Diagnosis of vertical root fracture in teeth close and distant to implant: an in vitro study to assess the influence of artifacts produced in cone beam computed tomography
To evaluate the influence of artifacts produced by zirconium implant on the diagnosis of vertical root fracture (VRF) in teeth close and distant to the implant in cone beam computed tomography (CBCT) images. We also determined if kilovoltage (kVp) and metal artifact reduction (MAR) tool could influence this diagnosis.
Materials and methods
Twenty single-root teeth were divided in control and fractured groups (n = 10). The teeth were randomly positioned in the first and second and right and left pre-molar alveoli of a dry human mandible. CBCT exams were acquired using a ProMax 3D unit with varying kVp (70, 80, or 90 kVp), with or without MAR, and with and without a zirconium implant placed in the alveolus of first right molar. The images were evaluated by five observers. The area under the receiver operating characteristic curve (ROC), sensitivity, and specificity were calculated and compared by analysis of variance with a significance level of 5%.
In general, ROC and sensitivity were not affected by the factors studied (p > 0.05). The main effects occurred in specificity; when implant was used without MAR, the values were lower for tooth 45 for all kVps (p = 0.0001).
Artifacts produced in the vicinity of teeth with suspected VRF impair the diagnosis by decreasing the specificity, because they can mimic the VRF line generating false positives. However, MAR improves the specificity, being its use recommended when metallic objects are present near teeth with suspected VRF.
Since nowadays, many patients who undergo CBCT show implants and they definitively produce artifacts, it is important to evaluate the influence of such artifacts in the diagnosis of teeth that are close to the generator-artifact object.
KeywordsVertical root fracture Cone beam computed tomography Artifact Kilovoltage Artifact reduction tool
The authors would like to thank the evaluators.
The work was supported by CAPES (Coordenação do Aperfeiçoamento de Pessoal de Nível Superior—Brazil, process number 88881.118874/2016–01) and the Division of Oral and Maxillofacial Radiology, University of Texas Health Science Center at San Antonio, USA.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Research Ethics Committee of the Piracicaba Dental School, UNICAMP (#2.163.038) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study, formal consent is not required.
- 1.Ferreira LM, Visconti MA, Nascimento HA, Dallemolle RR, Ambrosano GM, Freitas DQ (2015) Influence of CBCT enhancement filters on diagnosis of vertical root fractures: a simulation study in endodontically treated teeth with and without intracanal posts. Dentomaxillofac Radiol 44(5):20140352. https://doi.org/10.1259/dmfr.20140352 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Bechara B, Alex McMahan C, Moore WS, Noujeim M, Teixeira FB, Geha H (2013) Cone beam CT scans with and without artefact reduction in root fracture detection of endodontically treated teeth. Dentomaxillofac Radiol 42(5):20120245. https://doi.org/10.1259/dmfr.20120245 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Neves FS, Freitas DQ, Campos PS, Ekestubbe A, Lofthag-Hansen S (2014) Evaluation of cone-beam computed tomography in the diagnosis of vertical root fractures: the influence of imaging modes and root canal materials. J Endod 40(10):1530–1536. https://doi.org/10.1016/j.joen.2014.06.012 CrossRefPubMedGoogle Scholar
- 10.Bezerra IS, Neves FS, Vasconcelos TV, Ambrosano GM, Freitas DQ (2015) Influence of the artefact reduction algorithm of Picasso Trio CBCT system on the diagnosis of vertical root fractures in teeth with metal posts. Dentomaxillofac Radiol 44(6):20140428. https://doi.org/10.1259/dmfr.20140428 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Gaêta-Araujo H, Silva de Souza GQ, Freitas DQ, de Oliveira-Santos C (2017) Optimization of tube current in cone-beam computed tomography for the detection of vertical root fractures with different intracanal materials. J Endod 43(10):1668–1673. https://doi.org/10.1016/j.joen.2017.04.003 CrossRefPubMedGoogle Scholar
- 12.Pinto MGO, Rabelo KA, Sousa Melo SL, Campos PSF, Oliveira LSAF, Bento PM, Melo DP (2017) Influence of exposure parameters on the detection of simulated root fractures in the presence of various intracanal materials. Int Endod J 50(6):586–594. https://doi.org/10.1111/iej.12655 CrossRefPubMedGoogle Scholar
- 15.Pauwels R, Stamatakis H, Bosmans H, Bogaerts R, Jacobs R, Horner K, Tsiklakis K, SEDENTEXCT Project Consortium (2013) Quantification of metal artifacts on cone beam computed tomography images. Clin Oral Implants Res 24(Suppl A100):94–99. https://doi.org/10.1111/j.1600-0501.2011.02382.x CrossRefPubMedGoogle Scholar
- 18.Smeets R, Schöllchen M, Gauer T, Aarabi G, Assaf AT, Rendenbach C, Beck-Broichsitter B, Semmusch J, Sedlacik J, Heiland M, Fiehler J, Siemonsen S (2017) Artefacts in multimodal imaging of titanium, zirconium and binary titanium-zirconium alloy dental implants: an in vitro study. Dentomaxillofac Radiol 46(2):20160267. https://doi.org/10.1259/dmfr.20160267 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.SEDENTEXCT Project (2012) Radiation protection: cone beam CT for dental and maxillofacial radiology. Evidence based guidelines. European Commission, Geneva http://www.sedentexcteu/guidelines. Acessed 12 March 2018 Google Scholar
- 26.Uzun I, Gunduz K, Celenk P, Avsever H, Orhan K, Canitezer G, Ozmen B, Cicek E, Egrioglu E (2015) Comparing the effect of different voxel resolutions for assessment of vertical root fracture of permanent teeth. Iran J Radiol 12(3):e18290. https://doi.org/10.5812/iranjradiol.18290. PubMedPubMedCentralGoogle Scholar
- 27.Bragatto FP, Iwaki Filho L, Kasuya AV, Chicarelli M, Queiroz AF, Takeshita WM, Iwaki LC (2016) Accuracy in the diagnosis of vertical root fractures, external root resorptions, and root perforations using cone-beam computed tomography with different voxel sizes of acquisition. J Conserv Dent 19(6):573–577CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Queiroz PM, Groppo FC, Oliveira ML, Haiter-Neto F, Freitas DQ (2017) Evaluation of the efficacy of a metal artifact reduction algorithm in different cone beam computed tomography scanning parameters. Oral Surg Oral Med Oral Pathol Oral Radiol 123(6):729–734. https://doi.org/10.1016/j.oooo.2017.02.015 CrossRefPubMedGoogle Scholar
- 30.Kamburoglu K, Kolsuz E, Murat S, Eren H, Yüksel S, Paksoy CS (2013) Assessment of buccal marginal alveolar peri-implant and periodontal defects using a cone beam CT system with and without the application of metal artefact reduction mode. Dentomaxillofac Radiol 42(8):20130176. https://doi.org/10.1259/dmfr.20130176 CrossRefPubMedPubMedCentralGoogle Scholar
- 31.de-Azevedo-Vaz SL, Peyneau PD, Ramirez-Sotelo LR, Vasconcelos Kde F, Campos PS, Haiter-Neto F (2016) Efficacy of a cone beam computed tomography metal artifact reduction algorithm for the detection of peri-implant fenestrations and dehiscences. Oral Surg Oral Med Oral Pathol Oral Radiol 121(5):550–556. https://doi.org/10.1016/j.oooo.2016.01.013 CrossRefPubMedGoogle Scholar
- 33.Pauwels R, Silkosessak O, Jacobs R, Bogaerts R, Bosmans H, Panmekiate S (2014) A pragmatic approach to determine the optimal kVp in cone beam CT: balancing contrast-to-noise ratio and radiation dose. Dentomaxillofac Radiol 43(5):20140059. https://doi.org/10.1259/dmfr.20140059 CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Demirturk Kocasarac H, Helvacioglu Yigit D, Bechara B, Sinanoglu A, Noujeim M (2016) Contrast-to-noise ratio with different settings in a CBCT machine in presence of different root-end filling materials: an in vitro study. Dentomaxillofac Radiol 45(5):20160012. https://doi.org/10.1259/dmfr.20160012 CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Helvacioglu-Yigit D, Demirturk Kocasarac H, Bechara B, Noujeim M (2016) Evaluation and reduction of artifacts generated by 4 different root-end filling materials by using multiple cone-beam computed tomography imaging settings. J Endod 42(2):307–314. https://doi.org/10.1016/j.joen.2015.11.002 CrossRefPubMedGoogle Scholar
- 36.Pinheiro LR, Scarfe WC, de Oliveira Sales MA, Gaia BF, Cortes AR, Gusmão Paraiso Cavalcanti M (2017) Effectiveness of periapical radiography versus cone beam computed tomography with different kilovoltage settings in the detection of chemically created peri-implant bone defects: an in vitro study. Int J Oral Maxillofac Implants 32(4):741–750. https://doi.org/10.11607/jomi.5311 CrossRefPubMedGoogle Scholar