TY - JOUR
T1 - Clinical Factors Associated with Apical Periodontitis Visible on Cone-beam Computed Tomography but Missed with Periapical Radiographs
T2 - A Retrospective Clinical Study
AU - Jang, Young Eun
AU - Kim, Bom Sahn
AU - Kim, Yemi
N1 - Funding Information:
Supported by the National Research Foundation of Korea grant funded by the Korean government (grant no. NRF-2018R1D1A1B07045394) .
Publisher Copyright:
© 2020 American Association of Endodontists
PY - 2020/6
Y1 - 2020/6
N2 - Introduction: Cone-beam computed tomographic (CBCT) imaging is useful in detecting apical periodontitis, which is often missed in periapical (PA) radiographs. This study aimed to identify preoperative predictors correlated with the presence of apical periodontitis visible only in CBCT images and to investigate the important characteristics of such lesions. Methods: In total, 332 consecutive patients with both PA radiographs and CBCT images were enrolled in this study. The patients’ clinical charts were reviewed retrospectively to collect information regarding their symptoms and diagnoses. Periapical lesions were assessed using a modified CBCT PA index by 2 endodontists. Patient-related factors (age, sex, and symptoms) and tooth-related factors (tooth type, location, pulp status, and pulpal diagnosis) were assessed to determine their relationships with the presence of apical periodontitis visible only in CBCT images. Results: Apical periodontitis was detected in 24.6% and 35.5% of untreated teeth by PA radiographs and CBCT images, respectively. In a multivariate logistic regression analysis, pulp necrosis was significantly correlated with the presence of apical periodontitis visible only in CBCT images (odds ratio = 5.401; 95% confidence interval, 1.911–15.265; P = .001); the involvement of molars showed borderline nonsignificant correlation (odds ratio = 2.843; 95% confidence interval, 0.990–8.164; P = .052). Lesion sizes smaller than 2 mm in diameter and the involvement of molars were significant factors of lesions visible only in CBCT images (P < .05). Conclusions: Pulp necrosis was a preoperative predictor of apical periodontitis visible only in CBCT images. This research could provide a proper indication for CBCT imaging at diagnostic stages.
AB - Introduction: Cone-beam computed tomographic (CBCT) imaging is useful in detecting apical periodontitis, which is often missed in periapical (PA) radiographs. This study aimed to identify preoperative predictors correlated with the presence of apical periodontitis visible only in CBCT images and to investigate the important characteristics of such lesions. Methods: In total, 332 consecutive patients with both PA radiographs and CBCT images were enrolled in this study. The patients’ clinical charts were reviewed retrospectively to collect information regarding their symptoms and diagnoses. Periapical lesions were assessed using a modified CBCT PA index by 2 endodontists. Patient-related factors (age, sex, and symptoms) and tooth-related factors (tooth type, location, pulp status, and pulpal diagnosis) were assessed to determine their relationships with the presence of apical periodontitis visible only in CBCT images. Results: Apical periodontitis was detected in 24.6% and 35.5% of untreated teeth by PA radiographs and CBCT images, respectively. In a multivariate logistic regression analysis, pulp necrosis was significantly correlated with the presence of apical periodontitis visible only in CBCT images (odds ratio = 5.401; 95% confidence interval, 1.911–15.265; P = .001); the involvement of molars showed borderline nonsignificant correlation (odds ratio = 2.843; 95% confidence interval, 0.990–8.164; P = .052). Lesion sizes smaller than 2 mm in diameter and the involvement of molars were significant factors of lesions visible only in CBCT images (P < .05). Conclusions: Pulp necrosis was a preoperative predictor of apical periodontitis visible only in CBCT images. This research could provide a proper indication for CBCT imaging at diagnostic stages.
KW - Apical periodontitis
KW - cone-beam computed tomographic–detected lesions
KW - cone-beam computed tomography
KW - pulp necrosis
KW - “as low as reasonable achievable” principle
UR - http://www.scopus.com/inward/record.url?scp=85083005648&partnerID=8YFLogxK
U2 - 10.1016/j.joen.2020.03.005
DO - 10.1016/j.joen.2020.03.005
M3 - Article
C2 - 32295704
AN - SCOPUS:85083005648
SN - 0099-2399
VL - 46
SP - 832
EP - 838
JO - Journal of Endodontics
JF - Journal of Endodontics
IS - 6
ER -