Cone beam computed tomography in endodontics

Radiomics-Driven CBCT Texture Analysis as a Novel Biosensor for Quantifying Periapical Bone Healing: A Comparative Study of Intracanal Medications

This study aimed to evaluate the effectiveness of two intracanal medications in promoting periapical bone healing following endodontic treatment using radiomics-enabled texture analysis of cone-beam computed tomography (CBCT) images as a novel biosensing technique. By quantifying tissue changes through advanced image analysis, this approach seeks to enhance the monitoring and assessment of endodontic treatment outcomes. Thirty-four single-rooted teeth with pulp necrosis and periapical lesions were allocated to two groups (17 each): calcium hydroxide +2% chlorhexidine gel (CHX) and Ultracal XS®. CBCT scans were obtained immediately after treatment and three months later. Texture analysis performed using MaZda software extracted 11 parameters based on the gray level co-occurrence matrix (GLCM) across two inter-pixel distances and four directions. Statistical analysis revealed significant differences between medications for S [0,1] inverse difference moment (p = 0.043), S [0,2] difference of variance (p = 0.014), and S [0,2] difference of entropy (p = 0.004). CHX treatment resulted in a more organized bone tissue structure post-treatment, evidenced by reduced entropy and variance parameters, while Ultracal exhibited less homogeneity, indicative of fibrous or immature tissue formation. These findings demonstrate the superior efficacy of CHX in promoting bone healing and underscore the potential of texture analysis as a powerful tool for assessing CBCT images in endodontic research.

AI-driven segmentation of the pulp cavity system in mandibular molars on CBCT images using convolutional neural networks

OBJECTIVE

To develop and validate an artificial intelligence (AI)-driven tool for automated segmentation of the pulp cavity system of mandibular molars on cone-beam computed tomography (CBCT) images.

MATERIALS AND METHODS

After ethical approval, 66 CBCT scans were retrieved from a hospital database and divided into training (n = 26, 86 molars), validation (n = 7, 20 molars), and testing (n = 33, 60 molars) sets. After automated segmentation, an expert evaluated the quality of the AI-driven segmentations. The expert then refined any under- or over-segmentation to produce refined-AI (R-AI) segmentations. The AI and R-AI 3D models were compared to assess the accuracy. 30% of the testing sample was randomly selected to assess accuracy metrics and conduct time analysis.

RESULTS

The AI-driven tool achieved high accuracy, with a Dice similarity coefficient (DSC) of 88% ± 7% for first molars and 90% ± 6% for second molars (p > .05). The 95% Hausdorff distance (HD) was lower for AI-driven segmentation (0.13 ± 0.07) compared to manual segmentation (0.21 ± 0.08) (p < .05). Regarding time efficiency, AI-driven (4.3 ± 2 s) and R-AI segmentation (139 ± 93 s) methods were the fastest, compared to manual segmentation (2349 ± 444 s) (p < .05).

CONCLUSION

The AI-driven segmentation proved to be accurate and time-efficient in segmenting the pulp cavity system in mandibular molars.

CLINICAL RELEVANCE

Automated segmentation of the pulp cavity system may result in a fast and accurate 3D model, facilitating minimal-invasive endodontics and leading to higher efficiency of the endodontic workflow, enabling anticipation of complications.

The effect of cone beam computerized tomography voxel size and the presence of root filling on the assessment of middle mesial canals in mandibular molar teeth

INTRODUCTION

The study aims to compare the detection of the middle mesial canal (MMC) in mandibular molar teeth using cone beam computed tomography (CBCT) with different voxel sizes when the mesiobuccal (MB) and mesiolingual (ML) canals have three distinct phases (unpreparation, preparation and obturation and the removal of the obturation and repreparation).

METHODS

Two hundred forty-two extracted human mandibular molars were collected and kept in a physiological saline solution prior to use. 0.2-, 0.28- and 0.35-mm voxel sizes CBCT (n = 242) were performed in three phases (Ph): Ph1, no MB and ML canal preparation or obturation; Ph2, after MB and ML canals preparation and obturation; and Ph3, after the removal of the obturation of MB and ML canals and canals repreparation. Images were analyzed using OnDemand3D® software. After the CBCT acquisition in Ph3, all the samples were clarified to visualize the presence of the MMC directly. A blinded, previously calibrated examiner analyzed all the images.

RESULTS

The MMC was detected in 15 of the 242 teeth after the clearing technique. The lowest MMC detection rate was observed at 0.35-mm voxel size regardless of the ML and MB canal condition, while the highest was observed at 0.2-mm voxel size (P < 0.05). There is no statistically significant difference between 0.2-mm and 0.28-mm voxel sizes (P > 0.05). In all voxel sizes, the highest rate of detectability of the MMC was seen in Phase 1, while the lowest was in Phase 2.

CONCLUSIONS

It may be appropriate to take a 0.20-mm voxel size CBCT image, especially after the removal of root canal filling.

CLINICAL RELEVANCE

An appropriate CBCT voxel size and the absence of root canal filling in the root canal system help to detect the missing MMC.

Accuracy of linear measurements for implant planning based on low-dose cone beam CT protocols: a systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review was to verify the accuracy of linear measurements performed on low-dose CBCT protocols for implant planning, in comparison with those performed on standard and high-resolution CBCT protocols.

METHODS

The literature search included four databases (Pubmed, Web of Science, Embase, and Scopus). Two reviewers independently screened titles/abstracts and full texts according to eligibility criteria, extracted the data, and examined the methodological quality. Risk of bias assessment was performed using the Quality Assessment Tool For In Vitro Studies. Random-effects meta-analysis was used for pooling measurement error data.

RESULTS

The initial search yielded 4684 titles. In total, 13 studies were included in the systematic review, representing a total of 81 samples, while 9 studies were included in the meta-analysis. The risk of bias ranged from medium to low. The main results across the studies indicate a strong consistency in linear measurements performed on low-dose images in relation to the reference methods. The overall pooled planning measurement error from low-dose CBCT protocols was -0.24 mm (95% CI, -0.52 to 0.04) with a high level of heterogeneity, showing a tendency for underestimation of real values. Various studies found no significant differences in measurements across different protocols (eg, voxel sizes, mA settings, or dose levels), regions (incisor, premolar, molar) and types (height vs. width). Some studies, however, noted exceptions in measurements performed on the posterior mandible.

CONCLUSION

Low-dose CBCT protocols offer adequate precision and accuracy of linear measurements for implant planning. Nevertheless, diagnostic image quality needs must be taken into consideration when choosing a low-dose CBCT protocol.

Cone-beam computed tomography in endodontics: from the specific technical considerations of acquisition parameters and interpretation to advanced clinical applications

The implementation of imaging methods that enable sensitive and specific observation of anatomical structures has been a constant in the evolution of endodontic therapy. Cone-beam computed tomography (CBCT) enables 3-dimensional (3D) spatial anatomical navigation in the 3 volumetric planes (sagittal, coronal and axial) which translates into great accuracy for the identification of endodontic pathologies/conditions. CBCT interpretation consists of 2 main components: (i) the generation of specific tasks of the image and (ii) the subsequent interpretation report. A systematic and reproducible method to review CBCT scans can improve the accuracy of the interpretation process, translating into greater precision in terms of diagnosis and planning of endodontic clinical procedures. MEDLINE (PubMed), Web of Science, Google Scholar, Embase and Scopus were searched from inception to March 2023. This narrative review addresses the theoretical concepts, elements of interpretation and applications of the CBCT scan in endodontics. In addition, the contents and rationale for reporting 3D endodontic imaging are discussed.

The importance of cone-beam computed tomography in endodontic therapy: A review

INTRODUCTION

Cone-beam computed tomography (CBCT) is a valuable tool in endodontics, particularly for assessing root morphology.

AIM

To understand the importance of root morphology in endodontic treatment.

METHODOLOGY

A comprehensive search of various databases was performed, and 804 studies were identified. After evaluating the studies using the inclusion criteria and eliminating duplicates, 12 articles were included in this review.

RESULTS

CBCT assessment demonstrated a high prevalence of single canals in maxillary incisors, varying root configurations in maxillary first premolars, and diverse anatomical distributions in mandibular molars, such as C-shaped canals, more commonly observed in women.

CONCLUSION

The findings from this review concluded that CBCT is a valuable tool for the diagnosis and treatment of root canal anomalies in endodontics.

[Strategies for the use of cone beam tomography in teeth with suspected root fracture. Report of case series]

Root fractures are after caries and periodontal disease, the third cause of loss of dental units, being very common in posterior and endodontically treated teeth. The symptoms they produce are ambiguous and their diagnosis depends on the combination of multiple clinical and imaging factors. Among the diagnostic studies available to establish the origin of the symptoms is the cone beam computed tomography (CBCT). The objective of this case report is to describe the strategies used in the acquisition and interpretation of the CBCT in three patients with suspected root fractures. The use of a reduced field of view, with a voxel of 0.150 mm or less, accompanied by dynamic volume exploration made it possible to detect bone defects as an indirect sign for locating root fracture lines.

Quantitative and qualitative comparisons of pulp cavity volumes produced by cone beam computed tomography and micro-computed tomography through semiautomatic segmentation: An ex vivo investigation

OBJECTIVE

The aim of this study was to measure the volume and visually assess 3-dimensional (3D) virtual models of pulp cavities obtained through semiautomatic segmentation on images from 6 cone beam computed tomography (CBCT) units compared with the reference standard of micro-CT.

STUDY DESIGN

Fifteen mandibular premolar teeth were scanned with 6 CBCT units: Prexion 3D Elite, i-CAT Next Generation, NewTom 5G, Cranex 3D, 3Shape X1, and Orthophos SL 3D, using the smallest available field of view and highest resolution settings. Pulp cavity volumes were quantitatively assessed by 2 calibrated examiners. The volumes from each CBCT unit were compared with micro-CT. Qualitative assessment of the 3D reconstructions was also performed. Repeated-measures analysis of variance and the Friedman test compared the CBCT reconstructions to micro-CT. Intra- and interexaminer agreements were calculated with the intraclass correlation coefficient and kappa statistic.

RESULTS

The CBCT-based volumes were all significantly larger than micro-CT (P ≤ .0061). Prexion, X1, and Orthophos provided the segmentations that most closely resembled the reference standard. Intra- and interexaminer agreements ranged from good to excellent for quantitative measurements. Interexaminer agreement for qualitative evaluation was substantial.

CONCLUSIONS

Semiautomatic segmentation of CBCT images is a feasible method to produce virtual 3D models of the pulp cavity. Prexion, X1, and Orthophos were the CBCT units that resulted in 3D reconstructions most similar to the reference standard.

Endodontic treatment of the maxillary first molar with palatal canal variations: A case report and review of literature

BACKGROUND

Root canal variations frequently occur in maxillary first molars, which greatly affects the success of its treatment. The second mesiobuccal (MB) root canal is the most common root canal variation. However, only a few studies have been conducted on palatal root canal variations. Herein, we report the presence of two separate root canals in a palatal root of the maxillary first molar.

CASE SUMMARY

A 39-year-old woman complained of pain in the maxillary right region for 1 year, which recently worsened. Clinical examination revealed a poorly restored right maxillary first molar and caries detected at the filling marginal. Cold and heat test results indicated severe pain in the right maxillary first molar. The patient was diagnosed with irreversible pulpitis, and subsequently, root canal treatment (RCT) was performed. In total, five root canals were found in the maxillary first molar, including two separate root canals in the palatal root. RCT was successfully performed using an endodontic microscope and cone-beam computed tomography (CBCT). The CBCT image revealed a vertucci type I canal morphology in the distobuccal root, while the MB and palatal root canals were type Ⅳ. At the 1-mo follow-up, the maxillary first molar was completely asymptomatic, and the X-ray results indicated a successful RCT. Finally, the ceramic crown restoration was performed.

CONCLUSION

An endodontic microscope and CBCT are useful in effectively identifying and treating root canal variations.

Automatic Classification System for Periapical Lesions in Cone-Beam Computed Tomography

Imaging examinations are of remarkable importance for diagnostic support in Dentistry. Imaging techniques allow analysis of dental and maxillofacial tissues (e.g., bone, dentine, and enamel) that are inaccessible through clinical examination, which aids in the diagnosis of diseases as well as treatment planning. The analysis of imaging exams is not trivial; so, it is usually performed by oral and maxillofacial radiologists. The increasing demand for imaging examinations motivates the development of an automatic classification system for diagnostic support, as proposed in this paper, in which we aim to classify teeth as healthy or with endodontic lesion. The classification system was developed based on a Siamese Network combined with the use of convolutional neural networks with transfer learning for VGG-16 and DenseNet-121 networks. For this purpose, a database with 1000 sagittal and coronal sections of cone-beam CT scans was used. The results in terms of accuracy, recall, precision, specificity, and F1-score show that the proposed system has a satisfactory classification performance. The innovative automatic classification system led to an accuracy of about 70%. The work is pioneer since, to the authors knowledge, no other previous work has used a Siamese Network for the purpose of classifying teeth as healthy or with endodontic lesion, based on cone-beam computed tomography images.

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.

Comprehensive evaluation of root and root canal morphology of mandibular second molars in a Saudi subpopulation evaluated by cone-beam computed tomography

BACKGROUND

The study's goal was to use Cone Beam Computed Tomography (CBCT) to assess the root and root canal anatomy of mandibular second molars with C-shaped root canal configurations in residents of the Hail district. The impact of gender and side on the frequency of root canal morphology was considered.

METHODS

The sample size for this study was 304 untreated mandibular second molars with completely developed roots on the right and left sides. Using CBCT on the teeth, the root form and canal morphology for each root are based on Vertucci's classification. The occurrence of canals in the shape of a C. The prevalence and resemblance of the left and right sides or men and females were investigated. The Chi-square test was performed to evaluate the findings.

RESULTS

Of the 304 mandibular second molars studied, 286 teeth had two roots (94.1%), whilst 13 (4.3%) were C-shaped root canal systems. 77 molars (25.3%) had two canal orifices, 219 (72.0%) had three canal orifices, and six (2.0%) and one (0.3%) had four and five root canal orifices, respectively. Type IV was the most common for mesial root, accounting for 57.7% of the sample (n = 176). For distal root, the most common occurrence was type I, which occurred 282 times (96.60%). The most prevalent root canal morphology was the presence of two canals in the mesial root and one canal in the distal root of teeth with two distinct roots (variant 3). (69.4%). The overall prevalence of C-shaped root canal systems is (4.3%) (n = 13).

CONCLUSIONS

The patient's race is an undeniable factor that influences root canal anatomy. The root canal morphology of mandibular second molars revealed significant differences between Saudi subpopulations. The majority of mandibular second molars had two roots and three root canals. When treating these molars, the presence of a C-shaped root canal system must be taken into account.

Assessment of the relationship of the distance between mandibular first and second molars with the inferior alveolar canal and cortical bone plate in an Egyptian subpopulation: a CBCT study

The aim of the current cone beam computed tomography (CBCT) study was to evaluate the proximity of mandibular first and second molar roots to the inferior alveolar canal (IAC) and mandibular cortex in an Egyptian subpopulation. Scans of 120 patients (480 molars, 960 roots) were obtained from the College of Dentistry database at the Suez Canal University, Egypt. Buccal and lingual bone plates and root thickness were measured at the specified resected root end 3 mm from the radiographic apex, and so was the proximity of the root apices to the IAC. Measurements of the right and left mandibular first and second molars were recorded for each root. Three examiners performed the measurements separately. ANOVA was used to compare the different roots. Bonferroni's post-hoc test was used for pair-wise comparisons when ANOVA was significant. The significance level was set at p ≤ 0.05. The findings displayed a closer proximity of the mandibular second molar apices to the IAC, as compared to the mandibular first molars. The mesial roots were at a shorter distance than the distal ones. Moreover, the mandibular second molars revealed the thickest total bone width including the root. So, it is beneficial for endodontists to be aware of the relation of the mandibular first and second molars to the surrounding cortical bone plates and the IAC before starting either nonsurgical or surgical endodontic treatment.

Vertical root fractures in root treated teeth-current status and future trends

Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is crucial in identifying teeth that may be susceptible. Thorough clinical examination with magnification and co-axial lighting is essential in identifying VRFs, and although CBCT is unable to reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, and therefore, increases the probability of correct diagnosis and management. The prevalence of VRFs in root filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre-existing fractures and biochemical effects of loss of vitality, are highly relevant. Careful assessment of the occlusal scheme, presence of deflective contacts and identification of parafunctional habits is imperative in both preventing and managing VRFs. Furthermore, anatomical factors such as root canal morphology, may predispose certain teeth to VRF. The influence of access cavity design and root canal instrumentation protocols should be considered although the impact of these on the fracture resistance of root filled teeth is not clearly validated. The post-endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed 'passively' and excessive 'post-space' preparation should be avoided. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. Currently, there are limited options other than extraction for the management of VRF, although root resection may be considered in multi-rooted teeth. Innovative techniques to 'repair' VRFs using both orthograde and surgical approaches require further research and validation. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, together with expedient and appropriate post-endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs.

A comparative study on mandibular premolar root canal morphology employing cone-beam computed tomography and microcomputed tomography imaging

Aim:

The present study was to investigate the root canal morphology of mandibular premolars in Malaysian population using cone-beam computed tomography (CBCT) and microcomputed tomography (micro-CT) scanned images.

Materials and Methods:

Sixty selected mandibular premolars were evaluated in vitro and the root canal morphologies of the samples were categorized based on Vertucci's classification. The position of apical foramen, presence, and location of lateral canal, as well as prevalence of apical delta, were also determined.

Results:

Invariably, Type I variety (Vertucci's classification) was the most frequent root canal morphology followed by Type V and Type III after micro-CT imaging. CBCT investigation also revealed Type I as the most numerous; however, the second most common configuration was Type III followed closely by others. There was a moderate agreement in Vertucci's classification of root canal configuration and also prevalence of apical delta (kappa: 0.516 and 0.550, respectively). However, only a fair agreement (kappa: 0.289) was observed between CBCT and micro-CT on the prevalence of lateral canal.

Conclusion:

CBCT should be cautiously used in determining root canal configuration as deficiencies were evident and revealed during micro-CT imaging.

Craniofacial Osteomas: From Diagnosis to Therapy

An osteoma is a benign bone lesion with no clear pathogenesis, almost exclusive to the craniofacial area. Osteomas show very slow continuous growth, even in adulthood, unlike other bony lesions. Since these lesions are frequently asymptomatic, the diagnosis is usually made by plain radiography or by a computed tomography (CT) scan performed for other reasons. Rarely, the extensive growth could determine aesthetic or functional problems that vary according to different locations. Radiographically, osteomas appear as radiopaque lesions similar to bone cortex, and may determine bone expansion. Cone beam CT is the optimal imaging modality for assessing the relationship between osteomas and adjacent structures, and for surgical planning. The differential diagnosis includes several inflammatory and tumoral pathologies, but the typical craniofacial location may aid in the diagnosis. Due to the benign nature of osteomas, surgical treatment is limited to symptomatic lesions. Radical surgical resection is the gold standard therapy; it is based on a minimally invasive surgical approach with the aim of achieving an optimal cosmetic result. Reconstructive surgery for an osteoma is quite infrequent and reserved for patients with large central osteomas, such as big mandibular or maxillary lesions. In this regard, computer-assisted surgery guarantees better outcomes, providing the possibility of preoperative simulation of demolitive and reconstructive surgery.

Prediction of neurosensory disorders after impacted third molar extraction based on cone beam CT Maglione's classification: A pilot study

Background

Surgical difficulty assessment in the extraction of impacted mandibular third molars is a constant challenge for oral surgeons.

Aim

The first aim was to apply Maglione's new classification on patients that needed surgical extraction of impacted mandibular third molars, and the second aim was to study the correlation of the classification classes with the occurrence of postoperative neurosensory disorders.

Materials & methods

The present prospective clinical trial pilot study was conducted on patients attending oral and maxillofacial surgery clinics from February 2017 until January 2018 for the surgical extraction of impacted lower third molars.

Results

Fifty-one out of sixty-nine patients made the surgical removal of one impacted mandibular third molar. The most common subclass was 1B (24.6%), followed by subclass 3B (23.2%). Subclass 3A and 4B showed an equal distribution of (11.6%) each, and then subclass 2B (10%). The most significant subclass was 4B with (5.9%) neurosensory disturbance. None of the patients had a permanent disturbance.

Conclusion

Maglione's classification offers unique detailed description of the buccolingual relationship of MTM with IAC that could be used as a future reliable radiographic guide to reduce the risk of post-operative neurosensory disturbances after MTM surgical removal.

Comparison of two pediatric rotary file systems and hand instrumentation in primary molar: An ex vivo cone-beam computed tomographic study

Background

Pulpal involvement, secondary to dental caries, is not uncommon and is a challenging task for pediatric dentists. Morphological differences in root canal of deciduous teeth increases the complexity of management. The aim of this study was to compare two rotary file systems and hand instrumentation for root canal preparation in regard to canal transportation, centering ability ratio, and dentin thickness using cone-beam computed tomography (CBCT).

Methods

A total of 72 canals from 24 freshly extracted mandibular deciduous second molars were divided into a set of 8 teeth, then prepared using 2 rotary files systems: the Kedo-S pediatric file system (Group A) and Pro AF Baby Gold file system (Group B) were compared to hand instrumentation (Group C). CBCT scans before and after root canal preparation were used to evaluate tested parameters. Instrumentation time for all three techniques was also measured using a chronometer.

Results

Although rotary file systems have shown superior results in root canal preparation as compared to hand instrumentation, no significant differences were observed between all the groups for canal transportation and dentin thickness at all three levels of prepared canals. A comparison of centering ability ratio between all the groups was found to be statistically significant only at the cervical level. A significant difference was observed between hand instrumentation using K-files (117.3 s) and both rotary systems (Kedo-S (81 s) and Pro AF Baby Gold (81.5 s)) in terms of canal preparation time (P < 0.001).

Conclusions

Both tested rotary systems and hand instrumentation demonstrated comparable canal preparation results, with differences that were statistically non-significant in most tested parameters, without shaping errors. However, both the rotary systems were more efficient and faster than hand instrumentation.

Which factors related to apical radiolucency may influence its radiographic detection? A study using CBCT as reference standard

Objectives

This study aimed to evaluate the detection rate of apical radiolucencies in 2-dimensional images using cone-beam computed tomography (CBCT) as the reference standard, and to determine which factors related to the apical radiolucencies and the teeth could influence its detection.

Materials and Methods

The sample consisted of exams of patients who had panoramic (PAN) and/or periapical (PERI) radiography and CBCT. The exams were assessed by 2 oral radiologists and divided into PAN+CBCT (227 teeth–285 roots) and PERI+CBCT (94 teeth–115 roots). Radiographic images were evaluated for the presence of apical radiolucency, while CBCT images were assessed for presence, size, location, and involvement of the cortical bone (thinning, expansion, and destruction). Diagnostic values were obtained for PERI and PAN.

Results

PERI and PAN presented high accuracy (0.83 and 0.77, respectively) and specificity (0.89 and 0.91, respectively), but low sensitivity, especially for PAN (0.40 vs. 0.65 of PERI). The size of the apical radiolucency was positively correlated with its detection in PERI and PAN (p < 0.001). For PAN, apical radiolucencies were 3.93 times more frequently detected when related to single-rooted teeth (p = 0.038). The other factors did not influence apical radiolucency detection (p > 0.05).

Conclusions

PERI presents slightly better accuracy than PAN for the detection of apical radiolucency. The size is the only factor related to radiolucency that influences its detection, for both radiographic exams. For PAN, apical radiolucency is most often detected in single-rooted teeth.

Dental cone beam CT: An updated review

Cone beam computed tomography (CBCT) is a diverse 3D x-ray imaging technique that has gained significant popularity in dental radiology in the last two decades. CBCT overcomes the limitations of traditional two-dimensional dental imaging and enables accurate depiction of multiplanar details of maxillofacial bony structures and surrounding soft tissues. In this review article, we provide an updated status on dental CBCT imaging and summarise the technical features of currently used CBCT scanner models, extending to recent developments in scanner technology, clinical aspects, and regulatory perspectives on dose optimisation, dosimetry, and diagnostic reference levels. We also consider the outlook of potential techniques along with issues that should be resolved in providing clinically more effective CBCT examinations that are optimised for the benefit of the patient.

The influence of voxel size and artifact reduction on the detection of vertical root fracture in endodontically treated teeth

OBJECTIVE

The aim of this study was to evaluate the effect of voxel size and artefact reduction (AR) on the identification of vertical root fractures (VRFs) in endodontically treated teeth.

METHODS

A total of a hundred sound, extracted human mandibular single-rooted premolars were decoronated, after which root canal preparation was performed, canals were filled with gutta percha by single cone technique. Randomly selected fifty specimens were fractured, repositioned and glued together. The teeth were examined with cone beam computed tomography (CBCT) in five different voxel sizes (0.125, 0.200, 0.250, 0.300, and 0.400 voxels). Two scans were performed for each tooth, one with AR and one without AR. Two radiologists evaluated the CBCT scans.

RESULTS

All voxel dimensions were successful in detecting VRFs in CBCT scans. But as the voxel size increased, the percentage of detecting VRFs decreased. High accuracy, sensitivity, specificity and predictive values were found for VRF detection on CBCT scans. Accuracy and sensitivity values decreased (from 100 to 82) while voxel dimensions increased (from 0.125 to 0.400). High-resolution images (0.125, 0.200, and 0.250 voxels) caused an increase in sensitivity for detection of VRFs. AR did not affect the accuracy, sensitivity, specificity and predictive values for VRF detection on CBCT scans.

CONCLUSIONS

High-resolution CBCT images resulted in an increase in sensitivity and specificity for detection of VRFs compared with lower-resolution CBCT images. The use of AR did not further improve its diagnostic potential.

Endodontic management of a tooth with apical overfilling and perforating external root resorption: A case report

Successful non-surgical orthograde retreatment of a tooth with external root resorption in apical third of root and overfilling material beyond the apical barrier which was diagnosed with the help of cone beam computed tomography (CBCT), was reported. Biodentine was used as the treatment of choice for obturation of resorption area.

Preoperative Estimation of Endodontic Working Length with Cone-Beam Computed Tomography and Standardized Paralleling Technique in comparison to Its Real Length

An accurate estimation of the working canal length is essential for successful root canal treatment. This study is aimed at investigating the diagnostic accuracy of root canal length estimation on cone-beam computed tomography (CBCT) scans and digital paralleling radiographs (PAs), using the real canal length as a gold standard, and at evaluating the influence of canal curvature on this estimation. Sixty extracted human premolar teeth were selected for this study. Root canal length measurement was performed on CBCT scans (NewTom, Giano, Verona, Italy) and digital paralleling radiography (EzRay Air W; Vatech, Korea). The real working length was established by subtracting 0.5 mm from the actual canal length. No significant difference was found between CBCT and digital paralleling radiography. There was a tendency for underestimation of the root canal length measured on the CBCT images in 52 (86.7%) of the examined teeth and overestimation in 5 teeth (8.3%). All the digital radiographs slightly overestimated the real canal length. The analysis revealed a strong correlation between the estimation from moderate to severe curvature for digital radiography and CBCT images. Preoperative working length estimation can be made closest to its real clinical canal length on the standardized paralleling technique, using a long (16-inch) target-receptor distance.

Applications of cone beam computed tomography in endodontics

Background

Endodontic disease can adversely affect the quality of life and therefore early diagnosis and consequent timely treatment is of paramount importance for the Endodontist. Radiology is an essential component in treatment planning, disease monitoring and assessment of treatment outcome. Periapical radiographs and panoramic radiography are frequently utilised but they provide only two-dimensional representation of three-dimensional structures. The advent of cone beam computed tomography (CBCT) offers three-dimensional accuracy of the hard tissue images with a reasonable cost and this has revolutionised imaging of the dentomaxillofacial structures. This imaging system has been seen to overcome some limitations of conventional radiography, as brought out in this review. The improvement in the accuracy is, however, accompanied at the cost of increased radiation exposure to the patient. Nevertheless, smaller areas of exposure are normally appropriate for endodontic imaging, and adjustment in the exposure parameters can further moderate the effective dose (Loubele et al. 37(6):309-18, 2008).

Aims and objectives

The aim of this review is to present the pertinent literature on the various applications of cone beam computed tomography in the field of endodontics.

Methods

Literature was electronically searched on the following sources; Medline and Keats Library. Further, a manual search was performed on the following journals: International Endodontic Journal, Journal of Endodontics, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Endodontology, Journal of Dental Research, European Journal of Oral Sciences & Odontology and Dentomaxillofacial Radiology. A preliminary search was performed to gain an idea of the available literature using keywords ‘Cone Beam Computed Tomography’ to view the volume of the literature evident and identify questions to be addressed in this review. The initial search showed 243 potential articles. After scrutinising the titles and abstracts of the retrieved articles, 70 relevant studies were reviewed in full text. Furthermore, ‘published guidelines on the use of CBCT’ were also searched so as to include the results as an additional source material. All the articles eligible to be included in the review were in the English language and ranged from the year 1960 to the present. Also all the studies reviewed were based on the various uses of cone beam computed tomography in the field of endodontics. The keywords used to search were ‘Cone Beam Computed Tomography (CBCT)’, ‘Conventional radiography’, ‘Applications of CBCT in endodontics’, ‘CBCT and tooth morphology’, ‘CBCT and apical periodontitis’, ‘CBCT and vertical root fractures’, ‘CBCT and resorption’, ‘CBCT and pre-surgical assessment’, ‘CBCT and dento-alveolar trauma’ and ‘CBCT and endodontic outcome’.

Results

Every case is unique and CBCT should be considered only after studying each case individually. CBCT imaging needs to be adopted or used where information from conventional imaging systems is either inadequate for the management of endodontic problems or inconclusive. Having said that, it is safe to state that 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 and enhanced resolution would be available.

Treatment of Maxillary Second Premolar with 4 Roots

Aim. To report a case of maxillary second premolar with four roots and four separate foramina and the use of CBCT to help identify the root canal system configuration. Summary. A 45-year-old female patient with a no significant medical history was referred for treatment tooth #15. The tooth was diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. After taking periapical radiographs and expected uncommon morphology, CBCT was taken to help confirm canals configuration and aid in the treatment of the case. Root canals treatment was carried without complication under dental operating microscope using a rotary system and continuous wave obturation.

Schneiderian membrane thickness variation following endodontic procedures: a retrospective cone beam computed tomography study

BACKGROUND

To assess the change of the Schneider membrane thickness measured by CBCT before and after root canal treatment, retreatment and pulp capping procedures.

METHODS

This retrospective study was conducted on CBCT scans of a patient population of Guy's Hospital NHS Foundation Trust, London. Three groups of patients were studied: Group 1 consisted of patients referred for primary endodontic treatment; Group 2 for endodontic retreatment; Group 3 for indirect pulp capping procedures (serving as a control group). Follow up scans were carried out 1 year after treatment. Measurements were carried out on CBCT scans and data were analysed statistically by Wilcoxon Signed Rank Test. Linear regression was used to assess predictive parameters for membrane thickness.

RESULTS

A statistically significant reduction of the Schneider membrane thickness was observed one year after endodontic treatment and retreatment (P < 0.05) but no significant reduction was observed after pulp capping procedures. Linear regression showed that age and gender were significant predictors influencing the Schneider membrane thickness.

CONCLUSIONS

Within the limitations of this retrospective study, following root canal treatment and re-treatment a Schneiderian membrane thickness reduction occurred at 1-year follow-up. The removal of odontogenic infection following endodontic treatment may help reducing the thickness of the Schneider membrane.

A Bibliometric Analysis of Articles Published in Brazilian Dental Journal over 30 years

This study assessed bibliometric characteristics of all articles published in Brazilian Dental Journal (BDJ) in its 30 years of existence (1990-2019) and factors associated with citation rates. A document search was carried out in Scopus in December, 2019 and information about the articles were exported, including citations. Type of study and main subject in each article were categorized. Number of citations was categorized in tertiles. Logistic regression models were used to assess the association between variables related to articles' characteristics and number of citations. In 30 years, 1705 articles were published and 18507 citations received, with average 57 articles and 334 pages published yearly and 10.9 cites/doc. The most frequent types of study were laboratorial (63%), clinical (18.5%), and case reports (11%); the main subjects were dental materials (21.6%), endodontics (19.3%), and oral pathology/stomatology (13.1%). Most articles had origin in Brazil (90%), followed by USA (4.6%) and UK (1.5%). Aside from BDJ, Journal of Endodontics (3.5%) and International Endodontic Journal (2.2%) were journals that most often cited BDJ. Main origins of citations were Brazil (36.7%), USA (10.6%), and India (9%). Older articles had higher odds to be highly cited (12% increase/year), longer articles had lower odds (9% decrease/page). Narrative reviews and epidemiological studies were associated with more citations and systematic reviews with less citations. In conclusion, BDJ covered many subjects and study types in 30 years, showing increased growth in international audience. The journal may be regarded as one of the leading Brazilian journals in dentistry published in English.

Knowledge and Attitude of Iranian Dentists towards Cone-Beam Computed Tomography

Objectives

We aimed to evaluate the knowledge and attitude of Iranian dentists towards cone-beam computed tomography (CBCT).

Materials and Methods

A 20-item questionnaire was distributed among 410 Iranian dentistry graduates attending the 56th Congress of Iranian Dental Association held in Tehran, Iran. The questionnaire included items on demographic characteristics, namely full name, age, gender, work experience, type of current activity (individual or group), and the highest educational level. In addition, the questionnaire contained items on the knowledge and attitude of dentists. The obtained data were analyzed using statistical tests.

Results

In this study, 49.3% and 22.4% of the subjects were male and female, respectively, 47.1% of whom used CBCT, while 49.8% did not. In detail, 72.2% of the dentists used the technique to evaluate the location of implants, whereas 19.7%, 3.2%, and 2.7% of the subjects applied it to localize the inferior alveolar nerve (IAN), evaluate the location of implants and localize the IAN, and perform cephalometric analysis, respectively. The main causes of lack of prescription of CBCT entailed high cost (80%), high rate of patient absorbed dose (27.6%), insufficient number of CBCT centers (46.3%), and the long duration of the process (15.6%).

Conclusion

CBCT is an advantageous imaging technique in dentistry. Considering the increased application of CBCT in dentistry, attending workshops could help train dentists to use the technique.

Endodontic Retreatment of an Upper First Molar with Bifurcated Palatal Canal Using Preoperative Cone-beam Computed Tomography: A Case Report

BACKGROUND:

Anatomic variations in palatal canal morphology in maxillary first molars (MFMs) are relatively rare occurrences. Therefore, omission is common unless clinicians recognize their presence.

CASE REPORT:

The aim of this report is to point out new signs that can be viewed as indicators of the existence of additional canals in the palatal root (PR) in this upper first molar endodontic retreatment case. Moreover, the role of preoperative cone-beam computed tomography (CBCT) in both discovering and determining the location of those additional canals will also be discussed.

CONCLUSION:

Besides formerly discussed signs that indicate the existence of this canal, clinicians should also pay attention to other signals on periapical radiograph, including the aberrant divergence of a palatal canal at apical third and an unusual lesion occurring laterally in the periapical area of palatal root.

Cone beam computed tomography in Endodontics - a review of the literature

The use of cone beam computed tomography (CBCT) in the diagnosis and/or management of endodontic problems is increasing and is reflected in the exponential rise in publications on this topic in the last two decades. The aim of this paper is to: (i) Review current literature on the endodontic applications of CBCT; (ii) Based on current evidence make recommendations for the use of CBCT in Endodontics; (iii) Highlight the areas in which more research is required.

Ex Vivo Detection of Apical Delta in Premolars: A Comparative Study Using Periapical Radiography, Cone-beam Computed Tomography, and Micro-computed Tomography

INTRODUCTION

Imaging methods are essential for the correct identification of root canal anatomy, which is a key factor for successful endodontic therapy. This study aimed to evaluate the performance of periapical radiography (PR) and cone-beam computed tomographic (CBCT) imaging in identifying the apical delta (AD) using micro-computed tomographic imaging as the gold standard.

METHODS

PR and CBCT images of 110 human premolars (120 root canals) were obtained using the VistaScan digital intraoral system (Durr Dental, Beitigheim-Bissinger, Germany) and the 3D Accuitomo CBCT unit (J Morita, Kyoto, Japan), respectively. Two oral radiologists assessed the PR and CBCT images for the presence of ADs using a 5-point scale. Additionally, in the CBCT images, the number of apical foramina was also evaluated. The gold standard was established by means of micro-computed tomographic imaging. The diagnostic values related to PR and CBCT imaging were compared using the McNemar test. The detection of the number of foramina was compared using the paired t test (α ≤ 0.05).

RESULTS

ADs were present in 40 root canals (33.3%). Both PR and CBCT images differed significantly from the gold standard (P < .05) in the detection of ADs. CBCT imaging showed higher values than PR for all diagnostic tests (P < .05). Despite the moderate accuracy of PR (0.62) and CBCT imaging (0.73), these methods presented very low sensitivity values (0.07 and 0.35 for PR and CBCT, respectively). CBCT imaging had a tendency of underestimating the number of foramina (P < .05).

CONCLUSIONS

CBCT imaging showed better performance than PR in the detection of ADs; both imaging modalities underestimate its presence when compared with the gold standard. In general, the number of apical foramina cannot be reliably assessed using CBCT imaging.

Dendritic cells and their relation to apical peridontitis

The purpose of this manuscript was to re-discuss apical periodontitis, apical biofilm, and its possible relationship with dendritic cells (DC). DCs are potent regulators of the immune system and their function is divided into three categories that involve the presentation of antigens: the presentation of antigens and activation of T cells; a not well established category suggested that DCs induce and maintain immunological tolerance; and the maintenance of the immune memory in conjunction with B cells. DCs in periapical inflammatory lesions are composed of at least two subpopulations that can be distinguished on the basis of ultrastructure and phenotype. These populations might differ in lineage, state of maturation, differentiation, activation, and/or function. The authors hereby analyzed the root apexes of teeth under SEM, after performing apicoectomy due to the failure of conventional endodontic treatment. Microbial biofilm with multispecies and areas of resorption with the presence of Howship lacunae, and images suggestive of denditric cells could be observed. The presence of DCs in periapical lesion could be an indication of the severity of the lesion, with a constant presence of antigen in the periradicular region.

Endodontic Management of Mandibular Second Premolar with Type IX Canal Configuration Using Cone-Beam Computed Tomography as a Diagnostic Aid: A Rare Case Report

Successful endodontic treatment requires knowledge of the root canal anatomy, cleaning, and shaping followed by three-dimensional filling of the root canals. With the advent of newer diagnostic aids such as cone-beam computed tomography (CBCT) and magnifying tools such as dental operating microscope and loupes, it has become easier for an operator to identify the root canal anatomy of teeth and reduce the risk of procedural accidents and failures. Variations in root canal configuration require modification in access cavity preparation, disinfection, and obturation of the canals. Mandibular premolars are identified to have unusual root and canal anatomy which increases the risk of endodontic failure when additional canals remain undiagnosed. The present case report elaborates successful endodontic management of a mandibular second premolar with Type IX root canal configuration using CBCT as a diagnostic tool.

Second Mesiobuccal Root Canal of Maxillary First Molars in a Brazilian Population in High-Resolution Cone-Beam Computed Tomography

Introduction:

The second canal of the mesiobuccal root (MB2) of the maxillary first molars (MFM) is difficult to detect in conventional radiographs and can be a major cause of failure in endodontic treatments. The aim of this study was to investigate the prevalence and anatomy of the MB2 by using high-resolution cone-beam computed tomography (CBCT).

Methods and Materials:

Three radiologists examined 414 high-resolution CBCTs. Of these, the CBCTs of 287 patients (mean age 49.43±16.76) who had at least one MFM were selected, making a total of 362 teeth. Prevalence and its relation with gender and age of the patients, side of the tooth, and Vertucci’s classification were analyzed. Data were statistically analyzed (P<0.05).

Results:

A total of 68.23% of the teeth exhibited the MB2. The presence of the MB2 was equivalent in both genders and significantly higher in younger patients. There was no correlation between the presence of the MB2 in relation to both the sides of the MFM and the FOV size. Smaller FOV recognized higher Vertucci’s grades.

Conclusions:

It was concluded that the prevalence of the MB2 canal in maxillary first molars in this Brazilian population examined with high-resolution CBTCs is 68.23%, being more prevalent in young patients. Gender and the side examined are no factors for determining the presence of MB2. Although the both FOVs of the high-resolution CBTCs (FOV 8 and 5) detect the MB2 canal, smaller FOV (FOV 5) is more accurate in the analysis of the internal anatomy of such root canals, according to the Vertucci´s classification.

Prevalence of technical errors and periapical lesions in a sample of endodontically treated teeth: a CBCT analysis

OBJECTIVES

The aims of this study are to identify the most frequent technical errors in endodontically treated teeth and to determine which root canals were most often associated with those errors, as well as to relate endodontic technical errors and the presence of coronal restorations with periapical status by means of cone-beam computed tomography images.

METHODS

Six hundred eighteen endodontically treated teeth (1146 root canals) were evaluated for the quality of their endodontic treatment and for the presence of coronal restorations and periapical lesions. Each root canal was classified according to dental groups, and the endodontic technical errors were recorded. Chi-square's test and descriptive analyses were performed.

RESULTS

Six hundred eighty root canals (59.3%) had periapical lesions. Maxillary molars and anterior teeth showed higher prevalence of periapical lesions (p < 0.05). Endodontic treatment quality and coronal restoration were associated with periapical status (p < 0.05). Underfilling was the most frequent technical error in all root canals, except for the second mesiobuccal root canal of maxillary molars and the distobuccal root canal of mandibular molars, which were non-filled in 78.4 and 30% of the cases, respectively.

CONCLUSIONS

There is a high prevalence of apical radiolucencies, which increased in the presence of poor coronal restorations, endodontic technical errors, and when both conditions were concomitant. Underfilling was the most frequent technical error, followed by non-homogeneous and non-filled canals.

CLINICAL RELEVANCE

Evaluation of endodontic treatment quality that considers every single root canal aims on warning dental practitioners of the prevalence of technical errors that could be avoided with careful treatment planning and execution.

Evaluation of Distolingual Canal/Roots in Mandibular Molars and Mesiobuccal Canals in Maxillary Molars by CBCT

Background/Purpose:

The objectives of this study were to identify the bilateral distolingual (DL) canals / roots of the mandibular first molars and second mesiobuccal (MB2) canals of the maxillary first molars in the same Turkish individuals using cone-beam computed tomography (CBCT).

Materials and Methods:

A total of 150 CBCT images including all mandibular and maxillary first molars were retrospectively investigated in a Turkish subpopulation. The patient age, sex and presence of roots and root canals were assessed. The frequency, of bilateral DL canals, DL roots, and MB2 canals were reviewed. Data were analyzed using Fisher’sexact test and Chi-square test.

Results:

The prevalences of right DL canals, DL roots and MB2 canals were 31.3, 14.0 and 34.7%, respectively. The prevalences of left DL canals, DL roots and MB2 canals were 31.3, 4 and 27.3%, respectively. There was no statistically difference in the frequency of right and left DL canals, DL roots of mandibular first molars and MB2 canals of maxillary first molars according to gender.

Conclusion:

CBCT is a competent tool for the detection of additional distolingual canals/roots and second mesio buccal canals, and it is a valuable aid for dentists providing root canal treatment.

Evaluation of the root and canal systems of maxillary molars in Taiwanese patients: A cone beam computed tomography study

Background

This study evaluated variations in root canal configuration in the maxillary permanent molars of Taiwanese patients by analyzing patients' cone beam computed tomography (CBCT) images. Comparisons were made among these configurations and those previously reported. This information may serve as a basis for improving the success rate of endodontic treatment.

Methods

The root canal systems of 114 Taiwanese patients with bilateral maxillary first or second molars were examined using CBCT images. The number of roots, canals per root, and additional mesiobuccal (MB) canals, as well as the canal configuration were enumerated and recorded.

Results

Of the 196 maxillary first molars examined, three (1.5%) had a single root, two (1.0%) had two roots, and 191 (97.5%) had three separate roots. Out of all first molar roots examined, 44% of mesiobuccal (MB) roots had a single canal and the remainder had a second MB (MB2) canal. Of the 212 maxillary second molars examined, 16 (7.1%) had a single root, 51 (24.2%) had two roots, 143 (67.8%) had three roots, and two (0.9%) had four separate roots. For the MB roots, 92.3% of three-rooted maxillary second molars had a single canal and the remainder had an MB2 canal. In all three-rooted maxillary first and second molars, each of the distal and palatal roots had one canal.

Conclusions

The root canal configurations of the MB roots of maxillary molars were more varied than those of the distobuccal and palatal roots, and the root canal configurations of maxillary second molars were more varied than those of the first molars. These findings demonstrate CBCT as a useful clinical tool for endodontic diagnosis and treatment planning.

3D printing in dentistry

3D printing has been hailed as a disruptive technology which will change manufacturing. Used in aerospace, defence, art and design, 3D printing is becoming a subject of great interest in surgery. The technology has a particular resonance with dentistry, and with advances in 3D imaging and modelling technologies such as cone beam computed tomography and intraoral scanning, and with the relatively long history of the use of CAD CAM technologies in dentistry, it will become of increasing importance. Uses of 3D printing include the production of drill guides for dental implants, the production of physical models for prosthodontics, orthodontics and surgery, the manufacture of dental, craniomaxillofacial and orthopaedic implants, and the fabrication of copings and frameworks for implant and dental restorations. This paper reviews the types of 3D printing technologies available and their various applications in dentistry and in maxillofacial surgery.

Status of Endodontic Treatment and the Correlations to the Quality of Root Canal Filling and Coronal Restoration

INTRODUCTION

This cross-sectional study evaluated the prevalence and quality of root canal treatment in 1,977 digital radiological files.

MATERIALS AND METHODS

Data were statistically analyzed using descriptive analysis, and the chi-square test was performed with a 5% significance level.

RESULTS

The mean age of the study population was 34.9 years. The endodontic treatment frequency was 6.14%, significantly higher in premolars. Adequate endodontic treatment was observed in 39.7% of analyzed cases. Molars were significantly more frequent with regard to inadequate filling quality. In 47.6% of cases, the filling's apical limit was classified as adequate, and there was a higher incidence of molars that were inadequate. Restorations were classified as adequate in 79.0% of cases, and molars were responsible for the highest frequency of inadequate restorations. The frequency of teeth with endodontic treatment that showed no periapical changes was 47.7%. There was no significant difference in the presence of periapical change according to gender. An increased presence of periapical change was observed with increasing age. The periapical lesions were observed in 45% of cases and related to inadequate filling quality. The apical limit was considered inadequate and related to periapical changes in 42% of cases. Periapical changes were present in 52% of cases, regardless of the quality of the filling and apical limit. Such changes were present in 42% of cases with adequate coronal restoration.

CONCLUSION

It can be concluded that apical periodontitis (AP) is associated with the quality of endodontic treatment. The coronal restoration affects significantly the success rate of endodontic treatment.

CLINICAL SIGNIFICANCE

The quality of the root filling and coronal restoration is closely related to periapical health.

Abbott P. A Clinical Update on the Different Methods to Decrease the Occurrence of Missed Root Canals

One of the main causes of endodontic treatment failure is the clinician's inability to localize all the root canals. Due to the complex anatomy of the root canal system, missed canals are not uncommon. There are several strategies to decrease the possibility of missed root canals starting with good pre-operative radiographies. In order to overcome the limitations of conventional radiographies, cone-beam computed tomography (CBCT) can be considered. A correct access cavity preparation is of pivotal importance in localizing the orifices of the root canals. Furthermore, ultrasonics are very important devices to find missed canals. Increasing magnification and illumination enhance the possibility of finding all root canals during root canal treatment. The purpose of the present paper was to review all of the above techniques and devices.

Cone-beam computed tomography as a surgical guide to impacted anterior teeth

Surgical procedure for removal of impacted teeth is a challenge for clinicians as it involves accuracy in the diagnosis and localization of the dental elements. The cone-beam computed tomography (CBCT), compared to the conventional radiography, has a greater potential to provide complementary information because of its three-dimensional (3D) images, reducing the possibility of failures in surgical procedures. Two 10-year-old boys presented with aesthetic issues associated with the juxtaposition of ectopic teeth with the permanent ones. Both two-dimensional and 3D preoperative radiographic diagnostic sets were produced. The occlusal and panoramic radiographs were not enough for proper localization of impacted incisors. Thus, the CBCT was used as a surgical guide. After 2 years of longitudinal following, no lesion was recorded, and the orthodontic treatment has proven successful. In all cases, CBCT contributed to both diagnosis and correct localization of supernumerary teeth, aiding the professional in the treatment planning, and consequently in the clinical success. The surgeries were completely safe, avoiding damage in noble structures, and providing a better recovering of the patients.

Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT

OBJECTIVE

This study aimed to assess the quality of root fillings, coronal restorations, complications of all root-filled teeth and their association with apical periodontitis (AP) detected by cone-beam computed tomography (CBCT) images from an adult Turkish subpopulation.

MATERIAL AND METHODS

The sample for this study consisted of 242 patients (aging from 15 to 72 years) with 522 endodontically treated teeth that were assessed for technical quality of the root canal filling and periapical status of the teeth. Additionally, the apical status of each root-filled tooth was assessed according to the gender, dental arch, tooth type and age classification, undetected canals, instrument fracture, root fracture, apical resorption, apical lesion, furcation lesion and type and quality of the coronal structure. Statistical analysis was performed using percentages and chi-square test.

RESULTS

The success rate of the root canal treatment was of 54.4%. The success rates of adequate and inadequate root canal treatment were not significantly different (p>0.05). Apical periodontitis was found in 228 (45.6%) teeth treated for root canals. Higher prevalence of AP was found in patients aging from 20 to 29 years [64 (27%) teeth] and in anterior (canines and incisors) teeth [97 (41%) teeth].

CONCLUSIONS

The technical quality of root canal filling performed by dental practitioners in a Turkish subpopulation was consistent with a high prevalence of AP. The probable reasons for this failure are multifactorial, and there may be a need for improved undergraduate education and postgraduate courses to improve the clinical skills of dental practitioners in endodontics.