Radiology in Endodontics

Augmented Reality-Guided Apicoectomy Based on Maxillofacial CBCT Scans

Implementation of augmented reality (AR) image guidance systems using preoperative cone beam computed tomography (CBCT) scans in apicoectomies promises to help surgeons overcome iatrogenic complications associated with this procedure. This study aims to evaluate the intraoperative feasibility and usability of HoloLens 2, an established AR image guidance device, in the context of apicoectomies. Three experienced surgeons carried out four AR-guided apicoectomies each on human cadaver head specimens. Preparation and operating times of each procedure, as well as the subjective usability of HoloLens for AR image guidance in apicoectomies using the System Usability Scale (SUS), were measured. In total, twelve AR-guided apicoectomies on six human cadaver head specimens were performed (n = 12). The average preparation time amounted to 162 (±34) s. The surgical procedure itself took on average 9 (±2) min. There was no statistically significant difference between the three surgeons. Quantification of the usability of HoloLens revealed a mean SUS score of 80.4 (±6.8), indicating an "excellent" usability level. In conclusion, this study implies the suitability, practicality, and simplicity of AR image guidance systems such as the HoloLens in apicoectomies and advocates their routine implementation.

Clinical and radiological outcomes of dynamic navigation in endodontic microsurgery: a prospective study

OBJECTIVES

This study was aimed at evaluating the clinical and radiological outcomes of novel dynamic navigation (DN)-aided endodontic microsurgery (EMS), with an analysis of potential prognostic factors.

MATERIALS AND METHODS

Forty-six teeth from 32 patients who received DN-aided EMS were included. Clinical and radiographic assessments were performed at least 1 year postoperatively. Two calibrated endodontists assessed radiological outcomes according to two-dimensional (2D) periapical radiography (PA) and three-dimensional (3D) cone-beam computed tomography (CBCT) imaging using Rud's and Molven's criteria and modified PENN 3D criteria, respectively. Fisher's exact test was used for statistical analysis of the predisposing factors.

RESULTS

Of the 32 patients with 46 treated teeth, 28 with 40 teeth were available for follow-up. Of the 28 patients, four (five teeth) refused to undergo CBCT and only underwent clinical and PA examinations, and the remaining 24 (35 teeth) underwent clinical, PA, and CBCT examinations. Combined clinical and radiographic data revealed a 95% (38/40) success rate in 2D healing evaluations and a 94.3% (33/35) success rate in 3D healing evaluations. No significant effect was found in sex, age, tooth type, arch type, preoperative lesion volume, preoperative maximum lesion size, presence/absence of crown and post, and the root canal filling state on the outcome of DN-aided EMS.

CONCLUSIONS

DN-aided EMS has a favorable prognosis and could be considered an effective and reliable treatment strategy. Further investigations with larger sample sizes are required to confirm these results.

CLINICAL RELEVANCE

DN-aided EMS could be considered an effective and reliable treatment strategy.

Recent Advances in Endodontic Diagnosis and Modern Treatment Plans

Generally, to achieve success in endodontics, it is essential to perform all stages of treatment with cautiousness and excellence [...].

Middle mesial canal in mandibular first molar: A narrative review

Purpose

This review aimed to assess the incidence, anatomical characteristics, identification, and clinical management using conventional techniques and advanced tools to manage MMCs successfully.

Methods

Medline/PubMed and Scopus databases were searched using "Middle mesial canal," "Middle mesial root canal," OR "Accessory mesial canal" keywords from 1 January 1970 and 1 February 2023. The most pertinent articles were chosen for the review from the retrieved articles. In addition, relevant articles were added by manually searching the list of references.

Results

The incidence of MMC is noticeable in younger people, and the confluent canal is the most common type. The majority of MMCs merged with mesiobuccal (MB) canals rather than mesiolingual (ML) canals. Clinical management could be employed using the standard endodontics protocol, and recent radiography technologies, magnification, rotary, and obturation materials can facilitate the procedures.

Conclusion

The possibility of the incidence of MMC is not unusual. Detection and thorough debridement followed by obturation of the canal could increase the success rate of clinical outcomes.

An Endodontic forecasting model based on the analysis of preoperative dental radiographs: A pilot study on an endodontic predictive deep neural network

INTRODUCTION

This study aimed to evaluate the use of deep convolutional neural network (DCNN) algorithms to detect clinical features and predict the three years outcome of endodontic treatment on preoperative periapical radiographs.

METHODS

A database of single-root premolars that received endodontic treatment or retreatment by endodontists with presence of three years outcome was prepared (n = 598). We constructed a 17-layered DCNN with a self-attention layer (PRESSAN-17), and the model was trained, validated, and tested to 1) detect seven clinical features, i.e., full coverage restoration (FCR), presence of proximal teeth (PRX), coronal defect (COD), root rest (RRS), canal visibility (CAV), previous root filling (PRF), and periapical radiolucency (PAR), and 2) predict the three years endodontic prognosis by analyzing preoperative periapical radiographs as an input. During the prognostication test, a conventional DCNN without a self-attention layer (RESNET-18) was tested for comparison. Accuracy and area under the receiver-operating-characteristic (ROC) curve (AUC) were mainly evaluated for performance comparison. Gradient-weighted class activation mapping (Grad-CAM) was used to visualize weighted heatmaps.

RESULTS

PRESSAN-17 detected FCR (AUC = 0.975), PRX (0.866), COD (0.672), RRS (0.989), PRF (0.879) and PAR (0.690) significantly, compared to the no-information rate (p<0.05). Comparing the mean accuracy of 5-fold validation of two models, PRESSAN-17 (67.0%) showed a significant difference to RESNET-18 (63.4%, p<0.05). Also, the area under average ROC of PRESSAN-17 was 0.638, which was significantly different compared to the no-information rate. Grad-CAM demonstrated that PRESSAN-17 correctly identified clinical features.

CONCLUSIONS

Deep convolutional neural networks may aid in the prognostication of endodontic treatment outcome.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.

Post Placement and Restoration of Endodontically Treated Canines: A Finite Element Analysis Study

The purpose of this study was to show the improved outcomes of restoring endodontically treated teeth with fiberglass posts compared to restorations using metal posts. In our study, we used the Finite Element Method (FEM), which is based on the principle that a physical model that supports a given load distributes the stress throughout its volume. We sought to assess what stress results in a tooth when it is restored using a fiberglass post compared to restoration using a metal post. The finite element analysis showed that a system consisting of a tooth with a fiberglass post is more stable in terms of the maximum stress than a system consisting of a tooth with a metal post. The maximum displacements and deformations were obtained in the case of a canine restored with a fiberglass post, which showed that this system had a high elasticity, therefore, higher strength than a canine restored with a metal post, which had high rigidity.