Dental Vertical Root Fractures: Value of CT in Detection

TLDR

The study aims to evaluate CT’s diagnostic value for dental vertical root fractures compared with conventional radiography. Thirty‑seven patients with 42 suspected fractured teeth were examined with dental radiography and axial CT, and two radiologists independently and jointly assessed fracture lines, with findings compared to intraoperative confirmation. Intraoperative confirmation showed 28 of 42 teeth fractured; CT achieved 100% sensitivity and specificity versus 23%/70% for radiography, with consensus sensitivity 75% for CT, confirming CT’s superiority despite occasional false negatives from artifacts or small roots.

Abstract

PURPOSE: To determine the value of computed tomography (CT) in the diagnosis of dental vertical root fractures relative to the value of conventional dental radiography. MATERIALS AND METHODS: Thirty-seven patients with 42 teeth in which vertical root fracture was clinically suspected underwent dental radiography and axial CT. Two radiologists evaluated the images independently and by consensus for a fracture line. The results were compared with intraoperative findings. RESULTS: Twenty-eight of the 42 teeth were proved intraoperatively to be fractured. The sensitivity and specificity averaged for the two reviewers in the assessment of vertical fractures were 23% and 70%, respectively, with dental radiography and 100% and 100%, respectively, with CT. Consensus reading showed sensitivities of 25% for dental radiography and 75% for CT. Eight (reviewer A) or nine (reviewer B) false-negative CT findings were encountered in cases in which metallic artifacts obscured parts of the root and in cases in which the root was very small in diameter. Interobserver agreement was 95% for dental radiography and 93% for CT. CONCLUSION: CT is superior to dental radiography in the detection of dental vertical root fractures.