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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (2): 333-338. doi: 10.19723/j.issn.1671-167X.2023.02.019

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Effect of various intracanal materials on the diagnostic accuracy of cone-beam computed tomography in vertical root fractures

Jin-hua ZHANG1,3,Jie PAN1,*(),Zhi-peng SUN2,Xiao WANG3   

  1. 1. Department of Stomatology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digi-tal Medical Devices, Beijing 100081, China
    2. Department of Radiology, Peking University School and Hospital of Stomatology, Beijing 100081, China
    3. Department of Stomatology, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-04-11 Online:2023-04-18 Published:2023-04-12
  • Contact: Jie PAN E-mail:panjie72@sina.com

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Abstract:

Objective: To study the effect of various intracanal materials on the accuracy of oral maxillofacial cone-beam computed tomography (CBCT) for the diagnosis of vertical root fracture (VRF). Methods: A total of twenty-four structurally intact single root canal dried and isolated teeth extracted for orthodontic treatment or periodontal disease were collected. The teeth were decrowned along the cemento-enamel junction (CEJ) and then used as samples for the study after conventional root canal preparation and post preparation. The 24 samples were divided into two groups with 12 samples in each group. Group A was the control group (no VRF group). According to intracanal materials, they were divided into five subgroups: blank group, fiber post group, gutta-percha point group, titanium post group and gold-palladium post group. Group B was the experimental group (VRF group), and subgroups were grouped as above. The VRF model was prepared by a unified method in the VRF group: the root was completely fractured in the buccolingual direction with a custom root canal nail and then cemented and reset. The control group was not subjected to the simulation of VRF. Titanium post and gold-palladium post were made according to the individuality of the root canal preparation, and the tightness of the post to the root canal wall was confirmed by X-ray radiograph. Then all the samples were scanned by CBCT in the isolate swine mandibular alveolar sockets. The diagnostic accuracy was statistically analyzed via blind interpretation by experienced endodontic specialists and oral and maxillofacial medical imaging specialists. Results: The accuracy of the diagnosis of VRF in the blank group, fiber post group, gutta-percha point group, titanium post group, and gold-palladium post group in CBCT was 95.83%, 91.67%, 87.50%, 79.17%, and 45.83%, respectively. Compared with the blank group, the differences were not statistically significant in the fiber post group (P>0.999), the gutta-percha point group (P=0.500) and the titanium post group (P=0.125). The lowest diagnostic accuracy of VRF was found in the gold-palladium post group, and the difference was statistically significant compared with all other groups (P < 0.001). Conclusion: Various intracanal materials have different degrees of influence on the diagnostic accuracy of VRF diagnosis in CBCT. The influence of fiber post, gutta-percha point and titanium post was small, while the influence of gold-palladium post was significant.

Key words: Cone-beam computed tomography, Intracanal materials, Vertical root fractures

CLC Number: 

  • R781

Figure 1

Crack width on axial plane of VRF (buccal-lingual direction) measured by Micro-CT"

Figure 2

Scanned model of an isolated swine mandible"

Figure 3

Axial CBCT images of vertical root fractures of various intracanal materials A, blank; B, fiber post; C, gutta-percha point; D, titanium post; E, gold-palladium post (VRF group); F, gold-palladium post (control group). The red arrow represents the root fracture line."

Table 1

Results of CBCT scans examination of various intracanal materials"

Group True positive False positive True negative False negative Total
Blank 11 0 12 1 24
Fiber post 11 1 11 1 24
Gutta-percha point 10 1 11 2 24
Titanium post 9 2 10 3 24
Gold-palladium post 4 5 7 8 24

Table 2

Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CBCT scans of various intracanal materials /%"

Group Sensitivity Specificity Accuracy Positive predictive value Negative predictive value
Blank 91.67 100.00 95.83 100.00 92.31
Fiber post 91.67 91.67 91.67 91.67 91.67
Gutta-percha point 83.33 91.67 87.50 90.91 84.62
Titanium post 75.00 83.33 79.17 81.81 76.92
Gold-palladium post 33.33 58.33 45.83 44.44 46.67

Table 3

Statistical analysis of CBCT scans of various intracanal materials"

Group Number of correct diagnosis Number of error diagnosis P value compared with the blank group
Blank 23 1
Fiber post 22 2 >0.999
Gutta-percha point 21 3 0.500
Titanium post 19 5 0.125
Gold-palladium post 11 13 < 0.001
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