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Three-dimensional dental imaging by spiral CT

Three-dimensional image acquisition, display, and analysis of dental structures was performed and validated using spiral computed tomography (SCT) with metal artifact suppression. Isolated extracted teeth, a dry mandible, cadaver mandible, and cadaver head were scanned and reconstructed using a spiral CT scanner (Siemens Somatom PLUS-S) with 1 mm detector collimation, 1-mm table feed, and 0.1 - 1 mm reconstruction interval using specially developed software. Algorithms for metal artifact reduction including extended attenuation range and interpolation of missing projections were applied. Volumetric rendering of voxel sum images was performed to synthesize images comparable to conventional intraoral dental radiographs. Direct comparison of voxel-based synthetic and digitized film images was made. Several isolated, extracted teeth were sectioned with a diamond saw and submitted for histomorphometric analysis to aid in direct comparison with CT slice images obtained by multiplanar reconstruction. Metal artifact reduction was successful in markedly reducing the streaks and star patterns that usually accompany metallic restorations and intraoral appliances. Individual teeth were comparable to CT slice images. Voxel sum images were comparable to dental radiographs; however, for the SCT images, the spatial resolution was higher within the plane of section than it was orthogonal to the plane of section. Serial examinations were obtained by SCT, registered by surface matching, and interval change measured by 3D subtraction. Simulated lesions and restorations were introduced and quantitatively evaluated pre- and post-interventionally to assess imaging method performance.