Vasileios Kapralos1, Andreas Koutroulis2, Eleni Irinakis2, Pantelis Kouros3, Kleoniki Lyroudia2, Ioannis Pitas4, Georgios Mikrogeorgis2. 1. Department of Endodontology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Dentistry Building, Aristotle University of Thessaloniki Campus, 54124, Thessaloniki, Greece. vasilis.kapralos@gmail.com. 2. Department of Endodontology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Dentistry Building, Aristotle University of Thessaloniki Campus, 54124, Thessaloniki, Greece. 3. Department of Operative Dentistry, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece. 4. Artificial Intelligence and Information Analysis Laboratory, School of Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Abstract
OBJECTIVE: Ex-vivo evaluation of the detectability of vertical root fractures (VRFs) using digital subtraction radiography (DSR) and conventional digital periapical radiography (CDPR); investigation of the effect of root canal filling, x-ray angulation, and thickness of the VRF in the diagnostic accuracy. MATERIALS AND METHODS: Sixty root canals were mechanically prepared and radiographed either with a gutta-percha root canal filling or without, at 0o and ± 10o. VRFs were introduced with a universal testing machine. The width and angulation of the fracture line with the radiographic beam were calculated. DSR was performed comparing radiographs obtained prior to and after the VRF induction. Five examiners evaluated the resultant images and analysis was performed using receiver operator characteristic (ROC) statistics and binary logistic regression tests. RESULTS: No significant differences in sensitivity, specificity, and the areas under the ROC curves (AUC) between the CDPR and DSR were detected (p > 0.05), except for root canal filled teeth where the AUC for DSR was higher (p < 0.05). Using DSR, a VRF was 1.3 times more likely to be diagnosed [95% confidence intervals (CI): 1.045-1.59; p = 0.018]. A correct diagnosis was 2.399 times more likely to occur in non-filled teeth regardless of the radiographic technique (95% CI 1.940-2.965; p = 0). The regression coefficients were positive for width and negative for angle. CONCLUSIONS: DSR showed a better diagnostic accuracy of VRFs compared with CDPR, in single root canal filled teeth. The angulation, the width, and the presence of a root canal filling affected the diagnostic potential. CLINICAL RELEVANCE: DSR is a cost- and time-effective imaging technique that could contribute in early diagnosis of VRFs.
OBJECTIVE: Ex-vivo evaluation of the detectability of vertical root fractures (VRFs) using digital subtraction radiography (DSR) and conventional digital periapical radiography (CDPR); investigation of the effect of root canal filling, x-ray angulation, and thickness of the VRF in the diagnostic accuracy. MATERIALS AND METHODS: Sixty root canals were mechanically prepared and radiographed either with a gutta-percha root canal filling or without, at 0o and ± 10o. VRFs were introduced with a universal testing machine. The width and angulation of the fracture line with the radiographic beam were calculated. DSR was performed comparing radiographs obtained prior to and after the VRF induction. Five examiners evaluated the resultant images and analysis was performed using receiver operator characteristic (ROC) statistics and binary logistic regression tests. RESULTS: No significant differences in sensitivity, specificity, and the areas under the ROC curves (AUC) between the CDPR and DSR were detected (p > 0.05), except for root canal filled teeth where the AUC for DSR was higher (p < 0.05). Using DSR, a VRF was 1.3 times more likely to be diagnosed [95% confidence intervals (CI): 1.045-1.59; p = 0.018]. A correct diagnosis was 2.399 times more likely to occur in non-filled teeth regardless of the radiographic technique (95% CI 1.940-2.965; p = 0). The regression coefficients were positive for width and negative for angle. CONCLUSIONS:DSR showed a better diagnostic accuracy of VRFs compared with CDPR, in single root canal filled teeth. The angulation, the width, and the presence of a root canal filling affected the diagnostic potential. CLINICAL RELEVANCE: DSR is a cost- and time-effective imaging technique that could contribute in early diagnosis of VRFs.
Entities:
Keywords:
Dental digital radiography; Diagnostic imaging; Digital subtraction radiography; Endodontics; Vertical root fracture