Comparison of incidental findings on cone beam computed tomographic and 2-dimensional images.

Cone beam computed tomography (CBCT) provides a 3-dimensional (3D) view of the patient and has a high frequency of incidental findings (IFs) that do not relate to the area of interest. Many of these IFs are not always visible on 2-dimensional (2D) intraoral or panoramic radiographs. Thus, the aim of the present study was to assess the IFs that did or did not appear on 3D vs 2D images. Significant IFs were recorded from a review of 510 CBCT reports by board-certified oral and maxillofacial radiologists. The IFs on CBCTs with 5-, 8-, and 11-cm fields of view (n = 170 per group) were recorded. A subset of these significant IFs was also viewed on intra-oral and panoramic radiographs to determine whether they were or were not visible in 2D imaging. A total of 677 significant IFs were discovered on 302 (59.2%) of the 510 reports. When a subset of 293 IFs was reviewed on intraoral and panoramic imaging, 112 (38.2%) were not visible on 2D radiographs, while 50 (17.1%) could not be confirmed with certainty. The frequency of significant IFs on CBCT imaging is high and increases with larger fields of view. A substantial number of these findings could not be seen on 2D radiographs, implying that many IFs are visible only on 3D images. Clinicians who order CBCT scans need to carefully review the volume in its entirety, regardless of previous imaging, so as not to miss any significant and relevant findings.

Periapical Microsurgery: A 4-dimensional Analysis of Healing Patterns.

INTRODUCTION: Currently, the success of periapical microsurgery is determined by the restoration of the lamina dura and the elimination of symptoms. However, inadequate site preservation may prevent later implant placement. Although not possible before, the advent of cone-beam computed tomographic imaging and computer-aided registration allows for indirect and accurate 3-dimensional analysis of the surgical site over time. This study analyzed the volumetric healing pattern of the buccal plate after periapical microsurgery, with a specific focus on the buccolingual thickness of bone and the regression of the surface contour of the cortical plate. METHODS: Thirty-seven patients were scheduled for follow-up at least 1 year after periapical microsurgery (median = 25 months, total range = 12-31 months). Volumetric healing was analyzed by converting preoperative and postoperative cone-beam computed tomographic images into digital 3-dimensional models. The models were then registered to be able to analyze the changes in volume over time. Analysis was completed using Geomagic software (3D Systems, Rock Hill, SC), which allowed for registration of the volumes, calculation of volume change, and calculation of the margin of error. RESULTS: Twelve cases qualified for volumetric analysis. The median volumetric reduction of the cortical plate was -24.9 mm3 (interquartile range = -8.94 to -67 mm3), with an average linear error of 0.7 mm. This corresponded to an average loss in buccolingual dimension of 0.1-0.25 mm. Regression of the cortical plate was within the margin of error in all cases. CONCLUSIONS: After periapical microsurgery, and in the absence of grafting materials or membranes, healing occurs with little to no regression of the buccal cortical plate.

The effect of image enhancements and dual observers on proximal caries detection.

OBJECTIVES: The aim of this study was to determine if the use of certain image enhancements and dual observers had an effect on the detection of caries, dentin extension, and cavitation. STUDY DESIGN: Seven observers viewed unenhanced and enhanced images taken on photostimulable phosphor plates (PSP) and Schick 33 sensors and were asked to determine whether proximal caries lesions, dentin extension, and cavitation were present. Pairs of observers also evaluated the unenhanced PSP images and recorded their confidence. Micro-computed tomography was used as the gold standard. RESULTS: For caries lesion detection, PSP outperformed Schick sensors, although the differences are most likely not clinically significant. Observers (single and dual) and filters had no effect on any of the diagnostic tasks. Schick sensors and unfiltered images were more specific for dentin extension. CONCLUSIONS: Caries detection was statistically greater with the PSP plate, but both detectors allowed for high accuracy. Expensive software or time-consuming consultations did not improve outcomes.