A suggested technique for the application of the cone beam computed tomography periapical index

Objectives: Cone beam CT (CBCT) produces undistorted three-dimensional (3D) images of the maxillofacial region with a radiation dosage lower than conventional CT. The periapical index score (PAI) is commonly used to follow up the lesions in the bone using periapical radiographs. Recently, a new PAI based on CBCT was introduced (CBCT-PAI). The aim of this technical report is to present a modified reproducible method to assess the CBCT-PAI. Methods: CBCT was used to evaluate a periapical bone lesion observed in the area of tooth number 13 before treatment and 2 years after treatment. The modified CBCT-PAI was applied to both the examinations to measure the lesion. The dimensional analysis of the lesion was performed in each plane, assessing three fixed and reproducible dimensions: mesiodistal (M-D), buccolingual (B-L) and coronoapical (C-A). The images were evaluated by three mutually independent examiners. Data were collected and reported in a chart. The results were compared with each other and with the PAI score from the periapical radiographs. Results: The three observers reported the same measurements of the lesion for each plane. The CBCT-PAI follow-up showed a reduction of the size of the lesion (5D vs 4D) but also an increase in the erosion of the buccal cortical plate. The comparison of CBCT-PAI with classic PAI showed the first method to be more precise. Conclusions: This technical report shows how the CBCT-PAI can be applied to the CBCT exam of a periapical lesion in a reproducible way. Dentomaxillofacial Radiology (2011) 40, 506-512. doi: 10.1259/dmfr/78881369