Imaging Sci Dent.  2024 Jun;54(2):139-145. 10.5624/isd.20230233.

Vertical root fracture diagnosis in teeth with metallic posts: Impact of metal artifact reduction and sharpening filters

• Ruiz DC
• Rosado LPL
• Fontenele RC
• Farias-Gomes A
• Freitas DQ

• KMID: 2557116
• DOI: http://doi.org/10.5624/isd.20230233

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 intraexaminer 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.

Keyword

Tooth Fractures; Radiographic Image Enhancement; Cone-Beam Computed Tomography; Artifacts