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Comparison of 6 cone-beam computed tomography systems for image quality and detection of simulated canine impaction-induced external root resorption in maxillary lateral incisors

https://doi.org/10.1016/j.ajodo.2011.03.021Get rights and content

Introduction

The most frequent adverse effect of canine impaction is resorption of the adjacent incisors. The subjective image quality and the radiographic diagnostic accuracy for detection of simulated canine-induced external root resorption lesions in maxillary lateral incisors were compared among 6 cone-beam computed tomography (CBCT) systems in vitro.

Methods

A child cadaver skull in the early mixed dentition was obtained. This skull had an impacted maxillary left canine and allowed a reliable simulation. Simulated root resorption cavities were created in 8 extracted maxillary left lateral incisors by the sequential use of 0.16-mm diameter round burs in the distopalatal root surface. Cavities of varying depths were drilled in the middle or apical thirds of each tooth root according to 3 setups: slight (0.15, 0.20, and 0.30 mm), moderate (0.60 and 1.00 mm), and severe (1.50, 2.00, and 3.00 mm) resorption. The lateral incisors, including 2 intact teeth, were repositioned individually in the alveolus with approximal contacts to the impacted maxillary left canine. Six sets of radiographic images were obtained with 3D Accuitomo-XYZ Slice View Tomograph (J. Morita, Kyoto, Japan), Scanora 3D CBCT (Soredex, Tuusula, Finland), Galileos 3D Comfort (Sirona Dental Systems, Bensheim, Germany), Picasso Trio (E-WOO Technology, Giheung-gu, Republic of Korea), ProMax 3D (Planmeca OY, Helsinki, Finland), and Kodak 9000 3D (Trophy, Croissy-Beaubourg, France) for each tooth setup. The CBCT images were acquired and subsequently analyzed by 12 observers. Linear models for repeated measures were used to compare the CBCT systems for the image quality and the degree of agreement between the diagnosed severity of root resorption and the true severity.

Results

The differences in the image quality between CBCT systems were statistically significant (P <0.001). The root resorption scores between CBCT systems showed a significantly higher score for the ProMax when compared with the Galileos and the Kodak. However, the differences in agreement between the diagnosed severity of root resorption and the true severity for all resorption sizes were not significantly different (P >0.05) among the different CBCT systems.

Conclusions

High image quality is important when detecting root resorption. The CBCT systems used in this study had high accuracy with no significant differences between them in the detection of the severity of root resorption.

Section snippets

Material and methods

A child cadaver skull in the early mixed dentition phase was used; this skull had an impacted left maxillary canine (Fig 1). CBCT radiographs of the dry skull were taken in specific in-vitro conditions as described by Alqerban et al.26 Briefly, 8 setups were examined, each with a different maxillary left lateral incisor placed into the extraction site of the maxillary left lateral incisor. Each of the 8 selected lateral incisors was specifically modified to simulate the resorption process

Results

The image quality scores of pulp, dentin, and enamel; lamina dura; and overall image noise scored by 12 observers (first evaluation session) of each CBCT system are shown in Figure 3, A. The results of the second evaluation session of the image quality of dental structures by the 2 radiologists are shown in Figure 3, B. Figure 4 shows the sum of the image quality scores for each CBCT system. The differences in the image quality scores between CBCT systems were statistically significant (P

Discussion

Image quality has been extensively discussed in the literature. The assessment of root resorption caused by an impacted canine to the adjacent teeth by using images of high quality is essential to allow for the best visualization of early resorption and to decrease misinterpretation caused by image noise. The 3D imaging has been readily available for accurate, easily interpreted representations of root resorption. In previous studies, CBCT has been used to evaluate the severity of resorptive

Conclusions

Based on the results of this study, the CBCT systems tested showed variable image qualities. This might have surely affected the detectability and diagnostic accuracy of root resorption lesions. All CBCT systems in this study showed high accuracy in the detection of root resorption. There was no significant difference among CBCT systems in the detection of the severity of root resorption.

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    The authors report no commercial, proprietary, or financial interest in the products or companies described in this article.

    The research leading to these results received funding from the European Atomic Energy Community’s Seventh Framework Program FP7/2007-2011 under grant agreement no 212246 (SEDENTEXCT: Safety and Efficacy of a New and Emerging Dental X-ray Modality).

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    Listing of partners on www.sedentexct.eu.

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