Comparing cone-beam computed tomography with periapical radiography for assessing root canal obturation in vivo using microsurgical findings as validation.
OBJECTIVE
The aim of this study was to verify whether there is a difference in the in vivo performance characteristics of CBCT and periapical radiography (PR) in assessing the apical extension of root canal obturation (RCO) and to evaluate the ability of CBCT in void detection using microsurgical findings as validation.


METHODS
This study included 323 tooth roots that required surgical treatment and for which pre-existing periapical radiographs and CBCT images were available. Three calibrated observers individually analyzed the periapical radiographs, CBCT images and photomicrographs of each root. Performance characteristics of CBCT and PR were compared in terms of their evaluation of the apical extension of the RCOs. The ability of CBCT to detect voids in the RCOs was evaluated using microsurgical findings as validation. Kappa values were used for intraobserver/interobserver agreement.


RESULTS
Perfect intraobserver/interobserver agreement (1.0) was achieved when using photomicrography. The two agreements of PR were superior to those of CBCT when CBCT was used to detect voids (p < 0.05). The sensitivity of CBCT [0.86, 95% confidence interval (CI) 0.76-0.93] was superior to that of PR (0.66, 95% CI 0.54-0.76) in detecting overextension (p < 0.005). CBCT showed a poor sensitivity (0.24, 95% CI 0.19-0.30) and specificity (0.67, 95% CI 0.54-0.78) in void detection.


CONCLUSIONS
CBCT was better than PR for evaluating the apical extension of RCOs. CBCT, with its poor sensitivity and specificity, might both overestimate and underestimate the proportion of voids in RCOs. CBCT was not suitable for evaluating the quality of RCOs.
1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
Dongzhe
D
Song
1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.|2 Department of Conservative Dentistry and Endodontics, West China College of Stomatology, Sichuan University, Chengdu, China.
Lan
L
Zhang
1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
Wei
W
Zhou
1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
Qinghua
Q
Zheng
1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
Xingyu
X
Duan
1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.|2 Department of Conservative Dentistry and Endodontics, West China College of Stomatology, Sichuan University, Chengdu, China.
Xuedong
X
Zhou
1 State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.|2 Department of Conservative Dentistry and Endodontics, West China College of Stomatology, Sichuan University, Chengdu, China.
Dingming
D
Huang
D000328:Adult; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D010784:Photomicrography; D019252:Radiography, Dental, Digital / Q000379:methods*; D015203:Reproducibility of Results; D012389:Root Canal Obturation; D014092:Tooth Root / Q000000981:diagnostic imaging* / Q000601:surgery