Is cone-beam computed tomography (CBCT) an alternative to plain radiography in assessments of dental disease? A study of method agreement in a medically compromised patient population.

OBJECTIVES: Poor oral health and dental infections can jeopardize medical treatment and be life-threatening. Due to this, patients with head and neck malignancies, generalized tumor spread, organ transplant, or severe infection are referred for a clinical oral and radiographic examination. The aim of this study was to compare the diagnostic agreement of three radiographic modalities: intraoral radiographs (IO), panoramic radiographs (PX), and cone beam computed tomography (CBCT) for diagnosis of dental diseases. MATERIALS AND METHODS: Three hundred patients were examined with IO, PX, and CBCT. Periapical lesions, marginal bone level, and caries lesions were diagnosed separately by four oral radiologists. All observers also assessed six teeth in 30 randomly selected patients at two different occasions. Kappa values and percent agreement were calculated. RESULTS: The highest Kappa value and percent agreement were for diagnosing periapical lesions (0.76, 97.7%), and for the assessment of marginal bone level, it varied between 0.58 and 0.60 (87.8-89.3%). In CBCT, only 44.4% of all teeth were assessable for caries (Kappa 0.68, 93.4%). The intra-observer agreement, for all modalities and diagnoses, showed Kappa values between 0.5 and 0.93 and inter-observer agreement varied from 0.51 to 0.87. CONCLUSIONS: CBCT was an alternative to IO in diagnosing periapical lesions. Both modalities found the same healthy teeth in 93.8%. All modalities were performed equally regarding marginal bone level. In caries diagnosis, artifacts were the major cause of fallout for CBCT. CLINICAL RELEVANCE: Intraoral radiography is the first-hand choice for diagnosing dental disease. For some rare cases where intraoral imaging is not possible, a dedicated panoramic image and/or CBCT examination is an alternative.

Influence of patient position and other inherent factors on image quality in two different cone beam computed tomography (CBCT) devices.

OBJECTIVES: The aim of this in vitro study was to evaluate how a deviation from the horizontal plane, affects the image quality in two different CBCT-devices. METHODS: A phantom head SK150 (RANDO, The Phantom Laboratory, Salem, NY, USA) was examined in two CBCT-units: Accuitomo 80 and Veraviewepocs 3D R100 (J. Morita Mfg. Corp. Kyoto, Japan). The phantom head was placed with the hard palate parallel to the horizontal plane and tilted 20 ° backwards. Exposures were performed with different field of views (FOVs), voxel sizes, slice thicknesses and exposure settings. Effective dose was calculated using PCXMC 2.0 (STUK, Helsinki, Finland). Image quality was assessed using contrast-to-noise-ratio (CNR). Region of interest (ROI) was set at three different levels of the mandibular bone and soft tissue, uni- and bilaterally in small and large FOVs, respectively. CNR values were calculated by CT-value and standard deviation for each ROI. Factor analysis was used to analyze the material. RESULTS: Tilting the phantom head backwards rendered significantly higher mean CNR values regardless of FOV. The effective dose was lower in small than in large FOVs and varied to a larger extent between CBCT-devices in large FOVs. CONCLUSIONS: Head position can affect the image quality. Tilting the head backward improved image quality in the mandibular region. However, if influenced by other variables e.g. motion artifacts in a clinical situation, remains to be further investigated. ADVANCES IN KNOWLEDGE: Image quality assessed using CNR values to investigate the influence of different patient positions and FOVs.

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 40 years (1973-2013). II. Review of clinical and radiographic findings.

The aim of this epidemiological study performed in 2013 was to analyze various clinical and radiographic data on oral health and compare the results to those of four cross-sectional studies carried out 1973-2003. In 1973, 1983, 1993, 2003, and 2013 random samples of 1,000; 1,104; 1,078; 987; and 1,010 individuals, respectively, were studied. The individuals were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, 70, and 80o years. Eighty-year-olds were not included in 1973. All subjects were inhabitants of the city of Jönköping, Sweden. The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations, oral hygiene, calculus, periodontal status, and endodontic treatment. The frequency of edentulous individuals aged 40-70 years was 16, 12, 8, 1, and 0.3% in 1973, 1983, 1993, 2003, and 2013, respectively. No complete denture weareryounger than 80-years old was found in 2013. During the 40-year period, the mean number of teeth in the age groups 30-80 years increased. In 2013, the 60-year-olds had nearly complete dentitions. Implants were found in all age groups from 30 years of age. The total number of individuals with implants was 36 in 2013. This was higher than earlier surveys, 4 in 1993, and 18 in 2003. The percentage of children and adults without caries and restorations increased during the 40-year period. It was found that the percentage of caries-free 3- and 5-year-olds were 79% and 69%, respectively, of the individuals in 2013. In the age groups 10-20 years, the percentage of caries-free individuals increased between 2003 and 2013. In 2013, 43% of the 15-year-olds were completely free from caries and restorations compared to 20% in 2003. In all age groups 5-60 years, DFS was lower in 2013 compared to the earlier examinations.There was no major change in DFS between 2003 and 2013 in the age groups 70 and 80 years. The most obvious change was the decrease in number of FS over the 40-year period of time. Regarding crowned teeth the most clear changes between 1973 to 2013 were the decrease in percentage of crowned teeth in the age groups 40 and 50-year-olds. The percentage of endodontically treated teeth decreased between 1973 and 2013 in all age groups. In age groups 10-30-year-olds a major reduction from about 30% to 15% in mean plaque score was seen between 1973-2003. Only a minor change in plaque score was seen during the last decade. For the age groups 40 years and older, a decrease in the percentage of surfaces with plaque was observed between 2003-2013. The percentage of tooth sites with gingivitis was for 20 years and older about 40% in 1973. In 2013, the percentage was about 15%. The frequency of sites with gingivitis was generally lower in 2013 compared with the otheryears,1973-1993. The percentage of individuals with probing pocket depths > 4mm increased with age. Between 2003-2013 a clear reduction was seen in all age groups in frequency of individuals with probing pocket depth > 4mm. Over the 40-year period an increase in the number of individuals with no marginal bone loss and a decrease in the number of subjects with moderate alveolar bone loss were seen. The continuous improvement in oral health and the reduced need of restorative treatment will seriously affect the provision of dental helath care and dental delivery system in the near future.

Oral health of individuals aged 3-80 years in Jönköping, Sweden, during 40 years (1973-2013). I. Review of findings on oral care habits and knowledge of oral health.

The aim of the this study was to present data on oral care habits and knowledge of oral health in 2013, and to compare these data with results from a series of four previous cross-sectional epidemiological studies. All these studies were carried out in the city of Jönköping, Sweden, in 1973, 1983, 1993, 2003, and 2013. The 1973 study constituted a random sample of 1,ooo individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. The same age groups with addition of a group of 80-year-olds were included in the 1983, 1993, 2003, and 2013 studies, which comprised 1,104; 1,078; 987; and 1,010 individuals, respectively. A questionnaire about dental care habits and knowledge of oral health was used. The questionnaire contained the same questions in all the five studies, although some had to be slightly modernised during the 40-year period. During the period 1973-2013, a continous increase of individuals in the age group 20-60 years were treated by the Public Dental Service amounting to about 50%. Almost 70% of the 70- and 80-year-olds were treated by private practitioners. In 2013, 10-20% of the individuals in the age groups 30-40 years did not regularly visit neither Public Dental Service nor a private practitioner. The corresponding figures for the individuals 50-80 years old were 4-7%. Similar number of avoidance was reported in the previous studies. In the survey 2013, about 20-30% of the individuals in the age groups 20-50 felt frightened, sick, or ill at ease at the prospect of an appointment with the dentist. These findings were in agreement with the results from the surveys 1973-2003. Among the younger age groups, 0-15 years, a reduction in self-reported "ill at ease" was found in the surveys 2003 and 2013 compared to the previous surveys in this series. In 2013, the knowledge of the etiology of caries was known by about 60% of the individuals which was similar to that reported 1973-2003. Twenty per cent of the individuals stated that they did not know which etiological factors that causes caries. This percentage was equivalent during the period 1973-2013.About 85% of the individuals in all age groups brushed their teeth with fluoride tooth paste at least two times a day. These frequencies have gradually increased during the 40-year period. Around 40% in the age groups 50-80 years used toothpicks regularly in 2013. This is a about 1/3-1/2 less compared to 2003. In the age groups 20-40 years 3-14% used toothpicks for proximal cleaning in 2013. In 2013, about 35% of the individuals never consumed soft drinks, in comparison with 20% in 2003. In the age groups 3-20 years about 20% were consuming soft drinks every day or several times a week,which is a reduction by half compared to 2013.

Surgical reconstruction of peri-implant bone defects with prehydrated and collagenated porcine bone and collagen barriers: case presentations.

BACKGROUND: Surgical reconstruction of peri-implant defects is challenging and unpredictable due to, for example, the extent of the bone defect or the osteogenic potential of adjunctive materials used. PURPOSE: To study the healing capacity of a new bone xenograft material in the treatment of peri-implant defects. MATERIAL AND METHODS: In three cases with advanced peri-implant defects, flap surgery was performed. After thorough debridement including cleaning of the exposed implant surface, prehydrated and collagenated porcine bone (PCPB) particles were placed into the defect. A bioresorbable collagen barrier was adapted and placed over the defect and the flaps were relocated. After 6 and 12 months of healing, clinical and radiographic examinations were done. In one case, the surgical procedure was repeated 6 months postoperatively. One year after the second surgery, a bone biopsy was harvested and analyzed with histology. RESULTS: All defects healed uneventfully. At 6 months, probing depths were reduced by 3-4 mm with no bleeding on probing or pus formation. At 12 months, healthy peri-implant conditions were found. Intra-oral radiographs showed gain of the marginal bone level by 2-4 mm. In the case where reconstructive surgery was repeated, histology showed osteoconductive properties as bone formation with typical osteoblastic seams was observed directly on the surface of the grafted particles. CONCLUSION: The presented cases show that PCPB have favorable properties enhancing bone regeneration in peri-implant bone defects.

Otosclerosis: anatomy and pathology in the temporal bone assessed by multi-slice and cone-beam CT.

OBJECTIVE: To assess the use of cone beam computed tomography (CBCT) compared with multi-slice computed tomography (MSCT) in otosclerosis, with special emphasis on middle- and inner-ear anatomy. STUDY DESIGN: Prospective study. PATIENTS: Twenty patients who underwent a stapedectomy 30 years ago were selected on the basis of bone conduction threshold values. Their mean age was 65 years (range, 48-76 yr). INTERVENTION: All patients underwent CBCT and MSCT with a slice thickness of 0.5 to 0.6 mm. MAIN OUTCOME MEASURES: Sixteen middle- and inner-ear anatomic structures and stapedial prostheses were analyzed by visual grading analysis. To assess critical reproduction and thereby the clinical applicability of CBCT, a dichotomization was made. Assessment of otosclerotic foci was performed using a grading system dividing the lesions in; (1) sole fenestral lesions, (2) retrofenestral lesions with or without fenestral lesions and (3) severe retrofenestral lesions. RESULTS: The 16 anatomic structures were clearly reproduced by both imaging techniques. However, there was an interobserver variation in judging the superiority of 1 method in favor of the other. Otosclerotic lesions were diagnosed in 80/95% using MSCT and 50/85% using CBCT (evaluators 1 and 2, respectively). Retrofenestral lesions were diagnosed in 5 of 10 of ears with severe-to-profound hearing loss, whereas no retrofenestral lesions were diagnosed in the 10 ears with mild-to-moderate hearing loss. The stapedial prostheses were adequately or very well reproduced by both methods. CONCLUSION: CBCT is a new imaging technique with a considerably lower radiation dose than conventional MSCT. Our study indicates that CBCT is suitable and, in many ways, equivalent to MSCT, for temporal bone imaging in otosclerosis.