Browse > Article
http://dx.doi.org/10.5624/isd.2017.47.1.25

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  

Campello, Andrea Fagundes (Faculty of Dentistry, Estacio de Sa University)
Goncalves, Lucio Souza (Faculty of Dentistry, Estacio de Sa University)
Guedes, Fabio Ribeiro (Faculty of Dentistry, Federal University of Rio de Janeiro)
Marques, Fabio Vidal (Faculty of Dentistry, Estacio de Sa University)
Publication Information
Imaging Science in Dentistry / v.47, no.1, 2017 , pp. 25-31 More about this Journal
Abstract
Purpose: The 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 Methods: An 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 chisquare test. Results: The 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). Conclusion: CBCT 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.
Keywords
Cone-Beam Computed Tomography; Radiography, Dental, Digital; Periapical Periodontitis;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Siqueira JF Jr, Rocas IN, Lopes HP. Treatment of endodontic infections. London: Quintessence; 2011.
2 Estrela C, Bueno MR, Leles CR, Azevedo B, Azevedo JR. Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis. J Endod 2008; 34: 273-9.   DOI
3 Peters CI, Peters OA. Cone beam computed tomography and other imaging techniques in the determination of periapical healing. Endod Topics 2012; 26: 57-75.   DOI
4 Folk RB, Thorpe JR, McClanahan SB, Johnson JD, Strother JM. Comparison of two different direct digital radiography systems for the ability to detect artificially prepared periapical lesions. J Endod 2005; 31: 304-6.   DOI
5 Hadley DL, Replogle KJ, Kirkam JC, Best AM. A comparison of five radiographic systems to D-speed film in the detection of artificial bone lesions. J Endod 2008; 34: 1111-4.   DOI
6 White SC, Atchison KA, Hewlett ER, Flack VF. Efficacy of FDA guidelines for prescribing radiographs to detect dental and intraosseous conditions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 80: 108-14.   DOI
7 Patel S, Dawood A, Mannocci F, Wilson R, Pitt Ford T. Detection of periapical bone defects in human jaws using cone bean computed tomography and intraoral radiography. Int Endod J 2009; 42: 507-15.   DOI
8 Lopez FU, Kopper PM, Cucco C, Della Bona A, de Figueiredo JA, Vier-Pelisser FV. Accuracy of cone-beam computed tomography and periapical radiography in apical periodontitis diagnosis. J Endod 2014; 40: 2057-60.   DOI
9 Venskutonis T, Daugela P, Strazdas M, Juodzbalys G. Accuracy of digital radiography and cone beam computed tomography on periapical radiolucency detection in endodontically trated teeth. J Oral Maxillafac Res 2014; 5: e1.
10 Green TL, Walton RE, Taylor JK, Merrell P. Radiographic and histologic periapical findings of root canal treated teeth in cadaver. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83:707-11.   DOI
11 de Paula-Silva FW, Wu MK, Leonardo MR, da Silva LA, Wesselink PR. Accuracy of periapical radiography and conebeam computed tomography scans in diagnosing apical periodontitis using histopathological findings as a gold standard. J Endod 2009; 35: 1009-12.   DOI
12 Special Committee to revise the join AAE/AAOMR position statement on use of CBCT in Endodontics. AAE and AAOMR join position statement: use of cone bean computed tomography in endodontic 2015 update. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120: 508-12.   DOI
13 Soh G, Loh FC, Chong YH. Radiation dosage of a dental imaging system. Quintessence Int 1993; 24: 189-91.
14 Tsai P, Torabinejad M, Rice D, Azevedo B. Accuracy of conebeam computed tomography and periapical radiography in detecting small periapical lesions. J Endod 2012; 38: 965-70.   DOI
15 Mota de Almeida FJ, Knutsson K, Flygare L. The impact of cone beam computed tomography on the choice of endodontic diagnosis. Int Endod J 2015; 48: 564-72.   DOI
16 Ganguly R, Ramesh A. Systematic interpretation of CBCT scans: why do it? J Mass Dent Soc 2014; 62: 68-70.
17 de Paula-Silva FW, Santamaria M Jr, Leonardo MR, Consolaro A, da Silva LA. Cone-beam computerized tomographic, radiographic, and histologic evaluation of periapical repair in dogs' post-endodontic treatment Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 796-805.   DOI
18 Leonardi Dutra K, Haas L, Porporatti AL, Flores-Mir C, Nascimento Santos J, Mezzomo LA, et al. Diagnostic accuracy of cone-bean computed tomography and conventional radiography on apical periodontitis: a systematic review and meta-analysis. J Endod 2016; 42: 356-64.   DOI
19 Kanagasingam S, Mannocci F, Lim CX, Yong CP, Patel S. Diagnostic accuracy of periapical radiography and cone beam computed tomography in detecting apical periodontitis using histopathological findings as a reference standard. Int Endod J (in press).
20 Barbat J, Messer HH. Detectability of artificial periapical lesions using direct digital and conventional radiography. J Endod 1998; 24: 837-42.   DOI