Dr. Ove Peters

Rooting Out the Problem

By Nancy Eaton

Setting Your Teeth on Edge. In the past five years, Dr. Ove Peters, DMD, MS, Ph.D., has helped pioneer dental anatomy visualization using volume rendering. It’s a giant leap forward from the previous method of viewing dental anatomy, which included manually sawing and photographing cross-sections of teeth.

When you’re sitting in the dentist’s chair, few things can ruin your day more than hearing the words, “You need root canal treatment.”

With modern endodontics techniques (and enough novocaine), most patients experience a relatively painless root canal procedure. But it’s still time-consuming and stressful — particularly considering a jaw-dropping 10 percent of the more than 30 million root canal treatments performed in the U.S. each year fail and need to be done over.

At the University of California at San Francisco, dental researcher and instructor Dr. Ove Peters is working to improve those odds. Dr. Peters is using microcomputed tomography (µCT), Macintosh computers, and VStudio MAX, an innovative 3D visualization application, to more accurately map the internal anatomy of teeth. Using Dr. Peters’s highly detailed three-dimensional images, endodontics students learn to evaluate their approach to root canal procedure and refine their technique, and dental instrument manufacturers gain valuable information to help with product design.

Canals Sometimes Overlooked

But what is root canal treatment and why can it fail? When the soft tissue inside a tooth becomes infected, often because of decay or trauma, endodontists drill to remove all this bacteria-ridden tissue, including in the tiny canals that run inside the roots of the tooth. The goal is to halt the infection and preserve the tooth, as opposed to extracting it. The procedure is fairly straightforward on teeth with simple roots, such as incisors. But molars often have complex root systems that twist and branch. Even using the most modern technology and techniques, it’s difficult for endodontists to know if they’ve removed all the infected tissue inside every one of the tiny canals. If not, infection can flare up again, requiring an additional procedure.

“The potential for students to assess examples of different kinds of root canal anatomy in three dimensions is significant and does lead to improvements in spatial perception, a very important prerequisite for dentistry in general and endodontics in particular.”

Endodontists shoot X-rays from various angles to study teeth before they start drilling. But X-rays are low resolution images and can only tell part of the story. “Endodontists have a little bit of an idea what is going on three-dimensionally using X-rays, but there are significant limitations,” says Dr. Peters. “They can just roughly assess it.”

A More Detailed Way to Visualize

This is where CT technology can make a difference. Early in 2000, dental researchers, including Dr. Peters, began exploring micro-computed tomography (µCT) as a better way to visualize tooth anatomy after it proved successful in analyzing human bones. For the first time, researchers could precisely measure and compare root canal spaces before and after they shaped them with instruments.

“It became obvious that these images could also be used for education,” says Dr. Peters. “The potential for students to assess examples of different kinds of root canal anatomy in three dimensions is significant and does lead to improvements in spatial perception, a very important prerequisite for dentistry in general and endodontics in particular.”

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