Aim: To compare the diagnostic performance of cone-beam computed tomography (CBCT) relative to periapical radiographs (PAs) for detecting the effects of periapical lesions (PLs) on the roots and surrounding structures.
Materials and methods: This prospective study considered teeth with PLs referred for extraction. To be included, the teeth must also have a recent diagnostic quality PA and a recent CBCT examination with the tooth in question imaged clearly. The images were anonymized, scrambled, and reviewed by two calibrated observers. The extracted teeth were sent along with their periapical tissues for histopathologic examination. Data collected included patient age and gender, the tooth in question, and the histopathologic diagnosis of the apical tissues. The observers were required to record the presence or absence of root resorption, encroachment on the maxillary sinus, and compression of the mental foramen and/or mandibular canal.
Results: Cone-beam computed tomography performed superior to PA, detecting more effects on the surrounding structures, but this was only statistically significant for the effect of external root resorption (ERR) (p < 0.001). This was true irrespective of the histopathologic diagnosis of PL.
Conclusion: The diagnostic performance of CBCT was significantly superior to that of PA for detecting ERR on teeth with PL.
Clinical significance: The diagnostic accuracy of CBCT exceeds that of PA for detecting the effects of PL. However, the diagnostic accuracy is one of many factors to consider when choosing a diagnostic imaging modality for a specific task. Overall, CBCT examinations should be reserved for challenging cases after PAs have failed to provide all the required diagnostic information.
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