Abstract
The purpose of this study was to analyze four different cone-beam computed tomography (CBCT) protocols to identify horizontal root fractures (HRF) in endodontically treated teeth, with or without the presence of a metallic post. Thirty extracted single-rooted human premolars were treated endodontically. Afterwards, an observer induced a horizontal fracture in 15 teeth. Each tooth was inserted in an empty mandibular socket and submitted to a computed tomography scan taken with and without the metallic post. The acquisition followed four different protocols, with different fields of view (FOV) and voxel sizes, as follows: FOV 6 X 16 cm/0.2 mm voxel; FOV 6 X 16 cm/0.25 mm voxel; FOV 8 X 8 cm/0.2 mm voxel; FOV 8 X 8 cm/0.25 mm voxel. Two observers checked all the acquisitions within a two-week interval, and the values of sensitivity, specificity, accuracy and kappa were calculated. The sensitivity, specificity and accuracy values were better for the 8 X 8 cm/0.2 mm and 16 X 6 cm/0.25 mm protocols, ranging from 0.60 to 0.86 and 0.53 to 0.80, respectively. The intra- and interobserver concordance ranged from 0.65 to 0.72. The protocols where FOV and voxel were proportional showed better results. The 8 x 8 cm/0.2 mm protocol had the least interference from the metallic artifact. All four protocols showed a decline in values in the presence of the metallic artifact.
Highlights
Root fracture is a type of dental injury with the worst prognosis in dentistry
Different fields of view (FOV) sizes and acquisition times may influence the quality of a CT scan and the radiation dose delivered to the patient
The FOV selection is directly related to the voxel size and influences spatial and contrast resolution
Summary
Root fracture is a type of dental injury with the worst prognosis in dentistry. A correct diagnosis is essential for effective dental treatment, and this is accomplished by clinical and radiographic examination.[1]The etiology of root fracture is multifactorial. Root fracture is a type of dental injury with the worst prognosis in dentistry. A correct diagnosis is essential for effective dental treatment, and this is accomplished by clinical and radiographic examination.[1]. The etiology of root fracture is multifactorial. The fracture generally occurs in both anterior teeth and posterior teeth, secondary to trauma or iatrogenic procedures.[2]. The diagnosis of root fracture is more difficult to perform correctly after the obturation and insertion of a metallic post. Two-dimensional techniques are not accurate to diagnose dental fractures, because the fractures may be masked, if the projection angle is not perpendicular to the fracture line.[3]
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