Detecção de instrumentos endodônticos fraturados em molares inferiores por meio de radiografia periapical digital: um estudo ex vivo

Abstract

The present study aimed to compare the AUC of imaging protocols on digital periapical radiographs acquired with different X-ray devices and solid sensors, in identifying different sizes of fractured endodontic instruments in filled root canals of lower molars. The study was experimental, ex vivo laboratory, characterized by the analysis of radiographic images of 34 lower molar teeth with three root canals. The teeth were divided into three groups, 1 control group with 4 teeth and 2 groups with 2 and 3 mm mechanized instruments with 15 teeth each. The images were acquired with the Focus Xray device (70kV, 7mA, 0.06s) using the Carestream Dental 5200 solid sensor, also with the Díox Portable Digital MI FIT T2 and a third image acquisition with the Focus The images were analyzed using JPEG View software by two previously calibrated radiologists and two endodontists, able to use the zoom, brightness and contrast tools. Each examiner evaluated the teeth focusing on the mesial root and mesiobuccal canal for the presence/absence of a fractured endodontic instrument according to a 5-point rating scale (1, definitely absent; 2, probably absent; 3, uncertain; 4, probably present; and 5, definitely present). The data were analyzed using SPSS version 27 software, with a significance level of 5%. In the orthoradial projection, there was a significant difference only in acquisition 3 for both radiologists (AUC 0.967 and p<0.003; AUC 0.817 and p<0.042). In the ortho, mesio and distorradial projections, there was a statistically significant difference in acquisition 1 for two radiologists and an endodontist (AUC 0.933 and p<0.005; AUC 0.946 and p<0.004; AUC 0.950 and p<0.004), in acquisition 2 for an endodontist (AUC 0.800 and p<0.054) and in acquisition 3 for two radiologists and one endodontist (AUC 0.917 and p<0.008; AUC 0.875 and p<0.001; AUC 0.875 and p<0.001). When observing the relationship between the size of the fractured instruments, a statistically significant difference was identified for two radiologists and one endodontist, in the 3 mm size (p< 0.004, p< 0.009, p< 0.019) and for the 2 mm size of the instrument fractured, a statistically significant difference was observed for both radiologists (p< 0.006, p< 0.007). Digital periapical radiography is the imaging modality of first choice in the detection of fractured endodontic instruments, and the majority of fractured instruments in this study were identified, thus confirming the importance of this exam and of further studies with new acquisitions of digital radiographs using different parameters for standardizing an exposure protocol and also the use of different filling cements that can influence radiopacity and the observation of the fractured endodontic instrument.