Department of Conservative Dentistry, College of Medicine, Ewha Womans University, Seoul, Korea.
Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
J Endod. 2020 Jun;46(6):832-838. doi: 10.1016/j.joen.2020.03.005. Epub 2020 Apr 12.
Cone-beam computed tomographic (CBCT) imaging is useful in detecting apical periodontitis, which is often missed in periapical (PA) radiographs. This study aimed to identify preoperative predictors correlated with the presence of apical periodontitis visible only in CBCT images and to investigate the important characteristics of such lesions.
In total, 332 consecutive patients with both PA radiographs and CBCT images were enrolled in this study. The patients' clinical charts were reviewed retrospectively to collect information regarding their symptoms and diagnoses. Periapical lesions were assessed using a modified CBCT PA index by 2 endodontists. Patient-related factors (age, sex, and symptoms) and tooth-related factors (tooth type, location, pulp status, and pulpal diagnosis) were assessed to determine their relationships with the presence of apical periodontitis visible only in CBCT images.
Apical periodontitis was detected in 24.6% and 35.5% of untreated teeth by PA radiographs and CBCT images, respectively. In a multivariate logistic regression analysis, pulp necrosis was significantly correlated with the presence of apical periodontitis visible only in CBCT images (odds ratio = 5.401; 95% confidence interval, 1.911-15.265; P = .001); the involvement of molars showed borderline nonsignificant correlation (odds ratio = 2.843; 95% confidence interval, 0.990-8.164; P = .052). Lesion sizes smaller than 2 mm in diameter and the involvement of molars were significant factors of lesions visible only in CBCT images (P < .05).
Pulp necrosis was a preoperative predictor of apical periodontitis visible only in CBCT images. This research could provide a proper indication for CBCT imaging at diagnostic stages.
锥形束 CT（CBCT）成像在检测根尖周病方面很有用，而根尖周病在根尖（PA）射线照相中经常被遗漏。本研究旨在确定与仅在 CBCT 图像中可见的根尖周病相关的术前预测因子，并研究此类病变的重要特征。
本研究共纳入 332 例同时接受 PA 射线照相和 CBCT 成像的连续患者。回顾性审查患者的临床图表，以收集有关其症状和诊断的信息。两名牙髓病医生使用改良的 CBCT PA 指数评估根尖周病变。评估患者相关因素（年龄、性别和症状）和牙齿相关因素（牙齿类型、位置、牙髓状态和牙髓诊断），以确定它们与仅在 CBCT 图像中可见的根尖周病之间的关系。
PA 射线照相和 CBCT 图像分别在未经治疗的牙齿中检测到 24.6%和 35.5%的根尖周病。在多变量逻辑回归分析中，牙髓坏死与仅在 CBCT 图像中可见的根尖周病显着相关（优势比=5.401；95%置信区间，1.911-15.265；P=0.001）；磨牙的参与显示出边界性非显着相关性（优势比=2.843；95%置信区间，0.990-8.164；P=0.052）。直径小于 2mm 的病变大小和磨牙的参与是仅在 CBCT 图像中可见的病变的重要因素（P<0.05）。
牙髓坏死是仅在 CBCT 图像中可见的根尖周病的术前预测因子。这项研究可以为诊断阶段的 CBCT 成像提供适当的指征。
