Cosimo Nardi1, Linda Calistri2, Giulia Grazzini2, Isacco Desideri3, Chiara Lorini4, Mariaelena Occhipinti5, Francesco Mungai6, Stefano Colagrande2. 1. Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: cosimo.nardi@unifi.it. 2. Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 3. Department of Experimental and Clinical Biomedical Sciences, Radiotherapy Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 4. Department of Health Science, University of Florence, Florence, Italy. 5. Department of Experimental and Clinical Medicine, Section of Respiratory Medicine, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 6. Department of Radiology, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Abstract
INTRODUCTION: This study aimed to evaluate the diagnostic accuracy of panoramic radiography (PAN) for the detection of clinically/surgically confirmed apical periodontitis (AP) in root canal-treated teeth using cone-beam computed tomographic (CBCT) imaging as the reference standard. METHODS: Two hundred forty patients with endodontically treated AP (diseased group) were detected via CBCT imaging using the periapical index system. They were divided into groups of 20 each according to lesion size (2-4.5 mm and 4.6-7 mm) and anatomic area (incisor, canine/premolar, and molar) in both the upper and lower arches. Another 240 patients with root filling and a healthy periapex (healthy group) were selected. All diseased and healthy patients underwent PAN first and a CBCT scan within 40 days. The periapical index system was also used to assess AP using PAN. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value for PAN images with respect to CBCT imaging were analyzed. The k value was calculated to assess both the interobserver reliability for PAN and the agreement between PAN and CBCT. RESULTS: PAN showed low sensitivity (48.8), mediocre negative predictive value (64.7), good diagnostic accuracy (71.3), and high positive predictive value (88.6) and specificity (93.8). Both interobserver reliability for PAN and agreement between PAN and CBCT were moderate (k = 0.58 and 0.42, respectively). The best identified AP was located in the lower canine/premolar and molar areas, whereas the worst identified AP was located in the upper/lower incisor area and upper molar area. CONCLUSIONS: PAN showed good diagnostic accuracy, high specificity, and low sensitivity for the detection of endodontically treated AP.
INTRODUCTION: This study aimed to evaluate the diagnostic accuracy of panoramic radiography (PAN) for the detection of clinically/surgically confirmed apical periodontitis (AP) in root canal-treated teeth using cone-beam computed tomographic (CBCT) imaging as the reference standard. METHODS: Two hundred forty patients with endodontically treated AP (diseased group) were detected via CBCT imaging using the periapical index system. They were divided into groups of 20 each according to lesion size (2-4.5 mm and 4.6-7 mm) and anatomic area (incisor, canine/premolar, and molar) in both the upper and lower arches. Another 240 patients with root filling and a healthy periapex (healthy group) were selected. All diseased and healthy patients underwent PAN first and a CBCT scan within 40 days. The periapical index system was also used to assess AP using PAN. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value for PAN images with respect to CBCT imaging were analyzed. The k value was calculated to assess both the interobserver reliability for PAN and the agreement between PAN and CBCT. RESULTS: PAN showed low sensitivity (48.8), mediocre negative predictive value (64.7), good diagnostic accuracy (71.3), and high positive predictive value (88.6) and specificity (93.8). Both interobserver reliability for PAN and agreement between PAN and CBCT were moderate (k = 0.58 and 0.42, respectively). The best identified AP was located in the lower canine/premolar and molar areas, whereas the worst identified AP was located in the upper/lower incisor area and upper molar area. CONCLUSIONS: PAN showed good diagnostic accuracy, high specificity, and low sensitivity for the detection of endodontically treated AP.
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