title: Diagnostic accuracy of periapical radiography and cone beam computed tomography in detecting apical periodontitis using histopathological findings as a reference standard.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of periapical radiography (PR) and cone beam computed tomography (CBCT) in detecting apical periodontitis (AP) using histopathological findings as a reference standard.
  
  
  METHODS
  Jaw sections containing 67 teeth (86 roots) were collected from unclaimed bodies due for cremation. Imaging was carried out to detect AP by digital PR with a central view (DP group), digital PR combining central with 10˚ mesially and distally angled (parallax) views (DPS group) and CBCT scans. All specimens underwent histopathological examination to confirm the diagnosis of AP. Sensitivity, specificity and predictive values of PR and CBCT were analysed using rater mean (n = 5). Receiver-operating characteristic (ROC) analysis was carried out.
  
  
  RESULTS
  Sensitivity was 0.27, 0.38 and 0.89 for DP, DPS and CBCT scans, respectively. CBCT had specificity and positive predictive value of 1.0 whilst DP and DPS had specificity and positive predictive value of 0.99. The negative predictive value was 0.39, 0.44 and 0.81 for DP, DPS and CBCT scans, respectively. Area under the curve (AUC) for the various imaging methods was 0.629 (DP), 0.688 (DPS), and 0.943 (CBCT).
  
  
  CONCLUSIONS
  All imaging techniques had similar specificity and positive predictive values. Additional parallax views increased the diagnostic accuracy of PR. CBCT had significantly higher diagnostic accuracy in detecting AP compared to PR, using human histopathological findings as a reference standard.
authors.affiliation: Department of Operative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
authors.forename: S
authors.initials: S
authors.lastname: Kanagasingam
authors.affiliation: Department of Operative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
authors.forename: C X
authors.initials: CX
authors.lastname: Lim
authors.affiliation: Department of Operative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
authors.forename: C P
authors.initials: CP
authors.lastname: Yong
authors.affiliation: Department of Endodontology, King's College Dental Institute, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Mannocci
authors.affiliation: Department of Operative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.|Department of Endodontology, King's College Dental Institute, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Patel
mesh_terms: D019540:Area Under Curve; D002102:Cadaver; D054893:Cone-Beam Computed Tomography; D008296:Malaysia; D010485:Periapical Periodontitis / Q000000981:diagnostic imaging* / Q000473:pathology*; D019252:Radiography, Dental, Digital / Q000379:methods*; D012015:Reference Standards; D012680:Sensitivity and Specificity
keywords: apical periodontitis; cone beam computed tomography; histology; periapical radiography