Imaging furcation defects with low-dose cone beam computed tomography

Abstract

Different cone beam computed tomography (CBCT) protocols have shown promising results for imaging furcation defects. This study evaluates the suitability of low-dose (LD)-CBCT for this purpose. Fifty-nine furcation defects of nine upper and 16 lower molars in six human cadavers were measured by a high-dose (HD)-CBCT protocol, a LD-CBCT protocol, and a surgical protocol. HD-CBCT and LD-CBCT measurements were made twice by two investigators and were compared with the intrasurgical measurements, which served as the reference. Furcation defect volumes generated from HD-CBCT and LD-CBCT imaging were segmented by one rater. Cohen’s kappa and intraclass correlation coefficient (ICC) values were calculated to determine intra- and interrater reliability. The level of significance was set at α = 0.05. In total, 59 furcation defects of nine upper and 16 lower human molars were assessed. Comparing CBCT furcation defect measurements with surgical measurements revealed a Cohen’s kappa of 0.5975 (HD-and LD-CBCT), indicating moderate agreement. All furcation defects identified by HD-CBCT were also detected by LD-CBCT by both raters, resulting in a Cohen’s kappa of 1. For interrater agreement, linear furcation defect measurements showed an ICC of 0.992 for HD-CBCT and 0.987 for LD-CBCT. The intrarater agreement was 0.994(r1)/0.992(r2) for HD-CBCT and 0.987(r1)/0.991(r2) for LD-CBCT. The intermodality agreement was 0.988(r1)/0.991(r2). Paired t-test showed no significant differences between HD-CBCT and LD-CBCT measurements. LD-CBCT is a precise and reliable method for detecting and measuring furcation defects in mandibular and maxillary molars in this experimental setting. It has the potential to improve treatment planning and treatment monitoring with a far lower radiation dose than conventional HD-CBCT.

Vital root resection with radicular retrograde partial pulpotomy in furcation‐involved maxillary molars in patients with periodontitis: Technique description and case series considering clinical and economic aspects

“…Moreover, three‐dimensional imaging would be useful in such cases to exclude apical involvement as well (Walter et al., 2009). In the future, the disadvantage of radiation exposure could be reduced or circumvented by low‐dose CBCT protocols or by dental MRIs, as promising initial results of furcation assessment in both diagnostic methods suggest (Juerchott et al., 2020; Ruetters et al., 2022).…”

The “Dedicated” C.B.C.T. in Dentistry

“…There are large differences between the various C.B.C.T.s regarding the technologies and parameters for managing the dose load and image control [5]. Therefore, in addition to the protocols suggested by the manufacturer, the choice of equipment is important to allow a wide and adequate possibility of customization and optimization according to the diagnostic task [8,15,19]. There are certain parameters for managing the exposure load control and cone beam CT image quality.…”

“…is that they provide high-quality, accurate 3D images of the oral and maxillofacial region. This is particularly useful for orthodontic, implant and maxillofacial surgery planning [1,5] [see Supplementary Materials], in periodontology for the study and planning of furcation defects; in clinical and surgical endodontics; and in the evaluation of the temporomandibular joint ATM [8,9]. Lowdose and ultra-low-dose C.B.C.T.…”

“…The therapeutic advantages are not limited to a single branch of dentistry, but extended to other specialties such as surgery, prosthetics, and the planning of prosthetic and implantprosthetic treatment [5]; orthodontics as orthodontic therapy planning; oromaxillofacial combined surgery and mini screws as anchoring systems; and periodontology in complex bone and furcation defects [8]. In these disciplines, the use of 3D radiology allows for a concrete improvement in the diagnosis, planning, monitoring [20] and execution of therapy [5,14,21,22].…”