Song Dongzhe, Zhang Lan, Zhou Wei, Zheng Qinghua, Duan Xingyu, Zhou Xuedong, Huang Dingming
1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
2 Department of Conservative Dentistry and Endodontics, West China College of Stomatology, Sichuan University, Chengdu, China.
Dentomaxillofac Radiol. 2017 Jul;46(5):20160463. doi: 10.1259/dmfr.20160463. Epub 2017 Mar 23.
The aim of this study was to verify whether there is a difference in the in vivo performance characteristics of CBCT and periapical radiography (PR) in assessing the apical extension of root canal obturation (RCO) and to evaluate the ability of CBCT in void detection using microsurgical findings as validation.
This study included 323 tooth roots that required surgical treatment and for which pre-existing periapical radiographs and CBCT images were available. Three calibrated observers individually analyzed the periapical radiographs, CBCT images and photomicrographs of each root. Performance characteristics of CBCT and PR were compared in terms of their evaluation of the apical extension of the RCOs. The ability of CBCT to detect voids in the RCOs was evaluated using microsurgical findings as validation. Kappa values were used for intraobserver/interobserver agreement.
Perfect intraobserver/interobserver agreement (1.0) was achieved when using photomicrography. The two agreements of PR were superior to those of CBCT when CBCT was used to detect voids (p < 0.05). The sensitivity of CBCT [0.86, 95% confidence interval (CI) 0.76-0.93] was superior to that of PR (0.66, 95% CI 0.54-0.76) in detecting overextension (p < 0.005). CBCT showed a poor sensitivity (0.24, 95% CI 0.19-0.30) and specificity (0.67, 95% CI 0.54-0.78) in void detection.
CBCT was better than PR for evaluating the apical extension of RCOs. CBCT, with its poor sensitivity and specificity, might both overestimate and underestimate the proportion of voids in RCOs. CBCT was not suitable for evaluating the quality of RCOs.
本研究旨在验证锥形束计算机断层扫描（CBCT）和根尖片（PR）在评估根管充填（RCO）根尖延伸方面的体内性能特征是否存在差异，并以显微手术结果作为验证，评估CBCT检测空隙的能力。
本研究纳入323颗需要进行手术治疗且已有根尖片和CBCT图像的牙根。三名经过校准的观察者分别分析每个牙根的根尖片、CBCT图像和显微照片。比较CBCT和PR在评估RCO根尖延伸方面的性能特征。以显微手术结果作为验证，评估CBCT检测RCO中空隙的能力。kappa值用于观察者内/观察者间一致性分析。
使用显微照片时，观察者内/观察者间一致性达到完美（1.0）。当使用CBCT检测空隙时，PR的两种一致性均优于CBCT（p < 0.05）。在检测超充方面，CBCT的敏感度[0.86，95%置信区间（CI）0.76 - 0.93]优于PR（0.66，95%CI 0.54 - 0.76）（p < 0.005）。CBCT在空隙检测中显示出较低的敏感度（0.24，95%CI 0.19 - 0.30）和特异度（0.67，95%CI 0.54 - 0.78）。
在评估RCO根尖延伸方面，CBCT优于PR。CBCT的敏感度和特异度较差，可能高估和低估RCO中空隙的比例。CBCT不适合评估RCO的质量。
