ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Cone Beam Computed Tomography (CBCT) Provides Greater Accuracy Than Conventional Periapical Radiographs in Detecting Periapical Lesions in Patients with Vital Teeth
Clinical Question In patients with vital teeth, does CBCT provide greater accuracy than conventional periapical radiographs in detecting periapical lesions?
Clinical Bottom Line The accuracy of cone beam computed tomography (CBCT) was significantly higher than that of conventional periapical radiographs in detecting periapical lesion in patients with vital teeth.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24565653Pope/2014166 vital teeth in overall 200 teeth of 68 patientsRetrospective Clinical Study
Key resultsA total of 200 teeth were included in this study; 166 showed signs of vital pulpal status. The CBCT-periapical index score (CBCT-PAI score, using CBCT) was greater than the periapical index score (PAI score, using conventional periapical radiographs) in 72% (119 of 166) of teeth with a vital pulp having a radiographic PDL space widening of 0 to 1 mm (P < .001).
#2) 23146642Abella/2012307 paired roots in 138 teeth of 130 patientsComparative Study
Key results307 paired roots of vital teeth were assessed with both periapical radiographs and CBCT images. Periapical lesions were detected in 10 (3.3%) and absent in 297 (96.7%) roots when assessed with conventional periapical radiography. When the same 307 roots were assessed with CBCT scans, periapical lesions were present in 42 (13.7%) and absent in 265 (86.3%) roots. The accuracy of CBCT was significantly higher than that of periapical radiographs (P < .05).
Evidence Search (("Cone-Beam Computed Tomography/methods"[Mesh]) AND "Dental Pulp Test"[Mesh]) AND (("Pulpitis"[Mesh]) OR "Periapical Tissue"[Mesh]) 
Comments on
The Evidence
Validity: These two articles are clinical studies. Pope’s study includes 166 vital teeth, and Abella’s study includes 307 roots of vital teeth. Both studies had a large sample size and showed statistically significant greater accuracy of CBCT than of periapical radiographs. Therefore, these studies demonstrated clinical validity. Perspective: In contemporary clinical endodontics, CBCT is one of the most essential diagnostic tools. Although diagnostic accuracy of CBCT has been reported in many clinical studies, its use in detecting periapical pathology in vital teeth is limited. These studies demonstrate that in vital teeth, CBCT provides greater accuracy than conventional periapical radiographs in detecting periapical lesions.
Applicability CBCT is very useful to detect periapical lesions in vital teeth. Clinicians can use this diagnostic tool to diagnose more accurately and easily periapical pathosis.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Endodontics)
Keywords Cone beam computed tomography (CBCT), Periapical radiographs, Vital teeth, Pulpitis
ID# 3111
Date of submission: 11/10/2016spacer
E-mail takimotok@livemail.uthscsa.edu
Author Koyo Takimoto, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Nikita Ruparel, DDS, MS, PhD
Faculty mentor/Co-author e-mail Ruparel@uthscsa.edu
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