Evaluation of the efficacy of the metal artifact reduction algorithm in the detection of a vertical root fracture in endodontically treated teeth in cone-beam computed tomography images: An in vitro study.

Abstract

Three-dimensional (3D) cone-beam computed tomography (CBCT) scans play an important role in dental diagnostics and treatment planning, especially in detecting vertical root fractures (VRFs). However, artifacts caused by high-density dental materials can negatively affect the quality of CBCT images by decreasing contrast and masking structures. The aim of this study was to assess the efficacy of artifact removal software in detecting VRFs in endodontically treated teeth on CBCT scans. This study evaluated 70 endodontically treated single-rooted teeth. Half of the teeth were cracked by introducing a wedge into the canal and tapping gently with a hammer; the rest remained untouched as a control group. The teeth were then mounted in a bovine rib bone. Soft tissue was simulated using red dental wax. Cone-beam computed tomography scans were taken using the NewTom® 3G, ProMax® 3D and Cranex® 3D CBCT systems, and the MATLAB software was applied. The images were evaluated by 2 oral and maxillofacial radiologists, and the results were recorded in a checklist. The data was analyzed using the κ coefficient, McNemar's test and the receiver operating characteristic (ROC) curves. A significant inter-observer agreement was noted between the 2 observers in detecting VRFs using all CBCT systems. In all systems, the use of the MATLAB software improved the detection of VRFs, but the difference was not significant in the NewTom 3G (p = 0.119) and ProMax 3D (p = 0.455) systems. However, the difference was significant in the Cranex 3D system (p = 0.039). The MATLAB artifact removal software can enhance the detection of VRFs on CBCT scans to some extent.