Is the efficacy of cone beam computed tomography in the diagnosis of tooth ankylosis influenced by dose reduction protocols?

Published:August 22, 2022DOI:


      To evaluate the diagnostic efficacy of cone beam computed tomography (CBCT) examinations acquired with varying dose protocols in the diagnosis of simulated tooth ankylosis (TA).

      Study Design

      Tooth ankylosis was simulated in 15 of 30 teeth, and CBCT examinations were acquired at 3 mA levels (8, 6.3, and 5) and 3 voxel sizes (0.08, 0.125, and 0.2 mm). Four radiologists independently assessed the presence of TA using a 5-point scale. Sensitivity, specificity, and area under the curve (AUC) obtained through receiver operating characteristic analysis were compared among mA levels and voxel sizes using two-way analysis of variance (α = 0.05). Intra- and interexaminer reliability levels were assessed with the weighted kappa examination.


      Sensitivity was low (0.32-0.49), and specificity was reasonably high (0.71-0.83). Mean values of AUC were low, ranging between 0.54 and 0.67, which reveals poor overall discrimination between health and disease. The detection of TA was not significantly influenced by mA level or voxel size (P > .05). Intra- and interexaminer agreements ranged from slight to moderate (0.160-0.535) and from fair to substantial (0.236-0.697), respectively.


      Despite the limited efficacy of CBCT for TA detection, when indicated as a complementary examination, mA reduction should be considered for dose optimization purposes.
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        • Hadi A
        • Marius C
        • Avi S
        • Mariel W
        • Galit B-B
        Ankylosed permanent teeth: incidence, etiology and guidelines for clinical management.
        Med Dent Res. 2018; 1: 1-11
        • Rhoads SG
        • Hendricks HM
        • SA Frazier-Bowers
        Establishing the diagnostic criteria for eruption disorders based on genetic and clinical data.
        Am J Orthod Dentofac Orthop. 2013; 144: 194-202
        • Lauridsen E
        • Andreasen JO
        • Bouaziz O
        • Andersson L.
        Risk of ankylosis of 400 avulsed and replanted human teeth in relation to length of dry storage: a re-evaluation of a long-term clinical study.
        Dent Traumatol. 2020; 36: 108-116
        • Ducommun F
        • Bornstein MM
        • Bosshardt D
        • Katsaros C
        • Dula K.
        Diagnosis of tooth ankylosis using panoramic views, cone beam computed tomography, and histological data: a retrospective observational case series study.
        Eur J Orthod. 2018; 40: 231-238
        • Noujeim M
        • Prihoda TJ
        • Langlais R
        • Nummikoski P.
        Evaluation of high-resolution cone beam computed tomography in the detection of simulated interradicular bone lesions.
        Dentomaxillofacl Radiol. 2009; 38: 156-162
        • Choi IGG
        • Cortes ARG
        • Arita ES
        • Georgetti MAP.
        Comparison of conventional imaging techniques and CBCT for periodontal evaluation: a systematic review.
        Imaging Sci Dent. 2018; 48: 79-86
        • Pauwels R
        • Faruangsaeng T
        • Charoenkarn T
        • Ngonphloy N
        • Panmekiate S.
        Effect of exposure parameters and voxel size on bone structure analysis in CBCT.
        Dentomaxillofacial Radiol. 2015; 4420150078
        • Pauwels R
        • Araki K
        • Siewerdsen JH
        • Thongvigitmanee SS.
        Technical aspects of dental CBCT: state of the art.
        Dentomaxillofacial Radiol. 2015; 4420140224
        • Yeung AWK
        • Jacobs R
        • Bornstein MM.
        Novel low-dose protocols using cone beam computed tomography in dental medicine: a review focusing on indications, limitations, and future possibilities.
        Clin Oral Investig. 2019; 23: 2573-2581
        • Ludlow JB
        • Timothy R
        • Walker C
        • et al.
        Effective dose of dental CBCT - A meta analysis of published data and additional data for nine CBCT units.
        Dentomaxillofacl Radiol. 2015; 4420140197
        • Oenning AC
        • Pauwels R
        • Stratis A
        • et al.
        Halve the dose while maintaining image quality in paediatric Cone Beam CT.
        Sci Rep. 2019; 9: 5521
        • Oliveira ML
        • Ambrosano GMB
        • Almeida SM
        • Haiter-Neto F
        • Tosoni GM.
        Efficacy of several digital radiographic imaging systems for laboratory determination of endodontic file length.
        Int Endod J. 2011; 44: 469-473
        • Hosmer DW
        • Lemeshow S
        • Sturdivant RX.
        Applied Logistic Regression.
        John Wiley & Sons, Hobobklen, NJ2013
        • Landis JR
        • Koch GG.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Campbell KM
        • Casas MJ
        • Kenny DJ
        • Chau T.
        Diagnosis of ankylosis in permanent incisors by expert ratings, Periotest and digital sound wave analysis.
        Dent Traumatol. 2005; 21: 206-212
        • Huttner EA
        • Machado DC
        • De Oliveira RB
        • Antunes AGF
        • Hebling E.
        Effects of human aging on periodontal tissues.
        Spec Care Dent. 2009; 29: 149-155
        • Bartold M.
        Periodontal tissues in health and disease: introduction.
        Periodontol 2000. 2006; 40: 7-10
        • Oliveira ML
        • Tosoni GM
        • Lindsey DH
        • Mendoza K
        • Tetradis S
        • Mallya SM.
        Influence of anatomical location on CT numbers in cone beam computed tomography.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 115: 558-564
        • Özmeric N
        • Kostioutchenko I
        • Hägler G
        • Frentzen M
        • PM Jervøe-Storm
        Cone-beam computed tomography in assessment of periodontal ligament space: in vitro study on artificial tooth model.
        Clin Oral Investig. 2008; 12: 233-239
        • Wanderley VA
        • Vasconcelos K de Faria
        • Leite AF
        • et al.
        Impact of the blooming artefact on dental implant dimensions in 13 cone-beam computed tomography devices.
        Int J Implant Dent. 2021; 7: 67
        • Pauwels R
        • Beinsberger J
        • Stamatakis H
        • et al.
        Comparison of spatial and contrast resolution for cone-beam computed tomography scanners.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114: 127-135
        • Tayman MA
        • Kamburoğlu K
        • Öztürk E
        • Küçük Ö.
        The accuracy of periapical radiography and cone beam computed tomography in measuring periodontal ligament space: ex vivo comparative micro-CT study.
        Aust Endod J. 2020; 46: 365-373
        • Nyquist H.
        Certain topics in telegraph transmission theory.
        Trans Am Inst Electr Eng. 1928; 47: 617-644
        • Pauwels R
        • Silkosessak O
        • Jacobs R
        • Bogaerts R
        • Bosmans H
        • Panmekiate S.
        A pragmatic approach to determine the optimal kVp in cone beam CT: balancing contrast-to-noise ratio and radiation dose.
        Dentomaxillofacial Radiol. 2014; 4320140059
        • Rege ICC
        • Botelho T de L
        • Martins AFL
        • Leles CR
        • Mendonça EF.
        Pixel gray measurement for the diagnosis of dental ankylosis in cone beam computed tomography images.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2021; 131: 721-729
        • Oliveira ML
        • Tosoni GM
        • Lindsey DH
        • Mendoza K
        • Tetradis S
        • Mallya SM.
        Assessment of CT numbers in limited and medium field-of-view scans taken using aAccuitomo 170 and Veraviewepocs 3De cone-beam computed tomography scanners.
        Imaging Sci Dent. 2014; 44: 279-285