Diagnostic Accuracy of Cone-beam Computed Tomography and Conventional Periapical Radiography in Detecting Strip Root Perforations

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Background: Perforations are the one of the greatest cause of failure in endodontics. Early diagnosis of root perforations is a critical factor in treatment outcome. The aim of this study was to compare the sensitivity, specificity, and accuracy of conventional periapical (PA) radiography with cone-beam computed tomography (CBCT) in detecting strip root perforations in filled and unfilled root canals. Methods and Materials: In this in vitro experimental study, mesial root canals of 100 extracted mandibular molar teeth were prepared. Distal wall of the mesiolingual canals were thinned by rotating a Gates Glidden. Then the mesial roots of 51 teeth were randomly perforated. All samples were examined with PA (3 horizontal angles) and CBCT before and after obturation. The images were evaluated for diagnosis of strip root perforations by two observers. Sensitivity, specificity, and accuracy of each technique for detection of strip root perforation were calculated. The data were subjected to statistical analysis using Chi-square and Fisher exact tests. Results: In unfilled canals, sensitivity, specificity, and accuracy of the techniques for detection of strip root perforation were significantly different (P < 0.05). After obturation, PA was significantly more sensitive than CBCT (P < 0.05). Conclusion: Under the conditions of this in vitro study, in the absence of root filling materials, CBCT was superior to PA for detection of strip root perforation but for perforation detection in obturated root canals, PA with three different horizontal angulations was more reliable.

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