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Digital archive of theses discussed at the University of Pisa


Thesis etd-12092019-160927

Thesis type
Tesi di dottorato di ricerca
Thesis title
New frontiers in oral and maxillofacial diagnostic imaging: from preclinical studies to clinical applications
Academic discipline
Course of study
tutor Prof. Caramella, Davide
  • Cone-Beam Computed Tomography
  • Diagnostic Imaging
  • Stomatognathic Diseases
  • Ultrasonography
Graduation session start date
Release date
My PhD project was aimed at ascertaining the role and potential application of Cone-Beam Computed Tomography (CBCT) and Ultra-High Frequency Ultrasound (UHFUS) in the study of oral and maxillofacial diseases. This was motivated by two research questions:
1) What alternative role can CBCT have in the study of mineralized structures of the maxillofacial district?
2) How can oral soft tissue diseases be investigated by means of UHFUS, and what kind of information can we obtain?
In this scenario, potential ex-vivo and in-vivo applications of the two imaging techniques were evaluated and validated.
CBCT is a widely used diagnostic technique in oral and maxillofacial imaging. It provides high spatial resolution images with lower radiation dose compared to MSCT. However, CBCT is not suitable for the study of soft tissues due to low contrast resolution.
CBCT was employed in the study of ancient human remains and manufacts, being introduced to the field of paleoimaging for the first time. A comparison with MSCT was made in terms of paleopathological studies, and interestingly CBCT was employed for the study of atherosclerosis on a mummy.
Clinical applications of CBCT included the study of three clinical cases, namely a desmoplastic fibroma of the mandible, an eosinophilic granuloma, and a case of peri-implantitis, the latter evaluated with CBCT in combination with UHFUS.
UHFUS is a recently introduced technique operating at higher frequencies compared to conventional ultrasonography (70-100 MHz). Conventional ultrasonography has been described as a reliable support to diagnosis and grading of oral cancer, due to its capability to measure the depth of infiltration, a recently introduced parameter by the American Joint Committee on Cancer. However, several pathologic conditions may affect oral mucosa. We therefore performed a feasibility study in order to evaluate whether ultrasonography was able to recognize artificially induced lesions on an ex-vivo specimen. The encouraging results obtained promoted the design of an in-vivo study, which was proposed to the local ethics committee (Comitato Etico Area Vasta Nord.-Ovest, CEAVNO) and approved. We therefore started investigating oral mucosa by means of UHFUS, having chosen the technique on the basis of its capability to image superficial layers with resolution comparable to histology. After performing a feasibility study, in which UHFUS was used in combination with CBCT, we focused on oral diseases, describing typical and atypical UHFUS pattern of oral mucosa. Moreover, intraoral application of UHFUS was extended to the study of minor salivary glands in Sjögren’s Syndrome diagnostic work-up, showing high sensitivity and providing useful guidance to bioptic sampling for diagnosis confirmation.
The findings suggest an increasingly important role for diagnostic imaging in the oral and maxillofacial district, with the support of innovative application of CBCT and UHFUS techniques.