Map-reading Strategy to Diagnose Root Perforations Near Metallic Intracanal Posts by Using Cone Beam Computed Tomography

IntroductionTo determine the diagnostic hypothesis on the basis of periapical radiography (PR) is a great challenge for radiologists and endodontists. Visualization of three-dimensional structures, available with cone beam computed tomography (CBCT), favors precise definition of the problem and treatment planning. However, metallic artifact effect of intracanal posts might also induce untrue images. The aim of this article is to suggest a map-reading strategy to diagnose root perforations near metallic intracanal posts (ICPs) by using CBCT.Methods and ResultsThe incapacity to locate correctly the position of root perforation might lead to clinical failures. One strategy to minimize metallic artifact in root perforation associated with ICP is to obtain sequential axial slices of each root, with an image navigation protocol from coronal to apical (or from apical to coronal), with axial slices of 0.2 mm/0.2 mm. This map reading provides valuable information showing dynamic visualization toward the point of communication between the root canals and the periodontal space, associated with radiolucent areas, suggesting root perforation.ConclusionsThe accurate management of CBCT images might reveal abnormality that is unable to be detected in conventional PR. A map-reading approach reduces problems related to detection of root perforations near metallic artifacts. The final diagnosis should always be made in conjunction with the clinical findings.