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.

Effect of voxel size on detection of fenestration, dehiscence and furcation defects using cone-beam computed tomography.

OBJECTIVES: This study aimed to assess the effect of voxel size on detection of fenestration, dehiscence, and furcation defects using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This in vitro, experimental study evaluated 4 sheep skulls with both the maxilla and mandible accompanied by the surrounding soft tissue. Fenestration (n = 30), dehiscence (n = 65), and furcation defects (n = 46; 18 grade I, 25 grade II, and 3 grade III) were randomly created by round and needle burs in both jaws, and 40 areas served as control sites. CBCT scans were obtained with 0.300 and 0.150 mm3 voxel sizes and 8 × 11cm2 field of view (FOV), and were randomly observed by four observers (two oral and maxillofacial radiologists and two periodontists). The kappa values, sensitivity and specificity were calculated for each voxel size and compared using paired t test. RESULTS: By an increase in image resolution, diagnostic sensitivity increased while specificity decreased. The kappa values for fenestration (0.602-0.623), and grade III furcation defects (0.903-1.00) were optimal (> 0.6), and almost similar for both voxel sizes. The kappa values for dehiscence, and grades I and II furcation defects were unfavorable (< 0.6) and almost similar for both voxel sizes, except for grade I furcation defects, which had a significant difference in kappa values between the two voxel sizes (0.014 and 0.34). CONCLUSION: Smaller voxel size had higher sensitivity and lower specificity for detection of all defects except for grade I furcation defects, for which the smaller voxel size had higher sensitivity and higher specificity.

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.

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.

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.