Imaging Science in Dentistry

Korean Academy of Oral and Maxillofacial Radiology (대한영상치의학회)
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Vertical root fracture diagnosis in teeth with metallic posts: Impact of metal artifact reduction and sharpening filters

  • Debora Costa Ruiz (Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas) ;
  • Lucas P. Lopes Rosado (Department of Dentistry, University Center of Espirito Santo) ;
  • Rocharles Cavalcante Fontenele (OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven) ;
  • Amanda Farias-Gomes (Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas) ;
  • Deborah Queiroz Freitas (Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas)
  • Received : 2023.10.25
  • Accepted : 2024.02.06
  • Published : 2024.06.30
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Abstract

Purpose: This study examined the influence of a metal artifact reduction (MAR) tool, sharpening filters, and their combination on the diagnosis of vertical root fracture (VRF) in teeth with metallic posts using cone-beam computed tomography (CBCT). Materials and Methods: Twenty single-rooted human premolars - 9 with VRF and 11 without - were individually placed in a human mandible. A metallic post composed of a cobalt-chromium alloy was inserted into the root canal of each tooth. CBCT scans were then acquired under the following parameters: 8 mA, a 5×5 cm field of view, a voxel size of 0.085 mm, 90 kVp, and with MAR either enabled or disabled. Five oral and maxillofacial radiologists independently evaluated the CBCT exams under each MAR mode and across 3 sharpening filter conditions: no filter, Sharpen 1×, and Sharpen 2×. The diagnostic performance was quantified by the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. These metrics were compared using 2-way analysis of variance with a significance level of α=5%. Intra- and inter-examiner agreement were assessed using the weighted kappa test. Results: Neither MAR nor the application of sharpening filters significantly impacted AUC or specificity (P>0.05). However, sensitivity increased when MAR was combined with Sharpen 1× and Sharpen 2× (P=0.015). The intra-examiner agreement ranged from fair to substantial (0.34-0.66), while the inter-examiner agreement ranged from fair to moderate (0.27-0.41). Conclusion: MAR in conjunction with sharpening filters improved VRF detection; therefore, their combined use is recommended in cases of suspected VRF.

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References

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