Ability to detect endodontic complications using three different cone beam computed tomography units with and without artefact reduction modes: an ex vivo study

Abstract

Aim To assess observer performance in detecting endodontic complications using three different cone beam computed tomography (CBCT) units with and without the application of artefact reduction modes. Methodology The study involved 40 freshly extracted human mandibular teeth (n = 10 per group) and divided randomly into four endodontic complication groups. Group 1) Instrument fracture; Group 2) Strip perforation; Group 3) Canal underfilling; and Group 4) Canal overfilling. Images of each tooth were obtained using three different CBCT units offering artefact reduction algorithms: the ProMax 3D Max, the Pax Flex 3D and the Dentri S. Four observers evaluated the images for the presence/absence of the four simulated endodontic complications. Weighted kappa coefficients and intra‐class correlation coefficients (ICCs) were calculated to reveal the intra‐ and inter‐observer agreement for each imaging mode, respectively. Receiver operating characteristic (ROC) analysis was used to evaluate the observers’ performance. DeLong tests were used to compare the results for each image mode and observer using a significance level of α = 0.05. Results In each of the four simulated endodontic complication groups, no significant differences were observed with and without application of artefact reduction for any of the three CBCT units tested. Only two significant differences were detected, and both were between the ProMax 3D Max at low mode AR and ProMax 3D Max without AR: observer 2 in group 1 (P = 0.0001) and observer 4 in group 4 (P = 0.0256). Conclusion For each of the three CBCT units tested, application of artefact reduction for detecting endodontic complications is not recommended as a routine tool.

Potential of a New Cone-Beam CT Software for Blooming Artifact Reduction

“…Several alternatives for metal artifact correction during CBCT image acquisition, reconstruction or other procedures have been tested (14)(15)(16)21,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). A metal artifact reduction (MAR) algorithm has been evaluated (28) using CBCT scans of dental materials, such as dental amalgam and copper-aluminum alloy.…”

Influence of metal artefact reduction tool on the detection of vertical root fractures involving teeth with intracanal materials in cone beam computed tomography images: A systematic review and meta‐analysis

“…Radiographic examination is an important part of the diagnosis and planning of endodontic treatment (Koç et al, 2019; Venskutonis et al, 2014). Periapical radiography is the technique of choice in endodontics; nevertheless, due to the superior diagnostic accuracy of cone‐beam computed tomography (CBCT), this imaging modality has been increasingly used in endodontic practice (Bechara et al, 2013a; Tofangchiha et al, 2017), which should be used when more information is needed than those provided by two‐dimensional radiography (AAE & AAOMR Joint Position Statement, 2015; ESE, 2019).…”

“…Periapical radiography is the technique of choice in endodontics; nevertheless, due to the superior diagnostic accuracy of cone‐beam computed tomography (CBCT), this imaging modality has been increasingly used in endodontic practice (Bechara et al, 2013a; Tofangchiha et al, 2017), which should be used when more information is needed than those provided by two‐dimensional radiography (AAE & AAOMR Joint Position Statement, 2015; ESE, 2019). Therefore, in Endodontics, CBCT examination is only indicated and justified when the diagnosis by clinical examination and periapical radiographs are not sufficient (AAE & AAOMR Joint Position Statement, 2015; ESE, 2019), mainly due to radiation dose and high costs (Costa et al, 2020; Koç et al, 2019).…”

“…Artefacts are structures visualized in the reconstructed image, but which are not present in the real object (Costa et al, 2020; Freitas et al, 2018; Schulze et al, 2011). In the image, they appear as dark streaks and dark zones around high‐density materials (Koç et al, 2019; Schulze et al, 2011). In cases where the high‐density material totally absorbs the X‐ray beam, extinction artefacts occur, seen in the image as dark bands located behind the object (Schulze et al, 2011).…”

“…However, the results of those studies are controversial. Although some studies have found a positive influence of the use of MAR in image quality when assessed objectively (Helvacioglu‐Yigit et al, 2016; Queiroz et al, 2018), other studies have reported there is no influence of the MAR in the detection of several endodontic conditions (Costa et al, 2020; Kajan et al, 2018; Koç et al, 2019; Tofangchiha et al, 2017). Furthermore, several studies have also reported that MAR decreases the CBCT image quality in terms of the diagnosis of VRF (Bechara et al, 2013a; Bezerra et al, 2015; de Oliveira, 2019), indicating that the use of the tool cannot be justified.…”