Analysis of Artefacts in Endodontically Treated Teeth on Cone Beam Computed (CBCT) Images and their Impact on Diagnostic Value

Abstract

The aim of this paper was to investigate the incidence of artefacts produced by endodontically treated teeth on CBCT images and their impacts the diagnostic value of the image for endodontic purposes. A retrospective analysis of 57 root filled teeth from 40 CBCT scans from UCLAN dental clinic between 2016-2020 was undertaken. Each tooth was split into crown and root section with the incidence of all known artefacts recorded by the binary yes/no variable. Subjective assessment into the diagnostic acceptability of the image in relation to endodontic indications stated in the European Society of Endodontics guidance was done. Age, gender, field of view, tooth type, location, coronal restoration of subject tooth and adjacent teeth were recorded. Statistical analysis (SPSS v28, IBM system) was used to assess the relationship between study factors, artefact expression and the effects on diagnostic quality. Scatter artefacts were present in 100% of samples with Beam Hardening being present in 94.7% of samples. Image Noise, Motion and Aliasing (distortion) artefacts reported an incidence ranging between 0-17.5%. The significance level was set at p<0.05. Of the study characteristics Beam Hardening was affected by tooth type/location, coronal restoration of subject tooth and adjacent tooth whereas Motion and Aliasing artefacts were affected by the number of roots and tooth type/location respectively. Beam Hardening, Image Noise, Motion and Aliasing artefacts were shown to have a statistically significant association with the diagnostic acceptability of the scans of root filled teeth for endodontic purposes especially in the axial and sagittal views. Beam Hardening had the most significant impact on diagnostic quality. This is the first study to show artefact expression is much more prevalent than previously reported and has strong ability to affect the diagnostic acceptability of CBCT scans of root filled teeth taken for endodontic purpose.