Incidence of ramifications located in the apical 3 mm of the root with the use of digital periapical radiography, CBCT and computerized microtomography

Abstract

It is recognized in the literature that the apical region of the roots presents a varied morphology and can exhibit the presence of numerous ramifications, such as apical delta, secondary and accessory canals. These ramifications may harbor a high prevalence of bacterial cells, capable of proliferating and inducing an inflammatory response, with consequent bone resorption. Thus, it is important to emphasize the role of apical ramifications in relation to contamination and failure of endodontic treatment. Therefore, the aim of this study is to evaluate the incidence of root canal ramifications in the last 3 mm of the dental root, using digital radiographic, Cone-beam Computed Tomography (CBCT) and Micro Computed Tomography (Micro-CT) and, evaluating among these methods, if there are any differences in the visual aspects of root canal ramifications in this region. This study will have a sample of 60 incisor roots, 60 canine roots, 60 premolar roots and 60 molar roots, adding up to 240 dental roots. The GE 1000® will be used to obtain the digital radiography images, the Picasso Trio for CBCT images and SkyScan 1174 for micro-CT images. All images will be evaluated by 3 specialists, two endodontists and one radiologist. Statistical analysis will be performed by using Kappa to verify the reproducibility of the described method, assessing intraobserver and interobserver agreement. The sensitivity, specificity, accuracy and the Receiver Operating Characteristic (ROC) curve will also be calculated and analyzed by ANOVA, followed by the Tukey test with a significance level of 5% (± = 0.05). It is expected that by assessing the incidence of these ramifications, the endodontist will have a better understanding of the importance that these canals have in the diagnosis, planning and treatment of endodontic problems. (AU)