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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 4  |  Page : 97-99

A comparison between RVG and 2D and 3D measurements using cone-beam computed tomography to predetermine root canal lengths


Department of Restorative Dental Science, King Khalid University, Saudi Arabia

Date of Submission28-Jul-2021
Date of Acceptance20-Sep-2021
Date of Web Publication27-Dec-2021

Correspondence Address:
Dr. Mohammed Hussain Dafer Al Wadei
Department of Restorative Dental Science, King Khalid University.
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_29_21

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  Abstract 

Introduction: One of the major problems in endodontic treatment is identifying and maintaining the biological length of the root canal system. The aim of this clinical study was to compare the effect of working length determination using radiovisiography (RVG) and two-dimensional (2D) and three-dimensional (3D) measurements using cone-beam computed tomography (CBCT). Materials and Methods: Sixty mandibular teeth were taken and three groups of 10 each were made. Teeth with previous endodontic treatments, metal restorations, resorptions, incomplete apex formations, and multiple visible foramina were excluded. The root canal length was determined using RVG, CBCT measurement method 2D, and CBCT measurement method 3D. The difference between CBCT measurements, RVG, and the actual canal length were compared to evaluate the accuracy of each method. Results: It was observed that no significant statistically difference was seen with 3D measurements and actual measurements. Measurements with RVG were better than those with CBCT 2D. Conclusion: Our study shows that CBCT 3D measurements are accurate when compared with RVG and CBCT 2D in the determination of root canal length.

Keywords: Cone-beam computed tomography, endodontics, radiovisiography, root canal length, stereomicroscope


How to cite this article:
Dafer Al Wadei MH. A comparison between RVG and 2D and 3D measurements using cone-beam computed tomography to predetermine root canal lengths. Int J Oral Care Res 2021;9:97-9

How to cite this URL:
Dafer Al Wadei MH. A comparison between RVG and 2D and 3D measurements using cone-beam computed tomography to predetermine root canal lengths. Int J Oral Care Res [serial online] 2021 [cited 2022 Jan 19];9:97-9. Available from: https://www.ijocr.org/text.asp?2021/9/4/97/333812




  Introduction Top


The radiographic method, traditionally the most popular and trusted way for length measurement in the field of endodontics, has advantages such as the direct observation of the anatomy of the root canal system, the number and curvature of roots, the presence or absence of the disease, and, in addition, acts as an initial guide for working length estimation.[1],[2] There are, however, a number of disadvantages that make this technique not quite suitable in every situation (e.g., the danger of overestimation of the root canal length even when it seems to be short of the radiographic apex because of normal anatomic variations in the apical region).[3],[4] Other shortcomings of radiography include technique sensitivity and subjectivity, the danger of ionizing radiation, and errors of superimposition caused by producing a two-dimensional (2D) representation from a three-dimensional (3D) object.[4],[5] Cone-beam computed tomography (CBCT) is a validated tool used to explore root canal morphology in 3D. Axial slices can show root canal angles and define the location of the major foramen, which is not identifiable with sufficient precision in periapical radiographs (PAS). Since the introduction of CBCT in dental medicine, this radiographic technique has also become an important method for diagnosis and treatment planning in endodontology.[6],[7] In addition to improving comprehension of tooth anatomy, CBCT has become an established method for diagnosing periapical pathologies, root fractures, and internal/external root resorptions. A better understanding of the third dimension of dental roots could also help to increase the accuracy of endodontic working length measurements and performance of root canal measurements on pre-existing CBCT scans, which is a potential new method for determining root canal length before initiating endodontic treatment. By taking advantage of all the visual information available in the field of view, clinicians can apply already existing CBCT data toward further interventions in the same region of the jaw, such as root canal treatments.[7],[8] The purpose of this study was to validate this new measurement method by analyzing its reliability and precision through a comparison with the standard clinical measurement procedure that uses CBCT.


  Materials and Methods Top


Sixty mandibular teeth were taken and three groups of 20 each were made. Teeth with previous endodontic treatments, metal restorations, resorptions, incomplete apex formations, and multiple visible foramina were excluded. The root canal length was determined using:

  1. Radiovisiography (RVG);


  2. CBCT measurement method 2D;


  3. CBCT measurement method 3D.


Differences between CBCT measurements, RVG, and the actual canal length were compared to evaluate the accuracy of each method. 3D image acquisition was performed using the CBCT CS 9300 (78 kV, 2 mA, Planmeca, Helsinki, Finland). The open source software CS 3D On Demand was used for the 3D multiplanar reconstruction and length measurements. All CBCT measurements were performed by a single experienced investigator. Subsequently, access cavities were prepared using Endo Acess and Endo Z, and patency of the root canals was verified with a size 08 K-file. Root canals were irrigated with 5.25% sodium hypochlorite. Coronal third was flared using a rotary file (ProTaper Shaping file SX, Dentsply Maillefer, Ballaigues, Switzerland) to gain a straight line access. The actual length of each root canal was measured by a different blinded examiner. A size 10 K-file was advanced within the root canal until it was visible with a stereomicroscope (Leica WILD M3Z; Leica Microsystems GmbH, Wetzlar, Germany). The rubber stop was adapted to the predefined coronal reference, and the actual canal length was determined.


  Results Top


The mean and standard deviations of the differences between CBCT 3D, RVG, and CBCT 2D were calculated. An analysis of variance (ANOVA) test was done, and comparison was done between the groups and within the group. Tukey’s honestly significant difference (HSD) test was done and the results are shown in [Table 1] and [Table 2]. No significant difference was seen with 3D measurements and actual measurements, and measurements with RVG were better than those with 2D.
Table 1: ANOVA test

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Table 2: Tukey’s HSD test

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  Discussion Top


Conventional measurement methods with tools such as an electronic apex locator and PAS have been well documented in literatures.[8],[9],[10] Since the introduction of CBCT in dental medicine, this radiographic technique has also become an important method for diagnosis and treatment planning in endodontology. In addition to improving comprehension of tooth anatomy, CBCT has become an established method for diagnosing periapical pathologies, root fractures, and internal/external root resorptions. Molar teeth can be especially challenging in this respect. Overlying dentine at the orifice should be removed initially to facilitate complete and straight access to the root canal, decrease the initial curvature, and prevent working length reduction during instrumentation. Radiographs could not always detect the apical foramen, and thus, length measurements could be unreliable because of superimpositions.[11],[12],[13],[14],[15] In contrast to radiographs, CBCT imaging can display both the mesiodistal and buccolingual shape of root canals and is able to show the apical foramen. Hence, in this study, a straight-line access was prepared, and the coronal third of the root canal was flared before the actual working length was measured. The primary objective of this study was to predetermine the root canal length using CBCT 3D, CBCT 2D, and RVG.

Sixty mandibular molars were taken for the study. It was found that results with CBCT 3D were more accurate when compared with RVG and CBCT 2D. The mean discrepancy found in this study between the CBCT measurements and the actual working length was in accordance as registered by the mentioned authors (0.40 mm according to Janner et al.[14] and 0.51 mm in the study published by Jeger et al.[15]). Measurements with CBCT 3D were better than those with RVG and CBCT 2D. This can be due to coronal references that are located buccally or lingually, and root canals with multiple curvatures cannot be projected reliably in a single plane.


  Conclusion Top


We can conclude that under experimental conditions, CBCT 3D measurements are accurate than RVG and CBCT 2D in the determination of root canal length.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ricucci D, Langeland K. Apical limit of root canal instrumentation and obturation, part 2. A histological study. Int Endod J 1998;31:394-409.  Back to cited text no. 1
    
2.
Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod 1990;16:498-504.  Back to cited text no. 2
    
3.
Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: Systematic review of the literature—Part 2. Influence of clinical factors. Int Endod J 2008;41:6-31.  Back to cited text no. 3
    
4.
Kojima K, Inamoto K, Nagamatsu K, Hara A, Nakata K, Morita I, et al. Success rate of endodontic treatment of teeth with vital and nonvital pulps. A meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:95-9.  Back to cited text no. 4
    
5.
Bergenholtz G, Spångberg L. Controversies in endodontics. Crit Rev Oral Biol Med 2004;15:99-114.  Back to cited text no. 5
    
6.
Peters OA. Current challenges and concepts in the preparation of root canal systems: A review. J Endod 2004;30:559-67.  Back to cited text no. 6
    
7.
Ponce EH, Vilar Fernández JA. The cemento-dentino-canal junction, the apical foramen, and the apical constriction: Evaluation by optical microscopy. J Endod 2003;29:214-9.  Back to cited text no. 7
    
8.
ElAyouti A, Weiger R, Löst C. Frequency of overinstrumentation with an acceptable radiographic working length. J Endod 2001;27:49-52.  Back to cited text no. 8
    
9.
Kazzi D, Horner K, Qualtrough AC, Martinez-Beneyto Y, Rushton VE. A comparative study of three periapical radiographic techniques for endodontic working length estimation. Int Endod J 2007;40:526-31.  Back to cited text no. 9
    
10.
Radel RT, Goodell GG, McClanahan SB, Cohen ME. In vitro radiographic determination of distances from working length files to root ends comparing Kodak RVG 6000, Schick CDR, and Kodak Insight Film. J Endod 2006;32:566-8.  Back to cited text no. 10
    
11.
Williams CB, Joyce AP, Roberts S. A comparison between in vivo radiographic working length determination and measurement after extraction. J Endod 2006;32:624-7.  Back to cited text no. 11
    
12.
Pendlebury ME, Horner K, Eaton KA. Selection Criteria for Dental Radiography. 1st ed. London, UK: Faculty of General Dental Practitioners, Royal College of Surgeons of England; 2004. p. 6-17.  Back to cited text no. 12
    
13.
ElAyouti A, Weiger R, Löst C. The ability of root Zx apex locator to reduce the frequency of overestimated radiographic working length. J Endod 2002;28:116-9.  Back to cited text no. 13
    
14.
Janner SF, Jeger FB, Lussi A, Bornstein MM. Precision of endodontic working length measurements: A pilot investigation comparing cone-beam computed tomography scanning with standard measurement techniques. J Endod 2011;37:1046-51.  Back to cited text no. 14
    
15.
Jeger FB, Janner SF, Bornstein MM, Lussi A. Endodontic working length measurement with preexisting cone-beam computed tomography scanning: A prospective, controlled clinical study. J Endod 2012;38:884-8.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2]



 

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