Diagnosis Of Vertical Root Fractures Research Articles

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.

Vertical root fracture diagnosis in teeth with metallic posts: Impact of metal artifact reduction and sharpening filters

Vertical root fracture diagnosis in teeth with metallic posts: Impact of metal artifact reduction and sharpening filters

Influence of a Metal Artifact Reduction Filter on the Diagnostic Accuracy of Complete and Incomplete Vertical Root Fractures

IntroductionThis study aimed to assess the influence of the e-vol DX BAR filter on the diagnostic accuracy of complete and incomplete vertical root fractures (VRFs). MethodsTwenty single-rooted teeth were selected. The tooth crowns were removed, and the root canals were prepared up to a 40/.06 instrument (ProTaper Next). Each specimen was scanned in a Prexion 3D cone-beam computed tomography (CBCT) device, in a dry human skull, in 4 different situations: no root canal filling, gutta-percha, fiberglass post, and metal post. The specimens were fractured in a universal testing machine by using a customized wedge. Each specimen was reinspected to confirm the presence of incomplete VRFs. Another set of CBCT scans was performed. Then, the fractures were completed in the universal testing machine, the teeth were reinspected, and the CBCT images were acquired again. Images were assessed by using the e-Vol DX software system, with the BAR filter and with the original images, for the diagnosis of VRFs. Statistical analysis was performed by using the DeLong and McNemar tests for the comparison of the area under the receiver operating characteristic curves (AUC), accuracy, sensitivity, and specificity values. ResultsThe use of the BAR filter did not improve the diagnostic values of AUC, accuracy, sensitivity, and specificity in both fracture patterns (P > .05). Incomplete VRFs presented significantly lower AUC, accuracy, and sensitivity compared with complete VRFs (P < .0001). ConclusionsThe BAR filter did not improve the diagnostic accuracy of VRFs. The intracanal materials also did not influence the diagnosis. Incomplete VRFs were highly associated with a decrease in sensitivity.

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.

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.

Influence of CBCT parameters on image quality and the diagnosis of vertical root fractures in teeth with metallic posts: an ex vivo study.

The aim of this study was to evaluate the influence of peak kilovoltage (kVp) and a metal artifact reduction (MAR) tool on image quality and the diagnosis of vertical root fracture (VRF) in cone-beam computed tomography (CBCT). Twenty single-rooted human teeth filled with an intracanal metal post were divided into 2 groups: control (n = 10) and VRF (n = 10). Each tooth was placed into the socket of a dry mandible, and CBCT scans were acquired using a Picasso Trio varying the kVp (70, 80, 90, or 99), and the use of MAR (with or without). The examinations were assessed by 5 examiners for the diagnosis of VRF using a 5-point scale. A subjective evaluation of the expression of artifacts was done by comparing random axial images of the studied protocols. The results of the diagnoses were analyzed using 2-way analysis of variance and the Tukey post hoc test, the subjective evaluations were compared using the Friedman test, and intra-examiner reproducibility was evaluated using the weighted kappa test (α = 5%). The kVp and MAR did not influence the diagnosis of VRF (p > 0.05). According to the subjective classification, the 99 kVp protocol with MAR demonstrated the least expression of artifacts, while the 70 kVp protocol without MAR led to the most artifacts. Protocols with higher kVp combined with MAR improved the image quality of CBCT examinations. However, those factors did not lead to an improvement in the diagnosis of VRF.

Artificial intelligence in endodontics: A narrative review

Aim: With the help of developments in artificial intelligence (AI), picture archiving systems, and computer-aided diagnostic systems, dentists have been able to augment the quality of treatment and ensure a favorable outcome, by improving and facilitating the delivery of appropriate dental care. There has been a breakthrough in designing the diagnosis, treatment plans, and predicting prognoses recently, which has helped to explore newer options for better treatment. Materials and Methods: A literature search was conducted using MeSH terms in a variety of databases, including PubMed, Cochrane, Scopus, and Web of Science, to gather information on “Artificial intelligence (AI) in endodontics.” Unpublished data, literature written in other languages, and articles with only abstracts were discarded. Forty-one relevant articles were included. Results: Since there were not many papers referring to AI in endodontics, papers published relating to AI in dentistry were also referred. The search showed that the use of AI in dentistry, specifically in endodontics, has enormous promise. Although useful, AI has its disadvantages as well as the need for long-term studies. Conclusion: AI, consisting of a sequence of algorithms, work on a concept that mimics the human brain and thinking. AI in endodontics has been used widely in locating apical foramina, identifying periapical pathologies, diagnosis of vertical root fractures, evaluating the outcome of regenerative procedures and retreatments, and assessment of root morphologies and difficulties associated with canal preparations. Being a potential game changer and beginning something called a “fourth industrial revolution,” AI has what it takes to revolutionize endodontics with time.

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 image processing filters in detection of apical root resorption, interproximal dental decay, and vertical root fractures: A review

<h3>Background</h3> Digital radiography has been available in dentistry for over 35 years and its usage by dental practitioners is now a prerequisite for providing the standard of care. One advantage of digital radiography is the use of image processing filters (IPFs) to increase the diagnostic signals and decrease the non-diagnostic signals. For various diagnostic purposes, IPFs can be selected based on the practitioner's demand, experience, and decision. <h3>Objectives</h3> The purpose of this study was to evaluate published reports of the effectiveness of image processing filters (IPFs) of digital radiographs in detecting apical root resorption (ARR), interproximal dental decay (IDD), and vertical root fractures (VRF). <h3>Study design</h3> Original research presentations were selected by using the following inclusion criteria: (1) CMOS digital x-ray images, (2) IPFs built in to the MiPACS image management software, (3) Questionnaire studies, and (4) Studies that used human teeth. The search was limited to studies of Loma Linda University School of Dentistry Center for Dental Research. <h3>Results</h3> The search resulted in 3 studies fulfilling the above criteria, which evaluated IPFs in ARR, IDD, and VRF. ICC analysis showed excellent correlation in all studies. For ARR, the most accurate diagnoses as measured with the area under the curve (AUC) of receiver operating characteristic analysis was obtained with the Endo filter (AUC = .950; 95%CI: .869 - 1.0). The least accurate was the Dentin to Enamel filter (AUC = .758; 95%CI: .551 - .965). For IDD, the Edge Enhance filter was most accurate (AUC = 0.772; 95%CI: .669- .875) and the least was the Dentin to Enamel filter (AUC = 0.420; 95%CI: .287 - .553). For VRF, the most accurate diagnoses were achieved with the Contrast filter (AUC = 0.769; 95%CI: .687 - .851); the Endo filter was least accurate (AUC = 0.702; 95%CI: .612 - .792). <h3>Conclusions</h3> IPF can affect the diagnosis of ARR, IDD, and VRF depending on which type of filter is applied. A proper selection of filters is recommended to increase the possibility of the early diagnosis of pathology, thus reducing the need for further invasive dental treatment. <b>Statement of Ethical Review</b> Human/Animal subjects were used and this study was approved by an institutional ethics panel

Recent trends in vertical root fracture

In the modern era where dentistry is more considerate in preserving the natural tooth in the oral cavity, Vertical Root Fractures (VRFs) are diagnosed as the third most common reason for extraction of tooth. VRFs are more common in endodontic ally treated tooth. As the symptoms of VRFs are not precise, the clinical diagnosis of VRFs at the early stage becomes questionable. Persistent presence of VRFs leads to the damage of the surrounding supporting structures making rehabilitation of extracted tooth site more challenging. In recent times emerging trends in treatment modalities of VRFs has been introduced. This review article highlights the recent trends in aetiology, diagnosis, pathogenesis and treatment of VRF teeth.

Diagnosis of Vertical Root Fracture by Digital Radiography With and Without Unsharp Masking Filter: An In-vitro Study

Background and Objectives The digital radiography offers a variety of image processing techniques. Due to the importance of the accuracy of this method and its widespread applications, in this study we aim to investigate the diagnose of vertical root fracture (VRF) by conventional digital radiography with and without unsharp masking (UM) filter. Subjects and Methods Radiographs were taken from 24 extracted anterior teeth before and after VRF induction. The root canal was prepared with passive step-back technique, and then the teeth were divided into two halves buccolingually with a very thin disk. The two halves were re-attached to each other and mounted in a mixture of gypsum and sawdust. After processing by the UM filter, the radiographs were evaluated by two observers to detect the presence or absence of VRF. Results For the first observer, the sensitivity of both methods was the same, while the specificity of the UM filtering mode was higher. For the second observer, the sensitivity of the unfiltered mode was higher, while the specificity of the two methods was the same. Conclusion There is no significant difference between digital radiography with and without the UM filter in diagnosing VRF. Due to the high sensivity and specifity of the UM filtering method, the specialist can use this filter based on personal preferences.

Present status and future directions: vertical root fractures in root filled teeth.

Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is crucial in identifying teeth that may be susceptible. Thorough clinical examination with magnification and co‐axial lighting is essential in identifying VRFs, and although CBCT is unable to reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, and therefore, increases the probability of correct diagnosis and management. The prevalence of VRFs in root filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre‐existing fractures and biochemical effects of loss of vitality is highly relevant. Careful assessment of the occlusal scheme, presence of deflective contacts and identification of parafunctional habits are imperative in both preventing and managing VRFs. Furthermore, anatomical factors such as root canal morphology may predispose certain teeth to VRF. The influence of access cavity design and root canal instrumentation protocols should be considered although the impact of these on the fracture resistance of root filled teeth is not clearly validated. The post‐endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed ‘passively’ and excessive ‘post‐space’ preparation should be avoided. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. Currently, there are limited options other than extraction for the management of VRF, although root resection may be considered in multi‐rooted teeth. Innovative techniques to ‘repair’ VRFs using both orthograde and surgical approaches require further research and validation. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, together with expedient and appropriate post‐endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs.

Vertical root fracture diagnosis in endodontically treated teeth

Annotation. Timely diagnosis of vertical root fractures is a big challenge to dentists, because there are no specific clinical signs, symptoms and X-ray features. The aim of the research is to study clinical cases of vertical root fractures in endodontically treated teeth and to carry out analysis the methods of their diagnosis, clinical features and radiological characteristics. In patients aged 40-65 years, 34 clinical cases of vertical root fracture are considered. The main and additional methods of patients’ examination are analyzed. The statistical calculation of the obtained results is performed by the method of variation statistics with the determination of the Student’s t-test using computer programs Microsoft® Excel 2017 and “Statistica 6.1”. Clinical symptoms and abnormal findings during examination were recorded but not subjected to statistical analysis. Clinical examination revealed periodontal swelling or abscess in 6 patients, isolated narrow and deep periodontal pocket in 24 patients, low localized fistula in 9 patients. Radiological results: only in 6 clinical cases a vertical fracture line was observed on intraoral X-ray images; in 30 cases the destruction of bone tissue in the periapical area, mainly in the halo-type radiolucency was determined; in 4 cases no pathological changes in periapical bone tissue were revealed. Vertical root fracture was confirmed by muco-periosteal flap detachment in all cases. It has been established that a number of signs, namely: isolated deep narrow periodontal pocket; coronally located fistula; characteristic bone destruction (J-shaped or “halo” radiolucency) on the radiograph indicate the likelihood of vertical root fracture. Signs of fenestration of the bone adjacent to the fractured root and visualization of the fracture line after mucoperiosteal flap surgery are pathognomonic.

Exploring the use of enhanced cone-beam CT technique to diagnose vertical root fracture

ObjectivesTo explore the feasibility of using sodium iodide (NaI)+dimethyl sulfoxide (DMSO)+ethyl alcohol+ethyl acetate as a cone-beam CT (CBCT) contrast agent in the diagnosis of vertical root fracture (VRF). Methods21 endodontically treated VRF teeth of 21 patients were collected in this study. All these 21 teeth were confirmed subtle fracture lines under transillumination, the number and position of fracture lines were recorded. All these patients had CBCT routine scanning (RS1) before extraction. After extraction, the teeth was performed micro-CT scanning and 3 in vitro CBCT scanning: CBCT routine scanning in vitro(RS2), CBCT enhanced scanning using meglumine diatrizoate (MD) as contrast agent(ES1); and CBCT enhanced scanning using NaI+DMSO+ethyl alcohol+ethyl acetate as contrast agent(ES2). The number of fracture lines was evaluated on all the 5 scanning modes and the accuracy of diagnosis was calculated. ResultsIn all, there were 43 fracture lines on the 21 teeth. The accuracy of detection of fracture lines of CBCT RS1, RS2, ES1, ES2 and micro-CT was 0%, 20.9% (9/43), 11.6% (5/43), 93% (40/43) and 95.3% (41/43) respectively. Significant differences were found between ES2 vs. RS2, ES2 vs. ES1 (p < 0.01); however, no significant difference was found between ES2 vs. micro-CT (p > 0.05). ConclusionCBCT enhanced scanning using NaI+DMSO+ethyl alcohol+ethyl acetate as contrast agent could be a prospective technique in the diagnosis of 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.

Diagnosis of Vertical Root Fractures in Endodontically Treated Teeth by Cone-Beam Computed Tomography.

The purpose of this study was to investigate the characteristics and the detection ability of vertical root fractures in endodontically treated teeth by intraoral radiography and cone-beam computed tomography (CBCT). CBCT images of 50 patients with root fractures in endodontically treated teeth were reviewed, and 36 vertical root fractures were taken in this study. The cause of fracture, core construction, kind of teeth, and fracture direction (bucco-lingual and mesio-distal fractures) were investigated. Detection ability of vertical root fractures by intraoral radiography and CBCT was also examined. Statistical analyses concerning the characteristics were performed by χ2 test, and the detection ability was analyzed by cross-tabulation. All of the fractured teeth were nontraumatized teeth. The vertical root fracture occurrence was not differed by core construction. The vertical root fracture number was largest at the premolar teeth (p = 0.005), and the number of the bucco-lingual fracture was larger than the mesio-distal fracture (p = 0.046). Vertical root fractures were detectable using CBCT, while undetectable by intraoral radiography (p < 0.001). Vertical root fractures occurred easily in premolar teeth with bucco-lingual direction, and CBCT is an adequate radiographic method to diagnose vertical root fracture.

Impact of intracanal post-material on vertical root fractures diagnosis: A high-resolution cone-beam computed tomography study

Aim: Root fractures depict a challenge to dentists, especially when they are oriented vertically. They can be responsible for an important percentage of extractions of endodontically treated teeth. The objective of this research was to compare the accuracy of vertical root fractures (VRF) diagnosis in teeth treated endodontically and with posts in root canals, using images acquired by three different cone-beam computed tomography (CBCT) scanners and different acquisition protocols, a varying field of view (FOV), voxel size, kilovoltage (KVp), and milliamperes (mA). Materials and Methods: This study evaluated the diagnostic capacity of three different brands of CBCT devices. Overall, 240 images of single root teeth were included and they were divided into two groups: the test group in which teeth were artificially fractured, and the control group, without fractures. The CBCT images were assessed, reaching a consensus between three examiners. Descriptive statistics and a binary logistic regression test were performed. Sensibility, specificity, and accuracy values also were obtained. Statistical significance was set at P < 0.05. Results: Two studied scanners contributed 77.8% of diagnostic errors, and 61.1% of the errors were in the presence of metal in the root canal. There were no significant differences between the standard (STD) and high-definition (HD) protocols. Conclusion: The equipment brand and the condition of the tooth are important factors in the VRF assessment using CBCT.

Early diagnosis of vertical root fracture

Early diagnosis of vertical root fracture

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.

Cone Beam Tomography and Periapical Radiographs for Early Vertical Root Fracture Diagnosis. Systematic Review

Background: Determining the position, direction, and size of the fracture in early stages is of great value in choosing the appropriate treatment. Purpose: To compare the diagnostic accuracy of conventional periapical radiographs (PR) with cone beam computerized tomography (CBCT) to identify vertical root fractures (VRF) in root treated teeth. Methods: This review used the Cochrane Handbook and the recommendations given by SIGN 50 as a guide. Meta DiSc 1.4 software was used to calculate the operative characteristics of sensitivity, specificity, positive, and negative values. Results: Initially 651 articles were obtained; after completing the review 4 articles were chosen: 2 studies had a sensitivity of 60-61 % using conventional PR and 80 % CBCT; specificity 70-71 % using conventional RP and 69 % CBCT; there were no significant differences between the two (p &gt;0.05). Digital dental radiography (DDR) had a specificity of 78 % compared to 70 % of the conventional RP. Conclusions: Based on the results and the information published, both tools, digital dental radiograph (DDR) and CBCT are useful to diagnose VRF. There were no significant differences between the CBCT and conventional (PR) (p &gt;0.05) either in advanced or early stages of VRF. To answer research the question more studies are required. To make an early VRF diagnosis on initial stages, the current imaging tools, clinical methods, and patient's symptoms must be considered. As a final option, a surgical exploration is required to confirm its presence.