Influence of Artifacts Induced by Dental Implants on The Detection of Vertical Root Fractures in Cone Beam Computed Tomographic Scans. An in-Vitro Study

Abstract

Aim:The aim of this study was to evaluate the influence of implant metal artifacts on the detection of vertical root fracture of teeth adjacent to dental implants. Materials and Methods:Sixty extracted single-rooted teeth were randomly divided into vertical root fracture (VRF) and non-fractured groups (NVF) (n=30). Root fracture was induced in VFR, then teeth were positioned in the right and left posterior areas of epoxy-resin mandible model mesial and distal to two titanium implants. Three CBCT scan protocols were done: roots without implants, roots with implant without artifact reduction and roots with implant with artifact reduction. The images were evaluated by three observers. Area under the receiver-operating characteristic curve (ROC), diagnostic accuracy, sensitivity, and specificity were calculated.Results: Statistically significant difference was found in diagnostic accuracy of CBCT of vertical root fracture for all test groups with highest accuracy in group without implant (p =0.022). Post hoc pairwise comparisons showed statistically significant difference between accuracy of group without implants and group with implants and without algorithm (p=0.019). Sensitivity, specificity, positive and negative predictive values were higher in group without implant but there was no statistically significant difference between the three groups.Conclusions: Implant metal artifacts influenced the diagnostic accuracy, sensitivity and specificity for detection of vertical root fracture but still high levels were achieved and all image possessed high diagnostic quality. Artifact reduction tool improved the accuracy and specificity and can be recommended when the teeth involved are near dental implant.