Análise de diferentes protocolos de aparelhos de tomografia computadorizada de feixe cônico na identificação de fraturas radiculares verticais

Abstract

The clinical and radiographic characteristics of root fractures resemble those of periodontal disease and endodontic failure, compromising the differential diagnosis even in more advanced cases. An early diagnosis of this condition is essential to preserve the supporting periapical tissues and to avoid inappropriate and/or unnecessary treatments. This study evaluated the effectiveness of different Cone Beam Computed Tomography (CBCT) device protocols with different image resolutions in identifying root fractures. Twenty-four single-rooted teeth were used and were endodontically prepared in a standardized way. The canals were filled in 16 teeth, 8 of which received, in addition to gutta-percha, fiberglass posts, or metallic posts. Root fractures were induced in half of the sample. The teeth were then included in a dry jaw and subsequently scanned by two CBCT devices OP300 Maxio CBCT unit (Instrumentarium Dental, Tuusula, Finland) in 4 protocols and 3D Veraview X800 F150P (J Morita, Kyoto, Japan) in 3 different protocols. Five evaluators (three oral radiologists and two endodontists), blinded, experienced, and previously calibrated, analyzed, and classified the images using a 5-point scale for detecting root fractures. Statistical analysis of the results was performed using diagnostic tests and weighted Kappa. The OP 300 Maxio and 3D Veraview X800 F150P devices presented an accuracy of 0.88 and 0.83 and a sensitivity of 0.78 and 0.83, respectively. The OP 300 Maxio device showed a high specificity of 0.98, while that of the 3D Veraview X800 F150P was 0.83. Both CBCT devices tested were suitable for identifying root fractures. The high-resolution device (3D Veraview X800 F150P) demonstrated greater accuracy in detecting root fractures in roots with metallic posts, while the OP300 Maxio showed greater accuracy in the presence of fiberglass posts. The presence of gutta-percha compromised identification in both devices. [resumo fornecido pelo autor]