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Accuracy of film-based, digital, and enhanced digital images for endodontic length determination.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Apr;99
Woolhiser GA, Brand JW, Hoen MM, Geist JR, Pikula AA, Pink FE.
OBJECTIVE: This study compared the accuracy of D- and F-speed intraoral radiographs
and digital and enhanced digital radiographic images for endodontic file length determination.
STUDY DESIGN: Size 15 K-files were bonded in 51 canals of 34 human cadaver teeth.
The distance from file tip to root apex was measured on D- and F-speed film and
on unenhanced and enhanced digital images. The quality of the images was rated by
the observers. Overlying cadaver bone and root structure were subsequently removed
to expose the file tip for actual measurement to the apex. The distance measured
on each image was compared with the actual measurement. ANOVA, Kruskal-Wallis,
sign test, and Pearson correlation statistical analyses were applied. RESULTS:
There were no significant differences in measurement accuracy among the 4 image
types (P < or = .05). Subjective ratings showed a preference for the quality
of enhanced digital images. Conclusion All 4 image types were similar in accuracy
of file measurement. The image quality of
enhanced digital images was subjectively superior to the others.
Students' attitudes to digital radiography and measurement accuracy of two digital systems in connection with root canal treatment.
Eur J Dent Educ. 2004 Nov;8(4):167-71.
Wenzel A, Kirkevang LL.
The aim of this study was to evaluate students' attitudes towards digital radiography
and measurement accuracy in digital images recorded with a CCD-sensor and a photostimulable
phosphor (PSP) plate radiography system in connection with root canal treatment.
Thirty-one dental students participated in an endodontic course. Two single-rooted
teeth were assigned at random to two receptors for digital radiographic examination,
either (i) the RVG-ui CCD sensor or (ii) the Digora PSP plate system. After the
endodontic treatment had been completed for the first tooth, the student filled
in a questionnaire on their use of the digital system. Thereafter, the students
switched radiography system and repeated the procedure for the second tooth.
Eventually, the students completed the questionnaire by answering questions
that directly compared the two digital systems. The gutta-percha filled tooth
was measured using the system's own software. Two measurements of each tooth
were performed: total tooth length (TTL) and root filling length (RFL). The
teeth were dismounted from the plaster blocks and the true TTL and RFL was
measured with an electronic slide calliper. The majority of the students
had used the contrast enhancement facility (CCD sensor = 52%, PSP = 71%)
and the zoom facility (65-68%) whilst some had used the density enhancement
facility (CCD sensor = 39%, PSP = 55%). The students stated that they saved
more time when they used the CCD sensor than when they used the PSP system
(P < 0.001), and that it was easier to position the tooth with the PSP plate
than with the sensor (P < 0.01). The lengths measured on the digital images
from both digital systems were marginally larger than the true tooth lengths
(P < 0.05). However, there was no
difference between the two digital systems for the TTL/RFL ratio (P > 0.05).
Evaluation of endodontic files in digital radiographs before and after employing three image processing algorithms.
Dentomaxillofac Radiol. 2004 Jan;33(1):6-11.
Li G, Sanderink GC, Welander U, McDavid WD, Nasstrom K.
OBJECTIVES: Two digital image processing algorithms, one aimed at correction for
exponential attenuation and one at correction for visual response, have been developed.
The aims of the present study were to test whether digital radiographs processed with
these algorithms improve determination of the length of endodontic files and whether
such processed radiographs are comparable with the radiographs processed with a default
image processing method employed by one commercially available digital intraoral system.
METHODS: A dried human skull embedded in an acrylic compound was used for exposing
radiographs of the upper and lower premolars and molars with endodontic files
(Kerr files size 10 and size 15) positioned to the full length of the roots or 1.5 mm
short of it. Radiographs were then processed in three sets. In one set, the radiographs
were processed to compensate for exponential attenuation and the response of the human
visual system. In the second, the radiographs were processed with the same compensation
but with an additional shift in grey levels so that the output luminance in dentin at
root tips corresponds to the mean of the luminance range of a computer monitor.
In the third, the radiographs were processed with the default processing method
in the Sidexis program. Ten viewers evaluated all radiographs. Receiver operating
characteristic (ROC) curves were obtained and areas under the curves were calculated.
RESULTS: For file size 10, ROC curves for processed radiographs were higher than
that for originals, while for file size 15, ROC curves for processed and original
radiographs were close to each other. Significant differences were found between
processed and original radiographs regarding areas under ROC curves for file
size 10 but not between the differently processed radiographs. For file size 15,
no significant differences were found. CONCLUSION: Radiographs processed to
correct for attenuation and visual response may improve determination of
the length of thin endodontic files. Such processed radiographs are comparable with the radiographs processed with the default processing method
in the Sidexis program.
Fraudulent management of digital endodontic images.
Int Endod J. 2004 Mar;37(3):214-20.
Guneri P, Akdeniz BG.
AIM: To present examples of radiographic image reconstructions in endodontic treatment,
to discuss the potential problems arising from the use of image processing software and
to mention some current methods to prevent such counterfeit utilization of digital
endodontic radiographs. SUMMARY: Conventional Ultra-Speed periapical films of root
canal treatment were digitized with flatbed scanner (Umax Powerlook II, Umax Technologies,
Inc., Taiwan). Digital images were altered with PHOTOSHOP 6.0 software
(Adobe Corporation, San Jose, CA, USA). Carious lesions, periapical pathoses,
fake root canals and artificial fillings were created, and inadequate treatment
was corrected by application of various image manipulation functions of the
software. KEY LEARNING POINTS: Digital endodontic images can be altered with
image processing software. The use of digital radiographic data inevitably raises
concerns about security, reliability and the potential for fraud.
Root canal preparation with Endo-Eze AET: changes in root canal shape assessed by micro-computed tomography.
Int Endod J. 2005 Jul;38(7):456-64.
Paque F, Barbakow F, Peters OA.
AIM: To evaluate the relative performance of Endo-Eze Anatomic Endodontic Technology (AET)
stainless steel instruments when shaping maxillary molar root canals in vitro. Methodology
Extracted human maxillary molars were scanned, before and after root canal shaping with
Endo-Eze AET, employing micro-computed tomography (muCT) at an isotropic resolution of
34 microm. Three-dimensional root canal models were reconstructed and evaluated for
volume, surface area, 'thickness' (diameter), canal transportation and prepared surface.
Preparation errors such as apical zips, perforations and fractured instruments were
visually determined from those models. Means were contrasted using anova and Scheffe
post-hoc tests. RESULTS: Volume and surface area increased significantly and similarly
in mesiobuccal (mb), distobuccal (db) and palatal (p) canals and gross preparation
errors (n = 17) were found. Mean root canal diameters, 5 mm coronal to the apex,
increased from 0.31 to 0.52, 0.35 to 0.50 and 0.50 to 0.70 mm for mb, db and p canals,
respectively. Mean canal transportation ranged from 0.15 to 0.29, 0.15 to 0.27 and
0.21 to 0.33 mm for apical, middle and coronal root canal levels, respectively,
with highest values found for mb canals (P < 0.003). Root canals were significantly
straightened during preparation (P < 0.002). CONCLUSIONS: In summary,
Endo-Eze AET instruments shaped root canals in maxillary molars with
substantial canal transportation, particularly in mesiobuccal root canals.
Preparation with this instrument removed high volumes of dentine, even though
apical preparation was size 30. Based on the current results, Endo-Eze AET
cannot be recommended for the preparation of teeth with curved root canals.
In vitro comparison of root-canal measurements with conventional and digital radiology.
Int Endod J. 2002 Jun;35(6):542-50.
Lozano A, Forner L, Llena C.
AIM: The present study compared the efficacy of digital and conventional radiology for
root-canal length measurement. METHODOLOGY: Seventy extracted teeth with pre-served
roots were used. Root-canal length measurements were completed with K-Flexofiles
(numbers 08, 10 and 15) with conventional and digital radiography using two systems
(radiovisiography and photostimulate storage phosphor). All films and sensors were
exposed at projections of 0 degrees and 20 degrees to the mesial. The images obtained
were evaluated with and without magnification, and analysed using the Cohen's kappa test.
The accuracy of the three systems to determine the root-canal length were evaluated by
measuring the distance from the tip of the file to the apex. RESULTS: Most of the values
corresponding with the apex occurred with conventional radiology. The digital systems
yielded negative values that improved with a size 15 file. The agreement between the
two digital systems was the best with size 15 file using 0 degrees projection (66.7%).
CONCLUSIONS: Conventional radiology remains the technique of choice in determining
the root-canal length; the digital techniques yielded good results for size 15 file.
Non-Destructive, Preclinical Evaluation of Root Canal Anatomy of Human Teeth with Flat-Panel Detector Volume CT (FD-VCT).
Rofo. 2005 Dec;177(12):1683-90.
Heidrich G, Hassepass F, Dullin C, Attin T, Grabbe E, Hannig C.
PURPOSE: Successful endodontic diagnostics and therapy call for adequate depiction
of the root canal anatomy with multimodal diagnostic imaging. The aim of the present
study is to evaluate visualization of the endodont with flat-panel detector volume CT
(FD-VCT). MATERIALS AND METHODS: 13 human teeth were examined with the prototype of a
FD-VCT. After data acquisition and generation of volume data sets in volume rendering
technology (VRT), the findings obtained were compared to conventional X-rays and
cross-section preparations of the teeth. RESULTS: The anatomical structures of the
endodont such as root canals, side canals and communications between different root
canals as well as denticles could be detected precisely with FD-VCT. The length of
curved root canals was also determined accurately. The spatial resolution of the
system is around 140 microm. Only around 73 % of the main root canals detected with
FD-VCT and 87 % of the roots could be visualized with conventional dental X-rays.
None of the side canals, shown with FD-VCT, was detectable on conventional X-rays.
In all cases the enamel and dentin of the teeth could be well delineated. No
differences in image quality could be discerned between stored and freshly extracted
teeth, or between primary and adult teeth. CONCLUSION: FD-VCT is an innovative
diagnostic modality in preclinical and experimental use for non-destructive
three-dimensional analysis of teeth. Thanks to the high isotropic spatial
resolution compared with conventional X-rays, even the minutest structures,
such as side canals, can be detected and evaluated. Potential applications
in endodontics include diagnostics and evaluation of all steps of root canal treatment,
ranging from trepanation
through determination of the length of the root canal to obturation.
Radiographic success of ferric sulfate and formocresol pulpotomies in relation to early exfoliation..
Pediatr Dent. 2005 May-Jun;27(3):233-7.
Vargas KG, Packham B.
PURPOSE: The purpose of this retrospective study was to evaluate the radiographic
findings with formocresol and ferric sulfate pulpotomies in relation to early tooth loss.
METHODS: Vital pulpotomies with either ferric sulfate or formocresol, performed by faculty
members between 1992 and 2002 at The University of Iowa, were evaluated retrospectively.
Radiographic criteria were established to assess success or failure of the treated tooth.
This was then correlated with time of tooth loss and space management. RESULTS: Eighty-five
molars, followed between 6 to 61 months, met the inclusion criteria. Of these, 15 (43%)
teeth treated with ferric sulfate, 23 (56%) treated with formocresol, and 5 (55%) treated
with a combination of ferric sulfate and formocresol remained free of any radiographic
pathology. Overall, 13% of the pulpotomized teeth were prematurely lost due to abscess
formation and in need of space management. Regardless of the treatment type, internal
root resorption was the most common cause of premature exfoliation. CONCLUSIONS: Both
ferric sulfate and formocresol pulpotomies can lead to premature exfoliation of
primary teeth, with the subsequent need for orthodontic space maintenance. Therefore,
radiographic criteria should be taken
into consideration when evaluating pulpotomized teeth at recall visits.
The imaging of root canal obturation using micro-CT.
Int Endod J. 2005 Sep;38(9):617-26.
Jung M, Lommel D, Klimek J.
AIM: To examine the potential and accuracy of micro-computed tomography (micro-CT)
for imaging of filled root canals. METHODOLOGY: The root canals of five extracted
maxillary teeth were shaped manually with K-files. After irrigation and drying,
the root canals were filled by lateral condensation using gutta-percha cones and
AH plus (Dentsply Maillefer, Ballaigues, Switzerland) as sealer. The filled root
canals were examined by micro-CT at resolutions <11 microm. Three-dimensional
reconstructions of the root canal fillings were made. The roots were sectioned
histologically and standard photographs of the sectioned surfaces were taken.
Digitized photographic images and the corresponding micro-CT sections were
correlated qualitatively by superimposition. Quantitative morphometric data
were obtained with respect to the surface area of the root canal filling and
the individual gutta-percha points of the histological and the micro-CT sections.
Pearson correlation coefficients were calculated. RESULTS: There was a good
qualitative correlation between the images from the histological and the micro-CT sections.
The fillings were clearly differentiated from the root canal walls. Individual
gutta-percha cones and sealer were discernable. Pearson correlation coefficients
showed a highly significant correlation between the two methods (P < 0.001) with
respect to the area of the complete root canal filling (r = 0.992) and the gutta-percha cones
(r = 0.968). CONCLUSIONS: The micro-CT technique was a highly accurate and
nondestructive method for the evaluation of root canal fillings and its constituents.
Qualitative and quantitative correlation
between histological and micro-CT examination of root canal fillings was high.
An evaluation of the quality of root fillings in mandibular incisors and maxillary and mandibular canines using different methodologies.
J Dent. 2005 Sep;33(8):683-8.
van der Sluis LW, Wu MK, Wesselink PR.
OBJECTIVES: To evaluate the quality of root fillings in mandibular incisors and maxillary
and mandibular canines using different methodologies of evaluation, namely radiographs,
the fluid transport test and the percentage of gutta-percha (PGP), and to determine if
a correlation occurs between the results of the different methodologies used. METHODS:
One group of mandibular incisors with oval canals (n=20) and one group of maxillary
and mandibular canines (n=20) were instrumented and obturated by cold lateral compaction
using AH 26 as the sealer. The filled roots were bucco-lingually and mesio-distally
radiographed. Using a scoring system, the quality of each root filling was radiographically
evaluated, the higher the score the poorer the quality. Fluid transport along the root
filling was then measured using a fluid transportation device. Each root was horizontally
sectioned 4 and 6mm from the apex. Images of the cross-sections were taken, using a
microscope and a digital camera. Images were scanned into a PC as TIFF images. Using a
KS 100 Imaging system the canal area and the gutta-percha filled areas were measured.
The percentage of gutta-percha filled areas was calculated. RESULTS: Considering the
radiographic scores of the two different projections together the score was
significantly higher for the mandibular incisors than for the canines (P=0.039).
The radiographic score was significantly higher for the mesio-distal radiograph in
comparison with the bucco-lingual radiograph (P=0.0001), for the canines as well
as the incisors. Using only the bucco-lingual radiograph there was no significant
difference between the mandibular incisors and the canines (P=0.992).
The mandibular incisors displayed significantly more fluid transport than
the canines (P=0.049). A significantly greater percentage of gutta-percha
filled areas was found in the cross-sections of canines as compared to the
cross-sections of mandibular incisors (P=0.000001). The correlation between
the radiographic score of the mesio-distal radiograph and the PGP 4 and 6mm was significant (P=0.013). There was no significant correlation
between the FT and the radiograph or the FT and the PGP. CONCLUSIONS: The quality of
the root fillings in oval canal-mandibular incisors may be compromised.
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