In Vivo Detection of Subtle Vertical Root Fracture in Endodontically Treated Teeth by Cone-beam Computed Tomography

Lei Zhang; Tiemei Wang; Ya Cao; Congyue Wang; Baochun Tan; Xuna Tang; Renxiang Tan; Zitong Lin

doi:10.1016/j.joen.2019.03.006

In Vivo Detection of Subtle Vertical Root Fracture in Endodontically Treated Teeth by Cone-beam Computed Tomography

J Endod. 2019 Jul;45(7):856-862. doi: 10.1016/j.joen.2019.03.006. Epub 2019 Apr 26.

Authors

Lei Zhang¹, Tiemei Wang², Ya Cao², Congyue Wang³, Baochun Tan⁴, Xuna Tang⁵, Renxiang Tan⁶, Zitong Lin⁷

Affiliations

¹ Department of Prosthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
² Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
³ Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
⁴ Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
⁵ Department of Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
⁶ State Key Laboratory of Pharmaceutical Biotechnology, Institute of Functional Biomolecules, Nanjing University, Nanjing, China; State Key Laboratory Cultivation Base for Traditional Chinese Medicine Quality and Efficacy, Nanjing University of Chinese Medicine, Nanjing, China.
⁷ Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: linzitong_710@163.com.

PMID: 31030978
DOI: 10.1016/j.joen.2019.03.006

Abstract

Introduction: The purpose of this study was to evaluate the diagnostic accuracy of cone-beam computed tomographic (CBCT) imaging in the detection of subtle vertical root fractures (VRFs) in endodontically treated teeth in vivo and to discuss direct and indirect evidence for the diagnosis of subtle VRFs.

Methods: Twenty-nine endodontically treated teeth with suspected VRFs from 29 patients were examined using CBCT imaging. CBCT images were scored based on evaluation of the fracture line and vertical buccopalatal (lingual) bone loss. VRF was diagnosed only when a definite fracture line was detected on CBCT images, and findings of periodontal exploration or surgical extraction were considered the gold standard. The diagnostic sensitivity, specificity, and accuracy were assessed.

Results: Of the 29 teeth, 27 were positive and 2 were negative for VRF according to the gold standard. Sensitivity, specificity, and accuracy were 33.3%, 100%, and 37.9%, respectively, based on the direct finding of a fracture line on CBCT images. However, vertical buccopalatal (lingual) bone loss was found in 25 of 27 teeth with VRFs.

Conclusions: Although the accuracy of CBCT imaging for the diagnosis of subtle VRFs in endodontically treated teeth in vivo was poor, vertical buccopalatal (lingual) bone loss is an important indirect sign for the diagnosis of VRFs, which can be found on CBCT images.

Keywords: Cone-beam computed tomography; fracture line; vertical bone loss; vertical root factures.

MeSH terms

Cone-Beam Computed Tomography*
Humans
Sensitivity and Specificity
Tooth Fractures* / diagnostic imaging
Tooth Root / diagnostic imaging
Tooth Root / injuries
Tooth, Nonvital*