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Alkandari FA, Alotaibi MK, Al-Qahtani S, Alajmi S. The use of guided tissue regeneration in endodontic Microsurgery: Setting a threshold. Saudi Dent J 2024; 36:461-465. [PMID: 38525183 PMCID: PMC10960144 DOI: 10.1016/j.sdentj.2023.12.005] [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: 06/26/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 03/26/2024] Open
Abstract
Aim We aimed to compare the radiographic outcomes of conventional and regenerative approaches in endodontic microsurgery (EMS) and set a critical defect size for healing in conventional and regenerative therapies. Methodology The study evaluated 53 root canal-treated teeth (33 patients) with periapical lesions. Among them, 19 teeth (35.8 %) were treated with regenerative treatment, whereas 34 teeth (64.1 %) were managed with the conventional approach. Conventional and regenerative approaches were performed by endodontic and periodontic residents under consultants' supervision. Healing was evaluated after a minimum period of 6 months by comparing pre- and post-operative cone-beam computed tomography (CBCT) findings. The radiographic interpretation was conducted by a single examiner who was not participating in the surgeries and was blind on the type of treatment prior to CBCT evaluation. New healing criteria were proposed owing to the limitations on the present criteria in evaluating endodontic surgery after regenerative treatment. Critical measurements were calculated for each approach based on periapical lesion dimensions. Results The regenerative approach presented significantly better healing than conventional treatment (mean, 1.21 and 1.59, respectively; p = 0.047). Based on the critical-point calculations, the conventional approach was effective in lesions of up to 3 mm depth and height, whereas the regenerative approach resulted in better healing rates in lesions with 3-9 mm depth and 3-6 mm height. Conclusions Performing the regenerative approach in EMS resulted in better healing rates than those of the conventional approach. The conventional approach is recommended for small periapical lesions, whereas the first had better results in larger lesions.
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Affiliation(s)
| | - Mazen K. Alotaibi
- Dental department, Periodontics Unit, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sami Al-Qahtani
- Dental department, Periodontics Unit, King Saud University, Riyadh, Saudi Arabia
| | - Samhan Alajmi
- Kuwait Board of Endodontics, Kuwait Institute for Medical Specialties, Kuwait
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Wang Z, Guo X, Chen C, Qin L, Meng L. Effect of field of view and voxel size on CBCT-based accuracy of dynamic navigation in endodontic microsurgery: an in vitro study. J Endod 2023:S0099-2399(23)00290-X. [PMID: 37269977 DOI: 10.1016/j.joen.2023.05.018] [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: 01/04/2023] [Revised: 04/20/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION This study aimed to evaluate the influence of field of view (FOV) and voxel size on the accuracy of dynamic navigation (DN)-assisted endodontic microsurgery (EMS). METHODS Nine sets of maxillary and mandibular three-dimensional-printed jaw models composed of 180 teeth were divided into nine groups with different FOVs (80 × 80 mm, 60 × 60 mm, and 40 × 40 mm) and voxel sizes (0.3, 0.16, and 0.08 mm). The endodontic DN system was used to plan and execute the EMS. The accuracy of the DN-EMS was represented by the platform deviation, end deviation, angular deviation, resection angle, and resection length deviation. Statistical analyses were performed using SPSS 24.0, and the significance level was set at p < 0.05. RESULTS The average platform, end, angular, resection angle, and resection length deviation were 0.69 ± 0.31 mm, 0.93 ± 0.44 mm, 3.47 ± 1.80°, 2.35 ± 1.76°, and 0.41 ± 0.29 mm, respectively. No statistically significant differences in accuracy were observed between the nine FOV and voxel size groups. CONCLUSION FOV and voxel size did not appear to play an important role in the accuracy of DN-EMS. Considering the image quality and radiation dose, it is reasonable to select a limited FOV (such as 40 × 40 mm and 60 × 60 mm) to cover only the registration device, involved teeth, and periapical lesion. The voxel size should be selected according to the required resolution and CBCT units.
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Affiliation(s)
- Zan Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China;; Department of Cariology and Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiaolong Guo
- Department of Oral Radiology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Chen Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China;; Department of Cariology and Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Li Qin
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China;; Department of Cariology and Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Liuyan Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China;; Department of Cariology and Endodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China;.
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Chan F, Brown LF, Parashos P. CBCT in contemporary endodontics. Aust Dent J 2023; 68 Suppl 1:S39-S55. [PMID: 37975281 DOI: 10.1111/adj.12995] [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] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
Cone-beam computed tomography (CBCT) is a three-dimensional imaging modality which can aid endodontic diagnosis and treatment planning. While there are guidelines available describing the indications, there are divergent philosophies on when this technology should be applied in clinical practice. This paper reviews the applications of CBCT including the clinical relevance of parameters which can be assessed, highlights the limitations of this technology, and provides guidance on how to maximise its clinical utility.
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Affiliation(s)
- F Chan
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| | - L F Brown
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| | - P Parashos
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
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Tay KX, Lim LZ, Goh BKC, Yu VSH. Influence of cone beam computed tomography on endodontic treatment planning: A systematic review. J Dent 2022; 127:104353. [PMID: 36349644 DOI: 10.1016/j.jdent.2022.104353] [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: 03/13/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this systematic review was to evaluate how treatment plans changed when cone beam computed tomography (CBCT) imaging was used in endodontic treatment decision-making. DATA Studies examining changes in clinicians' treatment plans with and without the use of CBCT were included. Risk of bias assessment was completed using a modification of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. SOURCES A systematic search was performed in PubMed, Embase, Scopus, Cochrane databases from inception to 14 September 2021. STUDY SELECTION The initial search identified 3379 titles and abstracts; 20 articles fulfilled inclusion and exclusion criteria for full text review. An additional three articles were identified through citation searching. Sixteen studies met inclusion and exclusion criteria for data extraction and analysis. Fifteen studies reported changes in treatment plan with CBCT imaging. Five studies reported changes in 45 - 66.7% of the cases but did not mention specific treatment options. Of the 11 remaining studies, 10 studies reported changes in 24.3 - 56% of cases and changes in treatment options, while one study reported no significant change in treatment plan after CBCT imaging was introduced. With CBCT imaging, clinicians were more likely to prescribe further intervention that included endodontic treatment and extractions. CONCLUSION Although the current evidence was heterogeneous, it was clear that CBCT offered more information than periapical radiography. This influenced endodontic treatment decision-making and in more complex cases, led to further intervention including non-surgical and surgical endodontic treatment and extractions. CLINICAL SIGNIFICANCE Additional information from CBCT imaging influenced endodontic treatment decision-making in the following situations: high difficulty cases, diagnosis of symptomatic teeth after failed root canal treatment, evaluation of periapical healing, pre-surgical treatment planning, and management of traumatised immature teeth and external cervical resorption.
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Affiliation(s)
- Kai-Xian Tay
- Department of Dental Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore; Discipline of Endodontics, Operative Dentistry & Prosthodontics, Faculty of Dentistry, National University of Singapore, 9 Lower Kent Ridge Road, 119085, Singapore
| | - Li Zhen Lim
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, 9 Lower Kent Ridge Road, 119085, Singapore.
| | - Benny Kwee Chien Goh
- Discipline of Endodontics, Operative Dentistry & Prosthodontics, Faculty of Dentistry, National University of Singapore, 9 Lower Kent Ridge Road, 119085, Singapore
| | - Victoria Soo Hoon Yu
- Discipline of Endodontics, Operative Dentistry & Prosthodontics, Faculty of Dentistry, National University of Singapore, 9 Lower Kent Ridge Road, 119085, Singapore
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Cotti E, Schirru E. Present status and future directions: Imaging techniques for the detection of periapical lesions. Int Endod J 2022; 55 Suppl 4:1085-1099. [PMID: 36059089 DOI: 10.1111/iej.13828] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
Diagnosing and treating apical periodontitis (AP) in an attempt to preserve the natural dentition, and to prevent the direct and indirect systemic effects of this condition, is the major goal in endodontics. Considering that AP is frequently asymptomatic, and is most often associated with a lesion in the periapex of the affected tooth, within the maxillary bones, imaging becomes of paramount importance for the diagnosis of the disease. The aim of this narrative review was to investigate the most relevant classic and current literature to describe which are, to date, the diagnostic imaging systems most reliable and advanced to achieve the early and predictable detection of AP, the best measures of the lesions and the disclosure of the different features of the disease. Dental panoramic tomography (DPT) is a classic exam, considered still useful to provide the basic diagnosis of AP in certain districts of the maxillary bones. Periapical radiographs (PRs) represent a valid routine examination, with few, known limitations. Cone-beam computed tomography (CBCT) is the only system that ensures the early and predictable detection of all periapical lesions in the jaws, with the minor risk of false positives. These techniques can be successfully implemented, with ultrasounds (USI) or magnetic resonance (MRI) imaging, exams that do not use ionising radiations. MRI and USI provide information on specific features of the lesions, like the presence and amount of vascular supply, their content and their relationship with the surrounding soft tissues, leading to differential diagnoses. Further, all the three-dimensional systems (CBCT, USI and MRI) allow the volumetric assessment of AP. Pioneering research on artificial intelligence is slowly progressing in the detection of periapical radiolucencies on DPTs, PRs and CBCTs, however, with promising results. Finally, it is established that all imaging techniques have to be associated with a thorough clinical examination and a good degree of calibration of the operator.
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Affiliation(s)
- Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Elia Schirru
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Diagnosis Efficacy of Cone-Beam Computed Tomography in Endodontics—A Systematic Review of High-Level-Evidence Studies. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12030938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: The integration of clinical inspection and diagnostic imaging forms the basis for endodontic diagnosis, decision making, treatment planning, and outcome assessments. In recent years, CBCT imaging has become a common diagnostic tool in endodontics. CBCT should only be used to ensure that the benefits to the patient exceed the risks. As such, our aim in this study was to evaluate the high level diagnostic efficacy studies and their risk of bias. Methods: A systematic search of the literature was conducted to identify studies evaluating the use of CBCT imaging in endodontics. The following databases were searched: Medline (PubMed), Scopus, and Cochrane Central. The identified studies were subjected to rigorous inclusion criteria. Studies considered as having a high efficacy level were then subjected to a risk of bias assessment using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Results: Initially, 1568 articles were identified for possible inclusion in the review. Following title and abstract assessment, duplicate removal, and a full-text evaluation, 22 studies were included. Of those studies, 2 had a low risk of bias and 20 had a high risk of bias. Six studies investigated non-surgical treatment, eight investigated surgical treatment, two investigated both non-surgical and surgical treatment, and six studies investigated diagnostic thinking or decision making. Conclusion: The evidence for the influence of CBCT on decision making and treatment outcomes in endodontics is predominantly based on studies with a high risk of bias.
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THE IMPACT OF CONE BEAM COMPUTED TOMOGRAPHY ON DIAGNOSTIC THINKING, TREATMENT OPTION, AND CONFIDENCE IN DENTAL TRAUMA CASES: A BEFORE-AND-AFTER STUDY. J Endod 2022; 48:320-328. [PMID: 34999095 DOI: 10.1016/j.joen.2021.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The aim of this study was to identify whether cone beam computed tomography (CBCT) affects endodontists' diagnostic thinking, treatment option, and confidence in dental trauma cases. METHODS Twelve endodontists reviewed fifteen dental trauma cases with clinical histories and periapical radiographs (PRs) and answered questions regarding their diagnostic thinking and treatment decisions and their confidence in both. One month later, the same participants reviewed the same cases and answered similar questionnaires with the aid of CBCT imaging. A statistical analysis of their responses was conducted. RESULTS Differences were observed in diagnostic thinking when using PR or CBCT (P<0.05) and use of PR was associated with higher number of "Unsure" answers to questions about diagnoses. After reviewing PR images, the approach most frequently endorsed was "Don't start conventional endodontic treatment and order CBCT," whereas the most common decision taken after analyzing the CBCT images was "Start conventional endodontic treatment". Clinical interventions were proposed more often when participants the participants evaluated the clinical case using CBCT than when using PR (P<0.05). The participants' degree of confidence in their diagnostic thinking was not different after analysis using PR or CBCT (P>0.05). However, there was a difference between PR and CBCT in participants' confidence in their treatment decisions (P<0.05). Participants who initially indicated a lack of confidence in their diagnosis or treatment option gained confidence when CBCT images were available. However, the inverse behavior was also observed for participants who were initially confident on the basis of PR (P<0.05). Participants who decided to start treatment after CBCT analysis were less confident than when using PR (P<0.05). CONCLUSIONS In dental trauma cases, CBCT influenced participants' diagnostic thinking and choice of treatment modality and affected their confidence in the decision-making process.
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Sharma G, Abraham D, Gupta A, Aggarwal V, Mehta N, Jala S, Chauhan P, Singh A. Comparison of healing assessments of periapical endodontic surgery using conventional radiography and cone-beam computed tomography: A systematic review. Imaging Sci Dent 2022; 52:1-9. [PMID: 35387097 PMCID: PMC8967488 DOI: 10.5624/isd.20210195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/03/2021] [Accepted: 10/11/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Garima Sharma
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Dax Abraham
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Namrata Mehta
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Sucheta Jala
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Parul Chauhan
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Arundeep Singh
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, Haryana, India
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Carrion SJ, Coelho MS, Soares ADJ, Frozoni M. Apical periodontitis in mesiobuccal roots of maxillary molars: influence of anatomy and quality of root canal treatment, a CBCT study. RESTORATIVE DENTISTRY & ENDODONTICS 2022; 47:e37. [DOI: 10.5395/rde.2022.47.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
| | - Marcelo Santos Coelho
- Department of Endodontic, São Leopoldo Mandic School of Dentistry, Campinas, SP, Brazil
| | | | - Marcos Frozoni
- Department of Endodontic, São Leopoldo Mandic School of Dentistry, Campinas, SP, Brazil
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Umer F, Javed F. Decompression strategy for critical-sized lesions: A case series and literature review. AUST ENDOD J 2021; 47:731-740. [PMID: 34145932 DOI: 10.1111/aej.12536] [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: 03/27/2021] [Revised: 04/23/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Critical-sized lesions are defined as the smallest sized intraosseous wound in a particular bone that will not heal spontaneously during the lifetime of that animal. These critical-sized entities pose a unique challenge in endodontics, where these lesions are most likely cystic, with dimensions extending over 10 mm. This paper describes a structured methodology to treat such cases whilst also highlighting inconsistencies and variability between practitioners regarding management of critical-sized lesions. The case series demonstrates that non-surgical root canal therapy followed by surgical decompression may be the treatment of choice for such pathosis. A 16 gauge nasogastric tube was used as a decompression device and sutured to surrounding mucosa. Healing was evaluated using both two- and three-dimensional radiographs. Decompression of critical-sized lesions would appear to be a reliable, conservative and an altogether complete procedure that may not warrant second-stage surgery.
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Affiliation(s)
- Fahad Umer
- Operative Dentistry, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Faizan Javed
- Operative Dentistry, Department of Surgery, Aga Khan University, Karachi, Pakistan
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Mota de Almeida FJ, Hassan D, Nasir Abdulrahman G, Brundin M, Romani Vestman N. CBCT influences endodontic therapeutic decision-making in immature traumatized teeth with suspected pulp necrosis: a before-after study. Dentomaxillofac Radiol 2021; 50:20200594. [PMID: 34086502 DOI: 10.1259/dmfr.20200594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To evaluate the impact of cone-beam computed tomography (CBCT) in endodontic therapeutic decision-making of immature traumatized teeth with suspected pulp necrosis. METHODS Over two years, consecutive patients with a dental trauma in their front teeth (apex >0.5 mm) and with suspected pulp necrosis based on clinical and radiographic findings were referred to a specialist clinic in Sweden. Fifteen patients aged 6-13 (18 teeth) were included and clinically examined by an endodontist. Intraoral radiographs and CBCT examinations were obtained. Five practitioners, three endodontists and two residents in endodontics, used these examinations to determine the most appropriate treatment for the 18 cases (all central incisors) on two occasions scheduled 19 weeks apart. On the first occasion, the practitioners had access to clinical information and the intraoral radiographs ('before' CBCT); on the second occasion, the practitioners had also access to a radiologist report and the CBCT images ('after' CBCT). Their treatment plans - no treatment, watchful waiting, endodontic orthograde treatment, or extraction - were made anonymously and independently. Results were analysed using descriptive statistics and Wilcoxon signed-rank test. RESULTS 'After' CBCT, practitioners changed treatment plans in 30% of the 90 assessments, 74% of which were more aggressive (p = 0.028). In 49% of the assessments, practitioners who chose the watchful and waiting treatment plan 'before' CBCT changed to a more aggressive therapy such as endodontic orthograde treatment and extraction 'after' CBCT (p = 0.005). CONCLUSION This study provides evidence that CBCT influences endodontic therapeutic decision-making regarding immature traumatised teeth with suspected pulp necrosis, chiefly when expectant management (i.e., watchful and waiting) was selected before access to CBCT.
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Affiliation(s)
| | - Dalya Hassan
- Department of Odontology, Umeå University, Umeå, Sweden
| | | | - Malin Brundin
- Department of Odontology, Umeå University, Umeå, Sweden
| | - Nelly Romani Vestman
- Department of Endodontics, Region of Västerbotten, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
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Yapp KE, Brennan P, Ekpo E. Endodontic disease detection: digital periapical radiography versus cone-beam computed tomography-a systematic review. J Med Imaging (Bellingham) 2021; 8:041205. [PMID: 33644251 PMCID: PMC7904533 DOI: 10.1117/1.jmi.8.4.041205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/28/2021] [Indexed: 02/01/2023] Open
Abstract
Purpose: To assess the comparative diagnostic performance of digital periapical (PA) radiography and cone-beam computed tomography (CBCT) imaging on endodontic disease detection and to provide study methodology and design recommendations for future studies comparing the diagnostic performance of imaging modalities on endodontic disease detection. Approach: A search of the Medline, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials databases was conducted. Studies that compared the performance of CBCT to digital PA radiography for detecting endodontic disease had an independent reference standard determining the presence of endodontic disease and conducted data analysis including either sensitivity, specificity, receiver operating characteristic (ROC) analysis or free response operating characteristic analysis were included. Of the 20,530 identified studies, only 3 fulfilled the inclusion criteria. Results: Most studies assessed for eligibility were excluded due to limitations and biases in study design-15 of 18 studies had no reference standard. Only one retrospective clinical study reported on the diagnostic performance of CBCT and showed a sensitivity of 86% and specificity of 26%. Two cadaver studies reported sensitivity ranging from 60% to 100%, specificity ranging from 79% to 100%, and an area under the ROC curve of 0.943 for CBCT. The reported sensitivity for digital PA radiography ranged from 27% to 60%, specificity was 99%, and the area under the ROC curve was 0.629. Conclusions: There is a lack of quality evidence and insufficient data to compare diagnostic performance of digital PA and CBCT imaging. This emphasizes the need for well-designed studies to inform clinicians about the relative diagnostic performance of these imaging modalities.
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Affiliation(s)
- Kehn E Yapp
- The University of Sydney, School of Health Sciences, Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, Australia
| | - Patrick Brennan
- The University of Sydney, School of Health Sciences, Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, Australia
| | - Ernest Ekpo
- The University of Sydney, School of Health Sciences, Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, Australia
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Kakavetsos VD, Markou ME, Tzanetakis GN. Assessment of Cone-beam Computed Tomographic Referral Reasons and the Impact of Cone-beam Computed Tomographic Evaluation on Decision Treatment Planning Procedure in Endodontics. J Endod 2020; 46:1414-1419. [DOI: 10.1016/j.joen.2020.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 12/24/2022]
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14
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do Carmo WD, Verner FS, Aguiar LM, Visconti MA, Ferreira MD, Lacerda MFLS, Junqueira RB. Missed canals in endodontically treated maxillary molars of a Brazilian subpopulation: prevalence and association with periapical lesion using cone-beam computed tomography. Clin Oral Investig 2020; 25:2317-2323. [PMID: 32875385 DOI: 10.1007/s00784-020-03554-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/26/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the prevalence of missed canals in endodontically treated maxillary molars through cone-beam computed tomography (CBCT) images and to verify their association with the presence of periapical lesions. MATERIAL AND METHODS Three oral radiologists evaluated 633 maxillary molars in CBCT exams regarding number of roots, number of root canals, number of missed canals, anatomic identification of missed canals, presence of periapical lesions, and root location of the periapical lesions. Data were statistically analyzed at a 5% significance level. RESULTS Descriptive statistical analysis showed that among 395 first molars, 218 had at least one missed canal, and 186 (46.5%) had a missed canal and periapical lesion simultaneously. Of these, 72.4% (134) of the missed canals were only mesiobuccal 2 (MB2). Among 238 s molars evaluated, 121 presented at least one missed canal, and 104 (43.6%) had a missed canal and periapical lesion simultaneously. Of these, 81.7% (85) of the missed canals were only MB2. The chi-squared test showed an association between the presence of missed canals and periapical lesions for 1st and 2nd maxillary molars. Teeth that presented a missed canal showed an odds ratio (OR) of 2.57 (p < 0.0001) of being associated with a periapical lesion. Missed canal occurrence was positively related to the number of root canals (z = 13.06, p < 0.0001), meaning when the number of root canals is higher, there is a higher probability of missed canal occurrence. According to the model calculated prediction, for a one-unit increase in the number of canals, the probability of missed canals increases by 4.22%. CONCLUSIONS It was concluded that MB2 was the most frequently missed canal, associated with the presence of periapical lesions in endodontically treated maxillary molars. CLINICAL RELEVANCE Professionals' negligence of anatomical root variations has been contributed to the high prevalence of missed canals, leading to failures in endodontic treatment. Their association with periapical lesion occurrence emphasizes the importance of correct detection and instrumentation of these canals.
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Affiliation(s)
- Weslley Duarte do Carmo
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), Av. Dr. Raimundo Rezende, 330, Centro, Sala 301, Governador Valadares, Minas Gerais, 35010-177, Brazil
| | - Francielle Silvestre Verner
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), Av. Dr. Raimundo Rezende, 330, Centro, Sala 301, Governador Valadares, Minas Gerais, 35010-177, Brazil
| | - Larisse Martins Aguiar
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), Av. Dr. Raimundo Rezende, 330, Centro, Sala 301, Governador Valadares, Minas Gerais, 35010-177, Brazil
| | - Maria Augusta Visconti
- School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Matheus Diniz Ferreira
- School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mariane Floriano Lopes Santos Lacerda
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), Av. Dr. Raimundo Rezende, 330, Centro, Sala 301, Governador Valadares, Minas Gerais, 35010-177, Brazil
| | - Rafael Binato Junqueira
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), Av. Dr. Raimundo Rezende, 330, Centro, Sala 301, Governador Valadares, Minas Gerais, 35010-177, Brazil.
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15
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Impact of Platelet-rich Plasma in the Healing of Through-and-through Periapical Lesions Using 2-dimensional and 3-dimensional Evaluation: A Randomized Controlled Trial. J Endod 2020; 46:1167-1184. [DOI: 10.1016/j.joen.2020.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022]
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16
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Rohlin M, Horner K, Lindh C, Wenzel A. Through the quality kaleidoscope: reflections on research in dentomaxillofacial imaging. Dentomaxillofac Radiol 2020; 49:20190484. [PMID: 31971827 DOI: 10.1259/dmfr.20190484] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The REduce research Waste And Reward Diligence statement has highlighted how weaknesses in health research can produce misleading results and waste valuable resources. Research on diagnostic efficacy in the field of dentomaxillofacial radiology (DMFR) is no exception to these criticisms and could be strengthened by more robust study designs, consistent use of a core set of outcome measures and completeness in reporting. Furthermore, we advocate that everyone participating in collaborative research on clinical interventions subscribes to the importance of methodological quality in how imaging methods are used. The aim of this paper, therefore, is to present a guide to conducting high-quality research on diagnostic efficacy in DMFR.We initially propose a framework inspired by the hierarchical model of efficacy of Fryback and Thornbury, highlighting study designs, measures of analysis, completeness of reporting and established guidelines to assist in these aspects of research. Bias in research, and measures to prevent or limit it, are then described.It is desirable to climb the Fryback and Thornbury "ladder" from technical efficacy, via accuracy and clinical efficacy, to societal efficacy of imaging methods. Efficacy studies on the higher steps of the ladder may be difficult to perform, but we must strive to answer questions of how useful our methods are in patient management and assess benefits, risks, costs, ethical and social issues. With the framework of six efficacy levels as the structure and based on our experience, we present information that may facilitate quality enhancement of diagnostic efficacy research in DMFR.
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Affiliation(s)
| | - Keith Horner
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, UK
| | | | - Ann Wenzel
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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17
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Huang S, Chen NN, Yu VS, Lim HA, Lui JN. Long-term Success and Survival of Endodontic Microsurgery. J Endod 2020; 46:149-157.e4. [DOI: 10.1016/j.joen.2019.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/02/2019] [Accepted: 10/25/2019] [Indexed: 12/28/2022]
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18
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Popowicz W, Palatyńska-Ulatowska A, Kohli MR. Targeted Endodontic Microsurgery: Computed Tomography–based Guided Stent Approach with Platelet-rich Fibrin Graft: A Report of 2 Cases. J Endod 2019; 45:1535-1542. [DOI: 10.1016/j.joen.2019.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 08/15/2019] [Accepted: 08/24/2019] [Indexed: 12/29/2022]
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19
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Mota de Almeida FJ, Flygare L, Knutsson K, Wolf E. ‘Seeing is believing’: a qualitative approach to studying the use of cone beam computed tomography in endodontics in Sweden. Int Endod J 2019; 52:1519-1528. [DOI: 10.1111/iej.13144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022]
Affiliation(s)
| | - L. Flygare
- Department of Radiation Sciences Umeå University UmeåSweden
| | - K. Knutsson
- Department of Oral‐and‐Maxillofacial Radiology Malmö University MalmöSweden
| | - E. Wolf
- Department of Endodontics, Faculty of Odontology Malmö University Malmö Sweden
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