Diagnostic accuracy of conventional radiography and digital radiography in detecting of root fractures (invitro study)

Root fracture is a clinical problem which often is difficult to detect and diagnose. As the root fracture detection is based on demonstration of a fracture line or lines, radiographic examination is important. The aim of this study was to compare diagnostic efficacy of direct digital radiography with conventional radiography for detecting experimental root fractures. This study was based on observational diagnostic method which eighty one extracted single rooted human teeth were endodontically instrumented and divided into two groups, a control group of 40 teeth and a fractured group of 41 teeth in which root fractures were produced with Instron machine. Each tooth was imaged using the parallel technique with a CCD-based digital system and E-speed film. The images were interpreted by three experienced oral and maxillofacial radiologists without prior knowledge of the distribution of the root fractures. Three image groups were taken: conventional film, digital images and enhanced digital images. Sensitivity, specificity, false negative and false positive percentage, accuracy of each method in comparison with golden standard (visual examination of fractured and intact teeth) were analyzed. The degree of agreement in detecting root fractures with each imaging system compared with each other was expressed as the kappa value. The sensitivity, specificity and accuracy for root fractures in conventional radiography were 73.2%, 87.5% and 80.2% respectively, in direct digital radiography were 78%, 77.5% and 77.8% respectively and in enhanced direct digital radiography were 82.9%, 85% and 84% respectively. The most sensitive was enhanced direct digital radiography and the most specific was conventional radiography. There was fair to good agreement between conventional radiography and digital radiography (k=0.68), fair to good agreement between enhanced digital radiography and conventional radiography (k=0.73) and excellent agreement between digital radiography and enhanced digital radiography (k=0.90). The diagnostic efficacy of Conventional radiography, digital radiography and enhanced digital radiography in detecting root fractures was comparable with each other.