title: Detection of vertical root fractures by using cone-beam computed tomography: a clinical study.
abstract: BACKGROUND
  Vertical root fractures of teeth (VRFs) often pose a diagnostic dilemma because of the difficulty in detection of these in intraoral radiographs except in certain cases with very distinct clinical findings. This often leads to unwarranted extraction of the tooth. Cone-beam computed tomography (CBCT) produces three-dimensional images and allows precise visualization and evaluation of VRFs or cracks in extracted teeth, as reported previously. This clinical pilot study was designed to determine the diagnostic accuracy of noninvasive CBCT for detection of suspected VRFs in endodontically treated teeth by using exploratory surgery to confirm the presence or absence of a fracture.
  
  
  METHODS
  Thirty-two teeth in 29 patients with clinical signs and symptoms suggestive of VRF were included in the study after informed consent was obtained. They underwent a limited area CBCT evaluation. All CBCT studies were blinded, and 2 board-certified oral and maxillofacial radiologists assessed the presence or absence of VRF through sequential evaluation of the three-dimensional volume. Subjects underwent surgical exploration as part of treatment, which helped establish the presence or absence of VRF.
  
  
  RESULTS
  Pearson correlation coefficient by using surgical finding to confirm presence/absence of fracture was 0.602, positive predictive value was 91%, and negative predictive value was 67%. The sensitivity was 88%, and specificity was 75%.
  
  
  CONCLUSIONS
  This study revealed the superior diagnostic accuracy of CBCT for detection of VRF.
authors.affiliation: Department of Endodontics, College of Dentistry, University of Florida, Gainesville, Florida 32610-0436, USA. unair@dental.ufl.edu
authors.forename: Mitchell
authors.initials: M
authors.lastname: Edlund
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Nair
authors.forename: Umadevi P
authors.initials: UP
authors.lastname: Nair
mesh_terms: D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003937:Diagnosis, Differential; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008866:Microsurgery; D008875:Middle Aged; D010514:Periodontal Pocket / Q000000981:diagnostic imaging; D010865:Pilot Projects; D011237:Predictive Value of Tests; D016300:Radiography, Bitewing; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013524:Surgical Flaps; D014082:Tooth Fractures / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery; D014092:Tooth Root / Q000000981:diagnostic imaging / Q000293:injuries*; D019553:Tooth, Nonvital / Q000000981:diagnostic imaging; D014098:Toothache / Q000000981:diagnostic imaging; D055815:Young Adult