Abstract
Introduction
Cone-beam computed tomographic (CBCT) imaging is useful in detecting apical periodontitis,
which is often missed in periapical (PA) radiographs. This study aimed to identify
preoperative predictors correlated with the presence of apical periodontitis visible
only in CBCT images and to investigate the important characteristics of such lesions.
Methods
In total, 332 consecutive patients with both PA radiographs and CBCT images were enrolled
in this study. The patients’ clinical charts were reviewed retrospectively to collect
information regarding their symptoms and diagnoses. Periapical lesions were assessed
using a modified CBCT PA index by 2 endodontists. Patient-related factors (age, sex,
and symptoms) and tooth-related factors (tooth type, location, pulp status, and pulpal
diagnosis) were assessed to determine their relationships with the presence of apical
periodontitis visible only in CBCT images.
Results
Apical periodontitis was detected in 24.6% and 35.5% of untreated teeth by PA radiographs
and CBCT images, respectively. In a multivariate logistic regression analysis, pulp
necrosis was significantly correlated with the presence of apical periodontitis visible
only in CBCT images (odds ratio = 5.401; 95% confidence interval, 1.911–15.265; P = .001); the involvement of molars showed borderline nonsignificant correlation (odds
ratio = 2.843; 95% confidence interval, 0.990–8.164; P = .052). Lesion sizes smaller than 2 mm in diameter and the involvement of molars
were significant factors of lesions visible only in CBCT images (P < .05).
Conclusions
Pulp necrosis was a preoperative predictor of apical periodontitis visible only in
CBCT images. This research could provide a proper indication for CBCT imaging at diagnostic
stages.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of EndodonticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diagnostic yield of conventional radiographic and cone-beam computed tomographic images in patients with atypical odontalgia.Int Endod J. 2011; 44: 1092-1101
- Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis.J Endod. 2008; 34: 273-279
- Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography.Int Endod J. 2009; 42: 507-515
- 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
- Roentgenographic and direct observation of experimental lesions in bone: II.1961.J Endod. 2003; 29: 702-712
- The potential applications of cone beam computed tomography in the management of endodontic problems.Int Endod J. 2007; 40: 818-830
- Periapical bone defects of root filled teeth with persistent lesions evaluated by cone-beam computed tomography.Int Endod J. 2011; 44: 245-252
- Prevalence of apical periodontitis in endodontically treated premolars and molars with untreated canal: a cone-beam computed tomography study.J Endod. 2016; 42: 538-541
- Endodontic outcome predictors identified with periapical radiographs and cone-beam computed tomography scans.J Endod. 2011; 37: 326-331
- Accuracy of cone-beam computed tomography and periapical radiography in apical periodontitis diagnosis.J Endod. 2014; 40: 2057-2060
- Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103: 114-119
- ALARA still applies.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100: 395-397
- Association between the presence of apical periodontitis and clinical symptoms in endodontic patients using cone-beam computed tomography and periapical radiographs.J Endod. 2015; 41: 1824-1829
- Identify and define all diagnostic terms for pulpal health and disease states.J Endod. 2009; 35: 1645-1657
- Identify the endodontic treatment modalities.J Endod. 2009; 35: 1675-1694
- Identify and define all diagnostic terms for periapical/periradicular health and disease states.J Endod. 2009; 35: 1658-1674
- Diagnosis.in: Hargreaves K.M. Berman L.H. Pathways of the Pulp. 11th ed. Mosby-Elsevier, St Louis, MO2016: 2-32
- A new periapical index based on cone beam computed tomography.J Endod. 2008; 34: 1325-1331
- Evaluating the periapical status of teeth with irreversible pulpitis by using cone-beam computed tomography scanning and periapical radiographs.J Endod. 2012; 38: 1588-1591
- An evaluation of the periapical status of teeth with necrotic pulps using periapical radiography and cone-beam computed tomography.Int Endod J. 2014; 47: 387-396
- Accuracy of periapical radiography and cone-beam computed tomography scans in diagnosing apical periodontitis using histopathological findings as a gold standard.J Endod. 2009; 35: 1009-1012
- A comparative investigation of cone-beam computed tomography and periapical radiography in the diagnosis of a healthy periapex.J Endod. 2014; 40: 360-365
- New dimensions in endodontic imaging: part 1. Conventional and alternative radiographic systems.Int Endod J. 2009; 42: 447-462
- Roentgenographic interpretation of experimentally produced bony lesions. Part I.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1971; 32: 606-612
- The dynamics of pulp inflammation: correlations between diagnostic data and actual histologic findings in the pulp.Oral Surg Oral Med Oral Pathol. 1963; 16: 846-871
- Correlation of pulpal histopathology and clinical symptoms in human teeth subjected to experimental irritation.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1969; 27: 187-201
- Cortical bone thickness in dentate and edentulous human cadavers.J Periodontol. 2007; 78: 874-878
- Thickness of buccal bone in the mandible and its clinical significance in mono-cortical screws placement. A CBCT analysis.Int J Oral Maxillofac Surg. 2013; 42: 77-81
- The detection of periapical pathosis using periapical radiography and cone beam computed tomography - part 1: pre-operative status.Int Endod J. 2012; 45: 702-710
Article info
Publication history
Published online: April 12, 2020
Identification
Copyright
© 2020 American Association of Endodontists.
