Comparison of Dental Findings with Computed Tomographic and Clinical Examination in Patients with End-Stage Heart Failure

Abstract

Background: This study aimed to evaluate the diagnostic value of pre-existing computed tomography (CT) examinations for the detection of dental pathologies compared with clinical dental examination in patients with end-stage heart failure. Methods: For this purpose, 59 patients with end-stage heart failure and pre-existing non-dental CT images of the craniofacial region were included. Virtual orthopantomograms (vOPG) were reconstructed. Dental pathologies were analyzed in vOPG and source-CT images. Imaging and clinical findings less than 6 months apart were compared (n = 24). Results: The subjective image quality of vOPG was more often rated as insufficient than CT (66%; 20%; p < 0.01). Depending on examination (CT, vOPG or clinic), between 33% and 92% of the patients could require dental intervention such as treatment of caries and periodontitis or tooth extraction. vOPG led to a higher (80%) prevalence of teeth requiring treatment than CT (39%; p < 0.01). The prevalence of teeth requiring treatment was similar in CT (29%) and clinic (29%; p = 1.00) but higher in vOPG (63%; p < 0.01). CT (stage 3 or 4: 42%) and vOPG (38%) underestimated the stage of periodontitis (clinic: 75%; p < 0.01). Conclusions: In conclusion, available CT images including the craniofacial region from patients with end-stage heart failure may contain valuable information regarding oral health status. The assessability of vOPGs might be insufficient and must be interpreted with caution.

Keywords: computed tomography; heart disease; heart transplantation; oral health; radiographs.

Figure 1

Flowchart of the study population explaining patient selection according to availability of image records; CT: computed tomography examination; OTN: overall treatment need; TRT: teeth requiring treatment; vOPG: virtual orthopantomogram.

Figure 2

Reconstruction of vOPG from CT. Sagittal maximum intensity projection (a) for level selection of upper and lower limits and occlusal plain (green lines), para-axial plain (b) for contour selection of alveolar processes (red line: center of reconstruction), and margin selection of maximum intensity projection for the vOPG (outer white lines), and final vOPG (c) with very good image quality; CT = computed tomography examination; vOPG = virtual orthopantomogram.

Figure 3

Dental part of CT images in axial (a), sagittal (b), and coronal plane (c), and vOPG (d) of the same patient. The solid and dashed line in a corresponds to the plane of sagittal (b) and coronal (c) reconstructions reconstructed in 1 mm slice thickness, respectively. Note the periapical abscess at the left maxillary first premolar with root canal treatment (arrow in (b–d)) is much more conspicuous on CT than vOPG. The asterisk (*) marks a defect after tooth extraction (a,c,d). The dashed box in d contains areas of overlap due to closed jaws during examination impairing evaluability particularly of vOPG. Horizontal streak artefacts may be noted in all reconstructions parallel to the image acquisition plane in all reconstruction resulting from metal implants. CT = computed tomography examination; vOPG = virtual orthopantomogram.