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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

Clinical Oral Investigations volume 23, pages 1263–1270 (2019)Cite this article

Abstract

Objectives

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%.

Results

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).

Conclusions

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.

Clinical Relevance

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.

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Acknowledgements

The authors would like to thank the evaluators.

Funding

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.

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Affiliations

  1. Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, Piracicaba, São Paulo, 13414-903, Brazil

    Deborah Queiroz Freitas

  2. Division of Oral Radiology, School of Dentistry, Federal University of Bahia, Rua Araújo Pinho, 62, Salvador, Bahia, 40110-040, Brazil

    Taruska Ventorini Vasconcelos

  3. Department of Comprehensive Dentistry, Division of Oral and Maxillofacial Radiology, University of Texas Health Science Center at San Antonio, 7707, Floyd Curl Drive, San Antonio, TX, 78229, USA

    Marcel Noujeim

Authors
  1. Deborah Queiroz Freitas
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  2. Taruska Ventorini Vasconcelos
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  3. Marcel Noujeim
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Corresponding author

Correspondence to Deborah Queiroz Freitas.

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The authors declare that they have no conflict of interest.

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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.

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Cite this article

Freitas, D.Q., Vasconcelos, T.V. & Noujeim, M. 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. Clin Oral Invest 23, 1263–1270 (2019). https://doi.org/10.1007/s00784-018-2558-z

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  • DOI: https://doi.org/10.1007/s00784-018-2558-z

Keywords

  • Vertical root fracture
  • Cone beam computed tomography
  • Artifact
  • Kilovoltage
  • Artifact reduction tool