Two-dimensional Periapical, Panoramic Radiography Versus Three-dimensional Cone-beam Computed Tomography in the Detection of Periapical Lesion After Endodontic Treatment: A Systematic Review.

Delphine P Antony,Ms Nivedhitha,Toby Thomas

doi:10.7759/cureus.7736

Abstract

Radiographic imaging is a common resource for endodontic diagnosis, treatment, and prognosis. Two-dimensional (2D) periapical and digital panoramic radiographs often showed image distortion; this issue was resolved with the emergence of three-dimensional (3D) cone-beam computed tomography (CBCT). This review examines the accuracy of various radiographic techniques in the assessment of periapical lesion after endodontic treatment. Our goal was to determine whether a 2D radiograph (periapical and panoramic) is as accurate as a 3D radiograph (i.e., CBCT) in the assessment of periapical lesion after endodontic treatment. We searched the electronic databases Medline and Cochrane and trial registries for ongoing trials. We included both retrospective and prospective studies comparing the efficacy of periapical healing with various radiographic techniques after endodontic treatment. The outcome of interest was the percentage detection of periapical lesions and periapical healing assessment after endodontic treatment. All data were collected using a specially designed extraction form. We assessed the risk of bias in the studies using the Cochrane tool for diagnostic tests (QUADAS). We judged two studies to be at low risk and two to be at moderate risk of bias. Although there was a difference in the percentage detection of periapical healing efficacy by various radiographic techniques, all studies reported that CBCT had higher accuracy in the detection of periapical lesions compared to periapical and panoramic radiography. The next best choice is periapical radiographs, followed by panoramic radiographs as they provide better visualization and accuracy.

Highlights

BackgroundApical periodontitis (AP) is an inflammation of the periodontium caused by trauma, irritation, or infection through the root canal, regardless of whether the pulp is vital or non-vital
The detection of apical periodontitis was considerably higher with cone-beam computed tomography (CBCT) than with periapical radiography
The prevalence of correct identification apical periodontitis was higher with CBCT in comparison with periapical and panoramic radiographs

Summary

Introduction

Apical periodontitis (AP) is an inflammation of the periodontium caused by trauma, irritation, or infection through the root canal, regardless of whether the pulp is vital or non-vital. It represents the main indication for root canal treatment. The assessment of periapical status through radiographic examination is important because it may help to define treatment needs and relates treatment outcomes to various technical and clinical factors of the endodontic intervention. The radiographic assessment of AP is done using the periapical index (PAI). The PAI represents an ordinal scale of five scores ranging from no disease to severe periodontitis with exacerbating features [1]. A radiological examination is a major tool in dentistry for a thorough exploration that helps to achieve the goals mentioned above

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