Morphology and root canal configuration of maxillary canines: a systematic review and meta-analysis

BACKGROUND

This study assessed the internal morphology of maxillary canines (MxC) through a systematic review of existing literature.

METHODS

Research articles up to June 2024 were retrieved from five electronic databases (MEDLINE via PubMed, Embase, Scopus, LILACS, and Cochrane). Predefined search terms and keywords were used, and potential studies were identified by cross-referencing and bibliographies of the selected articles reviewed.

RESULTS

Two hundred studies were identified, 73 duplicates were removed, 127 records were screened, and 113 were removed after consultation of title and abstract. After full-text consultation and hand searching, finally 22 studies were included. Using the method for describing the root canal configuration (RCC) of Briseño Marroquín et al. (2015) and Vertucci (Ve) (1984), the most frequently reported RCC of MxC were 1-1-1/1 (Ve I, 75.4-100%), 2-2-1/1 (Ve II, 0.1-20%), 1-2-1/1 (Ve III, 0.1-11.6%), 2-2-2/2 (Ve IV, 0.1-0.4%), 1-1-2/2 (Ve V, 0.1-2.4%), 2-1-2/2 (Ve VI, 0.5-1.2%), and 1-2-1/2 (Ve VII, 0.1-0.2%). The meta-analysis of six studies (Europe/Asia) showed that a significantly higher number of RCC of 2-2-1/1 (Ve II) (OR [95%CI] = 1.34 [0.53, 3.41]), 1-2-1/1 (Ve III) (OR [95%CI] = 2.07 [1.01, 4.26]), and 1-1-2/2 (Ve V) (OR [95%CI] = 2.93 [1.07, 8.07]), were observed in males, and 2-2-2/2 (Ve IV) (OR [95%CI] = 0.08 [0.00, 4.00]) in females. No sex differences in the RCC of 1-1-1/1 (Ve I) and 1-2-1/2 (Ve VII) were observed.

CONCLUSIONS

Cone beam computed tomography is the most frequently used method for research on the RCC of MxC. Despite the high prevalence of type 1-1-1/1 (Ve I) RCC in MxC, clinicians should remain vigilant for more complex and sex-differentiated patterns in up to 25% of cases to prevent endodontic treatment complications or failures.

Cone-beam computed tomography-based descriptive classification for transverse root fracture

Transverse root fracture (TRF) is classified as a cervical, middle or apical third root fracture on a periapical radiograph. The International Association of Dental Traumatology (IADT) suggests that cone-beam computed tomography (CBCT) should be considered, when conventional radiographs provide 'insufficient' information for diagnosis and treatment planning. Considering that CBCT can divulge additional information, it would be beneficial to have a clinically pertinent three-dimensional classification for TRF. The proposed alphanumeric classification includes the traumatised tooth number, describes the number of TRF, the facial and lingual location of each fracture line on the anatomic root, and its position relative to the crest of the alveolar bone. Further, diastasis, displacement of the coronal fragment and status of the alveolar bone at the site of TRF are also documented. This comprehensive classification system would provide a standard format for reporting, aid in referral communication and can be applied for future outcome studies on TRF.

Influence of an adjacent zirconium implant, tube current, and metal artifact reduction algorithm on horizontal root fracture diagnosis in cone beam computed tomography

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.

Global cone-beam computed tomography adoption, usage and scan interpretation preferences of dentists and endodontists

AIM

This study investigated the adoption of cone-beam computed tomography (CBCT) by dentists and endodontists around the world, including their preferences in endodontic CBCT usage.

METHODOLOGY

An online questionnaire surveyed dental association members in Australia and New Zealand, and endodontic association members in Australia, Britain, Canada, Italy, New Zealand and the USA, about their CBCT training history, considerations in acquisition/interpretation, access to and usage of CBCT, preferred scan interpreter, and preferred endodontic scan settings. Data were analysed with Chi-squared, independent sample t-tests, Cochran's Q and McNemar's tests.

RESULTS

Responses from 578 endodontic specialists or postgraduates (Group E) and 185 non-endodontic dentists (Group NE) were included. Continuing professional education (CPE) was the most common source of CBCT training (69.2%). Factors considered in CBCT acquisition/interpretation included beam hardening (75.4%), radiation exposure (61.1%) and patient movement (58.3%). Group E reported higher CBCT usage (90.8%) than Group NE (45.4%, p < .001) and greater workplace access to CBCT (81.1% vs. 25.9%, p < .001). Scans were interpreted by the respondent in most workplace scans (83.3%) and externally taken scans (60.5%); Group E were significantly more likely to interpret themselves than Group NE. Small field of view (83.6%) and high resolution (86.6%) were most preferred as settings for endodontic CBCTs; Group NE were less likely to choose these settings. There were some geographic variations within Group E.

CONCLUSIONS

CBCT training was most commonly acquired via CPE. Endodontic respondents reported very high CBCT usage and access in the workplace. There are educational implications regarding CBCT limitations, appropriate applications and interpretation.

Morphological Assessment of Nasopalatine Canal Using Cone Beam Computed Tomography: A Retrospective Study of 124 Consecutive Patients

This study aimed to assess and analyze the morphology and dimensions of the nasopalatine canal (NPC), as well as the adjacent buccal osseous plate (BOP), and to investigate the effect of gender, edentulism, NPC types, absence of maxillary central incisors (ACI) and age on the NPC and BOP, using cone beam computed tomography (CBCT). A total of 124 CBCT examinations (67 female and 57 male patients) were retrospectively included and evaluated. The assessment of the dimensions of the NPC, as well as the dimensions of the adjacent BOP, was performed by three Oral and Maxillofacial Radiologists on reconstructed sagittal and coronal CBCT sections under standardized conditions. Regarding the dimensions of the NPC and the adjacent BOP, the mean values were significantly higher among males than females. Furthermore, edentulous patients showed a significant reduction in BOP dimensions. Additionally, NPC types showed a significant effect on the length of the NPC, and the ACI had a significant effect on reducing BOP dimensions. Age had a significant effect on the diameter of the incisive foramen, with the mean values generally increasing with an increasing age. CBCT imaging of this anatomical structure contributes significantly to its full assessment.

A Three-Dimensional Analysis of Morphological Variations in Maxillary Second Molar in a North Indian Population Using Cone-Beam Computed Tomography

Background: Cone beam computed tomography (CBCT) has evolved in the field of endodontics and has helped to diagnose and treat the case very easily and accurately. The researchers set out to pinpoint the exact placement of the roots and canals in the maxillary second molars of North Indians by analyzing CBCT pictures.

Methods: In this study, in vivo CBCT was used to examine the maxillary second molars (n = 70) in detail. Both the number and configuration of root canals may be determined using Vertucci's categorization.

Results: Most people had three roots in their second molars (85.7%). Most maxillary second molars that had three roots looked like they had three separate roots (81.7%). In the roots of 85.7% of maxillary second molars, one canal was found in the mesiobuccal roots, and 14.2% had an MB2 canal. All of the canals in the palatal, distobuccal root, and MB1 root were Type I. The Type II canal configuration was found in 11.7% of MB2 canals. Type IV canals were found in 5% of the MB2 canals. The number of maxillary second molars with MB2 was found to be the same for both men and women (P =0.11). The number of MB2 cases did not depend on where the teeth were or how old the person was (P=0.08 and 0.06, respectively). The fact that both second molars appeared at the same time was important (P<0.001).

Conclusions: We report the occurrence of unusual morphologic abnormalities that affect only one root and have only been described in case reports. CBCT scans can help doctors better understand root canal anatomy and potentially enhancing endodontic management outcomes.

Evaluation of root canal morphology in permanent maxillary and mandibular anterior teeth in Saudi subpopulation using two classification systems: a CBCT study

BACKGROUND

Adequate knowledge of root canal morphology and possible variations is essential to achieve perfect root canal treatment and overcome treatment failure. Appropriate knowledge on root and canal morphology, communication, and documentation amongst dentists will be challenging from a diagnostic and successful treatment point of view.

METHODS

A total of 3420 samples were included in this study from 285 cone-beam computed tomography images of the Saudi residents, including 171 males and 114 females aged 15 to 68 years from retrospective data dated from January 2018 to April 2021. The images were examined in sagittal, axial and coronal views using a 3D version software 1.0.10.6388. The number of canal and canal morphology was recorded using Vertucci and the new classification system. The SPSS 26 was used to conduct the statistical analysis as descriptive statistics such as mean; standard deviation and frequency were calculated. The Chi-square test analysed the data with the significance level set at 0.05.

RESULTS

A total of 285 subjects participated in the study. Majority of the participants were Saudi nationals (80.7%), followed by Indian (7.4%), Pakistani (4.2%) and other nationalities. According to Vertucci and the new classification system, Type I and ¹TN¹ were the most common types, followed by Type III and Type IV, and then ¹TN^1-2-1 and ¹TN^1-2 in mandibular anteriors. The prevalence of canal variations in mandibular canine was higher in females than in males (P = 0.002). Maxillary laterals and mandibular anteriors showed the significant difference in the prevalence of root canal variation in relation to the ethnicity (P = 0.001) and age of the patients. Younger patients showed more variations than the older patients (P = 0.012, P = 0.023, P = 0.001, P = 0.001) in terms of maxillary laterals, mandibular central, laterals and canines, respectively.

CONCLUSION

Mandibular permanent anteriors showed a wide range of canal variations and canal complexity. Males and females did not demonstrate a wide range of variation in the root canal morphology except for the canines in relation to the gender of the patients.

Vertical Root Fracture in Non-Endodontically and Endodontically Treated Teeth: Current Understanding and Future Challenge

A vertical root fracture (VRF) is a complex complication that usually leads to tooth extraction. The aim of this article is to review the prevalence, demography, distribution, diagnostic methods, etiology and predisposing factors, clinical features, radiographic characteristics and treatment strategies of VRFs in non-endodontically treated teeth (VRFNETT) and endodontically treated teeth (VRFETT). Search terms for each subject related to VRFNETT and VRFETT were entered into MEDLINE, PubMed and Google Scholar. Systematic reviews, retrospective cohort studies, demographic research, clinical studies, case reports and case series were reviewed. Most of the VRFs were found in patients older than 40 years old. Older populations were discovered in the non-endodontically treated VRF group when compared to the endodontically treated VRF group. Male patients were found at a greater prevalence than females in the non-endodontically treated VRF group. The initial occurrence of a VRF may accompany radiolucent lines within the root canal, unusual space between the canal wall and intracanal material, a widening of the PDL space along the periradicular surfaces, angular bony destruction, step-like bone defects, V-shaped diffuse bone defects, or root resorptions corresponding to the fracture line before the clear separation of the fractured fragment. The indicative clinical and radiographic signs of VRF included a coronally positioned sinus tract, deep-narrow periodontal defects, the displacement of a fractured fragment, periradicular radiolucent halos and the widening of the root canal space. Interestingly, VRFNETT are more often observed in the Chinese population. Some patients with multiple VRFs were observed, suggesting possible predisposing factors in genetics and tooth development. The management of a VRF usually involves a multidisciplinary approach. The common distribution and features of VRFNETT and VRFETT were elucidated to facilitate recognition and diagnosis. Besides extraction, variable therapeutic schemes, such as the repair of the VRF, root amputation and others reported in earlier literature, are available. A long-term prognosis study of the various therapeutic strategies is needed.

Root canal length measurement of molar teeth using conebeam computed tomography (CBCT): comparison of two dimensional versus three-dimensional methods

Purpose:

This study aimed to evaluate the validity of 2-dimensional (2D) and 3-dimensional (3D) cone-beam computed tomographic (CBCT) root canal length measurements of molar teeth compared with actual root canal lengths and the influence of canal curvature on the accuracy of CBCT measurements.

Materials and methods:

Seventy root canals of 24 molar teeth were scanned using CBCT, and the root canals were categorized as; ‘straight/curved,’ ‘highly curved,’ and ‘multiple curved.’ The 2D measurements were performed within a suitable slice between the major foramen and the corresponding cusp. The 3D measurements were performed within the slices in regular intervals of axial planes in between the same reference points. The reproducibility and reliability of the methods were analyzed by intraclass correlation coefficient. Differences between the actual and CBCT root canal lengths were evaluated by chi-square and McNemar tests if the measurements were within acceptable limits of ±0.5 mm.

Results:

Both methods were found to be reproducible and presented excellent reliability. However, the 3D method was significantly more accurate, with an 85.7% frequency of measurements within acceptable limits (p<0.05). In ‘multiple curved’ root canals, the 3D method presented more reliable measurements than the 2D method. For ‘straight/curved’ root canals, the 2D method gave results significantly closer to the actual root canal length in comparison with ‘highly curved’ root canals (p<0.05).

Conclusion:

The 3D measurements are more accurate than 2D measurements. If an already existing CBCT is present, it could be an alternative method for predetermination of root canal lengths in molar teeth.

Paediatric dentist's ability to detect and diagnose dental trauma using 2D versus 3D imaging

BACKGROUND

Visualisation of the third dimension has been reported to increase effectiveness of correctly diagnosing traumatic dental injuries.

AIM

To assess the ability of paediatric dentists to detect and diagnose Traumatic Dental Injuries (TDI) using two different imaging modalities, intraoral radiographs (2D) and CBCT scans (3D). In addition, observer's confidence regarding the obtained diagnosis, using either technique, was assessed.

MATERIAL AND METHODS

Both 2D and 3D images of 20 dental trauma cases in children were presented in random order to a panel of thirteen paediatric dentists. Observers received instructions for the screening of the images for radiographic findings related to dental trauma, using structured scoring sheets for 2D and 3D images. Observed data were compared to those recorded by two experienced benchmark observers. A ten-point scale was used for assessing observer's confidence regarding their final diagnosis using 2D versus 3D images.

RESULTS

Performance of individual observers showed wide variation. Statistical significance was reached for correctly detected and correctly diagnosed findings (p = 0.02), in favor of 3D. Most of the observers reported comparable confidence using 2D and 3D, two observers were more confident using 3D and one observer was more confident using 2D.

CONCLUSIONS

Paediatric dentist's ability to detect and diagnose findings in patients with TDI was higher on 3D images. Most observers showed a similar confidence score of their diagnostic performance both on 2D and on 3D.

Diagnosis and Management of Traumatic Dental Injuries Using Intraoral Radiography and Cone-beam Computed Tomography: An In Vivo Investigation

INTRODUCTION

The aim of this study was to compare periapical radiographs (PRs) and upper standard occlusal (USO) radiographs with cone-beam computed tomographic (CBCT) imaging on clinicians' confidence in the diagnosis and management of traumatic dental injuries (TDIs).

METHODS

This study included 35 maxillary anterior teeth from 25 patients with at least 1 PR (parallax view) and a CBCT scan. Fourteen patients also had a USO radiograph. Ten examiners selected a diagnosis and treatment plan, which were compared with a reference standard. Sensitivity, specificity, positive and negative predictor values, and receiver operating characteristic analysis were used to determine the diagnostic accuracy.

RESULTS

CBCT imaging exhibited significantly higher sensitivity than both conventional radiographic techniques combined (PRs and PRs + USO radiographs) for all diagnoses (TDI: 99% vs 84%, lateral luxation: 80% vs 34%, extrusions: 92% vs 42%, and cortical plate fracture: 58% vs 1%) other than horizontal root fractures in which the results were close to statistical significance (88% vs 69%). CBCT imaging was significantly more accurate for all diagnoses (TDI: 91% vs 70%, lateral luxations: 83% vs 61%, extrusive luxations: 92% vs 68%, alveolar cortical plate fractures: 78% vs 48%, and horizontal root fractures: 93% vs 82%). Examiners had the most confidence with CBCT imaging and the least confidence in diagnosing using PRs + USO radiographs than with PRs alone. Agreement with management plans was significantly better using CBCT imaging compared with PRs and PRs + USO radiographs.

CONCLUSIONS

CBCT imaging improved the clinical diagnosis of TDIs. The addition of USO radiographs to PRs did not improve the diagnosis of TDIs in this investigation. CBCT imaging improved confidence in the diagnosis of TDI cases and treatment planning compared with conventional radiography.

In vivo detection of vertical root fractures in endodontically treated teeth: Accuracy of cone-beam computed tomography and assessment of potential predictor variables

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.

CBCT in orthodontics: a systematic review on justification of CBCT in a paediatric population prior to orthodontic treatment

BACKGROUND

Taking into account radiation doses, safety, and protection, we highlighted the features in which cone-beam computed tomography (CBCT) can offer an advantage compared to the conventional two-dimensional imaging in paediatric dentistry before orthodontic treatment.

OBJECTIVE

The aim of this article was to conduct a systematic review to assess the diagnostic efficacy of CBCT in the paediatric population at a pre-orthodontic phase.

SEARCH METHODS

MEDLINE via PubMed was searched to identify all peer-reviewed articles potentially relevant to the review until 1 July 2018. Relevant publications were selected by two reviewers independently.

SELECTION CRITERIA

The literature selection for this systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was based on predetermined inclusion criteria.

DATA COLLECTION AND ANALYSIS

Data were collected on overall study characteristics and examination characteristics of the selected studies. Methodological quality of the selected studies was evaluated. Original studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Thereafter, levels of evidence were obtained according to Grading of Recommendations Assessment, Development and Evaluation criteria.

RESULTS

As a result of the QUADAS assessment, a total of 37 articles were included in the protocol. Following a proper protocol, CBCT was regarded as a reliable tool for assessment and management of impacted canine and root fracture. It provided a better evaluation of normal and pathological condylar shape and volume. CBCT was a superior choice for pre-surgical diagnostic applications in cleft lip and/or palate over a medical computed tomography based on its lower radiation exposure, shorter investigation time, and low purchase costs.

CONCLUSIONS

CBCT is justified only in those cases where conventional radiography fails to provide a correct diagnosis of pathology. Therefore, it cannot be regarded as a standard method of diagnosis. CBCT imaging may also be justified when it positively affects treatment options or provides treatment optimization.

REGISTRATION

None.

CONFLICT OF INTEREST

None to declare.

Diagnostic efficacy of cone beam computed tomography in paediatric dentistry: a systematic review

Purpose

To determine in which clinical situations it is indicated or contra-indicated to prescribe cone beam computed tomography (CBCT) for paediatric patients.

Methods

Systematic review of in vivo paediatric research studies of diagnostic efficacy using CBCT, with supplementary searches for guideline documents on CBCT and for systematic reviews permitting inclusion of ex vivo and adult studies.

Results

After screening, 190 publications were included, mostly case studies. No systematic reviews were found of in vivo paediatric research. Fourteen studies of diagnostic efficacy were identified. The supplementary searches found 18 guideline documents relevant to the review and 26 systematic reviews. The diagnostic efficacy evidence on CBCT was diverse and often of limited quality. There was ex vivo evidence for diagnostic accuracy being greater using CBCT than radiographs for root fractures. The multiplanar capabilities of CBCT are advantageous when localising dental structures for surgical planning. Patient movement during scanning is more common in children which could reduce diagnostic efficacy.

Conclusions

No strong recommendations on CBCT are possible, except that it should not be used as a primary diagnostic tool for caries. Guidelines on use of CBCT in the paediatric age group should be developed cautiously, taking into account the greater radiation risk and the higher economic costs compared with radiography. CBCT should only be used when adequate conventional radiographic examination has not answered the question for which imaging was required. Clinical research in paediatric patients is required at the higher levels of diagnostic efficacy of CBCT.

Electronic supplementary material

The online version of this article (10.1007/s40368-019-00504-x) contains supplementary material, which is available to authorized users.

Treatment options for permanent teeth with coronal one-third root fractures

BACKGROUND AND OVERVIEW

Teeth with coronal one-third root fractures are considered to have a poor prognosis. Historically, such teeth were likely to be extracted. Observations have indicated that at least some teeth with such fractures can survive for a significant amount of time.

CASE DESCRIPTIONS

The authors report on 2 cases of coronal one-third root fractures that have survived for 10 and 35 years and suggest that the long-term splinting of these teeth aided in their survival.

CONCLUSION AND PRACTICAL IMPLICATION

Stabilizing teeth with coronal one-third root fractures may allow such teeth to survive for long periods, which can be of great benefit, especially for young patients.

Effect of object position in the field of view and application of a metal artifact reduction algorithm on the detection of vertical root fractures on cone-beam computed tomography scans: An in vitro study

Purpose

To assess the effects of object position in the field of view (FOV) and application of a metal artifact reduction (MAR) algorithm on the diagnostic accuracy of cone-beam computed tomography (CBCT) for the detection of vertical root fractures (VRFs).

Materials and Methods

Sixty human single-canal premolars received root canal treatment. VRFs were induced in 30 endodontically treated teeth. The teeth were then divided into 4 groups, with 2 groups receiving metal posts and the remaining 2 only having an empty post space. The roots from different groups were mounted in a phantom made of cow rib bone, and CBCT scans were obtained for the 4 different groups. Three observers evaluated the images independently.

Results

The highest frequency of correct diagnoses of VRFs was obtained with the object positioned centrally in the FOV, using the MAR algorithm. Peripheral positioning of the object without the MAR algorithm yielded the highest sensitivity for the first observer (66.7%). For the second and third observers, a central position improved sensitivity, with or without the MAR algorithm. In the presence of metal posts, central positioning of the object in the FOV significantly increased the diagnostic sensitivity and accuracy compared to peripheral positioning.

Conclusion

Diagnostic accuracy was higher with central positioning than with peripheral positioning, irrespective of whether the MAR algorithm was applied. However, the effect of the MAR algorithm was more significant with central positioning than with peripheral positioning of the object in the FOV. The clinical experience and expertise of the observers may serve as a confounder in this respect.

Management of Multiple Dental Trauma: Case Report with Eight-Year Follow-up

This case report documents the clinical approach adopted for two maxillary incisors with intrusion and horizontal root fracture in the middle third after trauma. The proposed procedures involved maintaining pulp vitality and periodontal stability of the fractured teeth with 8 years of follow-up.

Cone-beam CT in paediatric dentistry: DIMITRA project position statement

DIMITRA (dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks) is a European multicenter and multidisciplinary project focused on optimizing cone-beam CT exposures for children and adolescents. With increasing use of cone-beam CT for dentomaxillofacial diagnostics, concern arises regarding radiation risks associated with this imaging modality, especially for children. Research evidence concerning cone-beam CT indications in children remains limited, while reports mention inconsistent recommendations for dose reduction. Furthermore, there is no paper using the combined and integrated information on the required indication-oriented image quality and the related patient dose levels. In this paper, therefore, the authors initiate an integrated approach based on current evidence regarding image quality and dose, together with the expertise of DIMITRA's members searching for a state of the art. The aim of this DIMITRA position statement is to provide indication-oriented and patient-specific recommendations regarding the main cone-beam CT applications in the pediatric field. The authors will review this position statement document when results regarding multidisciplinary approaches evolve, in a period of 5 years or earlier.

The Evaluation of Root Fracture with Cone Beam Computed Tomography (CBCT): An Epidemiological Study

Background

The aim of this study was evaluation of the cone-beam computed tomography (CBCT) image of 50 patients at the ages of 8-15 suspecting root fracture and root fracture occurred, exposed to dental traumatic. In additionally, this study was showed effect of crown fracture on root fracture healing.

Material and Methods

All of the individuals included in the study were obtained images with the cone-beam computed tomography range of 0,3 voxel and 8.9 seconds.(i-CAT®, Model 17-19, Imaging SciencesInternational, Hatfield, Pa USA).The information obtained from the history and CBCT images of patients were evaluated using chi-square test statistical method the mean and the distribution of the independent variables.

Results

50 children, have been exposed to trauma, was detected root fracture injury in 97 teeth. Horizontal root fracture 63.9% of the 97 tooth, the oblique in 31.9%, both the horizontal and oblique in 1.03%, partial fracture in 2.06% ,and both horizontally and vertical in 1.03% was observed.The most affected teeth, respectively of, are the maxillary central incisor (41.23% left, right, 37.11%), maxillary left lateral incisor (9.27%), maxillary right lateral incisor (11.34%), and mandibular central incisor (1.03%).

Conclusions

Crown fractures have negative effects on spontaneous healing of root fractures. CBCT are used selected as an alternative to with conventional radiography for diagnosis of root fractures. In particular, ıt's cross-sectional image is quite useful and has been provided more conveniences seeing the results of diagnosis and treatment for clinician. Key words:Root fracture, CBCT, Epidemiolog.

Maintenance of Pulp after Horizontal Root Fractures in Three Maxillary Incisors: A Thirteen-Year Evaluation

This case report documents the clinical approach adopted for three upper incisors with horizontal root fracture in the middle or cervical third. The proposed procedures involved maintaining pulp vitality and periodontal stability of the fractured teeth with 13 years of follow-up.

Association between demographic and radiographic characteristics of the schneiderian membrane and periapical and periodontal diseases using cone-beam computed tomography scanning: A retrospective study

Background. This study was undertaken to assess the pathological and spatial associations between periapical and periodontal diseases of the maxillary first molars and thickening of maxillary sinus mucosa with cone-beam computed tomography.

Methods. A total of 132 CBCT images of subjects 20‒60 years of age were evaluated retrospectively. The patients' sex and age and demographic and pathologic findings of the maxillary sinus in the first molar area were recorded, graded and analyzed.

Results. Approximately 59% of patients were male and 41% were female, with no significant difference in the thickness of schneiderian membrane between males and females. Based on the periapical index scoring, the highest frequency was detected in group 1. Based on the results of ANOVA, there were no significant differences in the frequencies of endodontic‒periodontal lesions and an increase in schneiderian membrane thickness. There were significant relationships between periapical and periodontal infections (P<0.001) and schneiderian membrane thickness. Furthermore, a significant relationship was detected between the thickness of the schneiderian membrane and the distance between the sinus floor and the root apices (P=0.38).

Conclusion. A retrospective inspection of CBCT imaging revealed that periapical lesions and periodontal infections in the posterior area of the maxilla were associated with thickening of the schneiderian membrane. In addition, there was a significant relationship between the location of maxillary posterior teeth, i.e. the thickness of bone from the root apex to the maxillary sinus floor, and schneiderian membrane thickness.

Relationship between the Mental Foramen, Mandibular Canal, and the Surgical Access Line of the Mandibular Posterior Teeth: A Cone-beam Computed Tomographic Analysis

INTRODUCTION

The purpose of this study was to investigate the relationships between the location of the mental foramen (MF) and the mandibular canal (MC) and the surgical access line (SAL) of the mandibular posterior teeth using cone-beam computed tomographic (CBCT) scans.

METHODS

CBCT scans of 204 subjects ranging in age from 18-76 years old were evaluated. The vertical and horizontal distances from the MF to the SAL of the mandibular premolars and first molars and the vertical distance from the MC to the SAL of the second premolars and first molars were measured via CBCT scans.

RESULTS

The average vertical distance between the MF and the SALs showed significant increases sequentially from the first premolars to the distal roots of the first molars, and the shortest average distance of 2.74 mm was obtained for the first premolars. The SALs of the second premolars were the closest to the MF in the horizontal direction with an average distance of 1.5 mm. In 19.9% of the cases, the vertical and horizontal distances between the MF and the SALs of the second premolars were less than 2 mm. In addition, the MF was located superior to the root apices in 6.62% of the cases. The majority of the SALs were located at a vertical distance from the MC that was more than 2 mm. Men and women exhibited significant differences in both the horizontal distance from the MF to the SALs of the first premolars and the vertical distance from the MC to the SALs of the second premolars.

CONCLUSIONS

To improve the success of endodontic microsurgery, adequate knowledge of the anatomic relationships between the location of the MF and MC and the SAL of the mandibular posterior teeth is indispensable to surgeons.

Contemporary imaging for the diagnosis and treatment of traumatic dental injuries: A review

Traumatic dental injuries (TDI) have an array of presentations. Diagnostic challenges are common and clinicians' ability to correctly identify specific injuries dictates the optimal course of treatment(s). The aim of this review was to outline and assess all dental imaging techniques and their applications to traumatic dental injuries. A particular interest is given to the advancement of 3D imaging techniques and their role in diagnosis and treatment planning. The benefits of achieving a more accurate diagnosis are paramount to perfecting clinical judgments and outcomes.

Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography

Different locations and healing patterns of horizontal root fractures bear different prognoses. Conventional periapical radiographs have been routinely used for the evaluation of the locations and healing of horizontal root fractures, with the limitation of presenting two-dimensional images. The three-dimensional imaging technology, cone-beam computed tomography (CBCT), has recently gained interest in dental traumatology, in particular for locating and diagnosing root fractures. However, the assessment of healing patterns of horizontal root fracture using CBCT compared to conventional radiographs has not been established. This case report describes the different healing patterns evaluated by two-dimensional radiographs and CBCT of a horizontally root-fractured maxillary right central incisor treated with mineral trioxide aggregate (MTA) with a two-year follow-up. The findings suggest that the healing patterns of horizontal root fractures seen on conventional radiographs and CBCT may be different.

Effect of Amperage and Field of View on Detection of Vertical Root Fracture in Teeth with Intracanal Posts

INTRODUCTION

This study sought to assess the effects of amperage (mA) and field of view (FOV) on intracanal metal post artifacts and the diagnostic parameters for detection of vertical root fracture (VRF) in teeth with intracanal posts.

METHODS AND MATERIALS

In this diagnostic study, 80 human single-canal teeth were evaluated by cone-beam computed tomography (CBCT). Nickel chrome cast posts were placed into root canals after root canal therapy and canal preparation. In the test group, fracture was induced by an instron machine while no fracture was induced in the control group. Deterministic and probabilistic sensitivity and specificity values at different exposure settings were statistically analyzed using the one-way ANOVA and pairwise comparisons were performed by Tukey's test.

RESULTS

Significant differences were found between the two groups in terms of deterministic (P<0.0001) and probabilistic (P<0.013) sensitivity and deterministic (P<0.037) and probabilistic (P<0.0001) specificity at different FOV and mA combinations.

CONCLUSION

A smaller FOV and lower mA should be preferably used for detection of VRFs in teeth with intracanal posts.

Detection of vertical root fractures in endodontically treated teeth in the absence and in the presence of metal post by cone-beam computed tomography

Background

Aim of this study was to investigate the influence of gutta-percha and metallic posts on the efficiency of Cone Beam Computed Tomography (CBCT) in diagnosing Vertical Root Fracture (VRF).

Methods

Forty-eight teeth were divided into 3 experimental and 3 control groups. The teeth of the first experimental group and the first control group received neither gutta-percha nor metal posts. The teeth of the second experimental group and the second control group were filled with gutta-percha, and the teeth of the third experimental group and the third control group were filled with the metal posts. The teeth of the experimental groups were artificially fractured. The teeth were evaluated through images taken by a Prexion scanner with a 0.1 mm resolution. Fisher’s exact test was used to measure the following values: sensitivity, false negative, specificity, false positive and accuracy for the VRF detection through the scanner. Three observers calibrated and blinded to the protocol evaluated the images.

Results

The inter-observer Kappa coefficient was 0.83. The presence of posts and gutta-percha reduced the sensitivity and the accuracy in detecting the VRF. Regarding to the sensitivity (p = 0.837, p = 0.304, p = 0.837 for evaluator 1, 2 and 3, respectively) and specificity (p = 0.162, p = 0.056, p = 0.062 for evaluator 1, 2 and 3, respectively), Fisher’s exact test showed no statistically significant difference among the evaluated groups. However, a significant difference was observed in relation to the accuracy in the results of evaluator 2 (p = 0.03), which showed a much lower accuracy for the post group (50 %) than for the Nonfilled group (93.8 %).

Conclusions

The Prexion tomograph was precise in detecting vertical root fractures and the CBCT diagnostic ability was not influenced by the presence of posts or gutta-percha.

Cone-beam computed tomography study of the root and canal morphology of mandibular permanent anterior teeth in a Chongqing population

OBJECTIVE

To investigate the root and canal morphology of permanent mandibular anterior teeth in a Chongqing population using cone-beam computed tomography (CBCT).

METHODS

CBCT images of 1,725 patients in a Chongqing population were selected, and a total of 9,646 mandibular anterior teeth were analyzed. The number of root canals and the canal configurations were investigated.

RESULTS

In total, 0.3% (11/3,257) of lateral incisors and 0.8% (26/3,014) of canines had double roots, and 3.8% (127/3,375) of central incisors, 10.6% (345/3,257) of lateral incisors, and 4.2% (127/3,014) of canines had multi-root canals. The difference in the incidence of multi-canals in lateral incisors between female and male was statistically significant. The frequency of multi-canals in the different age groups was 5.0% for central incisors for ages 21-30 years, 14.7% for lateral incisors for ages 41-50 years, and 8.1% for canines for ages 41-50 years.

CONCLUSION

With the limitations of the current study, we found that a high percentage of mandibular anterior teeth had multiple canals in the studied Chinese Chongqing population. The current data may provide clinicians practicing in Chongqing with a more thorough understanding of root canal morphology.

Effect of Object Position in Cone Beam Computed Tomography Field of View for Detection of Root Fractures in Teeth with Intra-Canal Posts

Background:

Vertical root fracture (VRF) is a common problem in endodontically treated teeth. Due to its poor prognosis, a reliable technique must be used to make an accurate diagnosis. Cone beam computed tomography (CBCT) has been recently introduced for maxillofacial imaging. Despite the high diagnostic value of this method, metal artifacts resulting from intra-canal posts still make the detection of VRFs challenging.

Objectives:

This study aimed to assess the effect of object position in the field of view (FOV) of CBCT on detection of VRFs in teeth with intra-canal posts.

Materials and Methods:

The crowns of 60 extracted premolar teeth were cut at the level of cementoenamel junction (CEJ). Root canals were filled with gutta-percha and filling of the coronal 2/3 of the root canals was subsequently removed to fabricate intra-canal cast posts. The teeth were randomly divided into two groups of 30. Fracture was induced in group one using an Instron machine. Group two was considered as the control group with no fracture. All teeth were then randomly positioned and scanned in five different positions starting at the center of the FOV as well as right, left anterior and posterior relative to the center (3, 9, 12, and 6 O’clock) via the New Tom VGI CBCT unit. Two observers evaluated images for VRFs. Sensitivity and specificity of fracture diagnosis in each position was calculated in comparison with the gold standard. Wilcoxon test was used for data analysis.

Results:

Considering deterministic and probabilistic diagnostic parameters, probabilistic sensitivity was similar in all positions; but probabilistic specificity of the center position (65.1%) was significantly higher than that of 6 and 12 O’clock positions. Considering the deterministic diagnostic parameters, the overall sensitivity and specificity values decreased in all positions in FOV, but sensitivity of the center position of FOV was significantly higher than that of other positions; specificity was significantly higher at the 3 O’clock position (58.5%).

Conclusion:

Concerning the positions in FOV, the center position is suitable for detection of VRF in teeth with intra-canal posts due to significantly higher sensitivity at this position. The 3 O’clock position would be suitable for assessment of intact teeth without fractures due to significantly higher specificity at this position.

The effect of metal artifacts on the identification of vertical root fractures using different fields of view in cone-beam computed tomography

Purpose

The aim of this study was to investigate the effects of metal artifacts on the accurate diagnosis of root fractures using cone-beam computed tomography (CBCT) images with large and small/limited fields of view (FOVs).

Materials and Methods

Forty extracted molar and premolar teeth were collected. Access canals were made in all teeth using a rotary system. In half of the teeth, fractures were created by the application of mild pressure with a hammer. The teeth were then randomly put into a wax rim on an acryl base designed in the shape of a mandible. CBCT scans were obtained using a Newtom 5G system with FOVs of 18 cm×16 cm and 6 cm×6 cm. A metal pin was then placed into each tooth, and CBCT imaging was again performed using the same fields of view. All scans were evaluated by two oral and maxillofacial radiologists. The specificity, sensitivity, positive predictive value, negative predictive value, and likelihood ratios (positive and negative) were calculated.

Results

The maximum levels of sensitivity and specificity (100% and 100%, respectively) were observed in smallvolume CBCT scans of teeth without pins. The highest negative predictive value was found in the small-volume group without pins, whereas the positive predictive value was 100% in all groups except the large-volume group with pins.

Conclusion

The specificity of CBCT decreased with the presence of a pin in the large-volume group, but not in the small-volume group.

Diagnostic imaging modalities in head and neck disease

BACKGROUND

Because of the complex anatomy of the head and neck region, conventional projection radiography alone is unreliable and carries a high risk of misdiagnosis. The poor risk-benefit ratio of conventional radiography has led to their replacement by tomographic imaging for nearly all studies in this region.

METHOD

This review is based on pertinent articles retrieved by a selective search in the PubMed database (January 1980 to May 2013) as well as on the relevant guidelines from Germany and abroad.

RESULTS

The indication for diagnostic imaging in the anatomically complex head and neck region should be established for a specific type of imaging study on the basis of a thorough clinical examination. Conventional films, though easy to obtain, often cannot answer the diagnostic question and may yield confusing information leading to misdiagnosis. Computed tomography (CT) has the best risk-benefit profile and a high diagnostic value, but low-dose protocols have not yet been put into use in all centers. Magnetic resonance imaging (MRI) is best for bone and soft-tissue diagnosis, but consumes more resources. Digital volume tomography (DVT) is another type of three-dimensional, sectional imaging with high local resolution; the associated radiation exposure and image quality are generally both low, but may vary depending on the apparatus used. DVT cannot be used to evaluate the soft tissues. Ultrasonography can be used to evaluate superficial structures in the head and neck region; nuclear imaging can be used to evaluate thyroid disease and cancer.

CONCLUSION

Inflammatory, traumatic, and neoplastic diseases of the head and neck are best evaluated with cross-sectional imaging (CT, MRI) in accordance with current guidelines. Conventional x-rays should, in general, only be used for dental evaluation, with rare exceptions.

The importance of cone-beam computed tomography in the management of endodontic problems: a review of the literature

INTRODUCTION

To obtain essential information in clinical endodontics, cone-beam computed tomographic (CBCT) imaging can be used in all phases of treatment including diagnosis, treatment planning, during the treatment phase, and through post-treatment assessment and follow-up. The purpose of this article was to review the use of CBCT imaging in the diagnosis, treatment planning, and assessing the outcome of endodontic complications.

METHODS

Literature was selected through a search of PubMed electronic databases for the following keywords: tooth root injuries, tooth root radiography, tooth root perforation, tomography, cone-beam computed tomography, endodontic complications, tooth root internal/external resorption, root fractures, and broken instruments. The research was restricted to articles published in English. One hundred twelve articles met the inclusion criteria and were included in this review.

RESULTS

Currently, intraoral radiography is the imaging technique of choice for the management of endodontic disease, but CBCT imaging appears to have a superior validity and reliability in the management of endodontic diagnosis and complications.

CONCLUSIONS

Endodontic cases should be judged individually, and CBCT imaging should be considered in situations in which information from conventional imaging systems may not yield an adequate amount of information to allow the appropriate management of endodontic problems. CBCT imaging has the potential to become the first choice for endodontic treatment planning and outcome assessment, especially when new scanners with lower radiation doses will be available.

Comparison of periapical radiography with cone beam computed tomography in the diagnosis of vertical root fractures in teeth with metallic post

Aim:

To compare the diagnostic accuracy of conventional periapical radiography and cone beam computed tomography (CBCT) in detecting vertical root fracture (VRF) in tooth with metallic post (MP).

Materials and Methods:

Twenty endodontically-treated teeth received MPs, artificial fractures were created in 10 teeth, and they were all examined with tomography and radiography. The sample consisted of periapical radiography with post and without post, and tomography with post and without post; each group with five fractured and five non-fractured teeth. The images were evaluated by three dental/maxillofacial radiologists and statistical validations were carried out using receiver operating characteristic (ROC) analysis.

Results:

Sensitivity and specificity of the area under the ROC (Az) of tomography with post (Az = 0.953) and without post (Az = 0.956) were significantly higher than those of periapical radiography with post (Az = 0.753) and without post (Az = 0.778).

Conclusion:

CBCT was more accurate than conventional periapical radiography in detecting VRF.

Spontaneous healing responses detected by cone-beam computed tomography of horizontal root fractures: a report of two cases

Horizontal root fractures (HRF) usually affect the anterior teeth as a result of trauma, and generally heal spontaneously, depending on the vitality of the pulp. Diagnosis based on clinical findings, sensitivity tests, and radiographic examination is important to determine the presence of a root fracture and to prevent a root fracture from passing unnoticed. Cone-beam computed tomography (CBCT) has been used successfully for diagnosis and prognosis imaging of root fractures and has proved to be superior to other radiographic methods. This study reports two cases of dental trauma caused by a collision and a sports accident. The patients suffered horizontal root fractures in the maxillary left central incisor and in the mandibular left central incisor. The diagnosis of root fracture was confirmed by cone-beam computed tomography (CBCT) images, which also demonstrated spontaneous healing of the fracture line. The repair occurred by interposition of connective tissue in the former case and by interposition of bone and connective tissue in the latter case. The final diagnoses of both cases were based on CBCT images, indicating the importance of a CBCT examination to reach a firm diagnosis and to follow the healing process of root fracture cases, avoiding unnecessary radical endodontic treatment.

Dilaceration and Eruption Disturbances in Permanent Teeth: A Sequelae of Trauma to Their Predecessors-Diagnosis and Treatment Using Cone Beam CT

Alterations in the morphology of permanent teeth following trauma to their predecessors is a challenging task for diagnosis and it may require advanced imaging techniques. Newer imaging modalities have replaced the conventional radiological procedures, as they allow 3D reconstruction images and views which are free of superimposition. Cone Beam CT (CBCT) offers a three-dimensional view, which the conventional two-dimensional dental radiography fails to provide. The current article highlights the advantages of CBCT which are seen in evaluation of the morphological variations and eruptive disturbances in the permanent teeth, as sequelae to trauma in their predecessors.

Assessment of vertical root fracture using cone-beam computed tomography

PURPOSE

The aim of this study was to investigate the accuracy of cone-beam computed tomography (CBCT) in the diagnosis of vertical root fractures in a tooth with gutta-percha and prefabricated posts.

MATERIALS AND METHODS

This study selected 96 extracted molar and premolar teeth of the mandible. These teeth were divided into six groups as follows: Groups A, B, and C consisted of teeth with vertical root fractures, and groups D, E, and F had teeth without vertical root fractures; groups A and D had teeth with gutta-percha and prefabricated posts; groups B and E had teeth with gutta-percha but without prefabricated posts, and groups C and F had teeth without gutta-percha or prefabricated posts. Then, the CBCT scans were obtained and examined by three oral and maxillofacial radiologists in order to determine the presence of vertical root fractures. The data were analyzed using IBM SPSS 20.0 (IBM Corp., Armonk, NY, USA).

RESULTS

The kappa coefficient was 0.875±0.049. Groups A and D showed a sensitivity of 81% and a specificity of 100%; groups E and B, a sensitivity of 94% and a specificity of 100%; and groups C and F, a sensitivity of 88% and a specificity of 100%.

CONCLUSION

The CBCT scans revealed a high accuracy in the diagnosis of vertical root fractures; the accuracy did not decrease in the presence of gutta-percha. The presence of prefabricated posts also had little effect on the accuracy of the system, which was, of course, not statistically significant.

Changes of pulp-chamber dimensions 1 year after rapid maxillary expansion

INTRODUCTION

The purpose of this study was to examine the effect of orthopedic forces on maxillary first molars' and maxillary central incisors' pulp chambers in children having rapid maxillary expansion as the only intervention compared with children having no orthodontic intervention by using cone-beam computed tomography images.

METHODS

In this prospective controlled clinical study, we evaluated 60 maxillary first molars and 60 maxillary central incisors from 30 children (18 boys, 12 girls) in the mixed dentition and during the pubertal growth period. The treated group had rapid maxillary expansion with the Haas expander, followed by 6 months of retention and 6 months of follow-up out of retention; the control group had no intervention during the study. Cone-beam computed tomography scans were taken initially and 1 year after the rapid maxillary expansion active phase. Initially, a 3-dimensional scrolling in all pulp chambers of the evaluated teeth was performed with Dolphin Imaging software (version 11.0; Dolphin Imaging & Management Solutions, Chatsworth, Calif) to describe the incidence of pulp-chamber calcifications. The dimensions of the pulp chambers of the molars and incisors were also investigated. Cross-sectional and longitudinal slices were used for each molar (coronal and axial slices) and incisor (sagittal and axial slices). The area (mm(2)) was obtained from 3 slices of each kind (6 measurements for each tooth).

RESULTS

The results suggest that rapid maxillary expansion did not induce new pulp-chamber calcification. Also, it did not interfere in normal pulp-chamber dimension changes of the anchorage molars.

CONCLUSIONS

The pulp chamber of the central incisors can be expected to be minimally wider 1 year after the therapy.