Cone-beam computed tomography versus digital periapical radiography in the detection of artificially created periapical lesions: A pilot study of the diagnostic accuracy of endodontists using both techniques

Abstract

PurposeThe aim of this study was to compare the diagnostic accuracy of previously trained endodontists in the detection of artificially created periapical lesions using cone-beam computed tomography (CBCT) and digital periapical radiography (DPR).Materials and MethodsAn ex vivo model using dry skulls was used, in which simulated apical lesions were created and then progressively enlarged using #1/2, #2, #4, and #6 round burs. A total of 11 teeth were included in the study, and 110 images were obtained with CBCT and with an intraoral digital periapical radiographic sensor (Instrumentarium dental, Tuusula, Finland) initially and after each bur was used. Specificity and sensitivity were calculated. All images were evaluated by 10 previously trained, certified endodontists. Agreement was calculated using the kappa coefficient. The accuracy of each method in detecting apical lesions was calculated using the chi-square test.ResultsThe kappa coefficient between examiners showed low agreement (range, 0.17-0.64). No statistical difference was found between CBCT and DPR in teeth without apical lesions (P=.15). The accuracy for CBCT was significantly higher than for DPR in all corresponding simulated lesions (P<.001). The correct diagnostic rate for CBCT ranged between 56.9% and 73.6%. The greatest difference between CBCT and DPR was seen in the maxillary teeth (CBCT, 71.4%; DPR, 28.6%; P<.01) and multi-rooted teeth (CBCT, 83.3%; DPR, 33.3%; P<.01).ConclusionCBCT allowed higher accuracy than DPR in detecting simulated lesions for all simulated lesions tested. Endodontists need to be properly trained in interpreting CBCT scans to achieve higher diagnostic accuracy.

An Insight into Histopathologic Examination as a Gold Standard for the Diagnosis of Chronic Apical Periodontitis

“…Campello et al (2017) found that the accuracy of CBCT was much higher than the digital radiography in detecting artificially created periapical lesions. The correct diagnosis recorded using CBCT was 73.6% and by radiograph 56.9% of the cases, the greatest differences being observed in maxillary (71.4% and 28.6%) and multi-rooted teeth (83.3% and 33.3%) respectively [12].…”

“…In teeth with irreversible pulpitis, the radiography identified the presence of apical pathology in 3% and the CBCT in 14% of the cases [9]. Nevertheless, according to the American Association of Endodontists the CBCT must be considered an adjunct to 2-dimensional imaging techniques reserved only for special cases [12]. Campello et al (2017) found that the accuracy of CBCT was much higher than the digital radiography in detecting artificially created periapical lesions.…”

“…Nevertheless, according to the American Association of Endodontists the CBCT must be considered an adjunct to 2-dimensional imaging techniques reserved only for special cases [12]. Campello et al (2017) found that the accuracy of CBCT was much higher than the digital radiography in detecting artificially created periapical lesions. The correct diagnosis recorded using CBCT was 73.6% and by radiograph 56.9% of the cases, the greatest differences being observed in maxillary (71.4% and 28.6%) and multi-rooted teeth (83.3% and 33.3%) respectively [12].…”

La imagenología en el diagnóstico y la planificación de sistemas de conductos radiculares: una revisión actualizada

“…La revisión de la literatura coincide en que las radiografías convencionales carecen de sensibilidad para determinar patologías apicales, por el alto ruido que provoca la presencia de estructuras anatómicas, lo cual demuestra que, entre las imágenes 2D, las más certeras son aquellas de tipo digital. En la revisión actual, el 90% de la literatura ofrece datos favorables para el uso de TCHC de campo pequeño; sin embargo, las lesiones apicales de gran tamaño (entre 1.4 mm-1.8mm de diámetro) no presentan diferencias significativas respecto de la técnica imagenológica empleada para su visualización ( [31][32][33][34][35][36] ).…”

Use of Texture Feature Maps for the Refinement of Information Derived from Digital Intraoral Radiographs of Lytic and Sclerotic Lesions

“…Moreover, the relative complexity of the region is increased by the presence of superimposing structures that result in "anatomical noise". All of these factors contribute to the difficulty in recognition of bone resorption on radiographic images, which impedes 2 of 14 the accuracy of diagnosis using digital intraoral radiography (DIR) images and may result in periapical lesions going undetected or detection is inadequate [5][6][7].…”