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Jethi N, Mishra R, Brar R, Bhadoria K. Diagnosis of Vertucci Type VII Anatomy in the Mandibular Left Lateral Incisor Using Digital Radiography: An Ex Vivo Case Study. Cureus 2024; 16:e63382. [PMID: 39070461 PMCID: PMC11283846 DOI: 10.7759/cureus.63382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Mandibular lateral incisors sometimes feature an additional lingual canal, which, if not identified and missed during endodontic treatment, can lead to postoperative pain. Thus, a proper diagnosis of the internal anatomy of a tooth is necessary before treatment begins. Radiovisiography (RVG), a cost-effective and widely employed dental imaging technique, is used in clinics to visualize the internal root structure of teeth. The zoom function of RVG allows for a detailed examination of complex internal anatomical variations, facilitating a more accurate diagnosis and treatment planning process. This case study identified a rare Vertucci Type VII root canal system in a mandibular left lateral incisor using the zoom-in feature of radiovisiography (Vatech, EZ sensor). Additionally, horizontal sectioning was performed, and these sections were imaged to verify the accuracy of digital radiographs in diagnosing such cases as part of a preclinical demonstration for aspiring endodontists.
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Affiliation(s)
- Navdeep Jethi
- Conservative Dentistry and Endodontics, Daswani Dental College and Research Centre, Kota, IND
| | - Rachana Mishra
- Conservative Dentistry and Endodontics, Daswani Dental College and Research Centre, Kota, IND
| | - Rubaab Brar
- Department of Pedodontics and Preventive Dentistry, Daswani Dental College and Research Centre, Kota, IND
| | - Kanchan Bhadoria
- Conservative Dentistry and Endodontics, Daswani Dental College and Research Centre, Kota, IND
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Pires M, Martins JNR, Pereira MR, Vasconcelos I, Costa RPD, Duarte I, Ginjeira A. Diagnostic value of cone beam computed tomography for root canal morphology assessment - a micro-CT based comparison. Clin Oral Investig 2024; 28:201. [PMID: 38453706 PMCID: PMC10920457 DOI: 10.1007/s00784-024-05580-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES The aim of this study was to assess cone beam computed tomography (CBCT) as a root canal anatomy diagnostic tool by comparison with micro-CT gold-standard. MATERIALS AND METHODS 216 two-rooted mandibular molars were first scanned in a CBCT device (200 μm voxel size) and posteriorly in a micro-CT scanner (19.61 μm). The volumes were sequentially screened to classify main root canal anatomy according to Vertucci classification, and for the presence of lateral canals and apical deltas, in both mesial and distal roots. RESULTS Both methods revealed a higher prevalence of Vertucci Type II and IV in the mesial root, and Vertucci Type I in the distal root. The percentage of agreement for main root canal anatomy classification between CBCT and micro-CT scores was high (85.2%). CONCLUSION Sensibility to detect both lateral canals and apical deltas with CBCT was low. These results attest to the fact that minor anatomical changes might be difficult to identify with CBCT imaging, hampering its diagnostic value.
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Affiliation(s)
- Mariana Pires
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal.
| | - Jorge N R Martins
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquímica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Mário Rito Pereira
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - Isabel Vasconcelos
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Center for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Marinha Grande, Portugal
| | | | - Isabel Duarte
- TEMA - Centre for Mechanical Technology and Automation, Department of Mechanical Engineering, University of Aveiro, Aveiro, 3810-193, Portugal
- LASI - Intelligent Systems Associate Laboratory, Guimarães, Portugal
| | - António Ginjeira
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquímica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
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Allawi S, Ayoubi H, Al‐Tayyan M, Toutangy E, Tolibah YA. Evaluation of roots, root canal morphology, and bilateral symmetry of maxillary first molars in a Syrian subpopulation using cone beam computed tomography. Clin Exp Dent Res 2023; 9:1149-1155. [PMID: 37694669 PMCID: PMC10728511 DOI: 10.1002/cre2.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/21/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE Successful endodontic treatments require a comprehensive knowledge of the root canal anatomy, so this study aimed to investigate the number of roots, configurations of root canals, and their bilateral symmetry of maxillary first molars in the Syrian subpopulation, and also the effect of gender on this symmetry. MATERIALS AND METHODS The study sample consisted of 250 cone beam computed tomography images (140 for females; and 110 for males), including 500 maxillary first molars. Images were investigated by two endodontists. Root number and canal configuration in each root were recorded, according to Vertucci classification, by studying the image at all levels (axial, coronal, sagittal, oplique, and three-dimensional) to assess the bilateral symmetry and its relation to gender. Statistical analysis was performed with SPSS and the χ2 test was used to compare the bilateral symmetry in males and females. RESULT The most common shape of the maxillary first molars was three roots (97.6%). All the roots are symmetrical by 100% in both genders. The root canal configuration was mainly Vertucci type I classification in the distobuccally (73.6%), and palatal root (98%). While the most common types in mesial root were type II (33.3%), this root showed all different types of Vertucci classifications except type VIII, and the proportion of symmetry was (37.2%) without significant difference between the gender (p = .441). CONCLUSION Most maxillary first molars in a Syrian population were three-rooted with four root canals (type II), the numbers of roots achieved perfect symmetry 100%, and higher than symmetry ratios in the number of canals and canals configurations (37.2%).
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Affiliation(s)
- Safaa Allawi
- Department of Endodontics, Faculty of DentistryDamascus UniversityDamascusSyria
| | - Helen Ayoubi
- Department of Endodontics, Faculty of DentistryDamascus UniversityDamascusSyria
| | - Mouhammad Al‐Tayyan
- Department of Endodontics, Faculty of DentistryDamascus UniversityDamascusSyria
| | - Eyad Toutangy
- Department of OrthodonticsSyrian Private UniversityDamascusSyria
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Yoo YJ, Hwang J, Park SH, Hwang J, Cho S, Kim SY. A novel analysis of the formation and resorption changes in dental hard tissue using longitudinal in vivo micro computed tomography. Dent Mater J 2023; 42:708-716. [PMID: 37612095 DOI: 10.4012/dmj.2023-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
This study was to investigate the new analysis manner of dental hard tissue change using in vivo micro-computed tomography (CT) in rat. Scanning, registration, analyzing, and presenting method to track longitudinal in vivo micro-CT data on dental hard tissues were validated in murine models: formative, dentin thickness after direct pulp capping with mineral trioxide aggregate; resorptive, development of apical bone rarefaction in apical periodontitis model. Serial in vivo micro-CT scans were analyzed through rigid-registration, active-contouring, deformable-registration, and motion vector-based quantitative analyses. The rate and direction of hard tissue formation after direct pulp capping was datafied by tracing coordinate shift of fiducial points on pulp chamber outline in formative model. The development of apical periodontitis could be monitored with voxel counts, and quantitatively analyzed in terms of lesion size, bone loss, and mineral density in resorptive model. This study supports the application of longitudinal in vivo micro-CT for resorptive- and formative-phase specific monitoring of dental hard tissues.
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Affiliation(s)
- Yeon-Jee Yoo
- Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University
| | - Joonil Hwang
- Department of Nuclear and Quantum Engineering, KAIST
| | - So-Hyun Park
- Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University
| | - Jaehong Hwang
- Department of Nuclear and Quantum Engineering, KAIST
| | | | - Sun-Young Kim
- Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University
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Al-Rammahi HM, Chai WL, Nabhan MS, Ahmed HMA. Root and canal anatomy of mandibular first molars using micro-computed tomography: a systematic review. BMC Oral Health 2023; 23:339. [PMID: 37248469 DOI: 10.1186/s12903-023-03036-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND A thorough understanding of root and canal anatomy is crucial for successful root canal treatment outcomes. This systematic review aims to explore the published micro-CT studies investigated the anatomy of root and canal system in permanent mandibular first molars. METHOD An electronic search was performed on Web of science, PubMed, and Scopus. Micro-CT journal studies investigated the root and canal anatomy of permanent double-rooted mandibular first molars were included. Data on study characteristics, objectives of interest, specifications of the studies, and micro-CT specifications were extracted. Risk of bias assessment (ROB) of the included studies was performed using Anatomical Quality Assessment (AQUA) tool. The extracted data were presented in tables and figures to present and synthesise the results. A meta-analysis was performed for the studies related to the prevalence of Vertucci's canal configurations, middle mesial canal (MMC) configurations, and Fan's isthmus types. RESULTS Amongst 1358 identified studies, thirty met the inclusion criteria. In terms of the objectives, the selected studies showed high anatomical variability in mandibular first molars. Twenty-two (73%), 25 (83%), and 12 (40%) of the studies reported the population/ethnicity, micro-CT specifications, and ethical approval, respectively. 28 (93%) studies did not disclose the method of sample size estimation. In only 6 (20%) of the studies, the authors had calibrated the assessment approaches. Mostly, a potential ROB was reported in domain 1 (objective(s) and subject characteristics) and domain 3 (methodology characterization). Whilst, low risk was reported in domains 2 (study design), 4 (descriptive anatomy), and 5 (reporting of results). The overall ROB was reported to be ''moderate'' in the vast majority of the studies (27/30). Meta-analysis results showed high levels of heterogeneity among the studies related to MMCs (I2 = 86%) and Fan's isthmus (I2 = 87%). As for the root canal configuration, pooled prevalence showed that Vertucci type IV and type I were the most prevalent in mesial and distal root canals, respectively. CONCLUSION Based on moderate risk of bias level of evidence, micro-CT studies have shown wide range of qualitative and quantitative data presentations of the roots and canals in mandibular first molars. Protocol and registration. The protocol of this systematic review was prospectively registered in the Open Science Framework database ( https://osf.io ) on 2022-06-20 with the registration number 10.17605/OSF.IO/EZP7K.
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Affiliation(s)
- Hasan M Al-Rammahi
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Conservative Dentistry, Faculty of Dentistry, University of Babylon, AL Hillah city, Iraq
| | - Wen Lin Chai
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohamed Shady Nabhan
- Department of Prosthetic Dentistry, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Hany M A Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Wang Y, Chen Y, Jing Y, Qiao F, Yin B, Liu J, Zhou J, Chen M, Wu L. Prediction of accessory canals on the apical third of mandibular second molar based on micro-computed tomography. Dentomaxillofac Radiol 2023; 52:20220057. [PMID: 36631421 PMCID: PMC9974238 DOI: 10.1259/dmfr.20220057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the anatomical factors influencing the incidence of accessory canals (ACs) in the apical third of the mandibular second molar in Chinese population. METHODS Micro-CT was performed on 86 root canals. The five possible factors influencing the incidence of ACs in the apical third were named X1 to X5. These factors were the canal length of the apical third, fused roots, location of apical foramen, curvature of the root canals, and complexity of the canals. Statistical analysis was performed by the least absolute shrinkage and selection operator, receiver operating characteristic curve, and the χ2 test (α = 0.05). RESULTS The selected variables in the least absolute shrinkage and selection operator regression model were fused roots and complex root canals. The area under the curve was 0.737, indicating that the model had a certain predictive ability. ACs were mainly distributed in the buccal wall and mesial wall of root canals in the apical third of molars (p < 0.05). CONCLUSIONS For Chinese population, fused roots and complex root canals are anatomical factors influencing ACs in the apical one-third of mandibular second molars, and the ACs mainly occur in the buccal wall and mesial wall of the root canal.
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Affiliation(s)
- Yinghui Wang
- Department of Endodontics, School of Stomatology, Tianjin Medical University, Tianjin, China
| | - Yufan Chen
- Department of Stomatology, the First hospital of Hebei Medical University, Hebei, China
| | - Yao Jing
- Department of Endodontics, Affiliated Stomatological Hospital of Xuzhou Medical University, Xuzhou, China
| | - Feng Qiao
- Oral and Maxillofacial Surgery, School of Stomatology, Tianjin Medical University, Tianjin, China
| | - Bin Yin
- Department of Stomatology, Community Health Service Center, Meijiang Street, Hexi District, Tianjin, China
| | - Juan Liu
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jie Zhou
- Department of Stomatology, Wuqing People Hospital, Tianjin, China
| | - Min Chen
- Department of Endodontics, School of Stomatology, Tianjin Medical University, Tianjin, China
| | - Ligeng Wu
- Department of Endodontics, School of Stomatology, Tianjin Medical University, Tianjin, China
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Fenelon TA, Parashos P. Prevalence and morphology of C-shaped and non-C-shaped root canal systems in mandibular second molars. Aust Dent J 2022; 67 Suppl 1:S65-S75. [PMID: 35716050 DOI: 10.1111/adj.12925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are no cone-beam computed tomography (CBCT)-based data on the anatomy of mandibular second molars in an Australian population. This study investigated the prevalence and descending morphology of mandibular second molars with and without C-shaped canals using retrospective analysis of CBCT scans. METHODS Scans from 715 patients were screened for the presence of C-shaped canals and assessed for cross-sectional configuration at 5 axial levels. Non-C-shaped molars were assessed for other morphological characteristics. Data were modelled against patient, tooth and CBCT scan characteristics. RESULTS A total of 1278 teeth from 657 patients were evaluated. The overall prevalence of C-shaped canals was 13%. Cross-sectional configuration of C-shaped canals was variable, with an average of 2.8 unique cross-sections per tooth. Non-C-shaped teeth were predominantly Vertucci Type II (60%) and Type IV (29%) configurations in mesial roots, and Type I (91%) in distal roots. Additional roots occurred in 4.3% of teeth and there was a significant association between radix paramolaris and distal root bifurcation (P < 0.001). CONCLUSIONS Cross-sectional analysis confirmed the complexity and variability of C-shaped canals. Clinicians should be cognisant of the prevalence and variability of C-shaped root canal morphology and how this may affect endodontic treatment. © 2022 Australian Dental Association.
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Affiliation(s)
- Thomas Alexander Fenelon
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Peter Parashos
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
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Ahmed HMA. A critical analysis of laboratory and clinical research methods to study root and canal anatomy. Int Endod J 2022; 55 Suppl 2:229-280. [DOI: 10.1111/iej.13702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry Faculty of Dentistry University of Malaya Kuala Lumpur
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Nambiar P, Pang K, Raja K. A comparative study on mandibular premolar root canal morphology employing cone-beam computed tomography and microcomputed tomography imaging. J Conserv Dent 2022; 25:173-178. [PMID: 35720827 PMCID: PMC9205352 DOI: 10.4103/jcd.jcd_606_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Aim: The present study was to investigate the root canal morphology of mandibular premolars in Malaysian population using cone-beam computed tomography (CBCT) and microcomputed tomography (micro-CT) scanned images. Materials and Methods: Sixty selected mandibular premolars were evaluated in vitro and the root canal morphologies of the samples were categorized based on Vertucci's classification. The position of apical foramen, presence, and location of lateral canal, as well as prevalence of apical delta, were also determined. Results: Invariably, Type I variety (Vertucci's classification) was the most frequent root canal morphology followed by Type V and Type III after micro-CT imaging. CBCT investigation also revealed Type I as the most numerous; however, the second most common configuration was Type III followed closely by others. There was a moderate agreement in Vertucci's classification of root canal configuration and also prevalence of apical delta (kappa: 0.516 and 0.550, respectively). However, only a fair agreement (kappa: 0.289) was observed between CBCT and micro-CT on the prevalence of lateral canal. Conclusion: CBCT should be cautiously used in determining root canal configuration as deficiencies were evident and revealed during micro-CT imaging.
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Choi YJ, Lee C, Jeon KJ, Jang JT, Han SS. Canal configuration and root morphology of mandibular premolars using cone-beam computed tomography in a Korean population. Clin Oral Investig 2021; 26:3325-3332. [PMID: 34846559 DOI: 10.1007/s00784-021-04313-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to investigate the anatomy of mandibular premolars from two perspectives-the canal configuration and radicular grooves-using cone-beam computed tomography (CBCT) in a large Korean population. MATERIALS AND METHODS CBCT images of mandibles acquired from March 2018 to December 2019 for dental treatment were randomly selected. In each image, the root canal of premolars was classified into 8 types according to the canal merging or diverging pattern and the number of apical foramens. The presence and the location of radicular grooves were also assessed. Statistical analysis was performed. RESULTS A total of 1463 first and 1448 s premolars from 732 patients (390 males, 342 females, mean age of 36.1 years) were evaluated. A single canal with one foramen predominated in both first (85.7%) and second (99.5%) premolars, while complete or partial multi-canals accounted for 14.3% and 0.5% of first and second premolars, respectively. The prevalence of radicular grooves was significantly higher in first premolars (13.2%) than in second premolars (0.5%) and in males (4.3%, n = 119) than in females (2.5%, n = 73). CONCLUSIONS Although most premolars were complete single canals, the first premolars showed a relatively higher number of complex canals compared to the second premolar. In addition, radicular grooves in mandibular premolars were significantly more common in male patients. CLINICAL RELEVANCE When planning the endodontic treatment of mandibular premolars, clinicians should be aware of their morphologic complexity, especially in the first premolar of male patients.
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Affiliation(s)
- Yoon Joo Choi
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Chena Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Kug Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Ji-Taek Jang
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.
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Al-Zubaidi SM, Almansour MI, Al Mansour NN, Alshammari AS, Alshammari AF, Altamimi YS, Madfa AA. Assessment of root morphology and canal configuration of maxillary premolars in a Saudi subpopulation: a cone-beam computed tomographic study. BMC Oral Health 2021; 21:397. [PMID: 34389013 PMCID: PMC8364052 DOI: 10.1186/s12903-021-01739-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to use CBCT to look into the root canal morphology of maxillary premolars in a Saudi Arabian subpopulation and associate the results to existing canal morphology classifications. METHODS The sample size for this analysis was 500 right and left untreated maxillary first and second premolars with fully formed roots from 250 Saudi residents (125 male and 125 female). The following observations were made using CBCT on the teeth related: (1) The number and morphology of roots; (2) The canal morphology for each root according to Vertucci's classification. The frequency and similarities between the right and left sides, as well as between females and males, were studied. The Chi-square test was used to assess the results. RESULTS Of the 500 maxillary first premolars studied, 199 teeth had one root (39.8%), whilst 293 (58.6%) were two-rooted. Three-rooted maxillary first premolars were found in 8 (1.6%). For maxillary second premolars, 416 premolars had one root (83.2%), whilst 79 (15.8%) had two roots and the rest 5 (1.0%) were three roots. There were significant differences of number of root were found between groups (p > 0.05). For maxillary first premolar, Type IV was the most frequent, accounting for 57.8% of the sample (n = 289), followed by type II (32.8%, n = 164). For maxillary second premolar, Type I was mainly occurrence 302 (60.4%), followed by Type II (16.4%, n = 82). CONCLUSIONS The majority of maxillary first premolars had two roots and two root canals, while one root and one root canal was the most common anatomical configuration for maxillary second premolars. Additional canal forms do occur on occasion, and clinicians should pay close attention to them.
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Affiliation(s)
- Saad M Al-Zubaidi
- Department of Restorative Dental Science, Collage of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia.
| | - Moazzy I Almansour
- Department of Restorative Dental Science, Collage of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
| | | | | | - Ahad F Alshammari
- Department of Restorative Dental Science, Collage of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
| | - Yazeed S Altamimi
- Department of Restorative Dental Science, Collage of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
| | - Ahmed A Madfa
- Department of Restorative Dental Science, Collage of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
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Aung NM, Myint KK. Diagnostic Accuracy of CBCT for Detection of Second Canal of Permanent Teeth: A Systematic Review and Meta-Analysis. Int J Dent 2021; 2021:1107471. [PMID: 34335767 PMCID: PMC8315866 DOI: 10.1155/2021/1107471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Missed canal is one of the common reasons for nonsurgical endodontic retreatments. The missed canals were frequently associated with periapical pathology. The aim of this systematic review was to find the diagnostic accuracy of CBCT for detection of the second canal of the root canal system of permanent teeth. MATERIALS AND METHODS The articles were selected from seven electronic databases according to selection criteria. All eligible studies were judged by the reviewers. The selected studies were checked with the QUADAS-2 tool for risk of bias and applicability concerns. Finally, 12 studies were selected for qualitative and quantitative analyses. The summary estimates of sensitivities and specificities and SROC curves were calculated and drawn by RevMan 5.3 and MetaDTA software. RESULTS Summary estimates of CBCT for detection of second canal anatomy in permanent teeth were 94% sensitivity and 93.1% specificity. 96.6% sensitivity of MB2 was followed by 88.8% sensitivity of maxillary and mandibular premolars and 81% that of mandibular molars. The specificity of 97.6% for premolars was trialed by 85% specificity of mandibular molars and MB2. For permanent mandibular canines, 67% sensitivity and 100% specificity were estimated. CBCT showed more agreement with detecting the second canal with micro-CT, estimating 100% sensitivity and 95.6% specificity. The highest prevalence of the second canal comprised the highest sensitivity of 99.1% and lowest specificity of 77.5%. After the exclusion of case-control studies, a 3% drop of sensitivity from the summary estimate was observed. Multiple spectrum of the second canal had 8.6% higher sensitivity and 4.4% lower specificity than single spectrum. CONCLUSION CBCT is informative for detecting the second canal. Clinicians should keep in mind that the accuracy can vary in different types of teeth, with the prevalence of second canal across different populations, and with the spectrum of second canal anatomy in spite of the reviewers having postulated overestimation of the findings.
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Affiliation(s)
- Nyan M. Aung
- Department of Oral Biological Science, University of Dental Medicine, Mandalay 05041, Myanmar
| | - Kyaw K. Myint
- Department of Oral Biological Science, University of Dental Medicine, Mandalay 05041, Myanmar
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Gudac J, Hellén-Halme K, Machiulskiene V. Prognostic validity of the Periapical and Endodontic Status Scale for the radiographically assessed 2-year treatment outcomes in teeth with apical periodontitis: a prospective clinical study. BMC Oral Health 2021; 21:354. [PMID: 34281553 PMCID: PMC8290628 DOI: 10.1186/s12903-021-01723-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background Endodontic treatment planning and treatment success evaluation are largely based on radiographic assessment of anatomical and treatment-related parameters of teeth with apical periodontitis (AP). This prospective clinical study aimed to assess radiographically the 2-year endodontic treatment outcomes for teeth with AP, and to evaluate prognostic validity of Periapical and Endodontic Status Scale (PESS). Methods A total of 128 patients, representing 176 teeth with AP were examined by cone-beam computed tomography at baseline and at 24 months after endodontic treatment. Treatment outcome was evaluated using estimates of periapical radiolucency and the relationship between anatomical structures and location. The strength of the associations between these and treatment-related parameters was tested by logistic regression analysis. PESS sensitivity and specificity were calculated for every treatment risk group (low, moderate, high) of teeth. Results One hundred and fifty-seven teeth, representing 350 root canals had a positive treatment outcome, while 19 teeth, representing 53 root canals had a negative treatment outcome at 24 months. The probability of negative outcome was 25 times higher in the moderate/high-risk group than in the mild-risk group of teeth (OR = 25.1; 95%CI [12.2–51.5]). Pre-treatment complications and retreatment cases with radiolucency were associated with negative outcomes (OR = 35.9; 95%CI [12.6–102.4]; OR = 26.437; 95%CI [10.9–64.1], respectively). PESS sensitivity and specificity was over 80% in all risk groups except for high risk group, due to very low number of cases. Conclusions Endodontic treatment outcome depends on the severity of periapical changes. The presence of complications and retreatment cases with periapical lesions are associated with negative treatment outcome. The PESS is a valid instrument to predict outcome of teeth with low-moderate treatment risk of AP.
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Affiliation(s)
- Jelena Gudac
- Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, Eiveniu str. 2, 50161, Kaunas, Lithuania.
| | - Kristina Hellén-Halme
- Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, Carl Gustafs väg 34, 21421, Malmö, Sweden
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, Eiveniu str. 2, 50161, Kaunas, Lithuania
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Pinto JC, Wanderley VA, de Faria Vasconcelos K, Leite AF, Pauwels R, Nadjmi M, Oliveira ML, Tanomaru-Filho M, Jacobs R. Evaluation of 10 Cone-beam Computed Tomographic Devices for Endodontic Assessment of Fine Anatomic Structures. J Endod 2021; 47:947-953. [PMID: 33691170 DOI: 10.1016/j.joen.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The purpose of this study was to classify 10 cone-beam computed tomographic (CBCT) devices using a ranking model according to the detection of fine endodontic structures. METHODS A dedicated dentate anthropomorphic phantom was scanned 2 times using 10 CBCT devices without any metal (metal-free condition) and with an endodontically treated tooth containing a metallic post (metal condition). A reference image acquired on an industrial micro-CT scanner was used to register all CBCT images, yielding corresponding anatomic slices. Afterward, 3 experienced observers assessed all acquired CBCT images for their ability to assess a narrow canal, isthmus, and apical delta ramification using a categoric rank from 1 (best) to 10 (worst). Fleiss kappa statistics were used to calculate intra- and interobserver agreements for each CBCT device separately. Based on the observers' scores, general linear mixed models were applied to compare image quality among different CBCT devices for performing endodontic diagnostic tasks (α = .05). RESULTS The 10 CBCT devices performed differently for the evaluated endodontic tasks (P < .05), with 3 devices performing better for endodontic feature detection. Yet, in the presence of metal, only 2 devices were able to keep a high level of endodontic feature detection. CONCLUSIONS The evaluated endodontic tasks were CBCT device dependent, and their detection was influenced by the presence of metal.
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Affiliation(s)
- Jader Camilo Pinto
- Department of Restorative Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil; OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Victor Aquino Wanderley
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - André Ferreira Leite
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dentistry, Faculty of Health Sciences University of Brasília, Brasília, Brazil
| | - Ruben Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark; Department of Mechanical Engineering, Catholic University of Leuven, Leuven, Belgium
| | - Mansour Nadjmi
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Matheus L Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Mario Tanomaru-Filho
- Department of Restorative Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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15
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Taveras Parra C, Fiori-Chíncaro GA, Agudelo-Botero AM. [Imaginology in the diagnosis and planning of root duct systems: an updated review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e045. [PMID: 38464410 PMCID: PMC10919806 DOI: 10.21142/2523-2754-0901-2021-045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/18/2020] [Indexed: 03/12/2024] Open
Abstract
Root canal systems present a varied morphological conformation for each group of teeth. Several authors have described the anatomical conformation and its variants in different classifications, including the main, collateral, lateral, secondary, accessory, interduct, recurrent, apical delta and interradicular cavus canals. Currently, radiology still does not allow visualization of all these structures. However, proper use of imaging techniques together with the use of new 3D equipment for adjustments of acquisition parameters with adequate software and algorithms allows greater image precision, facilitating diagnosis and the planning of the most adequate approach for endodontic treatments. The objective of this article was to conduct a review of the literature to identify new concepts and useful imaging tools for better diagnoses.
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Affiliation(s)
- Crismely Taveras Parra
- Universidad Iberoamericana (UNIBE). Santo Domingo, República Dominicana. Universidad Iberoamericana (UNIBE) Santo Domingo República Dominicana
| | - Gustavo Adolfo Fiori-Chíncaro
- División de Radiología Bucal y Maxilofacial, Universidad Científica del Sur. Lima, Perú. Universidad Científica del Sur División de Radiología Bucal y Maxilofacial Universidad Científica del Sur Lima Peru
| | - Ana María Agudelo-Botero
- Universidad Autónoma de Manizales. Manizales, Colombia. Universidad Autónoma de Manizales Universidad Autónoma de Manizales Manizales Colombia
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Villa-Machado PA, Restrepo-Patiño DM, Calvo-Trejos JP, Restrepo-Restrepo FA, Tobón-Arroyave SI, Provenzano JC, Siqueira JF, Alves FRF. Cone-beam Computed Tomographic and Micro-computed Tomographic Evaluations of the Root Apexes of Teeth with Posttreatment Apical Periodontitis. J Endod 2020; 46:1695-1701. [PMID: 32682792 DOI: 10.1016/j.joen.2020.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/05/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION This study evaluated the association of different variables that may influence the outcome of root canal treatment through cone-beam computed tomographic (CBCT) and micro-computed tomography (micro-CT) assessments of root apexes obtained by endodontic microsurgery of teeth with posttreatment apical periodontitis (AP), the agreement between CBCT and micro-CT findings, and the association of these variables with symptoms or lesion size. METHODS Clinical and CBCT records and root apexes obtained by endodontic microsurgery from 11 cases of symptomatic AP and 22 cases of asymptomatic AP were available. Apical root specimens were further scanned using micro-CT imaging. CBCT parameters included periapical radiolucency size, apical extent/density of root canal filling, and occurrence of procedural errors. Micro-CT images evaluated the same parameters plus the presence of filling material in lateral canals and ramifications, the volume of the filled/nonfilled apical root canal, and the percentage of the nonfilled canal space. The agreement between CBCT/micro-CT observations was evaluated. RESULTS Mandibular teeth, a lesion size <5 mm, a nonfilled volume <0.04 mm3, and the decreased percentage of the nonfilled canal volume were significantly associated with symptomatic AP. Maxillary teeth and inadequate apical filling density were significantly associated with larger lesions. Agreement between CBCT/micro-CT scores varied from fair (procedural errors) to satisfactory (extent/density of filling). CONCLUSIONS Tooth location, lesion size, the nonfilled apical canal volume, and the percentage of the nonfilled apical canal volume were associated with symptomatic AP. In addition, lesion size was significantly associated with tooth location and apical root canal filling density. CBCT imaging may not provide a reliable evaluation of procedural errors associated with posttreatment disease.
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Affiliation(s)
- Paula A Villa-Machado
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Diana M Restrepo-Patiño
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Juliana P Calvo-Trejos
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Felipe A Restrepo-Restrepo
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Sergio I Tobón-Arroyave
- POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia.
| | - José C Provenzano
- Department of Endodontics and Dental Research Group, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil
| | - José F Siqueira
- Department of Endodontics and Dental Research Group, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil
| | - Flávio R F Alves
- Department of Endodontics and Dental Research Group, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil
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17
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Gudac J, Hellén-Halme K, Venskutonis T, Puisys A, Machiulskiene V. Comparison of Selected Anatomical and Treatment-related Diagnostic Parameters Estimated by Cone-Beam Computed Tomography and Digital Periapical Radiography in Teeth with Apical Periodontitis. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2020; 11:e4. [PMID: 32760477 PMCID: PMC7393929 DOI: 10.5037/jomr.2020.11204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 01/29/2023]
Abstract
Objectives To compare selected anatomical and treatment-related diagnostic parameters estimated by cone-beam computed tomography and by digital periapical radiography in teeth with apical periodontitis, and to evaluate reliability of different examiners in interpretation of images obtained by both methods. Material and Methods Teeth with apical periodontitis were evaluated independently by 2 endodontists and 1 radiologist based on 128 cone-beam computed tomography (CBCT) and 162 digital periapical radiography (DPR) images. Anatomical (size, relation with root, location of periapical radiolucency) and treatment-related (canal obturation length, homogeneity, coronal seal) parameters were assessed. Fleiss kappa reflected inter-observer agreement while intra-examiner agreement was estimated by Cohen’s kappa. McNemar and McNemar-Bowker tests served for evaluation of differences between CBCT- and DPR-based estimates. Results Cohen’s kappa ranged from 0.62 to 1 for all examiners. Fleiss kappa values were nearly perfect for majority of parameters. Diagnostic discrepancy between methods was found for size of radiolucency that in 15 - 17% cases was larger, and in 25 - 28% smaller in DPR than in CBCT images. DPR revealed 20% of root canals scored as non-obturated while in CBCT - obturation present. Canal obturation was rated as homogenous by CBCT, while absent or non-homogenous by DPR, in 17 - 23%, and 11 - 14% of cases, respectively. Radiologist detected more root perforations in CBCT than in DPR images. Conclusions Good intra- and inter-examiner agreement for anatomical and treatment-related diagnostic parameters was achieved using cone-beam computed tomography and digital periapical radiography methods and demonstrated similar diagnostic capability, although variation regarding root perforations and canal obturation quality was observed.
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Affiliation(s)
- Jelena Gudac
- Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, KaunasLithuania
| | - Kristina Hellén-Halme
- Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmo University, MalmoSweden
| | - Tadas Venskutonis
- Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, KaunasLithuania
| | | | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, KaunasLithuania
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18
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Borges CC, Estrela C, Decurcio DDA, PÉcora JD, Sousa-Neto MD, Rossi-Fedele G. Cone-beam and micro-computed tomography for the assessment of root canal morphology: a systematic review. Braz Oral Res 2020; 34:e056. [PMID: 32578799 DOI: 10.1590/1807-3107bor-2020.vol34.0056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/14/2020] [Indexed: 11/21/2022] Open
Abstract
This study presents an overview of the accuracy of cone beam computed tomography (CBCT) compared with micro-computed tomography (μCT) in the assessment of root canal morphology of extracted human permanent teeth. A database search in PubMed, PubMed Central, Embase, Scopus, Opengrey, Scielo and Virtual Health Library was conducted which compared root canal morphology of extracted human permanent teeth on the accuracy of CBCT with μCT. In accordance with PRISMA statement guidelines, data were extracted on study characteristics, target mediators, sampling and assay techniques and the parameters associated with obtaining the image and ability to identify the root canal morphology. Amongst 2734 records, ten fulfilled the inclusion criteria. Four studies compared the accuracy of CBCT and μCT in the assessment of root canal morphology using Vertucci's classification, with at least one CBCT group or subgroup of each study presented high agreement compared to the μCT. Six studies assessed more detailed root canal morphology, including two articles that found a lack of agreement between these imaging systems. Risk of bias was deemed low in three studies, moderate in four and high in three. CBCT can be as accurate as μCT in the assessment of several morphological features of extracted human permanent teeth; however there are some exceptions related to the more detailed morphological aspects. Voxel size likely influences the ability to detect these features, though the different aspects of exposure setting used in studies components may be confounding factors. CBCT may be considered for the assessment of root canal morphology ex-vivo.
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Affiliation(s)
- Caroline Cristina Borges
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil
| | - Carlos Estrela
- Universidade Federal de Goiás - UFG, Faculty of Dentistry, Department of Stomatological Sciences, Goiânia, Brazil
| | - Daniel de Almeida Decurcio
- Universidade Federal de Goiás - UFG, Faculty of Dentistry, Department of Stomatological Sciences, Goiânia, Brazil
| | - Jesus Djalma PÉcora
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil
| | - Manoel Damião Sousa-Neto
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil
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