Objective: The aim of this study is to compare the effectiveness of periapical radiography, cone-beam computed tomography (CBCT), and microscopic examination in identifying root canal morphology in mandibular premolars, and to determine the most effective method for clinicians. Material and Methods: Ninety-seven extracted human mandibular premolars were analyzed. Periapical radiographs and CBCT images were obtained, and the number of canals was examined under microscopic magnification. Three endodontists evaluated the images and recorded canal configurations according to Vertucci's classification. Results: Vertucci type 1 was the most frequently detected canal type with CBCT (74.2%), followed by periapical radiography (67.0%) and microscopy (46.4%). Vertucci type 2 was detected at the highest rate with the microscope (35.1%), compared to CBCT (9.3%) and periapical radiography (17.5%). Vertucci type 3 was observed at the lowest rate among the three methods. Vertucci type 4 was detected at the highest rate by microscope (7.2%). Vertucci type 8 was the rarest type, detected at the rate of 1.0% with all three methods. The Fleiss kappa coefficient was 0.407, indicating moderate agreement among the evaluators. Conclusion: CBCT is one of the most successful methods for identifying complex canal systems; however, it may be insufficient for detecting additional canals. Periapical radiography showed a high agreement and remained a reliable diagnostic tool. Microscopy provides a significant advantage in detecting narrow or extra canals, but may not be sufficient for diagnosis alone and should be supported by other methods. A case-specific combination of imaging methods is preferred to detect missed canals.
Kamalak et al. (Thu,) studied this question.