Effect of various intracanal materials on the diagnostic accuracy of cone-beam computed tomography in vertical root fractures / 北京大学学报(医学版)

OBJECTIVE@#To study the effect of various intracanal materials on the accuracy of oral maxillofacial cone-beam computed tomography (CBCT) for the diagnosis of vertical root fracture (VRF).@*METHODS@#A total of twenty-four structurally intact single root canal dried and isolated teeth extracted for orthodontic treatment or periodontal disease were collected. The teeth were decrowned along the cemento-enamel junction (CEJ) and then used as samples for the study after conventional root canal preparation and post preparation. The 24 samples were divided into two groups with 12 samples in each group. Group A was the control group (no VRF group). According to intracanal materials, they were divided into five subgroups: blank group, fiber post group, gutta-percha point group, titanium post group and gold-palladium post group. Group B was the experimental group (VRF group), and subgroups were grouped as above. The VRF model was prepared by a unified method in the VRF group: the root was completely fractured in the buccolingual direction with a custom root canal nail and then cemented and reset. The control group was not subjected to the simulation of VRF. Titanium post and gold-palladium post were made according to the individuality of the root canal preparation, and the tightness of the post to the root canal wall was confirmed by X-ray radiograph. Then all the samples were scanned by CBCT in the isolate swine mandibular alveolar sockets. The diagnostic accuracy was statistically analyzed via blind interpretation by experienced endodontic specialists and oral and maxillofacial medical imaging specialists.@*RESULTS@#The accuracy of the diagnosis of VRF in the blank group, fiber post group, gutta-percha point group, titanium post group, and gold-palladium post group in CBCT was 95.83%, 91.67%, 87.50%, 79.17%, and 45.83%, respectively. Compared with the blank group, the differences were not statistically significant in the fiber post group (P>0.999), the gutta-percha point group (P=0.500) and the titanium post group (P=0.125). The lowest diagnostic accuracy of VRF was found in the gold-palladium post group, and the difference was statistically significant compared with all other groups (P < 0.001).@*CONCLUSION@#Various intracanal materials have different degrees of influence on the diagnostic accuracy of VRF diagnosis in CBCT. The influence of fiber post, gutta-percha point and titanium post was small, while the influence of gold-palladium post was significant.

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

Abstract 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.

Resumo O objetivo deste estudo foi comparar a influência dos artefatos de cimentos endodônticos na detecção de fratura radicular vertical (FRV) em tomografia computadorizada de feixe cônico (TCFC). Pré-molares e incisivos centrais foram divididos em cinco grupos diferentes: Controle, Pulp Canal Sealer, AH Plus, Sealer 26 e BC Sealer (n = 10, por grupo). As FRVs foram induzidas mecanicamente e os dentes inseridos em uma réplica da mandibula humana. Posteriormente, imagens de TCFC (Cranex 3Dx, Soredex, Tuusula, Finlândia) foram obtidas e dois observadores foram solicitados a identificar fratura radicular separadamente, o critério utilizado foi a análise visual. Tanto para pré-molares quanto para incisivos centrais, os coeficientes kappa de concordância intraobservador variaram de bom a excelente (K: 80% - 87%), e os valores de concordância interobservador variaram de regular a moderado (K: 30% - 35%). A seguir, a área sob a curva (AUC) dos valores da característica de operação do receptor (ROC) para FRVs destacou que o uso do cimento BC Sealer reduziu a capacidade dos observadores de discriminar FRVs em relação a outros cimentos endodônticos. Além disso, os valores de sensibilidade para pré-molares variaram de 20% a 60%, e a especificidade variou de 60% a 100%; enquanto os valores de sensibilidade para incisivos centrais variaram de 30% a 70%, e a especificidade variou de 70% a 100%. Em conclusão, os baixos valores de sensibilidade, principalmente para pré-molares, demonstraram uma dificuldade no diagnóstico de FRV. Além disso, o BC Sealer induziu significativamente mais artefatos de imagem do que outros cimentos. Esses resultados evidenciam que os cimentos endodônticos podem interferir no diagnóstico das FRVs.