Prevalence and Size of Periapical Radiolucencies Using Cone-beam Computed Tomography in Teeth without Apparent Intraoral Radiographic Lesions: A New Periapical Index with a Clinical Recommendation

Torabinejad, Mahmoud; Rice, Dwight; Maktabi, O.; Oyoyo, Udochukwu; Abramovitch, Kenneth

doi:10.1016/j.joen.2017.11.015

Cited by 45 publications

(47 citation statements)

References 26 publications

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“…Patel et al (2012a) detected periapical lesions in 20% and 48% of 123 teeth planned for primary root canal treatment when PR and CBCT were used, respectively. Similar findings have been reported in other studies (Davies et al 2015, Uraba et al 2016, Torabinejad et al 2018 (Table 2).…”

Section: Detection Of Apical Periodontitissupporting

confidence: 92%

Cone beam computed tomography in Endodontics – a review of the literature

et al. 2019

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The use of cone beam computed tomography (CBCT) in the diagnosis and/or management of endodontic problems is increasing and is reflected in the exponential rise in publications on this topic in the last two decades. The aim of this paper is to: (i) Review current literature on the endodontic applications of CBCT; (ii) Based on current evidence make recommendations for the use of CBCT in Endodontics; (iii) Highlight the areas in which more research is required.

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Section: Detection Of Apical Periodontitissupporting

confidence: 92%

Cone beam computed tomography in Endodontics – a review of the literature

et al. 2019

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“…Although this work demonstrated an almost perfect agreement for the apical extent of root canal filling and a substantial concordance for root canal filling density between DPR and CBCT scores, this concordance was only moderate amongst DPR-PAI and CBCT-PAI assessments. In agreement to the former, other authors have demonstrated inconsistencies in the findings obtained by the two imaging methods (Kanagasingam et al 2017, Torabinejad et al 2018. Accordingly, the treatment outcome as determined by DPR, the apical extent and density of root fillings as diagnosed by DPR and the outcome predictors identified only by using DPR data could be incorrect (Liang et al 2011).…”

Section: Discussionmentioning

confidence: 76%

“…, Torabinejad et al . ). Accordingly, the treatment outcome as determined by DPR, the apical extent and density of root fillings as diagnosed by DPR and the outcome predictors identified only by using DPR data could be incorrect (Liang et al .…”

Section: Discussionmentioning

confidence: 97%

Prognosis of root canal treatment in teeth with preoperative apical periodontitis: a study with cone‐beam computed tomography and digital periapical radiography

et al. 2019

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Aim This observational cohort study aimed: (i) to determine retrospectively after a 1‐ to 12‐year follow‐up period, the strength and independence of the association of various patient‐, tooth‐ and treatment‐related prognostic variables with the outcome of root canal treatment in patients with pre‐therapeutic apical periodontitis; and (ii) to establish the concordance between those predictors evaluated by both cone‐beam computed tomography (CBCT) and digital periapical radiography (DPR). Methodology The study cohort included 125 teeth in 84 individuals. The postoperative clinical signs/symptoms, plus DPR/CBCT‐PAI estimations, were used to determine the healing outcome. For statistical analysis, results were dichotomized into completely healed periapical structures versus persistent disease cases. The association between candidate predictor variables with persistent disease was analysed individually and adjusted for confounders using a multivariate binary logistic regression model. Results The success rate was 53.6%. After logistic regression analysis, mandibular tooth location, periapical lesion size >10 mm, poor quality of the coronal restoration, lack of magnification/illumination, lack of disinfection of gutta‐percha, time elapsed to definitive coronal restoration >1 week and poor density of root canal filling remained as robust predictors of failures. Concordance between DPR and CBCT scores varied from moderate to almost perfect agreement. Conclusions The findings of this study suggest that several tooth‐ and treatment‐related predictor variables, including tooth location, periapical radiolucency size, quality of the coronal restoration, magnification/illumination, disinfection of gutta‐percha, time elapsed to definitive coronal restoration, as well as, the density of root canal filling may act strongly and independently for determining the root canal treatment outcome in teeth with pre‐therapeutic apical periodontitis.

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“…No histopathological evaluation was performed to verify the finding, but the authors speculated if this widening of PDL should be considered as a normal tissue reaction to root canal treatment/part of healing and hence not regarded as pathology warranting further endodontic treatment (Torabinejad et al . ). Furthermore, root filling materials contain radiopaque substances that may induce artefacts, which may decrease the diagnostic value of the CBCT (Schulze et al .…”

Section: Discussionmentioning

confidence: 97%

“…The difference in relation to treatment status of the root may be supported by a recent study where almost 20% of root filled teeth were assessed with a width of the periodontal ligament space (PDL) >1.0 mm in CBCT, even though no symptoms were reported by the patient and no AP was found in PR. No histopathological evaluation was performed to verify the finding, but the authors speculated if this widening of PDL should be considered as a normal tissue reaction to root canal treatment/part of healing and hence not regarded as pathology warranting further endodontic treatment (Torabinejad et al 2018). Furthermore, root filling materials contain radiopaque substances that may induce artefacts, which may decrease the diagnostic value of the CBCT (Schulze et al 2011).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of cone beam computed tomography used for assessment of apical periodontitis: an ex vivo histopathological study on human cadavers

et al. 2018

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Aim To assess the diagnostic accuracy of Cone Beam Computed Tomography (CBCT) to diagnose apical periodontitis (AP) using histopathology of ex vivo human jaws as the reference standard. Methodology Based on periapical radiographs of jaw specimens from human bodies donated for science, a sample of 223 teeth with 340 roots including all tooth groups, and different disease and treatment statuses was selected. Cone Beam Computed Tomography was performed using Cranex® 3Dx (Soredex Oy, Tuusula, Finland), small field‐of‐view (5 × 5 cm), and isotropic resolution 0.085 mm. Three observers assessed the presence of AP using a probability index. Histopathological examination of the periapical area was used as a reference standard to calculate estimates of diagnostic accuracy. Results For non‐root filled teeth all estimates of diagnostic accuracy; sensitivity (SENS), specificity (SPEC), positive predictive value (PPV) and negative predictive value (NPV) were high. All estimates were lower for root filled teeth. When mild AP was classified as ‘AP’, SENS, SPEC and NPV were significantly lower in root filled roots (P < 0.001 in all cases). The same tendency was seen when mild AP was classified as ‘No AP’ but here only the difference in SPEC was significant (P < 0.001). Conclusion The diagnostic accuracy of CBCT used for diagnosis of AP is dependent on the treatment status of the tooth. For non‐root filled teeth the diagnostic accuracy of CBCT is high and almost all cases of AP can be diagnosed correctly with only a very small risk of over‐diagnosis. All diagnostic accuracy parameters were lower for root filled roots, hence the diagnosis of AP on root filled roots using CBCT was less accurate.

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Prevalence and Size of Periapical Radiolucencies Using Cone-beam Computed Tomography in Teeth without Apparent Intraoral Radiographic Lesions: A New Periapical Index with a Clinical Recommendation

Cited by 45 publications

References 26 publications

Cone beam computed tomography in Endodontics – a review of the literature

Cone beam computed tomography in Endodontics – a review of the literature

Prognosis of root canal treatment in teeth with preoperative apical periodontitis: a study with cone‐beam computed tomography and digital periapical radiography

Diagnostic accuracy of cone beam computed tomography used for assessment of apical periodontitis: an ex vivo histopathological study on human cadavers

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