Universidade de São Paulo, Faculdade de Odontologia, Departamento de Estomatologia, São Paulo, SP, Brasil.
J Appl Oral Sci. 2017 Mar-Apr;25(2):227-233. doi: 10.1590/1678-77572016-0332.
To compare periapical radiograph (PR) and cone-beam computed tomography (CBCT) in the diagnosis of alveolar and root fractures.
Sixty incisor teeth (20 higid and 40 with root fracture) from dogs were inserted in 60 anterior alveolar sockets (40 higid and 20 with alveolar fracture) of 15 macerated canine maxillae. Each fractured socket had a root fractured tooth inserted in it. Afterwards, each maxilla was submitted to PR in two different vertical angulation incidences, and to CBCT imaging with a small field of view (FOV) and high-definition protocol. Images were randomized and posteriorly analyzed by two oral and maxillofacial radiologists two times, with a two-week interval between observations.
Sensitivity and specificity values were good for root fractures for PR and CBCT. For alveolar fractures, sensitivity ranged from 0.10 to 0.90 for PR and from 0.50 to 0.65 for CBCT. Specificity for alveolar fractures showed lower results than for root fractures for PR and CBCT. Areas under the ROC curve showed good results for both PR and CBCT for root fractures. However, results were fair for both PR and CBCT for alveolar fractures. When submitted to repeated measures ANOVA tests, there was a statistically significant difference between PR and CBCT for root fractures. Root fracture intraobserver agreement ranged from 0.90 to 0.93, and alveolar fracture intraobserver agreement ranged from 0.30 to 0.57. Interobserver agreement results were substantial for root fractures and poor/fair for alveolar fractures (0.11 for PR and 0.30 for CBCT).
Periapical radiograph with two different vertical angulations may be considered an accurate method to detect root fractures. However, PR showed poorer results than CBCT for the diagnosis of alveolar fractures. When no fractures are diagnosed in PR and the patient describes pain symptoms, the subsequent exam of choice is CBCT.
比较根尖片（PR）和锥形束 CT（CBCT）在诊断牙槽突和根折中的作用。
将 60 颗犬切牙（20 颗完整和 40 颗根折）插入 15 个犬上颌前牙槽窝（40 个完整和 20 个牙槽突骨折）中。每个骨折牙槽窝中都插入了一颗根折的牙齿。之后，每个上颌骨都分别进行了两种不同垂直角度的 PR 拍摄，并进行了小视野（FOV）和高清协议的 CBCT 成像。图像被随机化，由两名口腔颌面放射科医生进行两次分析，两次观察之间间隔两周。
PR 和 CBCT 对根折的敏感性和特异性均较好。对于牙槽突骨折，PR 的敏感性范围为 0.10 至 0.90，而 CBCT 的敏感性范围为 0.50 至 0.65。PR 和 CBCT 对牙槽突骨折的特异性均低于根折。ROC 曲线下面积显示 PR 和 CBCT 对根折的结果均较好。然而，PR 和 CBCT 对牙槽突骨折的结果均为一般。当进行重复测量方差分析时，PR 和 CBCT 对根折的结果有统计学意义。根折的观察者内一致性范围为 0.90 至 0.93，牙槽突骨折的观察者内一致性范围为 0.30 至 0.57。根折的观察者间一致性结果为高度一致，而牙槽突骨折的观察者间一致性结果为低/一般（PR 为 0.11，CBCT 为 0.30）。
两种不同垂直角度的根尖片可能被认为是检测根折的准确方法。然而，PR 对牙槽突骨折的诊断结果不如 CBCT。如果 PR 未诊断出骨折，且患者描述有疼痛症状，则后续的首选检查是 CBCT。
