The detection of vertical root fractures in root filled teeth with periapical radiographs and CBCT scans S. Patel 1 , E. Brady 1 , R. Wilson 2 , J. Brown 3 & F. Mannocci 1 1 Department of Conservative Dentistry, King’s College London Dental Institute, London; 2 Department of Periodontology, King’s College London Dental Institute, London; and 3 Department of Dento-Maxillofacial Imaging, King’s College London Dental Institute, London, UK Abstract Patel S, Brady E, Wilson R, Brown J, Mannocci F. The detection of vertical root fractures in root filled teeth with periapical radiographs and CBCT scans. International Endodontic Journal, 46, 1140–1152, 2013. Aim To compare ex vivo the diagnostic accuracy of cone beam computed tomography (CBCT) with periapi- cal radiography in detecting artificially prepared incom- plete and complete vertical root fractures (VRFs) in the presence of a gutta-percha root filling in human teeth. Methodology The root canals of 20 extracted human premolar and molar teeth were radiographed and scanned with CBCT before a simulated VRF was induced (group 1). These teeth were radiographed and scanned with CBCT again after an incomplete (group 2) and complete (group 3) VRFs were induced. A suitably sized gutta-percha point was inserted into the prepared root canal prior to each series of radio- graphs and CBCT scans being taken. Results There was no improvement in the detection of artificially created vertical root fractures (VRF) in root filled teeth using CBCT compared with periapical radiographs. The overall area under the curve (AUC) value of incomplete and complete VRF was 0.53 for periapical radiography and 0.45 for CBCT (P = 0.034). The overall sensitivity of periapical radiography (0.05) was lower than CBCT (0.57) regardless of the extent of the VRF (P = 0.027). Periapical radiographs (0.98) had a higher overall specificity than CBCT (0.34) (P = 0.027). Conclusions Under the conditions of this ex vivo study, periapical radiographs and CBCT were not accurate in detecting the presence and absence of simulated VRF. The imaging artefacts caused by the gutta-percha root filling within the root canal most probably resulted in the overestimation of VRF with CBCT and also the overall inaccuracy of this system. Keywords: cone beam computed tomography, digi- tal radiography, vertical root fracture. Received 11 June 2012; accepted 9 February 2013 Introduction Vertical root fracture (VRF) affects root filled teeth (Llena-Puy et al. 2001) and may result in tooth loss (Torbj€ orner et al. 1995, Caplan & Weintraub 1997, Sathorn et al. 2005). The prevalence of VRF in root filled teeth has been reported to be between 3% and 13% (Testori et al. 1993, Torbj€ orner et al. 1995, Fuss & Lustig 1999, Tour e et al. 2011). A recent study looking at the reasons for extraction of root filled teeth concluded that 32% of extracted teeth were fractured (Chen et al. 2008). The prevalence of verti- cal root fracture is reported to be higher in root filled teeth than in teeth with vital pulps (Chan et al. 1999, Cohen et al. 2003). Clinical features of VRF include: direct visualization of a fracture line, one or more sinus(es), a deep nar- row isolated periodontal probing depth on one or both Correspondence: Shanon Patel, 45 Wimpole Street, London, W1G 8SB, UK (e-mail: shanonpatel@gmail.com). © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd International Endodontic Journal, 46, 1140–1152, 2013 doi:10.1111/iej.12109 1140