New Technique for Detecting Cracked Teeth and Evaluating the Crack Depth by Contrast-enhanced Cone Beam Computed Tomography: an in Vitro Study

Abstract Background: Develop a new technique based on contrast-enhanced cone beam computed tomography (CBCT) to improve the detection of cracked teeth and the accuracy of crack depth evaluation in vitro. Methods: We developed an in vitro artificial simulation model of cracked teeth. Pre-experimental CBCT (pre-CBCT), and micro-computed tomography (micro-CT) were first performed for all cracked teeth (n = 31). Contrast-enhanced CBCT was then performed by infiltrating the crack with ioversol under vacuum conditions. The results of pre-CBCT, micro-CT, and contrast-enhanced CBCT were recorded. SPSS v.26.0 software (IBM Corp, Somers, NY) and R software , version 3.6.0 (R Foundation for Statistical Computing; http://www.r-project.org/) and RStudio 1.1. 46 3 (RStudio, PBC, Boston, MA, US) were used to perform the statistical analysis for the study. Results: The sensitivities of pre-CBCT and contrast-enhanced CBCT were 48.4%, and 67.7%, respectively. ICC value of crack depth as measured by pre-CBCT and contrast-enhanced CBCT was 0.847 (95% confidence interval:0.380-0.960; P < 0.001). The areas under ROC curves (AUC) of pre-CBCT and contrast-enhanced CBCT were different, the AUC of pre-CBCT was 0.958 ( P = 0.000, 95% CI :0.843-1.074), and the AUC of enhanced CBCT was 0.979 ( P = 0.000, 95% CI :0.921-1.037), and the difference was not statistically significant (Z=-0.707, P = 0.480). The ICC value of crack depth as measured by contrast-enhanced CBCT and micro-CT was 0.753 (95% CI: 0.248-0.911; P < 0.001). Conclusion: Contrast-enhanced CBCT under vacuum conditions with a contrast medium can only significantly improve the cracks detection rate of cracked teeth, but not measure the crack depths accurately.