Reliability of Ultrasonography in differentially diagnosing periapical lesions of endodontic origin in comparison with Intra-oral periapical radiography and Cone-beam computed tomography: An in vivo study

Abstract

Background: Periapical granuloma, radicular cyst, and periapical abscess represent periapical changes of frequent occurrence. Addressing this diagnostic dilemma is a matter of great concern, as it aids in governing the treatment planning and predicting its outcome. Aim: To evaluate the comparative accuracy of ultrasonography (USG), intraoral periapical (IOPA) radiography, and cone-beam computed tomography (CBCT) in differentially diagnosing periapical lesions of endodontic origin. Methods: Thirty-five patients having periapical lesions associated with anterior teeth requiring endodontic therapy were included in the study. The lesions were analyzed using IOPA radiographs, CBCT scans, and USG with color Doppler (CD). Periapical surgery ensued and enucleated tissue samples were subjected to histopathological analysis. To evaluate the accuracy, diagnoses made by each of the three modalities were compared with the gold standard histopathological reports, and the diagnostic accuracy, sensitivity, and specificity of each were calculated. Statistical Analysis: Cohen kappa (κ) was used for interrater reliability, and Pearson's contingency coefficient (C) was used for correlating findings of USG with histopathology. Results: USG showed good concordance with histopathological findings (contingency coefficient: 0.664). It also showed a higher accuracy rate compared to IOPA radiography and CBCT in differentially diagnosing periapical lesions. Conclusion: USG with CD holds the potential to be used as a noninvasive adjunct in periapical diagnostics.

Management of type III Dens Invaginatus with a periapical lesion in a maxillary lateral incisor: A case report

“…13 Teeth infected and with necrotic pulp may be associated with radicular cysts. 14 In the present case report, histopathological examination confirmed the presence of a radicular cyst. To provide better bone growth and quicker bone healing, a mixture of hydroxyapatite crystal and PRF was placed inside the osseous defect along with a PRF membrane covering.…”

The paradigm of the inflammatory radicular cyst: biological aspects to be considered

“…Therefore, an accurate preoperative diagnosis could enable correct therapeutic decisions towards executing surgical procedures. Multiple studies have evaluated the accuracy of non-invasive or minimally invasive methods such as CBCT, ultrasound, magnetic resonance imaging (MRI) and fluid aspiration, compared with histological examinations, in assessing the histopathological nature of the AP before intervention ( 13 , 109 , 128 – 143 ). Although promising, these studies' results are still controversial ( Table 3 ).…”

“…Recently, White and Pharoah (2014) proposed six specific cone-beam computed tomography (CBCT) diagnostic criteria for IRC: (i) location: apex of the involved tooth, (ii) well-defined corticated limits, (iii) shape of lesion: curved or circular, (iv) internal structure: radiolucent, (v) effect on surrounding structures: displacement and resorption of the roots of adjacent teeth and (vi) cortical plate perforation ( 12 ). However, when compared with histopathological findings, clinical diagnosis based on radiographic techniques (periapical radiography and CBCT) and adhering to the criteria mentioned above have proven to have limited accuracy (between 54.29% and 71.43%) in assessing the histopathological nature of the AP before intervention ( 13 ). Currently, histopathologic examinations are regarded as the gold standard for diagnosing IRCs ( 6 , 10 ).…”

Clinicopathological comparison of periapical cyst and periapical granuloma in a cohort of Tamil population

“…Among these periapical radiolucencies, periapical cysts (PCs) and granulomas, always associated with nonvital teeth, are the most common inflammatory lesions formed secondary to insult to the pulp, most commonly due to dental caries. [ 2 3 4 ] History of trauma may be elucidated in many other cases, particularly in children and young adults. [ 5 6 ] However, in some cases, with large carious lesions in children with good host immune response, instead of necrosis, the pulp shows hyperplasia which is regarded as pulp polyp/chronic hyperplastic pulpitis.…”