Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 05 Feb 2020

Diagnostic Potential of Panoramic Radiography and CBCT in Detecting Implant-Related Ex Vivo Injuries of the Inferior Alveolar Canal Border

DDS, PhD,
DDS, PhD,
DDS, PhD, and
MD
Page Range: 206 – 213
DOI: 10.1563/aaid-joi-D-19-00005
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The aim of this ex vivo study was to compare the diagnostic performances of panoramic radiography and cone beam computerized tomography (CBCT) in detecting implant-related injuries of the inferior alveolar canal. Monocortical bone windows were created in 60 fresh sheep hemimandibles, the inferior alveolar canals were revealed and 120 dental implants were inserted. Three types of injuries, described as pilot drill damage (PDRILL), collapsing of the superior border of the canal (COLL), penetration of the implant tip into the canal (PENET) and one control group, were simulated. Standard (PANO) and dentition mode panoramic (PANO-DENT) images as well as CBCT data presented as multiplanar reconstruction (MPR) and cross-sectional (CROSS) views were evaluated by 6 observers who had also expressed their level of confidence to their final diagnosis. Intra- and interobserver agreement scores were rated good. The area under the curve (AUC) values and the confidence scores for CROSS and multiplanar reformation (MPR) views were both significantly higher than those of PANO and PANO-DENT (P < .05 for each) in PDRILL group. In COLL group, observers showed less confidence to PANO and PANO-DENT compared to CROSS and MPR techniques (P < .05 for each). No other significant differences were found. Within the limits of this experimental study, it can be suggested that the standard and dentition modes of panoramic radiography can be as effective as CBCT in the detection of penetrating and collapsing injuries, but multiplanar and cross-sectional views of the CBCT are more accurate than panoramic radiography in the detection of pilot drill injuries in sheep mandible.

Figure 1.
Figure 1.

Borders (a) and separation (b) of the monocortical bone window; (c) downsizing of the hemimandibles to standard bone blocks; (d) clinical photograph of simulated injuries: canal penetration (left) and collapsing of the cortical border (right). Positioning of the radiographic phantom before panoramic (e) and cone beam computerized tomography imaging (f).


Figure 2.
Figure 2.

(a) Pilot drill injury (left) and collapsing of the superior border of the inferior alveolar canal (right) in standard panoramic radiography. (b) Images taken with the dentition mode of the panoramic radiography showing pilot drill injury (left) and control samples with no damage (right). (c) Pilot drill perforation (left) and collapsing of the canal border (right) in the multiplanar reconstructed image from sagittal plane. (d) The cross-sectional image of collapsing of the cortical border and the penetration of the implant tip into the inferior alveolar canal (e).


Contributor Notes

Corresponding author, e-mail: senem.yildirimturk@istanbul.edu.tr
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