Effect of Object Position in Cone Beam Computed Tomography Field of View for Detection of Root Fractures in Teeth with Intra-Canal Posts

Abstract

Background:Vertical root fracture (VRF) is a common problem in endodontically treated teeth. Due to its poor prognosis, a reliable technique must be used to make an accurate diagnosis. Cone beam computed tomography (CBCT) has been recently introduced for maxillofacial imaging. Despite the high diagnostic value of this method, metal artifacts resulting from intra-canal posts still make the detection of VRFs challenging.Objectives:This study aimed to assess the effect of object position in the field of view (FOV) of CBCT on detection of VRFs in teeth with intra-canal posts.Materials and Methods:The crowns of 60 extracted premolar teeth were cut at the level of cementoenamel junction (CEJ). Root canals were filled with gutta-percha and filling of the coronal 2/3 of the root canals was subsequently removed to fabricate intra-canal cast posts. The teeth were randomly divided into two groups of 30. Fracture was induced in group one using an Instron machine. Group two was considered as the control group with no fracture. All teeth were then randomly positioned and scanned in five different positions starting at the center of the FOV as well as right, left anterior and posterior relative to the center (3, 9, 12, and 6 O’clock) via the New Tom VGI CBCT unit. Two observers evaluated images for VRFs. Sensitivity and specificity of fracture diagnosis in each position was calculated in comparison with the gold standard. Wilcoxon test was used for data analysis.Results:Considering deterministic and probabilistic diagnostic parameters, probabilistic sensitivity was similar in all positions; but probabilistic specificity of the center position (65.1%) was significantly higher than that of 6 and 12 O’clock positions. Considering the deterministic diagnostic parameters, the overall sensitivity and specificity values decreased in all positions in FOV, but sensitivity of the center position of FOV was significantly higher than that of other positions; specificity was significantly higher at the 3 O’clock position (58.5%).Conclusion:Concerning the positions in FOV, the center position is suitable for detection of VRF in teeth with intra-canal posts due to significantly higher sensitivity at this position. The 3 O’clock position would be suitable for assessment of intact teeth without fractures due to significantly higher specificity at this position.

Effect of anatomical region on the formation of metal artefacts produced by dental implants in cone beam computed tomographic images

“…Although Rabelo et al 19 observed that variations of mA and kV do not affect the quantification of artefacts in CBCT images with different intracanal filling materials, it is important to note that other factors may affect artefact formation, such as voxel size, slice thickness and FOV size. 7 Therefore, it is necessary to develop future in vitro studies that take these variables into account when counting the artefacts generated by implants. Moreover, it is essential to develop research that associates the number of artefacts with diagnostic accuracy to ascertain the real level of interference of these unwanted images on clinical dental practice.…”

“…3,4 Cone beam CT (CBCT) has become the most widely used examination in implantology, as it minimizes the limitations of two-dimensional images. [4][5][6][7] Owing to its capacity to provide three-dimensional information, CBCT provides high image quality, diagnostic accuracy and linear measurement precision, thus increasing dental implant installation safety and treatment success rates. 2,3,[5][6][7][8][9] However, in the post-surgical follow-up phase, metal artefacts form inside the field of view (FOV), affecting tomographic image quality, [1][2][3][4][5][6][9][10][11] affecting, e.g.…”

“…2,6,10 These artefacts tend to cause excessive variation in grey values near the metal structure, 3 affecting image quality and making it difficult to evaluate osseointegration and inflammatory processes near the implants. 4,7,9,15 Some studies suggest that the formation of metal artefacts can be affected by anatomical region, the position of the object within the FOV and the adjacent anatomical structures outside of the FOV, 7,8 but there is no consensus regarding which regions (maxilla or mandible, anterior or posterior) are more involved in the formation of artefacts or what the effects of the object's location within the FOV are. Thus, the aim of this study was to use CBCT images to quantify the formation of metal artefacts produced by titanium dental implants installed in different maxillomandibular regions.…”

Role of Computed Tomography Scan in Dental Trauma: A Cross-Sectional Study

“…InStat (Windows version, GraphPad Software, CA, USA ) was used for statistical analysis of the study. Wilcoxon test 22 following Tukey post hoc test (considering critical value q > 4.418 as significant) 23 was performed for predictive values between the 4 diagnostic modalities. The results were considered significant at a 99% confidence level.…”

Vertical root fracture: Biological effects and accuracy of diagnostic imaging methods

“…They concluded that the center-scanned position was found to be the only position that had reliable sensitivity for detecting VRFs. [ 22 ] Moreover, note that advances in radiology must also be accompanied by advanced user-level expertise with the specific diagnostic task.…”