Comparison of Selected Anatomical and Treatment-related Diagnostic Parameters Estimated by Cone-Beam Computed Tomography and Digital Periapical Radiography in Teeth with Apical Periodontitis

Jelena Gudac; Kristina Hellén-Halme; Tadas Venskutonis; Algirdas Puisys; Vita Machiulskiene

doi:10.5037/jomr.2020.11204

Comparison of Selected Anatomical and Treatment-related Diagnostic Parameters Estimated by Cone-Beam Computed Tomography and Digital Periapical Radiography in Teeth with Apical Periodontitis

J Oral Maxillofac Res. 2020 Jun 30;11(2):e4. doi: 10.5037/jomr.2020.11204. eCollection 2020 Apr-Jun.

Authors

Jelena Gudac¹, Kristina Hellén-Halme², Tadas Venskutonis¹, Algirdas Puisys³, Vita Machiulskiene¹

Affiliations

¹ Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, KaunasLithuania.
² Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmo University, MalmoSweden.
³ Vilnius Implantology Center clinic, VilniusLithuania.

Abstract

Objectives: To compare selected anatomical and treatment-related diagnostic parameters estimated by cone-beam computed tomography and by digital periapical radiography in teeth with apical periodontitis, and to evaluate reliability of different examiners in interpretation of images obtained by both methods.

Material and methods: Teeth with apical periodontitis were evaluated independently by 2 endodontists and 1 radiologist based on 128 cone-beam computed tomography (CBCT) and 162 digital periapical radiography (DPR) images. Anatomical (size, relation with root, location of periapical radiolucency) and treatment-related (canal obturation length, homogeneity, coronal seal) parameters were assessed. Fleiss kappa reflected inter-observer agreement while intra-examiner agreement was estimated by Cohen's kappa. McNemar and McNemar-Bowker tests served for evaluation of differences between CBCT- and DPR-based estimates.

Results: Cohen's kappa ranged from 0.62 to 1 for all examiners. Fleiss kappa values were nearly perfect for majority of parameters. Diagnostic discrepancy between methods was found for size of radiolucency that in 15 - 17% cases was larger, and in 25 - 28% smaller in DPR than in CBCT images. DPR revealed 20% of root canals scored as non-obturated while in CBCT - obturation present. Canal obturation was rated as homogenous by CBCT, while absent or non-homogenous by DPR, in 17 - 23%, and 11 - 14% of cases, respectively. Radiologist detected more root perforations in CBCT than in DPR images.

Conclusions: Good intra- and inter-examiner agreement for anatomical and treatment-related diagnostic parameters was achieved using cone-beam computed tomography and digital periapical radiography methods and demonstrated similar diagnostic capability, although variation regarding root perforations and canal obturation quality was observed.

Keywords: cone-beam computed tomography; digital radiography; periapical periodontitis.