Comparison of Periapical Radiography and Limited Cone-Beam Computed Tomography in Mandibular Molars for Analysis of Anatomical Landmarks before Apical Surgery

doi:10.1016/j.joen.2010.11.014

Journal of Endodontics

Volume 37, Issue 2, February 2011, Pages 151-157

https://doi.org/10.1016/j.joen.2010.11.014 Get rights and content

Abstract

Introduction

The purpose of the present study was to evaluate the detectability and dimensions of periapical lesions, the relationship of the mandibular canal to the roots of the respective teeth, and the dimension of the buccal bone by using limited cone-beam computed tomography (CBCT) in comparison to conventional periapical (PA) radiographs for evaluation of mandibular molars before apical surgery.

Methods

The study comprised 38 molars with 75 roots. The type of PA lesion as diagnosed on PA radiographs was compared with the type of lesion seen on sagittal and coronal CBCT sections. The distances of the apices of the first mandibular molars and basal border of the PA lesion to the coronal lining of the mandibular canal were assessed with PA radiographs and corresponding sagittal and coronal CBCT images. Furthermore, coronal CBCT images were used to measure the distance from the apices to the buccal bone surface and the corresponding width of the cortical bone plate.

Results

Of 58 detected PA lesions, 15 (25.9%) lesions diagnosed with sagittal CBCT slices were missed with PA radiography. The distance between the apices and the upper border of the mandibular canal was only measurable in 24 of 68 radiographs (35.3%) by using PA images. The cortical bone wall had a mean thickness of 1.7 mm, whereas the total buccal bone wall (cortical and spongious) measured 5.3 mm on average.

Conclusions

The present study highlights the advantages of using limited CBCT for treatment planning in mandibular molars before apical surgery.

Section snippets

Patient Selection

Patients were consecutively enrolled in the present study from June 2007–February 2008. The patients were all referred to the Department of Oral Surgery and Stomatology at the University of Bern, Bern, Switzerland for further evaluation of possible apical surgery in the posterior mandible. Patients were selected according to the following criteria: (1) there were clinical signs or symptoms and/or radiographic findings of apical periodontitis in at least 1 mandibular molar, (2) teeth had been

Detection and Dimensions of PA Lesions (PA Radiographs versus Limited CBCT)

Thirty-two roots had no discernible lesions when evaluated with PA radiography alone, whereas only 17 roots had no visible lesion in the sagittal CBCT sections. Lesions in 43 roots were detected by both modalities, whereas in 15 roots lesions were discernible only with sagittal CBCT images and missed by PA radiography (Table 3). Similar results were also found regarding the coronal CBCT sections. Overall results showed that 25.9% in relation to sagittal CBCT sections and 27.1% in relation to

Discussion

The present study compared the efficacy of PA radiography and limited CBCT imaging in detecting PA lesions in mandibular molars referred for apical surgery. The study showed that of 58 lesions detected with sagittal CBCT sections, 15 (25.9%) were not detected with PA radiography, a clinically quite important difference. Similar findings were reported by Lofthag-Hansen et al (13) in a study examining maxillary molars and premolars and mandibular molars with endodontic problems and comparing PA

Conclusions

The present study showed that 15 (25.86%) PA lesions detected with sagittal CBCT slices were missed with PA radiography in mandibular molars. The distance between the apices of the first mandibular molars and the upper border of the mandibular canal was not measurable in 44 radiographs out of 68 (64.7%). However, for cases in which the mandibular canal was visible in the PA image, the measured distances were not statistically significantly different from values calculated with sagittal or

Acknowledgments

The authors deny any conflicts of interest related to this study.

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Citation Excerpt :
The level of agreement between reviewers was almost perfect (κ = 0.96). Of the 27 papers, 13 articles compared digital periapical radiography (DPR) vs CBCT,29,34-45 2 articles compared conventional periapical radiography (CPR) and DPR vs CBCT,30,46 2 compared DPR and panoramic radiography vs CBCT,47,48 5 compared CPR vs CBCT,16,49-52 1 compared CPR and panoramic radiography vs CBCT,8 1 compared periapical radiography vs CBCT but failed to mention the features of both CBCT and periapical x-ray devices,53 and 3 articles compared panoramic radiography vs CBCT54-56 (Supplemental Table S10; available at doi:10.1016/j.oooo.2021.07.002). A summary of radiologic features is provided in the supplementary material (Supplemental Table S11; available at https://doi.org/10.1016/j.oooo.2021.07.002).
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Clinical ResearchComparison of Periapical Radiography and Limited Cone-Beam Computed Tomography in Mandibular Molars for Analysis of Anatomical Landmarks before Apical Surgery

Abstract

Introduction

Methods

Results

Conclusions

Section snippets

Patient Selection

Detection and Dimensions of PA Lesions (PA Radiographs versus Limited CBCT)

Discussion

Conclusions

Acknowledgments

Oral Surg Oral Med Oral Pathol

J Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Dent Clin North Am

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Endod

J Endod

J Endod

J Oral Maxillofac Surg

J Endod

Dent Clin North Am

Dent Clin North Am

J Endod

J Endod

J Endod

Clinical Research
Comparison of Periapical Radiography and Limited Cone-Beam Computed Tomography in Mandibular Molars for Analysis of Anatomical Landmarks before Apical Surgery