Accuracy of Software-Based Three-Dimensional Root Canal Length Measurements Using Cone-Beam Computed Tomography

Assessment of Systemic and Maxillary Bone Loss in Cancer Patients with Endo-Periodontal Lesions Using Dkk-1 Biomarker and Dental Radiological Examinations

The aim of our study was to correlate systemic bone loss by evaluating human Dickkopf-related protein 1 (Dkk-1) biomarker compared to horizontal bone loss as well as the presence and size of periapical lesions assessed by dental X-ray (ortopantomography—OPT) and cone beam computed tomography (CBCT) in patients with cancer in the ears, nose and throat (ENT) region vs. healthy controls. The study included 63 subjects divided into a study group of 33 cancer patients with ENT cancer (larynx/oropharynx/sinuses) and a control group of 30 healthy individuals. Blood samples were collected from both groups to assess Dkk-1 level using a sandwich enzyme immunoassay. The dental radiological examination consisted of a panoramic X-ray and a CBCT in order to appraise the horizontal bone loss, the presence and size of the periapical lesions in 2D vs. 3D images. The panoramic X-ray showed that in the control group, the maximum bone loss reached 13.2 mm, with an average of 4.930 ± 3.258 mm, while in the study group, the maximum horizontal bone loss was 11.3 mm, with an average of 5.191 ± 2.109 mm. The CBCT 3D investigation, when compared to the OPT, showed increased values for horizontal bone loss, both in the control group and in the study group; in the control group, the maximum bone loss reached 14.10 mm, with an average of 5.736 ± 3.471 mm, and in the study group, the maximum value was 12.40 mm, and the average was again slightly higher (6.152 ± 2.519 mm). The mean value for Dkk-1 in cancer patients was 1.209 ± 0.110 ng/mL, significantly lower than the value observed in healthy patients (1.712 ± 0.100 ng/mL). CBCT revealed higher values for the investigated parameters when compared to panoramic X-rays. Taking into account the preliminary nature of our study, we observed a significant correlation between the level of bone loss recorded by the Dkk-1 biomarker and radiological dental examination in patients with ENT cancer when compared to the control group.

Root canal length estimated by cone-beam computed tomography at different slice thicknesses, dedicated endodontic software, or measured by an electronic apex locator

The aim of the present study was to evaluate the agreements between the root canal length estimations using cone-beam computed tomography (CBCT) at different slice thicknesses, dedicated software, or an electronic apex locator (EAL) and the actual lengths (AL). In total, 111 extracted human molars with 302 root canals were chosen. Teeth were scanned using a CBCT device at a voxel size of 0.075 mm. Root canal lengths were estimated using CBCT software at different slice thicknesses (0.6, 1.2, and 2.4 mm) and dedicated software for proposed or operator lengths. The endodontic access cavities were created, and root canal lengths were estimated with an EAL for electronic length (EL) and a ruler for AL. Data were tested using paired t-tests and Bland–Altman plots to detect the differences between the methods in length estimation at a significance of 0.05. The accuracy in the range of ± 0.5 mm was 100% for the EAL. There was an agreement between the EL and CBCT at a slice thickness of 1.2 mm (p = 0.349). CBCT at the smallest slice thickness estimation was not the best modality in agreement with the AL. The EAL was an accurate and reliable method for root canal length measurement.

Endodontic length measurements using 3D Endo, cone-beam computed tomography, and electronic apex locator

BACKGROUND

The objective of this study is to investigate the accuracy of the 3D Endo software, cone-beam computed tomography (CBCT) software, and the electronic apex locator (EAL) in endodontic length determination.

METHODS

302 root canals in 111 human extracted molars were chosen. Access cavity was performed, and root canal lengths were measured with a digital caliper for actual length (AL) and EAL for electronic length. Teeth were then scanned using CBCT device at voxel size of 0.10 mm. It measured root canal lengths using the CBCT (Romexis Viewer), 3D Endo for proposed length (3D-PL) and correct length (3D-CL). Mean differences between the four methods with the AL were calculated and compared. Fisher's exact test, paired t-test, Bland-Altman plot were used to test the differences among the experimental modalities in working length determination at the significance of 0.05.

RESULTS

The accuracy in the range of ± 0.5 mm of the EAL ProPex II was highest among the experimental modalities, however this method disagreed with the actual length.

CONCLUSIONS

The correct working length after adjustment from the semi-automatically length by the 3D Endo software and Romexis Viewer measurements agreed with the AL.

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.

Comparative Evaluation of Accuracy of Different Apex Locators: Propex IQ, Raypex 6, Root ZX, and Apex ID with CBCT and Periapical Radiograph-In Vitro Study

OBJECTIVES

This study aimed to validate the accuracy of working length (WL) measurements obtained with the newly introduced Propex IQ apex locator and to compare it with the latest generations of other electronic apex locators, CBCT, and conventional periapical radiographs by using the actual WL measurements obtained by using an endodontics microscope as a reference.

MATERIALS AND METHODS

Thirty-five extracted single-rooted human mandibular first premolars with curvatures from 10° to 20° were selected according to the inclusion and exclusion criteria and cut at the cementoenamel junction to achieve a standard reference point for WL determination. The actual WL was obtained by inserting a size-15 k-file in the root canal until the tip of the file was visible under an endodontic microscope. The definitive WL was measured using Propex IQ (Dentsply Sirona), Raypex 6 (VDW Dental), Root ZX (Morita), and Apex ID (Kerr Dental). In addition, radiographic WL was obtained using periapical radiographs and CBCT. One-way ANOVA was used for comparisons of the WL values, with a p value < 0.05. The percentage of success of each method for determination of the definitive WL was assessed using cross-tabulation and chi-square tests.

RESULTS

CBCT radiographs and Propex IQ apex locator yielded the most accurate WL measurements in comparison with the actual WL measurements (p < 0.05). Raypex 6, Root ZX, and Apex ID yielded more accurate WL measurements than conventional periapical radiographs (p < 0.05). Periapical radiographs yielded the least accurate WL measurements in comparison with the actual WL values (p < 0.05).

CONCLUSIONS

Within the limitations of this study, the Propex IQ apex locator showed higher accuracy than Raypex 6, Root ZX, and Apex ID for WL determination in the root canal. Nevertheless, CBCT radiographs yielded the maximum accuracy for WL measurements.

Endodontic length measurements using cone beam computed tomography with dedicated or conventional software at different voxel sizes

The aim of this study is to investigate the accuracies and the agreements of the 3D Endo software, conventional CBCT software Romexis Viewer at three voxel sizes, and the EAL ProPex Pixi in endodontic length measurements. Three hundred and twenty-nine root canals in 120 intact human extracted molars were accessed. The actual lengths (AL) and electronic lengths (EL) were measured using the ruler and electronic apex locator (EAL), respectively. Teeth were scanned using the CBCT at different voxel sizes (0.075, 0.10, and 0.15 mm). Root canal lengths were measured using 3D Endo with proposed length (3D-PL) by software, corrected length (3D-CL), Romexis Viewer. The Fisher's exact test, paired t-test and Bland-Altman plots were calculated to detect the agreements of the four methods with AL measurements. The ProPex Pixi measurements obtained the highest accuracy in the range of ± 0.5 mm. There was agreement between the 3D-PL and the 3D-CL with AL measurements at voxel size of 0.15 mm and at voxel size of 0.10 mm, respectively. The CBCT Romexis Viewer measurements agreed with AL at three voxel sizes. The conventional CBCT measurements using Romexis Viewer and dedicated software did not reach to the 100% accuracy in the range of ± 0.5 mm.

Correlation of objective image quality and working length measurements in different CBCT machines: An ex vivo study

To investigate potential correlations between objective CBCT image parameters and accuracy in endodontic working length determination ex vivo. Contrast-to-noise ratio (CNR) and spatial resolution (SR) as fundamental objective image parameters were examined using specific phantoms in seven different CBCT machines. Seven experienced observers were instructed and calibrated. The order of the CBCTs was randomized for each observer and observation. To assess intra-operator reproducibility, the procedure was repeated within six weeks with a randomized order of CBCT images. Multivariate analysis (MANOVA) did not reveal any influence of the combined image quality factors CNR and SR on measurement accuracy. Inter-operator reproducibility as assessed between the two observations was poor, with a mean intra-class correlation (ICC) of 0.48 (95%-CI  0.38, 0.59) for observation No. 1. and 0.40 (95%-CI 0.30, 0.51) for observation No. 2. Intra-operator reproducibility pooled over all observers between both observations was only moderate, with a mean ICC of 0.58 (95%-CI 0.52 to 0.64). Within the limitations of the study, objective image quality measures and exposure parameters seem not to have a significant influence on accuracy in determining endodontic root canal lengths in CBCT scans. The main factor of variance is the observer.

Endodontic Length Measurements Using Different Modalities: An In Vitro Study

INTRODUCTION

The aim of this study was to investigate and compare the accuracy of the 3D Endo software, conventional CBCT software Romexis Viewer, and the EAL E-Pex Pro in WL determination.

MATERIALS AND METHODS

Three hundred and two root canals in 110 intact human extracted molars were accessed. The actual lengths (ALs) were measured. Root canal lengths were measured using 3D Endo with proposed length (3D-PL) by software, correct length (3D-CL), Romexis Viewer, and the E-Pex Pro. The percentages of the measurements in the range of ±0.5 mm to the AL were compared using the Fisher's exact test. The paired t test and Bland-Altman plots were calculated to detect the agreement of the four methods with the AL measurements. The statistical significance was set at P<0.05.

RESULTS

The accuracies in the range of ±0.5 mm to the AL were 83.8%, 86.7%, 48.3%, and 99.7% for 3D-PL, 3D-CL, Romexis Viewer, and E-PexPro, respectively. There were agreements between 3D-PL and Romexis Viewer with the AL measurements.

CONCLUSION

The CBCT measurements using 3D Endo with the proposed length by the software and Romexis Viewer with the voxel size of 0.15 mm agreed with the AL measurements of the root canals.