CBCT is also an accepted modality to evaluate and visualize the complicated morphology of an individual tooth 5. Data available from the pre-existing CBCT scan allows for precise diagnosis, proper treatment planning, and predictable canal instrumentation 4. Although the reliability and accuracy of the EAL are better than that of traditional radiograph, the performance of the EAL might be falsified by certain situations such as obstruction of canal, or complexities in anatomical features 3.Ĭone-beam computed tomographic (CBCT) scan is a contemporary radiographic imaging system and has been advocated that can overcome shortcomings in conventional radiographic methods 4. With the coming out of “multiple frequencies” or “ratio method” mechanisms, the following generations of electronic apex locator (EAL) overbalance the early generations, which base on the far simpler mechanisms 2. This analogue or digital radiograph presents a two-dimensional plenary projection of a three-dimensional structure, leading to misinterpret actual condition, identify root apex incorrectly, overestimate WL, and manage endodontic therapy hardly 1. Traditionally periapical (PA) radiograph has been tough in many dental schools for working length determination, besides being utilization as a diagnostic method. The mission in locating the endpoint of endodontic treatment has usually required the combination of many contemporary modalities and operator skills. Regardless of this inconsistent feature, an effort should be incessantly performed to enclose root canal treatment inside the canal space. The end point of root canal procedure is apical constriction, an inconstantly anatomic landmark. An appropriate working length (WL) is important in confining the instrumentation inside the radicular space, restricting extrusion of debris and ensuring proper obturation 1. The conventional CBCT measurements using Romexis Viewer and dedicated software did not reach to the 100% accuracy in the range of ± 0.5 mm.Įndodontic treatment requires not only knowledge of and familiarity with root anatomy, root canal morphology and their alterations, but also the exact lengths of these root canals to ensure the optimally removal of canal components in the root canal preparation phase 1. The CBCT Romexis Viewer measurements agreed with AL at three voxel sizes. There was agreement between the 3D-PL and the 3D-CL with AL measurements at voxel size of 0.15 mm and at voxel size of 0.10 mm, respectively. The ProPex Pixi measurements obtained the highest accuracy in the range of ± 0.5 mm. The Fisher’s exact test, paired t-test and Bland–Altman plots were calculated to detect the agreements of the four methods with AL measurements. Root canal lengths were measured using 3D Endo with proposed length (3D-PL) by software, corrected length (3D-CL), Romexis Viewer. Teeth were scanned using the CBCT at different voxel sizes (0.075, 0.10, and 0.15 mm). The actual lengths (AL) and electronic lengths (EL) were measured using the ruler and electronic apex locator (EAL), respectively. Three hundred and twenty-nine root canals in 120 intact human extracted molars were accessed. The aim of this study is to investigate the accuracies and the agreements of the 3D Endo software, conventional CBCT software Romexis Viewer at three voxel sizes, and the EAL ProPex Pixi in endodontic length measurements.
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