Diagnostic accuracy of periapical radiolucency using periapical radiography and cone-beam computed tomography
Abstract
Objectives: This research is aimed to compare the accuracy of periapical radiography in detecting periapical radiolucency with that of Cone-beam Computed Tomography (CBCT) and to assess the additional information that CBCT provides.Materials and Methods: 96 patients with a primary diagnosis of endodontic problem had been studied retrospectively. Each root was examined for the presence or absence of periapical lesions according to the Periapical Index (PAI) Score. Roots and root canals identified through perapical radiography and CBCT were recorded. Additional information from CBCT regarding effects of lesions in cortical bone and maxillary sinus was also noted. Sensitivity, specificity, positive predictive value, and negative predictive value were analyzed.
Results: The result showed that accuracy of periapical radiography as expressed by its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) was 0.65, 0.90, 0.86, 0.75, respectively.
Conclusion: Periapical radiography has a low sensitivity in detecting periapical lesions compared to CBCT. CBCT also provides more detailed information that is useful in endodontic treatment.
References
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Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J. 2007;40:818-30.
Patel S, Wilson R, Dawood A, Mannocci F. The detection of periapical pathosis using periapical radiography and cone beam computed tomography - part 1: pre-operative status. Int Endod J. 2012;45:702-10.
Ramis-Alario A, Tarazona-Alvarez B, Cervera-Ballester J, Soto-Peñaloza D, Peñarrocha-Diago M, Peñarrocha-Oltra D, Peñarrocha-Diago M. Comparison of diagnostic accuracy between periapical and panoramic radiographs and cone beam computed tomography in measuring the periapical area of teeth scheduled for periapical surgery. A cross-sectional study. J Clin Exp Dent. 2019 Aug 1;11(8):e732-e8.
Bender IB, Seltzer S. Roentgenographic and direct observation of experimental lesions in bone: I. 1961. J Endod. 1961;29:702-6.
Tsai P, Torabinejad M, Rice D, Azevedo B. Accuracy of cone-beam computed tomography and periapical radiography in detecting small periapical lesions. Journal of Endodontics. 2012;38(7):965–70.
Bender IB. Factors influencing the radiographic appearance of bony lesions. J Endod. 1982;23:5-14.
Huumonen S, Ørstavik D. Radiological aspects of apical periodontitis. Endod Top. 2002;I:3-25.
Tyndall DA, Rathore S. Cone-beam CT diagnostic applications: caries, periodontal bone assessment, and endodontic applications. Dent Clin North Am. 2008;52:825-41.
European Commission, Radiation Protection 136: European guidelines on radiation protections in dental radiology. 2004;28-9.
Sedentext CT, Radiation Protection: Cone Beam CT for Dental and Maxillofacial Radiology. 2011;57-8.
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.
Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986;2:20-34.
Lofthag-Hansen S, Huumonen S, Gröndahl K, Gröndahl HG. Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:114-9.
Patel S, Dawood A, Mannocci F, Wilson R, Pitt Ford T. Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography. Int Endod J. 2009;42:507-15.
Kanagasingam, S, Lim, CX, Yong, CP, Mannocci, F, Patel, S. Diagnostic accuracy of periapical radiography and cone beam computed tomography in detecting apical periodontitis using histopathological findings as a reference standard. International Endodontic Journal. 2017;50:417–26.
Sogur E, Baksi BG, Gröndahl HG, Lomcali G, Sen BH. Detectability of chemically induced periapical lesions by limited cone beam computed tomography, intra-oral digital and conventional film radiography. Dentomaxillofac Radiol. 2009;38:458-64.
Patel, S, Brown, J, Pimentel, T, Kelly, RD, Abella, F, Durack, C. Cone beam computed tomography in Endodontics – a review of the literature. International Endodontic Journal. 2019;52:1138–52.
Patel S. New dimensions in endodontic imaging: Part 2. Cone beam computed tomography. Int Endod J. 2009;42:463-75.
Song D, Zhang L, Zhou W, Zheng Q, Duan X, Zhou X, Huang D. Comparing cone-beam computed tomography with periapical radiography for assessing root canal obturation in vivo using microsurgical findings as validation. Dentomaxillofac Radiol. 2017 Jul;46(5):20160463.
Zhang R, Wang H, Tian YY, Yu X, Hu T, Dummer PM. Use of cone-beam computed tomography to evaluate root and canal morphology of mandibular molars in Chinese individuals. Int Endod J. 2011;44:990-9.
Huang RY, Cheng WC, Chen CJ, Lin CD, Lai TM, Shen EC, Chiang CY, Chiu HC, Fu E. Three-dimensional analysis of the root morphology of mandibular first molars with distolingual roots. Int Endod J. 2010;43:478-84.
Tian YY, Guo B, Zhang R, Yu X, Wang H, Hu T, Dummer PM. Root and canal morphology of maxillary first premolars in a Chinese subpopulation evaluated using cone-beam computed tomography. Int Endod J. 2012;45:996-1003.
Iqbal A, Karobari MI, Alam MK, Khattak O, Alshammari SM, Adil AH, Noorani TY, Algarani HA, Alonazi MA, Sirivastava KC, Issrani R. Evaluation of root canal morphology in permanent maxillary and mandibular anterior teeth in Saudi subpopulation using two classification systems: a CBCT study. BMC Oral Health. 2022 May 10;22(1):171.
Abella F, Patel S, Duran-Sindreu F, Mercadé M, Bueno R, Roig M. Evaluating the periapical status of teeth with irreversible pulpitis by using cone-beam computed tomography scanning and periapical radiographs. J Endod. 2012;38:1588-91.
Narayanan LL, Vaishnavi C. Endodontic microbiology. J Conserv Dent. 2010 Oct;13(4):233-9.
Hu X, Lei L, Cui M, Huang Z, Zhang X. Anatomical analysis of periapical bone of maxillary posterior teeth: a cone beam computed tomography study. J Int Med Res. 2019 Oct;47(10):4701-10.
Al Mheiri E, Chaudhry J, Abdo S, El Abed R, Khamis AH, Jamal M. Evaluation of root and canal morphology of maxillary permanent first molars in an Emirati population; a cone-beam computed tomography study. BMC Oral Health. 2020 Oct 7;20(1):274.
Chanani A, Adhikari HD. Reliability of cone beam computed tomography as a biopsy-independent tool in differential diagnosis of periapical cysts and granulomas: An In vivo Study. J Conserv Dent. 2017 Sep-Oct;20(5):326-31.
Koivisto J, van Eijnatten M, Ludlow J, Kiljunen T, Shi XQ, Wolff J. Comparative dosimetry of radiography device, MSCT device and two CBCT devices in the elbow region. J Appl Clin Med Phys. 2021 May;22(5):128-38.
Weiss R, Read-Fuller A. Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review. Dent J (Basel). 2019 May 2;7(2):52.
Smeets R, Schöllchen M, Gauer T, Aarabi G, Assaf AT, Rendenbach C, Beck-Broichsitter B, Semmusch J, Sedlacik J, Heiland M, Fiehler J, Siemonsen S. Artefacts in multimodal imaging of titanium, zirconium and binary titanium-zirconium alloy dental implants: an in vitro study. Dentomaxillofac Radiol. 2017 Feb;46(2):20160267.
Campello AF, Gonçalves LS, Guedes FR, Marques FV. 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. Imaging Sci Dent. 2017 Mar;47(1):25-31.
Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J. 2007;40:818-30.
Patel S, Wilson R, Dawood A, Mannocci F. The detection of periapical pathosis using periapical radiography and cone beam computed tomography - part 1: pre-operative status. Int Endod J. 2012;45:702-10.
Ramis-Alario A, Tarazona-Alvarez B, Cervera-Ballester J, Soto-Peñaloza D, Peñarrocha-Diago M, Peñarrocha-Oltra D, Peñarrocha-Diago M. Comparison of diagnostic accuracy between periapical and panoramic radiographs and cone beam computed tomography in measuring the periapical area of teeth scheduled for periapical surgery. A cross-sectional study. J Clin Exp Dent. 2019 Aug 1;11(8):e732-e8.
Bender IB, Seltzer S. Roentgenographic and direct observation of experimental lesions in bone: I. 1961. J Endod. 1961;29:702-6.
Tsai P, Torabinejad M, Rice D, Azevedo B. Accuracy of cone-beam computed tomography and periapical radiography in detecting small periapical lesions. Journal of Endodontics. 2012;38(7):965–70.
Bender IB. Factors influencing the radiographic appearance of bony lesions. J Endod. 1982;23:5-14.
Huumonen S, Ørstavik D. Radiological aspects of apical periodontitis. Endod Top. 2002;I:3-25.
Tyndall DA, Rathore S. Cone-beam CT diagnostic applications: caries, periodontal bone assessment, and endodontic applications. Dent Clin North Am. 2008;52:825-41.
European Commission, Radiation Protection 136: European guidelines on radiation protections in dental radiology. 2004;28-9.
Sedentext CT, Radiation Protection: Cone Beam CT for Dental and Maxillofacial Radiology. 2011;57-8.
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.
Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986;2:20-34.
Lofthag-Hansen S, Huumonen S, Gröndahl K, Gröndahl HG. Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:114-9.
Patel S, Dawood A, Mannocci F, Wilson R, Pitt Ford T. Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography. Int Endod J. 2009;42:507-15.
Kanagasingam, S, Lim, CX, Yong, CP, Mannocci, F, Patel, S. Diagnostic accuracy of periapical radiography and cone beam computed tomography in detecting apical periodontitis using histopathological findings as a reference standard. International Endodontic Journal. 2017;50:417–26.
Sogur E, Baksi BG, Gröndahl HG, Lomcali G, Sen BH. Detectability of chemically induced periapical lesions by limited cone beam computed tomography, intra-oral digital and conventional film radiography. Dentomaxillofac Radiol. 2009;38:458-64.
Patel, S, Brown, J, Pimentel, T, Kelly, RD, Abella, F, Durack, C. Cone beam computed tomography in Endodontics – a review of the literature. International Endodontic Journal. 2019;52:1138–52.
Patel S. New dimensions in endodontic imaging: Part 2. Cone beam computed tomography. Int Endod J. 2009;42:463-75.
Song D, Zhang L, Zhou W, Zheng Q, Duan X, Zhou X, Huang D. Comparing cone-beam computed tomography with periapical radiography for assessing root canal obturation in vivo using microsurgical findings as validation. Dentomaxillofac Radiol. 2017 Jul;46(5):20160463.
Zhang R, Wang H, Tian YY, Yu X, Hu T, Dummer PM. Use of cone-beam computed tomography to evaluate root and canal morphology of mandibular molars in Chinese individuals. Int Endod J. 2011;44:990-9.
Huang RY, Cheng WC, Chen CJ, Lin CD, Lai TM, Shen EC, Chiang CY, Chiu HC, Fu E. Three-dimensional analysis of the root morphology of mandibular first molars with distolingual roots. Int Endod J. 2010;43:478-84.
Tian YY, Guo B, Zhang R, Yu X, Wang H, Hu T, Dummer PM. Root and canal morphology of maxillary first premolars in a Chinese subpopulation evaluated using cone-beam computed tomography. Int Endod J. 2012;45:996-1003.
Iqbal A, Karobari MI, Alam MK, Khattak O, Alshammari SM, Adil AH, Noorani TY, Algarani HA, Alonazi MA, Sirivastava KC, Issrani R. Evaluation of root canal morphology in permanent maxillary and mandibular anterior teeth in Saudi subpopulation using two classification systems: a CBCT study. BMC Oral Health. 2022 May 10;22(1):171.
Abella F, Patel S, Duran-Sindreu F, Mercadé M, Bueno R, Roig M. Evaluating the periapical status of teeth with irreversible pulpitis by using cone-beam computed tomography scanning and periapical radiographs. J Endod. 2012;38:1588-91.
Narayanan LL, Vaishnavi C. Endodontic microbiology. J Conserv Dent. 2010 Oct;13(4):233-9.
Hu X, Lei L, Cui M, Huang Z, Zhang X. Anatomical analysis of periapical bone of maxillary posterior teeth: a cone beam computed tomography study. J Int Med Res. 2019 Oct;47(10):4701-10.
Al Mheiri E, Chaudhry J, Abdo S, El Abed R, Khamis AH, Jamal M. Evaluation of root and canal morphology of maxillary permanent first molars in an Emirati population; a cone-beam computed tomography study. BMC Oral Health. 2020 Oct 7;20(1):274.
Chanani A, Adhikari HD. Reliability of cone beam computed tomography as a biopsy-independent tool in differential diagnosis of periapical cysts and granulomas: An In vivo Study. J Conserv Dent. 2017 Sep-Oct;20(5):326-31.
Koivisto J, van Eijnatten M, Ludlow J, Kiljunen T, Shi XQ, Wolff J. Comparative dosimetry of radiography device, MSCT device and two CBCT devices in the elbow region. J Appl Clin Med Phys. 2021 May;22(5):128-38.
Weiss R, Read-Fuller A. Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review. Dent J (Basel). 2019 May 2;7(2):52.
Smeets R, Schöllchen M, Gauer T, Aarabi G, Assaf AT, Rendenbach C, Beck-Broichsitter B, Semmusch J, Sedlacik J, Heiland M, Fiehler J, Siemonsen S. Artefacts in multimodal imaging of titanium, zirconium and binary titanium-zirconium alloy dental implants: an in vitro study. Dentomaxillofac Radiol. 2017 Feb;46(2):20160267.
Campello AF, Gonçalves LS, Guedes FR, Marques FV. 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. Imaging Sci Dent. 2017 Mar;47(1):25-31.
Published
2023-04-29
How to Cite
YASA, I Putu Gede Andyka; NASUTIANTO, Haris; OKANO, Tomohiro.
Diagnostic accuracy of periapical radiolucency using periapical radiography and cone-beam computed tomography.
Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI), [S.l.], v. 7, n. 1, p. 1-8, apr. 2023.
ISSN 2686-1321.
Available at: <http://jurnal.pdgi.or.id/index.php/jrdi/article/view/934>. Date accessed: 26 apr. 2024.
doi: https://doi.org/10.32793/jrdi.v7i1.934.
Section
Original Research Article
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
