Variable-resolution cone-beam computerized tomography with enhancement filtration compared with intraoral photostimulable phosphor radiography in detection of transverse root fractures in an in vitro model

ObjectivesThe aim of this study was to compare the diagnostic accuracy of an intraoral photostimulable storage phosphor (PSP) plate system and cone-beam computerized tomography scanning (CBCT) for detection of experimentally induced transverse root fractures and to evaluate differences between original images and images enhanced with high-pass filters.Study designSixty-nine extracted human teeth, 34 with root fractures and 35 without, were examined under standardized conditions using an intraoral PSP system (Digora Optime; Soredex). The images were saved in original 8-bit format and in a version sharpened with a high-pass filter. The teeth were examined with CBCT (i-Cat; Imaging Sciences) in 2 resolutions: 0.125 mm and 0.25 mm voxel size. Original images were saved together with images enhanced with 2 high-pass filters, sharpen and angio-sharpen. Six observers scored the presence of a root fracture in all modalities in random order. Sensitivity, specificity, and accuracy [(true positives + true negatives)/all scores] were calculated for each modality and each observer. Differences were estimated by analyzing the binary data, assuming additive effects of observer and modality in a generalized linear model.ResultsHigh-resolution original CBCT images had higher sensitivity (P < .05) than lower-resolution images and PSP images (0.125 mm resolution 87%, 0.25 mm resolution 72%, and PSP 74%). Angio-sharpen–filtered images for both CBCT resolutions had higher sensitivities (P < .02) than the original images (0.125 mm resolution: 95% vs. 87%; 0.25 mm resolution: 81% vs. 72%). There was no significant difference between the lower-resolution CBCT and PSP images. Only small differences in specificity were seen between modalities, and accuracy was higher for high-resolution CBCT than for the other modalities (P < .03).ConclusionsHigh-resolution i-Cat CBCT images resulted in an increase in sensitivity without jeopardizing specificity for detection of transverse root fractures compared with lower-resolution CBCT images, which were not more accurate than periapical PSP images. The angio-sharpen high-pass filter improved sensitivity in the high-resolution CBCT images in this in vitro model.