The accuracy of CBCT for the detection and diagnosis of vertical root fractures in vivo

Abstract

Aim To compare the in vivo accuracy of CBCT for the detection of fracture lines versus the diagnosis of vertical root fractures (VRFs) according to characteristic patterns of associated bone resorption. Methodology Eighty‐eight patients with symptoms typical of VRFs in root filled teeth, who underwent a CBCT examination and later had the teeth extracted, were divided into two groups: the fracture group (n = 65) and the control group (n = 23). Five blinded observers assessed the CBCT images in two sessions. During the first session, they were asked to state the diagnosis according to the CBCT and clinical data. During the second session after 2 weeks, they assessed only axial slices and were asked to detect a fracture line. The mean CBCT specificity, sensitivity, accuracy values and area under the receiver operating characteristic (AUROC) curve were calculated and compared using the Wilcoxon signed‐rank test. Results The average sensitivity of CBCT for the diagnosis of VRFs was 0.84 ± 0.2. The accuracy and AUC values were 0.81 ± 0.08 and 0.84 ± 0.17, respectively. The sensitivity, accuracy and AUC values for the detection of VRFs were significantly lower: 0.17 ± 0.24 (P = 0.042), 0.54 ± 0.07 (P = 0.043), and 0.52 ± 0.09 (P = 0.043), respectively. The specificity of CBCT for the detection and diagnosis of VRFs did not differ significantly (P = 0.50). Conclusion Cone‐beam computed tomography was helpful in VRF diagnosis even when it was not possible to visualize the fracture line.

Differences in the corono-apical location of sinus tracts and buccal cortical bone defects between vertically root-fractured and non-root-fractured teeth based on periradicular microsurgery

“…In this study, the presence of VRF and its relationship with buccal cortical bone defects was assessed by direct microscopic visualization, which is regarded as the most definitive method for detecting these conditions [13]. CBCT is another method for detection of VRF [15][16][17][18]. However, its diagnostic ability for VRF is not sufficient, particularly in root-filled teeth where imaging artifacts from radio-dense obturating materials impair diagnostic accuracy [18][19][20].…”

“…CBCT is another method for detection of VRF [15][16][17][18]. However, its diagnostic ability for VRF is not sufficient, particularly in root-filled teeth where imaging artifacts from radio-dense obturating materials impair diagnostic accuracy [18][19][20]. CBCT may also be useful for detection of osseous changes associated with a VRF [24], although its accuracy for detection of buccal cortical bone defects requires attention because it may overestimate their presence [25,26].…”

“…In particular, in cases with incomplete fracture(s), there are no typical radiographic patterns of bone resorption around the fractured root [10,11]. Cone-beam computed tomography (CBCT) has recently been evaluated for its potential to detect VRF [15][16][17][18]. However, its ability to detect VRF in root-filled teeth is unclear, mainly due to distortion or artifacts arising from root canal filling materials and posts [18,19,20].…”

The impact of cone beam computed tomography in diagnosis and endodontic treatment planning decisions - case reports

“…The use of CBCT has shown excellent benefits for endodontic treatments. Some of the already well-known examples of its use are the precise identification of periapical lesions (Es-trela et al, 2008), the diagnosis of root fractures (Byakova et al, 2019) as well as the localiza-tion of extra canals in teeth with complex anatomy such as molars (Alexandre et al, 2019).…”

Assessment of true vertical root fracture line in endodontically treated teeth using a new subtraction software – A Micro‐CT and CBCT study

“…Although many studies have been performed to identify the capability of a CBCT scan in vitro or in vivo diagnoses of VRFs (2,10–12), there are still endodontically treated teeth with subtle VRFs which could not be diagnosed accurately in the clinic. To date, no studies have investigated how many true fracture lines could be demonstrated on CBCT images.…”