*2.3.3.2 Group II (control)*

The control group patients (n = 11) were not subjected to the application of ultrasound therapy. Those patients went through two stages of implant placement surgery. At stage I implant surgery, the dental implant was placed to replace a single missing maxillary premolar tooth. Uncovery and impression were taken for the dental implant at stage II implant surgery, and supra-structure prosthetic construction comprising of screw-retained porcelain fused to metal crown was inserted at 2 months postoperatively. Clinical data collections composed of resonance frequency analysis (RFA) value measurements using Osstell ISQ device and linear measurements of CBCT images at three different views were taken immediately after the placement of the implant and in the follow-up clinical examinations at 3 and 6 months postoperatively.

**13**

**2.4 Data collection**

**Figure 5.**

**Figure 4.**

increases its benefits.

data collection started (**Figure 5**).

*Flowchart of steps for data transformation from UDHS to USM.*

*Marginal Bone Changes around Dental Implants after LIPUS Application: CBCT Study*

*RFA measurement procedure, the probe close to the SmartPeg™. (A) At bucco-palatal and mesio-distal directions, a value of 70 reveals as primary stability on the day of implant placement surgery (B).*

The CBCT scan of each patient was carried out at the Radiographic Department, University Dental Hospital Sharjah, Sharjah, United Arab Emirates. All patients underwent computed tomography scans using GALILEOS; then, the data are converted to DICOM format in which they get exported to USM to be processed using Planmeca Promexis 3D software, and then the data returned to UDHS where

The machine used produces X-rays in cone shape that centers on the X area of the detector. Its tube detector system can be rotated at 360° around the patient's head which exposes the patient for a series of images to be taken by GALILEOS/

The cone beam volumetric tomography (CBVT) X-ray unit used in this study was Planmeca ProMax 3D Max. It records the finest details of the patient's oral anatomy. It offers a maximum field view (Ø23 × 26 cm) which explores new possibilities in diagnostic radiology. It has an advanced imaging software system that

Sirona Dental Systems Scan specifications summarized in **Table 2**.

*DOI: http://dx.doi.org/10.5772/intechopen.87220*

*Marginal Bone Changes around Dental Implants after LIPUS Application: CBCT Study DOI: http://dx.doi.org/10.5772/intechopen.87220*

#### **Figure 4.**

*Clinical Implementation of Bone Regeneration and Maintenance*

Ultrasound frequency 1.5 MHz Intensity (SATA) 30 mW/cm2 Temporal average power 20 W

*The therapeutic ultrasound machine Gymna Pulson® 330 with intraoral probe and actual setting parameters* 

*Intraoral ultrasound device: technical specifications of the ultrasound signal.*

*Ultrasound therapy delivered using probe on the buccal aspect of the implant site.*

**12**

*2.3.3.2 Group II (control)*

*\*Kerr et al. [65].*

**Table 1.**

**Figure 3.**

**Figure 2.**

*on display.*

and 6 months postoperatively.

The control group patients (n = 11) were not subjected to the application of ultrasound therapy. Those patients went through two stages of implant placement surgery. At stage I implant surgery, the dental implant was placed to replace a single missing maxillary premolar tooth. Uncovery and impression were taken for the dental implant at stage II implant surgery, and supra-structure prosthetic construction comprising of screw-retained porcelain fused to metal crown was inserted at 2 months postoperatively. Clinical data collections composed of resonance frequency analysis (RFA) value measurements using Osstell ISQ device and linear measurements of CBCT images at three different views were taken immediately after the placement of the implant and in the follow-up clinical examinations at 3

*RFA measurement procedure, the probe close to the SmartPeg™. (A) At bucco-palatal and mesio-distal directions, a value of 70 reveals as primary stability on the day of implant placement surgery (B).*

**Figure 5.**

*Flowchart of steps for data transformation from UDHS to USM.*

#### **2.4 Data collection**

The CBCT scan of each patient was carried out at the Radiographic Department, University Dental Hospital Sharjah, Sharjah, United Arab Emirates. All patients underwent computed tomography scans using GALILEOS; then, the data are converted to DICOM format in which they get exported to USM to be processed using Planmeca Promexis 3D software, and then the data returned to UDHS where data collection started (**Figure 5**).

The machine used produces X-rays in cone shape that centers on the X area of the detector. Its tube detector system can be rotated at 360° around the patient's head which exposes the patient for a series of images to be taken by GALILEOS/ Sirona Dental Systems Scan specifications summarized in **Table 2**.

The cone beam volumetric tomography (CBVT) X-ray unit used in this study was Planmeca ProMax 3D Max. It records the finest details of the patient's oral anatomy. It offers a maximum field view (Ø23 × 26 cm) which explores new possibilities in diagnostic radiology. It has an advanced imaging software system that increases its benefits.


#### **Table 2.**

*Specifications of CBCT machine used in Dental clinic, UDHS.*

CBVT technology is utilized in Planmeca ProMax 3D Max. It is an advanced, multipurpose, and active imaging machine. It can be utilized in various fields of dentistry that include maxillofacial surgery, implantology, endodontic, orthodontics, periodontics, and for the analysis of TMJ. The newly designed advanced ProMax has evolved into a classical 3D platform with CBVT.

Instead of a continuous beam, each volume is produced by throbbing the X-ray tube during the scanning. It reduces the dose as well as the rotational distortions during the scanning procedure. The total time required for scanning may be from 18 to 26 seconds. However, the exact exposure time may be only 3 seconds. Accurate and distortion-free image for 3D construction is produced by the ScI semiconductor flat panel. Correction for geometric magnification is not required for the images produced by Planmeca ProMax 3D Max.

To ensure immobilization of the patient during exposure, standard methods have been taken as follow:


Lead apron was placed on each patient prior to exposure. All metallic objects (e.g., hairpins and earrings) and any intraoral removable prosthesis were removed.

### **3. Results**

#### **3.1 Radiological results using CBCT images**

The orthopantomogram (OPG) was shown to be a useful tool for radiological screening of the patient during selection stage. Complex cases such as proximity to vital structures and inadequate bone height and width were excluded from the study. In the CBCT images obtained at day 0, there was adequate availability of bone height and width at the platform of dental implant for both groups. At 3 months, there was an increase of buccal plate thickness of 0.3–0.6 mm in the

**15**

**Figure 6.**

*control group at 3 and 6 months (D, E).*

*Marginal Bone Changes around Dental Implants after LIPUS Application: CBCT Study*

**3.2 Evaluation of marginal bone changes for both groups at different time** 

and corono-palatal and less reduction of the bone height at apico-buccal and apico-palatal in the ultrasound group, but the bony tissue overgrowth was more pronounced at the buccal bone plate at 3 and 6 months rather than at the palatal bone plate. In the control group, the marginal bone loss was more in height and

ultrasound group compared to the control group. At 6 months, there was marginal bone loss around dental implant in the control group and marginal bone increase in

CBCT images were obtained at day 0, 3, and 6 months follow-up. The marginal bone level was assessed and measured at three different views (coronal, sagittal,

In the coronal view, there was an overgrowth of the bone width at corono-buccal

In the sagittal view, there was an overgrowth of the bone width at sagitto-mesial and sagitto-distal aspects of dental implants and less reduction of the bone height at apico-mesial and apico-distal in the ultrasound group, but the bony tissue overgrowth was more pronounced at the mesial bone plate at 3 and 6 months. In the control group, there was a reduction in the bone width and height from day 0 to

In the axial view, the bony tissue overgrowth was revealed more at the axiobuccal than axio-palatal at 3 and 6 months in the ultrasound group, while in the control group, there was marginal bone loss in all aspects of dental implant

*Representative CBCT images of marginal bone level in the coronal view. Both groups showed an adequate availability of bone height and width at day 0 (A). An overgrowth of buccal bone plate thickness observed in the ultrasound group at 3 and 6 months (B, C). Marginal bone loss around dental implant observed in the* 

*DOI: http://dx.doi.org/10.5772/intechopen.87220*

and axial) at time-point interval.

**intervals**

6 months (**Table 4**).

(**Table 5**).

height and width in the ultrasound group (**Figure 6A**–**E**).

width than the in the ultrasound group (**Table 3**).

*Marginal Bone Changes around Dental Implants after LIPUS Application: CBCT Study DOI: http://dx.doi.org/10.5772/intechopen.87220*

ultrasound group compared to the control group. At 6 months, there was marginal bone loss around dental implant in the control group and marginal bone increase in height and width in the ultrasound group (**Figure 6A**–**E**).

## **3.2 Evaluation of marginal bone changes for both groups at different time intervals**

CBCT images were obtained at day 0, 3, and 6 months follow-up. The marginal bone level was assessed and measured at three different views (coronal, sagittal, and axial) at time-point interval.

In the coronal view, there was an overgrowth of the bone width at corono-buccal and corono-palatal and less reduction of the bone height at apico-buccal and apico-palatal in the ultrasound group, but the bony tissue overgrowth was more pronounced at the buccal bone plate at 3 and 6 months rather than at the palatal bone plate. In the control group, the marginal bone loss was more in height and width than the in the ultrasound group (**Table 3**).

In the sagittal view, there was an overgrowth of the bone width at sagitto-mesial and sagitto-distal aspects of dental implants and less reduction of the bone height at apico-mesial and apico-distal in the ultrasound group, but the bony tissue overgrowth was more pronounced at the mesial bone plate at 3 and 6 months. In the control group, there was a reduction in the bone width and height from day 0 to 6 months (**Table 4**).

In the axial view, the bony tissue overgrowth was revealed more at the axiobuccal than axio-palatal at 3 and 6 months in the ultrasound group, while in the control group, there was marginal bone loss in all aspects of dental implant (**Table 5**).

#### **Figure 6.**

*Clinical Implementation of Bone Regeneration and Maintenance*

**Scanner name GALILEOS ComfortPLUS**

Focal spot size 0.5 Voltage kV 85 Current mA 10 Exposure time 14 seconds Number of single exposures 200 200

Manufacturer Sirona Dental Systems GmbH, Bensheim, Germany Detector type Image intensifier (I.I.), Thales or Siemens

CBVT technology is utilized in Planmeca ProMax 3D Max. It is an advanced, multipurpose, and active imaging machine. It can be utilized in various fields of dentistry that include maxillofacial surgery, implantology, endodontic, orthodontics, periodontics, and for the analysis of TMJ. The newly designed advanced

Instead of a continuous beam, each volume is produced by throbbing the X-ray tube during the scanning. It reduces the dose as well as the rotational distortions during the scanning procedure. The total time required for scanning may be from 18 to 26 seconds. However, the exact exposure time may be only 3 seconds. Accurate and distortion-free image for 3D construction is produced by the ScI semiconductor flat panel. Correction for geometric magnification is not required for the images

To ensure immobilization of the patient during exposure, standard methods

3.The patient was asked to bite on the bite block of the machine using the upper and lower incisors to standardize patient's position according to X-ray tube

Lead apron was placed on each patient prior to exposure. All metallic objects

The orthopantomogram (OPG) was shown to be a useful tool for radiological screening of the patient during selection stage. Complex cases such as proximity to vital structures and inadequate bone height and width were excluded from the study. In the CBCT images obtained at day 0, there was adequate availability of bone height and width at the platform of dental implant for both groups. At 3 months, there was an increase of buccal plate thickness of 0.3–0.6 mm in the

(e.g., hairpins and earrings) and any intraoral removable prosthesis were

ProMax has evolved into a classical 3D platform with CBVT.

*Specifications of CBCT machine used in Dental clinic, UDHS.*

1.Frankfort plane of the patient parallel to the floor.

2.Midsagittal plane perpendicular to the floor.

**3.1 Radiological results using CBCT images**

produced by Planmeca ProMax 3D Max.

have been taken as follow:

head rotation.

removed.

**Table 2.**

**3. Results**

**14**

*Representative CBCT images of marginal bone level in the coronal view. Both groups showed an adequate availability of bone height and width at day 0 (A). An overgrowth of buccal bone plate thickness observed in the ultrasound group at 3 and 6 months (B, C). Marginal bone loss around dental implant observed in the control group at 3 and 6 months (D, E).*

#### *Clinical Implementation of Bone Regeneration and Maintenance*


*Day 0 readings for AB and AP are not shown since there are no parameters given.*

*\*\*CB = corono-buccal*

*# CP = corono-palatal*

*† AB = apico-buccal*

*‡ AP = apico-palatal*

#### **Table 3.**

*Descriptive statistics of linear measurements (mean, SD) of marginal bone changes between ultrasound and control groups in coronal view (values in millimeters).*


*Day 0 readings for AM and AD are not shown since there are no parameters given.*

*\*\*SM = sagitto-mesial*

*# SD = sagitto-distal*

*† AM = apico-mesial*

*‡AD = apico-distal.*

#### **Table 4.**

*Descriptive statistics of linear measurements (mean, SD) of marginal bone changes between ultrasound and control groups in sagittal view (values in millimeters).*

**17**

**views**

*\*\*AM = axio-mesial*

*AD = axio-distal*

*AB = axio-buccal*

*AP = axio-palatal*

*#*

*†*

*‡*

**Table 5.**

*Marginal Bone Changes around Dental Implants after LIPUS Application: CBCT Study*

Day 0 AM\*\* 1.41 (0.31) 1.40 (0.44)

3 months AM 1.52 (0.39) 0.87 (0.25)

6 months AM 1.66 (0.57) 0.63 (0.30)

**(n = 11)**

AD# 1.42 (0.37) 1.40 (0.33) AB† 1.44 (0.37) 1.42 (0.52) AP‡ 1.45 (0.47) 1.43 (0.36)

AD 1.48 (0.19) 0.89 (0.27) AB 1.60 (0.37) 0.90 (0.30) AP 1.53 (0.35) 1.35 (0.18)

AD 1.63 (0.21) 0.72 (0.30) AB 1.82 (0.41) 0.84 (0.22) AP 1.63 (0.21) 0.98 (0.34)

Mean(SD) Mean(SD)

**Control (n = 11)**

**3.3 Comparison of marginal bone changes within each group at three different** 

*Descriptive statistics of linear measurements (mean, SD) of marginal bone changes between ultrasound and* 

In the coronal view, within the ultrasound group, there was statistically significant increase in the buccal and palatal bones' thickness (height and width) from day 0 to 3 months, day 0 and 6 months, and from 3 to 6 months as p value was less than 0.05, but it was more pronounced at the buccal bone plate, while in the control group, there was no statistically significant increase in bone thickness, and there

In the sagittal view, within the ultrasound group, there was statistically significant increase in the mesial and distal bones' thickness (height and width) from day 0 to month 3, day 0 and month 6, and from month 3 to month 6 as p value was less than 0.05, while in the control group, there was no statistically significant increase in bone thickness, and there was marginal bone loss at all aspects of dental implant. In the axial view, within the ultrasound group, there was statistically significant

increase in the buccal, palatal, mesial, and distal bones' thickness (height and width) from day 0 to 3 months, day 0 and 6 months, and from 3 months to month 6 as p value was less than 0.05, while in the control group, there was no statistically

**3.4 Comparison of marginal bone changes between two groups at three** 

In the coronal view, there was statistically significant increase in buccal and palatal bone width between two groups (ultrasound and control) at 3 and 6 months

was marginal bone loss at all aspects of 9\*dental implant.

significant increase in bone thickness.

*control groups in axial view (values in millimeters).*

**different views**

*DOI: http://dx.doi.org/10.5772/intechopen.87220*

**Time Ultrasound**

**Time Ultrasound (n = 11) Control (n = 11)** Mean(SD) Mean(SD) Day 0 AM\*\* 1.41 (0.31) 1.40 (0.44) AD# 1.42 (0.37) 1.40 (0.33) AB† 1.44 (0.37) 1.42 (0.52) AP‡ 1.45 (0.47) 1.43 (0.36) 3 months AM 1.52 (0.39) 0.87 (0.25) AD 1.48 (0.19) 0.89 (0.27) AB 1.60 (0.37) 0.90 (0.30) AP 1.53 (0.35) 1.35 (0.18) 6 months AM 1.66 (0.57) 0.63 (0.30) AD 1.63 (0.21) 0.72 (0.30) AB 1.82 (0.41) 0.84 (0.22) AP 1.63 (0.21) 0.98 (0.34)

*Marginal Bone Changes around Dental Implants after LIPUS Application: CBCT Study DOI: http://dx.doi.org/10.5772/intechopen.87220*

*\*\*AM = axio-mesial*

*# AD = axio-distal*

*† AB = axio-buccal*

*‡ AP = axio-palatal*

#### **Table 5.**

*Clinical Implementation of Bone Regeneration and Maintenance*

**Time Ultrasound**

*Day 0 readings for AB and AP are not shown since there are no parameters given.*

**Time Ultrasound**

*Day 0 readings for AM and AD are not shown since there are no parameters given.*

*control groups in sagittal view (values in millimeters).*

*control groups in coronal view (values in millimeters).*

*\*\*CB = corono-buccal*

*AB = apico-buccal*

*AP = apico-palatal*

*CP = corono-palatal*

*#*

*†*

*‡*

**Table 3.**

**(n = 11)**

CP# 1.44 (0.37) 1.42 (0.36)

CP 1.55 (0.34) 1.37 (0.26) AB† 1.20 (0.73) 1.20 (0.39) AP‡ 0.89 (0.83) 0.87 (0.74)

CP 1.62 (0.22) 1.02 (0.34) AB 1.65 (0.73) 0.88 (0.29) AP 1.02 (0.62) 0.76 (0.53)

**(n = 11)**

SD# 1.41 (0.35) 1.38 (0.34)

SD 1.46 (0.20) 0.92 (0.25) AM† 0.89 (0.72) 0.83 (0.74) AD‡ 0.87 (0.83) 0.84 (0.45)

SD 1.62 (0.23) 0.78 (0.30) AM 1.18 (0.73) 0.75 (0.32) AD 1.12 (0.60) 0.71 (0.40)

Mean(SD) Mean(SD)

Day 0 CB\*\* 1.43 (0.24) 1.43 (0.50)

3 months CB 1.62 (0.36) 0.92 (0.25)

6 months CB 1.81 (0.41) 0.85 (0.30)

*Descriptive statistics of linear measurements (mean, SD) of marginal bone changes between ultrasound and* 

Day 0 SM\*\* 1.40 (0.30) 1.39 (0.41)

3 months SM 1.47 (0.39) 0.88 (0.26)

6 months SM 1.66 (0.57) 0.65 (0.29)

*Descriptive statistics of linear measurements (mean, SD) of marginal bone changes between ultrasound and* 

Mean(SD) Mean(SD)

**Control (n = 11)**

> **Control (n = 11)**

**16**

*#*

*†*

**Table 4.**

*\*\*SM = sagitto-mesial*

*SD = sagitto-distal*

*AM = apico-mesial ‡AD = apico-distal.*

*Descriptive statistics of linear measurements (mean, SD) of marginal bone changes between ultrasound and control groups in axial view (values in millimeters).*
