A comparison of image artifacts with gutta-percha and different sealers on root filled teeth using cone beam computed tomography: An in vitro study

Different materials cause artifacts in cone-beam computed tomography (CBCT) images, which, in turn, reduce the quality of images. The aim of this study was to investigate the abundance of artifacts induced by different root canal therapy sealers with two different CBCT resolutions.

Roots of four maxillary central phantom teeth were prepared using rotary files in three steps. In the first step, the first tooth was scanned first without gutta-percha and then with gutta-percha No. 25. Gutta-percha No. 25 with resin, the zinc oxide-eugenol (ZOE)-based sealer and the ceramic-based sealer were placed in the teeth No. 2, 3 and 4, respectively. The second step was performed similar to the first step, except that gutta-percha No. 35 was used in the tooth No. 1 with resin- and ZOE-based sealers in the teeth No. 2 and 3. due to the lack of access to the ceramic-based sealer that was not used to continue the study . In the third step, canal obturation was performed in the teeth No. 2 and 3 with resin and ZOE-based sealers. At each step, three CBCT scans were obtained in high and standard resolution conditions. Contrast-to-noise ratio was obtained in three root plans, and the data were analyzed.

Gutta-percha alone produced more artifacts than gutta-percha with sealers. Moreover, ZOE-based sealers induced more artifacts than other sealers. There was no significant difference between the three steps. Similarly, at different resolutions, there was no significant difference between gutta-percha and sealer artifacts. The ZOE-based sealers had more artifacts at 1/3 apical whereas resin sealers had more artifacts at 1/3 coronal.

The higher artifact of gutta-percha in comparison with gutta-percha and sealer and the artifact decrease in the combination of gutta-percha and resin-based sealer than ZOE-based sealer has led us to recommend the use of resin-based sealer while root canal therapy in order to better evaluation of the CBCT Images of root canal.