Background Endodontic treatment planning and treatment success evaluation are largely based on radiographic assessment of anatomical and treatment-related parameters of teeth with apical periodontitis (AP). This prospective clinical study aimed to assess radiographically the 2-year endodontic treatment outcomes for teeth with AP, and to evaluate prognostic validity of Periapical and Endodontic Status Scale (PESS). Methods A total of 128 patients, representing 176 teeth with AP were examined by cone-beam computed tomography at baseline and at 24 months after endodontic treatment. Treatment outcome was evaluated using estimates of periapical radiolucency and the relationship between anatomical structures and location. The strength of the associations between these and treatment-related parameters was tested by logistic regression analysis. PESS sensitivity and specificity were calculated for every treatment risk group (low, moderate, high) of teeth. Results One hundred and fifty-seven teeth, representing 350 root canals had a positive treatment outcome, while 19 teeth, representing 53 root canals had a negative treatment outcome at 24 months. The probability of negative outcome was 25 times higher in the moderate/high-risk group than in the mild-risk group of teeth (OR = 25.1; 95%CI [12.2–51.5]). Pre-treatment complications and retreatment cases with radiolucency were associated with negative outcomes (OR = 35.9; 95%CI [12.6–102.4]; OR = 26.437; 95%CI [10.9–64.1], respectively). PESS sensitivity and specificity was over 80% in all risk groups except for high risk group, due to very low number of cases. Conclusions Endodontic treatment outcome depends on the severity of periapical changes. The presence of complications and retreatment cases with periapical lesions are associated with negative treatment outcome. The PESS is a valid instrument to predict outcome of teeth with low-moderate treatment risk of AP.
Objectives To compare selected anatomical and treatment-related diagnostic parameters estimated by cone-beam computed tomography and by digital periapical radiography in teeth with apical periodontitis, and to evaluate reliability of different examiners in interpretation of images obtained by both methods. Material and Methods Teeth with apical periodontitis were evaluated independently by 2 endodontists and 1 radiologist based on 128 cone-beam computed tomography (CBCT) and 162 digital periapical radiography (DPR) images. Anatomical (size, relation with root, location of periapical radiolucency) and treatment-related (canal obturation length, homogeneity, coronal seal) parameters were assessed. Fleiss kappa reflected inter-observer agreement while intra-examiner agreement was estimated by Cohen’s kappa. McNemar and McNemar-Bowker tests served for evaluation of differences between CBCT- and DPR-based estimates. Results Cohen’s kappa ranged from 0.62 to 1 for all examiners. Fleiss kappa values were nearly perfect for majority of parameters. Diagnostic discrepancy between methods was found for size of radiolucency that in 15 - 17% cases was larger, and in 25 - 28% smaller in DPR than in CBCT images. DPR revealed 20% of root canals scored as non-obturated while in CBCT - obturation present. Canal obturation was rated as homogenous by CBCT, while absent or non-homogenous by DPR, in 17 - 23%, and 11 - 14% of cases, respectively. Radiologist detected more root perforations in CBCT than in DPR images. Conclusions Good intra- and inter-examiner agreement for anatomical and treatment-related diagnostic parameters was achieved using cone-beam computed tomography and digital periapical radiography methods and demonstrated similar diagnostic capability, although variation regarding root perforations and canal obturation quality was observed.
Background and Objectives: There is limited information regarding comparison of long-term dynamics of periapical bone destruction estimated by digital periapical radiography (DPR) and by cone-beam computed tomography (CBCT). This study aimed to compare the radiographically assessed periapical changes of endodontically treated teeth over 2 years of follow-up and to analyse disagreements in periapical lesion size estimates around the same roots using DPR and CBCT. Materials and Methods: A total of 176 endodontically treated teeth, of 128 patients with apical periodontitis, were assessed by DPR and CBCT, at baseline and after 2 years. All periapical radiolucencies were categorised by severity (S0, S1, S2, S3) concerning their size. Descriptive statistics were used to report distribution of the radiolucencies at baseline and at follow-up, and their size transitions over 2 years. Site-specific comparison of the radiolucencies identified by two methods was performed using Z test and Pearson’s chi-square test. Results: majority of the detected radiolucencies were scored as S0: 65% and 68% at baseline; 89% and 83% at follow-up, by DPR and CBCT, respectively. Site-specific score comparison showed that disagreements comprised 18% and 20% of the total number of radiolucencies detected by DPR and CBCT, respectively. There were more disagreements between DPR and CBCT within categories S1 and S2 + S3 compared to S0: at baseline, they comprised 17–33% and after two years 62–95% of all detected radiolucencies within the category. 65% of non-matching score transitions over two years occurred between S0 and S1. The CBCT-based evaluation resulted in negative treatment outcomes for 10 more root canals than the DPR-based result. Conclusions: Most remarkable disagreement between DPR and CBCT recordings was observed within the radiolucency categories S2 and S3. However, the diagnostic accuracy of both radiographic methods was questionable as it resulted in a high proportion of non-matching S0-S1 lesion transitions over 2 years.
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