Department of Endodontology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Dentistry Building, Aristotle University of Thessaloniki Campus, 54124, Thessaloniki, Greece.
Department of Operative Dentistry, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Clin Oral Investig. 2020 Oct;24(10):3671-3681. doi: 10.1007/s00784-020-03245-0. Epub 2020 Feb 21.
Ex-vivo evaluation of the detectability of vertical root fractures (VRFs) using digital subtraction radiography (DSR) and conventional digital periapical radiography (CDPR); investigation of the effect of root canal filling, x-ray angulation, and thickness of the VRF in the diagnostic accuracy.
Sixty root canals were mechanically prepared and radiographed either with a gutta-percha root canal filling or without, at 0 and ± 10. VRFs were introduced with a universal testing machine. The width and angulation of the fracture line with the radiographic beam were calculated. DSR was performed comparing radiographs obtained prior to and after the VRF induction. Five examiners evaluated the resultant images and analysis was performed using receiver operator characteristic (ROC) statistics and binary logistic regression tests.
No significant differences in sensitivity, specificity, and the areas under the ROC curves (AUC) between the CDPR and DSR were detected (p > 0.05), except for root canal filled teeth where the AUC for DSR was higher (p < 0.05). Using DSR, a VRF was 1.3 times more likely to be diagnosed [95% confidence intervals (CI): 1.045-1.59; p = 0.018]. A correct diagnosis was 2.399 times more likely to occur in non-filled teeth regardless of the radiographic technique (95% CI 1.940-2.965; p = 0). The regression coefficients were positive for width and negative for angle.
DSR showed a better diagnostic accuracy of VRFs compared with CDPR, in single root canal filled teeth. The angulation, the width, and the presence of a root canal filling affected the diagnostic potential.
DSR is a cost- and time-effective imaging technique that could contribute in early diagnosis of VRFs.
使用数字减影放射摄影术（DSR）和传统数字根尖放射摄影术（CDPR）对垂直根折（VRF）的可检测性进行离体评估；研究根管充填、X 射线角度和 VRF 厚度对诊断准确性的影响。
将 60 个根管进行机械制备，并分别在根管内有或无牙胶根管充填的情况下，以 0°和±10°拍摄放射照片。使用万能试验机引入 VRF。计算骨折线与放射线束的宽度和角度。在 VRF 诱导前后进行 DSR。五位检查者评估所得图像，并使用接收者操作特征（ROC）统计和二元逻辑回归检验进行分析。
在 CDPR 和 DSR 之间，除了根管充填的牙齿外，DSR 的 AUC 更高（p<0.05），否则在灵敏度、特异性和 ROC 曲线下面积（AUC）方面，两者之间没有显著差异（p>0.05）。使用 DSR，VRF 的诊断可能性增加 1.3 倍[95%置信区间（CI）：1.045-1.59；p=0.018]。无论使用何种放射技术，未充填的牙齿更有可能正确诊断[95%CI 1.940-2.965；p=0]。回归系数对宽度为正，对角度为负。
与 CDPR 相比，DSR 在单根管充填的牙齿中对 VRF 的诊断准确性更高。角度、宽度和根管充填的存在影响了诊断潜力。
DSR 是一种具有成本效益和时间效益的成像技术，可有助于早期诊断 VRF。
