The influence of metallic posts in the detection of vertical root fractures using different imaging examinations

To assess the influence of metallic posts in the detection of simulated vertical root fractures (VRFs) using the following imaging examinations: 2 cone beam CT (CBCT) systems [CBCT1: NewTom(®) 3G (QR Srl, Verona, Italy) and CBCT2: i-CAT Next Generation(®) (Imaging Sciences International, Hatfield, PA)] and film and digital radiographs. Additionally, the influence of the orientation of the fracture line in the detection of VRFs was evaluated.

100, human, single-rooted endodontically treated premolars were divided into 5 groups (Group 1: with posts and buccolingual VRFs, Group 2: with posts and mesiodistal VRFs, Group 3: without posts and with buccolingual VRFs, Group 4: without posts and with mesiodistal VRFs, and Group 5: with posts and without VRFs). The premolars were placed in human mandibles and imaged using the four examination modalities. The sensitivity and the specificity of each examination in the experimental groups were calculated. The data were analysed using Student's t-test.

The presence of metallic posts reduced the sensitivity of the CBCT1 system (p = 0.0244). Digital radiographs and the CBCT1 and CBCT2 systems had a higher sensitivity in detecting buccolingual fractures in teeth with posts, whereas film and digital radiographs had a higher sensitivity in detecting buccolingual fractures in teeth without posts (p < 0.05). The CBCT1 examination demonstrated the lowest specificity (p < 0.05).

The presence of metallic posts did not influence the sensitivity of most of the examinations, excluding the CBCT1 system. The fracture line orientation may influence VRF detection.