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Intraosseous lesion, Cone beam computed tomography, Ultrasonography, Artificial mandible, IntroductionIn the radiographic evaluation of jaw lesions, extraoral techniques, panoramic radiograph, periapical, and occlusal techniques from intraoral radiographs can be considered as the first choice [ 1, - 3, ]. Although these two-dimensional methods provide the opportunity to evaluate the maxillofacial bone structure easily and with less radiation dose, they have problems such as the inability to measure the size of the lesions and their relationship with significant anatomic structures accurately in addition to disadvantages such as poor resolution, distortion, and magnification [ 1, , 3, - 4, ]. By employing computed tomography (CT) technique, images with three dimensions, in different planes, without superposition and real dimensions can be obtained from the lesion. Due to these characteristics, CT is considered as the gold standard in the diagnosis and treatment planning of intraosseous lesions [ 1, , 5, - 7, ]. Cone beam computed tomography (CBCT) can be used as an alternative to CT in dental practice and provides very valuable additional information to images obtained with classical methods in the diagnosis, treatment planning, and patients follow-up. It provides three dimensional and high-resolution images of hard tissues with low radiation dose [ 8, - 9, ].Ultrasonography (USG) has recently been used frequently in maxillofacial imaging and its usage in diagnosis of head-neck lesions has been broadly accepted [ 10, - 14, ]. Literature has shown USG to be a beneficial imaging method in the diagnosis and detection of lesions in jaw bones [ 5, , 15, - 17, ].The aim of this study was to compare and evaluate CBCT, which is frequently used today in dental radiology to examine radiological features of perforated lesions formed in artificial mandible, with USG, which is used in soft tissue evaluations. Material and MethodFor the study, radiological evaluations of 60 artificial mandibles obtained from white plaster cast and artificial intraosseous lesions were made by using CBCT and USG. For artificial lesion, finger parts of latex examination gloves were cut, materials with various intensities were placed inside and bubbles were obtained by tightly tying their openings (Figure 1,). For artificial lesion, milk was used in 16 artificial mandibles, water was used in 15, beef liver in 16 and olive oil was used in 13 artificial mandibles. Next, these bubbles were placed in moulds in the shape of a mandible and plaster cast was put into them. After hardening, the perforation area was verified (Figure 2,).Figure 1. Placing different materials in the bubbles obtained from the finger part of latex gloves to obtain artificial lesion (a, Water, b, Milk, c, Olive oil, d, Liver)Figure 2. Placing bubbles of artificial lesion in mandible shaped mould and obtaining artificial mandibles including intraosseous artificial lesion, (a and b, Artificial mandible mould, c, Placing the artificial intraosseous lesion in the mould, d, Filling cast in artificial mandible with artificial lesion, e, Taking artificial mandible and lesion out of the mould, f, Perforated lesions including, Asterisk, milk, arrow, water, triangle, liver, circle, olive oil)CBCT scanning and analysis of artificial mandible intraosseous lesionsCBCT Imaging ProcedureThe images of artificial mandible intraosseous lesions used in the study were obtained by using NewTom 5G (Verona, Italy) CBCT machine, with 18x16 field of view, scanning time of 18 seconds, and exposure times of 3, 6 seconds. Evaluation was made with new NewTom software program. In order to determine the lesions border for measurement, the studies were conducted in the dark room.Evaluation of CBCT ImagesSizesAntero-posterior sizes of the lesions were measured on 0.3mm axial sections. Bucco-lingual and superior-inferior sizes of the lesions were measured on 1mm thickness coronal sections (Figure 3a, and b,).IntensityOf 10mm2 area in the middle of the CBCT coronal sectional image was evaluated according to new newtom software program Hounsfield unit (HU) scale measurement and the data were recorded separately for each lesion (Figure 3c,).Figure 3. Measurement of lesion sizes, a, Axial, b, Coronal CBCT imagesUSG scanning and analyses of artificial mandible intraosseous lesionsUSG Imaging ProcedureArtificial lesions in the study were evaluated with GE Logiq F8 (Jiangsu, China) USG device and 7-12 MHz linear array transducer probe. While scanning, medium size latex gloves filled with water were placed on the lesions, to smooth the scanned surface and to establish a good acoustic contact. Water based gel was applied on the surface of water filled glove surface corresponding to the lesion for a good acoustic contact and transversal and longitudinal images were taken (Figure 4,).Figure 4. USG imaging procedure of the artificial mandible intraosseous lesion by placing the glove filled with water imitating soft tissue on the lesion Evaluation of USG ImagesIn the USG images, the dimensions of the lesions were measured in anterior-posterior, bucco-lingual and superior-inferior sides (Figure 5,) and the echogenicity of the lesions were recorded for each lesion (Figure 6,). Figure 5. Size measurements of artificial lesion with USG, a, Number 1 measurement in anterior-posterior, probe transverse position, b, Number 1 bucco-lingual measurement and number 2 superior- inferior measurement, probe longitudinalFigure 6. Lesion echogenicity a, Water, b, Milk, c, Olive oil anechoic, d, Liver hypoechoic appearanceStatistical AnalysisOne sample t-test was used to statistically evaluate the difference between the averages size of the measurements. One-way Anova test was used to evaluate the difference between HU average values of the intensities of water, milk, olive oil, and liver groups, which were the materials that constituted the lesion content.ResultsWhile the mean value of the anterior-posterior sizes of artificial lesions was found as 19.83&,plusmn 2.67mm in CBCT images, mean value of the same size was found as 18.7&,plusmn 3mm in USG images. Statistically significant difference was found between these two values (p=0.000) (Table 1,). While the mean value of the bucco-lingual sizes of artificial lesions was found as 18.33&,plusmn 2.22mm in CBCT images, USG mean of the same size was found as 17.46 &,plusmn 2.11mm. Statistically significant difference was found between these two values (p= 0.000) (Table 1,). MeanStandart deviationMean differencePCBCT A-P19.83832.671391.13000.000USG A-P18.70833.01815CBCT B-L18.33002.22210.865000.000USG B-L17.46502.11579CBCT SUP-INF19.69502.171421.015000.000USG SUP-INF18.68002.38972Table 1.Comparison of artificial lesions dimensions with one Sample t- testWhile the mean value of the superior-inferior sizes of artificial lesions was found as 19.69&,plusmn 2.17mm in CB-CT images, mean value of the same size was found as 18.68&,plusmn 2.38mm in USG images. Statistically significant difference was found between these two values (p= 0.000) (Table 1,).The mean value of intensity of artificial lesions based on HU in CBCT images were found to be 174.6&,plusmn 57.31 in water containing lesions, 175.8&,plusmn 51.22 in milk containing lesions, 174.13&,plusmn 88.81 in liver containing lesions, and -3.85&,plusmn 60.01 in oil containing lesions. There was a statistically significant difference between these values (p= 0.000) (Table 2,). Moreover, the echogenicity of artificial lesions was anechoic for water, milk and olive oil, while it was hypoechoic for liver. Lesion contentNMeanStandart DeviationPMilk16175.81a51.2230.000Water15174.60a57.318Liver16174.13a88.819Olive oil13-3.85b60.010Total60136.1398.472 One-way Anova, superscripts show statistically significant differen-ce between groups (Tukey testi, p&,lt 0.0001) (a, no statistically significant, b, there is a statistically significant difference) |