Effect of CBCT dose reduction on the mandibular canal visibility: ex vivo comparative study

Zaki, Islam M; Hamed, Walaa Mohamed; Ashmawy, Mostafa

doi:10.1007/s11282-020-00448-9

Cited by 10 publications

(4 citation statements)

References 35 publications

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“…Lahoud et al 21 observed that the algorithm performed better in CBCTs with a higher cortication degree 21 . Since the visibility of the MC may change according to the resolution of the CBCT acquisition protocol 30 , in the present study, different CBCT machines and resolution protocols were used. Different resolution protocols increased the generalizability of the presently validated tool, achieving a global accuracy of 0.997 for both MC with and without AL.…”

Section: Discussionmentioning

confidence: 99%

Automated segmentation of the mandibular canal and its anterior loop by deep learning

Oliveira-Santos

Jacobs

Pícoli

et al. 2023

Sci Rep

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Accurate mandibular canal (MC) detection is crucial to avoid nerve injury during surgical procedures. Moreover, the anatomic complexity of the interforaminal region requires a precise delineation of anatomical variations such as the anterior loop (AL). Therefore, CBCT-based presurgical planning is recommended, even though anatomical variations and lack of MC cortication make canal delineation challenging. To overcome these limitations, artificial intelligence (AI) may aid presurgical MC delineation. In the present study, we aim to train and validate an AI-driven tool capable of performing accurate segmentation of the MC even in the presence of anatomical variation such as AL. Results achieved high accuracy metrics, with 0.997 of global accuracy for both MC with and without AL. The anterior and middle sections of the MC, where most surgical interventions are performed, presented the most accurate segmentation compared to the posterior section. The AI-driven tool provided accurate segmentation of the mandibular canal, even in the presence of anatomical variation such as an anterior loop. Thus, the presently validated dedicated AI tool may aid clinicians in automating the segmentation of neurovascular canals and their anatomical variations. It may significantly contribute to presurgical planning for dental implant placement, especially in the interforaminal region.

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Section: Discussionmentioning

confidence: 99%

Automated segmentation of the mandibular canal and its anterior loop by deep learning

Oliveira-Santos

Jacobs

Pícoli

et al. 2023

Sci Rep

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“…This is of particular importance for the evaluation of internal structures such as root canals [8][9][10]. In fact, CBCT can be useful to a variety of analysis that demand accuracy for the visualization of facial structures [11,12]. Therefore, these two techniques are useful to assess external and internal root anatomical variations.…”

Section: International Journal Of Advanced Engineering Research and Science (Ijaers)mentioning

confidence: 99%

Multiple Roots and Canals in Mandibular Canines and Premolars in a Brazilian Population: A Cross Sectional Study Using CBCT and Panoramic Radiography

Méndez¹,

Limoeiro²,

Piana³

2020

IJAERS

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This study aimed to estimate the prevalence of external and internal numerical root variations of mandibular canines and premolars in southern Bahia. 384 Panoramic Radiography (PAN) and 384 Cone Beam Computed Tomography (CBCT) of patients over 14 years old who had all mandibular canines and premolars were evaluated for internal and external numerical variation. Gender predilection of morphological configurations was assessed using the x 2 test (p <0.05). For the PAN, 0.5% of the patients had a canine with two roots, while 2.1% and 3% had first premolar and second premolar with two roots, respectively. Regarding internal variation, 2.9% had a canine with two canals, while 15.9% and 6.5% had a first premolar and second premolar with two canals, respectively. For the CBCT, 2.7% of the patients had a canine with two roots, while 16.4% and 2.1% had first premolar and second premolar with two roots, respectively. Three rooted first and second premolar accounted for 0.3%. Regarding the internal variation, 3.4% had a canine with two canals, while 24% and 6.5% had a first premolar and second premolar with two canals, respectively. Three or four canals accounted for 0,7% for first premolars and 0.3% for second premolars. Despite many variants, the most prevalent root configuration for these groups in Bahia´s southern region is one root with one canal. This finding may serve as a guide in clinical endodontic therapy.

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“…Likewise, the substantial to almost perfect intra-and interobserver agreement for all observers further confirms the reliability of identifying these landmarks. Comparative literature is limited; however, two non-clinical studies on CBCT imaging of the mandibular canal can be noted: Neves et al [28] showed that the region providing best visibility of the canal was the dentulous mandibular region of third molars, and Zaki et al [47], that the tube current necessary for adequate visibility of the canal was higher than otherwise needed in low-dose protocols. Both studies advocated the potential of using dose protocols tailored to the purpose of the investigation, since Zaki et al [47], opined that some reduction in tube current was still possible.…”

Section: Discussionmentioning

confidence: 99%

“…Comparative literature is limited; however, two non-clinical studies on CBCT imaging of the mandibular canal can be noted: Neves et al [28] showed that the region providing best visibility of the canal was the dentulous mandibular region of third molars, and Zaki et al [47], that the tube current necessary for adequate visibility of the canal was higher than otherwise needed in low-dose protocols. Both studies advocated the potential of using dose protocols tailored to the purpose of the investigation, since Zaki et al [47], opined that some reduction in tube current was still possible. This is consistent with the suggestions of Pauwels et al [21,43] that exposure protocols should be selected according to diagnostic requirements for the level of contrast and detail.…”

Section: Discussionmentioning

confidence: 99%

Radiographic imaging in relation to the mandibular third molar: tooth characteristics, modality choice, optimization, and absorbed dose

Josefine

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Radiographic imaging of the mandibular third molar (M3) is a valuable diagnostic tool. It provides information on tooth position, root morphology, and relations to surrounding anatomical structures that facilitates diagnosis and treatment planning. Three modalities are commonly used in dentistry: intraoral and panoramic radiography, and cone beam computed tomography (CBCT). Over time, panoramic radiography became a justified choice in most cases of M3 removal. In the last decade, a three-dimensional (3D) alternative, CBCT, has seen increasing use. The advantages of 3D come at the cost of higher radiation doses and societal expense. The four studies in this thesis originated from current knowledge gaps and clinical needs. The use of panoramic radiography for evaluating the M3 and its relation to the inferior alveolar nerve (IAN) is well-established practice; however, its application has declined over time, possibly due to the rising popularity of CBCT imaging. Thus, it is of interest to investigate the suitability of panoramic imaging of the M3. Choice of imaging modality is important from dose delivery and socioeconomic standpoints. A survey of clinician experiences and preferences in imaging modalities for pre-surgical analysis was needed. In diagnostic imaging, the common goal is to reduce radiation exposure to the lowest threshold that still delivers reliable diagnostic information. Due to the growing use of CBCT, there is a need to optimize exposure settings and use reliable measurement methods in dosimetric analysis. Nevertheless, for the M3, the present literature has neither evaluated a low-dose protocol in a clinical setting nor compared the standard method of measuring absorbed dose in dental CBCT with an alternative method. This thesis is based on the following papers: Paper I, an observational study, evaluated M3 characteristics and IAN relation, incidental findings, and image quality regarding patient positioning on 442 panoramic radiographs. Key findings: A majority of M3s were erupted and vertically positioned, regardless of age. The IAN was located inferior to the roots in just over half of the cases; an overlapping position was most common if the tooth was retained or semi-retained, or patient age less than 30 years. Frequent incidental findings were apical radiolucencies, idiopathic osteosclerosis, and tooth fragments. Patient positioning was suboptimal in one-third of the radiographs; common errors included patient placement posterior to the image layer and an upward-tilted head. Paper II was a web-based questionnaire sent to general dentists and to residents and specialists in oral and maxillofacial surgery. The survey comprised multiple-choice questions with four M3 cases depicted in images. Key findings: A majority of respondents received a report within 2 weeks of their CBCT referral and would read it and view the images before surgery; one-third did not. Panoramic radiographs were the preferred modality in pre-surgical planning; differences between professions were significant. Panoramic radiographs and CBCT were seen as facilitating treatment planning, and CBCT as also reducing post-operative complications. CBCT tended to be preferred in more complex M3 cases. Paper III was a clinical trial investigating an alternative, low-dose CBCT protocol with lower tube current than the default protocol. After justification for CBCT, 48 patients (62 M3s) referred for a pre-surgical investigation were recruited. Two scans of each site were made using the two protocols Key findings: No significant differences occurred in visibility of root and mandibular canal relationship and proximity, root morphology, and possible root resorption of the second molar. Visibility of the periodontal ligament was significantly better in default images. Subjective image quality in low-dose images (60% less radiation) was acceptable in most cases. Paper IV was a laboratory study comparing two dosimeters in a CBCT scan of the M3 region. Five slices of an anthropomorphic phantom were prepared with thermoluminescent dosimeters (TLD-100) at 75 sites and covered with Gafchromic film LD-V1. Key findings: Point dose measurements at all TLD sites correlated well with doses measured on film; agreement was better at lower doses. Minimum and maximum doses on film versus at TLD sites deviated greatly on all slices and for several organs. To conclude, panoramic radiography is useful in evaluating M3 and IAN relationships. Clinicians consider pre-surgical information to differ depending on imaging modality; modality preference seems to depend on case complexity. Optimized CBCT protocols can be used for the M3. Gafchromic film is a favorable alternative in dental CBCT dosimetry

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Effect of CBCT dose reduction on the mandibular canal visibility: ex vivo comparative study

Cited by 10 publications

References 35 publications

Automated segmentation of the mandibular canal and its anterior loop by deep learning

Automated segmentation of the mandibular canal and its anterior loop by deep learning

Multiple Roots and Canals in Mandibular Canines and Premolars in a Brazilian Population: A Cross Sectional Study Using CBCT and Panoramic Radiography

Radiographic imaging in relation to the mandibular third molar: tooth characteristics, modality choice, optimization, and absorbed dose

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