Detection Of Horizontal Root Fractures Research Articles

Effect of Field of View and Resolution in Detection of Horizontal Root Fractures in CBCT images: An In Vitro Study.

New cone-beam computed tomography (CBCT) devices are capable of imaging with different resolutions and field of views (FOVs), in which higher resolutions and FOVs impose a higher dose to the patient. This study was an attempt to investigate the detection accuracy from different FOVs and resolutions in detection of horizontal root fractures. Through this experimental study, in five different field of views (FOV) and resolutions (voxel size) of New Tom VGi CBCT (Italy) system was used to scan fifty teeth with horizontal root fractures in half of them. The images were evaluated by four observers (two maxillofacial radiologists and two general dentists) who recorded the presence or absence of horizontal root fractures. The data were analyzed by SPSS 22 software and MacNemar and kappa test were used to compare results with reality. The highest sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy (AZ) were attributed to 8×8 FOV and high resolutions (0.125 mm voxel size) but the difference between sensitivity, specificity, PPV and NPV was not significant. Kappa values for inter-observer agreement between radiologists and general dentists and also intra-observer agreement were in excellent ranges. The highest Kappa in both cases was attributed to 8×8 FOV and high resolutions. There was no significant difference to diagnose of horizontal root fracture between two observer groups and for all of the FOVs and voxel sizes.

The Effects of Imaging Enhancement Tools in the Detection of Horizontal Root Fractures.

Detection of root fracture is challenging both clinically and radiographically. Root fractures occur in different planes with unpredictable presentations. The aim of the study was to evaluate the diagnostic accuracy of selected digital image enhancement tools in the detection of horizontal Root Fracture (RF). Fifty three roots, of single and multi-rooted teeth, in eight dentate human cadaver mandibles were selected for this study. Following minimally traumatic extraction of the teeth, horizontal fractures were induced in 23 roots and remounted in the empty sockets of their respective human dry mandibles. The remaining teeth with no fractures were used as the control group. Twenty two periapical radiographs were obtained by using the paralleling technique and using Complementary Metal Oxide Semiconductor (CMOS). Image J software was used to enhance the original images with the Inversion (IN), Histogram-Equalization (EQ) and Polynomial (Poly) tools. A total of 88 periapical images (original and three enhanced images) were reviewed independently by three Oral and Maxillofacial Radiologists and two Endodontists. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the accuracy of fracture detection and the kappa statistic was used to assess agreement among reviewers. The diagnostic accuracy for one of the observers was significantly different in detection of RF with only EQ enhancement tool. Sensitivity and specificity were not significantly different. Interobserver agreement showed no significant difference between imaging methods. Intra-observer agreement was high to moderate. There was no significant difference between the different imaging modalities. No statistical difference for the agreement was found among or between the endodontists and radiologists in this study.

Detection of horizontal root fracture using four different protocols of cone-beam computed tomography

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.

Influence of X-ray beam angulations on the detection of horizontal root fractures

Aims: The aim of this study was to evaluate the variation of vertical angle for detection of fractures. Materials and Methods: Twenty-five (25) single-rooted premolar teeth were divided into two groups, fractured teeth (n = 15) and non-fractured teeth (n = 10). Artificially fractured teeth were classified according to location, number of fragments, and direction of fracture line: Horizontal, oblique, or complex. The tooth fragments were juxtaposed with cyanoacrylate, and the specimens (fractured and non-fractured) were placed individually in the dental alveolus of a human jaw with the aid of silicone rubber impression material and submitted to eight periapical radiographs in a digital sensor with a vertical range of 10 degrees (−40, −30, −20, −10, 0, +10, +20, +30). Three examiners evaluated the characteristics of the fractures and their correlation with the radiographic diagnosis (perceived or not) by varying the vertical angle. Statistical Analysis: Descriptive analysis was performed through the analytical comparison and Kappa test inter-examiner. Results: Among the three examiners, inter-examiner Kappa value was 0.536. The radiographic identification of root fracture in the 15 prepared samples was 60% (nine) at angle 0, and at the angles of +10, −10, and −20, it was less than 50%. Conclusions: Multiple radiographs with variations of vertical angle are fundamental to facilitate the diagnosis of horizontal root fractures in premolars.

Influence of Cone-beam Computed Tomographic Scan Mode for Detection of Horizontal Root Fracture

IntroductionThe purpose of the present study was (1) to test the accuracy of a small-volume cone-beam computed tomographic (CBCT) device in detecting horizontal root fractures (HRFs) in teeth with and without an intracanal metallic post (IMP) and (2) to investigate the use of 2 different acquisition protocols of a CBCT device for HRF diagnosis. MethodsForty endodontically treated teeth with and without an IMP were examined using PreXion 3D CBCT scanner (Terarecon, San Mateo, CA) with a 5-cm high and 5-cm diameter cylinder at 0.10-mm voxel reconstruction. Two observers analyzed the samples to determine the presence and location of HRFs. ResultsSensitivity values ranged from 0.40–0.80. The most favorable results were found for the samples with no IMP observed using the protocol of a higher number of x-ray projections (0.70–0.80). Accuracy in the groups with an IMP ranged from 75%–90% in the 1024 x-ray projection protocol (HI-HI group) versus 70%–85% for the same samples examined in the 512 x-ray projection protocol (HI-STD group). Intraobserver agreement ranged from relevant to perfect concordance for both protocols (HI-HI = Kappa: 0.60–1.00 and HI-STD = Kappa: 0.55–0.89). Interobserver agreement ranged from moderate to perfect concordance for both protocols (HI-HI = Kappa: 0.79–0.89 and HI-STD = Kappa: 0.42–0.76). ConclusionsEven though there are statistically significant differences for the protocol with the higher number of x-ray projections, we found high accuracy, sensitivity, sensibility, and intra- and interobserver agreement in detecting HRFs for both Prexion 3D protocols.

Comparison of intraoral radiography and cone-beam computed tomography for the detection of horizontal root fractures: an in vitro study

This study aimed to compare the diagnostic accuracy of two different cone-beam computed tomography (CBCT) units with several intraoral radiography techniques for detecting horizontal root fractures. The study material comprised 82 extracted human maxillary incisors without root fractures that had not undergone any root canal treatment. Root fractures were created in the horizontal plane in 31 teeth by a mechanical force using a hammer with the tooth placed on a soft foundation as described in a previous study. The teeth were divided into two groups: a control group with no fractures and a test group with fractures. These were randomized to the empty maxillary anterior sockets of a dry human maxilla. Each tooth was imaged at various vertical angles using each of the following modalities: a 3D Accuitomo 170 CBCT, a NewTom 3G CBCT, a VistaScan PSP, a CCD sensor, and conventional film. Specificity and sensitivity for assessing horizontal root fracture by each radiographic technique were calculated. Chi-square statistics were used to evaluate differences between modalities. Kappa statistics assessed the agreement between observers. Results were considered significant at P < 0.05. The kappa values for inter-observer agreement between observers ranged between 0.88 and 0.98 for the 3D Accuitomo 170, 0.82 and 0.91 for the NewTom 3G, and 0.61 and 0.72 for the different types of intraoral images. The diagnostic accuracy for detecting fracture lines in 3D Accuitomo 170 (0.93) was significantly higher than NewTom 3G (0.87), VistaScan (0.71), CCD (0.70), and CF (0.68). 3D Accuitomo 170 has the highest sensitivity and diagnostic accuracy for detecting horizontal root fracture among the 5 radiographic modalities examined. CBCT should be considered as the most reliable imaging modality of choice for the diagnosis of horizontal root fracture. CBCT imaging offers the clear advantage over conventional imaging that traumatized teeth can be visualized in all three dimensions--especially the oro-facial dimension.

Detection of Horizontal Root Fracture with Small-volume Cone-Beam Computed Tomography in the Presence and Absence of Intracanal Metallic Post

Introduction The aim of the present study was to test the accuracy of small-volume cone-beam computed tomography (CBCT) scanning in the detection of horizontal root fractures and to assess the influence of a metallic post. Methods Forty teeth were divided into four groups based on the presence of metallic posts and horizontal root fracture. The teeth were examined by small-volume CBCT scanning at 0.2-mm voxel resolution. Three observers analyzed the samples for the presence of a horizontal root fracture. Sensitivity and specificity were calculated. Results High values for accuracy (73%–88%) were obtained in the groups without a metallic post, and statistically significant differences were found when the group with a metallic post has been observed (55%–70%). Intraobserver agreement also showed statistically significant differences in the groups with a metallic post. Conclusions Small-volume CBCT scanning showed high accuracy in detecting horizontal root fracture without a metallic post. However, the presence of a metallic post significantly reduced the specificity and sensitivity of this examination.

Effectiveness of limited cone‐beam computed tomography in the detection of horizontal root fracture

To compare the diagnostic accuracy of conventional film radiography, charge coupled device (CCD) and photostimulable phosphor plate (PSP) digital images and limited cone-beam computed tomography in detecting simulated horizontal root fracture. Root fractures were created in the horizontal plane in 18 teeth by a mechanical force and fragments were relocated. Another 18 intact teeth with no horizontal root fracture served as a control group. Thirty-six teeth were placed in the respective empty maxillary anterior sockets of a human dry skull in groups three by three. Intraoral radiographs were obtained in three different vertical views by utilizing Eastman Kodak E-speed film, CCD sensor, RVG 5.0 Trophy and a PSP sensor Digora, Optime. Cone beam CT images were taken with a unit (3D Accuitomo; J Morita MFG. Corp, Kyoto, Japan). Three dental radiologists separately examined the intraoral film, PSP, CCD and cone beam CT images for the presence of horizontal root fracture. Specificity and sensitivity for each radiographic technique were calculated. Kappa statistics was used for assessing the agreement between observers. Chi-square statistics was used to determine whether there were differences between the systems. Results were considered significant at P < 0.05. Cone beam CT images revealed significantly higher sensitivities (P < 0.05) than the intraoral systems between which no significant differences were found. Specificities did not show any statistically significant differences between any of the four systems. The kappa values for inter-observer agreement between observers (four pairs) ranged between 0.82-0.90 for the 3DX evaluations and between 0.63-0.71 for the different types of intraoral images. Limited cone beam CT, outperformed the two-dimensional intraoral, conventional as well as digital, radiographic methods in detecting simulated horizontal root fracture.

Accuracy of three different electronic apex locators in detecting simulated horizontal and vertical root fractures

The aim of this in vitro study was to evaluate the accuracy of three electronic apex locators (EALs): Root ZX, Foramatron D10 and Apex NRG, in the detection of fractures in teeth having simulated horizontal and vertical root fractures. A total of 90 extracted intact, straight, single-rooted teeth were divided into six groups of 15 teeth each. In Groups A, B and C, an incomplete horizontal fracture was simulated by preparing a horizontal incision in the coronal, middle or apical portion of the root until the circumferential half of the canal was exposed in the horizontal plane respectively. In Groups D, E and F, an incomplete vertical root fracture was simulated by preparing a vertical straight incision to expose the canal in the coronal, middle or apical portion of the root all the way in the longitudinal plane respectively. The simulated fractures were 0.25 mm in thickness in all groups. The teeth were embedded in 1% agar and the canals were irrigated with saline solution during electronic measurement. Detection of the simulated root fractures was established with a size 10 K-file when the meter value reached 'APEX' on each EAL. In Groups A, B and C, Kruskal-Wallis tests revealed that there were no statistically significant differences between the three EALs. However, statistically significant differences were found among the EALs in Groups D, E and F (P < 0.0001, one-way anova and Tukey's post-hoc test). In conclusion, the three EALs tested were accurate and acceptable clinical tools in the detection of horizontal root fractures. However, the three EALs were unreliable in detecting the position of vertical root fractures.