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Accuracy of digital radiography and cone beam computed tomography on periapical radiolucency detection in endodontically treated teeth.

Venskutonis T, Daugela P, Strazdas M, Juodzbalys G - J Oral Maxillofac Res (2014)

Bottom Line: Overall, it was observed a statistical significant difference between the number of periapical lesions observed in the CBCT (n = 42) and radiographic (n = 24) examinations (P < 0.05).In molar teeth, CBCT identify a significantly higher amount of periapical lesions than with the radiographic method (P < 0.05).The difference was more pronounced in molar teeth.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oral Diseases, Lithuanian University of Health Sciences, Kaunas Lithuania.

ABSTRACT

Objectives: The aim of the present study was to compare the accuracy of intraoral digital periapical radiography and cone beam computed tomography in the detection of periapical radiolucencies in endodontically treated teeth.

Material and methods: Radiographic images (cone beam computed tomography [CBCT] scans and digital periapical radiography [PR] images) from 60 patients, achieved from September 2008 to July 2013, were retrieved from databases of the Department of Oral Diseases, Lithuanian University of Health Sciences. Twenty patients met inclusion criteria and were selected for further evaluation.

Results: In 20 patients (42.4 [SD 12.1] years, 65% men and 35% women) a total of 35 endodontically treated teeth (1.75 [SD 0.91]; 27 in maxilla and 8 in mandible) were evaluated. Overall, it was observed a statistical significant difference between the number of periapical lesions observed in the CBCT (n = 42) and radiographic (n = 24) examinations (P < 0.05). In molar teeth, CBCT identify a significantly higher amount of periapical lesions than with the radiographic method (P < 0.05). There were significant differences between CBCT and PR in the mean number of lesions identified per tooth (1.2 vs 0.66, P = 0.03), number of teeth with lesions (0.71 vs 0.46, P = 0.03) and number of lesions identified per canal (0.57 vs 0.33, P = 0.005). Considering CBCT as "gold standard" in lesion detection with the sensitivity, specificity and accuracy considering as score 1, then the same parameters of PR were 0.57, 1 and 0.76 respectively.

Conclusions: Within the limitations of the present study, it can be concluded that cone beam computed tomography scans were more accurate compared to digital periapical radiographs for detecting periapical radiolucencies in endodontically treated teeth. The difference was more pronounced in molar teeth.

No MeSH data available.


Related in: MedlinePlus

A = CBCT image in a sagittal view showing the presence of periapical radiolucency on the apical aspect of the mesial root of a mandibular first molar. B = digital periapical radiography of the same tooth showing a normal aspect of the bone in the periapical area.
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fig1: A = CBCT image in a sagittal view showing the presence of periapical radiolucency on the apical aspect of the mesial root of a mandibular first molar. B = digital periapical radiography of the same tooth showing a normal aspect of the bone in the periapical area.

Mentions: Detection and characterisation of AP represents an important pre-operative prognostic factor for the root canal treatment [2,3]. Advanced stage AP and the evaluation of the endodontic treatment are easily identified with conventional radiographic methods such as intraoral PR. Though PR still remain as the best routinely employed method for the evaluation of the periapical status of teeth, diagnosis, and treatment planning, it has several limitations: such as the presence of anatomical noise, the two-dimensionality and geometric distortion [3,16]. Gao et al. [9] mentioned that PR limitations are most expressed in the assessment of molar teeth. The apical region of maxillary molars is often overlapped with the image of the radio-dense zygomatic process. Similarly, the cortical plate of the mandible can make the identification of small, developing lesion unpredictable [9] (Figure 1). It is interesting to know that even image enhancement did not increase diagnostic accuracy [23,24]. Furthermore, Barbat and Messer [24] observed a large inter-observer variation for both film and digital radiographs. Clinically, CBCT images provide more relevant information than periapical images and eliminate the superimposition of anatomical structures [25,26], which is useful to identify pathological processes occurring within the cancellous bone [3] (Figure 2). It is established that during the evaluation of radiographic methods, the reference method is either post-mortem study or biopsy on surgical intervention [27]. In a study by Velvart et al. [12], all 78 CBCT-scanned human periapical lesions were confirmed to be true bone defects during periapical surgery. Otherwise, clinical documentation of the diagnostic accuracy of CBCT is lacking.


Accuracy of digital radiography and cone beam computed tomography on periapical radiolucency detection in endodontically treated teeth.

Venskutonis T, Daugela P, Strazdas M, Juodzbalys G - J Oral Maxillofac Res (2014)

A = CBCT image in a sagittal view showing the presence of periapical radiolucency on the apical aspect of the mesial root of a mandibular first molar. B = digital periapical radiography of the same tooth showing a normal aspect of the bone in the periapical area.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4115593&req=5

fig1: A = CBCT image in a sagittal view showing the presence of periapical radiolucency on the apical aspect of the mesial root of a mandibular first molar. B = digital periapical radiography of the same tooth showing a normal aspect of the bone in the periapical area.
Mentions: Detection and characterisation of AP represents an important pre-operative prognostic factor for the root canal treatment [2,3]. Advanced stage AP and the evaluation of the endodontic treatment are easily identified with conventional radiographic methods such as intraoral PR. Though PR still remain as the best routinely employed method for the evaluation of the periapical status of teeth, diagnosis, and treatment planning, it has several limitations: such as the presence of anatomical noise, the two-dimensionality and geometric distortion [3,16]. Gao et al. [9] mentioned that PR limitations are most expressed in the assessment of molar teeth. The apical region of maxillary molars is often overlapped with the image of the radio-dense zygomatic process. Similarly, the cortical plate of the mandible can make the identification of small, developing lesion unpredictable [9] (Figure 1). It is interesting to know that even image enhancement did not increase diagnostic accuracy [23,24]. Furthermore, Barbat and Messer [24] observed a large inter-observer variation for both film and digital radiographs. Clinically, CBCT images provide more relevant information than periapical images and eliminate the superimposition of anatomical structures [25,26], which is useful to identify pathological processes occurring within the cancellous bone [3] (Figure 2). It is established that during the evaluation of radiographic methods, the reference method is either post-mortem study or biopsy on surgical intervention [27]. In a study by Velvart et al. [12], all 78 CBCT-scanned human periapical lesions were confirmed to be true bone defects during periapical surgery. Otherwise, clinical documentation of the diagnostic accuracy of CBCT is lacking.

Bottom Line: Overall, it was observed a statistical significant difference between the number of periapical lesions observed in the CBCT (n = 42) and radiographic (n = 24) examinations (P < 0.05).In molar teeth, CBCT identify a significantly higher amount of periapical lesions than with the radiographic method (P < 0.05).The difference was more pronounced in molar teeth.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oral Diseases, Lithuanian University of Health Sciences, Kaunas Lithuania.

ABSTRACT

Objectives: The aim of the present study was to compare the accuracy of intraoral digital periapical radiography and cone beam computed tomography in the detection of periapical radiolucencies in endodontically treated teeth.

Material and methods: Radiographic images (cone beam computed tomography [CBCT] scans and digital periapical radiography [PR] images) from 60 patients, achieved from September 2008 to July 2013, were retrieved from databases of the Department of Oral Diseases, Lithuanian University of Health Sciences. Twenty patients met inclusion criteria and were selected for further evaluation.

Results: In 20 patients (42.4 [SD 12.1] years, 65% men and 35% women) a total of 35 endodontically treated teeth (1.75 [SD 0.91]; 27 in maxilla and 8 in mandible) were evaluated. Overall, it was observed a statistical significant difference between the number of periapical lesions observed in the CBCT (n = 42) and radiographic (n = 24) examinations (P < 0.05). In molar teeth, CBCT identify a significantly higher amount of periapical lesions than with the radiographic method (P < 0.05). There were significant differences between CBCT and PR in the mean number of lesions identified per tooth (1.2 vs 0.66, P = 0.03), number of teeth with lesions (0.71 vs 0.46, P = 0.03) and number of lesions identified per canal (0.57 vs 0.33, P = 0.005). Considering CBCT as "gold standard" in lesion detection with the sensitivity, specificity and accuracy considering as score 1, then the same parameters of PR were 0.57, 1 and 0.76 respectively.

Conclusions: Within the limitations of the present study, it can be concluded that cone beam computed tomography scans were more accurate compared to digital periapical radiographs for detecting periapical radiolucencies in endodontically treated teeth. The difference was more pronounced in molar teeth.

No MeSH data available.


Related in: MedlinePlus