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Can E, Böning G, Lüdemann WM, Hosse C, Kolck J, Paparoditis S, Nguyen T, Piper SK, Geisel D, Wieners G, Gebauer B, Elkilany A, Jonczyk M. Evaluation of a prototype metal artifact reduction algorithm for cone beam CT in patients undergoing radioembolization. Sci Rep 2024; 14:16399. [PMID: 39014057 PMCID: PMC11252118 DOI: 10.1038/s41598-024-66978-y] [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: 04/20/2024] [Accepted: 07/06/2024] [Indexed: 07/18/2024] Open
Abstract
Metal artifacts notoriously pose significant challenge in computed tomography (CT), leading to inaccuracies in image formation and interpretation. Artifact reduction tools have been designed to improve cone beam computed tomography (CBCT) image quality by reducing artifacts caused by certain high-density materials. Metal artifact reduction (MAR) tools are specific algorithms that are applied during image reconstruction to minimize or eliminate artifacts degrading CBCT images. The purpose of the study is to evaluate the effect of a MAR algorithm on image quality in CBCT performed for evaluating patients before transarterial radioembolization (TARE). We retrospectively included 40 consecutive patients (aged 65 ± 13 years; 23 males) who underwent 45 CBCT examinations (Allura FD 20, XperCT Roll protocol, Philips Healthcare, Best, The Netherlands) in the setting of evaluation for TARE between January 2017 and December 2018. Artifacts caused by coils, catheters, and surgical clips were scored subjectively by four readers on a 5-point scale (1 = artifacts affecting diagnostic information to 5 = no artifacts) using a side-by-side display of uncorrected and MAR-corrected images. In addition, readers scored tumor visibility and vessel discrimination. MAR-corrected images were assigned higher scores, indicating better image quality. The differences between the measurements with and without MAR were most impressive for coils with a mean improvement of 1.6 points (95%CI [1.5 1.8]) on the 5-point likert scale, followed by catheters 1.4 points (95%CI [1.3 1.5]) and clips 0.7 points (95%CI [0.3 1.1]). Improvements for other artifact sources were consistent but relatively small (below 0.25 points on average). Interrater agreement was good to perfect (Kendall's W coefficient = 0.68-0.95) and was higher for MAR-corrected images, indicating that MAR improves diagnostic accuracy. A metal artifact reduction algorithm can improve diagnostic and interventional accuracy of cone beam CT in patients undergoing radioembolization by reducing artifacts caused by diagnostic catheters and coils, lowering interference of metal artifacts with adjacent major structures, and improving tumor visibility.
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Affiliation(s)
- Elif Can
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Georg Böning
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Willie Magnus Lüdemann
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Clarissa Hosse
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johannes Kolck
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sophia Paparoditis
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thao Nguyen
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sophie K Piper
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dominik Geisel
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Gero Wieners
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernhard Gebauer
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Aboelyazid Elkilany
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Martin Jonczyk
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Soltani P, Devlin H, Etemadi Sh M, Rengo C, Spagnuolo G, Baghaei K. Do metal artifact reduction algorithms influence the detection of implant-related injuries to the inferior alveolar canal in CBCT images? BMC Oral Health 2024; 24:268. [PMID: 38395919 PMCID: PMC10885517 DOI: 10.1186/s12903-024-04043-w] [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: 11/25/2023] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The routine application of dental implants for replacing missing teeth has revolutionized restorative and prosthetic dentistry. However, cone beam computed tomography (CBCT) evaluations of structures adjacent to the implants are limited by metal artifacts. There are several methods for reducing metal artifacts, but this remains a challenging task. This study aimed to examine the effectiveness of metal artifact reduction (MAR) algorithms in identifying injuries of implants to the inferior alveolar canal in CBCT images. METHOD In this in vitro study, mono-cortical bone windows were created and the inferior alveolar canal was revealed. Using 36 implants, pilot drill and penetration damage of the implant tip into the canal was simulated and compared to the control implants with distance from the canal. CBCT images were evaluated by four experienced observers with and without the MAR algorithm and compared to direct vision as the gold standard. The values of accuracy, sensitivity, and specificity were obtained and compared by receiver operating characteristic (ROC) curve (α = 0.05). RESULT The area under the ROC curve values for detection of pilot drill injuries varied between 0.840-0.917 and 0.639-0.854 in the active and inactive MAR conditions, respectively. The increase in ROC area was only significant for one of the observers (P = 0.010). For diagnosing penetrative injuries, the area under the ROC curve values was between 0.990-1.000 and 0.722-1.000 in the active and inactive MAR conditions, respectively. The improvement of ROC curve values in active MAR mode was only significant for one of the observers (P = 0.006). CONCLUSION Activation of MAR improved the diagnostic values of CBCT images in detecting both types of implant-related injuries to the inferior alveolar canal. However, for most observers, this increase was not statistically significant.
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Affiliation(s)
- Parisa Soltani
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Hugh Devlin
- The Dental School, The University of Bristol, Bristol, UK
- Department of Restorative Dentistry, School of Dentistry, Jordan University, Amman, Jordan
| | - Milad Etemadi Sh
- Department of Oral and Maxillofacial Surgery, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Carlo Rengo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
- Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, Moscow, 119991, Russia
| | - Kimia Baghaei
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Hezar- Jarib Ave, Isfahan, Iran.
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Shavakhi M, Soltani P, Aghababaee G, Patini R, Armogida NG, Spagnuolo G, Valletta A. A Quantitative Evaluation of the Effectiveness of the Metal Artifact Reduction Algorithm in Cone Beam Computed Tomographic Images with Stainless Steel Orthodontic Brackets and Arch Wires: An Ex Vivo Study. Diagnostics (Basel) 2024; 14:159. [PMID: 38248036 PMCID: PMC10813925 DOI: 10.3390/diagnostics14020159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
The presence of high-density and high-atomic number materials results in the generation of artifacts in cone beam computed tomographic (CBCT) images. To minimize artifacts in CBCT images, the metal artifact reduction (MAR) tool was developed. This study aims to quantitatively evaluate the effectiveness of the MAR algorithm in CBCT images of teeth with stainless steel orthodontic brackets with or without arch wires in buccal and lingual positions obtained using the Galileos Sirona CBCT scanner. In this in vitro study, 20 stainless steel brackets were attached to the maxillary dentition from the right second premolar to the left second premolar teeth of a human skull. In the first group, 10 brackets were bonded to the buccal surface, and in the second group, 10 brackets were bonded to the palatal surface of these teeth. CBCT scans were obtained for each group with or without orthodontic stainless steel wires using a Galileos Sirona CBCT scanner with exposure parameters of 85 kVp and 21 mAs. CBCT images were obtained two times with and two times without MAR activation. The DICOM format of the CBCT images was imported to ImageJ software (version 1.54), and the contrast-to-noise ratio (CNR) was calculated and compared for each bracket in 15 and 20 mm distances and 20, 40, and 90 degrees on each side. Statistical analysis was performed using the t test (α = 0.05). CNR values of different distances and different teeth were not significantly different between the two MAR modes (p > 0.05). MAR activation had a significant impact in increasing CNR and reducing artifacts only when brackets were in palatal (p = 0.03). In the other bracket and wire positions, the effect of the MAR algorithm on CNR was not significant (p > 0.05). In conclusion, MAR activation significantly increased CNR, but only when the brackets were in a palatal position. In the other bracket and wire positions, the effect of the MAR algorithm is not significant.
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Affiliation(s)
- Mojgan Shavakhi
- Department of Orthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran;
| | - Parisa Soltani
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran;
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Naples, Italy; (N.G.A.); (A.V.)
| | - Golnaz Aghababaee
- Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran;
| | - Romeo Patini
- Department of Head, Neck and Sense Organs, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy;
| | - Niccolò Giuseppe Armogida
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Naples, Italy; (N.G.A.); (A.V.)
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Naples, Italy; (N.G.A.); (A.V.)
- Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, 119991 Moscow, Russia
| | - Alessandra Valletta
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Naples, Italy; (N.G.A.); (A.V.)
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Orhan K, Kocyigit D, Firincioglulari M, Adisen MZ, Kocyigit S. Quantitative assessment of image artifacts from zygoma implants on CBCT scans using different exposure parameters. Proc Inst Mech Eng H 2023; 237:1082-1090. [PMID: 37528643 DOI: 10.1177/09544119231190447] [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] [Indexed: 08/03/2023]
Abstract
This study was aimed at quantifying artifacts from zygoma implants in cone-beam computed tomography (CBCT) images using different exposure parameters. Two cadaver heads, one with two zygoma implants on each side and the other for control, were scanned using 18 different exposure parameters. Quantitative analysis was performed to evaluate the hypodense and hyperdense artifact percentages calculated as the percentage of the area. Hyperdense artifacts and hypodense artifacts were detected, followed by the calculation of the hyperdense and hypodense artifact percentages in the image. In the qualitative analysis of the artifacts, the scores used were as follows: absence (0), moderate presence (1), or high presence (2) for hypodense halos, thin hypodense lines, and hyperdense lines. Artifact analysis was performed qualitatively and quantitatively using the post-hoc Tukey and Two-way ANOVA tests. As a result, in the qualitative analyses, zygoma implants showed a significant difference compared to the control group with regard to hyperdense and hypodense artifacts (p < 0.05). There was a significant difference between the means according to the FOV size arithmetic averages (p < 0.05). In terms of voxel size, the difference was found to be significant, where 400 microns showed the highest hypodense artifact while 200 microns showed the lowest hypodense artifact. In conclusion, hypodense and hyperdense artifacts were significantly higher in cadavers with zygoma implants than in controls. As FOV and voxel size increase, more hypodense artifacts are produced by zygoma implants so smaller FOV and voxel sizes should be used to prevent poor image quality of adjacent teeth.
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Affiliation(s)
- Kaan Orhan
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
- Medical Design Application and Research Center (MEDITAM), Ankara University, Ankara, Turkey
| | - Doruk Kocyigit
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Kirikkale University, Kirkkale, Turkey
| | - Mujgan Firincioglulari
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Cyprus International University, Nicosia, Cyprus
| | - Mehmet Zahit Adisen
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Kirikkale University, Kirkkale, Turkey
| | - Seda Kocyigit
- Department of Oral and Maxillofacial Surgery, Ministry of Health Turkey, Uskudar, Istanbul, Turkey
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Habibzadeh S, Ghoncheh Z, Kabiri P, Mosaddad SA. Diagnostic efficacy of cone-beam computed tomography for detection of vertical root fractures in endodontically treated teeth: a systematic review. BMC Med Imaging 2023; 23:68. [PMID: 37264339 DOI: 10.1186/s12880-023-01024-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Vertical root fractures (VRFs) sometimes occur in endodontically treated teeth. They have a difficult diagnosis and a dismal result. The objective of this review was to evaluate the diagnostic performance of cone-beam computed tomography (CBCT) for detecting VRFs in teeth that had undergone endodontic treatment. METHODS Literature was reviewed from Web of Science, PubMed, Cochrane Review, SCOPUS, and Embase databases between 2000 and 2022. The searched keywords included "endodontically treated teeth," "cone-beam computed tomography," "CBCT," "tooth fracture," "vertical root fracture," "VRF," "accuracy," "sensitivity," and "specificity." Only articles in the English language were included. The final analysis included 20 papers that satisfied the eligibility requirements. RESULTS The overall mean ± SD values (%) for the diagnostic sensitivity and specificity of CBCT for detection of VRFs in endodontically treated teeth in the presence of root-filling materials without an intracanal post were 71.50 ± 22.19 and 75.64 ± 19.41, respectively. The overall mean (SD) value (%) for the sensitivity of CBCT for the detection of VRFs in the presence of root-filling materials and intracanal posts was 72.76 (18.73), while the mean (SD) specificity was 75.44 (18.26). The accuracy of CBCT (mean ± SD) was 78.47 ± 17.19% and 74.02 ± 10.64%, respectively, for teeth without intracanal posts and those with posts. CONCLUSIONS Further clinical research is needed to validate the optimum efficiency of CBCT as a diagnostic technique for detecting VRFs in teeth that have had endodontic treatment, given the low sensitivity, significant heterogeneity of studies, and lack of in-vivo studies on the subject.
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Affiliation(s)
- Sareh Habibzadeh
- Associate Professor, Department of Prosthodontics, School of Dentistry, International Campus, Tehran University of Medical Sciences, Tehran, Iran
- Associate Professor, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghoncheh
- Associate Professor, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Associate Professor, Department of Oral & Maxillofacial Radiology, School of Dentistry, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Kabiri
- Dentist, School of Dentistry, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
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Demirturk Kocasarac H, Koenig LJ, Ustaoglu G, Oliveira ML, Freitas DQ. CBCT image artefacts generated by implants located inside the field of view or in the exomass. Dentomaxillofac Radiol 2022; 51:20210092. [PMID: 34289314 PMCID: PMC8802698 DOI: 10.1259/dmfr.20210092] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To compare artefacts in cone-beam computed tomography (CBCT) arising from implants of different materials located either inside the field of view (FOV) or in the exomass, and to test different image-acquisition parameters to reduce them. METHODS CBCT scans of a human mandible prepared with either a titanium, titanium-zirconium, or zirconia implant were acquired with the Planmeca ProMax utilizing FOV sizes of 8 × 5 cm and 4 × 5 cm, which placed the implant inside the FOV (8 × 5 cm) or in the exomass (4 × 5 cm). The scanning parameters considered three conditions of metal artefact reduction (MAR), disabled, low, and high, and 2 kVp levels (80 and 90). The standard deviation (SD) of grey values of regions of interest was obtained. The effects of implant material, implant position, MAR condition, kVp level, and their interactions were evaluated by Analysis of Variance (α = 5%). RESULTS The zirconia implant produced the highest SD values (more heterogeneous grey values, corresponding to greater artefact expression), followed by titanium-zirconium, and titanium. In general, implants in the exomass produced images with higher SD values than implants inside the FOV. MAR was effective in decreasing SD values, especially from the zirconia implant, only when the implant was inside the FOV. Images with 80 kVp had higher SD values than those with 90 kVp, regardless of the other factors (p < 0.05). CONCLUSIONS Implants in the exomass lead to greater artefact expression than when they are inside the FOV. Special attention should be paid to scanning parameters that reduce metal-related artefacts, such as MAR activation and increasing kVp. This is especially important with a zirconia implant inside the FOV.
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Affiliation(s)
- Husniye Demirturk Kocasarac
- Division of Oral and Maxillofacial Radiology, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wisconsin, United States
| | - Lisa J Koenig
- Division of Oral and Maxillofacial Radiology, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wisconsin, United States
| | - Gulbahar Ustaoglu
- Department of Periodontics, Bolu Abant Izzet Baysal University Faculty of Dentistry, BAIBU Golkoy Yerleskesi, Merkez/Bolu, Turkey
| | - Matheus Lima Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Arriola-Guillén L, de Lima Moreno J, Boessio Vizzotto M, da Silveira Tiecher P, Assein Arús N, Dias da Silveira H. Impact of intracanal post-material on vertical root fractures diagnosis: A high-resolution cone-beam computed tomography study. J Int Oral Health 2022. [DOI: 10.4103/jioh.jioh_209_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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.
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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
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