Accuracy of Dental Operating Microscope versus CBCT in detecting number of root canals for maxillary first molars indicated for retreatment

Abstract

One of the main causes of root canal treatment failure, whether primary treatment of retreatment is a practitioner’s inability to locate and disinfect all canals present in a root canal system. This notion have been proven time and time again in literature, and hence canal detection aids such as Cone beam computer tomography (CBCT) scans and Dental operating microscopes (DOM) are becoming of more importance and value in the daily clinical life of an endodontist. CBCT scans while currently regarded as the gold standard in terms of an aide in canal detection, cannot be used in every case to avoid exposing patients to high radiation dose. Furthermore, errors in CBCT scan segmentation have been recorded due to inexperience of some practitioner. However, DOM may be a useful aid which avoids the high radiation dose and segmentation errors met when using CBCT scans. Aim: to determine the diagnostic accuracy of dental operatong microscopes in detecting the number of canals present in maxillary first molars indicated for retreatment in comparison to CBCT scans. Materials and methods: Thirty-six patients with obturated upper first molars, indicated for retreatment were included in this study. A pre-treatment periapical x-ray was taken to aid practitioner in access cavity preparation. A pre-operative CBCT scan was taken for all patients, but not shown to the practitioner performing the access cavity. CBCT stage: CBCT scans performed of all participants was randomly distributed upon endodontic specialists for segmentation and the number of canals was recorded. Clinical stage: patients were randomly distributed upon 6 endodontic post graduate students* students enrolled in the endodontic master’s program at MIU*. The students then proceeded to form access cavities, remove root canal filling, and record the number of canals found. The Data collected in both stages was then compared.

Result:  Kappa = 0.930 indicates that there was a very good agreement between the number of canals that were found by means of CBCT and the clinical examination that was performed using a dental operating microscope. The P-value for the two different approaches was 0.097, which indicates that there was no statistically significant difference between the number of canals that were found.

Conclusion: There was no significant difference between detected number of canals by the CBCT and dental operating microscope