Of the 3 main endodontic softwares, PBS Endo is the least expensive. Endovision was started by Bruce Lieberthal, a general dentist, in the Boston area in He sold it to Discus Dental and they incorporated it into their General Practice management software.
It was then purchased by Henry Schein in Their market has historically been large, multi-location, corporate type, financially-driven, dental practices. They bring a more corporate perspective to management software. Endovision was endorsed as a software vendor by the AAE but that endorsement was rescinded for cause in For a copy of this letter, please contact us.
The rubber stop was adjusted to the occlusal reference point, the file was withdrawn from the canal and the length was measured as mentioned above. This length was recorded as the electronic length EL. Afterwards, all teeth were arranged and immersed in the plastic molds. The 3 mm thick floor of the mold was made by wax and the remaining part was light impression silicone, that reached to the cemento-enamel junctions of teeth. The slices of the tooth were scanned and observed until the best image of entire length of the canal in bucco-lingual view at the greatest curved angle was selected.
The measuring line was drawn from the occlusal reference to the apical foramen AF , accompanying any deviations from the course of the canal, and was measured in millimeters. The conventional CBCT measurements were performed twice with an interval of two weeks to check the intra-examiner reliability.
The operator confirmed the canal orifice and the apex foramen for each canal of each tooth. Once these two landmarks were defined, the automatic line would be drawn immediately by software to connect these two points. The canal pathway was defined by selecting and adjusting the positions of as many points as possible on this line in horizontal and vertical planes from the orifice to apex. This step was performed by operator. The 3D Endo software reconstructed automatically the 3-D image and inside canal system and inserted a virtual K-file reaching to the apex.
After adjusting the coronal angulation of the file following the straight-line access concept, the operator pressed the Suggest button to automatically produce the proposed length 3D-PL Fig.
This length was recorded as 3D-PL. The position of the rubber stop at the proposed length normally was adjusted by the operator for best suitable location, and this length was recorded as corrected length 3D-CL Fig. The 3D Endo measurements were performed twice with an interval of two weeks to check the intra-examiner reliability.
The data were first screened for normality of distribution using the Shapiro—Wilk test. The ICC indices for the intra-examiner reliability were greater than 0.
The 3D-CL measurements reached to highest accurate proportion at the smallest size of voxel when compared to the 3D-PL measurements.
Except for the voxel size of 0. Using the analysis method of the previous studies 14 , 15 , 16 , there were five fixed biases and two proportional biases for the present study. There were not significant differences in the mean differences between 3D-PL voxel size of 0. The Bland—Altman plots for the agreements of the four modalities with AL were displayed in the four figures, Figs.
The important role of the working length determination had never diminished, especially in the existing of more and more modern effective instruments for preparation 17 , 18 , the complexity of the root canal system There was fixed bias between the ProPex Pixi and the AL measurements with the means of the EAL measurements were constantly lower than the latter, across the entire range of measurements. The results of the present study showed that there were the 3D-PL measurements at voxel size of 0.
The results of the present study also showed that the accuracies of the 3D-CL measurements were higher than that of 3D-PL measurements at voxel sizes of 0. The virtual rubber stop on the file was corrected using the anatomic landmarks on the occlusal surface by the operator in the effort of reaching to the most accurate length.
The results showed that, at smaller voxel sizes, the adjustments of the rubber stop positions were easier, leading to more accurate correct lengths. This agreed with the results of the previous studies 6 , 9 , The conventional CBCT Romexis Viewer measurements in the present study obtained the more accurate at smaller voxel sizes, like that of the previous studies 6 , The present study used the Bland—Altman plots for analysis of the agreement of the measurements with the AL, differed from the previous studies 6 , The 3D Endo measurements also confirmed the similar results in the present study, that the smaller voxel sizes yielded more accurate measurements.
Studies on determination of WL with CBCT commonly used human extracted teeth in dry mandible or in jaw model 6 , 20 , The setting with the dry human mandible is better than other contexts in controlling of some clinical variations such as artifacts caused from position or motion of patient, beam hardening from other surroundings, or noise from other anatomic structures The arrangement of teeth in the impression tray of the present study does not eliminate completely artifacts from the neighboring teeth in the tray.
However, CBCT images are clear and anatomic landmarks are defined easily and exactly owing to of high resolution The Romexis Viewer measurements agreed with the AL with good mean differences, just higher than that of the best method in the present study.
This result differed from the other previous studies 1 , 6 , 11 , Although the human extracted teeth seem appropriately for evaluation the accuracy of CBCT WL determination, the artificial endodontic training tooth still completely satisfies requirements of this purpose Authors just select the actual root canal length of the artificial tooth as the gold standard in evaluation of the accuracy of the CBCT WL The 3D Endo software can improve accurate 3D root canal length determination, however, the operator should check, control, and maintain continuously the working length during the preparation phase to detect changes, especially in severe curved canal One important shortcoming with CBCT in endodontic WL determination on the heavily metallic restored tooth is the significant artifact More artifact means a greater approximate range of length, and in these cases, CBCT provides only an estimate of the length Proper knowledge of root canal anatomy and morphology is indispensable for every clinician in endodontics for locating the root canal orifices.
CBCT imaging has supplied an exact, noninvasive approach for clinical chairside assessment of root canal anatomy 4. The 3D Endo software is an effective, quick, and easy modality for identification and visualization of canal trajectories in three dimensions. This software reveals promise in supporting operator for quantifying anatomical complexities preoperatively 10 , Endodontics can be performed at a high level without CBCT imaging, but it cannot be practiced at the highest level Image-guided endodontics with minimally invasive access and instrumentation is recently recommended by authors for better in preservation as much tooth structure as possible However, this is not the major key to use for the routine examination in endodontics.
The benefits from the examination far outweigh the risks related to ionizing radiation exposure should be carefully considered Although the radiation exposure for each dental examination is less than dose of radiation from other sources, the exposure time is so short, leading to the augmentation of damage.
Diagnostic examinations should be performed at the lowest dose of radiation, following the ALARA principle: as low as reasonably achievable The American Association of Endodontists statement suggests that the risk—benefit ratio is too high for CBCT to be a routine screening tool, even though the radiation levels are low with focused-field device Therefore, the application of CBCT only for root canal length measurement is not advocated The present study used three different voxel sizes for evaluation of the accuracy and agreement of the CBCT measurements compared to the AL.
This differed from the previous studies using 3D Endo software 9 , One important feature of the present study was the root canals of the human extracted molars with appropriately calculated sample size used for the evaluation, that differed from the other studies 9 , However, the present study did not include the dry jaws to simulate the clinical situation and use the intact human molars for a real situation with the pre-existing CBCT data of the patients.
Further studies should perform to confirm the effectiveness of the 3D Endo software with better conditions to simulate the clinical situations such as dry jaws, intact human premolars, molars. Pham, K. The accuracy of endodontic length measurement using cone-beam computed tomography in comparison with electronic apex locators.
Article Google Scholar. Nekoofar, M. The fundamental operating principles of electronic root canal length measurement devices.
Martins, J. Clinical efficacy of electronic apex locators: systematic review. Article PubMed Google Scholar. Nudera, W. Google Scholar. To succeed as the owner of an endodontic practice, you not only have to provide outstanding medical care. You also have to stand out in how you interact with your referrers and patients.
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