Could Low-dose Cone-beam CT be Used for Endodontic Intraoperative Diagnosis?

INTRODUCTION: Cone-beam computed tomography (CBCT) allows three-dimensional evaluation and has high diagnostic accuracy of endodontic conditions. Considering that the most indicated protocol for endodontics should have smaller field-of-view and higher spatial resolution, a higher radiation dose may be associated. Thus, this study evaluated the accuracy of an optimized CBCT protocol for the detection of intraoperative endodontic complications. METHODS: An image phantom was custom-made with a human mandible covered with Mix-D and forty mandibular first molars. The teeth were subdivided into 4 groups of endodontic complications which were simulated. All teeth were individually inserted into the left second molar socket of the phantom and CBCT images were acquired with OP 300 unit adjusted to a field-of-view of 6 x 4 cm, 90kVp, and 2 dose protocols: low and high. Furthermore, a titanium implant, a tooth with endodontic treatment, and a cobalt-chromium post were inserted into the empty sockets adjacent to the teeth of interest and additional images were acquired. Four endodontists evaluated the images and indicated the presence of endodontic complications on a 5-point scale. Sensitivity, specificity, and area under the receiver operating characteristic curve were obtained. The different groups were compared by ANOVA and Tukey tests (alpha = 0.05). RESULTS: In most conditions, irrespective of the presence of metallic materials, the values of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve did not differ significantly (P > .05) between the dose protocols. CONCLUSIONS: Optimized CBCT protocols should be considered for the detection of intraoperative endodontic Diagnostic complications.