Basic Research
Accuracy of Cone-Beam Computed Tomography and Periapical Radiography in Detecting Small Periapical Lesions

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Abstract

Introduction

The aim of this study was to determine the diagnostic accuracy of 2 cone-beam computed tomography (CBCT) machines and periapical (PA) radiography in detecting simulated apical lesions created with the smallest dental burs available.

Methods

By using mandibles from human cadavers, simulated apical lesions were created and then progressively enlarged in 16 roots by using sizes #1/4, #1/2, #1, #2, #4, and #6 round burs. Imaging was obtained after each enlargement with a Kodak 9000 3D (Kodak) CBCT, a Veraviewpocs 3De (Morita) CBCT, and intraoral digital PA radiography. Specificity and sensitivity at variable decision thresholds were calculated and plotted on receiver operator characteristic curves. The area under the curve (AUC) served as an estimate of diagnostic accuracy.

Results

The overall AUCs for Kodak, Morita, and PA radiography were 0.767 (95% confidence interval [CI], 0.743–0.792), 0.753 (95% CI, 0.728–0.779), and 0.584 (95% CI, 0.554–0.615), respectively. The AUCs for Kodak and Morita were both statistically significantly larger than the AUC for all corresponding simulated lesion sizes imaged with PA radiography. Between Kodak and Morita, there were no statistically significant differences in AUCs for any of the corresponding simulated lesion sizes.

Conclusions

Both CBCT devices demonstrated poor accuracy in detecting simulated lesions smaller than 0.8 mm in diameter, fair to good accuracy when simulated lesion diameter was between 0.8–1.4 mm, and excellent accuracy when simulated lesions were larger than 1.4 mm in diameter. PA radiography, at best, demonstrated poor diagnostic accuracy for all simulated lesion sizes.

Section snippets

Materials and Methods

Six half-mandible block sections procured from the Department of Anatomy at Loma Linda University were dissected of all soft tissue. Roots with canal filling materials, posts, vertical root fractures, or detectable PA radiolucencies were discarded along with all non-native materials including restorations and implants. The remaining roots were carefully extracted. A dental operating microscope (G-6; Global Surgical Inc, St Louis, MO) was used to screen out for defects at the base of the socket.

Results

The 2 CBCT devices had higher specificities than PA radiography (0.754), with the specificity of the Morita (0.892) being slightly higher than that of Kodak (0.862) (Table 1).

The overall AUCs for Kodak, Morita, and PA radiography were 0.767, fair (95% CI, 0.743–0.792); 0.753, fair (95% CI, 0.728–0.779); and 0.584, fail/random guessing (95% CI, 0.554–0.615) (Table 2). For both CBCTs, the AUCs for all simulated lesion sizes were higher than the AUCs for each of the corresponding simulated lesion

Discussion

The values of specificity for both PA radiography and the 2 CBCT devices compare favorably with those reported by Stavroupoulous and Wenzel (13) in a pig jaw study. In contrast, Estrela et al (5) and Patel et al (12) reported much higher specificities for PA radiography. Aside from observer variability, a possible explanation for these differences is that Patel et al used only the distal root of the first mandibular molar where the surrounding cancellous bone is much thicker than for the

Acknowledgments

Special thanks to Udochukwu Oyoyo.

The authors deny any conflicts of interest related to this study.

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