Detection of Vertical Root Fractures Using Cone-Beam Computed Tomography in the Presence and Absence of Gutta-Percha

Abstract

Background Vertical root fractures (VRFs) can significantly reduce dental prognosis. Cone-beam computed tomography (CBCT) offers better visualization of VRF than conventional radiography. However, gutta-percha creates artifacts in cone-beam CT (CBCT) images and reduces the diagnosis quality. The purpose of this study was to evaluate the accuracy of CBCT in detection of VRF in presence and absence of gutta-percha in canals. Materials and Methods In this cross-sectional study, 50 extracted mandibular premolars were selected. After preparing the access cavity, canals were instrumented using step-back method, and gutta-percha #40 was placed afterwards. The fractures were created using electromechanical universal testing machine on 25 teeth. The teeth were randomly placed in dry mandibular dental sockets, and the first CBCTs were taken. Then the gutta-percha was removed, and the second CBCTs were taken. Results The results of Kappa coefficient between two observers in roots with and without gutta-percha were 0.644 and 0.830, respectively (p value ≤ 0.001). The sensitivity and specificity of VRF diagnosis in assessing gutta-percha filled canals were 32% and 68% for the first observer, respectively (Kappa < 0.000, p value = 1.000), and 40% and 68% for the second observer, respectively (Kappa = 0.080, p value = 0.556). The sensitivity and specificity of VRF diagnosis in assessing the empty canals (without gutta-percha) were 72% and 96% for the first observer, respectively (Kappa = 0.680, p value ≤ 0/001), and 72% and 96% for the second observer, respectively (Kappa = 0.680, p value ≤ 0/001). Conclusion The intracanal filling materials such as gutta-percha reduce the diagnostic ability of vertical root fractures. Hence, it is recommended to remove those materials from root canals before imaging to improve the diagnostic potential of CBCT.

Evaluation of the efficacy of the metal artifact reduction algorithm in the detection of a vertical root fracture in endodontically treated teeth in cone-beam computed tomography images: An in vitro study

“…Hekmatian et al evaluated the effect of the presence of gutta-percha on the detection of VRFs on CBCT images and reported that the presence of gutta-percha in the canal decreased the ability to detect VRFs. 20 Kamburoğlu et al reported that dark areas around guttapercha on the CBCT images of endodontically treated mandibular premolars caused false positive results and led to misdiagnoses of root fracture. 21 Hassan et al evaluated the effect of root filling materials on the detection of VRFs on CBCT images, and reported that they significantly decreased the accuracy and sensitivity of the detection of VRFs.…”

In vivo detection of vertical root fractures in endodontically treated teeth: Accuracy of cone-beam computed tomography and assessment of potential predictor variables

“…When a VRF occurs, it extends to the periodontal ligament, thus inducing an inflammatory process in the adjacent periodontal tissue due to bacterial contamination from oral cavity ( 13 , 14 ), which in turn leads to the granulomatous tissue formation and periodontal breakdown ( 15 ). The detection of a VRF is challenging and its distinction usually requires a clinical and radiographic correlation, and sometimes the surgical exploration ( 5 ). Clinical signs and symptoms include localized periodontal swelling or abscess, sinus tract, tooth mobility, tenderness to palpation/percussion, and isolated periodontal pockets ( 16 ).…”

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

“…Thus, the use of smaller voxel size is preferable to reduce the presence of artifacts and to improve the diagnostic accuracy of root fractures in root-filled teeth. Moreover, as suggested by Hekmatian et al, 28 it is recommended to remove those materials from root canals before imaging to improve the diagnostic potential of CBCT.…”