Cone-Beam Computed Tomography Detection of Separated Endodontic Instruments

Area of Science:

• Dentistry
• Endodontics
• Radiology

Background:

• Separated endodontic instruments pose a challenge in root canal treatment.
• Accurate identification of these fragments is crucial for successful treatment outcomes.
• Various imaging modalities are used, including cone-beam computed tomography (CBCT) and digital periapical radiography (DPR).

Purpose of the Study:

• To compare the diagnostic accuracy, sensitivity, and specificity of different CBCT protocols and DPR for identifying separated endodontic instruments in filled root canals.
• To evaluate the effectiveness of various imaging techniques in detecting fractured endodontic files.

Main Methods:

• 108 root canals in 36 mandibular molars were prepared and obturated, with 24 containing separated instruments (stainless steel hand files or reciprocating instruments).
• Images were acquired using three CBCT protocols (i-CAT Classic, i-CAT Next Generation, PreXion 3D) and one DPR protocol.
• Two endodontists assessed images for the presence of fractured files using a 5-point scale.

Main Results:

• Digital periapical radiography (DPR) identified 37.5% of separated instruments, while no instruments were detected with any CBCT protocol (P > .05).
• DPR demonstrated the highest accuracy (83.3%) and sensitivity (37.5%) among the tested methods.
• The type of separated instrument (stainless steel hand file or reciprocating instrument) did not significantly affect detection rates (P > .05).

Conclusions:

• Digital periapical radiography (DPR) is superior to the evaluated cone-beam computed tomography (CBCT) protocols (ICC, ICN, PXD) for detecting separated endodontic instruments.
• Despite DPR's higher accuracy, a significant number of separated instruments remained undetected by all imaging methods.
• Further research is needed to improve the detection rates of separated endodontic instruments.