根尖X线片和锥形束CT评价根尖周骨病变的比较研究

Comparison of periapical radiography and cone-beam computed tomography in endodontic treated teeth for assessment of periapical lesions

目的:比较根尖X线片和锥形束CT(cone-beam computed tomograghy,CBCT)两种影像学手段在判断根管治疗后根尖病变的有无及揭示病变变化方面的差异。方法:收集术前诊断为慢性根尖周炎,于北京大学口腔医院牙体牙髓科接受根管治疗及复查患者的病案资料(包括根尖X线片和CBCT影像学资料)233例,由经过一致性检验的两名评价者,对复查时治疗后根尖病变有无做出诊断,并判断根尖病变的变化(病变消失、缩小、不变、增大)。经Mc Nemar检验及Fisher确切概率检验分别比较根尖X线片及CBCT在判断病变有无、揭示病变变化方面是否存在差异。结果:在233份复查资料中,CBCT发现治疗后根尖病变178例,相较于根尖X线片发现的146例,差异有统计学意义(P<0.01)。在25%(57/233)的病例中,根尖X线片和CBCT揭示根尖病变变化趋势不同,统计学分析表明根尖X线片和CBCT这两种影像学手段在判断病变变化方面存在差异(P<0.01)。结论:根尖X线片和锥形束CT在判断治疗后根尖病变的有无、揭示根尖病变变化方面存在差异。

Objective： To compare the assessments of the presence or absence and the changes of posttreatment periapical lesions using periapical radiographs versus cone-beam computed tomography（ CBCT）. Methods： Imaging records were selected from a sample of 233 radiographic examinations（ including periapical radiographs and CBCT） of patients with chronic apical periododontitis who received treatment and review in Department of Cariology and Endodontology of Peking University School of Stomatology. After testing the inter-observer and intra-observer agreement,two observers determined the presence or absence of a periapical lesion and classified the changes of lesions in 4 categories： absence,reduction or enlargement of lesion,or uncertain. The differences between CBCT and periapical radiographs in detecting the presence or absence and the changes of periapical lesions were compared using Mc Nemar test and Fisher＇s exact test respectively. Results： In the study,233 teeth were assessed with both periapical radiographs and CBCT images. Periapical lesions were detected in 178 teeth on CBCT scans and in 146 teeth on periapical radiographs. CBCT images revealed a significantly larger number of lesions than were revealed by periapical radiographs（ P〈0. 01）. There was disagreement on the changes of lesions between the two radiological technologies in 25% teeth,and the difference was statistically significant（ P〈0. 01）.Conclusion： Significant differences were observed between periapical radiographs and CBCT in detection of post-treatment periapical lesions and assessment of the changes of periapical lesions.