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