A Position Paper Subcommittee of the American Academy of Oral and Maxillofacial Radiology (AAOMR) reviewed the literature since the original position statement on selection criteria for radiology in dental implantology, published in 2000. All current planar modalities, including intraoral, panoramic, and cephalometric, as well as cone beam computed tomography (CBCT) are discussed, along with radiation dosimetry and anatomy considerations. We provide research-based, consensus-derived clinical guidance for practitioners on the appropriate use of specific imaging modalities in dental implant treatment planning. Specifically, the AAOMR recommends that cross-sectional imaging be used for the assessment of all dental implant sites and that CBCT is the imaging method of choice for gaining this information. This document will be periodically revised to reflect new evidence.

Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography

Cone-beam computerized tomography imaging and analysis of the upper airway: a systematic review of the literature

Objective The most common diagnostic imaging modalities for cross-sectional imaging in dental implant planning are currently cone-beam computed tomography (CBCT) and multislice CT (MSCT). However, clinical differences between CBCT and MSCT in this task have not been fully clarified. In this investigation, the detection of fine anatomical structures in the mandible was assessed and compared between CBCT and MSCT images. Study design The sample consisted of 28 patients who had undergone CBCT and MSCT. The bifid mandibular canal in the mandibular ramus, accessory mental and buccal foramina, and median and lateral lingual bony canals were observed in 2-D images, and the findings were compared between CBCT and MSCT. Results Four of 19 canals observed in CBCT were not observed in MSCT images. Three accessory mental foramina in 2 patients and 28 lateral lingual bony canals in 18 patients were observed consistently using the two methods. Conclusion Depiction of fine anatomic features in the mandible associated with neurovascular structures is consistent between CBCT and MSCT images.

Comparison between cone-beam and multislice computed tomography depicting mandibular neurovascular canal structures.

Objectives: The aim of this study was to assess the frequency of the foramina and their canals on the lingual surface of the mandible using computed tomography (CT), which was carried out for dental implant planning.

Material and methods: First, the visibility of the lingual canals of the CT image was verified by dissecting five cadavers. CT images of 200 patients, who had decided on implant treatment, were used in this study. The visibility of the foramina and their canals on the lingual surface of the mandible were assessed.

Results: The foramina were divided into two groups by the positions of the mandible, the medial lingual foramen and the lateral lingual foramen. At least one foramen was found in all patients. In the medial group, a higher level of mental spine was seen in 190 patients, the same level of mental spine was observed in 99 patients and a lower level of mental spine was observed in 114 patients. The lateral lingual foramina were found in 160/200 patients and 88/200 patients presented bilaterally. CT can predict the position and the size of the foramina and their canals on the lingual surface of the mandible. All the patients had more than one foramen in the middle of the lingual surface of the mandible on the CT image.

Conclusion: The frequency of the lingual foramina in the medial region was 100% and that in the lateral region was 80%. It would also be useful to emphasize the significant variation in the precise location of these lingual foramina, and that these can only be visualized presurgically with volumetric imaging modalities, such as CT or Cone beam 3D systems.

Assessment of the blood supply to the lingual surface of the mandible for reduction of bleeding during implant surgery

Three-dimensional (3D) bioprinting strategies use computer-aided processes to enable automated simultaneous spatial patterning of cells and/or biomaterials. These technologies are suitable for a broad range of biomedical applications owing to their capability to produce structurally sophisticated and functionally relevant tissue constructs. Extrusion-based 3D bioprinting strategies were among the first modalities developed and are now arguably the most widely used for producing 3D tissue constructs. These technologies have rapidly evolved over the past two decades, providing a powerful tool set for the biofabrication of tissues that can facilitate translational efforts in the field. In this Primer, we describe the methodology of 3D extrusion bioprinting, focusing on the selection of hardware, software and bioinks. We expand upon recent advances in 3D extrusion bioprinting by illustrating the key variations that promote its biofabrication abilities. Finally, we provide an outlook on possible future refinements of the technology. 3D extrusion bioprinting methods can be used to produce tissue constructs in vitro and in situ and are arguably the most commonly used bioprinting strategies. In this Primer, Zhang and colleagues describe the variants of 3D extrusion bioprinting methods and their specific applications, considerations for the formulation of bioinks and strategies for assessing print quality. The authors conclude by looking to recent and upcoming developments in 4D printing and artificial intelligence-assisted dynamic printing strategies.

3D extrusion bioprinting

The retromolar foramen (RMF) is an anatomical structure on the alveolar surface of the retromolar area. This foramen runs consecutive to the retromolar canal (RMC), which diverges from the mandibular canal. It is important to confirm the RMF and canal locations prior to surgical procedures, such as extraction of an impacted molar and bone harvesting as a donor site for bone graft surgery. This aim of this study was to investigate the RMF in Japanese cadaver mandibles using cone-beam computed tomography (CBCT) images and anatomical observations. Ninety sides of 46 cadaver mandibles were investigated in this study. CBCT images around the retromolar region were acquired for all of the mandibles. The frequency and anteroposterior and buccolingual locations of the RMF were examined on these images. Subsequently, four sides of three mandibles were dissected to confirm the contents of the RMC/RMF. In 24 of 46 (52%) mandibles and 34 of 90 (37%) sides, at least one RMF was observed in the images. In 26 dentate mandibles, 12 (48%) mandibles and 14 (33%) sides presented at least one RMF. The average location of the RMF was 14.4 mm posterior from the distal edge of the second molar. The buccolingual location was 3.0 mm lingual from the mandibular canal. Observations made during the cadaver dissections confirmed that the vessels and nerves diverged from the mandibular canal. The findings suggest that the RMF is not a rare anatomical structure and that practitioners should take this foramen into account in all anesthetic and surgical procedures involving the retromolar area.

Observation of the retromolar foramen and canal of the mandible: a CBCT and macroscopic study

Objectives
We investigated the lingual foramina and their bony canals in the median region of the mandible using cone beam computed tomography (CBCT).

Classification of the lingual foramina and their bony canals in the median region of the mandible : cone beam computed tomography observations of dry Japanese mandibles

Extracting and three-dimensional (3D) printing an organ in a region of interest in DICOM images typically calls for segmentation as a first step in support of 3D printing. The DICOM images are not exported to STL data immediately, but segmentation masks are exported to STL models. After primary and secondary processing, including noise removal and hole correction, the STL data can be 3D printed. The quality of the 3D model is directly related to the quality of the STL data. This study focuses and reports on the DICOM to STL segmentation performance for nine software packages. Multidetector row CT scanning was performed on a dry human mandible with two 10-mm-diameter bearing balls as a phantom. The DICOM image file was then segmented and exported to an STL file using nine different commercial/open-source software packages. Once the STL models were created, the data (file) properties and the size and volume of each file were measured, and differences across the software packages were noted. Additionally, to evaluate differences between the shapes of the STL models by software package, each pair of STL models was superimposed, with the observed differences between their shapes characterized as the shape error. Results: The data (file) size of the STL file and the number of triangles that constitute each STL model were different across all software packages, but no statistically significant differences were found across software packages. The created ball STL model expanded in the X-, Y-, and Z-axis directions, with the length in the Z-axis direction (body axis direction) being slightly longer than that in the other directions. The mean shape error between software packages of the mandibular STL model was 0.11 mm, but there was no statistically significant difference between them. Our results revealed that there are some differences between the software packages that perform the segmentation and STL creation of the DICOM image data. In particular, the features of each software package appeared in the fine and thin areas of the osseous structures. When using these software packages, it is necessary to understand the characteristics of each.

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DICOM segmentation and STL creation for 3D printing: a process and software package comparison for osseous anatomy

The shape of the anterior region of the maxilla is critical when planning implant treatment. The purpose of the present study was to assess the typical morphology of the incisive canal and surrounding bone. In total, 70 maxillae of Japanese dry skulls were used after being divided into dentate and edentulous groups. Cone-beam computed tomography (CBCT) images of the maxilla were acquired by using standardized methods. Using the anterior nasal spine as a reference point, the change in position was measured and analyzed statistically. Also, three-dimensional (3-D) images of the incisive canal were classified into five subsets: cylinder, groove, penetration, bifurcation at the superior portion, and bifurcation at the inferior portion. The quantity of alveolar bone in the incisor region was greatly reduced from the alveolar ridge and labial surface. Moreover, the vertical position of the incisive foramen was significantly (P < 0.05) superior in the edentulous groups. Regarding the classification of maxillae by the 3-D shape of the incisive canal, many canals were cylindrical. Horizontal bone reduction from the labial side and vertical bone reduction from the alveolar crest were conspicuous; thus, the angle of the anterior alveolar bone changed after the loss of teeth. The incisive canal diameter in the edentulous group was larger than in the dentate group. The nondestructive assessment of the incisive canals and surrounding bone with CBCT showed two typical shapes for the presence or absence of the incisors. These findings indicate the importance of image diagnosis before esthetic restoration.

Three-dimensional observations of the incisive canal and the surrounding bone using cone-beam computed tomography

To determine the width and morphology of the mandible in the impacted third molar region, and to identify the location of the mandibular canal prior to planning impacted third molar operations. Cone beam computed tomography (CBCT) data of 87 mandibular third molars from 62 Japanese patients were analyzed in this study. The width of the lingual cortical bone and apex-canal distance were measured from cross-sectional images in which the cortical bone was thinnest at the lingual side in the third molar region. Images were used for measuring the space (distance between the inner border of the lingual cortical bone and outer surface of the third molar root), apex-canal distance (distance from the root of the third molar tooth to the superior border of the inferior alveolar canal) and the cortical bone (width between the inner and outer borders of the lingual cortical bone). The means of the space, apex-canal distance and lingual cortical width were 0.31, 1.99, and 0.68 mm, respectively. Impacted third molar teeth (types A–C) were observed at the following frequencies: type A (angular) 37 %; type B (horizontal), 42 %; type C (vertical), 21 %. The morphology of the mandible at the third molar region (types D–F) was observed as: type D (round), 49 %; type E (lingual extended), 18 %; and type F (lingual concave), 32 %. The width and morphology of the mandible with impacted teeth and the location of the mandibular canal at the third molar region could be clearly determined using cross-sectional CBCT images.

Rieko Asaumi

Papers

Observation of the retromolar foramen and canal of the mandible: a CBCT and macroscopic study

Classification of the lingual foramina and their bony canals in the median region of the mandible : cone beam computed tomography observations of dry Japanese mandibles

DICOM segmentation and STL creation for 3D printing: a process and software package comparison for osseous anatomy

Three-dimensional observations of the incisive canal and the surrounding bone using cone-beam computed tomography

Correlation of mandibular impacted tooth and bone morphology determined by cone beam computed topography on a premise of third molar operation