Efficacy of Cone Beam Computed Tomography (CBCT) and Periapical (PA) Radiography in Endodontic Diagnosis and Treatment Planning

Abstract

Aim: The benefits and limitations of cone beam computed tomography (CBCT) over conventional periapical (PA) radiographs have been studied by many authors since many years ago. The subtle point of negotiation is to understand to what extent the use of CBCT over periapical can have a positive influence on initial radiographic diagnosis in different dental specialties in last recent researches. This article research was achieved by identifying which modality is superior in diagnostic accuracy and outlining what can affect the efficacy of CBCT and PA radiography in the assessment of early periapical lesions, vertical root fractures and bone defects respectively. Material and Methods: A retrospective study was conducted with the use of two different electronic databases were search between years 2006–2017, PubMed Central® (PMC), and ProQuest, with a strict inclusion and exclusion criteria. Search was limited to English and articles that compared CBCT to PA radiography with the inclusion of the factors studied. The search strategy included a self made formula for the insertion of keywords into the search engine. Formula was to either enter one radiographic technique followed by the factor being studied, or two radiographic techniques followed by one factor being studied. Articles that appeared in more than one database were considered as duplicates and were only considered once. Two examiners (Hassan Al Basri (HAB) and Mohhamed Fadhul (MF)) searched for the articles on the search engines. HB was assigned to search in PubMed, while MF explored ProQuest. A total of 262 title/abstracts were identified through the data base search engines. Most of the articles were found on PubMed (n = 189) while the other were identified on ProQuest (n = 173). Relevant articles by title/abstract were all recorded and categorized according to the relevance to the factor being studied as shown in the results (n = 107). Results: The total number of articles were categorized according to the factor being studied (n = 39) to end up with (n = 15) for periapical lesions, (n = 13) for vertical root fracture and (n = 11) for bone defects. Each category had its own table for analysis and data recording as shown in tables and diagrams. The 13 out of 15 articles concluded that CBCT is superior to PA radiography in, while the rest (n = 2) concluded that no difference was seen between the two modalities in the detection of periapical lesions. 10 out of 13 articles for vertical root fracture and 5 out of 11 in bone defects also concluded that CBCT is superior to PA in the detection of each factor respectively. Pie charts were used to illustrate these differences. Conclusion: The main findings of this study demonstrate that with in all three factors studied, the majority of studies emphasized that CBCT was superior to periapical radiography. Despite the limitations of the review conducted, evidence suggests that cone beam computed tomography is superior to periapical radiography in image quality and diagnostic. However, it can be concluded that the specifications like field of view and voxel size affect the quality of CBCT images and therefore can affect its ability to detect periapical lesions, vertical root fractures and bone defects when compared to periapical radiographs. However, dental clinicians should be cautious with further search regarding the radiation dose of CBCT.