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Arkhipova A, Bovanova N, Lastovichek D, Ramonova A, Generalov E, Byakova S. Radiographic Criteria for Differential Diagnosis Between Vertical Root Fracture and Apical Periodontitis in Single-Rooted Endodontically Treated Premolars Using Cone-Beam Computed Tomography. J Endod 2024; 50:329-335. [PMID: 38185244 DOI: 10.1016/j.joen.2023.12.008] [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] [Received: 09/26/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION This study explores the differences between the patterns of bone defects associated with vertical root fracture (VRF) and apical periodontitis (AP) in single-rooted endodontically treated premolars (SRETPs) based on cone-beam computed tomography (CBCT) data. METHODS Eighty-four SRETPs were extracted and categorized into the VRF and AP groups. On preoperative CBCT images, the location of bone defects according to the root thirds in buccolingual and mesiodistal directions across the study groups were compared. RESULTS The majority of bone defects in the VRF group were longitudinal and combined, involving more than one root thirds in buccolingual and mesiodistal directions simultaneously. A uniform approach to comparing bone defects using the sites of periradicular area with bone loss as a comparison unit was developed. In the VRF group, bone loss sites in the middle and coronal thirds were detected more often and were located mainly buccolingually compared with the AP group (P < .001). CONCLUSION Bone defects in the middle or middle and coronal root thirds in the buccolingual direction may be potential radiographic signs useful in differentiating between VRF and AP in SRETPs. The introduction of the uniform approach to assessment of bone loss patterns will give practitioners a single simple tool and improve the quality of endodontic treatment.
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Affiliation(s)
| | | | | | | | - Evgenii Generalov
- Faculty of Physics, Lomonosov Moscow State University, Moscow, Russia
| | - Svetlana Byakova
- Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, Moscow, Russia
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Landa de Bellera R. [Strategies for the use of cone beam tomography in teeth with suspected root fracture. Report of case series]. REVISTA CIENTÍFICA ODONTOLÓGICA 2023; 10:e136. [PMID: 38390605 PMCID: PMC10880688 DOI: 10.21142/2523-2754-1004-2022-136] [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] [Received: 11/14/2022] [Accepted: 12/13/2022] [Indexed: 02/24/2024] Open
Abstract
Root fractures are after caries and periodontal disease, the third cause of loss of dental units, being very common in posterior and endodontically treated teeth. The symptoms they produce are ambiguous and their diagnosis depends on the combination of multiple clinical and imaging factors. Among the diagnostic studies available to establish the origin of the symptoms is the cone beam computed tomography (CBCT). The objective of this case report is to describe the strategies used in the acquisition and interpretation of the CBCT in three patients with suspected root fractures. The use of a reduced field of view, with a voxel of 0.150 mm or less, accompanied by dynamic volume exploration made it possible to detect bone defects as an indirect sign for locating root fracture lines.
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Affiliation(s)
- Rosanna Landa de Bellera
- División de Endodoncia, Cidem Imagenología. Valencia, Carabobo, Venezuela. División de Endodoncia Cidem Imagenología Valencia, Carabobo Venezuela
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de Lima Dias-Junior LC, Correa M, Cesar Lyra Porto O, Estrela C, da Silveira Teixeira C, da Fonseca Roberti Garcia L, Antunes Bortoluzzi E. Influence of a Metal Artifact Reduction Filter on the Diagnostic Accuracy of Complete and Incomplete Vertical Root Fractures. J Endod 2023; 49:1352-1361. [PMID: 37479111 DOI: 10.1016/j.joen.2023.07.010] [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: 05/08/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION This study aimed to assess the influence of the e-vol DX BAR filter on the diagnostic accuracy of complete and incomplete vertical root fractures (VRFs). METHODS Twenty single-rooted teeth were selected. The tooth crowns were removed, and the root canals were prepared up to a 40/.06 instrument (ProTaper Next). Each specimen was scanned in a Prexion 3D cone-beam computed tomography (CBCT) device, in a dry human skull, in 4 different situations: no root canal filling, gutta-percha, fiberglass post, and metal post. The specimens were fractured in a universal testing machine by using a customized wedge. Each specimen was reinspected to confirm the presence of incomplete VRFs. Another set of CBCT scans was performed. Then, the fractures were completed in the universal testing machine, the teeth were reinspected, and the CBCT images were acquired again. Images were assessed by using the e-Vol DX software system, with the BAR filter and with the original images, for the diagnosis of VRFs. Statistical analysis was performed by using the DeLong and McNemar tests for the comparison of the area under the receiver operating characteristic curves (AUC), accuracy, sensitivity, and specificity values. RESULTS The use of the BAR filter did not improve the diagnostic values of AUC, accuracy, sensitivity, and specificity in both fracture patterns (P > .05). Incomplete VRFs presented significantly lower AUC, accuracy, and sensitivity compared with complete VRFs (P < .0001). CONCLUSIONS The BAR filter did not improve the diagnostic accuracy of VRFs. The intracanal materials also did not influence the diagnosis. Incomplete VRFs were highly associated with a decrease in sensitivity.
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Affiliation(s)
| | - Marcio Correa
- Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Olavo Cesar Lyra Porto
- Department of Endodontics, School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Carlos Estrela
- Department of Endodontics, School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | | | - Eduardo Antunes Bortoluzzi
- Division of Endodontics, Department of Diagnosis & Oral Health, School of Dentistry, University of Louisville, Louisville, Kentucky
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Cao D, Zhang P, Gao A, Gulibire A, Xie X, Liang J, Hu Z, Yin W, Lin Z. Development of a predictive model for identifying previously undetected vertical root fractures. AUST ENDOD J 2023; 49:302-310. [PMID: 35861533 DOI: 10.1111/aej.12667] [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: 01/03/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to develop a predictive model to screen for undetected vertical root fractures (VRFs) in root canal treated teeth. We included 95 root canal treated teeth with suspected VRFs; 77 for training and 18 for validation. Following clinical and cone-beam CT parameters were recorded: sex, tooth type, coronal restoration, time interval from completion of endodontic treatment to definitive diagnosis (TI), type of bone loss (BL), apical extent of root filling (AR) and the ratio of root filling diameter to the actual diameter in the coronal (1/3TA) and middle (2/3TA) root thirds. A predictive model p = 1/(1 - e-x ) was generated, where x = -7.433 + 1.977BL + 1.479 (2/3TA) + 1.102 AR; the sensitivity and specificity were 0.852 and 0.875 for training and 0.917 and 0.833 for validation. VRF teeth were more likely to have vertical bone loss and overfilled root canals. This model had a high diagnostic efficacy for VRFs.
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Affiliation(s)
- Dantong Cao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Peng Zhang
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Antian Gao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Aihemaiti Gulibire
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xin Xie
- Department of Stomatology, Third People's Hospital of Danyang City, Danyang, China
| | - Jiahao Liang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ziyang Hu
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weiwei Yin
- Nantong Stomatological Hospital, Nantong, China
| | - Zitong Lin
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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Haupt F, Wiegand A, Kanzow P. Risk factors for and clinical presentations indicative of vertical root fracture in endodontically treated teeth - a systematic review and meta-analysis. J Endod 2023:S0099-2399(23)00323-0. [PMID: 37307871 DOI: 10.1016/j.joen.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The aim of this study was to identify specific clinical signs or symptoms and potential risk factors which are most likely associated with the presence of a vertical root fracture (VRF) in endodontically treated teeth (ETT). METHODS Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Scopus, and Web of Science) were searched by two reviewers in October 2022 for clinical studies, in which at least either the clinical presentation or potential risk factors associated with a VRF were assessed. Risk of bias was assessed using the Newcastle-Ottawa scale. Meta-analyses of odds ratios (ORs) were performed separately for several signs or symptoms and risk factors. RESULTS Fourteen sources reporting on 2,875 teeth (489 with VRF and 2,388 without VRF) were included in the meta-analyses. Regarding the clinical presentation, the presence of sinus tracts (OR=4.87; 95%-CI: 1.58-15.0), increased periodontal probing depths (OR=13.24; 95%-CI: 5.44-32.22), swelling/abscess (OR=2.86; 95%-CI: 1.74-4.70), and tenderness to percussion (OR=1.74; 95% CI: 1.18-2.61) were significantly associated with the presence of a VRF (Padj. value<.05). None of the assessed risk factors (sex, type of teeth, tooth location, posts, indirect restoration, apical extension of the root canal filling), were found to be significantly associated with the presence of a VRF (Padj. value>.05). CONCLUSIONS Four clinical presentations were identified to be the most significant signs or symptoms for a VRF in ETT: presence of sinus tracts, increased probing depths, swelling/abscess, tenderness to percussion. None of the assessed risk factors pointed out to be significantly associated with a VRF. REGISTRATION CRD42022354108 (PROSPERO).
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Affiliation(s)
- Franziska Haupt
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany.
| | - Annette Wiegand
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany
| | - Philipp Kanzow
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany
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Groenke BR, Idiyatullin D, Gaalaas L, Petersen A, Law A, Barsness B, Royal M, Fok A, Nixdorf DR. Sensitivity and Specificity of MRI versus CBCT to Detect Vertical Root Fractures Using MicroCT as a Reference Standard. J Endod 2023; 49:703-709. [PMID: 36972896 PMCID: PMC10330038 DOI: 10.1016/j.joen.2023.03.011] [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: 01/09/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Vertical root fracture (VRF) in root-canal-treated teeth frequently results in tooth loss, partly because VRFs are difficult to diagnose and when detected the fracture is often beyond the point of preservation with surgical intervention. Nonionizing magnetic resonance imaging (MRI) has demonstrated the ability to detect small VRFs, but it is unknown how its diagnostic capabilities compare with the current imaging standard for VRF detection, cone-beam computed tomography (CBCT). This investigation aimed to compare the sensitivity and specificity between MRI and CBCT for detecting VRF, using micro-computed tomography (microCT) as a reference. METHODS A total of 120 extracted human tooth roots were root canal treated using common techniques, and VRFs were mechanically induced in a proportion. Samples were imaged using MRI, CBCT, and microCT. Axial MRI and CBCT images were examined by 3 board-certified endodontists, who evaluated VRF status (yes/no) and gave a confidence assessment for that decision, from which a receiver operating characteristic curve was generated. Intra- and inter-rater reliability were calculated, sensitivity and specificity, and area under the curve. RESULTS Intra-rater reliability was 0.29-0.48 for MRI and 0.30-0.44 for CBCT. Inter-rater reliability for MRI was 0.37 and for CBCT 0.49. Sensitivity was 0.66 (95% confidence interval [CI], 0.53-0.78) and 0.58 (95% CI, 0.45-0.70), and specificity 0.72 (95% CI, 0.58-0.83) and 0.87 (95% CI, 0.75-0.95) for MRI and CBCT, respectively. Area under the curve was 0.74 (95% CI, 0.65-0.83) for MRI and 0.75 (95% CI, 0.66-0.84) for CBCT. CONCLUSIONS There was no significant difference in sensitivity or specificity between MRI and CBCT in detecting VRF, despite the early-stage development of MRI.
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Affiliation(s)
- Beth R Groenke
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota.
| | | | - Laurence Gaalaas
- Department of Radiology, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Alan Law
- Private Practice, The Dental Specialists, Woodbury, Minnesota; Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | | | - Mathew Royal
- Private Practice, The Dental Specialists, Roseville, Minnesota
| | - Alex Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, Minneapolis, Minnesota
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Departments of Radiology & Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota
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Habibzadeh S, Ghoncheh Z, Kabiri P, Mosaddad SA. Diagnostic efficacy of cone-beam computed tomography for detection of vertical root fractures in endodontically treated teeth: a systematic review. BMC Med Imaging 2023; 23:68. [PMID: 37264339 DOI: 10.1186/s12880-023-01024-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
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.
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Affiliation(s)
- Sareh Habibzadeh
- Associate Professor, Department of Prosthodontics, School of Dentistry, International Campus, Tehran University of Medical Sciences, Tehran, Iran
- Associate Professor, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghoncheh
- Associate Professor, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Associate Professor, Department of Oral & Maxillofacial Radiology, School of Dentistry, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Kabiri
- Dentist, School of Dentistry, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
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Lagos de Melo LP, Queiroz PM, Moreira-Souza L, Nadaes MR, Santaella GM, Oliveira ML, Freitas DQ. Influence of CBCT parameters on image quality and the diagnosis of vertical root fractures in teeth with metallic posts: an ex vivo study. Restor Dent Endod 2023; 48:e16. [PMID: 37284345 PMCID: PMC10240088 DOI: 10.5395/rde.2023.48.e16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 06/08/2023] Open
Abstract
Objectives The aim of this study was to evaluate the influence of peak kilovoltage (kVp) and a metal artifact reduction (MAR) tool on image quality and the diagnosis of vertical root fracture (VRF) in cone-beam computed tomography (CBCT). Materials and Methods Twenty single-rooted human teeth filled with an intracanal metal post were divided into 2 groups: control (n = 10) and VRF (n = 10). Each tooth was placed into the socket of a dry mandible, and CBCT scans were acquired using a Picasso Trio varying the kVp (70, 80, 90, or 99), and the use of MAR (with or without). The examinations were assessed by 5 examiners for the diagnosis of VRF using a 5-point scale. A subjective evaluation of the expression of artifacts was done by comparing random axial images of the studied protocols. The results of the diagnoses were analyzed using 2-way analysis of variance and the Tukey post hoc test, the subjective evaluations were compared using the Friedman test, and intra-examiner reproducibility was evaluated using the weighted kappa test (α = 5%). Results The kVp and MAR did not influence the diagnosis of VRF (p > 0.05). According to the subjective classification, the 99 kVp protocol with MAR demonstrated the least expression of artifacts, while the 70 kVp protocol without MAR led to the most artifacts. Conclusions Protocols with higher kVp combined with MAR improved the image quality of CBCT examinations. However, those factors did not lead to an improvement in the diagnosis of VRF.
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Affiliation(s)
- Larissa Pereira Lagos de Melo
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Polyane Mazucatto Queiroz
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Larissa Moreira-Souza
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Mariana Rocha Nadaes
- Dental Clinic Department, Division of Oral Radiology, Dental School, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | - Gustavo Machado Santaella
- Department of Diagnosis and Oral Health, University of Louisville, School of Dentistry, Louisville, KY, USA
| | - Matheus Lima Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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Groenke BR, Idiyatullin D, Gaalaas L, Petersen A, Chew HP, Law A, Barsness B, Royal M, Ordinola-Zapata R, Fok A, Aregawi W, Nixdorf DR. Minimal Detectable Width of Tooth Fractures Using Magnetic Resonance Imaging and Method to Measure. J Endod 2022; 48:1414-1420.e1. [PMID: 36100083 PMCID: PMC9704057 DOI: 10.1016/j.joen.2022.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/21/2022] [Accepted: 08/31/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Vertical root fracture (VRF) in root canal-treated (RCT) teeth is a common cause of pain, bone resorption, and tooth loss. VRF is also difficult to diagnose and measure. Magnetic resonance imaging (MRI) has the potential to identify VRF due to beneficial partial volume averaging, without using ionizing radiation. This investigation aimed to describe the narrowest VRFs detectable based on MRI, using micro-computed tomography (microCT) as the reference standard and proposes a method using profile integrals to measure the widths of small VRFs. METHODS VRFs were induced in 62 RCT tooth root samples. All samples were imaged in a phantom using MRI and reference imaging was obtained using microCT. The stacks of 3-dimensional axial MRIs were assessed by 3 board-certified endodontists. Evaluators determined the most coronal slice within the stack that was discernible as the extent of the VRF. This slice was measured on correlated microCT sections to determine the minimum VRF width (μm) detectable using a profile integral-based method to measure small fractures and negate the effects of the point spread function. RESULTS Using profile integrals to measure VRF width was repeatable and resulted in estimates that were on average 1 μm smaller than known reference widths. Adjusted median VRF width detected using MRI was 45 μm (first quartile: 26 μm, third quartile: 64 μm). CONCLUSION Using profile integrals is a valid way to estimate small VRF width. The MRI approach demonstrated ability to repeatedly detect VRFs as small as 26 μm.
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Affiliation(s)
- Beth R Groenke
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota.
| | | | - Laurence Gaalaas
- Department of Radiology, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Hooi Pin Chew
- Division of Biomaterials, University of Minnesota, Minneapolis, Minnesota
| | - Alan Law
- Private Practice, The Dental Specialists, Woodbury, Minnesota
| | | | - Mathew Royal
- Private Practice, HealthPartners, St Paul, Minnesota
| | - Ronald Ordinola-Zapata
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | - Alex Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, Minneapolis, Minnesota
| | - Wondwosen Aregawi
- Minnesota Dental Research Center for Biomaterials and Biomechanics, Minneapolis, Minnesota
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Departments of Radiology & Neurology, Medical School, University of Minnesota, Minneapolis, Minnesota
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10
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Exploring the use of enhanced cone-beam CT technique to diagnose vertical root fracture. J Mech Behav Biomed Mater 2022; 130:105175. [DOI: 10.1016/j.jmbbm.2022.105175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/20/2022]
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Patel S, Bhuva B, Bose R. Vertical root fractures in root treated teeth-current status and future trends. Int Endod J 2022; 55 Suppl 3:804-826. [PMID: 35338655 PMCID: PMC9324143 DOI: 10.1111/iej.13737] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is crucial in identifying teeth that may be susceptible. Thorough clinical examination with magnification and co-axial lighting is essential in identifying VRFs, and although CBCT is unable to reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, and therefore, increases the probability of correct diagnosis and management. The prevalence of VRFs in root filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre-existing fractures and biochemical effects of loss of vitality, are highly relevant. Careful assessment of the occlusal scheme, presence of deflective contacts and identification of parafunctional habits is imperative in both preventing and managing VRFs. Furthermore, anatomical factors such as root canal morphology, may predispose certain teeth to VRF. The influence of access cavity design and root canal instrumentation protocols should be considered although the impact of these on the fracture resistance of root filled teeth is not clearly validated. The post-endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed 'passively' and excessive 'post-space' preparation should be avoided. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. Currently, there are limited options other than extraction for the management of VRF, although root resection may be considered in multi-rooted teeth. Innovative techniques to 'repair' VRFs using both orthograde and surgical approaches require further research and validation. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, together with expedient and appropriate post-endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs.
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Affiliation(s)
- Shanon Patel
- Department of Endodontology, King's College London Dental Institute, London, UK.,Specialist Practice, London, UK
| | - Bhavin Bhuva
- Department of Endodontology, King's College London Dental Institute, London, UK
| | - Raul Bose
- Department of Endodontology, King's College London Dental Institute, London, UK
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Mizuhashi F, Watarai Y, Ogura I. Diagnosis of Vertical Root Fractures in Endodontically Treated Teeth by Cone-Beam Computed Tomography. J Imaging 2022; 8:jimaging8030051. [PMID: 35324606 PMCID: PMC8949458 DOI: 10.3390/jimaging8030051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to investigate the characteristics and the detection ability of vertical root fractures in endodontically treated teeth by intraoral radiography and cone-beam computed tomography (CBCT). CBCT images of 50 patients with root fractures in endodontically treated teeth were reviewed, and 36 vertical root fractures were taken in this study. The cause of fracture, core construction, kind of teeth, and fracture direction (bucco-lingual and mesio-distal fractures) were investigated. Detection ability of vertical root fractures by intraoral radiography and CBCT was also examined. Statistical analyses concerning the characteristics were performed by χ2 test, and the detection ability was analyzed by cross-tabulation. All of the fractured teeth were nontraumatized teeth. The vertical root fracture occurrence was not differed by core construction. The vertical root fracture number was largest at the premolar teeth (p = 0.005), and the number of the bucco-lingual fracture was larger than the mesio-distal fracture (p = 0.046). Vertical root fractures were detectable using CBCT, while undetectable by intraoral radiography (p < 0.001). Vertical root fractures occurred easily in premolar teeth with bucco-lingual direction, and CBCT is an adequate radiographic method to diagnose vertical root fracture.
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Affiliation(s)
- Fumi Mizuhashi
- Department of Removable Prosthodontics, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan;
- Correspondence: ; Tel.: +81-25-267-1500
| | - Yuko Watarai
- Department of Removable Prosthodontics, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan;
| | - Ichiro Ogura
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan;
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13
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Silva EJNL, De-Deus G, Souza EM, Belladonna FG, Cavalcante DM, Simões-Carvalho M, Versiani MA. Present status and future directions - Minimal endodontic access cavities. Int Endod J 2022; 55 Suppl 3:531-587. [PMID: 35100441 DOI: 10.1111/iej.13696] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
In the last decades, the move of Medicine towards minimally invasive treatments is notorious and scientifically grounded. As Dentistry naturally follows its footsteps, minimal access preparation also became a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue, backed up by the idea that this is an effective way to reduce the incidence of post-treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key-points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra-flexible instruments, visual magnification, superior illumination, and three-dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection, and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make it clear the role of the access size/design on long-term teeth survival. Moreover, it is inevitable that a clinical approach like minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost-benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in-depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws, but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close-to-in-situ laboratory model or a large and well-controlled clinical trial to solve this matter.
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Affiliation(s)
- Emmanuel João Nogueira Leal Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Erick Miranda Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão
| | | | | | - Marco Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Arriola-Guillén L, de Lima Moreno J, Boessio Vizzotto M, da Silveira Tiecher P, Assein Arús N, Dias da Silveira H. Impact of intracanal post-material on vertical root fractures diagnosis: A high-resolution cone-beam computed tomography study. J Int Oral Health 2022. [DOI: 10.4103/jioh.jioh_209_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Wang AHT, Panzarella FK, Fontana CE, Junqueira JLC, da Silveira Bueno CE. Effect of cone-beam computed tomography metal artefact reduction on incomplete subtle vertical root fractures. Imaging Sci Dent 2022; 53:11-19. [PMID: 37006793 PMCID: PMC10060756 DOI: 10.5624/isd.20220106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose This study compared the accuracy of detection of incomplete vertical root fractures (VRFs) in filled and unfilled teeth on cone-beam computed tomography images with and without a metal artefact reduction (MAR) algorithm. Materials and Methods Forty single-rooted maxillary premolars were selected and, after endodontic instrumentation, were categorized as unfilled teeth without fractures, filled teeth without fractures, unfilled teeth with fractures, or filled teeth with fractures. Each VRF was artificially created and confirmed by operative microscopy. The teeth were randomly arranged, and images were acquired with and without the MAR algorithm. The images were evaluated with OnDemand software (Cybermed Inc., Seoul, Korea). After training, 2 blinded observers each assessed the images for the presence and absence of VRFs 2 times separated by a 1-week interval. P-values<0.05 were considered to indicate significance. Results Of the 4 protocols, unfilled teeth analysed with the MAR algorithm had the highest accuracy of incomplete VRF diagnosis (0.65), while unfilled teeth reviewed without MAR were associated with the least accurate diagnosis (0.55). With MAR, an unfilled tooth with an incomplete VRF was 4 times more likely to be identified as having an incomplete VRF than an unfilled tooth without this condition, while without MAR, an unfilled tooth with an incomplete VRF was 2.28 times more likely to be identified as having an incomplete VRF than an unfilled tooth without this condition. Conclusion The use of the MAR algorithm increased the diagnostic accuracy in the detection of incomplete VRF on images of unfilled teeth.
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Affiliation(s)
- Andréa Huey Tsu Wang
- Division of Endodontics, Research Institute, São Leopoldo Mandic Dental School, Campinas, Brazil
| | - Francine Kühl Panzarella
- Division of Oral Radiology, Research Institute, São Leopoldo Mandic Dental School, Campinas, Brazil
| | - Carlos Eduardo Fontana
- Division of Endodontics, Centre for Health Sciences, Pontifical Catholic University of Campinas, Campinas, Brazil
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Varghese VS, Atwal PK, Kurian N, Sabu AM, Cherian JM. Detecting vertical root fractures. Br Dent J 2021; 231:601-602. [PMID: 34824405 DOI: 10.1038/s41415-021-3683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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PradeepKumar AR, Shemesh H, Nivedhitha MS, Hashir MMJ, Arockiam S, Uma Maheswari TN, Natanasabapathy V. Diagnosis of Vertical Root Fractures by Cone-beam Computed Tomography in Root-filled Teeth with Confirmation by Direct Visualization: A Systematic Review and Meta-Analysis. J Endod 2021; 47:1198-1214. [DOI: 10.1016/j.joen.2021.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/19/2022]
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18
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Gao A, Cao D, Lin Z. Diagnosis of cracked teeth using cone-beam computed tomography: literature review and clinical experience. Dentomaxillofac Radiol 2021; 50:20200407. [PMID: 33237813 DOI: 10.1259/dmfr.20200407] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cone-beam computed tomography (CBCT) has been widely used in diagnosis of vertical root fractures (VRFs) in recent years. According to the American Association of Endodontists (AAE) classification, there are five types of cracked teeth and VRF is one of them. Due to the variability and overlapping of the cracks and fractures, some narrow fractures on the roots of VRFs could not be detected by CBCT, and some wide cracks on the crown of cracked teeth could be detected by CBCT. In this review, we firstly discussed the value of CBCT in the diagnosis of the AAE five types of cracked teeth and presented CBCT manifestations of some typical cases. Secondly, we summarized the factors influencing the diagnosis of cracks/fractures using CBCT, namely, CBCT device-related factors, patient-related factors, and evaluator-related factors. The possible strategies to improve the diagnostic accuracy in the clinic practice are also discussed in this part. Finally, we compared the differences of root fractures with lateral canals and external root resorption on CBCT images.
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Affiliation(s)
- Antian Gao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Dantong Cao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zitong Lin
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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Application of image processing techniques to aid in the detection of vertical root fractures in digital periapical radiography. Clin Oral Investig 2021; 25:5077-5085. [PMID: 33543383 DOI: 10.1007/s00784-021-03820-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/29/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To present an image processing framework to improve the detection of vertical root fractures (VRFs) in digital periapical radiography. MATERIALS AND METHODS Thirty endodontically treated human teeth (15 of them fractured with a metal post inserted into them, and 15 for the control) were enclosed in a dry mandible and radiographed individually. The proposed framework was applied to the raw data, as a preprocessing step, and was composed of four stages: geometric adjustment and negative, denoising, adaptive contrast enhancement, and gamma correction. The contrast-to-noise ratio (CNR) and sharpness of the image's VRF region were used for the objective evaluation of the method. In addition, five examiners evaluated the original and enhanced images, using a 5-point scale to assess confidence. RESULTS The objective results showed that the proposed framework increased the CNR of the VRF region by 173% compared to the standard preprocessing method provided by the detector's manufacturer. The results found by the human observers indicated that the area under the curve (AUC) and sensitivity of the diagnosis of VRF significantly increased by 4% and 17% (p ≤ 0.05), respectively, when the examiners evaluated the image with the proposed method concomitantly with the image available in the commercial software. However, the specificity was reduced. CONCLUSIONS The proposed image processing framework can be used as an additional tool to that provided by the manufacturer to increase the sensitivity and AUC of the diagnosis of VRF. CLINICAL RELEVANCE The proposed method can be easily used in clinical practice to aid VRF detection, since it does not incur high computational costs and does not increase the radiation dose applied to the patient.
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Quintero-Álvarez M, Bolaños-Alzate LM, Villa-Machado PA, Restrepo-Restrepo FA, Tobón-Arroyave SI. In vivo detection of vertical root fractures in endodontically treated teeth: Accuracy of cone-beam computed tomography and assessment of potential predictor variables. J Clin Exp Dent 2021; 13:e119-e131. [PMID: 33574996 PMCID: PMC7864364 DOI: 10.4317/jced.57471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/23/2020] [Indexed: 01/17/2023] Open
Abstract
Background This study aimed: (a) to determine the diagnostic performance of cone-beam computed tomography (CBCT) for detection of vertical root fractures (VRFs); (b) to evaluate the predictive value of diagnostic criteria regarding the definition of VRFs; and (c) to examine the robustness of the association of patient-, tooth-, and treatment-related variables with VRFs.
Material and Methods 130 root-filled teeth with signs/symptoms of VRFs underwent clinical and CBCT assessments. Definite diagnosis of VRF was confirmed by endodontic microsurgical (EMS) exploration. Determination of diagnostic performance of CBCT was based on standard algorithms derived from two-way contingency table analysis. Predictive value of diagnostic criteria and the association between predictor variables with VRFs were analyzed using logistic regression models.
Results VRFs were detected during EMS in 50% of the teeth. Based on the finding of fracture lines on CBCT scans, sensitivity, specificity, and accuracy were 86.2%, 13.8%, and 50%, respectively. Teeth having more than three diagnostic criteria present had significant higher odds for VRF diagnosis. After logistic regression analysis, parafunctional habits, one-canal roots, excessive root canal enlargement, and absence of intra-radicular posts remained as robust predictor variables of VRFs.
Conclusions Although the sensitivity of CBCT for VRFs detection is high, the risk of false-positive results related to its low specificity makes that all suspected cases must be confirmed by surgical exploration. VRFs cannot be reliably diagnosed by isolated clinical signs/symptoms; instead those teeth possessing more than three diagnostic criteria might be considered practically pathognomonic. The parafunctional habits, one-canal roots, excessive root canal enlargement, and the absence of intra-radicular posts may act strongly/independently for the occurrence of VRFs in endodontically treated teeth. Key words:Cone-beam computed tomography, diagnostic accuracy, diagnostic surgery, predictor variables, root canal treatment, vertical root fracture.
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Affiliation(s)
- Marcela Quintero-Álvarez
- Senior Resident, Graduate Endodontic Program, Faculty of Dentistry, University of Antioquia. Medellín, Colombia
| | | | - Paula-Andrea Villa-Machado
- Associate Professor. Graduate Endodontic Program, Faculty of Dentistry, University of Antioquia. Medellín, Colombia
| | | | - Sergio-Iván Tobón-Arroyave
- Titular Professor. Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia. Medellín, Colombia
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Gulibire A, Cao Y, Gao A, Wang C, Wang T, Xie X, Liang J, Li W, Lin Z. Assessment of true vertical root fracture line in endodontically treated teeth using a new subtraction software - A Micro-CT and CBCT study. AUST ENDOD J 2020; 47:290-297. [PMID: 33314451 DOI: 10.1111/aej.12476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
This study aimed to find true facture lines in endodontically treated teeth on CBCT images using digital subtraction and to evaluate the influence of width of facture lines in the diagnosis. Thirty-two endodontically treated teeth with vertical root fractures (VRFs) from 30 patients were included in this study. The CBCT images of the patients and the micro-CT images of extracted teeth were imported into our digital subtraction software to distinguish the true facture lines from the streak artefacts. Of them, 23(71.87%) teeth did not present true fracture lines on the CBCT images (CBCT negative), and 9 (28.13%) teeth presented true fracture lines on the CBCT images (CBCT positive). The width of the facture lines was significantly different between these two groups (P < 0.05). To summarise, for in vivo endodontically treated teeth with subtle VRFs, many true fractures lines could not be demonstrated on CBCT images and wider fractures could be better distinguished.
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Affiliation(s)
- Aihemaiti Gulibire
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ya Cao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Antian Gao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Congyue Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tiemei Wang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xin Xie
- Department of Stomatology, Third People's Hospital of Danyang City, Danyang, China
| | - Jiahao Liang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weifeng Li
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Zitong Lin
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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Accuracy of High-resolution Small-volume Cone-Beam Computed Tomography in the Diagnosis of Vertical Root Fracture: An In Vivo Analysis. J Endod 2020; 46:1059-1066. [DOI: 10.1016/j.joen.2020.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/07/2020] [Accepted: 04/11/2020] [Indexed: 11/24/2022]
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Pereira B, Martins JNR, Baruwa AO, Meirinhos J, Gouveia J, Quaresma SA, Monroe A, Ginjeira A. Association between Endodontically Treated Maxillary and Mandibular Molars with Fused Roots and Periapical Lesions: A Cone-beam Computed Tomography Cross-sectional Study. J Endod 2020; 46:771-777.e1. [PMID: 32299702 DOI: 10.1016/j.joen.2020.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/20/2020] [Accepted: 03/01/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Fused root variations of the root canal system increase the complexity of the inner root canal system anatomy. The aim of the present study was to determine, in in vivo conditions, the proportion of periapical lesions in association with endodontically treated maxillary and mandibular molars with fused roots presenting previous root canal treatment by assessing preexisting data via cone-beam computed tomographic volumes. METHODS A total of 1160 CBCT scans with an overall sample of 20,836 teeth were screened. A global count of 3701 maxillary molars and mandibular second molars were included in the study. The Cohen kappa test and interclass correlation coefficient tested the intra- and interrater reliability, respectively. The percentage of periapical lesions associated with molars with or without root fusion was determined. Proportions were expressed with 95% confidence intervals (CIs). The z test for proportions was used to analyze differences between subgroups, and an odds ratio was calculated in order to understand the association between periapical lesions and root configuration. RESULTS Fused molars presented a prevalence of periapical lesions in endodontically treated teeth of 74.0% (95% CI, 65.2%-82.8%), whereas nonfused molars had a proportion of periapical lesions in root canal-treated teeth of 69.5% (95% CI, 65.2%-73.8%; P > .05). Endodontically treated molars with fused roots presented with 1.3 higher odds of being associated with periapical lesions than endodontically treated molars with nonfused roots. CONCLUSIONS A tendency of a higher proportion of periapical lesions was found in the fused rooted molars with a history of root canal treatment when compared with nonfused teeth; however, no statistically significant difference was noted.
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Affiliation(s)
- Beatriz Pereira
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - Jorge N R Martins
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal.
| | - Abayomi Omokeji Baruwa
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - João Meirinhos
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - José Gouveia
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - Sérgio A Quaresma
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | | | - António Ginjeira
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
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