Blickdiagnostik – eine Art Detektivspiel

Die enorme Entwicklung von der intraoralen Bildgebung zur digitalen Volumentomographie an vorderster Front mitgemacht hat unter anderem PD Dr. med. dent. Karl Dula. Mit der speziell für die Zahnmedizin gedachten räumlichen Bildgebung in allen drei Ebenen beschäftigt sich der Privatdozent intensiv sowohl in der Lehre und Forschung als auch als Präsident der Schweizerischen Gesellschaft für Dento-Maxillo-Faziale Radiologie (SGRDMF). Die Redaktorin sprach mit dem Präsidenten, wel- cher in den 25 Jahren seiner zahnärztlichen Tätigkeit eine nie geahnte Entwicklung seines Faches miterlebt hat

Study on the necessity for cross-section imaging of the posterior mandible for treatment planning of standard cases in implant dentistry.

OBJECTIVE To investigate whether cross-section imaging influences the planning and therapy of standard implant cases in the posterior mandible. MATERIAL AND METHODS In a prospective study conducted over 16 months, the planned treatment (standard implant therapy without bone augmentation procedures in the premolar and molar regions of the mandible) was compared with the postoperative result in 50 randomly selected patients. Clinical examinations and panoramic radiographs were performed pre- and postoperatively, whereas cross-sectional tomography was performed only preoperatively. RESULTS The vertical magnification factor in the panoramic radiographs was very constant pre- and postoperatively with 1 : 1.27 and in the spiral tomograms with 1 : 1.52. In 11 of 77 implant sites, the mandibular canal could not be evaluated in the spiral tomograms. The additional information from cross-sectional spiral tomography did not influence the original planning in 74 of 77 (96.1%) implant sites. Based on the postoperative panoramic radiograph, the average distance from the tip of the implants to the mandibular canal was 3.04+/-2.06 mm. In two cases (2.6%), transient postoperative altered tactile sensation of the mental nerve was found. CONCLUSION The information from preoperative cross-sectional spiral tomography has minor impact on treatment planning in standard implant cases in mandibular premolar and molar regions. The clinical examination provides sufficient information for selecting implant diameter and the panoramic radiograph provides sufficient information for implant length selection

Postoperative tomographic assessment of veneer bone grafting with implant placement in the maxillary anterior region.

Various ridge augmentation and sinus lift procedures were performed in severely resorbed alveolar crests of a maxilla to provide some volume for implant treatment. It was reported that the outcome of maxillary sinus lift procedures was evaluated with conventional tomography or computerized tomography, and that grafted bone around implants markedly progressed in resorption, particularly at the implant apex. However, veneer bone grafting with implant placement has not been evaluated after treatment with imaging techniques. Therefore, the purpose of this study was to assess veneer bone grafting after maxillary anterior implant treatment. Seven patients with a mean age of 24 years, with implants placed in the maxillary anterior region with or without autogenous veneer bone grafting were postoperatively examined using conventional tomography. On tomograms, the ratio of bone-to-implant contact and the area of bone were measured in labial bones with bone grafts, and they were compared with the values without bone grafts. In cases with bone grafting, the average ratio of bone-to-implant contact was 63.6%, whereas 81.8% was formed in cases without bone grafting. The average area of bone was 12.9 mm and 23.4 mm in patients with and without bone grafting, respectively. No significant difference was found between the implants with and without bone grafts. Resorbed labial bone was observed in the maxillary anterior region with and without veneer bone grafting

[Focal osteosclerotic lesions of the jaws--a review focusing on diagnostic and therpeutic aspects].

The diagnosis of osteosclerotic lesions is sometimes quite challenging for the general dental practitioner. When having no clear reason for a sclerotic process in the jaw bone, the dentist is often left without a definite diagnosis and treatment plan. Additionally, the literature often mixes terms for sclerotic bone lesions in the mandible or maxilla, causing further confusion about classification, therapy and prognosis of these entities. Although osteosclerotic jaw lesions can arise in every decade of life, they often are encountered by chance on routine radiographic examinations. For further diagnosis these lesions are even referred for invasive procedures such as bone biopsies. Nevertheless, accurate knowledge about the pathogenesis, radiographic and clinical appearance of these lesions could already lead to a diagnosis without the need for further biopsies. The present review focuses on the focal osteosclerosis of the jaws, discussing diagnosis, treatment and important differential diagnoses

Strahlenbelastung und Strahlenschutz bei der Digitalen Volumentomographie

Aussagen über das Ausmaß des von diagnostischer Röntgenstrahlung ausgehenden Schädigungsrisikos für Organismen resp. Teile von Organismen zu machen ist alles andere als banal. Klar ist aber: Die DVT unterscheidet sich auch im Bereich der applizierten Strahlendosis wesentlich von anderen radiologischen Techniken. Auf der einen Seite liegt ihre Dosis in aller Regel höher als bei „einfacheren“ Methoden wie intraoralen Röntgenaufnahmen und Panoramaschichtaufnahmen, aber niedriger als bei der Computertomographie. Auf der anderen Seite sind Abweichungen von dieser Regel durch die vielfältigen Einstellungsmöglichkeiten bei der DVT möglich und nicht einmal selten. Kleinvolumige, niedrig aufgelöste DVT-Aufnahmen eines Oberkieferseitenzahnbereiches im Low-dose-Modus sind für Implantatabklärungen klinische Routine. Sie verursachen dann eine Patientendosis, die deutlich geringer ist als beispielsweise bei einer halbseitigen Panoramaschichtaufnahme oder sogar einem konventionellen Bitewing

Cone beam computed tomography (CBCT) for diagnosis and treatment planning in periodontology: A systematic review.

OBJECTIVE The improvement in diagnostic accuracy and optimization of treatment planning in periodontology through the use of three-dimensional imaging with cone beam computed tomography (CBCT) is discussed controversially in the literature. The objective was to identify the best available external evidence for the indications of CBCT for periodontal diagnosis and treatment planning in specific clinical situations. DATA SOURCES A systematic literature search was performed for articles published by 2 March 2015 using electronic databases and hand search. Two reviewers performed the study selection, data collection, and validity assessment. PICO and PRISMA criteria were applied. From the combined search, seven studies were finally included. CONCLUSION The case series were published from the years 2009 to 2014. Five of the included publications refer to maxillary and/or mandibular molars and two to aspects related to vertical bony defects. Two studies show a high accuracy of CBCT in detecting intrabony defect morphology when compared to periapical radiographs. Particularly, in maxillary molars, CBCT provides high accuracy for detecting furcation involvement and morphology of surrounding periodontal tissues. CBCT has demonstrated advantages, when more invasive treatment approaches were considered in terms of decision making and cost benefit. Within their limits, the available data suggest that CBCT may improve diagnostic accuracy and optimize treatment planning in periodontal defects, particularly in maxillary molars with furcation involvement, and that the higher irradiation doses and cost-benefit ratio should be carefully analyzed before using CBCT for periodontal diagnosis and treatment planning

Diagnosis of tooth ankylosis using panoramic views, cone beam computed tomography, and histological data: a retrospective observational case series study

Objectives: The aim of this study was to determine whether cone beam computed tomography is a reliable radiological method to diagnose tooth ankylosis. Materials and methods: A series of teeth clinically diagnosed as ankylosed were collected after extraction in a private practice from 2009 to 2015 and analyzed retrospectively. Inclusion criteria comprised permanent molars extracted due to failed tooth eruption in the absence of any visible mechanical obstruction, existing panoramic view (PV), and cone beam computed tomography (CBCT) and histological sections of sufficient quality. The CBCT scans and PVs were evaluated twice for signs of ankylosis by two independent observers using the following score: clear signs, possible signs, and no signs. The histological sections were evaluated and graded similarly to the radiographs by a specialist blinded to the radiographs and treatment. Results: Out of an initial group of 22 patients, 9 subjects with 10 affected teeth were included for final evaluation. The age ranged from 8.3 to 17 years. No agreement was seen in comparing the PV scores to the histological sections. Fair to moderate agreement was seen in comparing the CBCT scores to the histological sections. All histologically confirmed ankylosis were detected in CBCT by both observers but some false positive results were found. Limitation: Only a small sample size was available as the disorder is rare. It is difficult to distinguish ankylosis from primary failure of eruption. Conclusion: CBCT images can be a useful adjunctive diagnostic tool to diagnose ankylosed teeth, but cannot be recommended as a single diagnostic modality as false positive results were found.status: publishe