Title In Follow-Up of Patients with Root-End Resection, CBCT Shows More Bone Defects Than Periapical Radiography, But it is Uncertain Whether This Information is Related to Success or Failure of Root-End Resection
Clinical Question In patients with root-end resection, does CBCT imaging provide more effective post-surgical follow-up of periapical healing than periapical radiography?
Clinical Bottom Line For follow-up of patients with root-end resection, CBCT appears to be more effective than periapical radiography in terms of detecting remaining bone defects. This is based on only a single trial of 50 patients, and it is unclear how this information is related to the success or failure of the resection procedure. The most efficient technique for post-surgical follow-up of periapical healing is still not directly addressed and would require more clinical studies with greater sample sizes.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
20026710Christiansen/200950 patientsClinical Study
Key results1 week post-operatively, there was no statistically significant difference between CBCT and periapical radiography when all periapical bone defects were measured both on periapical radiographs and CBCT images (P =0.58). Periapical bone defect area was measured 10% smaller on periapical radiographs (mean = 12.4 mm2, SD = 8.2) than on the CBCT images (mean = 13.0 mm2, SD = 7.8). 12 months post-operatively, more remaining defects (average 28%) were detected on CBCT than on periapical radiographs, whereas in 5% of the cases a periapical defect was seen on the periapical radiograph but not on the CBCT image.
Evidence Search Prognosis/Broad[filter] AND (("cone-beam computed tomography"[MeSH Terms] OR ("cone-beam"[All Fields] AND "computed"[All Fields] AND "tomography"[All Fields]) OR "cone-beam computed tomography"[All Fields] OR ("cone"[All Fields] AND "beam"[All Fields] AND "computed"[All Fields] AND "tomography"[All Fields]) OR "cone beam computed tomography"[All Fields]) AND ("apicoectomy"[MeSH Terms] OR "apicoectomy"[All Fields]) AND ("wound healing"[MeSH Terms] OR ("wound"[All Fields] AND "healing"[All Fields]) OR "wound healing"[All Fields]) AND ("follow-up studies"[MeSH Terms] OR ("follow-up"[All Fields] AND "studies"[All Fields]) OR "follow-up studies"[All Fields] OR ("follow"[All Fields] AND "up"[All Fields] AND "studies"[All Fields]) OR "follow up studies"[All Fields]))
Comments on
The Evidence
Validity: This is a clinical study to compare efficacy of CBCT and periapical radiography regarding follow-up of patients with root-end resection. All patients underwent periapical surgery; then, each received periapical and CBCT imaging at the 1 week and 12 month interval. Evidence only showed that at the 1-year follow-up, a difference was found between two techniques, with CBCT detecting more bone defect areas compared to periapical radiography; whether this difference is statistically significant or this information is related to the success or failure of periapical surgery was not clear. The study had a relatively small sample size and bias/human error may be present due to the three different observers who were not calibrated. Perspective: It is important to note that patients were evaluated with both periapical radiography and CBCT and were also followed up with three specialists in the field of interest for a year. This article provides a base line because it was a clinical study. More studies with larger sample sizes and longer follow-up times are needed to strengthen the evidence in regards to assessing success or failure of the surgical procedure.
Applicability Patients involved in this study are representative of a typical patient population undergoing periapical surgery needing follow-up. Periapical radiographs have been widely used for follow-up of root-end resection. With the recent developments in CBCT and its wide range of applications, many clinicians use it for multiple purposes. The most effective technique to evaluate periapical healing cannot be determined with current literature. Patients should be informed about the risks of higher radiation dose, limited availability of CBCT, and higher costs as well as advantages of each imaging option before proceeding.
Specialty (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery)
Keywords Cone Beam Computed Tomography (CBCT), periapical radiography, root-end resection, periapical surgery, apicoectomy, follow-up
ID# 3113
Date of submission 11/10/2016
E-mail demirturk@uthscsa.edu
Author Husniye Demirturk Kocasarac, DDS
Co-author(s) e-mail
Faculty mentor S. Thomas Deahl, II, DMD, PhD
Faculty mentor e-mail deahl@uthscsa.edu
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