Diagnostic accuracy of endoscopy for the detection of isthmuses of mandibular molar teeth using micro-CT as reference

Abstract

Purpose: The aim of this study was to evaluate the efficacy of endoscopic visualisation to detect the presence and type of isthmuses within the mesial root canals of mandibular first molar teeth compared with micro-computed tomography (micro-CT) images as reference. Materials and methods Thirty-two mesial roots of mandibular first molars presenting isthmuses were selected based on micro-CT scans. In all, 12 type I and 20 band-shaped isthmuses were collected. The specimens were mounted in the posterior socket of dental phantom manikin for endoscopic visualisation. The ability of endoscopes to visualize the presence of isthmuses and distinguish the type of isthmuses was compared. Micro-CT images of the specimens were used as references. Data were analyzed using Fisher’s exact tests. Results Sensitivity of endoscope to detect isthmuses were also calculated for each isthmus type. In 37.5% of the samples, isthmus presence was correctly diagnosed via orthograde endoscopic visualization. Type I istmuses were significantly more detected than band-shaped isthmuses (P < 0.05). Endoscope showed higher sensitivity to detect type I isthmus than band-shaped isthmus. Conclusion The endodontic endoscope could detect type I isthmuses more accurately than band- shaped isthmuses.

Keywords

• Isthmus
• micro-computed tomography
• endoscopic visualization
• root canal anatomy

References

1. 1. Marceliano–Alves MF, Lima CO, Nayre-Bastos PM, Bruno AM, Vidaurre F, Coutinho TM, Fidel SR, Lopes RT. Mandibular mesial root canal morphology using micro–computed tomography in a Brazilian population. Aust Endod J 2019; 45: 51-6.
2. 2. Martins JNR, Marques D, Silva EJNL, Caramês J, Versiani MA. Prevalence studies on root canal anatomy using cone-beam computed tomographic imaging: a systematic review. J Endod 2019; 45: 372-86.
3. 3. Keleş A, Keskin C. A micro–computed tomographic study of band–shaped root canal isthmuses, having their floor in the apical third of mesial roots of mandibular first molars. Int Endod J 2018; 51: 240-6.
4. 4. Von Arx T. Frequency and type of canal isthmuses in first molars detected by endoscopic inspection during periradicular surgery. Int Endod J 2005; 38: 160- 8.
5. 5. Teixeira FB, Sano CL, Gomes BPFA, Zaia AA, Ferraz CCR, Souza-Filho FJ. A preliminary in vitro study of the incidence and position of the root canal isthmus in maxillary and mandibular first molars. Int Endod J 2003; 36: 276- 80.
6. 6. Fan B, Pan Y, Gao Y, Fang F, Wu Q, Gutmann JL. Three-dimensional morphologic analysis of isthmuses in the mesial roots of mandibular molars. J Endod 2010; 36: 1866-9.
7. 7. Siqueira JF, Alves FR, Versiani MA, Rocas IN, Almeida BM, Neves MA, Sousa-Neto MD. Correlative bacteriologic and micro–computed tomographic analysis of mandibular molar mesial canals prepared by Self-Adjusting File, Reciproc, and Twisted File systems. J Endod 2013; 39: 1044-50.
8. 8. Ordinola–Zapata R, Bramante C, Versiani M, Moldauer BI, Topham G, Gutmann JL, Nunez A, Duarte MA, Abella F. Comparative accuracy of the clearing technique, CBCT and Micro–CT methods in studying the mesial root canal configuration of mandibular first molars. Int Endod J 2017; 50: 90-6.

9. 9. Domark JD, Hatton JF, Benison RP, Hildebolt CF. An ex vivo comparison of digital radiography and cone-beam and micro computed tomography in the detection of the number of canals in the mesiobuccal roots of maxillary molars. J Endod 2013; 39: 901-5.
10. 10. Carr GB, Murgel CA The use of the operating microscope in endodontics. Dent Clin 2010; 54: 191-214.
11. 11. Mendes AB, Soares AJ, Martins JNR, Silva EJNL, Frozoni MR. Influence of access cavity design and use of operating microscope and ultrasonic troughing to detect middle mesial canals in mandibular first molars. Int Endod J 2020; doi:10.1111/IEJ.13352.
12. 12. Khalighinejad N, Aminoshariae A, Kulild JC, Williams KA, Wang J, Mickel A. The effect of the dental operating microscope on the outcome of nonsurgical root canal treatment: a retrospective case-control study. J Endod 2017; 43: 728- 32.
13. 13. Engelke W, Leiva C, Wagner G, Beltrán V. In vitro visualization of human endodontic structures using different endoscope systems. Int J Clin Exp Med 2005; 8: 3234-40.
14. 14. Moshonov J, Michaeli E, Nahlieli O. Endoscopic root canal treatment. Quintessence Int 2009; 40: 739–44.
15. 15. Keleş A, Keskin C, Alqawasmi R, Aydemir H. Accuracy of an endoscope to detect root canal anastomoses in mandibular molar teeth: a comparative study with micro-computed tomography. Acta Odontol Scand. 2020; Mar 6:1. doi: 10.1080/00016357.2020.1735515.
16. 16. Silva AA, Belladonna FG, Rover G, Lopes RT, Moreira EJL, De-Deus G, Silva EJNL. Does ultraconservative access effect the efficacy of root canal treatment and the fracture resistance of two-rooted maxillary premolars? Int Endod J 2020; 53: 265-75.
17. 17. Fujimoto M, Okuda M, Yoshii S, Ikezawa S, Toshitsugu U, Tassery H, Cuisinier F, Kitamura C. Endoscopic System Based on Intraoral Camera and Image Processing. IEEE Trans Biomed Eng 2019; 66: 1026-33.
18. 18. Bahcall JK, DiFiore PM, Poulakidas TK. An endoscopic technique for endodontic surgery. J Endod 1999; 25: 132-5.
19. 19. Detsch SG, Cunningham WT, Langloss JM. Endoscopy as an aid to endodontic diagnosis. J Endod 1979; 5: 60-2.
20. 20. Tolentino ES, Amoroso-Silva PA, Alcalde MP, Honorio HM, Iwaki LCV, Rubira-Bullen IRF, Hungaro-Duarte MA. Accuracy of high resolution small- volume cone-beam computed tomography in detecting complex anatomy of the apical isthmi: ex vivo analysis. J Endod 2018; 44: 1862-6.
21. 21. Tolentino ES, Amoroso-Silva PA, Alcalde MP, Honorio HM, Iwaki LCV, Rubira-Bullen IRF, Hungaro-Duarte MA. Limitation of diagnostic value of cone-beam CT in detecting apical root isthmuses. J Appl Oral Sci. 2020; Mar 27; 28:e20190168. doi: 10.1590/1678-7757-2019-0168.
22. 22. Hu X, Huang Z, Huang Z, Lei L, Cui M, Zhang X. Presence of isthmi in mandibular mesial roots and associated factors: an in vivo analysis. Surg Radiol Anat 2019; 41: 815-22.
23. 23. Gani OA, Boiero CF, Correa C, Masin I, Machado R, Silva EJ, Vansan LP. Morphological changes related to age in mesial root canals of permanent mandibular first molars. Acta Odontol Latinoam 2014; 27: 105-9.
24. 24. Estrela C, Rabelo LE, de Souza JB, Alencar AH, Estrela CR, Sousa Neto MD, Pecora JD. Frequency of root canal isthmi in human permanent teeth determined by cone-beam computed tomography. J Endod 2015; 41: 1535-9.