In horses with secondary sinusitis caused by dental disease, is computed tomography more accurate than radiography for the identification of apical dental pathology? A Knowledge Summary by

Abstract

PICO question In adult horses with secondary sinusitis caused by dental disease, is computed tomography more accurate than radiography for the identification of apical dental pathology? Clinical bottom line Category of research question Diagnosis The number and type of study designs reviewed The literature search identified four papers that were critically reviewed. The publications consist of two retrospective case controlled studies, one clinical study and one descriptive study Strength of evidence Weak Outcomes reported Four studies reported the sensitivity of computed tomography (CT) for the diagnosis of apical dental pathology in horses presented for evaluation of clinical signs of sinus disease with histopathological evidence of apical dental pathology. All studies reported the radiographic changes present in these horses or used absence of definitive radiographic changes consistent with apical dental disease as a reason to undertake further CT evaluation. All four papers found that CT identified teeth with apical pathology that radiography had not Conclusion CT is more accurate than radiography for the diagnosis of equine maxillary apical dental pathology; however, clear guidelines on the CT changes associated with apical dental pathology are required. Loss of the lamina dura, infundibular changes or pulpal gas as singular findings on CT imaging can be seen in teeth with no underlying histopathological evidence of apical disease, and in maxillary teeth imaged in horses without clinical signs of maxillary cheek tooth pathology.