Ultrasound-based jawbone surface quality evaluation after alveolar ridge preservation

• Published in: Journal of periodontology (1970)
• Main Authors: Rodriguez, Amanda B, Kripfgans, Oliver D, Kozloff, Kenneth M, Samal, Ankita, Woo, Jae-Man, Shehabeldin, Mostafa, Chan, Hsun-Liang
• Format: Journal Article
• Language: English
• Published: United States 14.05.2024
• Subjects: bone mineral density; bone regeneration; wound healing; alveolar ridge preservation; ultrasonography; jaw, edentulous
• ISSN: 1943-3670
• DOI: 10.1002/JPER.23-0370

Bone readiness for implant placement is typically evaluated by bone quality/density on 2-dimensional radiographs and cone beam computed tomography at an arbitrary time between 3 and 6 months after tooth extraction and alveolar ridge preservation (ARP). The aim of this study is to investigate if high-frequency ultrasound (US) can classify bone readiness in humans, using micro-CT as a reference standard to obtain bone mineral density (BMD) and bone volume fraction (BVTV) of healed sockets receiving ARP in humans. A total of 27 bone cores were harvested during the implant surgery from 24 patients who received prior extraction with ARP. US images were taken immediately before the implant surgery at a site co-registered with the tissue biopsy collection location, made possible with a specially designed guide, and then classified into 3 tiers using B-mode image criteria (1) favorable, (2) questionable, and (3) unfavorable. Bone mineral density (hydroxyapatite) and BVTV were obtained from micro-CT as the gold standard. Hydroxyapatite and BVTV were evaluated within the projected US slice plane and thresholded to favorable (>2200 mg/cm ; >0.45 mm /mm ), questionable (1500-2200 mg/cm ; 0.4-0.45 mm /mm ), and unfavorable (<1500 mg/cm ; <0.4 mm /mm ). The present US B-mode classification inversely scales with BMD. Regression analysis showed a significant relation between US classification and BMD as well as BVTV. T-test analysis demonstrated a significant correlation between US reader scores and the gold standard. When comparing Tier 1 with the combination of Tier 2 and 3, US achieved a significant group differentiation relative to mean BMD (p = 0.004, true positive 66.7%, false positive 0%, true negative 100%, false negative 33.3%, specificity 100%, sensitivity 66.7%, receiver operating characteristics area under the curve 0.86). Similar results were found between US-derived tiers and BVTV. Preliminary data suggest US could classify jawbone surface quality that correlates with BMD/BVTV and serve as the basis for future development of US-based socket healing evaluation after ARP.