Influence of X-ray beam angulations on the detection of horizontal root fractures

Aims: The aim of this study was to evaluate the variation of vertical angle for detection of fractures. Materials and Methods: Twenty-five (25) single-rooted premolar teeth were divided into two groups, fractured teeth (n = 15) and non-fractured teeth (n = 10). Artificially fractured teeth were classified according to location, number of fragments, and direction of fracture line: Horizontal, oblique, or complex. The tooth fragments were juxtaposed with cyanoacrylate, and the specimens (fractured and non-fractured) were placed individually in the dental alveolus of a human jaw with the aid of silicone rubber impression material and submitted to eight periapical radiographs in a digital sensor with a vertical range of 10 degrees (−40, −30, −20, −10, 0, +10, +20, +30). Three examiners evaluated the characteristics of the fractures and their correlation with the radiographic diagnosis (perceived or not) by varying the vertical angle. Statistical Analysis: Descriptive analysis was performed through the analytical comparison and Kappa test inter-examiner. Results: Among the three examiners, inter-examiner Kappa value was 0.536. The radiographic identification of root fracture in the 15 prepared samples was 60% (nine) at angle 0, and at the angles of +10, −10, and −20, it was less than 50%. Conclusions: Multiple radiographs with variations of vertical angle are fundamental to facilitate the diagnosis of horizontal root fractures in premolars.