Cone-beam Computed Tomography Technology Research Articles

Evaluation of a compact cone beam CT concept with high image fidelity for point-of-care brain imaging.

Cone beam computed tomography (CBCT) has potential advantages for developing portable, cost-effective point-of-care CT systems for intracranial imaging, such as early stroke diagnosis, hemorrhage detection, and intraoperative navigation. However, large volume imaging with flat panel detector based CBCT significantly increases the scattered radiation fluence which reduces its image quality and utility. To address these issues, a compact CBCT concept with enhanced image quality was investigated for intracranial imaging. The new system features a novel antiscatter collimator and data correction method to address the challenges in imaging large volumes with CBCT. A benchtop CBCT prototype was constructed. Imaging studies with anthropomorphic phantoms showed that soft tissue visualization, Hounsfield Unit (HU) accuracy, contrast, and spatial resolution increased significantly with the proposed CBCT concept, and they were comparable to the values measured in the gold standard multidetector-row CT (MDCT) images. Contrast-to-noise ratio (CNR) in CBCT images was within 12-31% of the CNR in MDCT images. These findings indicate that a compact CBCT system integrated with effective scatter suppression techniques may have increased utility in the context of brain imaging, and the proposed approach may enable the development of point-of-care CT systems for head imaging based on flat panel detector based CBCT technology.

Relationship of incidence of radix entomolaris and C-shaped canal in mandibular molars using CBCT: A multi-centre study.

This study aimed to evaluate the relationship of incidence between radix entomolaris (RE) in permanent mandibular first molars (FM) with C-shaped canal (CSC) in permanent mandibular second molars (SM). A total of 1015 cone-beam computed tomography (CBCT) images of permanent mandibular molars from Malaysian patients were collected retrospectively and analysed by researchers from seven dental schools in Malaysia trained in CBCT technology. The presence and absence of RE and CSC were scored as 'yes' or 'no'. The prevalence of FM with RE was 21.2% and SM with CSC was 37.9%. The co-occurrence of RE and CSC in the same quadrant was 6.5% (OR = 1.497, p = 0.014). Female, Chinese and samples from Eastern Peninsular Malaysia were associated with CSC in SM (p < 0.05). The increased appearance of CSC in SM when RE is present in FM makes it imperative for clinicians to be vigilant during examination and diagnosis to prevent potential endodontic mishaps.

Conventional versus cone-beam computed tomography in lung biopsy: diagnostic performance, risks, and the advantages of tract embolization with gelfoam particle suspension.

With the widespread adoption of computed tomography (CT) technology, the number of detected pulmonary nodules has gradually increased. CT-guided percutaneous needle biopsy has become the primary method for qualitative diagnosis of pulmonary nodules. Benefiting from its three-dimensional (3D) reconstruction capability, cone-beam CT (CBCT) technology has also been widely adopted. Nevertheless, pneumothorax remains the most common complication of these diagnostic and therapeutic procedures. This study assessed the diagnostic accuracy of conventional CT (CCT)- and CBCT-guided coaxial core needle biopsy (CCNB) and the effectiveness of gelfoam particle suspension in reducing complications through tract embolization. A retrospective analysis was conducted on 320 patients who had undergone CCNB for nodules ≤3 cm from January 2020 to June 2022 at Zhongshan People's Hospital, comprising 325 biopsies (145 CCT-guided and 180 CBCT-guided). Gelfoam tract embolization was specifically used in biopsies of patients identified with a high risk of complications. Comparative statistics involved diagnostic outcomes (sensitivity, specificity, accuracy), procedural lengths, complication occurrences, and radiation doses. Diagnostically, both CCT (sensitivity 93.3%, specificity 100%, accuracy 94.1%) and CBCT (sensitivity 92.8%, specificity 100%, accuracy 93.8%) offered a similarly high performance. The CCT technique was preferable in terms of shorter median operational times (19 vs. 24 minutes; P<0.001) and greater radiation exposure (13.9 vs. 10.1 mSv; P<0.001). The complication rates of CBCT and CCT, such as those of pneumothorax (18.9% vs. 20.7%; P=0.69) and hemorrhage (23.9% vs. 18.6%; P=0.25), were comparable. Of note, the comparison of biopsies with and without gelfoam embolization revealed a marked reduction in postoperative pneumothorax incidence (1.24% vs. 7.9%; P=0.004) and the requirement for drainage (0% vs. 4.27%; P=0.02), indicating the effectiveness of this procedure. CCT- and CBCT-guided lung biopsies demonstrate equivalent diagnostic capacities, with CCT providing shorter median operational times. Importantly, gelfoam embolization substantially diminishes the risk of postoperative pneumothorax, underscoring its value in high-risk patients.

Evolving Oral Diagnostics: Cone-beam Computed Tomography's (CBCT) Importance in Contemporary Dentistry

Recent improvements in cone-beam computed tomography (CBCT) have transformed maxillofacial imaging, which formerly depended on 2D imaging. This review highlights the benefits of CBCT in many dental specialties, including implant dentistry, endodontics, orthodontics, and temporomandibular joint examination. CBCT provides remarkable diagnostic accuracy while reducing radiation exposure, making it an invaluable tool in the dental practice. Artificial Intelligence and machine learning integration in CBCT technology offers numerous benefits, including automated image analysis, pathology detection, treatment planning, radiation dose reduction, image enhancement, workflow optimization, predictive analytics, personalized treatment plans, tele dentistry, and dental education. AI's role in dentistry is expected to improve diagnostic and therapeutic capacities while optimizing CBCT scans, resulting in better patient care.

Accuracy of Volumetric Bone Mineral Density Measurement in Weight Bearing, Cone Beam Computed Tomography

Background: Weight bearing computed tomography (WBCT) utilizes cone beam CT technology to provide assessments of lower limb joint structures while they are functionally loaded. Grey-scale values indicative of X-ray attenuation that are output from cone beam CT are challenging to calibrate, and their use for bone mineral density (BMD) measurement remains debatable. To determine whether WBCT can be reliably used for cortical and trabecular BMD assessment, we sought to establish the accuracy of BMD measurements at the knee using modern WBCT by comparing them to measurements from conventional CT.Methods: A hydroxyapatite phantom with three inserts of varying densities was used to systematically quantify signal uniformity and BMD accuracy across the acquisition volume. We evaluated BMD in vivo (n = 5, female) using synchronous and asynchronous calibration techniques in WBCT and CT. To account for variation in attenuation along the height (z-axis) of acquisition volumes, we tested a height-dependent calibration approach for both WBCT and CT images.Results: Phantom BMD measurement error in WBCT was as high as 15.3% and consistently larger than CT (up to 5.6%). Phantom BMD measures made under synchronous conditions in WBCT improved measurement accuracy by up to 3% but introduced more variability in measured BMD. We found strong correlations (R = 0.96) as well as wide limits of agreement (-324 mgHA/cm3 to 183 mgHA/cm3) from Bland-Altman analysis between WBCT and CT measures in vivo that were not improved by height-dependent calibration.Conclusion: Whilst BMD accuracy from WBCT was found to be dependent on apparent density, accuracy was independent of the calibration technique (synchronous or asynchronous) and the location of the measurement site within the field of view. Overall, we found strong correlations between BMD measures from WBCT and CT and in vivo measures to be more accurate in trabecular bone regions. Importantly, WBCT can be used to distinguish between anatomically relevant differences in BMD, however future work is necessary to determine the repeatability and sensitivity of BMD measures in WBCT.

Dosimetric characteristics of 3D-printed and epoxy-based materials for particle therapy phantoms

Objective3D printing has seen use in many fields of imaging and radiation oncology, but applications in (anthropomorphic) phantoms, especially for particle therapy, are still lacking. The aim of this work was to characterize various available 3D printing methods and epoxy-based materials with the specific goal of identifying suitable tissue surrogates for dosimetry applications in particle therapy.Methods3D-printed and epoxy-based mixtures of varying ratios combining epoxy resin, bone meal, and polyethylene powder were scanned in a single-energy computed tomography (CT), a dual-energy CT, and a µCT scanner. Their CT-predicted attenuation was compared to measurements in a 148.2 MeV proton and 284.7 MeV/u carbon ion beam. The sample homogeneity was evaluated in the respective CT images and in the carbon beam, additionally via widening of the Bragg peak. To assess long-term stability attenuation, size and weight measurements were repeated after 6–12 months.ResultsFour 3D-printed materials, acrylonitrile butadiene styrene polylactic acid, fused deposition modeling printed nylon, and selective laser sintering printed nylon, and various ratios of epoxy-based mixtures were found to be suitable tissue surrogates. The materials’ predicted stopping power ratio matched the measured stopping power ratio within 3% for all investigated CT machines and protocols, except for µCT scans employing cone beam CT technology. The heterogeneity of the suitable surrogate samples was adequate, with a maximum Bragg peak width increase of 11.5 ± 2.5%. The repeat measurements showed no signs of degradation after 6–12 months.ConclusionWe identified surrogates for soft tissue and low- to medium-density bone among the investigated materials. This allows low-cost, adaptable phantoms to be built for quality assurance and end-to-end tests for particle therapy.

EXCECUTION OF CBCT IN ORTHODONTIC DIAGNOSIS AND TREATMENT PLANNING

Since a precise diagnosis and well-thought-out treatment plan are essential to any medical intervention, cone beam computed tomography (CBCT) was developed and is now extensively utilized. With the use of CBCT technology, one may view images in three dimensions and determine the precise location and size of lesions in any anatomical region. For the same reason, CBCT can be utilized for optimal treatment planning and efficient dental care not only in surgical disciplines but also in fields like endodontics, prosthodontics, and orthodontics. This review's objective is to provide dental professionals with up-to-date information on CBCT applications across all dental specialties, enabling them to make better informed diagnoses and consistent treatment decisions.

Advancing dental diagnostics: The significance of cone-beam computed tomography (CBCT) in modern dentistry

Dental radiology has historically relied on 2-dimensional (2D) imaging, but recent advancements in Cone-Beam Computed Tomography (CBCT) have revolutionized maxillofacial imaging. This review explores the applications of CBCT, emphasizing its advantages in dental specialties such as implant dentistry, endodontics, orthodontics, and temporomandibular joint evaluation. CBCT offers unparalleled diagnostic accuracy while minimizing radiation exposure, making it a valuable tool in dental practice. The integration of artificial intelligence (AI) and machine learning into CBCT technology presents exciting possibilities for automated image analysis, pathology detection, treatment planning, radiation dose reduction, image enhancement, workflow optimization, predictive analytics, customized treatment plans, teledentistry, and dental education. AI's role in dentistry is poised to enhance diagnostic and treatment capabilities while optimizing CBCT scans, ultimately improving patient care.

Cone-beam computed tomography in implant dentistry - guidelines, current concepts and limitations for practice

This article issues scientific background of Cone-beam computed tomography (CBCT) and the importance of taking x-rays before and after implant placement in daily practice as a common care. The review will introduce cone-beam computed tomography guidelines, restrictions and intraoperartive issues for instance nerve damage and bleeding incidents. Modern CBCT technology enables specialists to avoid making a wrong diagnosis, which translates into a higher percentage of people with a positive treatment outcome.&#x0D; Diagnostic radiology is a crucial element of every dental treatment planning. CBCT market is expanding gradually since two decades, there are more than 85 distinct CBCT tools available. CBCT is a three-dimensional (3D) imaging used nowadays in dentistry with increased frequency and offers volumetric data on jaw bones and teeth with relatively low radiation doses and costs. Currently, the greatest advantage of CBCT examinations over radiographs is the fact that the image obtained is presented in a 3D projection and not, as is the case, in 2D. It has the ability to help a wider range of patients, but the use of CBCT also has negative consequences. Routine or excessive use has resulted in increased radiation doses accumulating in the patient's body, which translates into an increased risk of adverse effects. The risk varies according to the age of the patient under study and is directly proportional to it, that is, it is highest for young people and lower for older people. The potential risk is also slightly higher in the female population. For this reason, creating awareness of the mandatory patient safety management of CT scans is a key process by which X-ray exposures can be optimised.

The preliminary in vitro study and application of deep learning algorithm in cone beam computed tomography image implant recognition

To properly repair and maintain implants, which are bone tissue implants that replace natural tooth roots, it is crucial to accurately identify their brand and specification. Deep learning has demonstrated outstanding capabilities in analysis, such as image identification and classification, by learning the inherent rules and degrees of representation of data models. The purpose of this study is to evaluate deep learning algorithms and their supporting application software for their ability to recognize and categorize three dimensional (3D) Cone Beam Computed Tomography (CBCT) images of dental implants. By using CBCT technology, the 3D imaging data of 27 implants of various sizes and brands were obtained. Following manual processing, the data were transformed into a data set that had 13,500 two-dimensional data. Nine deep learning algorithms including GoogleNet, InceptionResNetV2, InceptionV3, ResNet50, ResNet50V2, ResNet101, ResNet101V2, ResNet152 and ResNet152V2 were used to perform the data. Accuracy rates, confusion matrix, ROC curve, AUC, number of model parameters and training times were used to assess the efficacy of these algorithms. These 9 deep learning algorithms achieved training accuracy rates of 100%, 99.3%, 89.3%, 99.2%, 99.1%, 99.5%, 99.4%, 99.5%, 98.9%, test accuracy rates of 98.3%, 97.5%, 94.8%, 85.4%, 92.5%, 80.7%, 93.6%, 93.2%, 99.3%, area under the curve (AUC) values of 1.00, 1.00, 1.00, 1.00, 1.00, 1.00, 1.00, 1.00, 1.00. When used to identify implants, all nine algorithms perform satisfactorily, with ResNet152V2 achieving the highest test accuracy, classification accuracy, confusion matrix area under the curve, and receiver operating characteristic curve area under the curve area. The results showed that the ResNet152V2 has the best classification effect on identifying implants. The artificial intelligence identification system and application software based on this algorithm can efficiently and accurately identify the brands and specifications of 27 classified implants through processed 3D CBCT images in vitro, with high stability and low recognition cost.

Comparison of intraoperative CT- and cone beam CT-based spinal navigation for the treatment of atlantoaxial instability

BACKGROUND CONTEXTDue to the complexity of neurovascular structures in the atlantoaxial region, spinal navigation for posterior C1–C2 instrumentation is nowadays a helpful tool to increase accuracy of surgery and safety of patients. Many available intraoperative navigation devices have proven their reliability in this part of the spine. Two main imaging techniques are used: intraoperative CT (iCT) and cone beam computed tomography (CBCT). PURPOSEComparison of iCT- and CBCT-based technologies for navigated posterior instrumentation in C1-C2 instability. STUDY DESIGNRetrospective study. PATIENT SAMPLEA total of 81 consecutive patients from July 2014 to April 2020. OUTCOME MEASURESScrew accuracy and operating time. METHODSPatients with C1–C2 instability received posterior instrumentation using C2 pedicle screws, C1 lateral mass or pedicle screws. All screws were inserted using intraoperative imaging either using iCT or CBCT systems and spinal navigation with autoregistration technology. Following navigated screw insertion, a second intraoperative scan was performed to assess the accuracy of screw placement. Accuracy was defined as the percentage of correctly placed screws or with minor cortical breach (<2 mm) as graded by an independent observer compared to misplaced screws. RESULTSA total of 81 patients with C1–C2 instability were retrospectively analyzed. Of these, 34 patients were operated with the use of iCT and 47 with CBCT. No significant demographic difference was found between groups. In the iCT group, 97.7% of the C1–C2 screws were correctly inserted; 2.3% showed a minor cortical breach (<2 mm); no misplacement (>2 mm). In the CBCT group, 98.9% of screws were correctly inserted; no minor pedicle breach; 1.1% showed misplacement >2 mm. Accuracy of screw placement demonstrated no significant difference between groups. Both technologies allowed sufficient identification of screw misplacement intraoperatively leading to two screw revisions in the iCT and three in the CBCT group. Median time of surgery was significantly shorter using CBCT technology (166.5 minutes [iCT] vs 122 minutes [CBCT]; p<.01). CONCLUSIONSSpinal navigation using either iCT- or CBCT-based systems with autoregistration allows safe and reliable screw placement and intraoperative assessment of screw positioning. Using the herein presented procedural protocols, CBCT systems allow shorter operating time.

Assessment of the Prevalence of Radix Entomolaris and Distolingual Canal in Mandibular First Molars in 15 Countries: A Multinational Cross-sectional Study with Meta-analysis

AimThe aim of this study was two-folded: i) to assess the prevalence of Distolingual Canal (DLC) and Radix Entomolaris (RE) in Mandibular First Molars (M1Ms), using Cone Beam Computed Tomography (CBCT) images and ii) to assess the impact of sociodemographic factors on the prevalence of these conditions worldwide. MethodsCBCT images were scanned retrospectively and the ones including bilateral M1Ms were included in the study. The evaluation was performed by 1 researcher in each country, trained with CBCT technology. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating axial sections from coronal to apical. The presence of DLC and RE in M1Ms (yes/no) was identified and recorded. ResultsSix thousand three hundred four CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries regarding the prevalence of both RE and DLC (P < .05). The prevalence of DLC ranged from 3% to 50%, and the overall prevalence was 22% (95% CI: 15%–29%). RE prevalence ranged from 0% to 12%, and the overall prevalence was 3% (95% CI: 2%–5%). There were no significant differences between left and right M1Ms or between genders for either DLC or RE (P > .05). ConclusionThe overall prevalence of RE and DLC in M1Ms was 3% and 22%. Additionally, both RE and DLC showed substantial bilaterally. These variations should be considered by endodontic clinicians during endodontic procedures in order to avoid potential complications.

IMPLICATIONS OF CBCT IN PEDIATRIC DENTISTRY-A REVIEW

The introduction of CBCT(Cone Beam Computed Tomography) devices, modified the way dentistry is practiced. CBCT was encircled into dentistry very expeditiously due to its low cost, compact size, low ionizing radiation exposure. CBCT with 3D (Three dimensional) technology is a replacement for conventional 2D (Two dimensional) imaging &amp; has a wide application among child patients in pediatric dentistry. This article provides an overview of basics of CBCT technology &amp; reviews the specific implications of CBCT technology to pediatric &amp; preventive dentistry.

Radiation safety standards during 3D CBCT imaging: A review in dentistry

The development of cone-beam computed tomography (CBCT) technology altered the practise of oral and maxillofacial radiology. When compared to medical computed tomography, CBCT was quickly adopted in dentistry settings due to its small size, relatively reduced cost, and decreased ionising radiation exposure. CBCT referrals are still being made incorrectly due to a lack of sufficient education among dentists and specialists. Furthermore, in order to get high-quality pictures, operators may raise the radiation dose, exposing the patient to unnecessary hazards. The objective of this review is to give an insight into 3D imaging with CBCT technology and a prudent radiation monitoring during CBCT for the benefit of both patients and dentists.

Anatomical Evaluation of Posterior Maxillary Roots in Relation to the Maxillary Sinus Floor in a Saudi Sub-Population: A Cross-Sectional Cone-Beam Computed Tomography Study

To evaluate the mean distance and differences between posterior maxillary teeth and maxillary sinus floor (MSF) concerning the age and gender of the patients, a total of 124 maxillary sinuses and 496 posterior maxillary teeth were randomly selected in 62 cone-beam computed tomography (CBCT) images. Mean distances between posterior maxillary roots (PMRs) from different teeth and the MSF were measured using a calibrated tool in the software. Other relations regarding the gender and age of the patients were determined. The mean root-MSF distances in the right and left first premolars were more significant compared to the second premolars. No significant relation was found between the apices of the right and left first and second molar roots and the floor of the maxillary sinus concerning gender. A statistically significant relation was found between the apices of the buccal root of the right first premolar, right and left first and second molars and floor of the maxillary sinus concerning the age group 21-40 years (p-value = 0.009). This study showed that the second molar mesiobuccal root apex is frequently related to the sinus floor. Differences were reported concerning age, concerning the distance between posterior maxillary teeth and the maxillary sinus floor. CBCT technology helped provide the clinical proximity between the MSF and the posterior teeth root apices during the treatment planning.

Oral and Maxillofacial Radiology Diagnosis: The Role of Image Modality Selection, Interpretation Skills and Use of Cone Beam Computed Tomography Technology

Oral and Maxillofacial Radiology Diagnosis: The Role of Image Modality Selection, Interpretation Skills and Use of Cone Beam Computed Tomography Technology

Guided osteotomy

Cone-beam computed tomography (CBCT), a modern technology in three-dimensional imaging has gained wide acceptance in the field of endodontics. Treatment strategies and surgical guidance have both benefited from this strategy. By the use of conventional periapical radiographs sometime the intraoral localization of root apex is found to be difficult and it is inescapable to prevent significant amount of bone removal. Moreover, the duration of retraction of gingival flap increases and more amount of alveolar bone removal are usually required, leading to prolonged time of surgery. The more intraoperative time, the higher are the chances of postoperative pain, discomfort and even leads to increase risk of infection. The combination of intraoral or extraoral scan and CBCT provides favorable treatment outcomes. Leveraging CBCT, computer-aided design, and three-dimensional printing technology, this case report discusses a method of periapical surgery using a surgical template for guided osteotomy and root resection of the maxillary central incisor.

Applications of cone beam computed tomography in the field of prosthodontics: A review

Cone beam computed tomography (CBCT) is one of the latest radiographic modality available. It is use are enormous in medical and dental field. Among all CBCT is an essential commodity in the field of prosthodontics. The amazing capability of CBCT for providing sub-millimeter resolution in images of high diagnostic quality, with short scanning times (10–70 s) and radiation dosages reportedly up to 15–100 times lower than those of conventional Computed tomography scans are the unique features of CBCT. The aim of this article is to educate the Prosthodontist to CBCT technology, provide an overview of CBCT systems and review the specific application of various CBCT display modes to clinical Prosthodontics practice.

CONE-BEAM COMPUTED TOMOGRAPHY IN ORTHODONTICS – A REVIEW

Radiographic imaging is an important part of orthodontic diagnosis and treatment planning. Cone Beam Computed Tomography (CBCT) is a diagnostic imaging technology designed to produce undistorted three-dimensional images similar to computed tomography (CT) but at low equipment cost, simpler image acquisition, and lower patient radiation dose. CBCT technology utilizes a cone beam-shaped source and a two- dimensional detector to provide multidimensional accurate images for diagnosis and treatment planning. CBCT helps in localizing impacted teeth, identifying and quantifying asymmetry, visualizing airway abnormalities, evaluating placement sites for temporary skeletal anchorage devices, viewing condylar position and temporomandibular joint

Cone-Beam Computed Tomography Image Features under Intelligent Three-Dimensional Reconstruction Algorithm in the Evaluation of Intraoperative and Postoperative Curative Effect of Dental Pulp Disease Using Root Canal Therapy

Objective. The objective of this study was to analyze the application effect of algorithm-based three-dimensional reconstruction of cone-beam computed tomography (CBCT) images in the treatment of dental pulp disease (DPD) and the evaluation of the curative effect after treatment. Methods. 120 patients with DPD in hospital were selected as the research objects. In this study, based on the regridding model in the algorithm, the mapping relationship between the undersampled CBCT image and the fully sampled CBCT image was connected, and a model that can be used for image restoration and reconstruction was obtained after training. The algorithm model was used to reconstruct and repair the CBCT images of the research objects, and then, the reconstructed CBCT images were segmented based on the improved level set algorithm. After that, it analyzed and compared the accuracy of X-ray and CBCT based on three-dimensional reconstruction for the diagnosis accuracy of DPD and compared the average bone density of patients and the effect of root canal filling in each time period after root canal treatment. Result. After the image was reconstructed with the regridding model, a CBCT image of the patient’s teeth with less noise and clearer structure was obtained. The segmentation accuracy of the level set algorithm reached 85.5% on average, and the undersegmentation rate (UR) and the over-segmentation rate (OR) were both less than 6%. The diagnostic rates of X-ray and three-dimensional CBCT examination of DPD were 43.7% and 100%, respectively, and the difference was statistically significant ( P &lt; 0.05 ). Under the monitoring of the three-dimensional reconstruction of CBCT technology, the average bone density of the test group patients after 12 months of root canal treatment was the same as that of healthy people. Under X-ray examination, the average bone density of the test group patients was still lower than that of healthy people after 12 months of root canal treatment. Under the three-dimensional reconstruction of CBCT, the underfilling rate of patients after root canal treatment was 5%, the proper filling rate was 85%, and the overfilling rate was 10%. Conclusion. In summary, the CBCT reconstructed by the intelligent three-dimensional algorithm was effectively improved, which enhanced the image quality and segmentation efficiency. Analysis on diagnosis efficiency and treatment effect proved that CBCT can be an effective method to evaluate the initial curative effect of DPD treatment during and after the surgery and can provide valuable information in future dental treatment, thereby enhancing the success rate of DPD using root canal therapy.