Intraoral Digital Radiography versus Cone Beam Computed Tomography (CBCT) in Detection and Measurement of Simulated Periapical Lesions: an In Vitro Study

Abstract

At present, the majority of the treatments that are performed in the dental clinic are related to disease entities involving the dental pulp and periapex. Dental pulp undergoes a sequence of pathologic changes mainly due to caries, mechanical, chemical or thermal insults. And due to the close pysiopathological relationship between pulp and periapical lesions, all these irritants may reach the periapical tissues resulting in periapical pathologic changes (Lopez 2004 and Soares et al 2008). Apical lesions are most often asymptomatic, this makes their diagnosis difficult without the aid of radiographs. In order to investigate and screen pathologic conditions of the jaws, many radiographic techniques are now available. These techniques involve, periapical radiography (conventional and digital), panoramic radiography, conventional tomography (spiral tomography), computed tomography and, more recently, cone beam computed tomography (CBCT) have been suggested. Moreover, magnetic resonance imaging, ultrasonography and nuclear medicine have also been used for the imaging of periapical lesions (Ørstavik and Larheim 2008 b and Estrela et al 2008). Periapical radiography is usually considered as the standard technique for radiographic assessment of periapical pathosis. It is a low-cost technique, available in almost all dental offices, and it provides a high image quality at a low radiation dose compared to other conventional radiographic methods (Forsberg & Halse 1997). Furthermore, advances in digital systems include a 50–80% reduction in radiation exposure, wider exposure latitude, immediate image generation and manipulation and elimination of chemical processing of radiographs. Digital radiography systems have given the Summary and conclusion 110 clinician the ability to rapidly acquire and manipulate intraoral images (Huumonen & Ørstavik 2002) But conventional radiographs have limitations that have stimulated an extensive search for improvement. Radiographs are the two-dimensional projection of three-dimensional (3D) structures; most of the times they are not sufficient to provide information on the actual size of the lesions, as well as their spatial relationship with anatomic landmarks, and it has been proposed that the amount of bone that has to be resorbed before a lesion becomes clearly visible is quite extensive (Cotti& Campisi 2004).