Comparing standard- and low-dose CBCT in diagnosis and treatment decisions for impacted mandibular third molars: a non-inferiority randomised clinical study.

Autor: Hung KF; Division of Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China., Yeung AWK; Division of Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China., Wong MCM; Division of Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China., Bornstein MM; Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland., Leung YY; Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China. mikeyyleung@hku.hk.
Jazyk: angličtina
Zdroj: Clinical oral investigations [Clin Oral Investig] 2024 Nov 19; Vol. 28 (12), pp. 647. Date of Electronic Publication: 2024 Nov 19.
DOI: 10.1007/s00784-024-06022-5
Abstrakt: Objective: This randomised clinical study aimed to assess the influence of low-dose cone-beam computed tomography (CBCT) on the visibility of the mandibular canal (MC) and its proximity to mandibular third molars (M3Ms) as assessed by general dental practitioners (GPs) and oral-maxillofacial surgeons (OMFSs), as well as its impact on their clinical decisions, when compared to standard-dose CBCT.
Methods: 154 impacted M3Ms from 90 patients were randomly assigned to three groups for two CBCT exposures using one standard-dose (333 mGy×cm 2 ) and one of the three investigated low-dose (78-131 mGy×cm 2 ) protocols. Blinded assessments of the MC visibility, M3M-MC proximity, surgical approach, crown/root sectioning, and referral decisions, were made by GPs and OMFSs on the images separately. Pairwise comparisons for MC visibility between paired scans were evaluated using Wilcoxon signed rank test, followed by a non-inferiority test with non-inferiority margin of 0.5 on a four-point scale. Differences in other variables between paired scans were evaluated using Wilcoxon signed-rank or McNemar tests.
Results: The majority (78.5-99.3%) of MCs were clearly identified on standard-dose CBCT by all observers. Pairwise comparisons showed significant differences between paired scans only in MC visibility but not in the M3M-MC proximity or treatment decisions. The mean differences in MC visibility between paired scans ranged 0-0.22 with the upper bounds of the 95% confidence intervals (0.09-0.36) falling within the non-inferiority region.
Conclusions: The investigated low-dose CBCT protocols could provide acceptable image quality for the evaluation of impacted M3Ms in most cases. When compared to standard-dose CBCT, these low-dose CBCT images did not significantly affect the assessments of the M3M-MC proximity, treatment strategies, and patient management decisions made by GPs and OMFSs.
Clinical Relevance: The low-dose protocols might be clinically acceptable for M3M management while greatly reducing radiation exposure.
Competing Interests: Declarations Ethics approval and consent to participate This study was conducted in full compliance with radiological protection standards for human research as defined by the U.S. Food and Drug Administration (FDA) regulations and the latest recommendations by International Commission on Radiological Protection (ICRP) committee. This study has been approved by local institutional review board (UW21-027) and registered in HKU Clinical Trials Registry (HKUCTR-2977). Informed consent Written informed consent was obtained from all patients. Conflict of interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Competing interests The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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