Introduction: A separated instrument in the root canal may compromise adequate treatment of the entire root canal system. Radiographic detection of retained instruments is a very important step for proper treatment planning. Cone Beam Computed Tomography (CBCT) scans provide three-dimensional (3D) imaging of maxillofacial anatomy. Yet, the presence of canal filling in close proximity to a fractured instrument may cause beam hardening artifacts in CBCT images that may reduce the diagnostic accuracy. So that, the need for Metal artifact reduction (MAR) tool is mandatory to improve image quality.
Objectives: The purpose of this study was to assess the accuracy of the MAR tool of CBCT in the detection of separated endodontic instruments in root canals.
Methodology: One hundred forty-four canals of mandibular molar teeth were divided into four groups: the control group having empty canals, the fracture group with a fractured file fragment, the fill group with gutta-percha points, and the fill/fracture group that was filled with presence of a fractured file fragment. The teeth were radiographed by CBCT with MAR tool application and periapical X-Ray using complementary metal oxide semiconductor (CMOS) sensor to evaluate the diagnostic accuracy of both techniques in the identification of the separated fragment.
Results: In the presence of filling, periapical radiography showed greater diagnostic accuracy than CBCT with MAR tool activation. In the absence of filling, there was no statistically significant difference between the two radiographic techniques.
Conclusions: Periapical radiography is the best technique for detection of fractured instruments in filled and unfilled root canals.