Detection of artificially induced vertical root fractures of different widths by cone beam computed tomography invitro and invivo.

Abstract

To compare the diagnostic accuracy of cone beam computed tomography (CBCT) for the detection of artificially induced vertical root fractures (VRFs) of different widths invitro and invivo. Vertical root fractures were induced in 25 extracted nonendodontically treated single-rooted human teeth (maxillary first premolars, maxillary canines and mandibular incisors). Twenty teeth without VRFs served as a control group. CBCT scanning (3D Accuitomo 170) was performed invitro and invivo. For the invivo scanning, teeth were autoclaved, embedded into bite plates, placed in sterile plastic bags and then inserted into the mouths of volunteers. Teeth with VRFs were sectioned into axial slices and examined using a stereomicroscope to measure the widths of the VRFs. Five observers assessed the presence of VRFs using axial CBCT. Values for sensitivity, specificity, accuracy and interexaminer agreement were calculated. The accuracy, specificity and sensitivity of CBCT were significantly higher invitro than invivo for VRFs with widths 50-150μm (P<0.05). The sensitivity and accuracy of CBCT were significantly higher for the detection of VRFs with widths greater than 150μm invivo and invitro (P<0.05). The accuracy of CBCT invivo was 0.29 and 0.8 for fracture widths ranging from 50 to 150μm and wider than 150μm, respectively. No significant differences in CBCT specificity were found between VRF widths both invitro and invivo. The interexaminer reliability of the raters revealed a kappa value of 0.72, demonstrating substantial agreement. The detectability of VRFs by CBCT invitro and invivo was dependent upon fracture width. The accuracy of CBCT in detecting VRFs of 50-300μm width invivo was significantly lower compared to the invitro accuracy.