Detection Of Vertical Root Fractures Research Articles

A narrative review on the current uses of artificial intelligence in endodontics

Abstract Artificial intelligence (AI) has been widely introduced to dentistry in the past decade. Its application in endodontics is limited to different areas such as working length determination, morphological assessment, detection of vertical root fracture, and the detection of periapical lesion. Therefore, this study aims to highlight the available evidence for the uses of AI in endodontics. It also presents the current status as well as the future perspectives on the uses of AI and its potential application in everyday practice. A literature search was conducted from January 2000 to January 2023 using PubMed and Google Scholar for the terms AI and endodontics. Thirty-one studies were evaluated and summarized, highlighting the potential use of different AI models in endodontics. The evaluation of the studies indicated that the use of AI is promising and could aid in tailored endodontics therapy. It would help the clinician in the detection of periapical radiolucency, root fractures, and determination of working length. However, well-designed, high-quality research is required to assess the possible implementation of AI into day-to-day practice in endodontics.

Influence of the metal post material, tooth location in the dental arch, and metal artifact reduction tool on vertical root fracture diagnosis in cone beam CT.

This study aimed to evaluate the influence of the metal post composition, tooth location in the dental arch, and metal artifact reduction (MAR) on vertical root fracture (VRF) diagnosis in cone beam computed tomography (CBCT). Twenty-two unirradicular premolars (12 sound and 10 fractured) and two alveolar sockets of a mandible (anterior and posterior regions) composed the sample. CBCT scans of each tooth with a metal post placed into the root canal-silver-palladium (Ag-Pd), cobalt-chromium (Co-Cr), or nickel-chromium (Ni-Cr)-were individually acquired for each mandibular region, and two conditions of MAR, using a OP300 device (Instrumentarium, Finland). Images were assessed by five evaluators independently for VRF detection. Diagnostic values were calculated and compared among all groups using multi-way ANOVA with Tukey post hoc test to investigate the effect of post material, anatomical region, and MAR on VRF diagnosis (α = 0.05). Values of area under the receiver operating curve and specificity were not influenced by the studied factors (p > 0.05). Sensitivity was influenced by the MAR in both mandibular regions (p < 0.05). In the anterior region, sensitivity values increased when the MAR was enabled, regardless of the metal post material (p < 0.05). Similar behavior was noticed in the posterior region for Ni-Cr (p < 0.05) but not for Ag-Pd and Co-Cr posts (p > 0.05). The MAR improved the sensitivity in VRF diagnosis for all tested metal posts in the mandibular anterior region and for the Ni-Cr post in the mandibular posterior region. Therefore, for images obtained in the OP300 CBCT device, activation of the MAR is suggested in these cases.

Diagnostic efficacy of cone-beam computed tomography for detection of vertical root fractures in endodontically treated teeth: a systematic review

BackgroundVertical root fractures (VRFs) sometimes occur in endodontically treated teeth. They have a difficult diagnosis and a dismal result. The objective of this review was to evaluate the diagnostic performance of cone-beam computed tomography (CBCT) for detecting VRFs in teeth that had undergone endodontic treatment.MethodsLiterature was reviewed from Web of Science, PubMed, Cochrane Review, SCOPUS, and Embase databases between 2000 and 2022. The searched keywords included "endodontically treated teeth," "cone-beam computed tomography," "CBCT," "tooth fracture," "vertical root fracture," "VRF," "accuracy," "sensitivity," and "specificity." Only articles in the English language were included. The final analysis included 20 papers that satisfied the eligibility requirements.ResultsThe overall mean ± SD values (%) for the diagnostic sensitivity and specificity of CBCT for detection of VRFs in endodontically treated teeth in the presence of root-filling materials without an intracanal post were 71.50 ± 22.19 and 75.64 ± 19.41, respectively. The overall mean (SD) value (%) for the sensitivity of CBCT for the detection of VRFs in the presence of root-filling materials and intracanal posts was 72.76 (18.73), while the mean (SD) specificity was 75.44 (18.26). The accuracy of CBCT (mean ± SD) was 78.47 ± 17.19% and 74.02 ± 10.64%, respectively, for teeth without intracanal posts and those with posts.ConclusionsFurther clinical research is needed to validate the optimum efficiency of CBCT as a diagnostic technique for detecting VRFs in teeth that have had endodontic treatment, given the low sensitivity, significant heterogeneity of studies, and lack of in-vivo studies on the subject.

Influence of voxel size and filter type on detecting vertical root fracture using cone-beam computed tomography.

Vertical root fractures (VRFs) can start at any level of the root and progress longitudinally to the coronal attachment. This study aimed to investigate the effects of different exposure parameters used when obtaining CBCT scans in detecting simulated VRFs. Hence, 80 intact human mandibular single-rooted pre-molar teeth without root fractures were included in the study. No statistically significant difference was found between the filters in terms of VRF detection in the group with the roots with only root canal filling (Groups 1 and 5); however, 100 voxels were found to be more successful in terms of VRF detection than other voxel sizes. Results of this study suggest that using lower voxel sizes leads to an accurate diagnosis of vertical root fracture, in addition, our results revealed that using AR filters did not improve the diagnostic accuracy in detecting VRFs.

Detection of vertical root fractures by cone-beam computed tomography based on deep learning

This study aims to evaluate the performance of ResNet models in the detection of in vitro and in vivo vertical root fractures (VRF) in Cone-beam Computed Tomography (CBCT) images. A CBCT image dataset consisting of 28 teeth (14 intact and 14 teeth with VRF, 1641 slices) from 14 patients, and another dataset containing 60 teeth (30 intact and 30 teeth with VRF, 3665 slices) from an in vitro model were used for the establishment of VRFconvolutional neural network (CNN) models. The most popular CNN architecture ResNet with different layers was fine-tuned for the detection of VRF. Sensitivity, specificity, accuracy, PPV (positive predictive value), NPV (negative predictive value), and AUC (the area under the receiver operating characteristic curve) of the VRF slices classified by the CNN in the test set were compared. Two oral and maxillofacial radiologists independently reviewed all the CBCT images of the test set, and intraclass correlation coefficients (ICCs) were calculated to assess the interobserver agreement for the oral maxillofacial radiologists. The AUC of the models on the patient data were: 0.827(ResNet-18), 0.929(ResNet-50), and 0.882(ResNet-101). The AUC of the models on the mixed data get improved as:0.927(ResNet-18), 0.936(ResNet-50), and 0.893(ResNet-101). The maximum AUC were: 0.929 (0.908-0.950, 95% CI) and 0.936 (0.924-0.948, 95% CI) for the patient data and mixed data from ResNet-50, which is comparable to the AUC (0.937 and 0.950) for patient data and (0.915 and 0.935) for the mixed data obtained from the two oral and maxillofacial radiologists, respectively. Deep-learning models showed high accuracy in the detection of VRF using CBCT images. The data obtained from the in vitro VRF model increases the data scale, which is beneficial to the training of deep-learning models.

Influence of the technical parameters of CBCT image acquisition on vertical root fracture diagnosis: a systematic review and meta-analysis.

To evaluate the influence of image acquisition parameters (voxel, FOV, kVp, mA) on the accuracy of cone-beam computed tomography (CBCT) in detecting vertical root fracture (VRF). Searches were performed in 6 main databases and the gray literature, without restrictions of language or date. Observational clinical studies (OCS) and in vitro-extracted teeth (IV) studies were considered eligible for inclusion when investigating the accuracy (sensitivity, specificity) of CBCT in detecting VRF in human teeth. The risk of bias was assessed using QUADAS-2, and a meta-analysis was performed using Review Manager v5.4 software and Jamovi software v1.6. A total of 60 out of 132 articles was included after fulfilling the eligibility criteria. Of these, 54 were IV studies while 6 were OCS. In the IV studies, it was seen that smaller FOV sizes tended to present higher accuracy values. The meta-analysis of the 6 OCS showed that the overall sensitivity and specificity values for 0.08mm and 0.1mm voxels were greater (0.84 and 0.79, respectively) than the sensitivity and specificity values for 0.125mm and 0.2mm voxels (0.70 and 0.55, respectively). Despite the uncertain risk of bias found for the IV and OCS studies, smaller voxel and FOV sizes seem to provide more accurate VRF detection values when using CBCT. This information is crucial for supporting the clinician when prescribing CBCT in cases of a clinical suspicion of VRF, and contributes to the personalization of the CBCT prescription, thereby ensuring greater accuracy in the VRF diagnosis. Registration This protocol was registered at the PROSPERO database (International Prospective Register of Systematic Review) under registration number CRD42020210118.

Effect of Dental Distance from Implant and MAR Algorithm on the Detection of Vertical Root Fracture in CBCT Images

Three-dimensional cone-beam computed tomography (CBCT) has an important role in the detection of vertical root fractures (VRFs). The effect of artifact generation by high-density objects like dental implants on image quality was well documented. This study aimed to assess the effect of tooth-implant distance and the application of metal artifact reduction (MAR) algorithm on the detection of VRFs on CBCT scans. This study was conducted on 20 endodontically treated single-rooted teeth. VRFs were induced in 10 teeth, while the other 10 remained intact. The implant was inserted in the right second premolar socket area, and two teeth were inserted in right canine and right first premolar sockets area randomly and underwent CBCT with and without the application of MAR algorithm. SPSS 21 was used to analyze the results (alpha=0.05). According to the findings of this study, all four variables of sensitivity, specificity, accuracy, and positive predictive values in diagnosis were higher in cases without MAR software at both close(roots in first premolar sockets) and far distances (roots in canine sockets) from the implant. However, the highest rate of diagnosis accuracy of the first and second radiologists was in the far distance group from the implant without MAR, and the lowest rate of diagnosis accuracy in the first and second radiologists was in the close distance to the implant. Applying MAR algorithm had no positive effect on detection of VRFs on CBCT scans in both close and distant scenarios.

Influence of Artifacts Induced by Dental Implants on The Detection of Vertical Root Fractures in Cone Beam Computed Tomographic Scans. An in-Vitro Study

Influence of Artifacts Induced by Dental Implants on The Detection of Vertical Root Fractures in Cone Beam Computed Tomographic Scans. An in-Vitro Study

Effect of different intracanal posts and exposure parameters on detection of vertical root fractures by cone-beam computed tomography.

This study evaluated the effect of different amperage values and voxel sizes of two CBCT scanners on VRF detection in the presence of different intracanal posts. After post-space preparation, VRFs were induced in half of the samples of 20 maxillary premolars. Five different intracanal posts were passively placed in each root canal. Samples were scanned using CS 9300 and Cranex3D with two different voxel sizes and amperage setting in each unit. The diagnostic sensitivity, specificity and accuracy were compared using the Mann-Whitney and Kruskal-Wallis tests (α=0.05). Changes in amperage and voxel size did not affect the detection of VRFs (p ⟩ 0.05). The VRF detection accuracy was the highest in fibreglass and the lowest in nickel-chromium group. Changes in amperage and voxel size within assessed values do not seem to influence the detection of VRF whereas different intracanal post-materials have significant effect on VRF detection.

Impact of Fracture Line Width on Radiographic Diagnosis of Vertical Root Fractures: Analysis of the Generalised Estimating Equation Model.

To undertake a joint analysis of the influence of fracture width, dental thickness and distance of the fracture from the cortical bone on the radiographic diagnosis of vertical root fractures. Thirty-six uniradicular bovine teeth were endodontically treated and distributed into three groups according to the remaining root dentine thickness: 1.2 mm, 1.5 mm and 1.8 mm. Each group comprised 12 teeth, six with vertical root fracture and six without. Scanning electron microscopy (SEM) images of the fractured tooth groups were obtained and the fracture lines were measured. All specimens were inserted into bone defects created in bovine ribs, at different distances from the external cortical bone. Digital periapical radiographs were randomly evaluated by three blinded examiners (presence or absence of fractures). The specificity for periapical radiography was found to be 89% and the accuracy rate was 57.4%. The mixed-model regression using the generalised estimating equation (GEE) model showed that the width of the fracture line and the thickness of the dental remnant play an important role in radiographic detection of vertical root fractures. There is a lower chance of correct diagnosis with fracture line widths < 0.2 mm (odds ratio [OR] 0.294, 95% confidence interval [CI] 0.103 to 0.836; P = 0.022) and tooth thicknesses < 1.2 mm (OR 0.342, 95% CI 0.157 to 0.747; P = 0.007). Fracture line widths < 0.2 mm and smaller root thicknesses lead to a less accurate diagnosis of vertical root fractures on periapical radiographs.

The Effect of Gamma Value Alterations for Detecting Vertical Root Fracture in Indirect Digital Radiograph (an In-vitro Study)

Background and Objectives Most digital imaging systems offer a variety of image processing techniques. Due to the importance of the accuracy of these images and their widespread application, this study aims to evaluate the detection of vertical root fracture (VRF) in indirect digital images by changing their gamma values. Subjects and Methods In this study, 23 extracted teeth were prepared as samples from dental clinics in Ahvaz, Iran. The radiographs were obtained from the samples before and after VRF induction. After root canal preparation, a very thin disc was used to divide the teeth into two halves in the buccal-lingual direction to create a VRF. The two halves were re-attached to each other and mounted in in molds filled with a mixture of plaster and sawdust. After processing the images by adjusting their gamma values using low, medium and high settings, the images were viewed by two radiologists for the presence or absence of VRF. Results In all three modes of gamma adjustment, the sensitivity, specificity and overall accuracy of images were high and there was no significant difference between the three modes. Conclusion The high gamma for digital images can used to as a filter to detect VRF. The images with medium and low gamma values are less helpful for detecting VRF

Evaluation of contrast alternation efficacy in diagnosis of vertical root fracture in conventional digital radiography

Background and objective: Most digital imaging systems today offer a variety of image processing techniques. Due to the importance of the accuracy of this imaging and its widespread use in this study we investigate the effect of contrast change in the diagnosis of vertical root fracture in conventional digital radiography. Materials and methods: in this in vitro study 24 human single-rooted teeth induced vertical root fracture with underwent vrf. Digital images were prepared before and after induction vrf. Images with three low, medium and high contrasts were examined by two radiologists.Data were tested using kappa and MacNemar tests in SPSS software. Overall accuracy was calculated using Roc curve analyzes. Results: The highest sensitivity specificity and overall accuracy are related to images with moderate contrast (95.83%, 100% and 98% in the first observer and 100%, 100% and 100% in the second observer, respectively). In case of low and high contrast to detect vertical root fracture, there is no statistically significant difference with reality (p&lt;0/001). Conclusion: Medium contrast can be used as a processing filter in the detection of vertical root fractures.

Influence of endodontic sealers artifacts in the detection of vertical root fractures.

The aim of this study was to compare the influence of endodontic sealers artifacts on the detection of vertical root fracture in cone beam computed tomography (CBCT). Premolars and central incisors were assigned into five different groups: Control, Pulp Canal Sealer, AH Plus, Sealer 26, and BC Sealer (n= 10, per group). VRFs were mechanically induced and the teeth were inserted into an image phantom. Subsequently, CBCT (Cranex 3Dx, Soredex, Tuusula, Finland) images were obtained and two observers were asked separately to identify root fracture, by visual analysis. For both premolar and central incisors, kappa coefficients of intraobserver agreement varied from good to excellent (K: 80% - 87%), and the values for interobserver agreement varied from fair to moderate (K: 30% - 35%). As follows, the area under the curve (AUC) of receiver operating characteristic (ROC) values for VRFs highlighted that the use of BC sealer reduced the observers' ability to discriminate VRFs relative to other sealers. Moreover, sensitivity values for premolars teeth ranged from 20% to 60%, and specificity ranged from 60% to 100%; while sensitivity values for central incisors ranged from 30% to 70%, and specificity ranged from 70% to 100%. In conclusion, the low sensitivity values, mainly for premolars, demonstrated the difficulty in VRF diagnosis. Furthermore, BC Sealer induced significantly more imaging artifacts than other sealers. These results highlighting that endodontic sealers may interfere with the diagnosis of VRFs.

In vitro diagnostic accuracy of cone-beam computed tomography with variable gamma values for detection of vertical root fractures in teeth with prefabricated metal posts.

Background:Cone-beam computed tomography (CBCT) has the highest sensitivity and specificity for the detection of vertical root fractures (VRFs). This study aimed to compare the diagnostic accuracy of CBCT with different gamma values for the detection of VRFs.Materials and Methods:In this in vitro, experimental study, multiplanar CBCT scans were obtained from 61 extracted premolars with prefabricated titanium posts using NewTom CBCT scanner. Next, VRFs were artificially induced in all teeth with a mallet, and the teeth underwent CBCT with three different gamma values. The images were evaluated by two observers twice with a 2-week interval for the presence/absence of VRFs. Data were analyzed using the kappa coefficient, McNemar test, and Chi-square test. The sensitivity, specificity, and overall accuracy of CBCT with different gamma values for the detection of VRFs were assessed by receiver operating characteristic curve. The level of significance was lesser than 0.05 (P < 0.05).Results:Changing the gamma value did not change the sensitivity, specificity, or accuracy of CBCT for the detection of VRFs. No significant difference was noted between the two observers in the detection of VRFs on CBCT scans taken with different gamma grades. The inter- and intra-observer agreement were excellent for all gamma grades.Conclusion:Any gamma value preferred by the observer can be used for the detection of VRFs on CBCT scans.

Effect of cone-beam computed tomography metal artefact reduction on incomplete subtle vertical root fractures.

This study compared the accuracy of detection of incomplete vertical root fractures (VRFs) in filled and unfilled teeth on cone-beam computed tomography images with and without a metal artefact reduction (MAR) algorithm. Forty single-rooted maxillary premolars were selected and, after endodontic instrumentation, were categorized as unfilled teeth without fractures, filled teeth without fractures, unfilled teeth with fractures, or filled teeth with fractures. Each VRF was artificially created and confirmed by operative microscopy. The teeth were randomly arranged, and images were acquired with and without the MAR algorithm. The images were evaluated with OnDemand software (Cybermed Inc., Seoul, Korea). After training, 2 blinded observers each assessed the images for the presence and absence of VRFs 2 times separated by a 1-week interval. P-values<0.05 were considered to indicate significance. Of the 4 protocols, unfilled teeth analysed with the MAR algorithm had the highest accuracy of incomplete VRF diagnosis (0.65), while unfilled teeth reviewed without MAR were associated with the least accurate diagnosis (0.55). With MAR, an unfilled tooth with an incomplete VRF was 4 times more likely to be identified as having an incomplete VRF than an unfilled tooth without this condition, while without MAR, an unfilled tooth with an incomplete VRF was 2.28 times more likely to be identified as having an incomplete VRF than an unfilled tooth without this condition. The use of the MAR algorithm increased the diagnostic accuracy in the detection of incomplete VRF on images of unfilled teeth.

Digital file format does not influence the radiographic diagnosis of vertical root fracture.

ObjectiveTo evaluate the influence of the file format of digital periapical radiographs on the diagnosis of vertical root fracture (VRF).Study designPeriapical radiographic images of 34 single-rooted teeth—19 with VRF, and 15 without VRF were acquired using two digital systems—Digora Toto, and Digora Optime, and exported into four different file formats—TIFF, BMP, PNG, and JPEG, totaling 272 radiographs. The radiographs were assessed by five examiners for the detection of VRF, using a 5-point scale (1—definitely absent; 2—probably absent; 3—uncertain; 4—probably present; 5—definitely present). Diagnostic values of area under the ROC curve, specificity, and sensitivity for the diagnosis of VRF were calculated. The results were compared by two-way Analysis of Variance with post hoc Tukey’s test. The intra- and inter-examiner agreements were measured by the Kappa test. The significance level was set at 5% for all analyses.ResultsThe values of intra-examiner agreement varied from moderate (0.56) to almost perfect (0.81), while the values of inter-examiner agreement varied from fair (0.29) to moderate (0.60). The image file format did not influence the diagnostic values for VRF for any of the radiographic systems tested (p > 0.05). Digora Toto had significantly greater values of area under the ROC curve than Digora Optime for all file formats (p = 0.001).ConclusionThe image file format of periapical radiographs does not influence the diagnosis of VRF, regardless of the digital radiography system.

Cone beam CT optimisation for detection of vertical root fracture with metal in the field of view or the exomass

Dose optimisation has been revisited in the literature due to the frequent use of cone beam computed tomography (CBCT). Although the reduction of the field-of-view (FOV) size has shown to be an effective strategy, this indirectly increases the negative effect from the exomass. The aim of this study was to evaluate the diagnostic accuracy of an optimised CBCT protocol in the detection of simulated vertical root fracture (VRF) in the presence of metal in the exomass and/or inside the FOV. Twenty teeth were endodontically instrumented and VRF was induced in half of them. All teeth were individually placed in a human mandible covered with a soft tissue equivalent material, metallic materials were placed at different dispositions in the exomass and/or endomass, and CBCT scans were obtained at two dose protocols: standard and optimised. Five radiologists evaluated the images and indicated the presence of VRF using a 5-point scale. Area under the ROC curve (AUC), sensitivity, and specificity were calculated and compared using ANOVA (α = 0.05). Overall, AUC, sensitivity, and specificity did not differ significantly (p > 0.05) between the dose protocols. In conclusion, optimised dose protocols should be considered in the detection of simulated VRF irrespective of the occurrence of artefacts from metallic materials in the exomass and/or inside the FOV.

Detection of vertical root fractures in the presence of artefacts by digital radiography and cone beam computed tomography

The correct diagnosis of vertical root fractures (VRF) in the presence of artifacts is a challenge for clinicians and endodontists. Moreover, there is controversy about which imaging technique is best for this purpose. In an in vitro model, we evaluated the diagnosis of VRF in teeth treated endodontically with and without intraradicular metal posts, using the Clark technique and cone beam computed tomography (CBCT), as well as the interference of artifacts with the diagnosis. Twenty-two first or second maxillary or mandibular premolars were included. Teeth were randomly allocated to three groups: G1 (two teeth without fracture with endodontic treatment and one with an intraradicular metal post); G2 (10 fractured teeth with endodontic treatment); and G3 (10 fractured teeth with endodontic treatment plus a metal post). The examiners recorded the presence or absence of fracture and its location and classified its type. There was no statistically significant difference between image acquisition systems. When differentiating the teeth (first vs. second premolars), there was a statistically significant difference among the examiners (p=0.020). However, when comparing the values obtained by the examiners regarding the visualization of the fracture site as well as the presence of fracture correlated with the presence of a metal post and angulation, there were no statistically significant differences (p&gt;0.05). Digital radiographs and CBCT were similar for the diagnosis of VRF. High sensitivity was observed by CBCT image reconstructions. Therefore, the presence of metal posts generated artifacts, resulting in low sensitivity, specificity and accuracy.

Influence of metal artefact reduction tool on the detection of vertical root fractures involving teeth with intracanal materials in cone beam computed tomography images: A systematic review and meta-analysis.

The effectiveness of the metal artefact reduction (MAR) tool for the detection of vertical root fracture (VRF) by cone beam computed tomography (CBCT) images is controversial. To evaluate the effectiveness of the MAR tool on VRF detection involving teeth with intracanal materials in CBCT images. In September 2019, an electronic search was performed in six databases (PubMed, Scopus, Web of Science, Cochrane, Lilacs and Embase). The electronic search was updated in May 2020 through searches in Google Scholar and references of included studies (embracing the electronic and gray literature searches). No language or year restrictions were applied. Independently, two reviewers examined titles, abstracts and full texts according to the eligibility criteria that were as follows: diagnostic studies that evaluated the effectiveness of the MAR tool on the diagnosis of VRF in human teeth (laboratory or in vivo studies) on CBCT images. The risk of bias was evaluated using the Quality Assessment Tool for Diagnostic of Accuracy Studies-2 (QUADAS-2). For conducting the meta-analysis, the values of sensitivity, specificity, diagnostic odds ratio (DOR) and area under the ROC curve (AUC) were obtained, considering the subgroups with and without MAR active. The Grading of Recommendation, Assessment, Development and Evaluation instrument was applied to assess the level of evidence across the studies using GRADEpro software. A total of 8 laboratory studies were included in both systematic review and meta-analysis. The values of sensitivity, specificity, DOR and AUC to VRF diagnosis with and without MAR active were, respectively, 0.586 and 0.603; 0.699 and 0.713, 3.037 and 3.767; 0.67 and 0.71. The quality of the evidence suggested low confidence in estimating the outcomes. The MAR tool decreased slightly the diagnostic values of VRF involving teeth with intracanal materials in laboratory studies. However, it is important to highlight that most studies had an uncertain risk of bias. Although a low level of evidence and high heterogeneity were observed in the included studies, the meta-analysis revealed better diagnosis values for VRF detection when the MAR was deactivated when analysing extracted teeth in a laboratory setting. PROSPERO-CRD42020145222. This study was financed in party by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES).

Combined Use of 2 Cone-beam Computed Tomography Scans in the Assessment of Vertical Root Fracture in Teeth with Intracanal Material

IntroductionThe purpose of this preliminary study was to evaluate the diagnostic accuracy of the combined use of 2 cone-beam computed tomographic (CBCT) volumes obtained with the tooth of interest positioned at different orientations in the detection of vertical root fracture (VRF). MethodsThirty single-rooted teeth were divided into 2 main groups (n = 15): control and with VRF. The teeth were individually placed in a phantom composed of a human skull and mandible, which was CBCT scanned in 2 spatial orientations: conventional (with the Frankfurt plane parallel to the floor) and angled acquisition (tilted 90° backward). Also, each tooth was scanned with gutta-percha, a metal post, and without any intracanal material. Three oral radiologists individually evaluated the images resulting from conventional acquisition and verified the presence or absence of VRF (conventional CBCT assessment), setting a score on a 5-point scale. Subsequently, the observers evaluated both images resulting from the conventional and angled acquisitions (combined CBCT assessment). The diagnostic values of the conventional and combined assessments were compared using 2-way analysis of variance with the post hoc Tukey test. The significance level was set at 5% (α = 0.05). ResultsThe combined CBCT assessment showed higher accuracy and sensitivity in the VRF diagnosis of teeth filled with gutta-percha (P < .05). In teeth with a metal post, all diagnostic values were higher in the combined CBCT assessment (P < .05). ConclusionsThis preliminary study suggests that the CBCT-based diagnosis of VRF in teeth with intracanal material was improved when the assessment combines images obtained at 2 orientations.