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. 2025 Aug;50(3):e23.
doi: 10.5395/rde.2025.50.e23. Epub 2025 Jul 24.

How protocol, posts, and experience affect fracture detection in multi-rooted teeth using cone-beam computed tomography: an ex vivo experimental study

Gleica Dal' Ongaro Savegnago  1 , Gabriela Marzullo de Abreu  2 , Carolina Baumgratz Spiger  2 , Lucas Machado Maracci  1 , Wislem Miranda de Mello  1 , Gabriela Salatino Liedke  3
Affiliations

How protocol, posts, and experience affect fracture detection in multi-rooted teeth using cone-beam computed tomography: an ex vivo experimental study

Gleica Dal' Ongaro Savegnago et al. Restor Dent Endod. 2025 Aug.

Abstract

Objectives: This study aimed to evaluate the influence of cone-beam computed tomography (CBCT) acquisition protocol, the presence of intraradicular metal post, and examiner experience on the detection of complete root fractures in multi-rooted teeth.

Methods: Twenty human molar teeth filled with gutta-percha were placed into artificial alveoli created in bovine ribs. The sample was divided into two groups based on the presence or absence of intraradicular posts in the distal roots. CBCT scans were obtained using four acquisition protocols with varying voxel sizes (0.28, 0.2, 0.125, and 0.80 mm). Following the creation of controlled fractures using a chisel and hammer, CBCT imaging was repeated, resulting in 160 images. Five examiners assessed the images using OnDemand software (KaVo Dental GmbH). Sensitivity, specificity, and accuracy were calculated for each examiner, CBCT protocol, and post-condition. Statistical comparisons were performed using Cochran's Q test and McNemar test, and a significance level of 5%.

Results: In teeth without metallic posts, sensitivity, specificity, and accuracy values exceeded 0.70, 0.70, and 0.80, respectively. However, the presence of metallic posts significantly reduced diagnostic performance, particularly in low-resolution protocols evaluated by less-experienced examiners.

Conclusions: CBCT acquisition protocols should be selected based on the presence of metallic posts to optimize root fracture detection in multi-rooted teeth. Examiner experience also plays a critical role in diagnostic accuracy.

Keywords: Cone-beam computed tomography; Examiner experience; Root fracture.

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Conflict of interest statement

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Axial cone-beam computed tomography slices of a sample tooth without post acquired on the four protocols. (A) Low dose resolution, (B) standard resolution, (C) high resolution, and (D) endo resolution.
Figure 2.
Figure 2.
Axial cone-beam computed tomography slices of a sample tooth with post acquired on the four protocols. (A) Low dose resolution, (B) standard resolution, (C) high resolution, and (D) endo resolution.
See this image and copyright information in PMC

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