Stationary intraoral tomosynthesis imaging for vertical root fracture detection

Abstract

The purpose of this study was to compare the radiographic detection of induced vertical root fractures among periapical, limited-FOV CBCT, and stationary intraoral tomosythesis imaging, as well as the relationship between these variables and their impact on evaluator confidence in diagnosis of vertical root fractures. Tomosynthesis imaging uses a multi-source X-ray carbon nanotube array that allows for a acquisition of multiple basis images and subsequent reconstruction of a 3D volume. Sixty fully developed extracted human premolar root samples were assigned two one of four groups based on being either obturated or unobturated and fractured or unfractured. Samples were mounted in artificial alveolar bone then imaged with two-dimensional periapical imaging, limited-FOV CBCT, and stationary intraoral tomosynthesis. Three blinded evaluators assessed for the presence of fractures (yes or no) as well as reported a level of confidence (1 through 5). Generalized estimated equations was used to analyze the data. Within the limitations of this study, it can be concluded that stationary intraoral tomosynthesis improves the sensitivity of detection of induced root fractures compared to a single radiograph. Limited-FOV CBCT is the most sensitive imaging modality for detection of fractures among obturated and unobturated root samples. There is no significant difference in specificity or overall accuracy in fracture detection among periapical, CBCT, and tomosynthesis imaging. The presence of obturation material has a statistically significant reduction in sensitivity of fracture detection and accuracy for periapical radiographs. Obturation status did not have a significant impact on sensitivity for tomosynthesis imaging. . Furthermore, tomosynthesis imaging is superior to periapical imaging in root fracture detection insofar as the presence of obturation material does not significantly reduce fracture detection.