CBCT Performance and Endodontic Sealer Influence in the Diagnosis of Vertical Root Fractures

To evaluate the performance of three cone beam computed tomography (CBCT) machines in detecting vertical root fractures (VRFs) in teeth filled with different sealers. A total of 80 single-rooted premolars were subjected to instrumentation and restoration with gutta-percha + AH Plus sealer, gutta-percha + sealer 26, gutta-percha + fill canal, and gutta-percha without sealer as the control. Half of the samples were randomly subjected to root fracture and all the teeth were scanned by i-CAT (Imaging Sciences International, Hatfield, USA), PreXion (PreXion Inc., San Mateo, USA), and OrthoPhos XG (Sirona Dental System, Bensheim, Germany). Three examiners analyzed the images for the presence of fractures. The highest accuracy was obtained with the PreXion device, with Az = 0.85, while the i-CAT device provided higher sensitivity (0.93). The specificity values observed ranged between 0.75 and 0.70. Chi-squared tests ( > 0.05) demonstrated that the sealers did not exert a significant influence on the diagnosis of VRF. It may be concluded that endodontic sealers do not influence the detection of VRF. The PreXion device was the most accurate, having the highest specificity value. Radiopaque materials might affect the diagnosis of VRFs because they can simulate fracture lines, leading to false-positive results. Moreover, CBCT machines present different specificities that could exert some influence on that.