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PA radiographs taken at different angles (KaVo Kerr, Brea, CA) and a limited field\u2010of\u2010view CBCT scan (KaVo Kerr, Brea, CA) of 0.125mm<jats:sup>3<\/jats:sup> voxel size were evaluated. Two calibrated independent endodontic practitioners examined all radiographic images in a random and blinded sequence, under similar viewing conditions. Agreement above chance (kappa) was calculated for parameters of interest (Graphpad by Dotmatics, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.graphpad.com\/\">https:\/\/www.graphpad.com\/<\/jats:ext-link>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighty\u2010two APEL (15 incisors, 25 premolars, 42 molars; 59.8% treated 4\u201310\u2009years prior) in 77 patients (34 male, 43 female, median age 51\u201360) were examined. Root filling quality was acceptable with 14\/82 (17.0%) lacking density and homogeneity. Weighted kappa on <jats:italic>lesion size<\/jats:italic> (0.5\u20131.9, 2\u20134.9 and 5\u20139.9\u2009mm) between PA radiographs and CBCT was 0.466 \u2013 in 24 APEL, lesion size was &gt;2\u2009mm larger on CBCT whilst in 4 APEL, lesions were &gt;2\u2009mm smaller on CBCT. On <jats:italic>proximity<\/jats:italic> to maxillary sinus and neurovascular structures (\u2018yes\u2019, \u2018no\u2019, \u2018unable to tell\u2019), kappa was 0.237, with 9 APEL scored \u2018unable to tell\u2019 on PA radiographs and 0 uncertainty on CBCT. Agreement between PA radiographs and CBCT on <jats:italic>missed canals<\/jats:italic> (\u2018not likely\u2019, \u2018somewhat likely\u2019, \u2018very likely\u2019, \u2018unable to tell\u2019) was 0.349, with 13 teeth scored \u2018somewhat likely\u2019 and \u2018very likely\u2019 on CBCT and only 6 teeth similarly scored on PA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Overall, CBCT provided a more comprehensive examination of teeth with APEL than PA radiographs. Larger lesion sizes were generally observed, especially in posterior teeth. Sinus involvement was more readily identified, and the assessment of the presence of missed canals could be performed with more certainty. Where lesion monitoring is chosen, CBCT imaging should be considered for a more thorough assessment of posterior teeth, and where there is uncertainty in PA radiograph interpretation of anterior teeth.<\/jats:p><\/jats:sec>","DOI":"10.1111\/iej.14272","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T04:19:57Z","timestamp":1749788397000},"page":"1551-1564","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["<scp>2D<\/scp> versus <scp>3D<\/scp> radiographic assessment of asymptomatic persistent endodontic lesions"],"prefix":"10.1111","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6345-3258","authenticated-orcid":false,"given":"Klare","family":"Chan Shu Wen","sequence":"first","affiliation":[{"name":"Faculty of Dentistry National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee Chee","family":"Wee","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8635-5475","authenticated-orcid":false,"given":"Mingrun","family":"Wei","sequence":"additional","affiliation":[{"name":"Khoo Teck Puat Hospital Dental Surgery  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lim Kian Chong","family":"Gerald","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2546-9652","authenticated-orcid":false,"given":"Victoria Soo Hoon","family":"Yu","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"e_1_2_12_2_1","article-title":"Endodontic\u2010related facial paresthesia: systematic review","volume":"80","author":"Alves F.R.","year":"2014","journal-title":"Journal of the Canadian Dental Association"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/iej.13419"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/iej.13397"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2010.11.014"},{"issue":"5","key":"e_1_2_12_6_1","first-page":"345","article-title":"Roentgenologic periapical diagnosis. 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