Is Cone-Beam CT Reliable for Apical Foramen Assessment? A Micro-CT-Referenced Study

This study evaluated the diagnostic accuracy of two cone-beam CT (CBCT) dose protocols for identifying the number and trajectory deviation of apical foramina. Forty lower molars were scanned in Micro-CT. Thereafter, all teeth were inserted into the mandible sockets and a titanium implant and an endodontically treated tooth with a cobalt-chromium post were inserted into adjacent sockets. CBCT acquisitions were performed using two dose protocols. The images were assessed for the number and trajectory deviation of apical foramina. Agreement with micro-CT was evaluated using the kappa test, and accuracy, sensitivity, and specificity were calculated. Analysis of variance was used to compare diagnostic performance values (α = 0.05). Kappa values indicated poor-to-acceptable agreement with micro-CT. Overall, neither the CBCT dose protocol, root type, nor the presence of high-density materials significantly influenced diagnostic performance. Under the ex vivo conditions, CBCT showed limited agreement with micro-CT for assessing the number and trajectory deviation of apical foramina.