Accuracy of Cone-Beam Computed Tomography in Detection of Root Perforations Using Different Voxel Sizes in Comparison to Digital Periapical Radiograph, An in vitro study

Abstract

Objectives: The aim of this study is to quantitatively compare the diagnostic accuracy of CBCT with 0.2 and 0.4 mm3 voxel sizes and a digital PR for the detection of strip perforation for mesial root of the mandibular first molar with and without root canal obturation when evaluated by different observer specialty. Materials and Methods: 48 intact mandibular first molars were selected for this study, the teeth were divided to the following groups: (i) no strip perforation and no obturation, (ii) no strip perforation and obturation, (iii) strip perforation and no obturation, (iv) strip perforation and obturation. Each tooth was inserted in a dry mandible to obtain intraoral digital, CBCT images were obtained using two voxel sizes 0.2 and 0.4 mm3. Two general practitioners, two endodontists, and two dentomaxillofacial radiologists were asked to evaluate all images for detection of strip root perforation individually and together. The sensitivity and specificity of all images modalities to diagnose perforations were calculated. Results: There was no statistically significant difference between the accuracy of the PR images observed by the two general practitioners and two radiologists, while they showed a statistically low significant difference compared to the images observed by the two endodontists. CBCT images accuracy showed a higher significant difference than PR images observed by general practitioners and radiologists. Conclusions:  CBCT was associated with significantly greater accuracy for detection of strip root perforation than PR. When two endodontist specialists observed the PR together, they showed a higher significance difference in the detection of root perforation compared to general practitioners and radiologists, and they showed no significant difference compared CBCT images. There was no significant difference between 0.2 and 0.4 mm3 voxel sizes of CBCT images. Clinical Relevance: The accuracy of PR in the detection of root perforation is equal to that of CBCT when observed by two endodontists, and it is higher than the accuracy of PR images observed by general practitioners and radiologists.