Kıvanç Kamburoğlu

Effectiveness of limited cone‐beam computed tomography in the detection of horizontal root fracture

To compare the diagnostic accuracy of conventional film radiography, charge coupled device (CCD) and photostimulable phosphor plate (PSP) digital images and limited cone-beam computed tomography in detecting simulated horizontal root fracture. Root fractures were created in the horizontal plane in 18 teeth by a mechanical force and fragments were relocated. Another 18 intact teeth with no horizontal root fracture served as a control group. Thirty-six teeth were placed in the respective empty maxillary anterior sockets of a human dry skull in groups three by three. Intraoral radiographs were obtained in three different vertical views by utilizing Eastman Kodak E-speed film, CCD sensor, RVG 5.0 Trophy and a PSP sensor Digora, Optime. Cone beam CT images were taken with a unit (3D Accuitomo; J Morita MFG. Corp, Kyoto, Japan). Three dental radiologists separately examined the intraoral film, PSP, CCD and cone beam CT images for the presence of horizontal root fracture. Specificity and sensitivity for each radiographic technique were calculated. Kappa statistics was used for assessing the agreement between observers. Chi-square statistics was used to determine whether there were differences between the systems. Results were considered significant at P < 0.05. Cone beam CT images revealed significantly higher sensitivities (P < 0.05) than the intraoral systems between which no significant differences were found. Specificities did not show any statistically significant differences between any of the four systems. The kappa values for inter-observer agreement between observers (four pairs) ranged between 0.82-0.90 for the 3DX evaluations and between 0.63-0.71 for the different types of intraoral images. Limited cone beam CT, outperformed the two-dimensional intraoral, conventional as well as digital, radiographic methods in detecting simulated horizontal root fracture.

Detection of vertical root fracture using cone-beam computerized tomography: an in vitro assessment

OBJECTIVES This study aimed to compare 2 cone-beam CT units [NewTom 3G (small FOV), Iluma (ultra/low resolution)] and an intraoral CCD sensor in the detection of vertical root fracture (VRF). STUDY DESIGN The VRFs were created in 30 teeth, and 30 intact teeth served as control samples. All images were evaluated twice by 4 observers. Kappa coefficients were calculated to assess intra- and interobserver agreement, and t tests were used to compare Az values (alpha = 0.05). RESULTS Both intra- and interobserver agreement values were higher for the ultra-resolution Iluma and NewTom 3G images compared with the low-resolution Iluma and intraoral CCD images. Az values for the ultra-resolution Iluma and NewTom 3G images were also higher than for the Iluma low-resolution and intraoral CCD images. No significant differences (P > .05) in diagnostic accuracy were found between the Iluma ultra-resolution and NewTom 3G images, with the exception of the second reading of observer 2 (P = .036), and no significant differences (P > .05) were found between the intraoral digital and low-resolution Iluma images. CONCLUSION Both ultra-resolution Iluma and NewTom 3G images performed better than low-resolution Iluma and intraoral CCD images in the detection of VRF.

Comparison of digital with conventional radiography in detection of vertical root fractures in endodontically treated maxillary premolars: an ex vivo study

OBJECTIVE The purpose of the present study was to compare the diagnostic ability of conventional intraoral film radiography and a charged-coupled device (CCD) sensor in detecting vertical root fractures (VRF) in endodontically treated single-rooted extracted human maxillary premolars. STUDY DESIGN The study consisted of 60 extracted single-rooted endodontically treated maxillary premolars: 30 with clinically confirmed VRF (experimental group) and 30 with no VRF (control group). An intraoral CCD sensor and conventional Kodak Insight Film were used. Two observers evaluated the digital and conventional radiographs twice with an interval of 4 weeks. Specificity and sensitivity for each radiographic technique were calculated and subjected to statistical analysis. Kappa values were calculated for intra- and interobserver agreement. Fishers exact test was used to evaluate detection of VRF. The overall differences in sensitivity and specificity between radiographic techniques were evaluated by McNemar test. RESULTS The specificity of the digital system was significantly better (P = .016) for the second observer at the first reading. There were no significant differences in sensitivity and specificity for both observers between the 2 systems for other readings (P > .05). CONCLUSIONS No difference was found between the intraoral CCD sensor and conventional radiography in detecting vertical root fractures for single rooted maxillary premolars ex vivo.

Diagnostic accuracy of different imaging modalities in detection of proximal caries

OBJECTIVE The purpose of this study was to assess the in vitro diagnostic ability of visual inspection, film, charge-coupled device (CCD) sensor, photostimulable phosphor (PSP) sensor and cone beam CT in the detection of proximal caries in posterior teeth compared with the histological gold standard. METHODS Visual inspection, film, CCD, PSP and cone beam CT images were used to detect proximal caries in the mesial and distal surfaces of 138 teeth (276 surfaces). Visual inspection and evaluation of all intraoral digital and conventional radiographs and cone beam CT images were performed twice by three oral radiologists. Weighted kappa coefficients were calculated to assess intra- and interobserver agreement for each image set, and scores were compared with the histological gold standard using receiver operating characteristic (ROC) analysis to evaluate diagnostic ability. RESULTS Intraobserver kappa coefficients calculated for each observer for each method of detecting caries ranged from 0.739 to 0.928. Strong interobserver agreement ranging from 0.631 to 0.811 was found for all detection methods. The highest Az values for all three observers were obtained with the cone beam CT images; however, differences between detection methods were not statistically significant (P > 0.05). CONCLUSION Visual inspection, film, CCD, PSP plates and cone beam CT performed similarly in the detection of proximal caries.

Observer Ability to Detect Ex Vivo Simulated Internal or External Cervical Root Resorption

INTRODUCTION The objective of this study was to assess observer ability to detect ex vivo simulated internal and external cervical root resorption. METHODS A total of 90 single-rooted mandibular anterior teeth were split along the coronal plane. By using a 0.5-mm diameter round bur, 50 of the teeth were drilled to simulate resorptive cavities (25 internal and 25 external cervical resorption), and the remaining 40 teeth were left without surface defects. The sectioned teeth were rejoined and placed in the alveolar sockets of a dry human mandible in groups of 6 and imaged with intraoral film by using 3 different angulations and with a cone-beam computed tomography (CBCT) unit. Film and CBCT image sets were evaluated twice by 3 separate observers. Teeth were scored for the presence and location of resorption by using a 5-point scale. Intraobserver and interobserver kappa coefficients and Az values were calculated for each observer and image set. Differences between modalities were compared by using z statistics, with the significance level set at α = 0.05. RESULTS Both intraobserver and interobserver agreements were statistically higher (p < .05) for the Iluma CBCT images than for the intraoral images. Az values for CBCT images were also statistically higher (p < .05) than for film images for all observers and readings. In addition, kappa and Az values of external cervical resorption cavities were statistically higher (p < .05) than those of internal cervical resorption cavities for all observers, image types, and readings. CONCLUSIONS High-resolution Iluma CBCT images performed better than film in the ex vivo detection and localization of simulated internal and external cervical root resorption.

Accuracy of CBCT images in the assessment of buccal marginal alveolar peri-implant defects: effect of field of view

OBJECTIVES To investigate the reliability and accuracy of cone beam CT (CBCT) images obtained at different fields of view in detecting and quantifying simulated buccal marginal alveolar peri-implant defects. METHODS Simulated buccal defects were prepared in 69 implants inserted into cadaver mandibles. CBCT images at three different fields of view were acquired: 40 × 40, 60 × 60 and 100 × 100 mm. The presence or absence of defects was assessed on three sets of images using a five-point scale by three observers. Observers also measured the depth, width and volume of defects on CBCT images, which were compared with physical measurements. The kappa value was calculated to assess intra- and interobserver agreement. Six-way repeated analysis of variance was used to evaluate treatment effects on the diagnosis. Pairwise comparisons of median true-positive and true-negative rates were calculated by the χ² test. Pearsons correlation coefficient was used to determine the relationship between measurements. Significance level was set as p < 0.05. RESULTS All observers had excellent intra-observer agreement. Defect status (p < 0.001) and defect size (p < 0.001) factors were statistically significant. Pairwise interactions were found between defect status and defect size (p = 0.001). No differences between median true-positive or true-negative values were found between CBCT field of views (p > 0.05). Significant correlations were found between physical and CBCT measurements (p < 0.001). CONCLUSIONS All CBCT images performed similarly for the detection of simulated buccal marginal alveolar peri-implant defects. Depth, width and volume measurements of the defects from various CBCT images correlated highly with physical measurements.

Assessment of buccal marginal alveolar peri-implant and periodontal defects using a cone beam CT system with and without the application of metal artefact reduction mode

OBJECTIVES To investigate the accuracy of cone beam CT (CBCT) images obtained with and without artefact reduction (AR) in detecting simulated buccal peri-implant and buccal periodontal defects. METHODS 42 implants inserted into edentulous mandibles, and 38 teeth present in dry mandibles were used. Simulated buccal peri-implant defects (n = 22) and buccal periodontal defects (n = 22) were prepared. 20 implants and 18 teeth without simulated defects were the control group. Images of the mandibles were obtained using a Planmeca ProMax(®) 3D Max CBCT unit (Planmeca Oy, Helsinki, Finland). Image reconstructions were prepared without and with low, medium and high AR modes. Images were viewed randomly by six observers twice for the presence of defects. Kappa coefficient was calculated. F2_LD_F1 design for non-parametric analysis of longitudinal data was used. Area under curves (AUCs) were calculated for each observer. Significance level was taken as α = 0.05. RESULTS Intraobserver kappa ranged from 0.140 to 0.792 for peri-implant and from 0.189 to 1.0 for periodontal defects. All factors were statistically significant (p < 0.001), except for image mode and implant brand. Pairwise interactions were found between periodontal defects and peri-implant defects (p < 0.001), observers (p < 0.001), observer and image mode (p < 0.001), defect model and observer (p < 0.001) and defect model, image mode and observer (p = 0.04). AUC values ranged from 0.39 to 0.52 for peri-implant and from 0.45 to 0.71 for periodontal defects. Higher AUC values were found for periodontal defects than for peri-implant defects. CONCLUSIONS Buccal peri-implant defects were more difficult to detect than buccal periodontal defects. No difference was found among CBCT images obtained with and without AR modes.

Occlusal caries detection by using a cone-beam CT with different voxel resolutions and a digital intraoral sensor

OBJECTIVES This study assessed in vitro the diagnostic ability of intraoral digital CCD sensor images and CBCT images at different voxel resolutions in the detection of occlusal caries. STUDY DESIGN The study sample consisted of 130 mandibular molars (61 sound and 69 diseased). Digital intraoral images and CBCT images were obtained at 0.1-mm, 0.2-mm, and 0.3-mm voxel sizes. All images were evaluated separately by 4 observers, and evaluations were repeated after a 4-week interval. Weighted kappa coefficients were calculated to assess intra- and interobserver agreement for each image set, and scores were compared with the histological gold. For the estimation of nonparametric imaging modality effects and tests of hypotheses, SAS 9.0 and SAS macros were used for F1_LD_F1 factorial design. An a priori level of significance of P equals .05 was used. RESULTS High intra- and interobserver agreements were obtained (Kappa value range: 0.825 to 0.948 for intraobserver agreement and 0.700 to 0.903 for interobserver agreement). Estimated relative treatment effects (RTE) ranged from 0.26 to 0.85, which varied with caries level and imaging modality. Differences between RTE values obtained with ultra-resolution and high- and low-resolution images were not statistically significant for all caries levels. Comparing 3D and intraoral imaging modalities among caries levels showed that imaging modality performance was different for deep enamel, superficial dentine, and deep dentine; however, imaging modality performance was not statistically different for healthy and superficial enamel caries groups. CONCLUSION At all voxel sizes, CBCT images can be considered a tool for use in the diagnosis of occlusal caries.

Accuracy of chemically created periapical lesion measurements using limited cone beam computed tomography

OBJECTIVES The aim was to assess the accuracy and reproducibility of measurements of chemically created periapical lesions using limited cone beam CT. METHODS Periapical lesions were chemically created in 18 mandibular cadaver teeth. Mandibles were dissected buccolingually using a bone-cutting burr. Diameters and depths were measured directly in the cross-sectional slices using a precision digital caliper. The cross-sectional slices were then embedded in wax, and cone beam CT images were acquired using a NewTom 3G Plus scanner with both 6 inch and 9 inch fields of view (FOVs). Two oral radiologists measured the diameter and depth of periapical lesions on the cross-sectional images using the built-in measurement tools. Measurements were repeated after a 1 week interval. Inter- and intraobserver agreement was calculated by ANOVA. Regression analysis was used to test the correlation between the cone beam CT and digital caliper measurements. RESULTS No significant differences were found in diameter or depth measurements between or within observers or between 6 inch and 9 inch FOV images. Regression analysis of diameter and depth measurements made by direct caliper versus 6 inch or 9 inch FOV images revealed a high regression coefficient (for diameter: 6 inch FOV, R(2) = 94.6%; 9 inch FOV, R(2) = 94.8%; P<0.001; for depth: 6 inch FOV, R(2) = 99.3%; 9 inch FOV, R(2) = 99.3%; P<0.001) showing a strong linear relationship. For the diameter, the mean deviation from direct caliper measurements was 0.0625 mm and 0.08958 mm, respectively; for the 6 inch FOV and 9 inch FOV images, and for depth, the mean deviation was, respectively, -0.1001 mm and 0.09875 mm. CONCLUSIONS Cone beam CT yielded highly accurate and reproducible results in the quantitative assessment of periapical lesions.

The effects of digital image enhancement on the detection of vertical root fracture

AIM To determine the effects of digital image enhancement on observer ability to detect experimentally induced vertical root fractures (VRF). MATERIAL AND METHODS A total of 64 extracted human mandibular premolar teeth were used in this study. In 32 teeth, VRFs were created in the bucco-lingual planes by gently tapping with screw-type root-canal pins. The remaining 32 intact teeth served as a control group. Digital images were obtained using a charge coupled device sensor. Three observers separately examined the original and four types of digitally enhanced images (enhanced using sharpness, zoom-in, reverse-contrast, and pseudo-3D functions) at 1-week intervals. All teeth were evaluated using a 5-point scale for the presence/absence of VRF. Evaluations of each image set were repeated 1 month after the initial viewings. Kappa coefficients were calculated to investigate the degree of intra- and inter-observer agreement. The areas under the receiver operating characteristic (ROC) curves (Az values) were calculated using the MedCalc statistical software. ROC values for each image type, observer and viewing were compared using t-tests. A level of alpha = 0.05 was considered significant. RESULTS Kappa coefficients for intra-observer agreement ranged from 0.304 to 0.679. Inter-observer agreement kappa values ranged from 0.109 to 0.399 for the first reading and from 0.106 to 0.380 for the second reading. Statistical comparisons between Az values for each observer showed no significant differences (P > 0.05) among image types. CONCLUSION There were no differences in diagnostic outcomes among differently enhanced images in the in vitro detection of VRF.