06 February 2019

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When is it necessary to use CBCT instead of periapical radiography?

Simona Chirico

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INTRODUCTION 
Periapical radiography is used as an instrument of investigation in endodontics, both for the diagnosis and for the evaluation of the outcome of an endodontic therapy. But are we sure it can always be enough? The introduction of cone beam computed tomography (CBCT) in endodontics has led several dentists to prefer its use, given the best effectiveness and precision, in particular for lesion detection. Therefore, which of the two would be preferable to use for the evaluation of periapical lesions? 

A review published in the Journal of Endodontics tried to answer this question, with the aim to compare this two imaging modalities, to identify the odds ratio and quantify endodontic outcomes. 

MATERIALS AND METHODS 
Two reviews in the literature were analyzed, following a research on MEDLINE, Embase, Cochrane, and PubMed database. 

RESULTS
The odds of CBCT imaging locating a lesion is 2,04 more than the odds of traditional radiography locating the same lesion (95% confidence interval, 1.52–2.73). This may not be of concern for an obvious lesion in which a clear diagnosis may be made, but when clinically challenged with a difficult diagnosis and/or decision making, CBCT imaging might provide a greater amount of information needed to establish an accurate diagnosis. 

CONCLUSIONS 
Although CBCT imaging can overcome several limitations of 2-dimensional radiography, there are other issues to consider such as radiation, high levels of scatter and noise, variations in dose distribution within a volume of interest, and cost. For these reasons, CBCT imaging should be used when the history and clinical examination clearly show that the benefits outweigh the potential risks and when 2-dimensional intraoral radiography is inconclusive.  

For additional informations:
Cone-beam Computed Tomography Compared with Intraoral Radiographic Lesions in Endodontic Outcome Studies: A Systematic Review