Limitation of diagnostic value of cone-beam CT in detecting apical root isthmuses

Tolentino, Elen de Souza; Amoroso-Silva, Pablo Andrés; Alcalde, Murilo Priori; Honório, Heitor Marques; Iwaki, Lílian Cristina Vessoni; Rubira-Bullen, Izabel Regina Fischer; Duarte, Marco Antônio Húngaro

doi:10.1590/1678-7757-2019-0168

Cited by 16 publications

(20 citation statements)

References 25 publications

(6 reference statements)

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“…Anatomical complexities such as isthmuses are not uncommon 2 3 20 21 and may represent a challenge in endodontic therapy. As in other studies, 9 10 this study used micro-CT as a reference standard, since it enables non-destructive 3-dimensional microscopy of the internal dental anatomy. 22 Nevertheless, it is not available for clinical use, which is where CBCT may come into play.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The present methodology was based on previous in vivo 2 and ex vivo 1 9 10 investigations. For each tooth, the isthmus was located by viewing the apical 3-mm axial images of the mesial root, 9 10 using a map-reading strategy in axial reconstructions from the coronal to apical region. 1 2 , 9 , 10 All isthmuses were classified according to the criteria of Hsu and Kim 28 as type II (definite connection is present between the 2 main canals).…”

Section: Discussionmentioning

confidence: 99%

“… 7 8 Because micro-CT provides high-resolution, detailed, and accurate information on root canal morphology, it can be used as a reference standard in anatomical in vitro studies. 9 10 11 …”

Section: Introductionmentioning

confidence: 99%

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Comparison of limited- and large-volume cone-beam computed tomography using a small voxel size for detecting isthmuses in mandibular molars

et al. 2021

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Purpose This study was performed to compare the ability of limited- and large-volume cone-beam computed tomography (CBCT) to display isthmuses in the apical root canals of mandibular molars. Materials and Methods Forty human mandibular first molars with isthmuses in the apical 3 mm of mesial roots were scanned by micro-computed tomography (micro-CT), and their thickness, area, and length were recorded. The samples were examined using 2 CBCT systems, using the smallest voxels and field of view available for each device. The Mann-Whitney, Friedman, and Dunn multiple comparison tests were performed (α=0.05). Results The 3D Accuitomo 170 and i-Cat devices detected 77.5% and 75.0% of isthmuses, respectively ( P >0.05). For length measurements, there were significant differences between micro-CT and both 3D Accuitomo 170 and i-Cat ( P <0.05). Conclusion Both CBCT systems performed similarly and did not detect isthmuses in the apical third in some cases. CBCT still does not equal the performance of micro-CT in isthmus detection, but it is nonetheless a valuable tool in endodontic practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of limited- and large-volume cone-beam computed tomography using a small voxel size for detecting isthmuses in mandibular molars

et al. 2021

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“…CBCT images have shown limited sensibility (65%–75%) in detecting apical isthmuses in mesial roots of mandibular first molars (Tolentino et al . 2018, 2020); second, to avoid sectioning them after the irrigation protocols; doing so could alter the sample because of the action of the diamond disk and the smear layer produced, and consequently alter the evaluation through CLSM. Amongst the control group, the contamination levels within the root canals and the isthmuses in the three canal thirds were not significantly different, and the standard deviations were not very high, indicating that the contamination method was homogeneous.…”

Section: Discussionmentioning

confidence: 99%

A laboratory study of root canal and isthmus disinfection in extracted teeth using various activation methods with a mixture of sodium hypochlorite and etidronic acid

et al. 2020

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AimTo evaluate in a laboratory setting the antibiofilm activity of several irrigating protocols including conventional irrigation, ultrasonic activation and XP‐endo Finisher, with a mixture of sodium hypochlorite and etidronic acid in infected isthmuses and root canals of extracted human mandibular molar teeth.MethodologyFifty‐six mesial roots of mandibular molars, half of them with a continuous isthmus from the cervical to the apical third between the two root canals (type 1), and the other half with a continuous isthmus from the cervical to the middle third and one canal in the apical third (type 2), were included. The root canals were contaminated for 7 days with an Enterococcus faecalis suspension. There were three experimental groups plus a control group (n = 7 per type of root canal anatomy). All the root canals, except for the control group that was not treated, were chemomechanically prepared and then assigned to one of the experimental groups according to the final adjunctive procedure: conventional irrigation, ultrasonic activation or XP‐endo Finisher activation. The irrigating solution used was a combination of 2.5% sodium hypochlorite and 9% etidronic acid, and the final protocols were applied for three cycles of 30 s with a 3 mL volume. The antibiofilm activity was evaluated at each location (root canal and isthmus) and third (cervical, middle and apical) using confocal laser scanning microscopy and the live/dead technique. Statistical analysis was performed using SPSS (descriptive statistics) and SUDAAN (P‐value calculations).ResultsRoot canals had significantly lower biovolume values than the isthmuses (P < 0.05). The biovolume in the root canals was significantly reduced in all the experimental groups in all the thirds except for conventional irrigation in the apical third (P > 0.05). In the cervical and middle thirds, ultrasonic activation was associated with the lowest biovolumes (P < 0.05), followed by XP‐endo Finisher. In the isthmus, disinfection was similar in all the thirds for all the protocols. Conventional irrigation was associated with intermediate values with no significant differences from the control group or from the activated protocols (P > 0.05), although the latter were significantly different from the control group (P < 0.05). No differences were found between ultrasonic activation and XP‐endo Finisher in the middle and apical thirds (P > 0.05) in the isthmuses.ConclusionsIn this laboratory study on extracted teeth, the isthmus was more difficult to disinfect than root canals. In the root canals, ultrasonic activation and XP‐endo Finisher had a greater effectiveness than conventional irrigation. In the isthmuses, no differences were observed between the two activation techniques and conventional irrigation.

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Morphometric micro-CT study of contralateral mandibular incisors

Sevgi,

Johnsen,

Hussain

et al. 2023

Clin Oral Invest

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Objectives This study aimed to determine the degree of similarity and symmetry in the anatomy of contralateral mandibular incisors. Three-dimensional (3D) models of extracted teeth were obtained from microtomography (micro-CT) scans. Qualitative and quantitative assessments of the morphology and comparison of contralateral pairs were made. The null hypothesis was that contralateral mandibular incisors could not be considered identical in simple morphometric measurements. Methods Sixty pairs of mandibular incisors were extracted from 30 patients and scanned with micro-CT. Virtual models of the cemento-enamel junction to the root apex were rendered. Parameters such as length, canal width, dentinal thicknesses, tortuosity, centerline length, accessory canals, root canal configurations, and root canal orifice cross-sections were used to compare the teeth. Width and thickness comparisons between paired teeth in the same individual were made by paired t-test (Wilcoxon signed-rank test for variables not normally distributed). An online randomization tool generated randomized pairs (independent of the individual/patient). Subsequently, an unpaired t-test (or Mann–Whitney U test for non-normally distributed parameters) and a correlation analysis were conducted. Canal configurations were classified according to preexisting classification schemes. The number and location of accessory canals and apical foramina were registered and compared. Results Utilizing advanced imaging techniques and quantitative analyses, our study establishes that contralateral mandibular incisors exhibit a remarkable degree of symmetry in multiple morphological parameters, including length, canal width, and dentinal thicknesses. The apical third showed a high degree of inter-variability for the contralateral pairs. The rigorous statistical analysis of the normalized parameters by Z-score showed no statistically significant differences between the contralateral mandibular incisors. Comparisons between central and lateral teeth revealed differences in root length but no significant disparity in the distribution of accessory canals. Central teeth, on average, were longer, while accessory canals were distributed relatively evenly between central and lateral teeth. Conclusions The findings of this study further establish the significant similarities between contralateral mandibular incisors, reinforcing their suitability as a reliable substrate for root canal comparison studies. Clinical relevance The absence of statistically significant differences between contralateral pairs in normalized parameters underscores their potential as a reliable reference point for root canal comparison studies in clinical dentistry. Furthermore, our findings emphasize the importance of individualized treatment planning, considering the natural symmetry in mandibular incisors to enhance clinical decision-making. This research contributes valuable insights to the field of endodontics, offering a standardized approach to sample selection and enriching the understanding of dental anatomy.

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Limitation of diagnostic value of cone-beam CT in detecting apical root isthmuses

Cited by 16 publications

References 25 publications

Comparison of limited- and large-volume cone-beam computed tomography using a small voxel size for detecting isthmuses in mandibular molars

Comparison of limited- and large-volume cone-beam computed tomography using a small voxel size for detecting isthmuses in mandibular molars

A laboratory study of root canal and isthmus disinfection in extracted teeth using various activation methods with a mixture of sodium hypochlorite and etidronic acid

Morphometric micro-CT study of contralateral mandibular incisors

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