Skip to main content
Download PDF

Does endodontics influence radiological detection of external root resorption? an in vitro study

BMC Oral Health volume 23, Article number: 221 (2023) Cite this article

Abstract

Background

External root resorption (ERR) has a multifactorial etiology and is difficult to diagnose, which means that is continues to be of research interest. This work mainly aims to determine whether external root resorption can be differentially detected in root-filled versus non-endodontically treated teeth using digital periapical radiography (DPR) and cone-beam computed tomography (CBCT).

Methods

The Checklist for Reporting In-vitro Studies (CRIS) guidelines were followed throughout this study. This experiment highlights the preparation and generation of standardized synthetic teeth measured on three-dimensional records converted into Digital Imaging and Communication on Medicine (DICOM) file format. Twelve replicate maxillary incisors were randomized into two groups: (G1) six non-endodontically treated, and (G2) six endodontically treated teeth. In both groups, actual tooth lengths of all specimens were measured and compared with measurements obtained using DPR and CBCT. Simulated ERR lesions [0.12, 0.18, 0.20 mm × 0.5 mm depth in the mesial, distal and palatal apical regions] were created progressively, radiographic images were recorded, and 24 DPRs and 96 CBCTs were obtained in total. Eight blinded, previously calibrated researchers made a total of 1920 measurements (using Horos Software). Data were analyzed using the Shapiro–Wilk, ANOVA, Kruskal–Wallis and Wilcoxon rank post-hoc tests [Bonferroni correction in multiple comparison tests (p < 0.05)].

Results

ICC values for intra- and inter-examiner agreement were appropriate. DPR overestimated ERR detection compared to the actual and CBCT measurements [Mean diff = 0.765 and 0.768, respectively]. CBCT diagnosis of ERR lesions in specimens without root canal treatment was significantly more accurate than DPR diagnoses on both non-endodontically and endodontically-treated specimens [p = 0.044; p = 0.037, respectively]. There was an 18.5% reduction in sensitivity in all DPR diagnoses made on endodontic teeth versus those made on non-endodontically treated teeth. For the smallest ERR lesions, this sensitivity was even more marked, with 27.8 and 25% less sensitivity, respectively.

Conclusions

The results of this study highlight that both CBCT and DPR are good diagnostic methods for ERR. Nevertheless, root canal filling material influences diagnostic capability in ERR. The clinical significance was that the presence of intracanal material reduces the detection and diagnosis of ERR by DPR in teeth with root canal treatment.

Peer Review reports

Background

External root resorption (ERR) has a multifactorial etiology and is difficult to diagnose, which means that is continues to be of research interest. The ERR is defined as the permanent loss of dental tissue, affects the cementum and dentine, and in the most severe forms, it may even compromise the dental pulp tissue [1, 2]. A growing body of research suggests that the upper anterior teeth are those most susceptible to root resorption in the apical third (ERR) secondary to the mechanical stimuli generated by orthodontic forces [2,3,4,5,6]. However, a number of other different predisposing factors have been associated with the triggering of this pathological phenomenon [7]; more particularly, the influence of specific biological or genetic factors, together with certain treatment-dependent factors [8], has been associated with this iatrogenic effect in the context of orthodontic treatment [9]. With regard to the latter factors, it has been shown that the effect of orthodontic movement on vital or root-filled teeth varies according to their susceptibility to ERR [10]. Other evidence however shows that endodontic teeth are more prone to be affected by ERR [2], while other authors have pointed out that teeth lacking pulp tissue have a protective effect against ERR when subjected to orthodontic movement [3, 11,12,13]. Some explanatory hypotheses have been suggested to explain these data, although there is still no conclusive information in the literature [6].

In this context, one of the most common difficulties in the detection of ERR is the visualization and accuracy of radiographic images [14, 15]. This pathology is difficult to diagnose due to scatter and beam-hardening artifacts caused by surrounding high-density structures, as well as the use of metal posts, tooth restorations and root filling materials [16]. High bone density in the posterior region of the jaw, which prevents visualization of minor changes in root shortening, should also be considered [17]. Other factors that affect radiographic detection of ERR are the density and contrast of the images, the dental position, and the shape of the lesion in three dimensions [18]. Finally, tooth angulations and root torsion [19] and the presence and density of gutta-percha in the root canal can also make it difficult to detect external root surface lesions radiographically [20]. Overall, there is very little in vitro research evaluating the influence of root filling material on the diagnosis of ERR by radiological imaging. Therefore, the null-hypothesis was that the root-filling does not influence the ERR detection. The aim of the present study was to assess, using two different radiographic methods, whether differential perceptions in diagnosis of ERR on vital / endodontic teeth are a potential source of misdiagnosis.

Methods

Study design and specimens

Twelve standardized, synthetic replicates of central maxillary and lateral incisors were randomly divided into two groups: (G1) six non-endodontic teeth and (G2) six root canal-treated teeth. To prevent the morphology of the maxillary incisors from influencing the visualization of resorptions, the allocation of tooth type to each group was randomized. After randomization, four central and two lateral incisors were assigned to group 1 and three central and three lateral incisors to group 2. This randomization was applied to determine the root canal morphology of each group. Figure 1 summarizes the workflow of the study.

Fig. 1
figure 1

Schematic illustration of the methodology workflow used

Full size image

Generation of standardized synthetic replicas

Teeth were prepared from a radiopaque synthetic resin Acry C&B Rx (Ruthinium Group, RO, Italy) presentation powder and self-healing liquid. Mixing time was 6 min and polymerization time 10 min. The procedure was performed from two high-precision Hydrorise silicone molds (Monophase, Zhermack, RO, Italy). The molds were polymerized in a pot under 2 atm. of pressure. Water temperatures ranged between 45OC—50OC, while the teeth remained inside their respective containers. The synthetic specimens were appropriate and reliable for the purposes of the study. All synthetic replicas were evaluated and measured to quantify and guarantee the accuracy of the six replicas of each central and lateral incisor generated (Data not shown).

The root canals of the six tooth specimens in group 2 were then treated by a single operator, using Tagger’s hybrid crown-down technique. Filling procedures were prepared using standardized GP cones (Dentsply, Rio de Janeiro, Brazil) with AH Plus sealer (Dentsply, Konstanz, Germany). Proper condensation of the maxillary incisors was determined by visualization with digital periapical radiography (DPR) and cone-beam computed tomography (CBCT). Digital measurements (Gocheer, Shenzhen, China) were taken to quantify the precise length of all treated and non-treated tooth specimens from apex to incisal edge.

Interventions and allocation: external root resorption simulation

The replicas were manipulated at the root apex to artificially create root shortening with different tooth lengths. The same operator [21] simulated external root resorption 4 mm from the root apex. Pits were positioned perpendicular to the surface, with high-speed rotation and constant cooling, and the same procedure was repeated at the second, third, and fourth stages. At each stage, artificial ERR lesions were artificially created with three different pit sizes (0.12 mm, 0.18 mm, 0.20 mm) in the mesial, distal, and palatal positions, and 0.05 mm depth [14]. All drill bits had an active length of 0.05 mm and an average grain size of 100 μm. At each stage, digital periapical radiography (DPR) and cone-beam computed tomography (CBCT) images were taken after sequential creation of the lesions.

Radiographic exposure and generation of diagnostic images: DPR and CBCT images

Radiographic images were taken after placing each pair of teeth on a frame with a universal radiographic film positioner. The support system was placed parallel to the ground and checked with an iHandy spirit level (iHandySoft Inc 2017©, version 1.70.3 for iOS 10.3).

Digital periapical radiographs were obtained with Timex 70E wall-mounted (Gnatus, SP, Brazil) X-ray equipment, using 0.32 s. of exposure. The phosphor plates were then read using the Digora® Optime system (Soredex, Tuusula, Finland) and Scanora 5.1.2 software, free version for Windows.

CBCT images were obtained using i-CATTM tomography (Imaging Sciences International LLC, Hatfield, PA, USA) and free-to-use iCATVision Q software, 1.8.1.10 for Windows. Exposure parameters were mAs = 37.07 and 120 KVP, and resolution was 0.20v—26.9 s [22]. The reconstructed volume size was 16 cm diameter x 6 cm depth. In the clinical setting, natural radiation attenuation and scattering is the result of the presence of soft tissue [23]. To simulate this effect, CBCT scans were captured while the block sections were submerged in water in a clear 13 × 9x 5 cm plastic container [23]. All images were obtained by an expert radiologist.

Radiographic assessment and measurements

The DPR and CBCT images were evaluated by eight previously calibrated and blinded investigators [24,25,26] using Horos Software (GNU, General Public License), version 3.3.6 for Mac (Figs. 2, 3). To minimize bias, observers were blinded to the aims of the study. The observers then adjusted the Digital Imaging and Communication on Medicine (DICOM) files according to their needs using the brightness, contrast, and zoom tools. The same dark room was used to analyze the images from all available planes [14]. The longitudinal axis of the maxillary incisors is illustrated in Fig. 4a. In addition, each calibrated evaluator generated a single measurement in the sagittal plane of the ERR on the CBCT images and two measurements in the coronal plane, as illustrated in Fig. 4b-d. The specimens and groups distribution is explained in Supplementary material. Appendix I.

Fig. 2
figure 2

Illustration of endodontic tooth no.1 and non-endodontic tooth no.2 on DPR images. a Stage 1, teeth without resorption. b Stage 2, teeth with ERR of 0.12 mm. c Stage 3, teeth with ERR of 0.18 mm. d Stage 4, teeth with ERR of 0.20 mm

Full size image
Fig. 3
figure 3

Illustration of endodontic tooth no.1 and non-endodontic tooth no.5 in the coronal plane on CBCT images. a Stage 1, tooth no.1 without resorption. b Stage 2, tooth no.1 with resorption of 0.12 mm diameter. c Stage 3, tooth no.1 with resorption of 0.18 mm diameter. d Stage 4, tooth no.1 with resorption pits of 0.20 mm diameter. e Stage 1, tooth no.5 without resorption. f Stage 2, tooth no.5 with resorption of 0.12 mm diameter. g Stage 3, tooth no.5 with resorption of 0.18 mm diameter. h Stage 4, no. 5 tooth with resorption of 0.20 mm diameter

Full size image
Fig. 4
figure 4

Illustration of measurements on DPR and CBCT images of endodontic tooth no.1. a Measurements of mesial and distal ERR on DPR images. b Location of guides for measuring the diameter of palatal ERR in the sagittal plane on CBCT images. c Axial plane view to help visualize the mesial, distal, and palatal resorption pits on CBCT images (d) Guides for measuring diameters of mesial and distal ERR in the coronal plane on CBCT images

Full size image

Statistics

Method error

The consistency of the measurements was assessed using the intraclass correlation coefficient (ICC), with their respective 95% confidence intervals. To determine intra-examiner agreement, each examiner measured all tooth lengths and external root resorptions twice. Inter-examiner reliability was calculated and the mean of the eight raters’ measurements was selected for further data analysis [21].

Comparative, post-hoc analysis and diagnostic method testing

Descriptive statistics were calculated for each group using means and standard deviation. The Shapiro–Wilk test was used to determine the goodness-of-fit of the data to a normal distribution. Repeated measures ANOVA was calculated. Univariate analysis of variance was applied to determine the effects of location and size of ERR pits on perception. The Kruskal–Wallis test was applied to determine whether there were significant differences between the four groups according to endodontic type and diagnostic technique [(i) non-endodontic DPR; (ii) endodontic DPR; (iii) non-endodontic CBCT; and (iv) endodontic CBCT]. The Wilcoxon rank post-hoc test was performed for all pairwise comparisons. The Bonferroni multiple comparisons procedure was also used to evaluate differences in tooth length according to diagnostic method; significance values were adjusted when applying the Bonferroni correction in the multiple comparison tests.

Sensitivity, specificity, area under the curve (AUC) and likelihood ratio (LR) were calculated for each group. The data were recorded on Excel 16.16.22 spreadsheets (© 2018 Microsoft, Redmond, WA, USA) for Mac. Commercially available SPSS Statistics software (© IBM, SPSS Inc, Chicago, IL, USA), version 25 for Mac was used for data analysis. The level of statistical significance was set at (p < 0.05).

Results

Accuracy of the method

The ICC values for intra- and inter-examiner agreement are shown in Table 1. The results were statistically significant (p < 0.001) for all ICC scores. Based on the results obtained, all eight raters’ measurements showed excellent ICC values, and the means of the eight raters’ measurements were selected for further data analysis.

Table 1 Intra- and inter-examiner agreement in measures for dental length and diameter of ERR
Full size table

Mean difference in tooth length by CBCT versus digital periapical radiography (DPR)

Table 2 shows the results of the measurements of specimens without resorption lesions, together with the post-hoc adjustments. The data returned statistically significant differences between DPR measurements versus actual lengths (p < 0.001), and also versus CBCT measurements (p < 0.001). It can be concluded that the DPR measurements were overestimated compared to the actual ones (Mean diff = 0.765) and also compared to those made by CBCT (Mean diff = 0.768). The absolute length measurements obtained with CBCT however did not differ from the actual tooth lengths (Mean diff = -0.002; p = 0.573).

Table 2 Estimated Marginal Means and pairwise comparisons mean difference for dental length
Full size table

Evaluation of external root resorption using CBCT versus digital periapical radiography

The results of the evaluation of specimens with ERR after assessing the effect of location and diameter of root resorption lesions are shown in Table 3. More particularly, there were no statistically significant differences between the DPR (p = 0.728) and CBCT (p = 0.411) diagnostic techniques, and there were no statistically significant differences between the location or diameter of ERR lesions and their effect on either of the methods analyzed, DPR or CBCT (p = 0.527).

Table 3 ANOVA test of between the effects of location and diameter size of ERR lesions
Full size table

Comparisons are shown in Table 4. CBCT diagnosis of ERR lesions in specimens without root canal treatment was significantly more accurate than the diagnoses by DPR on both non-endodontic (p = 0.044) and endodontic specimens (p = 0.037), respectively. However, these differences were not found when considering the diagnosis of ERR on endodontically treated teeth compared to both types of specimen by DPR (p > 0.05; post-hoc test with Bonferroni correction).

Table 4 Pairwise comparisons using Wilcoxon rank sum test with continuity correction data
Full size table

Quality of diagnostic tests

A comparison of the diagnostic tests and their quality is presented in Table 5 and Fig. 5. The sensitivity of DPR for detection of ERR versus the gold standard (true resorption) was 90.7%, with an AUC of 95.4%. However, when the 60 images of endodontic teeth only vs true resorption were selected, sensitivity decreased to 81.5%, with an AUC of 90.7%, versus 100% sensitivity and AUC in teeth without root fillings. With respect to the quality of the diagnostic tests, CBCT obtained an LR- 0.00, and DPR on endodontic teeth obtained an LR- 0.19 (Table 5).

Table 5 Comparison and quality of DPR-CBCT diagnostic tests vs Real resorption
Full size table
Fig. 5
figure 5

Receiver Operating Characteristic (ROC) curves for the ability to detect ERR in endodontic and non-endodontic teeth using DPR and CBCT

Full size image

As can be seen in Fig. 6, when DPR was used to assess the graduated ERR lesions, sensitivity increased to 88.9% for the 0.20 lesions, compared to 75% and 72.2% respectively for the 0.18 mm and 0.12 mm lesions, respectively (Table 5).

Fig. 6
figure 6

Receiver Operating Characteristic (ROC) curves for the ability to detect incremental ERR lesions (0.12 mm, 0.18 mm, 0.20 mm) in endodontic teeth using DPR

Full size image

Discussion

According to the results obtained, endodontic treatment affects the ability to distinguish ERR. CBCT was proved to be a better and more accurate diagnostic technique than DPR for both types of measurement: estimation of tooth length and assessment of external root resorption lesions. The results showed differential detection of ERR in non-endodontic teeth when analyzed with CBCT compared to teeth with and without root canal treatment analyzed with DPR.

Two main aspects, physical and optical, can affect the perception of ERR when a tooth has received root canal treatment. Among the physical factors, some authors [16] have stated that the differential observation of images depends on the exposure time, X-ray time and radiographic equipment used. The radiation source can also affect radiopacity in the detection and diagnosis of ERR. The density of radiographic noise-generating materials such as fillers, metal posts, implants, and restorations can contribute to radiographic distortion [16]. The high density of gutta-percha interferes with the radiation node more than in non-endodontic teeth. In this study, we compared filled and intact root canals, and ERR was more clearly visible in the non-endodontic teeth. A surface as radiopaque as that of a root-filled tooth makes it very difficult to visually inspect adjacent structures.

Among the optical factors, the quality of the radiographic image can be severely affected by dental angulations and torsions [18]. The location and shape of the ERR should also be taken into account. The compact type of bone in the mandible and the cancellous bone in the upper jaw also potentially influence the diagnosis of ERR. Some authors [17, 18] have stated that lesions confined to the cancellous bone are more difficult to detect early. ERR involves loss of mineral tissue influenced by the action of the osteoclast cells. Some authors have mentioned [27] that changes in density will only be visible on periapical radiographs after considerable resorption. In an in vivo study [17] comparing DPR and CBCT images of 156 endodontically-treated human teeth, the results showed that the zygomatic process of the maxilla can limit the identification of radiographic periapical lesions.

After an in vivo study [18] conducted on 35 endodontically treated teeth, it was concluded that the root resorption lesion had to constitute almost 50% to 60% of bone mineral loss before it could be detected radiographically. One in vitro study [1] investigated resorption in fifteen maxillary anterior teeth with a single root and single canal. The authors argued that 60 to 70% of the mineralized trabecular bone had to be lost before resorption could be detected on a radiograph and that DPR images should be used with caution for the purpose of an ERR diagnosis. With respect to type of radiographic method, some researchers [25, 28] have concluded that CBCT can detect ERR in root-filled teeth more easily and with greater precision than DPR. DPR may be affected to some extent by distortion due to incorrect positioning or angulation during radiographic projection. In the present experiments however, the design and implementation of a digital angle positioner for capturing DPR images ensured that factors of this sort did not alter the sequence of images.

It would have been more desirable to use upper incisor teeth in this study, but these are the ones that are most commonly damaged [26]. However, the radiopacity and radiolucency of the synthetic maxillary incisors matched dental tissue, as was verified by an expert radiologist who compared DICOM images of an ex vivo tooth with a random tooth selected from this research study. This implies that the synthetic teeth in this study were satisfactory. One of the main advantages of using synthetic teeth is that no ethics committee approval is required, which saves time for researchers in this field. To the best of our knowledge, the use of synthetic teeth has not been reported previously. More specifically, this is the first in vitro study to compare CBCT and DPR in the detection of EER on non-endodontic and endodontic teeth using synthetic maxillary incisors.

The methodology used in this research was similar to one proposed by previous authors [26], who simulated external inflammatory resorption on non-endodontic mandibular incisors. In the present study, we included endodontically treated teeth in order to compare them with non-endodontic teeth. This is the first in vitro study to date to compare the detection of ERR on non-endodontic and endodontic teeth using CBCT and DPR. Equally importantly, in the present study, we worked with previously trained and calibrated examiners with expertise in dental radiology and Horos software tools. Various authors [25, 29] have argued that expertise is of critical importance in the detection of ERR in both the DPR and CBCT types of projection, DPR in particular.

At the same time, this research study adopted a widely-used experimental model based on root resorption produced by round burs [14, 15]. Three sizes of root resorption were chosen to make comparisons and for detection power, particularly when the smallest drill was used. Based on the results, CBCT was a better diagnostic technique than DPR. Our findings are corroborated by a number of medical studies [23, 26, 28,29,30], although the differences we observed between detection of ERR on non-endodontic and endodontic teeth are, to the best of our knowledge, a novelty in the field. In the present study, a DPR diagnosis was observed to be 18.5% less sensitive on endodontically-treated versus non-endodontic teeth. The decrease in sensitivity was even more marked on the smallest ERR lesions, with 27.8 and 25% less sensitivity, respectively.

We speculate that these results are due to the radiopacity of endodontic teeth, which results in greater root brightness than in non-endodontic teeth. Apart from that, DPR was studied using two-dimensional images and, for all the reasons mentioned above, it is particularly difficult to detect ERR on DPR images. In all 2D image experiments, palatal resorptions were only detected on non-endodontic and endodontic teeth with the largest drill bit. Overall, detection of ERR in endodontically-treated teeth may be underdiagnosed and more careful inspection is required than when screening for ERR in vital teeth.

Conclusions

The results of this study highlight that both CBCT and DPR are good diagnostic methods for ERR. Nevertheless, root-filling material modifies the diagnostic capacity of ERR and makes the use of DPR less accurate in the detection and diagnosis of ERR than in non-endodontic teeth.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

References

  1. GollerBulut D, Uğur Aydın Z. The impact of different voxels and exposure parameters of CBCT for the assessment of external root resorptions: A phantom study. Australian Endodontic J : J Australian Soc Endodontol Inc. 2019;45(2):146–53.

    Article  Google Scholar 

  2. Sameshima GT, Iglesias-Linares A. Orthodontic root resorption. Journal of the World Federation of Orthodontists. 2021;10(4):135–43.

    Article  PubMed  Google Scholar 

  3. Mirabella AD, Artun J. Risk factors for apical root resorption of maxillary anterior teeth in adult orthodontic patients. Am J Orthod Dentofacial Orthop : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics. 1995;108(1):48–55.

    Article  Google Scholar 

  4. Pustułka K, Trzcionka A, Dziedzic A, Skaba D, Tanasiewicz M. The Radiological assessment of root features and periodontal structures in endodontically treated teeth subjected to forces generated by fixed orthodontic appliances. a prospective, clinical cohort study. J Clin Med. 2021;10(10):2078.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Haque S, Zakir M. The effects of orthodontic tooth movement in endodontically treated teeth. Bangladesh J Orthod Dentofacial Orthop. 2019;7(1):12–5.

  6. Sondeijker CFW, Lamberts AA, Beckmann SH, Kuitert RB, van Westing K, Persoon S, et al. Development of a clinical practice guideline for orthodontically induced external apical root resorption. Eur J Orthod. 2020;42(2):115–24.

    Article  PubMed  Google Scholar 

  7. Iglesias-Linares A, Hartsfield JK. Cellular and Molecular Pathways Leading to External Root Resorption. J Dent Res. 2017;96(2):145–52.

    Article  PubMed  Google Scholar 

  8. Ciurla A, Szymańska J, Płachno BJ, Bogucka-Kocka A. Polymorphisms of encoding genes IL1RN and P2RX7 in apical root resorption in patients after orthodontic treatment. Int J Mol Sci. 2021;22(2):777.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Nowrin SA, Jaafar S, Ab Rahman N, Basri R, Alam MK, Shahid F. Association between genetic polymorphisms and external apical root resorption: A systematic review and meta-analysis. Korean J Orthod. 2018;48(6):395–404.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Alhadainy HA, Flores-Mir C, Abdel-Karim AH, Crossman J, El-Bialy T. Orthodontic-induced External Root Resorption of Endodontically Treated Teeth: A Meta-analysis. Journal of endodontics. 2019;45(5):483–9.

    Article  PubMed  Google Scholar 

  11. Ioannidou-Marathiotou I, Zafeiriadis AA, Papadopoulos MA. Root resorption of endodontically treated teeth following orthodontic treatment: a meta-analysis. Clin Oral Invest. 2013;17(7):1733–44.

    Article  Google Scholar 

  12. Lee YJ, Lee TY. External root resorption during orthodontic treatment in root-filled teeth and contralateral teeth with vital pulp: A clinical study of contributing factors. Am J Orthod Dentofac Orthop. 2016;149(1):84–91.

    Article  Google Scholar 

  13. Kurnaz S, Buyukcavus MH. External root resorption in root-filled and vital teeth after extraction and non-extraction orthodontic treatments: a split-mouth retrospective study. Acta Odontol Scand. 2021;79(4):282–8.

    Article  PubMed  Google Scholar 

  14. Takeshita WM, Chicarelli M, Iwaki LC. Comparison of diagnostic accuracy of root perforation, external resorption and fractures using cone-beam computed tomography, panoramic radiography and conventional & digital periapical radiography. Indian J Dental Res : official publication of Indian Society for Dental Research. 2015;26(6):619–26.

    Article  Google Scholar 

  15. Bernardes RA, de Paulo RS, Pereira LO, Duarte MA, Ordinola-Zapata R, de Azevedo JR. Comparative study of cone beam computed tomography and intraoral periapical radiographs in diagnosis of lingual-simulated external root resorptions. Dental Traumatol : official publication of International Association for Dental Traumatology. 2012;28(4):268–72.

    Article  Google Scholar 

  16. Demiralp KÖ, Kamburoğlu K, Güngör K, Yüksel S, Demiralp G, Uçok O. Assessment of endodontically treated teeth by using different radiographic methods: an ex vivo comparison between CBCT and other radiographic techniques. Imaging Sci Dentist. 2012;42(3):129–37.

    Article  Google Scholar 

  17. Saidi A, Naaman A, Zogheib C. Accuracy of cone-beam computed tomography and periapical radiography in endodontically treated teeth evaluation: a five-year retrospective study. J Int Oral health : JIOH. 2015;7(3):15–9.

    PubMed  PubMed Central  Google Scholar 

  18. Venskutonis T, Daugela P, Strazdas M, Juodzbalys G. Accuracy of digital radiography and cone beam computed tomography on periapical radiolucency detection in endodontically treated teeth. J Oral Maxillofac Res. 2014;5(2):e1.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tieu LD, Normando D, Toogood R, Flores-Mir C. Impact on perceived root resorption based on the amount of incisal inclination as determined from conventional panoramic radiography. Am J Orthod Dentofac Orthop. 2015;148(4):685–91.

    Article  Google Scholar 

  20. Kapralos V, Koutroulis A, Irinakis E, Kouros P, Lyroudia K, Pitas I, et al. Digital subtraction radiography in detection of vertical root fractures: accuracy evaluation for root canal filling, fracture orientation and width variables. An Ex-Vivo Study Clin oral Invest. 2020;24(10):3671–81.

    Article  Google Scholar 

  21. Spin-Neto R, Kruse C, Hermann L, Kirkevang LL, Wenzel A. Impact of motion artefacts and motion-artefact correction on diagnostic accuracy of apical periodontitis in CBCT images: an ex vivo study in human cadavers. Int Endod J. 2020;53(9):1275–88.

  22. DeligaSchröder AG, Westphalen FH, Schröder JC, Fernandes Â, DitzelWestphalen VP. Accuracy of different imaging cbct systems for the detection of natural external radicular resorption cavities: an ex vivo study. Journal of endodontics. 2019;45(6):761–7.

    Article  Google Scholar 

  23. Tsai P, Torabinejad M, Rice D, Azevedo B. Accuracy of cone-beam computed tomography and periapical radiography in detecting small periapical lesions. J Endodontics. 2012;38(7):965–70.

    Article  Google Scholar 

  24. Patel S, Dawood A, Mannocci F, Wilson R, Pitt FT. Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography. Int Endod J. 2009;42(6):507–15.

    Article  PubMed  Google Scholar 

  25. Patel S, Dawood A, Wilson R, Horner K, Mannocci F. The detection and management of root resorption lesions using intraoral radiography and cone beam computed tomography - an in vivo investigation. Int Endod J. 2009;42(9):831–8.

    Article  PubMed  Google Scholar 

  26. Durack C, Patel S, Davies J, Wilson R, Mannocci F. Diagnostic accuracy of small volume cone beam computed tomography and intraoral periapical radiography for the detection of simulated external inflammatory root resorption. Int Endod J. 2011;44(2):136–47.

    Article  PubMed  Google Scholar 

  27. Razi T, Mohammadi A, Ghojazadeh M. Comparison of accuracy of conventional periapical radiography and direct digital subtractions radiography with or without image enhancement in the diagnosis of density changes. J Dent Res Dent Clin Dent Prospects. 2012;6(2):54–8.

    PubMed  PubMed Central  Google Scholar 

  28. Lima TF, Gamba TO, Zaia AA, Soares AJ. Evaluation of cone beam computed tomography and periapical radiography in the diagnosis of root resorption. Aust Dent J. 2016;61(4):425–31.

    Article  PubMed  Google Scholar 

  29. D’Addazio PSS, Campos CN, Özcan M, Teixeira HGC, Passoni RM, Carvalho ACP. A comparative study between cone-beam computed tomography and periapical radiographs in the diagnosis of simulated endodontic complications. Int Endod J. 2011;44(3):218–24.

    Article  PubMed  Google Scholar 

  30. Creanga AG, Geha H, Sankar V, Teixeira FB, McMahan CA, Noujeim M. Accuracy of digital periapical radiography and cone-beam computed tomography in detecting external root resorption. Imag Sc Dentist. 2015;45(3):153–8.

    Article  Google Scholar 

Download references

Acknowledgements

This work was funded by the Iberoamerica scholarships: Santander Research 2019/2020 and the Complutense University of Madrid- Spain, under the BOUC 14-3-2019 (ED01/19) grant. It was partly financed by the University of Guayaquil- Ecuador 2017/2021 under the (UG-CGB-126-17-7-2017) grant.

Funding

Santander Research 2019/2020 and the Complutense University of Madrid- Spain; University of Guayaquil- Ecuador 2017/2021, UG-CGB-126–17-7–2017.

Author information

Authors and Affiliations

  1. School of Dentistry, University of Guayaquil, Guayaquil, Ecuador

    C. Parrales-Bravo

  2. School of Dentistry, Complutense, BIOCRAN Research Group, Complutense University of Madrid, Madrid, Spain

    C. Parrales-Bravo & A. Iglesias-Linares

  3. School of Dentistry, University of São Paulo, São Paulo, Brazil

    S. P. Friedrichsdorf, C. Costa & J. B. Paiva

Authors
  1. C. Parrales-Bravo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. P. Friedrichsdorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. B. Paiva
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Iglesias-Linares
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

A. Iglesias-Linares, C. Costa, JB. Paiva, contributed to conception, design, data acquisition, analysis, and interpretation, drafted and critically revised the manuscript; C. Parrales-Bravo, S.P. Friedrichsdorf, contributed to design, data acquisition, analysis, and interpretation, drafted and critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to A. Iglesias-Linares.

Ethics declarations

Ethics approval and consent to participate

not applicable

Consent for publication

not applicable

Competing interests

authors declare no conflict of interest

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1

: Supplementary material Appendix I. Specimens and groups distribution.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parrales-Bravo, C., Friedrichsdorf, S.P., Costa, C. et al. Does endodontics influence radiological detection of external root resorption? an in vitro study. BMC Oral Health 23, 221 (2023). https://doi.org/10.1186/s12903-023-02871-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12903-023-02871-w

Keywords

BMC Oral Health

ISSN: 1472-6831

Contact us