An evaluation of the periapical status of teeth with necrotic pulps using periapical radiography and cone-beam computed tomography

Abstract

Aim: To evaluate the presence or absence of periapical (PA) radiolucencies on individual roots of teeth with necrotic pulps, as assessed with digital PA radiographs and cone-beam computed tomography (CBCT).

Methodology: Digital PA radiographs and CBCT scans were taken from 161 endodontically untreated teeth (from 155 patients) diagnosed with non-vital pulps (pulp necrosis with normal PA tissue, symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess and chronic apical abscess). Images were assessed by two calibrated endodontists to analyse the radiographic PA status of the teeth. A consensus was reached in the event of any disagreement. The data were analysed using a McNemar's test, and significance was set at P ≤ 0.05.

Results: Three hundred and forty paired images of roots were assessed with both digital PA radiographs and CBCT images. Fifteen additional roots were identified with CBCT. PA radiolucencies were present in 132 (38.8%) roots when assessed with PA radiographs, and in 196 (57.6%) roots when assessed with CBCT. This difference was statistically significant (P < 0.05). In teeth diagnosed with pulp necrosis, symptomatic apical periodontitis or acute apical abscess, CBCT images revealed a statistically larger number of PA radiolucencies than did PA radiographs (P < 0.05). No statistical differences were observed between PA radiographs and CBCT in teeth classified with asymptomatic apical periodontitis (P = 0.31) or chronic apical abscess (P = 1).

Conclusions: Unlike PA radiographs, CBCT revealed a higher prevalence of PA radiolucencies when endodontically untreated teeth with non-vital pulps were examined.

Keywords: apical periodontitis; cone-beam computed tomography; necrotic pulps; non-vital teeth; periapical radiographs.