Evaluation of CBCT Accuracy in the Diagnosis of Horizontal Root Fractures in the Presence and Absence of Intracanal Metallic Post: An In Vitro Study

Most dental traumas occur in the maxillary anterior region, and the related complications can be observed as root and crown fractures or luxation injuries. Root fracture indicates cementum, dentin, and pulp fractures that may be extended longitudinally or horizontally across the tooth root. This study aimed to investigate the accuracy of two different voxel sizes in cone beam computed tomography (CBCT) and the effect of filtration and artifact reductionalgorithm (AR) in the diagnosis of horizontal root fracture (HRF) in the presence and absence of intracanal metallic post (IMP).

Artificial HRF was created randomly in 15 endodontically treated teeth at mid-root and coronal areas. Moreover, 15 intact teeth served as the control group. The cast posts were made for 30 teeth before fracture. The teeth were inserted in artificial casts for imaging and the images were prepared by CBCT system in 0.075 mm and 0.15 mm voxel sizes and were subjected to filtration and AR systems. An experienced radiologist analyzed the radiographic images. The sensitivity, specificity, and accuracy of the HRF diagnosis condition were calculated.

Sensitivity values ranged from 46.7% in 0.15 mm voxel size in the presence of IMP to 100% in 0.075 mm voxel size in the absence of IMP. The specificity rate for all the studied techniques was 100%. The most negative effect of IMP was observed in the diagnosis of one-third of the coronal root and cervical area fractures.

The highest sensitivity and accuracy (100%) in the Promax 3DMax system was observed in 0.075mm voxel size in the absence of IMP. This result was in line with the results obtained with real samples. Filtration and AR systems were ineffective in the diagnose the HRF.