Dental Ultrasound in Periodontology and Implantology: Examination, Diagnosis and Treatment Outcome Evaluation

256 Pages·2021·9.547 MB·English

by  Hsun-Liang (Albert) Chan, Oliver D. Kripfgans

Dental Ultrasound
in Periodontology
and Implantology
Examination, Diagnosis and
Treatment Outcome Evaluation
Hsun-Liang (Albert) Chan
Oliver D. Kripfgans
Editors
123
Dental Ultrasound in Periodontology
and Implantology
Hsun-Liang (Albert) Chan •
Oliver D. Kripfgans
Editors
Dental Ultrasound
in Periodontology
and Implantology
Examination, Diagnosis and Treatment
Outcome Evaluation
Editors
Hsun-Liang(Albert)Chan OliverD.Kripfgans
DepartmentofPeriodonticsandOral DepartmentofRadiology,MedicalSchool
Medicine,SchoolofDentistry UniversityofMichigan–AnnArbor
UniversityofMichigan–AnnArbor AnnArbor,MI,USA
AnnArbor,MI,USA
ISBN978-3-030-51287-3 ISBN978-3-030-51288-0 (eBook)
https://doi.org/10.1007/978-3-030-51288-0
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Animplantclinicallydiagnosedwithperiimplantitis,shownonCBCT(right),B-modeultrasound
(center), and color-mode ultrasound (left). B-mode ultrasound delineated mucosa, thin facial
bone, and implant surface well. The pixel brightness in soft tissue may indicate the degree of
inflammationandtissueloss.Thecolor-modeshowsthebloodvelocity,whichmaybeanindicator
fortheseverityofinflammation.TheshadeswereaddedtotheB-modeimageforillustrationof
differentstructures
Thisbookisdedicatedtoallwhobreak
throughexistingmindsetsandlookforthe
future.
Wewouldalsoliketodedicatethisbookto
Eric,wholeftustooearly.Youwillalwaysbe
remembered.
Foreword
The visualization of soft and hard tissues in the dental, oral, and craniofacial
complexiscriticallyimportantinthediagnosisofdisease,congenitaldeficiencies,
orfollowingtraumaticinjury.Inthedevelopmentofthisbook,DentalUltrasound
inPeriodontologyandImplantology:Examination,Diagnosis,andTreatmentOut-
come Evaluation, Drs. Hsun-Liang (Albert) Chan and Oliver D. Kripfgans have
assembled an excellent and first-of-its-kind text that comprehensively describes
the many advances of the dynamic and rapidly evolving field of oral and dental
ultrasonography. The discipline of biomedical imaging is moving at a fast pace
and this landmark book makes available information on key facets of dental
ultrasonographyrangingfromthephysicsandmechanismofactiononnonionizing
imaging for oral and dental structures to the improved imaging of teeth, dental
implants,andsupportingsofttissuesaswellasothervitalstructuressocriticalfor
oraldiagnosticprocedures.
Theopeningchapterofthebook,“UltrasonicImaging:PhysicsandMechanism”,
provides the reader the fundamentals on the physics of ultrasonic imaging that
includes the “what,” “how,” and “why” of this technology to help the learner
better understand the unique aspects of this imaging technology to noninvasively
identify soft and hard tissues in the oral cavity. The next chapter on Ultrasonic
Imaging in Comparison to Other Imaging Modalities highlights how ultrasonic
approaches compare to other traditional imaging techniques such as 2D intraoral
radiographyand3Dcone-beamcomputedtomography.Dr.Apsshowshowtheuse
of ultrasonic imaging can complement and/or in some cases potentially replace
the use of other more invasive approaches to identify oral structures. Chapter 3,
SystemRequirementsforIntraoralUltrasonicScanning,givesanicehighlightofthe
platforms,systemrequirements,andnewunitscomingontothemedicalanddental
marketplacefortheapplicationofthesetechnologiestotheoralcavity.Thisaspectis
changingrapidlyinthedecision-makingchallengeswiththechanginglandscapeof
manufacturersofimagingdevices.InChap.4,CurrentDigitalWorkflowforImplant
Therapy: Advantages and Limitations, Drs. Siqueira, Soki, and Chan assemble
very well the role of ultrasonography to interface with the digital workflow so
important in dental implant treatment planning. There are many opportunities to
combine existing 2D and 3D radiography with ultrasound for preoperative, but
also intraoperative diagnosis of structures for optimal dental implant positioning
to enhance function and esthetics. The team goes on to demonstrate how these
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x Foreword
imaging approaches can be coupled with chairside 3D printing or CAD/CAM for
the fabrication of implant guides to improve the workflow for more ideal implant
placements. Chapter 5 focuses on the use of Ultrasound for Periodontal Imaging
and while an emerging area with accumulating research activity, this approach to
identify tooth-supporting structures offers good potential for the better assessment
ofperiodontaldiseasesandthestatusofsoftandhardtissuesadjacenttoteeth.
Implant dentistry using tooth replacement oral implants has revolutionized
reconstructive dentistry. This therapy has allowed patients to be rehabilitated
with endosseous titanium prostheses that can replace missing teeth in partially
or fully edentulous individuals to improve their function and esthetics. The next
five major chapters of the book (Ultrasonic Imaging for Estimating the Risk of
Peri-Implant Esthetic Complications, Ultrasound Indications in Implant-Related
andOtherOralSurgery,UltrasonicImagingforEvaluatingPeri-ImplantDiseases,
UltrasonographyforWoundHealingEvaluationofImplantRelatedSurgeries,and
Ultrasonic Evaluation of Dental Implant Stability) provide in-depth and useful
materialrelatedtodentalimplantpositionandstatus.Giventhetremendoushealth
care costs, time involved, and increasing prevalence of peri-implant diseases, the
useofatechnology suchasdentalultrasonography provides aunique approach to
noninvasivelyidentifytheposition,bone,andsofttissuesupportofdentalimplants.
The beneficial evidence provided in these chapters will aid the clinician to better
consider ultrasound in progressive disease states or during oral wound healing
situations where traditional methods result in more invasive assessments that may
beunjustified.
ThefinalchaptersinthebookfocusonPhotoacousticUltrasoundforEnhanced
ContrastinDentalandPeriodontalImagingandVolumetricUltrasoundandRelated
DentalApplications.Thesesectionsofthebookhighlighttheuseofthesedynamic
imaging approaches that have implications in other dental presentations such as
in the diagnosis of dental caries, tooth pulpal pathology, and other hard–soft
tissue pathologies including traumas that can cause fractures or cracks on the
teeth that often are challenging for the clinician to diagnose. The final chapter
on volumetric and quantitative aspects has tremendous potential for use in the
longitudinal assessment of bony and soft tissue changes following augmentation
proceduresordiseaseprogressionscenarios.
Motivated by this comprehensive approach in noninvasive dental imaging of
ultrasonography,thismightbean“enlightenmentperiod”inbiomedicalimagingin
dentistry.Thisstate-of-the-arttechnologynowallowsustofirmlyconsiderthemany
optionsavailabletousasclinicianstobetterprepareandtreatmentplanourcasesto
optimizethedeliveryoforalhealthcare.ThistextbookbyDrs.ChanandKripfgans
lays out a contemporary and exciting look for us as clinicians, researchers, and
students alike to better understand the many exciting possibilities for the use of
dentalultrasonographyforinnovativeresearchandclinicalcare.
Boston,MA,USA WilliamV.Giannobile
July2020
Preface
Healthcare is an ever-evolving field that navigates through many expectations. It
should be set to be conservative with a negligible chance of error to maintain the
promiseofthehippocraticoathofdonoharm.Harmdoesnothavetobephysical
harmbutcanmanifestitselfinavarietyofways.Investmentofresourcesintonew
developmentsobviouslytakesthoseresourcesawayfrompatientsandcouldbeseen
as harm to them. Healthcare providers come with a range of objectives besides
theirdedicationtocareandsupport.Universitiesservethepublicwithteachingand
research.University(dentalandmedical)hospitalsandclinicsprovidehealthcareto
patients today and contribute to advancing knowledge to provide better healthcare
tomorrow.
This book is the first attempt to advance ultrasound imaging in the field of
Dentistry. Current diagnostic methodologies in dental care consist of radiographic
and optical methods. X-rays and cone-beam CT are established imaging method-
ologiesforprovidingahighlevelofdentalcare.Opticalmethodsarealsoavailable
and contribute diagnostic information. Ultrasound is a well-established imaging
modalityinmedicine.Ithaspropagated intomanyspecialtyareasandshowshigh
levels of acceptance from patients. However, there is little or no use of ultrasound
in dental care, except for the intersection of medicine and dental, i.e. oral and
maxillofacial surgery. This is surprising for two reasons: First, ultrasound has
excellentsofttissuecontrastandprovidesreal-timecross-sectionalimageswithout
anyionizingradiation.Second,manyoraldiseasesstartfrominflammationinsoft
tissues. Thus, ultrasound would be an excellent diagnostic modality. However, for
alongtime,severallimitationshindereditspracticaluseinthedentalclinic.Image
resolution was low due to the absence of high-frequency ultrasound probes. In
addition,suchprobesweretoolargeforuseintheoralcavity.
Advancesinelectronics,signalprocessing,integration,andminiaturizationhave
allowedmedicalultrasoundtoenternewareas.Theseincludeimaginginpreclinical
rodent studies as well as the use of ultrasound in settings that require very little
tissue penetration, such as dermatology. Dental soft tissues also require very little
penetration. Gingiva and mucosa tissues are thin compared to those imaged in the
traditionaluseofultrasound.Thus,thecurrentstateoftheartofultrasoundmaybea
strongadditiontocontemporarydentistryanditmayhelpcaregiverstoofferprecise
diagnosisandprognosistotheirpatients.Precisionoralcareislargelydependenton
quantitativesubclinicalandclinicaldatafordentiststomakeclinicaldecisionsand
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xii Preface
evaluate treatment outcomes. Many established and yet to-be-studied quantitative
ultrasound parameters may be found applicable to diagnose periodontal and peri-
implant diseases, among other oral lesions. One of the objectives of this book is
toprovidefirst-handinformationregardingourresearchresults,theadvantagesand
limitationsofdentalultrasound,andpracticalimplementationstothereaders.
It should be noted that dental and medical nomenclature are used in parallel in
this book. While they share a substantial fraction of their extent, they also differ
in some aspects. This is where the readers can find themselves between the two
worlds.Forexample,thedefinitionoflateral.Picturea2Dcross-sectionalsagittal
mid-facial scan of the right maxillary central incisor. Dental nomenclature defines
the “lateral” position with respect to such a scan to be either toward the mesial
or distal side of the scan plane. Medical ultrasound nomenclature would define
the same direction to be the elevational plane toward either the mesial or distal
direction,whereasthelateral(ultrasound)directionisdefinedtobein-planeinthe
scan,perpendiculartotheaxial(depth)extentofthescan.
AnnArbor,MI,USA Hsun-Liang(Albert)Chan
AnnArbor,MI,USA OliverD.Kripfgans
February2020