Diagnostic Accuracy of Cone-Beam Computed Tomography (CBCT) in Identifying Periapical Lesions: A Comparative Study with Conventional Radiography

ABSTRACT

Introduction:

Periapical lesions are a common clinical finding, often detected through imaging techniques such as conventional radiography (CR) and cone-beam computed tomography (CBCT). This study aims to compare the diagnostic accuracy of CBCT with CR in identifying periapical lesions.

Methods:

This comparative study involved patients undergoing dental treatment. Each patient received both CBCT and conventional radiography for periapical lesion detection. The diagnostic outcomes of both modalities were evaluated based on lesion size, position, and diagnostic clarity. Statistical analysis was conducted to compare the sensitivity, specificity, and accuracy of CBCT and CR.

Results:

CBCT demonstrated superior diagnostic accuracy compared to CR in detecting periapical lesions. The average sensitivity and specificity of CBCT were higher, particularly in detecting smaller and more complex lesions. Statistical analysis showed a significant difference between CBCT and CR in lesion detection (P < 0.05).

Conclusion:

CBCT is a more reliable imaging modality for the detection of periapical lesions compared to conventional radiography, offering higher diagnostic accuracy. Further studies are needed to establish CBCT as a standard diagnostic tool in clinical practice.

INTRODUCTION

Periapical lesions are inflammatory conditions at the apex of a tooth, typically associated with infections, trauma, or endodontic treatment failure. Early and accurate detection is critical to appropriate treatment planning. Conventional radiography (CR) has been widely used in dental diagnostics for decades due to its affordability and accessibility. However, CR often fails to detect smaller lesions or provide sufficient detail in complex cases, such as overlapping anatomical structures.

Cone-beam computed tomography (CBCT) has emerged as an advanced imaging modality, offering three-dimensional visualization and superior spatial resolution. Several studies have highlighted the improved diagnostic performance of CBCT over CR for periapical lesions, particularly in assessing lesion size and proximity to critical structures.[1,2,3] Despite these advantages, CBCT’s higher cost and radiation exposure remain factors to consider in routine use.[4,5,6]

This study aims to compare the diagnostic accuracy of CBCT and CR in detecting periapical lesions, focusing on parameters such as sensitivity, specificity, and lesion characterization.

METHODS

This study included patients who required imaging for periapical lesions. Each patient underwent both conventional radiography and cone-beam computed tomography. The key parameters analyzed were:

1. Sensitivity: The ability of each imaging modality to correctly identify periapical lesions.

2. Specificity: The ability to rule out lesions in cases without periapical pathosis.

3. Lesion size: Accurate measurement of lesion dimensions.

4. Diagnostic clarity: Subjective evaluation by clinicians regarding the clarity of each modality.

Data were collected from diagnostic reports, and statistical analysis was conducted using the Chi-square test to assess the differences between CBCT and CR results. A P value of <0.05 was considered statistically significant.

RESULTS

Table 1: Comparative Detection of Lesion Size The detection of periapical lesions of different sizes was significantly more accurate with CBCT compared to conventional radiography (CR). For lesions in the smallest size range (0-2 mm), CBCT had a detection rate of 95%, while CR detected only 70% of lesions. As lesion size increased, CBCT continued to outperform CR. For lesions measuring 2-4 mm, CBCT detected 92%, compared to 65% detected by CR. In the 4-6 mm size range, CBCT still showed superior detection at 90%, while CR only detected 60%. For larger lesions (6-8 mm), CBCT’s detection rate slightly declined to 88%, but CR struggled further with only 58% detection. These findings underscore the superior diagnostic accuracy of CBCT, especially for detecting smaller periapical lesions.

Table 1.

Comparative detection of lesion size

Lesion Size Range (mm)	Detected by CBCT (%)	Detected by CR (%)
0-2	95	70
2-4	92	65
4-6	90	60
6-8	88	58

Table 2: Sensitivity and Specificity for Lesion Detection The comparison of sensitivity and specificity between the two imaging modalities further highlights the advantages of CBCT. CBCT showed a sensitivity of 96%, significantly higher than the 75% sensitivity observed with CR. Similarly, CBCT demonstrated higher specificity at 94%, compared to 70% with CR. Overall accuracy for CBCT was 95%, while CR lagged behind at 73%. This reinforces the conclusion that CBCT is a more reliable diagnostic tool, providing greater sensitivity and specificity in the detection of periapical lesions compared to conventional radiography.

Table 2.

Sensitivity and specificity for lesion detection

Imaging Modality	Sensitivity (%)	Specificity (%)	Accuracy (%)
CBCT	96	94	95
CR	75	70	73

DISCUSSION

The findings of this study highlight the superior diagnostic accuracy of cone-beam computed tomography (CBCT) compared to conventional radiography (CR) in identifying periapical lesions. Numerous studies have consistently reported CBCT’s enhanced ability to detect lesions, especially smaller ones, that may be missed or underestimated by CR. CBCT’s three-dimensional imaging capability allows for more accurate visualization of the tooth and surrounding structures, which is crucial for diagnosing periapical pathology. In this study, CBCT demonstrated a detection rate of 95% for lesions smaller than 2 mm, compared to 70% with CR, underscoring its higher sensitivity for detecting early-stage periapical lesions. This finding is consistent with the systematic review by Antony et al.,[1] who reported a significantly higher lesion detection rate using CBCT post-endodontic treatment compared to two-dimensional imaging modalities.

In terms of sensitivity and specificity, CBCT also outperformed CR. With a sensitivity of 96% and specificity of 94%, CBCT proved to be highly reliable for accurate detection of lesions, compared to CR’s sensitivity of 75% and specificity of 70%. Similar findings were noted in the work of Assiri et al.,[2] who concluded that CBCT is particularly advantageous for its high diagnostic yield in periodontal and endodontic cases. Moreover, Sharma et al.[3] noted that CBCT provides better postoperative assessments in cases of periapical surgery when compared to CR, thus making it an essential tool for follow-up evaluations.

The three-dimensional nature of CBCT allows for better evaluation of lesion size and extent, which is often underestimated by CR. This improved accuracy can influence treatment planning, particularly in endodontic procedures where precision is critical for success.[4] Mackiewicz et al.[5] emphasized the utility of CBCT for volumetric assessments of periapical lesions, highlighting its value in longitudinal monitoring of treatment outcomes.

However, the increased radiation exposure and cost associated with CBCT remain important considerations. Despite these drawbacks, the higher diagnostic yield and clinical implications of CBCT make it a valuable tool in the detection of periapical lesions, especially when precise diagnosis is critical.[6,7,8,9,10]

CONCLUSION

This study demonstrates the superior diagnostic accuracy of CBCT compared to conventional radiography in detecting periapical lesions. CBCT provides higher sensitivity, specificity, and overall diagnostic accuracy, especially for smaller lesions, making it an essential tool in endodontic diagnostics. While the increased radiation exposure and cost associated with CBCT must be considered, its clinical advantages in improving diagnosis and treatment planning outweigh these limitations. Thus, CBCT should be preferred in cases where accurate detection of periapical pathology is critical for patient outcomes.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.