Improved Detection and Localization of Apical Lytic Lesions in Previously Obturated Teeth Using Cone Beam Computed Tomography as Compared to Conventional Radiography

Purpose: To determine the diagnostic ability of Cone Beam Computed Tomography (CBCT) to detect and localize apical pathoses as compared to two-dimensional conventional direct digital intraoral radiographs (DDR), in order to accurately determine the location and extent of these lesionsto improve treatment outcomes. Methods: Previously obtained CBCT and DDR data from 45 patients with a diagnosis of failed endodontic therapy were included. Images were analyzed by three calibrated observers for the presence of periapical radiolucencies, number and location of roots involved, and any cortical erosion/perforation resulting from the lytic lesion. The readings were repeated after an interval of two weeks. Results: Significantly more number of roots (25%) involved with periapical pathoses were detected using CBCT. Localization of cortical erosions/perforations was possible only with CBCT. Validation of imaging findings was effected using direct visualization of the regions of interest at the time of surgery. Conclusions: CBCT images were significantly superior to DDR for detection of apical pathoses and localization of erosion/perforation of cortices with respect to roots of teeth.Results illustrate the advantages of three-dimensional imaging for localization of pathoses in diagnostically challenging cases with possible implications on treatment planning.Accurate localization of these lesions and a higher and accurate detection rate may result in better outcomes in re-treatment cases. More studies are needed to assess the time required for full healing post endodontic treatment using the additional information gleaned from CBCT data.