Using a CBCT to find a vertical root fracture (VRF)
The accuracy of CBCT diagnosis of a vertical root fracture VRF is poor, especially if the root has a post. Dias JOE 2020 Kumar JOE 2021 meta-analysis finds the same result. CBCT imaging is still not good toll for diagnoinsg vertiacl root fracture in teeth with root canals.
A tooth with a vertical fracture will often cause diffuse pain around the tooth that is difficult or impossible for the patient or doctor to accurately identify. It can make several teeth in the area sore and although the patient can point to a general area, they have trouble pinpointing a particular tooth. If Traditional x-rays are not helpful because cracks in teeth, and thus vertical root fractures, do not show up. Cracked teeth are often clinically difficult to diagnosis, although if the crack is a vertical root fracture there may be an excessive probing depth in the area to help. However, that is not always the case, so to have a CBCT system that can detect vertical root fractures is very helpful. Unfortunately, this can be a lot to ask of a CBCT systems. It is often impossible because the teeth that are most likely to need an extraction have metal posts or root canals and that creates interference right in the area that needs to be viewed.
I was happy to see that iCAT showed vertical root fractures better than other systems recently tested and published in the Journal of Endodontics. Elsaltani JOE 2016
CBCT vertical root fracture in tooth without post or root canal
CBCT vertical root fracture in tooth with root canal
Viewing these images shows very nicely the detail the iCAT is capable of. Especially impressive is the imaging of the tooth with a root canal, as this is a far more common scenario that we would encounter clinically and have trouble diagnosing exactly what is going on. Although this was done with the Next Generation and not the CBCT FLX system that we have, it’s nice to see the company that we have invested in come out on top. As an orthodontic, as well as a general and pediatric dental office, the thing we like about the iCAT FLX is the ability to take imaging with much lower levels of radiation. We can customize the imaging based on how much information we actually need.