Association between the Presence of Apical Periodontitis and Clinical Symptoms in Endodontic Patients Using Cone-beam Computed Tomography and Periapical Radiographs

Introduction: Cone-beam computed tomographic (CBCT) imaging is a valuable adjunct to endodontic practice. Among the endodontic applications of CBCT imaging, it aids in the diagnosis of apical periodontitis, often in cases in which there is no evidence of pathosis identified by conventional imaging. The purpose of this study was to correlate the presence of apical periodontitis of teeth evaluated with 2-dimensional periapical (PA) radiographs and 3-dimensional CBCT volumes with clinical signs and symptoms. Methods: Clinical records were reviewed from patients examined at the graduate endodontics clinic. The examination included clinical examination, sensibility tests, PA radiographs, and limited field-of-view CBCT scans. Of 498 cases, 67 fulfilled the inclusion criteria and were evaluated for apical periodontitis and symptomology. CBCT slices and PA radiographs were evaluated by 2 board-certified endodontists and a board-certified oral and maxillofacial radiologist for the presence of apical periodontitis. Results: Thirty eight of 67 teeth showed the presence of apical radiolucencies on PA radiographs and on CBCT imaging, whereas 14 teeth had no evidence of apical radiolucencies on either imaging modality. Fifteen cases showed the presence of apical radiolucencies visible on CBCT imaging that were not visible on PA radiographic images. The presence of apical radiolucencies on CBCT slices and PA radiographic images was correlated with clinical signs and symptoms, including the chief complaint. Conclusions: This research has important implications to prevent overexposure to radiation and to provide treatment for those patients with persistent symptoms lacking proper diagnosis based on conventional (2D) radiographs.