title: Diagnostic yield of conventional radiographic and cone-beam computed tomographic images in patients with atypical odontalgia.
abstract: OBJECTIVE
  To investigate whether the additional diagnostic yield of a cone-beam computed tomography (CBCT) examination over conventional radiographs in patients primarily suspected of having atypical odontalgia (AO) improves differentiation between AO and symptomatic apical periodontitis (SAP) in patients with severe chronic intraoral pain.
  
  
  METHODS
  In this clinical study, 25 patients (mean age 54 ± 11 years, range 34-72) participated; 20 were diagnosed with AO and 5 with SAP. All patients were recruited from the clinics of the Faculty of Odontology, Malmö University. AO inclusion criteria were chronic pain (>6 months) in a region where a tooth had been endodontically or surgically treated, with no pathological cause detectable in clinical or radiologic examinations. SAP inclusion criteria were recurrent pain from a tooth diagnosed with apical periodontitis in clinical and radiographic examinations. Assessments comprised a self-report questionnaire on pain characteristics, a comprehensive clinical examination and a radiographic examination including panoramic and intraoral radiographs and CBCT images. The main outcome measure was periapical bone destruction.
  
  
  RESULTS
  Sixty per cent of patients with AO had no periapical bone destructions detectable with any radiographic method. Overall, CBCT rendered 17% more periapical bone destructions than conventional radiography. Average pain intensity in patients with AO was 5.6 (± 1.8) on a 0-10 numerical rating scale, and average pain duration was 4.3 (± 5.2) years.
  
  
  CONCLUSIONS
  Cone-beam computed tomography improves identification of patients without periapical bone destruction, which may facilitate differentiation between AO and SAP.
authors.affiliation: Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden. maria.pigg@mah.se
authors.forename: M
authors.initials: M
authors.lastname: Pigg
authors.forename: T
authors.initials: T
authors.lastname: List
authors.forename: K
authors.initials: K
authors.lastname: Petersson
authors.forename: C
authors.initials: C
authors.lastname: Lindh
authors.forename: A
authors.initials: A
authors.lastname: Petersson
mesh_terms: D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging; D001047:Apicoectomy; D059350:Chronic Pain / Q000000981:diagnostic imaging; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D017823:Furcation Defects / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010485:Periapical Periodontitis / Q000000981:diagnostic imaging; D016300:Radiography, Bitewing; D011862:Radiography, Panoramic; D012391:Root Resorption / Q000000981:diagnostic imaging; D057566:Self Report; D014092:Tooth Root / Q000000981:diagnostic imaging; D019553:Tooth, Nonvital / Q000000981:diagnostic imaging; D014098:Toothache / Q000000981:diagnostic imaging*