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1.  Occlusal Caries Depth Measurements Obtained by Five Different Imaging Modalities 
Journal of Digital Imaging  2010;24(5):804-813.
The study aimed to assess the accuracy and reproducibility of occlusal caries depth measurements obtained from different imaging modalities. The study comprised 21 human mandibular molar teeth with occlusal caries. Teeth were imaged using film, CCD, two different cone-beam computerized tomography (CBCT) units and a microcomputer tomography (micro-CT). Thereafter, each tooth was serially sectioned, and the section with the deepest carious lesion was scanned using a high-resolution scanner. Each image set was separately viewed by three oral radiologists. Images were viewed randomly, and each set was viewed twice. Lesion depth was measured on film images using a digital caliper, on CCD and CBCT images using built-in measurement tools, on micro-CT images using the Mimics software program, and on histological images using AxioVision Rel. 4.7. Intra- and inter-rater reliabilities were assessed according to the Bland/Altman method by calculating Intraclass Correlation Coefficients (ICCs). Mean/median values obtained with intraoral systems were lower than those obtained with 3-D and histological images for all observers and both readings. Intra-observer ICC values for all observers were highest for histology and micro-CT. In addition, intra-observer ICC values were higher for histology and CBCT than for histology and intra-oral methods. Inter-observer ICC values for first and second readings were high for all observers. No differences in repeatability were found between Accuitomo and Iluma CBCT images or between intra-oral film and CCD images. Micro-CT was found to be the best imaging method for the ex vivo measurement of occlusal caries depth. In addition, both CBCT units performed similarly and better than intra-oral modalities.
doi:10.1007/s10278-010-9355-9
PMCID: PMC3180550  PMID: 21116675
Occlusal caries; Depth measurement; CBCT; Micro-CT; Radiography
2.  Analysis of linear measurement accuracy obtained by cone beam computed tomography (CBCT-NewTom VG) 
Dental Research Journal  2012;9(Suppl 1):S57-S62.
Background:
One of the major uses of cone beam computed tomography (CBCT) is presurgical implant planning. Linear measurement is used for the determination of the quantity of alveolar bone (height and width). Linear measurements are used in orthodontic analysis and definition of jaw tumor size. The objective of this study is to evaluate the accuracy of the linear measurement of CBCT (Newtom VG) in the axial and coronal planes, with two different voxel sizes.
Materials and Methods:
In this accuracy diagnostic study, 22 anatomic landmarks in four dry human skulls were marked by gutta-percha. Fifteen linear measurements were obtained using a digital caliper. These were considered to be the gold standard (real measurement). The skulls were scanned by CBCT (Newtom VG) at two settings: (a) Voxel size 0.3 mm (b) voxel size 0.15 mm High Resolution (HR). The radiographic distance measurements were made in the axial and coronal sections by three observers. The radiographic measurements were repeated two weeks later for evaluation of intraobserver reliability. SPSS software version 17 was used for data analysis. The level of significance was considered to be 5% (P ≤ 0.05).
Results:
The mean differences of real and radiographic measurements were -0.10±0.99 mm in the axial sections, -0.27±1.07 mm in the coronal sections, +0.14±1.44 mm in the axial (HR) sections, and 0.02±1.4 mm in the coronal (HR) sections. The intraclass correlation (ICC) for CBCT measurements in the axial sections was 0.9944, coronal sections 0.9941, axial (HR) sections 0.9935, and coronal (HR) sections 0.9937. The statistical analysis showed high interobserver and intraobserver reliability (P ≤ 0.05).
Conclusion:
CBCT (Newtom VG) is highly accurate and reproducible in linear measurements in the axial and coronal image planes and in different areas of the maxillofacial region. According to the findings of the present study, a CBCT scan with a larger voxel size (0.3 mm in comparison to 0.15 mm) is recommended when the purpose of the CBCT scan is to measure linear distances. This will result in lower patient radiation dose and faster scan time.
PMCID: PMC3692201  PMID: 23814563
Cone-beam computed tomography; implant; measurement; skull
3.  Influence of cone beam CT scanning parameters on grey value measurements at an implant site 
Dentomaxillofacial Radiology  2013;42(3):79884780.
Objectives:
The aim of this study was to determine the grey value variation at the implant site with different scan settings, including field of view (FOV), spatial resolution, number of projections, exposure time and dose selections in two cone beam CT (CBCT) systems and to compare the results with those obtained from a multislice CT system.
Methods:
A partially edentulous human mandibular cadaver was scanned by three CT modalities: multislice CT (MSCT) (Philips, Best, the Netherlands), and two CBCT systems: (Accuitomo 170®, Morita, Japan) and (NewTom 5G®, QR, Verona, Italy). Using different scan settings 36 and 24 scans were obtained from the Accuitomo and the NewTom, respectively. The scans were converted to digital imaging and communications in medicine 3 format. The analysis of the data was performed using 3Diagnosys® software (v. 3.1, 3diemme, Cantù, Italy) and Geomagic studio® 2012 (Morrisville, NC). On the MSCT scan, one probe designating the site for pre-operative implant placement was inserted. The inserted probe on MSCT was transformed to the same region on each CBCT scan using a volume-based three-dimensional registration algorithm. The mean voxel grey value of the region around the probe was derived separately for each CBCT. The influence of scanning parameters on the measured mean voxel grey values was assessed.
Results:
Grey values in both CBCT systems significantly deviated from Hounsfield unit values measured with MSCT (p = 0.0001). In both CBCT systems, scan FOV and spatial resolution selections had a statistically significant influence on grey value measurements (p = 0.0001). The number of projections selection had a statistically significant influence in the Accuitomo system (p = 0.0001) while exposure time and dose selections had no statistically significant influence on grey value measurements in the NewTom (p = 0.43 and p = 0.37, respectively).
Conclusions:
Grey-level values from CBCT images are influenced by device and scanning settings.
doi:10.1259/dmfr/79884780
PMCID: PMC3667541  PMID: 22933535
cone beam CT; registration; grey values; bone density
4.  Measurement accuracy and reliability of tooth length on conventional and CBCT reconstructed panoramic radiographs 
INTRODUCTION:
This in vivo study assessed accuracy and reliability of tooth length measurements obtained from conventional panoramic radiographs and CBCT panoramic reconstructions to that of a digital caliper (gold standard).
METHODS:
The sample consisted of subjects who had CBCT and conventional panoramic radiographic imaging and who required maxillary premolar extraction for routine orthodontic treatment. A total of 48 teeth extracted from 26 subjects were measured directly with digital calipers. Radiographic images were scanned and digitally measured in Dolphin 3D software. Accuracy of tooth length measurements made by CBCT panoramic reconstructions, conventional panoramic radiographs and digital caliper (gold standard) were compared to each other by repeated measures one-way ANOVA with Bonferroni correction and by single measures intraclass correlation coefficient.
RESULTS:
Repeated root length measures with digital calipers, panoramic radiographs and CBCT constructed panoramic-like images were all individually highly reliable. Compared to the caliper (gold standard), tooth measurements obtained from conventional panoramic radiographs were on average 6.3 mm (SD = 2.0 mm) longer, while tooth measurements from CBCT panoramic reconstructions were an average of 1.7 mm (SD = 1.2 mm) shorter.
CONCLUSIONS:
In comparison to actual tooth lengths, conventional panoramic radiographs were relatively inaccurate, overestimating the lengths by 29%, while CBCT panoramic reconstructions underestimated the lengths by 4%.
doi:10.1590/2176-9451.19.5.045-053.oar
PMCID: PMC4296663  PMID: 25715716
Reproducibility of results; Radiography; Tooth root
5.  The accuracy of linear measurements of maxillary and mandibular edentulous sites in cone-beam computed tomography images with different fields of view and voxel sizes under simulated clinical conditions 
Imaging Science in Dentistry  2016;46(2):93-101.
Purpose
The objective of this study was to investigate the effect of varying resolutions of cone-beam computed tomography images on the accuracy of linear measurements of edentulous areas in human cadaver heads. Intact cadaver heads were used to simulate a clinical situation.
Materials and Methods
Fiduciary markers were placed in the edentulous areas of 4 intact embalmed cadaver heads. The heads were scanned with two different CBCT units using a large field of view (13 cm×16 cm) and small field of view (5 cm×8 cm) at varying voxel sizes (0.3 mm, 0.2 mm, and 0.16 mm). The ground truth was established with digital caliper measurements. The imaging measurements were then compared with caliper measurements to determine accuracy.
Results
The Wilcoxon signed rank test revealed no statistically significant difference between the medians of the physical measurements obtained with calipers and the medians of the CBCT measurements. A comparison of accuracy among the different imaging protocols revealed no significant differences as determined by the Friedman test. The intraclass correlation coefficient was 0.961, indicating excellent reproducibility. Inter-observer variability was determined graphically with a Bland-Altman plot and by calculating the intraclass correlation coefficient. The Bland-Altman plot indicated very good reproducibility for smaller measurements but larger discrepancies with larger measurements.
Conclusion
The CBCT-based linear measurements in the edentulous sites using different voxel sizes and FOVs are accurate compared with the direct caliper measurements of these sites. Higher resolution CBCT images with smaller voxel size did not result in greater accuracy of the linear measurements.
doi:10.5624/isd.2016.46.2.93
PMCID: PMC4925656  PMID: 27358816
Cone-Beam Computed Tomography; Dental Implants; Cadaver; Imaging, Diagnostic
6.  Comparison between 3D volumetric rendering and multiplanar slices on the reliability of linear measurements on CBCT images: an in vitro study 
Objective
The purpose of this study was to determine the accuracy and reliability of two methods of measurements of linear distances (multiplanar 2D and tridimensional reconstruction 3D) obtained from cone-beam computed tomography (CBCT) with different voxel sizes.
Material and Methods
Ten dry human mandibles were scanned at voxel sizes of 0.2 and 0.4 mm. Craniometric anatomical landmarks were identified twice by two independent operators on the multiplanar reconstructed and on volume rendering images that were generated by the software Dolphin®. Subsequently, physical measurements were performed using a digital caliper. Analysis of variance (ANOVA), intraclass correlation coefficient (ICC) and Bland-Altman were used for evaluating accuracy and reliability (p<0.05).
Results
Excellent intraobserver reliability and good to high precision interobserver reliability values were found for linear measurements from CBCT 3D and multiplanar images. Measurements performed on multiplanar reconstructed images were more accurate than measurements in volume rendering compared with the gold standard. No statistically significant difference was found between voxel protocols, independently of the measurement method.
Conclusions
Linear measurements on multiplanar images of 0.2 and 0.4 voxel are reliable and accurate when compared with direct caliper measurements. Caution should be taken in the volume rendering measurements, because the measurements were reliable, but not accurate for all variables. An increased voxel resolution did not result in greater accuracy of mandible measurements and would potentially provide increased patient radiation exposure.
doi:10.1590/1678-775720130445
PMCID: PMC4349120  PMID: 25004053
Cone-beam computed tomography; Reliability; Mandible
7.  Variation in voxel value distribution and effect of time between exposures in six CBCT units 
Dentomaxillofacial Radiology  2014;43(4):20130376.
The aim of this study is to assess the variation in voxel value distribution in volumetric data sets obtained by six cone beam CT (CBCT) units, and the effect of time between exposures. Six CBCT units [Cranex® 3D (CRAN; Soredex Oy, Tuusula, Finland), Scanora® 3D (SCAN; Soredex Oy), NewTom™ 5G (NEWT; QR Srl, Verona, Italy), Promax® Dimax 3 (Planmeca Oy, Helsinki, Finland), i-CAT (Imaging Sciences International, Hatfield, PA) and 3D Accuitomo FPD80 (Morita, Kyoto, Japan)] were tested. Two volumetric data sets of a dry human skull embedded in acrylic were acquired by each CBCT unit in two sessions on separate days. Each session consisted of 20 exposures: 10 acquired with 30 min between exposures and 10 acquired immediately one after the other. CBCT data were exported as digital imaging and communications in medicine (DICOM) files and converted to text files. The text files were re-organized to contain x-, y- and z-position and grey shade for each voxel. The files were merged to contain 1 record per voxel position, including the voxel values from the 20 exposures in a session. For each voxel, subtractions were performed between Data Set 1 and the remaining 19 data sets (1 − 2, 1 − 3, etc) in a session. Means, medians, ranges and standard deviations for grey shade variation in the subtraction data sets were calculated for each unit and session. For all CBCT units, variation in voxel values was observed throughout the 20 exposures. A “fingerprint” for the grey shade variation was observed for CRAN, SCAN and NEWT. For the other units, the variation was (apparently) randomly distributed. Large discrepancies in voxel value distribution are seen in CBCT images. This variation should be considered in studies that assess minute changes in CBCT images.
doi:10.1259/dmfr.20130376
PMCID: PMC4082261  PMID: 24678846
cone beam CT; voxel value; grey shade distribution
8.  Comparative study of mandibular linear measurements obtained by cone beam computed tomography and digital calipers 
Objectives: Cone beam computed tomography (CBCT) is an innovative dental of imaging system characterized by rapid volumetric imaging with patient exposure to a single dose of radiation. The present study was carried out to compare the linear measurements obtained with CBCT and digital caliper in 20 mandibles from human cadavers. Study design: A total of 4800 linear measurements were measured between different mandibular anatomical points with CBCT and digital caliper. The real measurements were defined as those obtained with the digital caliper. Posteriorly, the mandibles were scanned to obtain the CBCT images, with software-based measurements of the distances. Results: The measurements obtained with the digital caliper were greater. The CBCT technique underestimated distances greater than 100 mm. Conclusions: CBCT allows to obtain linear mandibular anatomical measurements equivalent to those obtained with digital caliper. The differences existing between both methods were clinically acceptable.
Key words:Computed tomography, cone beam CT, accuracy, reliability, digital caliper.
doi:10.4317/jced.51426
PMCID: PMC4134857  PMID: 25136429
9.  Standardized method to quantify the variation in voxel value distribution in patient-simulated CBCT data sets 
Dentomaxillofacial Radiology  2014;44(2):20140283.
Objectives:
To suggest a standardized method to assess the variation in voxel value distribution in patient-simulated CBCT data sets and the effect of time between exposures (TBE). Additionally, a measurement of reproducibility, Aarhus measurement of reproducibility (AMORe), is introduced, which could be used for quality assurance purposes.
Methods:
Six CBCT units were tested [Cranex® 3D/CRAN (Soredex Oy, Tuusula, Finland); Scanora® 3D/SCAN (Soredex Oy); NewTom™ 5G/NEW5 (QR srl, Verona, Italy); i-CAT/ICAT (Imaging Sciences International, Hatfield, PA); 3D Accuitomo FPD80/ACCU (Morita, Kyoto, Japan); and NewTom VG/NEWV (QR srl)]. Two sets of volumetric data of a wax-imbedded dry human skull (containing a titanium implant) were acquired by each CBCT unit at two sessions on separate days. Each session consisted 21 exposures: 1 “initial” followed by a 30-min interval (initial data set), 10 acquired with 30-min TBE (data sets 1–10) and 10 acquired with 15-min TBE (data sets 11–20). CBCT data were exported as digital imaging and communications in medicine files and converted to text files containing x, y and z positions and grey shade for each voxel. Subtractions were performed voxel-by-voxel in two set-ups: (1) between two consecutive data sets and (2) between any subsequent data set and data set 1. The mean grey shade variation for each voxel was calculated for each unit/session.
Results:
The largest mean grey shade variation was found in the subtraction set-up 2 (27–447 shades of grey, depending on the unit). Considering subtraction set-up 1, the highest variation was seen for NEW5, between data sets 1 and the initial.
Conclusions:
Discrepancies in voxel value distribution were found by comparing the initial examination of the day with the subsequent examinations. TBE had no predictable effect on the variation of CBCT-derived voxel values. AMORe ranged between 0 and 64.
doi:10.1259/dmfr.20140283
PMCID: PMC4614169  PMID: 25354021
cone beam CT; voxel value; grey shade distribution
10.  Radiographic detection of artificially created horizontal root fracture using different cone beam CT units with small fields of view 
Dentomaxillofacial Radiology  2013;42(4):20120261.
Objectives:
To compare limited cone beam computerized tomography (CBCT) units with different field of views (FOVs) and voxel sizes in detecting artificially created horizontal root fracture (HRF) in extracted human teeth.
Methods:
Artificial HRF was created in the horizontal plane in 40 teeth. Another 40 intact teeth served as a control group. 80 teeth were placed in the respective maxillary anterior sockets of a human dry skull in groups. Six image sets were obtained: (1) Accuitomo 170, 40 × 40 mm FOV (0.080 mm3); (2) Accuitomo 170, 60 × 60 mm FOV (0.125 mm3); (3) Kodak 9000, 50 × 37 mm FOV (0.076 mm3); (4) Kodak 9000, 50 × 37 mm FOV (0.100 mm3); (5) Vatech Pax-Duo3D 50 × 50 mm FOV (0.080 mm3) and (6) Vatech Pax-Duo3D 85 × 85 mm FOV (0.120 mm3). Images were evaluated twice by five observers. Kappa values were calculated for observer agreement. Areas under the receiver operating characteristic (ROC) curves (Az values) were calculated, and the Az values for each image type were compared using t-tests (α = 0.05).
Results:
Intraobserver kappa coefficients ranged from 0.81 to 0.95 for the Accuitomo 170 images, from 0.80 to 0.92 for the Kodak 9000 images and from 0.76 to 0.95 for Vatech PanX-Duo3D. The Az values for different image types and observers ranged from 0.93 to 0.97 for Accuitomo 170 images, from 0.93 to 0.98 for Kodak 9000 images and from 0.93 to 0.97 for the Vatech PanX-Duo3D images. No statistically significant differences (p > 0.05) were found between the Az values.
Conclusions:
Limited CBCT units performed similarly in detecting simulated HRF.
doi:10.1259/dmfr.20120261
PMCID: PMC3667510  PMID: 23420851
horizontal root fracture; CBCT; detection; radiography
11.  A comparative evaluation of cone beam CT and micro-CT on trabecular bone structures in the human mandible 
Dentomaxillofacial Radiology  2013;42(8):20130145.
Objectives:
The main purpose of this study was to determine the accuracy of cone beam CT (CBCT) in measuring the trabecular bone microstructure, in comparison with micro-CT. The subobjective was to examine to what extent bone quality assessment is influenced by X-ray tube current and voltage settings as well as soft tissue surrounding the bone.
Methods:
Eight human mandibular bone samples were scanned using three different clinical exposure protocol within water (W1–3) and without water (NW1–3) by a high-resolution (80 µm) CBCT machine (3D Accuitomo 170®; Morita, Kyoto, Japan). Subsequently, the samples underwent micro-CT scanning (SkyScan 1174®; SkyScan, Antwerp, Belgium). After image acquisition, similar volumes of interest of the trabecular structures captured with CBCT and micro-CT were aligned with each other. Segmentation was then performed, and the morphometric parameters were quantified within the volumes of interest by CTAn software (CTAnalyser®; SkyScan, Antwerp, Belgium). Descriptive statistical analyses and multiple comparisons between all protocols were applied in R software.
Results:
High positive Pearson's correlation coefficients were observed between CBCT and micro-CT protocols for all tested morphometric indices except for trabecular thickness. No significant differences were observed between all exposure protocols except for trabecular separation. When examining the soft-tissue effect on trabecular bone structures, no significant differences between NW (1–3) and W (1–3) protocols were observed for all variables.
Conclusions:
The present study demonstrated the potential of high-resolution CBCT imaging for in vivo applications of quantitative bone morphometry and bone quality assessment. However, the overestimation of morphometric parameters and acquisition settings in CBCT must be taken into account.
doi:10.1259/dmfr.20130145
PMCID: PMC3922263  PMID: 23833320
cone beam CT; micro-computed tomography; bone architecture; quantitative bone morphometry
12.  Trabecular bone histomorphometric measurements and contrast-to-noise ratio in CBCT 
Dentomaxillofacial Radiology  2014;43(8):20140196.
Objectives:
The aim of this study was to evaluate how imaging parameters at clinical dental CBCT affect the accuracy in quantifying trabecular bone structures, contrast-to-noise ratio (CNR) and radiation dose.
Methods:
15 radius samples were examined using CBCT (Accuitomo FPD; J. Morita Mfg., Kyoto, Japan). Nine imaging protocols were used, differing in current, voltage, rotation degree, voxel size, imaging area and rotation time. Radiation doses were measured using a kerma area product-meter. After segmentation, six bone structure parameters and CNRs were quantified. Micro-CT (μCT) images with an isotropic resolution of 20 μm were used as a gold standard.
Results:
Structure parameters obtained by CBCT were strongly correlated to those by μCT, with correlation coefficients >0.90 for all studied parameters. Bone volume and trabecular thickness were not affected by changes in imaging parameters. Increased tube current from 5 to 8 mA, decreased isotropic voxel size from 125 to 80 μm and decreased rotation angle from 360° to 180° affected correlations for trabecular termini negatively. Decreasing rotation degree also weakened correlations for trabecular separation and trabecular number at 80 μm voxel size. Changes in the rotation degree and tube current affected CNR significantly. The radiation dose varied between 269 and 1153 mGy cm2.
Conclusions:
Trabecular bone structure can be accurately quantified by clinical dental CBCT in vitro, and the obtained structure parameters are strongly related to those obtained by μCT. A fair CNR and strong correlations can be obtained with a low radiation dose, indicating the possibility for monitoring trabecular bone structure also in vivo.
doi:10.1259/dmfr.20140196
PMCID: PMC4240257  PMID: 25168811
CBCT; micro-computed tomography; trabecular bone; histomorphometry; bone segmentation; osteoporosis
13.  Comparison of mandibular bone microarchitecture between micro-CT and CBCT images 
Dentomaxillofacial Radiology  2015;44(5):20140322.
Objectives:
To compare microarchitecture parameters of bone samples scanned using micro-CT (µCT) to those obtained by using CBCT.
Methods:
A bone biopsy trephine bur (3 × 10 mm) was used to remove 20 cylindrical bone samples from 20 dry hemimandibles. Samples were scanned using µCT (µCT 35; SCANCO Medical, Brüttisellen, Switzerland) with a voxel size of 20 µm and CBCT (3D Accuitomo 170; J. Morita, Kyoto, Japan) with a voxel size of 80 µm. All corresponding sample scans were aligned and cropped. Image analysis was carried out using BoneJ, including the following parameters: skeleton analysis, bone surface per total volume (BS/TV), bone volume per total volume (BV/TV), connectivity density, anisotropy, trabecular thickness and spacing, structure model index, plateness and fractal dimension. Pearson and Spearman correlation coefficients (R) were calculated. CBCT values were then calibrated using the slope of the linear fit with the µCT values. The mean error after calibration was calculated and normalized to the standard deviation of the µCT values.
Results:
R-values ranged between 0.05 (plateness) and 0.83 (BS/TV). Correlation was significant for both Spearman and Pearson’s R for 8 out of 16 parameters. After calibration, the smallest normalized error was found for BV/TV (0.48). For other parameters, the error range was 0.58–2.10.
Conclusions:
Despite the overall correlation, this study demonstrates the uncertainty associated with using bone microarchitecture parameters on CBCT images. Although clinically relevant parameter ranges are not available, the errors found in this study may be too high for some parameters to be considered for clinical application.
doi:10.1259/dmfr.20140322
PMCID: PMC4628495  PMID: 25564887
cone-beam computed tomography; microcomputed tomography; bone; bone quality; computer-assisted image processing
14.  Evaluation of accuracy of 3D reconstruction images using multi-detector CT and cone-beam CT 
Imaging Science in Dentistry  2012;42(1):25-33.
Purpose
This study was performed to determine the accuracy of linear measurements on three-dimensional (3D) images using multi-detector computed tomography (MDCT) and cone-beam computed tomography (CBCT).
Materials and Methods
MDCT and CBCT were performed using 24 dry skulls. Twenty-one measurements were taken on the dry skulls using digital caliper. Both types of CT data were imported into OnDemand software and identification of landmarks on the 3D surface rendering images and calculation of linear measurements were performed. Reproducibility of the measurements was assessed using repeated measures ANOVA and ICC, and the measurements were statistically compared using a Student t-test.
Results
All assessments under the direct measurement and image-based measurements on the 3D CT surface rendering images using MDCT and CBCT showed no statistically difference under the ICC examination. The measurements showed no differences between the direct measurements of dry skull and the image-based measurements on the 3D CT surface rendering images (P>.05).
Conclusion
Three-dimensional reconstructed surface rendering images using MDCT and CBCT would be appropriate for 3D measurements.
doi:10.5624/isd.2012.42.1.25
PMCID: PMC3314834  PMID: 22474645
Reproducibility of Results; Three-Dimensional Image; Skull
15.  Detection of cavitated approximal surfaces using cone beam CT and intraoral receptors 
Dentomaxillofacial Radiology  2013;42(1):20120019.
Objectives
The aim of this study was to compare cone beam CT (CBCT) in a small field of view (FOV) with a solid-state sensor and a photostimulable phosphor plate system for detection of cavitated approximal surfaces.
Methods
257 non-filled approximal surfaces from human permanent premolars and molars were recorded by two intraoral digital receptors, a storage phosphor plate (Digora Optime, Soredex) and a solid-state CMOS sensor (Digora Toto, Soredex), and scanned in a cone beam CT unit (3D Accuitomo FPD80, Morita) with a FOV of 4 cm and a voxel size of 0.08 mm. Image sections were carried out in the axial and mesiodistal tooth planes. Six observers recorded surface cavitation in all images. Validation of the true absence or presence of surface cavitation was performed by inspecting the surfaces under strong light with the naked eye. Differences in sensitivity, specificity and agreement were estimated by analysing the binary data in a generalized linear model using an identity link function.
Results
: A significantly higher sensitivity was obtained by all observers with CBCT (p < 0.001), which was not compromised by a lower specificity. Therefore, a significantly higher overall agreement was obtained with CBCT (p < 0.001). There were no significant differences between the Digora Optime phosphor plate system and the Digora Toto CMOS sensor for any parameter.
Conclusions
CBCT was much more accurate in the detection of surface cavitation in approximal surfaces than intraoral receptors. The differences are interpreted as clinically significant. A CBCT examination performed for other reasons should also be assessed for approximal surface cavities in teeth without restorations.
doi:10.1259/dmfr.20120019
PMCID: PMC3729187
radiography; digital; computed tomography; diagnosis; dental caries
16.  Evaluation of demineralized bone and bone transplants in vitro and in vivo with cone beam computed tomography imaging 
Dentomaxillofacial Radiology  2010;39(5):264-269.
Objectives
The objective of this study was to determine the ability of two flat panel cone beam CT (CBCT) devices to identify demineralized bone and bone transplants in vivo and in vitro.
Methods
Datasets from patients with autologous bone grafts (n = 9, KaVo 3DeXam (KaVo, Biberach, Germany); n = 38, Accuitomo 40 (Morita, Osaka, Japan)) were retrospectively evaluated. Demineralized and non-demineralized porcine cancellous bone blocks were examined with the two CBCT devices. A SawBone® skull (Pacific Research Laboratories, Vashon, WA) was used as a positioning tool for the bone blocks. Descriptive evaluation and image quality assessment were conducted on the KaVo 3DeXam data (voxel size 0.3 mm) using the OsiriX viewer as well as on the Morita Accuitomo data (voxel size 0.25 mm) using proprietary viewer software.
Results
Both in vivo and in vitro, the descriptive analysis of the images of the two devices showed well-visualized bone transplants with clearly defined cancellous bones and well-defined single bone trabeculae in all cross-sections. In vitro, demineralized samples showed lower radiographic opacity but no significant loss of quality compared with fresh bone (P = 0.070). Single cancellous bone trabeculae were significantly better visualized with the Morita 3D Accuitomo device than with the KaVo 3DeXam device (P = 0.038).
Conclusion
Both the KaVo 3DeXam and Morita 3D Accuitomo devices produce good-quality images of cancellous bones in in vivo remodelling as well as after in vitro demineralization.
doi:10.1259/dmfr/147454468
PMCID: PMC3520252  PMID: 20587649
cone beam computed tomography; bone augmentation; implantology
17.  Accuracy of Bolton analysis measured in laser scanned digital models compared with plaster models (gold standard) and cone-beam computer tomography images 
Korean Journal of Orthodontics  2016;46(1):13-19.
Objective
The aim of this study was to compare the accuracy of Bolton analysis obtained from digital models scanned with the Ortho Insight three-dimensional (3D) laser scanner system to those obtained from cone-beam computed tomography (CBCT) images and traditional plaster models.
Methods
CBCT scans and plaster models were obtained from 50 patients. Plaster models were scanned using the Ortho Insight 3D laser scanner; Bolton ratios were calculated with its software. CBCT scans were imported and analyzed using AVIZO software. Plaster models were measured with a digital caliper. Data were analyzed with descriptive statistics and the intraclass correlation coefficient (ICC).
Results
Anterior and overall Bolton ratios obtained by the three different modalities exhibited excellent agreement (> 0.970). The mean differences between the scanned digital models and physical models and between the CBCT images and scanned digital models for overall Bolton ratios were 0.41 ± 0.305% and 0.45 ± 0.456%, respectively; for anterior Bolton ratios, 0.59 ± 0.520% and 1.01 ± 0.780%, respectively. ICC results showed that intraexaminer error reliability was generally excellent (> 0.858 for all three diagnostic modalities), with < 1.45% discrepancy in the Bolton analysis.
Conclusions
Laser scanned digital models are highly accurate compared to physical models and CBCT scans for assessing the spatial relationships of dental arches for orthodontic diagnosis.
doi:10.4041/kjod.2016.46.1.13
PMCID: PMC4751296  PMID: 26877978
Three-dimensional scanner; Digital models; Dental cast analysis
18.  Accuracy and reliability of stitched cone-beam computed tomography images 
Imaging Science in Dentistry  2015;45(1):41-47.
Purpose
This study was performed to evaluate the linear distance accuracy and reliability of stitched small field of view (FOV) cone-beam computed tomography (CBCT) reconstructed images for the fabrication of implant surgical guides.
Materials and Methods
Three gutta percha points were fixed on the inferior border of a cadaveric mandible to serve as control reference points. Ten additional gutta percha points, representing fiduciary markers, were scattered on the buccal and lingual cortices at the level of the proposed complete denture flange. A digital caliper was used to measure the distance between the reference points and fiduciary markers, which represented the anatomic linear dimension. The mandible was scanned using small FOV CBCT, and the images were then reconstructed and stitched using the manufacturer's imaging software. The same measurements were then taken with the CBCT software.
Results
The anatomic linear dimension measurements and stitched small FOV CBCT measurements were statistically evaluated for linear accuracy. The mean difference between the anatomic linear dimension measurements and the stitched small FOV CBCT measurements was found to be 0.34 mm with a 95% confidence interval of +0.24 - +0.44 mm and a mean standard deviation of 0.30 mm. The difference between the control and the stitched small FOV CBCT measurements was insignificant within the parameters defined by this study.
Conclusion
The proven accuracy of stitched small FOV CBCT data sets may allow image-guided fabrication of implant surgical stents from such data sets.
doi:10.5624/isd.2015.45.1.41
PMCID: PMC4362990  PMID: 25793182
Cone-Beam Computed Tomography; Computer-Aided Design; Dental Implants
19.  Comparing the Effect of Different Voxel Resolutions for Assessment of Vertical Root Fracture of Permanent Teeth 
Iranian Journal of Radiology  2015;12(3):e18290.
Background:
The teeth with undiagnosed vertical root fractures (VRFs) are likely to receive endodontic treatment or retreatment, leading to frustration and inappropriate endodontic therapies. Moreover, many cases of VRFs cannot be diagnosed definitively until the extraction of tooth.
Objectives:
This study aimed to assess the use of different voxel resolutions of two different cone beam computerized tomography (CBCT) units in the detection VRFs in vitro.
Materials and Methods:
The study material comprised 74 extracted human mandibular single rooted premolar teeth without root fractures that had not undergone any root-canal treatment. Images were obtained by two different CBCT units. Four image sets were obtained as follows: 1) 3D Accuitomo 170, 4 × 4 cm field of view (FOV) (0.080 mm3); 2) 3D Accuitomo 170. 6 × 6 cm FOV (0.125 mm3); 3) NewTom 3G, 6˝ (0.16 mm3) and 4) NewTom 3G, 9˝ FOV (0.25 mm3). Kappa coefficients were calculated to assess both intra- and inter-observer agreements for each image set.
Results:
No significant differences were found among observers or voxel sizes, with high average Z (Az) results being reported for all groups. Both intra- and inter-observer agreement values were relatively better for 3D Accuitomo 170 images than the images from NewTom 3G. The highest Az and kappa values were obtained with 3D Accuitomo 170, 4 × 4 cm FOV (0.080 mm3) images.
Conclusion:
No significant differences were found among observers or voxel sizes, with high Az results reported for all groups.
doi:10.5812/iranjradiol.18290
PMCID: PMC4632561  PMID: 26557279
Cone-Beam Computed Tomography; Permanent Dentition; Diagnosis
20.  In Vitro Detection of Dental Root Fractures with Cone Beam Computed Tomography (CBCT) 
Iranian Journal of Radiology  2014;11(1):e11485.
Background:
Since the diagnosis of non-displaced longitudinal fractures present difficulties for the dentist, three-dimensional evaluation is necessary.
Objectives:
The aim of this study is to demonstrate the accuracy of cone beam computed tomography (CBCT) in detecting dental root fractures in vitro.
Materials and Methods:
An in vitro model consisting of 210 recently extracted human mandibular teeth was used. Root fractures were created by mechanical force. The teeth were placed randomly in the empty dental alveoli of a dry human mandible and 15 different dental arcs were created. Images were taken with a unit Iluma ultra cone-beam CT scanner (Imtec Corporation, Germany). Three dental radiologists separately evaluated the images.
Results:
According to the fracture types and fracture presence, there was an overall statistically significant agreement between the key and readings. Kappa values for intra observer agreement ranged between 0.705 and 0.804 indicating that each observer gave acceptable ratings for the type and presence of fractures.
Conclusions:
Detailed information about root fractures may be obtained using CBCT.
doi:10.5812/iranjradiol.11485
PMCID: PMC3955851  PMID: 24693295
Tooth Fractures; In Vitro; Cone-Beam Computed Tomography
21.  Comparison of precision and accuracy of linear measurements performed by two different imaging software programs and obtained from 3D-CBCT images for Le Fort I osteotomy 
Dentomaxillofacial Radiology  2013;42(5):20120178.
Objective:
The purpose of this study was to compare the precision and accuracy of linear measurements for Le Fort I osteotomy performed by two different imaging software programs and obtained from three-dimensional cone beam CT (3D-CBCT) images.
Methods:
The study population consisted of 11 dried skulls submitted to CBCT, which generated 3D images. Linear measurements were based on craniometric anatomical landmarks pre-defined by the authors as specifically used for Le Fort I osteotomy and were identified by two radiologists twice each, independently, using Vitrea 3.8.1 (Vital Images Inc., Plymouth, MN) and open-source digital imaging communication in medicine viewer OsiriX 1.2 64-bit (Pixmeo, Geneva, Switzerland). Subsequently, a third examiner made physical measurements using a digital caliper (167 series; Mitutoyo Sul Americana Ltd, Suzano, SP, Brazil).
Results:
The results demonstrated a statistically significant difference between OsiriX and the gold standard, especially in the pterygoid process (TPtg L = 0.019, LLpPtg R = 0.016 and LLpPtg L = 0.012). Vitrea showed no statistical difference in comparison with the gold standard, and showed a high level of accuracy in all the measurements performed. The major difference found was 0.42 mm (LLpPtg R). Interexaminer analysis ranged from 0.90 to 0.97 using Vitrea and from 0.8 to 0.97 using OsiriX. Intraexaminer correlation coefficient ranged from 0.90 to 0.98 and from 0.84 to 0.98 for Examiners 1 and 2, respectively, using Vitrea and from 0.93 to 0.99 for Examiner 1 and from 0.64 to 0.96 for Examiner 2 using OsiriX.
Conclusion:
Vitrea may be considered as precise and accurate, insofar as it was able to perform all the 3D linear measurements. On the other hand, linear measurements performed using OsiriX were not successful in producing accurate linear measurements for Le Fort I osteotomy.
doi:10.1259/dmfr.20120178
PMCID: PMC3635772  PMID: 23520394
cone beam computed tomography; 3D imaging; X-ray computed tomography; osteotomy Le Fort
22.  Accuracy of linear measurement in the Galileos cone beam computed tomography under simulated clinical conditions 
Dentomaxillofacial Radiology  2011;40(5):299-305.
Objectives
The aim of this study was to determine the geometric accuracy of cone beam CT (CBCT)-based linear measurements of bone height obtained with the Galileos CBCT (Sirona Dental Systems Inc., Bensheim, Hessen, Germany) in the presence of soft tissues.
Methods
Six embalmed cadaver heads were imaged with the Galileos CBCT unit subsequent to placement of radiopaque fiduciary markers over the buccal and lingual cortical plates. Electronic linear measurements of bone height were obtained using the Sirona software. Physical measurements were obtained with digital calipers at the same location. This distance was compared on all six specimens bilaterally to determine accuracy of the image measurements.
Results
The findings showed no statistically significant difference between the imaging and physical measurements (P > 0.05) as determined by a paired sample t-test. The intraclass correlation was used to measure the intrarater reliability of repeated measures and there was no statistically significant difference between measurements performed at the same location (P > 0.05).
Conclusions
The Galileos CBCT image-based linear measurement between anatomical structures within the mandible in the presence of soft tissues is sufficiently accurate for clinical use.
doi:10.1259/dmfr/72117593
PMCID: PMC3520257  PMID: 21697155
tomography, cone-beam computed; cadaver; head
23.  Crown and root lengths of incisors, canines, and premolars measured by cone-beam computed tomography in patients with malocclusions 
Korean Journal of Orthodontics  2013;43(6):271-278.
Objective
The purposes of this study were to determine the accuracy of crown and root length measurements of premolars using cone-beam computed tomography (CBCT) and to generate reference CBCT-based data on incisor, canine, and premolar lengths in patients with malocclusions.
Methods
Imaging was performed using a CBCT scanner with a 0.292-mm voxel size and 12-bit grayscale. The CBCT-based length measurements were compared with direct measurements of 94 subsequently extracted premolars without metal restorations using the paired t-test. Furthermore, the crown and root lengths of incisors, canines, and premolars in 62 Korean patients with malocclusions were measured using CBCT, and Pearson's correlation coefficients were calculated to examine the relationship between the crown and root length measurements of each tooth type.
Results
The differences between the CBCT-based and direct measurements of the extracted premolars were not significant, with 95% limits of agreement of -0.90 to 0.90 mm for crown length and -1.23 to 1.18 mm for root length. Weak positive correlations between the crown and root length measurements were observed for the mandibular canine and premolars.
Conclusions
The CBCT-based measurements showed a wider range of limits of agreements for root length than for crown length. The CBCT-based data can be used as a reference for evaluating root length and resorption of teeth without metal restorations in patients with malocclusions.
doi:10.4041/kjod.2013.43.6.271
PMCID: PMC3879283  PMID: 24396736
Computed tomography; Anatomy; Root resorption
24.  Evaluation of diagnostic accuracy and dimensional measurements by using CBCT in mandibular first molars 
Background
This study aimed to assess the diagnostic accuracy of cone beam computed tomography (CBCT) and quantitatively evaluate the morphology of mandibular first molars using CBCT.
Material and Methods
Twenty-four double-rooted mandibular first molars were evaluated by NewTom VGi CBCT. The distance from the furcation and apex to the cementoenamel junction (CEJ), diameter and thickness of canal walls, the buccolingual (BL) to mesiodistal (MD) ratio (ΔD), prevalence of oval canals at different sections and taper of the canals were all determined. In order to assess the diagnostic accuracy of CBCT, distance from the furcation and apex to the CEJ and thickness of canal walls at the CEJ and apex were compared with the gold standard values (caliper and stereomicroscope). Statistical analyses were carried out using intraclass correlation coefficient (ICC), paired t-test and repeated measures ANOVA.
Results
A high correlation existed between the CBCT and gold standard measurements (P<0.001). In dimensional measurements, length of mesial root was higher than the distal root and lingual furcation was farther from the CEJ than the buccal furcation (P<0.001). An important finding of this study was the mesiodistal taper of the mesiobuccal (MB) and mesiolingual (ML) canals; which was equal to 0.02.
Conclusions
CBCT has acceptable diagnostic accuracy for measurement of canal wall thickness. Cleaning and shaping of the canals should be performed based on the unique anatomy of the respective canal; which necessitates the use of advanced imaging techniques for thorough assessment of root canal anatomy in a clinical setting.
Key words:Permanent mandibular first molar, accuracy, cone-beam computed tomography, dimensional measurement.
doi:10.4317/jced.52570
PMCID: PMC4739359  PMID: 26855697
25.  Evaluation of accuracy of cone beam computed tomography for measurement of periodontal defects: A clinical study 
Aims:
The aim of the present study was to evaluate the accuracy of Cone Beam Computed Tomography (CBCT) measurements of alveolar bone defects caused due to periodontal disease, by comparing it with actual surgical measurements which is the gold standard.
Materials and Methods:
Hundred periodontal bone defects in fifteen patients suffering from periodontitis and scheduled for flap surgery were included in the study. On the day of surgery prior to anesthesia, CBCT of the quadrant to be operated was taken. After reflection of the flap, clinical measurements of periodontal defect were made using a reamer and digital vernier caliper. The measurements taken during surgery were then compared to the measurements done with CBCT and subjected to statistical analysis using the Pearson's correlation test.
Results:
Overall there was a very high correlation of 0.988 between the surgical and CBCT measurements. In case of type of defects the correlation was higher in horizontal defects as compared to vertical defects.
Conclusions:
CBCT is highly accurate in measurement of periodontal defects and proves to be a very useful tool in periodontal diagnosis and treatment assessment.
doi:10.4103/0972-124X.154176
PMCID: PMC4520112  PMID: 26229268
Bone defects; cone beam computed tomography; intra-oral radiograph; periodontal disease

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