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

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)