Assessment of fractures in endodontically treated teeth restored with and without root canal posts using high-resolution cone beam computed tomography

Abstract

Background Root fractures are a diagnostic challenge for dentists in endodontic treatment. This study aimed to determine the relationship between the characteristics of tooth fractures and the presence of root canal posts in endodontically treated teeth using high-resolution cone beam computed tomography (CBCT). Material and Methods Fifty high-resolution CBCT scans of endodontically treated teeth with a diagnosis of fracture were obtained, of which 30 were from women and 20 were from men. These scans were acquired with three Veraviewepocs 3D units and one 3D Accuitomo 170 unit, with a 40 × 40-mm field of view and 125 μm voxel size. The variables assessed included the type of fracture, extent of fracture, type of retention, post length, cause of endodontic failure, location of the lesion, and time required to detect the fracture (difficulty score). For data analysis, the chi-squared test, Student’s t-test, and multiple linear regression (α <0.05) were used. Results No association was found between the type of fracture and type of retention or between the type of fracture and its extent ( P >0.05). On the other hand, the type of fracture significantly influenced the time required for its detection. Additionally, the most difficult plane for detecting the fracture and the difficulty score were associated, with statistically significant results. Conclusions The type of fracture in endodontically treated teeth was not associated with the type of post used for restoration. All of the CBCT systems used to detect tooth fracture showed the same efficiency. Key words: Cone-Beam CT, Tooth Fracture, Root Canal Post.

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

“…The diagnosis of VRF is a challenge for clinicians and endodontists and its early detection directly influences treatment planning (Tsesis et al, 2010). In the present study, there were no significant differences in sensitivity, specificity, or accuracy between the diagnostic methods based on the plate system and on CBCT scans, as also observed by others (Aristizabal-Elejalde et al, 2020). While the diagnostic methods were considered variable, both methods showed 50% sensitivity regarding the fracture.…”

“…Although systematic reviews have reported that the sensitivity and specificity of CBCT are about 75% to 84% and 64% to 65%, respectively (Chang et al, 2016;Talwar et al, 2016), a more recent study detected 24% sensitivity when analysing unmanipulated radiographic images and 80% sensitivity for volumetric analysis, demonstrating a good ability to identify VRF (Aristizabal-Elejalde et al, 2020). Of note, we used a voxel of 0.2 mm, as recommended by other studies (Hassan et al, 2009;Kobayashi-Velasco et al, 2017;Wenzel et al, 2009).…”

“…On the basis of the above considerations, we emphasize that clinicians and endodontists should be aware of the importance of exhausting digital radiographic techniques prior to requesting CBCT as a means of diagnosing VRF since radiographic images are easier to access and represent a simple diagnostic tool. On the other hand, when CBCT is necessary, its limitations should be considered regardless of the examiner's experience (Aristizabal-Elejalde et al, 2020). Based on the study design, the results should be interpreted with caution, since the number of examiners was limited for the analyses.…”

“…Threedimensional images with reconstruction, manipulation of slices and absence of overlapping structures allow a more detailed assessment. Nevertheless, the presence of artifacts may hinder and/or modify the diagnosis, particularly when hypodense images are formed (Aristizabal-Elejalde et al, 2020).…”

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

“…The production of artefacts in CBCT images is associated with a decrease in diagnostic accuracy for VRFs. 5 7 8 High-density dental materials can produce artefacts, such as hyperdense streaks and hypodense bands; these may be superimposed on the root fracture line, preventing fracture detection. 9 …”