Root Fractures In Teeth Research Articles

Vertical root fracture detection with cone-beam computed tomography in Biodentine™ filled teeth

PurposeThis study aimed to evaluate the accuracy of detecting vertical root fractures in Biodentine™-filled teeth using the Promax 3Dmax cone-beam computed tomography (CBCT) unit compared to periapical radiographs. It tested hypotheses regarding CBCT’s diagnostic superiority in non-root-filled and Biodentine™-root-filled maxillary central incisors and assessed the impact of smaller field of view and lower intensity settings on detection accuracy.Materials and methodsExtracted maxillary incisors were divided into groups based on fracture status and root filling material, then placed in a Thiel-embalmed skull to simulate clinical conditions. The teeth were imaged using periapical radiographs and the CBCT unit under different settings. Fracture thickness was measured with microcomputed tomography for accuracy benchmarking. Multiple observers assessed the images, and statistical analyses were conducted to evaluate diagnostic performance.ResultsIntra-rater reliabilities of consensus scores ranged from good to very good. Specificities were generally higher than sensitivities across all imaging modalities, but sensitivities remained constantly low. None of the Area Under the Curve scores exceeded 0.6, indicating poor overall accuracy for all imaging modalities. Paired comparisons of the area differences under Receiver Operator Characteristic curves revealed no significant differences between the CBCT and periapical radiograph techniques for detecting vertical root fractures in either Biodentine™-filled or non-root-filled teeth.ConclusionsThere was no significant accuracy improvement of the current CBCT device (Promax 3Dmax, Planmeca, Finland) over periapical radiographs in detecting small vertical root fractures in both non-root-filled and Biodentine™-root-filled maxillary central incisors. A smaller field of view with lower intensity did not enhance detection accuracy. These results highlight the challenges in accurately detecting small VRFs, emphasizing the need for further research and technological advancements in this domain.

Partial root canal treatment retains root fractured tooth

Partial root canal treatment retains root fractured tooth

The Impact of Bonding Agents and Bone Defects on the Fracture Resistance of Reattached Vertically Root-Fractured Teeth

Many patients experience vertical root fractures, and clinicians often consider conservative treatment options like reattaching the fractured root segments. The study investigated the impact of different bonding agents on the fracture resistance of rebonded vertically fractured teeth with various alveolar bone defects. Human premolar teeth with a single root were sectioned and reattached using dual-cure resin cement (DCRC), resin-modified glass ionomer (RMGI), and cyanoacrylate. The reattached teeth were then restored with a resin fiber post, composite resin core, and full veneer metal copings. These teeth were embedded in acrylic blocks with angular, V-shaped, and step-shaped bone defects to simulate various alveolar bone conditions. After subjecting the samples to thermal cycling, the fracture resistance was evaluated using a universal testing machine. Teeth samples reattached with RMGI exhibited a higher average fracture resistance. The study also found that DCRC proved to be an effective bonding agent for VRF teeth. However, cyanoacrylate-rebonded teeth exhibited the lowest fracture resistance. The V-shaped defects had a significant impact on the fracture resistance of reattached VRF teeth, with largely unfavorable fractures observed in these cases. Predominantly favorable fractures were observed in the teeth treated with RMGI. The fracture loads in both RMGI and DCRC groups exceeded the expected masticatory load.

RESTORATION OF CORONAL PART IN CHEWING TEETH WITH SIGNIFICANT LOSS OF HARD TISSUES BY POST AND CORE CROWN

The purpose of this study was to improve the quality of orthopedic treatment of hard dental tissues of chewing teeth destroyed below the level of the gums by a post and core crown using ashless modeling plastics.
 We examined 30 patients with severe destruction of the hard tissues of the crown portion of the teeth (IROPZ more than 80%) and concurrent periodontal diseases. A retrospective analysis revealed that teeth with deep subgingival defects restored by casts functioned as follows: for up to 1 year in 17 cases (14.2%), from 1 to 3 years in 36 cases (30.0%), from 3 to 5 years in 43 cases (35.8%), and for more than 5 years in 24 cases (20.0%).
 The results of a comparative evaluation of the effectiveness of tooth restoration with subgingival defects using ashless acrylic plastic "Modeplast" as a modeling material demonstrated the highest quality of such inserts, with most observed cases showing no signs of secondary caries. Complications, such as the dislodgement of metal inserts, were noted in 6.7% of cases, violation of marginal fit in 4.5%, and partial decementation of the structure in 8.3%. Incorrect positioning and suboptimal pin dimensions of the post and core crown occurred with approximately equal frequency: 3.5% and 3.2%, respectively. Destruction of the hard tissues of the tooth and caries relapse during restoration with metal inserts were noted in 13.3% and 29.1% of cases, respectively. Typical complications leading to tooth extraction included tooth root fractures (13.3%).
 The developed method of manufacturing post and core crowns using ashless acrylic plastic "Modeplast" at the modeling stage enables to gently remove tooth tissues and atraumatic fit of the post to the gums, prevents the accumulation of dental plaque and does not have a destructive effect on periodontal tissues.

Healing and long-term prognosis of root-fractured permanent teeth: a retrospective longitudinal study.

The purpose of the present study was to evaluate permanent teeth with post-traumatic transversal root fractures, for their initial healing modality, the effect of candidate predictors and their long-term prognosis. A retrospective longitudinal clinical study was conducted to evaluate records from patients bearing transversal root fractures in permanent teeth in order to radiographically assess short-term healing and non-healing events in the fracture line, their prognostic factors and their relationship with long term outcomes. The inter-fragmentary tissues were classified as healing: hard tissue (HT), connective tissue (CT) or connective tissue and bone (CT + B) and non-healing: interposition of granulation tissue (GT). A competing risk survival analysis was conducted to estimate the hazards of healing and non-healing events in the short-term and the effect of demographic, clinical, and treatment variables was assessed using the subdistribution regression model (Fine & Gray). Radiographic findings showed 61.4% of healing in the short-term being strongly influenced by the presence and type of concomitant injuries to the coronal fragment. Teeth with concomitant crown fractures (sHR 24.38, 95% CI [3.16-188.3], p = 0.0022), luxations with dislocations (sHR 10.58, 95% CI [1.37-81.9], p = 0.0240) and subluxations (HR 9.66, 95% CI [1.14-81.7], p = 0.0370) were more likely to present non-healing of root fractures in the short-term. The healing rate in the long-term was of 75.9%, most of them with interposition of bone and connective tissue. Kappa statistics demonstrated an overall agreement of 67.1% between short and long-term healing patterns, in special HT and CT + Bone modalities. Healing at the fracture site was the most frequent outcome, both in the short-term and in the long-term. Short-term healing modality was strongly influenced by the presence and type of concomitant injuries to the crown fragment, being the worst prognosis observed in root-fractured teeth with concomitant crown fractures, followed by concomitant luxations with dislocation. Post-traumatic transversal root fractures have a positive prognosis supporting therefore, a more conservative approach for these teeth before considering more radical treatments.

Stiffness Modeling of Tooth Interior Fatigue and Tooth Flank Fracture and Their Fault Characteristics in Electromechanical Coupling Systems

Tooth flank fracture (TFF) and tooth interior fatigue fracture (TIFF) usually occur on case-harden gears in electromechanical coupling systems, both starting from the core caused by metal fatigue. The cracks propagate rapidly compared with the total life of a gear, so that it is necessary to detect and identify the faults in time when they take place in order to avoid danger. In this paper, the time-varying mesh stiffness model of two types of faults is established by the potential energy method and validating by the finite element method. Based on the stiffness model, the influence of faults on the electromechanical system and their fault characteristics are analyzed, which provides a theoretical basis for the health detection of electromechanical coupling systems. The results indicate that in the early stage of the three faults, i.e., tooth root fracture, tooth interior fatigue fracture, and tooth flank fracture, it is hard to discriminate the faults. But after the second stage, the faults can be distinguished by the vibration amplitude, frequency band components, and phase diagrams. The TFF can be discerned into different stages by frequency domains and phase diagrams. When the fracture occurs completely, three faults can be easily distinguished by the time domain and phase diagram. In the frequency domain, the TRF can also be distinguished from the other two faults by referring to the sideband component near the meshing frequency.

Evaluation of a Novel Veterinary Dental Radiography Artificial Intelligence Software Program.

There is a growing trend of artificial intelligence (AI) applications in veterinary medicine, with the potential to assist veterinarians in clinical decisions. A commercially available, AI-based software program (AISP) for detecting common radiographic dental pathologies in dogs and cats was assessed for agreement with two human evaluators. Furcation bone loss, periapical lucency, resorptive lesion, retained tooth root, attachment (alveolar bone) loss and tooth fracture were assessed. The AISP does not attempt to diagnose or provide treatment recommendations, nor has it been trained to identify other types of radiographic pathology. Inter-rater reliability for detecting pathologies was measured by absolute percent agreement and Gwet's agreement coefficient. There was good to excellent inter-rater reliability among all raters, suggesting the AISP performs similarly at detecting the specified pathologies compared to human evaluators. Sensitivity and specificity for the AISP were assessed using human evaluators as the reference standard. The results revealed a trend of low sensitivity and high specificity, suggesting the AISP may produce a high rate of false negatives and may not be a good tool for initial screening. However, the low rate of false positives produced by the AISP suggests it may be beneficial as a "second set of eyes" because if it detects the specific pathology, there is a high likelihood that the pathology is present. With an understanding of the AISP, as an aid and not a substitute for veterinarians, the technology may increase dental radiography utilization and diagnostic potential.

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

This study examined the influence of a metal artifact reduction (MAR) tool, sharpening filters, and their combination on the diagnosis of vertical root fracture (VRF) in teeth with metallic posts using cone-beam computed tomography (CBCT). Twenty single-rooted human premolars - 9 with VRF and 11 without - were individually placed in a human mandible. A metallic post composed of a cobalt-chromium alloy was inserted into the root canal of each tooth. CBCT scans were then acquired under the following parameters: 8 mA, a 5×5 cm field of view, a voxel size of 0.085 mm, 90 kVp, and with MAR either enabled or disabled. Five oral and maxillofacial radiologists independently evaluated the CBCT exams under each MAR mode and across 3 sharpening filter conditions: no filter, Sharpen 1×, and Sharpen 2×. The diagnostic performance was quantified by the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. These metrics were compared using 2-way analysis of variance with a significance level of α=5%. Intra- and inter-examiner agreement were assessed using the weighted kappa test. Neither MAR nor the application of sharpening filters significantly impacted AUC or specificity (P>0.05). However, sensitivity increased when MAR was combined with Sharpen 1× and Sharpen 2× (P=0.015). The intra-examiner agreement ranged from fair to substantial (0.34-0.66), while the inter-examiner agreement ranged from fair to moderate (0.27-0.41). MAR in conjunction with sharpening filters improved VRF detection; therefore, their combined use is recommended in cases of suspected VRF.

Interdisciplinary management of horizontal root fracture in middle third with osseous bone defect – A clinical report

Dental trauma are the main cause of emergencies in dental practice. Amongst these, root fractures are relatively uncommon but comprises about 0.5 to 7% of all injuries affecting permanent dentition. Most commonly, root fracture occurs from a horizontal impact mostly in oblique direction. The incidence is more common at the mid-third of the root rather at the apical and cervical thirds. Such hideous injury must be restored to normal as early as possible to retain the dental health and appearance. This report records the case of horizontal root fracture of upper anterior tooth, treated with Mineral Trioxide Aggregate (MTA) and fractured root fragments were unified with the aid of a stainless steel reamer after an endodontic treatment. Alloplastic bone graft and GTR membrane were used for osseous bone defect. Mineral trioxide aggregate (MTA) has several impending & forthcomin clinical applications owing to its grander sealing property and biocompatibility. A 12 months follow-up revealed a well stabilized assembly of the root fragments and periodontal healing.

Healing of oblique tooth root fracture concomitant with coronal fragment extrusion in permanent dentition: A case report

Healing of oblique tooth root fracture concomitant with coronal fragment extrusion in permanent dentition: A case report

Comparison of physics forceps to conventional forceps in simple dental extraction

Background: In this study, Conventional forceps & Physics forceps were compared in simple dental extractions with respect to crown and root fracture of tooth during extraction, alveolar bone plate fracture, gingival laceration, requirement of sutures, duration of surgery, comparative pain evaluation through visual analogue scale and analgesic requirement in the first 24 hours post operatively. Methods: This study was conducted at our centre where 200 patients requiring simple dental extractions were randomly divided into two groups, each having 100 patients. Extractions in one group were done using Conventional forceps and in other group were done using Physics forceps. All parameters were measured during surgery & questionnaires were given to all the patients to assess the pain perception & analgesic requirement postoperatively till 24 hours. Results: The results of present study showed decreased incidence of crown and root fracture of tooth, alveolar bone plate fracture, gingival lacerations, requirement of sutures, lesser duration for extraction and lesser pain perception in Physics forceps group. No significant difference was found between two groups for analgesic intake. Conclusions: Physics forceps group patients had superior results compared to patients in Conventional forceps group which may be attributed to lesser hard and soft tissue injuries and better pain control in Physics forceps group.

Crack growth based tooth root life prediction model—an influence quantity analysis

One of the key challenges of epicyclic gearboxes in turbo gearbox applications is the high number of load cycles reached by the gearbox components. Standards such as ISO 6336 deliver design guidelines for bending strength up to a limiting number of NG = 3∙106 and AGMA up to 107 load cycles which is far less than the expected lifetime of turbo gearbox applications.To design gears for geared turbofans safely and weight-optimized, the tooth root load capacity in the very high cycle fatigue (VHCF) range must be known as precisely as possible. Most VHCF SN-curve concepts show a continuously decreasing fatigue strength, so that a consideration of a constant fatigue strength level does not meet the material behavior. A life prediction model can be used to determine the specific load that can be carried for each number of load cycles.In this paper, the nasgro crack growth equation is applied to gears to determine the tooth root life in the VHCF range. A lifetime for surface and sub-surface induced fractures is calculated, resulting in a stepped SN-curve. Most of the cycles until fracture occur during crack initiation and micro crack growth, while the macro crack is a small part of the total number of load cycles until tooth root fracture. The nasgro equation is able to represent micro and macro crack growth and is extended by further approaches to the threshold of crack initiation Kth, which also consider the characteristics of short and long crack growth. In addition, the tooth root stress depth curve (via FEM), the hardness depth curve, the residual stress depth curve and the defect distribution will be included in the life-time prediction as important influencing variables of the VHCF tooth root load capacity. The influence of the inputs is determined in an influence quantity analysis. In the future the lifetime prediction model is validated with rig tests up to the VHCF range.

Incidence and Management of Tooth Root Fracture in Mandibular Fracture Line - A Retrospective Study.

In cases of trauma, the most common fractures of the facial region are the nasal bone fractures followed by mandibular fractures. About 60% of mandible fractures are associated with teeth in the fracture line; however conversely, the dentulous mandible has a higher susceptibility of fracture in any impact. Whenever a tooth is involved in the fracture line, it is not unlikely that the tooth root fracture will be associated with it. The prognosis and treatment of such a tooth persistent in a fracture line depends upon the level of tooth root fracture. This retrospective study was conducted in the Department of Oral and Maxillofacial Surgery in a Meerut hospital. The eligibility criteria were based on the cases involving fracture line passing through the teeth bearing area of mandible. Total of 56 cases of mandibular fracture treated from January 2021 till December 2022 by open reduction and fixation were included in the study. A total of 56 patients (66 fracture lines) with mandibular fractures were selected, out of which 18 (32%) patients had fracture of the root of the tooth in the fracture line. Third molar root fracture were present in 12 cases (66.6%), first premolars in 4 cases (22.2%), and first molars in 2 cases (11.1%). There were 14 multi rooted teeth (77.7%) and 4 single rooted teeth (22.2%) involvement. All the multi rooted teeth fracture were treated by extraction during open reduction and fracture fixation. The single rooted teeth were successfully treated by endodontic treatment postoperatively. The fracture line passing through the dentate segment may fracture the tooth crown and/or root or propagate through the socket without any injury to the root. Root fracture at cervical and middle third is constantly exposed to oral fluids. The affected tooth may be mobile and lose vitality. Teeth in the line of fracture must be removed when they preclude the correct reduction of the segments or if they represent a risk for infection. If the tooth or root does not cause any hindrance during reduction or it is not infected, the tooth can be salvaged by endodontic therapy. The incidence of root fracture was seen in 32% of cases. Fracture of the third molar roots was the single largest group (66.6%). No root fracture was observed in the anterior segment.

The risk of healing complications in primary teeth with root fractures: A retrospective cohort study.

Primary teeth are frequently affected by traumatic dental injuries. Root fractures are rare and have a reported incidence of 2% in the primary dentition. Hence, there is limited evidence on this topic. This study aims to evaluate the risk of healing complications in primary teeth with root fracture and to identify possible sequelae in the permanent dentition following root fracture in the primary dentition. A retrospective analysis of a cohort of 53 patients with 74 root fractured primary teeth. The standard follow-up program included clinical and radiographic examination after 4 weeks, 8 weeks, 6 months, and 1 year after the trauma and when the patient was 6 years of age. The following complications were registered: pulp necrosis (PN), pulp canal obliteration (PCO), ankylosis with replacement root resorption (ARR), infection-related root resorption (IRR), premature tooth loss (PTL), and repair-related resorption (RRR). The Kaplan-Meier and Aalen-Johansen estimators were employed. The level of significance was 5%. A total of 74 teeth were included. 42 teeth were extracted at the initial examination. Risks estimated after 3 years: PTL 45.9% [95% CI: 28.8-63.0], PCO 12.9% [95% CI: 2.3-23.4], PN 14.9% [95% CI: 3.9-25.9], RRR 2.6% [95% CI: 0.0-7.5]. No teeth showed ARR or IRR. All complications were diagnosed within the first year. Most common sequelae in the permanent dentition was demarcated opacities, with an estimated risk of 20% [95% CI: 8.2-41.3]. There is a low risk of healing complications following a root fracture in the primary dentition. Root fractures often result in early extraction of the coronal fragment. The remaining apical fragment will undergo a physiological resorption. Aside from opacities, there is a low risk of sequelae in the permanent dentition.

Analysis of Tooth Root Crack Initiation, Propagation and Fracture Surface Based on Gear Bending Fatigue Test

Analysis of Tooth Root Crack Initiation, Propagation and Fracture Surface Based on Gear Bending Fatigue Test

A Retrospective Cohort Study of Traumatic Root Fractures in Primary Dentition: Can Splinting Type Improve Therapeutic Outcomes?

(1) Introduction: Deciduous traumatic dental injuries pose a serious global health concern. Root fractures show an incidence rate of approximately 2%; however, the literature is limited regarding the appropriate treatment and prognosis of affected teeth. This retrospective study aims to analyze the long-term outcomes of orthodontic splinting using brackets compared with composite resin-only splinting in two homogeneous samples affected by root fractures. The study also examines the onset and patterns of root resorption. (2) Methods: The first group included 25 patients with 27 deciduous upper incisors affected by root fracture; Group 2 consisted of 35 patients with 38 root fractures of maxillary deciduous teeth. The categorical data for both groups were analyzed using the chi-squared homogeneity test. Age groups were compared using the Mann–Whitney U test; p < 0.005 was considered statistically significant. (3) Results: In both groups, the male gender predominated similarly. In Group 1, early decidual loss occurred in 16% of cases, whereas in Group 2 it occurred in 51% of cases. Pulp canal obliteration was observed in 68% of deciduous teeth in Group 1, compared with 30% in Group 2. No complications affecting permanent teeth were noted in Group 1; in Group 2, 29% developed enamel dysplasia and 26% experienced delayed eruption, with statistically significant differences in these proportions. Apical fragment resorption was observed in 92% of cases in Group 1 and 30% in Group 2. (4) Conclusions: The treatment of deciduous tooth root fractures using orthodontic splints can yield significant benefits, such as reduction of early tooth loss. Furthermore, the study confirms that early resorption of the distal fragment of fractured roots is a common physiological phenomenon in primary teeth and typically occurs within a year following trauma.

Initial impact force analysis and simulation of planetary helical gear transmission

The planetary gear transmission is widely used because of its advantages such as large transmission ratio and high transmission efficiency. But at the moment of starting, there is a speed difference between driving gear and driven wheel due to the backlash between the teeth, this will easily cause the initial collision and impact force, which seriously affect the life of gear transmission, even lead to tooth surface pitting and root fracture failure, therefore, it is necessary to conduct a quantitative analysis of the initial collision. Based on the gear meshing principle and the system dynamics theory, the analytical calculation formula of initial impact force for the internal and external meshing gear pair was derived. The impact simulation analysis model of planetary helical gear transmission was established based on the finite element LS-DYNA, and the simulation analysis results were compared with the analytical calculation results, which verified the correctness of the analytical calculation model. This paper reveals the impact collision mechanism and studies the influence law of the speed and temperature on the impact force, thus laying a good theoretical foundation for the dynamic modification design of the planetary gear transmission and preventing the failure of the gear teeth from impact collision.

Development and validation of a method for creating incomplete vertical root fracture in extracted teeth.

The present study reported a method for inducing incomplete root fracture in human extracted teeth for the purpose of evaluating the merits of different diagnostic imaging techniques. Thirty-five single-rooted teeth were inspected under magnification and transillumination to exclude previously fractured teeth. Tooth crowns were removed, and the root canals were prepared up to the ProTaper Next X4 (40.06) file. Each root was lined with wax and embedded in a polystyrene resin block. The setup was attached to a universal testing machine for pressing a customized conical wedge (diameter at tip: 0.6mm; taper: 0.2mm/mm) into the instrumented canal with a 2kN load at 5mm/min. The machine was programmed to stop after a sudden 10% drop in loading force. Each specimen was removed from the resin block and inspected under × 20 magnification and transillumination to identify the fracture characteristics (pattern, surfaces and root-third affected). The gap width of each specimen was measured at different locations along the fracture line. The protocol induced incomplete vertical root fractures in all specimens. Fracture widths were < 100μm in all specimens (mean gap width: 34.9μm). The proposed methodology was successful in inducing incomplete vertical root fractures with characteristics that resemble the clinical presentation of these conditions. The method is easy to execute, highly reproducible and helps to minimize bias in laboratory studies that aims to mimic vertical root fractures.

Finite Element Analysis of Stress Distribution in Root Canals When Using a Variety of Post Systems Instrumented with Different Rotary Systems.

It is very important for clinicians to provide restorative treatments that provide durability for endodontically treated teeth. Trauma, occlusal premature contact, and features of teeth are some of the issues that can cause vertical root fractures (VRFs) in root canal-treated teeth. The aim of this 3-D study was to compare stress distribution on mandibular premolar teeth when using a variety of post designs instrumented with different rotary systems. Six mandibular premolar teeth were instrumented with the following tools: ProTaper Next, WaveOne (WO), Reciproc (R), ReciprocBlue (RB), F6-Skytaper, and TF-Adaptive. Teeth were scanned using cone beam computed tomography (CBCT) and the images were transferred to the Catia V5R25 software. Data were recorded in a stereolithography (STL) format. Four different post systems were used, fabricated from metal, fiber, zirconia, and titanium, respectively. Dentin, gutta, post, core, and crown models were added to the solid model. ANSYS V17.2 finite element analysis (FEA) software was used to determine stress distribution on each assembly. Finite analysis models were created that allowed for the calculation of stress distribution of 250-N loading at a 45° angle and vertical in relation to the roots. The maximum principal stress and von Mises values were higher under oblique loading on the roots. The F6-Skytaper and WO systems showed lower stress than other systems. The TF-Adaptive instrument showed higher stress distribution than the other models. Fiber and titanium posts showed lower stress than others. The F6-Skytaper, R, and RB instruments were found to be most effective in terms of displacement of the crown, resulting in the lowest stress values. Fiber and titanium posts showed better results than other post systems, while root canals instrumented with the F6-Skytaper and WO instruments were less likely to result in root fractures.

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.