Evaluating the Periapical Status of Teeth with Irreversible Pulpitis by Using Cone-beam Computed Tomography Scanning and Periapical Radiographs

Introduction: The purpose of this study was to compare the prevalence of apical periodontitis (AP) on individual roots of teeth with irreversible pulpitis viewed with periapical (PA) radiographs and cone-beam computed tomography (CBCT) scans. Methods: PA radiographs and CBCT scans were taken of 138 teeth in 130 patients diagnosed with irreversible pulpitis (symptomatic and asymptomatic). Two calibrated examiners assessed the presence or absence of AP lesions by analyzing the PA and CBCT images. A consensus was reached in the event of any disagreement. The data were analyzed using the hypothesis test, and significance was set at P <= .05. Results: Three hundred seven paired roots were assessed with both PA and CBCT images. A comparison of the 307 paired roots revealed that AP lesions were present in 10 (3.3%) and absent in 297 (96.7%) pairs of roots when assessed with PA radiography. When the same 307 sets of roots were assessed with CBCT scans, AP lesions were present in 42 (13.7%) and absent in 265 (86.3%) paired roots. The prevalence of AP lesions detected with CBCT was significantly higher in the symptomatic group compared with the asymptomatic group (P < .05). An additional 22 roots were identified with CBCT alone. Conclusions: The present study highlights the advantages of using CBCT for detecting AP lesions, especially in teeth with symptomatic irreversible pulpitis. (J Endod 2012;38:1588-1591)