Effect of implant presence, tube current, and metal artifact reduction tool on internal root resorption detection using cone beam computed tomography

Diagnosis of internal root resorption (IRR) is essential for appropriate treatment. However, in cone-beam computed tomography (CBCT) scans, artifacts generated by dental implants may compromise image quality. Therefore, the study aimed to evaluate the influence of the presence of titanium and zirconia implants, different tube current (mA settings), and metal artifact reduction (MAR) tool activation on the diagnosis of internal root resorption (IRR) using CBCT exams. Twenty teeth (ten with IRR and ten without) were individually positioned in a human mandible. CBCT examinations were obtained with and without two types of implants (titanium and zirconia) adjacent to the tooth, using mA settings of 4, 8, and 10. Each exam was obtained with MAR tool either activated or deactivated on the OP300 unit. Four examiners independently evaluated the scans. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity values were compared using repeated-measures multiway ANOVA (α = 5%). Inter- and intraexaminer agreement for IRR diagnosis was assessed using weighted Kappa. AUC (0.89–0.99), sensitivity (0.85–0.98), and specificity (0.85-1.00) values were high and not significantly affected by implant presence, mA setting, or MAR activation ( p > 0.05). Intraexaminer agreement ranged from substantial to almost perfect (0.77–0.95), while interexaminer agreement varied from fair to almost perfect (0.37–0.85). The presence of implants, variation in mA settings, and MAR tool activation did not significantly affect IRR diagnosis. Since diagnostic performance remained unchanged, lower mA protocols may be considered under comparable CBCT acquisition conditions without compromising diagnostic accuracy.