Purpose: This study examined the influence of a metal artifact reduction (MAR) tool, sharpening filters, and their combination on the diagnosis of vertical root fracture (VRF) in teeth with metallic posts using cone-beam computed tomography (CBCT). Materials and Methods: Twenty single-rooted human premolars - 9 with VRF and 11 without - were individually placed in a human mandible. A metallic post composed of a cobalt-chromium alloy was inserted into the root canal of each tooth. CBCT scans were then acquired under the following parameters: 8 mA, a 5 × 5 cm field of view, a voxel size of 0.085 mm, 90 kVp, and with MAR either enabled or disabled. Five oral and maxillofacial radiologistsindependently evaluated the CBCT exams under each MAR mode and across 3 sharpening filter conditions: no filter, Sharpen 1 × , and Sharpen 2 × . The diagnostic performance was quantified by the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. These metrics were compared using 2-way analysis of variance with a significance level of α = 5%. Intra- and inter-examiner agreement were assessed using the weighted kappa test. Results: Neither MAR nor the application of sharpening filters significantly impacted AUC or specificity (P>0.05). However, sensitivity increased when MAR was combined with Sharpen 1 × and Sharpen 2 × (P = 0.015). The intraexaminer agreement ranged from fair to substantial (0.34-0.66), while the inter-examiner agreement ranged from fair to moderate (0.27-0.41). Conclusion MAR in conjunction with sharpening filters improved VRF detection; therefore, their combined use is recommended in cases of suspected VRF.

Purpose: This study was conducted to compare the objective image quality of radiographs acquired with a handheld X-ray device to those obtained with a wall-mounted X-ray device. Materials and Methods: Brightness, noise, uniformity, and contrast were evaluated. To assess the first 3 parameters,radiographs of an acrylic block were acquired with an unused photostimulable phosphor (PSP) plate from the VistaScan system (Mini Easy, Dürr Dental, Bietigheim-Bissingen, Germany). Initially, 6 radiographs were taken with a Focus X-ray wall-mounted device (Instrumentarium, Tuusula, Finland) operating at 60 kVp, 7 mA, and 0.125 s.Another 6 radiographs were captured using an Eagle handheld X-ray device (Alliage, São Paulo, Brazil) at 60 kVp, 2.5 mA, and 0.35 s. The means and standard deviations of the gray values for all radiographs were calculated using ImageJ (National Institutes of Health, Bethesda, MD, USA). For contrast assessment, radiographs of an aluminum step wedge were obtained using the same PSP plate, X-ray devices, and acquisition parameters. The percentage of contrast variation was determined. The impacts of the devices on image quality were compared using the Student t-test, with a significance level of 5% (P<0.05). Results: Compared with the wall-mounted device, the handheld device produced radiographs with higher brightness and noise, as indicated by mean values of 6.57 (0.49) and 3.49 (0.02), respectively. Furthermore, it demonstrated lower uniformity and contrast, with respective means of 3.75 (0.02) and 35.48 (0.09) (P<0.05). Conclusion Radiographs obtained using a handheld X-ray device exhibit lower theoretical image quality than those acquired with a wall-mounted device.

Purpose: This study was conducted to compare the objective image quality of radiographs acquired with a handheld X-ray device to those obtained with a wall-mounted X-ray device. Materials and Methods: Brightness, noise, uniformity, and contrast were evaluated. To assess the first 3 parameters,radiographs of an acrylic block were acquired with an unused photostimulable phosphor (PSP) plate from the VistaScan system (Mini Easy, Dürr Dental, Bietigheim-Bissingen, Germany). Initially, 6 radiographs were taken with a Focus X-ray wall-mounted device (Instrumentarium, Tuusula, Finland) operating at 60 kVp, 7 mA, and 0.125 s.Another 6 radiographs were captured using an Eagle handheld X-ray device (Alliage, São Paulo, Brazil) at 60 kVp, 2.5 mA, and 0.35 s. The means and standard deviations of the gray values for all radiographs were calculated using ImageJ (National Institutes of Health, Bethesda, MD, USA). For contrast assessment, radiographs of an aluminum step wedge were obtained using the same PSP plate, X-ray devices, and acquisition parameters. The percentage of contrast variation was determined. The impacts of the devices on image quality were compared using the Student t-test, with a significance level of 5% (P<0.05). Results: Compared with the wall-mounted device, the handheld device produced radiographs with higher brightness and noise, as indicated by mean values of 6.57 (0.49) and 3.49 (0.02), respectively. Furthermore, it demonstrated lower uniformity and contrast, with respective means of 3.75 (0.02) and 35.48 (0.09) (P<0.05). Conclusion Radiographs obtained using a handheld X-ray device exhibit lower theoretical image quality than those acquired with a wall-mounted device.

Purpose: This study was conducted to compare the objective image quality of radiographs acquired with a handheld X-ray device to those obtained with a wall-mounted X-ray device. Materials and Methods: Brightness, noise, uniformity, and contrast were evaluated. To assess the first 3 parameters,radiographs of an acrylic block were acquired with an unused photostimulable phosphor (PSP) plate from the VistaScan system (Mini Easy, Dürr Dental, Bietigheim-Bissingen, Germany). Initially, 6 radiographs were taken with a Focus X-ray wall-mounted device (Instrumentarium, Tuusula, Finland) operating at 60 kVp, 7 mA, and 0.125 s.Another 6 radiographs were captured using an Eagle handheld X-ray device (Alliage, São Paulo, Brazil) at 60 kVp, 2.5 mA, and 0.35 s. The means and standard deviations of the gray values for all radiographs were calculated using ImageJ (National Institutes of Health, Bethesda, MD, USA). For contrast assessment, radiographs of an aluminum step wedge were obtained using the same PSP plate, X-ray devices, and acquisition parameters. The percentage of contrast variation was determined. The impacts of the devices on image quality were compared using the Student t-test, with a significance level of 5% (P<0.05). Results: Compared with the wall-mounted device, the handheld device produced radiographs with higher brightness and noise, as indicated by mean values of 6.57 (0.49) and 3.49 (0.02), respectively. Furthermore, it demonstrated lower uniformity and contrast, with respective means of 3.75 (0.02) and 35.48 (0.09) (P<0.05). Conclusion Radiographs obtained using a handheld X-ray device exhibit lower theoretical image quality than those acquired with a wall-mounted device.

Purpose: This study examined the influence of metal artifact reduction (MAR), the application of sharpening filters,and their combination on the diagnosis of horizontal root fracture (HRF) in teeth adjacent to a zirconia implant on cone-beam computed tomography (CBCT) examinations. Materials and Methods: Nineteen single-rooted teeth (9 with HRF and 10 without) were individually positioned in the right central incisor socket of a dry human maxilla. A zirconia implant was placed adjacent to each tooth.Imaging was performed using an OP300 Maxio CBCT (Instrumentarium, Tuusula, Finland) unit with the following settings: a current of 8 mA, both MAR modes (enabled and disabled), a 5 × 5 cm field of view, a voxel size of 0.085 mm, and a peak kilovoltage of 90 kVp. Four oral and maxillofacial radiologists independently evaluated the CBCT scans under both MAR conditions and across 3 levels of sharpening filter application (none, Sharpen 1 × , and Sharpen 2 × ). Diagnostic metrics were calculated and compared using 2-way analysis of variance (α = 5%). The weighted kappa test was used to assess intra- and inter-examiner reliability in the diagnosis of HRF. Results: MAR tool activation, sharpening filter use, and their combination did not significantly impact the area under the receiver operating characteristic curve, sensitivity, or specificity of HRF diagnosis (P>0.05). Intra- and inter-examiner agreement ranged from fair to substantial. Conclusion The diagnosis of HRF in a tooth adjacent to a zirconia implant is not affected by the activation of MAR,the application of a sharpening filter, or the combination of these tools.