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Byline: Dattaraj. Sawarkar, Pankaj. Singh, Saquib. Siddique, Deepak. Agrawal, Guru. Satyarthee, Deepak. Gupta, Sumit. Sinha, Shashank. Kale, Bhawani. Sharma Introduction : Odontoid fractures constitute 9-20% of all adult cervical spine [...]

Purpose: This study aimed to evaluate the accuracy of detecting vertical root fractures in Biodentine™-filled teeth using the Promax 3Dmax cone-beam computed tomography (CBCT) unit compared to periapical radiographs. It tested hypotheses regarding CBCT's diagnostic superiority in non-root-filled and Biodentine™-root-filled maxillary central incisors and assessed the impact of smaller field of view and lower intensity settings on detection accuracy. Materials and methods: Extracted maxillary incisors were divided into groups based on fracture status and root filling material, then placed in a Thiel-embalmed skull to simulate clinical conditions. The teeth were imaged using periapical radiographs and the CBCT unit under different settings. Fracture thickness was measured with microcomputed tomography for accuracy benchmarking. Multiple observers assessed the images, and statistical analyses were conducted to evaluate diagnostic performance. Results: Intra-rater reliabilities of consensus scores ranged from good to very good. Specificities were generally higher than sensitivities across all imaging modalities, but sensitivities remained constantly low. None of the Area Under the Curve scores exceeded 0.6, indicating poor overall accuracy for all imaging modalities. Paired comparisons of the area differences under Receiver Operator Characteristic curves revealed no significant differences between the CBCT and periapical radiograph techniques for detecting vertical root fractures in either Biodentine™-filled or non-root-filled teeth. Conclusions: There was no significant accuracy improvement of the current CBCT device (Promax 3Dmax, Planmeca, Finland) over periapical radiographs in detecting small vertical root fractures in both non-root-filled and Biodentine™-root-filled maxillary central incisors. A smaller field of view with lower intensity did not enhance detection accuracy. These results highlight the challenges in accurately detecting small VRFs, emphasizing the need for further research and technological advancements in this domain. [ABSTRACT FROM AUTHOR]

Early diagnosis of cracked tooth syndrome may prevent further crack propagation, thus allowing the retention or a more conservative treatment of the tooth. For this purpose, in the second part of this paper the diagnostic and clinical features are presented, so that the dentist can recognize the related signs and symptoms and reach the final diagnosis. The available methods and techniques for the management of cracked tooth are presented, and a detailed description of the application of both direct and indirect restorations is provided and highlights all factors that may affect tooth prognosis. [ABSTRACT FROM AUTHOR]

The aim of this review was to evaluate whether CBCT is reliable for the detection of root fractures in teeth without root fillings, and whether the voxel size has an impact on diagnostic accuracy. The studies published in PubMed, Web of Science, ScienceDirect, Cochrane Library, Embase, Scopus, CNKI and Wanfang up to May 2014 were the data source. Studies on nonroot filled teeth with the i- CAT ( n = 8) and 3D Accuitomo CBCT ( n = 5) units were eventually selected. In the studies on i- CAT, the pooled sensitivity was 0.83 and the pooled specificity was 0.91; in the 3D Accuitomo studies, the pooled sensitivity was 0.95 and pooled specificity was 0.96. The i- CAT group comprised 5 voxel size subgroups and the 3D Accuitomo group contained 2 subgroups. For the i- CAT group, there was a significant difference amongst the five subgroups (0.125, 0.2, 0.25, 0.3 and 0.4 mm; P = 0.000). Pairwise comparison revealed that 0.125 mm voxel subgroup was significantly different from those of 0.2, 0.25 and 0.3 mm voxel subgroups, but not from the 0.4 mm voxel subgroup. There were no significant differences amongst any other two subgroups (by α′ = 0.005). No significant difference was found between 0.08 mm and 0.125 mm voxel subgroups ( P = 0.320) for the 3D Accuitomo group. The present review confirms the detection accuracy of root fractures in CBCT images, but does not support the concept that voxel size may play a role in improving the detection accuracy of root fractures in nonroot filled teeth. [ABSTRACT FROM AUTHOR]