Radiographic modalities for diagnosis and treatment planning in implant dentistry

Early in the development of implant technology it became apparent that conventional dental imaging techniques were limited for evaluating patients for implant surgery. During the treatment planning phase, the recipient bed is routinely assessed by visual examination and palpation, as well as by periapical and panoramic radiology. These two imaging modalities provide a two-dimensional image of mesial-distal and occlusal-apical dimensions of the edentulous regions where implants might be placed. When adequate occlusal-apical bone height is available for endosteal implants, the buccal-lingual width and angulation of the available bone are the most important criteria for implant selection and success. However, neither buccal-lingual width nor angulation can be visualized on most traditional radiographs. Although clinical examination and traditional radiographs may be adequate for patients with wide residual ridges that exhibit sufficient bone crestal to the mandibular nerve and maxillary sinus, these methods do not allow for precise measurement of the buccolingual dimension of the bone or assessment of the location of unanticipated undercuts. For these concerns, it is necessary to view the recipient site in a plane perpendicular to a curved plane through the arch of the maxilla or mandible in the region of the proposed implants. Implant dentists soon recognized that, for optimum placement of implants, cross-sectional views of the maxilla and mandible were the ideal means of providing necessary pre-operative information. Today, the two most often employed and most applicable radiographic studies for implant treatment planning are the panoramic radiograph and tomography. Although distortion can be a major problem with panoramic radiographs, when performed properly they can provide valuable information, and are both readily accessible and cost efficient. To help localize potential implant sites and assist in obtaining accurate measurements, it is recommended that surgical stents be used with panoramic radiographs. In simple cases, where a limited number of implants are to be placed, panoramic radiography and/or tomography may be used to obtain a view of the arch of the jaw in the area of interest. For complex, cases, where multiple implants are required, the CT scan imaging procedure is recommended. Because of its ability to reconstruct a fully three dimensional model of the maxilla and mandible, CT provides a highly sophisticated format for precisely defining the jaw structure and locating critical anatomic structures. The use of CT scans in conjunction with software that renders immediate "treatment plans" using the most real and accurate information provides the most effective radiographic modality currently available for the evaluation of patients for oral implants. To follow patients after implant surgery, DSR can be helpful by addressing the limitations of other radiographic modalities in detecting postoperative changes. By eliminating unchanged information, DSR allows the clinician's eye to focus on actual changes that have occurred between the recordings of two images.     

On the efficacy of the rank transformation in stepwise logistic and discriminant analysis

Workers exposed to harmful dusts such as coal often are screened for possible pneumoconiosis. A classification devised by the International Labor Office (ILO) is used for film interpretation. Film interpretation is time consuming and requires the comparison of the subject's radiograph with as many as 22 standard films and the completion of a nonintuitive form. A computer program has been written to aid in interpretation of films. This program, written in SuperCard, uses hypermedia concepts to link textual, diagrammatic, and digital images. The program includes digitized ILO radiographs, guidelines, references, and other textual and radiographic material. The program is easy to use and reduces the time required to interpret films. The concepts of how the program is constructed are emphasized so that others may devise similar program aids.     

Effects of extract from Clerodendron trichotomum on blood pressure and renal function in rats and dogs

A number of factors may determine the diagnostic accuracy of digitized intraoral radiographs. Conventional film radiographs were digitized with three different digitizers, a laser-scanner, a drum-scanner and a TV camera. Digital images, varying in pixel size, grey level and image processing, were displayed on three different video-monitors and assessed by 10 dentists. The detectability of incipient proximal surface caries was used as an index of the diagnostic accuracy and the effect of the different factors compared by means of receiver operating characteristic (ROC) analysis. Images digitized by the drum-scanner were found to have the best diagnostic accuracy. Sufficient diagnostic accuracy could be attained on the low-cost video monitor of a personal computer. Digital images with a pixel size of 100 microns and 32 grey levels were found to be acceptable for intraoral radiographs for diagnostic purposes. These results provide a practical guide for establishing a digital image acquiring system for any intraoral radiographs, reducing demands on data storage to a minimum.     

Roentgen stereophotogrammetric analysis using computer-based image-analysis

The two-dimensional position of markers in radiographs for Roentgen Stereophotogrammetric Analysis (RSA) is usually determined using a measuring table. The purpose of this study was to evaluate the reproducibility and the accuracy of a new RSA system using digitized radiographs and image-processing algorithms to determine the marker position in the radiographs. Four double-RSA examinations of a phantom and 18 RSA examinations from six patients included in different RSA-studies of knee prostheses were used to test the reproducibility and the accuracy of the system. The radiographs were scanned at 600 dpi resolution and 256 gray levels. The center of each of the tantalum-markers in the radiographs was calculated by the computer program from the contour of the marker with the use of an edge-detection software algorithm after the marker was identified on a PC monitor. The study showed that computer-based image analysis can be used in RSA-examinations. The advantages of using image-processing software in RSA are that the marker positions are determined in an objective manner, and that there is no need for a systematic manual identification of all the markers on the radiograph before the actual measurement.     

A flexible PC-based physiological monitor for animal experiments

We have developed a flexible physiological monitoring and analysis system for physiological studies in which data are obtained over extended periods. Our system uses low-cost personal computer hardware to concentrate data from existing multiple monitoring devices. All monitored parameters are displayed on a single screen and recorded in a single file. The system automates the process of physiological record keeping by providing continuous displays of vital signs. In addition, audible and visual alarms are produced when vital signs are outside of acceptable ranges, prompting the experimenter to take corrective actions. The central element of the system is a program running in a dedicated manner on an IBM PC-compatible computer. The program is written in the C language and makes use of a graphics library to display traces and analysis results in real time on any standard display for the PC. This program assigns the analog channels of an A/D board to particular physiological parameters by initially reading a configuration file, which also describes the alarm conditions and analysis routine for each parameter. All hardware specific code is isolated into well-defined modules. The program is both highly flexible with regard to different sets of parameters and highly portable for different experimental and computer environments.     

Anterior transpedicular fixation of the lower thoracic and lumbar spine. Experimental verification using a new direction finder

Currently, no anterior spinal implant provides a strong bone-screw interface because of the cancellous characteristics of the vertebral body. A more secure anchorage could be obtained by anterior transpedicular screw fixation. Four hundred transpedicular screws located between T7 and L5 were placed using the newly developed direction finder. Measurements were obtained directly from radiographs of the cadaveric specimens. In 10 cases (2.5%), the screws crossed the medial pedicle border, but never by more than 1.4 mm. A lateral protrusion was noted in another 41 screws (10%), with no protrusion greater than 2.2 mm. Encroachments beyond the superior or inferior border were not observed. The mean angle of the screws at each level measured between 7 and 19 in the transverse plane and between 2 and 4.5 in the sagittal plane. This technique should be reserved for vertebrae without significant arthritic changes. The rare screw with minimal infraction through the medial or lateral pedicle wall should not cause any vascular or neural compromise. The anterior transpedicular screw technique appeared relatively safe (88%) and encouraged the development of the new plate system for anterior spinal stabilization.     

Computer-assisted, improved evaluation of Comberg images with three-dimensional graphic reconstruction

BACKGROUND: Small metallic foreign bodies may easily be identified by conventional x-ray. The Comberg shell is a useful tool to discriminate between extra-respectively intraocular localization of the foreign body. However, poor results are common when evaluating the x-ray films. METHODS: We have improved evaluation of the radiographs by means of a program for a personal computer, regarding the following aspects: To avoid errors of measurement the relevant points of the radiograms are read by a digitizer-tableau. The different projection failure of the lateral respectively posteroanterior x-ray is calculated separately. For the calculation of the modell the true axial length of the eye is considered. CONCLUSION: A three dimensional image from varying points of view gives an instructive impression of the foreign body and its relation to structures of the eye. Handling of the presented computer program is easy. It standardizes analysis of the Comberg radiograms.     

Transverse Analysis of Strutted Box Girder Bridges

The computer program STRUTBOX is presented for the transverse analysis of strutted box girder bridges, and particularly for bridges designed and constructed using the strutted box widening method. The program allows the deck prestressing and other reinforcing to be proportioned for transverse flexure, and the web stirrups and slab reinforcing to be proportioned for longitudinal shear and torsion. The program also gives an indication as to the severity of shear lag effects. The program is based on the folded plate method and is no more difficult to use than a plane frame computer program. The paper also demonstrates how the results given by a folded plate analysis can be approximated by using some simple membrane force equations in conjunction with a plane frame analysis. What is particularly interesting is that there is danger in using a plane frame analysis alone to approximate the results of a folded plate analysis for strutted box girder bridges (as well as other box girder bridges) because there are significant differences in the axial force diagrams given by the two methods.     

The implant quality scale: a clinical assessment of the health--disease continuum

Implant success is as difficult to describe as the success criteria required for a tooth. A range from health to disease exists in both conditions. The primary criteria for assessing implant quality are pain and mobility. The presence of either one greatly compromises the implant, and removal is usually indicated. Probing depths may be related to the presence of local disease or pre-existing tissue thickness before the implant was inserted. An increasing probing depth is more diagnostic and signifies bone loss, gingival hyperplasia or hypertrophy. Bone loss is usually evaluated best with probing rather than with radiographs. The most common cause of bone loss during the first few years of function are exaggerated factors of stress. The bleeding index is easily observed and indicates inflammation of the gingiva. However, implant health status is not as related to sulcular inflammation as would be the case for a natural tooth. Implant failure is easier to describe and may consist of a variety of factors. Any pain, vertical mobility, uncontrolled progressive bone loss, and/or generalized periradiolucency warrant implant removal. Implant quality factors were established by James and modified by Misch into an implant quality scale which not only assesses the implant health-disease continuum, but relates treatment and prognosis to the existing conditions.     

Illusory biplane radiographic images

The commonly held belief that radiographs taken at right angles to one another will accurately portray the precise location of a metallic implant within a skeletal structure is erroneous. To the contrary, such biplane radiographs often provide misinformation about the exact location of metallic implants. The explanation for this phenomenon is discussed along with several methods to determine the accurate location of metallic implants when only biplane radiographs are available. Orthopedic surgeons should be particularly aware of this potential problem when biplane radiographs are taken at the time of insertion of multiple pins about the proximal femur.     

Computer-assisted measurement of lumbar spine radiographs

RATIONALE AND OBJECTIVES: The authors evaluated a method for obtaining reproducible, reliable measurements from standard lumbar spine radiographs for determining the degree of spondylolisthesis, vertebral body height, intervertebral disk space height, disk space angle, and degree of vertebral body wedging. MATERIALS AND METHODS: Four to six easily defined points were identified on each vertebral body on anteroposterior and lateral plain radiographs of the lumbosacral spine of patients. From these points, the degree of spondylolisthesis, the vertebral body height, the intervertebral disk space height, the disk space angle, and the degree of vertebral body wedging were easily calculated by using well-known geometric relationships. This method requires the use of a personal computer and a standard spreadsheet program but does not require the use of any other specialized radiographic equipment, computer hardware, or custom software. RESULTS: Calculations of intra- and interobserver variability for the measurement of spondylolisthesis, disk space height, disk space angle, and vertebral body height measurement showed that the technique is extremely reproducible. CONCLUSION: This technique may prove useful in the prospective evaluation of potential candidates for lumbar spinal stenosis surgery.     

Concentrations, biomagnification and spatial variation of organochlorine compounds in a pelagic food web in the northern part of the Baltic Sea

A computer program, BrainView, is presented which has been developed to reconstruct, visualize, and evaluate three dimensional (3D) biological and medical imaging data, such as images from histological sections, confocal microscopy, or magnetic resonance tomography. The program allows the simultaneous display of three orthogonal sectional planes, i.e. the horizontal, frontal, and sagittal planes, of reconstructed data and to move interactively through the brain to optimally assess the 3D data set. Furthermore, any arbitrary sectioning plane through a data set can be visualized. Implemented warping algorithms allow the geometric normalization of data sets of different animals, modalities or developmental stages as a preprocessing for the comparative evaluation of the data. For a quantitative analysis, data sets can be segmented based on equal grey levels and the corresponding equidensities were calculated. The program works on Apple-Macintosh computers and has a user-friendly graphical interface. The BrainView program is discussed in comparison to related programs.     

The prevalence of epilepsy follows the distribution of onchocerciasis in a west Ugandan focus

A study was made to determine whether skeletal alterations usually produced by rapid maxillary expansion may be compensated for in time by growth and/or comprehensive orthodontic treatment. In 30 patients, orthodontic treatment was started with rapid maxillary expansion, followed by fixed appliances, not combined with any other form of orthopedic device. Mean treatment time was 3.1 years. Nine measurements from the Ricketts analysis were studied, based on lateral cephalometric radiographs. Records were taken before orthodontic treatment and after completion of active therapy. A statistical analysis was made of the nine variables used, reflecting the vertical and anteroposterior skeletal proportions of the face, contrasting the changes before and after treatment. Of all the variables studied, the four that change with age according to the Ricketts analysis (mandibular plane angle, maxillary height, facial depth and facial convexity), yielded statistically significant differences after treatment, indicative of normal growth. The five remaining variables that remain constant with age according to the Ricketts analysis (facial axis, lower facial height, total facial height, palatal plane inclination and maxillary depth) showed no significant changes after treatment, also indicative of normal growth.     

Three-dimensional visualization and measurement of conformal dose distributions using magnetic resonance imaging of BANG polymer gel dosimeters

PURPOSE/OBJECTIVE: The measurement of complex dose distributions (those created by irradiation through multiple beams, multiple sources, or multiple source dwell positions) requires a dosimeter that can integrate the dose during a complete treatment. Integrating dosimeter devices generally are capable of measuring only dose at a point (ion chamber, diode, TLD) or in a plane (film). With increasing use of conformal dose distributions requiring shaped, noncoplanar beams, there will be an increased requirement for a dosimeter that can record and display a 3D dose distribution. The use of a 3D dosimeter will be required to confirm the accuracy of treatment plans produced by the current generation of 3D treatment-planning computers. METHODS AND MATERIALS: The use of a Fricke-infused gel and magnetic resonance imaging (MRI) to demonstrate the localization of stereotactic beams has been demonstrated (11). The recently developed BANG polymer gel dosimetry system (MGS Research, Inc., Guilford, CT), based on radiation-induced chain polymerization of acrylic monomers dispersed in a tissue-equivalent gel, surpasses the Fricke-gel method by providing accurate, quantitative dose distribution data that do not deteriorate with time (6, 9). The improved BANG2 formulation contains 3% N,N'-methylene-bisacrylamide, 3% acrylic acid, 1% sodium hydroxide, 5% gelatin, and 88% water, where all percentages are by weight. The gel was poured into volumetric flasks, of dimensions comparable to a human head. The gels were irradiated with complex beam arrangements, similar to those used for conformal radiation therapy. Images of the gels were acquired using a Siemens 1.5T imager and a Hahn spin-echo pulse sequence (90 degrees-tau-180 degrees-tau-acquire, for different values of tau). The images were transferred via network to a Macintosh computer for which a data analysis and display program was written. The program calculates R2 maps on the basis of multiple TE images, using a monoexponential nonlinear least-squares fit based on the Levenberg-Marquardt algorithm. The program also creates a dose-to-R2 calibration function by fitting a polynomial to a set of dose and R2 data points, obtained from gels irradiated in test tubes to known doses. This function can then be applied to any other R2 map, so that a dose map can be computed and displayed. RESULTS: Through exposure to known doses of radiation, the gel has been shown to respond linearly with dose in the range of 0 to 10 Gy, and its response is independent of the beam energy or modality. Dose distributions have been imaged in orthogonal planes, and can be displayed in a convenient form for comparison with isodose plans. The response of the gel is stable; the gel can be irradiated at any time after its manufacture, and imaging can be conducted any time following a brief interval after irradiation. CONCLUSION: The polymer gel dosimeter has been shown to be a valuable device for displaying three-dimensional dose distributions. The imaged dose distribution can be compared easily with calculated dose distributions, to validate a treatment planning system. In the future, gels may be prepared in anthropomorphic phantoms, to confirm unique patient dose distributions.     

The mouse homeobox gene, Gbx2: genomic organization and expression in pluripotent cells in vitro and in vivo

This paper reviews recent work on a project that uses a computer-aided approach for making 3-D reconstructions of serially sectioned mouse embryos (the digital mouse). The captured images are aligned using a warping program so that almost perfect alignment of adjacent sections is achieved with minimal deformation. The sections that are viewed on the computer screen are in fact computer-generated grey-level images with a resolution of about 10 microm. The reconstructed embryo may then be resectioned in any plane to simulate as near as possible an exact match on the computer screen to the viewer's own material. Individual anatomical domains may then be painted in different colors, and these domains may be selected by querying the textual database containing anatomical and other information. Further, it is now possible to generate 3-D images of individual anatomically-discrete components or related sets of components of a particular system in isolation from the rest of the embryo, or, if required, against a 'ghost-like' image of the intact embryo, or specific parts of an embryo. In the article, examples are given of the use of the system in interpreting the vascular, gut and paraxial mesoderm systems, while both the advantages and disadvantages of this approach are also discussed. The eventual aim will be to provide 3-D reconstructions of mouse embryos from fertilization up to 14 days postcoitum of development. When completed, this project will allow the accurate spatial mapping of gene-expression and cell lineage data onto the digital Atlas of normal mouse embryonic development.     

My workplace: head nurse surgical department, Kongsvinger Hospital. A hazardous position. Interview by Kjell Arne Bakke

A method for making transplants for repair of abutment tissue defects and deformations based on computer technology is proposed. The technology unites surgical treatment, clinical and x-ray computer-aided diagnosis, computer processing of information and models, experiments, and production. Correspondence of the implant to repaired structures, site of implantation, and individual defect was confirmed experimentally [5], clinically [10], and by control computer-aided tomography. For the first time an implant was made by computer technology, identical to abutment tissue defect, and a method for plastic repair of defects and deformations in the skull by individually prepared implants developed and realized under clinical conditions.     

Multiple‐Zone Potential Solution around Wing‐Body Configurations

An existing computer code to solve a supersonic potential equation around three‐dimensional configurations was modified. Using a generalized boundary‐conforming coordinate system, a full potential equation in conservation form was upwind differenced in supersonic direction. Grids were generated in each two‐dimensional cross‐flow plane using the algebraic method. A new topology for grid generation produced appropriate grids around thin wings and wing bodies. Usage of orthogonal grid generation in cross‐flow plane improved results and extended the various cases that can be handled by the code. A zonal flow field solution was obtained using a new method for the implementation of boundary conditions at wing locations on boundaries of each zone. Approximate factorizations were used to solve the resulting equations implicitly. Using these capabilities thin‐wing and wing‐body results are presented that compare well with other results. The capability of running this code on microcomputers makes this program a potentially valuable design tool in primary and middesign stages.     

Long-term evaluation of the use of coralline hydroxyapatite in orthognathic surgery

PURPOSE: This prospective study was designed to evaluate the long-term clinical and radiographic results of porous block hydroxyapatite (PBHA) used as a synthetic bone graft in orthognathic surgery and craniofacial augmentation. PATIENTS AND MATERIALS: A total of 245 consecutive patients were treated initially. Inclusion criteria for this study included a minimum clinical and radiographic follow-up of 5 years. In addition, all patients with known implant failures were included regardless of whether they met the study criteria. There were 111 patients that met the criteria for inclusion in this study. All patients had undergone orthognathic surgery with rigid fixation and had had inlay or onlay PBHA implants placed. Ninety-six percent of the implants were placed through an intraoral approach. Long-term postoperative radiographs were visually compared with immediate postoperative radiographs for implant position, stability, resorption, and other significant radiographic changes. The clinical examination evaluated for signs and symptoms of infection, wound dehiscence, implant exposure, implant displacement, changes in the overlying mucosa, and development of oronasal or oroantral fistulae. RESULTS: Four hundred seventy-one implants were placed: 403 in the maxilla, 44 in the mandible, and 24 in the periorbital region. There were 289 implants placed in direct communication with the maxillary sinus. The average follow-up time was 7.2 years (range, 5.0 to 10.3 years). Twenty-three implants (4.9%) were removed during the evaluation period. Lateral maxillary wall grafting had 95.7% success, with nine implants being lost in three patients. One chin implant was removed because of dissatisfaction with the aesthetics. Seven (14%) midpalatal implants used for maxillary expansion were lost, primarily because of exposure of the implant to the oral or nasal cavity at the time of surgery. When PBHA was used for alveolar cleft grafting, there was a 100% failure rate. CONCLUSION: The use of PBHA as a bone graft substitute in orthognathic surgery and for facial augmentation showed a high percentage of success and efficacy. However, adequate soft tissue coverage in the nasal floor and on the palate are paramount for success of midpalatal implants. PBHA should not be used for alveolar cleft grafting. Rigid fixation for inlay implants in the maxilla is important to provide stress shielding of the material and minimize micromovement during the initial healing phase.     

Earthquake Hydrodynamic Pressure on Dams

Hydrodynamic pressures on the vertical upstream face of straight dams during horizontal earthquakes were studied by Westergaad in 1933, and an analytical solution was obtained. Assuming that water is incompressible, an approximation can be made to reduce Westergaad’s mathematical formulation to the Laplace equation. The computer program SEEP2D, from the U.S. Army Corps of Engineers (COE), is available for the study of seepage flow in porous media; this flow can be expressed mathematically in a form of the Laplace equation. Therefore, we can use this computer program to study the hydrodynamic pressure on dams during a horizontal earthquake in the upstream/downstream direction. In practice, the proposed procedure is not limited to SEEP2D but can also be applied to any computer model capable of solving Laplace equations in bounded domains. Two examples are presented to show the application of the COE’s computer program, and the accuracy of the proposed method is discussed.     

Computer assisted spine surgery

When inserting screws into a vertebral pedicle, the surgeon usually exposes the back part of the vertebra and uses his or her anatomic knowledge to align the drill in the proper direction. A slight error in direction may result in an important error in the position of the tip of the screw. This is done with no direct visibility of crucial structures (spinal cord, pleura, vessels). Statistical analysis of a series of surgical procedures has shown that 10% to 40% of the screws are not installed correctly. To reduce the risk of complication, a computer assisted method is proposed that enables the surgeon to place a screw at a position preoperatively defined in 3 dimensions using computed tomography images. This allows the surgeon to align a standard surgical drill with the optimal position and direction. The depth of the pilot hole during drilling also is monitored by the system to prevent penetration of the anterior cortex of the vertebral body. Using this procedure, in vitro tests were performed and showed that an accuracy of less than 1 mm can be obtained. Clinical trials were done in 10 patients who suffered severe scoliosis or spondylolisthesis. The trajectory of the holes drilled in L2, L3, L4, and L5 vertebrae were checked for all clinical tests. Postoperative radiographs and computed tomography scans showed that the screws were well inserted in each plane for each pedicle. This technique also can be used to perform osteosynthesis at the thoracic and cervical levels.