Diagnostic accuracy comparing OPT and CBCT in the detection of non‐vital bone changes before tooth extractions in patients with antiresorptive intake

Abstract

Objectives: To compare the diagnostic accuracy in detecting early non-vital bone changes between orthopantomography (OPT) and cone-beam computed tomography (CBCT) in correlation with histopathological findings before tooth extractions in patients with antiresorptive (AR) intake. Subjects:Patients with an indication tooth extraction who had received OPT and CBCT preoperatively while or after undergoing AR treatment were prospectively enrolled over a 24-month period in the progesterone in spontaneous miscarriage (PRISM) trial. Imaging studies were randomly analyzed by three examiners for early non-vital bone changes using specific predefined characteristics and a 5-level scale (1 definite absence of criteria to 5 definite presence of criteria). Sensitivity and specificity values were calculated in correlation with the histopathologically evaluated bone samples at the time point of tooth extraction. Results:One hundred thirty patients with 237 treated extraction sites met the inclusion criteria. For all images evaluated by all examiners, CBCT (430/492; 87.4%; receiver operating characteristic [ROC]: area under the curve [AUC] = 0.88; p < 0.001) was more likely to detect histopathologically confirmed non-vital bone than the OPT (132/492; 26.8%; ROC: AUC = 0.562; p = 0.115). Conclusions:In the detection of non-vital bone changes, CBCT is superior to OPT in both sensitivity and specificity. Specific imaging characteristics allow for the prediction of early non-vital bone changes already at the time before tooth extractions.

Radiographical Pathological Incidental Findings before Orthodontic Treatment

“…One limitation of this study was the observation of incidental findings in twodimensional (2D) images, while threedimensional (3D) images, with CBCT, provide further information for diagnostic hypothesis and location of anomalies. Although CBCT imaging is increasingly utilized in diagnosis and treatment planning in orthodontics, it is not yet a routine diagnostic tool [14][15]. A common error in the present study was that the tongue was not placed in contact with the hard palate during exposure, a result also in concordance with other findings.…”

Evaluation of Medication-Related Osteonecrosis of the Jaw (MRONJ) in Terms of Staging and Treatment Strategies by Dental Students at Different Educational Levels

“…A recent clinical study by Ristow et al analyzed the diagnostic accuracy of panoramic radiographs and CBCT in the detection of non-vital bone changes before tooth extractions in patients with antiresorptive intake. They found the CBCT superior in sensitivity and specificity [ 37 ]. These findings are confirmed by a recent review describing panoramic radiographs to be sufficient in depicting osteolysis, osteosclerosis, and thickened lamina dura, but the CBCT and CT can show more features unique to MRONJ, such as periosteal reaction and bone-within-bone appearance.…”

Comparison of Different Antibiotic Regimes for Preventive Tooth Extractions in Patients with Antiresorptive Intake—A Retrospective Cohort Study

“…However, this finding is of great importance, both for physicians and from an epidemiological point of view, since the risk profile changes significantly as a result of acute infection [ 22 , 33 ]. In addition, acutely infected regions are more difficult to differentiate from pre-existing MRONJ [ 7 , 53 , 54 ]. This point must always be considered when interpreting data, as it directly influences the approach and results.…”

“…All surgical tooth extractions were performed by the same experienced surgeons following the standardized protocol and risk reduction measures for patients undergoing/after AR therapy as previously described by our group and in accordance with the German guideline [ 5 , 22 , 26 , 54 ]: (1) adjunctive antibiotic therapy (according to the assigned groups), (2) alveoplasty, and (3) thorough primary wound closure. In the case of purely preventive tooth extraction, the procedure was performed in an outpatient setting under local anesthesia with oral antibiotics.…”