Individualized periapical radiography determined by clinical and panoramic examination.

The efficiency of panoramic radiography compared with full-mouth periapical examination is an unresolved problem. The diagnostic yield of periapical lesions when the clinical signs and symptoms and the findings from a panoramic radiograph served as the basis for an individualized periapical radiographic examination was studied. Two hundred patients were examined clinically and radiographically. The periapical status was assessed step by step with access to increasing numbers of radiographs. For the clinical examination, the sensitivity was 0.24, the positive predictive value 0.62, the specificity 0.98, the negative predictive value 0.90 and the likelihood ratio for the positive test result 12. For radiographs indicated by the clinical examination plus the panoramic radiograph and selected periapical radiographs, both the sensitivity and the positive predictive value were 0.91, the specificity and the negative predictive value 0.99 each and the likelihood ratio was 91. False findings were twice as frequent in the upper as in the lower arch and particularly found in the incisor and premolar regions. In 30% of the patients no periapical radiograph was needed to supplement the panoramic radiograph. In the other patients, two supplementary periapical radiographs were needed on average. We conclude that the information obtained from the clinical and panoramic examinations supplemented with no more than two periapical radiographs will result in a high diagnostic yield on the periapical status.