Soft Tissue Measurement Method Using Radiopaque Material on Cone-beam Computed Tomography: An Ex Vivo Validation Study
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Ⅰ. Introduction : Previously, a noninvasive method using a radiopaque material and periapical radiography to measure the vertical length of the interdental papilla in natural teeth and implants was proposed1-3. By using radiopaque material, it was possible to demarcate soft tissue, without underexposing radiography. However, such two-dimensional information limits the assessment of the whole periodontium. The metric assessment of soft tissue dimensions around teeth and implants is of great clinical interest for the quantification and monitoring of gingival changes during therapies. Gingival soft tissue dimensions play significant roles in the assessment of whole treatment success, and thus should be monitored all through therapy. A lack of gingival thickness showed a tendency towards loss in attachment levels after traumatic, inflammatory, or surgical injuries4. Likewise, orthodontic tooth movement may adversely affect the mucogingival complex, especially at sites in which the keratinized gingiva and underlying bone appeared thin5. Acceptable methods for the accurate quantification of tissue changes when assessing new treatment modalities and materials influencing soft tissues are thus needed6. Cone-beam computed tomography (CBCT) is used routinely for imaging analyses of the maxillofacial region7. This modality provides clinicians with high-quality diagnostic images and has become an important tool in dentistry. However, the inability of CBCT to distinguish overlapped soft tissues, such as mucogingival thickness on the buccal side of alveolar bone, has limited its application exclusively to the imaging of hard maxillofacial tissues8. Several studies reported using CBCT9-12 for studying soft tissue thickness. Although validation process was not reported, these studies showed us a possibility to study delicate mucogingival soft tissue by retracting overlapped soft tissue. However, one validation study reported that soft tissues less than 0.5mm was not possible to be confirmed in spiral CT, thus making the application of spiral CT in very thin mucosa questionable13. In this study, we describe a method based on CBCT technology for the visualization and measurement of soft tissue dimensions, after demarcating the soft tissue with radiopaque material. The aim of this study was to investigate the validity and reproducibility of this method. Ⅴ. Conclusion : In conclusion, the results of the present study suggest that soft tissue measurement with CBCT and radiopaque material could be a reliable method, compared to the trans-gingival probing measurement method, with good validity and reproducibility.
Abstract
Purpose: The purpose of this study was to investigate the validity and reproducibility of a method based on cone-beam computed tomography (CBCT) technology for the visualization and measurement of gingival soft-tissue dimensions. Material and Methods: A total of 66 selected points in soft-tissue of the ex vivo head of an adult pig were investigated in this study. For the measurement of radiographic thickness (RT), wet softtissue surfaces were lightly covered with barium sulfate powder using a powder spray. CBCT was taken and DICOM files were assessed for soft-tissue thickness measurement at reference points. A periodontal probe and a rubber stop were used for the measurement of trans-gingival probing thickness (TPT). After flap elevation, actual thickness of soft-tissue (actual thickness, AT) was measured. Correlation analysis and intraclass correlation coefficients analysis (ICC) were performed for AT, TPT, and RT. Results: All variables were distributed normally. Strong significant correlations of AT with RT and TPT values were found. The two ICC values between TPT vs. AT and RT vs. AT differed significantly. Conclusion: Our results indicated that correlation of RT was stronger than that of TPT with AT. We concluded that soft tissue measurement with
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