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Detecting Residual Root Canal Filling Material After Retreatment: Cone-Beam Computed Tomography and Digital
Mohamad Alouda1, Samar Akil1, Mohammad Tamer Abbara2
1Department of Endodontics, Damascus University, Damascus P.O. Box 3062, Syria.
Dentistry Journal
|June 25, 2026
Summary
Comparing methods for detecting root canal filling material after retreatment, micro-CT proved most reliable. Cone-beam computed tomography (CBCT) overestimated remnants, while digital microscopy (DGM) underestimated them, highlighting method-specific limitations for clinical decisions.
Area of Science:
- Endodontics
- Dental Imaging
- Materials Science
Background:
- Accurate assessment of residual root canal filling material is crucial for evaluating retreatment efficacy.
- Existing methods for quantifying residual material vary in their clinical-physical dimensions, limiting comparability.
- This study aimed to compare cone-beam computed tomography (CBCT) and digital microscopy (DGM) against microcomputed tomography (micro-CT) for residual material detection post-retreatment.
Purpose of the Study:
- To compare the accuracy of cone-beam computed tomography (CBCT) and digital microscopy (DGM) in detecting residual root canal filling material after retreatment.
- To establish microcomputed tomography (micro-CT) as a reference standard for evaluating residual obturation material.
- To analyze the method-specific limitations in quantifying residual root canal filling material.
Main Methods:
- Fifteen human mandibular premolars underwent root canal instrumentation and obturation with gutta-percha and AH Plus Bioceramic sealer.
- Retreatment was performed using ProTaper Universal Retreatment files.
- Residual material was assessed in coronal, middle, and apical thirds using CBCT (0.10 mm voxel size), micro-CT (60 µm voxel size), and DGM after root splitting.
Main Results:
- Digital microscopy (DGM) showed low median residual surface percentages (0.34-1.52%).
- Cone-beam computed tomography (CBCT) showed significantly higher median residual volume percentages (10.20-14.20%) compared to micro-CT (3.27-5.04%), particularly in the middle third (p = 0.002).
- CBCT demonstrated higher sensitivity but lower specificity, while DGM exhibited high specificity but limited sensitivity in coronal and middle thirds.
Conclusions:
- Microcomputed tomography (micro-CT) served as the most reliable reference method in this laboratory setting.
- Cone-beam computed tomography (CBCT) tends to overestimate residual material, potentially leading to unnecessary retreatment decisions.
- Digital microscopy (DGM) underestimates residual material as it only assesses the exposed split surface, necessitating careful consideration of these limitations in clinical practice and research.