Restor Dent Endod.  2015 Feb;40(1):58-67. 10.5395/rde.2015.40.1.58.

Detection of root perforations using conventional and digital intraoral radiography, multidetector computed tomography and cone beam computed tomography

Affiliations
  • 1Department of Oral and Maxillofacial Radiology, Hamadan University of Medical Sciences Dental School, Hamadan, Iran. Dr.a.shokri@gmail.com
  • 2Department of Oral and Maxillofacial Radiology, Kurdistan University of Medical Sciences Dental School, Sanandaj, Iran.

Abstract


OBJECTIVES
This study aimed to compare the accuracy of conventional intraoral (CI) radiography, photostimulable phosphor (PSP) radiography, cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) for detection of strip and root perforations in endodontically treated teeth.
MATERIALS AND METHODS
Mesial and distal roots of 72 recently extracted molar were endodontically prepared. Perforations were created in 0.2, 0.3, or 0.4 mm diameter around the furcation of 48 roots (strip perforation) and at the external surface of 48 roots (root perforation); 48 roots were not perforated (control group). After root obturation, intraoral radiography, CBCT and MDCT were taken. Discontinuity in the root structure was interpreted as perforation. Two observers examined the images. Data were analyzed using Stata software and Chi-square test.
RESULTS
The sensitivity and specificity of CI, PSP, CBCT and MDCT in detection of strip perforations were 81.25% and 93.75%, 85.42% and 91.67%, 97.92% and 85.42%, and 72.92% and 87.50%, respectively. For diagnosis of root perforation, the sensitivity and specificity were 87.50% and 93.75%, 89.58% and 91.67%, 97.92% and 85.42%, and 81.25% and 87.50%, respectively. For detection of strip perforation, the difference between CBCT and all other methods including CI, PSP and MDCT was significant (p < 0.05). For detection of root perforation, only the difference between CBCT and MDCT was significant, and for all the other methods no statistically significant difference was observed.
CONCLUSIONS
If it is not possible to diagnose the root perforations by periapical radiographs, CBCT is the best radiographic technique while MDCT is not recommended.

Keyword

Cone beam computed tomography; Conventional intraoral radiography; Multidetector computed tomography; Photostimulable phosphor radiography; Root perforation; Strip perforation

MeSH Terms

Cone-Beam Computed Tomography*
Diagnosis
Molar
Multidetector Computed Tomography*
Radiography*
Sensitivity and Specificity
Tooth

Figure

  • Figure 1 Perforation in danger zone creates strip perforation. A, Danger zone; B, Safety zone.

  • Figure 2 Periapical radiography taken with conventional intraoral (CI) imaging technique. (a) Standard angulation; (b) Distal angulation. Arrow shows strip perforation.

  • Figure 3 Periapical radiography taken with digital photostimulable phosphor (PSP) radiographic imaging technique. (a) Standard angulation; (b) Distal angulation. Arrow shows strip perforation.

  • Figure 4 Images taken with cone beam computed tomography (CBCT) imaging technique. (a) Root perforation (arrow); (b) Strip perforation (arrow).

  • Figure 5 Images taken with multidetector computed tomography (MDCT) imaging technique. (a) Root perforation (arrow); (b) Strip perforation (arrow).


Reference

1. Fuss Z, Trope M. Root perforations: classification and treatment choices based on prognostic factors. Endod Dent Traumatol. 1996; 12:255–264.
Article
2. Ingle JI. A standardized endodontic technique utilizing newly designed instruments and filling materials. Oral Surg Oral Med Oral Pathol. 1961; 14:83–91.
Article
3. Tsesis I, Fuss Z. Diagnosis and treatment of accidental root perforations. Endod Topics. 2006; 13:95–107.
Article
4. Alhadainy HA. Root perforations. A review of literature. Oral Surg Oral Med Oral Pathol. 1994; 78:368–374.
5. Bryant ST, Dummer PM, Pitoni C, Bourba M, Moghal S. Shaping ability of .04 and .06 taper ProFile rotary nickel-titanium instruments in stimulated root canals. Int Endod J. 1999; 32:155–164.
Article
6. Berutti E, Fedon G. Thickness of cementum/dentin in mesial roots of mandibular first molars. J Endod. 1992; 18:545–548.
Article
7. Shemesh H, Cristescu RC, Wesselink PR, Wu MK. The use of cone-beam computed tomography and digital periapical radiographs to diagnose root perforations. J Endod. 2011; 37:513–516.
Article
8. Ball RL, Barbizam JV, Cohenca N. Intraoperative endodontic applications of cone-beam computed tomography. J Endod. 2013; 39:548–557.
Article
9. Patel S, Dawood A, Mannocci F, Wilson R, Pitt Ford T. Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography. Int Endod J. 2009; 42:507–515.
Article
10. Chindasombatjaroen J, Kakimoto N, Murakami S, Maeda Y, Furukawa S. Quantitative analysis of metallic artifacts caused by dental metals: comparison of cone-beam and multi-detector row CT scanners. Oral Radiol. 2011; 27:114–120.
Article
11. Gaia BF, Sales MA, Perrella A, Fenyo-Pereira M, Cavalcanti MG. Comparison between cone-beam and multislice computed tomography for identification of simulated bone lesions. Braz Oral Res. 2011; 25:362–368.
Article
12. Eskandarloo A, Mirshekari A, Poorolajal J, Mohammadi Z, Shokri A. Comparison of cone-beam computed tomography with intraoral photostimulable phosphor imaging plate for diagnosis of endodontic complications: a simulation study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114:e54–e61.
Article
13. Fuss Z, Assooline LS, Kaufman AY. Determination of location of root perforations by electronic apex locators. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 82:324–329.
Article
14. Skidmore AE, Bjorndal AM. Root canal morphology of the human mandibular first molar. Oral Surg Oral Med Oral Pathol. 1971; 32:778–784.
Article
15. Bender IB, Seltzer S. Roentgenographic and direct observation of experimental lesions in bone: I. 1961. J Endod. 2003; 29:702–706.
Article
16. Farman AG, Farman TT. A comparison of 18 different x-ray detectors currently used in dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 99:485–489.
Article
17. Udupa H, Mah P, Dove SB, McDavid WD. Evaluation of image quality parameters of representative intraoral digital radiographic systems. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 116:774–783.
Article
18. Li G, Berkhout WE, Sanderink GC, Martins M, van der Stelt PF. Detection of in vitro proximal caries in storage phosphor plate radiographs scanned with different resolutions. Dentomaxillofac Radiol. 2008; 37:325–329.
Article
19. Nair MK, Nair UP. Digital and advanced imaging in endodontics: a review. J Endod. 2007; 33:1–6.
Article
20. Naitoh M, Nakahara K, Suenaga Y, Gotoh K, Kondo S, Ariji E. Comparison between cone-beam and multislice computed tomography depicting mandibular neurovascular canal structures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109:e25–e31.
Article
21. Cheng JG, Zhang ZL, Wang XY, Zhang ZY, Ma XC, Li G. Detection accuracy of proximal caries by phosphor plate and cone-beam computerized tomography images scanned with different resolutions. Clin Oral Investig. 2012; 16:1015–1021.
Article
22. Spin-Neto R, Gotfredsen E, Wenzel A. Impact of voxel size variation on CBCT-based diagnostic outcome in dentistry: a systematic review. J Digit Imaging. 2013; 26:813–820.
Article
23. Haiter-Neto F, Wenzel A, Gotfredsen E. Diagnostic accuracy of cone beam computed tomography scans compared with intraoral image modalities for detection of caries lesions. Dentomaxillofac Radiol. 2008; 37:18–22.
Article
24. D'Addazio PS, Campos CN, Özcan M, Teixeira HG, Passoni RM, Carvalho AC. A comparative study between cone beam computed tomography and periapical radiographs in diagnosis of simulated endodontic complications. Int Endod J. 2011; 44:218–224.
25. Hassan B, Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod. 2009; 35:719–722.
Article
26. Bueno MR, Estrela C, De Figueiredo JA, Azevedo BC. Map-reading strategy to diagnose root perforations near metallic intracanal posts by using cone beam computed tomography. J Endod. 2011; 37:85–90.
Article
27. Wilkinson T, Maryniuk G. The correlation between sagittal anatomic sections and computerized tomography of the TMJ. J Craniomandibular Pract. 1983; 1:37–45.
Article
28. Solar P, Ulm C, Lill W, Imhof H, Watzek G, Blahout R, Gruber H, Matejka M. Precision of three-dimensional CT-assisted model production in the maxillofacial area. Eur Radiol. 1992; 2:473–477.
Article
29. Casselman JW, Quirynen M, Lemahieu SF, Baert AL, Bonte J. Computed tomography in the determination of anatomical landmarks in the perspective of endosseous oral implant installation. J Head Neck Pathol. 1988; 7:255–264.
30. Youssefzadeh S, Gahleitner A, Dorffner R, Bernhart T, Kainberger FM. Dental Vertical Root Fractures: Value of CT in Detection. Radiology. 1999; 210:545–549.
Article
31. Iikubo M, Kobayashi K, Mishima A, Shimoda S, Daimaruya T, Igarashi C, Imanaka M, Yuasa M, Sakamoto M, Sasano T. Accuracy of intraoral radiography, multidetector helical CT, and limited cone-beam CT for the detection of horizontal tooth root fracture. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108:e70–e74.
Article
32. Baxter BS, Sorenson JA. Factors affecting the measurement of size and CT number in computed tomography. Invest Radiol. 1981; 16:337–341.
Article
33. Shaha AR. Preoperative evaluation of the mandible in patients with carcinoma of the floor of mouth. Head Neck. 1991; 13:398–402.
Article
34. Fava LR, Dummer PM. Periapical radiographic techniques during endodontic diagnosis and treatment. Int Endod J. 1997; 30:250–261.
Article
35. Venskutonis T, Juodzbalys G, Nackaerts O, Mickevicienė L. Influence of voxel size on the diagnostic ability of cone-beam computed tomography to evaluate simulated root perforations. Oral Radiol. 2013; 29:151–159.
Article
36. Hovland EJ, Dumsha TC. Problems in the management of tooth resorption. Problem solving in endodontics. 3rd ed.St. Louis: CV Mosby;1997. p. 253–276.
37. Carvalho-Sousa B, Almeida-Gomes F, Carvalho PR, Maníglia-Ferreira C, Gurgel-Filho ED, Albuquerque DS. Filling lateral canals: evaluation of different filling techniques. Eur J Dent. 2010; 4:251–256.
Article
38. Loubele M, Bogaerts R, Van Dijck E, Pauwels R, Vanheusden S, Suetens P, Marchal G, Sanderink G, Jacobs R. Comparison between effective radiation dose of CBCT and MDCT scanners for dentomaxillofacial applications. Eur J Radiol. 2009; 71:461–468.
Article
39. Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106:106–114.
Article
Full Text Links
  • RDE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr