A Clinical Evaluation of Cone-beam Computed Tomography: Implications for Endodontic Microsurgery

Molly Kopacz; John J Neal; Calvin Suffridge; Terry D Webb; Jason Mathys; Daniel Brooks; Gregory Ringler

doi:10.1016/j.joen.2021.03.014

A Clinical Evaluation of Cone-beam Computed Tomography: Implications for Endodontic Microsurgery

J Endod. 2021 Jun;47(6):895-901. doi: 10.1016/j.joen.2021.03.014. Epub 2021 Mar 31.

Authors

Molly Kopacz¹, John J Neal², Calvin Suffridge¹, Terry D Webb¹, Jason Mathys¹, Daniel Brooks³, Gregory Ringler⁴

Affiliations

¹ Department of Endodontics, Naval Postgraduate Dental School, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Uniformed Services, University of the Health Sciences, Bethesda, Maryland.
² Department of Endodontics, Naval Postgraduate Dental School, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Uniformed Services, University of the Health Sciences, Bethesda, Maryland. Electronic address: jjneal34@icloud.com.
³ Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland.
⁴ Department of Uniformed Services, University of the Health Sciences, Bethesda, Maryland; Oral and Maxillofacial Radiology, Naval Postgraduate Dental School, Navy Medicine Professional Development Center, Bethesda, Maryland.

PMID: 33798543
DOI: 10.1016/j.joen.2021.03.014

Abstract

Introduction: Cone-beam computed tomographic (CBCT) imaging is a valuable diagnostic tool for endodontics. Some studies report that CBCT images have limitations in representing the true clinical presentation. This prospective, in vivo study compared limited field of view (LFOV) CBCT measurements with clinical measurements made during endodontic surgery.

Methods: Eighty-seven subjects requiring endodontic surgery and LFOV CBCT acquisition of the surgical site were enrolled. Data collection involved clinicians answering standardized questions during the radiographic and surgical assessment. Intraoperatively, data were collected and photographically documented. Postoperatively, CBCT scans were evaluated by 3 calibrated, board-certified specialists: 2 endodontists and 1 oral and maxillofacial radiologist. The 2 subsets of data were compared through statistical analysis to quantify their relationship.

Results: The subjects included 65 maxillary and 29 mandibular teeth from 87 subjects: 25 women and 62 men with an average age of 42 years old. The CBCT evaluators correctly identified the presence or absence of buccal plate fenestrations with 91.0% accuracy (95% confidence interval, 83.1-96.0) with 89.4% sensitivity and 92.9% specificity. The area of fenestrations measured clinically (mean = 19.6 ± 33.4 mm²) was generally larger than the area measured by CBCT imaging (mean across CBCT evaluators = 12.2 ± 19.1 mm²). Fenestration size in the maxillary arch was more likely to be underestimated than in the mandibular arch (P < .0001). Vertical bone height was also underestimated when measured on CBCT imaging.

Conclusions: Based on the findings of this study, LFOV CBCT imaging accurately identifies the presence or absence of buccal plate fenestrations, yet, when a fenestration is present, underestimates its area.

Keywords: Apicoectomy; buccal cortical plate; cone-beam computed tomography; dehiscence; endodontic microsurgery; fenestration; limited field of view CBCT; measurement accuracy; root-end surgery; treatment planning; vertical bone height.

Published by Elsevier Inc.

MeSH terms

Adult
Cone-Beam Computed Tomography
Endodontics*
Endodontists*
Female
Humans
Male
Microsurgery
Prospective Studies