Application Of Cone Beam CT In Clinical Diagnosis And Treatment Of Endodontics

Oral cone beam CT is a kind of cone beam computerized tomography or CBCT,which can display the normal and diseased tissue of maxillofacial region from a three-dimensional angle,namely from horizontal,sagittal and coronal position,and avoid the defects of image overlap and distortion of two-dimensional X-ray plain films.It has played a more and more important role in the process of clinical diagnosis and treatment of endodontic.Based on it,this paper discusses the unique advantages of CBCT imaging system in the diagnosis and treatment of Endodontics.The article mainly discusses within the following two parts:Part one:Application of cone beam CT in diagnosis of endodontic diseaseObjective:This part aims at discussing the value of the application of cone beam CT in diagnosis of endodontics disease by comparing the application of cone beam CT imageswith the conventional 2D images in diagnosis of endodontics disease.Methods:115 patients who were made a definite diagnosis with endodontic disease from June 2015 to June 2016 in our hospital were selected and the average age was 45.77±2.3 year according to random data table.Those 115 patients took routine oral examinationclinically with cone beam CT imaging system compared with the conventional 2D imaging techniques i.e.periapical films.Of all the cases,20 patients were diagnosed with pulpitis,32 periapical disease,40 root fracture and 23 tooth resorption.Among the patients,82 of whom were male while 33 of whom were female.The judgement of the definite diagnosis of all the patients with endodonticsdisease was made jointly by one radiologist-in-charge,one chief physician,and me,the researcher.All patients took ordinary X-ray films as well as cone beam CT and the related data were analyzed.Ordinary X-ray films and cone beam CT were observed and compared on the following aspects:(1)The differences in tooth state of the patients with endodontic diseases and in image formation of root canal morphology.(2)The differences in accuracy in diagnosing periapical diseases.(3)The differences in accuracy in diagnosing tooth root fracture.(4)The differences in diagnosing the type,nature,degree and etc.of tooth root absorption.Results:Compared with the traditional two-dimensional images,cone beam CT can get high-definition three-dimensional images from sagittal,horizontal and coronary position,and the related physicians can diagnose and analyze about the anatomical images of any area from various angles and levels.The cone beam imaging system can take films of different thickness of region according to different clinical needs to enable doctors to observe the shape and structure of the root canal from different angles.(1)Cone beam CT imaging system can clearly and definitely show the involved root canal with endodontic diseases,especially the complicated root canals.It can clearly show the number,the specific morphology,the shapeof the patient's root canal and whether there isanastomosis between the root canals and the specific position of anastomosis and so on.(2)Among the 32 cases of clinical screening involved tooth with periapical diseases,which were to be confirmed,the accuracy rate made by cone beam CT was 100%while only 13 cases were confirmed by ordinary X-ray films.Further more,the images were blurry.The detection rate was only 40.7%,P<0.05,the difference is statistically significant.(3)Among the 40 cases in which the patients had the involved tooth pulled out and were confirmed as root fracture,39 cases were confirmed by cone beam CT while only 5 cases were confirmed by ordinary X-ray films,P<0.05,the difference is statistically significant.(4)Among the 23 cases of root absorption,cone beam CT can clearly and three-dimensionally indicatethe specific position,the morphology,the size and the extent of damage of absorption,thus it can definitely diagnose intra absorption,inflammatory external absorption and root neck external absorption,which cannot be clearly shown by ordinary X-ray films whose images are blurry and cannot confirm many cases.Conclusions:The cone beam CT imaging system has obvious advantages in the diagnosis of endodontics.It can clearly show the root canal situation with the three-dimensional reconstruction.It can clearly show the periapical lesion,and especially,it has obvious advantages in diagnosing early periapical lesion.It can clearly show the root fracture,which can not be showed with conventional X-ray films,therefore it can help physicians have an intuitive,accurate and overall understanding of the position,scope,nature and degree of endodontics.It clearly shows the location,range,degree of internal and external absorption of the tooth,especially the early tooth absorption which is hard to be discovered with conventional X-ray films while CBCT can display it accurately,thereby CBCT can help physicians make early diagnosis.It is not difficult to see that cone beam CT has significant application value in clinical diagnosis of endodontics.Part two:Application of Cone beam CT system in the treatment of endodontic diseaseObjective:Based on comparing clinical cases and postoperative results of root canal treatment of periapical periodontitis,this part analyzes and summarizes the image differences between conventional X-ray films and cone beamCT imaging system,providing instruction in operation and evaluation of the postoperative effect for clinical root canal treatment.Methods:1.62 middle-aged patients who were made a definite diagnosis with chronic periapical periodontitis and treated in our hospitalfrom June 2015 to June 2016 were randomly selected including 45 men and 17 women and the average age was 42.3±2.2 years according to random data table.A team of experts and physicians took X-ray films and cone beam CT images simutaneously for the patients immediately after root canal treatment,3 months later,9 months later and 12 months later,and analyzed the image data.The control group was 62 persons,including 47 men and 15 women and the average age was 41.5±3.1 years,who were given a physical examination and confirmed dental health.Dental bone density of the patients' alveolar lesion area and that of the control group were measured at the same time,and the specific practice was the following:the conventional X-ray film,with its included software,measures the relatively average bone density between the two points on the largest diameter of the patient's lesion area as well as the relatively average bone density of the alveolar bone between the two points from the same position of the healthy teeth of the control group;while cone beam CT image system,with its included software,measures the maximum damage surface of the apical area,and takes the grey between the biggest two points on the surface of lesion and then gets a weighted average.It measures the grey average of all of the same position of all of the same surfaces of the healty teeth of the control group as well.Finally,the data were analyzed,and the advantages of the cone beam CT imaging system over conventional X-ray film in detecting the prognosis of root canal treatment were compared.2.56 aged patients with endodontic disease were selected and randomly devided into control group and observation group according to random data table.In the control group,there were 70 teeth from 27 patients including 15 men and 12 women and the average age was 66.8 ±2.3 years while in the observation groupthere were 77 teeth from 29 patients including 16 men and 13 women and the average age was 65.2±2.7 years according to random data table.Root canal treatment combined with cone beam CT technique was observation group,while root canal treatmentwith conventional X-ray films was control group.The situation of root canal filling was observed.The fine filling rate of the two groups was compared.Results:1.(1)Compared with conventional X-ray films,cone beam CT can provide more visualized and more definite prompt information of the treatment,and it can report the prognosis of the patient's root canal treatment more accurately.(2)It can clearly and accurately show various conditions of pulp cavities and root canals such as C-shaped root canals,MB2 and so on.(3)The CBCT imaging system can measure and compare bone density of coronal position and sagittal position at the same time after root canal treatment.The statistical result immediately after operation,3 months later and 9 months later was compared with normal tooth bone density,P<0.05,and the difference was statistically significant.The affected tooth bone density 12 months after operation was compared with normal alveolar bone density,P>0.05,and the difference was not statistically significant.(4)The conventional X-ray film can only compare bone density of the patient's postoperative coronal position.The statistical result immediately after operation and 3 months later,compared with normal tooth bone density,P<0.05,and the difference was statistically significant.Nine months later and 12 months later,compared with normal alveolar bone density,P>0.05,and the difference was not statistically significant.2.The fine filling rate of the observation group was remarkably higher than that of the control group,which had statistic difference,P<0.05.Conclusions:1.(1)Cone beam CT imaging system can perform a thorough examination of the process of the root canal treatment,which is clearer and more intuitive than the conventional X-ray film.(2)Cone beam CT has significant advantages in treating complicated or variant root canal systems such as C-shaped root canals,MB2 and so on.(3)The healing period of bone density of the lesion area is usually about 12 months after the root canal treatment for the patients with chronic periapical disease.Compared with X-ray films,cone beam CT can show the state of bone density more definitely.2.The application of cone beam CT can be used in root canal treatment for the aged patients with endodontic disease to achieve better filling effects.