Detection and measurements of apical lesions in the upper jaw by cone beam computed tomography and panoramic radiography as a function of cortical bone thickness
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In the current literature, cone beam computed tomography (CBCT) seems to be more accurate in detecting apical lesions (AL) than two-dimensional radiographs. Cortical bone thickness might have an influence on AL visibility. Therefore, the purpose of the study was to directly compare the diagnostic accuracy of panoramic radiography (PANO) and CBCT in detecting AL in the upper jaw and determine the influence of cortical bone thickness on AL visibility.
Materials and methods
Anonymised digital images of 351 patients who received a CBCT image and a panoramic radiograph within 90 days were examined for AL in the upper jaw. The analysis was conducted by a trained examiner and reviewed by an expert in dental radiology. Further, the dimensions of AL and cortical bone thickness in the region affected by AL were measured to determine their influence on visibility. Statistical analysis was carried out by means of statistical software (IBM SPSS 25; Armonk, NY, USA).
The mean age of the patients was 58.9 years with an almost equal gender distribution. A total of 2223 teeth in the upper jaw were included in the final analysis. CBCT detected AL on 144 teeth (6.5%), of which only 23 were also visible on a PANO. The difference between both methods was significant (p < 0.001). The dimensions of AL measured within a PANO were approximately twice as high as those measured by CBCT. However, the difference was not significant (p ≥ 0.005). Cortical bone thickness had no influence on AL visibility.
Conclusions and clinical relevance
Panoramic radiographs are unsuitable for a reliable diagnosis of AL in the upper jaw, while CBCT leads to a better visualisation of AL. Bone thickness has no significant influence on AL visibility with either imaging method.
KeywordsApical lesions Cone beam computed tomography Panoramic radiography Cortical bone thickness Visibility
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval of this study was sought and granted by the Medical Council of Baden-Württemberg, Germany (registration no. F-2014-006-z). All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
For this type of study formal consent is not required.
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