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The study evaluates the diagnostic accuracy of periapical radiography (PR) and cone beam computed tomography (CBCT) in the root canal configuration of upper first premolars. It is concluded that PR, although inexpensive and low in radiation, has limitations in complex anatomies, achieving an accuracy of 72%. On the other hand, the CBCT, with high-resolution three-dimensional images, achieved 96% accuracy, although it requires greater exposure to radiation. Both techniques are complementary depending on the complexity of the case.