Use of the metal artefact reduction tool in the identification of fractured endodontic instruments in cone‐beam computed tomography

Abstract

Aim To evaluate the influence of the metal artefact reduction (MAR) tool in the diagnosis of fractured instruments in root canals of extracted mandibular molars, with or without root canal fillings. Methodology The root canals of 31 mandibular molars were divided into four groups: (i) the control group, without root fillings; (ii) the fracture group, without fillings and with fractured files; (iii) the fill group, with root filling; and (iv) the fill/fracture group, root filled and with fractured files. The following instruments were used as fractured endodontic instruments: stainless steel hand files, NiTi reciprocating files and NiTi rotary files. Each tooth was inserted in a dry mandible to obtain cone‐beam computed tomography (CBCT) images using a CBCT OP300 3D Maxio (Instrumentarium Dental, Tuusula, Finland) and Picasso Trio (Vatech, Hwaseong, Republic of Korea), with and without application of the MAR tool. All images were evaluated by three radiologists for the presence or absence of fractured files on a 5‐point scale. The diagnostic accuracy (area under ROC curve) was calculated. Image noise was measured in regions of trabecular and cortical bone and soft tissue. The comparison between the ROC curve values with the MAR tool enabled or disabled was performed using a t‐test. A t‐test was also employed for comparing image noise when the MAR tool was enabled and disabled. The significance level was set at 5%. Results The use of the MAR tool did not influence the diagnostic accuracy for identifying fractured endodontic instruments in root canals with and without fillings in both CBCT systems (P > 0.05), nor did it influence the image noise (P > 0.05). Conclusions The MAR tool on these two devices did not increase the detection of fractured endodontic instruments and did not reduce image noise using extracted mandibular molars. Therefore, the MAR tool is not recommended for evaluation of fractured endodontic instruments in teeth with and without root fillings in mandibular molars.

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

“…No significant differences in presence of artifacts were found in the comparison of protocols. The influence of the metal artifact reduction (MAR) tool using two scanners, in the diagnosis of fractured instruments in root canals of mandibular molars with or without canal fillings, was determined recently (34). The MAR tool did not increase the detection of fractured endodontic instruments or reduce image noise.…”

“…The MAR tool did not increase the detection of fractured endodontic instruments or reduce image noise. Therefore, the MAR tool was not recommended for evaluations of fractured endodontic instruments in mandibular molars with or without root fillings (34). Pauwels et al (35) discussed important principles of image acquisition and reconstruction.…”

La imagenología en el diagnóstico y la planificación de sistemas de conductos radiculares: una revisión actualizada

“…Los nuevos estudios demuestran que, por causa de la prevalencia de la distorsión geométrica, la radiografía convencional ofrece un valor limitado en los tratamientos de conductos complejos, lo que lleva al clínico a la obtención de imágenes proporcionadas por una resolución espacial en todos los planos, hoy en día disponible en la tomografía computarizada de haz cónico (TCHC), que proporciona imágenes en 3D que disminuyen el campo de visión (FOV) y aumentan la precisión de la imagen radiográfica ( [1][2][3][4][5][6][7][8][9][10][11] ).…”

“…La radiología oral está en constante evolución, lo que obliga al clínico a una actualización de sus conocimientos básicos en imagenología. El uso de las TCHC para el dominio y reconocimiento del sistema de conductos radiculares resulta necesario en aquellos casos de abordaje complejo como lesiones postrauma, fracturas radiculares, reabsorciones, fracturas de postes, instrumentos fracturados, calcificaciones radiculares, así como para la planificación y ejecución de cirugías paraendodónticas ( 1,5,7,(10)(11)(12)(13)(14)(15) ).…”

“…Según la Asociación Estadounidense de Endodoncistas (AAE), la Academia Estadounidense de Radiología Oral y Maxilofacial (AAOMR) y la Sociedad Europea de Endodoncia (ESE), la TCHC solo se recomienda en aquellos casos en los que la radiografía bidimensional no proporciona información suficiente y confiable ( 7,10,11,16,17 ). Su valor se reconoce a la hora de realizar los procedimientos cumpliendo estrictamente los principios de ALARA (as low as reasonably achievable) ( 4,10,12,18 ).…”