Accuracy of Digital Radiography and Cone Beam Computed Tomography in Assessing Filling Material Extrusion Using...

This study compared the accuracy of digital periapical radiography (DPR) and cone beam computed tomography (CBCT) in detecting extruded filling material, using a human cadaver model. Micro-computed tomography (Micro-CT) served as the gold standard.

A total of 27 single-rooted teeth embedded in cadaveric mandibular segments, obtained from a prior retreatment study, were included: 25 with confirmed apical extrusion of filling material on micro-CT and 2 without extrusion serving as negative controls. The segments were imaged using both DPR and CBCT. Two calibrated endodontists independently assessed the images for visible extrusion; discrepancies were resolved by a third evaluator.

Although DPR demonstrated lower overall sensitivity than CBCT, both modalities showed identical specificity (100%). Diagnostic accuracy was 70% for DPR and 74% for CBCT, without statistically significant difference between them (P > .05). Moreover, the volume of extruded filling material was not a significant predictor of detection accuracy for either DPR (P > .05) or CBCT (P > .05).

In conclusion, both DPR and CBCT demonstrated low accuracy in detecting filling material extrusion, with no significant difference between them. The occurrence of false-negative results may compromise the reliable assessment of extruded filling materials. In cases of true extrusion, approximately one-third would go undetected by both methods.