Use Of Cone-beam Computed Tomographic Imaging Research Articles

The Association between Choice of Diagnostic Imaging Modality and Long-term Treatment Outcomes for Patients Undergoing Nonsurgical Root Canal Treatment on Maxillary First Molars

IntroductionRadiography has played a fundamental role in the advancement of nonsurgical root canal therapy (NSRCT), allowing for more accurate diagnosis and treatment. Typically, providers choose to perform NSRCT using periapical (PA) radiographs alone or, often in more difficult cases, in conjunction with cone-beam computed tomographic (CBCT) imaging. This study aimed to evaluate the outcomes of NSRCT based on imaging modality selection for the initial treatment of maxillary first molars. MethodsA retrospective chart review was conducted using 1385 cases of NSRCT on maxillary first molars. Charts were reviewed for patient demographics and treatment outcomes. Based on the imaging modality used, patients were stratified into 2 groups (PA radiographs alone or PA radiographs + CBCT imaging). Those who required additional treatment(s) after the completion of NSRCT were classified as having “posttreatment disease.” Statistical analysis was performed to assess the differences between groups. ResultsAfter the completion of primary endodontic therapy, 5.8% (n = 81) of the entire sample had posttreatment disease. CBCT imaging was used in 13.4% (n = 185) of NSRCTs. Although not significant, cases that were difficult enough to require the use of CBCT imaging had a higher rate of posttreatment disease compared to those that could be completed with PA radiographs alone (8.6% vs 5.4%, P > .05). Results from a multivariable logistic regression model showed that the need for CBCT imaging had a nonsignificant positive association with posttreatment disease (P > .05). ConclusionsThe decision to use CBCT imaging appears to serve as a proxy for case complexity and the associated increase in risk of posttreatment disease. This is important to keep in mind when assessing treatment prognosis.

Assessment of Cone-beam Computed Tomographic Referral Reasons and the Impact of Cone-beam Computed Tomographic Evaluation on Decision Treatment Planning Procedure in Endodontics

IntroductionThe aim of the present study was to assess the number of cone-beam computed tomographic (CBCT) referral cases from a private endodontic practice during a 1-year observation period and to investigate if preoperative use of CBCT imaging has an impact on the final diagnosis and decision treatment planning. MethodsThe data of the patients who attended a private endodontic office in Athens, Greece, seeking endodontic treatment from January 2018 to December 2018 were scanned to retrieve all the cases that were further referred for CBCT evaluation. Two qualified (University of Athens) and experienced (more than 10 years of daily practicing) endodontists referred the cases for CBCT imaging. All CBCT cases were evaluated to collect information about the number of cases, the reason for referral, the diagnosis before and after CBCT interpretation, and the treatment planning decision and management of each case. Descriptive statistics were used to describe the clinical characteristics of the study sample. Logistic regression was used to estimate the odds ratios and their 95% confidence intervals. ResultsOf a total of 1029 patients (1269 teeth) referred for endodontic treatment, 86 patients were further referred for CBCT imaging (8.35% of the patients). A total of 104 teeth (8.2% of the teeth) were scanned. The most frequent reason for CBCT referral was surgical treatment planning. In 18 of 104 (17.3%) cases, there has been a change of the initial diagnosis after CBCT interpretation. Posterior and endodontically treated teeth without lesions presented 4.35 and 6.6 times times higher odds, respectively, of having a change in the initial diagnosis after CBCT evaluation. ConclusionsA small percentage of patients referred for endodontic treatment or retreatment are further referred by specialists for CBCT imaging. CBCT scanning was considered necessary both for all surgical treatment planning cases and the evaluation of inflammatory resorptive defects.

Analysis of Fused Rooted Maxillary First and Second Molars with Merged and C-shaped Canal Configurations: Prevalence, Characteristics, and Correlations in a Saudi Arabian Population

IntroductionThe aims of this in vivo cone-beam computed tomographic (CBCT) study were to evaluate the prevalence, characteristics, and correlations between the fused rooted maxillary first and second molars as well as their consequent merged and C-shaped canals in a Saudi Arabian population. MethodsCBCT imaging of 726 maxillary first and second molars from 208 subjects of Saudi origin were evaluated in the present study. The prevalence of fused rooted maxillary molars, merged canals, C-shaped configurations, and correlations between the presence of fused rooted teeth between first and second molars were examined as the primary outcome. Differences by sex, location in the jaw, and bilateral symmetry (similarity between right- and left-side teeth in the same patient) were evaluated as the secondary outcome. The Z test was used for differences in the independent proportions, the chi-square test was used for differences between sex and locations, and the Cohen kappa test was used for bilateral symmetry. The kappa test was also used for intrarater reliability. A value of P < .05 was considered significant. ResultsThe prevalence of fused rooted maxillary first and second molars was 7% and 21%, respectively. Within fused rooted teeth, the presence of merged canals was 8.3% and 32.1%, whereas the prevalence of C-shaped canals was 8.3% and 5.1% in first and second maxillary molars, respectively. Among 57 subjects who had fused rooted maxillary molars, 19.3% showed a correlation between first and second molars. In fused rooted maxillary molars, 3.8% first molars and 13% second molars were bilaterally symmetrical. There were no statistically significant differences between sexes and right- and left-sided fused rooted maxillary molars, merged canals, or C-shaped canals. ConclusionsMaxillary second molars presented more complex external and internal morphology compared with maxillary first molars, with an overall prevalence of 14% of fused rooted maxillary molars and 3.7% merged and 0.8% C-shaped canal configurations for all maxillary molars. The clinician should be aware of such challenges, and for a better treatment outcome, the use of CBCT imaging (small field of view) and an operative dental microscope can be considered when a preoperative periapical radiograph shows signs of fused rooted maxillary molars.

The Incidence of Second Mesiobuccal Canals Located in Maxillary Molars with the Aid of Cone-beam Computed Tomography

IntroductionMany endodontic treatment failures in maxillary molars result from missed second mesiobuccal (MB2) canals. An MB2 canal orifice is present in as many as 95% of maxillary molars, but these canals are not always located during endodontic procedures. Additional tools, such as cone-beam computed tomographic (CBCT) imaging, may be needed to locate these canals in maxillary molars. Hence, the aims of this study were to investigate the frequency of use of CBCT imaging during the treatment of maxillary molars and to evaluate the influence of its use on the detection of MB2 canals. MethodsEndodontic treatment records, digital intraoral radiographs (when present), and CBCT images from all maxillary first and second molars treated at the University of Washington, Seattle, WA, between 2010 and 2014 (N = 886) were reviewed. Statistical analysis was performed to assess differences between the groups. ResultsOverall, an MB2 canal was found in 55.8% of the maxillary molars studied, and CBCT imaging assisted in detecting 11.7% of these canals. CBCT imaging was used in 16.5% of the cases treated and was used significantly more for retreatment cases. CBCT imaging was used preoperatively in 5.6% of cases, and the data show that significantly more MB2 canals were located when a preoperative CBCT image was available. More MB2 canals were located in first molars without full-coverage crowns. ConclusionsThe data show that CBCT imaging is a valuable tool in locating MB2 canals. Based on the results of his study, the use of CBCT imaging could be warranted when treating maxillary molars.

Rare Root Canal Configuration of Mandibular Second Premolar Using Cone-beam Computed Tomographic Scanning

The aim of this case report was to demonstrate how the use of cone-beam computed tomographic (CBCT) imagery is beneficial when treating a tooth with an unusual anatomic variation. A 43-year-old female patient presented to our private practice after a referral from her general dentist. Endodontic therapy was previously initiated and unable to be completed because of suspicious anatomic anatomy. CBCT imagery confirmed the presence of a C-shaped root configuration and 3 canals within the tooth. Root canal treatment was completed successfully without complications. The use of CBCT imaging was valuable in determining the root morphology and rare canal anatomy to enhance treatment and success.

A Comparison of 2- and 3-dimensional Healing Assessment after Endodontic Surgery Using Cone-beam Computed Tomographic Volumes or Periapical Radiographs

IntroductionThe aim of this study was to compare the assessment of healing after endodontic microsurgery using 2-dimensional (2D) periapical films versus 3-dimensional (3D) cone-beam computed tomographic (CBCT) imaging. MethodsThe healing of 51 teeth from 44 patients was evaluated using Molven's criteria (2D) and modified PENN 3D criteria. The absolute area (2D) and volume (3D) changes of apical lesions preoperatively and at follow-up were calculated by segmentation using OsiriX software (Pixmeo, Bernex, Switzerland) and ITK-Snap (free software). ResultsThere was a significant difference between the mean preoperative lesion volumes of 95.34 mm3 (n = 51, standard deviation [SD] ±196.28 mm3) versus 6.48 mm3 (n = 51, SD ±17.70 mm3) at follow-up (P < .05). The mean volume reduction was 83.7%. Preoperatively, mean lesion areas on periapical films were 13.55 mm2 (n = 51, SD ±18.80 mm2) and 1.83 mm2 (n = 51, SD ±.68 mm2) at follow-up (P < .05). According to Molven's criteria, 40 teeth were classified as complete healing, 7 as incomplete healing, and 4 as uncertain healing. Based on the modified PENN 3D criteria, 33 teeth were classified as complete healing, 14 as limited healing, 1 as uncertain healing, and 3 as unsatisfactory healing. The variation in the distribution of the 2D and 3D healing classifications was significantly different (P < .05). Periapical healing statuses incomplete healing or uncertain healing according to Molven's criteria could be clearly classified using 3D criteria. ConclusionsCBCT analysis allowed a more precise evaluation of periapical lesions and healing of endodontic microsurgery than periapical films. Significant differences existed between the 2 methods. Over the observation period, the mean periapical lesion sizes significantly decreased in volume. Given the correct indications, the use of CBCT imaging may be a valuable tool for the evaluation of healing of endodontic surgery.

Combined Therapy for a Rare Case of Type III Dens Invaginatus in a Mandibular Central Incisor with a Periapical Lesion: A Case Report

Type III dens invaginatus has a complex root canal structure that poses a greater challenge when endodontic treatment is necessary. Type III dens invaginatus rarely affects mandibular central incisors. In this case, we reported a combined therapy of type III dens invaginatus in a mandibular central incisor with a periapical lesion. Cone-beam computed tomographic (CBCT) imaging was used in the diagnosis and management of the unusual anatomy of dens invaginatus. First, the hard tissue of the dens invaginatus was removed using a dental operating microscope. The root canal was then prepared with a nickel-titanium instrument and filled with mineral trioxide aggregate and gutta-percha. Subsequently, a surgical treatment was performed using a dental operating microscope because the patient still had an apical infection after root canal treatment and the periapical lesion was not fully healed. In addition, the patient had requested a quick and thorough treatment for personal reasons. The granulomatous soft tissue was then curetted under local anesthesia followed by a surgical retrograde approach to negotiate and obturate the apical patent portion of the invagination. The bone window was filled with BonaGraft (YHJ Science and Trade, Beijing, China) and covered with a collagen membrane. The use of CBCT imaging and a dental operating microscope was important for ensuring a predictable outcome in this case.

Incidental findings on cone beam computed tomographic images: a Pandora's box?

Incidental findings on cone beam computed tomographic images: a Pandora's box?