Clinical Oral Investigations

, Volume 18, Issue 1, pp 285–292

Comparison of intraoral radiography and cone-beam computed tomography for the detection of horizontal root fractures: an in vitro study

  • Hakan Avsever
  • Kaan Gunduz
  • Kaan Orhan
  • İsmail Uzun
  • Bilal Ozmen
  • Erol Egrioglu
  • Muhammed Midilli
Original Article

Abstract

Objectives

This study aimed to compare the diagnostic accuracy of two different cone-beam computed tomography (CBCT) units with several intraoral radiography techniques for detecting horizontal root fractures.

Methods

The study material comprised 82 extracted human maxillary incisors without root fractures that had not undergone any root canal treatment. Root fractures were created in the horizontal plane in 31 teeth by a mechanical force using a hammer with the tooth placed on a soft foundation as described in a previous study. The teeth were divided into two groups: a control group with no fractures and a test group with fractures. These were randomized to the empty maxillary anterior sockets of a dry human maxilla. Each tooth was imaged at various vertical angles using each of the following modalities: a 3D Accuitomo 170 CBCT, a NewTom 3G CBCT, a VistaScan PSP, a CCD sensor, and conventional film. Specificity and sensitivity for assessing horizontal root fracture by each radiographic technique were calculated. Chi-square statistics were used to evaluate differences between modalities. Kappa statistics assessed the agreement between observers. Results were considered significant at P < 0.05.

Results

The kappa values for inter-observer agreement between observers ranged between 0.88 and 0.98 for the 3D Accuitomo 170, 0.82 and 0.91 for the NewTom 3G, and 0.61 and 0.72 for the different types of intraoral images. The diagnostic accuracy for detecting fracture lines in 3D Accuitomo 170 (0.93) was significantly higher than NewTom 3G (0.87), VistaScan (0.71), CCD (0.70), and CF (0.68).

Conclusions

3D Accuitomo 170 has the highest sensitivity and diagnostic accuracy for detecting horizontal root fracture among the 5 radiographic modalities examined. CBCT should be considered as the most reliable imaging modality of choice for the diagnosis of horizontal root fracture.

Clinical relevance

CBCT imaging offers the clear advantage over conventional imaging that traumatized teeth can be visualized in all three dimensions—especially the oro-facial dimension

Keywords

Cone-beam computed tomography Horizontal root fracture Diagnosis Root fractures 

References

  1. 1.
    Bornstein MM, Wölner-Hanssen AB, Sendi P, von Arx T (2009) Comparison of intraoral radiography and limited cone beam computed tomography for the assessment of root-fractured permanent teeth. Dent Traumatol 25:571–577PubMedCrossRefGoogle Scholar
  2. 2.
    Caliskan MK, Pehlivan Y (1996) Prognosis of root-fractured permanent incisors. Endod Dent Traumatol 12:129–136PubMedCrossRefGoogle Scholar
  3. 3.
    Kamburoğlu K, Ilker Cebeci AR, Gröndahl HG (2009) Effectiveness of limited cone-beam computed tomography in the detection of horizontal root fracture. Dent Traumatol 25:256–261PubMedCrossRefGoogle Scholar
  4. 4.
    Hovland EJ (1992) Horizontal root fractures. Treatment and repair. Dent Clin North Am 36:509–525PubMedGoogle Scholar
  5. 5.
    Poi WR, Manfrin TM, Holland R, Sonoda CK (2002) Repair characteristics of horizontal root fracture: a case report. Dent Traumatol 18:98–102PubMedCrossRefGoogle Scholar
  6. 6.
    Andreasen FM, Andreasen JO, Bayer T (1989) Prognosis of root fractured permanent incisors—prediction of healing modalities. Endod Dent Traumatol 5:11–22PubMedCrossRefGoogle Scholar
  7. 7.
    Cvek M, Andreasen JO, Borum MK (2001) Healing of 208 intraalveolar root-fractures in patients aged 7–17 years. Dent Traumatol 17:53–62PubMedCrossRefGoogle Scholar
  8. 8.
    Cvek M, Tsilingaridis G, Andreasen JO (2008) Survival of 534 incisors after intra-alveolar root fracture in patients aged 7–17 years. Dent Traumatol 24:379–387PubMedCrossRefGoogle Scholar
  9. 9.
    Kositbowornchai S, Nuansakul R, Sikram S, Sinahawattana S, Saengmontri S (2001) Root fracture detection: a comparison of direct digital radiography with conventional radiography. Dentomaxillofac Radiol 30:106–109PubMedCrossRefGoogle Scholar
  10. 10.
    Borelli P, Alibrandi P (1999) Unusual horizontal and vertical root fractures of maxillary molars: an 11-year follow-up. J Endod 25:136–139PubMedCrossRefGoogle Scholar
  11. 11.
    Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F et al (2007) Guidelines for the management of traumatic dental injuries. I Fractures and luxations of permanent teeth. Dent Traumatol 23:66–71PubMedCrossRefGoogle Scholar
  12. 12.
    Andreasen FM, Andreasen JO (1994) Root fractures. In: Andreasen JO, Andreasen FM (eds) Textbook and color atlas of traumatic injuries to the teeth, 3rd edn. Munsksgaard, Copenhagen, pp 279–311Google Scholar
  13. 13.
    Scarfe WC, Farman AG, Sukovic P (2006) Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc 72:75–80PubMedGoogle Scholar
  14. 14.
    Scarfe WC, Farman AG (2008) What is cone-beam CT and how does it work? Dent Clin N Am 52:707–730PubMedCrossRefGoogle Scholar
  15. 15.
    White SC, Pharoah MJ (2008) The evolution and application of dental maxillofacial imaging modalities. Dent Clin North Am 52:689–705PubMedCrossRefGoogle Scholar
  16. 16.
    Patel S, Dawood A, Whaites E, Pitt Ford T (2009) New dimensions in endodontic imaging: part 1. Conventional and alternative radiographic systems. Int Endod J 42:447–462PubMedCrossRefGoogle Scholar
  17. 17.
    Gunduz K, Avsever H, Orhan K, Çelenk P, Ozmen B et al (2013) Comparison of intraoral radiography and cone-beam computed tomography for the detection of vertical root fractures: an in vitro study. Oral Radiology 1:6–12CrossRefGoogle Scholar
  18. 18.
    Tanimoto H, Arai Y (2009) The effect of voxel size on image reconstruction in cone-beam computed tomography. Oral Radiol 25:149–153CrossRefGoogle Scholar
  19. 19.
    Wenzel A, Kirkevang LL (2005) High resolution charge-coupled device sensor vs medium resolution photostimulable phosphor plate digital receptors for detection of root fractures in vitro. Dent Traumatol 21:32–36PubMedCrossRefGoogle Scholar
  20. 20.
    Majorana A, Pasini S, Bardellini E, Keller E (2002) Clinical and epidemiological study of traumatic root fractures. Dent Traumatol 18:77–80PubMedCrossRefGoogle Scholar
  21. 21.
    Hashimoto K, Kawashima S, Kameoka S, Akiyama Y, Honjoya T, Ejima K et al (2005) High resolution charge-coupled device sensor vs. medium resolution photostimulable phosphor plate digital receptors for detection of root fractures in vitro. Dent Traumatol 21:32–36CrossRefGoogle Scholar
  22. 22.
    Kamburoğlu K, Murat S, Yüksel SP, Cebeci AR, Horasan S (2010) Detection of vertical root fracture using cone-beam computerized tomography: an in vitro assessment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:e74–e81PubMedCrossRefGoogle Scholar
  23. 23.
    Costa FF, Gaia BF, Umetsubo OS, Cavalcanti MG (2011) Detection of horizontal root fracture with small-volume cone-beam computed tomography in the presence and absence of intracanal metallic post. J Endod 37:1456–1459PubMedCrossRefGoogle Scholar
  24. 24.
    Costa FF, Gaia BF, Umetsubo OS, Pinheiro LR, Tortamano IP, Cavalcanti MG (2012) Use of large-volume cone-beam computed tomography in identification and localization of horizontal root fracture in the presence and absence of intracanal metallic post. J Endod 38:856–859. doi:10.1016/j.joen.2012.03.011 PubMedCrossRefGoogle Scholar
  25. 25.
    Scarfe WC, Levin MD, Gane D, Farman AG (2009) Use of cone beam computed tomography in endodontics. Int J Dent 634567. doi:10.1155/2009/634567
  26. 26.
    Iikubo M, Kobayashi K, Mishima A, Shimoda S, Daimaruya T, Igarashi C, Imanaka M, Yuasa M, Sakamoto M, Sasano T (2009) Accuracy of intraoral radiography, multidetector helical CT, and limited cone-beam CT for the detection of horizontal tooth root fracture. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108:e70–e74PubMedCrossRefGoogle Scholar
  27. 27.
    Al-Ekrish AA, Ekram MI, Al Faleh W, Al-Khader M, Al-Sadhan R (2012) The validity of different display monitors in the assessment of dental implant site dimensions in cone beam computed tomography images. Acta Odontol Scand. Nov 21. [Epub ahead of print]Google Scholar
  28. 28.
    Ilgüy M, Dinçer S, Ilgüy D, Bayirli G (2009) Detection of artificial occlusal caries in a phosphor imaging plate system with two types of LCD monitors versus three different films. J Digit Imaging 22:242–249PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Kutcher M, Kalathingal S, Ludlow J, Abreu M, Platin E (2006) The effect of lighting conditions on caries interpretation with a laptop computer in a clinical setting. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102:537–543PubMedCrossRefGoogle Scholar
  30. 30.
    Hellen-Halme K, Petersson A, Warfvinge G, Nilsson M (2008) Effect of ambient light and monitor brightness and contrast settings on the detection of approximal caries in digital radiographs: an in vitro study. Dentomaxillofac Radiol 37:380–384PubMedCrossRefGoogle Scholar
  31. 31.
    Lofthag-Hansen S, Thilander-Klang A, Ekestubbe A, Helmrot E, Grondahl K (2008) Calculating effective dose on a cone beam computed tomography device: 3D Accuitomo and 3D Accuitomo FPD. Dentomaxillofac Radiol 37:72–79PubMedCrossRefGoogle Scholar
  32. 32.
    Ludlow JB, Davies-Ludlow LE, Brooks SL (2003) Dosimetry of two extraoral direct digital imaging devices: NewTom cone beam CT and Orthophos Plus DS panoramic unit. Dentomaxillofac Radiol 32:229–234PubMedCrossRefGoogle Scholar
  33. 33.
    National Radiological Protection Board. Occupational, Public and Medical Exposure. Documents of the NRPB. Didcot, UK: NRPB, 1993; 4.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Hakan Avsever
    • 1
  • Kaan Gunduz
    • 2
  • Kaan Orhan
    • 3
  • İsmail Uzun
    • 4
  • Bilal Ozmen
    • 5
  • Erol Egrioglu
    • 6
  • Muhammed Midilli
    • 7
  1. 1.Department of Dentomaxillofacial RadiologyGATA, Dentistry CenterAnkaraTurkey
  2. 2.Faculty of Dentistry, Department of Dentomaxillofacial RadiologyOndokuz Mayıs UniversitySamsunTurkey
  3. 3.Faculty of Dentistry, Department of Dentomaxillofacial RadiologyNear East UniversityMersin 10Turkey
  4. 4.Faculty of Dentistry, Department of EndodonticsOndokuz Mayıs UniversitySamsunTurkey
  5. 5.Faculty of Dentistry, Department of PedodonticsOndokuz Mayıs UniversitySamsunTurkey
  6. 6.Department of StatisticsOndokuz Mayıs UniversitySamsunTurkey
  7. 7.Faculty of Dentistry, Department of Dentomaxillofacial RadiologyOndokuz Mayıs UniversitySamsunTurkey

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