Comparing panoramic radiography with Cone beam computed tomography (CBCT) in the detection of anatomical structures and its effect on treatment planning in the placement of implants in the posterior region of the mandible and maxilla (a Pilot Study).
Abstract: Aims and hypothesis: The aims of the study were to 1) determine if the Cone beam computed tomography (CBCT) would provide more anatomical structures details than panoramic radiography that may affect the surgical treatment planning of implant placement in the maxillary sinus region and the posterior region of the mandible, 2) evaluate and compare treatment options between experienced spe... read morecialists and residents, 3) evaluate and compare treatment options between specialties (periodontics, oral surgery and prosthodontics), and 4) evaluate and compare treatment options between second and third year residents in the Department of Periodontology. The primary hypothesis was that the CBCT image provides more information than a panoramic radiograph regarding anatomical structures impacting the treatment choice for implant placement (sinus proximity, IAN, bone dimension, surgical intervention prior to implant placement, e.g., sinus or ridge bone augmentation). The secondary hypothesis was that CBCT is better suited for choosing the optimal implant (length, diameter and shape) compared to a panoramic radiograph in the placement of an implant in the maxillary sinus region and posterior mandible. Materials and Methods: Five criteria were researched: maxillary sinus proximity (bone height), maxillary bone width, mandibular bone width, IAN proximity and the FSG in the posterior region of the mandible. 10 cases were chosen (2 cases for each criterion). Each case had both a CBCT and a panoramic radiograph. 10 periodontal residents (5 2nd year and 5 3rd year residents) and 5 prosthodontics residents were recruited. Five faculty were recruited from three departments: Periodontology, Prosthodontics and Oral Surgery. The participants had two sessions to evaluate the images and answer a hard copy survey questionnaire regarding the appropriate treatment plan for implant placement regarding a specific site in the case. The participants were exposed to either panoramic radiographs or CBCT images per session with a 1-month washout period in between. The CBCT and panoramic radiographs were presented to the enrolled clinicians/residents via a high quality hard copy image of the panoramic radiograph and CBCT with the related cross sections. The participants were not aware that both sets of images/radiographs were from the same patients (blinding). Results: All 30 participants completed both surveys. Bone width (maxilla or mandible) was the criterion with the most reduction in regards to choice of implant suitability between the two researched images. The reduction was seen in most cases when the CBCT image was used in comparison to panoramic radiograph. The departments with a surgical background had a more invasive surgical approach in regards to both site preparation and implant design. The prosthodontic department selected shorter implant lengths in comparison to the other two departments. The faculties were more reserved than residents in placing an implant when using a panoramic radiograph. 2rd year residents and 3nd had similar choices in regards to all researched criterions. Conclusions: This study shows that the use of a panoramic radiograph alone would restrict the clinician from having a full grasp of the existing anatomical landmarks leading to a considerable change of treatment outcome. Though this study is a pilot study, it shows that the treatment approach differs noticeably between departments and the level of experience the clinician has. Future studies are needed involving a larger number of participants and cases leading to more significant results that would support our findings.
Thesis (M.S.)--Tufts University, 2016.
Submitted to the Dept. of Periodontology.
Advisor: Nadeem Karimbux.
Committee: Aruna Ramesh, Matthew Finkelman, PhD, and Yong Hur.
Keyword: Dentistry.read less