(PR150) The Evaluation of the Reliability of Radiographic Features Using CBCT and Periapical Radiographs in the Differential Diagnosis of Periapical Lesions

Introduction: The diagnosis and treatment of endodontic infections involve multiple steps, with the gold standard for periapical lesion diagnosis being histological biopsy. Six radiographic criteria have been used to compare radiographic and histologic diagnoses. Cone Beam Computed Tomography (CBCT) may provide a more detailed yet less invasive tool for similar comparisons.

Objective: This study aimed to evaluate the six radiographic criteria from Oral Radiology (White & Pharoah) for diagnosing periapical lesions using CBCT. Materials and

Methods: Three blinded endodontists assessed radiographic features of 40 CBCT scans and 40 periapical (PA) radiographs of lesions previously diagnosed via histological biopsy as radicular cysts or periapical granulomas. The six criteria included: location (apex), periphery (corticated border), shape, internal structure, effects on surrounding structures (displacement or resorption), and corticated plate perforation. Data was analyzed using Logistic Regression and Fleiss Kappa statistics.

Results: CBCT showed no significant agreement between examiners. The most commonly selected criteria were shape (curved or circular) and internal structure (radiolucency). Logistic regression revealed that with each additional criterion present, the probability of the lesion being a granuloma decreased by 24.9% on PA radiographs and 33.9% on CBCT.

Conclusion: Although the study demonstrated inconsistent inter-examiner agreement for CBCT, the number of criteria selected influenced the likelihood of diagnosing a periapical cyst. Further research is recommended to investigate the role of CBCT in periapical diagnosis.