Comparison of Intraoral Radiography and Cone-Beam Computed Tomography for the Detection of Vertical Root Fractures: An In Vitro Study

Abstract

The aim of this study was to compare the diagnostic accuracy of two different cone-beam computed tomography units, a photostimulated phosphor sensor (PSP), conventional film, and a charge-coupled device (CCD) sensor for detecting vertical root fractures. Ninety extracted human mandibular single-rooted premolar teeth without root fractures were numbered and divided into two groups: a control group of 45 teeth with no fractures and a test group of 45 teeth with fractures. The teeth were randomly placed in the empty mandibular premolar sockets of a dry human mandible. Each tooth was imaged using the following modalities: 3D Accuitomo 170; NewTom 3G; VistaScan PSP; CCD sensor; and conventional film. Kappa coefficients were calculated to assess the intra- and interobserver agreements for each image set. A receiver operating characteristic analysis was used to compare the scores assigned to all the imaging systems and evaluate the observers' ability to differentiate between teeth with and without vertical root fractures. The 3D Accuitomo 170 4 x 4-cm field of view was found to detect artificially induced vertical root fractures significantly better than the NewTom 3G 6-in. field of view, VistaScan PSP, CCD sensor, and conventional film images. The 3D Accuitomo 170 was significantly superior to the NewTom 3G, VistaScan PSP, CCD sensor, and conventional film images in the detection of artificially induced vertical root fractures.