Comparison between periapical radiography and cone beam computed tomography for the diagnosis of anterior maxillary trauma in children and adolescents

Abstract

Background/Aims: Under-estimating the damage caused by trauma to the dental structures may delay treatment. Timely and accurate diagnosis remains challenging in clinical practice. Radiography is an important modality for the diagnosis of traumatic injuries. The aim of this study was to compare the efficacy of periapical radiography and cone beam computed tomography for the diagnosis of trauma to the anterior maxillary dentoalveolar region in children and adolescents. Material and methods: Images of patients who underwent both periapical radiography and cone beam computed tomography simultaneously because of trauma to the anterior maxillary region between January 2016 and January 2020 were analyzed retrospectively. Pairwise comparison between the receiver operating characteristic curves was performed to statistically compare the two methods for the diagnosis of crown fractures, root fractures, alveolar bone fractures and luxations, tooth resorption, and periapical radiolucencies.Results: A total of 190 patients met the inclusion criteria. There were 120 (63.2%) males and 70 (36.8%) females, with a mean age of 11.1 years (range: 6-17 years). A crown fracture was observed in 144 teeth, while a root fracture was observed in 71 teeth. Alveolar fracture and luxation were observed in 44 incisors. During followup, tooth resorption and periapical radiolucencies were observed in 25 and 33 teeth, respectively. Pairwise receiver operating characteristic curve analysis revealed that cone beam computed tomography was significantly superior to periapical radiography for the diagnosis of root fractures, alveolar fractures and luxations, and tooth resorption (p < .05). However, no significant differences were found for the diagnosis of crown fractures and periapical radiolucencies (p > .05). Conclusions:Cone beam computed tomography in the low-dose mode was better for diagnosing root and bone fractures and resorption, but no different to periapical radiographs for crown fractures and periapical radiolucencies in pediatric patients.

Is use of CBCT without proper training justified in paediatric dental traumatology? An exploratory study

“…This study showed that the use of CBCT without specific training did not improve the overall diagnostic performance of paediatric dentists in case of TDIs, despite the fact that CBCT is becoming a commonly used diagnostic imaging tool in dentistry. This is not in accordance with reports describing that CBCT provided superior interpretation of information with a better insight into diagnostic dilemmas and complex treatment decisions [ 28 – 31 ]. However, it should be emphasized that in these studies observers were specialists in endodontics or in oral maxillofacial radiology, all of them better trained in CBCT reading.…”

Root Canal Configuration and Its Relationship with Endodontic Technical Errors and Periapical Status in Premolar Teeth of a Saudi Sub-Population: A Cross-Sectional Observational CBCT Study

“…Cone-beam computed tomography is a revolutionary diagnostic tool that has proven superior to periapical radiographs for visualizing pulp canal configuration [19,20]. The features of CBCT that advocate its use for endodontic investigation include higher resolution, increased accuracy, three-dimensional imaging of the teeth, elimination of overlaps, earlier detection of apical lesions, and 3-D reconstruction of root canal systems [20][21][22][23][24][25][26]. In a joint position statement, the American Association of Endodontists (AAE) and American Academy of Oral and Maxillofacial Radiology (AAOMR) recommend the use of limited field-of-view CBCT for endodontic evaluation of teeth.…”

CBCT in contemporary endodontics

“…Recent studies reported CBCT exhibited greater sensitivity for the diagnosis of lateral luxations, alveolar cortical plate fractures, transverse root fractures, and tooth resorption. 106,107 However, in both studies the examiners were only provided with radiographs and/ or CBCT without any accompanying clinical information. The results may therefore not reflect the use of CBCT for trauma diagnosis in a clinical setting where the availability of other information may make it possible to accurately diagnose without a CBCT scan.…”