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

PLOS ONE, Dec 2019

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.

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

January The Extent of the Crack on Artificial Simulation Models with CBCT and Periapical Radiography Shuang Wang 1 2 3 Yiran Xu 0 1 3 Zhengyan Shen 1 2 3 Lijun Wang 1 3 Feng Qiao 1 3 Xu Zhang 1 2 3 Minghua Li 1 3 Ligeng Wu 1 2 3 0 Department of Endodontics, Stomatological Hospital of Yantai , Shandong , China , 3 Department of Radiology, School of Stomatology, Tianjin Medical University , Tianjin , China , 4 Department of Maxillofacial Surgery, School of Stomatology, Tianjin Medical University , Tianjin , China , 5 BYBO Dental Group , Beijing , China 1 Funding: This study was supported by the National Natural Science Foundation of China , Grant no. 81571016 2 Department of Endodontics, School of Stomatology, Tianjin Medical University , Tianjin , China 3 Editor: Ryan K. Roeder, University of Notre Dame , UNITED STATES - Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Competing Interests: The authors have declared that no competing interests exist. Background Methods 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. Forty-four teeth with different extents of artificial cracks, created by exposure to liquid nitrogen after hot water at 100ÊC, were collected. They were subjected to PR and CBCT. Microcomputed 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. Introduction Tooth cracks have become the third largest cause of tooth loss after dental caries and periodontal disease [ 1 ]. Early enamel cracks have no obvious symptoms, and patients often fail to see a dentist. Most patients with cracks who do see a dentist do so whilst suffering because of pulpitis and periapical periodontitis, or even root fracture [ 2 ]. This creates a great challenge for designing an appropriate treatment plan and assessing the long-term prognosis for cracked teeth [ 3 ]. Kim [ 4 ] studied 72 cracked teeth, and different treatment plans were undertaken based on their differing clinical symptoms. Tooth cracks exhibit these different clinical symptoms as a function of depth; when the crack is only in the enamel or superficial dentin, the teeth may be asymptomatic, or exhibit only dentin hypersensitivity to cold, sweet, and sour stimuli. If there is dental pulpitis or periapical periodontitis, however, the crack may have reached to the deep dentin layers or invaded the pulp cavity. Michaelson [ 5 ] reported 3 cases of cracked teeth. In early treatment, the crack was visible, but was not assessed for its range or depth. Additionally, no measures were taken to interfere with crack development. Though the depth of the crack in these cases was within the clinical treatment limit, a good therapeutic effect was still achieved. Nonetheless, early diagnosis and treatment can save the vital pulp of a cracked tooth where positive outcomes would otherwise be difficult [ 6,7 ]. Therefore, early intervention for cracked teeth is more likely to produce a bet (...truncated)


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Shuang Wang, Yiran Xu, Zhengyan Shen, Lijun Wang, Feng Qiao, Xu Zhang, Minghua Li, Ligeng Wu. The Extent of the Crack on Artificial Simulation Models with CBCT and Periapical Radiography, PLOS ONE, 2017, Volume 12, Issue 1, DOI: 10.1371/journal.pone.0169150