Clinical ResearchA Comparative Investigation of Cone-beam Computed Tomography and Periapical Radiography in the Diagnosis of a Healthy Periapex
Section snippets
Data Acquisition
This study was a retrospective analysis of imaging and clinical data acquired by 4 endodontic practices in Melbourne, Victoria, Australia involving 10 endodontists between January 2010 and December 2011. The study design was approved by the University of Melbourne Human Research Ethics Committee.
After exclusions, 68 patient records were identified from examinations that had teeth with a CBCT scan, a periapical radiograph, percussion test, CO2 pulp test, and/or electric pulp test (EPT)
Results
Of the 200 teeth, 166 yielded positive clinical signs of having healthy vital pulps, 14 had pulpal necrosis, and 20 had previous endodontic treatment. The CBCT-PAI scores for teeth that had a positive or negative response to the clinical pulp test are summarized in Table 2. Cross-tabulations indicated that the data were not consistent with the null hypothesis that the distribution of CBCT-PAI did not vary according to pulp status (P < .001). Pairwise comparisons between CBCT-PAI 0 versus 1, 0
Discussion
Distribution of pulp status was weighted toward teeth that responded positively to the pulp test because within the prescribed region of interest, there were generally more adjacent healthy teeth included in the field of view. This was beneficial because the objective of the current study was to investigate the normal variations of the apical tissues of teeth on a CBCT scan, which could potentially lead to false-positive diagnoses of apical periodontitis.
The results of this study showed that
Conclusions
The direct application of traditional interpretation of periapical radiography to CBCT interpretation may be flawed because the normal 3-dimensional anatomy of the PDL space appears to entail greater variation than previously thought. The findings of this study indicate that with CBCT, the majority of vital teeth show some degree of PDL widening. Additional research is required to develop our understanding of the appearance of healthy periapex and the manifestations of apical periodontitis on
Acknowledgments
The authors thank the following for their valuable contributions in the research project: Dr Sandy Clarke (University of Melbourne Statistical Consulting Centre), Clayray Dental Radiology, Dental and Medical Diagnostic Imaging, and the participating endodontic practices (Melbourne Endodontics, Endodontic Associates, Camberwell Endodontics, and North Western Endodontic Services) for their cooperation, patience, and contribution of cases.
The authors deny any conflicts of interest related to this
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