Evaluation of a metal artifact reduction algorithm and an adaptive image noise optimization filter in the estimation of peri-implant fenestration defects using cone beam computed tomography: an in-vitro study

Objective

The aim of this study is to assess the effects of metal artifact reduction (MAR) and adaptive image noise enhancer (AINO) in CBCT imaging on the detection accuracy of artificially created fenestration defects in proximity to titanium and zirconium implants in sheep jaw.

Methods

Six zirconium and 10 titanium implants were planted on mandibular jaws of three sheep, and artificial defects were created. All images were obtained with a standard voxel size (0.150 mm³) and with 4 scan modes: (1) without MAR/without AINO; (2) with MAR/without AINO; (3) without MAR/with AINO; and (4) with MAR/with AINO during CBCT scanning. A total of 60 CBCT scans were produced.

Results

For all types of implants, intra- and inter-observer kappa values were the highest for MAR filter. The scan mode of with MAR filter was found to have the highest area under the curve (AUC), whereas the scan mode of without both MAR and AINO filters was found to have the lowest AUC values with statistical significance (p?≤?0.05). Titanium implants were found to have higher AUC values than zirconium (p?≤?0.05).

Conclusion

Both MAR module and AINO filters enhance the accuracy of the detection of peri-implant fenestrations; however, the use of MAR filter solely can be recommended for detection of peri-implant fenestrations.

     

In Vivo Detection of Subtle Vertical Root Fracture in Endodontically Treated Teeth by Cone-beam Computed Tomography

IntroductionThe purpose of this study was to evaluate the diagnostic accuracy of cone-beam computed tomographic (CBCT) imaging in the detection of subtle vertical root fractures (VRFs) in endodontically treated teeth in vivo and to discuss direct and indirect evidence for the diagnosis of subtle VRFs.MethodsTwenty-nine endodontically treated teeth with suspected VRFs from 29 patients were examined using CBCT imaging. CBCT images were scored based on evaluation of the fracture line and vertical buccopalatal (lingual) bone loss. VRF was diagnosed only when a definite fracture line was detected on CBCT images, and findings of periodontal exploration or surgical extraction were considered the gold standard. The diagnostic sensitivity, specificity, and accuracy were assessed.ResultsOf the 29 teeth, 27 were positive and 2 were negative for VRF according to the gold standard. Sensitivity, specificity, and accuracy were 33.3%, 100%, and 37.9%, respectively, based on the direct finding of a fracture line on CBCT images. However, vertical buccopalatal (lingual) bone loss was found in 25 of 27 teeth with VRFs.ConclusionsAlthough the accuracy of CBCT imaging for the diagnosis of subtle VRFs in endodontically treated teeth in vivo was poor, vertical buccopalatal (lingual) bone loss is an important indirect sign for the diagnosis of VRFs, which can be found on CBCT images.     

Combined Use of 2 Cone-beam Computed Tomography Scans in the Assessment of Vertical Root Fracture in Teeth with Intracanal Material

IntroductionThe purpose of this preliminary study was to evaluate the diagnostic accuracy of the combined use of 2 cone-beam computed tomographic (CBCT) volumes obtained with the tooth of interest positioned at different orientations in the detection of vertical root fracture (VRF).MethodsThirty single-rooted teeth were divided into 2 main groups (n = 15): control and with VRF. The teeth were individually placed in a phantom composed of a human skull and mandible, which was CBCT scanned in 2 spatial orientations: conventional (with the Frankfurt plane parallel to the floor) and angled acquisition (tilted 90° backward). Also, each tooth was scanned with gutta-percha, a metal post, and without any intracanal material. Three oral radiologists individually evaluated the images resulting from conventional acquisition and verified the presence or absence of VRF (conventional CBCT assessment), setting a score on a 5-point scale. Subsequently, the observers evaluated both images resulting from the conventional and angled acquisitions (combined CBCT assessment). The diagnostic values of the conventional and combined assessments were compared using 2-way analysis of variance with the post hoc Tukey test. The significance level was set at 5% (α = 0.05).ResultsThe combined CBCT assessment showed higher accuracy and sensitivity in the VRF diagnosis of teeth filled with gutta-percha (P < .05). In teeth with a metal post, all diagnostic values were higher in the combined CBCT assessment (P < .05).ConclusionsThis preliminary study suggests that the CBCT-based diagnosis of VRF in teeth with intracanal material was improved when the assessment combines images obtained at 2 orientations.     

Sensitivity and Specificity of MRI versus CBCT to Detect Vertical Root Fractures Using MicroCT as a Reference Standard

IntroductionVertical root fracture (VRF) in root-canal–treated teeth frequently results in tooth loss, partly because VRFs are difficult to diagnose and when detected the fracture is often beyond the point of preservation with surgical intervention. Nonionizing magnetic resonance imaging (MRI) has demonstrated the ability to detect small VRFs, but it is unknown how its diagnostic capabilities compare with the current imaging standard for VRF detection, cone-beam computed tomography (CBCT). This investigation aimed to compare the sensitivity and specificity between MRI and CBCT for detecting VRF, using micro-computed tomography (microCT) as a reference.MethodsA total of 120 extracted human tooth roots were root canal treated using common techniques, and VRFs were mechanically induced in a proportion. Samples were imaged using MRI, CBCT, and microCT. Axial MRI and CBCT images were examined by 3 board-certified endodontists, who evaluated VRF status (yes/no) and gave a confidence assessment for that decision, from which a receiver operating characteristic curve was generated. Intra- and inter-rater reliability were calculated, sensitivity and specificity, and area under the curve.ResultsIntra-rater reliability was 0.29–0.48 for MRI and 0.30–0.44 for CBCT. Inter-rater reliability for MRI was 0.37 and for CBCT 0.49. Sensitivity was 0.66 (95% confidence interval [CI], 0.53–0.78) and 0.58 (95% CI, 0.45–0.70), and specificity 0.72 (95% CI, 0.58–0.83) and 0.87 (95% CI, 0.75–0.95) for MRI and CBCT, respectively. Area under the curve was 0.74 (95% CI, 0.65–0.83) for MRI and 0.75 (95% CI, 0.66–0.84) for CBCT.ConclusionsThere was no significant difference in sensitivity or specificity between MRI and CBCT in detecting VRF, despite the early-stage development of MRI.     

Influence of Metal Post in Adjacent Teeth in the Detection of Vertical Root Fracture Using Cone-beam Computed Tomography with Different Acquisition Parameters

IntroductionThe aim of the present study was to evaluate the detection of vertical root fracture (VRF) in the presence of adjacent teeth restored with a metal post and the influence of acquisition parameters (tube current and metal artifact reduction [MAR] algorithm) on this diagnostic task.MethodsCone-beam computed tomographic images of 10 single-rooted teeth were acquired before and after the simulation of VRF. The acquisitions were set up to simulate different conditions regarding the presence of adjacent teeth restored with a metal post (control, 1 adjacent tooth, and both adjacent teeth), different tube currents (4, 8, and 10 mA), and the use of MAR (without MAR and with MAR). Images were assessed by 5 oral and maxillofacial radiologists using a 5-point scale for the presence of VRF. Diagnostic values were calculated and compared by 2-way analysis of variance (significance level of 5%).ResultsThe area under the receiver operating characteristic curve (Az) values for VRF detection were affected by the presence of adjacent teeth and the variation of milliamperes. For 4 mA, when both restored teeth were present, Az values were significantly lower than the control group (P ≤ .05). In the presence of both restored teeth, 8 mA presented significantly higher Az values compared with 4 mA (P ≤ .05).ConclusionsThe presence of both adjacent teeth restored with a metal post impairs VRF detection; however, an increase in tube current up to 8 mA may aid in this diagnostic task. Moreover, the MAR tool does not seem to be efficient in those cases.     

牙周内窥镜与锥形束CT用于牙根纵裂诊断的比较研究

目的    比较牙周内窥镜与锥形束CT（CBCT）用于牙根纵裂（VRF）诊断中的临床价值。方法    选择邯郸市口腔医院牙周病科于2019年5月至2021年11月收治的疑似存在VRF的患者97例（患牙101颗）,均行牙周内窥镜、CBCT检查,再行外科手术治疗最终确诊。对上述2种影像学检查方法的诊断结果进行比较,评估其诊断效能。结果    97例患者101颗患牙中,行外科手术治疗最终诊断为VRF的患牙共计85颗,其中72颗为颊舌向VRF（占84.71%）,13颗为近远中向VRF（占15.29%）。牙周内窥镜与CBCT对VRF的诊断结果与金标准的一致性均较高（κ值分别为0.703和0.691,均P < 0.05）。牙周内窥镜对VRF的诊断灵敏度、特异度、准确度分别为91.76%、87.50%、91.09%,CBCT对VRF的诊断灵敏度、特异度、准确度分别为89.41%、93.75%、90.10%;牙周内窥镜对VRF的诊断效能与CBCT接近。结论    牙周内窥镜用于VRF的诊断效能较高,与CBCT检查基本一致,适用于VRF诊断。     

根管治疗后隐匿性牙根纵裂裂纹宽度对CBCT检出率的影响

目的:探讨裂纹宽度对使用锥形束CT(cone beam CT,CBCT)检测根管治疗后隐匿性牙根纵裂(vertical root fracture,VRF)的影响。方法:收集2016年3月~2019年3月期间26例根管治疗后怀疑隐匿性牙根纵裂患牙,所有患牙均行CBCT扫描并进行术前CBCT评价裂纹有无,所有患牙均因折裂或明显骨吸收拔除,拔除后的离体牙在显微镜下确认裂纹有无,并将拔除后的VRF患牙立即进行micro-CT扫描,使用ImageJ对micro-CT图像检测出的裂纹进行宽度测量。将VRF患牙中CBCT裂纹阳性组和阴性组的裂纹宽度使用t检验比较裂纹宽度的差异。结果:26个患牙拔除后确认24个为VRF患牙,24个患牙共有49条裂纹,CBCT术前诊断VRF患牙11颗,CBCT评价VRF牙的灵敏度为45.83%,特异度为100%,准确率为50%,micro-CT扫描VRF牙检出的准确率为100%,裂纹检出的准确率为95.92%。对micro-CT图像上检测出的裂纹使用ImageJ测量CBCT阴性组的裂纹宽度在15~99μm之间,阳性组的裂纹宽度在62~288μm之间,阳性组和阴性组之间的裂纹宽度具有显著性差异(P<0.05)。结论:根管治疗后隐匿性牙根纵裂牙在体CBCT检测的准确率相对较低,裂纹宽度是影响CBCT检测的重要因素之一。     

CBCT Patterns of Bone Loss and Clinical Predictors for the Diagnosis of Cracked Teeth and Teeth with Vertical Root Fracture

IntroductionThis study aimed to identify clinical and radiographic characteristics of teeth with longitudinal fractures to assist in the diagnosis and differentiation between cracked teeth and teeth with vertical root fracture (VRF).MethodsNinety-five patients (95 teeth) diagnosed with a longitudinal fracture (only cracked teeth or VRF) through clinical visualization of the fracture line were included in this study. Clinical and radiographic data were collected from the patients' records to identify the characteristics associated with each condition. Fifty-four patients (54 teeth) had full radiographic (periapical [PA] radiography and a cone-beam computed tomographic [CBCT] scan) and clinical findings (probing depths and clinical images of the fracture line). PA and CBCT images were evaluated by 2 independent examiners to identify the different patterns of bone loss associated with these teeth (no defect, an angular defect, a J-shaped defect, or a combined defect). Cohen kappa analysis was used to compare the results between the 2 examiners and between the findings of the PA and CBCT images. Pearson chi-square analysis, the Fisher exact test, and adjusted Bonferroni post hoc testing were used to establish an association between the type and extension of the longitudinal fracture with the probing depth, the CBCT pattern of bony defects, and the presence/absence of the buccal plate and also to compare the clinical and radiographic characteristics of cracked teeth and teeth with VRF (P < .05).ResultsCBCT images had 4.4 times the odds of detecting bony defects suggestive of longitudinal fractures compared with PA radiographs. Teeth with VRF were more associated with indirect restorations, deep probing (>6 mm), absence of the cortical plate, and a J-shaped defect on the CBCT image (P < .05). On the other hand, cracked teeth were associated with direct restorations, shallow probing (<6 mm), an intact cortical plate, and the presence of an angular defect on the CBCT image (P < .001). There was a significant correlation between a radicular extension of the fracture line and deep probing as well as J-shaped defects (P < .05).ConclusionsPatterns of bone loss on CBCT imaging can likely differentiate between cracked teeth and teeth with VRF. The presence of an angular defect may suggest the presence of a crack in the tooth before intervention. J-shaped defects, deep probing (>6 mm), and loss of the cortical plate are likely suggestive of VRF.     

Diagnosis of Mesiodistal Vertical Root Fractures in Teeth with Metal Posts: Influence of Applying Filters in Cone-beam Computed Tomography Images at Different Resolutions

Introduction

The aim of this article was to evaluate the influence of applying filters in cone-beam computed tomography (CBCT) images at different resolutions. These CBCT images were obtained for diagnosing mesiodistal vertical root fractures (VRFs) in teeth with metal posts.

Investigation of the effectiveness of CBCT and gray scale values in the differential diagnosis of apical cysts and granulomas

Purpose

The aim of this study was to investigate the effectiveness of cone-beam CT (CBCT) findings and gray scale values (GSV) in the differential diagnosis of apical cysts and granulomas.

Methods

Two independent researchers retrospectively analyzed the CBCT images of 21 teeth and histopathologically diagnosed them as having radicular cysts or apical granulomas. In the CBCT images, apical lesions were evaluated and categorized according to 7 criteria. These criteria were determined as relationship of lesions with dental roots, periphery of the lesion, shape, darker focus in the center, root resorption, displacement in related teeth, and cortical bone perforation. In addition, the minimum and maximum gray scale values of the lesions were measured and compared.

Results

There was a statistically significant relationship between histopathological (HP) diagnosis and well-defined cortical border and lesion shape (p?=?0.003, p?=?0.014, respectively). According to the HP diagnosis, no statistically significant difference was found among other variables (p?>?0.05)

Conclusion

The presence of a well-defined cortical border or partial cortical border is a distinctive criterion for cysts. Additionally, the shape of the lesion was found to be a significant criterion for the separation of the two lesions. The shape of cystic lesions was circular and apical granulomas had a more curved shape. There was no relationship between the histopathological diagnosis of lesions and CBCT gray scale values.

     

Comparative evaluation of cone beam CT and micro-CT on blooming artifacts in human teeth filled with bioceramic sealers

Aim

To assess blooming artifacts caused by root canal sealers in CBCT images compared with those that appeared in micro-CT scan images used as references.

Materials and method

Thirty freshly extracted human mandibular central incisors were used. Root canals were prepared with nickel titanium files with an ISO size 40/0.06 taper and filled with a single cone (40/0.06 taper) and three different sealers. The samples were divided into the following three groups with 10 roots each: (I) AH Plus sealer; (II) Sure Seal Root; and (III) Total BC sealer. Teeth were scanned with the same voxel sizes (0.2 mm) in different CBCT devices and the micro-CT images were acquired as reference images.

Results

Significantly different results in terms of blooming artifacts were detected between CBCT and micro-CT images, as well as among the CBCTs images. The canals filled with AH Plus sealer showed more blooming artifacts than those filled with bioceramic sealers (p < 0.05). Additionally, the worst blooming artifact was observed when the images were acquired with lower kilovoltage peak.

Conclusion

The appearance of blooming artifacts is dependent on sealer and CBCT, and their effects are significantly worse than they are in micro-CT images. The differential effect of different sealers and distinct CBCT protocols should be further investigated to enable the use of bioceramic sealers without a significant impact on post-treatment imaging.

Clinical relevance

Root canal sealers showed a different extent of blooming artifact in CBCT images. Hence, researchers and clinicians should be aware of these artifacts before conducting endodontic evaluations using CBCT images.

     

Evaluation of an artificial intelligence system for detecting vertical root fracture on panoramic radiography

Objectives

The aim of this study was to evaluate the use of a convolutional neural network (CNN) system for detecting vertical root fracture (VRF) on panoramic radiography.

Methods

Three hundred panoramic images containing a total of 330 VRF teeth with clearly visible fracture lines were selected from our hospital imaging database. Confirmation of VRF lines was performed by two radiologists and one endodontist. Eighty percent (240 images) of the 300 images were assigned to a training set and 20% (60 images) to a test set. A CNN-based deep learning model for the detection of VRFs was built using DetectNet with DIGITS version 5.0. To defend test data selection bias and increase reliability, fivefold cross-validation was performed. Diagnostic performance was evaluated using recall, precision, and F measure.

Results

Of the 330 VRFs, 267 were detected. Twenty teeth without fractures were falsely detected. Recall was 0.75, precision 0.93, and F measure 0.83.

Conclusions

The CNN learning model has shown promise as a tool to detect VRFs on panoramic images and to function as a CAD tool.

     

锥形束CT对牙根纵裂的诊断价值

目的评价锥形束CT(CBCT)对牙根纵裂(VRF)的临床诊断价值。方法对61例患者的67颗临床检查怀疑为VRF的患牙拍摄根尖X线片和CBCT,然后对所有患牙进行根尖切除、牙周翻瓣或拔除等外科手术,以确诊VRF是否存在。将根尖X线片和CBCT影像对VRF的诊断结果与外科手术结果进行比较和统计分析。结果外科手术证实62颗患牙VRF明确存在。CBCT诊断VRF的阳性检出率、灵敏度和准确度分别为83.6%、90.3%和91.0%,而根尖X线片为31.3%、33.9%和38.8%(P<0.01)。CBCT诊断颊舌向和近远中向VRF的灵敏度分别为93.2%和62.5%,高于根尖X线牙片的69.6%和12.8%(P<0.05)。结论 CBCT比根尖X线片更准确地诊断VRF。     

Accuracy and Reliability of Root Crack and Fracture Detection in Teeth Using Magnetic Resonance Imaging

IntroductionMagnetic resonance imaging (MRI) has the potential to aid in determining the presence and extent of cracks/fractures in teeth because of better contrast without ionizing radiation. The objectives were to develop MRI criteria for root crack/fracture identification and to establish reliability and accuracy in their detection.MethodsMRI-based criteria for crack/fracture appearance was developed by an MRI physicist and a panel of 6 dentists. Twenty-nine human adult teeth previously extracted after a clinical diagnosis of a root crack/fracture were frequency matched to 29 controls. Samples were scanned using an in vivo MRI protocol and the reference standard (ie, ex vivo limited field of view cone-beam computed tomographic [CBCT] imaging). A blinded, 4-member panel evaluated the images with a proportion randomly retested to establish intrarater reliability. Overall observer agreement, sensitivity, and specificity were computed for each imaging modality.ResultsSubjectively, MRI has increased crack/fracture contrast and is less prone to artifacts from radiodense materials relative to CBCT imaging. Intrarater reliability for MRI was fair to excellent (κ = 0.38–1.00), and for CBCT imaging, it was moderate to excellent (κ = 0.66–1.00). Sensitivity for MRI was 0.59 (95% confidence interval [CI], 0.39-0.76; P = .46), and for CBCT imaging, it was 0.59 (95% CI, 0.59–0.76; P = .46). Specificity for MRI was 0.83 (95% CI, 0.64–0.94; P < .01), and for CBCT imaging, it was 0.90 (95% CI, 0.73–0.98; P < .01).ConclusionsDespite advantages of increased contrast and the absence of artifacts from radiodense materials in MRI, comparable measures of sensitivity and specificity (to limited field of view CBCT imaging) suggest MRI quality improvements are needed, specifically in image acquisition and postprocessing parameters. Given the early stage of technology development, there may be a use for MRI in detecting cracks/fractures in teeth.     

Optimization of Tube Current in Cone-beam Computed Tomography for the Detection of Vertical Root Fractures with Different Intracanal Materials

Introduction

There is no consensus about the accuracy of cone-beam computed tomography (CBCT) for detecting vertical root fractures (VRFs), nor is there certainty about the isolated effect of different tube current parameters on the diagnosis of VRF through CBCT scans. This study aimed to evaluate how tube current affects the detection of VRF on CBCT examinations in the absence of intracanal materials and in the presence of gutta-percha (GP) and metal (MP) or fiberglass (FP) intracanal posts.

Diagnostic issues dealing with the management of teeth with vertical root fractures: a narrative review

AimThe objectives of this study were to review the existing literature of vertical root fractures (VRFs) dealing with its management and to describe a classification for the bone defects resulting after extraction.MethodologyAn electronic search was performed on biomedical databases using a combination of appropriated search terms combined through the use of Boolean operators. A classification of the bone defects associated with vertical root fracture (VRF) was also proposed.ResultsOutcomes data extracted from the selected articles were summarized. Conventional radiography could fail in directly detecting the presence of VRF but can allow finding bone resorption areas which are related to the fracture itself. Tridimensional radiography (CBCT) may allow a better visualization of such bone defects. The bone defects associated to VRF could be classified on the basis of the number of walls affected and of the depth (in apico-coronal direction).ConclusionsThe diagnosis of VRF is a challenging process that includes both clinical and radiographic examination. In most cases, when postextraction implant was placed, guided bone regeneration is required to compensate the bone defect caused by VRF. A deep knowledge of the characteristics of the associated bone defect may allow an immediate and predictable substitution with dental implants, when tooth extraction is the only option.     

Abrasivity of toothpastes: An in vitro study of toothpastes marketed in Norway

Abstract

Objectives. Cone beam computed tomography (CBCT) was introduced to Norwegian dental clinics in 2007. The aim of the study was to investigate how dental clinics use this imaging modality, including factors related to workflow and image quality, and to evaluate dentists’ opinions on and experiences of using it. Materials and methods. A web-based 59-item questionnaire regarding the clinical use of CBCT was sent to all 39 CBCT clinics in Norway. Results. Twenty-nine clinics (74%) responded. Most respondents (93%) were from clinics with more than one dentist and 83% had at least one specialist. All clinics had digital intraoral x-ray receptors and all but one had panoramic imaging. The most common indications for CBCT were implant treatment planning (34% of all clinics) and localization of impacted teeth (43% of specialist clinics). Seventy-two per cent of clinics reported an average of four or fewer CBCT examinations each week and 83% of respondents were subjectively satisfied with the image quality. The most commonly used enhancement functions were contrast (97%), brightness (90%) and zoom (86%). Conclusions. The Norwegian CBCT clinics surveyed were fully digitized and had multiple dentists. Periodontists and oral and maxillofacial surgeons were the most frequent specialties represented in the clinics. Clinics with only dental specialists performed more CBCT examinations/week than clinics with general practitioners or both general practitioners and specialists. The most common indications for CBCT examinations were related to treatment planning. This study found some challenges related to image quality and communication within the radiological team.     

Detection of vertical root fractures by using cone-beam computed tomography: a clinical study

Introduction

Vertical root fractures of teeth (VRFs) often pose a diagnostic dilemma because of the difficulty in detection of these in intraoral radiographs except in certain cases with very distinct clinical findings. This often leads to unwarranted extraction of the tooth. Cone-beam computed tomography (CBCT) produces three-dimensional images and allows precise visualization and evaluation of VRFs or cracks in extracted teeth, as reported previously. This clinical pilot study was designed to determine the diagnostic accuracy of noninvasive CBCT for detection of suspected VRFs in endodontically treated teeth by using exploratory surgery to confirm the presence or absence of a fracture.

Methods

Thirty-two teeth in 29 patients with clinical signs and symptoms suggestive of VRF were included in the study after informed consent was obtained. They underwent a limited area CBCT evaluation. All CBCT studies were blinded, and 2 board-certified oral and maxillofacial radiologists assessed the presence or absence of VRF through sequential evaluation of the three-dimensional volume. Subjects underwent surgical exploration as part of treatment, which helped establish the presence or absence of VRF.

Results

Pearson correlation coefficient by using surgical finding to confirm presence/absence of fracture was 0.602, positive predictive value was 91%, and negative predictive value was 67%. The sensitivity was 88%, and specificity was 75%.

Conclusions

This study revealed the superior diagnostic accuracy of CBCT for detection of VRF.     

Diagnosis of Vertical Root Fractures by Cone-beam Computed Tomography in Root-filled Teeth with Confirmation by Direct Visualization: A Systematic Review and Meta-Analysis

IntroductionThe purpose of this review was to determine the diagnostic accuracy of cone-beam computed tomographic (CBCT) imaging in detecting vertical root fractures (VRFs) in root-filled teeth compared with a reference standard (direct visualization).MethodsElectronic searches were performed in Medline, Scopus, Cochrane, and gray literature for English language articles until June 2020. Prospective and retrospective clinical studies using CBCT imaging to diagnose VRFs in root-filled teeth were included. Case reports and in vitro studies were excluded. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias and applicability concerns. Meta-analysis was performed using Stata 16.1 software (StataCorp, College Station, TX) via the MIDAS v.3.0 package and METANDI module. Publication bias was evaluated using Deeks’ funnel plot analysis. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was performed to evaluate the certainty of evidence. This systematic review was registered in the Open Science Framework (10.17605/OSF.IO/7JKE2).ResultsEight articles were included in this systematic review and meta-analysis. Risk of bias assessment showed that 5 articles in the patient selection domain had low risk of bias with low applicability concern. In the index test and reference standard domains, 7 articles had moderate risk of bias with moderate applicability concern. Three articles had high RB in the flow and timing domain. There was no publication bias. CBCT imaging had a pooled sensitivity and specificity of 0.78 (95% confidence interval [CI], 0.64–0.88) and 0.80 (95% CI, 0.63–0.91), respectively, and an accuracy of 0.86 (95% CI, 0.83–0.89). CBCT imaging also had pooled positive and negative likelihood ratios of 4 and 0.2, respectively. In GRADE analysis, the quality of evidence was low for sensitivity and moderate for specificity when CBCT imaging was used for the diagnosis of VRF.ConclusionsThe overall quality assessment of the included articles showed that in the patient selection domain, the risk of bias was low, and it was moderate in the index test and reference standard domains. Evidence from this systematic review and meta-analysis indicates that CBCT imaging is still not a good tool for diagnosing VRFs in root-filled teeth compared with direct visualization.     

A comparison of the use of cone-beam computed tomography and panoramic radiography in the assessment of pre-eruptive intracoronal resorption

Objective: This study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PIR) using cone beam computed tomography (CBCT) and panoramic radiography and to compare the findings of these imaging techniques.

Methods: This retrospective study consisted of 733 patients who had at least one unerupted tooth and had undergoneimaging with both three-dimensional (3D) CBCT and two-dimensional (2D) panoramic radiography. In all the images, the number of teeth with intracoronal resorption, affected tooth type and number, and size and location of the PIR defects were recorded. The McNemar test was used to compare the prevalence of PIR in the CBCT and panoramic images.

Results: Fewer PIR defects were detected in the panoramic images (3.1% of the patients) than in the CBCT images (9.5% of the patients) (pConclusions: CBCT detected more cases of PIR than panoramic radiography. The mandibular third permanent molar was the most commonly affected tooth.