Assessing cone-beam computed tomography artifact reduction using a cotton spacer for improved detection of vertical root fractures in endodontically treated teeth: An in vitro study
Year: 2026
Type: article
Abstract: Introduction: The detection of vertical root fractures (VRFs) in root canal-treated teeth with metallic posts is challenging because of beam hardening artifacts in cone-beam computed tomography (CBCT) images. This in vitro study aimed to evaluate whether placing a cotton spacer could reduce artifacts and improve diagnostic accuracy in CBCT detection of VRFs. Materials and Methods: Twenty single-rooted human teeth were selected and endodontically treated, and metallic posts were placed. VRFs were artificially induced in a subset. Teeth were mounted in dry human mandibles with simulated soft tissue and scanned via CBCT, both with and without a cotton spacer placed between the mandible and phantom head. Two observers independently evaluated the scans in the axial, coronal, and sagittal planes. Artifact reduction was quantified via ImageJ software. Diagnostic performance was assessed via sensitivity, specificity, predictive values, and Cohen’s kappa for inter- and intraobserver reliability. Statistical significance was tested via one-sample t -tests and Shapiro–Wilk tests. Results: Interobserver and intraobserver agreement improved with spacer use. The diagnostic accuracy for detecting VRFs improved from 65% (without spacers) to 80% (with spacers). The sensitivity increased from 40% to 60%, and the specificity increased from 90% to 100%. The use of a cotton spacer significantly reduced artifacts by an average of 25.19% ( P < 0.001). Conclusion: Incorporating a cotton spacer during CBCT imaging significantly reduces artifacts and improves both diagnostic accuracy and observer reliability in detecting VRFs in teeth with metallic posts.
Source: Saudi Endodontic Journal
Language: English
Subfield: Oral Surgery
Field: Dentistry
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7155875249