ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Comparing the Accuracy of Digital Radiography (DR), MDCT and CBCT in Detecting Vertical Root Fractures (VRF)
Clinical Question What is the most accurate diagnostic imaging technique in detecting VRF in present or absent of gutta-percha root filling?
Clinical Bottom Line In the absence of gutta-percha the CBCT was significantly more accurate and sensitive in detecting VRF, but the accuracy and the sensitivity of the CBCT is reduced in presence of gutta-percha due to metal artifact. Use of MDCT as an alternative technique may be recommended when VRF are suspected in root filled teeth. However, the radiation dose of MDCT is higher than CBCT.
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) 22413921Da Silveira/2013100 teethIn-Vitro analysis
Key resultsIn presence of gutta-percha CBCT was significantly higher than DR(P = 0.009), but MDCT was significantly higher than that of CBCT and DR(P < 0.001). However, the radiation dose of MDCT is higher than CBCT. In absence of gutta-percha the accuracy of CBCT was significantly higher than MDCT and DR (P = 0.003).
Evidence Search Vertical root fracture AND CBCT
Comments on
The Evidence
In these in-vitro studies, VRF was produced artificially and they used acrylic resin blocks to keep the fractured segments close to each other but, in In the clinical situation, tooth are surrounded by bone and soft tissues that might decrease the ability of an observer to detect VRF. The result of this study restricted to one type of digital radiograph complementary metal-oxide semiconductor (CMOS). Also, they used 8x8 cm field of view (FoV) Promax 3D unit to evaluate the VRF the result might change if they used 4x4 cm (FoV).
Applicability All adult patients suspected to vertical root fractures with/or without root canal filling.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Vertical root fracture, cone beam CT, digital radiography, MDCT, gutta-percha.
ID# 2320
Date of submission: 08/09/2012spacer
E-mail barayan@uthscsa.edu
Author Mohammed Barayan
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail deahl@uthscsa.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 Mohammed Barayan (San Antonio, TX) on 09/18/2012
Computed tomography (CT) provides 3-dimenstional images and overcomes many of the problems associated with digital radiograph, such as magnification, distortion and anatomical superimposition. Since MDCT used a large number of Kvp and mA, MDCT create a large amount of highly energetic photons that penetrate the patient’s body and hit the detector. MDCT has a better resolution (small voxel size) than CBCT, but the radiation dose is higher than CBCT. (oral radiology-principles & interpretation white-phoroah-6th edition.)
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