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

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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.