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Meta-Analysis
. 2024 Nov;129(11):1682-1695.
doi: 10.1007/s11547-024-01882-z. Epub 2024 Sep 3.

Diagnostic accuracy of periapical radiography and panoramic radiography in the detection of apical periodontitis: a systematic review and meta-analysis

Giulio Stera  1 , Martina Giusti  2 , Andrea Magnini  3 , Linda Calistri  3 , Rossana Izzetti  4 , Cosimo Nardi  5
Affiliations
Meta-Analysis

Diagnostic accuracy of periapical radiography and panoramic radiography in the detection of apical periodontitis: a systematic review and meta-analysis

Giulio Stera et al. Radiol Med. 2024 Nov.

Abstract

Objective: Apical periodontitis (AP) is one of the most common pathologies of the oral cavity. An early and accurate diagnosis of AP lesions is crucial for proper management and planning of endodontic treatments. This study investigated the diagnostic accuracy of periapical radiography (PR) and panoramic radiography (PAN) in the detection of clinically/surgically/histopathologically confirmed AP lesions.

Method: A systematic literature review was conducted in accordance with the PRISMA guidelines. The search strategy was limited to English language articles via PubMed, Embase and Web of Science databases up to June 30, 2023. Such articles provided diagnostic accuracy values of PR and/or PAN in the detection of AP lesions or alternatively data needed to calculate them.

Results: Twelve studies met inclusion criteria and were considered for the analysis. The average value of diagnostic accuracy in assessing AP lesions was 71% for PR and 66% for PAN. According to different accuracy for specific anatomical areas, it is recommended to use PR in the analysis of AP lesions located in the upper arch and lower incisor area, whereas lower premolar and molar areas may be investigated with the same accuracy with PR or PAN.

Conclusions: Two-dimensional imaging must be considered the first-level examination for the diagnosis of AP lesions. PR had an overall slightly higher diagnostic accuracy than PAN. Evidence from this review provided a useful tool to support radiologists and dentists in their decision-making when inflammatory periapical bone lesions are suspected to achieve the best clinical outcome for patients, improving the quality of clinical practice.

Keywords: Apical periodontitis; Diagnostic accuracy; Panoramic radiography; Periapical radiography; Two-dimensional imaging.

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Conflict of interest statement

Declarations Conflicts of interest The authors declare no conflicts of interest. Consent to participate Not applicable.Ethical approvalThis article does not contain any studies with human or animal subjects performed by any authors. Human or animal rights This article does not contain any studies with human or animal subjects performed by any authors.

Figures

Fig. 1
Fig. 1
Flowchart consistent with preferred reporting items for systematic review (PRISMA) statement
Fig. 2
Fig. 2
Forest plot from random effects of meta-analysis evaluating the diagnostic accuracy of PR (95% confidence interval [CI])
Fig. 3
Fig. 3
Forest plot from random effects of meta-analysis evaluating the diagnostic accuracy of PAN (95% confidence interval [CI])
Fig. 4
Fig. 4
Apical periodontitis affecting the upper left lateral incisor. A In panoramic radiography, no periapical bone lesion was detected at the level of the periapex. A large area of radiolucency around incisors of both sides and especially around the root of both lateral incisors can be observed because of the overlap of the air inside the nasal cavity. B Same patient. In periapical radiography, changes in bone structure with clear mineral loss can be undoubtedly noticeable at the level of the periapex
See this image and copyright information in PMC

References

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