Figure 1
Radiolucent line 11. Hassan B. Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009; 35:719-722. at the distal root of tooth #46 on periapical radiography (PR) (A). Presence of other lines in the roots on PR. Patient with local pain symptoms. CBCT scans was performed due to suspicion of root fracture. The line on the periapical image was not a fracture, but a projection of the lingual alveolar ridge (2, 3 and 4), visible in a 3D tomographic section (5 mm) (B and C). Multiplanar sections (D, E, F) indicated the alveolar ridge projected in the synchronized 3D section (C) 44. Edlund M, Nair MK, Nair UP. Detection of vertical root fractures by using cone-beam computed tomography: A clinical study. J Endod 2011; 37:768-772. forming the image of a line 22. Melo SLS, Bortoluzzi EA, Abreu M, Corrêa LR, Corrêa M. Diagnostic ability of a cone-beam computed tomography scan to assess longitudinal root fractures in prosthetically treated teeth. J Endod 2010; 36:1879-1882..
Figure 2
Distribution of root fractures. 1 (A) Fracture line orientation: 1. horizontal; 2. vertical; 3. oblique. 2 (B) Root position of the fracture: 1. cervical third; 2. middle third; 3. apical third; 3 (C) Coronoradicular fracture position: 1. coronary fracture; 2. coronal-radicular fracture; 3. root fracture; 4 (C) Fracture continuity: 1. crack; 2. incomplete fracture; 3. complete fracture; 5 (C) Bone extension of the fracture: 1. supraosseous fracture, 2. fracture at the bone level; 3. infraosseous fracture.
Figure 3
CBCT scans in axial plane with root fracture line (A - F). Curved line 11. Hassan B. Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009; 35:719-722. and well defined in axial sections is indicative of fracture, schematically represented in red (B). Thin and discrete line 22. Melo SLS, Bortoluzzi EA, Abreu M, Corrêa LR, Corrêa M. Diagnostic ability of a cone-beam computed tomography scan to assess longitudinal root fractures in prosthetically treated teeth. J Endod 2010; 36:1879-1882. in continuity schematically represented in black (B). Bone loss in local vertical alveolar. Location: palatal root of maxillary molar.
Figure 4
Presence of dense endodontic filling material 55. Wang P, Yan XB, Lui DG, et al. Detection of dental root fractures by using cone-beam computed tomography. Dentomaxillofac Radiol2011; 40:290-298., artifact-generating font 66. Metska ME , Aartman IHA, Wesselink PR , Özok AR. Detection of vertical root fractures in vivo in endodontically treated teeth by cone-beam computed tomography scans. J Endod 2012; 38:1344-1347. visible in the CBCT scans of the MPR (B, C and D). Curved shape of the endodontic material 11. Hassan B. Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009; 35:719-722. forms in the neighborhood a dark artifact also with a curved shape 33. Yiit-Özer S. Detection of vertical root fractures of different thicknesses in endodontically enlarged teeth by cone beam computed tomography versus digital radiography. J Endod2010; 36:1245-1249., like a copy. Discreetly curved shape of the endodontic material 44. Edlund M, Nair MK, Nair UP. Detection of vertical root fractures by using cone-beam computed tomography: A clinical study. J Endod 2011; 37:768-772. forms in the neighborhood a dark artifact also with a curved shape 33. Yiit-Özer S. Detection of vertical root fractures of different thicknesses in endodontically enlarged teeth by cone beam computed tomography versus digital radiography. J Endod2010; 36:1245-1249., which may be a fine, sharp line of artifact. 3D referential indexed (A).
Figure 5
CBCT scans in axial planes with irregular root fracture line (A to H). Axial tomographic section (B) with irregular line 11. Hassan B. Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009; 35:719-722. indicative of fracture schematically represented in red. Line present in other tomographic sections of MPR. Line in place without the possibility of projecting artifacts (H) schematically represented in blue. Curved line 33. Yiit-Özer S. Detection of vertical root fractures of different thicknesses in endodontically enlarged teeth by cone beam computed tomography versus digital radiography. J Endod2010; 36:1245-1249. in axial section indicative of fracture schematically represented in black (H). Location: maxillary molar root.
Figure 6
Discrete fracture line 11. Hassan B. Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009; 35:719-722. incompletely visible on the CBCT slices of the MPR (B and D). Bone loss 22. Melo SLS, Bortoluzzi EA, Abreu M, Corrêa LR, Corrêa M. Diagnostic ability of a cone-beam computed tomography scan to assess longitudinal root fractures in prosthetically treated teeth. J Endod 2010; 36:1879-1882. located equidistant from the fracture line. Lateral angles of bone loss close to the rectum 33. Yiit-Özer S. Detection of vertical root fractures of different thicknesses in endodontically enlarged teeth by cone beam computed tomography versus digital radiography. J Endod2010; 36:1245-1249. and preserved adjacent periodontal space 44. Edlund M, Nair MK, Nair UP. Detection of vertical root fractures by using cone-beam computed tomography: A clinical study. J Endod 2011; 37:768-772. visible (B). Wedge aspect of bone loss 55. Wang P, Yan XB, Lui DG, et al. Detection of dental root fractures by using cone-beam computed tomography. Dentomaxillofac Radiol2011; 40:290-298. suggests incomplete fracture visible (C), but this shape is also common in periodontal disease. 3D referential indexed (A).
Figure 7
CBCT scans in MPR with conventional contrast (B, C and D). Slices with reduced contrast (E). 3D indexed referential (A). Artifact 11. Hassan B. Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009; 35:719-722. forming a dark line at the apex of the intracanal post, which could be confused with a fracture (C and E). The visualization of post apex limit is best evidenced with the preset of contrast reduction using BAR filter on the e-Vol DX (E). New tomography slice after post removal (F) showing the elimination of the artifact line. Images of artifact lines 22. Melo SLS, Bortoluzzi EA, Abreu M, Corrêa LR, Corrêa M. Diagnostic ability of a cone-beam computed tomography scan to assess longitudinal root fractures in prosthetically treated teeth. J Endod 2010; 36:1879-1882. can be projected onto teeth adjacent to the generating source (B).
Figure 8
CBCT scans (MPR) with conventional contrast (B, C and D). Image with application of contrast reduction preset with BAR filter on e-Vol DX (F, G and H). 3D indexed referential (A and E). Fracture line 11. Hassan B. Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009; 35:719-722. partially visible in the sagittal slice with conventional contrast (C) and with wider visibility in the sagittal slice with reduced contrast (G). The curved shape of the line 22. Melo SLS, Bortoluzzi EA, Abreu M, Corrêa LR, Corrêa M. Diagnostic ability of a cone-beam computed tomography scan to assess longitudinal root fractures in prosthetically treated teeth. J Endod 2010; 36:1879-1882. in the axial plane (A and F) is indicative of root fracture. Line distant from the area of possible artifact generation is indicative of root fracture, which can lead to doubt in the axial plane with conventional contrast (B), and with contrast reduction (F) the fracture line 22. Melo SLS, Bortoluzzi EA, Abreu M, Corrêa LR, Corrêa M. Diagnostic ability of a cone-beam computed tomography scan to assess longitudinal root fractures in prosthetically treated teeth. J Endod 2010; 36:1879-1882. is clearly far from the post (artifact-generating source).
Figure 9
Accessory root canal visible in MPR CBCT sections (B, C and D) in the form of a line 11. Hassan B. Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009; 35:719-722. in the section (B); in line shape 22. Melo SLS, Bortoluzzi EA, Abreu M, Corrêa LR, Corrêa M. Diagnostic ability of a cone-beam computed tomography scan to assess longitudinal root fractures in prosthetically treated teeth. J Endod 2010; 36:1879-1882. in slice (D) and in point shape 33. Yiit-Özer S. Detection of vertical root fractures of different thicknesses in endodontically enlarged teeth by cone beam computed tomography versus digital radiography. J Endod2010; 36:1245-1249. in slice C, and the line-line-dot sequence characterizes the presence of a canal and excludes fracture. Image of lateral canal 44. Edlund M, Nair MK, Nair UP. Detection of vertical root fractures by using cone-beam computed tomography: A clinical study. J Endod 2011; 37:768-772. also visible in realistic 3D (E). Visible fracture in tomographic sections of the MPR (G and I) in the form of a line 55. Wang P, Yan XB, Lui DG, et al. Detection of dental root fractures by using cone-beam computed tomography. Dentomaxillofac Radiol2011; 40:290-298. in the section (G); line-shaped 66. Metska ME , Aartman IHA, Wesselink PR , Özok AR. Detection of vertical root fractures in vivo in endodontically treated teeth by cone-beam computed tomography scans. J Endod 2012; 38:1344-1347. in slice (I) and amorphous, moderately hypodense area 77. Kajan ZD, Taromsari M. Value of cone beam CT in detection of dental root fractures. Dentomaxillofac Radiol 2012;41:3-10. in slice (H). Image of fracture 44. Edlund M, Nair MK, Nair UP. Detection of vertical root fractures by using cone-beam computed tomography: A clinical study. J Endod 2011; 37:768-772. also visible in realistic 3D (J). 3D referential indexed (A and F).
Figure 10
Radicular groove 11. Hassan B. Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009; 35:719-722. visible on tomographic scans (MPR)(C, E, F and G) in the form of a fracture-like line. The rounded margins schematically represented in red 22. Melo SLS, Bortoluzzi EA, Abreu M, Corrêa LR, Corrêa M. Diagnostic ability of a cone-beam computed tomography scan to assess longitudinal root fractures in prosthetically treated teeth. J Endod 2010; 36:1879-1882. characterize the radicular groove and differ from fractures, being visible in the axial section (B) and in realistic 3D (A and B). 3D referential indexed in (D).