Diagnostic value of Cone-Beam Computed Tomography in diagnosing vertical root fractures in endodontically treated teeth – an in vitro study

Introduction. Vertical root fractures are frequently a cause of extraction of root filled teeth. Clinical and radiological diagnosis of such cases is very difficult. Aim of the study. To evaluate the effectiveness of imaging vertical root fractures of teeth with filled root canals by means of cone-beam computed tomography. Material and methods. Forty-eight bovine mandibular lateral incisors were used in the study, in which vertical root fractures were artificially created. After putting sections together root canals were prepared and filled. The teeth were scanned using the CS 9300 cone beam scanner (Carestream, USA) with the field of view 5 x 5 cm, with the resolution up to 90 μm. Results. In CBCT scans the first observer detected fracture lines in root filled teeth in 83.3% of cases and the second one in 66.7%. Radiographs of teeth with gutta-percha cones in root canals enabled the first observer to see 25% of fractures, and the second observer 16.7%. The inter-observer agreement expressed by the kappa coefficient equals 0.621 (p<0.0005). Conclusions. Cone-Beam tomography with small field of view and high resolution is significantly superior to radiographs in effective imaging of vertical root fractures in the presence of root canal filling.