Detection of fractured endodontic instruments in root canals: comparison between different digital radiography systems and cone-beam computed tomography

This study compared the detection of fractured instruments in root canals with and without filling by periapical radiographs from 3 digital systems and cone-beam computed tomographic (CBCT) images with different resolutions. Methods: Thirty-one human molars (80 canals) were used. Root canals were divided into the following groups: the control group, without fillings; the fracture group, without fillings and with fractured files; the fill group, filled; and the fill/fracture group, filled and with fractured files. Digital radiographs in ortho-, mesio-, and distoradial directions were performed in 2 semidirect systems (VistaScan [Diirr Dental, Beitigheim-Bissinger, Germany] and Express [Instrumentarium Imaging, Tuusula, Finland]) and a direct system (SnapShot [Instrumentarium Imaging]). CBCT images were acquired with 0.085-mm and 0.2-mm voxel sizes. All images were assessed and reassessed by 4 observers for the presence or absence of fractured files on a 5-point scale. The sensitivity, specificity, and accuracy were calculated. Results: In the absence of filling, accuracy values were high, and there were no statistical differences among the radiographic techniques, different digital systems, or the different CBCT voxels sizes. In the presence of filling, the accuracy of periapical radiographs was significantly higher than CBCT images. In general, Snapshot showed higher accuracy than VistaScan and Express. Conclusions: Periapical radiographs in 1 incidence were accurate for the detection of fractured endodontic instruments inside the root canal in the absence or presence of filling, suggesting that this technique should be the first choice as well as the direct digital radiographic system. In the presence of filling, the decision to perform a CBCT examination must take into consideration its low accuracy.This study compared the detection of fractured instruments in root canals with and without filling by periapical radiographs from 3 digital systems and cone-beam computed tomographic (CBCT) images with different resolutions. Methods: Thirty-one human molars (80 canals) were used. Root canals were divided into the following groups: the control group, without fillings; the fracture group, without fillings and with fractured files; the fill group, filled; and the fill/fracture group, filled and with fractured files. Digital radiographs in ortho-, mesio-, and distoradial directions were performed in 2 semidirect systems (VistaScan [Diirr Dental, Beitigheim-Bissinger, Germany] and Express [Instrumentarium Imaging, Tuusula, Finland]) and a direct system (SnapShot [Instrumentarium Imaging]). CBCT images were acquired with 0.085-mm and 0.2-mm voxel sizes. All images were assessed and reassessed by 4 observers for the presence or absence of fractured files on a 5-point scale. The sensitivity, specificity, and accuracy were calculated. Results: In the absence of filling, accuracy values were high, and there were no statistical differences among the radiographic techniques, different digital systems, or the different CBCT voxels sizes. In the presence of filling, the accuracy of periapical radiographs was significantly higher than CBCT images. In general, Snapshot showed higher accuracy than VistaScan and Express. Conclusions: Periapical radiographs in 1 incidence were accurate for the detection of fractured endodontic instruments inside the root canal in the absence or presence of filling, suggesting that this technique should be the first choice as well as the direct digital radiographic system. In the presence of filling, the decision to perform a CBCT examination must take into consideration its low accuracy43454454