1
|
Alshomrani F. Cone-Beam Computed Tomography (CBCT)-Based Diagnosis of Dental Bone Defects. Diagnostics (Basel) 2024; 14:1404. [PMID: 39001294 PMCID: PMC11241660 DOI: 10.3390/diagnostics14131404] [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: 05/29/2024] [Revised: 06/15/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Cone Beam Computed Tomography (CBCT) has completely changed the way that bone disorders are diagnosed and treated, especially in the dental and maxillofacial domains. This article examines the diverse applications of computed tomography (CBCT) in the diagnosis and treatment of facial trauma, including mandibular, dentoalveolar, and other facial fractures, as well as bone abnormalities like dislocations and fractures. CBCT is useful for a wide range of dental conditions and greatly improves diagnostic accuracy in periodontics, orthodontics, endodontics, and dental implantology. Additionally, a comparison between CBCT and conventional imaging methods was conducted, emphasizing the latter's inferior 3D imaging capabilities, allowing for more precise treatment planning and better patient outcomes with CBCT. Although CBCT has many benefits, it also has some drawbacks, such as requiring specific training for accurate interpretation, cost considerations, and a higher radiation exposure than with traditional dental X-rays. In order to optimize benefits and reduce risks, the conclusion highlights CBCT's revolutionary influence on clinical practice while arguing for its prudent and responsible application.
Collapse
Affiliation(s)
- Faisal Alshomrani
- Department of Diagnostic Radiology Technology, College of Applied Medical Science, Taibah University, Medinah 41477, Saudi Arabia
| |
Collapse
|
2
|
Machado ICP, Morais MO, Bicalho ALP, Ferrari PHP, Bueno JM, Junqueira JLC, Soares MQS. Prevalence and Characterization of External Cervical Resorption Using Cone Beam Computed Tomography. J Endod 2024; 50:164-172.e1. [PMID: 37977218 DOI: 10.1016/j.joen.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The aim of this study was to assess the prevalence of external cervical resorption (ECR) and characterize the cases of ECR using cone beam computed tomography (CBCT). METHODS High-resolution CBCT scans of 6216 patients (2280 males and 3936 females), consecutively acquired during the period July 2021 to March 2022, were analyzed. Identified cases of ECR were characterized by 3 evaluators regarding lesion height, circumferential spread, portal of entry proximity to root canal, stage, location, and width. RESULTS In a total of 38 patients and 40 teeth, ECR cases demonstrated an incidence of 0.61%. The median age of the patients was 39 years. Prevalence of ERC was 0.78% among males and 0.50% among females. The most affected teeth were the maxillary incisors and canines. The most frequent characteristics of the lesion were: extension up to the cervical third (47.5%), more than 270° circumferential spread (42.55%), probable pulpal involvement (57.5%), progressive stage (65%), supracrestal (52.1%) and mesial (34.7%) localization of >1 mm in size (52.1%) portals of entry. Cases with greater longitudinal involvement also showed greater circumferential progression (P = .008). There was no association between portal of entry location and bone crest or ECR reparative phase (P = .42). Inter-rater agreement ranged from good to very good. No association between portal of entry and ECR progression was observed. CONCLUSIONS ECR showed low prevalence in the Brazilian population, affecting mostly anterior maxillary teeth of patients within a wide age range. CBCT allowed characterization of ECR lesions with good interobserver agreement.
Collapse
Affiliation(s)
| | - Marilia Oliveira Morais
- Department of Oral Radiology, Centro Integrado de Radiodontologia CIRO, Goiânia, Goiás, Brazil
| | | | | | - Juliano Martins Bueno
- Oral Radiology Division, São Leopoldo Mandic Research Institute, Campinas, São Paulo, Brazil; Department of Oral Radiology, Centro Integrado de Radiodontologia CIRO, Goiânia, Goiás, Brazil
| | | | | |
Collapse
|
3
|
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.
Collapse
Affiliation(s)
- Rosanna Landa de Bellera
- División de Endodoncia, Cidem Imagenología. Valencia, Carabobo, Venezuela. División de Endodoncia Cidem Imagenología Valencia, Carabobo Venezuela
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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).
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Detecting Vertical Root Fractures Using Modified Methylene Blue Dye: A Preliminary In Vitro Study. Healthcare (Basel) 2023; 11:healthcare11040504. [PMID: 36833038 PMCID: PMC9957168 DOI: 10.3390/healthcare11040504] [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: 01/12/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Diagnostically, vertical root fractures (VRFs) can be a frustrating experience for the dentist. Misdiagnosis could result in significant time and effort losses involved in erroneously intervening endodontically and/or periodontally. Certainly, diagnosing VRFs is often very difficult, and diagnoses based on speculations have led to the extraction of many salvageable teeth. This study was conducted in the radiology unit of College of Dentistry, Prince Sattam bin Abdulaziz University, between December 2021 and June 2022 to evaluate the ability to detect VRFs following the use of a novel radio-opaque dye using periapical radiographs (PARs) and cone-beam computed tomography (CBCT). After carefully inducing VRFs on extracted, single-rooted, virgin premolars (n = 26), they were assigned to control (n = 2) and experimental groups (n = 24). The fracture site of the tooth in the control group received methylene blue dye, whereas the experimental group received a novel dye. Two differently angled PARs were obtained for all the teeth, followed by a CBCT image. Three blinded investigators participated in scoring a Likert scale form with a set of questions. Inter-/intra-examiner reliability showed excellent consistency using Cronbach's alpha test. The Z-test revealed CBCT and PAR to be equally adept at detecting VRFs, with the mean values showing no statistically significant differences. The extent of the VRFs and dye penetration were significantly better when angled radiographs and axial view CBCT were evaluated. Within the limitations of this study, the dye tested showed promising initial results as an aid in radiographically detecting VRFs. The use of such minimally invasive methods is critically needed for diagnosing and managing VRFs. However, further testing should be performed prior to its clinical use.
Collapse
|
9
|
de Lima KL, Silva LR, de Paiva Prado TB, Silva MAG, de Freitas Silva BS, Yamamoto-Silva FP. Influence of the technical parameters of CBCT image acquisition on vertical root fracture diagnosis: a systematic review and meta-analysis. Clin Oral Investig 2023; 27:433-474. [PMID: 36700991 DOI: 10.1007/s00784-022-04797-z] [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: 05/02/2022] [Accepted: 11/14/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To evaluate the influence of image acquisition parameters (voxel, FOV, kVp, mA) on the accuracy of cone-beam computed tomography (CBCT) in detecting vertical root fracture (VRF). MATERIAL AND METHODS Searches were performed in 6 main databases and the gray literature, without restrictions of language or date. Observational clinical studies (OCS) and in vitro-extracted teeth (IV) studies were considered eligible for inclusion when investigating the accuracy (sensitivity, specificity) of CBCT in detecting VRF in human teeth. The risk of bias was assessed using QUADAS-2, and a meta-analysis was performed using Review Manager v5.4 software and Jamovi software v1.6. RESULTS A total of 60 out of 132 articles was included after fulfilling the eligibility criteria. Of these, 54 were IV studies while 6 were OCS. In the IV studies, it was seen that smaller FOV sizes tended to present higher accuracy values. The meta-analysis of the 6 OCS showed that the overall sensitivity and specificity values for 0.08 mm and 0.1 mm voxels were greater (0.84 and 0.79, respectively) than the sensitivity and specificity values for 0.125 mm and 0.2 mm voxels (0.70 and 0.55, respectively). CONCLUSIONS Despite the uncertain risk of bias found for the IV and OCS studies, smaller voxel and FOV sizes seem to provide more accurate VRF detection values when using CBCT. CLINICAL RELEVANCE This information is crucial for supporting the clinician when prescribing CBCT in cases of a clinical suspicion of VRF, and contributes to the personalization of the CBCT prescription, thereby ensuring greater accuracy in the VRF diagnosis. Registration This protocol was registered at the PROSPERO database (International Prospective Register of Systematic Review) under registration number CRD42020210118.
Collapse
Affiliation(s)
- Kaique Leite de Lima
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Lorena Rosa Silva
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | | | - Maria Alves Garcia Silva
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Brunno Santos de Freitas Silva
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil. .,University of Anápolis, Anápolis, GO, Brazil.
| | - Fernanda Paula Yamamoto-Silva
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil.,University of Anápolis, Anápolis, GO, Brazil
| |
Collapse
|
10
|
Helvacioglu-Yigit D, Seki U, Kursun-Cakmak S, Demirturk Kocasarac H, Singh M. Comparative Evaluation of Artifacts Originated by Four Different Post Materials Using Different CBCT Settings. Tomography 2022; 8:2919-2928. [PMID: 36548537 PMCID: PMC9781935 DOI: 10.3390/tomography8060245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/26/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to evaluate whether cone beam computed tomography (CBCT) images in the presence of four different post materials, obtained from different kVps with varying resolutions and varying metal artifact reduction (MAR) algorithms, differed in artifact estimation, and to compare tooth regions in terms of artifact value. MATERIALS AND METHODS Forty premolar teeth were used in this study. Root canals were treated, and teeth were randomly distributed into four subgroups (n = 10) for the preparation of post materials: titanium, gold (Nordin), quartz fiber (Bisco DT Light), and glass fiber (Rely X). The CBCT images were taken with two different kVps, three different metal artifact reduction (MAR) algorithm options, and two different resolutions. For each protocol, the effective dose was calculated according to the dose area production (DAP) value. The standard analysis of variance technique and the Tukey multiple comparison adjustment method were used to assess interactions among material types, kVp, MAR, and voxel settings. RESULTS More artifacts were found in the middle third than in the cervical third (p < 0.05). The mean value of artifacts was highest for gold (Nordin), 90 kVp, no MAR, and 100 voxel size. Glass or quartz fiber posts at low resolution, with high MAR and 96 kVp, originated fewer artifacts. Moreover, the use of 90 and 96 kVp with 200 voxel size and high MAR provided the least amount of radiation. CONCLUSION The best setting for radiographic follow-up of post materials on the Planmeca ProMax is 96 kVp with low resolution and high MAR; this setting produced one of the lowest effective doses. CLINICAL SIGNIFICANCE This study estimated the best scanning protocol by lowering the effective dose to a minimum level according to the "as low as reasonably achievable" principle, as well as assessing the tooth region and the post material generating the fewest artifacts, in order to prevent image interpretation challenges such as false-positive and false-negative results stemming from the deterioration of the visibility of the root canal due to perforation, fractures, and voids in the root canal region.
Collapse
Affiliation(s)
- Dilek Helvacioglu-Yigit
- College of Dental Medicine, QU Health, Qatar University, Doha 2713, Qatar
- Correspondence: ; Tel.: +974-50011251
| | - Umut Seki
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Kocaeli University, Kocaeli 41190, Turkey
| | - Sebnem Kursun-Cakmak
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara 1487, Turkey
| | - Husniye Demirturk Kocasarac
- BeamReaders Inc., Kennewick, WA 99336, USA
- Department of Dentomaxillofacial Radiology, Kocaeli Health and Technology University, Kocaeli 41000, Turkey
| | - Maharaj Singh
- College of Nursing, Marquette University, Milwaukee, WI 53233, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
González AR, Tosoni GM, Freitas DQ, Oliveira ML. Influence of sharpening filters on the detection of root fractures using low-dose cone-beam computed tomography. Clin Oral Investig 2022; 26:4797-4803. [PMID: 35288809 DOI: 10.1007/s00784-022-04444-7] [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: 11/26/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the influence of sharpening filters in the detection of root fractures using low-dose cone-beam computed tomography (CBCT). MATERIALS AND METHODS Eighty-four CBCT volumes acquired at three mA levels of 28 teeth inserted in the dental socket of dry human skull were selected from a previous study. The teeth were divided into four groups according to the presence and absence of root fracture and endodontic filling. Five radiologists evaluated all CBCT volumes for the presence of root fracture with and without the application of "Sharpen 1x" and "Sharpen 2x" filters in OnDemand3D software. Area under the ROC curve (AUC), sensitivity, specificity, and inter- and intra-observer concordance were calculated and compared (α = 0.05). RESULTS Sharpening filters did not lead to significant differences in AUC, sensitivity, and specificity at the three mA levels tested (p > 0.05), regardless of the presence of endodontic filling (p > 0.05). However, the significant reduction of AUC observed in CBCT volumes at 4 mA without filter (p < 0.05) ceased to exist after the application of filters (p > 0.05). Sensitivity and specificity ranged from low and moderate. CONCLUSIONS The use of sharpening filters can be recommended in CBCT volumes at 4 mA for root fracture detection for leading to the same performance as those at 6.3 and 10 mA. The presence of endodontic filling material did not influence the action of filters in the diagnosis of root fracture. CLINICAL RELEVANCE Sharpening filters seem to contribute to the diagnosis of root fracture in CBCT volumes acquired with reduced radiation dose.
Collapse
Affiliation(s)
- Alexandra Robles González
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School (FOP/UNICAMP), University of Campinas, Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil
| | - Guilherme Monteiro Tosoni
- Department of Oral Diagnosis and Surgery, Division of Oral Radiology, Araraquara Dental School, São Paulo State University (FOAr/UNESP), Araraquara, SP, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School (FOP/UNICAMP), University of Campinas, Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil
| | - Matheus L Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School (FOP/UNICAMP), University of Campinas, Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil.
| |
Collapse
|
13
|
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.
Collapse
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;
| |
Collapse
|
14
|
Cavalcanti MGP, Salineiro FC, Barros FM, Barros FBA. Influence of endodontic sealers artifacts in the detection of vertical root fractures. Braz Dent J 2022; 33:22-30. [DOI: 10.1590/0103-6440202204392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/25/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract The aim of this study was to compare the influence of endodontic sealers artifacts on the detection of vertical root fracture in cone beam computed tomography (CBCT). Premolars and central incisors were assigned into five different groups: Control, Pulp Canal Sealer, AH Plus, Sealer 26, and BC Sealer (n= 10, per group). VRFs were mechanically induced and the teeth were inserted into an image phantom. Subsequently, CBCT (Cranex 3Dx, Soredex, Tuusula, Finland) images were obtained and two observers were asked separately to identify root fracture, by visual analysis. For both premolar and central incisors, kappa coefficients of intraobserver agreement varied from good to excellent (K: 80% - 87%), and the values for interobserver agreement varied from fair to moderate (K: 30% - 35%). As follows, the area under the curve (AUC) of receiver operating characteristic (ROC) values for VRFs highlighted that the use of BC sealer reduced the observers’ ability to discriminate VRFs relative to other sealers. Moreover, sensitivity values for premolars teeth ranged from 20% to 60%, and specificity ranged from 60% to 100%; while sensitivity values for central incisors ranged from 30% to 70%, and specificity ranged from 70% to 100%. In conclusion, the low sensitivity values, mainly for premolars, demonstrated the difficulty in VRF diagnosis. Furthermore, BC Sealer induced significantly more imaging artifacts than other sealers. These results highlighting that endodontic sealers may interfere with the diagnosis of VRFs.
Collapse
|
15
|
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.
Collapse
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
| | | | | |
Collapse
|
16
|
Liao WC, Chen CH, Pan YH, Chang MC, Jeng JH. Vertical Root Fracture in Non-Endodontically and Endodontically Treated Teeth: Current Understanding and Future Challenge. J Pers Med 2021; 11:jpm11121375. [PMID: 34945847 PMCID: PMC8707645 DOI: 10.3390/jpm11121375] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/22/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022] Open
Abstract
A vertical root fracture (VRF) is a complex complication that usually leads to tooth extraction. The aim of this article is to review the prevalence, demography, distribution, diagnostic methods, etiology and predisposing factors, clinical features, radiographic characteristics and treatment strategies of VRFs in non-endodontically treated teeth (VRFNETT) and endodontically treated teeth (VRFETT). Search terms for each subject related to VRFNETT and VRFETT were entered into MEDLINE, PubMed and Google Scholar. Systematic reviews, retrospective cohort studies, demographic research, clinical studies, case reports and case series were reviewed. Most of the VRFs were found in patients older than 40 years old. Older populations were discovered in the non-endodontically treated VRF group when compared to the endodontically treated VRF group. Male patients were found at a greater prevalence than females in the non-endodontically treated VRF group. The initial occurrence of a VRF may accompany radiolucent lines within the root canal, unusual space between the canal wall and intracanal material, a widening of the PDL space along the periradicular surfaces, angular bony destruction, step-like bone defects, V-shaped diffuse bone defects, or root resorptions corresponding to the fracture line before the clear separation of the fractured fragment. The indicative clinical and radiographic signs of VRF included a coronally positioned sinus tract, deep-narrow periodontal defects, the displacement of a fractured fragment, periradicular radiolucent halos and the widening of the root canal space. Interestingly, VRFNETT are more often observed in the Chinese population. Some patients with multiple VRFs were observed, suggesting possible predisposing factors in genetics and tooth development. The management of a VRF usually involves a multidisciplinary approach. The common distribution and features of VRFNETT and VRFETT were elucidated to facilitate recognition and diagnosis. Besides extraction, variable therapeutic schemes, such as the repair of the VRF, root amputation and others reported in earlier literature, are available. A long-term prognosis study of the various therapeutic strategies is needed.
Collapse
Affiliation(s)
- Wan-Chuen Liao
- School of Dentistry, College of Medicine, National Taiwan University, Taipei 100229, Taiwan; (W.-C.L.); (C.-H.C.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 100229, Taiwan
| | - Chi-Hung Chen
- School of Dentistry, College of Medicine, National Taiwan University, Taipei 100229, Taiwan; (W.-C.L.); (C.-H.C.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 100229, Taiwan
| | - Yu-Hwa Pan
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei 105406, Taiwan;
| | - Mei-Chi Chang
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei 105406, Taiwan;
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan 333324, Taiwan
- Correspondence: (M.-C.C.); (J.-H.J.)
| | - Jiiang-Huei Jeng
- School of Dentistry, College of Medicine, National Taiwan University, Taipei 100229, Taiwan; (W.-C.L.); (C.-H.C.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 100229, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan
- Correspondence: (M.-C.C.); (J.-H.J.)
| |
Collapse
|
17
|
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]
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Azarpazhooh A, Diogenes AR, Fouad AF, Glickman GN, Kishen A, Levin L, Roda RS, Sedgley CM, Tay FR, Hargreaves KM. Insights into the August 2020 Issue of the JOE. J Endod 2020; 46:1015-1016. [PMID: 32713461 PMCID: PMC7377996 DOI: 10.1016/j.joen.2020.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Anibal R Diogenes
- University of Texas Health San Antonio School of Dentistry, San Antonio, Texas
| | - Ashraf F Fouad
- University of North Carolina, Chapel Hill, North Carolina
| | | | - Anil Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | | | | | | | - Franklin R Tay
- The Dental College of Georgia, Augusta University, Augusta, Georgia
| | | |
Collapse
|