Comparison of Cone-Beam Computed Tomography and Periapical Radiography in Predicting Treatment Decision for Periapical Lesions: A Clinical Study

摘要

Objectives. To compare the ability of endodontists to determine the size of apical pathological lesions and select the most appropriate choice of treatment based on lesions' projected image characteristics using 2 D and 3 D images. Study Design. Twenty-four subjects were selected. Radiographic examination of symptomatic study teeth with an intraoral periapical radiograph revealed periapical lesions equal to or greater than 3 mm in the greatest diameter. Cone-beam Computed tomography (CBCT) images were made of the involved teeth after the intraoral periapical radiograph confirmed the size of lesion to be equal to greater than 3 mm. Six observers (endodontists) viewed both the periapical and CBCT images. Upon viewing each of the images from the two imaging modalities, observers (1) measured lesion size and (2) made decisions on treatment based on each radiograph. Chi-square test was used to look for differences in the choice of treatment among observers. Results. No significant difference was noted in the treatment plan selected by observers using the two modalities (x2(3) = .036, P > 0.05). Conclusion. Lesion size and choice of treatment of periapical lesions based on CBCT radiographs do not change significantly from those made on the basis of 2 D radiographs. The clinical, radiographic, and histological diagnosis of periapical lesions has been a challenge. Current diagnostic methods help in fair assessment of accurate size and nature of a periapical lesion which determine the treatment and prognosis of the tooth in question. Making the correct pulpal and periapical diagnosis is helpful for treatment and prognosis of the tooth . Even if biopsy is the gold standard in differentiating granulomas from cysts, clinicians are aware of the difficulty in obtaining biopsies in routine clinical practice . Therefore, there is an immediate need for a noninvasive method to diagnose lesions involving the periapical area.