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Investigation of Voids in the Apical Plug of MTA Using Cone-Beam Computed Tomography, Digital Radiography, and Analog
Mahsa Eskandarinezhad1, Sedighe Razi2, Tirdad Pirzadeh3
1Dept. of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
Background:
Achieving a satisfactory apical seal in root canals with open apices can be challenging, with the risk of filling material extrusion into the apex. Timely detection of voids in root canal filling material is crucial to prevent complications.
Purpose:
This study aimed to compare the accuracy of cone-beam computed tomography (CBCT), digital radiography, and conventional radiography in detecting voids in mineral trioxide aggregate (MTA) apical plugs.
Materials And Method:
In this in vitro study, thirty-two extracted upper maxillary incisors underwent decoronation, root canal instrumentation, and simulation of an apexification model for open apex teeth. The samples were then divided into two groups (n=16) based on void sizes including group A in which MTA was compacted manually as an apical plug, and group B in which MTA apical plug was made with simulated voids using an 0.4-mm diameter needle. CBCT, digital, and analog radiography scans were performed on all samples. The images were assessed by an endodontist and a radiologist to identify the presence of voids. The accuracy of the three methods in detecting voids in MTA apical plugs was evaluated using Chi-square analysis.
Results:
CBCT (43.8%) showed superior detection of small voids (group A) compared to analog (37.5%) and digital (18.7%) radiography methods, with analog radiography being more effective than digital radiography (p= 0.037). For large void detection (group B), digital radiography (94%) outperformed the other methods, while analog (81.3%) and CBCT (81.3%) techniques exhibited similar diagnostic abilities (p= 0.034). The significance level was set at p< 0.05.
Conclusion:
CBCT imaging is more effective than analog radiography for detecting small voids, and both methods outperform digital radiography, likely due to CBCT's three-dimensional imaging capabilities. In diagnosing large voids, digital radiography showed higher accuracy than the other techniques, while CBCT and analog radiography had similar diagnostic abilities. Variations in image processing and radiation doses used might account for the differences between these techniques.
