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1.

Introduction

Understanding tooth anatomy is crucial for effective endodontic treatment. This study investigated the roots and root canal morphology of maxillary first and second permanent molars in a Thai population using cone-beam computed tomographic (CBCT) imaging.

Methods

This study evaluated 476 maxillary first molars and 457 maxillary second molars receiving CBCT examination and determined the number of roots and canal morphology according to Vertucci's classification, and the prevalence of a second mesiobuccal (MB2) canal in the mesiobuccal (MB) root was correlated with sex, age, and tooth side.

Results

Three roots were most commonly found in maxillary first and second molars. MB2 canals in the MB root were found in 63.6% and 29.4% of first and second molars, respectively. The most common canal morphology in the first molar MB roots was type I (36.4%) followed by type II (28.8%), and type IV (25.3%). The most common canal morphology in the second molar MB roots was type I (70.6%) followed by type II (14.6%) and type IV (7.5%). Bilateral MB2 canals in the MB roots were present in 80.93% and 82.59% of the first and second molars, respectively. There was a significant correlation between males and the prevalence of MB2 canals in first molars (P < .05).

Conclusions

CBCT imaging is useful to determine root canal morphology. The prevalence of MB2 canals is approximately 60% and 30% in first and second molars, respectively. Furthermore, bilateral MB2 canals were commonly found. Our results can help endodontists to improve endodontic treatment outcomes.  相似文献   

2.

Introduction

The purpose of this study was to determine the prevalence of the second mesiobuccal canal (MB2) in 100 maxillary first molars using 3 independent methods and a combination method.

Methods

One hundred extracted human maxillary first molars were collected. The teeth were mounted in the maxillary first molar extraction sockets of a human cadaver head. A cone-beam computed tomographic (CBCT) scan was taken of each tooth. Two radiology faculty independently evaluated the CBCT volume for the presence of an MB2 canal. Additionally, teeth were accessed. If a canal was not found, a preoperative CBCT scan was viewed followed by a second attempt to locate an MB2 canal. Lastly, the mesiobuccal root was dissected by grinding in a coronal plane.

Results

A review of CBCT volumes found the presence of an MB2 canal 69% of the time. Accessing the tooth led to an MB2 detection of 78%. When a CBCT scan was viewed, this brought the access detection rate up to 87%. Coronal plane root grinding had an MB2 canal detection rate of 92%. Differences between each method were statistically significant.

Conclusions

The results of this study show that an MB2 canal is present up to 92% of the time. Direct access of teeth found statistically significant more MB2 canals than viewing CBCT volumes alone (P = .032). Therefore, exposing every patient to a preoperative CBCT scan may not be appropriate. However, taking a CBCT scan when an MB2 canal is not found clinically can significantly increase the chances of finding an MB2 canal (P < .001).  相似文献   

3.

Introduction

The purpose of this study was to determine the position of the apical foramen (AF) in relation to root surfaces of human permanent teeth using cone-beam computed tomographic (CBCT) imaging and novel advanced imaging analysis software (e-Vol DX; CDT Software, Bauru, SP, Brazil).

Methods

The AF position was determined on CBCT scans viewed and analyzed using e-Vol DX of 1400 teeth (422 patients) according to the root surface as follows: buccal, mesiobuccal, mesial, mesiolingual/palatal, lingual/palatal, distolingual/palatal, distal, distobuccal, and central. Categoric variables were described as frequencies and percentages. Frequencies were reported with their confidence intervals (95%). Categoric variables were analyzed using the chi-square test with Yates correction. The level of significance was set at α = 0.05.

Results

The most frequent AF position in maxillary anterior teeth was central (46%–60%). The AF in mandibular central incisors was buccal in 44% of the cases. In maxillary first and second premolars, 39.98% and 42.56% of all AFs were central. In maxillary first and second molars, 46.12% and 57.49% of all AFs were central. The most frequent AF position in mandibular first and second premolars was central (42.85% and 50.98%). In mandibular first molars, 48.72% of all AFs were central.

Conclusions

The AF position in human permanent teeth was central in 48.95% and 42.08% of the maxillary and mandibular teeth. CBCT images analyzed by e-Vol DX can be used to determine the true anatomic position of the AF and can be a useful tool for the treatment planning of nonsurgical and surgical endodontic treatments.  相似文献   

4.

Introduction

Maxillary first molar second mesiobuccal (MB2) root canal prevalence may change among different populations. The aim of this study was to analyze the worldwide prevalence of the MB2 root canal and understand its possible relation with sex, age, side, and root configuration using in vivo cone-beam computed tomographic (CBCT) assessment.

Methods

Observers from 21 regions were calibrated to achieve a similar CBCT assessment methodology and instructed to collect data from 250 maxillary first molars in previously existing examinations. Intra- and interrater reliability tests were performed. The sample size included 5250 molars and was defined by way of a preliminary trial. Data collected included MB2 presence, sex, age, side, number of roots per tooth, and mesiobuccal root configuration. The z test for proportions in independent groups was used to analyze the differences among subgroups. P < .05 was considered significant.

Results

The worldwide CBCT-assessed MB2 prevalence was 73.8%, ranging from 48.0% in Venezuela to 97.6% in Belgium. The prevalence in males and females was 76.3% and 71.8%, respectively (P < .05). Significantly higher MB2 proportions were found in younger patients and 3-rooted molar configurations. The group intraclass correlation coefficient and the percentage of agreement for the MB2 presence were 0.95 and 0.91, respectively. The intrarater Cohen kappa value was above 0.61 for all observers.

Conclusions

MB2 prevalence in the analyzed regions varied widely. The differences may be associated with specificities within each region but also patient demographics. Males, younger patients, and 3-rooted configurations were associated with higher MB2 proportions.  相似文献   

5.

Introduction

Limited field cone-beam computed tomography (CBCT) imaging has become a modality frequently used by endodontists to evaluate the teeth and surrounding tissues of their patients. Accurate image interpretation is vital to obtain needed treatment information as well as to discern coincidental findings that could be present. The goal of this study was to determine the accuracy of CBCT volume interpretation when performed by endodontists and endodontic residents.

Methods

Eighteen deidentified limited field CBCT scans were obtained and evaluated by an oral and maxillofacial radiologist and an endodontist experienced in reading CBCT images. Their collective findings were combined as the “gold standard” of interpretation for this investigation. Using standard CBCT software, 4 practicing endodontists and 5 second-year endodontic residents evaluated each scan and recorded any notable findings and whether or not each scan warranted referral to a radiology specialist. Their interpretations were then compared with the gold standard to determine accuracy and any significant differences among the groups.

Results

The overall accuracy was 58.3% for endodontists and 64.3% for residents. Paired t tests showed no statistically significant differences in accuracy between the 2 groups for findings in teeth or in bone, but residents were significantly better for maxillary sinus findings. Endodontists agreed with the gold standard 38.9% of the time and residents 49.8% of the time on necessity of referral. The Cohen kappa coefficient showed moderate agreement between the groups.

Conclusions

Endodontists and residents had similar accuracy in CBCT scan evaluation. More training and experience are warranted for both groups in order to maximize image assessment accuracy.  相似文献   

6.

Introduction

The purpose of this systematic review was to compare and quantify endodontic outcome using cone-beam computed tomographic (CBCT) imaging with intraoral periapical radiography.

Methods

Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. Additionally, bibliographies, gray literature of all relevant articles, and textbooks were manually searched. There was no disagreement between the 2 reviewers.

Results

Six articles met the inclusion criteria with low to moderate risk of bias (good/fair quality). The certainty of evidence was moderate, indicating that the authors are moderately confident that the true effect lies close to that of the estimate of the effect as determined by Grading of Recommendations Assessment Development and Evaluation criteria. The odds ratio of CBCT imaging versus traditional imaging to detect a periapical lesion was 2.04 (95% confidence interval, 1.52–2.73).

Conclusions

Although intraoral radiographs are the imaging modality of choice, when 2-dimensional intraoral radiography is inconclusive, CBCT imaging was reported in this investigation to have twice the odds of detecting a periapical lesion than traditional periapical radiography in endodontic outcome studies.  相似文献   

7.

Introduction

The purpose of this study was to evaluate the accuracy of small-volume cone-beam computed tomography (CBCT) to detect and measure isthmi in the apical root canals of mandibular molars by using micro–computed tomography (μ-CT) as the reference standard.

Methods

Forty mandibular first molars selected on the basis of μ-CT scan and presenting isthmi in the apical 3-mm mesial roots were scanned by using the highest-resolution settings of a small-volume CBCT unit. Isthmi lengths were measured and compared between both μ-CT and CBCT images to study the accuracy of CBCT readings. Quantitative data for sensitivity rate were depicted as percentage value with 95% confidence interval. Results were analyzed by using linear regression between true lengths (μ-CT) and CBCT lengths, Bland-Altman plot and t test, at α = 0.05.

Results

CBCT sensitivity for isthmi detection was 65% (95% confidence interval, 0.4667–0.8333). An average of 74.7% of the lengths could be measured, and differences among the lengths in μ-CT and CBCT were significant (P < .05; mean, 0.756 ± 0.655; t test), showing that there was no agreement between both methods.

Conclusions

Accuracy of identifying apical isthmi of mandibular molars was highly influenced by the evaluation method. Small-volume CBCT imaging could not detect and measure apical isthmi length accurately. Moreover, using high-resolution settings in CBCT, it was not reliable to forecast the actual apical root canal anatomy.  相似文献   

8.

Introduction

The aim of this study was to compare the biomechanical properties of first maxillary molars with different endodontic cavities using the finite element method.

Methods

Three finite element analysis models of a maxillary first molar were designed and constructed with 3 different types of endodontic cavities: a traditional endodontic cavity, a conservative endodontic cavity, and an extended endodontic cavity. An intact tooth model was used for comparison. Each model was subjected to 3 different force loads directed at the occlusal surface. The stress distribution patterns and the maximum von Mises (VM) stresses were calculated and compared.

Results

The peak VM stress on all models was at the site of the force load. The occlusal stresses were spread in an approximate actinomorphic pattern from the force loading point, and the stress was much higher when the force load was close to the access cavity margin. The peak root VM stresses on the root-filled teeth occurred at the apex and were significantly higher than that on the intact tooth, which appeared on the pericervical dentin. The area of pericervical dentin experiencing high VM stress increased as the cavities extended and the stress became concentrated in the area between the filling materials and the dentin.

Conclusions

The stress distribution on the occlusal surface were similar between the conservative endodontic cavity, the traditional endodontic cavity, and the extended endodontic cavity. With enlargement of the access cavity, the stress on the pericervical dentin increases dramatically.  相似文献   

9.

Introduction

The present study aimed to determine the incidence and anatomic variation of the middle mesial (MM) canal in mandibular permanent first molars using cone-beam computed tomographic imaging and to evaluate the association between the presence of MM canals and anatomic landmarks of the pulp chamber floor in the mesial root.

Methods

In this in vivo cross-sectional study, 210 CBCT scans of mandibular fist molars from 210 patients were included. CBCT scans were evaluated in 3 sections, and the following data were collected for further analysis: identification of the MM canal, the distance between the mesiobuccal (MB) and mesiolingual (ML) orifices, the presence of any isthmus between the MB and ML orifices, and the MB and ML root canal system (RCS) configurations. Binary logistic regression was performed to assess the effect of pulp floor anatomic characteristics as an independent variable on the outcome variable (the presence of an MM canal).

Results

The overall prevalence of the identification of an MM canal regardless of age was 14.7%. Mandibular first molars with an isthmus between the MB and ML RCS configurations were almost 5 times more likely to show an MM canal (P < .05, odds ratio [OR] = 4.9). The MB-ML intraorifice distance was inversely associated with the presence of an MM canal (P < .05, OR = 0.73). Patients less than 42 years old were 4 times more likely to have an MM canal in their CBCT scans compared with patients older than 42 years old (P < .05, OR = 3.9).

Conclusions

The suggested anatomic landmarks of the pulp chamber floor could act as a reliable predictive factor for the presence of an MM canal. This knowledge of anatomic clues may serve to better direct endodontists in locating an MM canal, which could prevent excessive removal of tooth structures.  相似文献   

10.

Introduction

The present study aimed to anatomically assess mandibular posterior teeth using cone-beam computed tomographic (CBCT) imaging for endodontic surgery.

Methods

A total of 170 CBCT scans were evaluated for anatomic variations of mandibular posterior teeth. All the scans were obtained using a Planmeca Promax CBCT unit (Planmeca, Helsinki, Finland) with exposure settings of 90 kVp, 12 mA, 12 seconds, and 0.3-mm resolution. All CBCT images were reconstructed by Romexis Viewer 3.8.2. software (Planmeca) on a 16-inch LCD monitor (22MP47HQ; LG, Seoul, South Korea), and axial, coronal and sagittal views were evaluated.

Results

The thickest buccal cortical plate was observed over the distal root of second molars (12.30 mm) among the molar teeth and over the second premolar root (5.41 mm) among the premolar teeth. The thinnest buccal cortical plate was observed over both the first and second premolar roots (0.42 mm) and over the mesial root of the first molar (0.62 mm) tooth. A 20.38-mm section was removed for surgical access during buccal resection of the distal root of the left second molar, and the closest distance from the apex to the inferior alveolar canal was 0 mm.

Conclusions

Adequate knowledge of the anatomic dimensions of teeth and their surrounding structures is imperative for endodontic surgery. Information concerning the root thickness of mandibular posterior teeth at the site of root resection (apical 3 mm), buccal cortical plate thickness, and the distance from the apex of each tooth to the inferior alveolar canal and mental foramen can guide the surgeon before and during surgery.  相似文献   

11.

Introduction

The present study aimed to quantitatively analyze apical foramen deviations of mesial root canals of mandibular first molar teeth by means of micro–computed tomographic (micro-CT) imaging.

Methods

Micro-CT images of the mesial roots of 109 mandibular first molar teeth with independent mesiobuccal (MB) and mesiolingual (ML) root canals were analyzed. The deviations of the apical foramina of the MB, ML, and middle mesial root canals from the anatomic apex were measured. The vertical distance between the apical foramina of each mesial root canal in relation to each other was also calculated.

Results

The distances from the apical foramina of the MB, ML, and middle mesial root canals to the anatomic apex of the mesial root were up to 2.51 mm, 3.21 mm, and 5.67 mm, respectively. There was no significant difference between the deviations of MB and ML root canals from each other (P > .05). The middle mesial root canal showed the greatest deviation compared with the MB and ML canals (P < .05).

Conclusions

The apical foramina of mesial root canals of mandibular first molar teeth showed greater variations from each other and anatomic apices than previously reported. Clinically, the use of electronic apex locators for the detection of minor apical foramen of each mesial root canal is of the utmost important.  相似文献   

12.

Introduction

The aim of this study was to measure the time consumed preparing retrograde cavities in root canals of maxillary molars filled using the GuttaCore (Dentsply Tulsa Dental Specialties, Tulsa, OK) technique and the cold lateral condensation technique (CLC) and to examine the quality of the root-end cavity preparation by ultrasonic tips using micro–computed tomographic (micro-CT) scanning.

Methods

A total of 24 maxillary molars were included; distobuccal and palatal canals were instrumented to size #40 and size #50, respectively. Teeth were randomly distributed into 2 experimental groups; half of the samples were filled with CLC, and half were filled with the GuttaCore technique. After 2 months, the apical 3 mm of each root apex was resected. A retrograde cavity was then prepared 3 mm deep into the root-end–filled canals using ultrasonic tips. The quality of the preparation was first confirmed by a surgical stereomicroscope, and the time required for the root-end preparation was recorded. After root-end cavity preparation, all samples were scanned by micro-CT scanning.

Results

There was no significant difference between the palatal and distobuccal canals in the time required to prepare a retrograde cavity. Less time was required in the GuttaCore group to remove all root filling material and finish the cavity preparation than in the CLC group (P < .05), especially in the palatal canals. Micro-CT results confirmed that all material was removed from the root-end cavities and the absence of microcracks.

Conclusions

GuttaCore was removed in less time from root-end cavities than root filling performed with the CLC technique. No damage to the surrounding dentin was detected by micro-CT scanning in the 2 groups.  相似文献   

13.

Introduction

The complexity of the root canal system of maxillary molars presents a constant challenge in the diagnosis and treatment of these teeth. This case report describes the importance of a surgical operating microscope and cone-beam computed tomographic (CBCT) imaging.

Methods

Root canal treatment of a left maxillary first molar with 3 roots and 7 canals was successfully performed. Seven canals were identified with the help of a surgical operating microscope and CBCT imaging. CBCT images also confirmed the 3 roots and 7 canals in the right maxillary first molar.

Results

CBCT images confirmed a type IV canal pattern in the distal and palatal root, whereas the mesial root had a type VIII canal pattern.

Conclusions

The use of a surgical operating microscope and CBCT imaging helps the clinician to diagnose unusual anatomy of a tooth and facilitate successful endodontic treatment.  相似文献   

14.

Introduction

Populations from different geographic regions and ethnic backgrounds may present differences in dental morphology. The aim of this study was to compare the differences in root and root canal configurations on Asian and white subpopulations using cone-beam computed tomographic imaging.

Methods

Information from Asian and white patients was retrieved from 2 cone-beam computed tomographic imaging databases in China and Western Europe. Two calibrated observers collected data regarding the number of roots and Vertucci root canal system configuration for all groups of teeth. A total of 15,655 teeth were analyzed. The z test for independent groups was used to analyze differences between the groups. The significance level was considered at a P value < .05. Reliability tests were performed between observers.

Results

Differences were noted in the number of roots per tooth in 6 groups of teeth. The Asian group showed a higher prevalence of single-root configurations in maxillary first premolars (83.2%) and mandibular second molars (45.4%) when compared with whites with 48.7% and 14.3%, respectively. Moreover, 3-rooted configurations in mandibular first molars were more common in Asians (25.9%) compared with whites (2.6%). Seventeen of the 20 analyzed roots had a higher prevalence of Vertucci type I configuration in Asians. Maxillary first molars with second mesiobuccal root canals were more commonly found in whites than in Asians (71.3% and 58.4%, respectively). A similar situation was found in maxillary second molars.

Conclusions

The Asian ethnic group presented a higher prevalence of Vertucci type I configuration, whereas the white group displayed a higher number of multiple root canal system morphologies. A clinician should be aware of these differences when treating patients from these ethnic groups.  相似文献   

15.

Introduction

This study compared the shaping ability of ProTaper Next (Dentsply Sirona, Tulsa, OK) and BT-RaCe (FKG Dentaire, La Chaux-de-Fonds, Switzerland) instrument systems in the mesial canals of mandibular molars using micro–computed tomographic (micro-CT) imaging.

Methods

A total of 17 type IV mesial roots of extracted first mandibular molars were scanned using micro-CT imaging before and after root canal preparation with the 2 instrument systems. Both systems were used in the same root but alternating the mesial canals from root to root. The following parameters were analyzed: root canal volume, surface area, unprepared surface areas, transportation, canal/root width ratio, and preparation time.

Results

There were no statistically significant differences between the 2 systems for all evaluated parameters (P > .05). The unprepared surface areas for the full canal length and the apical 5-mm segment were 33% and 14% for BT-RaCe and 31% and 14% for ProTaper Next, respectively. After preparation, all root canals had a diameter that was not larger than 35% of the root diameter at the coronal and middle segments.

Conclusions

The 2 systems showed no differences in any of the evaluated shaping parameters. None of the tested systems put the roots at risk of fracture because of excessive dentin removal.  相似文献   

16.

Introduction

Outcomes assessment of retreatment and endodontic microsurgery (EMS) are traditionally based on clinical findings and radiographs. The purpose of this study was to assess the volumetric change of periapical radiolucencies (PARLs) by cone-beam computed tomographic (CBCT)-based analysis in retreatment and EMS cases.

Methods

For 68 retreatment and 57 EMS cases, preoperative and recall clinical data, periapical (PA) radiographs, and CBCT imaging were retrospectively obtained. Specialized software was used by 2 board-certified endodontists for volumetric analysis of PARLs. For EMS and retreatment, clinical outcomes were determined by combining clinical data with CBCT-generated volumetric analysis (PA radiographs not used). Additionally, comparisons of percent volume reduction for EMS and retreatment were performed. Examiner interpretations of outcomes assessment using PA radiography and CBCT imaging were compared.

Results

In teeth with or without a preoperative PARL, EMS resulted in a statistically significant difference in complete healing (49/57 [86.0%]) versus retreatment (28/68 [41.2%], P < .0001). EMS resulted in a statistically significant difference in combined complete healing and reductive healing (54/57 [94.7%]) versus retreatment (56/68 [82.4%], P < .05). Of 46 recalls in which CBCT imaging detected a PARL, PA radiography detected 30 (a 35% false-negative rate). Of the 79 recall studies in which CBCT imaging did not detect a PARL, PA radiography did detect PARL in 13 (a 16.5% false-positive rate).

Conclusions

In this CBCT and clinical data-based outcomes assessment, EMS resulted in a greater mean volumetric reduction and a higher healing rate compared with retreatment. Postoperative CBCT imaging is more sensitive and specific than PA radiography in assessing PARL and has demonstrable usefulness in outcomes assessment.  相似文献   

17.

Introduction

Despite the increasing reports on mechanical aspects of contracted endodontic access cavities (CECs), we believe that the biological aspects (debridement) have not been adequately investigated. This study examined if 1 type of CEC (orifice-directed dentin conservation [DDC] access) was able to debride the pulp chamber, root canals, and isthmus of mesial roots of mandibular molars similar to a traditional endodontic access cavity (TEC).

Methods

Mandibular molars (N = 32) were selected and divided randomly into 2 experimental groups (n = 12) after micro–computed tomographic scanning (group 1: TEC and group 2: DDC) and histologic controls (n = 8). After instrumentation to a size 30/0.06 taper using 3% sodium hypochlorite as irrigant, specimens were processed for histologic evaluation, and the remaining pulp tissue (RPT) was measured from the pulp chamber, root canal, and isthmus at all root thirds. Data were analyzed using 1-way analysis of variance, Kruskal-Wallis, and appropriate post hoc tests (P = .05).

Results

The RPT in the pulp chamber was significantly higher in DDC compared with TEC (P < .05). Comparing the root thirds in each group, there was no significant difference in the RPT within the root canals or the isthmus (P > .05). The RPT within the root canals and isthmus was not significantly different between the 2 access cavity designs at any root third (P > .05).

Conclusions

Debridement of the pulp chamber was significantly compromised in DDC. The type of access cavity did not influence the amount of RPT in the root canals and isthmus.  相似文献   

18.

Introduction

This study aimed to evaluate the diagnostic accuracy of orthopantomography (OPT) for the detection of clinically/surgically confirmed apical periodontitis (AP) without endodontic treatment using cone-beam computed tomographic (CBCT) imaging as the reference standard.

Methods

One hundred twenty patients without endodontically treated AP (diseased group) were detected via CBCT imaging using the periapical index system. They were divided into groups of 10 each according to the size of the lesion (2–4.5 mm and 4.6–7 mm) and the anatomic area (incisor, canine/premolar, and molar) in both the upper and lower arches. Another 120 patients with a healthy root and periapex (healthy group) were selected. Each diseased and healthy patient underwent OPT first and a CBCT scan within 40 days of the OPT. The periapical index system was also used to assess AP by OPT. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for OPT images with respect to CBCT imaging were analyzed. The k value was calculated to assess both the interobserver reliability for OPT and the agreement between OPT and CBCT imaging.

Results

OPT showed low sensitivity (34.2), negative predictive value (59.3), and diagnostic accuracy (65.0) and high specificity (95.8) and positive predictive value (89.1). Interobserver reliability for OPT was substantial (k = 0.71), and agreement between OPT and CBCT imaging was fair (k = 0.30). The best and worst identified AP were located in the lower molar area and the upper/lower incisor area, respectively.

Conclusions

OPT showed high specificity and positive predictive value. However, overall, it was not an accurate imaging technique for the detection of untreated AP, especially in the incisor area.  相似文献   

19.

Background

The authors conducted a study to compare 2-dimensional (2D) lateral cephalometric radiography (LCR), 2D cone-beam computer tomographic (CBCT)–generated cephalogram and 3-dimensional (3D) CBCT for assessing cephalometric measurements.

Methods

The authors took 2D LCR, 2D CBCT-generated cephalogram, and 3D CBCT images involving 60 participants. They obtained 11 angular and 11 linear measurements for all images. They used 1-way analysis of variance and the Fisher least significant difference test for statistical comparisons. The authors used Pearson correlation and Pearson χ2 test to assess the relationship of these imaging modalities for vertical cephalometric analyses.

Results

Significant differences existed between the 2D cephalograms (LCR and CBCT-generated cephalogram) and the 3D CBCT in 2 angular measurements (maxillary first incisor-nasion (N) point A [A] and mandibular first incisor-N point B (B) (P = .027 and P < .001, respectively) and 5 linear measurements (N menton[Me]/sella gonion [Go], condylion [Co]A, Co gnathion, Go-Me and anterior nasal spine-posterior nasal spine) (P < .004). These measurement values with significant differences were generally greater (approximately 5° for angular measurements and 10 millimeters for linear measurements) on the 3D CBCT scans than on the 2D cephalograms. No significant difference was found between the 2 2D cephalograms (P > .164). No significant difference was found among the 3 imaging modalities for the vertical cephalometric analyses (P > .466).

Conclusions

Significant differences existed between the 2D cephalograms (LCR and CBCT-generated cephalogram) and the 3D CBCT scans in 2 angular and 5 linear measurements. The 2 2D cephalograms were similar for cephalometric measurements. The 3 imaging modalities had no significant difference for the vertical cephalometric analyses. CBCT might not add value for every orthodontic situation.

Practical Implications

These results find the values of cephalometric measurements on 3D CBCT scans may be greater than on the conventional LCR for some parameters. The 2D CBCT-generated cephalogram could be an alternative to the conventional LCR for patients whose large-field-of-view CBCT images are already available.  相似文献   

20.

Introduction

Accurate radiographic interpretation is of the utmost importance in the diagnosis and treatment of patients. Previous studies have indicated subjectivity in the radiographic interpretation of periapical tissues irrespective of using conventional radiography, digital radiography, or cone-beam computed tomographic (CBCT) imaging. No studies to date have evaluated the reliability of the interpretation of periapical tissues based on the size of periapical radiolucency (PAR). The purpose of this study was to assess the interobserver and intraobserver reliability of CBCT interpretation by observers from different specialties and different levels of experience when identifying PARs of various sizes.

Methods

Limited field of view CBCT scans were selected such that a variety of PARs with various sizes were included. Six observers with different levels of experience and fields of specialty evaluated periradicular tissues of 28 roots on the CBCT scans at 3 separate sittings each a month apart.

Results

The overall Fleiss kappa coefficient for interobserver reliability and intraobserver reliability was 0.88 and 0.85; the larger the PAR, the more reliable the radiographic interpretation. Increased experience level improved the intraobserver reliability.

Conclusions

CBCT imaging appears to be a reliable method for the interpretation of PAR. The larger the PAR is the more reliable the radiographic interpretation.  相似文献   

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