Dental undergraduate students' ability in diagnosing horizontal root fractures: a comparative analysis using CBCT and periapical radiography

Aims: Accurate radiographic diagnosis of horizontal root fractures is challenging and represents a key competency expected of undergraduate dental students. Although cone-beam computed tomography (CBCT) overcomes limitations of two-dimensional imaging, its impact on diagnostic consistency among dental students remains insufficiently explored. This study aimed to evaluate dental students’ ability to detect horizontal root fractures using different imaging techniques.Methods: This in vitro study included 35 extracted permanent maxillary and mandibular incisors and canines, 25 of which had artificially induced horizontal root fractures and 10 used as healthy controls. Periapical radiographs and CBCT images were obtained for all samples. Image interpretation was performed independently by 25 final-year dental students and a dentomaxillofacial radiology (DMFR) specialist. The fracture status recorded during sample preparation was used as the reference standard. Inter-observer agreement between each student and the expert was assessed using Cohen's kappa statistic, and diagnostic performance parameters were calculated.Results: In the evaluation of periapical radiographs, the agreement between students and the expert varied (0.364-1). In the evaluation of CBCT images, the vast majority of students (n=23) showed almost perfect agreement with the expert (0.851-1). In terms of diagnostic performance, the use of CBCT provided more consistent sensitivity, specificity, and accuracy values compared to periapical radiography; sensitivity and specificity were generally found to be above 90% in cases evaluated with CBCT. The DMFR specialist demonstrated high diagnostic performance in both imaging methods, and it was observed that the performance difference between students and specialist decreased with the use of CBCT. Diagnostic accuracy values ranged from 68.6% to 100% for periapical radiography and from 82.9% to 100% for CBCT.Conclusion: Altough the final-year dental students included in this study had significantly more hands-on experience in acquiring and interpreting periapical radiographs and had only received basic theoretical CBCT training with limited practical and clinical experience, CBCT use was associated with more consistent diagnostic performance among the students.