Comparison of Root Canal Filling Quality and Periapical Health Using Periapical, Panoramic, and Cone-beam Computed Tomography Radiographic Techniques

Original Article Comparison of Root Canal Filling Quality and Periapical Health Using Periapical, Panoramic, and Cone-beam Computed Tomography Radiographic Techniques Maryam Janani1, Negin Ghasemi1, Masoumeh Johari2, Leila Nazari3 1 Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran 3 Postgraduate Student of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran 2 Received 16June2021 and Accepted 28February 2022 Abstract Introduction: Radiography is one of the techniques used to evaluate the quality of obturation. This study compared the quality of root canal obturation and periapical tissue using periapical and panoramic radiographs and cone-beam computed tomography (CBCT).Methods: This descriptive cross-sectional study was conducted on 138 teeth of patients referring to Tabriz Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran. The patients were in the 15-72 age range and had undergone CBCT, panoramic, and periapical x-ray examinations of their endodontically treated teeth. The patients’ periapical, panoramic, and CBCT radiographs were retrieved from the faculty archives and studied. All the images and results were studied by an endodontist and a radiologist separately.Results: The results showed a significant difference between panoramic radiography and CBCT in identifying samples without voids. Panoramic radiographs showed the most samples without voids, and the CBCT method showed the least samples without voids (23.7% vs. 2.2%). The highest agreement in identifying the lesions was obtained between the panoramic and periapical methods. The CBCT technique showed the highest frequency (97.3%, P=0.003) of bone thickness changes in samples with lesions.Conclusion: Based on the results, a significant difference in the quality of root canal obturation was observed between periapical and panoramic radiographs withCBCT; however, no significant difference was observed between periapical and panoramic radiographs. Jananiet al. Keywords: Cone-beam Computed Tomography, Panoramic technique, Periapical radiography. -------------------------------------------------------JananiM,GhasemiN,JohariM, Nazari L.Comparison of Root Canal Filling Quality and Periapical Health Using Periapical, Panoramic, and Cone-beam Computed Tomography Radiographic Techniques. J Dent Mater Tech. 2022; 11(1): 37-46. Introduction Removal of infected pulp by mechanical and chemical cleaning and complete root canal obturation are important steps in endodontic treatment (1). Proper preparation and obturation, initial radiographs, and determination of the working length are factors that affect the prognosis of treated root canals (2). Usually the overall quality of the root canal obturation in teeth that have only single or two canals is better than molar teeth (3). Coronal microleakage is due to insufficient sealing, which can be reduced using the minimum thickness of intra-orifice barrier materials, such as CEM (4). Conventional intraoral radiographs are the most commonly used images for evaluating endodontic treatments (5). Periapical radiography is the only clinical method for evaluating endodontic treatments due to its less invasive nature (6). This radiograph can be used to examine the status of the pulp and pericardial tissues. The main limitation of periapical radiography is that it is twodimensional; therefore, it is often necessary to take another horizontal or vertical radiograph to better determine root canal anatomy (7). The parameters JDMT, Volume 11, Number 1, March 2022 37 affecting periapical radiography, including the tube current, exposure time, and the film processing step, must be carefully controlled for the desired density and contrast (8). Panoramic radiography is used to evaluate the general condition of the patient’s mouth, including the presence of pathological lesions, bone density, TMJ status, and the condition of the teeth (9). The main advantages of this radiographic technique include extensive coverage of facial bones and teeth, a low radiation dose of the patient, patient comfort during radiography, and short radiography time (10). However, the main disadvantages of this radiographic technique include a lack of fine anatomic details and non-uniform image magnification (11, 12). Cone-beam computed tomography (CBCT) was first used for angiography in 1982; however, it was later proposed for maxillofacial imaging (13, 14). Applications of the CBCT technique in endodontic treatments include determining tooth morphology, fractures, internal and external analysis of the root canal, identification of calcified canals, diagnosis of perforations, and evaluation of complications during and after root canal treatment (15, 16). Scarf et al. reported the advantages and disadvantages of CBCT images in endodontic treatments. The advantages include displaying anatomical structures in three dimensions, data collection in three spatial planes, magnification, adjustment of the visual field, and accurate measurement without distortion (17). Regarding the disadvantages of CBCT images, one can refer to lower spatial resolution, higher sensitivity to movement, and lower accuracy in measuring bone density, compared to the CT scan technique (18, 19). Huybrechts et al. examined the number of voids in root canal obturation materials using three analog, digital, and CBCT radiographic methods. The results showed the digital technique’s superiority in detecting small voids through the analog and CBCT techniques. However, due to the two-dimensional nature of the digital technique, there might be errors in void detection (20). Demir Alp et al. conducted a study on extracted mandibular molars in 2012 and evaluated the quality of obturation using conventional, digital, panoramic, and CBCT radiographic methods. The results showed the superiority of the CBCT technique over conventional and digital radiographic techniques (21). It is impossible to carry out CBCT preparation for all the patients; therefore, periapical and panoramic radiographs are used more frequently in assessing the quality of 38 JDMT, Volume 11, Number 1, December 2022 previous treatments and periapical status. Moreover, there is a paucity of studies on the diagnostic accuracy of panoramic, periapical, and CBCT imaging techniques. Therefore, this comparative study evaluated root canal obturation quality and periapical health using periapical, panoramic, and CBCT radiographic techniques. Materials and Methods The present descriptive cross-sectional study compared the quality of root canal obturation and periapical tissue health using periapical, panoramic, and CBCT radiographs. The study protocol was approved by the Ethics Committee of Tabriz University of Medical Sciences, Tabriz, Iran (IR.TBZMED.REC.1397.516). T (...truncated)