Department of Oral Diagnosis, University of Cuiabá, Cuiabá, MT, Brazil.
J Endod. 2011 Jan;37(1):85-90. doi: 10.1016/j.joen.2010.08.006. Epub 2010 Sep 16.
To determine the diagnostic hypothesis on the basis of periapical radiography (PR) is a great challenge for radiologists and endodontists. Visualization of three-dimensional structures, available with cone beam computed tomography (CBCT), favors precise definition of the problem and treatment planning. However, metallic artifact effect of intracanal posts might also induce untrue images. The aim of this article is to suggest a map-reading strategy to diagnose root perforations near metallic intracanal posts (ICPs) by using CBCT.
The incapacity to locate correctly the position of root perforation might lead to clinical failures. One strategy to minimize metallic artifact in root perforation associated with ICP is to obtain sequential axial slices of each root, with an image navigation protocol from coronal to apical (or from apical to coronal), with axial slices of 0.2 mm/0.2 mm. This map reading provides valuable information showing dynamic visualization toward the point of communication between the root canals and the periodontal space, associated with radiolucent areas, suggesting root perforation.
The accurate management of CBCT images might reveal abnormality that is unable to be detected in conventional PR. A map-reading approach reduces problems related to detection of root perforations near metallic artifacts. The final diagnosis should always be made in conjunction with the clinical findings.
对于放射科医生和牙髓病医生来说，根据根尖片（PR）确定诊断假设是一项巨大的挑战。锥形束 CT（CBCT）可提供三维结构的可视化，有利于精确定义问题和治疗计划。然而，根管内桩的金属伪影效应也可能导致图像失真。本文旨在通过 CBCT 提出一种阅读图的策略来诊断靠近金属根管内桩（ICP）的根穿孔。
无法正确定位根穿孔的位置可能导致临床失败。为了最小化与 ICP 相关的根穿孔处的金属伪影，可以采用一种策略，即通过冠状到根尖（或根尖到冠状）的图像导航协议获取每个根的连续轴位切片，轴位切片为 0.2mm/0.2mm。这种读图策略提供了有价值的信息，显示了根管和牙周间隙之间连通点的动态可视化，伴有透光区，提示根穿孔。
准确管理 CBCT 图像可能会揭示常规 PR 无法检测到的异常。读图方法可减少与检测靠近金属伪影的根穿孔相关的问题。最终诊断应始终结合临床发现。
