title: A Comparison of Cone-beam Computed Tomography with Periapical Radiography in the Detection of Separated Instruments Retained in the Apical Third of Root Canal-filled Teeth.
abstract: BACKGROUND
  This study compared the diagnostic efficacies of cone-beam computed tomographic (CBCT) imaging and periapical radiography (PR) in the detection of retained separated instruments located at the apical third of filled root canals.
  
  
  METHODS
  Sixty single-rooted extracted human teeth were instrumented to size #25 and were randomly divided to a simulated 2-mm #30 K-file (stainless steel or nickel-titanium) segment separation at the apical third of the canal (n = 40) or a control group without a separated instrument (n = 20). The canals were obturated to the separated instrument or the working length for the teeth without an instrument using gutta-percha with AH26 (Dentsply DeTrey GmbH, Konstanz, Germany) or Roth sealer (Roth International Ltd, Chicago, IL). The teeth were invested in a mandible model simulating the bone density and imaged using CBCT imaging and PR. The images were evaluated separately by 2 calibrated observers twice with an interval of 4 weeks. Cohen kappa was used to evaluate the observer agreement. Receiver operating characteristic curve analysis was used to evaluate the discrimination ability.
  
  
  RESULTS
  The intraobserver kappa was 0.744 and 0.627, and between the observers, it was 0.593 and 0.275 for PR and CBCT imaging, respectively. Using PR, the mean sensitivity was 71.25%, and the specificity was 93.75%. Using CBCT imaging, the sensitivity and specificity were 41.25% and 71.25%, respectively. Although for PR the area under the curve values ranged between 0.75 and 0.91 (P < .05), for CBCT they ranged between 0.48 and 0.60 (P > .05), regardless of the instrument or the sealer type.
  
  
  CONCLUSIONS
  PR performed better than CBCT imaging for the detection of retained separated instruments located at the apical third of extracted human root canal-filled teeth.
authors.affiliation: Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: dr.eyalrosen@gmail.com.
authors.forename: Eyal
authors.initials: E
authors.lastname: Rosen
authors.affiliation: Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Nuphar Blau
authors.initials: NB
authors.lastname: Venezia
authors.affiliation: Private Practice, Tel Aviv, Israel.
authors.forename: Hadas
authors.initials: H
authors.lastname: Azizi
authors.affiliation: Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey.
authors.forename: Kivanc
authors.initials: K
authors.lastname: Kamburoglu
authors.affiliation: Department of Oral Rehabilitation, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Meirowitz
authors.affiliation: School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Tomer
authors.initials: T
authors.lastname: Ziv-Baran
authors.affiliation: Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Igor
authors.initials: I
authors.lastname: Tsesis
mesh_terms: D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003762:Dental Instruments; D003786:Dental Pulp Cavity / Q000000981:diagnostic imaging*; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D006171:Gutta-Percha; D006801:Humans; D066298:In Vitro Techniques; D009532:Nickel; D019252:Radiography, Dental, Digital; D012390:Root Canal Therapy / Q000295:instrumentation*; D012680:Sensitivity and Specificity; D013193:Stainless Steel; D014025:Titanium
chemical_list: C040654:titanium nickelide; D013193:Stainless Steel; D009532:Nickel; D006171:Gutta-Percha; D014025:Titanium
keywords: Cone-beam computed tomography; diagnostic efficacy; periapical radiography; root canal–filled teeth; separated instruments