Réa Marcela Tarosso, Carvalho Lara, Andrade-Bortoletto Maria Fernanda Silva, Gaêta-Araujo Hugo, de Oliveira-Santos Christiano, de-Azevedo-Vaz Sergio Lins, Freitas Deborah Queiroz
Department of Oral Diagnosis - Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
Department of Oral Diagnosis - Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
J Endod. 2025 Sep;51(9):1235-1241. doi: 10.1016/j.joen.2025.05.020. Epub 2025 May 30.
Vertical root fractures (VRFs) detection in cone-beam computed tomography (CBCT) images can be challenging when gutta-percha artifacts are present. This study aimed to evaluate how anteroposterior and laterolateral head angulations (APHA and LLHA, respectively), as well as tooth position (anterior or posterior region), influence the diagnostic accuracy of VRFs detection in CBCT for endodontically treated teeth.
Twenty single-rooted teeth were endodontically treated. A phantom was created using a human mandible and ballistic gelatin. CBCT scans of each tooth, placed in both the anterior and posterior regions, were acquired with the phantom positioned at the standard position of 0°, at APHA of 30° and 45°, and at a LLHA of 20°, totaling 320 scans. The presence or absence of VRFs was assessed by 6 examiners using a 5-point scale. Area under the receiver operating characteristic curve, sensitivity, and specificity were analyzed using two-way repeated measures analysis of variance and Sidak's post hoc test. Intra- and interexaminer agreement was evaluated using the weighted Kappa coefficient (α = 0.05).
In general, the 30° and 45° APHA significantly increased area under the receiver operating characteristic curve and sensitivity values for VRF detection in both anterior and posterior regions compared to 0° and 20° LLHA. Angulations and tooth position did not influence specificity. For specificity values, the 45° APHA exhibited a significantly higher value than the other angulations in the anterior region.
VRFs diagnosis enhanced at 30° and 45° APHA, regardless the region.
当存在牙胶伪影时，在锥形束计算机断层扫描（CBCT）图像中检测垂直根折（VRF）可能具有挑战性。本研究旨在评估前后位和内外侧位头部角度（分别为APHA和LLHA）以及牙齿位置（前部或后部区域）如何影响CBCT对根管治疗牙齿VRF检测的诊断准确性。
对20颗单根牙进行根管治疗。使用人体下颌骨和弹道明胶制作一个模型。将每颗牙齿置于前部和后部区域，在模型位于0°标准位置、APHA为30°和45°以及LLHA为20°的情况下进行CBCT扫描，共获得320次扫描。6名检查者使用5分制评估VRF的存在与否。使用双向重复测量方差分析和Sidak事后检验分析受试者工作特征曲线下面积、敏感性和特异性。使用加权Kappa系数（α = 0.05）评估检查者内和检查者间的一致性。
总体而言，与0°和20° LLHA相比，30°和45°的APHA显著增加了前后部区域VRF检测的受试者工作特征曲线下面积和敏感性值。角度和牙齿位置不影响特异性。对于特异性值，45° APHA在前部区域的值显著高于其他角度。
无论在哪个区域，30°和45°的APHA均可提高VRF的诊断率。
