Use of the metal artefact reduction tool in the identification of fractured endodontic instruments in cone-beam computed tomography.

Abstract

To evaluate the influence of the metal artefact reduction (MAR) tool in the diagnosis of fractured instruments in root canals of extracted mandibular molars, with or without root canal fillings. The root canals of 31 mandibular molars were divided into four groups: (i) the control group, without root fillings; (ii) the fracture group, without fillings and with fractured files; (iii) the fill group, with root filling; and (iv) the fill/fracture group, root filled and with fractured files. The following instruments were used as fractured endodontic instruments: stainless steel hand files, NiTi reciprocating files and NiTi rotary files. Each tooth was inserted in a dry mandible to obtain cone-beam computed tomography (CBCT) images using a CBCT OP300 3D Maxio (Instrumentarium Dental, Tuusula, Finland) and Picasso Trio (Vatech, Hwaseong, Republic of Korea), with and without application of the MAR tool. All images were evaluated by three radiologists for the presence or absence of fractured files on a 5-point scale. The diagnostic accuracy (area under ROC curve) was calculated. Image noise was measured in regions of trabecular and cortical bone and soft tissue. The comparison between the ROC curve values with the MAR tool enabled or disabled was performed using a t-test. A t-test was also employed for comparing image noise when the MAR tool was enabled and disabled. The significance level was set at 5%. The use of the MAR tool did not influence the diagnostic accuracy for identifying fractured endodontic instruments in root canals with and without fillings in both CBCT systems (P>0.05), nor did it influence the image noise (P>0.05). The MAR tool on these two devices did not increase the detection of fractured endodontic instruments and did not reduce image noise using extracted mandibular molars. Therefore, the MAR tool is not recommended for evaluation of fractured endodontic instruments in teeth with and without root fillings in mandibular molars.