Restor Dent Endod.  2023 May;48(2):e16. 10.5395/rde.2023.48.e16.

Influence of CBCT parameters on image quality and the diagnosis of vertical root fractures in teeth with metallic posts: an ex vivo study

• Lagos de Melo LP
• Queiroz PM
• Moreira-Souza L
• Nadaes MR
• Santaella GM
• Oliveira ML
• Freitas DQ

• KMID: 2548219
• DOI: http://doi.org/10.5395/rde.2023.48.e16

Abstract

Objectives
The aim of this study was to evaluate the influence of peak kilovoltage (kVp) and a metal artifact reduction (MAR) tool on image quality and the diagnosis of vertical root fracture (VRF) in cone-beam computed tomography (CBCT).
Materials and Methods
Twenty single-rooted human teeth filled with an intracanal metal post were divided into 2 groups: control (n = 10) and VRF (n = 10). Each tooth was placed into the socket of a dry mandible, and CBCT scans were acquired using a Picasso Trio varying the kVp (70, 80, 90, or 99), and the use of MAR (with or without). The examinations were assessed by 5 examiners for the diagnosis of VRF using a 5-point scale. A subjective evaluation of the expression of artifacts was done by comparing random axial images of the studied protocols. The results of the diagnoses were analyzed using 2-way analysis of variance and the Tukey post hoc test, the subjective evaluations were compared using the Friedman test, and intra-examiner reproducibility was evaluated using the weighted kappa test (α = 5%).
Results
The kVp and MAR did not influence the diagnosis of VRF (p > 0.05). According to the subjective classification, the 99 kVp protocol with MAR demonstrated the least expression of artifacts, while the 70 kVp protocol without MAR led to the most artifacts.
Conclusions
Protocols with higher kVp combined with MAR improved the image quality of CBCT examinations. However, those factors did not lead to an improvement in the diagnosis of VRF.

Keyword

Artifacts; Cone-beam computed tomography; Diagnostic imaging; Vertical root fracture

Figure

• 

  Figure 1 Obtaining the axial images used in the qualitative assessment of artifacts in all protocols. (A) Axial orientation line positioned 3 mm from the superior limit of the root and perpendicular to the root in an adjusted coronal reconstruction. (B) Axial reconstruction used in the template.

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  Figure 2 Example of the template used in the qualitative evaluation of artifacts. The images correspond to the axial reconstructions of the same tooth (of the group with vertical root fracture) obtained with all the studied protocols. (A) 70 kVp with MAR. (B) 80 kVp without MAR. (C) 99 kVp with MAR. (D) 90 kVp with MAR. (E) 99 kVp without MAR. (F) 80 kVp with MAR. (G) 70 kVp without MAR. (H) 90 kVp without MAR. The arrows indicate the fracture.kVp, peak kilovoltage; MAR, metal artifact reduction.

• 

  Figure 3 Distribution of the responses of the examiners for artifact expression in all protocols.kVp, peak kilovoltage; MAR, metal artifact reduction.

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