Diagnostic efficacy of 3 imaging modalities in the detection of fractured endodontic instruments: an in vitro study

Objectives. To compare the diagnostic efficacy of periapical radiography (PAR) and cone beam computed tomography (CBCT) without and with a metal artifact reduction algorithm (MARA) in the detection of fractured endodontic instruments in unfilled and filled root canals that were straight and curved.Study Design. In total, 144 root canals from 48 mandibular molars were divided into 4 groups: the control group with empty canals, the fracture group with a fractured instrument, the fill group with root canal filling, and the fracture/fill group with a frac-tured instrument and root canal filling. The teeth were examined with PAR using a complementary metal oxide semiconductor sensor and CBCT without and with MARA to evaluate the diagnostic efficacy of the 3 techniques in the detection of fractured instruments. Three examiners evaluated the radiographs.Results. Overall, PAR exhibited significantly better diagnostic outcomes than CBCT without MARA. PAR yielded significantly bet -ter results than both CBCT protocols in the presence of root filling and in straight canals. In the absence of filling and in curved canals, there were no statistically significant differences among the 3 techniques.Conclusions. PAR was the imaging technique that best detected fractured instruments in filled and unfilled straight root canals.