Imaging Sci Dent.  2017 Mar;47(1):25-31. 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 A
• Gonçalves LS
• Guedes FR
• Marques FV

• KMID: 2391403
• DOI: http://doi.org/10.5624/isd.2017.47.1.25

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 chi-square 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.

Keyword

Cone-Beam Computed Tomography; Radiography, Dental, Digital; Periapical Periodontitis

MeSH Terms

Cone-Beam Computed Tomography*
Dentists*
Humans
Methods
Periapical Periodontitis
Pilot Projects*
Radiography*
Radiography, Dental, Digital
Sensitivity and Specificity
Skull
Tooth

Figure

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  Fig. 1 Stabilization guides, positioning tools, X-ray cylinder, and the skull in position for capturing the image.

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  Fig. 2 Acrylic device designed to position the anatomical pieces during cone-beam computed tomography scanning.

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  Fig. 3 Example of a template with cone-beam computed tomography and digital periapical images evaluated by the examiners.

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