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.

Current status of cone-beam computed tomography teaching in Brazilian undergraduate endodontic programs - A web-based survey

PURPOSES

This study aimed to assess the current status of cone-beam computed tomography (CBCT) education in Brazilian undergraduate Endodontic programs.

METHODS

One hundred program directors were emailed. The questionnaire asked whether the CBCT topic was included in the program, the availability of a CBCT machine, and, the total length of the dental program. For the group that does not teach, seven questions discussed the reasons for not teaching and whether another subject included this topic. For the programs that included CBCT, seven questions discussed the number of hours included, and the impression of the program directors with the quality of the teaching. The chi-square test was used for the correlation between the availability of the CBCT machine and the length of the dental program with the inclusion of the topic.

RESULTS

Thirty-five program directors replied to the questionnaire. Twenty-six (74.3%) reported that the topic of CBCT is not included in their programs. There was no impact of the availability of a CBCT machine on the inclusion of the topic (p > 0.05). The increased length of the dental program decreased the inclusion of the topic (p < 0.05). Fifty percent of the directors replied that lack of time is the reason for not including the topic. Among the programs that include CBCT, the majority (55.6%) deliver 3-5 h of lectures. The practical activities range from 1 to 5 h or more. The majority (77.8%) of the directors are satisfied with the content delivered and 44.4% understand that the students are competent in the interpretation of CBCT images.

CONCLUSIONS

The majority of the Endodontic undergraduate programs in Brazil do not include CBCT in the program. The availability of a CBCT machine does not impact the inclusion of the topic, the increased duration of the dental program decreases the inclusion of the CBCT topic.

Does clinical experience with dental traumatology impact 2D and 3D radiodiagnostic performance in paediatric dentists? An exploratory study

Background

The aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists’ performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D).

Materials and methods

Both 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer’s self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling.

Results

Overall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P < 0.05). This was not the case regarding interpretation of the findings. Self-assessed confidence was significantly higher in more experienced dentists, both when using 2D and 3D images (P < 0.05).

Conclusion

There was no proof that paediatric dentist’s higher experience with TDI is associated with better radiodiagnostic performance. Neither could it be proven that the use of Cone Beam Computed Tomography (CBCT) contributes to an improved interpretation of findings, for any experience level. More experienced dentists feel more confident, irrespective of the imaging modality used, but this does not correlate with improved performance. The overall poor performance in image interpretation highlights the importance of teaching and training in both dental radiology and dental traumatology.

Proximity of maxillary molar apexes to the cortical bone surface and the maxillary sinus

Objectives

Materials and Methods

Results

Conclusions

Evaluation of complete pulpotomy with Biodentine® on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis: 12 months follow-up

INTRODUCTION

Complete pulpotomy is the removal of the coronal portion of a vital pulp and is a means of preserving the vitality of the remaining root portion. The objective of this study was to evaluate the 12-month success rate of complete pulpotomy with Biodentine® on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis.

MATERIALS AND METHODS

A total of 68 molars diagnosed with symptomatic irreversible pulpitis in 68 patients aged 20 years and older were included in this study. The exclusion criteria were intraoperative clinical signs of pulp necrosis on the molar to be treated such as no bleeding, or uncontrollable pulp hemorrhage (more than 5 min of hemostasis) on at least one canal. A complete pulpotomy with Biodentine® was performed on molars with symptomatic irreversible pulpitis by the same operator and with the same protocol. At 12-month post-operative follow-up was conducted to evaluate clinical and radiological success.

RESULTS

A total of 66 patients received complete pulpotomy. Fifty-two could be examined at 12 months postoperatively. Clinical and radiological analysis at 12 months postoperatively revealed a success rate of 87% (45/52 molars) and a failure rate of 13% (7/52 molars). There was a relationship between age, tooth type, pre-operative periapical condition and treatment success with P<0.05.

CONCLUSION

Compliance with the indications and protocol for complete pulpotomy with Biodentine® on mature permanent molars with symptomatic irreversible pulpitis gives positive results at 12 month follow-up.

Current trends in the adoption and education of cone beam computed tomography and panoramic radiography machines across Australia

OBJECTIVES

This is a follow-up study to assess growth in the number of cone beam computed tomography (CBCT) and panoramic radiography (PR) machines in Australia. It is also the first study to evaluate the current status of both CBCT and PR education in Australia.

METHODS

CBCT and PR machine numbers were obtained from the radiation regulators across Australia. Australian dental schools were surveyed via email. The number of machines relative to population size and the number of dentists were calculated.

RESULTS

In 2020, there were 706 CBCT machines and 3,059 PR machines, representing a 204.3% increase in the number of CBCT machines and an 82.0% increase in the number of PR machines over six years. Majority of Australian dental schools owned PR and CBCT machines. Most taught PR acquisition and interpretation, however only one-third taught CBCT image acquisition and interpretation to predoctoral students.

CONCLUSIONS

CBCT machine numbers increased by nearly three-fold while PR machines only increased by 1.6 times over a six-year period relative to population size and number of dentists. Only very few Australian dental schools provide CBCT education to predoctoral students, raising concern as to whether graduates are adequately trained upon program completion.

Management of a Rare Case of Geminated and Fused Central Incisors in the Same Maxillary Dental Arch

A 27-year-old man presented with developmental disorders in the maxillary incisors and asymmetric smile. Differential diagnosis between geminated and fused maxillary central incisors was conducted using cone-beam computed tomography (CBCT). The complexities of root canal system was handled using suitable shaping instruments and ultrasonic activation tips. Root apexes were sealed with mineral trioxide aggregate plugs. The anterior maxillary gingiva was surgically recontoured, and CAD/CAM Zirconia crowns were placed after the gingival healing phase. The combination of the 3D radiological examination, the clinical screening, and the use of a diagnostic wax-up presented a successful approach to manage this rare clinical case.

Cone beam computed tomography in dentistry: practitioner awareness and attitudes. A scoping review

Familiarity with cone beam computed tomography is a requisite for all dental practitioners involved in its use or referral. This scoping review examines the knowledge, attitudes, competence and confidence of dental practitioners and students towards cone beam computed tomography in the dental setting. A search of Medline, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature was conducted to identify and chart existing evidence. Relevant studies written in English and published after 1998 and up to July 2020 were included. Of 679 papers, 39 studies were included for analysis. Key findings include deficient knowledge despite a widespread recognition of its importance and willingness to increase proficiency in its use, as well as a largely positive and optimistic view of the technology. Future studies on practitioners' knowledge and attitudes towards cone beam computed tomography are suggested to consider the contexts of an Australian setting.

Awareness and practice of 2D and 3D diagnostic imaging among dentists in Hong Kong

Aims To investigate the awareness and practice of 2D and 3D diagnostic imaging, including respective equipment, specifications, number of images acquired, indications for CBCT scans, preference between 2D and 3D imaging, and the confidence in acquiring and interpreting radiographic images among dentists in Hong Kong.Materials and methods A citywide survey was performed with an online questionnaire that was sent via the local dental association to registered dentists in Hong Kong. The anonymous survey focused on: their dental background; number, type and age of their intra-oral, panoramic devices; CBCT indications, field-of-view and consideration of low-dose protocols; and their confidence in taking and interpreting these images.Results From the feedback collected, 65% of dentists used digital intra-oral systems. Around 70% of respondents who perform CBCTs utilised low-dose protocols to reduce radiation dose. Age and years of practising dentistry were significant influencing factors in determining dentists' utilisation of low-dose protocols for CBCT devices. Male dentists and dentists with higher qualifications generally reported being more confident in taking and interpreting CBCT images. Dentists who were older and had more years of practising dentistry were generally more confident in interpreting CBCT images.Conclusion Only half of the dentists feel confident in taking and interpreting CBCT images, and there seems to be a limited knowledge of radiation dose-related risks. Therefore, continuous professional education should specifically focus on the potential of digital imaging and training in CBCT modalities, radiation dose protection and image interpretation.

CBCT in Advanced Dental Education: A Survey of U.S. Postdoctoral Periodontics Programs

Historically, predoctoral and advanced dental education programs used two-dimensional panoramic and periapical radiographs for implant planning. Three-dimensional (3D) Cone Beam Computed Tomography (CBCT) imaging has improved visualization of anatomic structures that can positively influence implant planning and surgical implant placement. The aim of this study was to assess how U.S. postdoctoral periodontics programs have incorporated CBCT technology into their curricula. A ten-question survey was sent to all 57 U.S. postdoctoral periodontics programs in November-December 2018. Thirty-seven responses were received, for a 65% response rate. All participating programs reported providing residents access to CBCT machines, and most of their residents received some training in the acquisition and interpretation of CBCT images. Nearly all (95%) participating programs provided training to apply implant planning software. Among the participating programs, 14% reported using a surgical guide fabricated with a CBCT scan 76-100% of the time, and 60% reported obtaining a CBCT scan for implant cases 76-100% of the time. These results suggest that, while residents are receiving training in CBCT and implant planning, it is not used often. There may be merit in adopting the American Academy of Oral and Maxillofacial Radiology's recommendation to use 3D imaging for all implant planning, with CBCT as the imaging modality of choice.

European Society of Endodontology position statement: Use of cone beam computed tomography in Endodontics: European Society of Endodontology (ESE) developed by

This Position Statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the use of Cone Beam Computed Tomography (CBCT) in Endodontics. This paper is an update of the ESE CBCT position statement which was published in 2014 (European Society of Endodontology 2014, https://doi.org/10.1111/iej.12267). Recent review articles provide more detailed background information and the basis for this position statement. It is intended that this position statement will be updated at least every 4-5 years to keep abreast of relevant research. The aim of this paper is to provide clinicians with evidence-based guidance on the application of CBCT in Endodontics. Since 2014, there has been an increase in the number of clinical studies confirming the positive impact of CBCT on treatment planning, decision-making when reviewing cases and reduced practitioner stress levels.