Influence of the metal post material, tooth location in the dental arch, and metal artifact reduction tool on vertical root fracture diagnosis in cone beam CT.

This study aimed to evaluate the influence of the metal post composition, tooth location in the dental arch, and metal artifact reduction (MAR) on vertical root fracture (VRF) diagnosis in cone beam computed tomography (CBCT). Twenty-two unirradicular premolars (12 sound and 10 fractured) and two alveolar sockets of a mandible (anterior and posterior regions) composed the sample. CBCT scans of each tooth with a metal post placed into the root canal-silver-palladium (Ag-Pd), cobalt-chromium (Co-Cr), or nickel-chromium (Ni-Cr)-were individually acquired for each mandibular region, and two conditions of MAR, using a OP300 device (Instrumentarium, Finland). Images were assessed by five evaluators independently for VRF detection. Diagnostic values were calculated and compared among all groups using multi-way ANOVA with Tukey post hoc test to investigate the effect of post material, anatomical region, and MAR on VRF diagnosis (α = 0.05). Values of area under the receiver operating curve and specificity were not influenced by the studied factors (p > 0.05). Sensitivity was influenced by the MAR in both mandibular regions (p < 0.05). In the anterior region, sensitivity values increased when the MAR was enabled, regardless of the metal post material (p < 0.05). Similar behavior was noticed in the posterior region for Ni-Cr (p < 0.05) but not for Ag-Pd and Co-Cr posts (p > 0.05). The MAR improved the sensitivity in VRF diagnosis for all tested metal posts in the mandibular anterior region and for the Ni-Cr post in the mandibular posterior region. Therefore, for images obtained in the OP300 CBCT device, activation of the MAR is suggested in these cases.

Do cone-beam computed tomography low-dose protocols affect the evaluation of the temporomandibular joint?

BACKGROUND: There is no established acquisition protocol based on scientific evidence for the acquisition of cone-beam computed tomography (CBCT) exams to evaluate the temporomandibular joint (TMJ). OBJECTIVES: To evaluate the influence of acquisition protocols and jaw positioning on the diagnostic accuracy of TMJ condylar morphological alterations (CMA), dimension, position and excursion. METHODS: Thirty-six TMJs on 18 dry skulls were imaged using a CBCT unit (OP300 Maxio, Instrumentarium, Tuusula, Finland) at two exposure settings (4.5 and 6.3 mA), three voxel resolutions (0.085, 0.125 and 0.280 mm), three jaw positions (concentric, anteriorised and posteriorised) and three jaw excursions (normoexcursion, hyperexcursion and hypoexcursion). The macroscopic anatomy examination and high-resolution CBCT images were used as ground truth for CMA. Twenty-five TMJs had at least one CMA with 11 healthy TMJs serving as controls. Three experienced oral and maxillofacial radiologists evaluated the parasagittal images for the presence of CMA, position and excursion and measured dimensions. The area under the ROC curve, sensitivity and specificity were calculated. Weighted Kappa (α = 0.05) was used to determine intra- and interexaminer reliability and comparisons between dependent variables analysed by Analysis of Variance at an a prior level of significance of 0.05. RESULTS: The agreement of the evaluation of the position and excursion with the reference standard was high, independent of the protocol (range, 0.75-0.91). Various combinations of acquisition protocols and jaw position did not influence the CMA evaluation. Erosion was overdiagnosed in protocols with larger voxel sizes and the detection of osteophytes greater in images with smaller voxel sizes. The anteroposterior dimension was greater in the open jaw position (p < .05). CONCLUSION: CBCT protocols using reduced radiation exposure from the CBCT machine evaluated in this study can be used to assess condylar morphology, dimension, position and excursion, without compromising diagnostic performances for these parameters.

Comparison of the expression of the volumetric alteration artifact in cylindrical and triangular fields of view in two cone-beam computed tomography devices.

OBJECTIVE: To compare the expression of the volumetric alteration (VA) artifact between cylindrical and convex triangular fields of view (FOVs) using high-density materials in different positions in two cone-beam computed tomography (CBCT) devices. MATERIALS AND METHODS: Cylinders of five high-density materials (amalgam, chromium-cobalt, gutta-percha, titanium, and zirconium) with known physical volume were individually submitted to CBCT acquisition in four positions inside a polymethylmethacrylate phantom using two different FOV shapes (convex triangular and cylindrical) on the Veraviewepocs® R100 (R100) and Veraview® X800 (X800) devices. Two oral radiologists obtained the tomographic volumes by segmenting each cylinder. The difference between the tomographic and physical volumes corresponded to the VA. These values were analyzed by intraclass correlation coefficient and analysis of variance for repeated measures with Tukey post hoc test (α = 5%). RESULTS: The FOV influenced the VA only in the X800 device (p = 0.014): the VA in the triangular FOV was greater than in the cylindrical FOV. The VA in the triangular FOV of the X800 device was greater than the R100 device (p < 0.0001). The material influenced the expression of the VA only in the R100 device (p < 0.0001); gutta-percha presented the highest VA, being underestimated, and differing from the other materials (p < 0.01). CONCLUSION: The triangular FOV increased the VA of high-density materials in the X800 device. CLINICAL RELEVANCE: It is important to know if there is an influence on the volumetric alteration artifact of dental materials due to the different image formation geometry in the convex triangular FOV.

Mapping the expression of beam hardening artefacts produced by metal posts positioned in different regions of the dental arch.

OBJECTIVES: To objectively assess the expression and direction of artefacts in the vicinity of metal posts positioned in different mandibular regions. MATERIALS AND METHODS: A human mandible had two sockets prepared-anterior and posterior regions-to accommodate a single-rooted tooth. Two CBCT units, Picasso Trio and OP300, were used. CBCT images of the tooth without metal post, and with silver-palladium, nickel-chromium, or cobalt-chromium posts (experimental groups) were individually acquired. Then, 8 lines of interest (LOIs) were determined around the root canal, in an axial reconstruction: 4 in orthogonal (buccal, lingual, mesial, and distal) directions, and 4 in oblique (mesiobuccal, distobuccal, mesiolingual, and distolingual) directions. The mean of gray values was measured for each LOI. RESULTS: For the OP300, in general, all experimental groups showed greater expression of hyperdense streaks in orthogonal LOIs and greater expression of hypodense streaks in oblique LOIs. For the Picasso Trio, for both mandibular regions, the buccal LOI showed greater expression of hypodense streaks; conversely, greater expression of hyperdense streaks was observed in the distal and distobuccal LOIs in the anterior region and in the mesiolingual LOI in the posterior region. The silver-palladium group showed significantly greater expression of beam hardening artefacts in the posterior region of the mandible, regardless of the CBCT unit (p < 0.05). The mandibular posterior region showed significantly lower gray values than the anterior region (p < 0.05). CONCLUSION: The expression and direction of artefacts produced in the vicinity of metal posts vary according to the mandibular region, composition of the post, and CBCT unit. CLINICAL RELEVANCE: The mapping of artefacts produced by metal posts reveals the root regions with greater expression of hypodense and hyperdense artefacts, which may contribute to recognizing regions more likely to mimic or hide root fracture lines.

Morphometric analysis of the mandibular fossa in dentate and edentulous patients: A cone beam computed tomography study.

STATEMENT OF PROBLEM: Mandibular fossa roof thickness and lateral inclination could be associated with the presence of bone changes in the mandibular condyle in dentate and edentulous patients. However, literature regarding the relationship between the presence and absence of teeth and the morphologic features of the temporomandibular joint is lacking. This knowledge could provide a better understanding of changes affecting the correct functioning of the stomatognathic system. PURPOSE: The purpose of this clinical study was to assess the mandibular fossa roof thickness and lateral inclination in relation to sex, presence or absence of teeth, and bone changes in the mandibular condyle through cone beam computed tomography (CBCT). MATERIAL AND METHODS: CBCT scans of 100 individuals (50 dentate and 50 edentulous) were evaluated in terms of mandibular fossa roof thickness and lateral inclination. Bone changes in the mandibular condyle were classified dichotomously in relation to osteophytes, erosion, sclerosis, and flattening. Differences were assessed with the Student t test, the chi-square test, and 2-way analysis of variance (ANOVA), with Tukey post hoc tests (α=.05). RESULTS: Sex was not related to mandibular fossa measurements. Edentulous participants showed a higher mandibular fossa lateral inclination (P<.001) and lower roof thickness (P=.001) than dentate participants. When the association between bone changes in the mandibular condyle was evaluated in dentate and edentulous groups, only sclerosis showed a statistically significant association (P<.001). The 2-way ANOVA showed that the mandibular fossa roof thickness was lower in edentulous participants in the presence of flattening and erosion and that the mandibular fossa lateral inclination was higher in the presence of osteophytes, erosion, and sclerosis (P<.001). Among dentate participants, the mandibular fossa lateral inclination was higher in the presence of flattening (P=.024). CONCLUSIONS: Mandibular fossa roof thickness and lateral inclination are not associated with sex. However, tooth absence and bone changes in the mandibular condyle are related to mandibular fossa measurements.

Vertical root fracture diagnosis in teeth with metallic posts: Impact of metal artifact reduction and sharpening filters.

Purpose: This study examined the influence of a metal artifact reduction (MAR) tool, sharpening filters, and their combination on the diagnosis of vertical root fracture (VRF) in teeth with metallic posts using cone-beam computed tomography (CBCT). Materials and Methods: Twenty single-rooted human premolars - 9 with VRF and 11 without - were individually placed in a human mandible. A metallic post composed of a cobalt-chromium alloy was inserted into the root canal of each tooth. CBCT scans were then acquired under the following parameters: 8 mA, a 5×5 cm field of view, a voxel size of 0.085 mm, 90 kVp, and with MAR either enabled or disabled. Five oral and maxillofacial radiologists independently evaluated the CBCT exams under each MAR mode and across 3 sharpening filter conditions: no filter, Sharpen 1×, and Sharpen 2×. The diagnostic performance was quantified by the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. These metrics were compared using 2-way analysis of variance with a significance level of α=5%. Intra- and inter-examiner agreement were assessed using the weighted kappa test. Results: Neither MAR nor the application of sharpening filters significantly impacted AUC or specificity (P>0.05). However, sensitivity increased when MAR was combined with Sharpen 1× and Sharpen 2× (P=0.015). The intra-examiner agreement ranged from fair to substantial (0.34-0.66), while the inter-examiner agreement ranged from fair to moderate (0.27-0.41). Conclusion: MAR in conjunction with sharpening filters improved VRF detection; therefore, their combined use is recommended in cases of suspected VRF.

Can human sex be estimated based on the dimensions of the maxillary sinuses? A systematic review of the literature on cone-beam and multi-slice computed tomography.

PURPOSE: To critically appraise and summarize the potential of linear and/or volumetric dimensions of the maxillary sinuses obtained with cone-beam and multi-slice computed tomography. METHODS: A bibliographic search was conducted in seven databases in August 2023. Cross-sectional retrospective studies using linear and volumetric measurements of the maxillary sinuses obtained with cone-beam and multi-slice computed tomography for sex estimation and presenting numerical estimation data were included. Narrative or systematic reviews, letters to the editor, case reports, laboratory studies in animals, and experimental studies were excluded. The critical appraisal and certainty of evidence were assessed using the guidelines described by Fowkes and Fulton and GRADE, respectively. RESULTS: A total of 656 studies were found, 32 of which were included. A total of 3631 individuals were analyzed and the overall sex estimation rate ranged from 54.9 % to 95 %. When compared with isolated measurements, combined linear measurements of the right and left maxillary sinuses, such as width, length, and height, provided a higher rate of sex estimation (54.9-95 %). In most of the studies (62.5 %), all measurements were higher in men than in women. Multiple methodological problems were found in the studies, especially distorting influences in 84.4 % of the answers. The certainty of evidence varied from very low to low. CONCLUSIONS: The combination of height, width, and length measurements of the right and left maxillary sinuses from cone-beam and multi-slice computed tomography can be useful in the estimation of sex of humans. Further primary studies are needed to increase the certainty of evidence. PROSPERO REGISTER: CRD42020161922.

Can the detection of second mesiobuccal canals be enhanced based on the volume of adjacent canals?

OBJECTIVES: The purpose of this study was to evaluate whether the presence of the second mesiobuccal (MB2) canal is related to volumetric differences on the adjacent canals of maxillary molars. DESIGN: Forty-seven maxillary first and second molars with and without the MB2 canal were individually scanned using microcomputed tomography (micro-CT). The volume of each canal was measured by an evaluator with experience in micro-CT analysis. The intraclass correlation coefficient (ICC) was obtained. Multiple logistic regression and odds ratio was calculated. To compare the volume of canals in molars with and without MB2, the Mann-Whitney test was applied (α = 0.05). RESULTS: The intra-examiner reproducibility was almost perfect (ICC=0.97). Multiple logistic regression demonstrated that the volume of the mesiobuccal (MB1) canal can possibly act as a predictor of the presence of the MB2 canal. It was also found that the MB1 canal volume is larger in molars without the MB2 canal (p = 0.01). No statistically significant difference was observed in the adjacent canals (p > 0.05). CONCLUSIONS: Despite the challenging detection of the presence of MB2 canals, clinicians should be aware that MB1 canals of reduced volume are highly suggestive of their presence.

Can maxillary molar dimensions predict the presence of the second mesiobuccal canal?

OBJECTIVE: To evaluate the potential of maxillary molar dimensions as predictors of the presence of the second mesiobuccal (MB2) canal. METHODS: Micro-computed tomography scans were obtained from 47 maxillary molars, out of which 26 had the MB2 canal. The distance between root canals, extension of the canals, and thickness of surrounding dentin were obtained from axial images at the furcation level, 3 mm from the apex, and 5 mm from the apex. The association between the measurements and the presence of the MB2 canal was assessed using multiple logistic regression and odds ratio. RESULTS: At the furcation level, the bucco-palatal extension of the MB1 canal significantly decreased the chance of the presence of the MB2 canal. Regarding the thickness of surrounding dentin measurements, the mesial and distal aspects of the MB1 canal at 3 mm from the apex were statistically significant to decrease and increase the chance of presence of the MB2 canal, respectively. Regarding the extension of the canals, only buccal-palatal extension seems to decrease the chance of the presence of the MB2 canal. CONCLUSION: The presence of the MB2 canal in the mesiobuccal root of maxillary molars is associated with the bucco-palatal extension and surrounding dentin thickness of the first mesiobuccal canal, and seems to be unrelated to the dimensions of the distobuccal and palatal roots.

The metal post material influences the performance of artefact reduction algorithms in CBCT images.

This study aimed to assess the effect of the MAR tool on the expression of artefacts in different regions of a tooth restored with different types of metal posts. Alveolar sockets (anterior, and posterior region) of a mandible and an unirradicular tooth were used. Cone beam computed tomography scans of the tooth without a metal post, and with cobalt-chromium (Co-Cr), nickel-chromium (Ni-Cr), or silver-palladium (Ag-Pd) were individually obtained, with 2 MAR conditions: disabled, and enabled. In an axial reconstruction, lines of interest (LOIs) were set around the canal: 4 in oblique (mesiobuccal, distobuccal, mesiolingual, distolingual) directions, and 4 in orthogonal (mesial, distal, buccal, lingual) directions. Beam-hardening artefacts expression was determined by calculating the difference in the mean of gray values (DMGV) between the experimental and control groups for each LOI. There was no significant difference in the DMGV values between "without MAR" and "with MAR" for any LOI, in neither anterior nor posterior mandible (p>0.05), for the Ni-Cr and Co-Cr groups. For the Ag-Pd, significant differences in the DMGV values were observed between "without MAR" and "with MAR" for most LOIs (p<0.05), mainly in oblique directions in the anterior region, and mesio-distal direction in the posterior region. MAR acted mostly in hypodense artefacts (negative DMGV). The effectiveness of the MAR tool of the OP300 CBCT unit varied according to the post material tested. It was effective in reducing the expression of artefacts raised by the Ag-Pd post, mainly in the tooth regions affected by hypodense artefacts, regardless of the mandibular region.

Morphological characteristics of the mesiobuccal root in the presence of a second mesiobuccal canal: a micro-CT study.

Objectives: This study investigated the internal morphology of mesiobuccal (MB) roots of maxillary molars with a second mesiobuccal (MB2) canal. Materials and Methods: Forty-seven maxillary first or second molars from Brazilians were scanned using micro-computed tomography. The following measurements were obtained from the MB roots: root thickness, root width, and dentin thickness of the buccal aspect of the first mesiobuccal (MB1) canal, between the MB1 and MB2 canals, and the palatal aspect of the MB2 and MB1 canals at 3 mm from the root apex and in the furcation region. For statistical analysis, the Student's t-test and analysis of variance with the post-hoc Tukey test were used (α = 0.05). Results: In maxillary molars with an MB2 canal, MB roots were significantly thicker (p = 0.0014) and narrower (p = 0.0016) than in maxillary molars without an MB2 canal. The dentin thickness of the palatal aspect of the MB1 canal was also significantly greater than that of MB roots without an MB2 canal at 3 mm from the root apex (p = 0.0007) and in the furcation region (p < 0.0001). In the furcation region of maxillary molars with an MB2 canal, the dentin thickness between the MB1 and MB2 canals was significantly smaller than that in the buccal and palatal aspects (p < 0.0001). Conclusions: The internal morphology of MB roots of maxillary molars with an MB2 canal revealed differences in dentin thickness, root diameter, and distance between the canals when compared with maxillary molars without an MB2 canal.

Distortion or magnification? An in vitro cone-beam CT study of dimensional changes of objects with different compositions.

OBJECTIVES: To assess whether dimensional changes occur as shape distortion (unevenly), contraction or magnification (evenly) in cone beam computed tomography (CBCT) considering materials, anatomical regions and metal artefact reduction algorithms. METHODS: Four cylinders of amalgam (Am), cobalt-chromium (Co-Cr), gutta-percha (Gu), titanium (Ti) and zirconium (Zi) were inserted inside a polymethylmethacrylate phantom in anterior and posterior regions for acquisitions in Picasso Trio and OP300 with MAR enabled and disabled. Two observers measured the dimensions of each cylinder in three axes: Y (height), Z (antero posterior diameter) and X (latero-lateral diameter). Repeated measures ANOVA with Tukey post-hoc test compared the data (α = 5%). RESULTS: Shape distortion occurred for all materials in anterior region of Picasso Trio without MAR (p < 0.05). With MAR enabled, Gu and Ti contracted (p ≥ 0.05), while the others showed distortion (p < 0.05). In posterior region, all materials distorted in both MAR conditions (p < 0.05), except Gu, which magnified without MAR (p ≥ 0.05) and contracted unevenly with MAR (p < 0.05). In anterior region of OP300, all materials magnified without MAR, (p ≥ 0.05) and had shape distortion with MAR (p < 0.05). In posterior region, only Am showed magnification without MAR (p ≥ 0.05), while all materials presented shape distortion with MAR (p < 0.05). CONCLUSION: Dimensional changes of high-density materials in CBCT can be either a magnification, a contraction or a distortion; the last condition is the most prevalent. Furthermore, changes differ considering material, anatomical region and MAR condition.

The metal post material influences the performance of artefact reduction algorithms in CBCT images

Abstract This study aimed to assess the effect of the MAR tool on the expression of artefacts in different regions of a tooth restored with different types of metal posts. Alveolar sockets (anterior, and posterior region) of a mandible and an unirradicular tooth were used. Cone beam computed tomography scans of the tooth without a metal post, and with cobalt-chromium (Co-Cr), nickel-chromium (Ni-Cr), or silver-palladium (Ag-Pd) were individually obtained, with 2 MAR conditions: disabled, and enabled. In an axial reconstruction, lines of interest (LOIs) were set around the canal: 4 in oblique (mesiobuccal, distobuccal, mesiolingual, distolingual) directions, and 4 in orthogonal (mesial, distal, buccal, lingual) directions. Beam-hardening artefacts expression was determined by calculating the difference in the mean of gray values (DMGV) between the experimental and control groups for each LOI. There was no significant difference in the DMGV values between "without MAR" and "with MAR" for any LOI, in neither anterior nor posterior mandible (p>0.05), for the Ni-Cr and Co-Cr groups. For the Ag-Pd, significant differences in the DMGV values were observed between "without MAR" and "with MAR" for most LOIs (p<0.05), mainly in oblique directions in the anterior region, and mesio-distal direction in the posterior region. MAR acted mostly in hypodense artefacts (negative DMGV). The effectiveness of the MAR tool of the OP300 CBCT unit varied according to the post material tested. It was effective in reducing the expression of artefacts raised by the Ag-Pd post, mainly in the tooth regions affected by hypodense artefacts, regardless of the mandibular region.

Resumo O objetivo nesse estudo foi avaliar o efeito da ferramenta de redução de artefato (FRA) na expressão de artefatos em diferentes regiões de um dente restaurado com diferentes tipos de pinos metálicos. Foram usados ​​alvéolos (regiões anterior e posterior) de uma mandíbula e um dente unirradicular. Imagens de tomografia computadorizada de feixe cônico do dente sem pino metálico intracanal e com pinos de cobalto-cromo (Co-Cr), níquel-cromo (Ni-Cr) ou prata-paládio (Ag-Pd) foram individualmente obtidas, com 2 condições de FRA: desativada e ativada. Em uma reconstrução axial, linhas de interesse (LOIs) foram definidas ao redor do canal: 4 em direções oblíquas (mésio-vestibular, disto-vestibular, mésio-lingual e disto-lingual) e 4 em direções ortogonais (mesial, distal, vestibular e lingual). A expressão dos artefatos de endurecimento do feixe foi determinada pelo cálculo da diferença na média dos valores de cinza (DMVC) entre os grupos experimental e controle para cada LOI. Não houve diferença significativa nos valores de DMVC entre as condições "sem FRA" e "com FRA" para nenhuma das LOIs, nem na região anterior nem na região posterior da mandíbula (p>0,05), para os grupos Ni-Cr e Co-Cr. Para o Ag-Pd, diferenças significativas nos valores de DMVC foram observadas entre "sem FRA" e "com FRA" para a maioria das LOIs (p<0,05), principalmente nas direções oblíquas na região anterior, e na direção mesio-distal na região posterior. A FRA atuou principalmente em artefatos hipodensos (DMVC negativos). A eficácia da FRA disponível no aparelho de TCFC OP300 variou de acordo com o material do pino testado. Ela foi efetiva na redução da expressão de artefatos originados por pinos de Ag-Pd, principalmente nas regiões do dente afetadas por artefatos hipodensos, independentemente da região mandibular.