When radiographically assessed, vertical fractures can present as an incomplete or complete radiolucent line that extends along the longitudinal axis of the tooth. Vertical root fractures are often not visible on clinical examination, do not have a favorable prognosis, being one of the most common reasons for the extraction of endodontically treated teeth. However, an early diagnosis, whether clinical or radiographic, is essential for a better prognosis of VRF.
Among the diagnostic tasks, the diagnosis of vertical root fractures (VRFs), based on clinical and radiographic assessments, is considered challenging. Periapical radiographs are commonly used to establish the diagnosis and treatment planning for several dental conditions (e.g., root fractures), as it allows a satisfactory assessment of the crown, root, and surrounding bone. The image file format of periapical radiographs does not influence the diagnosis of VRF, regardless of the digital radiography system. Digora Toto had significantly greater values of area under the ROC curve than Digora Optime for all file formats ( p = 0.001). The image file format did not influence the diagnostic values for VRF for any of the radiographic systems tested ( p > 0.05). The values of intra-examiner agreement varied from moderate (0.56) to almost perfect (0.81), while the values of inter-examiner agreement varied from fair (0.29) to moderate (0.60). The significance level was set at 5% for all analyses. The intra- and inter-examiner agreements were measured by the Kappa test. The results were compared by two-way Analysis of Variance with post hoc Tukey’s test. Diagnostic values of area under the ROC curve, specificity, and sensitivity for the diagnosis of VRF were calculated. The radiographs were assessed by five examiners for the detection of VRF, using a 5-point scale (1-definitely absent 2-probably absent 3-uncertain 4-probably present 5-definitely present). Periapical radiographic images of 34 single-rooted teeth-19 with VRF, and 15 without VRF were acquired using two digital systems-Digora Toto, and Digora Optime, and exported into four different file formats-TIFF, BMP, PNG, and JPEG, totaling 272 radiographs. To evaluate the influence of the file format of digital periapical radiographs on the diagnosis of vertical root fracture (VRF).