Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany.
Clin Oral Implants Res. 2018 Sep;29(9):922-930. doi: 10.1111/clr.13348. Epub 2018 Aug 15.
To evaluate the diagnostic value of cone-beam computed tomography (CBCT), intraoral radiography (IR), and dental magnetic resonance imaging (dMRI) for detecting and classifying peri-implant bone defects at zirconia implants.
Forty-eight zirconia implants were inserted in bovine ribs, 24 of which had standardized defects (1-wall, 2-wall, 3-wall, 4-wall) in two sizes (1 and 3 mm). CBCT, IR, and dMRI were performed and analyzed twice by four readers unaware of the nature of the defects. Cohen's and Fleiss' kappa (κ), sensitivity, and specificity were calculated for the presence/absence of bone defects, defect size, and defect type. Cochran's Q-test with post hoc McNemar was used to test for statistical differences.
A high intra- and inter-reader reliability (κ range: 0.832-1) and sensitivity/specificity (IR: 0.97/0.96; CBCT: 0.99/1; dMRI: 1/0.99) for bone defect detection were observed for all three imaging methods. For defect type classification, intra- (κ range: 0.505-0.778) and inter-reader (κ: 0.411) reliability of IR were lower compared to CBCT (κ range intrareader: 0.667-0.889; κ inter-reader: 0.629) and dMRI (κ range intrareader: 0.61-0.832; κ inter-reader: 0.712). The sensitivity for correct defect type classification was not significantly different for CBCT (0.81) and dMRI (0.83; p = 1), but was significantly lower for IR (0.68; vs. CBCT p = 0.003; vs. dMRI p = 0.004). The sensitivity advantage of CBCT and dMRI for defect classification was smaller for 1-mm defects (CBCT/dMRI/IR: 0.68/0.72/0.63, no significant difference) than for 3-mm defects (CBCT/dMRI/IR: 0.95/0.94/0.74; CBCT vs. IR p = 0.0001; dMRI vs. IR p = 0.003).
Within the limitations of an in vitro study, IR can be recommended as the initial imaging method for evaluating peri-implant bone defects at zirconia implants. CBCT provides higher diagnostic accuracy of defect classification at the expense of higher cost and radiation dose. Dental MRI may be a promising imaging method for evaluating peri-implant bone defects at zirconia implants in the future.
评估锥形束 CT（CBCT）、口腔内射线照相（IR）和牙科磁共振成像（dMRI）在检测和分类氧化锆种植体周围骨缺损方面的诊断价值。
将 48 个氧化锆种植体植入牛肋骨中，其中 24 个种植体有两种尺寸（1 毫米和 3 毫米）的标准缺损（1 壁、2 壁、3 壁、4 壁）。对 CBCT、IR 和 dMRI 进行了两次检查，并由四位对缺陷性质不知情的读者进行了两次分析。计算了 Cohen's 和 Fleiss' kappa（κ）、敏感性和特异性，以评估骨缺损的存在/不存在、缺损大小和缺损类型。使用 Cochran's Q 检验和事后 McNemar 检验来检验统计学差异。
三种成像方法均具有较高的内-和间-读者可靠性（κ 范围：0.832-1）和敏感性/特异性（IR：0.97/0.96；CBCT：0.99/1；dMRI：1/0.99），用于骨缺损检测。对于缺损类型分类，IR 的内-（κ 范围：0.505-0.778）和间-读者（κ：0.411）可靠性低于 CBCT（κ 范围内读者：0.667-0.889；κ 读者间：0.629）和 dMRI（κ 范围内读者：0.61-0.832；κ 读者间：0.712）。CBCT（0.81）和 dMRI（0.83；p=1）的正确缺陷类型分类的敏感性无显著差异，但 IR 的敏感性显著较低（0.68；与 CBCT p=0.003；与 dMRI p=0.004）。对于 1 毫米的缺损，CBCT 和 dMRI 对缺陷分类的敏感性优势（CBCT/dMRI/IR：0.68/0.72/0.63，无显著差异）小于 3 毫米的缺损（CBCT/dMRI/IR：0.95/0.94/0.74；CBCT 与 IR p=0.0001；dMRI 与 IR p=0.003）。
在体外研究的限制范围内，IR 可作为评估氧化锆种植体周围骨缺损的初始成像方法。CBCT 提供了更高的缺陷分类诊断准确性，但代价是更高的成本和辐射剂量。牙科 MRI 可能是未来评估氧化锆种植体周围骨缺损的有前途的成像方法。
