Basic Research| Volume 47, ISSUE 7, P1132-1137, July 2021

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Combined Use of 2 Cone-beam Computed Tomography Scans in the Assessment of Vertical Root Fracture in Teeth with Intracanal Material

Published:April 13, 2021DOI:



      The purpose of this preliminary study was to evaluate the diagnostic accuracy of the combined use of 2 cone-beam computed tomographic (CBCT) volumes obtained with the tooth of interest positioned at different orientations in the detection of vertical root fracture (VRF).


      Thirty single-rooted teeth were divided into 2 main groups (n = 15): control and with VRF. The teeth were individually placed in a phantom composed of a human skull and mandible, which was CBCT scanned in 2 spatial orientations: conventional (with the Frankfurt plane parallel to the floor) and angled acquisition (tilted 90° backward). Also, each tooth was scanned with gutta-percha, a metal post, and without any intracanal material. Three oral radiologists individually evaluated the images resulting from conventional acquisition and verified the presence or absence of VRF (conventional CBCT assessment), setting a score on a 5-point scale. Subsequently, the observers evaluated both images resulting from the conventional and angled acquisitions (combined CBCT assessment). The diagnostic values of the conventional and combined assessments were compared using 2-way analysis of variance with the post hoc Tukey test. The significance level was set at 5% (α = 0.05).


      The combined CBCT assessment showed higher accuracy and sensitivity in the VRF diagnosis of teeth filled with gutta-percha (P < .05). In teeth with a metal post, all diagnostic values were higher in the combined CBCT assessment (P < .05).


      This preliminary study suggests that the CBCT-based diagnosis of VRF in teeth with intracanal material was improved when the assessment combines images obtained at 2 orientations.

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        • Liao W.C.
        • Tsai Y.L.
        • Wang C.Y.
        • et al.
        Clinical and radiographic characteristics of vertical root fractures in endodontically and nonendodontically treated teeth.
        J Endod. 2017; 43: 687-693
        • Neves F.S.
        • Freitas D.Q.
        • Campos P.S.
        • et al.
        Evaluation of cone-beam computed tomography in the diagnosis of vertical root fractures: the influence of imaging modes and root canal materials.
        J Endod. 2014; 40: 1530-1536
        • De Martin E Silva D.
        • Campos C.N.
        • Pires Carvalho A.C.
        • et al.
        Diagnosis of mesiodistal vertical root fractures in teeth with metal posts: influence of applying filters in cone-beam computed tomography images at different resolutions.
        J Endod. 2018; 44: 470-474
        • Malhotra N.
        • Kundabala M.
        • Acharaya S.
        A review of root fractures: diagnosis, treatment and prognosis.
        Dent Update. 2011; 38: 615-628
        • da Silveira P.F.
        • Vizzotto M.B.
        • Liedke G.S.
        • et al.
        Detection of vertical root fractures by conventional radiographic examination and cone beam computed tomography - an in vitro analysis.
        Dent Traumatol. 2013; 29: 41-46
        • Gaêta-Araujo H.
        • Silva de Souza G.Q.
        • Freitas D.Q.
        • et al.
        Optimization of tube current in cone-beam computed tomography for the detection of vertical root fractures with different intracanal materials.
        J Endod. 2017; 43: 1668-1673
        • Pinto M.G.
        • Rabelo K.A.
        • Sousa Melo S.L.
        • et al.
        Influence of exposure parameters on the detection of simulated root fractures in the presence of various intracanal materials.
        Int Endod J. 2017; 50: 586-594
        • Ferreira L.M.
        • Visconti M.A.
        • Nascimento H.A.
        • et al.
        Influence of CBCT enhancement filters on diagnosis of vertical root fractures: a simulation study in endodontically treated teeth with and without intracanal posts.
        Dentomaxillofacial Radiol. 2015; 44: 20140352
        • Wanderley V.A.
        • Freitas D.Q.
        • Haiter-Neto F.
        • et al.
        Influence of tooth orientation on the detection of vertical root fracture in cone-beam computed tomography.
        J Endod. 2018; 44: 1168-1172
        • Cicchetti D.V.
        Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology.
        Psychol Assess. 1994; 6: 284-290
        • Chang E.
        • Lam E.
        • Shah P.
        • et al.
        Cone-beam computed tomography for detecting vertical root fractures in endodontically treated teeth: a systematic review.
        J Endod. 2016; 42: 177-185
        • Talwar S.
        • Utneja S.
        • Nawal R.R.
        • et al.
        Role of cone-beam computed tomography in diagnosis of vertical root fractures: a systematic review and meta-analysis.
        J Endod. 2016; 42: 12-24
        • Melo S.L.
        • Haiter-Neto F.
        • Correa L.R.
        • et al.
        Comparative diagnostic yield of cone beam CT reconstruction using various software programs on the detection of vertical root fractures.
        Dentomaxillofac Radiol. 2013; 42: 20120459
        • Oenning A.C.
        • Pauwels R.
        • Stratis A.
        • et al.
        • Dimitra Research Group
        Halve the dose while maintaining image quality in paediatric cone beam CT.
        Sci Rep. 2019; 9: 5521
        • Gaêta-Araujo H.
        • Alzoubi T.
        • Vasconcelos K.F.
        • et al.
        Cone beam computed tomography in dentomaxillofacial radiology: a two-decade overview.
        Dentomaxillofac Radiol. 2020; 49: 20200145