Comparison between dual-angle periapical technique and cone-beam computed tomography in the identification of a second canal in mandibular incisors in the presence of a zirconia implant: An in vitro study.

PURPOSE: To compare the accuracy of the dual-angle periapical technique (DPT) and CBCT acquired with two protocols in identifying lower incisors with a second canal adjacent to a zirconia implant.

MATERIALS AND

METHODS

Twenty single-rooted lower incisors were used, twelve with one canal and eight with two canals, confirmed with micro-CT. These roots and a zirconia implant were positioned in the alveolus of the mandibular right and left central incisors of a dry human mandible, respectively. Periapical radiographs were obtained using a Focus X-ray unit and a photostimulated phosphor plate (VistaScan system) with parameters of 70 kVp, 7 mA, and 0.125 seconds of exposure time. For each root, one standard and one with the tube shifted distally in 30°, with and without implant, totaling 80 radiographs. In addition, 80 CBCT scans were obtained with the OP300 Maxio (FOV 5×5 cm, 90 kVp), with and without implants, for each root. The variable parameters were: low-resolution (LR) (5 mA, 0.2 mm voxel) and high-resolution (HR) (10 mA, 0.085 mm voxel). Five evaluators assessed all images using a 5-point confidence scale. Two-way ANOVA with Sidak's post hoc test was used (P<0.05). Intra- and inter-examiner agreement were assessed with weighted kappa coefficients.

RESULTS

DPT and both CBCT protocols(LR and HR) showed comparable AUC, sensitivity, and specificity (P>0.05). DPT and both CBCT protocols presented AUC, sensitivity, and specificity unaffected by the implant(P>0.05).

CONCLUSION

DPT and both CBCT protocols showed comparable diagnostic accuracy of the second canal regardless of zirconia implant presence.