Reliability of Grayscale Value for Bone Density Determination in Oral Rehabilitation using Dental Implants.

Introduction: Quality and quantity of jaw bones have been previously classified in literature using different methods. Imaging modalities such as computed tomography (CT), successfully determine bone density of jaws. This study aims to establish the role of cone-beam CT (CBCT) in determining the density of cortical and cancellous bones at different jaw sites. Materials and Methods: Eighty-three possible implant sites in healthy patients were evaluated using NewTomGiano CBCT machine. Cross-sections were obtained and cortical and cancellous bone densities on different aspects of the virtual implant in terms of Hounsfield unit (HU) were determined using New Net Technologies software version 6.1 and were classified according to software from D1 to D4. Data were entered into SPSS software (version 19.0) and were statistically analyzed. Results: The mean HU showed the highest value for cortical and cancellous in the anterior mandible (mean HU 1874.01 and 1131.73, respectively) followed by the posterior mandible (mean HU 1789.20 and 872.95, respectively) and least in posterior maxilla (mean HU 1068.26 and 830.04, respectively). Maximum D1 bone type was found in cortical bone and D2 bone type was noted in cancellous bone area. Males showed very highly significant cortical bone thickness (P < 0.001) whereas females showed more cancellous bone thickness but the results were nonsignificant. Conclusion: A high degree of concordance between different regions of jaw bones with a strong correlation between the four bone types was obtained. Bone density plays a pivotal role in determining the prognosis of the implant. CBCT has proven to be beneficial in bone density analysis.

Process evaluation of health system costing - Experience from CHSI study in India.

BACKGROUND: A national study, 'Costing of healthcare services in India' (CHSI) aimed at generating reliable healthcare cost estimates for health technology assessment and price-setting is being undertaken in India. CHSI sampled 52 public and 40 private hospitals in 13 states and used a mixed micro-costing approach. This paper aims to outline the process, challenges and critical lessons of cost data collection to feed methodological and quality improvement of data collection. METHODS: An exploratory survey with 3 components-an online semi-structured questionnaire, group discussion and review of monitoring data, was conducted amongst CHSI data collection teams. There were qualitative and quantitative components. Difficulty in obtaining individual data was rated on a Likert scale. RESULTS: Mean time taken to complete cost data collection in one department/speciality was 7.86(±0.51) months, majority of which was spent on data entry and data issues resolution. Data collection was most difficult for determination of equipment usage (mean difficulty score 6.59±0.52), consumables prices (6.09±0.58), equipment price(6.05±0.72), and furniture price(5.64±0.68). Human resources, drugs & consumables contributed to 78% of total cost and 31% of data collection time. However, furniture, overheads and equipment consumed 51% of time contributing only 9% of total cost. Seeking multiple permissions, absence of electronic records, multiple sources of data were key challenges causing delays. CONCLUSIONS: Micro-costing is time and resource intensive. Addressing key issues prior to data collection would ease the process of data collection, improve quality of estimates and aid priority setting. Electronic health records and availability of national cost data base would facilitate conducting costing studies.

Assessment of correlation between dental calcification stages and skeletal maturity indicators.

INTRODUCTION: Assessment of age is a critical step in the identification of an individual in forensic cases. The hand-wrist radiographic evaluation and tooth development is also a useful measure of maturity because it represents a series of recognizable changes that occur in the same sequence from an initial event to a constant end point. AIM OF THE STUDY: To investigate the relationship of dental calcification stages and skeletal maturity indicators as assessed by the hand-wrist bone radiograph. OBJECTIVES: (1) Correlation of dental calcification stages and skeletal maturation. Information for decision-making in treatment plan in growing patients. MATERIALS AND METHODS: A cross-sectional pilot study was performed using orthopantomograph (OPG) and hand-wrist radiographs of fifty children (25 males and 25 females) with age ranging from 8 to 14 years. The hand-wrist radiographs and OPG were analyzed using Fishman's Skeletal Maturity Index and the Demirjian's system, respectively. SPSS software version 19 (IBM) was used in the calculation of all statistical analyses. RESULTS: Correlation coefficient ranged from 0.61 to 0.83 for males and from 0.81 to 0.86 for females. The canine stage F for both sexes coincided with the MP3 stage, which is indicative of the onset of a period of accelerating growth. CONCLUSION: The findings of this pilot study indicated that tooth calcification stages might be clinically used as a maturity indicator of the pubertal growth period.