CONE BEAM COMPUTED TOMOGRAPHY IS SUPERIOR TO DIGITAL PERIAPICAL RADIOGRAPHY FOR DIAGNOSIS OF STRIP ROOT PERFORATION

Background Strip root perforation requires meticulous diagnosis and may compromise the prognosis, if left undiscovered. It is a common reason for endodontic failure. Strip perforations, usually seen in the mid-section of a curved canal, may result from excessive instrumentation. Radiographic detection of strip perforations may be challenging. Objective The aim of this study was to compare the sensitivity, specificity, and accuracy of digital periapical (PA) radiography compared with cone beam computed tomography (CBCT) in detecting simulated perforation in filled and unfilled canals in extracted teeth. Materials and Methods After obtaining institutional review board approval, canals of 30 extracted mandibular molar teeth were prepared. Mesial roots of the 15 study teeth were perforated, and all canals were filled in the 15 study and 15 control teeth. The teeth were mounted in simulated D-3 bone. All teeth were imaged by using CBCT and triangulated PA radiography before and after obturation. Discontinuity seen near the furcations was considered perforation. Receiver operating characteristic (ROC) analysis was used to show sensitivity, specificity, and accuracy. Analysis of variance (ANOVA) was used to compare the results, and the kappa statistic for interobserver agreement. Results Az values for CBCT before and after obturation were 0.941 and 0.873, respectively, and for PA radiography, the values were 0.640 and 0.776, respectively (P < .01). In unfilled canals, the sensitivity and specificity of CBCT were 91% and 100%, respectively, and for angled PA radiography, these values were 52.5% and 49.5%, respectively. In obturated canals, the sensitivity and specificity of CBCT were 82%, and 90%, respectively; in angled PA radiography, the values were 70% and 88%, respectively. Interexaminer agreement was significantly better for CBCT than for PA radiography (P < .01). Discussion CBCT is more reliable than PA radiography for the detection of perforations, especially in unfilled canals. The accuracy of CBCT decreased after filling because of artifact formation. Accurate diagnosis of perforations in unfilled canals using PA radiography is limited. Strip root perforation requires meticulous diagnosis and may compromise the prognosis, if left undiscovered. It is a common reason for endodontic failure. Strip perforations, usually seen in the mid-section of a curved canal, may result from excessive instrumentation. Radiographic detection of strip perforations may be challenging. The aim of this study was to compare the sensitivity, specificity, and accuracy of digital periapical (PA) radiography compared with cone beam computed tomography (CBCT) in detecting simulated perforation in filled and unfilled canals in extracted teeth. After obtaining institutional review board approval, canals of 30 extracted mandibular molar teeth were prepared. Mesial roots of the 15 study teeth were perforated, and all canals were filled in the 15 study and 15 control teeth. The teeth were mounted in simulated D-3 bone. All teeth were imaged by using CBCT and triangulated PA radiography before and after obturation. Discontinuity seen near the furcations was considered perforation. Receiver operating characteristic (ROC) analysis was used to show sensitivity, specificity, and accuracy. Analysis of variance (ANOVA) was used to compare the results, and the kappa statistic for interobserver agreement. Az values for CBCT before and after obturation were 0.941 and 0.873, respectively, and for PA radiography, the values were 0.640 and 0.776, respectively (P < .01). In unfilled canals, the sensitivity and specificity of CBCT were 91% and 100%, respectively, and for angled PA radiography, these values were 52.5% and 49.5%, respectively. In obturated canals, the sensitivity and specificity of CBCT were 82%, and 90%, respectively; in angled PA radiography, the values were 70% and 88%, respectively. Interexaminer agreement was significantly better for CBCT than for PA radiography (P < .01). CBCT is more reliable than PA radiography for the detection of perforations, especially in unfilled canals. The accuracy of CBCT decreased after filling because of artifact formation. Accurate diagnosis of perforations in unfilled canals using PA radiography is limited.