Imaging characteristics of enamel pearls on CBCT and their co-relation with supernumerary tooth.

OBJECTIVES: Enamel pearl (EP) is an ectopic growth of enamel that is generally round and white and it firmly adheres to the external root surface of tooth. The aim of this study was to assess the prevalence and imaging features of enamel pearls (EPs) and to investigate the potential relationship between EP and supernumerary tooth. METHODS: Cone beam computed tomography (CBCT) images of 1003 patients were evaluated for the presence of EP. Descriptive characteristics of gender and age of patients and imaging features of EPs and presence of supernumerary tooth were recorded. RESULTS: In this study, 72 EPs were radiographically detected in 63 molars in 43 patients, with a person prevalence of 4.29% and tooth prevalence of 0.71%. Most of the EPs (95.83%) were detected in maxillary molars especially in third (n = 42, 58.33%) and second molars (n = 18, 25%). They were more frequently located at mesial (n: = 21; 29.16%); distal (n = 16; 22.22%) proximal surface of roots and the furcation between the disto-buccal and the palatal roots (n = 12; 16.67%) respectively. CBCT images of 109 (10.87%) patients showed supernumerary tooth/teeth and 13 of these also presented EP. A statistical significant relationship between supernumerary tooth and EP was found (p = 0.001). Additionally, CBCT images of four EPs showed corticated hypodens tracts similar to gubernaculum dentis (GD). CONCLUSIONS: Clinicians and radiologists should be aware that EPs are most frequently observed in maxilla especially in third and second molars. Presence of supernumerary tooth might be associated with higher presence of EPs.

Effect of Amalgam Restorations and Operation Parameters on Diagnostic Accuracy of Caries Detection Using Cone Beam Computed Tomography: An In Vitro Study.

This study was aimed to evaluate the diagnostic accuracy of cone beam computed tomography (CBCT) in detecting noncavitated approximal caries at different exposure parameters and to assess the impact of artifacts generated by amalgam restorations in an in vitro study. Seventy-eight approximal surfaces of extracted teeth were prepared with intentionally created noncavitated approximal caries of different depths; then, thirteen teeth with class 2 amalgam restorations were replaced with one tooth with normal surfaces in each block. CBCT volumes for all teeth were acquired using a Planmeca Promax 3D Mid imaging unit before and after placement of amalgam teeth, with different exposure parameters at low and high definition, both applying and omitting the Metal Artifact Reduction algorithm. The lesions were classified into four groups with regard to lesion extension. All teeth underwent histological analysis as gold standard. The histological examination showed that the distribution of lesions was as follows: 39.8% sound, enamel lesions of less and more than half the enamel thickness each 17.8%, and 24.6% dentin lesions. The detection sensitivity was found to be 0.972%, and specificity was found to be 0.937% for the detection of noncavitated approximal initial enamel and dentin caries. The highest diagnostic accuracy was found when using operating parameters of 90 kVp, 8 mA, and high resolution (75 µm) with nonamalgam teeth; all modes showed statistically significant higher AUCs than mode 2 (80 kVp, 7 mA, and 75 µm). However, for teeth with amalgam restorations, the highest accuracy was obtained at low resolution (200 µm) with the other parameters kept the same. It could be concluded that increasing the peak voltage and current improves diagnostic accuracy for the detection of noncavitated approximal caries. Moreover, diagnostic accuracy was found to be higher upon using high spatial resolution when diagnosing caries without adjacent amalgam restorations. There is a statistically significant difference with and without amalgam with respect to all modes.

Evaluation of healing at molar extraction sites with ridge preservation using a non-resorbable dense polytetrafluoroethylene membrane: A four-arm cohort prospective study.

OBJECTIVES: To examine ridge dimensional changes and histologic parameters of healing when ridge preservation (RP) was performed at molar sites using dense polytetrafluoroethylene (dPTFE) membrane alone, without a bone graft. MATERIAL AND METHODS: Eighteen patients had molar extraction and RP using dPTFE membrane alone. Ridge dimensions were measured using two standardized cone beam computerized tomography (CBCT) scans taken within 72 h and 3 months following extraction. Following a 3-month healing period, an implant osteotomy was prepared using a trephine drill and bone cores were collected for histological analysis. Four-arm analyses were performed using data from three previously published study arms of the same research group. RESULTS: There was a significant change in the buccal ridge height between the four groups at all aspects of the socket. Alveolar ridge width reduction at 3 mm from crest for all aspects (mesial, midpoint, distal) of the socket showed statistically significant difference for dPTFE alone group compared to the other three groups. Percentage of vital bone formation (62.10%) was significantly greater in dPTFE alone group compared to the other groups. CONCLUSIONS: RP using dPTFE membrane alone in molar sites with intact socket walls showed successful outcomes in maintaining ridge dimensions and in histologic wound healing.

Accuracy of dental calculus detection using digital radiography and image manipulation.

BACKGROUND: The aim of this study was to determine if image enhancement improves a clinician's ability to identify the presence of calculus on digital radiographs. METHODS: Seventy-one hopeless teeth were collected from 34 patients. Teeth were stained with 1% methylene blue, the largest interproximal calculus deposit was scored, and photographs of each interproximal root surface were taken. The surface area of calculus deposit was determined as a percentage of the total interproximal root surface area. Digital radiographs of teeth taken before extraction were modified using the following enhancements: auto-contrast, emboss, invert, and sharpen. Radiographic presence of calculus was determined by two examiners. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each examiner and enhancement. A receiver operating characteristic curve was used to compare differences between the image enhancements in the detection of dental calculus. The kappa statistic was used to compare ratings between examiners. RESULTS: None of the enhanced images were statistically superior to original images in identifying radiographic calculus (P > 0.05). The average sensitivity of digital radiography was 50%, average specificity was 82.2%, PPV was 94%, and NPV 23.2%. A threshold of >30% of interproximal root surface covered with calculus and increasing size of deposits were associated with improved detection (P < 0.05). CONCLUSIONS: Digital enhancements do not significantly improve radiographic detection of dental calculus. As area of calculus on the root surface and size of calculus deposits increased, sensitivity of detection also increased.

A Volumetric Assessment of External Cervical Resorption Cases and Its Correlation to Classification, Treatment Planning, and Expected Prognosis.

INTRODUCTION: External cervical resorption (ECR) is a relatively uncommon type of external resorption; its treatment planning and prognosis are largely dependent on the clinician's subjective assessment. This study aimed to provide a volumetric assessment of ECR cases while correlating them to the Heithersay classification, treatment decision, and prognosis determined by 3 calibrated, independent evaluators. METHODS: A total of 168 ECR cases with corresponding periapical radiographs and cone-beam computed tomographic (CBCT) imaging were included in this study. An oral and maxillofacial radiologist calculated the volume occupied by the resorptive defects in root structures on CBCT imaging using Amira software (Thermo Scientific, Waltham, MA). Also, 3 board-certified endodontists evaluated anonymized and randomized periapical radiographs and corresponding CBCT images in separate sessions. Examiners were asked to provide a Heithersay classification, whether they would surgically repair the ECR lesion, and the expected prognosis of each case. RESULTS: The percentage of radicular volume affected by ECR ranged from 0.5%-58% with a median of 12%. The volumetric quantification of ECR best correlated with classification and prognosis assigned by the independent examiners using CBCT evaluation. The greatest variation in agreement was observed on whether to surgically repair the ECR. However, examiners agreed more uniformly on not to treat when the resorptive port of entry was found on either the lingual or proximal surfaces of the tooth. CONCLUSIONS: For the first time, the volumetric quantification of resorptive defects was calculated in vivo and correlated to the Heithersay classification and prognosis. Because the longevity of teeth affected with ECR depends on the integrity of the remaining root, the findings of this study provide important information to help clinicians decide on treatment planning and inform their patients of the expected prognosis. Future studies should focus on automating volumetric assessments of ECR to aid in unbiased chairside treatment planning decisions.

Comparison of photothermal radiometry and modulated luminescence, intraoral radiography, and cone beam computed tomography for detection of natural caries under restorations.

OBJECTIVES: The aim of this ex vivo study was to measure the sensitivity, specificity, and receiver operating characteristic (ROC) area under the curve (AUC) of a caries diagnostic system based on photothermal radiometry and modulated luminescence (PTR/LUM) and compare them with the values for digital intraoral radiography (IR) and cone beam computed tomography (CBCT) in detecting recurrent decay. STUDY DESIGN: Class 2 composite restorations were prepared on 70 proximal surfaces: 35 with caries and 35 without caries. The gingival floor of the restored surfaces was assessed for caries under the restorations using each of the 3 modalities. Statistical calculations and analysis were performed using the R statistical computing environment. RESULTS: The average scores for sensitivity among the 6 observers were 0.89 for PTR/LUM, 0.38 for IR, and 0.40 for CBCT. Sensitivity for PTR/LUM was significantly greater than sensitivity for IR and CBCT. Average scores for specificity were 0.83, 0.80, and 0.70 for PTR/LUM, IR, and CBCT, respectively. CBCT had significantly lower specificity. The AUC was 0.65 for IR and 0.59 for CBCT, which were significantly different. PTR/LUM had moderate intraobserver agreement. CONCLUSIONS: PTR/LUM, which involves non-ionizing radiation, can serve as a sensitive adjunct in early caries detection and monitoring.

Assessment of signal-to-noise ratio and contrast-to-noise ratio in 3 T magnetic resonance imaging in the presence of zirconium, titanium, and titanium-zirconium alloy implants.

OBJECTIVE: We quantitatively compared the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in T1 weighted imaging (WI) and T2 WI sequences in 3 Tesla (T) magnetic resonance imaging (MRI) using zirconium, titanium (grades 4 and 5), and titanium-zirconium alloy implants to evaluate the effect of implant type and imaging sequence. STUDY DESIGN: MRI was acquired using a 3 T magnet with a 16-channel head coil. Implants of each type were mounted in gel and scanned in axial, coronal, and sagittal planes using fast spin echo sequences in T1 WI (TR = 600, TE = 12 milliseconds) and T2 WI (TR = 3000, TE = 80 milliseconds) sequences. Data were transferred to Synapse 3-D software, and images were measured twice by an oral and maxillofacial radiologist blinded to the type of implants. RESULTS: Zirconium implants resulted in the lowest SNR and CNR values (P < .05). No significant differences were identified between titanium (grades 4 and 5) and titanium-zirconium implants. The T2 WI sequence had a significantly higher SNR and CNR than T1 WI. There was no difference in intraobserver agreement between T1 WI and T2 WI. CONCLUSIONS: CNR and SNR at 3 T MRI are dependent on implant type and imaging sequence. Titanium (grades 4 and 5) and titanium-zirconium implants and the T2 WI sequence produced higher SNR and CNR values.

Effect of Image Resolution and Compression on Fractal Analysis of the Periapical Bone.

INTRODUCTION: Fractal dimension (FD) on periapical radiographs is used as a simple descriptor of the complex architecture of the trabecular bone surrounding the dentition. It is used on periapical and panoramic radiographs as a descriptor of the complex architecture of trabecular bone surrounding teeth. AIM: The aim of this study was to evaluate the effect of image resolution and different compression levels on fractal dimension of alveolar bone with images obtained using storage phosphor plate (SPP) system. METHODS: Periapical images of premolar and molar teeth on both sides of three dry human mandibles were obtained with Digora Optime (Soredex Corp., Helsinki, Finland) SPP system. The SPPs were exposed equally and scanned immediately after exposure with standard, high and very high resolutions. All the images then were compressed and saved by degrees of 0%, 25%, 50%, 75% and 90%. FD was calculated using public domain software (ImageJ with FracLac plug-in) on two non-overlapping regions of interest (ROIs) on premolar and molar periapical bone areas of each radiograph using differential box-counting method. The ROIs on corresponding images were of the same size and position. FDs were compared using two-way ANOVA and Tukey-Kramer multiple comparison tests (p=0.05). RESULTS: There was no significant difference in FD calculations in different levels of compression for all the resolutions. Images obtained with high resolution scans showed significantly lower variation in FD values compared to very high and standard resolutions for all compressions (p<0.0001). CONCLUSION: The high resolution demonstrated the lowest variation in FD values in all levels of compression which makes it the most reliable and consistent resolution for measuring the FD values. The level of compression does not make a significant difference in FD values for all the scan resolutions. Scanning resolution of SPPs should be carefully chosen when evaluating the change in FD of alveolar bone for various bone disorders.

Influence of Cone Beam Computed Tomography Settings on Implant Artifact Production: Zirconia and Titanium.

PURPOSE: This in vitro study assessed the artifact production related to titanium and zirconia implants in cone beam computed tomography (CBCT) and compared the effect of different protocol settings on image quality for both materials. MATERIALS AND METHODS: A titanium implant and a zirconia implant were placed in a dry mandible. CBCT scans were obtained separately for each implant using the ProMax 3D (Planmeca) unit; 20 protocols were tested with varying kilovoltage (70 to 90 kVp) and resolution (high and low), and with and without a metal artifact reduction tool. Standard deviation and contrast-noise ratio were calculated in regions of interest adjacent and distant to the implant. RESULTS: The zirconia produced more artifacts and its images were more affected by the different protocols than titanium. High kVps and an activated metal artifact reduction tool decreased the standard deviation values related to both implants. Activation of the metal artifact reduction tool also increased contrast-noise ratio values for both implants, whereas increasing kVp improved them only on titanium images. The standard deviation and contrast-noise ratio were not affected by resolution. CONCLUSION: The zirconia implant generated more image artifacts than the titanium implant. Increasing kVp and the metal artifact reduction tool are efficient in decreasing the CBCT artifacts for both implants, whereas resolution does not affect their production.

Healing at Molar Extraction Sites Using Freeze-Dried Bone Allograft and Collagen Wound Dressing: Case Series and Three-Arm Analyses.

PURPOSE: Ridge preservation limits dimensional changes after tooth extraction. However, it is still unclear if using a membrane may be advantageous over a collagen wound dressing. Therefore, the goal of this report was to evaluate the outcomes of ridge preservation using freeze-dried bone allograft with a collagen wound dressing. MATERIALS AND METHODS: This study included 21 patients who had one molar extracted, and the site received ridge preservation using freeze-dried bone allograft and a collagen wound dressing (test 2 group). Patients had two standardized cone beam computed tomography (CBCT) scans, taken within 72 hours and 3 months after extraction, to measure changes in ridge height and width, and buccal and lingual plate thicknesses. Changes in keratinized tissue width were recorded. Three-arm analyses were performed using historic data from a previous randomized controlled trial by the same study group, in which 20 molar sites received a collagen wound dressing alone (control) and 20 received ridge preservation with freeze-dried bone allograft and a dense polytetrafluoroethylene membrane (test 1) using the same methodology. RESULTS: There was a statistically significant difference in mean buccal ridge height changes between the control group (2.6 ± 2.06 mm) and test 2 group (1.55 ± 0.93 mm) but no difference in ridge and keratinized tissue width changes between groups. No correlation was found between buccal plate thickness and ridge width change. CONCLUSION: Freeze-dried bone allograft with collagen wound dressing as a barrier was used successfully for ridge preservation in intact molar extraction sites (< 50% bone loss) and can be considered as a treatment alternative to freeze-dried bone allograft with a dense polytetrafluoroethylene membrane.

Estimation of contrast-to-noise ratio in CT and CBCT images with varying scan settings in presence of different implant materials.

OBJECTIVES: To assess the contrast-to-noise ratio (CNR) of four different types of dental implant materials in CT and cone beam CT (CBCT) images with varying scan settings. METHODS: Four different types of implants: zirconium (Zr), titanium (Ti) Grade 4 and 5 and titanium-zirconium (Ti-ZrO2) alloy were placed in a 3% gelatin phantom in a cylindrical plastic container and scanned with two different CT machines (GE Medical systems and Toshiba Medical Systems) and one CBCT machine (I-CAT, Imaging Sciences International) with different voxel sizes of 0.2, 0.25, 0.3 and 0.4 mm. Images were analyzed using ImageJ software with the purpose of estimating the CNR. RESULTS: The CNR obtained from images acquired with CT was lower than the CBCT with all voxel sizes tested. 0.3 and 0.4 mm voxel sizes exhibited the highest CNR (p < 0.05) that gives the best image quality. Among the implant materials tested, titanium Grade 5 has the highest levels of CNR while Zirconium has the lowest (p < 0.05). CONCLUSIONS: The optimum protocol for radiographic follow-up in areas near implants on the I-CAT is low-resolution settings (0.3 and 0.4 mm voxel sizes) which gave the highest CNR thus image quality. In presence of Zr implants, an alternative imaging modality (i.e., MRI) may be considered to avoid low-quality images.

Evaluation of artifacts generated by titanium, zirconium, and titanium-zirconium alloy dental implants on MRI, CT, and CBCT images: A phantom study.

OBJECTIVE: The aim of this study was to assess artifacts generated by zirconium, titanium, and titanium-zirconium alloy implants on magnetic resonance imaging(MRI), computed tomography(CT), and cone beam computed tomography(CBCT) and to correlate the findings to the dose-area product and exposure factors on CT and CBCT. STUDY DESIGN: Three phantoms were built by embedding zirconium, titanium, and titanium-zirconium implants in ultrasound gel. MRI, CT, and CBCT images were acquired by using multiple sequences and settings. For MRI, "artifact" was described as the length of signal void beyond the limits of the implant. For CT and CBCT, "artifact" was calculated by subtracting the gray level of the darkest pixel from the level of the lightest pixel. RESULTS: On MRI, zirconium implants had minor distortion artifacts, whereas titanium and titanium-zirconium implants created extensive artifacts (P < .05). On CT and CBCT, artifacts were less prominent with titanium and titanium-zirconium implants compared with zirconium (P < .05). Titanium grade 5 implants with 0.3 and 0.4 mm3 voxels produced the least severe artifacts. CONCLUSIONS: MRI images were less affected by artifacts from zirconium implants, whereas CT and CBCT images showed less severe artifacts from titanium and titanium-zirconium alloy implants. CT generated greater artifacts compared with CBCT. Larger CBCT voxel sizes reduced the dose-area product and the severity of artifacts.

Diagnosis of vertical root fracture in teeth close and distant to implant: an in vitro study to assess the influence of artifacts produced in cone beam computed tomography.

OBJECTIVES: To evaluate the influence of artifacts produced by zirconium implant on the diagnosis of vertical root fracture (VRF) in teeth close and distant to the implant in cone beam computed tomography (CBCT) images. We also determined if kilovoltage (kVp) and metal artifact reduction (MAR) tool could influence this diagnosis. MATERIALS AND METHODS: Twenty single-root teeth were divided in control and fractured groups (n = 10). The teeth were randomly positioned in the first and second and right and left pre-molar alveoli of a dry human mandible. CBCT exams were acquired using a ProMax 3D unit with varying kVp (70, 80, or 90 kVp), with or without MAR, and with and without a zirconium implant placed in the alveolus of first right molar. The images were evaluated by five observers. The area under the receiver operating characteristic curve (ROC), sensitivity, and specificity were calculated and compared by analysis of variance with a significance level of 5%. RESULTS: In general, ROC and sensitivity were not affected by the factors studied (p > 0.05). The main effects occurred in specificity; when implant was used without MAR, the values were lower for tooth 45 for all kVps (p = 0.0001). CONCLUSIONS: Artifacts produced in the vicinity of teeth with suspected VRF impair the diagnosis by decreasing the specificity, because they can mimic the VRF line generating false positives. However, MAR improves the specificity, being its use recommended when metallic objects are present near teeth with suspected VRF. CLINICAL RELEVANCE: Since nowadays, many patients who undergo CBCT show implants and they definitively produce artifacts, it is important to evaluate the influence of such artifacts in the diagnosis of teeth that are close to the generator-artifact object.

Influence of acquisition parameters on the magnitude of cone beam computed tomography artifacts.

AIM: To evaluate the influence of kilovoltage (kVp) and metal artifact reduction tool (MAR) on the magnitude of cone beam CT (CBCT) artifacts. METHODS: A titanium and zirconia implants were inserted alternately in a posterior region of a mandible. CBCT exams were acquired with ProMax 3D (Planmeca Oy, Helsinki, Finland) and Picasso Trio machines (Vatech, Hwaseong, South Korea) using 70 kVp, 80 kVp and 90 kVp with and without MAR activation. The other exposure factors remained fixed at 5mA, field of view 80 × 50 mm and voxel 0.20 mm. The scans were performed before and after the insertion of the implants. Regions of interest were determined in different distances from the artifact production area (15, 25 and 35 mm) in an axial image, in which standard deviation (SD) of grayscale values was measured and contrast-to-noise ratio (CNR) was calculated. Analysis of variance was used to compare the data. RESULTS: Overall, in cases where the artifact was pronounced, MAR was efficient in reducing SD values. MAR also improved the CNR of ProMax images, but did not affect the Picasso images. Additionally, the higher was the kVp, the lower was the SD value and the higher was the CNR in both machines. CONCLUSION: In both machines, increasing kVp and MAR are effective in decreasing the CBCT artifacts in all their magnitude when they are pronounced. Therefore, the professionals should choose one of those options or even both considering the purpose of the CBCT imaging and radiation dose for the patient.

Magnitude of cone beam CT image artifacts related to zirconium and titanium implants: impact on image quality.

OBJECTIVES: To evaluate the magnitude of artifacts related to titanium and zirconium implants at different distances and angulations and their impact on cone beam CT(CBCT) image quality. METHODS: CBCT images were obtained before and after the insertion of titanium and zirconium implants in a mandible on different CBCT units: Picasso Trio, ProMax 3D and 3D Accuitomo 80. Artifact was assessed by measuring the standard deviation (SD) of gray values and contrast-to-noise ratio (CNR) of 11 regions of interest (ROIs) at different distances (1.5 cm, 2.5 cm and 3.5 cm) and angulations (65°, 90°, 115° and 140°) from implant region. RESULTS: For titanium images, SD values did not differ from those of images without implant in all ROIs; however, some effect occurred in Picasso images as higher values were observed in ROIs closer to the implant (p < 0.05). Zirconium images showed higher SD values than the others in some ROIs for Picasso and ProMax (p < 0.05). In ProMax, the difference was observed even in the farthest ROIs from the implant. CNR values were not influenced by the ROI in Picasso, but presented lower values in ROIs closer to the zirconium implant for ProMax and Accuitomo. CONCLUSIONS: The quantity and magnitude of artifacts in CBCT are influenced by the type of implant and CBCT unit. Although they are more pronounced in regions closer to the implant and located at 90° in relation to the mandibular long axis, they can reach as far as 3.5 cm from the artifact-generator object.

Correlation between the visibility of submandibular fossa and mandibular canal cortication on panoramic radiographs and submandibular fossa depth on CBCT

Background: To identify a correlation between the submandibular fossa (SF) visibility and mandibular canal (MC) cortication on panoramic image and the depth of SF measured on CBCT and also correlation between the depth of SF and vertical and horizontal location of MC on CBCT. Material and Methods: 500 CBCT scans and panoramic radiographs were evaluated. SF depth types were classified as type I (< 2mm); type II (2-3mm) and type III (> 3mm) on CBCT. Visibility of SF and the cortication of MC on panoramic radiographs were compared with the depth of SF on CBCT. Distances between MC and mandibular inferior, buccal and lingual cortices were measured. Results: No statistically significant correlation was found between radiolucent appearances of SF, cortication of MC, and depth of SF. The deepest part of the fossa was in the second molar area followed by third and first molars. Negative weak correlations were found between B-MC, L-MC distances and depth of SF. Conclusions: Visibility of SF and cortication of MC on panoramic radiographs did not correlate with the depth of SF. A marked radiolucent submandibular fossa on panoramic image does not undoubtedly indicate a deep fossa, which emphasizes the importance of 3-D imaging in implant planning (AU)

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Thickness of the Buccal Plate in Posterior Teeth: A Prospective Cone Beam Computed Tomography Study.

Buccal plate thickness is an important clinical parameter for postextraction implant treatment planning. The purpose of this study was to assess buccal plate thickness of the posterior maxilla and mandible using cone beam computed tomography (CBCT). A total of 265 patients and 934 teeth met the inclusion criteria for this study. CBCT volumes were taken and aligned for measurement at the ideal midsagittal cross-section. Buccal plate thickness was measured at 1, 3, and 5 mm apical to the alveolar crest. The frequency of thick (≥ 1 mm), thin (< 1 mm), and radiographic absence of the buccal plate were determined. The frequency of thin buccal plate decreases from anterior to posterior, with first premolars and first molar mesial roots most affected. Radiographic absence of the buccal plate was more common in the mandible, at first premolars, and among women. Thin and absent buccal plate are not uncommon in the posterior jaws; consequently, ridge preservation may be indicated even at posterior teeth.

The Effects of Imaging Enhancement Tools in the Detection of Horizontal Root Fractures.

INTRODUCTION: Detection of root fracture is challenging both clinically and radiographically. Root fractures occur in different planes with unpredictable presentations. AIM: The aim of the study was to evaluate the diagnostic accuracy of selected digital image enhancement tools in the detection of horizontal Root Fracture (RF). MATERIALS AND METHODS: Fifty three roots, of single and multi-rooted teeth, in eight dentate human cadaver mandibles were selected for this study. Following minimally traumatic extraction of the teeth, horizontal fractures were induced in 23 roots and remounted in the empty sockets of their respective human dry mandibles. The remaining teeth with no fractures were used as the control group. Twenty two periapical radiographs were obtained by using the paralleling technique and using Complementary Metal Oxide Semiconductor (CMOS). Image J software was used to enhance the original images with the Inversion (IN), Histogram-Equalization (EQ) and Polynomial (Poly) tools. A total of 88 periapical images (original and three enhanced images) were reviewed independently by three Oral and Maxillofacial Radiologists and two Endodontists. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the accuracy of fracture detection and the kappa statistic was used to assess agreement among reviewers. RESULTS: The diagnostic accuracy for one of the observers was significantly different in detection of RF with only EQ enhancement tool. Sensitivity and specificity were not significantly different. Interobserver agreement showed no significant difference between imaging methods. Intra-observer agreement was high to moderate. CONCLUSION: There was no significant difference between the different imaging modalities. No statistical difference for the agreement was found among or between the endodontists and radiologists in this study.