Gliga Alexandru, Imre Marina, Grandini Simone, Marruganti Crystal, Gaeta Carlo, Bodnar Dana, Dimitriu Bogdan Alexandru, Foschi Federico
Department of Operative Dentistry, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Unit of Endodontics, Department of Medical Biotechnologies, Periodontology, Restorative and Paediatric Dentistry, University of Siena, 53100 Siena, Italy.
J Clin Med. 2023 Jul 12;12(14):4647. doi: 10.3390/jcm12144647.
Diagnosis is a key aspect in endodontic treatment, in a decade where invasive interventions are misapprehended as social tendency instead of medical necessity. All diagnostic facets should be considered before intending the operative phase. Intraoral endodontic radiology-based diagnosis has been shown to be limited. Periapical X-ray is the most used endodontic imaging, yet it does not provide high accuracy. Traditionally, dentists have been trained to diagnose a cyst by certain aspects (size, shape and appearance); hence, an assumption that teeth are affected by "periapical cyst" were subjected to unnecessary extraction or apicoectomy. The aim of this systematic review is to critically appraise the publications that relate the histological diagnosis of a periapical lesion (considered the gold standard) to intraoral X-ray investigation. Ovid Medline, PubMed, ScienceDirect, Mendeley and Scopus were searched for English-language studies comparing periapical diagnosis obtained by using two techniques (histopathology and X-ray). Sixteen articles were included for the final analysis (qualitative and quantitative evaluation) out of which only two supported the statement that periapical diagnosis can be coherently assessed through periapical imaging. Although there is not enough evidence to deliver a definitive conclusion, there are many publications that refute the diagnosis of a cyst via periapical X-ray.
在一个将侵入性干预误解为社会趋势而非医疗必要手段的时代，诊断是牙髓治疗的一个关键方面。在进入手术阶段之前，应考虑所有诊断方面。基于口腔内牙髓放射学的诊断已被证明是有限的。根尖X线片是最常用的牙髓成像方法，但它的准确性不高。传统上，牙医接受过通过某些方面（大小、形状和外观）诊断囊肿的培训；因此，那些被认为受“根尖囊肿”影响的牙齿往往会被进行不必要的拔除或根尖切除术。本系统评价的目的是批判性地评估将根尖周病变的组织学诊断（被视为金标准）与口腔内X线检查相关联的出版物。通过检索Ovid Medline、PubMed、ScienceDirect、Mendeley和Scopus数据库，查找比较使用两种技术（组织病理学和X线）获得的根尖周诊断的英文研究。最终纳入16篇文章进行分析（定性和定量评估），其中只有两篇支持根尖周诊断可通过根尖周成像进行连贯评估这一说法。虽然没有足够的证据得出明确结论，但有许多出版物反驳了通过根尖X线片诊断囊肿的观点。
