Accuracy of High-resolution Small-volume Cone-Beam Computed Tomography in the Diagnosis of Vertical Root Fracture: An In Vivo Analysis.

INTRODUCTION: The purpose of this in vivo study was to evaluate the accuracy of small-volume cone-beam computed tomographic (CBCT) imaging compared with conventional periapical radiography (CPR) in the diagnosis of vertical root fractures (VRFs) using exploratory surgery as the reference standard. METHODS: Eighty-two dental records of 85 teeth with suspected VRFs that underwent CPR, CBCT imaging, and exploratory surgery were included. Two observers assessed CPR and CBCT images independently for the presence or absence of root fractures, and findings from the exploratory surgery were considered the reference standard. Diagnostic sensitivity, specificity, accuracy, and the receiver operating characteristic curve values were obtained. The effect of single- and multirooted teeth on diagnostic accuracy as well as the association between clinical symptoms and the presence of VRFs were also assessed. RESULTS: VRFs were surgically detected in 64 of the 85 teeth (75.3%), of which 62.5% were multirooted and 76.6% had intracanal posts. CBCT imaging was more sensitive and accurate (65.6% and 64%) than CPR (27.3% and 40.5%). Both CPR and CBCT diagnostic accuracies were higher in single- than multirooted teeth. Pain on percussion, a localized periodontal pocket, and tooth mobility were associated with the presence of VRFs (P < .05; odds ratio = 4.15, 13.5 and 4.1, respectively). CONCLUSIONS: The accuracy of CBCT imaging for the diagnosis of VRFs was poor, although it was higher than with CPR. Multirooted teeth in the presence of intracanal posts may limit its diagnostic value.

Reliability and accuracy of linear measurements in cone-beam computed tomography using different software programs and voxel sizes.

OBJECTIVES: The aim of this study is to evaluate the accuracy of linear measurements on cone-beam computed tomography (CBCT) images using three software programs and different voxel sizes. METHODS: Ten human mandibles with 25 silica markers were scanned for 0.250-, 0.300-, and 0.400-mm voxels in the i-CAT New Generation (Imaging Sciences International, Hatfield, PA, USA). Thirty-five linear measurements were carried out by two examiners two times on the multiplanar reconstructions in the following software programs: XoranCat version 3.1.62 (Xoran Technologies, Ann Arbor, MI, USA), RadiAnt DICOM 2.2.9 Viewer (Medixant, Poznan- Poland) and InVesalius 3.0.0 (Centro de Tecnologia da Informação Renato Archer, Campinas, SP, Brazil). The physical measurements were made by another observer two times using a digital caliper on the macerated mandibles. ANOVA test was used to compare voxels and software programs. Pearson correlation and the Bland-atman tests were used to compare physical and virtual measurements and to evaluate the accuracy of the software programs, respectively (P < 0.05). RESULTS: There was no statistically significant difference when the measurements were compared in acquisitions with different voxel sizes analyzed in the three software programs. There was also no difference when the measurements were compared between the software programs and the digital caliper. Excellent intra- and inter-observer reliability for the markers, physical measurements, and multiplanar reconstructions were found. CONCLUSION: Linear measurements in the XoranCat, Radiant, and InVesalius software programs are reliable and accurate compared with physical measurements. The different acquisition protocols using different voxel sizes did not influence the accuracy of linear measurements in CBCT images.