Comparison of the accuracy of periapical radiography with CBCT taken at 3 different voxel sizes in detecting simulated endodontic complications: an ex vivo study

Dentomaxillofac Radiol. 2018 May;47(4):20170399. doi: 10.1259/dmfr.20170399. Epub 2018 Feb 22.


Objectives: To compare the accuracy of a photostimulable phosphor plateP sensor with cone beam CT (CBCT) images in the detection of simulated endodontic complications.

Methods: Following simulated endodontic complications were created in 40 extracted human mandibular molar teeth: Group 1, Instrument separation (N = 10); Group 2, Strip perforation (N = 10); Group 3, Underfilling of root canals (N = 10); Group 4, Overfilling of root canals (N = 10). Intraoral and CBCT images (voxel size: 0.075 , 0.1 and 0.2 mm) were taken. Images were scored by 4 observers according to a 5-point scale. Weighted kappa and intraclass correlation coefficients were calculated. Receiveroperating characteristic analysis was performed and DeLong test was used to compare areaunder curve values. Significance level was set at p < 0.05.

Results: Intraobserver kappa ranged from moderate (0.417) to excellent (0.918). Intraclass correlation coefficients ranged from moderate (0.482) to excellent (0.855). For Group 1 (instrument separation) the highest Az values were obtained for intraoral images and the lowest for CBCT (0.2 mm voxel size) (p < 0.05). The highest Az values were obtained for Group 2 (strip perforation) among all groups. With all CBCT image settings, observers performed similarly and better than intraoral images (p < 0.05) in detection of strip perforation. For Group 3 (underfilling), higher Az values for CBCT images were obtained compared to intraoral images without statistically significant difference (p > 0.05). For Group 4 (overfilling), higher Az values for CBCT images were obtained when compared to digital intraoral for observer 1 and 2 (p < 0.05).

Conclusions: CBCT images may be useful as an adjunct to periapical imaging in the detection of endodontic complications, such as strip perforation and overfilled root canals.

Publication types

  • Comparative Study

MeSH terms

  • Cone-Beam Computed Tomography / methods*
  • Humans
  • In Vitro Techniques
  • Molar / diagnostic imaging
  • Periapical Diseases / diagnostic imaging*
  • Postoperative Complications / diagnostic imaging*
  • Radiography, Dental, Digital / methods*
  • Root Canal Therapy*