Advertisement

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
HEAD, NECK AND DENTAL RADIOLOGY

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

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

Notes

Funding

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.

References

  1. 1.
    American Association of Endodontists (2012) Glossary of endodontic terms, 8th edn. American Association of Endodontists, ChicagoGoogle Scholar
  2. 2.
    Huumonen S, Ørstavik D (2002) Radiological aspects of apical periodontitis. Endod Top 1:3–25CrossRefGoogle Scholar
  3. 3.
    Bender IB (1982) Factors influencing the radiographic appearance of bony lesions. J Endod 8:161–170CrossRefGoogle Scholar
  4. 4.
    LeQuire AK, Cunningham CJ, Pelleu GB Jr (1977) Radiographic interpretation of experimentally produced osseous lesions of the human mandible. J Endod 3:274–276CrossRefGoogle Scholar
  5. 5.
    Rohlin M, Kullendorff B, Ahlqwist M, Henrikson CO, Hollender L, Stenström B (1989) Comparison between panoramic and periapical radiography in the diagnosis of periapical bone lesions. Dentomaxillofac Radiol 18:151–155CrossRefGoogle Scholar
  6. 6.
    de Paula-Silva FW, Wu MK, Leonardo MR, da Silva LA, Wesselink PR (2009) Accuracy of periapical radiography and cone-beam computed tomography scans in diagnosing apical periodontitis using histopathological findings as a gold standard. J Endod 35:1009–1012CrossRefGoogle Scholar
  7. 7.
    Cotton TP, Geisler TM, Holden DT et al (2007) Endodontic applications of cone-beam volumetric tomography. J Endod 33:1121–1132CrossRefGoogle Scholar
  8. 8.
    Nardi C, De Falco L, Selvi V et al (2018) Role of cone-beam computed tomography with a large field of view in Goldenhar syndrome. Am J Orthod Dentofac Orthop 153:269–277CrossRefGoogle Scholar
  9. 9.
    Lofthag-Hansen S, Hummonen S, Grondahl K, Grondahl HG (2007) Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 103:114–119CrossRefGoogle Scholar
  10. 10.
    Liang X, Jacobs R, Hassan B et al (2010) A comparative evaluation of cone beam computed tomography (CBCT) and multi-slice CT (MSCT). Part I. On subjective image quality. Eur J Radiol 75:265–269CrossRefGoogle Scholar
  11. 11.
    Nardi C, Borri C, Regini F et al (2015) Metal and motion artifacts by cone beam computed tomography (CBCT) in dental and maxillofacial study. Radiol Med 120:618–626CrossRefGoogle Scholar
  12. 12.
    Schulze R, Heil U, Gross D et al (2011) Artifacts in CBCT: a review. Dentomaxillofac Radiol 40:265–273CrossRefGoogle Scholar
  13. 13.
    Esmaeili F, Johari M, Haddadi P, Vatankhah M (2012) Beam hardening artifacts: comparison between two cone beam computed tomography scanners. J Dent Res Dent Clin Dent Prospects 6:49–53PubMedPubMedCentralGoogle Scholar
  14. 14.
    Machado AH, Fardim KAC, de Souza CF, Sotto-Maior BS, Assis NMSP, Devito KL (2018) Effect of anatomical region on the formation of metal artefacts produced by dental implants in cone beam computed tomographic images. Dentomaxillofac Radiol 47:20170281CrossRefGoogle Scholar
  15. 15.
    Watanabe H, Honda E, Tetsumura A et al (2011) A comparative study for spatial resolution and subjective image characteristics of a multi-slice CT and a cone-beam CT for dental use. Eur J Radiol 77:397–402CrossRefGoogle Scholar
  16. 16.
    Nardi C, Talamonti C, Pallotta S et al (2017) Head and neck effective dose and quantitative assessment of image quality: a study to compare cone beam CT and multislice spiral CT. Dentomaxillofac Radiol 46:20170030CrossRefGoogle Scholar
  17. 17.
    Nardi C, Salerno S, Molteni R et al (2018) Radiation dose in non-dental cone beam CT applications: a systematic review. Radiol Med 123:765–777CrossRefGoogle Scholar
  18. 18.
    Lechuga L, Weidlich GA (2016) Cone beam CT vs. fan beam CT: a comparison of image quality and dose delivered between two differing CT imaging modalities. Cureus 8:e778PubMedPubMedCentralGoogle Scholar
  19. 19.
    Spin-Neto R, Costa C, Salgado DM, Zambrana NR, Gotfredsen E, Wenzel A (2018) Patient movement characteristics and the impact on CBCT image quality and interpretability. Dentomaxillofac Radiol 47:20170216CrossRefGoogle Scholar
  20. 20.
    Nemtoi A, Czink C, Haba D, Gahleitner A (2013) Cone beam CT: a current overview of devices. Dentomaxillofac Radiol 42:20120443CrossRefGoogle Scholar
  21. 21.
    Nardi C, Molteni R, Lorini C et al (2016) Motion artefacts in cone beam CT: an in vitro study about the effects on the images. Br J Radiol 89:20150687CrossRefGoogle Scholar
  22. 22.
    Kruse C, Spin-Neto R, Wenzel A, Kirkevang LL (2015) Cone beam computed tomography and periapical lesions: a systematic review analysing studies on diagnostic efficacy by a hierarchical model. Int Endod J 48:815–828CrossRefGoogle Scholar
  23. 23.
    American Association of Endodontists; American Academy of Oral and Maxillofacial Radiology. Use of cone beam CT in endodontics: 2015/2016 update. Accessed 08 Aug 2019. https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/06/conebeamstatement.pdf
  24. 24.
    Nascimento EHL, Oenning ACC, Freire BB, Gaêta-Araujo H, Haiter-Neto F, Freitas DQ (2018) Comparison of panoramic radiography and cone beam CT in the assessment of juxta-apical radiolucency. Dentomaxillofac Radiol 47:20170198CrossRefGoogle Scholar
  25. 25.
    Rohlin M, Kullendorff B, Ahlqwist M, Stenström B (1991) Observer performance in the assessment of periapical pathology: a comparison of panoramic with periapical radiography. Dentomaxillofac Radiol 20:127–131CrossRefGoogle Scholar
  26. 26.
    Molander B, Ahlqwist M, Gröndahl HG, Hollender L (1993) Comparison of panoramic and intraoral radiography for the diagnosis of caries and periapical pathology. Dentomaxillofac Radiol 22:28–32CrossRefGoogle Scholar
  27. 27.
    Berkhout WE, Suomalainen A, Brüllmann D, Jacobs R, Horner K, Stamatakis HC (2015) Justification and good practice in using handheld portable dental X-ray equipment: a position paper prepared by the European Academy of DentoMaxilloFacial Radiology (EADMFR). Dentomaxillofac Radiol 44:20140343CrossRefGoogle Scholar
  28. 28.
    Kitamura Y, Shogenji R, Yamada K et al (2004) Reconstruction of a high-resolution image on a compound-eye image-capturing system. Appl Opt 43:1719–1727CrossRefGoogle Scholar
  29. 29.
    Mansson LG (2000) Methods for the evaluation of image quality: a review. Radiat Prot Dosim 90:89–99CrossRefGoogle Scholar
  30. 30.
    Hussein FE, Liew AK, Ramlee RA, Abdullah D, Chong BS (2016) Factors associated with apical periodontitis: a multilevel analysis. J Endod 42:1441–1445CrossRefGoogle Scholar
  31. 31.
    Nardi C, Calistri L, Pradella S, Desideri I, Lorini C, Colagrande S (2017) Accuracy of orthopantomography for apical periodontitis without endodontic treatment. J Endod 43:1640–1646CrossRefGoogle Scholar
  32. 32.
    Nardi C, Calistri L, Grazzini G et al (2018) Is panoramic radiography an accurate imaging technique for the detection of endodontically treated asymptomatic apical periodontitis? J Endod 44:1500–1508CrossRefGoogle Scholar
  33. 33.
    Estrela C, Bueno MR, Leles CR et al (2008) Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis. J Endod 34:273–279CrossRefGoogle Scholar
  34. 34.
    Abella F, Patel S, Duran-Sindreu F, Mercadé M, Bueno R, Roig M (2012) Evaluating the periapical status of teeth with irreversible pulpitis by using cone-beam computed tomography scanning and periapical radiographs. J Endod 38:1588–1591CrossRefGoogle Scholar
  35. 35.
    Ørstavik D, Kerekes K, Eriksen HM (1986) The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol 2:20–34CrossRefGoogle Scholar
  36. 36.
    Molven O, Halse A, Fristad I (2002) Long-term reliability and observer comparisons in the radiographic diagnosis of periapical disease. Int Endod J 35:142–147CrossRefGoogle Scholar
  37. 37.
    Halse A, Molven O, Fristad I (2002) Diagnosing periapical lesions: disagreement and borderline cases. Int Endod J 35:703–709CrossRefGoogle Scholar
  38. 38.
    Harris D, Horner K, Groendahl K et al (2012) E.A.O. guidelines for the use of diagnostic imaging in implant dentistry 2011. A consensus workshop organized by the European Association for Osseointegration at the Medical University of Warsaw. Clin Oral Implants Res 23:1243–1253CrossRefGoogle Scholar
  39. 39.
    Uraba S, Ebihara A, Komatsu K, Ohbayashi N, Okiji T (2016) Ability of cone-beam computed tomography to detect periapical lesions that were not detected by periapical radiography: a retrospective assessment according to tooth group. J Endod 42:1186–1190CrossRefGoogle Scholar
  40. 40.
    Fayad MI, Nair M, Levin MD et al (2015) AAE and AAOMR joint position statement: use of cone beam computed tomography in endodontics 2015 update. Oral Surg Oral Med Oral Pathol Oral Radiol 120:508–512CrossRefGoogle Scholar
  41. 41.
    Yeung AWK, Jacobs R, Bornstein MM (2019) Novel low-dose protocols using cone beam computed tomography in dental medicine: a review focusing on indications, limitations, and future possibilities. Clin Oral Investig 23:2573–2581CrossRefGoogle Scholar

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

Personalised recommendations