{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T05:17:49Z","timestamp":1786684669114,"version":"build-2736575974"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T00:00:00Z","timestamp":1737072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Oregon Health & Science University Division of Endodontology Les Morgan Endowment"},{"name":"AAE Resident Research"},{"DOI":"10.13039\/100002569","name":"American Association of Endodontists Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002569","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To compare a novel photon-counting sensor, 2 CBCT protocols and 2 CMOS sensors on the detection of gaps between a gutta-percha cone and root canal walls.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Twenty-five mandibular incisors were prepared to 45\/0.04 (size\/taper) at working length. Teeth were placed in a partially dentate mandible and single gutta-percha cones of 7 sizes were placed at length, one at a time, for image acquisition with a photon-counting sensor, 2 CBCT protocols (90\u2009\u00b5m3, 120\u2009\u00b5m3) and 2 CMOS sensors. Three calibrated observers assessed images for gap presence. Sensitivity, specificity, accuracy, AUC, and agreement with gold standard were determined using ANOVA and Tukey test (P\u2009\u2264\u2009.05).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Photon-counting sensor showed superior sensitivity and accuracy (88.47%, 81.57%), significantly higher than the CBCT protocols (50.70%-56.33%, 45.87%-53.17%). Contrarily, the photon-counting sensor showed the lowest specificity (40.27%), significantly lower than the CBCT protocols (90.27%, 97.23%). CMOS sensors showed sensitivity, specificity, and accuracy between 72.23%-74.53%, not differing from other modalities. All intraoral sensors showed AUC around 82.87%-84.03%, significantly higher than CBCT protocol 120\u2009\u00b5m3 (74.07%). The file size was inversely related to gap size and percentual agreement with gold standard.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>CMOS sensors showed consistent results, while the photon-counting sensor had the highest sensitivity but lacked specificity. CBCT protocols excelled in specificity but had lower sensitivity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Advances in knowledge<\/jats:title>\n                  <jats:p>Novel photon-counting sensors and CBCT imaging provided no significant advantage over conventional sensors in assessing gaps as an indicator of quality of root canal filling. Furthermore, smaller gaps were more difficult to detect, regardless of the imaging technique used.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/dmfr\/twaf005","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T15:10:12Z","timestamp":1737126612000},"page":"173-179","source":"Crossref","is-referenced-by-count":4,"title":["Assessment of the quality of root canal fillings\u2014an <i>ex vivo<\/i> comparison of CBCT scans, conventional intraoral sensors, and a novel photon-counting sensor"],"prefix":"10.1093","volume":"54","author":[{"given":"Matt","family":"Jervis","sequence":"first","affiliation":[{"name":"Division of Endodontology, School of Dentistry, Oregon Health & Science University , Portland, OR 97201,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Waid","sequence":"additional","affiliation":[{"name":"Division of Endodontology, School of Dentistry, Oregon Health & Science University , Portland, OR 97201,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1654-5251","authenticated-orcid":false,"given":"Juliana B","family":"Melo da Fonte","sequence":"additional","affiliation":[{"name":"Division of Oral and Maxillofacial Diagnostic Sciences, School of Dental Medicine, University of Connecticut , Farmington, CT 06030,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6477-6997","authenticated-orcid":false,"given":"Daniela","family":"Pita de Melo","sequence":"additional","affiliation":[{"name":"College of Dentistry, University of Saskatchewan , Saskatoon, SK S7N 5E5,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karan J","family":"Replogle","sequence":"additional","affiliation":[{"name":"Division of Endodontology, School of Dentistry, Oregon Health & Science University , Portland, OR 97201,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2299-5769","authenticated-orcid":false,"given":"Saulo L","family":"Sousa Melo","sequence":"additional","affiliation":[{"name":"Division of Oral Diagnostic Sciences, School of Dentistry, Oregon Health & Science University , Portland, OR 97201,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,17]]},"reference":[{"key":"2025030423235446000_twaf005-B1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/j.1365-2591.2007.01323.x","article-title":"Outcome of primary root canal treatment: systematic review of the literature\u2014Part 2. Influence of clinical factors","volume":"41","author":"Ng","year":"2008","journal-title":"Int Endod J"},{"key":"2025030423235446000_twaf005-B2","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1016\/S0011-8532(22)03244-X","article-title":"Filling Root Canals in Three Dimensions","volume":"11","author":"Schilder","year":"1967","journal-title":"Dental Clinics of North America"},{"key":"2025030423235446000_twaf005-B3","first-page":"172","article-title":"The sealing of the pulpless teeth evaluated with radioisotopes","volume":"16","author":"Marshall","year":"1961","journal-title":"J Dent Med"},{"key":"2025030423235446000_twaf005-B4","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/j.1365-2591.1993.tb00560.x","article-title":"Fluid transport and bacterial penetration along root canal fillings","volume":"26","author":"Wu","year":"1993","journal-title":"Int Endod J"},{"key":"2025030423235446000_twaf005-B5","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/j.1600-9657.1994.tb00533.x","article-title":"Coronal leakage as a cause of failure in root-canal therapy: a review","volume":"10","author":"Saunders","year":"1994","journal-title":"Endod Dent Traumatol"},{"key":"2025030423235446000_twaf005-B6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1046\/j.1365-2591.2001.00396.x","article-title":"Aetiology of root canal treatment failure: why well-treated teeth can fail","volume":"34","author":"Siqueira","year":"2001","journal-title":"Int Endod J"},{"key":"2025030423235446000_twaf005-B7","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1067\/moe.2002.120254","article-title":"Survival of first-time nonsurgical root canal treatment performed in a dental teaching hospital","volume":"93","author":"Cheung","year":"2002","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"2025030423235446000_twaf005-B8","doi-asserted-by":"crossref","first-page":"708","DOI":"10.14219\/jada.archive.1961.0127","article-title":"Roentgenographic and direct observation of experimental lesion in bone: II","volume":"62","author":"Bender","year":"1961","journal-title":"J Am Dent Assoc"},{"key":"2025030423235446000_twaf005-B9","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/0030-4220(69)90037-1","article-title":"Estimating endodontic \u201cworking length\u201d with paralleling radiographs","volume":"27","author":"Vande Voorde","year":"1969","journal-title":"Oral Surg Oral Med Oral Pathol"},{"key":"2025030423235446000_twaf005-B10","first-page":"12","article-title":"Clark's rule vis a vis the buccal object rule: its evolution & application in endodontics","volume":"59","author":"Gutman","year":"2011","journal-title":"J Hist Dent"},{"key":"2025030423235446000_twaf005-B11","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1159\/000261291","article-title":"Depth of occlusal caries assessed clinically, by conventional film radiographs, and by digitized, processed radiographs","volume":"24","author":"Wenzel","year":"1990","journal-title":"Caries Res"},{"key":"2025030423235446000_twaf005-B12","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1159\/000261393","article-title":"Detection of occlusal caries without cavitation by visual inspection, film radiographs, xeroradiographs, and digitized radiographs","volume":"25","author":"Wenzel","year":"1991","journal-title":"Caries Res"},{"key":"2025030423235446000_twaf005-B13","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/0300-5712(92)90011-Z","article-title":"Effects of digital grey-scale modification on the diagnosis of small approximal carious lesions","volume":"20","author":"Verdonschot","year":"1992","journal-title":"J Dent"},{"key":"2025030423235446000_twaf005-B14","doi-asserted-by":"crossref","first-page":"100901","DOI":"10.1118\/1.4820371","article-title":"Vision 20\/20: single photon counting X-ray detectors in medical imaging","volume":"40","author":"Taguchi","year":"2013","journal-title":"Med Phys"},{"key":"2025030423235446000_twaf005-B15","doi-asserted-by":"crossref","first-page":"110229","DOI":"10.1016\/j.ejrad.2022.110229","article-title":"Photon counting detectors: concept, technical challenges, and clinical outlook","volume":"149","author":"Kreisler","year":"2022","journal-title":"Eur J Radiol"},{"key":"2025030423235446000_twaf005-B16","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.cden.2021.02.004","article-title":"Radiology in endodontics","volume":"65","author":"Setzer","year":"2021","journal-title":"Dent Clin North Am"},{"key":"2025030423235446000_twaf005-B17","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/iej.12121","article-title":"Ex vivo evaluation of artifacts mimicking fracture lines on cone-beam computed tomography produced by different root canal sealers","volume":"47","author":"Brito-Junior","year":"2014","journal-title":"Int Endod J"},{"key":"2025030423235446000_twaf005-B18","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1016\/j.joen.2017.03.035","article-title":"Assessment of volumetric distortion artifact in filled root canals using different cone-beam computed tomographic devices","volume":"43","author":"Celikten","year":"2017","journal-title":"J Endod"},{"key":"2025030423235446000_twaf005-B19","doi-asserted-by":"crossref","first-page":"3267","DOI":"10.1007\/s00784-018-2748-8","article-title":"Comparative evaluation of cone beam CT and micro-CT on blooming artifacts in human teeth filled with bioceramic sealers","volume":"23","author":"Celikten","year":"2019","journal-title":"Clin Oral Investig"},{"key":"2025030423235446000_twaf005-B20","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.joen.2015.11.002","article-title":"Evaluation and reduction of artifacts generated by 4 different root-end filling materials by using multiple cone-beam computed tomography imaging settings","volume":"42","author":"Helvacioglu-Yigit","year":"2016","journal-title":"J Endod"},{"key":"2025030423235446000_twaf005-B21","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1259\/dmfr\/43691321","article-title":"Evaluation of a cone beam CT artefact reduction algorithm","volume":"41","author":"Bechara","year":"2012","journal-title":"Dentomaxillofac Radiol"},{"key":"2025030423235446000_twaf005-B22","doi-asserted-by":"crossref","first-page":"20130070","DOI":"10.1259\/dmfr.20130070","article-title":"Effect of voxel size and partial volume effect on accuracy of tooth volumetric measurements with cone beam CT","volume":"42","author":"Ye","year":"2013","journal-title":"Dentomaxillofac Radiol"},{"key":"2025030423235446000_twaf005-B23","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1590\/0103-6440202204392","article-title":"Influence of endodontic sealers artifacts in the detection of vertical root fractures","volume":"33","author":"Cavalcanti","year":"2022","journal-title":"Braz Dent J"},{"key":"2025030423235446000_twaf005-B24","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/j.joen.2017.05.001","article-title":"Influence of different kinematics on apical extrusion of irrigant and debris during canal preparation using K3XF instruments","volume":"43","author":"Toyoglu","year":"2017","journal-title":"J Endod"},{"key":"2025030423235446000_twaf005-B25","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"2025030423235446000_twaf005-B26","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.joen.2010.11.032","article-title":"Endodontic outcome predictors identified with periapical radiographs and cone-beam computed tomography scans","volume":"37","author":"Liang","year":"2011","journal-title":"J Endod"},{"key":"2025030423235446000_twaf005-B27","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.oooo.2013.03.008","article-title":"Comparison of images from digital intraoral receptors and cone beam computed tomography scanning for detection of voids in root canal fillings: an in vitro study using micro-computed tomography as validation","volume":"115","author":"M\u00f8ller","year":"2013","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"key":"2025030423235446000_twaf005-B28","doi-asserted-by":"crossref","first-page":"867","DOI":"10.2214\/ajr.182.4.1820867","article-title":"How many observers are needed in clinical studies of medical imaging?","volume":"182","author":"Obuchowski","year":"2004","journal-title":"AJR Am J Roentgenol"},{"key":"2025030423235446000_twaf005-B29","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1111\/j.1365-2591.2009.01566.x","article-title":"Void detection in root fillings using intraoral analogue, intraoral digital and cone beam CT images","volume":"42","author":"Huybrechts","year":"2009","journal-title":"Int Endod J"},{"key":"2025030423235446000_twaf005-B30","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1016\/j.joen.2014.06.012","article-title":"Evaluation of cone-beam computed tomography in the diagnosis of vertical root fractures: the influence of imaging modes and root canal materials","volume":"40","author":"Neves","year":"2014","journal-title":"J Endod"},{"key":"2025030423235446000_twaf005-B31","doi-asserted-by":"crossref","first-page":"20160463","DOI":"10.1259\/dmfr.20160463","article-title":"Comparing cone-beam computed tomography with periapical radiography for assessing root canal obturation in vivo using microsurgical findings as validation","volume":"46","author":"Song","year":"2017","journal-title":"Dentomaxillofac Radiol"},{"key":"2025030423235446000_twaf005-B32","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0196-0644(99)70422-1","article-title":"Evaluating bias and variability in diagnostic test reports","volume":"33","author":"Mower","year":"1999","journal-title":"Ann Emerg Med"},{"key":"2025030423235446000_twaf005-B33","doi-asserted-by":"crossref","first-page":"45","DOI":"10.4103\/0301-4738.37595","article-title":"Understanding and using sensitivity, specificity and predictive values","volume":"56","author":"Parikh","year":"2008","journal-title":"Indian J Ophthalmol"},{"key":"2025030423235446000_twaf005-B34","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.oooo.2023.10.004","article-title":"The effect of voxel and field of view size on the volumetric alteration artifact of high-density materials with 2 cone beam computed tomography devices","volume":"137","author":"Lucca","year":"2024","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"key":"2025030423235446000_twaf005-B35","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/0363-0188(89)90030-3","article-title":"Visual illusions in the interpretation of the radiographic image","volume":"18","author":"Daffer","year":"1989","journal-title":"Curr Prob Diagn Radiol"},{"key":"2025030423235446000_twaf005-B36","doi-asserted-by":"crossref","first-page":"25","DOI":"10.4097\/kja.21209","article-title":"Receiver operating characteristic curve: overview and practical use for clinicians","volume":"75","author":"Nahm","year":"2022","journal-title":"Korean J Anesthesiol"},{"key":"2025030423235446000_twaf005-B37","first-page":"203","article-title":"Measures of diagnostic accuracy: basic definitions","volume":"19","author":"\u0160imundi\u0107","year":"2009","journal-title":"EJIFCC"},{"key":"2025030423235446000_twaf005-B38","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1046\/j.1365-2591.2002.00546.x","article-title":"Periapical health related to the quality of coronal restorations and root fillings","volume":"35","author":"Hommez","year":"2002","journal-title":"Int Endod J"},{"key":"2025030423235446000_twaf005-B39","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.joen.2018.02.019","article-title":"Clinical outcome of non-surgical root canal treatment using a single-cone technique with endosequence bioceramic sealer: a retrospective analysis","volume":"44","author":"Chybowski","year":"2018","journal-title":"J Endod"}],"container-title":["Dentomaxillofacial Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/dmfr\/advance-article-pdf\/doi\/10.1093\/dmfr\/twaf005\/61488187\/twaf005.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/dmfr\/article-pdf\/54\/3\/173\/61488187\/twaf005.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/dmfr\/article-pdf\/54\/3\/173\/61488187\/twaf005.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T23:24:11Z","timestamp":1741130651000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/dmfr\/article\/54\/3\/173\/7959524"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,17]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/dmfr\/twaf005","relation":{},"ISSN":["0250-832X","1476-542X"],"issn-type":[{"value":"0250-832X","type":"print"},{"value":"1476-542X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,3]]},"published":{"date-parts":[[2025,1,17]]}}}