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Title In Vitro Study Shows Cone Beam Computed Tomography is the Most Reliable Diagnostic Technique for Detecting Horizontal Root Fractures
Clinical Question How does CBCT compare to intraoral radiography in diagnosis of horizontal root fractures in patients with history of trauma?
Clinical Bottom Line For patients with a history of trauma CBCT should be considered the imaging modality of choice for the diagnosis of horizontal root fracture. This is supported by a lab study in which the sensitivity and specificity of the CBCT units were significantly higher than that of conventional film and digital sensors.
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) 23397452Avsever/201362 extracted human maxillary incisorsIn Vitro
Key resultsThe kappa values for inter-observer agreement for four observers ranged between 0.88-0.98 for 3D Accuitomo, 0.82-0.91 for NewTom 3G and 0.61-0.72 for intraoral images. For CBCT units, sensitivity and specificity were as follows: Accuitomo (0.97, 0.94) and NewTom 3G (0.89, 0.89); significantly higher than intraoral conventional modalities with sensitivity ranged from 0.67-0.71, and specificity ranged from 0.81-0.85. The sensitivity and specificity of the CBCT units were significantly higher than those from conventional dental radiography.
#2) 23420851Kamburoglu/201380 extracted human maxillary incisorsIn Vitro
Key resultsIntraobserver kappa coefficients ranged from 0.81 to 0.95 for the Accuitomo 170, from 0.80 to 0.92 for the Kodak 9000 and from 0.76 to 0.95 for Vatech PanX-Duo3D. PPV for 5 observers for each machine were as follows: Accuitomo 170 (0.91-0.98), Kodak 9000 (0.93-1.0) and Vatech PanX-Duo3D (0.89-1.0). NPV for Accuitomo 170 ranged from 0.89 to 0.98, for Kodak 9000 from 0.89 to 0.98 and for Vatech PanX-Duo3D from 0.85 to 0.98. This indicates that different CBCT units used at limited FOV and high resolution performed similarly in detecting simulated HRF.
Evidence Search cone beam computed tomography AND horizontal root fracture
Comments on
The Evidence
The gold standard in both studies was investigator’s knowledge of tooth status. Avsever study: Root fractures were artificially created in the horizontal plane of 31 teeth as the test group. 31 teeth with no fracture were in the control group. Images were obtained from intraoral conventional radiography, digital sensors, 3D Accuitomo 170 and NewTom 3G scanner CBCT units, and were observed by four experienced observers. Sensitivity, specificity, and mean diagnostic accuracy were used to compare the imaging methods. The results of this study confirmed two similar studies performed by Kamburoglu et al. and Likubo et al. in 2009. Kamburoglu study: The experimental group consisted of 80 human maxillary incisors. Root fractures were created in the horizontal plane in 40 teeth. Images were obtained from three different CBCT units( Accuitomo 170, Kodak 9000 and Vatech Pax-Duo3D) and were observed by five experienced observers. Sesitivity, specificity, PPV and NPV were calculated to compare the CBCT units. Limitations to both studies include but are not limited to 1- Fractures were artificially produced; 2- Use of only a few CBCT units despite the existence of many other CBCT brands and technologies. 3- Both studies are In Vitro and have the moderate level of evidence.
Applicability Although CBCT is considered as the most reliable technique for detecting horizontal root fractures, the diagnostic accuracy of CBCT images can be significantly affected by scatter and beam hardening artifacts caused by high-density adjacent structures such as metal posts, restorations and root filling material. The higher radiation dose of CBCT units and higher cost to the patient should be also considered when prescribing CBCT.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry)
Keywords Cone Beam Computed Tomography, Horizontal Root Fracture, Intraoral imaging
ID# 2532
Date of submission: 08/04/2013spacer
E-mail toghyani@uthscsa.edu
Author Shiva Toghyani
Co-author(s) Eldon Matthew Lamb
Co-author(s) e-mail lambEM@uthscsa.edu
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Faculty mentor/Co-author e-mail
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