Title

Internal Root Resorption is Better Detected with Cone-Beam Computed Tomography than with Intraoral Radiography

Clinical Question

Is cone-beam computed tomography more effective than intraoral radiographs in detecting internal root resorption?

Clinical Bottom Line

CBCT is able to detect internal root resorption at an almost gold-standard specificity and sensitivity in in-vitro studies; however, no gold standard is applicable to in-vivo studies.

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
19627378	Patel/2009	n=5 (external); n=5 (internal); n=5 (control)	Diagnostic accuracy study
Key results	For diagnosing internal 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 0.590 (0.216), 0.974 (0.064), 0.945 (0.136), and 0.713 (0.120), respectively. The kappa value for inter-examiner agreement was 0.365 and 0.925 for intraoral radiography and CBCT respectively for the diagnosis of internal resorption.
21238797	Kamburoğlu/2011	Extracted teeth; n=25(external); n=25 (internal); n= 40 (control)	In-vitro study
Key results	The kappa value for intra-examiner agreement ranged between moderate (0.457–0.103) to good (0.618–0.104) for intraoral radiography and good (0.606–0.096) and excellent (0.745–0.080) for CBCT for the diagnosis of internal resorption. The kappa value for inter-examiner agreement ranged between poor (0.105–0.089) to moderate (0.516–0.118) for intraoral radiography and moderate (0.551–0.104) and good (0.754–0.073) for CBCT. For intraoral radiographs the sensitivity ranged between 0.24 to 0.6; specificity, 0.63 to 0.95; PPV, 0.37 to 0.84; and NPV, 0.75 to 0.83. For CBCT, the sensitivity ranged between 0.52 to 0.72; specificity, 0.72 to 0.98; PPV, 0.5 to 0.87; and NPV, 0.84 to 0.88.
26780040	Lima/2016	n=28 (external); n=8 (internal); n=20 (control)	Diagnostic accuracy study
Key results	The accuracy of CBCT in diagnosing internal (P = 0.0038) inflammatory resorption was significantly higher than for periapical radiography. The kappa values for interobserver agreement ranged between 0.795 to 0.805 for periapical radiograph and 0.795 to 1.0 for CBCT. The kappa value for intraobserver agreement was greater than 0.8 for all examiners. CBCT had sensitivity, specificity, PPV, NPV and accuracy values of 0.938, 1.00, 1.00, 1.00 and 0.991 respectively. Periapical radiography had sensitivity, specificity, PPV, NPV and accuracy values of 0.563, 0.961, 0.690, 0.935, 0.908 and 0.0038 respectively.

Evidence Search

(cone beam computed tomography [MeSH Terms]) AND dental radiography [MeSH Terms]) AND internal root resorption [MeSH Terms]

Comments on
The Evidence

Validity: The most accurate diagnostic test for internal root resorption would be extraction and subsequent histologic or scanning electron microscope analysis; however, such methods are clinically unethical. Therefore, no clinical gold standard for the diagnosis of internal root resorption currently exists. Patel and Lima’s clinical studies used the consensus of a 6- and 4-clinician panel respectively as the gold standard. As stated by Patel et al., resorptive lesions are usually of atypical size and shape. The studies above measured internal resorptive lesions of differing sizes and locations in order to determine if these variables affected sensitivity and specificity values. Perspective: A perfect gold standard for detecting internal 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 and Lima studies). 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 internal root resorption is suspected but not readily detected with other radiographic techniques.

Applicability

Although CBCT 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 internal 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)

Keywords

Internal root resorption, Cone-beam computed tomography, CBCT

ID#

3404

Date of submission

11/21/2019

E-mail

baaklini@uthscsa.edu

Author

Nayla Baaklini

Co-author(s)

Angela Hoikka

Co-author(s) e-mail

Hoikka@uthscsa.edu

Faculty mentor

Dr. Hassem Geha

Faculty mentor e-mail

Geha@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
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

None available