Elsevier

Journal of Endodontics

Volume 40, Issue 3, March 2014, Pages 360-365
Journal of Endodontics

Clinical Research
A Comparative Investigation of Cone-beam Computed Tomography and Periapical Radiography in the Diagnosis of a Healthy Periapex

https://doi.org/10.1016/j.joen.2013.10.003Get rights and content

Abstract

Introduction

This research aimed to compare the appearance of healthy periapical tissues on cone-beam computed tomography (CBCT) with periapical radiography and to measure the periodontal ligament (PDL) space on CBCT for teeth with healthy and necrotic pulps.

Methods

Patient records from specialist endodontic practices were examined for teeth that had a high-resolution (0.08-mm voxel) and small field-of-view CBCT scan, a periapical radiograph, and clinical pulp tests (CO2 and electric pulp testing). The periapical regions of the CBCT scans and radiographs were scored individually by 2 calibrated, blinded examiners by using a modified CBCT-periapical index (CBCT-PAI) for both and represented as CBCT-PAI and PAI, respectively. The Fisher exact and χ2 statistics tested the relationships between CBCT-PAI, PAI, and pulp status.

Results

Of 200 teeth included in the study, 166 showed clinical signs of pulpal health, and the CBCT-PAI score was greater than the PAI in 72% (119 of 166), with a vital pulp likely to have a radiographic PDL space widening of 0–1 mm (P < .001). Although 2 healthy teeth showed radiolucencies 2–4 mm on CBCT scan when the periapical radiograph showed none, a PDL space of greater than 1–2 mm was indicative of a necrotic pulp (P < .001).

Conclusions

Teeth with necrotic pulps were more likely to have PDL widening, but the PDL space of a healthy tooth demonstrated significant variation when examined by CBCT. The radiographic interpretation of health and disease on CBCT must be further investigated before usage in outcome or epidemiologic investigations. This research questions the traditional radiographic interpretation of the PDL space.

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

References (38)

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