Accuracy of tuned aperture computed tomography in the diagnosis of radicular fractures in non-restored maxillary anterior teeth -: an in vitro study

Objectives: This study compared the accuracy of three radiographic imaging modalities for the detection of artificially induced radicular fractures on maxillary anterior teeth. Methods: Fractures were induced in 28 of 54 maxillary incisors in 15 cadaver specimens using a distally directed force. Radiographs evaluated included conventional two-dimensional direct digital radiographs (DDI), unprocessed Tuned Aperture Computed Tomography (TACT-U) and iteratively restored TACT (TACT-IR). Eight observers recorded their findings using a five-point confidence-rating scale. Receiver Operating Characteristic (ROC) analyses were done, followed by ANOVA to test for significant effects of observers, imaging modality and fracture location. Post hoc tests were carried out in instances where ANOVA indicated significance. Results: The areas under the ROC-curves (A,) were, respectively: DDL 0.53; TACT-U: 0.83 and TACT-IR: 0.97. TACT-IR and TACT-U performed significantly better than DDI (P < 0.001) with TACT-IR providing a higher detection accuracy than TACT-U (P < 0.033). A difference in detection accuracy was also noted based on fracture location (P < 0.001). Tukey's post hoc analyses revealed that fractures extending beyond the middle third of the root were more accurately detected. Inter-observer agreement was 0.68, and intra-examiner agreement, 0.87 (kappa analysis). Conclusions: TACT performed significantly better than direct digital images in detecting trauma-induced radicular fractures in unrestored, maxillary anterior teeth.