Detection of in vitro vertical root fractures with and without a metal artifact reduction algorithm.

Vertical root fractures are a diagnostic challenge for clinicians due to their non-specific clinical symptoms, small size, and slow progression. They are also challenging because they often occur in endodontically treated teeth. Both clinical symptoms and correlation with radiographic findings are important for the diagnosis of vertical root fractures. CBCT is recommended for diagnosis when two-dimensional imaging is inconclusive. Although CBCT has many advantages over two-dimensional imaging, there can be artifacts in the scans when there are high density materials such as gutta-percha or metal in the scan. These high-density materials are often found within the endodontically treated teeth in which vertical root fractures occur. There have been many techniques proposed and attempts to reduce the metal artifact in these scans. Many CBCT manufacturers have produced their own proprietary post-processing algorithms, yet very little is known about these proprietary systems of their efficacy. To date no study has evaluated the Carestream 9600 (Carestream Dental LLC, Atlanta Georgia) metal artifact reduction algorithm in the evaluation of vertical root fractures. Vertical root fractures were induced in 50 teeth and an additional 50 teeth were endodontically treated without vertical root fractures as controls. 300 randomized and anonymized scans were evaluated independently by two calibrated oral and maxillofacial radiology residents. Half of the scans had metal artifact algorithm while the other half did not. There is no difference in the accuracy of detecting a vertical root fracture with or without a metal artifact reduction algorithm using a Carestream 9600 (Carestream Dental LLC, Atlanta Georgia).