Detection of vertical root fracture using cone-beam computerized tomography: an in vitro assessment

Objectives: To assess the influence of the artefact reduction algorithm (AR) available on the Picasso Trio 3D ® imaging system (Vatech, Hwaseong, Republic of Korea) on image quality [greyscale values, contrast-to-noise ratio (CNR) and artefact formation] and diagnosis of vertical root fractures (VRFs) in the teeth with intracanal metal posts. Methods: 30 uniradicular teeth had their crowns removed and their roots endodontically treated to receive intracanal metal posts. In 20 teeth, both complete (n 5 10) and incomplete (n 5 10) VRFs were created. Each tooth was scanned twice, with and without AR activation. The mean and variation of greyscale values, as well as CNR, were calculated for all images. Subsequently, an evaluator compared the amount of artefact (cupping, white streaks and dark bands) in all images. Five evaluators rated for VRF presence using a five-point scale.Results: Mean greyscale values and CNR were significantly decreased in images acquired with the AR. The usage of the algorithm promoted an overall reduction of image artefacts. Regarding the diagnosis of complete and incomplete VRFs, the use of the AR had an overall negative impact on specificity and accuracy. Conclusions: While indeed reducing artefact formation, the use of the AR, instead of improving the impact on the diagnosis of VRFs in teeth with intracanal metal posts, had a negative impact on the diagnosis.

Section: Discussionmentioning

confidence: 99%

Influence of the artefact reduction algorithm of Picasso Trio CBCT system on the diagnosis of vertical root fractures in teeth with metal posts

Bezerra¹,

Neves²,

Vasconcelos³

et al. 2015

“…[15][16][17][18][19][20][21][22][23][24][25][26] However, in endodontically treated teeth and in teeth with metallic posts, the presence of image artefacts may influence the interpretation of results, which raises doubts regarding the validity of examining patients using CBCT. 13,16,18,19 A cost-benefit relationship can be justified only when studies demonstrate that these tests have a high sensitivity and specificity and effectively contribute to a diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…13,17,19,20 Endodontically treated teeth with posts are most susceptible to VRFs; 1,2,4 therefore, it is necessary to investigate the reliability of CBCT images in these cases.…”

Section: Introductionmentioning

confidence: 99%

The influence of metallic posts in the detection of vertical root fractures using different imaging examinations

Jakobson¹,

Westphalen²,

Neto³

et al. 2014

Objectives: To assess the influence of metallic posts in the detection of simulated vertical root fractures (VRFs) using the following imaging examinations: 2 cone beam CT (CBCT) systems [CBCT1: NewTom ® 3G (QR Srl, Verona, Italy) and CBCT2: i-CAT Next Generation ® (Imaging Sciences International, Hatfield, PA)] and film and digital radiographs. Additionally, the influence of the orientation of the fracture line in the detection of VRFs was evaluated. Methods: 100, human, single-rooted endodontically treated premolars were divided into 5 groups (Group 1: with posts and buccolingual VRFs, Group 2: with posts and mesiodistal VRFs, Group 3: without posts and with buccolingual VRFs, Group 4: without posts and with mesiodistal VRFs, and Group 5: with posts and without VRFs). The premolars were placed in human mandibles and imaged using the four examination modalities. The sensitivity and the specificity of each examination in the experimental groups were calculated. The data were analysed using Student's t-test.Results: The presence of metallic posts reduced the sensitivity of the CBCT1 system (p 5 0.0244). Digital radiographs and the CBCT1 and CBCT2 systems had a higher sensitivity in detecting buccolingual fractures in teeth with posts, whereas film and digital radiographs had a higher sensitivity in detecting buccolingual fractures in teeth without posts (p , 0.05). The CBCT1 examination demonstrated the lowest specificity (p , 0.05). Conclusions:The presence of metallic posts did not influence the sensitivity of most of the examinations, excluding the CBCT1 system. The fracture line orientation may influence VRF detection.

“…23 A number of studies have reported that CBCT is more sensitive than periapical radiography in detecting apical periodontitis, [24][25][26][27][28][29] and that CBCT can provide useful information for the diagnosis of VRF. 30 In another pilot study, 18 the lesions of endodontically treated maxillary incisors and pre-molars on CBCT images taken parallel to the row of teeth and to the tooth axis were measured and evaluated using the above Figure 10 Values of v/V for the vertical root fracture (VRF) and non-VRF groups. Figure 11 Receiver operating characteristic (ROC) curve with a selected cut-point of 0.53.…”

Section: Discussionmentioning

confidence: 99%

“…Vertical root fractures (VRFs) are most commonly associated with endodontically treated teeth, with an incidence varying from 3.7% to 30.8% in such teeth. [1][2][3][4] In a 5-year follow-up study of non-surgical endodontically treated teeth, a root fracture was an adverse event in 32.1% of cases, for which the elected treatment was extraction.…”

Section: Introductionmentioning

confidence: 99%

Differential diagnosis of vertical root fractures using reconstructed three-dimensional models of bone defects

Komatsu

Abe²,

Yoshioka³

et al. 2014

Objectives: The purpose of this study was to evaluate the accuracy of diagnosing vertical root fractures (VRFs) by comparing the volume of bone defects in VRFs with those in nonVRFs on reconstructed three-dimensional (3D) models (TDMs) using CBCT. Methods: 32 maxillary pre-molars and anterior teeth with radiolucent areas were evaluated on pre-operative CBCT images. Of the 32 teeth, 16 had a fractured root (VRF group) and 16 had a non-fractured root (non-VRF group). The radiolucent area of each tooth was traced in each dimension [mesiodistal, buccolingual and horizontal (the apicoincisal aspect)] by two observers, and 3D images were reconstructed with the Amira ® software (Visage Imaging Inc., Richmond, Australia). The volume, V, of the TDM was divided into the coronal side and the periapical side at the horizontal slice through the apical foramen, and v was defined as the volume of the coronal side. The values of v/V were calculated for all cases. The Mann-Whitney U test was used to compare values between the VRF group and the non-VRF group (p , 0.05). A receiver operating characteristic (ROC) curve was constructed to select the optimal cut-point. Results: There was a statistically significant difference in the value of v/V between the two groups (p , 0.05). With a cut-point derived from the ROC curve, and the sensitivity, specificity and accuracy of predicting the VRFs were 1.00, 0.75 and 0.88, respectively. Conclusions: Lesions resulting from VRFs can be distinguished from those of non-VRFs on 3D CBCT images with a high degree of accuracy, based on their different 3D shapes.