Abstract
The volumetric change that occurs in the pulp space over time represents a critical measure when it comes to determining the secondary outcomes of regenerative endodontic procedures (REPs). However, to date, only a few studies have investigated the accuracy of the available domain-specialized medical imaging tools with regard to three-dimensional (3D) volumetric assessment. This study sought to compare the accuracy of two different artificial intelligence-based medical imaging programs namely OsiriX MD (v 9.0, Pixmeo SARL, Bernex Switzerland, https://www.osirix-viewer.com) and 3D Slicer (http://www.slicer.org), in terms of estimating the volume of the pulp space following a REP. An Invitro assessment was performed to check the reliability and sensitivity of the two medical imaging programs in use. For the subsequent clinical application, pre- and post-procedure cone beam computed tomography scans of 35 immature permanent teeth with necrotic pulp and periradicular pathosis that had been treated with a cell-homing concept-based REP were processed using the two biomedical DICOM software programs (OsiriX MD and 3D Slicer). The volumetric changes in the teeth’s pulp spaces were assessed using semi-automated techniques in both programs. The data were statistically analyzed using t-tests and paired t-tests (P = 0.05). The pulp space volumes measured using both programs revealed a statistically significant decrease in the pulp space volume following the REP (P < 0.05), with no significant difference being found between the two programs (P > 0.05). The mean decreases in the pulp space volumes measured using OsiriX MD and 3D Slicer were 25.06% ± 19.45% and 26.10% ± 18.90%, respectively. The open-source software (3D Slicer) was found to be as accurate as the commercially available software with regard to the volumetric assessment of the post-REP pulp space. This study was the first to demonstrate the step-by-step application of 3D Slicer, a user-friendly and easily accessible open-source multiplatform software program for the segmentation and volume estimation of the pulp spaces of teeth treated with REPs.
Highlights
The volumetric change that occurs in the pulp space over time represents a critical measure when it comes to determining the secondary outcomes of regenerative endodontic procedures (REPs)
The Bland and Altman plots and the Intraclass correlation coefficient presented an absolute agreement between cone beam computed tomography (CBCT) segmented volumes (OsiriX MD and 3D Slicer) and real volumes. (See Fig. 6, Table 4)
The pulp space volume measured by two different medical imaging programs (OsiriX MD and 3D Slicer) showed a statistically significant decrease in post REP pulp space volume (See Fig. 7)
Summary
The volumetric change that occurs in the pulp space over time represents a critical measure when it comes to determining the secondary outcomes of regenerative endodontic procedures (REPs). This study was the first to demonstrate the step-by-step application of 3D Slicer, a user-friendly and accessible open-source multiplatform software program for the segmentation and volume estimation of the pulp spaces of teeth treated with REPs. The progressive development of medical imaging techniques has made it possible for an increased number of structures to be assessed and correlated with the morphological alterations associated with disease or treatment. The use of standard image interpretation systems, which are based on two-dimensional (2D) radiographs, makes it challenging to detect subtle volumetric changes following an R EP7,8 In these radiographs, any compromise in terms of the geometric configuration results in errors and, inaccurate readings, which negatively impact the interpretation of the imaging outcomes[9]. All the developed algorithms must prove their worth in a clinical environment
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