|Year : 2015 | Volume
| Issue : 1 | Page : 31-37
|Multidetector computed tomography dentascan analysis of root canal morphology of maxillary canine
Priti D Desai1, Kaushik Dutta2, Soumyabrata Sarakar3
1 Department of Conservative and Endodontic Dentistry, Gurunanak Institute of Dental Science and Research, Panihati, Kolkata, India
2 Department of Oral Medicine and Radiology, Gurunanak Institute of Dental Science and Research, Panihati, Kolkata, India
3 Department of Oral Medicine and Radiology, Haldia Institute of Dental Science and Research, Haldia, West Bengal, India
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|Date of Submission||03-Aug-2014|
|Date of Decision||28-Aug-2014|
|Date of Acceptance||10-Nov-2014|
|Date of Web Publication||11-May-2015|
| Abstract|| |
Aim: The aims of this in vitro study were to see potential applications of multidetector computed tomography (MDCT) in the analysis of root canal morphology.
Materials and Methods: In this in vitro study measurement of root and canal diameters, root and canal diameter ratios, and radicular wall thickness at different levels in maxillary canines with long oval root canals. A total of 40 human maxillary canines, with single long oval canals were selected for this study. The specimens were analyzed with MDCT (16 slice) through dentascan software. The cross-sections corresponding to 625 mm slice thickness from the radiologic apex were analyzed to measure the mesiodistal (MD) and buccolingual (BL) diameters of the canals and the thickness of the root and the walls. The BL/MD ratios of the canal (∆C) and the root (∆R) diameters were calculated, as was as the mean taper in both a BL and an MD dimension.
Results: A high correlation was established between the shape of the root canal and the corresponding root.
Conclusion: Clinical Implications of these techniques is useful to clinician and it can also be applied to improve preclinical training and analysis of fundamental procedures in endodontic and restorative treatment.
Keywords: Dentalscan analysis, maxillary canine, multidetector computed tomography
|How to cite this article:|
Desai PD, Dutta K, Sarakar S. Multidetector computed tomography dentascan analysis of root canal morphology of maxillary canine. Indian J Dent Res 2015;26:31-7
The anatomy of the human teeth is consisting of highly complicated network of multiplaner curves and anastomosing canals. Hence, understanding the morphology of pulp dentin complex is essential prior to any root canal therapy. Conventionally, the clinical assessment of root canal morphology was highly dependent on different conventional intraoral radiographic techniques, which are though able to provide considerable acceptance and convenience to the patient as well as the clinician, but unable to provide accurate diagnostic yield. Multi detector computed tomography (MDCT) is an advanced imaging modality that provides multiple cross sectional images along the three-dimensional (3D) planes. 3D images are with minimal image distortion and thereby enabling endodontists accurate analysis of the morphology of the root canal system with minimal patient discomfort.
|How to cite this URL:|
Desai PD, Dutta K, Sarakar S. Multidetector computed tomography dentascan analysis of root canal morphology of maxillary canine. Indian J Dent Res [serial online] 2015 [cited 2020 Jun 3];26:31-7. Available from: http://www.ijdr.in/text.asp?2015/26/1/31/156794
Potential use of computed tomography (CT) scan in endodontics includes diagnosis of periapical pathosis, assessment of root canal morphology, calcification, resorption, and root fracture as well as postsurgical assessment of treatment prognosis. Recently, a new CT software program namely "DentaScan" (GE-Electronics) has been introduced that uses sub-millimeter thickness transverse images of the jaws to reformat into cross sectional and panoramic views and has already proven to be competent for qualitative and quantitative analysis of bone as well as giving a better long term results for treatments. ,
Multidetector computed tomography is a form of CT technology used for diagnostic imaging. In MDCT, a multiple two-dimensional array of detector elements replaces the single linear array of detector elements used in typical conventional and helical CT scanners. The two-dimensional detector array permits CT scanners to acquire multiple slices or sections simultaneously and greatly increase the speed of CT image acquisition. The development of MDCT has resulted in the development of high resolution CT applications such as CT angiography, CT colonoscopy and CT for dental diagnosis (Dentascan, GE Electronics, USA) [Figure 1].
Imaging performance of cone-beam computed tomography (CBCT) and multi-image micro computed tomography (micro-CT) and four-row MDCT was done and it was proved that cone beam is better than MDCT.  A study conducted to demonstrate potential applications of micro-CT in the analysis of tooth morphology found that micro-CT offers a reproducible technique for 3-Dimention and non-invasive assessment of root canal systems.  Smitagovila, Mohangunduppa gave an overview about CBCT, they said the newest technology of CBCT for acquiring 3D images has a higher efficiency, inherent quickness in volumetric data acquisition. The high quality and affordable CBCT is suitable for diagnosis, treatment planning and treatment monitoring in endodontics.  CBCT and micro-CT are more advanced imagining techniques for root canal treatment, but the cost of it is very high and availability of these two is very less in India.
With increasing popularity of multi detector CT in the field of medical science the present study was conducted to find potential applications of multi detector CT in the analysis of root canal morphology for maxillary canine teeth.
| Materials and methods|| |
In this study CT scan of 20 patients were analyzed to see morphology of tooth with Dentascan Software (GE Electronic, USA). Forty maxillary canine images, both right and left side with single long oval canals were selected for morphological analysis.
The specimens were analyzed with MDCT (16 slice) through Dentascan software (GE Electronics, USA). The images were viewed in advantage workstation monitor at ×3 magnification, from apex to coronal up to 15 mm with window width 1400-2000 HU and preferably in single window. The buccolingual-mesiodistal (BL/MD) ratios of the canal (∆C) and the root (∆R) diameters were calculated, as was as the mean taper of root canal in both a BL and MD dimension [Figure 2] [Figure 3] [Figure 4] [Figure 5].
- Root and root canal diameters
- Root and root canal diameter ratios
- Radicular wall thickness of root in buccal, lingual, mesial, distal direction at different levels were measured in each image of maxillary canine, starting from apex, and adding 0.625 mm at each level up to 15 mm coronal towards canal orifice. So the cross-sections corresponding to 0.625 mm slice thickness from the radiologic apex were analyzed.
Statistical analysis (EPI Info™ 3.5.3.)
Descriptive statistical analysis was performed to calculate the means with corresponding standard deviations for diameter of canal and root for each tooth at each level and for wall thickness of root in buccal, lingual, mesial, distal side. Pearson correlation coefficient (r) with corresponding P values was calculated. t-test was used to compare the means. Multiple logistic regression was used to test the relationship after taking into consideration of the confounding factors. EPI INFO is a trademark of the Centers for Disease Control and Prevention.
[Table 1] [Table 2] [Table 3]
| Results|| |
|Table 1: Mean±SD in millimeters of canal and root BL and MD diameters and B, L, M and D thickness of dentinal walls for each cut surface (right and left canine) |
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|Table 2: BL/MD ratios of the canal (ÄC) and root (ÄR) diameters at different distances from the apex (levels) (right and left canine) |
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|Table 3: Mean taper of the root canal and of each root canal section in BL and the MD dimension (right and left canine) |
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Canal diameter at 0.625 mm from the apex were >0.50 mm (for MD it was 0.51 ± 0.11 mm and for BL it was 0.68 ± 0.13 mm) and they always increased toward the coronal aspect, as did the root diameters.
Canal diameter at 0.625 mm from the apex were > 0.45 mm (for MD it was 0.47 ± 0.05 mm and for BL it was 0.68 ± 0.15 mm) and they always increased toward the coronal aspect, as did the root diameters.
At all levels, that is, distance from apex the BL diameter was greater than MD for both the canal and the root. A high correlation was established between the shape of the root canal and the corresponding root (r = 0.526; P < 0.001).
At all levels, that is, distance from apex the BL diameter is greater than MD for both the canal and the root. A high correlation was established between the shape of the root canal and the corresponding root (r = 0.252; P < 0.001) [Figure 6] and [Figure 7].
|Figure 6: Buccolingual-mesiodistal diameter of canal and root at different levels (right canine)|
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|Figure 7: Buccolingual-mesiodistal diameter of canal and root at different levels (Left canine)|
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| Discussion|| |
The study of tooth and root canal morphology is a critical theme in endodontic practice. Quantitative and qualitative assessment of the root canal in all the possible dimensions hence is very essential for successful endodontic treatment. CT gathers a series of two-dimensional sets of image data and then reconstruct them into a series of cross sectional images in axial-coronal and sagittal dimensions as 3D images. When compared with the conventional imaging techniques, the CT scan images are quite superior in assessment of determining the spatial relationship within the tooth and with its surrounding structures. ,
Cross sectional 3D imaging is gaining its popularity in endodontics as it gives many advantages like it provides the precision in evaluation of the morphology of the root canal system, root canal preparations, cutting efficiency of instruments, quality of obturation of root canal and helps in assessment of apical micro leakage. Various methods for 3D observations are CT scan, CBCT, micro-CT.
Micro computed tomography is hence being considered the gold standard of endodontic evaluation. It is accurate, creates fewer artefacts, provides less complicated method, require less time. When making serial cross-sections using histological techniques, it is difficult to section precisely the area of interest and correlate the many sections that are produced. But with the use of micro-CT, the cross-sections can be made at a precise distance from the apex.  The major disadvantage of this imaging modality is its poor availability in clinical practicing field. CBCT, that uses collimated X-ray beam to evaluate anatomical structures can be used alternatively for endodontic evaluation purposes. Perhaps the most important advantage of CBCT is its ability to produce images of anatomical structures in submillimeter slice thicknesses and thereby provides accurate 3D visibilities of the teeth. The major disadvantages of this diagnostic tools includes the spatial resolution of CBCT images (0.4 mm to 0.076 mm or equivalent to 1.25-6.5 line pairs per/mm) is inferior to conventional film-based (approx. 20 l/mm) or digital intraoral radiography (ranging from 8 to 20 l/mm), there are chances of development of artefacts and also it is very expensive and availability for dental practitioner is very less. 
Lastly, CT scanning, a noninvasive medical imaging procedure can also render highly accurate and quantifiable cross-sectional and 3D images thereby providing a scope to the endodontists to accurately evaluate the root canal system morphology. ,,,,,
Besides that 16 slice or above, multidetector CT scan technology has enabled us to acquire the images in sub millimeter slice thickness in shorter duration of time thereby reducing the total radiation dose to the patient without loss of any image information. Along with that acquiring the images in isotropic voxel values has given us the opportunity to achieve images along all the planes with similar spatial resolution leading to routine utilization of 3D visualization tools. Benefits of MDCT are painless, noninvasive, accurate, fast and simple procedure, allows to see image of bone and soft tissue at the same time, provides very detailed images of various types of tissue, reveals internal injuries quickly, cost-effective imaging tool for a wide range of clinical problems, less sensitive to patient movement, dose of X-rays used in MDCT scans usually has no side-effects. Hence, MDCT was selected for this study to see its use in endodontics. Canine tooth was selected in this study because this was a primary study to know morphology of teeth with MDCT and canine has generally single canal with less anatomic variation. The selection of canine tooth with a long oval canal for this study was strictly to focus on root canal anatomy and curvature in root with the difference in root and canal dimensions in MD and BL directions.
Gu et al. had done a qualitative analysis the root canal morphology of three-rooted mandibular first molars by micro-CT scans and concluded that the geometric data of root canals are useful for endodontic treatment on three-rooted mandibular first molars.  Bolla et al. used CT scan in their case report to evaluate morphology of maxillary canine and found two canals in canine.  Mushtaq et al. in their case report concluded that the use of Spiral CT in endodontic diagnosis serves as an asset in diagnosing complex root canal anatomies to achieve a high degree of success.  Gregor et al. had shown correlating micro-CT Imaging with Quantitative Histology in his book on endodontics. 
A Dentascan examination is a specialized type of CT study, which is performed on a conventional CT scanner used to obtain true cross-sections of the mandible and maxilla from the easily obtained CT scans for patients with cyst, tumors, distractions, accuracy of root canal obturation, jaw growth, stages of tooth development, dental implant, cases of fractures in either the mandibular or maxillary arch. Dentascan is used in advanced computer programs to analyze an X-ray study by providing detailed two-dimensional and 3D images and enable diagnosis and plan the details of the surgery with accuracy, well before the operation. 
Prabu et al. also had studied of morphology of canine with spiral CT and they also found two canals in canine with spiral CT. And they concluded that "expect the unexpected;" this is the scenario any endodontist can confront; it is the responsibility of the clinician to utilize latest tools and deliver a quality endodontic treatment, for ensuring optimal success. 
According to result of these study BL/MD diameter ratio between root and root canal showed correlation between diameter of root canal and root which is similar to the study with micro-CT by Nicola.  Wall thickness of root in buccal, lingual, mesial, distal side from apex to 15 mm showed taper of root canal and it was found that right canine had less taper than left canine, this means that all the teeth are not to be treated in the same manner, different techniques and instruments are required according to the morphology of the tooth. It also showed that at 0.625 mm from apex BL diameter was greater than MD so in apical area presence of oval canals may be found. 
The overall regression model was statistically significant (F = 633.25; P < 0.0001; R 2 = 0.669). The mesial and distal location showed collinearity, and the mesial was excluded as independent variable in the model.
Both buccal (standard β =0.314; P < 0.0001) and lingual (standard β = 0.571; P < 0.001) locations were positively correlated with wall thickness compared with mesial and distal locations. Moreover, on analyzing the standard. β values it appeared that the lingual side compared with the buccal had a slightly higher influence on wall thickness. The level of section considered had a greatest positive impact on wall thickness (standard β = 0.657; P < 0.0001). In a coronal direction, part of the root wall thickness increases. 
| Conclusion|| |
Within limitation of this study, herewith we like to conclude that use of MDCT with dentascan allows clinician to understand morphology of root canal preoperatively before treatment planning with better long-term results. A clinical implication of use of MDCT is useful to clinician and it can also be useful to improve preclinical training in dental school and analysis of fundamental procedures in endodontic and restorative treatment. Further researches are required to see use of MDCT in endodontics.
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Priti D Desai
Department of Conservative and Endodontic Dentistry, Gurunanak Institute of Dental Science and Research, Panihati, Kolkata
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3]
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