The Extent of the Crack on Artificial Simulation Models with CBCT and Periapical Radiography

BACKGROUND: The aim of this study was to investigate the extent of the crack of a cracked tooth on an artificial simulation model with Periapical Radiography (PR) and cone beam computed tomography (CBCT) in vitro, providing the basis for early diagnosis and an appropriate treatment plan. METHODS: Forty-four teeth with different extents of artificial cracks, created by exposure to liquid nitrogen after hot water at 100°C, were collected. They were subjected to PR and CBCT. Micro-computed tomography (micro-CT) examination, regarded as a relatively more accurate measurement than others, was used to measure and record the crack depth. Three observers, an endodontic graduate student, an experienced endodontist, and an experienced radiologist, examined the PR and CBCT results independently, and the presence or absence of cracks with PR and CBCT were respectively recorded. The external consistency ICC with 95% confidence interval (95% CI) was used to analyze the consistency among the graduate student, endodontist, and radiologist; ROC curves were used for the analysis of diagnostic performance of both radiographic modalities for tooth cracks with crack depth. RESULTS: For the interpretation of the PR results, there were statistically significant differences among the three different observers (P < 0.001), and the interpretation of the CBCT results (P < 0.001). In the group of results read by the graduate student, the sensitivity of diagnosis with CBCT and PR was 77.27% and 22.73%, respectively (P < 0.001). In the group of results read by the endodontist, the sensitivity of diagnosis with CBCT and PR was 81.81% and 8.19%, respectively (P < 0.001). In the group of results read by the radiologist, the sensitivity of diagnosis with CBCT and PR was 88.64% and 11.36%, respectively (P < 0.001). As for CBCT diagnosis, the critical value for the graduate, endodontist, and radiologist was 3.20 mm, 2.06 mm, and 1.24 mm, respectively. For the PR diagnosis, the critical value for the graduate, endodontist, and radiologist was 6.12 mm, 6.94 mm, and 6.94 mm, respectively. CONCLUSIONS: Within the limitations of this study, on an artificial simulation model of cracked teeth for early diagnosis, we recommend that it would be better for a cracked tooth to be diagnosed by a radiologist with CBCT than PR, CBCT with a minimum depth of 1.24 mm.