Shanon Patel

New dimensions in endodontic imaging: part 2. Cone beam computed tomography

Cone beam computed tomography (CBCT) has been specifically designed to produce undistorted three-dimensional information of the maxillofacial skeleton, including the teeth and their surrounding tissues with a significantly lower effective radiation dose compared with conventional computed tomography (CT). Periapical disease may be detected sooner using CBCT compared with periapical views and the true size, extent, nature and position of periapical and resorptive lesions can be assessed. Root fractures, root canal anatomy and the nature of the alveolar bone topography around teeth may be assessed. The aim of this paper is to review current literature on the applications and limitations of CBCT in the management of endodontic problems.

New dimensions in endodontic imaging: part 1. Conventional and alternative radiographic systems

Conventional radiographs used for the management of endodontic problems yield limited information because of the two-dimensional nature of images produced, geometric distortion and anatomical noise. These factors often act in combination. This review paper assesses the limitations of periapical radiographs and seeks to clarify three-dimensional imaging techniques that have been suggested as adjuncts to conventional radiographs. These include tuned aperture computed tomography, magnetic resonance imaging, ultrasound, computed tomography and cone beam computed tomography (CBCT). Of these techniques, CBCT appears to be an effective and safe way to overcome some of the problems associated with conventional radiographs.

Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography

AIM To compare the diagnostic accuracy of intraoral digital periapical radiography with that of cone beam computed tomography (CBCT) for the detection of artificial periapical bone defects in dry human jaws. METHODOLOGY Small and large artificial periapical lesions were prepared in the periapical region of the distal root of six molar teeth in human mandibles. Scans and radiographs were taken with a charged couple device (CCD) digital radiography system and a CBCT scanner before and after each periapical lesion had been created. Sensitivity, specificity, positive predictive values, negative predictive values and Receiver Operator Characteristic (ROC) curves as well as the reproducibility of each technique were determined. RESULTS The overall sensitivity was 0.248 and 1.0 for intraoral radiography and CBCT respectively, i.e. these techniques correctly identified periapical lesions in 24.8% and 100% of cases, respectively. Both imaging techniques had specificity values of 1.0. The ROC Az values were 0.791 and 1.000 for intraoral radiography and CBCT, respectively. CONCLUSIONS With intraoral radiography, external factors (i.e. anatomical noise and poor irradiation geometry), which are not in the clinicians control, hinder the detection of periapical lesions. CBCT removes these external factors. In addition, it allows the clinician to select the most relevant views of the area of interest resulting in improved detection of the presence and absence of artificial periapical lesions.

External Cervical Resorption: A Review

External cervical resorption (ECR) is the loss of dental hard tissue as a result of odontoclastic action; it usually begins on the cervical region of the root surface of the teeth. The etiology, predisposing factors, diagnosis, and management of ECR are reviewed. Effective management and appropriate treatment can only be carried out if the true nature and exact location of the ECR lesion are known. The role of cone beam computed tomography as a diagnostic adjunct for the management of ECR is also reviewed.

Diagnostic accuracy of small volume cone beam computed tomography and intraoral periapical radiography for the detection of simulated external inflammatory root resorption

AIM To compare in an ex vivo model the ability of digital intraoral radiography and cone beam computed tomography (CBCT) to detect simulated external inflammatory root resorption lesions, and to investigate the effect of altering the degree of rotation of the CBCT scanners X-ray source and imaging detector on the ability to detect the same lesions. METHODOLOGY Small and large simulated external inflammatory resorption (EIR) lesions were created on the roots of 10 mandibular incisor teeth from three human mandibles. Small volume CBCT scans with 180° and 360° of X-ray source rotation and periapical radiographs, using a digital photostimulable phosphor plate system, were taken prior to and after the creation of the EIR lesions. The teeth were relocated in their original sockets during imaging. Receiver operator characteristic (ROC) analysis and kappa tests of the reproducibility of the imaging techniques were carried out and sensitivity, specificity, positive and negative predictive values (PPV and NPV) were also determined for each technique. RESULTS The overall area under the ROC curve (Az value) for intraoral radiography was 0.665, compared to Az values of 0.984 and 0.990 for 180° and 360° CBCT, respectively (P<0.001). The sensitivity and specificity of 180° and 360° CBCT were significantly better than intraoral radiography (P<0.001). CBCT, regardless of the degree of rotation, had superior NPVs (P<0.01) and PPVs (P<0.001) to periapical radiography. The intra- and inter-examiner agreement was significantly better for CBCT than it was for intraoral radiography (P<0.001). The ability of small volume CBCT to detect simulated EIR was the same regardless of whether 180° or 360° scans were taken. Examiners were significantly better able to identify the exact location of the artificial resorption lesions with CBCT than they were with periapical radiographs (P<0.001). CONCLUSION CBCT is a reliable and valid method of detecting simulated EIR and performs significantly better than intraoral periapical radiography. Small volume CBCT operating with 360° of rotation of the X-ray source and detector is no better at detecting small, artificially created EIR cavities than the same device operating with 180° of rotation.

Internal Root Resorption: A Review

INTRODUCTION Internal root resorption is the progressive destruction of intraradicular dentin and dentinal tubules along the middle and apical thirds of the canal walls as a result of clastic activities. METHODS The prevalence, etiology, pathogenesis, histologic manifestations, differential diagnosis with cone beam computed tomography, and treatment perspectives involved in internal root resorption are reviewed. RESULTS The majority of the documentation that exists in the literature is in the form of case reports, and there are only a limited number of studies that attempted to examine the histologic manifestations and biologic aspects of the disease. This might be due, in part, to the relatively rare occurrence of this type of resorption and the lack of an in vivo model, apart from the previous attempt on the use of diathermy, to predictably reproduce the condition for study. From a histologic perspective, internal root resorption is manifested in one form that is purely destructive, internal (root canal) inflammatory resorption, and another that is accompanied by repair, internal (root canal) replacement resorption that is featured by the deposition of metaplastic bone/cementum-like tissues adjacent to the sites of resorption. CONCLUSIONS From a differential diagnosis perspective, the advent of cone beam computed tomography has considerably enhanced the clinicians capability of diagnosing internal root resorption. Nevertheless, root canal treatment remains the treatment of choice for this pathologic condition to date.

European Society of Endodontology position statement: The use of CBCT in Endodontics

This Position Statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the use of Cone Beam Computed Tomography (CBCT). The statement is based on the current scientific evidence, and provides the clinician with evidence-based criteria on when to use CBCT in Endodontics. Given the dynamic and changing nature of research, development of new devices and clinical practice relating to CBCT, this Position Statement will be updated within 3 years, or before that time should new evidence become available.

Cone beam computed tomography in Endodontics - a review

Cone beam computed tomography (CBCT) produces undistorted three-dimensional information of the maxillofacial skeleton, including the teeth and their surrounding tissues with a lower effective radiation dose than computed tomography. The aim of this paper is to: (i) review the current literature on the applications and limitations of CBCT; (ii) make recommendations for the use of CBCT in Endodontics; (iii) highlight areas of further research of CBCT in Endodontics.

Cone beam CT in dental practice

Cone Beam Computed Tomography is a relatively new three-dimensional imaging technology, which has been specifically developed for imaging of the teeth and jaws. The aim of this paper is to acquaint the dental team with various forms of this technology and its potential applications. An understanding of the underlying principles will allow the users of this technology to tailor the imaging protocol to the patients individual needs to achieve appropriate imaging at the lowest radiation dose.

Evaluating the Periapical Status of Teeth with Irreversible Pulpitis by Using Cone-beam Computed Tomography Scanning and Periapical Radiographs

INTRODUCTION The purpose of this study was to compare the prevalence of apical periodontitis (AP) on individual roots of teeth with irreversible pulpitis viewed with periapical (PA) radiographs and cone-beam computed tomography (CBCT) scans. METHODS PA radiographs and CBCT scans were taken of 138 teeth in 130 patients diagnosed with irreversible pulpitis (symptomatic and asymptomatic). Two calibrated examiners assessed the presence or absence of AP lesions by analyzing the PA and CBCT images. A consensus was reached in the event of any disagreement. The data were analyzed using the hypothesis test, and significance was set at P ≤ .05. RESULTS Three hundred seven paired roots were assessed with both PA and CBCT images. A comparison of the 307 paired roots revealed that AP lesions were present in 10 (3.3%) and absent in 297 (96.7%) pairs of roots when assessed with PA radiography. When the same 307 sets of roots were assessed with CBCT scans, AP lesions were present in 42 (13.7%) and absent in 265 (86.3%) paired roots. The prevalence of AP lesions detected with CBCT was significantly higher in the symptomatic group compared with the asymptomatic group (P < .05). An additional 22 roots were identified with CBCT alone. CONCLUSIONS The present study highlights the advantages of using CBCT for detecting AP lesions, especially in teeth with symptomatic irreversible pulpitis.