Optimization of the algorithm for intraoral radiography of multi-rooted teeth on the example of the first maxillary molars and mandibular molars with radix entomolaris. Part 2

Abstract

Nowadays not a single dental appointment is complete without a detailed X-ray examination of the patient, and the most optimal methods of radiation diagnostics for dentistry are intraoral radiography of teeth and cone beam computed tomography (CBCT). At a modern dental appointment, the requirements for diagnostic accuracy are increasing, as treatment methods are getting more complicated, more technologically advanced, more expensive, a need for intraoperative dental examination appears, and, as a result, the responsibility for a poor-quality treatment is increasing as well. However, intraoral dental radiographs are often not informative enough, which can adversely affect the correct diagnosis and quality of treatment. Due to this, the preoperative study of the three-dimensional examination of the patient — CBCT should be considered more relevant. Based on the image obtained it is possible to only assess the conditions of the teeth and surrounding bone tissue, to determine the treatment plan but also to choose the most rational way to conduct an intraoral X-ray examination. Using a virtual three-dimensional model, we can determine the optimal position of the digital sensor in the oral cavity and select the required tilt angle of the X-ray beam to obtain a fully informative intraoral radiograph of the tooth that meets the purpose of the study. Nevertheless, local specialists do not yet use the resources of the CBCT software fully and sufficiently enough. Purpose of work: to demonstrate the possibility of obtaining preoperative images identical to intraoral dental radiographs with the help of CBCT tools in order to optimize the way of performing subsequent intraoperative radiography, increase the informative value of intraoral dental radiographs and improve the quality of endodontic treatment; to provide data on the prevalence and configuration of mandibular molar roots with an additional root (radix entomolaris) in the territory of the Russian Federation. The article presents the data of the examination of 274 patients in two groups: the first group includes the residents of the western part of the Russian Federation (Smolensk region, 137 patients, European group) and the second group includes the residents of Sakhalin Island (ethnic Koreans, 137 patients, Asian group). According to the data obtained, the incidence of the first and second mandibular molars with an additional root (radix entomolaris) is 4.5 times higher among the representatives of the Asian ethnic group than in the Europeans.
Conclusion.
In case of diagnosis of multirooted teeth, when we study the CBCT image, we can accurately determine the anatomical structure of the examined tooth, its spatial position in the jaw, select in advance the most rational method of intraoral radiography to decide at what angle of the X-ray tube and with what position of the digital sensor the most informative image of each root will be obtained during intraoperative examination. Using the viewer tools, it is possible to obtain a CT reformat that should correspond to an informative intraoral radiograph to be performed intraoperatively afterwards. This research describes the methods of conventional dental radiography and proposes an algorithm for optimizing intraoral examination of teeth on the grounds of CBCT, which will significantly increase the informative value of intraoral dental radiographs, thereby contributing to improvement of the quality of endodontic treatment. Since the most complicated aspect for intraoral radiography are maxillary molars and teeth with non-standard root structure, the visualization of the first maxillary molar and visualization of the mandibular molars with an additional root (radix entomolaris) are presented as examples.