Accuracy of High-resolution Small-volume Cone-Beam Computed Tomography in the Diagnosis of Vertical Root Fracture: An In Vivo Analysis

IntroductionThe purpose of this in vivo study was to evaluate the accuracy of small-volume cone-beam computed tomographic (CBCT) imaging compared with conventional periapical radiography (CPR) in the diagnosis of vertical root fractures (VRFs) using exploratory surgery as the reference standard.MethodsEighty-two dental records of 85 teeth with suspected VRFs that underwent CPR, CBCT imaging, and exploratory surgery were included. Two observers assessed CPR and CBCT images independently for the presence or absence of root fractures, and findings from the exploratory surgery were considered the reference standard. Diagnostic sensitivity, specificity, accuracy, and the receiver operating characteristic curve values were obtained. The effect of single- and multirooted teeth on diagnostic accuracy as well as the association between clinical symptoms and the presence of VRFs were also assessed.ResultsVRFs were surgically detected in 64 of the 85 teeth (75.3%), of which 62.5% were multirooted and 76.6% had intracanal posts. CBCT imaging was more sensitive and accurate (65.6% and 64%) than CPR (27.3% and 40.5%). Both CPR and CBCT diagnostic accuracies were higher in single- than multirooted teeth. Pain on percussion, a localized periodontal pocket, and tooth mobility were associated with the presence of VRFs (P < .05; odds ratio = 4.15, 13.5 and 4.1, respectively).ConclusionsThe accuracy of CBCT imaging for the diagnosis of VRFs was poor, although it was higher than with CPR. Multirooted teeth in the presence of intracanal posts may limit its diagnostic value.     

Improvement in accuracy of maxillary repositioning of Le Fort I osteotomy with Orthopilot™ Navigation System: evaluation of 30 patients

Traditional model surgery with facebow transfer is not very accurate. We aimed to demonstrate that the Orthopilot™ Navigation System improves the accuracy of maxillary repositioning during Le Fort I osteotomy. Thirty patients underwent Le Fort I osteotomy alone or associated to sagittal split osteotomy. The maxilla positioning was done in two phases. First, the maxilla was positioned with the traditional occlusal splint, the position (“without Orthopilot™”) was recorded by the Orthopilot™. In the second phase, the Orthopilot™ was used to improve positioning; and the final position (“with Orthopilot™”) was recorded, after osteosynthesis. Positioning data were compared with planned data. Positioning data with and without the Orthopilot™ were also compared. Accuracy was classified in distinct classes with three major criteria (conformity, non-conformity, failure) according to the discrepancies. Conformity rate was significantly greater with the Orthopilot™ (2 without the Orthopilot™ compared with 8 with the Orthopilot™; p = 0.01). The failure rate was significantly lower with the Orthopilot™ (18 without Orthopilot™ compared with 7 with the Orthopilot™; p = 0.002). Dispersions of discrepancies were usually lower in all directions with the Orthopilot™. Navigation reduced the risk of discrepancy without cancelling it, especially when large movements are planned. The Orthopilot™ therefore improved the accuracy of traditional occlusal splint during Le Fort I osteotomy.     

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography(MDCT) in suspected scaphoid fractures.METHODS: One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities.RESULTS: Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients(42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT(P < 0.01) concerning scaphoidfracture detection. The mean effective dose of MDCT was 0.1 m Sv compared to 0.002 m Sv of conventional radiography.CONCLUSION: Conventional radiography is insufficient for accurate scaphoid fracture detection. Regarding the almost negligible effective dose, MDCT should serve as the first imaging modality in wrist trauma.