Comparison of three contrast agents in the diagnosis of cracked teeth using Cone Beam Computed Tomography (CBCT)

Cracked teeth are difficult to detect on conventional cone beam computed tomography (CBCT). Contrast agents may improve visualization of fine and superficial cracks. This study compared three contrast agents for their diagnostic performance. Thirty-nine extracted premolars with induced micro-cracks were examined using three contrast agents: ioversol, barium sulfate, and meglumine ioxitalamate. Each tooth underwent CBCT before and after contrast application, followed by micro-computed tomography (micro-CT) as the reference standard. Two blinded observers recorded the number of cracks detected on CBCT and confirmed by micro-CT. Statistical analysis was performed using ANOVA with LSD post hoc comparisons. Micro-CT detected an average of 19.9 ± 9.3 cracks per tooth. On CBCT, ioversol and barium sulfate performed similarly (5.6 ± 2.3 and 5.8 ± 2.1 cracks, respectively), whereas meglumine ioxitalamate detected fewer (3.4 ± 1.7, p = 0.001). When matched against micro-CT, ioversol and barium sulfate detected ~ 4 cracks, while meglumine ioxitalamate detected fewer than 3. Barium sulfate detected the largest proportion of deep cracks (20.7%). Contrast-enhanced CBCT improves detection of fine cracks compared with unenhanced scans. Ioversol and barium sulfate demonstrated superior diagnostic value, while meglumine ioxitalamate offered limited benefit.