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

• Published in: Imaging science in dentistry Vol. 54; no. 2; pp. 139 - 145
• Main Authors: Ruiz, Débora Costa, Rosado, Lucas P Lopes, Fontenele, Rocharles Cavalcante, Farias-Gomes, Amanda, Freitas, Deborah Queiroz
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Academy of Oral and Maxillofacial Radiology 01.06.2024
• Subjects: Original; Artifacts; Tooth Fractures; Cone-Beam Computed Tomography; Radiographic Image Enhancement
• ISSN: 2233-7822; 2233-7830
• DOI: 10.5624/isd.20230233

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). 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. Neither MAR nor the application of sharpening filters significantly impacted AUC or specificity ( >0.05). However, sensitivity increased when MAR was combined with Sharpen 1× and Sharpen 2× ( =0.015). The intra-examiner agreement ranged from fair to substantial (0.34-0.66), while the inter-examiner agreement ranged from fair to moderate (0.27-0.41). MAR in conjunction with sharpening filters improved VRF detection; therefore, their combined use is recommended in cases of suspected VRF.