ABSTRACT
Objective: Diagnosis of vertical root fractures [VRFs] is critical in endodontics; which most of the times occurs in endodontically treated teeth with root canal fillings such as gutta percha. Despite Cone Beam Computed Tomography [CBCT] has significantly enhanced image quality compared to digital radiography [DR] which aid the diagnosis, artifacts has remained as a problem in VRF detection. The aim of this study was to compare accuracy of CBCT and digital radiography system in vertical root fracture with presence and absence of gutta-percha
Methods: In this experimental in vitro study, 60 premolar teeth were cut at the cementoenamel junction .The teeth were randomly divided into two groups; for one group root canal therapy was done and the roots filled with gutta-percha. The other group was the control one .At the first stage CBCT scan and digital radiography was done and subsequently, vertical root fractures were induced for all samples. Then all the teeth were scanned by CBCT and digital radiography system and three observer assessed CBCT images and digital radiographies for presence of vertical root fracture. ANOVA and weighted Kappa tests estimated the diagnostic accuracy values and inter-observer Agreement
Results: All values for CBCT were higher than Digital radiography except for absolute specificity and negative predictive value [p=0.409, p=0.053]. In both imaging systems, there was no statistical difference between presence and absence of gutta-percha. [p=0.599, p=1.000, p=0.673, p=0.373]
Conclusion: Diagnostic accuracy of vertical root fracture was not influenced by presence or absence of gutta-percha. Additionally, CBCT imaging system had higher diagnostic accuracy in comparison of digital radiography
ABSTRACT
Objective: The diagnosis of vertical root fracture [VRF] in endodontically treated teeth is a clinical challenge due to lack of specific clinical and radiographic signs. Although radiographic evaluation such as CBCT is helpful, intracanal posts can produce artifacts and may impair the quality of CBCT scans. This study aimed to compare the diagnostic accuracy of different resolutions of CBCT in detection of VRF in roots with casting post
Methods: Eighty extracted human premolars were under went routine endodontic procedure and cast posts were subsequently prepared. The teeth were randomly divided into two groups. The fracture lines were induced by an Instron machine in test group, while the teeth in control group had no fracture. The teeth were scanned by CBCT with two voxel resolution protocols [0.15mm and 0.2mm]. Three observers assessed the scans for presence of VRF on a 5-point scale. Diagnostic accuracy indices were estimated and the difference were analyzed with the Mann-Whitney test [p<0.05]
Results: Probabilistic sensitivity for 0.15mm and 0.2mm resolution was 59.16 [5.2] and 46.66 [16.64], respectively. Furthermore, probabilistic specificity for 0.15mm resolution was 56.16 [15.21] and for 0.2mm was 61.66 [8.77].There were no statistical differences between different resolutions in all diagnostic values including sensitivity, specificity, positive and negative predictive values [p>0.05]
Conclusion: Diagnostic ability of CBCT in presence of casting posts was not influenced by system resolution. According to ALARA principle, 0.2mm voxel resolution protocol is recommended in these cases
ABSTRACT
Objective: Diagnosis of vertical root fractures [VRFs] is critical in endodontics. Cone Beam Computed Tomography [CBCT] has significantly enhanced image quality compared to digital radiography [DR] and greatly aids the diagnosis of VRFs but, metal artifacts has remained as a problem in VRF detection. This study evaluated the effect of intra canal posts on the diagnostic accuracy of CBCT and DR for detection of VRFs
Methods: In this experimental in vitro study eighty extracted human premolar teeth were cut at the cement-enamel junction .After root canal preparation, the casting posts were made. Samples were randomly divided into 2 groups of 40; group one with induced fracture and group 2 as the control group. Radiographs were taken for all specimens with and without posts with both imaging systems. Three observers assessed the presence or absence of VRF. Accuracy of the two imaging systems and the effect of post on VRF detection were assessed, using two-way ANOVA test and inter observer coefficient agreement was calculated
Results: Absolute diagnostic sensitivity and specificity of CBCT and absolute sensitivity of DR in the group with intracanal posts were significantly lower than those in the group without posts [p=0.023, p=0.034 and p=0.034 respectively]. Absolute specificity of DR in the group with posts was significantly higher than that of the CBCT [p=0.014]. The absolute and complete specificity of CBCT in the group without posts was significantly higher than those of DR [p=0.024, p=0.04]. No statistically significant difference was found in inter observer agreement coefficient in presence or absence of posts or between the two imaging systems [p=0.119]
Conclusion: Intra canal posts decreased the diagnostic accuracy of CBCT and DR for detection of VRFs and this reduction was greater in CBCT. However, absolute specificity of DR in the group with posts was significantly higher than that of the CBCT, where as CBCT images of teeth without posts still had higher diagnostic accuracy than DR
ABSTRACT
Vertical root fracture [VRF] is a common failure in endodontically treated teeth. Due to VRF's poor prognosis, a reliable and valid detection method is critical for treatment planning. Conventional and digital radiographs are limited in VRF detection. Recently, Cone Beam CT [CBCT] system has been introduced. This study aimed to compare the diagnostic accuracy of these three imaging modalities for VRF detection. One hundred and twenty extracted single-rooted teeth were selected and sectioned through cementoenamel junction. The roots were divided in two groups; group one consisted of 60 teeth with induced root fracture and group two had 60 teeth with no fracture. In the first group the crack was made by instron system. All samples were imaged by the three imaging modalities. Diagnostic accuracy was then compared with methylene blue dye detection method. Kappa was used for statistical analysis. CBCT showed the highest sensitivity [94.6%] and specificity [98.2%]. Conventional radiography and digital radiography were not as accurate as CBCT. According to our study, CBCT seems to be better than conventional and digital radiography in detecting VRF and provides the most reliable data in comparison with the two other modalities