ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Cone Beam Computed Tomography (CBCT) is superior to conventional 2-D imaging at diagnosing a Vertical Root Fracture (VRF) in endodontically treated teeth.
Clinical Question Is Cone Beam Computed Tomography (CBCT) superior to conventional 2-D imaging at diagnosing a Vertical Root Fracture (VRF) in endodontically treated teeth?
Clinical Bottom Line The use of Cone Beam Computed Tomography (CBCT) is superior to conventional 2-D imaging at diagnosing a Vertical Root Fracture (VRF) in endodontically treated teeth.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21787486Edlund/201132 endodontically treated teeth in 29 patients (20-70 years old) with clinical signs and symptoms suggesting VRFNon-Randomized Clinical Trial
Key resultsUse of CBCT for detection of VRF is more effective than using conventional 2-D imaging. In this study, the CBCT yielded the following in detecting a VRF: Positive Predictive Value (PPV) of 91%, Negative Predictive Value (NPV) of 67%, sensitivity of 88% and specificity of 75%. Overall accuracy was 84%. These results are based on results from the iCAT and Morita CBCT machines, which had respective results. This is in comparison to an in-vitro study quoted by the authors, which reported low sensitivity of VRF detection for conventional films (38%) and direct digital films (48%).
Evidence Search (CBCT) AND VRF
Comments on
The Evidence
This in-vivo clinical study demonstrates the effectiveness of CBCT in diagnosing a VRF. Patients in this study had signs and symptoms of a VRF and underwent routine diagnostic tests prior to the use of CBCT. This demonstrates a normal clinical situation of using the ALARA principle where 2-D radiographs are taken first and the CBCT then used only when other diagnostic tools are not definitive.
Applicability If available to the clinician, CBCT is very useful to detect a VRF. However, it should only be used to ascertain a diagnosis only after other means of testing have been done without avail.
Specialty/Discipline (Endodontics) (General Dentistry) (Periodontics)
Keywords Diagnosis of Vertical Root Fracture (VRF), Cone Beam Computed Tomography (CBCT).
ID# 2305
Date of submission: 08/03/2012spacer
E-mail fujc@uthscsa.edu
Author Jonathan Fu
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Fabricio Teixeira, DDS, MS, PhD
Faculty mentor/Co-author e-mail fabricio-teixeira@uiowa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
by Jonathan Fu (San Antonio, TX) on 09/18/2012
Cone Beam Computed Tomography (CBCT) has been shown to be more reliable at detecting Vertical Root Fractures due to the fact that it overcomes the limitations of conventional two-dimensional radiography by producing a three-dimensional image. The three-dimensional image is a compilation of isotropic voxels produced by using a 2D extended digital array- which provides an area detector- and a 3D x-ray beam. A compilation of these single projection images-known as “basis” images”- are used by software to generate a volumetric 3D, “Field of View (FOV)” image, in 3 orthogonal planes (axial, saggital and coronal). This final 3D image results in a geometrically accurate, distortion free image, which can be freely manipulated by the clinician (publication PMID: 22814684).
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