Korean J Orthod.  2023 Mar;53(2):77-88. 10.4041/kjod22.120.

Accuracy of three-dimensional periodontal ligament models generated using cone-beam computed tomography at different resolutions for the assessment of periodontal bone loss

• Lyu H
• Xu L
• Ma H
• Hou J
• Wang X
• Wang Y
• Zhao Y
• Li W
• Li X

• KMID: 2540947
• DOI: http://doi.org/10.4041/kjod22.120

Abstract

Objective
To develop a method for generating three-dimensional (3D) digital models of the periodontal ligament (PDL) using 3D cone-beam computed tomography (CBCT) reconstruction and to evaluate the accuracy and agreement of the 3D PDL models in the measurement of periodontal bone loss.
Methods
CBCT data collected from four patients with skeletal Class III malocclusion prior to periodontal surgery were reconstructed at three voxel sizes (0.2 mm, 0.25 mm, and 0.3 mm), and 3D tooth and alveolar bone models were generated to obtain digital PDL models for the maxillary and mandibular anterior teeth. Linear measurements of the alveolar bone crest obtained during periodontal surgery were compared with the digital measurements for assessment of the accuracy of the digital models. The agreement and reliability of the digital PDL models were analyzed using intra- and interexaminer correlation coefficients and Bland–Altman plots.
Results
Digital models of the maxillary and mandibular anterior teeth, PDL, and alveolar bone of the four patients were successfully established. Relative to the intraoperative measurements, linear measurements obtained from the 3D digital models were accurate, and there were no significant differences among different voxel sizes at different sites. High diagnostic coincidence rates were found for the maxillary anterior teeth. The digital models showed high intra- and interexaminer agreement.
Conclusions
Digital PDL models generated by 3D CBCT reconstruction can provide accurate and useful information regarding the alveolar crest morphology and facilitate reproducible measurements. This could assist clinicians in the evaluation of periodontal prognosis and establishment of an appropriate orthodontic treatment plan.

Keyword

Digital models; Three-dimensional reconstruction; Cone-beam computed tomography

Figure

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  Figure 1 Process of alveolar bone and tooth segmentation in Mimics 19.0 software (Materialise, Leuven, Belgium). A, Manual alveolar bone segmentation. B, Manual tooth segmentation.

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  Figure 2 Digital tooth, bone, and soft tissue models in Geomagic (Geomagic, Cary, NC, USA). A, Digital tooth models with an intraoral scan superimposed over the crowns. B, Digital tooth and bone models. C, Digital tooth and bone models generated from cone-beam computed tomography datasets and a soft tissue model derived from an intraoral scan.

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  Figure 3 Digital linear measurements. The measurment referece lines at midlabial, distobracket, and distolabial sites are shown (white dotted line). A, Vertical bone level measurements (black arrow line) at mesiolabial, mesiobracket, midlabial, distobracket, and distolabial sites. B, Bone–bracket distance measurements (black arrow line) at mesiobracket, midlabial, and distobracket sites.

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  Figure 4 Intraoperative linear measurements. A–C, Linear measurements at the distolabial (A), midlabial (B), and mesiolabial (C) sites. D, E, Linear measurements at the distobracket (D) and mesiobracket (E) sites.

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  Figure 5 Establishment of digital periodontal ligament (PDL) models. A, Tooth and alveolar bone digital models. B, The alveolar bone crests are drawn on the tooth models. C, The curves of the alveolar bone crests were extracted. D, The tooth models are separated along the curves of the alveolar bone crests. E, The digital PDL models. F, Computation of the PDL area.

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  Figure 6 Bland–Altman plots of intraoperative and digital linear measurements with different cone-beam computed tomography (CBCT) voxel sizes. The difference against the mean and the limits of agreement are shown. A–C, Vertical bone level (VBL) measurements for the maxillary anterior teeth with different CBCT voxel sizes. D–F, Bone–bracket distance (BBD) measurements for the maxillary anterior teeth with different CBCT voxel sizes. G–I, VBL measurements for the mandibular anterior teeth with different CBCT voxel sizes. J–L, BBD measurements for the mandibular anterior teeth with different CBCT voxel sizes.

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  Figure 7 Bland–Altman plots of periodontal ligament (PDL) area measurements by examiner 1 and examiner 2.

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  Figure 8 Periodontal ligament models generated for a representative case. The periodontal ligament models of maxillary and mandibular anterior teeth for one of the four patients are shown in Geomagic (Geomagic, Cary, NC, USA).

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