A Novel Method to Estimate the Volume of Bone Defects Using Cone-Beam Computed Tomography: An In Vitro Study

Introduction: The routine use of high-resolution images derived from 3-dimensional cone-beam computed tomography (CBCT) datasets enables the linear measurement of lesions in the maxillary and mandibular bones on 3 planes of space. Measurements on different planes would make it possible to obtain real volumetric assessments. In this study, we tested, in vitro, the accuracy and reliability of new dedicated software developed for volumetric lesion assessment in clinical endodontics. Methods: Twenty-seven bone defects were created around the apices of 8 teeth in 1 young bovine mandible to simulate periapical lesions of different sizes and shapes. The volume of each defect was determined by taking an impression of the defect using a silicone material. The samples were scanned using an Accuitomo 170 CBCT (J. Morita Mfg Co, Kyoto, Japan), and the data were up-loaded into a newly developed dedicated software tool. Two endodontists acted as independent and calibrated observers. They analyzed each bone defect for volume. The difference between the direct volumetric measurements and the measurements obtained with the CBCT images was statistically assessed using a lack-of-fit test. A correlation study was undertaken using the Pearson product-moment correlation coefficient. Intra- and interobserver agreement was also evaluated. Results: The results showed a good fit and strong correlation between both volume measurements (p > 0.9) with excellent inter- and intraobserver agreement. Conclusions: Using this software, CBCT proved to be a reliable method in vitro for the estimation of endodontic lesion volumes in bovine jaws. Therefore, it may constitute a new, validated technique for the accurate evaluation and follow-up of apical periodontitis.