Root perforation (RP) is an important complication that can result in problematic orthodontic treatments. Therefore, early diagnosis of RP is necessary and of high importance. Current reports indicate the higher efficiency of Cone-Beam Computed Tomography (CBCT) compared to digital radiography (DR). This study aims to compare the efficacy of multi-angled DR and CBCT in the diagnosis of RP in mandibular molar teeth. Materials and methods: This diagnostic study checked 60 mandibular molar teeth. The studied teeth were groped in random in 4 equal groups namely: perforated obturated mesiobuccal, perforated without obturated, obturated imperforated and imperforated no-obturated. Digital radiography was conducted in mesial, distal and parallel views and CBCT was conducted in axial and cross-sectional views. Finally, the diagnostic value of both techniques was compared. Results: Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of DR and CBCT were 82% versus 27%, 83% versus 96%, 83% versus 63%, 82% versus 88% and 83% versus 58%, respectively. The sensitivity and negative predictive value of DR in no-obturated teeth was zero with an accuracy of 50% while those of CBCT were in an ideal level. In obturated teeth, however, CBCT showed a high sensitivity, a higher positive predictive value and a higher accuracy, compared to DR. Conclusion: CBCT has a higher diagnostic efficacy than DR in diagnosing PR in mandibular molar teeth.
