Comparative Evaluation of Electronic Apex Locators in Detecting Simulated Root Perforations: A Cone-beam Computed Tomography-based In Vitro Study

perforations, the presence of scatter and beam hardening due to adjacent high-density structures or materials can compromise the quality and diagnostic precision of CBCT images.Crowns, bridges, implants, restorations, root filling materials, and intracanal posts with elevated density may generate streak artifacts and distort the region of interest. IntroductIonA root canal perforation is an undesired link connecting the root canal system and the periodontium, which can result from pathological processes such as root resorption or from iatrogenic dental procedures. 1 The incidence of perforation ranges from 0.6 to 17.6% as reported by a recent systematic review. 2 Regardless of the location or etiology, perforation might affect the outcome for endodontic therapy.3 The diagnosis of the presence and localization of a perforation, as well as the determination of a treatment plan, can be challenging.Because the time elapsed between the creation of the perforation and its repair is critical to the prognosis for the tooth, early and accurate determination of the presence of a perforation is of paramount importance.4 Success of endodontic treatment is influenced by the location, extent, and repair time of the perforation.5 Several diagnostic tools, such as periapical radiography, electronic apex locators (EALs), surgical microscopy, endoscopy, and computed tomography (CT), have been proposed for detecting perforations.6 Among these, conebeam computed tomography (CBCT) has been shown to be the more accurate imaging modality, offering detailed images of the teeth and surrounding periodontal regions without distortion.7,8 While CBCT imaging offers three-dimensional visualization of 1-