Comparison of periapical radiography with cone beam computed tomography in the diagnosis of vertical root fractures in teeth with metallic post

Is cone-beam computed tomography more accurate than periapical radiography for detection of vertical root fractures? A systematic review and meta-analysis

BACKGROUND

This study aimed to conduct a systematic review and meta-analysis to summarize the available evidence comparing the diagnostic accuracy of periapical radiography (PA) and cone-beam computed tomography (CBCT) for detection of vertical root fractures (VRFs).

METHODS

A search was conducted in PubMed, Scopus, and Web of Science for articles published regarding all types of human teeth. Data were analyzed by Comprehensive Meta-Analysis statistical software V3 software program. The I2 statistic was applied to analyze heterogeneity among the studies.

RESULTS

Twenty-three articles met the criteria for inclusion in the systematic review and 16 for the meta-analysis. The sensitivity and specificity for detection of VRFs were calculated to be 0.51 and 0.87, respectively for PA radiography, and 0.70 and 0.84, respectively for CBCT.

CONCLUSIONS

The sensitivity of CBCT was higher than PA radiography; however, difference between the specificity of the two modalities was not statistically significant.

Influence of the technical parameters of CBCT image acquisition on vertical root fracture diagnosis: a systematic review and meta-analysis

OBJECTIVES

To evaluate the influence of image acquisition parameters (voxel, FOV, kVp, mA) on the accuracy of cone-beam computed tomography (CBCT) in detecting vertical root fracture (VRF).

MATERIAL AND METHODS

Searches were performed in 6 main databases and the gray literature, without restrictions of language or date. Observational clinical studies (OCS) and in vitro-extracted teeth (IV) studies were considered eligible for inclusion when investigating the accuracy (sensitivity, specificity) of CBCT in detecting VRF in human teeth. The risk of bias was assessed using QUADAS-2, and a meta-analysis was performed using Review Manager v5.4 software and Jamovi software v1.6.

RESULTS

A total of 60 out of 132 articles was included after fulfilling the eligibility criteria. Of these, 54 were IV studies while 6 were OCS. In the IV studies, it was seen that smaller FOV sizes tended to present higher accuracy values. The meta-analysis of the 6 OCS showed that the overall sensitivity and specificity values for 0.08 mm and 0.1 mm voxels were greater (0.84 and 0.79, respectively) than the sensitivity and specificity values for 0.125 mm and 0.2 mm voxels (0.70 and 0.55, respectively).

CONCLUSIONS

Despite the uncertain risk of bias found for the IV and OCS studies, smaller voxel and FOV sizes seem to provide more accurate VRF detection values when using CBCT.

CLINICAL RELEVANCE

This information is crucial for supporting the clinician when prescribing CBCT in cases of a clinical suspicion of VRF, and contributes to the personalization of the CBCT prescription, thereby ensuring greater accuracy in the VRF diagnosis. Registration This protocol was registered at the PROSPERO database (International Prospective Register of Systematic Review) under registration number CRD42020210118.

Diagnostic Accuracy of Caries and Periapical Lesions on a Monitor with and without DICOM-GSDF Calibration Under Different Ambient Light Conditions

To evaluate the diagnostic accuracy of caries and periapical lesions on a monitor with and without DICOM part 14: grayscale standard display function (DICOM-GSDF) calibration under different ambient light conditions. Forty digital bitewing radiographs were selected, with or without radiographic images of carious lesions and forty digital periapical radiographs with or without periapical lesions were selected from archives of the Radiology Department at the University Hospital of the Federal University of Sergipe. The gold standard radiographic images were determined through consensus between two radiologists with more than 15 and 30 years of experience. The selected radiographs were evaluated on a LG LED monitor with and without DICOM-GSDF calibration under different ambient light conditions: Lx1 (low ambient lighting), Lx2 (moderate ambient lighting) and Lx3 (high ambient lighting). Kappa (K_w) values determined that evaluator 1 showed almost perfect agreement for all devices, while evaluator 2 presented a substantial agreement for all devices. Monitors with and without DICOM-GSDF calibration have similar accuracy values. The three ambient light conditions analyzed have similar accuracy and can be used for caries lesions diagnosis (p > 0.05); however, the best diagnostic accuracy of periapical lesions was found in Lx 2. The displays with and without DICOM-GSDF calibration studied in this research have similar accuracy and can be used to evaluate digital radiographs without changing the diagnostic capacity. The different ambient lighting conditions did not influence the evaluation of caries lesions. The best diagnostic accuracy of periapical lesions was found in moderate ambient lighting.

Assessment of fractures in endodontically treated teeth restored with and without root canal posts using high-resolution cone beam computed tomography

Background

Root fractures are a diagnostic challenge for dentists in endodontic treatment. This study aimed to determine the relationship between the characteristics of tooth fractures and the presence of root canal posts in endodontically treated teeth using high-resolution cone beam computed tomography (CBCT).

Material and Methods

Fifty high-resolution CBCT scans of endodontically treated teeth with a diagnosis of fracture were obtained, of which 30 were from women and 20 were from men. These scans were acquired with three Veraviewepocs 3D units and one 3D Accuitomo 170 unit, with a 40 × 40-mm field of view and 125 μm voxel size. The variables assessed included the type of fracture, extent of fracture, type of retention, post length, cause of endodontic failure, location of the lesion, and time required to detect the fracture (difficulty score). For data analysis, the chi-squared test, Student’s t-test, and multiple linear regression (α <0.05) were used.

Results

No association was found between the type of fracture and type of retention or between the type of fracture and its extent (P>0.05). On the other hand, the type of fracture significantly influenced the time required for its detection. Additionally, the most difficult plane for detecting the fracture and the difficulty score were associated, with statistically significant results.

Conclusions

The type of fracture in endodontically treated teeth was not associated with the type of post used for restoration. All of the CBCT systems used to detect tooth fracture showed the same efficiency.

Key words:Cone-Beam CT, Tooth Fracture, Root Canal Post.

Radiographic diagnosis of root fractures: a systematic review, meta-analyses and sources of heterogeneity

OBJECTIVES

Many studies to evaluate the accuracy of root fracture diagnosis have been conducted. However, there is a scarcity of studies to assess the quality and the sources of heterogeneity in the literature. For this reason, the aim of this study was to conduct systematic reviews and meta-analyses to summarize the available evidence on detection of root fractures by cone beam CT (CBCT) and periapical radiograph (PR) images and the interference of artefact by investigating possible sources of heterogeneity.

METHODS

Studies reporting root fracture detection, from January 2010 to February 2016, were selected. All selected studies were subjected to selection criteria and then, comparative and qualitative analyses by using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool were performed. Pooled sensitivity, specificity and diagnostic odds ratios were calculated. Also, receiver operator characteristics (ROC) curves were built to summarize the results. SROC curve analyses were performed to investigate the heterogeneity among studies.

RESULTS

Initially, 799 articles were selected. After screening titles and abstracts, 743 articles were excluded. After reading the remaining 56 full-texts, 47 relevant articles were included in this study. Diagnostic odds ratio values revealed a wide range of results across the studies and determined a higher heterogeneity for PR compared with CBCT. The analyses of the SROC curves compared CBCT imaging versus PR in the diagnosis of root fracture, favouring CBCT modality.

CONCLUSIONS

CBCT was the imaging exam that rendered a higher diagnostic accuracy for root fractures.

Detection of furcation involvement using periapical radiography and 2 cone-beam computed tomography imaging protocols with and without a metallic post: An animal study

Purpose

The purpose of this study was to assess the accuracy, sensitivity, and specificity of the diagnosis of incipient furcation involvement with periapical radiography (PR) and 2 cone-beam computed tomography (CBCT) imaging protocols, and to test metal artifact interference.

Materials and Methods

Mandibular second molars in 10 macerated pig mandibles were divided into those that showed no furcation involvement and those with lesions in the furcation area. Exams using PR and 2 different CBCT imaging protocols were performed with and without a metallic post. Each image was analyzed twice by 2 observers who rated the absence or presence of furcation involvement according to a 5-point scale. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy, sensitivity, and specificity of the observations.

Results

The accuracy of the CBCT imaging protocols ranged from 67.5% to 82.5% in the images obtained with a metallic post and from 72.5% to 80% in those without a metallic post. The accuracy of PR ranged from 37.5% to 55% in the images with a metallic post and from 42.5% to 62.5% in those without a metallic post. The area under the ROC curve values for the CBCT imaging protocols ranged from 0.813 to 0.802, and for PR ranged from 0.503 to 0.448.

Conclusion

Both CBCT imaging protocols showed higher accuracy, sensitivity, and specificity than PR in the detection of incipient furcation involvement. Based on these results, CBCT may be considered a reliable tool for detecting incipient furcation involvement following a clinical periodontal exam, even in the presence of a metallic post.

Accuracy in the diagnosis of vertical root fractures, external root resorptions, and root perforations using cone-beam computed tomography with different voxel sizes of acquisition

AIM

The aim of this study is to assess the accuracy of images acquired with cone-beam computed tomography (CBCT) in the identification of three different root alterations.

MATERIALS AND METHODS

Forty human premolars were allocated to four experimental groups (n = 10): sound teeth (control), vertical root fracture (VRF), external root resorption (ERR), and root perforation (RP). After the root alterations had been produced, four teeth were randomly assembled into 10 macerated mandibles and submitted to CBCT. Images were acquired with five voxel sizes (0.125, 0.200, 0.250, 0.300, and 0.400 mm) and assessed by three experienced dental radiologists. Sensitivity, specificity, positive and negative predictive values, and the areas under the receiver operating characteristic curve (accuracy) were calculated. The accuracy of imaging in different voxel sizes was compared with Tukey exact binomial test (α=5%).

RESULTS

Accuracy with voxel sizes 0.125, 0.200, and 0.250 mm was significantly higher in the detection of ERRs and VRFs than voxel sizes 0.300 and 0.400 mm. No statistical difference was found in terms of accuracy among any of the studied voxel sizes in the identification of RPs.

CONCLUSIONS

Voxel size 0.125 mm produced images with the best resolution without increasing radiation levels to the patient when compared to voxel sizes 0.200 and 0.250 mm. Voxel sizes 0.300 and 0.400 mm should be avoided in the identification of root alterations.

Vertical root fracture: Biological effects and accuracy of diagnostic imaging methods

This review assessed the most up-to-date literature on the accuracy of detecting vertical root fractures (VRFs] using the currently available diagnostic imaging methods. In addition, an overview of the biological and clinical aspects of VRFs will also be discussed. A systematic review of the literature was initiated in December of 2015 and then updated in May of 2016. The electronic databases searched included PubMed, Emabse, Ovid, and Google Scholar. An assessment of the methodological quality was performed using a modified version of the quality assessment of diagnostic accuracy studies tool. Twenty-two studies were included in this systematic review after applying specific inclusion and exclusion criteria. Of those, 12 favored using cone beam computed tomography (CBCT) for detecting VRF as compared to periapical radiographs, whereas 5 reported no differences between the two methods. The remaining 5 studies confirmed the advantages associated with using CBCT when diagnosing VRF and described the parameters and limitations associated with this method, but they were not comparative studies. In conclusion, overwhelming evidence suggests that the use of CBCT is a preferred method for detecting VRFs. Nevertheless, additional well controlled and high quality studies are needed to produce solid evidence and guidelines to support the routine use of CBCT in the diagnosis of VRFs as a standard of care.