Periapical radiography versus cone beam computed tomography in endodontic disease detection: a free-response, factorial study

 Journal of Endodontics 

Published:February 09, 2023DOI:https://doi.org/10.1016/j.joen.2023.02.001

ABSTRACT

Aim

To assess and compare reader performance in interpreting digital periapical (PA) radiography and cone beam computed tomography (CBCT) in endodontic disease detection, using a free-response, factorial model.

Materials and Methods

A reader performance study of two image test-sets was undertaken using a factorial, free-response design, accounting for the independent variables: case type, case severity, reader type and imaging modality. Twenty-two readers interpreted 60 PA and 60 CBCT images divided into five categories: diseased – subtle, diseased – moderate, diseased – obvious, non-diseased – subtle, and non-diseased – obvious. Lesion localisation fraction, specificity, false positive marks, and the weighted alternative free-response receiver operating characteristic (wAFROC1) figure of merit were calculated.

Results

CBCT had greater specificity than PA in the obvious non-diseased cases (p=0.01) and no significant difference in the subtle non-diseased category. wAFROC1 values were higher for PA than CBCT in the subtle diseased (p=0.02) and moderate diseased (p=0.01) groups with no significant difference between in the obvious diseased group. CBCT had higher mean false positives than PA (p<0.05) in subtle diseased cases. Mean lesion localisation fraction in the moderate diseased group was higher in PA than CBCT (p=0.003). No relationships were found between clinical experience and all diagnostic performance measures, except for in the obvious diseased CBCT group, where increasing experience was associated mean false positive marks (p=0.04).

Conclusions

Reader performance in the detection of endodontic disease is better with periapical radiography than CBCT. Clinical experience does not impact upon the accuracy of interpretation of both PA radiography and CBCT.