Cone beam computed tomography aided diagnosis and treatment of endodontic cases: Critical analysis

Magnetic resonance imaging versus cone beam computed tomography in diagnosis of periapical pathosis – A systematic review

Objective

The diagnosis of any dental pathology can vary from being simple to challenging. While the use of cone beam computed tomography (CBCT) is well established, magnetic resonance imaging (MRI) remains a proof of concept. This systematic review aims to compare the diagnostic ability of MRI with CBCT in diagnosing periapical pathosis.

Materials and Methods

This systematic search was performed using the electronic databases of MEDLINE, Cochrane Library, Google Scholar, and Science Direct to identify relevant articles from 2010 to 2020. The search terms used were magnetic resonance imaging, cone beam computed tomography, diagnosis, and periapical diseases.

Result

In total, 3218 potentially relevant abstracts and titles were identified. After removing duplicates, 1288 articles were reviewed for titles and abstracts, and 29 articles were selected for full-text reading. From those, 19 articles were finally selected that included original research studies, case reports, and case series and were included for systematic review. Most of the studies included in this review suggested that the combined use of CBCT and MRI is needed for a better and more precise diagnosis of complex periapical pathoses. The main advantage of MRI is its ability to image soft tissues usingnonionizing radiation, and the main disadvantage in the case of CBCT is overdiagnosis of the lesion.

Conclusion

MRI has various advantages over CBCT with similar diagnostic utility. When diagnosing periapical pathogens, both MRI and CBCT are needed for an accurate diagnosis.

A Novel Volume-based Cone-beam Computed Tomographic Periapical Index

INTRODUCTION

The purpose of this study was to evaluate the variations in the volume of periapical lesions scored using a cone-beam computed tomographic periapical index (CBCTPAI) and to develop a new volume-based periapical index.

METHODS

Cone-beam computed tomographic images were obtained from InteleViewer (Intelerad Medical Systems Incorporated, Montreal, Canada). Teeth with a periapical radiolucency or with a history of endodontic treatment were included in this study. Using 3-dimensional medical imaging processing software (Mimics Research; Materialise NV, Leuven, Belgium), the maximum diameter of 273 periapical lesions and their corresponding CBCTPAI score was determined. The software was then used to determine the volume of the lesions using a semiautomatic segmentation technique.

RESULTS

There was a substantial variation in the volume for CBCTPAI scores 3, 4, and 5, which was demonstrated by the variance and range, thus making it difficult to use the current CBCTPAI as a method to predict volume and treatment outcomes. A new index, the cone-beam computed tomographic periapical volume index (CBCTPAVI), was developed using partition classification analysis. The results for the new index demonstrated high levels of sensitivity, specificity, precision, and area under the curve, all at 0.90 or more, except 1 sensitivity for CBCTPAVI 1 at 0.875. Overall, the accurate classification rate was 98.169%, and the root mean square error rate was low at 0.07.

CONCLUSIONS

The proposed CBCTPAVI will allow clinicians to classify lesions based on their true 3-dimensional size, accurately assess healing of lesions, and predict treatment outcomes.

Role of Computed Tomography Scan in Dental Trauma: A Cross-Sectional Study

Background:

Dental trauma is caused by fracture(s) in the vertical plane and the horizontal plane of roots. The objective of this study is to perform multiple diagnostic modalities for the diagnosis of horizontal root fracture(s) of the tooth.

Methods:

A total of 250 patients with dental complaints were subjected to intraoral radiography, multidetector helical computed tomography (MDHCT), and limited cone beam computed tomography (LCBCT). The suspected tooth was extracted, visually inspected, and subjected to microcomputed tomography (micro-CT). Images were observed in the lightbox, and a fracture was considered if it had been directly visualized as radiolucent line traversing tooth root. Wilcoxon test/Tukey post hoc test was performed at 99% of confidence level.

Results:

With respect to visual inspection, for LCBCT, intraoral radiography, MDHCT, and micro-CT, sensitivities were 0.988, 0.972, 0.967, and 0.979; accuracies were 0.956, 0.785, 0.905, and 0.888; false-positive values were 5, 21, 12, and 11; and false-negative values were 3, 24, 3, and 11, respectively. The area of the image visible at one time was in the order of treatment without radiography < intraoral radiography < MDHCT < micro-CT < LCBCT.

Conclusion:

The LCBCT had the highest sensitivity and accuracy for diagnosis of horizontal tooth root fracture(s).

Level of Evidence:

I.

Trial Registry:

researchregistry3647, dated December 31, 2016 (www.researchregistry.com).

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.