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Open Access 01-03-2021 | Magnetic Resonance Imaging | Original Article

Evaluation of magnetic resonance imaging artifacts caused by fixed orthodontic CAD/CAM retainers—an in vitro study

Authors: Christoph Roser, Tim Hilgenfeld, Sinan Sen, Tobias Badrow, Sebastian Zingler, Sabine Heiland, Martin Bendszus, Christopher J. Lux, Alexander Juerchott

Published in: Clinical Oral Investigations | Issue 3/2021

Abstract

Objectives

Magnetic resonance imaging (MRI) image quality can be severely impaired by artifacts caused by fixed orthodontic retainers. In clinical practice, there is a trend towards using computer-aided design/computer-aided manufacturing (CAD/CAM) retainers. This study aimed to quantify MRI artifacts produced by these novel CAD/CAM retainers.

Material and methods

Three CAD/CAM retainers and a stainless-steel retainer (“Twistflex”; clinical reference standard) were scanned in vitro at 3-T MRI using a high-resolution 3D sequence. The artifact diameters and three-dimensional artifact volumes (AV) were determined for all mandibular (AV_mand) and maxillary (AV_max) retainers. Moreover, the corresponding ratio of artifact volume to retainer volume (AV/RV_mand, AV/RV_max) was calculated.

Results

Twistflex caused large artifact volumes (AV_mand: 13530 mm³; AV_max: 15642 mm³; AV/RV_mand: 2602; AV/RV_max: 2235). By contrast, artifact volumes for CAD/CAM retainers were substantially smaller: whereas artifact volumes for cobalt–chromium retainers were moderate (381 mm³; 394 mm³; 39; 31), grade-5 titanium (110 mm³; 126 mm³; 12; 12) and nickel–titanium (54 mm³; 78 mm³; 12; 14) both produced very small artifact volumes.

Conclusion

All CAD/CAM retainers caused substantially smaller volumes of MRI artifacts compared to Twistflex. Grade-5 titanium and nickel–titanium CAD/CAM retainers showed the smallest artifact volumes.

Clinical relevance

CAD/CAM retainers made from titanium or nickel–titanium may not relevantly impair image quality in head/neck and dental MRI. Artifacts caused by cobalt–chromium CAD/CAM retainers may mask nearby dental/periodontal structures. In contrast, the large artifacts caused by Twistflex are likely to severely impair diagnosis of oral and adjacent pathologies.

Matsumoto M, Koike S, Kashima S, Awai K (2015) Geographic distribution of CT, MRI and PET devices in Japan: a longitudinal analysis based on National Census Data. PLoS One 10(5):e0126036. https://doi.org/10.1371/journal.pone.0126036CrossRefPubMedPubMedCentral

Flügge T, Hövener JB, Ludwig U, Eisenbeiss AK, Spittau B, Hennig J, Schmelzeisen R, Nelson K (2016) Magnetic resonance imaging of intraoral hard and soft tissues using an intraoral coil and FLASH sequences. Eur Radiol 26(12):4616–4623. https://doi.org/10.1007/s00330-016-4254-1

Prager M, Heiland S, Gareis D, Hilgenfeld T, Bendszus M, Gaudino C (2015) Dental MRI using a dedicated RF-coil at 3 Tesla. J Craniomaxillofac Surg 43(10):2175–2182. https://doi.org/10.1016/j.jcms.2015.10.011CrossRefPubMed

Hilgenfeld T, Prager M, Heil A, Schwindling FS, Nittka M, Grodzki D, Rammelsberg P, Bendszus M, Heiland S (2017) PETRA, MSVAT-SPACE and SEMAC sequences for metal artefact reduction in dental MR imaging. Eur Radiol 27(12):5104–5112. https://doi.org/10.1007/s00330-017-4901-1CrossRefPubMed

Sedlacik J, Kutzner D, Khokale A, Schulze D, Fiehler J, Celik T, Gareis D, Smeets R, Friedrich RE, Heiland M, Assaf AT (2016) Optimized 14 + 1 receive coil array and position system for 3D high-resolution MRI of dental and maxillomandibular structures. Dentomaxillofac Radiol 45(1):20150177. https://doi.org/10.1259/dmfr.20150177CrossRefPubMed

Ludwig U, Eisenbeiss AK, Scheifele C, Nelson K, Bock M, Hennig J, von Elverfeldt D, Herdt O, Flügge T, Hövener JB (2016) Dental MRI using wireless intraoral coils. Sci Rep 6:23301. https://doi.org/10.1038/srep23301

Gaudino C, Cosgarea R, Heiland S, Csernus R, Beomonte Zobel B, Pham M, Kim TS, Bendszus M, Rohde S (2011) MR-imaging of teeth and periodontal apparatus: an experimental study comparing high-resolution MRI with MDCT and CBCT. Eur Radiol 21(12):2575–2583. https://doi.org/10.1007/s00330-011-2209-0CrossRefPubMed

Schara R, Sersa I, Skaleric U (2009) T1 relaxation time and magnetic resonance imaging of inflamed gingival tissue. Dentomaxillofac Radiol 38(4):216–223. https://doi.org/10.1259/dmfr/75262837CrossRefPubMed

Juerchott A, Sohani M, Schwindling FS, Jende JME, Kurz FT, Rammelsberg P, Heiland S, Bendszus M, Hilgenfeld T (2020) In vivo accuracy of dental magnetic resonance imaging in assessing maxillary molar furcation involvement: a feasibility study in humans. J Clin Periodontol 47:809–815. https://doi.org/10.1111/jcpe.13299

10.

Juerchott A, Pfefferle T, Flechtenmacher C, Mente J, Bendszus M, Heiland S, Hilgenfeld T (2018) Differentiation of periapical granulomas and cysts by using dental MRI: a pilot study. Int J Oral Sci 10(2):17. https://doi.org/10.1038/s41368-018-0017-y

11.

Kress B, Buhl Y, Anders L, Stippich C, Palm F, Bähren W, Sartor K (2004) Quantitative analysis of MRI signal intensity as a tool for evaluating tooth pulp vitality. Dentomaxillofac Radiol 33(4):241–244. https://doi.org/10.1259/dmfr/33063878

12.

Cankar K, Vidmar J, Nemeth L, Sersa I (2020) T2 mapping as a tool for assessment of dental pulp response to caries progression: an in vivo MRI study. Caries Res 54(1):24–35. https://doi.org/10.1159/000501901CrossRefPubMed

13.

Korn P, Elschner C, Schulz MC, Range U, Mai R, Scheler U (2015) MRI and dental implantology: two which do not exclude each other. Biomaterials 53:634–645. https://doi.org/10.1016/j.biomaterials.2015.02.114CrossRefPubMed

14.

Flügge T, Ludwig U, Hövener JB, Kohal R, Wismeijer D, Nelson K (2020) Virtual implant planning and fully guided implant surgery using magnetic resonance imaging-proof of principle. Clin Oral Implants Res 31:575–583. https://doi.org/10.1111/clr.13592

15.

Hilgenfeld T, Juerchott A, Deisenhofer UK, Weber D, Rues S, Rammelsberg P, Heiland S, Bendszus M, Schwindling FS (2019) In vivo accuracy of tooth surface reconstruction based on CBCT and dental MRI-A clinical pilot study. Clin Oral Implants Res 30(9):920–927. https://doi.org/10.1111/clr.13498

16.

Heil A, Lazo Gonzalez E, Hilgenfeld T, Kickingereder P, Bendszus M, Heiland S, Ozga AK, Sommer A, Lux CJ, Zingler S (2017) Lateral cephalometric analysis for treatment planning in orthodontics based on MRI compared with radiographs: a feasibility study in children and adolescents. PLoS One 12(3):e0174524. https://doi.org/10.1371/journal.pone.0174524CrossRefPubMedPubMedCentral

17.

Maspero C, Abate A, Bellincioni F, Cavagnetto D, Lanteri V, Costa A, Farronato M (2019) Comparison of a tridimensional cephalometric analysis performed on 3T-MRI compared with CBCT: a pilot study in adults. Prog Orthod 20(1):40. https://doi.org/10.1186/s40510-019-0293-xCrossRefPubMedPubMedCentral

18.

Juerchott A, Freudlsperger C, Zingler S, Saleem MA, Jende JME, Lux CJ, Bendszus M, Heiland S, Hilgenfeld T (2020) In vivo reliability of 3D cephalometric landmark determination on magnetic resonance imaging: a feasibility study. Clin Oral Investig 24(3):1339–1349. https://doi.org/10.1007/s00784-019-03015-7

19.

Hasanin M, Kaplan SEF, Hohlen B, Lai C, Nagshabandi R, Zhu X, Al-Jewair T (2019) Effects of orthodontic appliances on the diagnostic capability of magnetic resonance imaging in the head and neck region: a systematic review. Int Orthod 17(3):403–414. https://doi.org/10.1016/j.ortho.2019.06.001CrossRefPubMed

20.

Wylezinska M, Pinkstone M, Hay N, Scott AD, Birch MJ, Miquel ME (2015) Impact of orthodontic appliances on the quality of craniofacial anatomical magnetic resonance imaging and real-time speech imaging. Eur J Orthod 37(6):610–617. https://doi.org/10.1093/ejo/cju103CrossRefPubMed

21.

Ozawa E, Honda EI, Parakonthun KN, Ohmori H, Shimazaki K, Kurabayashi T, Ono T (2018) Influence of orthodontic appliance-derived artifacts on 3-T MRI movies. Prog Orthod 19(1):7. https://doi.org/10.1186/s40510-018-0204-6CrossRefPubMedPubMedCentral

22.

Costa AL, Appenzeller S, Yasuda CL, Pereira FR, Zanardi VA, Cendes F (2009) Artifacts in brain magnetic resonance imaging due to metallic dental objects. Med Oral Patol Oral Cir Bucal 14(6):E278–E282PubMed

23.

Andriekute A, Vasiliauskas A, Sidlauskas A (2017) A survey of protocols and trends in orthodontic retention. Prog Orthod 18(1):31. https://doi.org/10.1186/s40510-017-0185-xCrossRefPubMedPubMedCentral

24.

Kravitz ND, Grauer D, Schumacher P, Jo YM (2017) Memotain: a CAD/CAM nickel-titanium lingual retainer. Am J Orthod Dentofac Orthop 151(4):812–815. https://doi.org/10.1016/j.ajodo.2016.11.021CrossRef

25.

Wolf M, Schumacher P, Jäger F, Wego J, Fritz U, Korbmacher-Steiner H, Jäger A, Schauseil M (2015) Novel lingual retainer created using CAD/CAM technology: evaluation of its positioning accuracy. J Orofac Orthop 76(2):164–174. https://doi.org/10.1007/s00056-014-0279-8

26.

Möhlhenrich SC, Jäger F, Jäger A, Schumacher P, Wolf M, Fritz U, Bourauel C (2018) Biomechanical properties of CAD/CAM-individualized nickel-titanium lingual retainers: an in vitro study. J Orofac Orthop 79(5):309–319. https://doi.org/10.1007/s00056-018-0144-2

27.

Blankenstein FH, Asbach P, Beuer F, Glienke J, Mayer S, Zachriat C (2017) Magnetic permeability as a predictor of the artefact size caused by orthodontic appliances at 1.5 T magnetic resonance imaging. Clin Oral Investig 21(1):281–289. https://doi.org/10.1007/s00784-016-1788-1CrossRefPubMed

28.

Elison JM, Leggitt VL, Thomson M, Oyoyo U, Wycliffe ND (2008) Influence of common orthodontic appliances on the diagnostic quality of cranial magnetic resonance images. Am J Orthod Dentofac Orthop 134(4):563–572. https://doi.org/10.1016/j.ajodo.2006.10.038CrossRef

29.

Zachriat C, Asbach P, Blankenstein KI, Peroz I, Blankenstein FH (2015) MRI with intraoral orthodontic appliance-a comparative in vitro and in vivo study of image artefacts at 1.5 T. Dentomaxillofac Radiol 44(6):20140416. https://doi.org/10.1259/dmfr.20140416CrossRefPubMedPubMedCentral

30.

Chinvipas N, Hasegawa Y, Terada K (2014) Repeated bonding of fixed retainer increases the risk of enamel fracture. Odontology 102(1):89–97. https://doi.org/10.1007/s10266-012-0095-9CrossRefPubMed

31.

Booth FA, Edelman JM, Proffit WR (2008) Twenty-year follow-up of patients with permanently bonded mandibular canine-to-canine retainers. Am J Orthod Dentofac Orthop 133(1):70–76. https://doi.org/10.1016/j.ajodo.2006.10.023CrossRef

32.

Aizenbud D, Hazan-Molina H, Einy S, Goldsher D (2012) Craniofacial magnetic resonance imaging with a gold solder-filled chain-like wire fixed orthodontic retainer. J Craniofac Surg 23(6):e654–e657. https://doi.org/10.1097/SCS.0b013e3182710609CrossRefPubMed

33.

Blankenstein F, Truong BT, Thomas A, Thieme N, Zachriat C (2015) Predictability of magnetic susceptibility artifacts from metallic orthodontic appliances in magnetic resonance imaging. J Orofac Orthop 76(1):14–29. https://doi.org/10.1007/s00056-014-0258-0CrossRefPubMed

34.

Shalish M, Dykstein N, Friedlander-Barenboim S, Ben-David E, Gomori JM, Chaushu S (2015) Influence of common fixed retainers on the diagnostic quality of cranial magnetic resonance images. Am J Orthod Dentofac Orthop 147(5):604–609. https://doi.org/10.1016/j.ajodo.2014.11.022CrossRef

35.

Ai T, Padua A, Goerner F, Nittka M, Gugala Z, Jadhav S, Trelles M, Johnson RF, Lindsey RW, Li X, Runge VM (2012) SEMAC-VAT and MSVAT-SPACE sequence strategies for metal artifact reduction in 1.5T magnetic resonance imaging. Investig Radiol 47(5):267–276. https://doi.org/10.1097/RLI.0b013e318240a919CrossRef

36.

Hilgenfeld T, Prager M, Schwindling FS, Jende JME, Rammelsberg P, Bendszus M, Heiland S, Juerchott A (2018) Protocol for the evaluation of MRI artifacts caused by metal implants to assess the suitability of implants and the vulnerability of pulse sequences. J Vis Exp 135. https://doi.org/10.3791/57394

37.

Zachrisson BU (2015) Multistranded wire bonded retainers: from start to success. Am J Orthod Dentofac Orthop 148(5):724–727. https://doi.org/10.1016/j.ajodo.2015.07.015CrossRef

38.

Starcuková J, Starcuk Z, Hubálková H, Linetskiy I (2008) Magnetic susceptibility and electrical conductivity of metallic dental materials and their impact on MR imaging artifacts. Dent Mater 24(6):715–723. https://doi.org/10.1016/j.dental.2007.07.002CrossRefPubMed

39.

Klinke T, Daboul A, Maron J, Gredes T, Puls R, Jaghsi A, Biffar R (2012) Artifacts in magnetic resonance imaging and computed tomography caused by dental materials. PLoS One 7(2):e31766. https://doi.org/10.1371/journal.pone.0031766CrossRefPubMedPubMedCentral

40.

Zachriat C (2016) Suszeptibilitätsartefakte durch kieferorthopädische Attachments in der 1,5 Tesla Magnetresonanztomographie

41.

Ni J, Ling H, Zhang S, Wang Z, Peng Z, Benyshek C, Zan R, Miri AK, Li Z, Zhang X, Lee J, Lee KJ, Kim HJ, Tebon P, Hoffman T, Dokmeci MR, Ashammakhi N, Li X, Khademhosseini A (2019) Three-dimensional printing of metals for biomedical applications. Mater Today Bio 3:100024. https://doi.org/10.1016/j.mtbio.2019.100024CrossRefPubMedPubMedCentral

42.

Raphael B, Haims AH, Wu JS, Katz LD, White LM, Lynch K (2006) MRI comparison of periprosthetic structures around zirconium knee prostheses and cobalt chrome prostheses. AJR Am J Roentgenol 186(6):1771–1777. https://doi.org/10.2214/AJR.05.1077CrossRefPubMed

43.

Hilgenfeld T, Prager M, Schwindling FS, Heil A, Kuchenbecker S, Rammelsberg P, Bendszus M, Heiland S (2016) Artefacts of implant-supported single crowns - impact of material composition on artefact volume on dental MRI. Eur J Oral Implantol 9(3):301–308PubMed

44.

Assaf AT, Zrnc TA, Remus CC, Khokale A, Habermann CR, Schulze D, Fiehler J, Heiland M, Sedlacik J, Friedrich RE (2015) Early detection of pulp necrosis and dental vitality after traumatic dental injuries in children and adolescents by 3-Tesla magnetic resonance imaging. J Craniomaxillofac Surg 43(7):1088–1093. https://doi.org/10.1016/j.jcms.2015.06.010CrossRefPubMed

45.

Iohara K, Fujita M, Ariji Y, Yoshikawa M, Watanabe H, Takashima A, Nakashima M (2016) Assessment of pulp regeneration induced by stem cell therapy by magnetic resonance imaging. J Endod 42(3):397–401. https://doi.org/10.1016/j.joen.2015.11.021CrossRefPubMed

46.

Lizio G, Salizzoni E, Coe M, Gatto MR, Asioli S, Balbi T, Pelliccioni GA (2018) Differential diagnosis between a granuloma and radicular cyst: effectiveness of magnetic resonance imaging. Int Endod J 51(10):1077–1087. https://doi.org/10.1111/iej.12933CrossRefPubMed

47.

Assaf AT, Zrnc TA, Remus CC, Schönfeld M, Habermann CR, Riecke B, Friedrich RE, Fiehler J, Heiland M, Sedlacik J (2014) Evaluation of four different optimized magnetic-resonance-imaging sequences for visualization of dental and maxillo-mandibular structures at 3 T. J Craniomaxillofac Surg 42(7):1356–1363. https://doi.org/10.1016/j.jcms.2014.03.026

48.

49.

Hilgenfeld T, Kastel T, Heil A, Rammelsberg P, Heiland S, Bendszus M, Schwindling FS (2018) High-resolution dental magnetic resonance imaging for planning palatal graft surgery-a clinical pilot study. J Clin Periodontol 45(4):462–470. https://doi.org/10.1111/jcpe.12870CrossRefPubMed

50.

Juerchott A, Freudlsperger C, Weber D, Jende JME, Saleem MA, Zingler S, Lux CJ, Bendszus M, Heiland S, Hilgenfeld T (2020) In vivo comparison of MRI- and CBCT-based 3D cephalometric analysis: beginning of a non-ionizing diagnostic era in craniomaxillofacial imaging? Eur Radiol 30(3):1488–1497. https://doi.org/10.1007/s00330-019-06540-xCrossRefPubMed

51.

Farahani K, Sinha U, Sinha S, Chiu LC, Lufkin RB (1990) Effect of field strength on susceptibility artifacts in magnetic resonance imaging. Comput Med Imaging Graph 14(6):409–413. https://doi.org/10.1016/0895-6111(90)90040-iCrossRefPubMed

Title: Evaluation of magnetic resonance imaging artifacts caused by fixed orthodontic CAD/CAM retainers—an in vitro study
Authors: Christoph Roser
Tim Hilgenfeld
Sinan Sen
Tobias Badrow
Sebastian Zingler
Sabine Heiland
Martin Bendszus
Christopher J. Lux
Alexander Juerchott
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Computer Aided Manufacturing
Computer Aided Design
Published in: Clinical Oral Investigations / Issue 3/2021
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-020-03450-x

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Evaluation of magnetic resonance imaging artifacts caused by fixed orthodontic CAD/CAM retainers—an in vitro study

Abstract

Objectives

Material and methods

Results

Conclusion

Clinical relevance

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Material and methods

Results

Conclusion

Clinical relevance

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