CBCT Performance and Endodontic Sealer Influence in the Diagnosis of Vertical Root Fractures

Abstract

Aim:To evaluate the performance of three cone beam computed tomography (CBCT) machines in detecting vertical root fractures (VRFs) in teeth filled with different sealers. Materials and methods: A total of 80 single-rooted premolars were subjected to instrumentation and restoration with gutta-percha + AH Plus sealer, gutta-percha + sealer 26, gutta-percha + fill canal, and gutta-percha without sealer as the control. Half of the samples were randomly subjected to root fracture and all the teeth were scanned by i-CAT (Imaging Sciences International, Hatfield, USA), PreXion (PreXion Inc., San Mateo, USA), and OrthoPhos XG (Sirona Dental System, Bensheim, Germany). Three examiners analyzed the images for the presence of fractures. Results: The highest accuracy was obtained with the PreXion device, with Az = 0.85, while the i-CAT device provided higher sensitivity (0.93).The specificity values observed ranged between 0.75 and 0.70. Chi-squared tests (p > 0.05) demonstrated that the sealers did not exert a significant influence on the diagnosis of VRF. Conclusion: It may be concluded that endodontic sealers do not influence the detection of VRF. The PreXion device was the most accurate, having the highest specificity value. Clinical significance: Radiopaque materials might affect the diagnosis of VRFs because they can simulate fracture lines, leading to false-positive results. Moreover, CBCT machines present different specificities that could exert some influence on that.Coronal access cavities were prepared, and the root canal treatment was done with a ProTaper Rotary System (DENTSPLY, Maillefer, Tulsa, OK, USA) up to size F3.The samples were divided into 4 groups with 20 teeth per group. The filling materials used per group were gutta-percha without a sealer, gutta-percha + AH Plus (DENTSPLY, Maillefer Tulsa, OK, USA), gutta-percha + sealer 26 (DENTSPLY, Maillefer Tulsa, OK, USA), and gutta-percha + fill canal (TechNew, Rio de Janeiro, Brazil).Teeth were wrapped in a thin layer of wax no.7 (TechNew, Rio de Janeiro, Brazil) until the region of the cervical collar. The teeth were then embedded in polyvinyl chloride (PVC) tubes containing acrylic resin.

Micro-CT evaluation of maxillary first molars: interorifice distances and internal anatomy of the mesiobuccal root

“…1,24,25 Despite the uncertain sensitivity of tomographic exams in identifying the complete anatomical complexity of the RCS, the quality/power/kV of the CBCT or micro-CT device is one of the factors that may interfere with the assessment of the isthmus. 23,28 In the present study, micro-CT was used, since it has been reported to provide a detailed three-dimensional morphological analysis. However, one of the disadvantages of this method is the impossibility of being used in in vivo evaluations.…”

The effects of different metal posts, cements, and exposure parameters on cone-beam computed tomography artifacts

“… 21 Few studies have assessed the capability of endodontic cements to induce CBCT artifacts. Freitas-e-Silva et al 22 found no difference between the evaluated endodontic cements in terms of their influence on vertical root fracture detection. Cavalcanti et al 23 found that BC Sealer induced significantly more imaging artifacts.…”

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

“…Problems with concordance have been reported in previous studies. 27 37 38 39 In one of these, 6 fewer than one-third of subtle fractures were detected by experienced radiologists, signalling the subjective nature of the interpretation of CBCT images. This finding highlights the need for improvement and constant training for those who interpret CBCT images.…”