Diagnostic efficacy of cone-beam computed tomography for detection of vertical root fractures in endodontically treated teeth: a systematic review.

BACKGROUND: Vertical root fractures (VRFs) sometimes occur in endodontically treated teeth. They have a difficult diagnosis and a dismal result. The objective of this review was to evaluate the diagnostic performance of cone-beam computed tomography (CBCT) for detecting VRFs in teeth that had undergone endodontic treatment. METHODS: Literature was reviewed from Web of Science, PubMed, Cochrane Review, SCOPUS, and Embase databases between 2000 and 2022. The searched keywords included "endodontically treated teeth," "cone-beam computed tomography," "CBCT," "tooth fracture," "vertical root fracture," "VRF," "accuracy," "sensitivity," and "specificity." Only articles in the English language were included. The final analysis included 20 papers that satisfied the eligibility requirements. RESULTS: The overall mean ± SD values (%) for the diagnostic sensitivity and specificity of CBCT for detection of VRFs in endodontically treated teeth in the presence of root-filling materials without an intracanal post were 71.50 ± 22.19 and 75.64 ± 19.41, respectively. The overall mean (SD) value (%) for the sensitivity of CBCT for the detection of VRFs in the presence of root-filling materials and intracanal posts was 72.76 (18.73), while the mean (SD) specificity was 75.44 (18.26). The accuracy of CBCT (mean ± SD) was 78.47 ± 17.19% and 74.02 ± 10.64%, respectively, for teeth without intracanal posts and those with posts. CONCLUSIONS: Further clinical research is needed to validate the optimum efficiency of CBCT as a diagnostic technique for detecting VRFs in teeth that have had endodontic treatment, given the low sensitivity, significant heterogeneity of studies, and lack of in-vivo studies on the subject.

Assessment of the diagnostic accuracy of strip and furcal perforations in different sizes by cone beam computed tomography.

OBJECTIVE: Root perforation is an adverse event that may accidentally occur during root canal treatment and can adversely affect the treatment plan and tooth prognosis. This study aimed to assess the accuracy of cone beam computed tomography (CBCT) for detecting the strip and furcal perforations with different sizes. METHODS: The mesiolingual canals of 155 extracted human mandibular first molars were instrumented and randomly divided into four experimental groups and one control group (n = 31). Furcal (in the pulp chamber floor) and strip perforations with 0.5, 1, 1.5, and 2 mm in diameter were manually created. The teeth were randomly mounted in bovine ribs and scanned using CBCT. Two radiologists unaware of the study groups observed the images and reported the greatest perforation diameter. The inter-observer agreements were calculated. The diagnostic accuracy was compared for furcal and strip perforations with different sizes. RESULTS: The inter-observer agreement for detecting furcal and strip perforations with different sizes were good. The diagnostic accuracy was 100% for the absence of perforation in each group. CONCLUSIONS: CBCT can detect the absence of perforation with high accuracy. The diagnostic accuracy of CBCT in the presence of strip and furcal perforation with different sizes was not significant.

How Does Voxel Size of Cone-beam Computed Tomography Effect Accurate Detection of Root Strip Perforations.

Introduction: Our study aimed to assess the diagnostic accuracy of different voxel sizes for cone-beam computed tomography (CBCT) when detecting strip perforations of variable sizes. We used 0.2 and 0.3 mm3 voxel for detecting root strip perforations. Methods and Materials: This was an in vitro study conducted on 155 extracted humans' mandibular first molars. The teeth were randomly divided into five groups (n=31). Perforation were not induced in the control group. In the remaining four groups, strip perforations of 0.5, 1, 1.5, and 2 mm diameters were created in the mesiolingual canal using #3 Gates Glidden drills. The CBCT scans were taken first with a 12×9 cm field of view (FOV), 90 kVp, 4 mA, and 0.2 mm3 voxel size for 24 sec and then with a 12×9 cm FOV, 90 kVp, 2 mA, and 0.3 mm3 voxel size for another 24 sec. Two observers evaluated the images and reported the largest diameter of perforations. The results were compared with the gold standard values (determined by an electronic digital caliper) using statistical methods, including the kappa coefficient and generalized estimating equation (P<0.05). Results: Based on the findings of our study, the inter-observer agreement ranged from 58-100%, while the intra-observer agreement was reported to be around 100%. The difference in accuracy between 0.2 and 0.3 mm3 voxel sizes was not statistically significant (P>0.05). In addition, the accuracy of detecting different perforation sizes in the CBCT did not follow a specific pattern. Conclusion: This in vitro study showed that CBCT is a reliable diagnostic tool, and even in lower dosages of 0.3 mm3 voxel size, image resolution and diagnostic accuracy was not affected. Moreover, smaller root perforations could be detected as accurately as larger ones with CBCT.

Assessment of the Capability of Bone Density Contrast Dissociation in Cone Beam Computed Tomography Compared to Digital Periapical Radiography by Using a Phantom.

STATEMENT OF THE PROBLEM: Assessment of bone density changes plays an important role in diagnosis, treatment, and follow-up procedures. The feasibility of cone-beam computed tomography (CBCT) for assessment of bone density changes is still controversial. PURPOSE: The aim of this study was to investigate the capability of bone density contrast dissociation of CBCT compared to digital periapical radiography. MATERIALS AND METHOD: In this in vitro, experimental study, we designed radiographic phantom for bone density simulation. The phantom was a polytetrafluoroethylene rectangular cube with five-chambers. Five micro-tubes (2 mL) containing different concentrations of dipotassium phosphate (K2HPO4) were placed within these chambers. Different concentrations of K2HPO4 were scanned by CBCT; the mean voxel value of each micro-tube was measured and compared with the concentration of K2HPO4 that represented bone density. RESULTS: CBCT results showed that there were no significant correlations between 300 mg/mL and lower concentrations of K2HPO4 and CBCT voxel values (P≤0.52) but there was a significant correlation between concentrations of K2HPO4 higher than 300 mg/mL and CBCT voxel values (p< 0.001). CONCLUSION: CBCT is a reliable method for the assessment of bone density changes in the high range of bone density but it is not reliable for such assessment in the lower range of bone density. Digital periapical imaging method may not be applied for the assessment of bone density, whereas in higher densities, the employment of CBCT seems to be feasible.

Traumatic bone cyst of mandible: a case series.

BACKGROUND: A traumatic bone cyst is an uncommon nonneoplastic lesion of the jaws that is considered as a "pseudocyst" because of the lack of an epithelial lining. This lesion is particularly asymptomatic and therefore is diagnosed by routine dental radiographic examination as a unilocular radiolucency with scalloped borders, mainly in the posterior mandibular region. The exact etiopathogenesis of the lesion remains uncertain, though it is often associated with trauma. CASE PRESENTATION: We report three Persian cases of traumatic bone cyst with different clinical and radiographic features, and we present a review of the literature to further discuss diagnostic and treatment challenges. Only one of the three patients reported a history of trauma, and despite the usual signs and symptoms of the lesion, extension of the defect to the ramus, swelling of the lingual cortex, and their unusual presence in the anterior mandible were noted in these patients. CONCLUSIONS: Because features of this cyst can be varied, careful history taking and radiographic evaluation alongside the clinical signs and symptoms have a very significant role in definitive diagnosis, appropriate treatment, and accurate assessment of prognosis.

Knowledge and Attitude of Iranian Dentists towards Cone-Beam Computed Tomography.

OBJECTIVES: We aimed to evaluate the knowledge and attitude of Iranian dentists towards cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A 20-item questionnaire was distributed among 410 Iranian dentistry graduates attending the 56th Congress of Iranian Dental Association held in Tehran, Iran. The questionnaire included items on demographic characteristics, namely full name, age, gender, work experience, type of current activity (individual or group), and the highest educational level. In addition, the questionnaire contained items on the knowledge and attitude of dentists. The obtained data were analyzed using statistical tests. RESULTS: In this study, 49.3% and 22.4% of the subjects were male and female, respectively, 47.1% of whom used CBCT, while 49.8% did not. In detail, 72.2% of the dentists used the technique to evaluate the location of implants, whereas 19.7%, 3.2%, and 2.7% of the subjects applied it to localize the inferior alveolar nerve (IAN), evaluate the location of implants and localize the IAN, and perform cephalometric analysis, respectively. The main causes of lack of prescription of CBCT entailed high cost (80%), high rate of patient absorbed dose (27.6%), insufficient number of CBCT centers (46.3%), and the long duration of the process (15.6%). CONCLUSION: CBCT is an advantageous imaging technique in dentistry. Considering the increased application of CBCT in dentistry, attending workshops could help train dentists to use the technique.

Comparison of Apical Transportation with the Use of Rotary System and Reciprocating Handpiece with Precurved Hand Files: An In Vitro Study.

INTRODUCTION: Success of root canal treatment depends on several factors; among which, maintaining the original canal path during mechanical preparation is extremely important. This in vitro study aimed to compare apical transportation using RaCe NiTi rotary system and precurved stainless steel (SS) hand files in a reciprocating handpiece. METHODS AND MATERIALS: Mesiobuccal canals of 40 extracted human mandibular first and second molars with 20 to 45° curvatures and 3 to 7 mm curve radius were chosen for this study. After working length determination, the teeth were divided into two groups (n=20). Root canals were prepared with RaCe in group 1 and NSK handpiece and precurved SS hand files in group 2 up to #30 with 2% taper in both groups. Radiographs were taken of teeth before and after instrumentation from buccolingual and mesiodistal directions. The images were superimposed using Adobe Photoshop CS3 software. Degree of straightening and amount of apical transportation at 0, 0.5, 1, 2, 3, 4 and 5 mm levels short of the working length were determined using digital subtraction radiography. The student's t test was used to compare the degree of straightening and Mann Whitney test was applied to compare apical transportation (millimeters) between the two groups. RESULTS: No significant difference was noted between the two groups on buccolingual or mesiodistal views in degree of straightening and apical transportation on buccolingual view (P>0.05). However, on mesiodistal view, NSK reciprocating handpiece caused greater apical transportation at 0. 0.5 and 1 mm levels (P<0.05). CONCLUSION: The RaCe system and precurved SS files in reciprocating handpiece were highly similar in terms of degree of straightening and apical transportation. Thus, engine-driven NSK reciprocating handpiece can be used as an efficient adjunct for root canal preparation.

Root Morphology of the Maxillary First and Second Molars in an Iranian Population Using Cone Beam Computed Tomography.

OBJECTIVES: This study sought to assess the root morphology and root canal anatomy of the maxillary first and second molars in an Iranian population using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Sound fully-developed maxillary first (n=345) and second (n=423) molars were evaluated on 450 CBCT scans ordered for pre-operative assessment for implant placement. The (I) number of roots and their morphology (II) number of canals per root, (III) canal configuration and presence of a second mesiobuccal canal according to the Vertucci's classification and (IV) unilateral or bilateral occurrence of a second mesiobuccal canal (MB2) were evaluated. RESULTS: Single roots were found in 1.1% of the first and 11.3% of the second molars. Four separate roots were identified in 0.5% of the first molars; none of the second molars had four separate roots. First and second molars showed a higher prevalence of three separate roots of mesiobuccal, distobuccal and palatal with one canal in each root (54% and 86 %, respectively). The most common anatomical variation in the maxillary first molars was related to the configuration of the MB root; the root canal system of the maxillary second molars showed more anatomical variations. CONCLUSIONS: Mesiobuccal roots of the maxillary molars had more variations in their canal system than the distobuccal or palatal roots. The root canal configuration of the maxillary second molars was more diverse than that of first molars; CBCT enhances mapping of the mesiobuccal root canal system with the potential to improve the quality of root canal treatment.

In Vitro Comparison of Diagnostic Accuracy of DIAGNOdent and Digital Radiography for Detection of Secondary Proximal Caries Adjacent to Composite Restorations.

Introduction: Early detection of secondary proximal caries is critical for the preservation of tooth vitality. This study sought to assess and compare the diagnostic accuracy of DIAGNOdent and digital radiography for detection of secondary proximal caries adjacent to composite restorations. Methods: Sixty extracted molars including 30 teeth with carious lesions and 30 sound teeth were randomly selected. Class II cavities were prepared in all teeth and carious dentin was intentionally left in the gingival floor of cavities in 30 carious teeth. All cavities were restored with composite resin. The teeth were mounted in wax blocks (three teeth per block) and examined for caries using (DIAGNOdent kaVo Dental, Biberach, Germany). Digital radiographs using DIGORA photostimulable phosphor (PSP) plates (Soredex Corporation, Helsinki, Finland) were obtained from all teeth using the parallel technique and were evaluated by 4 observers. Repeated measure analysis of variance (ANOVA) was applied to calculate sensitivity and specificity values of the two diagnostic techniques. Receiver operating characteristic (ROC) curve was plotted for DIAGNOdent results and based on that, the cutoff points were determined. Results: The sensitivity and specificity values at the cut-off point of 10.5 were 0.622±0.038 and 0.822±0.077 for DIAGNOdent and 0.591±0.093 and 0.891±0.083 for digital radiography, respectively. The area under the ROC curve was 0.7 for DIAGNOdent. Weighted kappa revealed moderate to almost perfect intra-observer agreement (0.46-0.99). Intraclass correlation coefficient (ICC) for DIAGNOdent was calculated to be 0.88. Conclusion: No statistically significant difference was noted in diagnostic accuracy of DIAGNOdent and digital radiography for detection of secondary proximal caries adjacent to composite restorations. Thus, DIAGNOdent may be used as an adjunct diagnostic tool for detection of secondary proximal caries beneath composite restorations.

Diagnosis of Approximal Caries after Delayed Scanning of Photostimulable Phosphor Plates.

STATEMENT OF THE PROBLEM: Considering the high diagnostic accuracy and wide dynamic range of photostimulable phosphor plates (PSPs), they can be a good alternative for radiographic films. PURPOSE: This study was aimed to assess the effects of delay in scanning PSPs on the diagnostic accuracy of detection of approximal caries. MATERIALS AND METHOD: Radiographs from fifty-two extracted molar and premolar teeth were radiographed using DIGORA PSP (Soredex Corporation, Helsinki, Finland). The teeth were either intact or with non-cavitated approximal caries. The plates were scanned immediately (time zero) and at 10 min, 30 min, 60 min and 120 min after exposure. Sixty-five images were obtained and evaluated for presence or absence of approximal caries by two oral and maxillofacial radiologists and 2 restorative specialists. The diagnostic accuracy of approximal caries detection was measured using a 5-point rating scale. Definite presence of caries was confirmed using a stereomicroscope. Analysis of caries detection data was performed by calculating sensitivity and specificity using repeated measures with ANOVA. RESULTS: Significant differences were found in complete negative predictive value, absolute negative predictive value and complete dentine sensitivity value between different scan times (p< 0.05). These values were significantly different at 10 min, 60 min and 120 min (p< 0.05). However, immediate scan and 30 min delay were not significantly different (p> 0.05). The accuracy of approximal caries detection at 120 min was less than at 60 min and at 60 min was less than at 30 min. CONCLUSION: In order to detect approximal caries more accurately, DIGORA PSPs should be scanned within 30 min after exposure.

Diagnostic Accuracy of Inverted and Unprocessed Digitized Periapical Radiographs for Detection of Peri-Implant Defects.

OBJECTIVES: This study aimed to compare the diagnostic accuracy of inverted and unprocessed digitized periapical radiographs for detection of peri-implant defects. MATERIALS AND METHODS: A total of 30 osteotomy sites were prepared in three groups of control, study group 1 with 0.425 mm defects and study group 2 with 0.725 mm defects using the SIC and Astra Tech drill systems with 4.25mm and 4.85mm diameters. Small and large defects were randomly created in the coronal 8mm of 20 implant sites; implants (3.4mm diameter, 14.5mm length) were then placed. Thirty periapical (PA) radiographs were obtained using Digora imaging system (Soredex Corporation, Helsinki, Finland), size 2 photostimulable storage phosphor (PSP) plate sensors (40.0mm×30.0mm) and Scanora software. Unprocessed images were inverted using Scanora software by applying image inversion and a total of 60 images were obtained and randomly evaluated by four oral and maxillofacial radiologists. Data were analyzed using the t-test. RESULTS: Significant differences were observed in absolute and complete sensitivity and specificity of the two imaging modalities for detection of small and large defects (P<0.05). Unprocessed digital images had a higher mean in terms of absolute sensitivity for detection of small defects, complete sensitivity for detection of large peri-implant defects and definite rule out of defects compared with inverted images. CONCLUSION: Unprocessed digital images have a higher diagnostic value for detection of small and large peri-implant defects and also for definite rule out of defects compared with inverted images.