Cone beam CT scans with and without artefact reduction in root fracture detection of endodontically treated teeth

Abstract

Objectives: Cone beam CT (CBCT) is used widely to depict root fracture (RF) in endodontically treated teeth. Beam hardening and other artefacts due to gutta-percha may increase the time of the diagnosis and result in an incorrect diagnosis. Two CBCT machines, ProMax ® (Planmeca, Helsinki, Finland) and Master 3D ® (Vatech, Hwaseong, Republic of Korea), have the option of applying an artefact reduction (AR) algorithm. The aim of this study was to determine whether using an AR algorithm in two CBCT machines enhances the accuracy of detecting RFs in endodontically treated teeth. Methods: 66 roots were collected and decoronated. All roots were treated endodontically using the same technique with gutta-percha and zinc oxide cement. One-half of the roots were randomly selected and fractured using a nail that was tapped gently with a hammer until complete fracture resulted in two root fragments; the two root fragments were glued together with one layer of methyl methacrylate. The roots were placed randomly in eight prepared beef rib fragments. Results: The highest accuracy was obtained when the ProMax was used without AR. The lowest accuracy was obtained with the Master 3D when used with AR. For both machines, accuracy was significantly higher without AR than with AR. Both with and without AR, the ProMax machine was significantly more accurate than the Master 3D machine. The same rank ordering was obtained for both sensitivity and specificity. Conclusions: For both machines, AR decreased the accuracy of RF detection in endodontically treated teeth. The highest accuracy was obtained when using the ProMax without AR.

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

“…13,17,18 The influence of AR has been studied; nevertheless, our literature review showed that only one study evaluated its influence on the diagnosis of root fractures. 4 That study, however, used root canals filled with gutta-percha, a material known to produce fewer artefacts than do metal posts. 28 Given the paucity of research regarding the issue, we pursued the task of scrutinizing an AR offered by a commercially available CBCT system (Picasso Trio 3D) concerning its ability to ease VRF diagnosis in teeth with intracanal metal posts.…”

“…However, we could not confirm this hypothesis, as some have already reported. 4,24 When assessing two different imaging systems with AR (Picasso Master 3D and Planmeca ProMax ® 3D Max; Planmeca Oy, Helsinki, Finland) regarding root fracture diagnosis in teeth filled with gutta percha, Bechara et al 4 reported overall inferior results with the use of the tool. By using an AR in an attempt to improve the detection of peri-implant and periodontal defects, Kamburoglu et al 24 were also unable to deliver promising conclusions.…”

“…4 That group judged that the images they obtained were suitable for root Table 3 Mean values (± standard deviation) for the area under the receiver operating characteristic curve (Az) and for the diagnostic tests (sensitivity, specificity and accuracy) with the artefact reduction algorithm (W/AR) and without the artefact reduction algorithm (Wo/AR) considering incomplete and complete vertical root fractures (VRFs) Influence of CBCT artefact reduction tool in root fracture diagnosis ISQ Bezerra et al fracture diagnosis given that values for the areas under the ROC curves (Az) were .0.5. This idea does not find support in our results since our Az values were slightly .0.5 without AR and lower with AR; therefore, CBCT seems scarcely a promising method for fracture detection in the presence of metal posts owing to the higher amount of artefacts formed.…”

“…[21][22][23] When evaluated for root fracture diagnosis in teeth filled with gutta-percha, the use of an AR led to decreased diagnostic sensitivity and specificity. 4 Additionally, no differences were observed in the detection of simulated periodontal and peri-implant vestibular defects with or without the use of an AR. 24 Thus, the benefits of using an AR are not well established, and studies to date have used either subjective or objective evaluations but not the two forms of assessments combined.…”

“…Artefacts affect image quality and may increase difficulty of root fracture diagnosis substantially. 4,12,[15][16][17][18] In teeth with intracanal fillings, artefacts occur owing to differences in the attenuation and absorption of X-ray beams by high-density material physics that cause beam-hardening phenomenon. The resulting image is altered by hypodense bands (dark bands), hyperdense striations (white streaks) and distortion of metal objects (cupping artefacts), which can all interfere with fracture detection and may lead to falsepositive results.…”