Restor Dent Endod.  2021 Aug;46(3):e43. 10.5395/rde.2021.46.e43.

Which factors related to apical radiolucency may influence its radiographic detection? A study using CBCT as reference standard

• Fontenele RC
• Nascimento EHL
• Gaêta-Araujo H
• Cardelli LOdA
• Freitas DQ

• KMID: 2548087
• DOI: http://doi.org/10.5395/rde.2021.46.e43

Abstract

Objectives
This study aimed to evaluate the detection rate of apical radiolucencies in 2-dimensional images using cone-beam computed tomography (CBCT) as the reference standard, and to determine which factors related to the apical radiolucencies and the teeth could influence its detection.
Materials and Methods
The sample consisted of exams of patients who had panoramic (PAN) and/or periapical (PERI) radiography and CBCT. The exams were assessed by 2 oral radiologists and divided into PAN+CBCT (227 teeth–285 roots) and PERI+CBCT (94 teeth–115 roots). Radiographic images were evaluated for the presence of apical radiolucency, while CBCT images were assessed for presence, size, location, and involvement of the cortical bone (thinning, expansion, and destruction). Diagnostic values were obtained for PERI and PAN.
Results
PERI and PAN presented high accuracy (0.83 and 0.77, respectively) and specificity (0.89 and 0.91, respectively), but low sensitivity, especially for PAN (0.40 vs. 0.65 of PERI). The size of the apical radiolucency was positively correlated with its detection in PERI and PAN (p < 0.001). For PAN, apical radiolucencies were 3.93 times more frequently detected when related to single-rooted teeth (p = 0.038). The other factors did not influence apical radiolucency detection (p > 0.05).
Conclusions
PERI presents slightly better accuracy than PAN for the detection of apical radiolucency. The size is the only factor related to radiolucency that influences its detection, for both radiographic exams. For PAN, apical radiolucency is most often detected in singlerooted teeth.

Keyword

Endodontics; Cone-beam computed tomography; Panoramic; Periapical; Radiography

Figure

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  Figure 1 Images of PERI+CBCT and PAN+CBCT groups evaluated. Lower left canine in PERI (A) and CBCT coronal reconstruction (B). An upper right first premolar observed in cropped PAN (C) and CBCT sagittal reconstruction (D). Arrows indicate the apical radiolucencies detected in CBCT reconstructions.CBCT, cone-beam computed tomography; PAN, panoramic radiograph; PERI, periapical radiograph.

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  Figure 2 An apical radiolucency in a multi-rooted tooth that was not detected in PAN (A), but detected in the CBCT sagittal reconstruction, indicated by the arrow (B). The arrows are indicating an apical radiolucency detected on both PAN (C) and CBCT sagittal reconstruction (D) of a single-root tooth.CBCT, cone-beam computed tomography; PAN, panoramic radiograph.

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