Comparison of imaging methods for detection of simulated horizontal and oblique root fractures in a new study model
DOI:
https://doi.org/10.14393/BJ-v41n0a2025-75691Keywords:
Cone-Beam Computed Tomography, Diagnostic Imaging, Radiology, Root Fractures.Abstract
This study aimed to compare the accuracy of standard, mesially shifted, and distally shifted periapical radiography with that of cone beam computed tomography (CBCT) in detecting oblique and horizontal root fractures. Nine teeth were randomly divided into the control, horizontal root fracture (HRF), and oblique root fracture (ORF) groups. Fractures were created without fragment separation using a perpendicular force and confirmed by transillumination. The imaging techniques included standard periapical radiography (SP), mesially shifted periapical radiography (MP), distally shifted periapical radiography (DP), and CBCT. Four postgraduate dental students evaluated the images for the presence or absence of fractures using a five-point scale. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic (ROC) curve were calculated for each observer. CBCT demonstrated higher sensitivity and accuracy than radiographic methods. ROC curve values were significantly greater for CBCT than for MP (p=0.005). For horizontal fractures, the sensitivity (p=0.125), specificity (p=0.630), and accuracy (p=0.201) showed no significant differences; however, the ROC curve area (p=0.003), favored CBCT. The inter- and intraobserver agreements ranged from moderate to substantial (0.45–0.78). The study model effectively simulated challenging root fractures without fragment discontinuation, and CBCT performed significantly better in detecting oblique root fractures.
References
ALAMRI, H. M. et al. Detecting vertical root fractures using modified methylene blue dye: a preliminary in vitro study. Healthcare (Basel). 2023, 11(4), 504. https://doi.org/10.3390/healthcare11040504
AL HADI, D. et al. Detection of vertical root fractures using three different imaging modalities: an in vitro study. The Journal of Contemporary Dental Practice. 2020, 21(5), 549-553.
ALMEIDA, G. de A. et al. Cone-beam computed tomography evaluation of dentoskeletal effects produced by the bonded expander and hyrax: a pilot study. Bioscience Journal. 2016, 32. https://doi.org/10.14393/BJ-v32n3a2016-32319
ANANTULA, K.; VANKAYALA, B.; YADAV, S. S. A three-dimensional finite element analysis of stress distribution in maxillary central incisor with a horizontal mid-root fracture after various management protocols. Journal of Conservative Dentistry and Endodontics. 2021, 24(5), 470-474. https://doi.org/10.4103/jcd.jcd_410_21
ANDRAWS YALDA, F. et al. Determination of a cone-beam CT low-dose protocol for root fracture diagnosis in non-endodontically treated anterior maxillary teeth. Dento Maxillo Facial Radiology. 2022, 51(2), 20210138. https://doi.org/10.1259/dmfr.20210138
ANDRAWS YALDA, F. et al. Does anthropomorphic model design in ex vivo studies affect diagnostic accuracy for dental root fracture using CBCT? Dento Maxillo Facial Radiology. 2020, 49(7), 20200093. https://doi.org/10.1259/dmfr.20200093
ANDREASEN, F. M.; ANDREASEN, J. O.; and TSILINGARIDIS, G. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 5th ed. Oxford, UK: Wiley Blackwell. 2018, 377-412.
AVSEVER, H. et al. Comparison of intraoral radiography and cone-beam computed tomography for the detection of horizontal root fractures: an in vitro study. Clinical Oral Investigations. 2014, 18(1), 285-292. https://doi.org/10.1007/s00784-013-0940-4
BUENO, M. R.; AZEVEDO, B. C.; ESTRELA, C. A critical review of the differential diagnosis of root fracture line in CBCT scans. Brazilian Dental Journal. 2021, 32(5), 114-128. https://doi.org/10.1590/0103-6440202104742
DA SILVEIRA, P. F. et al. Detection of vertical root fractures by conventional radiographic examination and cone beam computed tomography - an in vitro analysis. Dental Traumatology. 2013, 29(1), 41-46. https://doi.org/10.1111/j.1600-9657.2012.01126.x
DE LIMA, K. L. et al. Influence of the technical parameters of CBCT image acquisition on vertical root fracture diagnosis: a systematic review and meta-analysis. Clinical Oral Investigations. 2023, 27(2), 433-474. https://doi.org/10.1007/s00784-022-04797-z
DE LIMA, K. L. et al. Impact of fracture line width on radiographic diagnosis of vertical root fractures: analysis of the generalized estimating equation model. Chinese Journal of Dental Research. 2022, 25(3), 197-204. https://doi.org/10.3290/j.cjdr.b3317977
FERRUZZI, L.P.C., et al. Oral health-related quality of life of athletes with disabilities: a cross sectional study. Bioscience Journal. 2021, 37, e37008. https://doi.org/10.14393/BJ-v37n0a2021-5366
GHAZIZADEH, M. et al. Accuracy of digital image enhancement in detection of vertical and horizontal root fractures. Dental Research Journal. 2020, 17(4), 266-272. http://dx.doi.org/10.4103/1735-3327.292066
GAO, A.; CAO, D.; LIN, Z. Diagnosis of cracked teeth using cone-beam computed tomography: literature review and clinical experience. Dento Maxillo Facial Radiology. 2021, 50(5), 20200407. https://doi.org/10.1259/dmfr.20200407
HABIBZADEH, S. et al. Diagnostic efficacy of cone-beam computed tomography for detection of vertical root fractures in endodontically treated teeth: a systematic review. BMC Medical Imaging. 2023, 23(1), 68. https://doi.org/10.1186/s12880-023-01024-3
KAPRALOUS, V. et al. Digital subtraction radiography in detection of vertical root fractures: accuracy evaluation for root canal filling, fracture orientation and width variables. An ex-vivo study. Clinical Oral Investigations. 2020, 24(10), 3671-3681. https://doi.org/10.1007/s00784-020-03245-0
KIM, K. H. et al. Developing evidence-based clinical imaging guidelines for the diagnosis of vertically fractured teeth. Oral Radiology. 2024, 40(4), 471-483. https://doi.org/10.1007/s11282-024-00766-2
KOBAYASHI-VELASCO, S. et al. Diagnosis of alveolar and root fractures: an in vitro study comparing CBCT imaging with periapical radiographs. Journal of Applied Oral Science. 2017, 25(2), 227-233. https://doi.org/10.1590/1678-77572016-0332
LANDIS, J. R.; KOCH, G. G. The measurement of observer agreement for categorical data. Biometrics. 1977, 33(1), 159-174.
LIAO, W. C. et al. Vertical root fracture in non-endodontically and endodontically treated teeth: current understanding and future challenge. Journal of Personalized Medicine. 2021, 11(12), 1375. https://doi.org/10.3390/jpm11121375
MAREQUE-BUENO, M. S. et al. A retrospective clinical study to compare the ability of cone-beam computed tomographic images and periapical radiographs to reveal cracked teeth, split teeth, and teeth with vertical root fractures. The Journal of the American Dental Association. 2024, 155(7), 614-623.e2. https://doi.org/10.1016/j.adaj.2024.04.009
PATEL, S. et al. Diagnosis and management of traumatic dental injuries using intraoral radiography and cone-beam computed tomography: an in vivo investigation. Journal of Endodontics. 2021, 47(6), 914-923. https://doi.org/10.1016/j.joen.2021.02.015
PATEL, S.; BHUVA, B.; BOSE, R. Present status and future directions: vertical root fractures in root filled teeth. International Endodontic Journal. 2022, 55(3), 804-826. https://doi.org/10.1111/iej.13737
PAZ, J. L. C. et al. Dental undergraduate students' ability in the diagnosis of root fractures: comparative analysis of different imaging methods. Journal of Dental Education. 2022, 86(2), 136-143. https://doi.org/10.1002/jdd.12798
PAZ, J. L. C. et al. Fractured alveolar process displacement evaluation: effect of the rigidity of wire-composite splints. Dental Traumatology. 2021, 37(2), 247-255. https://doi.org/10.1111/edt.12616
PEREIRA, S. A. et al. Diagnostic accuracy of cone beam computed tomography and periapical radiography for detecting apical root resorption in retention phase of orthodontic patients: a cross-sectional study. Journal of Clinical Medicine. 2024, 13(5), 1248. https://doi.org/10.3390/jcm13051248
PRADEEPKUMAR, A. R. et al. Diagnosis of vertical root fractures by cone-beam computed tomography in root-filled teeth with confirmation by direct visualization: a systematic review and meta-analysis. Journal of Endodontics. 2021, 47(8), 1198-1214. https://doi.org/10.1016/j.joen.2021.04.022
SHA, X. et al. Comparison between periapical radiography and cone beam computed tomography for the diagnosis of anterior maxillary trauma in children and adolescents. Dental Traumatology. 2022, 38(1), 62-70. https://doi.org/10.1111/edt.12706
SOARES, C. J. et al. Influence of cavity preparation design on fracture resistance of posterior leucite-reinforced ceramic restorations. The Journal of Prosthetic Dentistry. 2006, 95(6), 421-429. https://doi.org/10.1016/j.prosdent.2006.03.022
SOARES, C. J. et al. Influence of root embedment material and periodontal ligament simulation on fracture resistance tests. Brazilian Oral Research. 2005, 19(1), 11-16. https://doi.org/10.1590/s1806-83242005000100003
SOARES, P. B. et al. Effect of bone loss simulation and periodontal splinting on bone strain: periodontal splints and bone strain. Archives of Oral Biology. 2011, 56(11), 1373-1381. https://doi.org/10.1016/j.archoralbio.2011.04.002
VALDIVIA, A. D. C. M. et al. Biomechanical effect of ferrule on incisors restored with a fiberglass post and lithium-disilicate ceramic crown after thermal cycling and fatigue loading. The Journal of Adhesive Dentistry. 2018, 20(2), 133-142. https://doi.org/10.3290/j.jad.a40305
YANG, P. et al. Detection of vertical root fractures by cone-beam computed tomography based on deep learning. Dento Maxillo Facial Radiology. 2023, 52(3), 20220345. https://doi.org/10.1259/dmfr.20220345
ZAROR, C. et al. Emergency and sequelae management of traumatic dental injuries: a systematic survey of clinical practice guidelines. BMC Oral Health. 2023, 23(1), 704. https://doi.org/10.1186/s12903-023-03409-w
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Jessica Ferreira Rodrigues, Daniela Jemio Quevedo, Gabriella Lopes de Rezende Barbosa, Carlos José Soares, Meire Coelho Ferreira, Priscilla Soares
This work is licensed under a Creative Commons Attribution 4.0 International License.
