Eur Endod J. Ahead of Print: EEJ-72324

Accuracy of Digital Radiography and Cone-Beam Computed Tomography in Assessing Filling Material Extrusion Using Micro-Computed Tomography as Gold Standard: A Study in Human Cadavers

Thamyres Monteiro¹, Maria KalineRomeiro Teodoro², Karen Brisson³, Karim Aazzouzi¹, Marília Marceliano-alves⁴, Andrea Campello⁵, Flávio Alves^6
1Department of Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
²Department of Restorative Dentistry, UNIFACOL University Center, Vitória de Santo Antão, PE, Brazil
³Laboratory of Molecular Microbial Ecology, Paulo de Góes Institute of Microbiology, Center for Health Sciences, Federal University of Rio de Janeiro (UFRJ), RJ, Brazil
⁴Department of Dentistry, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Department of Endodontics, Maurício de Nassau University Centre (UNINASSAU), Rio de Janeiro, Brazil; Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, India
⁵Department of Dentistry, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil.
⁶Department of Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil; Department of Dentistry, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil

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>0.05). Moreover, the volume of extruded filling material was not a significant predictor of detection accuracy for either DPR (p > 0.05) or CBCT (p>0.05). 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. (EEJ-2025-06-090)

Keywords: Cone-beam computed tomography, digital periapical radiography, microtomography, apical extrusion, image diagnosis, endodontic retreatment.

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