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Ríos-Osorio N, Quijano-Guauque S, Briñez-Rodríguez S, Velasco-Flechas G, Muñoz-Solís A, Chávez C, Fernandez-Grisales R. Cone-beam computed tomography in endodontics: from the specific technical considerations of acquisition parameters and interpretation to advanced clinical applications. Restor Dent Endod 2024; 49:e1. [PMID: 38449497 PMCID: PMC10912545 DOI: 10.5395/rde.2024.49.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 03/08/2024] Open
Abstract
The implementation of imaging methods that enable sensitive and specific observation of anatomical structures has been a constant in the evolution of endodontic therapy. Cone-beam computed tomography (CBCT) enables 3-dimensional (3D) spatial anatomical navigation in the 3 volumetric planes (sagittal, coronal and axial) which translates into great accuracy for the identification of endodontic pathologies/conditions. CBCT interpretation consists of 2 main components: (i) the generation of specific tasks of the image and (ii) the subsequent interpretation report. A systematic and reproducible method to review CBCT scans can improve the accuracy of the interpretation process, translating into greater precision in terms of diagnosis and planning of endodontic clinical procedures. MEDLINE (PubMed), Web of Science, Google Scholar, Embase and Scopus were searched from inception to March 2023. This narrative review addresses the theoretical concepts, elements of interpretation and applications of the CBCT scan in endodontics. In addition, the contents and rationale for reporting 3D endodontic imaging are discussed.
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Affiliation(s)
- Néstor Ríos-Osorio
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | - Sara Quijano-Guauque
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | - Sandra Briñez-Rodríguez
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | - Gustavo Velasco-Flechas
- Research Department COC-CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | | | - Carlos Chávez
- Postgraduate Endodontics Department, IMED, Guadalajara, México
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Abesi F, Golikani A. Diagnostic performance of cone-beam computed tomography for apical periodontitis: a systematic review and meta-analysis. Pol J Radiol 2023; 88:e597-e605. [PMID: 38362018 PMCID: PMC10867952 DOI: 10.5114/pjr.2023.134035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/22/2023] [Indexed: 02/17/2024] Open
Abstract
Purpose We aimed to conduct a systematic review and meta-analysis of studies examining the performance of cone-beam computed tomography (CBCT) imaging in apical periodontitis (AP) prediction. This was done to address the contradictory results reported in the existing literature on this topic. Material and methods We searched the Embase, PubMed, Cochrane library, and Scopus databases for literature published from inception to 30 June 2023 without language restriction using appropriate keywords. We included studies that reported the diagnostic accuracy values of CBCT in AP detection among humans by comparing AP diagnosis with a control group without lesions. We pooled the diagnostic accuracy values using a random effects model and presented the estimates as percentage and 95% confidence interval (CI). The heterogeneity between the surveys was explored by I2 statistic. Results Out of 301 citations initially identified, a total of 8 eligible studies were finally included. According to the analyses, the overall pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) estimated for CBCT were 94.6% (95% CI: 90.2-97.1; I2 = 55.9%, p = 0.026), 91.2% (95% CI: 81.7-96.0; I2 = 81.6%, p < 0.001), 93.0% (95% CI: 87.4-96.2; I2 = 56.5%, p = 0.024), and 92.3% (95% CI: 82.3-96.8; I2 = 86.4%, p < 0.001), respectively. The overall pooled sensitivity, specificity, PPV, and NPV of digital radiography were 61.0% (95% CI: 38.3-79.8; I2 = 94.4%, p < 0.001), 97.3% (95% CI: 85.6-99.5; I2 = 86.7%, p < 0.001), 98.3% (95% CI: 92.0-99.6; I2 = 74.4%, p = 0.002), and 41.6% (95% CI: 28.0-56.6; I2 = 89.5%, p < 0.001), respectively. Conclusions CBCT imaging has excellent diagnostic accuracy in AP prediction. Also, CBCT has better discriminant test performance for AP than digital radiography.
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Affiliation(s)
- Farida Abesi
- Department of Oral and Maxillofacial Radiology, Dental Faculty, Babol University of Medical Sciences, Babol, Iran
| | - Ali Golikani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
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de Lima JP, Mazzi-Chaves JF, de Sousa-Neto MD, Candemil AP. Could Low-dose Cone-beam CT be Used for Endodontic Intraoperative Diagnosis? J Endod 2023; 49:1161-1168. [PMID: 37451335 DOI: 10.1016/j.joen.2023.07.006] [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: 04/07/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Cone-beam computed tomography (CBCT) allows three-dimensional evaluation and has high diagnostic accuracy of endodontic conditions. Considering that the most indicated protocol for endodontics should have smaller field-of-view and higher spatial resolution, a higher radiation dose may be associated. Thus, this study evaluated the accuracy of an optimized CBCT protocol for the detection of intraoperative endodontic complications. METHODS An image phantom was custom-made with a human mandible covered with Mix-D and forty mandibular first molars. The teeth were subdivided into 4 groups of endodontic complications which were simulated. All teeth were individually inserted into the left second molar socket of the phantom and CBCT images were acquired with OP 300 unit adjusted to a field-of-view of 6 × 4 cm, 90kVp, and 2 dose protocols: low and high. Furthermore, a titanium implant, a tooth with endodontic treatment, and a cobalt-chromium post were inserted into the empty sockets adjacent to the teeth of interest and additional images were acquired. Four endodontists evaluated the images and indicated the presence of endodontic complications on a 5-point scale. Sensitivity, specificity, and area under the receiver operating characteristic curve were obtained. The different groups were compared by ANOVA and Tukey tests (α = 0.05). RESULTS In most conditions, irrespective of the presence of metallic materials, the values of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve did not differ significantly (P > .05) between the dose protocols. CONCLUSIONS Optimized CBCT protocols should be considered for the detection of intraoperative endodontic Diagnostic complications.
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Affiliation(s)
- João Pedro de Lima
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Jardel Francisco Mazzi-Chaves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Manoel Damião de Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Amanda Pelegrin Candemil
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
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Distefano S, Cannarozzo MG, Spagnuolo G, Bucci MB, Lo Giudice R. The "Dedicated" C.B.C.T. in Dentistry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5954. [PMID: 37297558 PMCID: PMC10252385 DOI: 10.3390/ijerph20115954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/14/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
This position statement represents a consensus of an expert committee composed by the Italian Academy of General Dentistry (Accademia Italiana Odontoiatria Generale COI-AIOG) and Italian Academy of Legal and Forensic Dentistry (Accademia Italiana di Odontoiatria Legale e Forense OL-F) on the appropriate use of cone beam computed tomography (C.B.C.T.) in dentistry. This paper analyzes the use of C.B.C.T. in light of the rapid evolution of volumetric technologies, with the new low- and ultra-low-dose exposure programs. These upgrades are determining an improvement in the precision and safety of this methodology; therefore, the need of a guideline revision of the use of C.B.C.T. for treatment planning is mandatory. It appears necessary to develop a new model of use, which, in compliance with the principle of justification and as low as reasonably achievable (ALARA) and as low as diagnostically acceptable (ALADA), can allow a functional "Dedicated C.B.C.T." exam optimized for the individuality of the patient.
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Affiliation(s)
| | - Maria Grazia Cannarozzo
- Cenacolo Odontostomatologico Italiano-Associazione Italiana Odontoiatria Generale, 95128 Catania, Italy
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Marco Brady Bucci
- Italian Academy of Legal and Forensic Dentistry (OL-F), 19122 La Spezia, Italy
| | - Roberto Lo Giudice
- Department Clinical and Experimental Medicine, Messina University, 98122 Messina, Italy
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A diagnostic accuracy study on an innovative auto-edge detection technique for identifying simulated implant fractures on radiographic images. Sci Rep 2022; 12:19647. [PMID: 36385492 PMCID: PMC9668839 DOI: 10.1038/s41598-022-24266-7] [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: 05/18/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
Implant fracture is a rare but devastating complication of treatment in partially or fully edentulous patients which requires prompt diagnosis. Nevertheless, studies on defining the most accurate technique for the detection of implant fractures are lacking. In the present study, the Canny edge detection algorithm was applied on multiple radiographic modalities including parallel periapical (PPA), oblique periapical (OPA), and cone beam CT (CBCT) with and without metal artifact reduction (MAR) to examine its accuracy for diagnosis of simulated implant fractures. Radiographs were taken from 24 intact implants and 24 implants with artificially created fractures. Images were evaluated in their original and Canny formats. The accuracy of each radiograph was assessed by comparison with a reference standard of direct observation of the implant. The greatest area under the receiver operating characteristic curve belonged to Canny CBCT with MAR (0.958), followed by original CBCT with MAR (0.917), original CBCT without MAR = Canny CBCT without MAR = Canny OPA (0.875), Canny PPA (0.833), original PPA = original OPA (0.792), respectively. The Canny edge detection algorithm is suggested as an innovative method for accurate diagnosis of clinically suspected implant fractures on CBCT and periapical radiographies.
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Effect of the Field of View Size on CBCT Artifacts Caused by the Presence of Metal Objects in the Exomass. Int J Dent 2022; 2022:2071108. [PMID: 36117513 PMCID: PMC9481401 DOI: 10.1155/2022/2071108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
Materials and Methods In this in vitro experimental study, titanium implants, teeth with cobalt-chromium (Co-Cr) intracanal posts, and teeth with mesio-occluso-distal (MOD) amalgam restorations were placed in an empty socket of the extracted third molar of a human mandible. These metallic materials were differently arranged in the exomass (zone outside of the FOV). A polypropylene tube containing dipotassium phosphate was placed in the empty socket of the right canine tooth in a dry human mandible. CBCT scans were taken with a NewTom VGI (Verona, Italy) scanner using a 6 × 6 cm and an 8 × 8 cm FOV. The histogram tool of OnDemand software (Cybermed, Seoul, Korea) was used to select circles with a 1.5 mm diameter as the (ROI) at the center of the homogenous solution of dipotassium phosphate tube on the axial plane. The mean gray value (GV) and its standard deviation (SD) in the region of interest (ROI) were calculated (P > 0.05). The data were analyzed by SPSS 26. Results The reduction in the size of the FOV significantly decreased the mean GV (P < 0.001). Metal objects in the exomass significantly decreased the mean GV (P < 0.001), and minimum mean GV and maximum SD were recorded for amalgam, followed by Co-Cr intracanal posts, and titanium implants. The unilateral presence of a metal object was associated with a higher mean GV and lower SD (P < 0.001). Conclusion Using a smaller FOV increases the size of the exomass, which may negatively affect the image quality. Metal objects in the exomass decrease the GV of CBCT scans and adversely affect the image quality.
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Alves Dos Santos GN, Faria-E-Silva AL, Ribeiro VL, Pelozo LL, Candemil AP, Oliveira ML, Lopes-Olhê FC, Mazzi-Chaves JF, Sousa-Neto MD. Is the quality of root canal filling obtained by cone-beam computed tomography associated with periapical lesions? A systematic review and meta-analysis. Clin Oral Investig 2022; 26:5105-5116. [PMID: 35618962 DOI: 10.1007/s00784-022-04558-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/17/2022] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the influence of root canal filling quality on periapical lesion status using cone-beam computed tomography (CBCT). MATERIALS AND METHODS The bibliographic search was conducted in electronic databases of PubMed, Embase, Scopus, and Web of Science without restrictions related to the year of publication and language. Inclusion criteria were prospective or retrospective cohort studies that followed periapical pathosis for, at least, 1 year. Three reviewers independently evaluated the eligibility for inclusion, extracted data, and assessed the risk of bias. The quality of the studies was based on the Newcastle-Ottawa Scale. This meta-analysis was performed to evaluate the quality of treatment by the homogeneity and apical extension of the filling. RESULTS Of the 1179 studies initially recovered, six cohort studies were included, out of which four were considered with a low risk of bias. The results showed that the absence of gaps in the filling reduced the chance of unhealed periapical lesions by 2.39 times (RR = 2.39; 95% CI: 1.62-3.53; p < 0.00001; I2 = 55%). An apical filling extension of 0-2 mm below the apex also contributed significantly to the absence of unhealed periapical lesions (RR = 1.49; 95% CI: 1.15-1.94; p = 0.003; I2 = 2%). CONCLUSION The homogeneity and apical extension of the filling influenced the presence of unhealed periapical lesions in endodontically treated teeth evaluated using CBCT. CLINICAL RELEVANCE Apical extension of the filling ranging between 0 and 2 mm short of the apical foramen and the homogeneity of the filling without gaps are directly related to the success rate of root canal treatment.
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Affiliation(s)
- Guilherme Nilson Alves Dos Santos
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Av. do Café, s/n, Ribeirão Preto, São Paulo, 14020-904, Brazil
| | | | - Vitor Luís Ribeiro
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Av. do Café, s/n, Ribeirão Preto, São Paulo, 14020-904, Brazil
| | - Laís Lima Pelozo
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Av. do Café, s/n, Ribeirão Preto, São Paulo, 14020-904, Brazil
| | - Amanda Pelegrin Candemil
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Av. do Café, s/n, Ribeirão Preto, São Paulo, 14020-904, Brazil
| | - Matheus L Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Fabiane Carneiro Lopes-Olhê
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Av. do Café, s/n, Ribeirão Preto, São Paulo, 14020-904, Brazil
| | - Jardel Francisco Mazzi-Chaves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Av. do Café, s/n, Ribeirão Preto, São Paulo, 14020-904, Brazil
| | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Av. do Café, s/n, Ribeirão Preto, São Paulo, 14020-904, Brazil.
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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.
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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.
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