Electronic processing of digital panoramic radiography for the detection of apical periodontitis

  • Cosimo NardiEmail author
  • Linda Calistri
  • Michele Pietragalla
  • Chiara Vignoli
  • Chiara Lorini
  • Valentina Berti
  • Francesco Mungai
  • Stefano Colagrande



This study aimed to evaluate the accuracy of both digital complete and small portion of panoramic radiography (PAN) in the detection of clinically/surgically confirmed asymptomatic apical periodontitis (AP) lesions with and without endodontic treatment.


A total of 480 patients/teeth including 120 AP with and without endodontic treatment, and 120 healthy periapex with and without endodontic treatment were detected via CBCT using the periapical index system. Each diseased and healthy patient underwent PAN first and a CBCT scan within 40 days. All 480 cases were assessed by four different methods, as follows: complete PAN with clinical examination of each tooth available and not available, respectively, and small portion of PAN in which a root with crown and root without crown were displayed, respectively. Periapical index system was also used to assess AP by PAN. Accuracy for both complete and small portion of PAN with respect to CBCT was analyzed.


The overall accuracy of the four methods for teeth with endodontic treatment (73.4) was higher than teeth without endodontic treatment (66.6). Accuracy of complete PAN and portion of PAN was 71.3 and 68.7, respectively. As regards teeth without endodontic treatment, accuracy was higher for complete PAN in the upper/lower incisive area and for small portion of PAN in the upper molar area. No difference was found in teeth with endodontic treatment.


Complete and small portion of PAN showed greater accuracy in the upper/lower incisive area and upper molar area of untreated teeth, respectively, whereas no difference was found in treated teeth.


Apical periodontitis Bone lesion Cone-beam computed tomography Diagnostic accuracy Panoramic radiography Periapical index 



This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no financial affiliation (employment, direct payment, stock holdings, retainers, consultantships, patent licensing arrangements, or honoraria), or involvement with any commercial organization with direct financial interest in the subject or materials discussed in this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  1. 1.Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2University of Florence - Azienda Ospedaliero-Universitaria CareggiFlorenceItaly
  2. 2.Department of Health ScienceUniversity of FlorenceFlorenceItaly
  3. 3.Department of Experimental and Clinical Biomedical Sciences, Nuclear Medicine UnitUniversity of Florence - Azienda Ospedaliero-Universitaria CareggiFlorenceItaly
  4. 4.Department of RadiologyUniversity of Florence - Azienda Ospedaliero-Universitaria CareggiFlorenceItaly

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