Ultrasonic Imaging of Bone Graft Healing in Extraction Sockets for Precise and Personalized Implant Therapy

摘要 拔牙后通过将同种异体骨或异种骨颗粒植入牙槽窝 通常应用窝腔来减少颌骨体积收缩，以便于随后的种植体放置。插座 加固后的愈合情况差异很大，从顺利愈合到感染、植骨失败 由于细菌感染和/或局部/全身状况导致的骨整合和严重骨丢失。愈合 决定植入物放置时间的持续时间也有很大的不同。目前，任意 接受接受牙槽扩大术后6个月的等待时间，当二维（2D）或3D X线片， 进行沿着目视检查，以评估硬组织和软组织愈合情况， 准备和后续植入手术的策略。但是，不建议使用3D射线照片 用于纵向使用以监测由于辐射问题引起的插座愈合。它们的图像分辨率较低 （250-500 µm），这限制了其评价骨表面愈合的能力，以及软组织对比度较低。一 可以纵向评估硬组织和软组织的非辐射和即时护理方法 需要一个明确的，准确的，及时的诊断插座愈合病理。一个高频率和 已经制造了可以在现成的扫描仪上操作的微型口腔内超声探头 我们的研究团队与工业界合作（见支持信）。我们小组进行的研究 证明了该探头在测量各种口腔和牙齿结构方面的准确性。核心假设 是开发基于超声的成像来表征和分级牙槽愈合病变， 疾病的范围和严重程度。为了验证这一假设，提出了两个目标：目标1。评价 超声图像对拔牙窝植骨术的诊断价值 纵向临床研究（移植物放置的-2个月至+6个月）。我们将比较其他成像 以及用于评估硬组织和软组织、解剖学和生理学状态的临床诊断工具 纵向研究时间进程。目标二。开发一种扩展视图扫描模式，用于获取大视场- 观察颌骨图像并确定颊（面部）到舌组织形态。我们将与 制造商（见支持信）修改现有的扫描仪，用于此牙科特定应用。设计 目标将包括创建一个扩展的、大角度的视野，以可视化颊侧到舌侧的颌骨 骨表面，并创建基于机器学习的测量工具，包括软组织和硬组织 厚度和表面分析。 成功执行所提出的目标将导致一个基于成像的工具，用于纵向插座 基于软组织和硬组织特征的增强评估，将允许护理提供者 选择与当前临床程序的偏离。随后将对此进行调查， 专门设计的临床试验

Abstract Socket augmentation after tooth extraction by placing either allograft or xenograft bone particulates in the socket is frequently applied to reduce jawbone volume shrinkage for subsequent implant placement. Socket healing after the augmentation varies largely, ranging from uneventful healing to infection, failure of bone graft integration and severe bone loss due to bacterial infection and/or local/systemic conditions. The healing duration, which dictates the timing of implant placement, is widely different as well. Currently, an arbitrary waiting time of 6 months after socket augmentation is adopted, when a 2-dimensional (2D) or 3D radiograph, along with a visual examination is performed to assess hard- and soft-tissue healing to determine the readiness and strategy for the subsequent implant surgery. However, 3D radiographs are not recommended for longitudinal use to monitor socket healing due to radiation concerns. They have lower image resolution (250-500 µm), which limits their ability to evaluate bone surface healing, and inferior soft tissue contrast. A non-radiation and point-of-care method that can evaluate both hard- and soft-tissue longitudinally is much needed for a definitive, accurate, and timely diagnosis of socket healing pathologies. A high-frequency and miniature-sized intraoral ultrasound probe that can operate on an off-the-shelf scanner has been manufactured in collaboration with industry (see support letter) by our research team. Research conducted by our group demonstrated accuracy of this probe in measuring various oral and dental structures. The central hypothesis is to develop ultrasound-based imaging to characterize and grade socket healing lesions in determining the extent and severity of disease. To test this hypothesis, two aims are proposed: Aim 1. Evaluate the diagnostic value of ultrasonic images for bone grafting procedures of dental extraction sockets in a longitudinal clinical study (from -2 months to +6 months of graft placement). We will compare other imaging and clinical diagnostic tools for assessing hard- and soft tissue, anatomical and physiological status throughout the longitudinal study time-course. Aim 2. Develop an extended-view scan-mode for acquiring large field- of-view jawbone images and determine buccal (facial) to lingual tissue morphology. We will engage the manufacturer (see support letter) to modify the existing scanner for this dental specific application. Design goals will include the creation of an extended, large angle, field-of-view to visualize the buccal to lingual jaw bone surface and to create machine learning based measurement tools, including soft- and hard-tissue thickness and surface analysis. Successful execution of the proposed aims will result in an imaging-based tool for longitudinal socket augmentation evaluation that is based on soft- and hard-tissue features and will allow the care provider to choose deviation from current clinical procedures where indicated. This would be investigated subsequently in a specifically designed clinical trial.