challenging. METHODS: This case report presents the clinical management of a mandibular first molar with three separate mesial canals including middle mesial canal, which was confirmed by cone-beam computed tomography (CBCT) images. RESULTS: Posttreatment images revealed three independent root canals in the mesial root obturated efficiently to the accepted lengths in all three canals. CONCLUSION: This case report highlights the usefulness of CBCT imaging for accurate diagnosis and management of the unusual canal morphology. Copyright (c) 2010 American Association of Endodontists.

Predicting the anatomical position of the palatal root apex in maxillary first premolars during surgical endodontic treatment.

Widmer SD. Kulild JC. Walker MP. Williams KB. Katz J.

Journal of Endodontics. 36(3):434-7, 2010 Mar.

AB INTRODUCTION: Although many studies have reported on the morphology of maxillary first premolars, to our knowledge, there has never been an investigation reporting the anatomic position of the palatal (P) root tip relative to the B root tip in mesiodistal (MD), buccopalatal (BP), and apicocoronal (AC) dimensions. Such information could help clinicians more accurately locate root apices, reduce surgical morbidity, and improve the precision and prognosis of endodontic periradicular surgery for this tooth. METHODS: Fifty extracted, bifurcated, human maxillary first premolars were individually mounted and photographed under 10x magnification and oriented to simulate a clinical view. RESULTS: The P apex was superimposed by the B apex in 25 of 50 specimens, distal to the B apex in 24 of 50, and mesial to the B apex in only 1 instance. When not superimposed by or mesial to the B apex, the P apex was usually 1.4+/-0.7 mm distal to the B apex. In 98% of specimens, the P apex was positioned palatocoronal or palatocoronodistal to the B apex. CONCLUSIONS: This knowledge can be used to clinically minimize the size of osteotomies required to locate P root apices during endodontic surgery. Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Evaluation of pathologists (histopathology) and radiologists (cone beam computed tomography) differentiating radicular cysts from granulomas.

Rosenberg PA. Frisbie J. Lee J. Lee K. Frommer H. Kottal S. Phelan J. Lin L. Fisch G.

Journal of Endodontics. 36(3):423-8, 2010 Mar.

AB INTRODUCTION: This study investigated the differentiation of radicular cysts from granulomas. Cone beam computed tomography (CBCT) imaging was compared with the existing standard, biopsy and histopathology. METHODS: Forty-five patients scheduled for an apicoectomy received a CBCT scan of the involved arch. Two oral and maxillofacial radiologists, working independently and using the same criteria, categorized the CBCT images as one of the following: cyst, likely cyst, likely granuloma, granuloma, or other. After apicoectomies, two oral pathologists, working independently and using the same criteria, diagnosed the surgical specimens as one of the following: radicular cyst, granuloma, or other. We examined the following: (1) interrater agreement between pathologists as to the biopsy diagnosis, (2) interrater agreement between radiologists as to the CBCT diagnosis, and (3) accuracy of radiologists' diagnostic assessments using histopathology as the standard. RESULTS: Findings showed strong interrater reliability between pathologists (kappa=0.79, z=5.46, p<0.0001) and weak interrater reliability between radiologists (kappa=0.14, p=not significant). Accuracy (true-positives plus true-negatives) for the two radiologists was 51% and 63%. CONCLUSION: Under the conditions of this study, based on the inconsistency of the radiologists' reports as evidenced by statistical analyses, it was concluded that CBCT imaging is not a reliable diagnostic method for differentiating radicular cysts from granulomas. Surgical biopsy and histopathological evaluation remain the standard procedure for differentiating radicular cysts from granulomas. Copyright (c) 2010. Published by Elsevier Inc.

Intraexaminer and interexaminer reliabilities of landmark identification on digitized lateral cephalograms and formatted 3-dimensional cone-beam computerized tomography images.

Lagravere MO. Low C. Flores-Mir C. Chung R. Carey JP. Heo G. Major PW.

American Journal of Orthodontics & Dentofacial Orthopedics. 137(5):598-604, 2010 May.

AB INTRODUCTION: The purposes of this study were to determine and compare the intraexaminer and interexaminer reliabilities of commonly used cephalometric landmarks identified on digitized lateral cephalograms and formatted cone-beam computerized tomography (CBCT) images. METHODS: CBCT images from 10 randomly selected adolescent patients were obtained from the orthodontic records of a private practice. Measurement errors, and intraexaminer, and interexaminer reliability correlation coefficients (ICC) were obtained for all landmark coordinates. RESULTS: Intraexaminer and interexaminer reliabilities for all coordinates for most landmarks on the digital lateral cephalograms and CBCT images were greater than 0.9 (ICC value). The means of landmark locations differed by approximately 1 mm in most coordinates from the lateral cephalograms and were predominantly higher than 1 mm for all coordinates from the CBCT images. CONCLUSIONS: Intraexaminer and interexaminer reliabilities were high for most landmarks. Coordinates with greater measurement errors in the lateral cephalograms (condylion, gonion, porion, mandibular incisor apex, and posterior nasal spine) were in structures without clearly defined borders. In the CBCT images, gonion, condylion, and porion were located on surfaces that were flat or curved, making it difficult to recognize a specific reference point. Other less reliable landmarks (anterior nasal spine, posterior nasal spine, mandibular incisor apex) were located in structures with lower densities and could not be visualized with 3-dimensional reconstruction; thus, they had high measurement errors. Copyright (c) 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Comparative analysis of traditional radiographs and cone-beam computed tomography volumetric images in the diagnosis and treatment planning of maxillary impacted canines.

Haney E. Gansky SA. Lee JS. Johnson E. Maki K. Miller AJ. Huang JC.

American Journal of Orthodontics & Dentofacial Orthopedics. 137(5):590-7, 2010 May.

AB INTRODUCTION: In this prospective study, we compared differences in the diagnosis and treatment planning of impacted maxillary canines between 2 imaging modalities. METHODS: Twenty-five consecutive impacted maxillary canines were identified from the pool of patients seeking orthodontic treatment. The first set of radiographs consisted of traditional 2-dimensional (2D) images including panoramic, occlusal, and 2 periapical radiographs. The second set comprised prints of 3-dimensional (3D) volumetric dentition images obtained from a cone-beam computed tomography (CBCT) scan. Seven faculty member completed a questionnaire for every impacted canine and diagnostic radiographic modality (2D and 3D). RESULTS: The data show that the judges produced different decisions regarding localization depending on the x-ray method. There were 21% disagreement (or discordance) in the perceived mesiodistal cusp tip position and 16% difference in the perceived labiopalatal position. In the perception of root resorption of adjacent teeth, there was 36% lack of congruence. Twenty-seven percent of the teeth that were planned to be left, recovered, or extracted with the 2D radiographs had different treatment plans when the judges viewed the 3D CBCT images (McNemar test, chi-square, 4.45; P = 0.035). The clinicians' confidence of the accuracy of diagnosis and treatment plan was statistically higher for CBCT images (P <0.001). CONCLUSIONS: These results showed that 2D and 3D images of impacted maxillary canines can produce different diagnoses and treatment plans. Copyright (c) 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.