In horses with secondary sinusitis caused by dental disease, is computed tomography more accurate than radiography for the identification of apical dental pathology?

Abstract

PICO question
 In adult horses with secondary sinusitis caused by dental disease, is computed tomography more accurate than radiography for the identification of apical dental pathology?
 
 Clinical bottom line
 Category of research question
 Diagnosis
 The number and type of study designs reviewed
 The literature search identified four papers that were critically reviewed. The publications consist of two retrospective case-controlled studies, one clinical study and one descriptive study
 Strength of evidence
 Weak
 Outcomes reported
 Four studies reported the sensitivity of computed tomography (CT) for the diagnosis of apical dental pathology in horses presented for evaluation of clinical signs of sinus disease with histopathological evidence of apical dental pathology. All studies reported the radiographic changes present in these horses or used absence of definitive radiographic changes consistent with apical dental disease as a reason to undertake further CT evaluation. All four papers found that CT identified teeth with apical pathology that radiography had not
 Conclusion
 CT is more accurate than radiography for the diagnosis of equine maxillary apical dental pathology; however, clear guidelines on the CT changes associated with apical dental pathology are required. Loss of the lamina dura, infundibular changes or pulpal gas as singular findings on CT imaging can be seen in teeth with no underlying histopathological evidence of apical disease, and in maxillary teeth imaged in horses without clinical signs of maxillary cheek tooth pathology
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.