Point of Care, High Resolution and 3-Dimensional Ultrasonography for Diagnosing Peri-Implant Bone Loss

项目摘要 种植体周围骨丢失，主要是由于种植体发挥功能后的种植体周围炎，如果不这样做，可能会导致种植体丢失 及时诊断和治疗。据估计，种植体周围炎影响约20%的 植入物.组织损失和受损的功能对数十万人的福利产生负面影响， 患者目前，种植体周围骨丢失主要通过二维（2D）根尖周X线片进行评估。 主要的局限性，即仅提供叠加图像，不可避免地降低了其诊断价值。锥- 射束计算机断层扫描提供了有用的横截面成像，但不建议用于 定期术后评估。非电离和床旁超声检查也可以提供横截面 图像和具有很大的潜力，以补充放射线照相的用途。我们的团队，在其他人中， 超声测量面部牙槽骨嵴尺寸的准确性。因此，超声波可能 增强临床医生评估种植体周围骨水平的能力，特别是在面部和腭/舌侧。 此外，边缘骨厚度，另一个重要的临床参数，评估长期骨缺损， 植入物软硬组织稳定性，可以用超声波测量。这项建议的主要目的是 验证三维超声测量种植体周围边缘骨尺寸的准确性。三 为实现这一目标，提出了以下目标： 目的1：为种植体周围边缘骨的超声系统建立最佳成像设置 测量.这些设置包括选择发射频率、谐波和复合使用。 假设1：超声成像可以描绘口腔硬组织（骨）边缘，用于诊断成像 程序（误差<10%，即与当前标准方法2D射线照片相同的误差），并提供 通过相对对比度区分组织类型的动态范围。 目的2：通过进行超声骨校准练习，建立评估者内和评估者间的可靠性 人体测量。假设2：类内相关系数（ICC） 测试者可以达到至少0.85。 目的3：在交叉研究中比较超声测量与术中直接和放射学测量。 人类调查部门假设3：平均超声骨水平和厚度测量值差异<0.5 mm和<0.3 mm，与相应的开放骨术中骨测量值相比。 超声测量与放射学测量无显著差异。 该提案的成功完成将验证非侵入性，实时和高分辨率超声检查 用于评估种植体周围的边缘骨尺寸。在未来的研究中，我们将测试超声检查， 表征种植体周围骨丢失及其进展。我们还将在更大范围内测量治疗效果。 使用超声波检查进行人体研究。

PROJECT SUMMARY Peri-implant bone loss, mostly due to peri-implantitis after implants are in function, can cause implant loss if not diagnosed and treated in a timely manner. It is estimated that peri-implantitis affects approximately 20% of implants. Tissue loss and compromised function negatively impact the welfare of hundreds of thousands of patients. Currently peri-implant bone loss is primarily assessed by 2-dimensional (2D) periapical radiographs. The main limitation, i.e. only providing superimposed images, inevitably reduces its diagnostic value. Cone- beam computed tomography provides useful cross-sectional imaging but is recommended not to be used for periodic post-op assessment. Non-ionizing and point-of-care ultrasonography can also offer cross-sectional images and holds great potential to complement radiographic uses. Our group, among others, has shown accuracy of ultrasound to measure facial alveolar bone crest dimensions. Therefore, ultrasound can potentially augment clinicians' ability to assess peri-implant bone level, especially on the facial and palatal/lingual sides. Additionally, marginal bone thickness, another important clinical parameter for assessing long-term peri- implant soft and hard tissue stability, can be measured with ultrasound. The primary aim of this proposal is to validate the accuracy of 3D ultrasonography for measuring peri-implant marginal bone dimensions. Three aims are proposed to achieve this objective: Aim 1: Establish optimal imaging settings for the ultrasound system for peri-implant marginal bone measurements. These settings include choice of transmit frequency, harmonic and compound use. Hypothesis 1: Ultrasonic imaging can delineate oral hard tissue (bone) edges for use in diagnostic imaging procedures (with <10% error, i.e. the same error as the current standard method 2D radiographs) and provide dynamic range for differentiation of tissue types by relative contrast. Aim 2: Establish intra- and inter-rater reliability by conducting a calibration exercise for ultrasound bone measurements in humans. Hypothesis 2: Intra-class correlation coefficient (ICC) within and between examiners can reach at least 0.85. Aim 3: Compare ultrasound measurements to intraoperative direct and radiographic measurements in a cross- sectional human investigation. Hypothesis 3: Mean ultrasonic bone level and thickness measures differ <0.5 mm and <0.3 mm, compared to the corresponding open bone intraoperative bone measurements, respectively. Ultrasound measures would be non-significantly different from radiographic measures. Successful completion of this proposal will validate non-invasive, real-time and high-resolution ultrasonography for assessing peri-implant marginal bone dimensions. In future investigations we will test ultrasonography for characterizing peri-implant bone loss and its progression. We will also measure treatment efficacy in larger scale human studies using ultrasonography.