Photon-Counting CT for Diagnosing Vertical Root Fractures in Teeth With Metal Posts: An Ex Vivo Comparative Analysis...

Area of Science:

• Dental Imaging
• Radiology
• Biomedical Engineering

Background:

• Photon-counting computed tomography (PCCT) offers enhanced signal efficiency and reduced noise compared to conventional cone-beam computed tomography (CBCT).
• Vertical root fractures (VRF) pose diagnostic challenges in endodontically treated teeth.

Purpose of the Study:

• To evaluate the diagnostic performance of PCCT in detecting VRF.
• To compare PCCT's VRF detection capabilities against four different CBCT devices.

Main Methods:

• Eighteen endodontically treated single-rooted teeth, with VRF induced in eight, were scanned.
• Scans were performed with and without metal posts (nickel-chromium and cobalt-chromium) using PCCT and four CBCT devices at highest resolution.
• Five radiologists assessed scans blindly; diagnostic accuracy was determined using ROC curve analysis (AUC), sensitivity, and specificity.

Main Results:

• PCCT and NewTom VGi showed significantly higher AUC values than Veraview X800 (p < 0.05).
• PCCT and CS9600 exhibited higher sensitivity for Ni-Cr posts compared to Accuitomo 3D and Veraview X800 (p < 0.05).
• PCCT, NewTom VGi, and CS9600 showed higher sensitivity for Co-Cr posts versus Veraview X800 (p < 0.05); specificity did not differ significantly.

Conclusions:

• The NAEOTOM Alpha PCCT demonstrated high diagnostic accuracy for VRF detection in an ex vivo setting.
• PCCT's performance was comparable to high-resolution CBCT devices.
• PCCT shows significant potential for VRF detection under controlled ex vivo conditions.