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Visibility of anatomical landmarks in the region of the mandibular third molar, a comparison between a low-dose and default protocol of CBCT
Malmö University, Faculty of Odontology (OD).ORCID iD: 0000-0003-4611-3708
Malmö University, Faculty of Odontology (OD). Department of Oral & Maxillofacial Radiology, KingAbdulaziz University, Jeddah, Saudi Arabia;.
Malmö University, Faculty of Odontology (OD). Specialized Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.ORCID iD: 0000-0002-8539-7742
Malmö University, Faculty of Odontology (OD). Section of Oral and Maxillofacial Radiology, Department ofClinical Dentistry, University of Bergen, Bergen, Norway.
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2023 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 81, no 6, p. 449-455Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Optimization of radiographic examinations is essential for radiation protection. The objective of the study was to investigate the clinical applicability of a low-dose CBCT protocol as compared to the default for pre-surgical evaluation of mandibular third molars.

MATERIAL & METHODS: Forty-eight patients (62 teeth) referred for pre-surgical mandibular third molar investigation were recruited after justification for CBCT. Two CBCT scans of each site were made using a default protocol and a low-dose protocol (Veraviewepocs 3D F40, J Morita Corp, Kyoto, Japan). The low-dose protocol had the same tube potential (90 kV) and exposure time (9.4 s) as the default, but with reduced tube current, from 5 mA to 2 mA. Four observers evaluated the visibility of five relevant anatomical variables. Image quality was ranked on a 3-point scale as diagnostically acceptable, doubtful, or unacceptable. The Wilcoxon signed-rank test compared differences between the two protocols. The significance level was set at p ≤ .05.

RESULTS: No significant differences were found between the two protocols for any observer regarding the visibility of the relationship and proximity between the roots and the mandibular canal; root morphology; and possible root resorption of the second molar. The periodontal ligament differed significantly in visibility between the two protocols (p ≤ .05).

CONCLUSIONS: This study indicates that a low-dose CBCT protocol with a 60% reduction of the tube current provides, in most cases, acceptable image quality for pre-surgical assessment of mandibular third molars. Optimization of CBCT protocols should be a priority according to recommended guidelines.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2023. Vol. 81, no 6, p. 449-455
Keywords [en]
Molar third, cone-beam computed tomography (CBCT), radiation
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-58540DOI: 10.1080/00016357.2023.2170462ISI: 000928538300001PubMedID: 36748228Scopus ID: 2-s2.0-85147663038OAI: oai:DiVA.org:mau-58540DiVA, id: diva2:1741312
Available from: 2023-03-03 Created: 2023-03-03 Last updated: 2024-02-26Bibliographically approved
In thesis
1. Radiographic imaging in relation to the mandibular third molar: tooth characteristics, modality choice, optimization, and absorbed dose
Open this publication in new window or tab >>Radiographic imaging in relation to the mandibular third molar: tooth characteristics, modality choice, optimization, and absorbed dose
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Radiographic imaging of the mandibular third molar (M3) is a valuable diagnostic tool. It provides information on tooth position, root morphology, and relations to surrounding anatomical structures that facilitates diagnosis and treatment planning. Three modalities are commonly used in dentistry: intraoral and panoramic radiography, and cone beam computed tomography (CBCT). Over time, panoramic radiography became a justified choice in most cases of M3 removal. In the last decade, a three-dimensional (3D) alternative, CBCT, has seen increasing use. The advantages of 3D come at the cost of higher radiation doses and societal expense. The four studies in this thesis originated from current knowledge gaps and clinical needs.

The use of panoramic radiography for evaluating the M3 and its relation to the inferior alveolar nerve (IAN) is well-established practice; however, its application has declined over time, possibly due to the rising popularity of CBCT imaging. Thus, it is of interest to investigate the suitability of panoramic imaging of the M3. Choice of imaging modality is important from dose delivery and socioeconomic standpoints. A survey of clinician experiences and preferences in imaging modalities for pre-surgical analysis was needed.

In diagnostic imaging, the common goal is to reduce radiation exposure to the lowest threshold that still delivers reliable diagnostic information. Due to the growing use of CBCT, there is a need to optimize exposure settings and use reliable measurement methods in dosimetric analysis. Nevertheless, for the M3, the present literature has neither evaluated a low-dose protocol in a clinical setting nor compared the standard method of measuring absorbed dose in dental CBCT with an alternative method.

This thesis is based on the following papers:

Paper I, an observational study, evaluated M3 characteristics and IAN relation, incidental findings, and image quality regarding patient positioning on 442 panoramic radiographs. 

Key findings: A majority of M3s were erupted and vertically positioned, regardless of age. The IAN was located inferior to the roots in just over half of the cases; an overlapping position was most common if the tooth was retained or semi-retained, or patient age less than 30 years. Frequent incidental findings were apical radiolucencies, idiopathic osteosclerosis, and tooth fragments. Patient positioning was suboptimal in one-third of the radiographs; common errors included patient placement posterior to the image layer and an upward-tilted head. 

Paper II was a web-based questionnaire sent to general dentists and to residents and specialists in oral and maxillofacial surgery. The survey comprised multiple-choice questions with four M3 cases depicted in images. 

Key findings: A majority of respondents received a report within 2 weeks of their CBCT referral and would read it and view the images before surgery; one-third did not. Panoramic radiographs were the preferred modality in pre-surgical planning; differences between professions were significant. Panoramic radiographs and CBCT were seen as facilitating treatment planning, and CBCT as also reducing post-operative complications. CBCT tended to be preferred in more complex M3 cases. 

Paper III was a clinical trial investigating an alternative, low-dose CBCT protocol with lower tube current than the default protocol. After justification for CBCT, 48 patients (62 M3s) referred for a pre-surgical investigation were recruited. Two scans of each site were made using the two protocols

Key findings: No significant differences occurred in visibility of root and mandibular canal relationship and proximity, root morphology, and possible root resorption of the second molar. Visibility of the periodontal ligament was significantly better in default images. Subjective image quality in low-dose images (60% less radiation) was acceptable in most cases. 

Paper IV was a laboratory study comparing two dosimeters in a CBCT scan of the M3 region. Five slices of an anthropomorphic phantom were prepared with thermoluminescent dosimeters (TLD-100) at 75 sites and covered with Gafchromic film LD-V1. 

Key findings: Point dose measurements at all TLD sites correlated well with doses measured on film; agreement was better at lower doses. Minimum and maximum doses on film versus at TLD sites deviated greatly on all slices and for several organs. 

To conclude, panoramic radiography is useful in evaluating M3 and IAN relationships. Clinicians consider pre-surgical information to differ depending on imaging modality; modality preference seems to depend on case complexity. Optimized CBCT protocols can be used for the M3. Gafchromic film is a favorable alternative in dental CBCT dosimetry

Place, publisher, year, edition, pages
Malmö: Malmö University Press, 2023. p. 89
Series
Malmö University Odontological Dissertations, ISSN 1650-6065
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-62211 (URN)10.24834/isbn.9789178773534 (DOI)978-91-7877-352-7 (ISBN)978-91-7877-353-4 (ISBN)
Public defence
2023-09-29, Aulan, Tandvårdshögskolan Malmö universitet, Smedjegatan 16, Malmö, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2023-08-31 Created: 2023-08-31 Last updated: 2024-02-26Bibliographically approved

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Cederhag, JosefineIskanderani, DurerAlstergren, PerShi, Xie-QiHellén-Halme, Kristina

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