Akademik Veri Yönetim Sistemi
Journal of Health Sciences and Medicine, cilt.9, sa.2, ss.433-440, 2026 (TRDizin)
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.
Keywords: Cone-beam computed tomography, dental students, diagnosis, education, radiology, root fractures