Diagnostic yield of conventional radiographic and cone-beam computed tomographic images in patients with atypical odontalgia

• Published in: International endodontic journal 2011-12, Vol.44 (12), p.1092-1101
• Main Authors: Pigg, M., List, T., Petersson, K., Lindh, C., Petersson, A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alveolar Bone Loss - diagnostic imaging; Apicoectomy; atypical odontalgia; chronic intraoral pain; Chronic Pain - diagnostic imaging; cone-beam computed tomography; Cone-Beam Computed Tomography - methods; Dentistry; Diagnosis, Differential; Female; Furcation Defects - diagnostic imaging; Humans; Male; Middle Aged; neuropathic pain; orofacial pain; Pain Measurement; Periapical Periodontitis - diagnostic imaging; radiography; Radiography, Bitewing; Radiography, Panoramic; Root Resorption - diagnostic imaging; Self Report; Tooth Root - diagnostic imaging; Tooth, Nonvital - diagnostic imaging; Toothache - diagnostic imaging
• ISSN: 0143-2885; 1365-2591
• DOI: 10.1111/j.1365-2591.2011.01923.x

Pigg M, List T, Petersson K, Lindh C, Petersson A. Diagnostic yield of conventional radiographic and cone‐beam computed tomographic images in patients with atypical odontalgia. International Endodontic Journal, 44, 1092–1101, 2011. Aim  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. Methodology  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. Conclusion  Cone‐beam computed tomography improves identification of patients without periapical bone destruction, which may facilitate differentiation between AO and SAP.