Diagnostic value of cone beam computed tomography for recognition of oblique root fractures: An in vitro study

Abstract

Background. Diagnosis of tooth root fractures is based on radiographic examination, which is not reliable in the case of oblique root fractures. Objectives. The aim of the study was to evaluate the efficacy of cone beam computed tomography (CBCT) imaging of oblique root fractures. Material and methods. Twenty-four bovine incisors were used in the study. They were randomly divided into 2 groups: an experimental group with artificially created oblique root fractures and a control group without fractures. The teeth underwent a CBCT evaluation with a CS 9300 cone-beam scanner (Carestream, Rochester, USA) using a 5 × 5 cm field of view with the resolution up to 90 μm, and a dental radiography. The specimens were examined by 2 observers with different job experience. Results. In the CBCT scans, fracture lines were detected in 95.8% of cases (the 1st observer made a proper diagnosis in 100% of cases and the 2nd in 91.7%). Fracture lines were identified on radiographs in 33.3% of roots (the 1st observer was able to see the lines in 41.7% of cases and the 2nd in 25%). The inter-observer agreement was very high (the kappa coefficient for CBCT scans was 1.00 and 0.88 for radiographs). The best diagnostic value was recorded for contiguous slices. Conclusions. Cone beam computed tomography with a small field of view and high resolution significantly surpasses radiographs in effective imaging of oblique tooth root fractures and should be the method of choice in the diagnosis of these fractures.