Evaluation of cone-beam computed tomography in the diagnosis of vertical root fractures: the influence of imaging modes and root canal materials

Abstract

Introduction: The purpose of this study was to evaluate the influence of cone-beam computed tomography (CBCT) imaging modes in the diagnosis of vertical root fractures with different intracanal materials.

Methods: The sample consisted of 30 single-rooted teeth divided into 3 groups (n = 10), control and complete and incomplete root fracture. In each tooth, different materials were used (gutta-percha, metal post, and fiber post) as well as no filling material. Each tooth/root was scanned in a 3D Accuitomo 170 CBCT device by using 4 different imaging modes (high-resolution, high-fidelity, high-speed, and standard). In addition, the dose-area product was calculated for each CBCT imaging mode. The images were randomly evaluated by 5 dentomaxillofacial radiologists.

Results: Complete root fractures were visualized more easily than incomplete fractures. The presence of metal post and gutta-percha negatively influenced the diagnosis of root fracture. Regarding the CBCT imaging modes, there was no influence for complete root fracture diagnosis. In cases of incomplete root fractures, high-fidelity, high-resolution, and standard had a higher diagnostic accuracy, especially in the fiber post and no filling groups.

Conclusions: The CBCT imaging modes had little influence in the diagnosis of complete and incomplete root fractures, whereas the presence of intracanal material had greater impact on the diagnostic ability, demonstrating that CBCT is not beneficial for the diagnosis of root fractures when metal posts are present.

Keywords: Beam hardening artifacts; cone beam computed tomography; diagnosis; endodontics; vertical root fracture.