Cone beam computed tomography vs. Periapical Radiograph: Diagnostic accuracy in endo and periodontal lesions

Abstract

Objectives: This study aimed to compare the diagnostic accuracy of dental specialists when assessing endodontic and periodontal lesions using periapical radiography (PR) alone and PR combined with cone-beam computed tomography (PR+CBCT). Methods: In this cross-sectional study, 30 endodontists and 30 periodontists evaluated ten clinical cases involving endodontic and periodontal tissues at two time points. The cases included vertical root fractures/fissures, endodontic perforation, persistent apical periodontitis, concomitant endo-periodontal injury, and localized periodontitis. Initially, participants reviewed clinical data and periapical radiographs for each case, formulating a diagnostic hypothesis via a structured questionnaire. Subsequently, CBCT images were introduced, and participants reassessed the images and reached a diagnosis again. The correct diagnosis, as established by the dentist responsible for each case, was included as one of the answer choices. Diagnostic accuracy for overall and specific lesion types after incorporating CBCT was analyzed using the McNemar test, with statistical significance set at 5%. Results: The overall percentage of correct diagnoses was 67.2% for PR+CBCT and 42.2% for PR. PR+CBCT provided accurate diagnoses in 58.8% of cases for both specialties. Regarding lesion type, PR+CBCT correctly identified a greater number of endo-periodontal lesions with and without root damage compared to PR alone. Conclusions: PR+CBCT significantly improves diagnostic accuracy for both endodontists and periodontists in cases involving both pulp and periodontal tissues.