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. 2022 Sep;52(3):245-258.
doi: 10.5624/isd.20220019. Epub 2022 May 13.

CBCT-based assessment of root canal treatment using micro-CT reference images

Alessando Lamira  1 , Jardel Francisco Mazzi-Chaves  1 , Laura Ferreira Pinheiro Nicolielo  2 , Graziela Bianchi Leoni  3 , Alice Corrêa Silva-Sousa  1 , Yara Terezinha Corrêa Silva-Sousa  3 , Ruben Pauwels  2   4   5 , Nico Buls  6 , Reinhilde Jacobs  2   7 , Manoel Damião Sousa-Neto  1
Affiliations

CBCT-based assessment of root canal treatment using micro-CT reference images

Alessando Lamira et al. Imaging Sci Dent. 2022 Sep.

Abstract

Purpose: This study compared the root canal anatomy between cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT) images before and after biomechanical preparation and root canal filling.

Materials and methods: Isthmus-containing mesial roots of mandibular molars (n=14) were scanned by micro-CT and 3 CBCT devices: 3D Accuitomo 170 (ACC), NewTom 5G (N5G) and NewTom VGi evo (NEVO). Two calibrated observers evaluated the images for 2-dimensional quantitative parameters, the presence of debris or root perforation, and filling quality in the root canal and isthmus. The kappa coefficient, analysis of variance, and the Tukey test were used for statistical analyses (α=5%).

Results: Substantial intra-observer agreement (κ=0.63) was found between micro-CT and ACC, N5G, and NEVO. Debris detection was difficult using ACC (42.9%), N5G (40.0%), and NEVO (40%), with no agreement between micro-CT and ACC, N5G, and NEVO (0.05<κ<0.12). After biomechanical preparation, 2.4%-4.8% of CBCT images showed root perforation that was absent on micro-CT. The 2D parameters showed satisfactory reproducibility between micro-CT and ACC, N5G, and NEVO (intraclass correlation coefficient: 0.60-0.73). Partially filled isthmuses were observed in 2.9% of the ACC images, 8.8% of the N5G and NEVO images, and 26.5% of the micro-CT images, with no agreement between micro-CT and ACC, and poor agreement between micro-CT and N5G and NEVO. Excellent agreement was found for area, perimeter, and the major and minor diameters, while the roundness measures were satisfactory.

Conclusion: CBCT images aided in isthmus detection and classification, but did not allow their classification after biomechanical preparation and root canal filling.

Keywords: Cone-Beam Computed Tomography; Endodontics; X-Ray Microtomography.

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Conflict of interest statement

Conflicts of Interest: None

Figures

Fig. 1
Fig. 1. A. Continuous white arrows indicate the presence of debris in the isthmus area. B. Dotted white arrows show the quality of the isthmus and root canal filling. I: micro-CT, II: 3D Accuitomo 170, III: NewTom 5G, IV: NewTom VGi evo.
Fig. 2
Fig. 2. Continuous white arrows indicate the presence of the isthmus area in root canals of mandibular molars, and dotted white arrows indicate the presence of debris. I: micro-CT, II: 3D Accuitomo 170, III: NewTom 5G, IV: NewTom VGi evo.
Fig. 3
Fig. 3. Linear regression models for images obtained before biomechanical root canal preparation. A. Linear regression values between micro-CT and 3D Accuitomo 170. B. Linear regression values between micro-CT and NewTom 5G. C. Linear regression values between micro-CT and NewTom VGi evo. I: area, II: perimeter, III: roundness, IV: major diameter, V: minor diameter.
Fig. 4
Fig. 4. White arrows indicate the presence of debris in the isthmus area in root canals of mandibular molars diagnosed with better visualization on micro-CT. I: micro-CT, II: 3D Accuitomo 170, III: NewTom 5G, IV: NewTom VGi evo.
Fig. 5
Fig. 5. Linear regression models for images obtained after biomechanical root canal preparation. A. Linear regression values between micro-CT and 3D Accuitomo 170. B. Linear regression values between micro-CT and NewTom 5G. C. Linear regression values between micro-CT and NewTom VGi evo. I: area, II: perimeter, III: roundness, IV: major diameter, V: minor diameter.
Fig. 6
Fig. 6. White arrows showing the quality of the isthmus and root canal filling. It is possible to detect in micro-CT images (I) the presence of filling material in the isthmus area, the presence of gaps and voids, as well as lateral and accessory filled canals, which are not seen in the CBCT images and could hinder the endodontic diagnosis. II: 3D Accuitomo 170, III: NewTom 5G, III: NewTom VGi evo.
Fig. 7
Fig. 7. Linear regression models for images obtained after root canal filling. A. Linear regression values between micro-CT and 3D Accuitomo 170. B. Linear regression values between micro-CT and NewTom 5G. C. Linear regression values between micro-CT and NewTom VGi evo. I: area, II: perimeter, III: roundness, IV: major diameter, V: minor diameter.
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