Great attention has been given to the study of radiolucent periapical lesions to avert possible misdiagnosis of apical periodontitis associated with certain radiolucent non-endodontic lesions. However, there are a significant number of radiopaque lesions found in the periapical region, which could be equally relevant to endodontic practice. The diagnosis and management of these radiopaque/hyperdense lesions could be challenging to the endodontist. These bone alterations could be neoplastic, dysplastic or of metabolic origin. In the context of the more widespread use of cone-beam CT, a detailed review of radiopaque inflammatory and non-inflammatory lesions is timely and may aid clinicians perform a differential diagnosis of these lesions. Distinguishing between inflammatory and non-inflammatory lesions simplifies diagnosis and consequently aids in choosing the correct therapeutic regimen. This review discusses the literature regarding the clinical, radiographic, histological and management aspects of radiopaque/hyperdense lesions, and illustrates the differential diagnoses of these lesions.

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Objectives This study aimed to evaluate the influence of different CBCT acquisition protocols on reducing effective radiation dose while maintaining image quality. Materials and Methods The effective dose emitted by a CBCT Picasso Trio® device was calculated using thermoluminescent dosimeters (TLDs) placed in a Rando Alderson phantom, following the ICRP 103 (2007) guidelines. Image quality was assessed by three experienced evaluators, who examined CBCT images for anatomical structure identification and image quality impressions. The relationship between image quality and confidence was evaluated using Fisher's Exact Test, and the agreement among raters was assessed using the Kappa test. Multiple linear regression analysis was performed to investigate whether the technical parameters could predict the effective dose. Results The optimized protocol with 3 mA, 99 kVp, and 450 projection images demonstrated good image quality and a lower effective dose for radiation-sensitive organs. Image quality and confidence had consistent values for all structures (p < .05). The multiple linear regression analysis resulted in a statistically significant model. The mA (b = 0.504; t = 3.406; p = 0.027), kVp (b = 0.589; t = 3.979; p = 0.016), and projection images (b = 0.557; t = 3.762; p = 0.020) were predictors of the effective dose. Conclusions Optimized CBCT acquisition protocols can significantly reduce effective radiation dose while maintaining acceptable image quality by adjusting the mA, projection images, and kVp. Clinical Relevance: These findings can contribute to the optimization of CBCT imaging protocols, allowing clinicians to obtain high-quality images with reduced radiation exposure.