J Am Dent Assoc. 2024 Jul;155(7):614-623.e2. doi: 10.1016/j.adaj.2024.04.009. Epub 2024 May 24.
This retrospective clinical study aimed to compare the sensitivity of cone-beam computed tomographic (CBCT) images and periapical (PA) radiographs to reveal cracked teeth, split teeth, and teeth with vertical root fractures (VRFs).
The authors included 98 patients (98 teeth) diagnosed with a longitudinal tooth fracture (LTF) (cracked tooth, split tooth, VRF) through direct visualization after extraction and with comprehensive clinical and radiographic records. They collected demographic, clinical, and radiographic data. The authors evaluated PA radiographs and CBCT images to identify fractures, fracture lines, and the different patterns of bone loss associated with these teeth. They used the McNemar test to compare PA radiographs and CBCT scans when assessing bone loss. They used the Fisher test to determine statistical relationships between fracture types and demographic, clinical, and radiologic traits. They used an analysis of variance test to compare patient age with fracture types.
CBCT images were significantly more effective (P < .05) in detecting bone loss patterns associated with LTFs than with PA radiographs, with 71% of cases detected via CBCT images compared with 42% via radiographs. Mean age was significantly greater (P < .05) in patients with teeth with VRFs than in patients with split teeth. A significant relationship was observed between the type of fracture and the following variables: root canal treatment (split, VRF, P = .002), deep probing depth (≥ 5 mm) (VRF, P = .026), and having more than 8 teeth extracted from the mouth (VRF, P = .032). Overall, there was a significant difference (P < .001) between the visualization of fracture lines (45% on PA radiographs, 65% on CBCT images).
CBCT scans provided more information on LTFs than PA radiographs, particularly in the identification of periradicular bone changes.
CBCT imaging can assist in making the clinical diagnosis of LTFs through observation of bone loss patterns, providing more information than PA radiographs.
本回顾性临床研究旨在比较锥形束 CT（CBCT）图像和根尖片（PA）对牙隐裂、牙纵裂和根折的敏感性。
作者纳入 98 例（98 颗牙）患者，这些患者均因拔牙后直接观察到牙体有纵向折裂（牙隐裂、牙纵裂、根折）而接受治疗，且有全面的临床和影像学记录。作者收集了人口统计学、临床和影像学数据。作者评估了 PA 片和 CBCT 图像，以识别这些牙齿的骨折、骨折线和与骨折相关的不同类型的骨丢失。作者使用 McNemar 检验比较了 PA 片和 CBCT 扫描在评估骨丢失时的效果。作者使用 Fisher 检验确定了骨折类型与人口统计学、临床和影像学特征之间的统计学关系。作者使用方差分析检验比较了患者年龄与骨折类型之间的关系。
与 PA 片相比，CBCT 图像在检测与 LTF 相关的骨丢失模式方面更为有效（P <.05），71%的病例通过 CBCT 图像检测到，而通过 PA 片仅检测到 42%的病例。根折组患者的平均年龄明显大于（P <.05）牙纵裂组患者。骨折类型与以下变量之间存在显著相关性：根管治疗（牙隐裂、根折，P =.002）、深牙周袋（≥5 mm）（根折，P =.026）和拔牙数超过 8 颗（根折，P =.032）。总体而言，骨折线的可视化程度存在显著差异（PA 片 45%，CBCT 片 65%，P <.001）。
与 PA 片相比，CBCT 扫描提供了更多关于 LTF 的信息，特别是在识别根尖周骨变化方面。
CBCT 成像可以通过观察骨丢失模式辅助临床诊断 LTF，比 PA 片提供更多信息。
