Alpesh Patel1, Boon Ching Tee2, Henry Fields3, Elizabeth Jones1, Jahanzeb Chaudhry4, Zongyang Sun5. 1. Resident, Division of Orthodontics, College of Dentistry, Ohio State University, Columbus, Ohio. 2. Research assistant, Division of Orthodontics, College of Dentistry, Ohio State University, Columbus, Ohio. 3. Professor and chair, Division of Orthodontics, College of Dentistry, Ohio State University, Columbus, Ohio. 4. Assistant professor, Division of Oral Pathology and Radiology, College of Dentistry, Ohio State University, Columbus, Ohio. 5. Associate professor, Division of Orthodontics, College of Dentistry, Ohio State University, Columbus, Ohio. Electronic address: sun.254@osu.edu.
Abstract
INTRODUCTION: In this study, we investigated the impact of defect size and scan voxel size on the accuracy of cone-beam computed tomography (CBCT) diagnoses of simulated condylar defects and assessed the value of orthodontic CBCT images typically scanned at lower settings (0.4-mm voxel size and full-size field of view) in diagnosing condylar erosion defects. METHODS: Cylindrical holes simulating condylar defects with varied diameters (≤2, 2-3, and >3 mm) and depths (≤2 and >2 mm) were created in 22 fresh pig mandibular condyles, with defect number and size per condyle and quadrant randomly determined. With the soft tissues repositioned, 2 CBCT scans (voxel sizes, 0.4 and 0.2 mm) of the pig heads were obtained from an i-CAT unit (Imaging Science International, Hatfield, Pa). Reconstructed CBCT data were analyzed independently by 2 calibrated, blinded raters using Dolphin-3D (Dolphin Imaging and Management Solutions, Chatsworth, Calif) for defect identification and localization and defect diameter and depth measurements, which were compared with physical diagnoses obtained from polyvinyl siloxane impressions. RESULTS: Identification and localization of simulated defects demonstrated moderate interrater reliability and excellent specificity and sensitivity, except for extremely small defects (both diameter and depth ≤2 mm) viewed with 0.4-mm scans, which had a significantly lower sensitivity (67.3%). Geometric measurements of simulated defects demonstrated good but not excellent interrater reliability and submillimeter inaccuracy for all defects. Receiver operating characteristic analyses demonstrated that the overall accuracy of diagnosing simulated condylar defects based on CBCT geometric measurements was fair and good for the 0.4-mm and 0.2-mm voxel-size scans, respectively. With the prevalence of condylar erosion defects in the patients considered, the positive predictive values of diagnoses based on 0.5-mm size (diameter or depth) cutoff points were near 15% and 50% for asymptomatic and symptomatic temporomandibular joints, respectively; the negative predictive values were near 95% and 90%, respectively. CONCLUSIONS: When using orthodontic CBCT images for diagnosing condylar osseous defects, extremely small (<2 mm) defects can be difficult to detect; caution is also needed for the diagnostic accuracy of positive diagnoses, especially those from asymptomatic temporomandibular joints.
INTRODUCTION: In this study, we investigated the impact of defect size and scan voxel size on the accuracy of cone-beam computed tomography (CBCT) diagnoses of simulated condylar defects and assessed the value of orthodontic CBCT images typically scanned at lower settings (0.4-mm voxel size and full-size field of view) in diagnosing condylar erosion defects. METHODS: Cylindrical holes simulating condylar defects with varied diameters (≤2, 2-3, and >3 mm) and depths (≤2 and >2 mm) were created in 22 fresh pig mandibular condyles, with defect number and size per condyle and quadrant randomly determined. With the soft tissues repositioned, 2 CBCT scans (voxel sizes, 0.4 and 0.2 mm) of the pig heads were obtained from an i-CAT unit (Imaging Science International, Hatfield, Pa). Reconstructed CBCT data were analyzed independently by 2 calibrated, blinded raters using Dolphin-3D (Dolphin Imaging and Management Solutions, Chatsworth, Calif) for defect identification and localization and defect diameter and depth measurements, which were compared with physical diagnoses obtained from polyvinyl siloxane impressions. RESULTS: Identification and localization of simulated defects demonstrated moderate interrater reliability and excellent specificity and sensitivity, except for extremely small defects (both diameter and depth ≤2 mm) viewed with 0.4-mm scans, which had a significantly lower sensitivity (67.3%). Geometric measurements of simulated defects demonstrated good but not excellent interrater reliability and submillimeter inaccuracy for all defects. Receiver operating characteristic analyses demonstrated that the overall accuracy of diagnosing simulated condylar defects based on CBCT geometric measurements was fair and good for the 0.4-mm and 0.2-mm voxel-size scans, respectively. With the prevalence of condylar erosion defects in the patients considered, the positive predictive values of diagnoses based on 0.5-mm size (diameter or depth) cutoff points were near 15% and 50% for asymptomatic and symptomatic temporomandibular joints, respectively; the negative predictive values were near 95% and 90%, respectively. CONCLUSIONS: When using orthodontic CBCT images for diagnosing condylar osseous defects, extremely small (<2 mm) defects can be difficult to detect; caution is also needed for the diagnostic accuracy of positive diagnoses, especially those from asymptomatic temporomandibular joints.
Authors: Liliane Rosas Gomes; Marcelo Regis Gomes; João Roberto Gonçalves; Antônio Carlos O Ruellas; Larry M Wolford; Beatriz Paniagua; Erika Benavides; Lúcia Helena Soares Cevidanes Journal: Oral Surg Oral Med Oral Pathol Oral Radiol Date: 2015-10-20