How protocol, posts, and experience affect fracture detection in multi-rooted teeth using cone-beam computed...

Area of Science:

• Dentistry
• Radiology
• Endodontics

Background:

• Complete root fractures are a significant diagnostic challenge in multi-rooted teeth.
• Cone-beam computed tomography (CBCT) is a key imaging modality for endodontic diagnosis.
• Intraradicular posts and varying CBCT acquisition protocols can influence diagnostic accuracy.

Purpose of the Study:

• To evaluate the impact of CBCT acquisition protocols on detecting complete root fractures.
• To assess the influence of intraradicular metallic posts on fracture detection.
• To determine the role of examiner experience in the accuracy of root fracture diagnosis.

Main Methods:

• Human molar teeth with and without intraradicular posts were subjected to controlled root fractures.
• CBCT scans were acquired using four protocols with different voxel sizes.
• Five examiners assessed fracture presence, and diagnostic performance metrics were calculated.

Main Results:

• High diagnostic performance (sensitivity, specificity, accuracy >0.70, >0.70, >0.80) was observed in teeth without posts.
• Metallic posts significantly reduced diagnostic performance, especially with low-resolution CBCT protocols and less experienced examiners.
• Examiner experience was a critical factor in diagnostic accuracy.

Conclusions:

• CBCT acquisition protocol selection should consider the presence of metallic posts for optimal root fracture detection.
• Optimizing CBCT protocols and considering examiner experience are crucial for accurate diagnosis of root fractures in multi-rooted teeth.