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Discussion
(F-speed) for the detection of periapical lesions (lesion sizes 1 mm x 1 mm and
2 mm x 2 mm) created in an ex vivo study in pig jaws, and found that the
NewTom 3G was statistically significantly better in terms of sensitivity (54%),
positive (83%) and negative (45%) predictive values, and diagnostic accuracy
(61%) when compared with digital intra-oral (23%, 70%, 35%, 39%) and film
radiography (28%, 70%, 35%, 44%) except for positive predictive value. The
specificity was similar for all three methods. No difference was found between
the two intra-oral techniques. De Paula-Silva and co-workers (2009) also used an
animal model to study the accuracy of periapical radiography (D-speed film) and
CBCT scans (NewTom 3G) in diagnosing periapical lesions using histological
findings as gold standard. Of 83 roots the periapical radiographs showed periapical
lesions in 71% of the roots, the CBCT scans in 84% and while 93% were
histologically diagnosed. Diagnostic accuracy was 0.78 for periapical radiography
and 0.92 for CBCT. When studying accuracy of CBCT (3D Accuitomo XYZ
Slice View Tomograph), panoramic and periapical radiography (F-speed film)
for the detection of periapical lesions in 888 consecutive patients Estrela and
co-workers (2008) used the diagnostic results from the CBCT images as the
reference method (gold standard). They found that the prevalence of periapical
lesions was significantly higher in the CBCT images and in 54.5% periapical
lesions were correctly identified with periapical radiography and in 27.8% with
panoramic radiography.
Also Low and co-workers (2008) compared periapical radiography (F-speed
film) and CBCT (3 DX Accuitomo XYZ Tomograph) for diagnosis of posterior
maxillary teeth of consecutive patients referred for apical surgery. The images
were analyzed by two specialists (oral radiology and endodontics), who had to
reach consensus in the interpretation of the radiographic findings. The material
included 37 premolars and 37 molars. The CBCT images showed significantly
more lesions (109 lesions), of which 34% were not detected with periapical
radiography. Detecting lesions with the intra-oral technique was more difficult in
second molars. They also point out other highlights with the CBCT technique,
like additional findings seen in CBCT images including expansion of lesions into
the maxillary sinus, sinus membrane thickening and missed root canals.
To summarize Study I supported by previously presented studies, it seems safe to
conclude that CBCT is more sensitive in detecting periapical lesions than intraoral radiography. For many reasons a 3D technique ought to be better than a 2D
technique, anything else would be counter-intuitive.
Radiography is used to detect pathology e.g., periapical lesions at remaining teeth in
presumptive implant patients, but it also plays an important role in giving information about the bone height and its width and intended implant sites´ relation
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