Clinical research
Comparison of Periapical Radiography and Limited Cone-Beam Tomography in Posterior Maxillary Teeth Referred for Apical Surgery

https://doi.org/10.1016/j.joen.2008.02.022Get rights and content

Abstract

This study compared periapical (PA) radiography and cone-beam tomography (CBT) for preoperative diagnosis in posterior maxillary teeth of consecutive patients referred for possible apical surgery. Images were concurrently analyzed by an oral radiologist and an endodontist to reach consensus in interpretation of the radiographic findings. The final material included 37 premolars and 37 molars with a total of 156 roots. CBT showed significantly more lesions (34%, p < 0.001) than PA radiography. Detecting lesions with PA radiography alone was most difficult in second molars or in roots in close proximity to the maxillary sinus floor. Additional findings were seen significantly more frequently in CBT compared with PA radiography including expansion of lesions into the maxillary sinus (p < 0.001), sinus membrane thickening (p < 0.001), and missed canals (p < 0.05). The present study highlights the advantages of using CBT for preoperative treatment planning in maxillary posterior teeth with apical pathology.

Section snippets

Patients

Fifty-three consecutive patients were enrolled in the study. The patients were referred to the Department of Oral Surgery and Stomatology at the University of Bern, Bern, Switzerland, for possible apical surgery. They visited the clinic from June 2005 to August 2006 and were selected according to the following criteria: (1) there were clinical signs or symptoms and/or radiographic findings of apical periodontitis of one tooth in the posterior maxilla, (2) teeth had been previously

The Detection of Lesions (PA Radiography and CBT)

Forty-seven roots had no discernible lesions when evaluated with both PA radiography and CBT. Seventy-two roots had lesions detected by both modalities, whereas 37 roots had lesions discernible only by CBT and missed by PA radiography (Table 3). Overall results showed that 34% of lesions were missed by PA radiography (p < 0.001).

The detection of lesions was influenced by apex location (in relation to the maxillary sinus) and by tooth type (TABLE 3, TABLE 4). There were significant differences

Discussion

The present study compared the efficacy of PA radiography and CBT in detecting periapical lesions in maxillary premolars and molars referred for apical surgery. The study showed that of 109 lesions detected with CBT, 34% were not detected with PA radiography. This difference was statistically highly significant (p < 0.001). Lofthag-Hansen et al (11) showed that 38% of lesions that were undetected by PA radiography despite the fact that an additional PA radiograph (angled view of 10°) was taken.

Conclusions

The present study showed that 34% of lesions detected with cone- beam tomography were missed with periapical radiography in maxillary premolars and molars. The probability of detecting lesions with PA alone was limited for teeth with apices in close contact with the floor of the maxillary sinus, for molars (in particular second molars), and when bone thickness between lesion and sinus (measured with CBT) was ≤1 mm. Additional findings such as lesion expansion into the sinus, sinus membrane

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