Abstract
The separation of endodontic files and strip perforation are among procedural intraoperative complications which may ultimately lead to the failure of root canal treatment. The aim of the present study was to compare the diagnostic potential of cone beam computed tomography (CBCT) and digital periapical radiographs in detecting separated rotary files and strip perforation in filled canals. Fifty human mandibular molars were selected for this study. The teeth were randomly divided into two groups based on endodontic errors (i.e., file separation and strip perforation). In each group, 25 of 50 mesial canals were randomly chosen for simulating the errors, while the other 25 canals were considered as the control group. In group one, a simulation of the separation of rotary files was performed using ProTaper F2 files. Strip perforation of the root canals in group two was achieved by number 2 and 3 Gates Glidden drills in the coronal third of the root canals. Digital periapical radiographs in two different horizontal angles and high-resolution CBCT scans were obtained from the teeth mounted on a dry human mandible with simulated soft tissue covering. Three experienced observers who were unaware of the study groups evaluated the digital periapical and CBCT image sets in two separate readings. Intraobserver and interobserver agreements, as well as accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated and compared. Intraobserver and interobserver agreements ranged from poor to excellent and poor to good, respectively. The accuracy, sensitivity, specificity, PPV, and NPV for digital radiography in detecting separated files were 0.950, 0.813, 0.957, 0.929, and 0.880, respectively. The same values for CBCT were 0.747, 0.667, 0.900, 0.833, and 0.783, respectively. For the diagnosis of strip perforation, these values were 0.855, 0.800, 0.909, 0.889, and 0.833 for periapical radiography and 0.955, 1.000, 0.920, 0.926, and 1.000 for CBCT. In conclusion, CBCT was superior for diagnosing strip perforation of the filled root canals, while digital periapical radiographs performed better in the detection of separated rotary files.
Highlights
Inflammation of the dental pulp can occur as a result of severe caries, periodontal diseases, or traumatic events
Separation of endodontic files and strip perforation are among the procedural intraoperative errors which may lead to the failure of root canal treatment [6,7]
The findings of the present study suggest that the diagnostic accuracy of digital periapical radiography is higher than that for cone beam computed tomography (CBCT) for detecting separated endodontic files, while they suggest that CBCT has a higher accuracy for detecting strip perforation of root canals
Summary
Inflammation of the dental pulp can occur as a result of severe caries, periodontal diseases, or traumatic events. A myriad of factors can lead to the failure of root canal treatment, which can be classified as preoperative, intraoperative, or postoperative factors [4,5]. Separation of endodontic files and strip perforation are among the procedural intraoperative errors which may lead to the failure of root canal treatment [6,7]. The possibility of separation of rotary nickel-titanium (NiTi) files is shown to range from 0.4% to 4.4% [8] Several etiologic factors such as operator proficiency, root canal anatomy, torque, reuse of NiTi files, autoclaving cycles, and materials used in combination with the rotary files are among the factors leading to the separation of endodontic files [9,10,11]. Mesial roots of the mandibular molars are susceptible to strip perforations due to their thin dentinal walls [12]
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