Citation Information :
Bonfanti E, Citterio CL, Baldoni M. Digital Orthopantomography vs Cone Beam Computed Tomography—Part 1: Detection of Periapical Lesions. J Contemp Dent Pract 2019; 20 (5):593-597.
Aim: Digital orthopantomography (OPT) is usually the first examination step in supervising an incoming patient. Cone beam computed tomography (CBCT) is the most refined and affordable method to search for different dental lesions. The aim of this paper is to evaluate the effectiveness of OPT and CBCT in detecting periapical lesions in different dental groups.
Materials and methods: An OPT and a CBCT scan of the dental arches of 45 patients were examined. The presence of AP was pointed out for OPT and CBCT. Sensitivity, specificity, predictive values, and accuracy were calculated for OPT, using CBCT as the reference standard.
Results: OPT showed low sensitivity (40.0), positive predictive value (90.4), negative predictive value (90.0), accuracy (90.0), and high specificity (99.2). It was found to have higher sensitivity in the lower front and premolar areas, while the lowest was found in the upper molar area.
Conclusions: OPT can be used for endodontic diagnosis in the lower central and premolar sections, but CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between apex and important anatomical structures exists.
Clinical significance: CBCT exposes the patient to higher doses of radiations when compared with OPT, but CBCT, with its more selective sensitivity and the possibility to offer a three-dimensional (3D) rendering of dental and periodontal structures, is an elective choice for uncertain cases and for specific dental areas.
Patel S, Durack C, et al. Cone beam computed tomography in Endodontics—a review. Int Endod J 2015;48(1):3–15. DOI: 10.1111/iej.12270.
Citterio F, Pellegatta A, et al. Analysis of the apical constriction using micro-computed tomography and anatomical sections. Giornale Italiano Di Endodonzia 2014;28:41–45.
Venino PM, Citterio CL, et al. A micro–computed tomography evaluation of the shaping ability of two nickel-titanium instruments, HyFlex EDM and ProTaper Next. J Endod 2017;43(4):628–632. DOI: 10.1016/j.joen.2016.11.022.
Maddalone M, Ferrari M, et al. Use of miniscrew implants in orthodontic distal movement [Utilizzo delle miniviti nelle meccaniche ortodontiche di distalizzazione]. Dental Cadmos 2010;78(8):97–105.
Maddalone M, Ferrari M, et al. Intrusive mechanics in orthodontics with the use of TAD's [Utilizzo delle miniviti nelle meccaniche ortodontiche di intrusione]. Dental Cadmos 2010;78(7):97–106.
Maddalone M, Gagliani M, et al. Prevalence of vertical root fractures in teeth planned for apical surgery. A retrospective cohort study. Int Endod J 2018 Sep;51(9):969–974.
Patel S, Wilson R, et al. The detection of periapical pathosis using digital periapical radiography and cone beam computed tomography—part 2: a 1 year post-treatment follow-up. Int Endod J 2012;45(8):711–723. DOI: 10.1111/j.1365-2591.2012.02076.x.
Friedman S. Prognosis of initial endodontic therapy. Endod Top 2002;2(1):59–88.
Lofthag-Hansen S, Huumonen S, et al. Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(1):114–119. DOI: 10.1016/j.tripleo.2006.01.001.
Estrela C, Bueno MR, et al. Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis. J Endod 2008;34(3):273–279. DOI: 10.1016/j.joen.2007.11.023.
Low KMT, Dula K, et al. Comparison of periapical radiography and limited cone-beam tomography in posterior maxillary teeth referred for apical surgery. J Endod 2008;34(5):557–562. DOI: 10.1016/j.joen.2008.02.022.
Davies A, Mannocci F, et al. The detection of periapical pathoses in root filled teeth using single and parallax periapical radiographs versus cone beam computed tomography—a clinical study. Int
DOI: 10.1111/iej.12352.
Theodorakou C, Walker A, et al. Estimation of paediatric organ and effective doses from dental cone beam CT using anthropomorphic phantoms. Br J Radiol 2012;85(1010):153–160. DOI: 10.1259/bjr/19389412.
Ivanoviæ M, Jovièiæ O, et al. Prevention of oral diseases in children with acute leukaemia. Srp Arh Celok Lek 2011;139(3–4): 242–247.
Ivanoviæ M, Jovièiæ O, et al. Oral manifestations of acute leukaemia. Srp Arh Celok Lek 2011;139(1–2):103–106.
Danin J, Strömberg T, et al. Clinical management of nonhealing periradicular pathosis. Surgery versus endodontic retreatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82(2):213–217.
Gorni FGM, Gagliani MM. The outcome of endodontic retreatment: a 2 year follow-up. J Endod 2004;30(1):1–4. DOI: 10.1097/00004770- 200401000-00001.
de Chevigny C, Dao TT, et al. Treatment outcome in endodontics: the Toronto study-phase 4: initial treatment. J Endod 2008;34(3):258–263. DOI: 10.1016/j.joen.2007.10.017.
Sundqvist G, Figdor D, et al. Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85(1):86–93.
Farzaneh M, Abitbol S, et al. Treatment outcome in endodontics: the Toronto study. Phases I and II: orthograde retreatment. J Endod 2004;30(9):627–633.
Patel S, Dawood A, et al. Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography. Int Endod J 2009;42(6):507–515. DOI: 10.1111/j.1365- 2591.2008.01538.x.
Huumonen S, Orstavik D. Radiological aspects of apical periodontitis. Endod Top 2002 Mar;1(1):3–25.
Pauwels R, Beinsberger J, et al. Effective dose range for dental cone beam computed tomography scanners. Eur J Radiol 2012;81(2): 267–271. DOI: 10.1016/j.ejrad.2010.11.028.
Suomalainen A, Kiljunen T, et al. Dosimetry and image quality of four dental cone beam computed tomography scanners compared with multislice computed tomography scanners. Dentomaxillofacial Radiol 2009;38(6):367–378. DOI: 10.1259/dmfr/15779208.
Loubele M, Bogaerts R, et al. Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications. Eur J Radiol 2009;71(3):461–468. DOI: 10.1016/j.ejrad.2008.06.002.
Kanagasingam S, Lim CX, et al. Diagnostic accuracy of periapical radiography and cone beam computed tomography in detecting apical periodontitis using histopathological findings as a reference standard. Int Endod J 2017;50(5):417–426. DOI: 10.1111/iej.12650.
Liang YH, Li G, et al. The association between complete absence of post-treatment periapical lesion and quality of root canal filling. Clin Oral Investig 2012;16(6):1619–1626. DOI: 10.1007/s00784-011-0671-3.
Nardi C, Calistri L, et al. Accuracy of orthopantomography for apical periodontitis without endodontic treatment. J Endod 2017;43(10):1640–1646. DOI: 10.1016/j.joen.2017.06.020.
Patel S. New dimensions in endodontic imaging: part 2. Cone beam computed tomography. Int Endod J 2009;42(6):463–475. DOI: 10.1111/j.1365-2591.2008.01531.x.
Lennon S, Patel S, et al. Diagnostic accuracy of limited-volume conebeam computed tomography in the detection of periapical bone loss: 360° scans versus 180° scans. Int Endod J 2011;44(12):1118–1127. DOI: 10.1111/j.1365-2591.2011.01930.x.
Abella F, Patel S, et al. An evaluation of the periapical status of teeth with necrotic pulps using periapical radiography and cone-beam computed tomography. Int Endod J 2014;47(4):387–396. DOI: 10.1111/iej.12159.
Torabinejad M, Rubinstein RA. The Art and Science of Contemporary Surgical Endodontics. Quintessence Publishing, 2017.