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

摘要 同种异体或异种骨颗粒植入拔牙后牙槽窝扩张术 在随后的种植体植入中，经常应用凹槽来减少颌骨体积的收缩。 眼窝隆起后的愈合差异很大，从平坦的愈合到感染、骨衰竭。 由于细菌感染和/或局部/全身情况，移植物融合和严重的骨丢失。治愈之道 决定种植体放置时间的持续时间也有很大不同。目前，一个武断的 采用插座增强后6个月的等待时间，当二维(2-D)或三维(3D)X光片时， 同时进行肉眼检查以评估硬组织和软组织愈合以确定 植入物手术的准备和策略。但是，不推荐使用纵向3-D射线照相 用于监测由于辐射问题导致的插座愈合情况。它们的图像分辨率较低(250-500微米)， 限制了他们评估骨表面愈合的能力，并且软组织对比度较差。一种无辐射和 可以纵向评估硬组织和软组织的护理点方法对于最终的、 准确、及时地诊断眼窝愈合病理。一种高频微小型口腔内声学振荡器 可以在现成扫描仪上操作的超声波探头已经与 由我们的研究团队提供行业支持。我们小组进行的研究证明了这种探头的准确性 测量各种口腔和牙齿结构。中心假设是开发基于超声波的成像技术 确定眼窝愈合损害的范围和严重程度，并对其进行定性和分级。为了测试这一点 假设，这一提议提出了两个目标。目的1.评价超声诊断价值 一项纵向临床研究中拔牙槽骨移植操作的图像(摘自-2 6个月至6个月的移植物植入)。我们将比较其他成像和临床诊断工具 在整个纵向研究期间评估硬组织和软组织、解剖和生理状态- 当然了。目的2.研制一种用于获取大视角的凹面扩展视场换能器阵列 颌骨图像和确定颊到舌的组织形态。我们将与制造商接洽，以便 为这一特定的牙科应用创建一个扩展孔径传感器。设计目标将包括 创建一个延伸的、大角度的视野，以可视化从颊到舌的颌骨表面。我们会 还进一步发展了我们现有的基于机器学习(ML)的测量工具，包括软组织和硬组织 尺寸和顶骨表面分析，以产生一个基于超声波的骨质量分类系统。 建议的AIMS的成功实施将产生一种纵向眼窝增强术的临床工具 基于超声软组织和硬组织特征的评估，将允许护理提供者选择 在显示的情况下偏离当前临床程序。这些案件将在随后的一次 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 the jawbone volume shrinkage for subsequent implant placement. Socket healing after 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 (2-D) or 3-D radiograph, along with a visual examination is performed to assess hard- and soft-tissue healing to determine the readiness and strategy for implant surgery. However, 3-D radiographs are not recommended for longitudinal use to monitor socket healing due to radiation concerns. They have low image resolution (250-500 µm), which limits their ability to evaluate bone surface healing, and have 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 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 their extent and severity. To test this hypothesis, two aims are proposed in this proposal. Aim 1. Evaluate the diagnostic value of ultrasound 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 a concave extended-view transducer array for acquiring large view-angle jawbone images and determine buccal to lingual tissue morphology. We will engage the manufacturer to create an extended aperture transducer for this specific dental application. Design goals will include the creation of an extended, large angle, field-of-view to visualize the buccal to lingual jawbone surface. We will also further our existing machine learning (ML) based measurement tools, including soft- and hard-tissue dimensions and crestal bone surface analysis to yield an ultrasound-based bone quality classification system. Successful execution of the proposed aims will result in a clinical tool for longitudinal socket augmentation evaluation that is based on ultrasound soft- and hard-tissue features and will allow the care provider to choose deviations from current clinical procedures where indicated. Those would be investigated subsequently in a specifically designed clinical trial.