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Objective <p>To assess the diagnostic performance of photon-counting detector computed tomography (PCD-CT) and cone-beam computed tomography (CBCT) at dose-matched radiation levels (high, standard, and low) for detecting and evaluating simulated endodontic conditions, treatments, and associated complications.</p> Methods <p>Sixteen extracted third molars with eight endodontic tasks were imaged using PCD-CT and CBCT. Qualitative (image quality, artifact susceptibility, diagnostic interpretability) and quantitative (endodontic working length) parameters were assessed by two observers using a five-point Likert scale. Descriptive statistics and weighted kappa (κ) were used for data analysis.</p> Results <p>High- and standard-dose PCD-CT demonstrated superior image quality and anatomical visualization compared to CBCT (median 5, IQR 5–5; κ = 1.0; all <i>p</i> &lt; 0.001). Low-dose PCD-CT remained diagnostically robust, outperforming CBCT, except in root canal visualization, where both performed similarly. Diagnostic accuracy of pathologies and complications was slightly higher with PCD-CT (80–88%) than with CBCT (75–88%). Endodontic working length measurements were consistently accurate across all protocols, with near-perfect inter-observer agreement (κ = 0.84–0.86, all <i>p</i> &lt; 0.001).</p> Conclusions <p>PCD-CT demonstrated superior diagnostic performance over CBCT across multiple endodontic tasks, particularly at high and standard doses. Even at low doses, PCD-CT maintained robust accuracy and image quality, outperforming dose-matched CBCT in most parameters. Endodontic working length assessment was equally reliable across both modalities. Overall, PCD-CT offers diagnostic advantages over CBCT, particularly in challenging cases involving complex anatomy or high-density materials. Its effective performance at lower radiation levels emphasizes its clinical potential and supports broader implementation in dentomaxillofacial diagnostics.</p>

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Photon-counting detector vs. cone-beam CT in endodontics: a study of simulated endodontic conditions, treatments, and associated complications

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月29日

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  • Adib Al-Haj Husain,
  • Victor Mergen,
  • Nadin Al-Haj Husain,
  • Hatem Alkadhi,
  • Tristan T. Demmert,
  • Harald Essig,
  • Sebastian Winklhofer,
  • Thomas Flohr,
  • Silvio Valdec,
  • Selinay Dogan,
  • Egon Burian,
  • Bernd Stadlinger

摘要

Objective

To assess the diagnostic performance of photon-counting detector computed tomography (PCD-CT) and cone-beam computed tomography (CBCT) at dose-matched radiation levels (high, standard, and low) for detecting and evaluating simulated endodontic conditions, treatments, and associated complications.

Methods

Sixteen extracted third molars with eight endodontic tasks were imaged using PCD-CT and CBCT. Qualitative (image quality, artifact susceptibility, diagnostic interpretability) and quantitative (endodontic working length) parameters were assessed by two observers using a five-point Likert scale. Descriptive statistics and weighted kappa (κ) were used for data analysis.

Results

High- and standard-dose PCD-CT demonstrated superior image quality and anatomical visualization compared to CBCT (median 5, IQR 5–5; κ = 1.0; all p < 0.001). Low-dose PCD-CT remained diagnostically robust, outperforming CBCT, except in root canal visualization, where both performed similarly. Diagnostic accuracy of pathologies and complications was slightly higher with PCD-CT (80–88%) than with CBCT (75–88%). Endodontic working length measurements were consistently accurate across all protocols, with near-perfect inter-observer agreement (κ = 0.84–0.86, all p < 0.001).

Conclusions

PCD-CT demonstrated superior diagnostic performance over CBCT across multiple endodontic tasks, particularly at high and standard doses. Even at low doses, PCD-CT maintained robust accuracy and image quality, outperforming dose-matched CBCT in most parameters. Endodontic working length assessment was equally reliable across both modalities. Overall, PCD-CT offers diagnostic advantages over CBCT, particularly in challenging cases involving complex anatomy or high-density materials. Its effective performance at lower radiation levels emphasizes its clinical potential and supports broader implementation in dentomaxillofacial diagnostics.