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 在接下来的种植体放置中，经常应用凹槽来减少颌骨体积的收缩。插座 植骨后的愈合情况差异很大，从顺利愈合到感染，再到植骨失败。 由于细菌感染和/或局部/全身条件导致的整合和严重的骨丢失。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(2D)或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 为随后的种植手术做好准备和策略。但是，不推荐使用3D射线照片 用于纵向使用，以监测由于辐射问题而导致的牙槽愈合情况。它们的图像分辨率较低 (250-500微米)，这限制了他们评估骨表面愈合和下部软组织对比的能力。一个 可以纵向评估硬组织和软组织的非放射和护理点法是非常重要的 需要对眼窝愈合病理进行明确、准确和及时的诊断。一种高频的和 可以在现成的扫描仪上操作的微型口腔内超声探头已经制造出来 由我们的研究团队与业界合作(见支持函)。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时的准确性。中心假说 是开发基于超声的成像来表征眼窝愈合的损害并对其分级，以确定 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.评估 超声图像对拔牙槽植骨术的诊断价值 纵向临床研究(移植物植入后-2个月至+6个月)。我们将比较其他成像 和临床诊断工具，在整个过程中评估硬组织和软组织、解剖和生理状态 纵向研究的时间进程。目的2.研制一种获取大视场的扩展视场扫描方式 OF-查看颌骨图像并确定颊(面)到舌的组织形态。我们将与 制造商(见支持函)为这一特定牙科应用修改现有扫描仪。设计 目标将包括创建一个扩展的、大角度的视野，以可视化从颊到舌的下巴 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。 建议的AIMS的成功实施将产生一种基于成像的纵向插口工具 基于软组织和硬组织特征的增强评估，将允许护理人员 在指示的地方选择偏离当前临床程序。这将在随后的#年进行调查。 一项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.