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

IF 3.1 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Clinical Oral Investigations Pub Date : 2024-11-19 DOI:10.1007/s00784-024-06022-5

Kuo Feng Hung, Andy Wai Kan Yeung, May Chun Mei Wong, Michael M Bornstein, Yiu Yan Leung

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Abstract

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×cm²) and one of the three investigated low-dose (78-131 mGy×cm²) 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.

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比较标准剂量和低剂量 CBCT 在下颌第三磨牙撞击诊断和治疗决策中的应用：非劣效随机临床研究。

研究目的这项随机临床研究旨在评估与标准剂量 CBCT 相比，低剂量锥束计算机断层扫描（CBCT）对普通牙科医生（GP）和口腔颌面外科医生（OMFS）评估的下颌管（MC）能见度及其与下颌第三磨牙（M3M）距离的影响，以及对他们临床决策的影响。方法：将 90 名患者的 154 个受影响的 M3M 随机分配到三组，使用一种标准剂量（333 mGy×cm2）和三种低剂量（78-131 mGy×cm2）方案中的一种进行两次 CBCT 暴露。全科医生和口腔外科医生分别对图像中的MC能见度、M3M-MC接近度、手术方法、牙冠/牙根切片以及转诊决定进行盲法评估。使用 Wilcoxon 符号秩检验评估配对扫描之间 MC 可见度的配对比较，然后进行非劣效性检验，非劣效性差值为 0.5（四分制）。配对扫描之间其他变量的差异采用 Wilcoxon 符号秩检验或 McNemar 检验进行评估：所有观察者都能在标准剂量的 CBCT 中清晰地识别出大多数（78.5%-99.3%）MC。配对比较显示，配对扫描之间仅在 MC 可见度方面存在显著差异，而在 M3M-MC 邻近度或治疗决策方面没有显著差异。配对扫描之间 MC 可见度的平均差异为 0-0.22，95% 置信区间的上限（0.09-0.36）在非劣效区域内：结论：所研究的低剂量 CBCT 方案可在大多数情况下提供可接受的图像质量，用于评估受撞击的 M3M。与标准剂量 CBCT 相比，这些低剂量 CBCT 图像不会对全科医生和 OMFS 对 M3M-MC 邻近度的评估、治疗策略以及患者管理决策产生明显影响：临床相关性：低剂量方案可能是临床上可接受的 M3M 管理方案，同时大大减少了辐射暴露。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Oral Investigations 医学-牙科与口腔外科

CiteScore

6.30

自引率

5.90%

发文量

484

审稿时长

3 months

期刊介绍： The journal Clinical Oral Investigations is a multidisciplinary, international forum for publication of research from all fields of oral medicine. The journal publishes original scientific articles and invited reviews which provide up-to-date results of basic and clinical studies in oral and maxillofacial science and medicine. The aim is to clarify the relevance of new results to modern practice, for an international readership. Coverage includes maxillofacial and oral surgery, prosthetics and restorative dentistry, operative dentistry, endodontics, periodontology, orthodontics, dental materials science, clinical trials, epidemiology, pedodontics, oral implant, preventive dentistiry, oral pathology, oral basic sciences and more.