Document Type : Original Article

Authors

1 Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Tehran University of Medical Sciences, International Campus, Tehran, Iran.

2 Dept. of Medical Physics and Biomedical Engineering, and Research Center for Science and Technology in Medicine, Tehran University of Medical Sciences, Tehran, Iran.

3 Research Center for Caries Prevention, Dentistry Research Institute, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.

4 School of Dentistry, Tehran University of Medical Sciences, International Campus, Tehran, Iran.

Abstract

Statement of the Problem: Assessment of bone density changes plays an important role in diagnosis, treatment, and follow-up procedures. The feasibility of cone-beam computed tomography (CBCT) for assessment of bone density changes is still controversial.
Purpose: The aim of this study was to investigate the capability of bone density contrast dissociation of CBCT compared to digital periapical radiography.
Materials and Method: In this in vitro, experimental study, we designed radiographic phantom for bone density simulation. The phantom was a polytetrafluoroethylene rectangular cube with five-chambers. Five micro-tubes (2 mL) containing different concentrations of dipotassium phosphate (K2HPO4) were placed within these chambers. Different concentrations of K2HPO4 were scanned by CBCT; the mean voxel value of each micro-tube was measured and compared with the concentration of K2HPO4 that represented bone density.
Results: CBCT results showed that there were no significant correlations between 300 mg/mL and lower concentrations of K2HPO4 and CBCT voxel values (p ≤0.52) but there was a significant correlation between concentrations of K2HPO4 higher than 300 mg/mL and CBCT voxel values  (p < 0.001).
Conclusion: CBCT is a reliable method for the assessment of bone density changes in the high range of bone density but it is not reliable for such assessment in the lower range of bone density. Digital periapical imaging method may not be applied for the assessment of bone density, whereas in higher densities, the employment of CBCT seems to be feasible.

Keywords

1. Campos MJ, de Souza TS, Mota Júnior SL, Fraga MR, Vitral RW. Bone mineral density in cone beam computed tomography: Only a few shades of gray. World J Radiol. 2014; 6: 607–612. [PMC free article] [PubMed[Google Scholar]
2. Kim DG. Can dental cone beam computed tomography assess bone mineral density? . J Bone Metab. 2014;21:117–126. [PMC free article] [PubMed[Google Scholar]
3. Shah N, Bansal N, Logani A. Recent advances in imaging technologies in dentistry. World J Radiol. 2014; 6: 794–807. [PMC free article] [PubMed[Google Scholar]
4. Avril L, Lombardi T, Ailianou A, Burkhardt K, Varoquaux A, Scolozzi P, et al. Radiolucent lesions of the mandible: a pattern-based approach to diagnosis. Insights Imaging. 2014; 5: 85–101. [PMC free article] [PubMed[Google Scholar]
5. Pauwels R, Nackaerts O, Bellaiche N, Stamatakis H, Tsiklakis K, Walker A, et al. Variability of dental cone beam CT grey values for density estimations. Br J Radiol. 2013; 86: 20120135. [PMC free article] [PubMed[Google Scholar]
6. Tanomaru-FIlho M, Jorge ÉG, Guerreiro-Tanomaru JM, Reis JM, Spin-Neto R, Gonçalves M. Two- and tridimensional analysis of periapical repair after endodontic surgery. Clin Oral Investig. 2015; 19: 17–25. [PubMed[Google Scholar]
7. Cassetta M, Stefanelli LV, Di Carlo S, Pompa G, Barbato E. The accuracy of CBCT in measuring jaws bone density. Eur Rev Med Pharmacol Sci. 2012; 16: 1425–1429. [PubMed[Google Scholar]
8. Nomura Y, Watanabe H, Honda E, Kurabayashi T. Reliability of voxel values from cone-beam computed tomography for dental use in evaluating bone mineral density. Clin Oral Implants Res. 2010; 21: 558–562. [PubMed[Google Scholar]
9. Matsumura S, Sobue T, Yadav S, Lurie A, Tadinada A. Value of a radiographic phantom to evaluate various tissue densities using CBCT. Oral Surg Oral Med Oral Pathol. 2017; 124: e30. [Google Scholar]
10. Oliveira ML, Freitas DQ, Ambrosano GM, Haiter-Neto F. Influence of exposure factors on the variability of CBCT voxel values: a phantom study. Dentomaxillofac Radiol. 2014; 43: 20140128. [PMC free article] [PubMed[Google Scholar]
11. Oliveira ML, Tosoni GM, Lindsey DH, Mendoza K, Tetradis S, Mallya SM. Influence of anatomical location on CT numbers in cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 115: 558–564. [PubMed[Google Scholar]
12. Geha H, Bechara B, Faddoul T, Noujeim M. A mathematical model relating changes of grey values to changes of thicknesses of a stepwedge. Dentomaxillofac Radiol. 2013; 42: 50719185. [PMC free article] [PubMed[Google Scholar]
13. Bender IB, Seltzer S. Roentgenographic and direct observation of experimental lesions in bone: II. 1961. J Endod. 2003; 29: 707–712. [PubMed[Google Scholar]
14. Mohajery M, Brooks SL. Oral radiographs in the detection of early signs of osteoporosis. Oral Surg Oral Med Oral Pathol. 1992; 73: 112–117. [PubMed[Google Scholar]
15. Patrick S, Birur NP, Gurushanth K, Raghavan AS, Gurudath S. Comparison of gray values of cone-beam computed tomography with hounsfield unitsof multislice computed tomography: An in vitro study. Indian J Dent Res. 2017; 28: 66–70. [PubMed[Google Scholar]
16. Hohlweg-Majert B, Metzger MC, Kummer T, Schulze D. Morphometric analysis-Cone beam computed tomography to predict bone quality and quantity. J Craniomaxillofac Surg. 2011; 39: 330–334. [PubMed[Google Scholar]
17. Naitoh M, Hirukawa A, Katsumata A, Ariji E. Evaluation of voxel values in mandibular cancellous bone: relationship between cone-beam computed tomography and multislice helical computed tomography. Clin Oral Implants Res. 2009; 20: 503–506. [PubMed[Google Scholar]
18. Parsa A, Ibrahim N, Hassan B, Motroni A, van der, Stelt P, Wismeijer D. Reliability of voxel gray values in cone beam computed tomography for preoperative implant planning assessment. Int J Oral Maxillofac Implants. 2012; 27: 1438–1442. [PubMed[Google Scholar]