title: Comparing the in vivo diagnostic accuracy of digital periapical radiography with cone-beam computed tomography for the detection of vertical root fracture.
abstract: BACKGROUND
  The purpose of this study was to determine whether there is a difference in the in vivo diagnostic accuracy of digital radiography (DR) and cone-beam computed tomography (CBCT) imaging in the detection of vertical root fracture (VRF). The presence/absence of VRF was confirmed by visual inspection of the extracted root surface and was the reference standard against which both imaging modalities were compared.
  
  
  METHODS
  Twenty-one unsalvageable teeth from 20 patients that had been radiographed and scanned with CBCT imaging were included in the study. The teeth were atraumatically extracted and visually inspected under a microscope to confirm the presence/absence of fracture. The widest point of each fracture was recorded using an optical coherence tomography scanner in order to quantify the size of fractures. Images were viewed under standardized conditions by 13 examiners and repeated 2 weeks later to assess their consistency.
  
  
  RESULTS
  DR and CBCT imaging showed similarly poor sensitivity of 0.16 and 0.27, respectively. Both imaging modalities had similarly high specificity of 0.92 and 0.83, respectively. There was no statistical difference between the diagnostic accuracy of either imaging modality. Fracture width did not affect the detection rate of either imaging modality. Receiver operating characteristic analysis revealed mean Az values of 0.535 and 0.552 for DR and CBCT imaging, respectively.
  
  
  CONCLUSIONS
  Both DR and CBCT imaging have significant limitations when detecting vertical root fractures.
authors.affiliation: Department of Endodontology, Kings College Dental Institute, London, United Kingdom.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chavda
authors.affiliation: Department of Endodontology, Kings College Dental Institute, London, United Kingdom.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mannocci
authors.affiliation: Biomedical Statistics, Dental Institute, Denmark Hill, London, United Kingdom.
authors.forename: Manoharan
authors.initials: M
authors.lastname: Andiappan
authors.affiliation: Department of Endodontology, Kings College Dental Institute, London, United Kingdom. Electronic address: shanonpatel@gmail.com.
authors.forename: Shanon
authors.initials: S
authors.lastname: Patel
mesh_terms: D054893:Cone-Beam Computed Tomography / Q000706:statistics & numerical data*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000706:statistics & numerical data; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D016300:Radiography, Bitewing / Q000706:statistics & numerical data*; D019252:Radiography, Dental, Digital / Q000706:statistics & numerical data*; D012015:Reference Standards; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000295:instrumentation; D014081:Tooth Extraction / Q000379:methods; D014082:Tooth Fractures / Q000000981:diagnostic imaging* / Q000473:pathology; D014092:Tooth Root / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D019553:Tooth, Nonvital / Q000000981:diagnostic imaging / Q000473:pathology
keywords: Cone-beam computed tomography; digital radiography; in vivo; vertical root fracture