Diagnosis of vertical root fractures in endodontically treated teeth utilising DSR

What is it about?

Vertical root fractures are commonly associated with root filled teeth. Diagnosis is challenging because the clinical signs are not completely pathognomonic and conventional periapical radiography is often unreliable. Digital subtraction radiography (DSR) is able to detect small radiographic changes between two successive radiographs by subtracting out the consistent radiographic elements. Its use could possibly assist in the diagnostic procedure. Four cases are presented to demonstrate the potential use of DSR in the detection of vertical root fractures in endodontically treated teeth. After the digital subtractions had been carried out, a dark line in the body of the roots was distinguishable raising the possibility of the presence of a vertical root fracture. The use of contrast enhancement and pseudocoloring techniques assisted with the diagnosis of vertical root fractures. DSR proved to be a useful diagnostic tool for the detection of vertical root fractures in these four clinical cases.

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Why is it important?

DSR is a technique that should be considered as a diagnostic method in great diagnostic dilemmas, such the detection of VRFs. Conventional diagnostic methods are always of great importance in the diagnosis of VRFs and modern techniques cannot always be substituted; however, through the four cases presented here, carrying out DSR before applying other imaging methods of greater cost and radiation dose proved significant. Further research studies should be conducted evaluating the potential use of DSR in the detection of VRFs .