In Vitro Comparison of Cone Beam Computed Tomography with Digital Periapical Radiography for Detection of Vertical Root Fracture in Posterior Teeth

STATEMENT OF THE PROBLEM The diagnosis of vertical root fracture (VRF) is a challenging task. PURPOSE This in vitro study compared cone beam computed tomography (CBCT) imaging with digital periapical radiography (DPR) made by three different horizontal angels (20°mesial, 0° and 20° distal) for accurate diagnosis of VRF. MATERIALS AND METHOD Among 120 posterior teeth included in this study, 60 were vertically fractured. Fractured and non-fractured teeth were randomly distributed into three groups defined as group 1 with no filling in the root canal, group 2 with gutta-percha in the canal, and group 3 with the intracanal post. All samples were placed in a dry mandible and imaged with CBCT and DPR techniques. Two blind observers investigated the images. RESULTS CBCT had higher sensitivity but lower specificity compared with DPR, except for the intracanal post group in which the sensitivity of DPR was higher; though the chi-square test showed the differences to be statistically insignificant. The sensitivity, specificity, and accuracy of CBCT and DPR were reduced in the cases that gutta-percha or post were present in the canal. Inter-observer agreement was higher for CBCT. A set of three DPRs with different horizontal angels were significantly more sensitive for VRF recognition than a single orthogonal DPR. CONCLUSION Based on our results, there was no significant difference between CBCT and a set of three DPRs with different angulations for VRF detection in posterior teeth. Therefore, it is suggested to consider DPRs with three different horizontal angels (20°mesial, 0° and 20° distal) for radiographic evaluation before CBCT examination.