Impact of Examiner Training and 3D Reconstruction on CBCT Detection of Anatomical Microstructure

Cone-beam computed tomography (CBCT) has become a reference imaging method in dentistry, providing higher diagnostic accuracy and detailed visualization of complex internal anatomy. This study evaluated the impact of examiner training and three-dimensional (3D) reconstruction on CBCT detection of anatomical microstructures. CBCT scans obtained from 30 teeth with anatomical variations were evaluated by examiners across five skill levels. The same anatomical structures (root canals, isthmuses, and foramina) were assessed using dynamic navigation with multiplanar reconstruction (MPR) and a 3D reconstruction tool available in the e-Vol DX software. The experimental groups included the examiners: undergraduate student, undergraduate student with specific CBCT training, general practitioner, endodontist, and radiologist (control). Each examiner analyzed axial slices with and without 3D reconstruction, recording the number of structures identified and the influence of 3D assistance. Data were analyzed using Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis tests (p < 0.05). For the general practitioner, 3D reconstruction significantly increased identification of root canals and foramina (p < 0.05), while other groups showed no significant differences between analyses. All examiners reported higher diagnostic confidence when using 3D reconstruction, with endodontists, general practitioners, and trained undergraduates indicating benefit in 100% of cases, and untrained undergraduates in 60%. The 3D reconstruction tool positively influenced the general practitioner's ability to detect root canals and foramina in mandibular premolars with complex anatomy. When using 3D reconstruction, examiners at all training levels achieved good diagnostic performance, enhancing both accuracy and confidence in anatomical interpretation.