Chan Shu Wen Klare, Wee Lee Chee, Wei Mingrun, Gerald Lim Kian Chong, Yu Victoria Soo Hoon
Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
Khoo Teck Puat Hospital Dental Surgery, Singapore, Singapore.
Int Endod J. 2025 Oct;58(10):1551-1564. doi: 10.1111/iej.14272. Epub 2025 Jun 13.
This prospective cohort study aimed to study lesion size, proximity to anatomical structures and detection of missed canals using 2D digital periapical (PA) radiographs and 3D cone beam computed tomography (CBCT) radiographic imaging, amongst a cohort of asymptomatic persistent endodontic lesions (APEL), and to develop a radiographic protocol for these asymptomatic lesions.
APEL persisting ≥4 years after endodontic treatment were recruited with informed consent. PA radiographs taken at different angles (KaVo Kerr, Brea, CA) and a limited field-of-view CBCT scan (KaVo Kerr, Brea, CA) of 0.125mm voxel size were evaluated. Two calibrated independent endodontic practitioners examined all radiographic images in a random and blinded sequence, under similar viewing conditions. Agreement above chance (kappa) was calculated for parameters of interest (Graphpad by Dotmatics, https://www.graphpad.com/).
Eighty-two APEL (15 incisors, 25 premolars, 42 molars; 59.8% treated 4-10 years prior) in 77 patients (34 male, 43 female, median age 51-60) were examined. Root filling quality was acceptable with 14/82 (17.0%) lacking density and homogeneity. Weighted kappa on lesion size (0.5-1.9, 2-4.9 and 5-9.9 mm) between PA radiographs and CBCT was 0.466 - in 24 APEL, lesion size was >2 mm larger on CBCT whilst in 4 APEL, lesions were >2 mm smaller on CBCT. On proximity to maxillary sinus and neurovascular structures ('yes', 'no', 'unable to tell'), kappa was 0.237, with 9 APEL scored 'unable to tell' on PA radiographs and 0 uncertainty on CBCT. Agreement between PA radiographs and CBCT on missed canals ('not likely', 'somewhat likely', 'very likely', 'unable to tell') was 0.349, with 13 teeth scored 'somewhat likely' and 'very likely' on CBCT and only 6 teeth similarly scored on PA.
Overall, CBCT provided a more comprehensive examination of teeth with APEL than PA radiographs. Larger lesion sizes were generally observed, especially in posterior teeth. Sinus involvement was more readily identified, and the assessment of the presence of missed canals could be performed with more certainty. Where lesion monitoring is chosen, CBCT imaging should be considered for a more thorough assessment of posterior teeth, and where there is uncertainty in PA radiograph interpretation of anterior teeth.
这项前瞻性队列研究旨在利用二维数字根尖片（PA）和三维锥形束计算机断层扫描（CBCT）影像学，研究一组无症状持续性牙髓病变（APEL）的病变大小、与解剖结构的接近程度以及遗漏根管的检测情况，并为这些无症状病变制定影像学方案。
招募根管治疗后持续存在≥4年的APEL患者，并获得其知情同意。评估了不同角度拍摄的PA片（KaVo Kerr，加利福尼亚州布雷亚）以及体素大小为0.125mm的有限视野CBCT扫描（KaVo Kerr，加利福尼亚州布雷亚）。两名经过校准的独立牙髓科医生在相似的观察条件下，以随机和盲法顺序检查所有影像学图像。计算感兴趣参数的高于机遇的一致性（kappa）（由Dotmatics提供的Graphpad，https://www.graphpad.com/）。
检查了77例患者（34例男性，43例女性，中位年龄51 - 60岁）中的82个APEL（15颗切牙，25颗前磨牙，42颗磨牙；59.8%在4 - 10年前接受治疗）。根管充填质量尚可，14/82（17.0%）缺乏密度和均匀性。PA片和CBCT之间关于病变大小（0.5 - 1.9、2 - 4.9和5 - 9.9mm）的加权kappa为0.466 - 在24个APEL中，CBCT上的病变大小比PA片大>2mm，而在4个APEL中，CBCT上的病变比PA片小>2mm。在上颌窦和神经血管结构的接近程度方面（“是”、“否”、“无法判断”），kappa为0.237，9个APEL在PA片上评分为“无法判断”，而CBCT上无不确定性。PA片和CBCT在遗漏根管方面（“不太可能”、“有些可能”、“非常可能”、“无法判断”）的一致性为0.349，13颗牙齿在CBCT上评分为“有些可能”和“非常可能”，而PA片上只有6颗牙齿得到类似评分。
总体而言，与PA片相比，CBCT对APEL牙齿的检查更全面。通常观察到更大的病变大小，尤其是在后牙。更容易识别鼻窦受累情况，并且对遗漏根管的存在评估可以更确定地进行。在选择病变监测时，对于后牙的更全面评估以及在前牙PA片解释存在不确定性时，应考虑使用CBCT成像。
