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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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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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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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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.
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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
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de Lima Dias-Junior LC, Corrêa M, da Silveira Teixeira C, de Souza DL, Tay FR, Estrela C, da Fonseca Roberti Garcia L, Bortoluzzi EA. Development and validation of a method for creating incomplete vertical root fracture in extracted teeth. Odontology 2023:10.1007/s10266-023-00787-z. [PMID: 36708433 DOI: 10.1007/s10266-023-00787-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: 11/16/2022] [Accepted: 01/19/2023] [Indexed: 01/29/2023]
Abstract
The present study reported a method for inducing incomplete root fracture in human extracted teeth for the purpose of evaluating the merits of different diagnostic imaging techniques. Thirty-five single-rooted teeth were inspected under magnification and transillumination to exclude previously fractured teeth. Tooth crowns were removed, and the root canals were prepared up to the ProTaper Next X4 (40.06) file. Each root was lined with wax and embedded in a polystyrene resin block. The setup was attached to a universal testing machine for pressing a customized conical wedge (diameter at tip: 0.6 mm; taper: 0.2 mm/mm) into the instrumented canal with a 2 kN load at 5 mm/min. The machine was programmed to stop after a sudden 10% drop in loading force. Each specimen was removed from the resin block and inspected under × 20 magnification and transillumination to identify the fracture characteristics (pattern, surfaces and root-third affected). The gap width of each specimen was measured at different locations along the fracture line. The protocol induced incomplete vertical root fractures in all specimens. Fracture widths were < 100 μm in all specimens (mean gap width: 34.9 μm). The proposed methodology was successful in inducing incomplete vertical root fractures with characteristics that resemble the clinical presentation of these conditions. The method is easy to execute, highly reproducible and helps to minimize bias in laboratory studies that aims to mimic vertical root fractures.
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Affiliation(s)
- Luiz Carlos de Lima Dias-Junior
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianópolis, Santa Catarina, Brazil
| | - Marcio Corrêa
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianópolis, Santa Catarina, Brazil
| | - Cleonice da Silveira Teixeira
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianópolis, Santa Catarina, Brazil
| | - Diego Leonardo de Souza
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianópolis, Santa Catarina, Brazil
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Carlos Estrela
- Department of Endodontics, School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry-Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianópolis, Santa Catarina, Brazil.
| | - Eduardo Antunes Bortoluzzi
- Department of Diagnosis & Oral Health, Division of Endodontics, School of Dentistry, University of Louisville, Louisville, KY, USA
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Hu Z, Cao D, Hu Y, Wang B, Zhang Y, Tang R, Zhuang J, Gao A, Chen Y, Lin Z. Diagnosis of in vivo vertical root fracture using deep learning on cone-beam CT images. BMC Oral Health 2022; 22:382. [PMID: 36064682 PMCID: PMC9446797 DOI: 10.1186/s12903-022-02422-9] [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: 05/22/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives Evaluating the diagnostic efficiency of deep learning models to diagnose vertical root fracture in vivo on cone-beam CT (CBCT) images.
Materials and methods The CBCT images of 276 teeth (138 VRF teeth and 138 non-VRF teeth) were enrolled and analyzed retrospectively. The diagnostic results of these teeth were confirmed by two chief radiologists. There were two experimental groups: auto-selection group and manual selection group. A total of 552 regions of interest of teeth were cropped in manual selection group and 1118 regions of interest of teeth were cropped in auto-selection group. Three deep learning networks (ResNet50, VGG19 and DenseNet169) were used for diagnosis (3:1 for training and testing). The diagnostic efficiencies (accuracy, sensitivity, specificity, and area under the curve (AUC)) of three networks were calculated in two experiment groups. Meanwhile, 552 teeth images in manual selection group were diagnosed by a radiologist. The diagnostic efficiencies of the three deep learning network models in two experiment groups and the radiologist were calculated. Results In manual selection group, ResNet50 presented highest accuracy and sensitivity for diagnosing VRF teeth. The accuracy, sensitivity, specificity and AUC was 97.8%, 97.0%, 98.5%, and 0.99, the radiologist presented accuracy, sensitivity, and specificity as 95.3%, 96.4 and 94.2%. In auto-selection group, ResNet50 presented highest accuracy and sensitivity for diagnosing VRF teeth, the accuracy, sensitivity, specificity and AUC was 91.4%, 92.1%, 90.7% and 0.96. Conclusion In manual selection group, ResNet50 presented higher diagnostic efficiency in diagnosis of in vivo VRF teeth than VGG19, DensenNet169 and radiologist with 2 years of experience. In auto-selection group, Resnet50 also presented higher diagnostic efficiency in diagnosis of in vivo VRF teeth than VGG19 and DensenNet169. This makes it a promising auxiliary diagnostic technique to screen for VRF teeth.
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Affiliation(s)
- Ziyang Hu
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Zhong Yang Road 30, Nanjing City, 210008, Jiangsu, People's Republic of China.,Department of Stomatology, Guangdong Medical University Affiliated Longhua Central Hospital, Shenzhen, China
| | - Dantong Cao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Zhong Yang Road 30, Nanjing City, 210008, Jiangsu, People's Republic of China
| | - Yanni Hu
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Zhong Yang Road 30, Nanjing City, 210008, Jiangsu, People's Republic of China
| | - Baixin Wang
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Yifan Zhang
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Rong Tang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Zhong Yang Road 30, Nanjing City, 210008, Jiangsu, People's Republic of China
| | - Jia Zhuang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Zhong Yang Road 30, Nanjing City, 210008, Jiangsu, People's Republic of China
| | - Antian Gao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Zhong Yang Road 30, Nanjing City, 210008, Jiangsu, People's Republic of China
| | - Ying Chen
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China.
| | - Zitong Lin
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Zhong Yang Road 30, Nanjing City, 210008, Jiangsu, People's Republic of China.
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Liang J, Hu Z, Cao D, Cao Y, Xie X, Gao A, Wang Z, Lin Z. Establishment of Narrow Root Fracture Models Using Modified Temperature Cycling Method and Diagnosis Using Different Cone-Beam CT Units. SCANNING 2022; 2022:3636795. [PMID: 35912120 PMCID: PMC9303484 DOI: 10.1155/2022/3636795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
AIM Using a modified thermal cycling method to establish narrow root fracture models and evaluate the diagnosis efficiency of them using four different cone-beam CT (CBCT) units. Methodology. Fifty-six intact teeth were selected, and the crowns of the teeth were embedded using general purpose acrylic resin. 50 root fracture models were established by soaking these teeth in liquid nitrogen and hot water cyclically; 6 teeth were used as the negative control. All the 56 teeth were scanned with the smallest voxel size of four different CBCT units (NewTom VGi, Planmeca Promax 3D Max, Kavo 3D eXam, and Soredex Scanora3D). 10 teeth were randomly selected, and the roots were sliced using slow-speed saw to obtain horizontal root sections. Scanning electron microscope (SEM) was used to measure the width of the fracture lines (FLs). The CBCT images were evaluated for the presence or absence of fracture lines. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the diagnosis of FLs using the four CBCT units. RESULTS Fifty narrow root fracture models were successfully established, and 25 root sections with 45 FLs were acquired. The width of FLs was from 3.43 μm to 143 μm; 32.2% of the points had width under 25 μm, while only 9.6% of them had width over 75 μm. The accuracy was 0.41, 0.54, 0.41, and 0.30 for NewTom VGi, Planmeca Promax 3D Max, Kavo 3D eXam, and Soredex Scanora3D, respectively. CONCLUSIONS The modified temperature cycling method is a simple and effective method to establish narrow root fracture models, and the diagnosis efficiency for these narrow fracture lines was quite poor using all the four different CBCT units.
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Affiliation(s)
- 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
| | - Dantong Cao
- 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
| | - Xin Xie
- Department of Stomatology, Third People's Hospital of Danyang City, Danyang, China
| | - Antian Gao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhiyong Wang
- Department of Oral and Maxillofacial Surgery, 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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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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Zhou J, Fu J, Xiao M, Qiao F, Fu T, Lv Y, Wu F, Sun C, Li P, Wu L. New technique for detecting cracked teeth and evaluating the crack depth by contrast-enhanced cone beam computed tomography: an in vitro study. BMC Oral Health 2022; 22:48. [PMID: 35236348 PMCID: PMC8892748 DOI: 10.1186/s12903-022-02085-6] [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: 11/24/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cracked teeth may cause various clinical symptoms depending on the extension depth of the crack and the subsequent bacterial infections. However, techniques to reliably determine the extension depths of cracks in teeth before treatment are lacking. The aim of this study was to develop a new technique based on contrast-enhanced cone beam computed tomography (CBCT) to improve the accuracy of crack depth evaluation in vitro. Methods We developed an in vitro artificial simulation model of cracked teeth. Pre-experimental CBCT (pre-CBCT), and micro-computed tomography (micro-CT) were first performed for all cracked teeth (n = 31). Contrast-enhanced CBCT was then performed by infiltrating the crack with ioversol under vacuum conditions. The sensitivities of pre-CBCT and contrast-enhanced CBCT for the diagnosis of cracked teeth were calculated. According to the K-means clusters, crack depths measured by micro-CT were changed into categorical variables. Bland–Altman plot and the intraclass correlation coefficient (ICC) were used to analyze the consistency of the crack depths between the pre-CBCT and contrast-enhanced CBCT, as well as the ICC between the contrast-enhanced CBCT and micro-CT. Receiver operating characteristic (ROC) curves were generated to assess the ability for predicting crack depth in the differential diagnosis using pre-CBCT and contrast-enhanced CBCT. Restricted cubic splines were also used to model the non-linear relationship between the crack depths of contrast-enhanced CBCT and micro-CT. Results The sensitivities of pre-CBCT and contrast-enhanced CBCT were 48.4%, and 67.7%, respectively. The ICC value of crack depth as measured by pre-CBCT and contrast-enhanced CBCT was 0.847 (95% confidence interval [CI] 0.380–0.960; P < 0.001). The areas under ROC curves (AUC) of pre-CBCT and contrast-enhanced CBCT were different: the AUC of pre-CBCT was 0.958 (P = 0.000, 95% CI 0.843–1.074), and the AUC of contrast-enhanced CBCT was 0.979 (P = 0.000, 95% CI 0.921–1.037), and the difference was not statistically significant (Z = − 0.707, P = 0.480). The ICC value of crack depth as measured by contrast-enhanced CBCT and micro-CT was 0.753 (95% CI 0.248–0.911; P < 0.001). Conclusion Contrast-enhanced CBCT under vacuum conditions with a contrast medium can significantly improve the crack detection rate of cracked teeth; however, it cannot measure the crack depths accurately.
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Affiliation(s)
- Jie Zhou
- Department of Stomatology, Wuqing People Hospital, Tianjin, China
| | - Jieni Fu
- Department of Endodontics, Hangzhou Stomatological Hospital, Hangzhou, Zhejiang, China
| | - Mo Xiao
- Department of Endodontics and Restorative Dentistry, School of Stomatology, Tianjin Medical University, #12 Qi Xiang Tai Road, He Ping District, Tianjin, 300070, China
| | - Feng Qiao
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Tianjin Medical University, Tianjin, China
| | - Tiantian Fu
- Department of Endodontics and Restorative Dentistry, School of Stomatology, Tianjin Medical University, #12 Qi Xiang Tai Road, He Ping District, Tianjin, 300070, China
| | - Yangyang Lv
- Department of Endodontics, Wuxi Stomatology Hospital, Jiangsu, China
| | - Fei Wu
- Department of Endodontics, Yantai Stomatological Hospital Affiliated to Binzhou Medical College, Yantai, China
| | - Cuicui Sun
- Department of Endodontics, Tianjin Stomatological Hospital, Tianjin, China
| | - Peng Li
- Department of Radiology, School of Stomatology, Tianjin Medical University, Tianjin, China
| | - Ligeng Wu
- Department of Endodontics and Restorative Dentistry, School of Stomatology, Tianjin Medical University, #12 Qi Xiang Tai Road, He Ping District, Tianjin, 300070, China.
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Bueno MR, Azevedo BC, Estrela C. A Critical Review of the Differential Diagnosis of Root Fracture Line in CBCT scans. Braz Dent J 2021; 32:114-128. [PMID: 34877973 DOI: 10.1590/0103-6440202104742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 11/21/2022] Open
Abstract
The objective of this critical review of literature is to discuss relevant clinical factors associated with root fractures (RF) visualized by using a new CBCT software. RF constitutes a common occurrence and a challenge in clinical practice, in which the diagnosis becomes essential for the definition of rapid and precise decision-making. The characterization of RF may involve different aspects, such as orientation of the fracture line (horizontal, vertical, oblique), root position of the fracture (cervical, middle, apical third), fracture's coronal-radicular position (coronary, coronal-radicular, radicular), continuity of the fracture (crack, incomplete fracture, complete), bone extension of the fracture (supraosseous, bone level, infraosseous fracture). Imaging examinations have been routinely used to aid in the RF diagnosis. Even with high-resolution cone-beam computed tomography (CBCT) scans, many doubts often remain about the diagnostic outcome. Many interferences in the analysis of image quality to determine the diagnosis are identified, such as the sharpness, the noise, light and dark artifacts, among others. The professional's knowledge is essential for identifying the different patterns of fracture lines and their repercussions on adjacent bone tissues, as well as for the analysis of artifacts that may hide or show similarities to fracture lines. Fractures lines and root fractures that may be associated with phantom conditions that mimic fractures should be carefully analyzed. CBCT is the exam indicated to identify a root fracture. It is also added to the success of the diagnosis that the professional has scientific knowledge, training and mastery of advanced CBCT software.
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Affiliation(s)
| | - Bruno Correa Azevedo
- University of Louisville, School of Dentistry, Oral Radiology Department, Louisville, KY, USA
| | - Carlos Estrela
- Professor of Endodontics, Federal University of Goiás, Goiânia, Brazil
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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: 7] [Impact Index Per Article: 2.3] [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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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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Effect of digital enhancement on the radiographic assessment of vertical root fractures in the presence of different intracanal materials: an in vitro study. Clin Oral Investig 2020; 25:195-202. [PMID: 32506327 DOI: 10.1007/s00784-020-03353-x] [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: 04/16/2019] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the effect of enhancement tools of intraoral digital radiographs on the assessment of vertical root fracture (VRF) and to quantify the resultant image noise. MATERIALS AND METHODS Thirty single-rooted human teeth (15 control and 15 fractured) were each radiographed in four intracanal conditions: no filling, gutta-percha, metal post, and fiberglass post, totaling 120 original images. Two filters were applied to the original images-Sharpen filter (SF) and Edge Enhancement filter (EE), and brightness and contrast were adjusted in four combinations (B&C1 to 4), resulting in 840 images. Five oral radiologists analyzed the images for VRF detection. Pixel intensity was obtained in two regions from the radiographs. Diagnostic values were calculated and compared by two-way ANOVA, and the SD values of pixel intensity values were compared by one-way ANOVA (α = 0.05). RESULTS There were no significant differences in accuracy for VRF detection between the experimental groups (p > 0.05). Teeth with metal post presented the lowest sensitivity (p < 0.05) for all experimental conditions, except for SF and EE (p > 0.05). B&C2, B&C3, and B&C4 had higher specificity than SF (p ≤ 0.05) for all intracanal conditions. Analysis of pixel intensity showed that all enhanced images presented statistically significant higher noise compared to those of the original images (p ≤ 0.05). CONCLUSION Digital enhancement tools in digital radiography increase image noise; however, they can be used without compromising VRF detection. CLINICAL RELEVANCE The use of digital enhancement does not impair the detection of VRF and, therefore, can be applied for this purpose according to the observer preference.
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Digital subtraction radiography in detection of vertical root fractures: accuracy evaluation for root canal filling, fracture orientation and width variables. An ex-vivo study. Clin Oral Investig 2020; 24:3671-3681. [PMID: 32080760 DOI: 10.1007/s00784-020-03245-0] [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: 07/15/2019] [Accepted: 01/29/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Ex-vivo evaluation of the detectability of vertical root fractures (VRFs) using digital subtraction radiography (DSR) and conventional digital periapical radiography (CDPR); investigation of the effect of root canal filling, x-ray angulation, and thickness of the VRF in the diagnostic accuracy. MATERIALS AND METHODS Sixty root canals were mechanically prepared and radiographed either with a gutta-percha root canal filling or without, at 0o and ± 10o. VRFs were introduced with a universal testing machine. The width and angulation of the fracture line with the radiographic beam were calculated. DSR was performed comparing radiographs obtained prior to and after the VRF induction. Five examiners evaluated the resultant images and analysis was performed using receiver operator characteristic (ROC) statistics and binary logistic regression tests. RESULTS No significant differences in sensitivity, specificity, and the areas under the ROC curves (AUC) between the CDPR and DSR were detected (p > 0.05), except for root canal filled teeth where the AUC for DSR was higher (p < 0.05). Using DSR, a VRF was 1.3 times more likely to be diagnosed [95% confidence intervals (CI): 1.045-1.59; p = 0.018]. A correct diagnosis was 2.399 times more likely to occur in non-filled teeth regardless of the radiographic technique (95% CI 1.940-2.965; p = 0). The regression coefficients were positive for width and negative for angle. CONCLUSIONS DSR showed a better diagnostic accuracy of VRFs compared with CDPR, in single root canal filled teeth. The angulation, the width, and the presence of a root canal filling affected the diagnostic potential. CLINICAL RELEVANCE DSR is a cost- and time-effective imaging technique that could contribute in early diagnosis of VRFs.
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Yuan M, Gao AT, Wang TM, Liang JH, Aihemati GB, Cao Y, Xie X, Miao LY, Lin ZT. Using Meglumine Diatrizoate to improve the accuracy of diagnosis of cracked teeth on Cone-beam CT images. Int Endod J 2020; 53:709-714. [PMID: 31985061 DOI: 10.1111/iej.13270] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 01/18/2023]
Abstract
AIM To explore in a laboratory setting the feasibility of using Meglumine Diatrizoate (MD) to improve the accuracy of diagnosis of cracked teeth on cone-beam CT (CBCT) images. METHODOLOGY Twenty-four teeth were cracked artificially by soaking them cyclically in liquid nitrogen and hot water. The number and position of crack lines were evaluated with a dental operating microscope and used as the gold standard. The artificially cracked teeth were then examined using routine scanning (RS) and enhanced scanning (ES) modes, respectively. For the ES mode, MD was painted on the surface of the crack lines, and then, CBCT scanning with the same parameters was performed after 10 min. A radiological graduate student and an experienced radiologist evaluated the presence or absence of crack lines, respectively. The differences between the RS and ES modes were determined and assessed using McNemar's test. Inter-examiner agreement and intra-examiner agreement were assessed using kappa analysis. RESULTS Fifty-seven crack lines were found in the 24 cracked teeth. In the RS mode, the accuracy of detection of crack lines was 23% (radiological graduate student) and 32% (experienced radiologist), whereas in the ES mode, the accuracy was 61% (radiological graduate student) and 65% (experienced radiologist). The inter-examiner agreement was 0.693 in RS mode and 0.849 in ES mode. The intra-examiner agreement was 0.872 and 0.949 for the radiological graduate student in RS and ES mode respectively; and one for the experienced radiologist both in RS and ES mode. CONCLUSIONS Compared with routine scanning mode, more crack lines could be detected in enhanced scanning mode using Meglumine Diatrizoate as a contrast medium. MD could be a potential contrast medium to improve the accuracy of detection of crack lines on CBCT images.
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Affiliation(s)
- M Yuan
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - A T Gao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - T M Wang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - J H Liang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - G B Aihemati
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Y Cao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - X Xie
- Department of Stomatology, Third People's Hospital of Danyang City, Danyang, China
| | - L Y Miao
- Department of Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Z T Lin
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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Qi LY, Chen C, Jiang L, Li JN, Liang YH. [Construction of swept source optical coherence tomography imaging system for root canal endoscopy and application in diagnosis of root fractures]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:753-757. [PMID: 31420635 DOI: 10.19723/j.issn.1671-167x.2019.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To construct swept source optical coherence tomography (SS-OCT) imaging system for root canal endoscopy, and to evaluate the accuracy of diagnosing artificial root fractures. METHODS An ultra-high-speed (40 kHz) swept laser source was developed based on the piezoelectric tuning filter and the Fourier domain mode locking (FDML) swept laser technology (patent number: 200620135940.2). Ultra-miniature gradient index lens technology (patent number: 201320241218.7) was used to create a thin endoscopic probe with a diameter of 0.86 mm for real-time image transmission. The SS-OCT light source had a wavelength of 1 310 nm and a bandwidth of 100 nm. The axial and transverse image resolutions were 15 μm and 25 μm, respectively. Artificial fractures were created on human mandibular premolars with single root and the premolar roots were prepared to 41 horizontal sections (1 mm thick). 27 root sections with fractures (width: 52-284 μm) and 14 the sections without fractures were observed under an optical stereomicroscope with a cold light source as the gold standard. The horizontal root sections were scanned by self-developed SS-OCT imaging system for root canal endoscopy with a central wavelength of 1 310 nm and bandwidth of 100 nm. The data were reconstructed with 30 μm thick slices at an interval of 30 μm. Two observers, a radiologist and an endodontist, were trained and independently evaluated all the reconstructed images blindly. The diagnostic performance of SS-OCT imaging system was calculated, and statistical analysis was performed. RESULTS SS-OCT root canal endoscopic imaging system composed of high-speed swept laser source, fiber coupler, endoscopic probe, reference arm and differential detector. Root sections could be scanned by SS-OCT and imaged in realtime at a depth of 1 to 2 mm. The kappa value for interobserver agreement was 0.792, and the intraobserver agreement was 1.000 and 0.709 for two observers respectively. All of 27 fractured root sections and 12 of 14 root sections without fractures were accurately diagnosed while 2 unfractured root sections were misdiagnosed. The sensitivity was 1.000 and the specificity was 0.857 for diagnosis of artificial root fractures by SS-OCT. The positive predictive value (PPV), negative predictive value (NPV) and the overall accuracy rate were 0.931, 1.000 and 0.951 respectively. CONCLUSION The swept source optical coherence tomography imaging system for root canal endoscopy is a promising imaging method for observing root fractures..
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Affiliation(s)
- L Y Qi
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - C Chen
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing 100034, China
| | - L Jiang
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing 100034, China
| | - J N Li
- State Key Laboratory of Transient Optics and Photonics, Xian Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, Xian, Shanxi 710000, China
| | - Y H Liang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.,Department of Stomatology, Peking University International Hospital, Beijing 102206, China
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In Vivo Detection of Subtle Vertical Root Fracture in Endodontically Treated Teeth by Cone-beam Computed Tomography. J Endod 2019; 45:856-862. [DOI: 10.1016/j.joen.2019.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/27/2019] [Accepted: 03/13/2019] [Indexed: 11/20/2022]
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Byakova SF, Novozhilova NE, Makeeva IM, Grachev VI, Kasatkina IV. The detection of vertical root fractures in post-core restored teeth with cone-beam CT: in vivo and ex vivo. Dentomaxillofac Radiol 2019; 48:20180327. [PMID: 31095425 DOI: 10.1259/dmfr.20180327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the accuracy of cone-beam CT ex vivo and in vivo for the detection of artificially created large and small vertical root fractures in extracted teeth restored with post-core. METHODS Individual metal cast post-cores were fixed in the root canals of 50 extracted single-rooted human teeth. In 30 teeth fractures were created by tapping posts with a hammer. The teeth were sterilised in autoclave and embedded into bite-plates made of silicon impression material. Cone-beam CT scanning was performed ex vivo and in vivo . For the in vivo scanning, teeth in sterile plastic bags were inserted into the mouths of volunteers. Then the teeth were sectioned with low-speed saw and the widths of the VRFs were measured microscopically. The teeth were distributed into 2 groups in accordance with the measured fractures' widths: large (wider than 180-250 µm) and small (80-150 µm). Five observers assessed the presence of vertical root fractures on axial CBCT slices. Sensitivity, specificity, accuracy and inter examiner agreement were calculated. RESULTS The accuracy of cone-beam CT in vitro for large and small vertical root fractures detection was 0.56 and 0.40 respectively (p = 0.043). The sensitivity values were 0.53 and 0.27 for large and small vertical root fractures, respectively (p = 0.043). The visualisation of fracture lines in vivo was impossible in 90 % of cases, because of low image quality. Inter examiner reliability analysis showed κ values ranging from 0.02 to 0.54. CONCLUSIONS Fracture width affected the in vitro detectability of vertical root fractures by cone-beam CT in teeth with metal cast post-cores. The detectability of root fractures in vivo was decreased because of low image quality, making the assessment of sound tooth tissue impossible.
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Affiliation(s)
- Svetlana F Byakova
- Department of Therapeutic Dentistry, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Nina E Novozhilova
- Department of Therapeutic Dentistry, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Irina M Makeeva
- Department of Therapeutic Dentistry, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Vasiliy I Grachev
- Independent X-ray Diagnostic Laboratory, "3D Lab", Bolshaya Andronievskaya, Moscow, Russia
| | - Inna V Kasatkina
- A.N. Frumkin Institute of Physical Chemistry and Electrochemistry RAS, Moscow, Russia
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Byakova SF, Novozhilova NE, Makeeva IM, Grachev VI, Kasatkina IV. The accuracy of CBCT for the detection and diagnosis of vertical root fracturesin vivo. Int Endod J 2019; 52:1255-1263. [DOI: 10.1111/iej.13114] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/07/2019] [Indexed: 12/14/2022]
Affiliation(s)
- S. F. Byakova
- Department of Therapeutic Dentistry Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of the Russian Federation MoscowRussia
| | - N. E. Novozhilova
- Department of Therapeutic Dentistry Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of the Russian Federation MoscowRussia
| | - I. M. Makeeva
- Department of Therapeutic Dentistry Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of the Russian Federation MoscowRussia
| | - V. I. Grachev
- Independent X‐ray diagnostic laboratory “3D Lab” MoscowRussia
| | - I. V. Kasatkina
- A.N. Frumkin Institute of Physical Chemistry and Electrochemistry RAS Moscow Russia
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Guo XL, Li G, Zheng JQ, Ma RH, Liu FC, Yuan FS, Lyu PJ, Guo YJ, Yin S. Accuracy of detecting vertical root fractures in non‐root filled teeth using cone beam computed tomography: effect of voxel size and fracture width. Int Endod J 2019; 52:887-898. [PMID: 30661246 DOI: 10.1111/iej.13076] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/15/2019] [Indexed: 01/16/2023]
Affiliation(s)
- X. L. Guo
- Department of Oral and Maxillofacial Radiology Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - G. Li
- Department of Oral and Maxillofacial Radiology Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - J. Q. Zheng
- Center of Digital Dentistry & Department of Prosthodontics Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - R. H. Ma
- Department of Oral and Maxillofacial Radiology Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - F. C. Liu
- Department of Epidemiology and Biostatistics School of Public Health Peking University Beijing China
| | - F. S. Yuan
- Center of Digital Dentistry & Department of Prosthodontics Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - P. J. Lyu
- Center of Digital Dentistry & Department of Prosthodontics Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - Y. J. Guo
- Department of Stomatology Beijing Children's Hospital Capital Medical University Beijing China
| | - S. Yin
- Department of Oral and Maxillofacial Radiology Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
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Unexpected Complication Ten Years after Initial Treatment: Long-Term Report and Fate of a Maxillary Premolar Rehabilitation. Case Rep Dent 2018; 2018:3287965. [PMID: 30305964 PMCID: PMC6164210 DOI: 10.1155/2018/3287965] [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: 07/25/2018] [Accepted: 08/26/2018] [Indexed: 11/29/2022] Open
Abstract
Full-coverage restorations represent a well-known rehabilitation strategy for compromised posterior teeth; in the last years, new ceramic materials like zirconia have been introduced and widely adopted for the prosthetic management of molar and premolar areas. A long-term follow-up of a maxillary premolar rehabilitation using a veneered zirconia crown is presented; after ten years of uneventful clinical service of the tooth-restoration complex, a serious complication—namely, a vertical root fracture (VRF)—occurred. An extended time lapse (9 years) between the end of restorative procedures and development of symptoms due to VRF has been observed. On the other hand, a complete functional and esthetic integrity of the zirconia crown (without chippings or crack development) is documented along the follow-up period. Due to periodontal breakdown and severity of fracture, the premolar was extracted. The illustrations of our late failure, aetiological factors, and available data on the literature regarding VRF are addressed. Patients and clinicians should be aware of potential occurrences of some long-term, serious complications when dealing with previously treated and/or structurally weakened teeth. The development of a VRF might be unexpected and might occur many years after the end of tooth rehabilitation, despite adoption of contemporary restorative protocols and techniques.
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Ashmawy MS, Yamany I, Abou-Khalaf A, Farid MM, Rady M. Detection of simulated vertical root fractures; which is better multi-detector computed tomography or cone beam computed tomography? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Disappearance of Intracanal Medication: A Preliminary Clinical Finding from Retrospective Review of Teeth with Vertical Root Fracture. Eur Endod J 2017; 2:1-6. [PMID: 33403352 PMCID: PMC7757969 DOI: 10.14744/eej.2017.17035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/29/2017] [Accepted: 08/31/2017] [Indexed: 11/25/2022] Open
Abstract
Objective: The purpose of this article was to report the finding of the disappearance of intracanal medication as a supporting evidence of vertical root fracture (VRF) through non-surgical intervention. Methods: A retrospective review of the dental records of patients seen by an endodontist in a private endodontic office from September 2013 to September 2016 was conducted by the same endodontist. Cases that met the inclusion and exclusion criteria were assigned as the subjects of this study, and data were extracted from their clinical and radiographic records. Patient’s demographic features, pre-operative signs and symptoms, details of rendered clinical procedures, follow-up visits, clinical and radiographic findings were recorded. Seventeen teeth for which non-surgical exploratory re-treatment was initiated were included in this study. Calcium hydroxide-based intracanal medication was placed for 2-4 weeks. Obturation of the root canals was performed if the tooth showed improvement of clinical signs and symptoms. If not, a cone-beam computed tomography (CBCT) scan was proposed to the patient to rule out VRF. Results: After the non-surgical re-treatment was initiated, 13 teeth showed improvement of clinical symptoms and the re-treatment was therefore completed. The remaining 4 teeth presented with unresolved clinical presentations (deep pocket, presence of sinus tract and/or tender to percussion and palpation). Four teeth showed partial disappearance of intracanal medication where VRF was confirmed using CBCT in 3 teeth and with a conventional periapical (PA) radiograph in 1 tooth. Conclusion: The disappearance of intracanal medication during non-surgical intervention was often associated with VRF. Thus, this feature may serve as an aid in diagnosing VRF.
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Optimization of Tube Current in Cone-beam Computed Tomography for the Detection of Vertical Root Fractures with Different Intracanal Materials. J Endod 2017; 43:1668-1673. [DOI: 10.1016/j.joen.2017.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/01/2017] [Accepted: 04/02/2017] [Indexed: 01/28/2023]
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Influence of Intracanal Materials in Vertical Root Fracture Pathway Detection with Cone-beam Computed Tomography. J Endod 2017; 43:1170-1175. [DOI: 10.1016/j.joen.2017.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/31/2017] [Accepted: 02/12/2017] [Indexed: 11/21/2022]
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The effects of different restorative materials on the detection of approximal caries in cone-beam computed tomography scans with and without metal artifact reduction mode. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:392-400. [DOI: 10.1016/j.oooo.2016.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/26/2016] [Accepted: 11/22/2016] [Indexed: 11/20/2022]
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