Introduction: Cone beam computed tomography (CBCT) has become a valuable diagnostic tool for endodontics. Although the literature generally supports the accuracy of this imaging modality, some studies report that CBCT images may have limitations in representing the true clinical presentation. Purpose: This study compared pre-surgical limited field of view (LFOV) CBCT images with the actual clinical presentation. Method: Patients were asked to enroll in the study if they required endodontic surgery and had a limited FOV CBCT. A total of 45 subjects were enrolled. A standardized set of questions assessing presence and dimensions of bony defects, and presence of root fractures was prepared. During surgery, clinical data were collected and documented with photographs. At the conclusion of enrollment, the CBCT images were evaluated by three calibrated board certified endodontists. The clinical presentation data were compared to data from CBCT interpretations. Conclusion: Though useful in endodontic surgical treatment planning, the LFOV CBCT image should not be considered an identical representation of the clinical presentation at surgery.