Detection of Vertical Root Fractures Using Three Different Imaging Modalities: An In Vitro Study

Area of Science:

• Dentistry
• Oral Radiology
• Endodontics

Background:

• Diagnosing nondisplaced longitudinal fractures, or vertical root fractures (VRFs), presents significant clinical challenges.
• Conventional radiographic techniques often struggle with the accurate detection of VRFs.
• Cone-beam computed tomography (CBCT) offers high-quality three-dimensional (3D) imaging for improved dental diagnostics.

Purpose of the Study:

• To compare the diagnostic accuracy of periapical radiographs, digital radiographs, and CBCT in identifying VRFs.
• To evaluate the efficacy of these imaging modalities in both endodontically and non-endodontically treated teeth.

Main Methods:

• An in vitro study utilized 60 extracted human mandibular premolars.
• Root canal treatment was performed on 30 teeth; VRFs were induced in 15 treated and 15 untreated teeth.
• Images were acquired using periapical, digital, and CBCT X-ray units, with evaluations by three endodontists.

Main Results:

• CBCT demonstrated the highest accuracy in detecting VRFs, significantly outperforming periapical and digital radiography (p=0.00).
• Excellent interobserver agreement was noted for CBCT (κ=0.98), digital (κ=0.88), and conventional periapical (κ=0.93) X-rays.
• CBCT exhibited superior sensitivity in identifying VRFs.

Conclusions:

• CBCT imaging provides the highest accuracy for detecting vertical root fractures in vitro.
• The diagnostic performance of CBCT surpasses periapical systems for both treated and untreated teeth.
• CBCT scans show enhanced sensitivity for VRF detection compared to periapical images.