Centre for Oral, Clinical and Translational Science, King's College London Dental Institute, London, United Kingdom; Specialist Practice, London, United Kingdom.
Centre for Oral, Clinical and Translational Science, King's College London Dental Institute, London, United Kingdom.
J Endod. 2021 Jun;47(6):914-923. doi: 10.1016/j.joen.2021.02.015. Epub 2021 Mar 8.
The aim of this study was to compare periapical radiographs (PRs) and upper standard occlusal (USO) radiographs with cone-beam computed tomographic (CBCT) imaging on clinicians' confidence in the diagnosis and management of traumatic dental injuries (TDIs).
This study included 35 maxillary anterior teeth from 25 patients with at least 1 PR (parallax view) and a CBCT scan. Fourteen patients also had a USO radiograph. Ten examiners selected a diagnosis and treatment plan, which were compared with a reference standard. Sensitivity, specificity, positive and negative predictor values, and receiver operating characteristic analysis were used to determine the diagnostic accuracy.
CBCT imaging exhibited significantly higher sensitivity than both conventional radiographic techniques combined (PRs and PRs + USO radiographs) for all diagnoses (TDI: 99% vs 84%, lateral luxation: 80% vs 34%, extrusions: 92% vs 42%, and cortical plate fracture: 58% vs 1%) other than horizontal root fractures in which the results were close to statistical significance (88% vs 69%). CBCT imaging was significantly more accurate for all diagnoses (TDI: 91% vs 70%, lateral luxations: 83% vs 61%, extrusive luxations: 92% vs 68%, alveolar cortical plate fractures: 78% vs 48%, and horizontal root fractures: 93% vs 82%). Examiners had the most confidence with CBCT imaging and the least confidence in diagnosing using PRs + USO radiographs than with PRs alone. Agreement with management plans was significantly better using CBCT imaging compared with PRs and PRs + USO radiographs.
CBCT imaging improved the clinical diagnosis of TDIs. The addition of USO radiographs to PRs did not improve the diagnosis of TDIs in this investigation. CBCT imaging improved confidence in the diagnosis of TDI cases and treatment planning compared with conventional radiography.
本研究旨在比较根尖片（PR）和上标准咬合（USO）片与锥形束 CT（CBCT）成像在临床医生对创伤性牙损伤（TDI）的诊断和治疗信心方面的差异。
本研究纳入了 25 名患者的 35 颗上颌前牙，每位患者均至少有 1 张 PR（视差）和 1 张 CBCT 扫描片。其中 14 名患者还接受了 USO 检查。10 名检查者选择诊断和治疗计划，并与参考标准进行比较。采用敏感性、特异性、阳性和阴性预测值以及受试者工作特征分析来评估诊断准确性。
对于所有诊断（TDI：99% vs 84%，侧向脱位：80% vs 34%，脱出：92% vs 42%，皮质板骨折：58% vs 1%），CBCT 成像的敏感性显著高于传统放射技术（PR 和 PR + USO 射线照相术）的组合，除了水平根折，结果接近统计学意义（88% vs 69%）。对于所有诊断（TDI：91% vs 70%，侧向脱位：83% vs 61%，脱位性脱位：92% vs 68%，牙槽皮质板骨折：78% vs 48%，水平根折：93% vs 82%），CBCT 成像的准确性也显著更高。检查者对 CBCT 成像的信心最高，对 PR + USO 射线照相术的诊断信心最低，而对 PR 的诊断信心最低。与 PR 和 PR + USO 射线照相术相比，使用 CBCT 成像时，与管理计划的一致性显著更好。
CBCT 成像提高了 TDI 的临床诊断能力。在本研究中，USO 射线照相术与 PR 联合使用并未改善 TDI 的诊断。与传统放射学相比，CBCT 成像提高了对 TDI 病例的诊断信心和治疗计划的制定。
