Title Cone-Beam Computed Tomography Improves Detection of External Root Resorption
Clinical Question In patients undergoing orthodontic treatment, is cone-beam computed tomography (CBCT) more effective than conventional radiographs (intraoral and extraoral) in detecting external root resorption?
Clinical Bottom Line CBCT is able to detect external root resorption at an almost gold-standard specificity and sensitivity in multiple in-vitro studies; however, very few in-vivo studies exist.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
19627378Patel/2009n=5 (external); n=5 (internal); n=5 (control)Retrospective Cohort Study
Key resultsFor diagnosing external root resorption, CBCT was found to possess sensitivity, specificity, PPV and NPV values all equal to 1.000 ± 0.000 (gold standard equivalent). Intraoral radiographs had sensitivity, specificity, PPV, and NPV values of 0.724 ± 0.302, 0.790 ± 0.076, 0.645 ± 0.114, and 0.865 ± 0.157, respectively.
23515150Shokri/2013n=54 maxillary first premolars with simulated lesions placed in cadaver boneIn-Vitro Study
Key resultsCBCT had similar sensitivity values to conventional radiography in detecting external resorptive lesions in the middle and coronal thirds of the roots. However, CBCT had 100% sensitivity when evaluating resorption in the apical third of the root, which is significantly higher than the sensitivity values of 0.83, 0.79, 0.72 generated by CCD, PSP, and conventional film.
22891767Ren/2013n=160 single rooted premolar teeth with simulated lesions placed in plasterIn-Vitro Study
Key resultsCBCT detected simulated resorptive lesions with sensitivity and specificity values of 0.758 and 0.963, respectively. Conventional periapical radiographs had respective sensitivity and specificity values of 0.675 and 0.825. These values were found to be significantly different (p < 0.001).
Evidence Search (("Root Resorption"[Mesh]) AND "Cone-Beam Computed Tomography"[Mesh]) AND "Radiography, Dental"[Mesh]
Comments on
The Evidence
Validity: All studies explicitly stated that while the ideal gold standard for the detection of external root resorption would be extraction of the tooth in question and subsequent histologic or scanning electron microscope analysis, such a procedure is clinically unethical. Therefore, no clinical gold standard for the diagnosis of external root resorption currently exists. Patel's clinical study used as gold standard the consensus of a 3-clinician panel, subsequently confirmed by response to therapy. As stated by Patel et. al, resorptive lesions are usually of atypical size and shape. The studies above measured external resorptive lesions of differing sizes and locations in order to determine if these variables affected sensitivity and specificity values. In all above studies, no competing interests were determined. Perspective: As stated before, a perfect gold standard for detection of external root resorption is currently non-existent. The use of CBCT for its diagnosis shows promise as a possible gold standard in the future, although more studies must be conducted at a higher level of evidence (preferably in-vivo, as in the Patel study). Additionally, CBCT generally exposes the patient to higher levels of radiation than conventional radiographs and therefore CBCT should be used conservatively, particularly in cases where external root resorption is suspected but not readily detected with other radiographic techniques.
Applicability Although Cone-Beam Computed Tomography is readily available in most in institutional settings, access to CBCT machines in the private setting widely varies. Also, the cost associated with CBCT image capture and interpretation may be significant. Additionally the patient must be willing to accept the additional exposure to ionizing radiation. As stated above, CBCT may be indicated in select cases where external root resorption is suspected, but not readily seen with other methods of imaging. This would allow patients to be aware of resorptive processes and seek intervention.
Specialty (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Orthodontics) (Dental Hygiene)
Keywords Cone-Beam Computed Tomography, CBCT, orthodontics, external root resorption
ID# 2549
Date of submission 08/06/2013
E-mail reyesrn@uthscsa.edu
Author Ryan Noel Reyes
Co-author(s) Martina Parrone
Co-author(s) e-mail parrone@uthscsa.edu
Faculty mentor
Faculty mentor e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available