1
|
Mareque-Bueno MS, Nagendrababu V, Dummer PMH, Ruíz-Piñón M, Arias-Moliz T, Uroz-Torres D, Garrido-Parada S, Martín-Biedma B, Castelo-Baz P. A retrospective clinical study to compare the ability of cone-beam computed tomographic images and periapical radiographs to reveal cracked teeth, split teeth, and teeth with vertical root fractures. J Am Dent Assoc 2024:S0002-8177(24)00212-5. [PMID: 38795077 DOI: 10.1016/j.adaj.2024.04.009] [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: 02/27/2024] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND This retrospective clinical study aimed to compare the sensitivity of cone-beam computed tomographic (CBCT) images and periapical (PA) radiographs to reveal cracked teeth, split teeth, and teeth with vertical root fractures (VRFs). METHODS The authors included 98 patients (98 teeth) diagnosed with a longitudinal tooth fracture (LTF) (cracked tooth, split tooth, VRF) through direct visualization after extraction and with comprehensive clinical and radiographic records. They collected demographic, clinical, and radiographic data. The authors evaluated PA radiographs and CBCT images to identify fractures, fracture lines, and the different patterns of bone loss associated with these teeth. They used the McNemar test to compare PA radiographs and CBCT scans when assessing bone loss. They used the Fisher test to determine statistical relationships between fracture types and demographic, clinical, and radiologic traits. They used an analysis of variance test to compare patient age with fracture types. RESULTS CBCT images were significantly more effective (P < .05) in detecting bone loss patterns associated with LTFs than with PA radiographs, with 71% of cases detected via CBCT images compared with 42% via radiographs. Mean age was significantly greater (P < .05) in patients with teeth with VRFs than in patients with split teeth. A significant relationship was observed between the type of fracture and the following variables: root canal treatment (split, VRF, P = .002), deep probing depth (≥ 5 mm) (VRF, P = .026), and having more than 8 teeth extracted from the mouth (VRF, P = .032). Overall, there was a significant difference (P < .001) between the visualization of fracture lines (45% on PA radiographs, 65% on CBCT images). CONCLUSIONS CBCT scans provided more information on LTFs than PA radiographs, particularly in the identification of periradicular bone changes. PRACTICAL IMPLICATIONS CBCT imaging can assist in making the clinical diagnosis of LTFs through observation of bone loss patterns, providing more information than PA radiographs.
Collapse
|
2
|
Ruiz DC, Reis LDO, Fontenele RC, Miranda-Viana M, Farias-Gomes A, Freitas DQ. Influence of an adjacent zirconium implant, tube current, and metal artifact reduction algorithm on horizontal root fracture diagnosis in cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:190-198. [PMID: 37940483 DOI: 10.1016/j.oooo.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE We evaluated the influence of an adjacent zirconium implant, tube current (mA), and a metal artifact reduction algorithm (MARA) on horizontal root fracture (HRF) diagnosis in cone beam computed tomography (CBCT). STUDY DESIGN Nineteen teeth (9 with HRF, 10 without) were individually placed in a human maxilla. Scan volumes were acquired without and with a zirconium implant adjacent to the tooth at settings of 4, 8, and 10 mA, with MARA disabled and enabled, using a 5×5 cm field of view, 0.085-mm voxel size, and 90 kV. Four maxillofacial radiologists individually assessed the scans. Diagnostic metrics were compared by multiway analysis of variance (α=5%). Inter- and intraexaminer agreements for HRF diagnosis were evaluated with the weighted kappa test. RESULTS Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were significantly lower in the presence of the implant (P≤.005). AUC values were higher in scans obtained with 8 and 10 mA compared with 4 mA (P=0.010), but 10 mA without MARA was better with the implant present. MARA did not significantly influence outcomes (P≥0.240). Inter- and intraexaminer agreements ranged from moderate to almost perfect. CONCLUSIONS The presence of the zirconium implant impairs HRF detection. Settings of 8 or 10 mA improve HRF detection regardless MARA condition without the implant. With an adjacent implant, 10 mA without MARA is recommended to improve diagnostic performance.
Collapse
Affiliation(s)
- Débora Costa Ruiz
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil.
| | - Larissa de Oliveira Reis
- Department of Dentistry, Federal University of Juiz de Fora Campus Governador Valadares, Governador Valadares, MG, Brazil
| | - Rocharles Cavalcante Fontenele
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Murilo Miranda-Viana
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Amanda Farias-Gomes
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| |
Collapse
|
3
|
Merken K, Monnens J, Marshall N, Johan N, Brasil DM, Santaella GM, Politis C, Jacobs R, Bosmans H. Development and validation of a 3D anthropomorphic phantom for dental CBCT imaging research. Med Phys 2023; 50:6714-6736. [PMID: 37602774 DOI: 10.1002/mp.16661] [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: 01/05/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Optimization of dental cone beam computed tomography (CBCT) imaging is still in a preliminary stage and should be addressed using task-based methods. Dedicated models containing relevant clinical tasks for image quality studies have yet to be developed. PURPOSE To present a methodology to develop and validate a virtual adult anthropomorphic voxel phantom for use in task-based image quality optimization studies in dental CBCT imaging research, focusing on root fracture (RF) detection tasks in the presence of metal artefacts. METHODS The phantom was developed from a CBCT scan with an isotropic voxel size of 0.2 mm, from which the main dental structures, mandible and maxilla were segmented. The missing large anatomical structures, including the spine, skull and remaining soft tissues, were segmented from a lower resolution full skull scan. Anatomical abnormalities were absent in the areas of interest. Fine detailed dental structures, that could not be segmented due to the limited resolution and noise in the clinical data, were modelled using a-priori anatomical knowledge. Model resolution of the teeth was therefore increased to 0.05 mm. Models of RFs as well as dental restorations to create the artefacts, were developed, and could be inserted in the phantom in any desired configuration. Simulated CBCT images of the models were generated using a newly developed multi-resolution simulation framework that incorporated the geometry, beam quality, noise and spatial resolution characteristics of a real dental CBCT scanner. Ray-tracing and Monte Carlo techniques were used to create the projection images, which were reconstructed using the classical FDK algorithm. Validation of the models was assessed by measurements of different tooth lengths, the pulp volume and the mandible, and comparison with reference values. Additionally, the simulated images were used in a reader study in which two oral radiologists had to score the realism level of the model's normal anatomy, as well as the modelled RFs and restorations. RESULTS A model of an adult head, as well as models of RFs and different types of dental restorations were created. Anatomical measurements were consistent with ranges reported in literature. For the tooth length measurements, the deviations from the mean reference values were less than 20%. In 77% of all the measurements, the deviations were within 10.1%. The pulp volumes, and mandible measurements were within one standard deviation of the reference values. Regarding the normal anatomy, both readers considered the realism level of the dental structures to be good. Background structures received a lower realism score due to the lack of detailed enough trabecular bone structure, which was expected but not the focus of this study. All modelled RFs were scored at least adequate by at least one of the readers, both in appearance and position. The realism level of the modelled restorations was considered to be good. CONCLUSIONS A methodology was proposed to develop and validate an anthropomorphic voxel phantom for image quality optimization studies in dental CBCT imaging, with a main focus on RF detection tasks. The methodology can be extended further to create more models representative of the clinical population.
Collapse
Affiliation(s)
- Karen Merken
- Department of Imaging and Pathology, Division of Medical Physics & Quality Assessment, KU Leuven, Leuven, Belgium
| | - Janne Monnens
- Department of Imaging and Pathology, Division of Medical Physics & Quality Assessment, KU Leuven, Leuven, Belgium
| | - Nicholas Marshall
- Department of Imaging and Pathology, Division of Medical Physics & Quality Assessment, KU Leuven, Leuven, Belgium
| | - Nuyts Johan
- Department of Imaging and Pathology, Division of Nuclear Medicine & Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Danieli Moura Brasil
- Department of Diagnosis and Oral Health, School of Dentistry, University of Louisville, Louisville, Kentucky, USA
| | - Gustavo Machado Santaella
- Department of Diagnosis and Oral Health, School of Dentistry, University of Louisville, Louisville, Kentucky, USA
| | - Constantinus Politis
- Department of Imaging and Pathology, Division of Oral and Maxillofacial Surgery, KU Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Department of Imaging and Pathology, Division of Oral and Maxillofacial Surgery, KU Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Hilde Bosmans
- Department of Imaging and Pathology, Division of Medical Physics & Quality Assessment, KU Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Bai B, Tang Y, Wu Y, Pei F, Zhu Q, Zhu P, Gu Y. Ex vivo detection of mandibular incisors' root canal morphology using cone-beam computed tomography with 4 different voxel sizes and micro-computed tomography. BMC Oral Health 2023; 23:656. [PMID: 37689620 PMCID: PMC10492267 DOI: 10.1186/s12903-023-03376-2] [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: 04/23/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND In recent years, cone-beam computed tomography (CBCT) has been widely used to evaluate patients' root canal anatomy due to its high resolution and noninvasive nature. As voxel size is one of the most important parameters affecting CBCT image quality, the current study evaluated the diagnostic potential of CBCT with 4 different voxel sizes in the detection of double root canal systems and accessory canals (ACs) in permanent mandibular incisors. METHODS A total of 106 extracted mandibular permanent incisors were collected from the dental clinics, and then were scanned by using micro-CT with a voxel size of 9 μm. The teeth were then fixed in the tooth sockets of human dry mandibles and scanned by using a CBCT device with 4 different voxel sizes (300, 200, 250, and 125 μm). Four observers detected in blind the root canal morphology of the teeth according to the CBCT images, and the presence or absence of a double root canal system, and the presence or absence of ACs, were scored according to a 5-point scale, respectively. Receiver operating characteristic (ROC) analysis was performed, and DeLong test was used to compare the area under the curve (AUC) values and the micro-CT data was taken as a gold standard. RESULTS Among 106 sample teeth, 25 specimens with a double root canal system were identified by the micro-CT. ROC curve analysis of the data obtained by the four observers showed that in the detection of double root canal systems, the AUC values ranged from 0.765 to 0.889 for 300 μm voxel size, from 0.877 to 0.926 for 250 μm voxel size, from 0.893 to 0.967 for 200 μm voxel size, and from 0.914 to 0.967 for 125 μm voxel size (all p < 0.01). In general, we observed a trend that the AUC values, sensitivity, and specialty increased with the decrease in the voxel size, and significantly higher AUC values were detected in 125 μm voxel size images. In the detection of ACs, ROC curve analysis showed that among the four observers, the AUC values ranged from 0.554 to 0.639 for 300 μm voxel size, from 0.532 to 0.654 for 250 μm voxel size, from 0.567 to 0.626 for 200 μm voxel size, and from 0.638 to 0.678 for 125 μm voxel size. CBCT images at a voxel size of 125 μm had a weak diagnostic potential (AUC: 0.5-0.7, all p < 0.05) in the detection of AC, with a lower sensitivity ranging from 36.8 to 57.9% and a higher specialty ranging from 73.6 to 98.8%. CONCLUSIONS CBCT with 300 μm voxel size could only provide moderate diagnostic accuracy in the detection of a double canal system in mandibular incisors. CBCT with a voxel size of 125 μm exhibited high diagnostic value in the detection of double canal systems, while showing low but statistically significant value in the detection of ACs.
Collapse
Affiliation(s)
- Bingbing Bai
- The Stomatology Hospital Affiliated of Suzhou Vocational Health College, Renmin Road 829#, Gusu Dist, Suzhou, 215002, China
| | - Ying Tang
- Department of Central Laboratory and Dentistry, Ninth People's Hospital of Suzhou, Soochow University, Ludang Road 2666#, Wujiang Dist, Suzhou, 215200, China
| | - Yihan Wu
- Department of Central Laboratory and Dentistry, Ninth People's Hospital of Suzhou, Soochow University, Ludang Road 2666#, Wujiang Dist, Suzhou, 215200, China
| | - Fan Pei
- Department of Central Laboratory and Dentistry, Ninth People's Hospital of Suzhou, Soochow University, Ludang Road 2666#, Wujiang Dist, Suzhou, 215200, China
| | - Qi Zhu
- Department of Central Laboratory and Dentistry, Ninth People's Hospital of Suzhou, Soochow University, Ludang Road 2666#, Wujiang Dist, Suzhou, 215200, China
| | - Peng Zhu
- The Stomatology Hospital Affiliated of Suzhou Vocational Health College, Renmin Road 829#, Gusu Dist, Suzhou, 215002, China
| | - Yongchun Gu
- Department of Central Laboratory and Dentistry, Ninth People's Hospital of Suzhou, Soochow University, Ludang Road 2666#, Wujiang Dist, Suzhou, 215200, China.
| |
Collapse
|
5
|
Kolsuz ME, Evli C, Aksoy U, Koohnavard M, Aksoy S, Orhan K. Influence of voxel size and filter type on detecting vertical root fracture using cone-beam computed tomography. AUST ENDOD J 2023; 49 Suppl 1:439-446. [PMID: 37133318 DOI: 10.1111/aej.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/25/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
Vertical root fractures (VRFs) can start at any level of the root and progress longitudinally to the coronal attachment. This study aimed to investigate the effects of different exposure parameters used when obtaining CBCT scans in detecting simulated VRFs. Hence, 80 intact human mandibular single-rooted pre-molar teeth without root fractures were included in the study. No statistically significant difference was found between the filters in terms of VRF detection in the group with the roots with only root canal filling (Groups 1 and 5); however, 100 voxels were found to be more successful in terms of VRF detection than other voxel sizes. Results of this study suggest that using lower voxel sizes leads to an accurate diagnosis of vertical root fracture, in addition, our results revealed that using AR filters did not improve the diagnostic accuracy in detecting VRFs.
Collapse
Affiliation(s)
- Mehmet Eray Kolsuz
- Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
| | - Cengiz Evli
- Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
| | - Umut Aksoy
- Department of Endodontics, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | | | - Seçil Aksoy
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
- Department of Dental and Maxillofacial Radiodiagnostics, Medical University of Lublin, Lublin, Poland
- Ankara University Medical Design Application and Research Center (MEDITAM), Ankara, Turkey
| |
Collapse
|
6
|
Cao D, Zhang P, Gao A, Gulibire A, Xie X, Liang J, Hu Z, Yin W, Lin Z. Development of a predictive model for identifying previously undetected vertical root fractures. AUST ENDOD J 2023; 49:302-310. [PMID: 35861533 DOI: 10.1111/aej.12667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to develop a predictive model to screen for undetected vertical root fractures (VRFs) in root canal treated teeth. We included 95 root canal treated teeth with suspected VRFs; 77 for training and 18 for validation. Following clinical and cone-beam CT parameters were recorded: sex, tooth type, coronal restoration, time interval from completion of endodontic treatment to definitive diagnosis (TI), type of bone loss (BL), apical extent of root filling (AR) and the ratio of root filling diameter to the actual diameter in the coronal (1/3TA) and middle (2/3TA) root thirds. A predictive model p = 1/(1 - e-x ) was generated, where x = -7.433 + 1.977BL + 1.479 (2/3TA) + 1.102 AR; the sensitivity and specificity were 0.852 and 0.875 for training and 0.917 and 0.833 for validation. VRF teeth were more likely to have vertical bone loss and overfilled root canals. This model had a high diagnostic efficacy for VRFs.
Collapse
Affiliation(s)
- Dantong Cao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Peng Zhang
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Antian Gao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Aihemaiti Gulibire
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xin Xie
- Department of Stomatology, Third People's Hospital of Danyang City, Danyang, China
| | - Jiahao Liang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ziyang Hu
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weiwei Yin
- Nantong Stomatological Hospital, Nantong, China
| | - Zitong Lin
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| |
Collapse
|
7
|
Smith RJR, McColl E, Bryce GE. Top tips for managing enamel infractions, cracks and fractures - Part 1: Diagnosis. Br Dent J 2023; 234:787-790. [PMID: 37291292 DOI: 10.1038/s41415-023-5984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- R J R Smith
- Enhanced Practitioner, Defence Centre for Rehabilitative Dentistry, Evelyn Woods Road, Aldershot, GU11 2LS, United Kingdom.
| | - E McColl
- Director of Clinical Dentistry, Peninsula Dental School (University of Plymouth), Plymouth, United Kingdom.
| | - G E Bryce
- Consultant in Restorative Dentistry, Defence Centre for Rehabilitative Dentistry, Evelyn Woods Road, Aldershot, GU11 2LS, United Kingdom.
| |
Collapse
|
8
|
Image quality for visualization of cracks and fine endodontic structures using 10 CBCT devices with various scanning protocols and artefact conditions. Sci Rep 2023; 13:4001. [PMID: 36899046 PMCID: PMC10006407 DOI: 10.1038/s41598-023-31099-5] [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: 07/19/2022] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
The aim of this study was to evaluate CBCT exposure protocols and CBCT devices in terms of image quality for the detection of cracks and fine endodontic structures using 3 conditions of metallic artifacts. An anthropomorphic phantom containing teeth with cracks, isthmus, narrow canal, and apical delta was scanned using ten CBCT devices. A reference industrial CT image was used to detect and measure all structures. Three conditions were created: (1) metal-free, (2) 'endo' and (3) 'implant' with metallic objects placed next to the teeth of interest. For each condition, three protocols were selected: medium field of view (FOV) standard resolution, small FOV standard and high resolution. The results showed that only small FOV high-resolution metal-free images from two devices (A and H) were appropriate to visualize cracks. For fine structure identification, the best result was observed for small FOV high resolution. However, the visualization significantly worsened in the presence of metallic artefacts. The ability of CBCT images for visualizing cracks is restricted to certain CBCT devices. Once metallic artefacts are present, crack detection becomes unlikely. Overall, small FOV high-resolution protocols may allow detection of fine endodontic structures as long as there are no high-dense objects in the region of interest.
Collapse
|
9
|
de Lima KL, Silva LR, de Paiva Prado TB, Silva MAG, de Freitas Silva BS, Yamamoto-Silva FP. Influence of the technical parameters of CBCT image acquisition on vertical root fracture diagnosis: a systematic review and meta-analysis. Clin Oral Investig 2023; 27:433-474. [PMID: 36700991 DOI: 10.1007/s00784-022-04797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/14/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To evaluate the influence of image acquisition parameters (voxel, FOV, kVp, mA) on the accuracy of cone-beam computed tomography (CBCT) in detecting vertical root fracture (VRF). MATERIAL AND METHODS Searches were performed in 6 main databases and the gray literature, without restrictions of language or date. Observational clinical studies (OCS) and in vitro-extracted teeth (IV) studies were considered eligible for inclusion when investigating the accuracy (sensitivity, specificity) of CBCT in detecting VRF in human teeth. The risk of bias was assessed using QUADAS-2, and a meta-analysis was performed using Review Manager v5.4 software and Jamovi software v1.6. RESULTS A total of 60 out of 132 articles was included after fulfilling the eligibility criteria. Of these, 54 were IV studies while 6 were OCS. In the IV studies, it was seen that smaller FOV sizes tended to present higher accuracy values. The meta-analysis of the 6 OCS showed that the overall sensitivity and specificity values for 0.08 mm and 0.1 mm voxels were greater (0.84 and 0.79, respectively) than the sensitivity and specificity values for 0.125 mm and 0.2 mm voxels (0.70 and 0.55, respectively). CONCLUSIONS Despite the uncertain risk of bias found for the IV and OCS studies, smaller voxel and FOV sizes seem to provide more accurate VRF detection values when using CBCT. CLINICAL RELEVANCE This information is crucial for supporting the clinician when prescribing CBCT in cases of a clinical suspicion of VRF, and contributes to the personalization of the CBCT prescription, thereby ensuring greater accuracy in the VRF diagnosis. Registration This protocol was registered at the PROSPERO database (International Prospective Register of Systematic Review) under registration number CRD42020210118.
Collapse
Affiliation(s)
- Kaique Leite de Lima
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Lorena Rosa Silva
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | | | - Maria Alves Garcia Silva
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Brunno Santos de Freitas Silva
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil. .,University of Anápolis, Anápolis, GO, Brazil.
| | - Fernanda Paula Yamamoto-Silva
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil.,University of Anápolis, Anápolis, GO, Brazil
| |
Collapse
|
10
|
Yang P, Guo X, Mu C, Qi S, Li G. Detection of vertical root fractures by cone-beam computed tomography based on deep learning. Dentomaxillofac Radiol 2023; 52:20220345. [PMID: 36802858 PMCID: PMC9944014 DOI: 10.1259/dmfr.20220345] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES This study aims to evaluate the performance of ResNet models in the detection of in vitro and in vivo vertical root fractures (VRF) in Cone-beam Computed Tomography (CBCT) images. METHODS A CBCT image dataset consisting of 28 teeth (14 intact and 14 teeth with VRF, 1641 slices) from 14 patients, and another dataset containing 60 teeth (30 intact and 30 teeth with VRF, 3665 slices) from an in vitro model were used for the establishment of VRFconvolutional neural network (CNN) models. The most popular CNN architecture ResNet with different layers was fine-tuned for the detection of VRF. Sensitivity, specificity, accuracy, PPV (positive predictive value), NPV (negative predictive value), and AUC (the area under the receiver operating characteristic curve) of the VRF slices classified by the CNN in the test set were compared. Two oral and maxillofacial radiologists independently reviewed all the CBCT images of the test set, and intraclass correlation coefficients (ICCs) were calculated to assess the interobserver agreement for the oral maxillofacial radiologists. RESULTS The AUC of the models on the patient data were: 0.827(ResNet-18), 0.929(ResNet-50), and 0.882(ResNet-101). The AUC of the models on the mixed data get improved as:0.927(ResNet-18), 0.936(ResNet-50), and 0.893(ResNet-101). The maximum AUC were: 0.929 (0.908-0.950, 95% CI) and 0.936 (0.924-0.948, 95% CI) for the patient data and mixed data from ResNet-50, which is comparable to the AUC (0.937 and 0.950) for patient data and (0.915 and 0.935) for the mixed data obtained from the two oral and maxillofacial radiologists, respectively. CONCLUSIONS Deep-learning models showed high accuracy in the detection of VRF using CBCT images. The data obtained from the in vitro VRF model increases the data scale, which is beneficial to the training of deep-learning models.
Collapse
Affiliation(s)
| | | | | | - Senrong Qi
- Department of Oral and Maxillofacial Radiology, Beijing Stomatology Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Gang Li
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center 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 & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| |
Collapse
|
11
|
Diagnosis of cracked tooth: Clinical status and research progress. JAPANESE DENTAL SCIENCE REVIEW 2022; 58:357-364. [PMID: 36425316 PMCID: PMC9678967 DOI: 10.1016/j.jdsr.2022.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
Cracked tooth is a common dental hard tissue disease.The involvement of cracks directly affects the selection of treatment and restoration of the affected teeth.It is helpful to choose more appropriate treatment options and evaluate the prognosis of the affected tooth accurately to determine the actual involvement of the crack.However, it is often difficult to accurately and quantitatively assess the scope of cracks at present.So it is necessary to find a real method of early quantitative and non-destructive crack detection.This article reviews the current clinical detection methods and research progress of cracked tooth in order to provide a reference for finding a clinical detection method for cracked tooth.
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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]
|
14
|
Andraws Yalda F, Theodorakou C, Clarkson RJ, Davies J, Feinberg L, Sengupta A, Horner K. Determination of a cone-beam CT low-dose protocol for root fracture diagnosis in non-endodontically treated anterior maxillary teeth. Dentomaxillofac Radiol 2022; 51:20210138. [PMID: 34494874 PMCID: PMC8802703 DOI: 10.1259/dmfr.20210138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine a "low-dose protocol" which provides acceptable diagnostic accuracy for detection of root fractures in unrestored anterior maxillary teeth, using an ex vivo model. METHODS 48 maxillary anterior teeth, half with horizontal or oblique root fractures, were imaged using CBCT in an anthropomorphic model. Nine X-ray exposure combinations were used, including the manufacturer's standard ("reference") exposure and high-resolution settings ("HiRes"), by varying kV, exposure time, and rotation angle. Measurements of Dose Area Product (DAP) were recorded. Five dental radiologists assessed the scans for root fractures and judged image quality. Parameters of diagnostic accuracy were calculated, including area under the Receiver Operating Characteristic curve (Az). Objective measures of image quality were made at the same exposure combinations using an image quality phantom. RESULTS Although there was a significant linear relationship between DAP and mean Az, only the lowest DAP exposure combination had a mean Az significantly different to the reference exposure. There was no significant effect on other diagnostic accuracy parameters when using HiRes compared with the reference exposure. There was a significant positive relationship between DAP and contrast resolution. HiRes did not significantly improve contrast resolution and made a small improvement to spatial resolution. CONCLUSIONS Scope existed for radiation dose reduction compared with the manufacturer's guidance. There was no improvement in diagnostic accuracy using HiRes settings. A cautious recommendation for this CBCT machine is that it is possible to achieve a dose reduction of about 20% compared with the reference exposure parameters.
Collapse
Affiliation(s)
| | - Chrysoula Theodorakou
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rosalyn J Clarkson
- Department of Radiology, Leeds Dental Institute, Clarendon Way, Leeds, UK
| | - Jonathan Davies
- Department of Dental Radiological Imaging, Guy's and St Thomas' NHS FoundationTrust, Guy's Hospital, London, UK
| | - Lee Feinberg
- Department of Radiology, Kings College Hospital, London, UK
| | - Anita Sengupta
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine andHealth, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Keith Horner
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine andHealth, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
15
|
Wang AHT, Panzarella FK, Fontana CE, Junqueira JLC, da Silveira Bueno CE. Effect of cone-beam computed tomography metal artefact reduction on incomplete subtle vertical root fractures. Imaging Sci Dent 2022; 53:11-19. [PMID: 37006793 PMCID: PMC10060756 DOI: 10.5624/isd.20220106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose This study compared the accuracy of detection of incomplete vertical root fractures (VRFs) in filled and unfilled teeth on cone-beam computed tomography images with and without a metal artefact reduction (MAR) algorithm. Materials and Methods Forty single-rooted maxillary premolars were selected and, after endodontic instrumentation, were categorized as unfilled teeth without fractures, filled teeth without fractures, unfilled teeth with fractures, or filled teeth with fractures. Each VRF was artificially created and confirmed by operative microscopy. The teeth were randomly arranged, and images were acquired with and without the MAR algorithm. The images were evaluated with OnDemand software (Cybermed Inc., Seoul, Korea). After training, 2 blinded observers each assessed the images for the presence and absence of VRFs 2 times separated by a 1-week interval. P-values<0.05 were considered to indicate significance. Results Of the 4 protocols, unfilled teeth analysed with the MAR algorithm had the highest accuracy of incomplete VRF diagnosis (0.65), while unfilled teeth reviewed without MAR were associated with the least accurate diagnosis (0.55). With MAR, an unfilled tooth with an incomplete VRF was 4 times more likely to be identified as having an incomplete VRF than an unfilled tooth without this condition, while without MAR, an unfilled tooth with an incomplete VRF was 2.28 times more likely to be identified as having an incomplete VRF than an unfilled tooth without this condition. Conclusion The use of the MAR algorithm increased the diagnostic accuracy in the detection of incomplete VRF on images of unfilled teeth.
Collapse
Affiliation(s)
- Andréa Huey Tsu Wang
- Division of Endodontics, Research Institute, São Leopoldo Mandic Dental School, Campinas, Brazil
| | - Francine Kühl Panzarella
- Division of Oral Radiology, Research Institute, São Leopoldo Mandic Dental School, Campinas, Brazil
| | - Carlos Eduardo Fontana
- Division of Endodontics, Centre for Health Sciences, Pontifical Catholic University of Campinas, Campinas, Brazil
| | | | | |
Collapse
|
16
|
Pauwels R, Pittayapat P, Sinpitaksakul P, Panmekiate S. Scatter-to-primary ratio in dentomaxillofacial cone-beam CT: effect of field of view and beam energy. Dentomaxillofac Radiol 2021; 50:20200597. [PMID: 33882256 DOI: 10.1259/dmfr.20200597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of field of view (FOV) and beam energy on the scatter-to-primary ratio (SPR) in dental cone-beam CT (CBCT). METHODS An anthropomorphic phantom representing an adult male (ATOM Max 711-HN, Norfolk, VA, USA) was scanned using the 3D Accuitomo 170 CBCT (J. Morita, Kyoto, Japan) using 11 FOVs. During each scan, half of the X-ray beam was blocked. Each scan was performed at three exposure settings with varying beam energy and equal radiation dose: 90 kV 5 mA, 77 kV 7.5 mA and 69 kV 10 mA. The SPR was estimated by measuring the grey values in the blocked and non-blocked regions of the RAW data. The effect of FOV on SPR was evaluated using Dunn's multiple comparison test, and the effect of the exposure settings was compared using a Wilcoxon signed rank test. RESULTS Larger FOVs showed increased scatter. FOVs with a shorter isocenter-detector distance showed a particularly high SPR. Most intercomparisons between FOVs were statistically significant. The largest difference was found between 17 × 12 cm and 6 × 6 cm (lower jaw), with the former showing a 4.9-fold higher SPR. The effect of beam energy was relatively small and varied between FOV sizes and positions. CONCLUSION While the choice of FOV size and position is determined by the diagnostic region of interest, the image quality deterioration for large FOVs due to scatter provides another incentive to limit the FOV size as much as possible.
Collapse
Affiliation(s)
- Ruben Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark.,Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Pisha Pittayapat
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Phonkit Sinpitaksakul
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Soontra Panmekiate
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
17
|
Pinto JC, Coaguila-Llerena H, Torres FFE, Lucas-Oliveira É, Bonagamba TJ, Guerreiro-Tanomaru JM, Tanomaru-Filho M. Influence of voxel size on dentinal microcrack detection by micro-CT after root canal preparation. Braz Oral Res 2021; 35:e074. [PMID: 34644728 DOI: 10.1590/1807-3107bor-2021.vol35.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/04/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to assess the influence of micro-computed tomography (micro-CT) voxel size on dentinal microcrack detection after root canal preparation using rotary heat-treated nickel-titanium files. Curved mesial root canals (n = 24) of mandibular molars were prepared using ProDesign Logic 30/.05 (PDL) or HyFlex EDM 25/.08 (HEDM). The specimens were scanned by micro-CT at 5 μm voxel size before and after root canal preparation. The percentage of microcracks was evaluated in images at 5, 10 and 20 μm voxel size, by two examiners at two moments. The Kappa and McNemar tests (α = 0.05) were used. The percentage of dentinal microcracks was similar before and after PDL and HEDM preparations, at 10 and 20 μm (p > 0.05). HEDM showed a higher percentage of dentinal microcracks in the middle third at 5 μm after preparation (p < 0.05). The detection of dentinal microcracks before and after instrumentation using PDL was more accurate at 5 μm than at 20 μm, in all thirds (p < 0.05). Within the limitations of this ex vivo study, as expected, the results showed that different resolutions influence the micro-CT analysis of microcracks. The highest accuracy in detecting microcracks was observed for analyses performed at 5 μm voxel size. HyFlex EDM caused even more microcracks to develop in the middle third, detectable only by visualization of images made at 5 μm voxel size.
Collapse
Affiliation(s)
- Jáder Camilo Pinto
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Restorative Dentistry, Araraquara, SP, Brazil
| | - Hernán Coaguila-Llerena
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Restorative Dentistry, Araraquara, SP, Brazil
| | | | - Éverton Lucas-Oliveira
- Universidade de São Paulo - USP, São Carlos Institute of Physics, Department of Physics and Interdisciplinary Science, São Carlos, SP, Brazil
| | - Tito José Bonagamba
- Universidade de São Paulo - USP, São Carlos Institute of Physics, Department of Physics and Interdisciplinary Science, São Carlos, SP, Brazil
| | | | - Mário Tanomaru-Filho
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Restorative Dentistry, Araraquara, SP, Brazil
| |
Collapse
|
18
|
de Oliveira Pinto MG, Melo SLS, Suassuna FCM, Marinho LE, Leite JBDS, Batista AUD, Bento PM, Melo DP. Influence of size of field of view (FOV), position within the FOV, and scanning mode on the detection of root fracture and observer's perception of artifacts in CBCT images. Dentomaxillofac Radiol 2021; 50:20200563. [PMID: 33565884 DOI: 10.1259/dmfr.20200563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the influence of field of view (FOV) size, scanning position within the FOV and scanning mode on the detection of root fracture and artifact perception. METHODS Forty single-rooted premolars restored with NiCr and AgPd posts were divided into two groups: fractured and sound. All teeth were scanned using four CBCT scanning protocols varying FOV sizes (80 × 80 mm and 50 × 55 mm) and scanning modes (Standard and High Definition). The sample was positioned within the FOV in two pre-set positions (central and lateral) and in four positions established by the operator (quadrants). Detection of root fracture and artifact perception were assessed by two observers using 5-point and 4-point scales. Sensitivity, specificity, accuracy, and AUC values were calculated and compared by ANOVA two-way and Tukey's test. Chi-square and Fisher's exact test were used to assess artifact perception. The level of significance was set at p < 0.05. RESULTS The central position within the FOV presented higher sensitivity, specificity, accuracy, and AUC values and differed from the lateral position within the FOV for the studied metal posts (p<0.05). Quadrant 2 presented the best sensitivity, accuracy, and AUC values (p<0.05). The lateral position within the FOV, AgPd posts, quadrants 1 and 3 and protocols 1 (SM, 80 × 80) and 2 (HD, 80× 80) presented higher frequency of artifacts classified as "severe". CONCLUSION Positioning the object in the center or closer to the anterior periphery of the FOV while using a small FOV improved the detection of root fracture and decreased artifact perception.
Collapse
Affiliation(s)
| | - Saulo L Sousa Melo
- Department of Integrative Biomedical & Diagnostic Sciences, School of Dentistry, Oregon Health & Science University, Portland, USA
| | | | - Luiz Eduardo Marinho
- Department of Oral Diagnosis, Division of Oral Radiology, State University of Paraíba, Campina Grande, Brazil
| | | | | | - Patrícia Meira Bento
- Department of Oral Diagnosis, Division of Oral Radiology, State University of Paraíba, Campina Grande, Brazil
| | - Daniela Pita Melo
- Department of Oral Diagnosis, State University of Paraíba, Campina Grande, Brazil
| |
Collapse
|
19
|
Mouzinho-Machado S, Rosado LDPL, Coelho-Silva F, Neves FS, Haiter-Neto F, de-Azevedo-Vaz SL. Influence of Voxel Size and Filter Application in Detecting Second Mesiobuccal Canals in Cone-beam Computed Tomographic Images. J Endod 2021; 47:1391-1397. [PMID: 34166686 DOI: 10.1016/j.joen.2021.06.011] [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] [Received: 02/10/2021] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study assessed the influence of voxel size and filter application in detecting second mesiobuccal (MB2) canals in cone-beam computed tomographic (CBCT) images. METHODS Using the OP300 CBCT system (Instrumentarium, Tuusula, Finland) and 3 voxel size protocols (80 μm, 125 μm, and 200 μm), we scanned 40 first molars: 20 with an MB2 canal and 20 without. All molars received silver palladium pins on the palatal root, whereas the non-MB2 molars were also filled with gutta-percha. Five oral radiologists assessed the presence of an MB2 canal under 3 filter application conditions: without filter, with sharpen 1 × filter, and with sharpen 2 × filter. Intra- and interobserver reproducibility was evaluated using the weighted kappa index. We compared the area under the receiver operating characteristic curves with SPSS Statistics v.20.0 (IBM Corp, Armonk, NY) using 2-way analysis of variance and the Tukey post hoc test with 5% significance level. RESULTS Our analysis found median intra- and interobserver agreement values of 0.70 and 0.56, respectively. The 80-μm voxel with sharpen 1 × filter image group had the highest sensitivity, accuracy, and negative predictive values. As for specificity and positive predictive, the 80-μm voxel group without filter application presented the highest values. The areas under the receiver operating characteristic curve were higher in the 80-μm groups than in the 125-μm and 200-μm voxel size groups (P < .05). We found no differences among the filters used (P = .22) or for the filter-voxel size interactions (P = .88). CONCLUSIONS A smaller voxel size increased the accuracy in detecting MB2 canals, whereas the enhancement filters did not.
Collapse
Affiliation(s)
- Sâmia Mouzinho-Machado
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Lucas de Paula Lopes Rosado
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Fernanda Coelho-Silva
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Frederico Sampaio Neves
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil; Division of Oral Radiology, Department of Propedeutics and Integrated Clinic, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Francisco Haiter-Neto
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Sergio Lins de-Azevedo-Vaz
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil; Department of Clinical Dentistry, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil.
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Pinto JC, Wanderley VA, de Faria Vasconcelos K, Leite AF, Pauwels R, Nadjmi M, Oliveira ML, Tanomaru-Filho M, Jacobs R. Evaluation of 10 Cone-beam Computed Tomographic Devices for Endodontic Assessment of Fine Anatomic Structures. J Endod 2021; 47:947-953. [PMID: 33691170 DOI: 10.1016/j.joen.2021.02.013] [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] [Received: 10/08/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The purpose of this study was to classify 10 cone-beam computed tomographic (CBCT) devices using a ranking model according to the detection of fine endodontic structures. METHODS A dedicated dentate anthropomorphic phantom was scanned 2 times using 10 CBCT devices without any metal (metal-free condition) and with an endodontically treated tooth containing a metallic post (metal condition). A reference image acquired on an industrial micro-CT scanner was used to register all CBCT images, yielding corresponding anatomic slices. Afterward, 3 experienced observers assessed all acquired CBCT images for their ability to assess a narrow canal, isthmus, and apical delta ramification using a categoric rank from 1 (best) to 10 (worst). Fleiss kappa statistics were used to calculate intra- and interobserver agreements for each CBCT device separately. Based on the observers' scores, general linear mixed models were applied to compare image quality among different CBCT devices for performing endodontic diagnostic tasks (α = .05). RESULTS The 10 CBCT devices performed differently for the evaluated endodontic tasks (P < .05), with 3 devices performing better for endodontic feature detection. Yet, in the presence of metal, only 2 devices were able to keep a high level of endodontic feature detection. CONCLUSIONS The evaluated endodontic tasks were CBCT device dependent, and their detection was influenced by the presence of metal.
Collapse
Affiliation(s)
- Jader Camilo Pinto
- Department of Restorative Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil; OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Victor Aquino Wanderley
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - André Ferreira Leite
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dentistry, Faculty of Health Sciences University of Brasília, Brasília, Brazil
| | - Ruben Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark; Department of Mechanical Engineering, Catholic University of Leuven, Leuven, Belgium
| | - Mansour Nadjmi
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Matheus L Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Mario Tanomaru-Filho
- Department of Restorative Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Gulibire A, Cao Y, Gao A, Wang C, Wang T, Xie X, Liang J, Li W, Lin Z. Assessment of true vertical root fracture line in endodontically treated teeth using a new subtraction software - A Micro-CT and CBCT study. AUST ENDOD J 2020; 47:290-297. [PMID: 33314451 DOI: 10.1111/aej.12476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
This study aimed to find true facture lines in endodontically treated teeth on CBCT images using digital subtraction and to evaluate the influence of width of facture lines in the diagnosis. Thirty-two endodontically treated teeth with vertical root fractures (VRFs) from 30 patients were included in this study. The CBCT images of the patients and the micro-CT images of extracted teeth were imported into our digital subtraction software to distinguish the true facture lines from the streak artefacts. Of them, 23(71.87%) teeth did not present true fracture lines on the CBCT images (CBCT negative), and 9 (28.13%) teeth presented true fracture lines on the CBCT images (CBCT positive). The width of the facture lines was significantly different between these two groups (P < 0.05). To summarise, for in vivo endodontically treated teeth with subtle VRFs, many true fractures lines could not be demonstrated on CBCT images and wider fractures could be better distinguished.
Collapse
Affiliation(s)
- Aihemaiti Gulibire
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ya Cao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Antian Gao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Congyue Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tiemei Wang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xin Xie
- Department of Stomatology, Third People's Hospital of Danyang City, Danyang, China
| | - Jiahao Liang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weifeng Li
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Zitong Lin
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| |
Collapse
|
24
|
McGuigan MB, Theodorakou C, Duncan HF, Davies J, Sengupta A, Horner K. An investigation into dose optimisation for imaging root canal anatomy using cone beam CT. Dentomaxillofac Radiol 2020; 49:20200072. [PMID: 32464075 DOI: 10.1259/dmfr.20200072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To identify a dose as low as diagnostically acceptable and a threshold level of image quality for cone beam CT (CBCT) imaging root canals, using maxillary first molar (M1M) second mesiobuccal (MB2) canals of varying complexity for two CBCT scanners. METHODS Dose-area product (DAP) and contrast-to-noise ratio (CNR) were measured for two scanners at a range of exposure parameters. Subjective-image-quality assessment at the same exposures was performed for three M1Ms of varying MB2 complexity, positioned in an anthropomorphic phantom. Nine raters (three endodontists, three dental radiologists and three junior staff) assessed canal visibility, using a 5-point confidence scale rating. RESULTS Identification of simple-moderate MB2 canal complexity was achieved at a range of protocols, with DAP values of ≥209.3 and ≥203.2 mGy cm² and CNRs of 3 and 7.6 for Promax®3D and Accuitomo-F170® respectively. For complex canal anatomy, target subjective image quality was not achieved, even at the highest DAP values for both scanners. Junior staff classified significantly more images as undiagnostic compared with senior staff (p = 0.043). CONCLUSIONS In this first study to address optimisation of CBCT imaging of root canal anatomy, a similar threshold dose for both scanners was identified for M1Ms with simple-moderate MB2 canal complexity. Increasing dose to enhance visualisation of more complex canal anatomy was ineffective. Selection of standard protocols (while avoiding lower kV/mA protocols) instead of high-resolution scans was a practical means of reducing patient dose. CNR is not a transferable measure of image quality.
Collapse
Affiliation(s)
| | - Christie Theodorakou
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Henry F Duncan
- Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Jonathan Davies
- Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anita Sengupta
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Keith Horner
- Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland.,Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| |
Collapse
|
25
|
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.
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Guo XL, Li G, Yin S, Ma RH, Guo YJ, Bornstein MM. Effect of fracture orientation on detection accuracy of vertical root fractures in non-endodontically treated teeth using cone beam computed tomography. Clin Oral Investig 2019; 23:4433-4439. [DOI: 10.1007/s00784-019-02905-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/04/2019] [Indexed: 11/25/2022]
|